In the meantime, I present to you some of the best postings from our blogs in the past week:

The Fort Hood Massacre: A disturbed psychiatrist, a gun and the reality of war

(Depression On My Mind) - I will go to my therapist’s office this afternoon. I will sit in the waiting room and read an old magazine. Another client will walk from a hallway that leads to my therapist’s office, pass through the waiting room and leave. My therapist will poke her head out, smile and …

Reclaiming Sexual Intimacy in Your Relationship

(Healing Together for Couples) - It takes more than just showing up to reclaim or renew a good sexual relationship. Would you just show up on the dance floor to dance the tango together? Apart from the fact that you may have no interest in the tango – probably not. To really dance, you …

Exploring the Upside of Depression

(Mindfulness and Psychotherapy) - Sharon Begley, science editor for Newsweek and author of The Plastic Mind: New science reveals our extraordinary potential to transform ourselves, just wrote an interesting article titled The Upside of Depression. In this article she reviews some recent research that basically flies in the face of the “Happiness” surge and says …

Are We Exploiting Daniel Johnston?

(Celebrity Psychings) - Out of those of you who weren’t familiar with Daniel Johnston when I told you about his performance at the Austin City Limits Music Festival last month, I’m willing to bet more than a few of you found him interesting (even if you read only my brief introduction to him). …

More Thoughts on Hurtful Family Relationships

(Family Mental Health) - Hello dear Family Mental Health readers. Due to an inclusion in an Everyday Health newsletter, my blog post Can You Step Away From a Hurtful Family Relationship? post got a tremendous response. If you are now a new reader because you saw that post and have come back for more…

Beyond Mindfulness

(Anxiety and OCD Exposed) - My wife, Dr. Smith, and I are big fans of mindfulness approaches to therapy and we’ve included discussions of mindfulness in most of our self help books within the For Dummies series (including Borderline Personality Disorder For Dummies). In brief, Mindfulness is typically described as involving focused attention on experiences …

Bipolar Disorder Q & A: How Do I Tell My Doc, “This Isn’t Working?!”

(Bipolar Beat) - Garett Asks: “Five months ago, I was diagnosed as having bipolar disorder. First I was on Depakote and then I told my doctor I was still having major problems with my sleep. I was always up and about knowing it was 3 o’clock in the morning. I told her about the …”

7 Signs Your Body Image Is Bruised (and 5 Solutions)

(Weightless) - In this day and age, it seems like a positive body image is a rarity. Whether you fit today’s skinny standards or wish you did, most women have issues with their bodies. Some may argue that bickering with one’s body is as old as time. We frequently hear friends and family lament about their thick thighs or pudgy middle. Personally, whether I’m with family or friends, an hour doesn’t go by without someone saying that they shouldn’t be eating that much, must skip dessert…

How can you just delete an entire diagnosis and do away with a diagnostic label that hundreds of thousands of clinicians use everyday and millions identify with? If you’re the American Psychiatric Association, the folks behind the latest DSM revision, you can pretty much do anything you want.

Before I get to Asperger’s, I have to note what’s really cringe-worthy in this article — how it completely misrepresents how mental disorders are diagnosed in practice today. Take this explanation, for instance:

Another broad change is to better recognize that psychiatric patients often have many health problems affecting mind and body and that clinicians need to evaluate and treat the whole patient.

Historically, [Dr. Darrel A. Regier, research director at the American Psychiatric Association] said, the diagnostic manual was used to sort hospital patients based on what was judged to be their most serious problem. A patient with a primary diagnosis of major depression would not be evaluated for anxiety, for example, even though the two disorders often go hand in hand.

Similarly, a child with the autism label could not also have a diagnosis of attention deficit hyperactivity disorder, because attention problems are considered secondary to the autism. Thus, they might go untreated, or the treatment would not be covered by insurance.

I’m not sure if this is a bad translation of what Dr. Regier was trying to say or what, but the suggestion that a person is only diagnosed with a single diagnostic label (and can only be treated for a single disorder at a time) is simply untrue (and a ridiculous assertion). People are diagnosed — and treated — every day with more than one disorder. Indeed, there are thousands of children who carry both an ADHD diagnosis and an autism diagnosis — the two are not mutually exclusive (nor have they ever been). So while maybe back in the 1970s the DSM was used in the manner Dr. Regier describes, it hasn’t been used in that manner in modern practice for decades.

But getting back to the core reason why Asperger’s Syndrome, as a diagnosis, may be going away is because the new DSM is apparently going more toward a continuum approach for disorders. It actually already has this capability in the current edition, but it’s not a part of every diagnosis (for instance, you’ll find it for major depressive disorder, but not for things like ADHD). I believe the new DSM will ensure that every disorder is treated equally in this way — you can have mild ADHD, moderate ADHD, or severe ADHD.

In the same manner, you can have a mild form of autism and it’ll just be called “mild autism” — not Asperger’s.

I think the effort to make the diagnostic manual of mental disorders more internally consistent is a needed change. But doing away with well-used labels like “Asperger’s” is perhaps prematurely unnecessary; why couldn’t we use both labels to describe this form of mild autism? Certainly exceptions to the consistency can be made (and will have to be made anyway, since not every disorder will fit nicely into any classification system one could design).

While not ideal, allowances should be made during the transitional edition of this mainstay of mental disorder diagnoses to ensure that everybody embraces it — both patients and professionals alike. It could be as simple as including the phrase, “(also known as Asperger’s Syndrome)” next to the “mild autism” diagnostic criteria.

Read the full article: A Vanishing Diagnosis for Asperger’s Syndrome

According to government statistics, people with binge eating disorder are considered clinically obese, but plenty of people can engage in binge eating while maintaining an average or less-than-obese weight. Binge eating disorder probably affects 2 to 3 percent of all adults.
People with a binge eating problem often experience:

• Eating much more rapidly than usual.
• Eating until uncomfortably full.
• Eating large amounts of food, even when not physically hungry.
• Eating alone out of embarrassment at the quantity of food being eaten.
• Feelings of disgust, depression, or guilt after overeating.

Binge eating disorder is a serious mental health concern that, left unchecked, can ruin a person’s life with the feeling of being out of control. The resulting weight gain can also contribute to a person’s poor self-image and self-esteem.

Group therapy is one treatment method used to help people who have binge eating disorder. There are many different kinds of group therapy available, and recently researchers (Peterson et al., 2009) compared three different types of group therapy treatment to gauge their effectiveness in treating binge eating:

• A traditional therapist-led psychotherapy group
• A therapist-assisted group (where the therapist played a secondary role in the group)
• A self-help group

Here’s how the researchers described these three groups: “In the therapist-led CBT groups, a doctoral-level psychotherapist provided psychoeducation during the first half of each session and homework review and discussion during the second half. In the therapist-assisted CBT groups, participants watched a psychoeducational videotape (a specific tape was designed for each session) during the first half of each session, and during the second half a doctoral-level psychotherapist joined the group to review homework and lead a discussion. In the self-help groups, participants watched a psychoeducational videotape during the first half of each session and conducted their own homework review and discussion during the second half. Participants rotated as facilitators for this group.”

The researchers assigned 259 adults to one of these three groups (plus a fourth — a waiting list for treatment, used as a control group). They tested for the severity of binge eating using abstinent rates from binge eating, as well as a measure called the Eating Disorder Examination at the start of treatment, at the end of treatment, and then two more times at followups at 6 and 12 months. Ideally, we’re looking for treatments that would reduce the person’s rate at engaging in binge eating behavior — the higher the abstinent rate, the more effective the treatment. The most effective treatment would have someone no longer engaging in binge eating altogether.

Their findings? “At end of treatment, the therapist-led (51.7%) and the therapist-assisted (33.3%) conditions had higher binge eating abstinence rates than the self-help (17.9%) and waiting list (10.1%) conditions.”

So let’s put these numbers into some context. Getting help from a professional therapist resulted in the most effective treatment at this point — 5 out of 10 people got significantly better, and in the group therapy where a therapist assisted, 3 out of 10 people were helped. But even in the self-help condition, nearly 2 out of 10 people were helped, nearly double that of the control group. In that context, getting some help is better than none at all. And time alone does help some people get better on their own. Patients in the therapist-led group had the highest rate of abstinence and the fewest dropouts at end of treatment.

But here’s where things get really interesting. What about those abstinent rates measured 6 and 12 months after treatment was completed? After all, effective treatment needs to stick in order to prove it’s better than nothing at all. The researchers found no differences between the groups’ abstinent rates at these two followups.

Leave it to the researchers to the best possible light onto their findings:

Therapist-led group cognitive-behavioral treatment for binge eating disorder led to higher binge eating abstinence rates, greater reductions in binge eating frequency, and lower attrition compared to group self-help treatment. Although these findings indicate that therapist delivery of group treatment is associated with better short-term outcome and less attrition than self-help treatment, the lack of group differences at follow-up suggests that self-help group treatment may be a viable alternative to therapist-led interventions.

Well, that’s the kicker then, isn’t it? What use is a professional intervention if you can’t tell it apart from the self-help group (or worse yet, the control group) after treatment is over?

What this research really demonstrates quite well is how any targeted intervention is better than none at all. And that watching a psychoeducational video and then having a discussion about it with a group of other people may be just as effective as a professionally-led psychotherapy group, in the long run.

Reference:

Peterson, C.B., Mitchell, J.E., Crow, S.J., Crosby, R.D. & Wonderlich, S.A. (2009). The Efficacy of Self-Help Group Treatment and Therapist-Led Group Treatment for Binge Eating Disorder. Am J Psychiatry. DOI: 10.1176/appi.ajp.2009.09030345

So it is with great pleasure to bring you a new blog about just this very topic — body image, the skinny fad and learning how to attain freedom from the (weight) numbers and dieting. The blog is called Weightless:

As our new blogger, Margarita Tartakovsky, wrote in her introduction to her blog, “Weightless is about well-being, not weight; about fostering body image, regardless of your size. It’s about exposing women’s magazines, other mediums and so-called experts, when they’re touting unhealthy tips and promoting restrictive standards.

The goal of Weightless is to help women develop a better body image and work toward accepting themselves as they are, while being healthy and happy (fad diets and skinny-mini standards prohibited!); and to become sharp consumers, who can pick apart a commercial or magazine article and know which advice is helpful or harmful.”

Our Weightless blogger (who, I assure you, actually does weigh something) is a long-time writer for Psych Central, Margarita Tartakovsky. Her writing career began unofficially in second grade when she composed her first-ever essay on Cinderella (her mom still has it), several months after emigrating from Russia. Officially, Margarita began freelancing after graduating with an MS in clinical psychology from Texas A&M University.

This is going to be a great blog and I encourage you check it out if you have any interest in the topic of self-image, body image, and how to unshackle yourself from yo-yo dieting and being a slave to your scale.

Weightless: A Blog About Body Image

I’m still planning on talking about additional online interventions for other mental disorders, but am waiting for the conference folks to publish the presentations on their website because the abstract book doesn’t always contain the valuable bits of information I need to properly summarize a topic area.

In the meantime, I thought I’d mention Beacon. Beacon is a website that has gone to the trouble of indexing and rating over 70 different online interventions in the following categories:

• Alcohol (3/3)
• Bipolar disorder (3/0)
• Depression (24/11)
• Eating disorder (anorexia or bulimia) (6/5)
• Generalized anxiety disorder (4/1)
• Obsessive compulsive disorder (1/1)
• Pain (5/2)
• Panic disorder (8/6)
• Phobias (2/0)
• Post traumatic stress disorder (PTSD) (4/3)
• Social anxiety (3/3)
• Stress (7/3)
• Tinnitus (1/1)
• Weight and Obesity (2/2)

The first number listed is the total number of online interventions the online researchers have found. The second number listed is the number of interventions that have at least some research backing for them (some interventions have very good support, and are so duly noted at Beacon). So for example, there are 24 online interventions indexed by Beacon for depression, but only 11 of them have at least a little research support — 13 of them have no research backing.

As a person interested in pursuing your own self-help methods for a particular concern, this website allows you to quickly identify a program or two that might be of interest. You can avoid those websites that don’t have any research backing, saving yourself some time (and perhaps, wasted effort).

Beacon is provided by the same research team that was responsible for MoodGYM and BluePages, the tireless and dedicated researchers at the Centre for Mental Health Research at The Australian National University, headed by the charming and personable Prof. Helen Christensen, Ph.D.

There is one small downside to using Beacon. In order to access its database, a free registration is required. Ordinarily, that wouldn’t be a big deal, but this one also asks for basic demographic information and requires users to fill out a 35-question general mental health survey before giving you access to Beacon. They are using this data to see if there’s any correlation or pattern of behaviors between what people complain about through the survey and what they then search for on the website. I think that’s okay since they tell you that up-front, but you should be well aware of that requirement before deciding to register and check the site out.

Check out Beacon now.

They split the participants into two types of diet - those who ate a diet largely based on whole foods, which includes lots of fruit, vegetables and fish, and those who ate a mainly processed food diet, such as sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products.

After accounting for factors such as gender, age, education, physical activity, smoking habits and chronic diseases, they found a significant difference in future depression risk with the different diets.

Those who ate the most whole foods had a 26% lower risk of future depression than those who at the least whole foods.

By contrast people with a diet high in processed food had a 58% higher risk of depression than those who ate very few processed foods.

There are three reasonable explanations for this finding. The one the researchers believe is that what you eat can directly impact your mood over the long run. Another explanation is that people who are more prone to depression live a kind of lifestyle where eating processed food is a normal part of it (think of a person who is harried and stressed out and doesn’t know how to manage stressors in their life very well). “Physical activity” and education don’t really rule out the possibility of the second explanation.

And the third explanation is that people with depression eat less healthily. That also seems like a reasonable explanation for this finding. The news article doesn’t say whether they assessed depression at the onset of the study (which seems like a pretty reasonable thing to have done).

Honestly, I’m not sure eating more healthy is going to directly impact your mood. It will, however, impact your overall general health, which does have an impact on your mood. So even if it’s not a direct relationship, it’s something to think about next time you find yourself stopping into McDonald’s for the 5th time this month (or week!).

Read the full article: Depression link to processed food

If you’re a parent and looking for some tips on how to handle Halloween this year in your house, look no further than this great article written by our own Dr. Hartwell-Walker two years ago:

Fast forward a decade or three and it’s not always so innocent or so much fun. Friends tell me of mobs of teens out terrorizing each other, shaking down the little kids, and demanding candy at the doors of those whose lights are on. Others tell me of carloads of kids being dropped off in their neighborhoods by parents who either think their own blocks are too dangerous or who want their kids to cash in on more free candy. Still others tell me of kids who can’t be bothered saying thank you when they collect their candy. They just want to be off to the next house to get more. It’s a sad comment on what the day has become and what kind of parenting is going on.

Keep in mind that Halloween is a fun time for kids to play a little make believe out in the real world. Let them enjoy the day (and night)! Happy Halloween to everyone!!

Read the full article: Halloween Safety Tips for Parents

Psychology researchers call it fluency while web developers call it usability, but they’re both basically talking about the same thing — how well something is designed can directly impact how much people use it. And not only the degree to which they use it, but also the amount of self-disclosure a person makes while using it.

Online researchers have repeatedly referred to the disinhibition effect of online behavior — people tend to disclose more about themselves or their personal details online than they do in similar face-to-face interactions. But why do people — especially teens — over-disclose on websites like Facebook or Twitter? What might be a contributing factor to encouraging people to disclose more than they ordinarily would?

Adam Alter from New York University and Daniel Oppenheimer (2009) from Princeton University set to answer this question in a recently published research study. Through the use of three laboratory experiments and one real-world experience with a live website, the researchers discovered that fluency (or usability) directly impacts people’s self-disclosure amounts.

Researchers manipulated fluency in the first three experiments by making the font harder to read on a number of exercises. In the first experiment, 33 undergraduates were asked to fill out a test that measured how strongly people “claim 18 virtuous but implausible attributes (e.g., “No matter who I’m talking to, I’m always a good listener”) and deny 15 common human frailties (e.g., “I like to gossip at times”). Lower scores on the scale indicate a willingness to disclose potentially self-incriminating flaws.” The study found that subjects tended to choose a greater percentage of socially desirable, non-disclosing responses when the test was printed in the difficult-to-read font. This experiment was replicated with another test just to make sure it wasn’t the test itself that was leading to the findings.

In the second experiment, subjects need to add a letter to an incomplete word in order to form a real word, the first one that popped into their head. According to the researchers, “eight of the [incomplete words] could be completed to form words associated with risk (e.g., “ris_” could be completed to form “risk” or “rise”), 5 could form words associated with self-presentational concerns (e.g., “_iked” could be made to form “liked” or “hiked”), and the remainder [could form] words associated with neither concept (e.g., “_og” could be made to form “dog”). Sixty-seven adults completed the study. Words show in the difficult-to-read font were more likely to be risk-related works.

In the third experiment, subjects were asked to complete a self-disclosure questionnaire in which they rated how comfortable they would be discussing their views on 30 self-relevant issues. The researchers found that “participants who found the font harder to read expressed greater discomfort and exhibited a diminished willingness to disclose their opinions on the 30 topics. However, this relationship between fluency and self-disclosure was mediated by the experience of negative emotions, [suggesting] that at least part of the reason why people prefer not to disclose self-relevant information when they experience disfluency is that disfluency enhances discomfort.”

The fourth and final experiment involved an existing confession-based website called grouphug.us that changed its design from gray text on a black background (harder to read and therefore less fluent) to black text on a white background (easier to read and therefore more fluent). Researchers had volunteers analyze the responses made on this website before and after the design change. They found that responses after the design change tended to disclose more embarrassing information.

The researchers summarized their results by noting that people self-disclosed more in high-fluency conditions — that is, when text was easier to read. When text was harder to read, subjects were more likely to hide their flaws and to think more about risk and concern. In the website experiment, people disclosed more revealing information about themselves when the website was easier to read.

The easier it is for us humans to process information means the more likely it is that we’ll engage in more of the behavior encouraging us to disclose. Alternatively, if we make it harder for people to read a website or fill out a form, a person is less likely to self-disclose.

This finding has many real-world implications, since self-disclosure is a big part of the psychotherapy relationship. Health (and mental health) professionals have many opportunities to induce greater fluency. The researchers suggest one example — by using simple words rather than long-winded alternatives, professionals can create more fluency (and more self-disclosure) from their patients. “Evidence from the negotiation literature similarly suggests that mutual disclosure benefits both negotiating parties, enabling them to identify their otherwise opaque mutual interests,” the researchers also noted.

Reference:

Alter, A.L. & Oppenheimer, D.M. (2009). Suppressing Secrecy Through Metacognitive Ease: Cognitive Fluency Encourages Self-Disclosure. Psychological Science. DOI: 10.1111/j.1467-9280.2009.02461.x.

You can tell he’s a gentleman because he wears a faded, outdated tan sports jacket. It’s seen better days, but so has the gentleman. He’s older, balding, and very much on his own. And yet, when you see him, you notice he has a sense of civilized purpose and dignity about him.

It’s how and where he walks that gets people’s attention. He doesn’t walk on the grassy berm next to the four-lane highway, he walks right in the gutter on the road, often in the right-hand most lane. If you were a distracted driver and were fiddling with your cell phone or radio, you could easily hit him.

That doesn’t seem to phase him or even enter into his decision about where he walks. Because he walks with a real sense of purpose, as if he’s got to be somewhere very important in a few minutes and if he just keeps on walking with determination and a swift stride, he’ll get there more quickly. The problem is, he walks for miles — miles upon miles upon miles. In a city, nobody would notice. In a car-congested suburb, such behavior draws attention.

It’s easy to draw conclusions about this man’s life, that he’s mentally ill (a significant portion of the homeless are mentally ill), that he has issues — to fill in all of the missing blanks that float around in my head. But something else strikes me, too. He’s a gentleman without a home, but a man who retains his dignity and determination… Or at the very least, the ability to put on a good face. In that way, he’s very much like many of us. He reminds me of my own humanity and frailty — that unbeknownst to us, we are just one or two steps away from this gentleman’s life.

I’m not sure what it is about him that draws people’s attention. Perhaps they just don’t want to run him over, but for as long as I’ve lived up here, I’ve seen him and he never seems the worse for wear.

Perhaps it’s because of where he walks and how he walks — like a man trying to outrun his demons — that makes me think of him some days like today… I think of him while I watch people walking by outside my office window, without much sense of purpose or care. The safe people — those of us with homes — we walk on the sidewalk. We don’t worry too much about the time, as I guess we know we’re going to get to where we’re going. And we don’t have to walk — we all have safe, warm cars to get us there.

The homeless highway gentleman doesn’t have those luxuries. He has no home he’s traveling to. He has no car to get him there. He’s getting from point A to point B the only way he can — depending solely upon himself. And since there are no sidewalks on the highway, he chooses to walk on the street instead of the uneven ground next to it.

More dangerous, perhaps. But also more civilized. Perhaps a reminder of the life he once led. And a reminder to us all — “Don’t hit me, I’m just as deserving as you to be sharing this road.” Of life.

After at least one gunshot echoed on the fifth floor, two nurses from [a neighboring] office went to treat the patient, who had apparently been shot in the head by the security guard [...]

“During the course of the stabbing incident, an off-duty security officer who was armed interceded,” [Police Commissioner Edward F. Davis] said.

“He produced a weapon and ordered the suspect to drop the knife. When the suspect did not comply, he shot the suspect.”

The off-duty security officer did not work at the hospital, but thankfully just happened to be in the hallway at the same time the incident occurred.

The police did not release details about the stabbing, nor what the person was being treated for. The police also did not say if the attacker had had a previous history of violence or criminal behavior, which is the most likely predictor of future violence. Bipolar disorder itself is not a predictor of increased criminality or criminal behavior.

The news story noted two previous unrelated violent criminal incidents within the hospital in the past 6 years. For a large teaching hospital that helps to treat the city’s indigent population for health care problems, it could be a lot worse.

Read the full story at The Boston Globe: Patient stabs doctor before being shot by security guard near Mass. General.

I can’t speak to Jani’s specific case, since I’ve never met the child, but I will say that labeling a child at this young an age with such a serious mental disorder (she was first diagnosed at age 5) is extraordinary. And of course it is easy to second-guess Jani’s experience and that of her parents from afar.

Her psychiatrist, Dr. Mark DeAntonio [from the UCLA Medical Center], says it’s very unusual for a child Jani’s age to have this kind of mental illness. “I’ve seen only really a handful of children in my 20 years that fit this kind of diagnosis,” he says. “This kind of alternate reality that she lives in—that’s very scary. That’s very disturbing.”

Disturbing indeed. Even more disturbing that Oprah would choose to highlight this kind of case with an entire show devoted to it — kind of smells opportunistic. But it wouldn’t be the first time Oprah took the sensationalistic route in portraying a mental disorder for ratings, rather than helping people truly understand people’s living with them.

I wouldn’t have written about it except that a few days ago an organization called Intervoice sent me a news release that contained an “open letter to Oprah Winfrey” regarding the episode and Jani. It’s hard for me to describe what Intervoice is, so I’ll just quote them instead:

However, there are also significant numbers of voice hearers who are overwhelmed by the negative and disempowering aspects of the experience. Many are diagnosed as having a serious mental health problem such as schizophrenia – a harmful and stigmatizing concept, in our eyes.

The experience of hearing voices prevents some people from living a fulfilled life in society (especially those in psychiatric and social care) and can lead to having a very poor quality of life. We seek to enable voice hearers troubled by their experience to change their relationship and attitude to their voices and to take up their lives again. We also want to ensure that our innovatory approach is better known by professionals, family members and friends.

We have spent the last 20 years trying to better understand why some people can cope with the experience and others can’t. We have discovered that those people who are not able to cope with their voices, on the whole have not been able to cope with the traumatic events that lay at the roots of their voice hearing experience.

I like their message — one of hope and empowerment. That hearing voices doesn’t have to be thought of as simple a “disorder” or problem that needs a fix (although many people may prefer to have the voices go away, if that’s their choice).

The organization included a long, 2,372 word letter to Oprah (sans bibliography) that emphasized these points. You can check out the entire content of the letter on their website (linked to below). But I thought this part of the letter was most interesting.

If Your Child Hears Voices…

The letter, which had 95 signatories including a fair share of PhDs, MDs, and other professionals from the international community, included 10 tips for what a parent might do if they find their child is hearing voices.

In our experience, what helps children the most is a systematic approach to understanding the voices. So, in order to help we have developed an interview to help map the experience. This can be used as a way to understand the stress the child is under, and then to work together to find solutions for the problems raised by the experience of hearing voices.

We would like to offer this 10-point guide for parents, indicating what they can do if their child tells them that he or she hears voices:

1. Try not to over react. Although it is understandable that you will be worried, work hard not to communicate your anxiety to your child.
2. Accept the reality of the voice experience for your child: ask about the voices, how long the child has been hearing them, who or what they are, do they have names, what they say, etc.
3. Let your child know that lots of children hear voices and that usually they go away after a while.
4. Even if the voices do not disappear your child might learn to live in harmony with his or her voices
5. It is important to break down your child’s sense of isolation and difference from other children. Your child is special - unusual perhaps, but really not abnormal.
6. Find out if your child has any difficulties or problems that he or she finds very hard to cope with, and work on trying to fix those problems. Think back to when the voices first started. When did the voices arise for the first time? What was happening to your child when the voices first appeared? Was there anything unusual or stressful that might have occurred?
7. If you think you need outside help, find a therapist who is prepared to accept your child’s experience and work systematically with him or her to understand and cope better with the voices.
8. Be ready to listen to your child if he or she wants to talk about the voices. Use drawing, painting, acting and other creative ways to help the child to describe what is happening in his or her life.
9. Get on with your lives and try not to let the experience of hearing voices become the centre of your child’s life or your own.
10. Most children who live well with their voices have supportive families around them who accept the experience as part of who their child is. You can do this too!

In conclusion we would like to stress that, in our view, labelling a seven-year-old child as schizophrenic and subjecting her to powerful psychotropic medication and periodic hospitalisation is unlikely to help resolve her problems with voices. Indeed, the opposite is most probable: Jani will simply become more powerless when it comes to finding ways to cope with her voices.

Because your well respected, award winning show reaches out to so many people, we are concerned that there will be many viewers who will be left with the impression that the kind of treatment Jani receives is the only one available. If this is the case then there will be children who will be subjected to an unnecessary lifetime in psychiatric care because their families believe there are no alternatives. It is very important to recognise that hearing voices, in itself, is not a sign of psychopathology - and - voice hearers who are patients can be helped to recover from their problems by being supported in developing their own ways of coping with their emotions.

We hope you will give consideration to the possibility of making a future programme showing the other side of the story, one of hope, optimism and with a focus on recovery. Perhaps you could make a programme about a child with similar voice experiences to Jani, who has been helped to come to terms with her or his voices and to discuss with the child, parents and therapists how this was achieved?

I’d have to agree by and large with their point, hence the reason you’re reading this entry today.

Just because something is unusual — such as hearing voices — doesn’t automatically make it a symptom of a more serious disorder. While it certainly can be (and in Jani’s case, only her doctors can make such a judgment), it may be something else instead.

We would love to see Oprah tackle mental health topics with an eye toward understanding they affect everyone, rich and poor, extraordinary and ordinary, young and old. And while it’s easy to always portray them in a negative light, how interesting would it be if someone talked more about some of the positives of having a different way of looking at the world. (Some people already do, most notably Tom Wootton in his books called The Depression Advantage and The Bipolar Advantage.)

Read the full letter here (PDF).

Read more about Jani here: The 7-Year-Old Schizophrenic

Conventional wisdom suggests that by “sleeping on it,” we clear our minds and relieve ourselves of the immediacy (and accompanying stress) of making a decision. Sleep also helps organize our memories, process the information of the day, and solve problems. Such wisdom also suggests that conscious deliberation helps decision making in general. But new research (Dijksterhuis et al., 2009) suggests something else might also be at work — our unconscious.

Previous research suggests that sometimes the more consciously we think about a decision, the worse the decision made. Sometimes what’s needed is a period of unconscious thought — equivalent to “sleeping on it” according to the researchers — in order to make better decisions. Here’s how they study this phenomenon:

[... In a] typical experiment demonstrating this effect, participants choose between a few objects (e.g., apartments), each described by multiple aspects. The objects differ in desirability, and after reading the descriptions, participants are asked to make their choice following an additional period of conscious thought or unconscious thought. In the original experiments, unconscious thinkers made better decisions than conscious thinkers when the decisions were complex.

The researchers suggest that unconscious thought, contrary to the way many of us think about it, is an active, goal-directed thought process. The primary difference is that in unconscious thought, the usual biases that are a part of our conscious thinking are absent. In unconscious thought, we weigh the importance of the components that make up our decision more equally, leaving our preconceptions at the door of consciousness.

So this is all fine and good, but how you do take laboratory findings and adapt them to a real-world experience to show that unconscious thinkers think better (e.g., with less distortions or biases)? One way to do this is to look at sports, because our weighting of different components is done beforehand and individually — not as an artificial variable manipulated by the researchers.

Each week over a period of 6 weeks, the researchers took 352 undergraduates from the University of Amsterdam and asked them to predict the outcome of four different upcoming soccer matches. Participants expertise about soccer was measured, and then they were asked to predict the result of each of the four upcoming soccer matches.

[Then] participants were divided into three experimental conditions. In the immediate condition, participants saw the four matches on the computer screen and were asked to provide their answers in 20 s[econds].

In both the conscious-thought and the unconscious-thought conditions, participants saw the four matches on the computer screen for 20 s[econds] and were told they would have to predict the outcomes later on.

Conscious-thought participants were told they had an additional 2 min to think about the matches. Unconscious-thought participants were told they would do something else for 2 min and performed a two-back task designed to occupy conscious processing.

A second experiment was conducted on another group of undergraduates to replicate the findings and understand more about the underlying process.

What did they find?

These experiments demonstrate that among experts, unconscious thought leads to better predictions of soccer results than either conscious thought or quick, immediate guesses.

Experiment 2 sheds light on why this may be so: Unconscious thinkers seem to be better at using the appropriate information to arrive at their estimates. Unconscious thinkers who had more accurate knowledge about the single best prediction criterion (world ranking) made better predictions. This was not true for conscious thinkers or for immediate decision makers.

Just to emphasize this finding — if you’re an expert and you had extra time to think about your decision in the area of your expertise (conscious thinker) or had to make a quick decision, you made worse decisions than those who were unconscious thinkers. The researcher hypothesize that conscious thought can lead to poor weighting in decision-making — the more you think about something, the more your biases interfere with good decision-making.

Unconscious thinkers in this experiment appear to weight the relative importance of diagnostic information more accurately than conscious thinkers did.

As always, these results must be taken with a grain of salt. The experiment was conducted only on undergraduates and may not generalize to other age groups or people with different educational backgrounds. Furthermore, other research has not found a significant performance difference between unconscious thinkers and conscious thinkers, and unconscious thought is not always the mode to rely on when faced with a complex decision (e.g., you can’t use this for gambling and certain kinds of information).

But for certain kinds of decisions — those that are complex and where you have some expertise — “sleeping on it” may be more helpful than spending minutes or hours of conscious thought on it. The brain makes good unconscious decisions, when we let it.

Reference:

Dijksterhuis, A. Bos, M.W., van der Leij, A., & van Baaren, R.B. (2009). Predicting Soccer Matches After Unconscious and Conscious Thought as a Function of Expertise. Psychological Science, DOI: 10.1111/j.1467-9280.2009.02451.x.

The Australian National University’s Centre for Mental Health Research is one of the unsung heroes in the development and research of programs to treat depression online, for both adults and teens. What they have done over the past decade is not exactly rocket science, and yet, surprisingly, most people have never heard of one of their free online programs. They’ve taken cognitive behavioral theories and techniques and translated them into online tutorials and programs. Then they did something a lot of organizations (and virtually all companies) fail to do — they did solid, randomized controlled trials to show their designed interventions work.

Their simplest intervention is an educational website about depression called BluePages. Yes, it offers the usual array of information about depression symptoms and treatments, but they’ve gone a step further and provided an evaluation of what treatments work for depression by evaluating the clinical research. Most interesting is that the BluePages website itself has clinical evidence backing its usefulness.

A more involved intervention offered by the same researchers from the CMHR is the MoodGYM training program. This is a web-based, self-guided program based upon cognitive-behavioral and interpersonal therapy techniques that is intended to help people with depression. MoodGYM is comprised of 6 modules.

We’ve mentioned MoodGYM previously in relationship to another online depression program and reported on the previous research about MoodGYM. MoodGYM has eight published research citations (some of which are noted in the references to this entry), and a few of them are randomized controlled trials.

MoodGYM is not for the faint of heart, however. In many ways, it is just as in-depth as a face-to-face clinical intervention and therefore takes nearly as much time and effort. And that’s one of its drawbacks — few people stick with the program to fully benefit from its positive effects. Despite this challenge, over 34,000 people visit MoodGYM every month and they have over 200,000 registered users. MoodGYM is reaching a lot of depressed people who want help for their depression, but can’t (or won’t) see a professional for it.

Another self-help program presented at the e-Mental Health Summit 2009 was Beating the Blues, a UK-based program composed of 8, 50-minute weekly sessions conducted on a computer or online. This program is available for free to most people living in the UK; it’s meant to be “prescribed” by a general practitioner. In the early research data presented at the conference, for those who completed the program, researchers saw a decrease of approximately 50 percent in patients’ outcome measure scores — they got significantly, clinically better after completing the program.

The Beating the Blues program suffered from the same problem that seems to plague all self-help programs — poor followup and completion by participants. Out of the people referred to the program in the research discussed by Kate Cavanagh of Newcastle University, only about 37 percent actually completed it. This leaves a lot of room for improvement for non-completers.

As Helen Christensen, the Director of the Australian National University’s Centre for Mental Health Research noted in her presentation to the conference, web-based interventions are attractive for many reasons. Their costs actually decline the more we can get people to use them, which is one of the few treatment interventions that can be said for. They are easy to make available and administer to the entire population, and they don’t require a professional’s oversight in a one-on-one environment.

She also mentioned a few ways of combating the drop-out problem in these programs. One is to start designing online interventions that are tailored for the individual. For instance, a teen might see a more entertainment-oriented, video-based program while an older adult might be more comfortable with text-based images and information. Voluntary reminders administered via your mobile phone, Twitter, Facebook or email might also be helpful. Incentives for completing major steps in the program — for instance, each module in the MoodGYM — might also help drive a person to finish the intervention.

I’ve touched upon only a few of the online depression interventions now available presented at the conference (another self-help program for the Netherlands was called Colour Your Life). The key point is that there are many of these kinds of online interventions available that directly treat mild to moderate depression — the most common form of depression that affects the greatest amount of people. If you’re suffering from depression, I encourage you to try out one of these free online depression programs. Help may be, literally, just a click away.

References:

Cavanagh, K.; Shapiro, D. A.; Van Den Berg, S.; Swain, S.; Barkham, M. & Proudfoot, J. (2006). The effectiveness of computerized cognitive behavioural therapy in routine care. British Journal of Clinical Psychology, 45(4), 499-514.

Griffiths, K.M. & Christensen, H. (2007). Internet-based mental health programs: A powerful tool in the rural medical kit. The Australian Journal of Rural Health, 15(2), 81-87.

Griffiths, K.M. Christensen, H. Jorm, A.F., Evans, K. & Groves, C. (2004). Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: Randomised controlled trial. British Journal of Psychiatry, 185(4), 342-349.

O’Kearney, R., Kang, K., Christensen, H. & Griffiths, K. (2009). A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls. Depression and Anxiety, 26(1), 65-72.

What is the Journal of Participatory Medicine? And what the heck is “participatory medicine” and how does it relate to mental health?

The second question first. Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. The ‘participatory’ concept may also be applied to fitness, nutrition, mental health, end-of-life care, and all issues broadly related to an individual’s health.

While we may think of this model most readily with medicine — patient in a bed with a life-threatening condition, doctor in white coat barking orders and what’s going to happen next — medicine must be considered most broadly defined in this context (indeed, many hours were spent on arguing whether “healthcare” shouldn’t have been substituted for medicine, to be more inclusive of all health professions). In this way, this model encompasses mental health care as well. Patients cannot be passive vessels waiting for “change” to just happen. It will not. It requires the patient’s active participation.

We actually see this no more clearly than in mental health care. Psychotherapy doesn’t work just based upon the expertise and skill of the therapist. The only patient in psychotherapy that gets better is one that actively is involved in their treatment, and participates in their own change. Yet another idea that psychology can teach to medicine.

The Journal of Participatory Medicine will therefore serve as a vehicle for communication of this concept. It seeks to explore the extent to which shared decision-making in health care, and deep patient engagement, affect outcomes. The Journal’s mission is to transform the culture of medicine to be more participatory. The Journal is an online-only, open-access journal — meaning it costs nothing to read its articles. If you’d like to engage in the discussion regarding an article, free registration at the site is required.

An empowered, informed patient will be the model of care for the future. Healthcare providers, such as physicians, nurses, pharmacists, surgeons and others, can either accept this partnership and embrace it, or they can reject it and try and to continue the old “doctor knows best” philosophy, one that is sorely outdated and no longer in step with the times.

The Journal is a project of the newly formed nonprofit Society for Participatory Medicine (of which I serve on the board and as Treasurer). The Journal receives no advertising or outside funding — it is funded solely by the Society. The Society is membership-supported, and you can learn more about membership here.

Please, take a moment to check out the Journal of Participatory Medicine, and let us know what you think!

At the time, I was generous and said that it’s likely that 30 to 50 percent of NAMI’s funding came from pharmaceutical companies. I was off. Way off.

The New York Times reported yesterday that nearly 75 percent of NAMI’s donations come from pharmaceutical companies — $23 million over 3 years’ time:

The mental health alliance, which is hugely influential in many state capitols, has refused for years to disclose specifics of its fund-raising, saying the details were private.

But according to investigators in Mr. Grassley’s office and documents obtained by The New York Times, drug makers from 2006 to 2008 contributed nearly $23 million to the alliance, about three-quarters of its donations.

Even the group’s executive director, Michael Fitzpatrick, said in an interview that the drug companies’ donations were excessive and that things would change.

How much can they change? NAMI is not some brand new organization that just happened upon pharmaceutical funding. They’ve been around for decades, and I wouldn’t be surprised to learn that the percentage of pharma funding has been similar for most of that time.

If you cut that funding substantially, NAMI will have to cut their advocacy efforts, services and staff. And that would be a shame, because despite the controversy, NAMI is one of only a handful of national organizations that advocates relentlessly on behalf of people with mental illness. Their peer, family and patient programs are unmatched throughout the country.

Their balance sheet is not encouraging. If you lopped off even just 25 percent of pharma funding (to bring it under half of their total revenues), you’d have to cut significant services and support programs. This kind of money can not just be “made up” by individual member contributions or other fundraising efforts. Dues from 2007 to 2008, for example, actually declined (while grant funding went up). Perhaps they could start with meetings and travel, which makes up nearly 13 percent of their annual budget.

The primary objection to this kind of significant funding from any single industry is that it has undue influence on the organization’s advocacy efforts:

For years, the alliance has fought states’ legislative efforts to limit doctors’ freedom to prescribe drugs, no matter how expensive, to treat mental illness in patients who rely on government health care programs like Medicaid. Some of these medicines routinely top the list of the most expensive drugs that states buy for their poorest patients.

Mr. Fitzpatrick defended these lobbying efforts, saying they were just one of many the organization routinely undertook. [...]

Documents obtained by The New York Times show that drug makers have over the years given the mental health alliance — along with millions of dollars in donations — direct advice about how to advocate forcefully for issues that affect industry profits. The documents show, for example, that the alliance’s leaders, including Mr. Fitzpatrick, met with AstraZeneca sales executives on Dec. 16, 2003.

Slides from a presentation delivered by the salesmen show that the company urged the alliance to resist state efforts to limit access to mental health drugs.

And that’s really the core of the problem.

The organization has seemingly allowed its relationship with pharmaceutical companies to guide (some might say “dictate”) some of their advocacy efforts. There’s no problem in taking pharmaceutical company money (we do here, after all). The problem comes when you’re secretive about such funding, and let it influence how you choose to deliver your services. NAMI has used such funding for great support and patient care programs, by and large, and it would be a shame if any of these are adversely impacted by this revelation.

We applaud NAMI’s forthcoming response to Senator Charles E. Grassley’s request for transparency, but we wish it hadn’t taken a U.S. Senator’s inquiry for them to make this information public. As a nonprofit advocacy organization, we expect such organizations to be transparent, especially about something that’s so clearly been an issue in the public spotlight.

Read the full article: Drug Makers Are Advocacy Group’s Biggest Donors