Monthly Archives: March 2007

Further interesting CBT efficacy research

The psychotherapy technique blog In The Room has a fascinating post about a new paper by Longmore and Worrell in Clinical Psychology Review which seems to preliminarily suggest that “Behavioural Activation proved as effective as antidepressant medication, and that both produced superior outcomes to cognitive therapy, which was no more effective than the pill placebo condition.”

The study also suggests that ‘non specific factors’ like the therapeautic alliance (the relationship between the individual therapist and the patient) makes more difference in initial recovery response rate of the patient than any cognitive behavioural elements.

In the comments to this post there is also a link to recently published research that indicates that CBT has no lasting effects on anxiety and psychosis.

Posted by: Eleanor

Best of the MindFields College Blog

Since last September we’ve had 72 posts on this blog on many different topics, so I’m going to filter out a few of what I consider the most interesting or important posts and put them all in the same place.

The Dream Catcher: Read the New Scientist interview with Joe Griffin  answering questions on REM sleep, depression, psychosis, trauma, conflict and cult behaviour
To sleep, perchance to dearouse: An account of my most vivid personal experience of dreaming dearousing a traumatic event I witnessed.

The Origins of the Human Givens Approach: Find out how the human givens approach originated.

The Magic Porridge Pot: Ivan Tyrrell bravely writes on ‘autistic’ government thinking and over regulation and what to do about it.

The link between dreaming and depression: Watch a short video which explains why depressed people wake up exhausted

How the link between REM sleep and depression affects the treatment of Bipolar disorder: Discussing Bipolar disorder, a post prompted by a question from another blogger.

This country needs more than ‘Supernannies’: Why the ‘givens’ of human nature should be the touchstone of any government policy.

What makes a good therapist or counsellor?: A checklist drawn up to protect people from potentially harmful types of counselling.

The link between worrying and depression: How worrying always preceeds depression, why this is related to REM sleep, and what you can do to break the cycle.

Is the NHS capable of learning from nature?: What is an effective system, and is the NHS one?
Posted by: Eleanor

PTSD: Fitting the definition

The excellent Anxiety, Addiction and Depression Treatments blog reported on an interesting study last week which suggested that the definition of PTSD needs to be more specific to avoid incorrect diagnosis.

“Based on clinical evidence that severely depressed patients also display many of the symptoms falling under the PTSD label, researchers believe that its definition needs to be refined in order to avoid frequently incorrect diagnoses. In a study of one hundred patients suffering from deep depression, researchers had them answer questions about whether they had experienced some of the varied symptoms of PTSD. To clarify the information given, two independent experts interviewed patients to determine which had undergone events fitting the definition of “traumatic” and whether these events might account for their present states. A majority of the study’s subjects had undergone such trauma, and most of that number also qualified for PTSD diagnoses, but the study’s most important finding was that an equal percentage of the patients without notable traumas could, under the current definition, be classified as suffering from PTSD. Such an overlap, experts say, has the potential to confuse treatments and render them ineffective.”

“Researchers say no clearly distinct biological differences between depression and PTSD have been established, though post-traumatic patients seem to respond differently to certain hormonal therapies. Differences, however subtle, exist between patients suffering from psychological disorders drawn from direct events and those who are clinically depressed, even though the two overlap in terms of observable symptoms and certain treatments may prove effective for both. This study suggests that we have yet to understand the intricacies of PTSD and that, in order to treat it more specifically in the future, we should immediately sponsor additional large-scale research projects with the ultimate goal of making these crucial distinctions at a time when an increasing percentage of our general population and especially our armed forces faces the debilitating effects of post-traumatic stress every day.”

And thank you Sisyphus for my Thinking Blogger nomination!

Posted by: Eleanor

Words from an Iraqi psychiatrist

Dr Haidr al-Maliki was as an army psychiatrist during Saddam Hussein’s regime.

He now works as a child psychiatrist at Ab Ibn Rushed Hospital in Baghdad. He lives with his wife and four children.

“There used to be about 80 psychiatrists in Iraq, now there are just 20 to 25.

And some of them will leave. Fifteen or so will eventually go to the UAE or to Jordan; it’s difficult.

About a year ago, during Ramadan, four boys aged about 15 to 20 came into my private clinic, in front of my patient.

They asked “Are you Dr Haidr?” I said yes. And they shot me several times.

One bullet went into my right shoulder, another into my right arm. I am left with nerve injury and muscle atrophy.

Afterwards they told me I couldn’t go to my clinic and that I had to leave the country. They didn’t say why.

So, now I don’t go out, I just stay at home. My own private jail.
During Saddam’s regime we could take our families to the cinema.

I want to drink, I want to dance, I want to visit my friends. But I can’t do anything. If I even think about going for a drink in my club 500m from my house, I will be killed.

Iraqi people are living in difficult times. Most of us have been exposed to aggression: attacks in the street, car bombings, kidnappings.

Most Iraqi people now deal with each other in an aggressive way; they show disturbed behaviour; they have lost their civility.

We don’t know how to treat these problems really.

But I can’t leave Iraq. If I and my friends leave, who will help our people?

Limitations of care

I was asked to open the child psychiatry centre in Ab Ibn Rushed hospital, but I have no training in children, really.

I read books and I try to help.

Most of the children are suffering from post-traumatic stress disorder, especially those who have been exposed to kidnapping.

Most of the children I see are bedwetting. They have disturbed behaviour or epilepsy.

We treat them with simple medication; it is very difficult.

Most of the families come here for help and sometimes we can do nothing for them, except offer support and advice.”

See the original article here at the BBC news site.

Posted by: Eleanor

Blairwatch interviews Adam Curtis

Go here to read the Blairwatch interview Adam Curtis about his new series, The Trap: what happened to our dreams of freedom.

“What I’m trying to do in these films is show that behind the way you think about yourself and the way those who govern you think about you, there are ideas. There are specific ideologies… The world we experience both personally and politically today is not the natural order. Many people think “oh this is it, we got there” because there aren’t alternatives. What I’m trying to say is “No, hang on. The way we think, the way we feel and the way those who govern us think and feel come from very specific ideologies”

The post has generated some very interesting comments..

If you’re looking for Ivan Tyrrell’s interview with Adam Curtis about his previous series, The Century of the Self then click here!

Posted by: Eleanor

Vote for your favourite psychology study!

Over at PsyBlog, Jeremy Dean has finished his compliation of top ten influential psychology studies. Some are very well known like Milgram’s infamous obedience study, but some I’d never heard of!

My favourite is still this one, a neat little study on how cognitions can greatly influence emotion in which Schachter & Singer suggest that genuine excitedness and euphoria can be induced by ‘experimental trickery’.

laugh

Vote for your favourite here.

Posted by: Eleanor

Number 10 reply to Therapy Petition


If you haven’t already seen it, here is the Governmental reply to this e-petition on the No 10 website that we supported: We the undersigned petition the Prime Minister to consider other psychotherapy approaches, not only cbt, in the proposed expansion of psychotherapeutic services within the NHS, instead of restricting choice for members of the public to one only model of therapy.

The reply:

“A ten-year programme of modernisation is underway to improve mental health services, to increase access to effective treatment and care, reduce unfair variation, raise standards and provide quicker and more convenient services. This programme of reform is backed by significant additional resources and is actively supported by the National Institute for Mental Health in England (NIMHE).

The Government is committed to expanding access to psychological therapies as a positive alternative to medication. We are aware of Lord Layard’s interest in this area, and he is closely involved in the Department’s work to develop models that will provide tangible evidence of the effectiveness of investing in talking therapies.

The Depression Report, published by Lord Layard and the London School of Economics’ Centre for Economic Performance Mental Health Policy Group on 19 June, advocates that psychological therapies, particularly cognitive behavioural therapy, should be made available to people suffering from depression, chronic anxiety and schizophrenia. It estimates that 10,000 new therapists are needed by 2013 to treat 800,000 people every year, through the creation of 250 treatment centres, each comprising 40 therapists.

The Depression Report is not a Departmental or Government publication. While we agree that more psychological therapies are needed, it is too early to make assumptions on the number of therapists needed. We have recently established a new programme to explore the ways of delivering evidence based psychological therapies effectively.

The Government has launched the Improving Access to Psychological Therapies (IAPT) programme to produce robust evidence in favour of increasing psychological therapy capacity. The programme consists of two demonstration sites in Doncaster and Newham, and a network of smaller regional projects that will bring together key programmes run by the NHS, the voluntary sector and local employers to test various models that could be implemented nationally. The programme will explore the ways of delivering evidence based psychological therapies effectively and will provide real, tangible evidence of the value of investing in talking therapies. Based on the learning from these sites, we will develop plans on the size, composition and training requirements of the workforce that will be required to roll out an improved psychological therapy service across England in the next five to ten years.

The demonstration site programme will cost £3.7million over the lifetime of the project and is being funded by the Department of Health. The two sites have been chosen because they serve very different demographics with different health needs, and they offer different treatment models such as community-based, voluntary sector-led, or employer-led.

The demonstration sites will develop new services for providing evidence based psychological interventions for people with depression, anxiety and other common mental health problems in primary and community settings. To date, services for people with these needs have been extremely limited leading to inappropriate services and/or reliance on medication and/or referral to secondary care.

The demonstration sites will also explore a variety of ways in which appropriate services for this group of people can be provided. This will include developing integrated teams of therapists provided by NHS and non-statutory providers. The new services will also be integrated with new Employment Advisers to support people in retaining and returning to work. The Advisers will enable the new services to develop more effective links with employers, occupational health services and Job Centre Plus.

The Department of Health is aware of the concerns about the emphasis that the IAPT programme places on CBT. The prospect of including other forms of psychological therapy in the programme has been discussed a number of times by the expert reference group which advises the programme’s board on matters of research efficacy and evaluation. However, it was decided that the IAPT programme should not deviate from its stated aim of increasing access to those therapies, like CBT, that are supported in the current National Institute for Health and Clinical Excellence (NICE) guidelines.

Notwithstanding the above, the Government recognises that many therapists are keen to ensure that the public can choose from a range of evidence-based and empirically validated therapies, together with those currently recommended by NICE. Indeed, given the relatively recent emergence of the recognition of the efficacy of psychological interventions, we expect that the IAPT programme will be capable of incorporating new research data in order to innovate and improve continuously the choice of psychological therapies being offered.”

Posted by: Eleanor