Psychiatry's assumptions challenged in the UK

It is worth mentioning that earlier this month, the British Psychological Society made news by stating that an entirely different understanding of mental health issues, separate from the nosology of psychiatry, is going to be necessary given the understandings being arrived at through psychological research.

This was in response to the highly criticized release of the American Psychiatric Association's new diagnostic manual, the Diagnostic and Statistical Manual, Fifth Edition (DSM 5).  Many psychiatrists themselves — some of them involved in the development of the previous manual — do not like many of the new changes.

The medical model of addressing mental health issues cannot stand on its own.  While medications may be useful, and even necessary, in helping some people, the assumption that medications or medical interventions are the answer to solving people's complex personal or social issues falls short of the current understandings of mental health and wellness.

Medications may be part of the answer, but most often are not the answer.

In fact, overwhelmingly, it is the experience of most psychologists that medications form a bridge to changing the life circumstances, but only some of the time, when nothing else has worked (developing insight, challenging problematic thoughts, developing new routines, altering relationship rules and boundaries, diet, identifying and modifying toxic habits, exercise, increased social contact, meditation, yoga, changing social networks, facing fears, etc. are just some examples of things to try before medication).  Once the circumstances are changed, in many cases, life improves and the medications are no longer needed. A taper of the medication is recommended at that point.

So why are we assuming that "mental health" requires a medical diagnosis?  Shouldn't we be assuming that "mental health" requires a complex psychosocial explanation instead, and then identify any collateral biomedical issues to address as part of the problem, rather than assuming the biomedical issues are the problem?

Food for thought. Happy weekend.

Autism research: Brain responses to words at age 2 predict severity

The latest bit of autism research by Dr. Patricia Kuhl, speech pathologist and psychologist, indicates that brain responses to words at age 2 are highly predictive of a broad range of cognitive abilities, facility with language, and adaptive behaviors.

This important bit of research adds to a growing body of research produced by Dr. Kuhl, who co-director of the University of Washington's Institute for Learning & Brain Sciences, and those working with her.  The research underscores the need for early intervention for autism, when the potential to fundamentally change brain development is at its maximum.  It is also hoped that it will lead to new treatments that are introduced in the early stages

You can find the Science Daily article here.

Apologies have a financial benefit

The "prudent" advice to avoid apologizing for mistakes (to avoid an admission of guilt) may not be good counsel after all.

As a matter of fact, apologizing competently and well can avoid costs.

Yesterday, there was a segment on National Public Radio's "Talk of the Nation" program with host John Donvan on which the benefits of making good apologies, and how to do it, was explored.  

Not only can you read the transcript, but you can hear the interview in its entirety.  The interview featured a medical doctor (Dr. Manoj Jain) and two psychologists (Dr. Jennifer Robbennolt and Dr. Guy Winch), all of whom had expertise on the benefits of sincere apologies.  

This is great stuff.  Hope you will take the opportunity to check it out.

You can also view the University of Michigan's policy on disclosure of and apology for medical mistakes here.

OCD checking: Research reveals a treatment

This one is so elegant it barely needs commentary.

Research presented this month (May 2013) in Canada reveals the way cognitive behavioral therapy (CBT) can help with obsessive-compulsive disorder (OCD) "checking and re-checking" behavior. 

Interestingly, many patients do not complain about their memories, yet still engage in the checking behavior. If the CBT focuses on the memory, the checking behavior is likely to reduce in frequency and intensity.

See the article here.

Suicidal youth: 20% have guns at home

Whether you are pro-gun or anti-gun, this news emerging from a recently conducted study should definitely raise some concerns about taking extra precautions for gun safety in homes with youth.

One fifth of youths at risk for suicide have guns in the home. A third of them know how to get the guns, a third know how to get the bullets, and 15 percent know how to get both.

And a frightening 40 percent of suicide completers among youth (those who actually died) had no known mental illness. So parents did not even have the notice that their children were at risk for a problem.

Whether or not you believe your adolescents or early adults are at risk for this most heartbreaking event, if you have guns in your home, please take extra precautions, because too many parents had no mental health warming signs at all.

Please see the article about the findings here.

"Boys will be boys" not true in Asia

Science Daily posted a very informative article about research done in Asia on early childhood self-regulation.  Basically, the research found that while in the U.S. it is common for boys aged 3-6 to have self-regulation problems compared to girls, in Asia there is no difference.

You may have heard that people live up, or down, to the expectations placed on them.  This appears to be true for children in Asia.  There appears to be no expectation that boys will behave any differently in terms of self-regulation from girls, at least in the home.

Maybe we need to expect more from our boys.

Social Phobia affects different areas of the brain

Social phobia is not the same as generalized anxiety, according to the National Institutes of Mental Health, citing a study in 2008.

Different areas of the brain are affected.  The NIMH has an emphasis on drug therapies, which is interesting because the majority of research suggests that the most effective treatment for nearly all forms of anxiety, including social anxiety, is Exposure and Response Prevention therapy (ERP).

Does it make you wonder who is influencing NIMH?

Don't let NIMH or anyone else tell you that drug therapies are the optimal choice especially when the research is lacking.  It is pure conjecture to say new drugs could be developed to treat it (see below). The treatment of choice, supported by all the research, is doing the work of cognitive-behavioral psychotherapy.  In fact, anti-anxiety agents are well documented as having an "elasticity effect" — meaning after the drug wears off, the anxiety is worse than it was before taking the drug.

Exposure and Response Prevention (ERP), if adhered to correctly, will reduce the impact of the stimuli leading to social phobia by teaching the affected person mastery of tolerating these stimuli.

For effective treatment, based in research, talk to a psychologist.

So we published this:

From NIMH (public domain, taxpayer funded):

Social Phobia Patients Have Heightened Reactions to Negative Comments

In a study using functional brain imaging, NIMH scientists found that when people with generalized social phobia were presented with a variety of verbal comments about themselves and others ("you are ugly," or "he's a genius," for example) they had heightened brain responses only to negative comments about themselves. Knowledge of the social cues that trigger anxiety and what parts of the brain are engaged when this happens can help scientists understand and better treat this anxiety disorder.

Background

Generalized social phobia (GSP) is the most common of all anxiety disorders. It is marked by overwhelming anxiety and self-consciousness in social situations. One approach to understanding anxiety disorders is to use functional brain imaging (fMRI) to explore how the brain responds to different types of social signals. fMRI can provide information on the relative activity—and thus the engagement—of different parts of the brain by tracking the local demands made for oxygen delivered by circulating blood. Scientists using this technology have reported, for example, that people with GSP have heightened responses to a variety of positive, negative, and neutral facial expressions, not just expressions that others perceive as threatening.

Results of this Study

People with GSP had heightened responses to negative comments (relative to a comparison group without the disorder) in two brain areas: the first, the medial prefrontal cortex (MPFC), is involved in the sense and evaluation of self; the second, the amygdala, is central to emotional processing. The responses revealed by scanning paralleled the participants' self-report of how they felt after seeing the various positive, negative, and neutral comments presented.

Significance

This work, conducted by NIMH intramural investigators Karina Blair, Ph.D., Daniel Pine, M.D., and colleagues, provided information on the specific social cues that trigger anxiety in people with GSP. It adds to previous evidence that the amygdala is involved and, in implicating the MPFC, gives clues for further research to explore on how people with GSP interpret social cues. Functional brain scanning can thus help to define patterns of brain functioning that underlie anxiety disorders, providing information that can inform treatment.

What's Next?

A previous study by these investigators found that the reaction of the brain to facial expressions was different in people with GSP than in those with general anxiety disorder (GAD). This suggests that the two disorders do not represent mild and severe forms in a single spectrum of anxiety disorders, but two neurologically different disorders.

Continuing research will reexamine these differences to see if they occur across different tasks, providing confirmation for understanding them as different disorders, which could lead to more targeted and effective forms of treatment for each disorder. Future studies will also explore more deeply the nature of the thought process underlying the reaction of people with GSP to negative comments about themselves and the interaction of the amygdala and MPFC. Finally, brain scanning offers a means to study the effects of treatment; scanning can, for example, provide information on the effects of medications in these parts of the brain.

Left amygdala (left) and medial prefrontal cortex (circled in yellow, right) activated strongly in people with social phobia (in comparison to those without GSP) in response to criticism of themselves.

References

Blair, K. et al. American Journal of Psychiatry. 2008 Sep;165(9):1193-202. Epub 2008 May 15. PMID: 18483136

Blair, K. et al. Archives of General Psychiatry. 2008 Oct;65(10):1176-1184.

Younger soldiers may have higher risk of PTSD

The following brief was posted in the Monitor on Psychology's May 2013 edition:

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Younger soldiers appear to be at greater risk for developing post-traumatic stress disorder, according to a study by Columbia University researchers. The scientists examined data from 260 male Vietnam veterans who had been diagnosed with PTSD. They found that men who were younger than 25 when they first went to Vietnam were seven times more likely to develop PTSD compared with men who served in Vietnam when they were in their 30s and 40s. The researchers also discovered that pre-war vulnerabilities, such as childhood physical abuse or a family history of substance abuse, were just as important as combat-related trauma in predicting whether veterans' PTSD symptoms would be long-lasting (Clinical Psychological Science, online Feb. 15).

***

This raises a lot of questions.  Recently, there was an extensive and excellently written article in the Huffington Post detailing the stresses on the remote-control pilots of the drones that the military is using to target terrorists.  

The May 5 Huffington Post article details the round-the-clock stresses of deciding when it is, in the words of Ecclesiastes 3:3, a "time to kill" falls heavily on young men and women — airmen a few years out of high school — who are looking for signs that terrorists are present and civilians are not.  Air Force Major Shauna Sperry, the psychologist assigned to these airmen, said the airmen experience a sense of helplessness, and agreed with the notion of a kind of moral injury that occurs for them with regard to the orders they must follow.

"They are so young," Major Sperry reportedly said. "They do what they have to do, but there is a toll that is taken."

So we published this:

Forgiveness and cooperation improve after prayer

An ongoing trend, gaining momentum since the late 1990s, has been the psychological study of the benefits of spiritual practices.  This is important because spiritual practices are an essential to so many people, with an estimated 5 billion of the planet's 7-billion plus people claiming some religious affiliation.

A recent study indicated that romantic partners and friends benefit when their partner/friend prays, specifically with better cooperation and a higher level of forgiveness.

The human race has achieved what it has by cooperation.  We are a profoundly pro-social species, despite a great deal of evidence to the contrary.

To read the article about the study on Science Daily, go here.

The article source is:

Nathaniel Lambert, Frank D. Fincham, Nathan C. Dewall, Richard Pond, Steven R. Beach. Shifting toward cooperative tendencies and forgiveness: How partner-focused prayer transforms motivation. Personal Relationships, 2013; 20 (1): 184 DOI: 10.1111/j.1475-6811.2012.01411.x

So we decided to post this.

ADHD? Not French kids

In France, fewer than 0.5% of kids are diagnosed and medicated for ADHD.

In the United States, that number is a staggering 9%.

In France, the assumption is that inattention and hyperactivity can be treated through psychotherapy, structure, and nutrition.

In the United States, for the most part, we prescribe.

This information was found in an article published in Psychology Today in 2012 by a psychologist named Dr. Marilyn Wedge, Ph.D.  Her ideas may not be popular among many parents.  But the state of affairs with ADHD being regarded as mainly a neurological disorder worthy of psychiatric treatment deserves questioning.  Especially with the ubiquitous availability of the medications, the private re-sale of them, and resulting rise in stimulant abuse.

So we published this:

Study: Old grumps may live longer

The following is quoted from the Monitor on Psychology's In Brief May 2013 section:

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Grumpy old men and women may live longer, according to research from the University of Erlangen–Nuremburg in Germany. Scientists examined data on current and expected future life satisfaction collected over 10 years from 40,000 people. They found that people who have low expectations for their future happiness experience less disability and die later than those who overestimate their future happiness. The findings suggest that pessimism about the future may encourage people to take more health and safety precautions (Psychology and Aging, online Feb. 18).

***

So we decided to make this:

Study: High school friends' grades associated with individual student grades

Here is the latest from the Monitor on Psychology's "In Brief" section:

Grade point averages may be contagious in high-school social networks, finds a study conducted by scientists at Binghamton University. Researchers asked 158 11th-graders to categorize their peers as best friends, friends, acquaintances, strangers or relatives and mapped how students performed in school relative to their peer groups. The researchers found that students whose friends were performing better academically were more likely to improve their own scores. Researchers also observed the opposite: When a student's friends' GPAs declined, the student's GPA also dropped (PLoS ONE, Feb. 13).

The original article may be found here.

So we posted this.