Category: Cognitive Behavioral Therapy

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Asthma Brings Surprising Challenges

00Anxiety, Cognitive Behavioral Therapy, Depression, Environment, Fear, Featured news, Health March, 19

Source: Free-Photos at Pixabay, Creative Commons

During the summer of 2017, Adrian and his partner, Kayla, ventured out to explore the dense forest in a remote area of south-eastern Canada where they were vacationing. Hiking on a trail that took them deep into the woods, Kayla shouted back at Adrian, urging him to catch up. Turning to him, Kayla could instantly tell something was wrong. After a wave of panic, he collapsed to the ground, gasping for air.  

As Adrian began to fade in and out of consciousness Kayla frantically dialed 911, despite knowing there was no cellphone service within miles of their location. They were completely isolated. Trying to provide comfort, all Kayla could say was, “This is not the end.” 

Approximately 300 million people worldwide suffer from asthma. This inflammatory lung disease, which causes swelling of the airways and constricted breathing, can be life-threatening. Globally, 250,000 people die each year from the condition, and researchers have yet to find a cure.  

Asthma is a common health concern, and the traumatic experience of an asthma attack can affect the emotional well-being of the sufferer and loved ones.

A Canadian study by Renee Goodwin and colleagues published in the Journal of Psychosomatic Research found that asthma is related to numerous mental health conditions, with the greatest links between asthma and posttraumatic stress disorder (PTSD), mania, and panic disorder. Using data from the World Health Organization, Kai On Wong and a team of researchers found that, globally, asthma is associated with depression and anxiety. 

Alex Watford is not surprised by these findings. In an interview with the Trauma and Mental Health Report, he discusses the toll his asthma has had on his mental health, and provides insight into what it is like to experience an asthma attack: 

“It feels like you’re drowning. All of a sudden, you’re not getting enough oxygen despite how much you try to breathe. While attempting to breathe, you can hear phlegm rapidly filling your lungs, slowly suffocating you. You then become light-headed and begin to lose vision while your body becomes weak and lifeless.” 

With diagnoses that include PTSD, anxiety, and depression, Watford believes his psychological distress is largely due to his terrifying flashbacks that cause him to live in constant fear of the next attack; fear which in turn provokes a level of anxiety that makes breathing difficult.

Clinical health psychologist Laura Flower, and Senior Research Fellow at the University of Southampton, Ben Ainsworth, describe Watford’s experience as the ‘cycle of breathlessness,’ a factor that contributes to the “complex and bi-directional” association between asthma and mental health challenges: 

“The experience of breathlessness is distressing; and it’s a normal reaction to be anxious about it. This anxiety then leads to an increased chance of breathlessness – which causes more anxiety.”

According to Flower and Ainsworth, the association between asthma and mental illness is further complicated by the complex relationships asthma sufferers have with their symptoms: 

“Some people are deconditioned to them (e.g. “it’s just my lungs, it’s just me”) and therefore aren’t motivated to manage them. Other people find them really uncomfortable, and are unable to work or enjoy a satisfactory quality of life. Both of these can lead to social isolation, poor lifestyle factors, such as fitness, which in turn worsen asthma symptoms.”

Watford describes how his daily life has been impacted by the disease:

“Having asthma affects my everyday life, as it makes having to walk long distances, such as across campus, really tough. This often deters me from going to class because I will feel so exhausted afterwards that attending feels useless. I often find myself avoiding many other activities for this same reason.” 

In a UK-based asthma community forum, members offer further insight into asthma’s invasive nature and speak to the unpredictability and uncertainty of life with asthma. 

“You don’t know what to expect tomorrow. Will you be able to breathe? Will there be someone there wearing strong perfumes or aftershave? Is there dust in the air? Oh, and just the sheer tiredness of it all, the worrying, not being in control of your surroundings…”

Some members say they are unable to perform simple tasks, such as walking up staircases or showering. Asthma sufferers describe the impact of the disorder as “genuinely life destroying and heart breaking”. 

Complicating matters further is the stigma associated with asthma, resulting from a lack of awareness and understanding. The stigma can lead to improper management of the disease, as well as social isolation that creates further mental health challenges in asthma sufferers. 

This is a theme that comes up in the asthma community forum:

“…sometimes we trivialize asthma as a society. It makes us think our illness isn’t that bad and so all the problems associated with it aren’t genuine.”

Clinical health psychologist Stacy Thomas, shares some of the ways psychologists, like herself, help asthma sufferers cope with the mental health aspects of chronic disorders, including asthma: 

“Using therapeutic interventions, health psychologists help to eliminate the psychological barriers that moderate the experience of asthma. For example, cognitive behavioural therapy, considered the ‘gold standard’ in terms of therapeutic approach, examines the thoughts and beliefs that contribute to problems with mood or anxiety, the tools one can use to find more balance in their thinking, and the behaviours that might need to be changed.”

Adrian survived his close call that summer hiking in the woods.  But like many others, he continues to re-live the attack with great intensity and struggles with the anxiety that such an experience leaves. Sometimes Adrian forgets that he suffers from asthma. For now, Adrian tries to remain positive, while patiently hoping for a cure. 

-Julia Martini, Contributing Writer, The Trauma and Mental Health Report.

-Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller

This article was originally published on Psychology Today

Does Experiencing Therapy Make a Better Therapist?

00Cognitive Behavioral Therapy, Emotion Regulation, Emotional Intelligence, Empathy, Featured news, Psychoanalysis, Therapy February, 16
John Sloan on Flickr

Source: John Sloan on Flickr

It seems intuitive. Psychologically adjusted clinicians should provide better psychotherapy.

Aside from the stressors of their own daily life, therapists face the emotional struggles and traumas of their clients on a daily basis. To meet these challenges effectively and to avoid burnout, therapists need to maintain a high degree of self-awareness and personal wellbeing.

So how does experiencing therapy help clinicians with their work?

British psychotherapist Drew Coster says that personal psychotherapy has helped him broaden his repertoire of techniques and taught him to focus on achieving his clients’ goals instead of focusing on a prescriptive model of treatment. Similarly, Chicago psychologistGerald Stein has explained that going through therapy can help clinicians identify problems in their treatment approach based on their personal experiences.

Studies have also shown that the therapist’s wellbeing affects the quality of the relationship developed with the client. The clinician-client relationship is often referred to as thetherapeutic alliance and it is related to better therapy outcome regardless of the therapist’s specific style or school of thought.

Psychologists Leslie Greenberg of York University and Shari Geller of the University of Toronto, authors of the Therapeutic Presence: A Mindful Approach to Effective Therapy, argue that therapist self-care builds the foundation for developing a good therapeutic relationship with the client. Only through personal balance and stability can clinicians be fully present, attentive, and helpful during sessions.

Self-care can take many forms and can include going through therapy. For practitioners, experiencing their own therapy helps promote self-awareness and personal growth. And it allows them to address private issues and biases that would otherwise hinder progress in their clients. Becoming aware of one’s strengths and limitations can help therapists determine what clients to take on and when to refer clients to other therapists.

Traditional psychoanalysis is the only therapeutic orientation that requires the therapist-in-training to actually go through the therapy process. Self-reflection and exploration are key components of humanistic and experiential therapies. And while cognitive and behavioural approaches do not emphasize personal development on the part of practitioners, mounting evidence for the importance of solid therapeutic alliances may be shifting this tradition.

Psychiatrist Steven Reidford, argues: “At the most commonsense level, a therapist who knows what it is like to be a patient may be more empathic, and may anticipate unstated feelings more readily than a therapist without this first-hand knowledge.”

Reidford cites the requirement for practitioners of psychoanalysis to undergo therapy, explaining that the Freudian concepts of emotional transference and countertransference between patients and therapists are readily applicable to other therapeutic styles like CBT. Instead of relying on theory and patient-report data, he suggests experiencing the phenomena firsthand. He explains that therapists’ primary tool is their emotional sensitivity, which can be honed by attending psychotherapy and getting familiar with one’s own feelings and biases. He also notes that being in therapy de-stigmatizes the process and can help therapists see their patients as individuals instead of maladies.

Experiencing therapy may be helpful from a simpler, more practical standpoint. Associate professor James Bennett-Levy of the University of Sydney found in a recent study that students learning the cognitive therapy approach found personal therapy helpful in enhancing their understanding of the theory and process of treatment. They also found it helpful in gaining a better understanding of their role as a therapist, developing greater empathy, and gaining a better understanding of themselves.

Personal counselling also allows the therapist to experience what it feels like to be the client. Clinicians in Bennett-Levy’s study stated that personally experiencing the treatment process, beyond reading about it or conducting it, provided a deeper understanding of the models and techniques they were studying.

It is important to keep in mind that this research was based on the therapists’ self-evaluations. Are these benefits reflected in psychotherapy outcomes for clients?

Most research on therapy for therapists has focused on self-evaluations of the positive and negative effects. While clinicians purport to gain insight and professional skills by attending therapy, little research exists measuring the specific impacts of therapy for therapists on client satisfaction. Nevertheless, as with anyone, therapy can help clinicians gain self-awareness and empathy, which may otherwise wane as a result of life stress.

– Essi Numminen, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Listening to voices

Can Some Lead A Better Life Listening to their Voices?

10Cognition, Cognitive Behavioral Therapy, Featured news, Psychopathy, Therapy, Trauma February, 16

Source: rumeysa babadostu on Flickr

Hearing voices is usually considered a sure sign of mental illness, but recent studies suggest that hearing voices is more common in the general population than previously thought. Though inconclusive, research estimates are that between 2 and 10% of people hear voices, with only 45% actually qualifying for a psychiatric diagnosis.

The notion that hearing voices can be non-pathological is still controversial.  Contemporary psychiatry views hallucinations (auditory or otherwise) as the result of abnormal brain function, representative of a more pervasive psychotic disorder.  Coming from a disordered brain, the content of voices are said to have no inherent meaning.  Treatments minimize or eliminate symptoms (usually through the use of medication) and provide coping strategies through cognitive behavioural therapy (CBT).

The ‘Hearing Voices Movement’ challenges the medical model.  Started in the early 1990s, the movement provides an alternative, non-pathological framework, claiming that hearing voices is fairly common in the general population and can exist outside of psychotic disorders.  They view voices as resulting from life events, (e.g., traumatic experiences), and that better coping comes from gaining insight into how the voices relate to unresolved trauma.

In a Dutch study published in 1989, Marius Romme, at the University of Limburg in Maastricht, and science journalist Sandra Escher found that out of 450 participants, about one third reported being able to cope well with their voices.  Of this group, people were more likely to have a positive interpretation of the voices, accepting them as part of their life instead of trying to fight or ignore them.   Although many of these participants still found some voices distressing, they were able to draw firmer boundaries and felt less powerless than the group that did not cope as well.

Building on the fundamentals revealed by their research, Romme and Escher were able to translate their findings into a therapeutic approach.  Known as the Maastricht approach, the aim is to foster curiosity about the content of the voices in order to gain insight, resolve underlying emotional problems due to past traumas, and eventually accept the voices as a part of the client’s life and self.

Voices can be positive, negative or banal –many voice hearers have some combination of the three.   In treatment, the client is asked to set aside a time to listen to the voices nonjudgmentally, as if they were talking to an actual person.  Along with the therapist, they try to unravel when the voices began and why.

In contrast, treatments like cognitive behavioural therapy (CBT) and similar methods aim to reduce the frequency, intensity and believability of hallucinations.  People receiving this type of therapy are encouraged to directly challenge the content of the voices, and cope by focusing on other things in their environment and use distraction to redirect their attention.

But when techniques like distraction and redirecting attention are used incorrectly, they result in people suppressing and fighting their symptoms, rather than learning to live with them.

Several studies show that individuals who try to suppress thoughts and hallucinations may increase their frequency and intensity, and exacerbate distress   (described in the work of Social Psychologist, Daniel Wegner of Trinity College).  Alternatively, the Maastricht approach encourages the client to eventually accept their voices without challenging their content or trying to fight them.

Some claim success for this kind of acceptance-based treatment, even in cases of psychosis.  In a study by clinical psychologists, Patricia Bach and Steven Hayes at the University of Nevada, Reno, 80 inpatients with schizophrenia were assigned to either continue their treatment as usual or engage in four sessions of acceptance and commitment therapy (ACT) in addition to usual treatment.

At the end, patients who attended the ACT sessions were three times less likely to be hospitalized again, and were more likely to question the voices’ control over them and evaluate the reality of the voices’ claims.  Bach and Hayes think the acceptance component allows people to be less distressed overall and view the voices as ‘just thoughts’ that don’t necessarily have meaning or power over them.

While ACT is a widely validated therapy, the Maastricht approach has less research to back up its claims.

The Maastricht approach is still considered peripheral in many circles, especially the idea of voices as an extension of human experience.   And critics of the treatment take issue with the implication that almost all auditory hallucinations are caused by traumatic experiences, overlooking or down-playing evidence regarding genetic and biological influences.  While it is true that many people who hear voices have experienced traumas in their lifetime, there is little evidence that trauma alone can directly cause auditory hallucinations.

And, some claim the Hearing Voices Movement ignores the needs of people with severe mental illnesses such as schizophrenia, which involves a host of other symptoms in addition to hearing voices.  Using the ‘hearing voices therapy’ only addresses one aspect of a multifaceted syndrome and may be harmful if the other symptoms worsen.

Still, when we look at the idea of hearing voices in a way that is not exclusively pathology-based, we open new possibilities, and we engage in what psychologist Andrew Moskowitz (University of Aarhus, Denmark) claims to be a necessary paradigm shift.  Indeed, it may be time for one.

– Jennifer Parlee, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T Muller, The Trauma and Mental Health Report

Copyright Robert T Muller 

This article was originally published on Psychology Today

Is Online Treatment the Next Frontier for CBT?

Is Online Treatment the Next Frontier for CBT?

10Cognitive Behavioral Therapy, Depression, Featured news, Psychiatry, Therapy, Trauma December, 15

Source: Mark Anderson on Flickr

Social media have dramatically changed the way many of us connect with family and friends. Some are now proposing that online relationships, particularly online therapeutic relationships may revolutionize mental health services by giving people with limited access a viable alternative to traditional treatment approaches.

One of these online alternatives, iCBT (internet-based Cognitive Behavioural Therapy) was derived from the tenets of traditional CBT pioneered by psychiatrist Aaron Beck.

Both target automatic negative thoughts that people have about themselves, the world, and their future, thoughts considered to be central to disorders like depression and anxiety.

But unlike traditional CBT where clients and therapists regularly meet in person, iCBT requires individuals to keep a journal recording their state of mind on an ongoing basis. Clients are given cognitive exercises, and their progress is tracked remotely by a therapist who reads the self-reflective journals, with feedback provided by e-mail.

The approach is currently being tested for its effectiveness in treating Generalized Anxiety Disorder (GAD). Psychologist and online therapist Marlos Postel conceptualizes iCBT as an approach that combines the advantages of structured self-help materials with the expertise of a therapist who directs activities and encourages clients.

Research from the University of New South Wales in Australia reports promising results, including improvements in patients with GAD, even compared to face-to-face treatments, with therapeutic gains maintained over three years.

Notably, many argue that online treatments eliminate an important ingredient, the therapeutic relationship between clinician and client. Research on the importance of this clinical relationship, the working alliance, has consistently shown it to be the single largest factor in predicting outcome. A central element of psychotherapy, it fosters trust, collaborativeness, and therapeutic change.

And some argue that underlying a strong alliance is the ability to detect non-verbal cues and subtle shifts in emotion that a client may demonstrate during therapy. Psychologist Madalina Sucala and colleagues from Mount Sinai School of Medicine in New York found that these cues account for a greater proportion of psychotherapy outcome than does treatment modality.

Notably, a different study conducted by Sucala found e-therapy and face-to-face approaches equivalent in outcome, despite the absence of non-verbal cues in e-therapy.

These discrepancies led researchers Gerhard Anderssona and Erik Hedman to suspect that some aspects of e-therapy may foster a different type of alliance between therapist and client. In a recent study, they found that iCBT creates a strong emotional connection between client and therapist because the therapist has more time to critically reflect on clients’ cases. Similarly, the online interactions did not affect client perceptions of how much their therapist cared for them or how much they trusted the therapist.

And co-director of the eCentreClinic and psychologist Nickolai Titov, an advocate for e-therapy, lists a number of advantages of the approach in a recent report. He found that iCBT is less-expensive—often 20-40% the cost of traditional therapy—and presents a viable alternative for rural locations where therapists are less accessible. Titov also found that many people can benefit from the relative anonymity of iCBT, as a common barrier to seeking therapy is embarrassment and fear of disclosure.

Therapists using modalities other than CBT have also started to come online. Clinicians using behavioural, interpersonal, and emotion-focused approaches have also begun offering online treatments. Even psychodynamic psychotherapy, which is traditionally a long-term, relational form of counselling, has been adapted into online formats.

Still, face-to-face mental health treatments are far from being replaced. Just as older styles of therapy are used alongside newer ones, online therapy may represent a promising treatment option for those comfortable with the format.

– Sumeet Farwaha, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today