Category: Depression

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Postpartum Depression Underdiagnosed in Men

20Depression, Featured news, Parenting, Post-Partum, Pregnancy June, 16

Source: John Hann on flickr

After his son Jaden was born, Jason Maharaj felt depressed, exhausted, and stressed. Following complications during the pregnancy, Jason’s wife was diagnosed with postpartum depression, and he had to look after both his son and his wife while continuing to work.

But Jason soon realized that his mood was unusual and he spoke to a clinician about his feelings. The clinician responded: “Now is not the time for you. Now is the time to take care of your wife.” Only after he reached his tipping point—snapping at his son and bursting into tears—did Jason receive a diagnosis of his own.

Postpartum depression is most commonly diagnosed in new mothers within 12 months of childbirth. However, 1 in 4 new fathers also experience symptoms of the disorder during this period.

The symptoms include depressed mood, little interest in regular activities, feelings of worthlessness, and loss of energy.

Fearing that an open discussion of their feelings would result in dismissal or stigmatization, many men experience symptoms but resist seeking help.

In a study conducted by Jane Iles, Pauline Slade, and Helen Spiby at the University of Sheffield in the UK, couples completed questionnaires about their stress levels at different times following childbirth—after 7 days, 6 weeks, and 3 months. Results showed that symptoms of postpartum depression were similar among men and women. Men’s acute symptoms often followed their partner’s or occurred simultaneously. In both men and women, higher levels of postpartum depression and posttraumatic stress were related to inadequate partner support.

Sherri Melrose, assistant professor at the Centre for Nursing and Health Studies at Alberta’s Athabasca University, believes that healthcare professionals could help families best by addressing the needs of both parents. She explains that men often respond to their depression by socially isolating themselves or by expressing aggressive and pessimistic mood patterns.

Jason Maharaj showed frustration toward his son, who was craving attention. “I jumped up and turned around and yelled at him,” he recalls.

Unlike many women who are more comfortable expressing sadness, men often react to their depression with anxiety and anger. Melrose notes that some men may turn to substance abuse, avoidance of familial responsibilities, or extra-marital affairs to cope.

But like women suffering with postpartum depression, a father’s reaction to the disorder depends heavily on the social support they receive, especially from partners. In the same study by Iles, Slade, and Spiby, the authors found that men who feel attached to their partners and receive support are less likely to withdraw, react violently, or cheat.

Melrose recommends that healthcare practitioners be taught to recognize not only the existence of postpartum depression in men as well as women, but also the different ways it can manifest.

Commonly, women are administered the 10-question Edinburgh Postnatal Depression Scale to determine signs of postpartum depression. But Melrose questions the validity of this scale for use with men, as it cites frequent crying as a major symptom, which is far less common in men.

The more recent Gotland Scale for Assessing Male Depression uses 10 questions specifically designed to assess masculine expression of depression, using phrases such as “stressed out” or “burned out” rather than “I have been so unhappy that I have been crying.” Melrose believes the Gotland Male Depression Scale may be more suitable to test postpartum depression in new fathers, but suggests further testing to confirm the scale’s reliability and validity.

Because postpartum depression in men is highly stigmatized, hospitals, outpatient clinics, daycares and other organizations serving parents and children should consider their role in educating new parents about its possible manifestation in men. Psychologists and physicians should also ensure they take the feelings of both parents seriously.

Until they do, it is unlikely the stigma surrounding the condition will dissipate.

– Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Plastic Surgery to Cope With Bullying?

20Addiction, Bullying, Child Development, Depression, Featured news, Health, Self-Esteem June, 16

Source: Aimee Heart on Flickr

Looks matter. Focusing on appearance is nothing new. And the growing popularity of plastic surgery has, to some extent, normalized changing our bodies to fit our ideals.

But how do we understand the limits, especially where children are concerned?

In 2014, fifteen-year-old Renata underwent nose and chin surgery to put an end to the constant bullying she was facing at school.

The teasing had become so bad that Renata was homeschooled for three years. And while she says that she is happy with the end results, there was great concern raised at the time by parents, health professionals, and the public over the surgeries.

Experts are split on whether children can benefit from undergoing plastic surgery to avoid bullying. But it should be acknowledged that Renata’s story is not that uncommon.

Fourteen-year-old Nadia Ilse, as well as 7-year-old Samantha Shaw, both had surgery to pin back their ears in response to bullying. They had the operations done for free by the Little Baby Face Foundation, a non-profit organization dedicated to correcting facial deformities of children from low-income families. Founder Thomas Romo tells NBC News that such procedures can have a positive impact on a child’s functioning:

“You take a child, and you change the way they look. To anybody who sees them, they’re good looking. That gives the child strength. We can’t go after the bully. But we can try and empower the children.”

A study by the Department of Psychology at the University of the West of England supports the idea of this kind of surgery, which can have a positive impact on mental health. In a pre- and post-operation comparison of 51 plastic surgery patients and 105 general surgery patients, the plastic surgery group experienced a greater decrease in their depression and anxiety.

But the extent of these positive results is questionable.

Over the course of 13 years, the Norwegian Social Research Institute studied body satisfaction in over 1,000 adolescent females, 78 of whom underwent cosmetic surgery. They found that although satisfaction with the specific body parts that were operated on increased, overall body satisfaction did not improve. Furthermore, participants who underwent cosmetic surgery had an increase in depression, anxiety, and substance abuse compared to those who had no surgery, suggesting that the positive mental effects of plastic surgery are localized and short-lived.

Child psychologist Nava Silton also tells Fox 9 News that plastic surgery could be covering up underlying emotional or mental health issues that a child might have, such as low self-esteem. Unaddressed emotional issues could lead to a plastic surgery addiction in adulthood.

Currently, there is no pre-surgery screening process for mental health issues. The American Board of Plastic Surgery (ASPS) recommends children only have plastic surgery if they understand the benefits and drawbacks, do not have unrealistic expectations, and initially requested the plastic surgery themselves. Yet media personality Laura Schlessinger questions a child’s ability to demonstrate such qualities, noting the importance of parents in guiding their children towards better decisions:

“Children, by virtue of their lack of maturity, may have exaggerated notions of how these procedures will improve their lives.”

Still, Renata insists that surgery was the right choice for her—one that she says boosted her confidence enough to return to school.

Children of different ages and different cognitive abilities vary in their ability to appreciate what they are getting themselves into, but wherever possible, it’s important to help them be realistic about the anticipated consequences of a surgical procedure that will change them permanently.

– Anjali Wisnarama, 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

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Mental Health Initiatives for Athletes Still Lacking

00Depression, Featured news, Health, Media, Sport and Competition, Teamwork, Therapy May, 16

Source: Charis Tsevis on Flickr

Canadian NHL teams’—including the Toronto Maple Leafs—third annual Hockey Talks was a month-long initiative to discuss mental health issues and treatment. Athletes and mental health professionals gathered to discuss the stigma and stereotypes associated with mental illness and disability.

One stereotype pertains to professional athletes themselves. The suicide of Toronto-born OHL player Terry Trafford and the suicides of other players in the NHL, as well as retired NHL goaltender Clint Malaschuk’s recovery after his battle with depression, posttraumatic stress disorder, and alcoholism, show that even professional athletes are not immune to mental illness.

Research by Lynette Hughes and Gerard Leavey at the Northern Ireland Association of Mental Health in Belfast, Northern Ireland, shows that athletes may be more vulnerable to developing mental illness than the general population. Results from their studies show that increased risk stems from pressure to perform, and from the variability in healthcare and diagnostic standards between sports psychologists, who are routinely employed by professional sports federations to work with players. But sports psychologists often target only those issues that will improve athletic performance, not overall mental health.

Alan Goldberg, a sport psychology consultant for the University of Connecticut (UConn), says that athletes often work with professionals to overcome problems on the field. Based on his work with the Huskies Hockey program at UConn, Goldberg thinks that players often have trouble communicating with teammates, controlling their temper, or motivating themselves to exercise. They can become anxious or lose focus during competitions, which may lead them to choke at key times.

Big teams can fall prey to these issues as well. The Toronto Maple Leafs’ former coach, Ron Wilson, accused hockey-forward Phil Kessel of being emotionally and physically inconsistent, crippling his performance and hurting his relationships with teammates.

According to Goldberg, sport psychologists focus on helping players enhance performance, cope with pressures of competition, recover from injuries, and keep up exercise routines. But players are more than the sport that they play.

Media scrutiny of players’ behavior, strain on personal relationships from frequent travel, public criticism of their performance, and intensive training regimes can all take a toll on physical and mental health. The problem is, these issues are rarely addressed by sports psychologists.

Treating depression, anxiety, and substance abuse, which are the most common mental illnesses among hockey players, is not in the job description of sport psychologists or exercise professionals hired to work with athletes. Instead, the focus of both athletes and support staff, is on winning. According to Goldberg:

“The overall goal of the sport psychology professional is to enhance the player’s game on the ice. To make them a better teammate and a better performer who can win games and championships.”

And the work schedules of professional athletes—including travel and time away from home—make it hard for them to seek out psychotherapy with psychologists outside the team. As a result, they are left with no access to care.

The mental health programs that do exist, such as the NHL’s Substance Abuse and Behavioural Health Program which help players cope with the use of performance-enhancing drugs, still focus more on the sport than on athletes’ lives. Yet newer initiatives like Hockey Talks have shown more promise.

Giving fans, players, and coaches a chance to voice their thoughts on all forms of mental illness and remove the stigma of professional athletes experiencing mental health problems can be exactly the push professional sports associations need to start providing athletes with the care they require.

Only by realizing that athletes have lives and cares outside of their professional sports can we begin to address mental health needs holistically.

– Veerpal Bambrah, 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

1 A blood test to diagnose depression-118138414119886042cd33f08a35cf742e1cc5c5

A Blood Test to Diagnose Depression?

00Addiction, Depression, Featured news, Neuroscience, Psychiatry, SSRIs March, 16

Source: Andrew Mason on Flickr

Researchers at the Feinberg School of Medicine at Northwestern believe it may be possible to diagnose depression using a blood test. According to Eva Redei, a professor of psychiatry at the university, previous studies with lab animals have identified 26 markers in the blood (called biomarkers) that are associated with depression.

With human subjects, Redei identified nine biomarkers that differed between depressed and non-depressed individuals. The biomarkers signify a difference in gene expression associated with depression and allowed Redei to identify all those suffering from Major Depressive Disorder (MDD) in a sample of 66 adults.

Further, Redei was able to use biomarkers to identify adults with MDD who benefited from Cognitive Behavioural Therapy (CBT).  When depression symptoms were improving, some of the original biomarkers that helped to identify depressed individuals disappeared in blood samples.

If replicable, these findings would have major implications for the future of mental health diagnosis. Patients sometimes seek the attention of a primary care physician when they have concerns about depression. Unfortunately, such physicians are not as equipped or experienced as psychiatrists and psychologists in diagnosing and treating depression. This increases the time between when individuals begin to experience symptoms and when they are able to receive treatment. On average, an official depression diagnosis can take between 2 to 40 months.

At the same time, untreated depression has severe risks. “The longer depression is not treated, the more difficult it is to treat,” says Redei. “There’s also a higher chance of suicide, and adverse effects in the person’s work environment, home environment, [and] social structure.”

Untreated depression usually worsens over time, and to cope, patients may succumb to addiction, self-injury, and reckless behaviors such as having unprotected sex and drunk driving. Risk of suicide also goes up the longer depression remains untreated.

Using a test such as this to identify depression could reduce some of the stigma tied to the disorder and bridge the gap between mental and physical health. Depression affects the whole person, body and mind. A test such as this underscores that connection.

Does it all sound too easy?

Perhaps.  New biological findings in mental illness have a way of promising a whole lot more than they deliver.

Nowhere is this seen more than in the area of depression (Anyone out there remember Peter Kramer’s 1993 classic, Listening to Prozac?)  Decades of research on SSRI’s, once hailed as revolutionary, are increasingly showing just how modest, indeed disappointing, the medication’s effects actually are.

So a healthy dose of skepticism is in order.

This study is one of the first in its category. Depression is an exceptionally complex disorder that can only be partially understood in terms of biology. For the above implications to be substantiated, many studies with larger sample sizes must replicate the findings.

In fact, a much larger study that looked for genetic associations with MDD in over 6,000 individuals (of whom 2,000 were diagnosed with MDD) found little to no genetic links.

Further, even if blood sampling were used to diagnose depression, it would not account for the social and environmental components of the disorder. It is possible that increased reliance on biological factors could lead to increased numbers of people being misdiagnosed and forced to suffer alone due to the narrow diagnostic scope that blood tests would provide.

Still, Redei’s research does show promise. She hopes that using blood tests to diagnose depression will help expedite the otherwise lengthy process. But she does not feel that current diagnostic practices should be replaced. Instead, the combination of blood tests and self-report evaluations of symptoms may be key to early diagnosis in the future.

Although further research is needed, the hope is that blood tests may eventually help clinicians with the question of which treatment may be most effective for which client. “I think this opens the possibility to begin to look at whether there are biomarkers that may be able to predict response to a behavioral treatment like cognitive behavioral therapy, pharmacotherapy and other forms of treatment,” says co-author David Mohr.

Redei’s research responds to the very real need for more efficient and effective methods of diagnosing depression.  And it opens doors to new ways of understanding the disorder and its identifying characteristics.

– Alessandro Perri, 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

When A Loved One Attempts Suicide

When A Loved One Attempts Suicide

10Depression, Featured news, Forgiveness, Post-Traumatic Stress Disorder, Suicide, Therapy, Trauma January, 16

Source: Wayne S. Grazio/Flickr

About two years ago, I personally came face to face with the suicide attempt of my best friend, Bella.  Distraught, she had called to tell me she loved me and that I was the best thing that ever happened to her.  I listened to her cry for a few minutes until she suddenly disconnected.  I was immediately filled with a sense of fear and dread.

Soon in my car breaking the speed limit, I was yet unaware how my life was about to change.

Bella suffered from clinical depression and although she kept it a secret from most, I was well aware of her struggles.  She had two kinds of days:  bad and terrible.  Her boyfriend had just broken up with her, which sent her into a tailspin.  She was in an inescapable depressive state, filled with thoughts of suicide.

Many parents who experience such episodes with their children are plagued with mixed emotions of self-blame, anger, shock, and grief.  They often feel powerless, not knowing how to help their children, and the threat of losing them is ever present.  Bella’s parents were no different.  They were emotionally exhausted and needed a break.  When I got to Bella’s house I told her parents that I would stay with her for a couple of hours.

We watched TV in silence, and soon Bella looked toward me decidedly, as if she had finally settled on a course of action.  She told me she had to go to the washroom downstairs.

Minutes passed and she had not returned.  An overwhelming anxiety came over me, I had to check on her.  As I walked down the stairs –my heart beating rapidly and my mind venturing to the unthinkable– I saw her.  Face blue, eyes red.  She was attempting to strangle herself with a rope she had found in the basement.

Although sparse, research on the effects of witnessing a peer’s suicide attempt shows that the event can have a strong impact on the witness.  Individuals may develop varying degrees of post-traumatic stress disorder (or PTSD) or other anxiety disorders.  Experiencing powerful and recurrent memories of the event and avoiding situations that may remind one of the trauma, create a cycle of negative thoughts and emotions that can make treatment challenging.

According to clinical psychologist, Daniel Hoover of Baylor College of Medicine, anyone in direct contact with a suicide attempt should seek out treatment following the event (which doesn’t necessarily have to be one-on-one counseling to be effective).

When I saw Bella trying to kill herself, I immediately rushed over, removed the rope and hugged her.  She cried, gasping for air, furiously yelling at me for stopping her.

For a long time afterward, this image of Bella was embedded in my mind.

And I felt profoundly guilty after the incident:  If I had not let Bella leave my sight, she might not have attempted suicide.  This thought often came to mind.  A vicious cycle of uncertainty plagued my daily activities.  I was holding myself accountable for actions that were ultimately out of my control.

I kept her suicide attempt a secret from everyone in my life.  I didn’t want to hurt her reputation or break her trust, and I became tormented by the trauma, but I couldn’t confide in family or friends for fear of having to explain Bella’s story.  For the first time in my life, I felt utterly alone.

Brian L. Mishara, author of The Impact of Suicide, suggests that telephone support programs can reduce the emotional burden on family and friends.  Counselors build a relationship with their client and provide information on healthy coping strategies and useful resources –all over the telephone.  Counseling calls tend to continue weekly over a period of time until the person feels comfortable coping with their traumatic experience.

Although challenging, recovery is possible.  Two years later, I’m doing much better.  For one thing, I needed to realize that Bella’s suicide attempt was not my fault.  You can only do so much to help a loved one when they are suffering from suicidal thoughts.  We want to protect our friends and family members, but we also need to protect ourselves.

And, suffering alone doesn’t work.  Withholding your thoughts after a traumatic event can compromise your physical, emotional, and psychological health.

Coping with a loved one’s suicide attempt is not easy.  Finding someone you trust and expressing your thoughts is helpful.  It’s much easier to cope when you have a trusted ally by your side.

– Alessandro Perri, 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

South Koreans Use Suicide to Preserve Honour.

South Koreans Use Suicide to Preserve Honour.

10Depression, Embarrassment, Featured news, Health, Stress, Suicide, Therapy December, 15

Source: Tanla Sevillano on Flickr

The suicide of a celebrity comes as a shock to fans. In the wake of Robin Williams’ death, there was an outpouring of grief. But suicide, like many aspects of mental health, varies across cultures. In October 2008, one of South Korea’s leading actresses and national icons, Choi Jin-Sil, hanged herself.

The importance of honour in Korean culture is evident throughout Choi’s story. She often spoke of the stigma of being a divorced, single mother in the public eye, which a national entertainment columnist likened to having a personality disorder. The divorce itself was a result of domestic abuse, yet a court cited Choi’s “failure of her contractual obligations” and inability to “maintain dignity and proper social and moral honour” in its ruling.

Choi’s death was only the beginning. It led to a wave of sympathy suicides in 2008, causing a 70% increase in suicides that October. In March 2010, Choi’s younger brother killed himself by hanging, and her ex-husband also hanged himself in January 2013.

This rash of suicides is exemplary of a common Korean belief: Psychological treatment is viewed with skepticism. An interview withKyooseob Ha, a psychiatrist with Seoul National University of Medicine, describes how Koreans are averse to seeking therapy, even for severe depression. Admitting to depression is seen as a character failure, shameful to the family. It is often concealed.

The same cultural norms dictate that preserving family reputation is paramount. Families asked about their loved ones who suffered from depression and committed suicide do not wish to speak about it. A common saying, “do not kill the person twice,” means that even if the person is gone, his or her “public face” can still be ruined.

Psychologist Hyong-soo Kim at Chosun University says this public face holds such sway that even in cases where people choose to see a therapist, Koreans will pay in cash to avoid their insurance companies finding out.

Research by psychiatrist Dae-hyun Yoon, at Seoul National University and the Korean Association for Suicide, shows that Koreans are more likely to seek the aid of a priest, psychic, or room salon (where a female bartender or hostess will listen to problems) than a professional therapist. Westernization hasn’t extended to mental health.

At the same time, Korea’s depression rates continue to rise and 80-90 percent of suicides are related to depression.

Refusal of professional treatment, along with wide public acceptance of suicide may be why South Korea was ranked by the Washington Post in 2010 as having the world’s highest suicide rate(in 2014, it ranked third-highest, following Greenland and Lithuania).

This has motivated South Korea’s government to develop intervention programs such as jump-barriers on bridges, glass doors along subway platforms, and 24-hour government-funded suicide hotlines. Though progress has been slow, some Koreans believe the traditional mindset to be flawed.

Currently, the Korean government is increasing funding for mental healthcare and suicide awareness. Online monitoring has led to the closure websites that encourage people to kill themselves. Gramoxone (a pesticide that was a common means of committing suicide) is now banned in Korea. And an expanded state pension system, as well as aid from major corporations, are giving less fortunate individuals the ability to access mental health services they could not previously afford.

Turning traditional ideals on themselves, public service messages now emphasize that the shame of a loved one committing suicide outweighs whatever circumstances led them to consider suicide in the first place. They focus on the idea that honour can be regained by living.

Local therapists know first-hand the values and lifestyles of their clients, and culturally based therapeutic approaches are key to curbing South Korea’s suicide rate. In a country where honour is tantamount to life, solutions must build on tradition, not break it.

– Olivia Jon, 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

Laughing at Mental Illness?

Laughing at Mental Illness?

10Addiction, Bias, Creativity, Depression, Embarrassment, Featured news, Health, Humor, Laughter, Self-Esteem December, 15

Source: Fractured-Ray on DeviantArt

Whether chuckling at a New Yorker cartoon or an episode of South Park, there is nothing wrong with a bit of laughter. But certain topics are off limits.

Depression, anxiety, psychosis. Is it ever okay to laugh at mental illness?

Many mental health advocates say that mental illness is never a laughing matter. This view was reflected in public outcry after a2013 McDonald’s ad showed an apparently depressed woman with the caption, “You’re Not Alone. Millions of people love the Big Mac.” The helpline under the ad connected callers to the McDonald’s head office. The fast-food giant faced tremendous backlash and quickly pulled the ad, apologizing to those they offended.

Psychologist Howard Samuels, founder of The Hills Treatment Centre in Los Angeles, says that when we laugh at mental health issues, we lessen the seriousness of the condition and dehumanize sufferers. He cites the example of former Toronto Mayor Rob Ford, whose substance abuse made for numerous jokes, ridicule that may have delayed his decision to seek treatment.

But Janine Hobson (name changed), a stand-up comedian for Vancouver’s Stand Up For Mental Health (SMH) and Toronto’s Laughing Like Crazy (LLC) disagrees. To her, the acceptability of finding humour in mental illness depends on who is making the joke and why. Does the person have a mental illness, and is the humour playing down the condition or helping that person connect to others?

According to Janine, a sufferer of bipolar disorder, SMH and LLC help people with mental illness overcome their conditions. As part of the two programs, participants come up with a comedy routine based on their experience with mental illness and the mental health system, performing their sketches in front of live audiences.

David Granirer, the founder of SMH and Janine’s trainer, thinks that comedy gives people with mental illness a powerful voice and helps reduce stigma and discrimination around these issues.

“People with mental illness suffer from the effects of misplaced public perceptions,” states Janine. “What do people think of the mentally ill? They’re dangerous, they’ll fly off the handle and kill you.People are afraid. The other myth is that mental illness is a symptom of a weak personality. When you have mental illness there’s a lot of shame.”

Proponents say that comedy diffuses shame and fights stereotypes. Addressing mental health issues through humour improves communication and creates a meaningful and memorable dialogue about the impact of mental illness on individuals and communities. At the same time, people with severe mental illness performing stand-up comedy—a daunting prospect for most—empowers sufferers and shows that mental illness does not have to be a handicap.

Although not a substitute for treatment, laughter can be a way for people to feel better about themselves and embrace their conditions while educating others.

“It’s a way of giving power and hope back to people like myself who are going through the system and have felt so disempowered over the years, which is so important to keeping someone spirited against the obstacles they face related to their illness,” claims Janine.

Research studies on laughter appear to support these views, showing that humour is related to the development of a positive and realistic self-concept, higher self-esteem and self-worth, and more positive emotional responses to stress. Humour that is good-natured, integrating, and non-hostile is associated with higher self-esteem and competence in interpersonal settings, and more positive feelings.

Janine emphasizes that participants of the SMH and LLC programs focus on their own experiences and make light of their ownproblems (as opposed to belittling or sensationalizing mental illness).

So, can we laugh about the frightening symptoms of schizophrenia? Hard to know, the answer depends on context. At its best, humour creates partnership, hope, and open-mindedness. At its worst, it triggers ridicule and bullying.

The difference is as thin as the line separating comedy and tragedy.

– Veerpal Bambrah, 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

Is Casual Sex Really So Bad?

Is Casual Sex Really So Bad?

20Anxiety, Depression, Featured news, Health, Relationships, Self-Esteem, Sex December, 15

Source: John Perivolaris on Flickr

Smartphone apps like Tinder, Grindr, Down, Tingle and Snapchat have opened up a new chapter in the complicated world of dating and casual sex.  Dubbed “hookup culture,” smartphone users 18-30 years of age are said to be navigating a very different sexual landscape than their parents did.

Early research on the topic found that undergraduates who engaged in casual sex reported lower self-esteem than those who did not.  Yet, other studies reported no evidence of higher risk for depressive symptoms, suicidal ideation, or body dissatisfaction.

According to adjunct professor Zhana Vrangalova of New York University, the phenomenon of casual sex is layered with individual, interpersonal, emotional, and social factors.  Reasons for engaging in hookups are different.

Her recently published study demonstrates that casual sex is not harmful in and of itself, rather one’s motivations for engaging in casual sex is what affects psychological well-being.

Vrangalova draws upon self-determination theory:  Behaviours arise from autonomous or non-autonomous motivations.  When we do something for autonomous reasons, we are engaging in behaviours that reflect our values – the ‘right’ reasons.  When we do something for non-autonomous reasons, we are seeking reward and avoiding punishment – the ‘wrong’ reasons.

In the context of casual sex, Vrangalova and her team of researchers were able to show that those who hooked up for non-autonomous reasons (i.e. wanting to feel better about themselves, wanting to please someone else, hoping it would lead to a romantic relationship, and wanting favours or revenge) had lower self-esteem and higher levels of depression and anxiety.

But those who engaged in casual sex for autonomous reasons – fun and enjoyment, sexual exploration, learning about oneself – reported higher than normal levels of self-esteem and satisfaction, with lower levels of anxiety.

If hooking up for the right reasons, casual sex does not appear to have a negative impact.  Still it’s not so simple.  A number of issues need to be addressed.

Many studies examine “hookup culture” on college campuses, particularly the sex life of middle to upper class young adults.  Since college years are often a tumultuous time of self-discovery and changing opinions, longitudinal research on the long-term benefits (or drawbacks) of casual sex need to be carried out.  Few studies have explored how casual sex affects the mental health of individuals above age 30.

Outside the college domain, information on how different casual sex arrangements (one night stands vs. friends with benefits vs. non-monogamy) affect mental health is scarce, as is research exploring how casual sex behaviours vary between people of different ethnicities.  Preliminary research shows that non-white women report lower desire for casual sex.  How or why this is the case has not been examined.

There is little doubt that the sexual landscape has changed in the past few decades. Technologies, and more specifically social media, have altered the way we approach and engage in interpersonal relationships. But the idea that younger generations are ditching the traditional dating scene in favour of hooking up has not been supported by recent research.

Hang-outs, group dates, friends with benefits, no-strings-attached… For those emerging adults who are engaging in these behaviours with a psychologically healthy frame of mind, is it really so bad?

– Magdelena Belanger, 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

Avatar Therapy Shows Promise For Voice Hearers

Avatar Therapy Shows Promise For Voice Hearers

00Depression, Featured news, Happiness, Health, Identity, Therapy October, 15

Source: Surian Soosay/Flickr

Auditory hallucinations are difficult to treat.  People show a wide range of response to antipsychotics.  And, the medications are associated with negative side effects. Psychological treatments like cognitive behavioral therapy (CBT) may help one cope with hearing voices, but they are usually not effective in quieting them or reducing their frequency.

An alternative method for voice hearers is a new computer–based approach called Avatar Therapy, developed at the University College London (UCL) by Emeritus Professor Julian Leff and his research team.

Avatar Therapy works as a collaborative process.  With the therapist, the patient constructs a digital representation of the face and voice that best suits one of their heard voices.  The therapist speaks as if they are one of the patient’s persecutors, and this speech is synced with the movement of the avatar’s lips, allowing for the patient to confront a simulation of their auditory hallucination in real time.

Patients have the opportunity to enter into a dialogue with their voices and learn how to gradually take control of the hallucinations.  By giving invisible and often menacing entities a face, these experiences can become easier to confront.  The therapeutic process allows for a safe space where the patient may practice  standing up to their voices in preparation for when they occur.

While research into Avatar therapy’s efficacy is limited to one pilot study, the results show promise.  After engaging 17 patients (who had not responded to medications) in up to seven 30 minute sessions of the therapy, patients experienced a significant reduction in the frequency and intensity of auditory hallucinations.

Also noteworthy is the abrupt cessation of voices in three of the patients who reported having experienced auditory hallucinations for 16, 13, and 3.5 years.  A follow up with these patients confirmed this cessation had continued three months after the pilot study. Patients also experienced a decrease in depression and suicidal thinking; encouraging results, since depression is often seen in cases of schizophrenia, and 1 in 10 of those diagnosed attempt suicide.

Patients were also given an MP3 recording of the conversations with their avatar from all the therapy sessions.  They were encouraged to listen to the recordings whenever they were feeling harassed by the voices.  This may have also contributed to their continued improvement.

Despite these preliminary results, Leff and his team caution that this approach may not be for everyone.  The study began with 26 patients, 9 of which dropped out.  The researchers attribute this drop out rate to the fear instilled in the patients by their voices and the threats uttered by them.

If this treatment is to have any effect, the patient must first be able to exercise a certain degree of tolerance over the voices, and be willing to manage the distress they produce. That said, another obstacle Leff and his colleagues face is working on ways to help patients develop stress management skills, so that more individuals may benefit from this approach.

The method may even open doors for further innovations in treatments for voice hearers, approaches that venture towards listening, understanding, and confronting one’s voices rather than suppressing them.

– Pavan Brar, 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