Friday, 19 December 2014

Merry Christmas from all at 96 Harley Psychotherapy

Well, it's that time of year again, when we let down our hair and hang up our stockings in preparation for Christmas and the festive season. It's also an opportunity to acknowledge that we are coming to the end of another year and, as any good therapist will tell you, endings are a great time to appraise and recognise how far we've come.

This year we've added many new faces to the 96 Harley Psychotherapy team. On the administrative side, we've been delighted to welcome Tanya Boncoeur and Chloe Booth, receptionist and PA, respectively. On the therapeutic side, we have new psychologists Jacquie Hetherton and Jennie Persson and psychotherapists Avraam Karagiannis and Ron Bushyager.

The depth and breadth of the skills to be found at number 96, as anyone who has experienced our practice will tell you, are second to none. We look forward to spreading our wings even further in the new year, with new therapists and new services waiting in the pipeline.

We've also been busy establishing a formal Department of Psychological Medicine, now registered with the Care Quality Commission (CQC), a mark of the integrity and calibre of the mental health services we provide. Under the aegis of this department we plan to be included in a parliamentary review booklet, which will be circulated to colleagues in the allied healthcare professions in the coming year. This will further consolidate our reputation and standing.

Regular visitors will also be delighted to know that our wonderful, whimsical, centre-piece of an elevator (which possibly drives much more business into the practice than can be quantified - a ride in it is better than a spin on the London Eye!) is scheduled to be serviced, so you can look forward to riding between floors with nary a hitch or a bump in 2015!

Once again, our annual Christmas drinks gathering - the most coveted ticket of the Harley Street social calendar - went off with a bang last night, with colleagues from all walks of the psychological spectrum and other collaborators blending to perfection - like a deep, rich, spicy brew of heartening mulled wine!
We thank them all and wish all our readers, followers, patients and other associates a happy, safe and harmonious Christmas.

We hope you have enjoyed reading our blog during 2014 and look forward to bringing you more news, views and topical updates in 2015. Your comments, suggestions and reflections on all our posts will, as ever, be gratefully received.

Written by Jacqui Hogan

Friday, 12 December 2014

Sunlight each day keeps depression at bay

Seasonal Affective Disorder (SAD), as the name suggests, has long been linked to the time of year; namely winter, when the days are short and the rays are in short supply. It seems reasonable to propose, then, that there may be a link between SAD and vitamin D, as sunlight is a direct precursor of vitamin D.

This is exactly the hypothesis recently put forward, formally, by a research team at the University of Georgia, who report their rationale in the journal Medical Hypothesis, under the title 'Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder.'

In it, the authors note that SAD usually begins in Autumn and continues throughout the winter months, with symptoms including anxiety, depression, irritability and feelings of guilt or hopelessness. It is more common, they say, among those who live at high altitudes or in cloudy regions.

Vitamin D levels fluctuate in direct response to available sunlight, with a lead time of about eight weeks from exposure to ultraviolet (UV) radiation. This correlates with the time between peak intensity of ultraviolet (UV) radiation and the initial onset of SAD symptoms, lending credibility to the notion of a direct relationship between SAD and vitamin D.

Author, Michael Kimlin, says that vitamin D is known to play a part in the synthesis of both dopamine and serotonin, low levels of which are associated with depression. Commenting on the research, he says:
"What we know now is that there are strong indications that maintaining adequate levels of vitamin D are also important for good mental health. A few minutes of sunlight exposure each day should be enough for most people to maintain an adequate vitamin D status."
That's all well and good for those of us perched somewhere on or near the equator, but what about us poor unfortunates who languish mole-like in solar deprivation during the winter months? Well the first thing to say is, make the most of what you've got; if the sun is shining, get out there and drink it in - even a few minutes is enough to make a valuable contribution, according to the authors of this study.

Failing that, the best source of dietary vitamin D is oily fish - salmon, mackerel, tuna and the like. If you really want to make sure you're getting enough, then, just like my grandmother used to say, a tablespoon of cod liver oil now and again may be the way to go.

With the incidence of depression at such an all-time high, let's not allow any that is obviously treatable to slip through the net. During winter, always rule out SAD.

Written by Jacqui Hogan

Friday, 5 December 2014

Fun and games

Smartphones are now equipped with a dazzling array of entertainments, using state-of-the-art graphics and algorithms. A quick pan around any public square thesedays, will reliably reveal young adults glued to their mobile devices.

It’s tempting to believe they might be using the technology to further work or school objectives; probably some of them are. But research suggests they are most often using their phones for gaming and entertainment.

A new study from Kent State University (USA) aims to better understand how young adult smartphone users experience daily leisure in the context of this new social phenomenon. The researchers surveyed a random sample of 454 college students, measuring total daily smartphone use, personality type and subjective experience of daily leisure.

The students were then divided into groups, based on similar patterns of smartphone use and personality type. Each group's experience of daily leisure was then compared. Three distinct types of smartphone users emerged: low-use 'extroverts', low-use 'introverts' and a high-use group.

The high-use group averaged more than ten hours phone use per day and accounted for approximately 25% of the sample. Perhaps unsurprisingly, particpants in this group reported a diminished experience of daily leisure. They experienced significantly more ‘leisure distress’ – that is, feeling uptight, stressed and anxious during free time. Andrew Lepp, lead researcher, commenting on the findings said:
"The high-frequency cell phone user may not have the leisure skills necessary to creatively fill their free time with intrinsically rewarding activities, For such people, the ever-present smartphone may provide an easy, but less satisfying and more stressful, means of filling their time."
By contrast, the low-use extrovert group averaged about three hours of smartphone use per day and experienced lower levels of leisure distress. They were more likely to actively engage in activities during their free time.

It seems evident from this study (if not from common sense) that being constantly connected to your phone is unlikely to enhance your experience of leisure. No matter what you’re doing on your phone, you’re doing something – arguably to distract yourself from uncomfortable feelings, as the findings suggest. There’s a word that describes activities employed to distract onseself from uncomfortable feelings – addiction.

Can you go a day without your smartphone? Does it serve as a useful substitute for more meaningful activities during leisure hours? Or maybe you work with those who are struggling with addiction in this area? No matter what, we'd love to hear from you.

Written by Jacqui Hogan  

Friday, 28 November 2014

To your health and happiness

As you pop that last frond of parsley into your alfalfa and wheat grass shake, ask yourself a question: am I happy?

Hopefully, the answer is yes and you'll down that nutritional depth charge, slam the glass back down on the table and dash out for a 10km run with spring in your stride and joy in your heart!

But an interesting new piece of research challenges the assumption that eating 'healthily' (i.e. a vegetarian diet) has a positive effect on mental wellbeing.

According to Dr John Lang, who developed the Wellness Index for preventative health company Alere, a vegetarian diet appears to be associated with an increased incidence of mental disorders, rather than a decrease.

His study, based on 50,000 yearly surveys, shows that vegetarians tend towards pessimism and are almost 30% more likely to suffer from panic attacks and anxiety disorders. Furthermore, they are almost 20% more likely to suffer from depression than the general population.

Dr Lang puts this down, not to the vegetarian diet per se, but suggests that the diet is a symptom, rather than a cause of mental ill health. He says:
"The diet isn't the cause, but rather the symptom. If you think of people who are committed to being vegetarian, it's a fairly significant commitment and it picks up those at the fringe of the obsessive-compulsive spectrum."
Interesting observation. But it's not all bad news for those who enjoy their TVP (Textured Vegetable Protein) over a T-bone steak. Vegetarians were shown in the study to have the highest nutrition scores, at 105.9 points compared to 100.7 points for meat-eaters. So at least if you're miserable, you can console yourself with the thought that you're in tip-top physical condition!

I say this tongue-in-cheek, of course. I've often heard people with mental difficulties say they wish their problems were physical, rather than so seemingly intangible - that way, they could at least feel justified in their disability.

Because the truth of the matter is, if you're mentally well, then everything, even physical ill-health can be suffered, if not cheerfully, then with patience and tolerance, sometimes even with gratitude for the positives that remain.

All of which underscores our desperate need, as a society, to come to back grass-roots mental wellbeing, rather than projecting our angst onto 'grass shoots' solutions. These may simply serve to address the physical rather than the spiritual. Good diet is all important, but it isn't the answer.

What are your thoughts? How do you see the relationship between diet and mental health? Is there a link between vegetarianism and OCD? Start the conversation below.

Written by Jacqui Hogan

Friday, 21 November 2014

Women on the verge of a nervous breakdown?

A new piece of research from the Psychology Department of the University of Texas in Austin suggests that women in positions of authority in the workplace may be more likely than others to experience symptoms of depression.

Interestingly, the paper, published in the Journal of Health and Social Behaviour, entitled Gender, Job Authority and Depression concomitantly shows that similar positions of authority are associated with fewer symptoms of depression in men.

Participants were sourced from the Wisconsin Longitudinal Study (begun in 1957) and data were gathered for this study between 1993 and 2004.

Over 1500 women and 1300 men (by 1993 around 54 years old) were interviewed and their positions at work recorded. Over the course of the nine years to 2004 the relationship between their level of authority at work and symptoms of depression were monitored.

The results were unexpected. According to present understanding, women in powerful positions should have scored lower on depression symptoms, since they display what are thought to be the strongest predictors of positive mental health - higher income, better education, more prestigious occupations and higher levels of autonomy than women in positions of lower authority.

But this was not the case. Team leader, Tatyana Pudrovska, commenting on the findings, noted:
"Women with job authority - the ability to hire, fire and influence pay have significantly more symptoms of depression than women without this power."
By contrast, the researchers found that men in authoritative positions at work showed fewer symptoms of depression than men in positions of lower authority and then, fewer symptoms of depression  than women in similar positions of authority.

So what's going on here? Is it simply wild-west research, Texan-style - i.e. the patronising answer? Do women in positions of authority in the workplace experience more discrimination, and therefore depression, than men in similar positions - i.e. the politically correct answer? Or could it be that men and women have different sets of natural endowments which make them innately more suited to, and therefore more comfortable in, different  types of roles - i.e. the answer that dare not speak its name?

Maybe there are another explanations for the findings - if so, we'd love to hear your thoughts. Please leave your comments below.

Written by Jacqui Hogan

Friday, 14 November 2014

How smart are smart drugs?

You can't blame anyone for wanting to have the cognitive edge, for wanting to be that little bit smarter. Especially students, who it is claimed have been turning to so-called 'smart' drugs, like modafinil, to increase their chances of exam success, at a rate of about one in five,

But new research from the University of Nottingham suggests that modafinil may be having the opposite effect to that which they desire.

Dr Ahmed Mohammed, of the School of Psychology at Nottingham University Malaysia Campus, in a study published in the open access journal PLOS ONE, has shown that the drug, in fact, has negative effects on healthy people.

In the randomised, double-blind study, 32 subjects were given modafinil and 32 were given placebo. All were then tested using the Hayling Sentence Completion Test, in which they were asked to respond both accurately and quickly. Mohammed found that the drug increased reaction times and failed to improve task performance. Of the results he said:
"It has been argued that modafinil might improve your performance by delaying your ability to respond. It has been suggested that this 'delay dependent improvement' might improve cognitive performance by making people less impulsive. We found no evidence to support those claims."
The current study also supports the findings of a previous study, which showed that modafinil impaired subjects' ability to respond in a creative way, particularly when they were asked to think laterally. This effect was pronounced in those who had been classified as creative thinkers to begin with.

So, that's the bad news. If we want to be smarter, we cannot simply rely on a pill to do the work for us (did we really think we could get away with it?). But are there ways we can enhance our natural cognitive gifts to enable us to perform at our intellectual peak?

Our grandmothers have the answers and it ain't rocket science; enough sleep, good nutrition, moderate exercise and balancing recreation and work activities, are just a few of the common sense actions we can take to make the most of the brains we've got.

(Dr Ahmed's research interests, by the way, are now moving on to non-pharmacological interventions, which seems like a helpful trajectory.)

Have you tried so-called 'smart' drugs? What effect did they have on you? Perhaps they helped under certain conditions? Or perhaps your experience is in keeping with the findings above? If you have other suggestions for how to improve on cognitive performance and brain vitality, please share your comment below.

Written by Jacqui Hogan


Friday, 7 November 2014

Children and mental health in the digital age

A recent report issued by the Commons Health Committee paints a grim picture of the situation on the ground for the mental health of children in the United Kingdom.

The report notes a radical increase in the number of children seeking help for mental health problems (25% to 30% a year) and links it to a rise in the number of violent video games, sharing of indecent images on mobile phones, bullying on social media and proliferation of websites for teenagers advocating self-harm.

The cross-party group acknowledges that social media and online communications are now integral to the fabric of life for the under-18s, but recommends a government enquiry into the effects, because of the potential for harm to this and future generations.

Sarah Wollaston, Chair of the committee, commented that so-called 'sexting' (sharing of indecent photographs) could be traumatic for vulnerable young women, who are persuaded to pose for intimate pictures then find that shots are widely shared. She also expressed unease about the impact of violent videos now being watched by young people.

Mental health services are under such pressure with this growing problem that, in some parts of England, children are only seen by a Psychiatrist once they have tried to take their own lives.

A Consultant Psychiatrist with the Cornwall Partnership NHS Trust, Liz Myers, told the committee that they were receiving four thousand referrals per year, but are only funded for two thousand.

One wonders at the need for a government enquiry when pure common sense suggests that if you expose children to concepts and imagery they are too young to process, of course you will harm their mental health. Arguably, exposing anyone to the same kind of material might cause problems.

But the juggernaut of 'progress' takes no hostages - rather it seems hell-bent on destroying all those who stand in its path. Admittedly, such an issue is way more complex than can be addressed here (like what can parents do to control access to this stuff when we are literally steeped in it?) but a first step must surely be to recognise its pernicious effect.

Something tells me it's not just a matter of controlling access, but looking underneath to the states that drive our youngsters to sink so very low. It is surely a sign of deep disillusionment and despair.

Do you have experience of working with children adversely affected by social media? Maybe you think the positives outweigh the negatives? Whatever your thoughts, we'd love to hear from you.

Written by Jacqui Hogan

Friday, 31 October 2014

The healing power of psychotherapy

Some people approach the whole notion of psychotherapy with skepticism, which may be down to a number of factors. But for those of us who have experienced life-changing results from an ongoing commitment to psychotherapy (specially with a gifted practitioner who has overcome similar challenges), the findings of a recent study will come as no surprise.

Published in the journal Psychotherapy and Psychosomatics, the research team, from universities in Germany and Switzerland, showed an association between post-traumatic stress disorder (PTSD) and DNA damage and, also, psychotherapy and DNA repair.

In the first leg of the study, 34 individuals with PTSD and 31 controls were assessed for levels of DNA breakage, by taking peripheral blood mononuclear cells and measuring the cellular capacity to repair breaks after exposure to ionising radiation. The results showed higher levels of DNA breakage among the PTSD group than among the controls, suggesting that traumatic stress is associated with DNA breakage.

In the second leg, 38 individuals with PTSD were randomly assigned to either psychotherapy or a wait-list control condition and the effect on DNA breakage and repair was measured. The results showed that psychotherapy reversed not only PTSD symptoms, but also DNA strand break accumulation.

These are remarkable findings, which may shed additional light on previous research which has revealed an association between traumatic stress and numerous diseases, including cancer. Stress may increase carcinogenesis at the molecular level by causing damage to DNA and impairing DNA repair mechanisms.

We shouldn't be surprised at the very real possibility that psychotherapy is operating at the molecular level, given the intimate relationship between mind, body and soul. Sometimes, though, it's just nice to see it so starkly supported.

What are your experiences of the healing power of psychotherapy? What do you see, as therapist and/or patient, as the changes that occur with successful psychotherapy outcomes. Your views and experiences would be greatly welcomed.

Written by Jacqui Hogan

Friday, 24 October 2014

How's your memory?

That's the question General Practitioners will increasingly be asking patients over fifty, only now it will take on a whole new meaning. This is in line with the news that GPs will now be rewarded £55 for each successful dementia diagnosis.

Dementia is being underdiagnosed, according to health authorities, who claim that only half the 800,000 people in the UK estimated to have dementia have been formally diagnosed.

Assuming this figure is correct, the problem still remains that there is no consensus around what dementia actually is and how it differs, in the early stages, from natural, age-related memory loss (which we've previously talked about here).

There is no screening test to accurately predict it and no-one can tell, even if it is dementia, what course it will take. Among the questions which might be asked are: how fast will it progress?  how much will my life be affected? will I die from it? These are perfectly reasonable questions, questions for which we have no answers. On top of this, there is currently no effective intervention.

So, there you have it. A disease which cannot be effectively defined, for which there is no screening test and no effective treatment - sounds like the perfect candidate for a £5m government 'payment for diagnosis' scheme, right?

Those who oppose the move, like the Patients Association, have described it as imposing a bounty on the heads of some patients and can see no good reason for the initiative - especially when there is already a £42m scheme in England offering GP practices payment for performing assessments on those who present with memory problems. Why the clamour to nail diagnoses, they naturally wonder?

Katherine Murphy, Chief Executive of the Patients Association says the proposed new scheme is "a distortion of good medical practice".

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists, said the scheme would not be effective without investment in social care and further research to assist in our understanding of dementia. He maintains:
"At the moment, evidence favours either improving social care or investing in research to find new treatments that actually nullify the course of the disease. Until that happens, I can see little point in this initiative."
But the government, it seems, is in no mood for debate on the subject. My advice, then, is to make sure that you and your loved ones are well schooled up on details like the date, prime minister's name and other such trivia before your next trip to the local GP. Because even if you do have early onset dementia by whatever spurious screening criteria are adopted, what's the benefit of knowing about it when there is no effective treatment?

And with a diagnosis will come the risk of being labelled 'incompetent', which means you may be putty in the hands of the system - such a label has serious legal implications. Call me a nay-sayer, call me a denier, but in this fast-emerging brave new world, I'd simply prefer not to know.

Written by Jacqui Hogan

Friday, 17 October 2014

A new resource for sex and love addiction

Sex and love addiction is one of those which can often slip under the radar, in the face of other more pressing addictions, like alcohol or drug dependency. But dig deep enough and it's not uncommon to find addiction to sex and/or so-called 'love' at the root of manifest relational difficulties.

A new book, Coming Off Love by Bridgit Newman, makes an unusual contribution to the literature on the subject, by giving a fascinating first person account of the withdrawal experience. In it, she describes, with skill and clarity, the boulder of denial which must be penetrated in order to break through to freedom from this powerful addiction.

Right up front, Coming Off Love provides a wonderfully simple and accurate definition of what addiction actually is (you can read the description in the prologue using the 'Look Inside' feature on Amazon here), and goes on to give a heart-rending account of Newman's journey from emotional slave to her toxic relationship to grateful member of Sex and Love Addicts Anonymous.

What's impressive is her ordinariness - she is neither a coke-snorting A-lister nor a smack-shooting junkie - and yet she powerfully succumbs to (what she observes is, arguably) the most socially lauded of all the addictions.

For the lay person (i.e. anyone coming cold to the subject), this is a compelling and illuminating read, especially for women (and perhaps even men) who find themselves in the perplexing position of arriving at 'a certain age' and finding it impossible to enter into secure and stable relationship.

For therapists who work in the field of addiction, this would make an excellent recovery resource for patients with relational difficulties (especially those in treatment for sex and love addiction), for whom identification with the author may provide insight, comfort, hope and relief.

Written by Jacqui Hogan

Friday, 10 October 2014

A model approach to psychotic illness?

Researchers from the University of Adelaide in Australia have developed a model that could help to predict the trajectory of a psychiatric patient's illness, thereby enabling more effective treatment.

Professor Bernhard Baune, Head of Psychiatry, says that the new model takes account of ten years of research in the field, and was formulated by reviewing and reinterpreting retrospective data.

It encompasses the wide range of variables known to impact upon disease progression, including sociodemographic, clinical, psychological and biological factors, slotting them into 'the equation' in order to model the expected path of an individual patient's illness. Of note is the fact that disease trajectory can be modelled from the first psychotic episode, which would have significant implications for the course of treatment subsequently pursued.

"Being able to predict the trajectory of psychotic illness is a kind of 'holy grail' in psychiatric medicine" says Professor Baune, who will present this work at the European Congress of Neuropharmacology in Berlin, towards the end of this month.

He observes that the application of such a model raises a number of ethical questions; for example, should a patient be offered treatment early in a disease trajectory which, heretofore, would have been reserved for many years down the track? Or, should certain treatments be withheld if modelling suggests the expected course of illness to be mild?

Top of the list of target conditions is schizophrenia, claimed by the UK Mental Health Foundation to affect 26 million people worldwide, 50% of whom, they report, cannot access adequate treatment. The Baune model is also applicable to other kinds of mental illness.

Though we must be open to any new treatment solutions for psychotic illness, one wonders at the application of such a model - or any model - to actual, lived human experience. Is the individual course of psychotic disease - or any disease - ever so predictable? Can such treatment determinism ever be the most effective approach?

Perhaps the answer is 'yes', but before embarking decisively in such a direction in behooves us to delve a little deeper into the 'reviewing and reinterpreting of retrospective data' upon which Professor Baune and his team appear to have based their new model.

There is, necessarily, a difference between a model formulated on the basis of new evidence and a model based on a 'reinterpreting' of the same set of facts. The latter type of model (of the kind proposed here) is what amounts to a second opinion. Translating opinions (or theories) into models has a habit of enshrining them as truth. In the case of psychotic illness, such 'truths' may be convenient, but they may have a negative impact on real lives.

What are your thoughts? Is it possible to accurately map the course of mental illness? As ever, your thoughts would be welcomed.

Written by Jacqui Hogan

Friday, 3 October 2014

Is suicide perfectly understandable?

As we've reported previously, suicide is a problem in our modern world (you can read more about it here). In 2012, the average suicide rate in the UK was around 12 per 100,000 of population, with the highest rate among men between ages 40 and 44. The US Center for Disease Control and prevention put the global suicide toll for 2012 at approximately one million. That's one million too many.

A new article entitled 'The destructiveness of perfectionism revisited: implications for the assessment of suicide risk and the prevention of suicide', published in the American Psychological Association journal Review of General Psychology, suggests that there is a very real relationship between suicide and perfectionism, and that perfectionism should be seriously considered during suicide risk assessments.

Other themes explored in the paper include suicidal ideation linked to chronic exposure to external pressures (i.e. socially prescribed perfectionism); the role of perfectionism in self-presentation and self-concealment; and how perfectionism, by its nature, supports 'successful' suicide attempts.

Author Gordon Flett, from York University in Canada, told New York Magazine:
"Perfectionistic people typically believe that they can never be good enough, that mistakes are signs of personal flaws, and that the only route to acceptability as a person is to be perfect"
This is clearly distorted thinking, underpinned by pride. Perfectionism asserts that total virtue is possible and that if one falls short of it, it must be down to one's own weakness - and weakness is not allowed. Perfectionism asserts a superhuman model of human nature and denies the reality that we are subordinate (or powerless, to use 12-step recovery parlance) to our innate shortcomings.

Challenging perfectionism requires the development of a right-sized understanding of our 'brokenness' as fallible beings and a commensurate right-sizing of expectations of ourselves in this realistic light.

When children are raised in homes in which there is lack of tolerance for what are perceived to be less advantageous traits (i.e. 'imperfections' in the eyes of caregivers), the result can be adults who believe themselves to be either worthless or superhuman - depending on how well they've fulfilled the performance demands placed upon them.

But when they are nurtured with acceptance of their natural aptitudes and the understanding that it's OK to fail, they develop a realistic sense of their capabilities, and humility, rather than toxic self-approbation, in the face of defeat.

Paradoxically, it is in acknowledgement of our weakness that we find our strength, as the wisdom of the ages tells us.

We live in difficult times. No longer are we taught that we are human and flawed, but rather, that we are human and invincible. We can achieve the world through our own merits if we would only do the right thing, say the right words, perform in the prescribed manner, to achieve the empty results on offer. 

For as long as such an illusion prevails, there will be those who simply cannot tolerate the truth about their own humanity. Believing 'it's all about them', they will exercise the most tragic of all acts of perfectionism - to purge the world of what they see as being unacceptably imperfect. 

We need them to understand the gifts that come with owning up to imperfection - and that it's the only possible way to grow in wisdom and virtue.

Written by Jacqui Hogan

Friday, 26 September 2014

A new treatment for complicated grief

By the time any of us reaches a certain age, we'll have encountered losses - some small, some large. It's just part of the deal. With the wind behind us, we'll somehow manage not to be overwhelmed by the emotional fall-out; but not everyone is quite so lucky.

For some, a significant loss in later life, like a bereavement, will trigger an extreme grief reaction. It may be the first time ever in a person's life that grief has been consciously encountered. This may progress to complicated grief (CG).

The American Center for Complicated Grief describes the condition as 'a form of grief that takes hold of a person's mind and won't let go'. Sufferers may say they feel stuck; they know their loved one is gone, but still can't come to terms with it. Time moves on but they can't seem to.

A research group in the US has designed a treatment specifically to help older people process complicated grief after the loss of a significant other. Reported recently in JAMA Psychiatry, it appears to be more effective than standard talk therapy for depression. The model - still deploying talk therapy - is based on attachment theory and aims to facilitate natural mourning.

When compared with standard interpersonal psychotherapy (IPT) in which bereavement was discussed in terms of effect on mood, rational assessment of the deceased and enhancement of relationships in the present, the CG-specific talk therapy was more than twice as effective. Furthermore, participants in the CG-specific group experienced a significantly greater improvement in illness severity than the IPT group, who remained at least moderately depressed at the conclusion of treatment. Symptom reduction per week (sixteen sessions delivered weekly) was also greater in the CG-targeted group.

This is an important finding, given the incidence of complicated grief and its debilitating impact. The authors conclude:
"Our results strongly support the need for physicians and other health care providers to distinguish CG from depression. Given the growing elderly population, the high prevalence of bereavement in aging individuals, and the marked physical and psychological impact of CG, clinicians need to know how to treat CG in older adults."
What's your experience? How often do you encounter complicated grief? Are there other aspects to this discussion that need to be taken into account? As ever, we'd love to hear your views.

Written by Jacqui Hogan

Friday, 19 September 2014

Nibbling away at our understanding of PTSD

Post Traumatic Stress Disorder (PTSD) has historically been linked to return soldiers involved in, or having witnessed, threats to life, usually during the course of war. More recently, however, it has been recognised that people exposed to physically, emotionally or mentally traumatic conditions in childhood may also go on to manifest a similar pattern of symptoms.

In the UK, it is estimated that some 3% of individuals will experience symptoms of PTSD (which includes this latter group), including flashbacks to the traumatic event/s, sleeping difficulties, social detachment, depression, emotional instability and hypervigilance.

A recent study in JAMA Psychiatry links PTSD to food addiction, which may explain why past research has reported a correlation with obesity.

The team conducted a cross-sectional analysis of almost 50,000 women who were part of the Nurses' Health Study II (sourced from across 14 US states) and aged between 25 and 42 in 1989.

In 2008, participants were followed up with a questionnaire to identify symptoms of PTSD, and the following year they were questioned on symptoms of food addiction.

The results showed that the greater the number of symptoms of PTSD, the higher was the prevalence of food addiction. Women with no symptoms of PTSD expressed a 6% incidence of food addiction, compared with 18% among those who expressed six or seven symptoms of PTSD. Furthermore, the earlier the age at which PTSD symptoms first occurred, the stronger the correlation with food addiction.

For anyone familiar with the phenomenon of comfort eating, these results won't come as a great surprise. Compulsive eating is an understandable response to feelings of anxiety, perhaps because of the intrinsic association between food and nurture. What is more surprising is that the association has not been made sooner - according to the researchers, this is the first study to make the connection.

Given the rising tide of obesity in our society, such work underscores the need to find effective solutions to managing the symptoms of PTSD - in fact, who needs an excuse for finding solutions to PTSD, itself a debilitating condition?

Do you have experience of working with PTSD and food addiction? Does it corroborate the findings of this study? As ever, we'd love to hear from you.

Written by Jacqui Hogan

Friday, 12 September 2014

The proven benefits of growing old gracefully

If it's true you're as old as you feel, then it would seem, from a recent piece of research, that you're also as depressed as others think you should feel for your age.

New research from the Yale School of Public Health in the USA suggests that older people who see growing old in a negative light are significantly more prone to mental health disorders than those who view the ageing process as being positive.

Researchers surveyed over 2,000 American veterans, aged 55 or older, from the National Health and Resilience in Veterans Study, a nationally representative cohort of nine million return soldiers. Participants' attitudes, markers of mental health and social activity were measured and assessed. The results were striking.

Among those with more positive attitudes to ageing, only 2% expressed symptoms of post-traumatic stress disorder (PTSD) versus 19% with a negative attitude, 5% had suicidal thoughts compared to 30% with a negative attitude, and 4% had anxiety disorder compared to 35% with a negative attitude. A stark contrast, indeed.

Lead author, Becca Levy, Associate Professor and Director of the Social and Behavioural Sciences Division at Yale says that, in her experience, negative age stereotypes can generate stress in older people which, in turn, raises the risk of psychiatric disorders later in life. She comments:
"These results suggest that reducing the negative age stereotypes that are present in media, marketing and everyday conversations could have mental health benefits." 
Well said. While the chances of the media and marketing machine which dominates the culture is unlikely to do an about-face in projecting images which glorify youth and suggest that life on earth is about inexorable decline, we can, at least, do something in our own lives (i.e. 'everyday conversations') to recognise the intrinsic value of the ageing process in moving us towards greater maturity and wisdom.

I believe this is a significant piece of research, because it suggests that the more older people who succumb to the prevailing dogma of ageing as being negative, the more we can expect to see a rising tide of depression and suicidal tendencies among older members of our community. What a great tragedy this would be.

I recently sent a birthday card to an elderly relative which read 'It isn't an ageing process, it's a perfecting process', which sums it all up, to me. A cheerful veteran of World War II, he bears his various aches and pains with good humour, fortitude and dignity. He's a great gift to our family and we are profoundly grateful for the example, wisdom and guidance he continues to provide, especially for younger members coming up the line.

The value of a positive attitude towards ageing cannot be underestimated - nor the necessity to defy the negative age stereotypes becoming so pervasive in this post-modern world.

Have you witnessed the contrast between the mental health consequences of  negative and positive attitudes to ageing? If so, we'd love to hear from you. Either way, we'd value your thoughts.

Written by Jacqui Hogan

Friday, 5 September 2014

Get to the art of mental health

There's nothing more satisfying than allowing that inner child to let rip with a fist full of crayons and a blank sheet of paper. That's my opinion, anyway. And members of the York community seem to be of a similar mind. They've decided to set up a new art and crafts group specifically for people with mental health problems, which will meet from 11 September.

Sarah-Jane McKenzie and her art teacher sister, Helen, are masterminding the project and their aim is for the artworks created to be sold on a stall in the refurbished York market, once a month.

Sarah-Jane knows, from personal experience, just how isolating mental health difficulties can be. She hopes to create a forum in which people can reach out to others and come to understand that they are not the only ones who suffer. She explains:
"Because the group is aimed at people with mental health problems (or people who have in the past experienced them) we won't feel any need to pretend or put on an act, or hide the details of problems we've had..."
She maintains that encouraging participants to make art and craft will, itself, prove therapeutic and promote renewed inspiration and motivation for those whose lives have been disrupted by mental ill health.

Some formal instruction will be given, but participants will be encouraged to bring their own projects and ideas and to shape the direction the group takes. Any money made on the York market stall will be ploughed back into funding for more materials, and any excess over and above this will be shared among the group. (More detail and contact information here.)

There has been growing interest in arts-in-health initiatives where 'the creative process' is seen to have therapeutic value in promoting wellbeing. The UK Mental Health Foundation claims on its website:
"International and UK research has found that many people with mental health problems find arts therapies helpful, either on their own or as part of a range of therapies, which may include medication and talking treatments."
Have you worked with arts-in-health initiatives? How successful have they been? Whether you're a therapist or someone with experience as a patient, do post your comments - we'd love to hear from you.

Written by Jacqui Hogan

Friday, 29 August 2014

Mental health and the up-coming general election

Last week saw the publication of what has been titled 'A manifesto for better mental health', jointly written by the Mental Health Foundation, Mental Health Network, Mind, the Royal College of Psychiatrists, Rethink Mental Illness and the Centre for Mental Health. That's a lot of mental health in one paragraph. Hopefully its fruits will be a lot of mental health for society at large.

The paper has been written in advance of next year's general election, in an effort to set out what the next government must do, in the eyes of these thinkers, to improve the lives of people in the United Kingdom labouring under the burden of mental ill health.

Mental health problems, according to the report, carry an economic and social cost of £105 billion annually. They account for almost 25% of the total disease burden - a staggering assertion - while the mental health sector receives only 13% of the NHS budget. Depression and anxiety now exist in what might be considered epidemic proportions - and that's not counting the morbidity that goes unreported. Oh yes, there is a problem.

So, what does the manifesto set out as its desired priorities for government action, be it a coalition or alternative shade of government post-May 2015?

1. More funding - no surprises here, then. A commitment to 'real terms' increases in line with the scale of the problem.

2. Give children a good start in life - by means of providing mental health support before, during and after pregnancy, putting mental health on the national curriculum and running parenting programmes across England.

3. Improve the physical health of people with mental health problems - support for smoking cessation and reducing preventable physical health problems.

4. Improve the lives of people with mental health problems - by supporting anti-stigma campaigns and offering employment support for people who are out of work.

5. Provide better access to support services - reduce waiting times and support mental crisis care in hospitals; work more closely with the police and the courts.

No-one could argue with the first point, though from whence the funds should hail is yet another conundrum. On the second point, on the positive side, at least we see a recognition that mental health outcomes do, indeed, depend upon what happens in the early years, but do we seriously believe that making mental health a subject for academic study - for children - will make any difference?

Then, try for the life of me, I cannot see how helping someone with depression or schizophrenia stop smoking will significantly improve their situation - if my car isn't running, mending a nick in the upholstery is unlikely to greatly advance my cause.

While it's important to sound the clarion call for the government, whichever government, to wake up to the scale of the mental health epidemic, the question is, do these measures get to the root of what's really going on? If they were implemented tomorrow, never mind next May, would they spearhead a reversal in the current worrying trend?

Six mental health authorities solemnly believe this to be the case, but what are your thoughts? Which action points would your manifesto contain? Can we come up with some viable alternatives? Please join in the conversation.

Written by Jacqui Hogan

Friday, 22 August 2014

Don't lose sleep over this...

Having recently shared a twin room with a heavy snorer, I can tell you a thing or two about sleep deprivation. I lasted a total of three nights and, had I sustained the remaining four for which we were booked, I'm convinced I would have gone mad (I paid the extra for a single room).

A new study suggests I'm not far wrong on this -  researchers from the University of Bonn and King's College London have shown that just 24 hours of sleep deprivation can lead to symptoms of schizophrenia (I would have upgraded sooner, had I known).

Twenty-four healthy volunteers aged between 18 and 40 were trialled in the sleep laboratory, in an initial run being allowed to sleep, normally, overnight. A week later, they were kept awake all night, with conversation, games, movies and walks. They were also exposed to a measurement known as 'pre-pulse inhibition' in which a startle response was elicited through headphones as part of the protocol. The following morning, on both occasions, they were asked to record their thoughts and feelings, using a questionnaire format.

After sleep deprivation, there were pronounced attention deficits, as can occur in the case of schizophrenia. The subjects were found to be more sensitive to light, colour and brightness and their sense of smell was altered. They also reported distortions in their perception of time and many had the impression of being able to read others' minds. Professor Ettinger, a psychologist from the University of Bonn, said the team had not expected that symptoms could be so pronounced after one night spent awake.

I can. And I'm relieved to know that sleep deprivation, though apparently inducing schizophrenia-like symptoms is not harmful; the symptoms rapidly disappear after a solid night's sleep. The researchers wonder whether the symptoms might become gradually weaker as one acclimatises to sleep deprivation. Bags not participating in any of their follow-up work!

Written by Jacqui Hogan

Friday, 15 August 2014

First aid for mental health

I've never done a course in first aid, which has always seemed to represent a glaring hole in my CV. You never know, after all, when you might be called upon to apply an emergency tourniquet or, worse still, perform CPR.

But now there's an altogether new species of first aider - the mental health first aider.

Pioneered in Australia, Mental Health First Aid (MHFA) is a programme focusing workplace training in the subject. It's now gaining traction in the UK, where one in four people experiences a mental health problem.

Poppy Jarman is CEO of MHFA England, through which around one thousand instructors have trained over 75,000 people in first aid for mental health since they began operations in 2007. She notes that:
"The fear surrounding mental ill health and the misunderstanding around recovery is one of the biggest barriers for creating mentally fit workplaces. We need to talk about mental health in the same way we do about physical health."
MHFA would like to see every office in the land staffed with somebody trained in mental health first aid and, given the number of people now stepping forward for training, this goal may well be achieved.

Charlotte Walker was once a traditional office first aider, dealing with anything from chest pain to nose bleeds. Today, she gives first aid training in the workplace for the mind, not the body, teaching delegates how to respond to the rising number of mental health episodes.

Anxiety and depression are top of the list of problems they may have to deal with, and psychosis and suicidal crises, though not as common, are also important parts of the training. She says that most workplace mental health problems won't be emergencies and that small acts of compassion by fellow workers are often all that is needed:
"Simple strategies like buddying up for walks in the park or encouraging each other to leave work at a reasonable time can help nip workplace stress in the bud." 
This seems like common sense to me - i.e. to help a colleague battling with stress with practical suggestions. But common sense, it seems, is in increasingly short supply. So, too, is empathy, where the competitive and counter-productive culture of 'me, me, me' (especially in the workplace) can only cause alienation and exacerbate underlying mental health problems.

It is a sad reflection of our times that we need such a thing as mental health first aiders, the locus of 'the battle' now shifting from the physical (material) to the mental (spiritual), which is much harder to grasp and quantify, and much harder to treat. We are, indeed, in difficult times.

What do you think about the MHFA initiative? Is it a positive development? Share your thoughts in the comment box below.

Written by Jacqui Hogan

Friday, 8 August 2014

The high price of funding cuts to North London mental health services

A recent review of mental health services in the Barnet, Enfield and Haringey NHS trust suggests that significant community funding cuts may be on the horizon.

Local NHS commissioners ordered the review, which was carried out by consultancy group Mental Health Strategies - who found that NHS mental health services across the region were 'unsustainable' at current levels. The solution comes down to further investment by the commissioners (you can guess how well that's going to fly) or to cost-cutting measures. Needless to say, my money's on the cost-cutting measures.

A £5.8 million overspend on acute admissions during 2013-14, in response to 'increased acute activity' has clearly spooked the Trust, which sees no change in the trend towards greater numbers of patients for 2014-15. A spokesperson from the trust said:
"The mental health trust is currently under pressure from increased numbers of patients, without the corresponding increases in its funding. It has already made major cost reductions over the last five years, but is unable to keep doing this while still providing safe, high quality care for patients."
So, the number of patients is increasing, and cuts are already in operation - they have been in operation for the last five years. Still, the report says, the situation is unsustainable. It proposes caseloads must be cut by at least 10% and staffing must be reduced to plug a £15 million funding deficit for services.

What does this mean, exactly? Well, you don't have to be a rocket scientist to figure out that with more patients needing mental health treatment and fewer services to meet that need, there will be more mental health patients finding their own way in the community. That's the bottom line here. The sums simply don't add up and guess who's going to pay the price?

The trust spokesperson continued:
"The trust still bears most of the financial risk around increases in the numbers of patients the trust is caring for, which is causing the trust major financial problems this year, as it did last year. This is not sustainable…"
Mark those words 'financial risk' - they are part of the lexicon of the new NHS. To threaten such risk looks set to become the justification for radical withdrawal of services, no matter how many mental health patients end up wandering the streets.

The rising burden of mental health patients is serious cause for concern. And it's not just a problem for them, it's a problem for all of us. Society cannot continue turning a blind eye to the underlying causes of  mental dysfunction - or rather, it can, and sooner or later, the consequences will make themselves felt in ways we can scarcely imagine. Throwing money at the problem was never going to be a sustainable solution in any case, as the number of people just keeps getting bigger. Maybe the withdrawal of services will give us the wake-up call we need.

What are your thoughts? What are the causes and what's the solution? As ever, your comments welcomed.

Written by Jacqui Hogan

Friday, 1 August 2014

Now there's DBT for BPD

Borderline personality disorder (BPD) is characterised by problems with regulating emotions and thoughts, impulsive and reckless behaviour and unstable relationships with other people. Depression, anxiety, self-harm and suicidal behaviours can also be part of the picture. I can't help but think that these symptoms sound remarkably like those of addiction - any addiction - and therein lies the difficulty with classifying mental health with any precision.

But one thing that's certain is that living with BPD (or any addiction, for that matter) is no bed of roses. So it's good to know that a relatively new form of therapy, Dialectical Behavioural Therapy (DBT), is helping people with BPD.

DBT was developed by Marsha Linehan, as an adaption of Cognitive Behavioural Therapy (CBT), to meet the emotional needs of people with BPD. CBT typically focuses on changing behaviour through rationalisation, but DBT brings something new to the process: so-called 'acceptance techniques'.

Acceptance techniques direct the attention to understanding and making sense of one's actions - for example a therapist working with DBT might help the patient to understand how engaging in painful, destructive behaviour of one kind or another made absolute sense in the context of their difficult formative experiences - which ultimately leads to self-acceptance and prepares the ground for CBT-style change techniques.

New UK research suggests that DBT is, indeed, proving successful in treating patients with BPD. Patients were allocated to DBT at two-monthly intervals and others to treatment as usual (TAU). During the 12-month intervention period, significantly fewer patients allocated to DBT than to TAU were hospitalised. A regression analysis showed that the odds of hospitalisation during the intervention period were significantly higher in the TAU than the DBT group and this held true after adjusting for whether patients had been hospitalised in the year prior to intervention.

The positive trend was continued into the 6-month follow-up period and the authors concluded:
"DBT should be considered an effective treatment for keeping self-harming patients with BPD out of hospital and that positive effects on self-harm and hospitalisation are sustained once treatment is over."
Have you worked with DBT? How does it compare with CBT and have you found it helpful for patients? Or perhaps you're a patient who has experienced DBT? Either way, we'd love to hear from you; please leave your comments below.

Written by Jacqui Hogan

Friday, 25 July 2014

Schizophrenia proven genetic, claims new US study

A new study published in Nature and widely reported in the mainstream media claims to have 'removed any doubt' about a biological cause for schizophrenia.

The study claims that more than one hundred genes associated with dopamine, the immune system and heavy smoking are implicated in causing the condition.

The researchers, from across many different countries, but led by the Stanley Centre for Psychiatric Research at the Broad Institute of MIT and Harvard, looked for genes that were common across of 150,000 participants, 25% of whom were diagnosed with schizophrenia. The over-representation of those with the condition (i.e. 1%, not 25%, of the American population are diagnosed with schizophrenia) was apparently necessary to identify the contributions of multiple genes to the schizophrenia picture.

Commenting on the diffuse and seemingly unrelated collection of genes identified, Steven Hyman, director of the Stanley Centre said:
"Some are very familiar genes expressed in nerve cells, and some are results where you scratch your head and you know you have more work to do."
Fortunately for Hyman, there will be no shortage of funding for continuing research on this theme - thanks to a $650 million donation by Ted Stanley (the largest ever to date in biomedical research), who obviously has more than a passing interest in both schizophrenia and the Stanley Centre.

Hyman made clear the end-game of the research is to wind up not with a list of genes but, rather, novel treatments. His colleague at the institute, former Merck executive, Ed Scolnick, has already developed a pioneering drug development programme which is ready and waiting to get those drugs into the public domain.

Smaller genetic studies have hinted at a link between the immune system and schizophrenia - people with schizophrenia often carry inflammatory blood markers. But equally, studies have implicated stress as a cause of schizophrenia, in which case you would expect to find immune compromise. Twin and adoption studies also clearly demonstrate the role of nurture in the development of the condition, even where there is thought to be a genetic predisposition.

The tone of the publicity being given to this research is authoritative and, combined with what is clearly a very large media spend, it runs the risk of being perceived by the public as ultimate truth - this is certainly the way it is being pitched.

On the very first day of my science degree, the lecturer penned onto the white-board in large capital letters THE SCIENTIFIC PRINCIPLE and, from there, went onto explain, at depth for several lectures, that in science, nothing is ever proven. We formulate hypotheses, yes, and the hypothesis is then either supported or refuted. We never, ever arrive at a conclusive position, simply a working model - that is, we have the humility to understand that life and science are bigger than we are and that our understanding is only valid until such time as further evidence illuminates the proposition.

We would be well advised to scrutinise this research and its context - it is not independent (a thing of the past, as far as anyone can tell) and therefore is bound to be influenced by the commercial aspirations of its funders. Perhaps schizophrenia can be attributed to a specific set of genes, but even if it can, there is too much evidence for the effectiveness of non-genetic interventions in the treatment of the condition to be certain either way.

We need to keep our eyes and ears open as the old order, rooted in morality, gives way to the new. Otherwise we risk falling prey to the obfuscation of reality. Ironically, we'll all be schizophrenic.

Written by Jacqui Hogan

Friday, 18 July 2014

'Pursuit of happiness' is the answer say UK mental health experts

This month, the CentreForum Mental Health Commission concludes what is being described as a 'landmark study on the state of mental health in England'. The 12-month commission has identified five key priorities for implementation between now and 2020. The final report calls for policy makers to:
  • Establish the mental wellbeing of the nation or 'the pursuit of happiness' as a clear and measurable goal of government
  • Roll out a national well-being programme to promote mutual support, self-care and recovery, and reduce the crippling stigma that too often goes hand in hand with mental ill-health
  • Prioritise investment in the mental health of children and young people right from conception
  • Make places of work mental health friendly, with government leading the way as an employer
  • Better equip primary care to identify and treat mental health problems, closing the treatment gap that leaves one in four of the adult population needlessly suffering from depression and anxiety and one to two percent experiencing severe mental illness such as schizophrenia
Now, I don't know about you, but while the intention of these recommendations may be noble, when you start to try to grab hold of these points, it seems there is nothing to sink your teeth into - the image of a toothless doberman springs to mind.

For instance, there is a big difference between establishing 'the mental wellbeing of the nation' and establishing 'the pursuit of happiness' as a measurable goal of government. As any therapist worth their salt will tell you 'mental wellbeing' and 'happiness' are not synonymous - it may well be that, in order to establish mental wellbeing, a period of decided unhappiness may be indicated, whilst difficult feelings are discussed and worked through.

Then there's the reality that what makes one individual 'happy' may not be in the interests of the social good - how about the paedophile whose greatest happiness is derived from, well, paedophilia?

And how exactly would one propose going about measuring the level of societal happiness - should the government decide the parameters? And, in any case, how can measuring in generality possibly tell you anything meaningful about individual suffering?

Moving to the second point, nothing wrong, on the face of it, with the idea of 'rolling out a national well-being programme', but again, who's to say what constitutes well-being? And are we not already steeped in national mental health well-being programmes, from support given through the NHS and other government-funded mental health organisations? Just what is being proposed here? And is there still a 'crippling stigma' surrounding mental ill health? Really? It seems to me that this is one area in which there has been much progress made in the last ten years - to the point where we risk actually enabling sufferers of mental ill health, through sheer sentimentality.

Other gripes - how exactly does one prioritise the mental health of a baby in utero (note the use of the word 'conception' in the third point) apart from letting it live, of course (but that's a whole other story) and is it true that people needlessly suffer from depression and anxiety?

Again, as any good therapist will tell you, depression and anxiety are often the clarion call to growth, the only way an individual can be woken up from painful, destructive and, yes, often crippling ways of being in the world.

At very best, these recommendations demonstrate a lack of insight and understanding into the true nature of mental ill health and at worst, they risk creating more suffering and frustration for those who will be told that the answer to their manifold difficulties is to 'get happy'.

What are your thoughts about the report? Is the pursuit of happiness the answer? Please leave your comments below.

Written by Jacqui Hogan 

Friday, 11 July 2014

An OCD treatment we'll keep coming back to?

Obsessive Compulsive Disorder (OCD) is a condition characterised by unreasonable thoughts and fears (obsessions) that lead to repetitive behaviours (compulsions). The archetypal example is hand-washing, but there are many different forms. In the case of hand-washing, to ease the fear of contamination, one may compulsively wash one's hands until they are chapped and sore (i.e. self-harm), yet still be unable to rid oneself of the conviction of ongoing risk from germs.

In fact, every addiction is an expression of OCD - the alcoholic compulsively returns to drink to ease (often unconscious) obsession, and the food addict returns to the fridge to avoid underlying emotional disturbance. Given the incidence of addiction in our culture, the level of need for effective treatment of OCD is clear.

A German research team has recently reported on an internet-based writing approach, with some promising results.

In an article published in Psychotherapy and Psychosomatics, whose title begins 'No talking, just writing', the team describes how 34 volunteers with DSMIV-classified OCD were randomised into a treatment and a control group, with follow-up at eight weeks and six months. The internet-based writing intervention consisted of 14 sessions and the main outcome measure was change in severity of OCD symptoms.

Symptoms were significantly improved in the treatment group and the effect remained consistent at six-month follow-up. Compliance was excellent, with only four participants (12%) leaving the study prematurely. Of the thirty completers, 90% considered their condition improved and would recommend such intervention to their friends.

So is internet-based writing therapy the way ahead for OCD? Obviously, larger sample sizes are needed, but this research clearly suggests positive potential.

What's your treatment experience with OCD, either as a patient or a clinician? How effective is medication and/or talk therapy in your experience and can you imagine a role for the internet in managing the condition? We'd love to hear your thoughts and insights.

Written by Jacqui Hogan