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