Monday, 10 August 2015

Church makes you happy

In this age of war, pestilence and the many other scourges we are seeing come to pass, it's good to know there's a means by which 'sustained happiness' can be achieved.

Researchers from the London School of Economics (LSE) and Erasmus MC studied data from over 900 Europeans over the age of 50 whose results are published under the title 'Social Participation and Depression in Old Age' (clearly, these researchers have some way to go before the big five-oh!).

Participants were followed over a four year period and assessed for whether different forms of social participation were associated with changes in depressive symptoms.

Increased participation in religious organisations, they found, was associated with a decline in depressive symptoms. LSE epidemiologist Dr Mauricio Avendano, commenting on the findings, said that, of all the different kinds of social participation, the only activity linked to 'sustained happiness' was going to a place of worship. He also noted:
"The church seems to play a very important social role in keeping depression at bay and also as a coping mechanism during periods of illness in later life."
Interestingly, attending church was found to be more helpful in maintaining mental wellbeing than participating in sport or charity work. The findings also showed that participation in political and community organisations was associated with an increase, rather than a decrease, in depressive symptoms.

While previous studies have examined the mental health impact of participation, this is, reportedly, the first paper of its kind to look at the effects of participation in specific activities.

Perhaps this is one of the reasons why the much subscribed 12-step programmes are so successful in the treatment of addiction, based, as they are, on handing over one's grip on life (or lack thereof) to God. This act of humility places one squarely in the territory of recognising one's human frailty for what it is, thereby giving one the opportunity to allow divine intervention.

The 12-step programme is based on the Christian faith of its founders, and therefore deploys such powerful principles as acknowledging our personal powerlessness and defects of character, and gives us the opportunity to make amends where we have erred and to forgive those who have offended us.

When we are given the means to process and address the spiritual content of our lives (and, after all, happiness is a spiritual good) we are given the keys to sustained happiness. The results of this helpful study therefore come as no surprise.

Written by Jacqui Hogan

Friday, 31 July 2015

Size really does (grey) matter

It's the size of the matter that matters, according to the results of a new study in Social Cognitive and Affective Neuroscience, snappily entitled 'Significant grey matter changes in a region of the orbitofrontal cortex in healthy participants predicts emotional dysregulation.'

Effective regulation of the emotions seems to be an increasingly prized commodity, with soaring diagnoses of borderline personality, bipolar and antisocial personality disorders dominating the mental health terrain. It has long been known that people diagnosed with such disorders exhibit compromised emotional regulation and a decrease in volume of certain regions of the brain.

The researchers on this study were interested to discover whether individuals deemed to be mentally healthy (i.e. not diagnosed with mental health disorders), but who rated themselves as having difficulty with regulating their emotions, also exhibited diminished brain volume on MRI.

Reassuringly, the answer was yes!

Such 'healthy' individuals were found to have a smaller volume lower frontal lobe (orbitofrontal cortex) than those who were 'healthy', but rated themselves as having no difficulty in regulating emotions.

Furthermore, the greater the problems with regulating emotions, the smaller the lobe volume. (This same area, by the way, corresponds to the area diminished in those diagnosed with mental disorders.)

The lead author on the study, Associate Professor Pedrag Petrovic, commenting on the findings, said:
The results support the idea that there is a continuum in our ability to regulate the emotions and if you are at the extreme end… this leads to a psychiatric diagnosis."
Or how about the possibility that there are many more people wandering around who could easily be diagnosed with mental illness - they just happen to slip through the net!

This study is encouraging in that it points to the fact that the so-called 'healthy' and the 'mentally ill' may have more in common than we are taught to think. Perhaps we are not so different from each other after all.

Rather, maybe we are all just a diagnosis away from a DSM-defined mental health disorder - as the saying goes, you don't have to be mad to work here, but it helps!

Written by Jacqui Hogan

Monday, 27 July 2015

The value of humility

How much do you think you know? And would you be right in your assessment?

A new piece of research places into question the seemingly straightforward task of judging one's own knowledge on a particular subject, and suggests that those who think they 'know it all' are more prone to lies and deception.

Psychological scientist Stav Atir of Cornell University and his colleagues set out to discover whether individuals who perceived (and stated) themselves to be experts in a particular subject, were more likely than others to lie about their knowledge.

As part of the experiment, they asked 100 individuals to rate their knowledge of personal finance, as well as their understanding of specific financial terms. Most of the terms were genuine, but the researchers also included a handful of fake terms (e.g. pre-rated stocks, annualised credit).

Interestingly, those who saw themselves as having a high degree of financial expertise were more likely to claim themselves to be experts in the bogus terms. This trend was also repeated in other subject areas, including geography, literature, philosophy and biology.

More fascinating is the observation that even when participants were told that some of the terms they were rating their knowledge against were fictitious, the self-proclaimed experts were still more likely to brazenly claim familiarity with made-up terms.

The research team concluded that a tendency to lie about knowledge in self-proclaimed experts might prevent them from educating themselves in these areas and thereby lead to negative consequences for them. Never mind about the consequences for those who may be victims of their advice!

Since when do we sympathise with the perpetrator and ignore the plight of the potential victim?

This research exposes the scourge of hubris, defined in the dictionary as 'excessive pride or self-confidence; arrogance'. It is the opposite to humility, which is defined as 'a modest opinion or estimate of one's own importance, rank, etc.'

To cultivate humility, we must first distinguish it from low self-esteem; humility comes from a position of strength. When we are humble, we know that we are intrinsically valuable as human beings, but fallible by virtue of our human nature. When we are humble, we have no need to 'big ourselves up' in order to look good in the eyes of the world.

By contrast, when we have low self esteem, we lack this understanding and are influenced by what others think. We need to look good, lest we be discovered for our perceived 'crime' of being less than perfect. Since perfection is unattainable, we are always falling short of the mark and always needing to cover up for our lack of perfection.

True humility is now becoming as rare as hen's teeth. If you are lucky enough to encounter it, you will be speaking to someone who is indeed an expert - an expert in life.

Written by Jacqui Hogan

Friday, 17 July 2015

Surveillance - a new treatment for depression

In case you hadn't noticed, there's a revolution going on. The rise of the machines, you might call it, or perhaps technology on steroids.

Nowhere is this more evident than in the brave new world of healthcare, where technology-enabled clothing and accessories can monitor your heart rate, contact lenses can detect blood sugar for diabetics and robotic walking devices are just a tip-toe away from changing the lives of wheelchair users.

Recent research published in The Journal of Medical Research suggests that depression may soon be in on the act, with an app that gathers data from sufferers' smartphones.

Forty participants were asked to complete an online health questionnaire, specifically designed to probe for symptoms of depression. They were then monitored over the course of two weeks, with the so-called 'Purple Robot' app gathering data on their phone usage and geographical location.

The results showed that those participants with symptoms of depression used their smartphone three times more often (an average of 68 minutes per day) than those who did not have depressive symptoms (an average of 17 minutes).

Furthermore, participants with depressive symptoms travelled to fewer locations than those without symptoms. Senior author, David Mohr, PhD, observed that 'when people are depressed, they tend to withdraw and don't have have the energy or motivation to go out and do things'. Commenting on the findings he also said:
"[This] information could ultimately be used to monitor people who are at risk of depression, and to perhaps offer them interventions... or to deliver the information to their clinicians."
So let's get this straight. What's being suggested here is to track the movements and phone calls of those at risk of depression, then submit their data to a third party, who (or which - don't discount a computer interface) would then presumably verify a diagnosis and trigger treatment.

If you didn't have depression to start with, odds are you would wind up with it, or, at the very least, a heightened sense of (justified) paranoia.

Though reliable figures for the incidence of depression are hard to come by, with anything between 1 in 4 and 1 in 10 in Western countries afflicted, the scope for mass surveillance with a system like this would be irresistible to those in big government. Expect to see more funding making its way into research like this.

Call me old-fashioned, but I think that depression, which can be difficult to diagnose and treat, and as individual as the experience, circumstances and temperament of the sufferer, requires a slightly lighter touch than this. Happily, it is impossible to reduce the spiritual to data points and app-fodder.

Written by Jacqui Hogan

Friday, 10 July 2015

How to spot a psychopath

Most people, if you ask them, will tell you that a psychopath is someone at the extreme end of the mental health spectrum. Which is true, but we tend to assume they are easily identifiable by the crimes they commit (most notoriously, murder).

Many who commit murder are indeed psychopathic, but the number of people who express superficial charm, lie, lack empathy and feel emotion only at surface level (thereby placing them on the diagnostic spectrum) may be greater than you think.

Professor Robert Hare, a Canadian criminal psychologist and the creator of a psychological assessment used to diagnose psychopathy, is one man who probably understands better than most the nature and true incidence of the disorder at large. He has studied and worked with psychopaths, in prisons and elsewhere, over a long career. He says of his experience:
"It stuns me, as much as it did when I started 40 years ago, that it is possible to have people who are so emotionally disconnected that they can function as if other people are objects to be manipulated and destroyed without any concern.”
Hare's test covers 20 criteria, each of which is given a score of 0 (psychopathy absent), 1 (psychopathy partially present) or 2 (psychopathy fully present). Scores over 30 represent 'red alert' and anything under 5 'breathe a sigh of relief'. They are, in no particular order:
  • Glibness and superficial charm
  • Over-inflated sense of self-worth
  • Lying
  • Cunning and manipulation
  • Lacking remorse
  • Emotional shallowness
  • Lack of empathy
  • Unwillingness to accept responsibility for actions
  • Tendency to boredom
  • Parasitic lifestyle
  • Lack of realistic long-term goals
  • Impulsivity
  • Irresponsibility
  • Lack of behavioural control
  • Behavioural problems in early life
  • Juvenile delinquency
  • Criminal versatility
  • History of broken parole
  • Multiple marriages
  • Promiscuous sexual behaviour
Recognise anyone you know?

Hare has been quoted as saying that 1% of the general population can be categorised as psychopathic and that prevalence in the financial services is 10%. While this latter figure has been disputed (and it would be, wouldn't it, given that the financial services run the media) the good professor may not be too far off the mark. Personally, I think it sounds a bit low.

We shouldn't be so surprised. Troubling research reported by Forbes showed that 3% of those assessed on a management development programme scored highly for psychopathy - well above the number for the general population. Prison populations weigh in at 15%.

Practically, it's worth remembering the reality and the scale of the problem, for those (hopefully) rare occasions when we ask of ourselves 'is it me who's gone mad or X?'

For more insight on the subject, with specific reference to the workplace, check out 'Snakes in suits: when psychopaths go to work', published in 2006 by Paul Babiak and Robert Hare.

Written by Jacqui Hogan

Friday, 3 July 2015

Sniffing around for answers to autism

Some time in the last ten years, it seems that autism has made its way into the public mind. A bit like 'bipolar', it is now not uncommon to meet people (that is, children) who suffer from the condition.

According to the Center for Disease Control (CDC) in America, one in every 68 children is now born with autism, compared to a rate of around one in 2,000 in the 1980s.

Some experts will tell you it's all about better diagnosis. Others will tell you it's a consequence of children's greater (and increasing) exposure to toxic chemicals.

One such proponent is Dr Stephanie Seneff, PhD and Senior Research Scientist at MIT. She predicts that, if we carry on as we are, we can expect half of all children to have autism by 2025. Which is why the following research, reported recently, may come in very handy.

Noam Sobel and Liron Rozekrantz from the Weizmann Institute of Science in Israel showed that children with autism can be reliably diagnosed using a simple 'sniff test'.

They presented 18 children with Autism Spectrum Disorder (ASD), and 18 'normal' children, with pleasant and unpleasant odours and measured their olfactory responses. Children without ASD recoiled from an unpleasant odour within 305 milliseconds, whereas children with ASD did not react. The difference in response was enough to correctly classify children with autism 81% of the time.

The authors concluded that such a test might turn out to be very useful in the clinical setting, and also raised the question 'is olfactory impairment possibly at the heart of social impairment?'

While their work is interesting, it seems that such a question ultimately distracts from the elephant in the room. Should we not be doing more to understand why the incidence of autism is skyrocketing, rather than becoming ever-more proficient at perfecting its diagnosis?

According to Dr Seneff, who has published over 170 scholarly peer-reviewed articles and has studied the link between environmental chemicals and neurological disorders for three decades, symptoms of glyphosate toxicity closely resemble those of autism. At a recent conference, she presented data (some of which in the chart above) which shows an oddly consistent correlation between the use of glyphosate pesticides and rising rates of autism. (Glyphosate pesticides are specifically formulated for genetically modified food crops.)

There is also mounting evidence that increased rates of vaccination are playing a significant role in the autism epidemic, with additives such as mercury, aluminium and formaldehyde being routinely administered by this means to children in the first year of life.

Does anyone else smell a rat in the growing number of cases of autism? Your insights, experience and observations welcomed.

Written by Jacqui Hogan

Friday, 26 June 2015

Inflammatory stuff

You know what it's like - some days everything just seems to go awry. The boiler starts leaking, your child gets sick and has to be picked up from school, and when you step out to get into the car you realise you've had a flat tyre.

These are the sorts of daily stressors that can seriously impede our serenity, and how we react to them over time may significantly impact on our long-term physical health, a recent study finds.

The investigators, reporting their results in Health Psychology, took a group of 872 adults from the US National Study of Daily Experiences and asked them to report daily stressors and emotional 'affect' over the course of eight consecutive days. Blood samples were taken on those days and assayed for inflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP).

The results showed that people who experienced greater suppression of positive affect on stressful days had elevated inflammatory biomarkers, especially IL-6. Heightened negative affect and reactivity was also associated with higher CRP, among women in particular.

According to the authors, this is the first study to link biomarkers of inflammation with emotional reactivity to stressors of everyday life. It highlights the important, yet sometimes overlooked, contribution of a positive mindset to keeping biological stress reactions under control.

That's all well and good but, as anyone who suffers from Post Traumatic Stress Disorder (PTSD) and/or anyone who treats it will tell you, keeping emotions right-sized can be difficult when the triggering stressor has the 'flavour' of a stressor from the past, especially one from a troubled childhood. Indeed the size of the reaction is often a tell-tale sign that the real-time stressor is not being treated simply for what it is, but rather, is being 'projected onto', possibly as a means of addressing the original trauma.

The key with stressful events in daily life, then, is to use them to effect greater self-knowledge and greater awareness of the past - and to harness this over time to intervene on reflexive over-reactions. In this way, daily stressors can even become a sort of friend; a means of integrating past traumas and cultivating the ability to 'keep calm and carry on'.

It seems highly likely that intense reactions to everyday stressors over time might conceivably affect our biochemistry and it's not too great a leap to imagine the harmful long-term health effects.

But the good news is that when the light is shone on such reactions and they can be chipped away at over time, the emotional fruits can be transformational.

Written by Jacqui Hogan

Saturday, 20 June 2015

What happens when even our mental health provision is depressed?

From 'Addressing the Deterioration in Public Psychotherapy Provision' (UKCP/BPC)

A recent report published by the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC) entitled 'Addressing the deterioration in public psychotherapy provision' leaves us in no doubt as to the state of government provision of mental health services.

Some of the more impressive statistics from this survey, last conducted in 2012, give a disturbing insight into what psychotherapists are seeing on the ground. For example:
  • Over three-quarters ((77%) of psychotherapists report an increase in the number of cases of patients with complex needs 
  • Despite this, coming up for half (44%) report a reduction in the clinical experience and qualifications of psychotherapy practitioners
  • In line with this finding, over two-thirds (67%) report a cut in higher band posts and an increase in the use of honorary staff or volunteers delivering services
  • Over half (52%) report a fall in the number of psychotherapy services being commissioned
Given this situation, it is not surprising that patients are increasingly being forced out of the public system and into the private sector. What is repeatedly being heard by therapists is that patients are coming for private treatment having been let down by the NHS, which could not provide the type or length of treatment they needed. For those who have eyes to see, this amounts to the effective privatisation of mental health in the United Kingdom.

This development is having serious knock-on effects. We are now seeing the growth of a third party sector in mental health; private contractors brokering such individuals as 'Psychological Wellbeing Practitioners' (PWPs) to support services like the NHS's Increasing Access to Psychological Therapies (IAPT) programme.

These services are based on a watered-down version of Cognitive Behavioural Therapy (CBT), and can by no means be considered as bona fide psychotherapy. The interventions are entirely scripted and there is one compulsory outcome - that everybody feels well. Veering off script on the part of the practitioner is considered a breach of contract.

Such labour agencies and contractors are now buying up burgeoning NHS mental health waiting lists and replacing already inadequate provision with even more impotent alternatives.

With NHS services now being frankly undermined, the UKCP/BCP report observes:
"The [survey] responses paint a picture of public sector therapists taking on more complex cases, of experienced therapists being laid off and clients turning to the private sector for help they cannot get on the NHS."
This is an important read for anyone working in mental health. The UKCP and BCP say that they are 'deeply concerned' about the lack of provision for the army of people who are now slipping through the net, unable to access genuine help on the NHS and unable to afford private treatment. As they acknowledge, their registrants are providing an invaluable service, often themselves volunteering and supporting low cost treatment programmes. They are picking up the pieces for patients caught in the revolving door of the NHS system.

What's your experience of the provision of public mental health services, either as a patient, from the inside as an NHS therapist or as a therapist working in private practice? What do you see happening that is fostering the breakdown? Is the system redeemable? Are there any signs of hope? Do your experiences corroborate the findings of the UKCP/BCP report? We'd love to hear your thoughts.

Written by Jacqui Hogan

Friday, 12 June 2015

Pesticides go incognito

At no other time in world history have we been exposed to such a heady cocktail of chemicals which, while supposedly making our lives easier, also put us at risk. From the fumes we inhale in traffic-choked cities to the plastic residues we ingest on cling-filmed foods, we are arguably being bombarded.

Pyrethroid insecticides are commonly found in household insect sprays, flea treatments for pets, medicinal shampoos and gardening products. Their mode of action is to block the neurotransmission of their unfortunate targets, who generally succumb to paralysis and death.

Which is why the researchers reported here were interested to test the hypothesis that the same chemicals might be influencing human neurotransmission, especially in children, who are biologically most vulnerable. They proposed that six year-olds exposed to pyrethroids, might exhibit negative cognitive effects.

The PELAGIE mother-child cohort was established to monitor 3,500 mother-child pairs between 2002 and 2006 in France. One of the parameters monitored was exposure to pyrethroids in utero and in childhood. A total of 287 women were randomly selected from this cohort and were followed up when their children were six years old.

Level of exposure to pyrethroids was assessed by measuring metabolites in the mothers' urine between the sixth and nineteenth weeks of pregnancy, and then later, on the children's sixth birthdays.

On that birthday, the children were also assessed for neuro-cognitive performance, particularly verbal comprehension and working memory. Family environment and other factors which might affect intellectual development were also taken into account.

The results showed that higher concentrations of pyrethroid metabolites in the urine of children (3PBA and cis-DBCA) were associated with a significant decrease in their cognitive performance. By contrast, metabolite concentrations in the mothers' urine during pregnancy showed no correlation with their children's cognitive performance.

Cecile Chevrier, lead author of the study, commenting on the results, said:
"Although these observations must be reproduced in further studies in order to draw definite conclusions, they indicate the potential responsibility of low doses of deltamethrine in particular [a precursor of cis-DBCA] and pyrethroid insecticides in general [for the decrease in cognitive performance observed among six year olds]."
Children are frequently exposed to pyrethroid neurotoxins, since they are closer to ground-level dust, engage in frequent hand-to-mouth contact and delight in handling pets who are often covered in toxic flea treatments. If pyrethroids work well on insects, it seems reasonable to assume they might also be working 'well' to reduce cognitive function in our children.

Given the number of pressures already facing the upcoming generation, it would seem prudent to consider at least reading the labels on insecticide packs, gardening products and lice shampoos to identify the presence of pyrethroids. And perhaps allowing Fido to have a few more scratching fits, instead of dousing him in toxic flea treatment, is a price that may be well worth paying.

Written by Jacqui Hogan

Friday, 5 June 2015

CBT forty years on

Albert Ellis (1913-2007)
Last year, the World Health Organization ranked depressive disorders as the third highest cause of disease burden in the world. You don't have to look very far to verify this claim.

Psychotherapy has been rightly identified as a fundamental approach to its treatment and Cognitive Behavioural Therapy (CBT) has enjoyed pride of place in the official psychotherapeutic armamentarium.

CBT was introduced more than forty years ago. Its founding fathers were Albert Ellis (pictured above) and Aaron Beck, who essentially put forward the hypothesis that emotional distress and dysfunctional behaviour were a product of maladaptive thoughts, with 'thoughts' being the critical word. In their world, all one needed to do to return to emotional wellness was to realise this and change ones' thoughts. Such change, they maintained, could be accomplished in a small number of sessions.

Studies since its inception have generally shown CBT to be a helpful intervention - so much so, that it has been adopted as the treatment of choice by Big Government - for example, patients in the UK have been able to receive CBT free of charge on the NHS; likewise patients within the public health system in Australia. The consensus has been that CBT is the way to go and there has been plenty of money thrown in its direction.

What hasn't been looked at, until now, is how the efficacy of CBT has evolved over time, a fact which two Norwegian researchers (Johnsen and Friborg) sought to rectify.

Their paper, entitled 'The effects of Cognitive Behavioural Therapy as an anti-depressive treatment is falling: a meta-analysis' leaves little to the imagination.

They examined outcome data from seventy clinical trials from the mid-1970s up until 2014, encompassing data from almost 2,500 patients diagnosed with depression. Almost 70% of subjects were women and the average age was 41 (in itself an interesting finding).

As part of the protocol, the authors focused only on studies which used the Hamilton Depression Rating Scale and Beck's own Depression Inventory, two popular ratings scales that involve either therapist or patient objectively scoring the efficacy of the CBT intervention.

The results showed that CBT has diminished in efficacy since the 1970s, a finding that holds true across different exclusion criteria.

So what's going on here? Is the psychotherapy model funded by governments around the world proving itself to be progressively less effective? The authors speculate:
"In the initial phase of the cognitive era, CBT was frequently portrayed as the gold standard for the treatment of many disorders. In recent times, however, an increasing number of studies... have not found this method to be superior to other techniques. Coupled with the increasing availability of such information to the public, including the internet, it is not inconceivable that patients' hope and faith in the efficacy of CBT has decreased…"
In other words, CBT appears not to have lived up to the hype and people are finding out.

Many therapists would argue that this finding is a formality, knowing that in practice, there is rarely one technique or remedy which 'does the trick'. One obvious short-coming of CBT is that it fails to recognise the psychodynamic - that is, the role of unconscious material in creating emotional distress and dysfunctional behaviour.

Mining the depths of a soul is rarely a rapid undertaking and so the notion that a sharp burst of six sessions could reliably unscramble thinking was always going to fall short of the mark. The emotions are, arguably, driving the thinking, so dealing with them must be top priority.

That's not to say there is no place for CBT in psychotherapy - far from it. As part of an integrated programme of change, it can be an invaluable tool. But it's not the only one, nor necessarily the optimal way.

Written by Jacqui Hogan

Saturday, 30 May 2015

Are you anxious to make a decision?

How many of us can genuinely say we find decision-making easy? Sure, when the question is tea or coffee, spots or stripes, wine or mineral water, it's no big deal. But what about when the stakes are higher, like 'should I take that job that pays less but is less stressful' or 'should we leave our friends and move to a new area for a better quality of life'?

MIT researchers have identified a neural circuit that seems to underlie decision-making in situations which combine this positive-negative element, otherwise known as approach-avoidance conflict.

Striosomes are clusters of cells found in the striatum of the brain, a region thought to be involved with anxiety. The researchers tested the hypothesis that these cells are also involved with approach-avoidance decision-making by studying mice.

The mice were placed in a maze and compelled to choose between either strong chocolate and bright light or weaker chocolate and dimmer light. Mice like chocolate and do not like bright light (not so silly) and so the first option was deemed to be 'high cost, high reward' and the second 'low cost, low reward'. Using a technique called optogenetics the researchers were also able to turn cortical input to striosomes on or off.

When the striosome circuit was switched off, the mice began choosing the 'high cost, high reward' option as much as 20% more often than when it was switched on. This suggests that the striosomes may be acting as gatekeepers that limit anxiety, thereby helping in the formation of a decision.

It is hoped that these findings will ultimately help researchers identify new ways to treat psychiatric disorders that often feature anxiety and impaired decision making, such as schizophrenia, depression and bipolar disorder. Commenting on this, Ann Graybiel, an MIT Institute Professor and the paper's senior author said:
"We would so like to find a way to use these findings to relieve anxiety disorder and other disorders in which mood and emotion are affected. That kind of work is a real priority."
I would like them to find a way, too. If diminishing the anxiety associated with decision-making is just a matter of tinkering with my striosomes, then bring it on - it would undoubtedly save me years of procrastination. But perhaps the picture is not quite so simple.

Some would say that decision-making is not an easy thing to do, especially when the stakes are high. Effective decision-making arguably demands a sophisticated interplay between memory, will and intellect, coupled with the ability to 'hold' potent feelings of anxiety, so that conflicting realities may be adequately processed.

This work may be helpful in identifying part of the mechanism involved with decision-making, but meanwhile, I'm going to work on developing my emotional maturity and see how that goes. This seems to me the obvious challenge in 'high cost, high reward' decision-making scenarios. What do you think?

Written by Jacqui Hogan

Friday, 22 May 2015

How much do you love me?

Do you have a penchant for a certain brand of perfume or aftershave? Would you camp out overnight to lay your hands on the latest piece of Apple kit?

One group of researchers has set out to discover whether people feel the same kind of love for brands as they do for people, in a study which says as much about the times we live in, as about the nature of love.

Tobias Langner and his colleagues, writing in Psychology & Marketing in a paper entitled 'Is it really love: a comparative investigation of the emotional nature of brand and interpersonal love', recruited 20 participants on the basis of two criteria:

1. They had to have a consumer brand they felt they 'could not live without'
2. They had to be in a romantic relationship

All were asked to look at images of their beloved brand logo, followed by images of their partner and then images of their closest friend. Their reactions were assessed, first subjectively, using a visual rating tool and then physiologically, using a skin test to detect levels of arousal.

Thankfully, sanity prevailed, and on both the subjective and physiological ratings scales, the participants' love for partners was significantly more intense than for their favourite brand. When probed on the findings in interview, participants maintained that their love of brands was about the tangible benefits imparted (i.e. what they got from the brand), while romantic love was much more altruistic in nature.

We can all breathe a sigh of relief then.

Um, not quite. The study also showed that the level of physiological arousal was equally strong when subjects were shown images of their favourite brand as their favourite friend. And on the subjective rating scale, the brand actually scored higher. You know who your friends are!

Perhaps that's why it's not so uncommon to see people glued to their iPhone or proudly strolling arm in strap with a Prada handbag. Maybe these items are standing in as some kind of partner substitute.

It's difficult to tell with such a small sample size, but if these results are anything to go by, it's a sad indictment of our culture. The day an inanimate object can usurp a human being one calls a friend is a sad day indeed. In truth, relationships with objects have nothing whatever to do with love and everything to do with attachment. Only when we can make the distinction between the two, do we have any hope of truly loving.

Do you, in your daily practice, see certain objects becoming misguided targets for feelings? Or, conversely, do you see human beings becoming the target of behaviours that rightly belong to objects? If so, let us know.

Written by Jacqui Hogan

Friday, 15 May 2015

Let them eat Prozac

The neurotransmitter theory, despite being a theory, has become hard-wired into our understanding of the way depression works. A shortfall in the neurotransmitter serotonin in the synapses between neurones represents a 'chemical imbalance' which leads to the symptoms of depression, right?

Professor David Healy, author of a book published in 2004 entitled 'Let them eat Prozac: the unhealthy relationship between the pharmaceutical industry and depression', challenges this understanding.

He argues in editorial in the latest edition of the British Medical Journal, that the notion that low levels of serotonin are responsible for depression was created by drug companies in the 1980s in response to concerns about patients developing dependence on tranquilisers. To quote from his paper:
"The serotonin reuptake inhibiting (SSRI) group of drugs came on stream in the late 1980s, nearly two decades after first being mooted. The delay centred on finding an indication. They did not have the hoped for lucrative antihypertensive or anti obesity profiles. A 1960s idea that serotonin concentrations might be lowered in depression had been rejected and in clinical trials the SSRIs had lost out to the older tricyclic antidepressants."
According to Healy, the marketing of SSRIs for depression was pursued to solve two problems - the lack of a satisfactory indication and the emerging problem of dependence on tricyclic antidepressants. Launching SSRIs as a viable treatment for depression gave the marketers an indication and the doctors a prescription alternative.

The BMJ article, while challenging 'the received wisdom' on SSRIs, also stresses that serotonin is not irrelevant.

Rather, it focuses on the marketing history of SSRIs and raises general questions about the weight the medical establishment sometimes places on theory over empirical evidence for lives saved or restored function. Professor Healy goes on to say:
"In other areas of life the products we use, from computers to microwaves, improve year on year, but this is not the case for medicines where this year's treatments may achieve blockbuster sales despite being less effective and less safe than yesterday's models."
It's an indisputable fact that, anecdotally at least, many mental health practitioners and patients have observed and experienced clinical benefits with SSRI treatment. And, in a way, perhaps that is the most important point here, notwithstanding the placebo effect.

Nonetheless, it behooves us to understand the historical context for all pharmacological medications, especially in the mental health arena, given the psychosocial implications, reality of side effects and increasing dominance of business interests.

What is your experience of SSRIs, either as a prescriber, witness or patient? We'd love to hear your informed reflections on this vitally important topic.

Written by Jacqui Hogan

Friday, 8 May 2015

These results are not to be sniffed at

If you think that emotions can be contagious, you'd be right. It's well established that feelings of happiness, for example, transfer between individuals through mimicry of facial expressions.

But a new piece of research suggests this is not the only way we influence each others' emotional states. It would appear that feelings can also be spread by chemical means - specifically via the novel route of underarm sweat!

Researchers from the faculty of Social and Behavioural Sciences at Utrecht University recruited 12 men to provide sweat samples. These intrepid fellows attended the lab, rinsed and dried their armpits and then submitted to having pads attached under each armpit. They were then asked to watch videos designed to induce particular emotional states - fear, happiness and neutrality were tested. Following the viewing, the sweat pads were removed and stored in vials.

The 'sniffers' who were recruited to the second half of the study were 36 women. The researchers noted that women were used because the feminine sense of smell is known to be more acute than the masculine, and also because women are more sensitive to emotional triggers than men.

These (arguably more intrepid) subjects were then comfortably seated and asked to place their chins on a chin rest. The sweat samples harvested in the first half of the study were then placed under their noses in a holder attached to the chin rest. Fear, happiness and neutral samples were then presented to them with a five minute break in between.

Facial expression data revealed that women exposed to the 'fear' sweat exhibited greater activity in the medial frontalis muscle, a common feature of fear reactions. Those exposed to the 'happy' sweat showed facial activity of a type related to the 'Duchenne' smile, which is a common feature of happy reactions. The 'neutral' sweat failed to impact on facial muscle activity.

These results, while in need of further testing, seem to point to the existence of some kind of  'chemosignals', which are capable of communicating emotional states between individuals. Psychological scientist, Gun Semin, a senior researcher on the project said of the findings:
"Our study shows that being exposed to sweat produced under happiness induces a simulacrum of happiness in receivers, and induces a contagion of the emotional state. This suggests that somebody who is happy will infuse others in their vicinity with happiness."
So there you have it - the word is out and the gauntlet is laid down. If you're a happy therapist (is there any other kind?) will you take the happy sweat challenge and 'hold' the deodorant, just for a day, to give unhappy patients a break?

I'm kidding of course, but what this study does point to is something that we probably already know - that emotional states are infectious. How we are inevitably affects those around us. What it gives us is a possible mechanism for how the effect may be mediated. But arguably, because it relates to the invisible and mysterious communication that happens between human beings, it is probably much more complex than can ever be fully understood or proven empirically.

Do you have any thoughts on this topic? Have you observed the contagion of emotional states? How do you approach the challenge of emotional containment within the counselling environment? As ever, your thoughts appreciated.

To tap into more of our content, follow us on Twitter @96Harleytherapy

Written by Jacqui Hogan

Friday, 1 May 2015

The latest weapon in the war on mental disorders

With the prevalence of mental disorders at an all-time high in the general population, any measure which promises to alleviate symptoms has to be worthy of attention.

Recently, a woman I know who has spent time in a psychiatric hospital, mentioned, in passing, that she had been greatly helped by a therapist who had followed up her admission with periodic telephone calls.

Which is why this latest piece of research from the Department of Psychiatry and Psychotherapy at University Medicine Greifswald in Germany on the use of so-called 'telemedicine' caught my eye.

The research revolved around testing the concept of following up patients who had been treated in a psychiatric day hospital with periodic telephone calls and personalised text messages. The primary objective was to evaluate the effectiveness of such interventions.

Some 113 patients were randomly assigned to one of three groups - follow-up by telephone only; follow-up by telephone and text and follow-up with the usual aftercare, involving no such intervention. All participants were monitored for six months post-admission and scored for anxiety, depression and somatisation.

The results showed that the greater the extent of 'telemedical' intervention, the greater the level of benefit, with the average anxiety score significantly lowered for the 'phone plus text' group as compared to controls. A similar trend was seen with depression scores, though the results were not statistically significant.

In addition, 75% of patients with the most severe depression at baseline responded significantly more positively to 'phone only' follow-up than to no active intervention.

This led the team to conclude:
"Telemedicine provides a novel option in psychiatric ambulatory care with statistically significant effects on anxiety. A positive tendency was observed for depression, especially in cases with higher symptom load at baseline."
Of course there is no substitute for face-to-face human contact, but this may be one application of technology (if the humble telephone can still be labelled such) which is justified. Though one might wonder at what happens once the phone goes quiet, these results are nonetheless worthy of reflection and perhaps even further exploration.

Have you experienced therapeutic success with so-called 'telemedicine', without even realising you were trail-blazing this new frontier? Or, like the woman to whom I referred, have you experienced personal benefit from the application of such technique? With depression and anxiety running at such a high ebb in the culture, we welcome feedback on all your experiences.

Written by Jacqui Hogan

Friday, 24 April 2015

Give thanks for a happy heart

All too often, it's the simple, commonsense practices which turn out to deliver genuine therapeutic benefits, with little recognition.

That's why this latest piece of research, published by the American Psychological Association, is highly deserving of attention and should warm the cockles of all our hearts. Because what it demonstrates is the power of that elusive spiritual resource gratitude on the objective functioning of the heart.

The study examined 186 men and women, all of whom had been diagnosed with asymptomatic heart failure of at least three months duration.

Using standard psychometric testing, the researchers measured levels of 'gratitude' and 'spiritual wellbeing' and then compared these scores with subjects' levels of fatigue, depressive symptoms, sleep quality and sense of personal effectiveness. They also measured the level of inflammatory markers known to negatively impact heart failure.

What surprised them most was the extent to which gratitude, as distinct from spiritual wellbeing, was positively correlated with the variables being measured.

Lead author Paul Mills, PhD and Professor of Family Medicine and Public Health at the University of California, commenting on the findings said:
"We found that more gratitude in these patients was associated with better mood, less fatigue and lower levels of inflammatory biomarkers related to cardiac health... It was the gratitude aspect of spirituality that accounted for those effects, not spirituality per se." 
To deepen their understanding of the findings, subjects were then asked to write down three things for which they were grateful, every day, for eight weeks. Those who kept the diaries showed reductions in circulating levels of inflammatory biomarkers, as well as an increase in heart rate variability, which is associated with reduced cardiac risk.

So gratitude is good for your heart! It makes sense that focusing on the positive aspects of life can result in improved mental and, ultimately, physical health.

Therapists treating patients with depression have long used gratitude diaries to help address the negative mindset which often overwhelms. It is also a popular recommendation among twelve-step recovery groups of the type pioneered by Alcoholics Anonymous.

What's special about this particular study is that it provides objective evidence of the impact of gratitude in the form of biological markers - satisfying the prevailing demands of 'evidence-based' medicine. All in all, extremely heartening.

Have you experienced the benefits of a systematic approach to gratitude, either for yourself or for a patient? If so, we'd love to hear from you.

Written by Jacqui Hogan

Friday, 17 April 2015

Time to get your house in order

We all know that housework, no matter how tiresome it may be, usually leaves us feeling a lot better than when we started.

According to a new piece of research, older adults who keep their homes clean and tidy feel emotionally better than those living in a chaotic environment.

Kathy Wright and her team from Case Western Reserve University School of Nursing in Ohio set out to understand how factors such as income, education, environment and health behaviours, like smoking, self-care and exercise, influence an older person's health.

The study's 337 participants ranged in age between 65 and 94 years and data was collected by interview. Geographic and socioeconomic information was then linked to health data.

Wright said she was surprised to discover that housework and maintaining property in good order contributed more to participants' sense of well-being than factors such as income or housing. She concluded that "A clean environment is therapeutic".

Perhaps we ought not be so surprised. If cleanliness is, indeed, close to Godliness, as the saying goes, then might we not have reasonable expectation of reaping the benefits of such activity? Like many sayings handed down from generation to generation, there's usually something to it.

With common sense fast becoming a scarce commodity, it's even just a little ironic that such phenomena would be the subject of scholarly research. But if proofs are needed, then so be it. 'Tidy house, tidy mind' can now be referenced for the sake of posterity.

Of course, there's also the impact of exercise which must be added to the equation. Exercise, as we've been highlighting in recent posts, has a direct effect on brain health and emotional wellbeing and presumably, housework undertaken with even a modicum of gusto, must make a contribution.

If you're out of the habit of exercise and would like to get back in action, we at 96 Harley Psychotherapy are amply equipped to help you do it. As well as our excellent team of Psychotherapists, we have an in-house gym and resident Physiotherapist (John Rutherford) and Exercise Physiologist (Giles Webster). Both can help you safely ease yourself into regular activity and address any underlying problems of pain or injury. You can find out more about them here.

Written by Jacqui Hogan

Friday, 10 April 2015

Give your brain a proper workout

Everywhere you look nowadays, there are businesses touting the means to extend your brain power. One that is clearly courting favour, judging by their advertising campaign, is 'Lumosity', which describes itself as a 'leader in the science of brain training'. It brings us a slew of apparently much-needed digital games in the areas of memory, attention, speed of processing and problem solving, promising to 'train our brains' to be more effective.

Amidst the hype of such novelties, it might be easy to forget the basics - that mental health (and therefore cognitive ability) is intrinsically linked to physical health, since we are whole persons, as opposed to brains on legs.

A recent study out of Boston University Medical Center has underscored this reality by showing that older adults with relatively greater cardio-respiratory (CR) health also have enhanced memory recall and cognitive abilities. On some parameters they even score as well as their younger counterparts.

The researchers compared thirty-three adults aged between 18 and 31 and twenty-seven aged between 55 and 82, with a wide range of cardio-respiratory fitness levels. All completed exercise testing to evaluate their CR function, as well as psychological testing to assess their planning, memory and problem-solving capacities.

Among the older group, those with higher CR levels performed as well as the younger group on planning and problem solving i.e. executive functions. On measures of memory, the young adults performed better than the 'high fitness' older group, who, in turn, performed better than the 'low fitness' older adults.

Scott Haynes, PhD and Assistant Professor of Psychiatry at the Boston University School of Medicine, said of the results:
"Our findings that cardio-respiratory fitness may mitigate age-related cognitive decline is appealing for a variety of reasons, including that aerobic activities to enhance it (walking, dancing etc) are inexpensive, accessible and could potentially improve quality of life."
So, before you enrol in the latest 'brain-training' programme (and I defy anyone to successfully strip that  terminology of its Orwellian undertones), consider committing to a regular programme of cardiovascular activity. Simply a walk in the park every day - or even every other day - will help keep your brain in order, as well as conferring the many other well-known benefits, too numerous to list here. Aside from all the academic proofs, it's sheer common sense.

For those who suffer with physical limitations or are out of the habit of regular exercise, we have a dedicated gym attached to the practice at 96 Harley Psychotherapy, and a Physiotherapist and Exercise Physiologist who can work with you to get you moving. We stand by this holistic approach and know from experience the inextricable link between physical and mental health. Speak to John Rutherford or Giles Webster whose contact details you'll find here.

What do you think about the new brain training programmes that are making their way onto the government and media stage? Are 'mind games' really the answer to sustained brain effectiveness?

As ever, your thoughts welcomed.

Written by Jacqui Hogan

Tuesday, 7 April 2015

The trauma of war

It seems that, despite all hopes to the contrary, we are ever more embroiled in war. And while physical casualties are often thoroughly reported, what commonly goes unreported are the emotional and mental effects which also carry the potential to devastate lives.

In recent years, Post-Traumatic Stress Disorder (PTSD) has received a lot of attention because of its relationship to survivors of dysfunctional families of origin. But, in fact, the condition was originally identified among survivors of war.

The term 'Post-Traumatic Stress Disorder' first appeared in the literature in 1980. When the DSM-III (third edition of the Diagnostic and Statistical Manual of Mental Disorders) was revised in the mid-1980s, the experiences of soldiers returning from the Vietnam War led to a more in-depth investigation of the concept and resulted in its inclusion in the manual.

Earlier descriptive accounts of stress-related disorders are emphatically linked to the history of war. The horrors of trench warfare during World War I and consequent psychological sequelae preceded the concept of 'shell shock' - which is, effectively, PTSD.

Fast-forward to the present day, and research among return soldiers from Afghanistan and Iraq suggests that up to 20% are likely to manifest symptoms of PTSD after they return from combat. Estimates of depression range between 3 and 25%.

We should not be surprised. Combat stressors, which include seeing dead bodies, being shot at, being attacked or ambushed, experiencing rocket or mortar fire, watching a friend being killed or seriously wounded, or oneself being seriously injured, cannot help but cause distress. Arguably, the very nature of the combat experience, no matter how well trained or prepared a soldier is, can do little but lead to a profound shift in the mental, emotional and overall psychological, landscape of the individual.

The National Center for PTSD, a division of the US Department of Veterans Affairs, notes that risk factors for developing the condition include longer deployment, more intense exposure to combat stressors, more severe physical injury, lower rank, lower level of education, female gender and not being married.

Against this backdrop, Dr Robin Lawrence, owner and founder of 96 Harley Psychotherapy and Consultant Psychiatrist and Psychotherapist of many decades' standing, is heading to the Ukraine in May to deliver training to staff at the Irpin Hospital. The programme will focus on the diagnosis and management of PTSD. With war in the Ukraine now a reality, this is important work. Dr Lawrence is pleased to be able to lend his support to the rehabilitation of soldiers in the region.

If you would like to find out more about PTSD or to speak to Dr Lawrence about his upcoming mission, please contact us here. And if you have experience of combat-related PTSD, we'd also love to hear from you.

Written by Jacqui Hogan

Monday, 30 March 2015

The remarkable case of the shrinking brain

Last week, we took a broad look at the relationship between chronic back pain (CBP) and depression. While you don't need to be Einstein to deduce a potential relationship between the two, what might be less obvious is the significant extent to which such chronic pain can affect the structure and chemistry of the brain.

According to a study in the Journal of Neuroscience, reportedly the first to examine the changes that occur to the brain during chronic pain conditions, CBP actually shrinks the brain by as much as 11%  - which is about the same amount of grey matter lost in approximately 10 to 20 years of normal aging!

Researcher Apkarian, and his co-workers, compared the brain morphology of 26 healthy volunteers and an equal number of patients who had been suffering from unrelenting back pain for at least a year, using magnetic resonance imaging (MRI). Those in the CBP group experienced pain primarily localised to the lumbrosaccral region, with or without sciatica.

Patients in this latter group demonstrated a large decrease in grey matter compared with the control group. Proposing a mechanism for this observation, Apkarian suggested:
"Given that, by definition, chronic pain is a state of continuous persistent perception with associated negative effects and stress, one mechanistic explanation for the decreased grey matter is overuse atrophy caused by excitotoxic and inflammatory mechanisms."
He went on to say that the observed atrophy may be a function of an irreversible process, such as neurodegeneration, given that other research has shown that neuronal death occurs in rats with neuropathic pain.

In earlier research, Apkarian had found that back pain sustained for at least six months is accompanied by abnormal brain chemistry in the area known to be important in emotion, decision-making and regulating social behaviour.

His body of work points to tangible evidence of actual changes to brain structure and function under the influence of pain - in this case, specifically, chronic back pain. It underscores the potential need to address such pain as early as possible, so as to avoid potentially irreversible changes to the brain.

If you have patients (or perhaps are a patient) with chronic back pain, consider the expert treatment available in our back pain clinic at 96 Harley Psychotherapy. John Rutherford, physiotherapist and Giles Webster, exercise physiologist, have many years of experience in successfully treating chronic pain and work within our multidisciplinary framework to achieve extraordinary results for patients. You can read more and/or contact the clinic here,

Written by Jacqui Hogan

Friday, 20 March 2015

The link between depression and back pain

When it comes to depression, we seem to spend a lot of time, collectively, trying to figure out the cause. But there is a group of patients for whom the cause might readily be identified - those with chronic back pain.

Depression is easily the most common emotion associated with back pain. In fact, research has shown that depression and chronic pain are the two most common conditions presenting to health professionals, and the rate of major depression increases in a linear fashion with pain severity. This should make the treatment of chronic back pain a high priority, both for the individual and society at large.

It's not so difficult to see how this relationship is being mediated, when you consider the many symptoms often experienced by patients who present with chronic back, or other spine-related, pain. These can predispose to feelings of hopelessness, despair and other symptoms of clinical depression. They might include:
  • Difficulty with sleeping at night, leading to tiredness and irritability during the day
  • Restricted movement, which may lead patients to stop participating in social activities 
  • Inability to work, leading to isolation and financial difficulties
  • Gastrointestinal problems caused by anti-inflammatory medications, as well as mental dullness from pain medications
  • Mental distraction, leading to memory and concentration difficulties
The consequences on family life can also be significant. Physical limitation hampers parents' ability to take care of children, perform necessary household chores and engage in family leisure activities. Stress and strain in family relationships can then contribute to a growing depression.

At 96 Harley Psychotherapy, we are well equipped to treat patients seeking relief from back pain as well as depression, be it endogenous or directly caused by pain.

Physiotherapist John Rutherford is a leading practitioner in the treatment of back pain, and works alongside our mental health team to provide relief for those chronically afflicted. With over 25,000 back treatments to his name, there are few who can offer such expert diagnosis and equally few who can so rapidly pinpoint a course of treatment designed for a return to functional mobility. You can read more about him here.

With depression being so very prevalent, it makes sense to eliminate that which can be relatively easily treated. Allowing back pain to continue is to run the risk of feeding a downward emotional spiral which can ultimately lead the patient to feel it is impossible to change the situation.

Do you have hands-on experience of depression linked to chronic back pain? Perhaps you've experienced a dramatic turnaround with the resolution of your own symptoms? If you have any reflections on this topic, please comment - we'd love to hear from you.

Written by Jacqui Hogan

Friday, 13 March 2015

Exercise is good for your brain

We all know the benefits of physical exercise, such as sustaining and improving muscle tone, increasing circulation, keeping tissues well oxygenated and a myriad of positive long-term effects. But do we know the impact of exercise on the brain?

A recent study, published in Neurology, found that exercise has a very distinct neurological benefit which has, up until now, gone unnoticed.

White Matter Hyperintensities (WMH) are tiny areas of damage to the brain, which are age-related and frequently found in the brains of middle-aged and older people. They have commonly been associated with impaired motor function, such as difficulty walking.

In the current study, 167 elderly participants were asked to wear movement monitors to track their physical activity over the course of up to 11 days. Magnetic Resonance Imaging (MRI) scans were used to assess the volume of WMH in their brains.

The findings showed that those who were more physically active were less affected by WMH damage than those who were less active. In other words, physical exercise appeared to be protecting participants against the standard effects of age-related neural damage.

Lead author Dr Debra Fleischman commenting on the results said:
"These findings may indicate that exercise can make neural networks more resilient. Physical activity may create a 'reserve' that protects motor abilities against the effects of age-related brain damage."
That's good news for those of us who regularly take that 20 mile jog or cycle there and back from London to Hastings. But for those of us who are more inclined to inglorious couch-potatodom, there is help at hand.

At 96 Harley Psychotherapy, we are not only home to some of the world's leading psychotherapists and other psychological practitioners, but also have a whole floor dedicated almost exclusively to physical therapy, including a gym.

John Rutherford and Giles Webster, a physiotherapist and exercise physiologist respectively, specialise in helping those who are physically compromised because of.back pain, injury, ME or other conditions, restore pain-free functional mobility. They also work with those who have simply been chronically inactive and wish to improve their levels of fitness, strength and flexibility.

If this latest piece of research is anything to go by, the more we exercise, the lower our risk of succumbing to age-related neurological damage connected to poor mobility. Working at exercising optimally and regularly is one of the most important ways we can insure ourselves against future disability.

Written by Jacqui Hogan

Friday, 6 March 2015

When is depression not depression?

No one can dispute that depression is now a major public health issue, with incidences skyrocketing all over the Western world.

A new piece of research by Fried et al., published in the Journal of Abnormal Psychology, seems to offer a glimmer of hope by suggesting that depression is being over-diagnosed among the bereaved.

In the study, entitled 'From loss to loneliness: the relationship between bereavement and depressive symptoms', the researchers followed 515 married men and women over the age of 65, who lost a spouse during the observation period. They compared the depression symptoms of those who had lost a spouse with an equally large (n=241) still-married control group.

Lead author, Dr Eiko Fried, identifies the two key findings:
"First, we found that spousal loss causes a very small number of specific depression symptoms, the most important of which is loneliness. Second, we observed that these few initial depression symptoms, in turn, trigger a specific network of subsequent depression symptoms."
The implications are significant, Fried notes, because it opens the door to targeting symptoms, such as loneliness, to prevent the activation of further symptoms and possibly full-fledged depression.

One of the concerns raised by the team is the fact that the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its latest edition (the DSM-5 published in 2013), actively removed the distinction between depression and natural bereavement. This has been highly controversial, since pathologising normal sadness increases the risk of labelling and medicalising those who are simply passing through the normal stages of grief.

This is not the first time the DSM-5 has been called into question. In 2013, another notable change to the text designated paedophilia a 'sexual orientation' rather than its former description as a 'disorder'. This is a radical shift, indicating as it does, that the desire for sex with children is just one other variant in the normal spectrum of sexual behaviours.

In the case of blurring the lines between bereavement and depression, it would appear that the DSM-5 has introduced the potential to put people at risk of misdiagnosis and unnecessary medicalisation; but in the case of reclassifying paedophilia as a lifestyle choice, it has potentially entered another realm.

We need more research like this to promote common-sense findings, which can make a real difference in peoples' lives and ensure they get the help they need, rather than suffer unnecessary harm. The authors are also to be applauded for shining a light on this subtle, but highly significant, edit to the DSM-5.

Do you have any thoughts on this topic? If so, we'd love to hear from you. Please comment.

Written by Jacqui Hogan

Friday, 27 February 2015

Concerning children's mental health

A recent government task-force review sheds some rather disturbing light on the state of child mental health services in England. The review focuses on concerns highlighted by a survey of Clinical Psychologists working across 43 separate specialist Child and Adolescent Mental Health Services (CAMHS) in 2014.

According to the Psychologists, in the last three years some 62% of services have decreased their staffing levels, with a bias towards the loss of more highly skilled professionals. In addition, further cuts are being planned for 42% of services.

Other findings showed that:
  • 71% of services have tightened their acceptance criteria and raised severity thresholds for being seen
  • 54% of respondents were concerned about the deterioration in provision for young people in crisis
  • 66% of services reported a decrease in the quality of treatment provision
  • 56% said the availability of psychological therapies had decreased in the last three years
  • 53% had noticed a more medicalised approach to treatment
On this last point, Professor Jamie Hacker-Hughes, President-Elect of the British Psychological Society commented:
"We are seriously concerned that over half the respondents reported a move to more diagnosis-led, medicalised approaches given the significant weight of evidence in favour of psychological interventions for the majority of child mental health issues."
He has a point. There is a substantial and growing body of outcome research from the UK and abroad demonstrating the efficacy of child and adolescent psychotherapy, which is one of the reasons why the National Institute of Clinical Excellence (NICE) clearly recommends it. And while medical treatment has its place, it would be a tragedy to see it become the mainstay of treatment for conditions such as childhood depression.

Corroborating the survey findings, figures released last month showed that NHS spending on children's mental health services in England has fallen, in real terms. by 6% since 2010. The charity Young Minds has also recently found that over half the councils in England cut or froze budgets for child and adolescent mental health spending between 2010-2011 and 2014-2015.

These are troubling times for mental health services in general, but it is especially upsetting to think that our children, who are our future, are being let down in the critical area of mental health service provision. And as the culture around them becomes increasingly dysfunctional, we can only expect the crisis to deepen.

Do you have thoughts on this important topic? If so, we'd love to hear them.

Written by Jacqui Hogan

Friday, 20 February 2015

Bedlam now on open display

This week, I heard the story of a mother whose son had been conscripted to Afghanistan with the Territorial Army. One of her anecdotes which particularly touched me was that of her son asking her to send, along with protein bars and practical sundries, a colouring-in book. She told of how, in a quiet moment, his commanding officer had given him advice about how to stay within the lines - a wonderful cameo of simplicity and humanity in a world gone mad around them.

Perhaps this incident gives a clue as to the potential role of making art, no matter how rudimentary, for those trapped in a mental war zone.

This week, a new £4m gallery and museum, Bethlem Museum of the Mind, opened up at the Bethlem Royal Hospital in South London (pictured above), the world's oldest psychiatric institution. Formerly known as Bedlam, Bethlem has been treating patients with mental illness for almost eight hundred years.

Over that time, it has acquired a large collection of art and artefacts, many of them created by patients, and it is this body of work which has just gone on display. The collection itself dates back to the sixteenth century, making it the oldest archive of objects related to mental health in the world.

As one of the former patients acknowledges in a short promotional video put together by the BBC, creating art helped him to express the darkness he felt inside, while at the same time providing liberation from the strictures and disciplines of being in the clinical environment. He speaks of how the experience helped him to communicate what was happening for him and the great extent to which it contributed to his recovery.

The collection now on display is significant, bringing together the work of patients from Bethlem, The Maudsley and other psychiatric institutions.

Some artists, such as Richard Dadd, who was painting during the reign of Queen Victoria, have achieved international acclaim, while some of the exhibits, such as a pair of seventeenth century statues entitled 'Raving and Melancholy Madness' by an artist named Caius Cibber are of historical significance as former major London landmarks.

Victoria Northwood, Head of Archives and Museum, hopes that the current exhibition will help stimulate debate among visitors and lead to a better understanding of the lives of those living with mental illness. We echo that aspiration. And if you decide to visit, you'll be able to enjoy world class works of art and learn more about the history of mental health through the museum's unique archive.

Do you have experience of working with art in patients with mental illness? Or have you, perhaps, been helped by art in making a recovery from mental illness? We welcome all contributions on this fascinating topic. And do consider visiting Bedlam.

Written by Jacqui Hogan

Friday, 13 February 2015

Valentine's Day Special

I've been trying to figure out the connection between the original St Valentine, a Roman priest who was beheaded under Claudius II on 14 February in the year 270 AD, and the restaurant-and-rose-fest we practice every year in his name. Maybe it has something to do with him sheltering Christians from persecution and, in losing his life for their sake, demonstrating perfect love.

Now, I'm not sure how many of the couples in candlelit restaurant windows on Valentine's night would lay down their lives for their paramours; with the wind behind them, they won't have to. They will simply be able to bask in the bliss of the rather more comfortable derivative passed down by St Valentine - that is, romantic love.

But what is romantic love and how does it impact our mental health?

It would appear that romantic love is certainly good for overall health. This was demonstrated by a study of 3,000 people, aged between 57 and 85, who reported that being in a satisfying romantic relationship improved their sense of wellbeing. Participants in close relationships were more likely to report that they were in "excellent" or "very good" health than merely "good" or "poor" health.

Such positive thinking, according to the Mayo clinic, has all sorts of positive knock-on effects for objective measures of physical and emotional health, including reducing the risk of depression and protecting against the common cold.

And indeed, it's hard to argue against the affective pleasures of being in a good romantic relationship (whatever exactly that is!).

But is all romantic love good for your mental health?

Show up at any 12-Step meeting catering to the needs of people suffering from love addiction and I'm sure you'll get a different response to the one you'd get from diners in the hypothetical restaurant above.

Because what passes for love in this case is usually neurotic attachment, in which things can go horribly wrong. When the reason for being with another is to assuage unconscious feelings of discomfort or inadequacy (which usually hail from the family of origin), life is not all beer and skittles.

The typical love addiction cycle waxes with periods of intense engagement (usually pleasurable, at least on the face of it), then wanes with one or both partners entering into avoidance. It's a roller coaster ride that can get very messy, especially when the object of attachment (i.e. one's partner) is removed from the scene, as happens in a break-up.

Which leads on to the question how do people fare in the mental health stakes when there is no romantic love? Should singletons gaze through that restaurant window with sadness and longing?

Not necessarily! According to the NHS, having a healthy network of friends can have many of the same positive benefits as being in a romantic relationship. And reported on the same platform, a longitudinal study of almost 700 older nuns found that many are keeping fit and mentally agile well into their 90s and past 100!

Which brings us back to St Valentine. He clearly understood that love is not a feeling but an action (or perhaps a committed set of actions). As M Scott Peck in his classic book 'The Road Less Travelled' writes 'Love is the willingness to extend oneself for the purpose of nurturing one's own or another's spiritual growth'. I do like that definition.

Happy Valentines!

Written by Jacqui Hogan

Friday, 6 February 2015

Getting up close and personalised

You may not have noticed it, but personalised medicine is about to be all the rage. It's one of the biggest trends in modern medicine and what it may mean to the average punter is fewer side effects on medication. The idea is that the drug you will be prescribed will be tailored to your own personal genetic profile, thereby avoiding pesky side effects that may apply to the broader gene pool. Sounds good in theory, doesn't it? And maybe it will be.

There's a new initiative reported on the starting blocks this week which aims at using personalised medicine to reduce the side effects of medication in people with mental illness. Potentially this could be a winner, given the well known problems with side effects on antidepressants and other mental health prescriptions.

Geneticists at the University of Pittsburgh Graduate School of Public Health in Pennsylvania are to implement the research project which will be conducted over 28 months. According to Dietrich Stephan, PhD, Professor and Chair of the Department of Human Genetics at the School of Public Health:
"An individual's genetic makeup defines how many common drugs are processed by the body and who is at risk for an adverse reaction from such therapies. Individuals can suffer immensely from the very drugs that are meant to improve their health if given drugs they cannot tolerate, often resulting in increased emergency room visits and elevated healthcare costs."
Participants will be selected from a pool of adults with mental illnesses who are currently prescribed, or who will be prescribed, at least one psychotropic medication during the study period. Participation will be voluntary and oversight provided by a senior counsellor and a recognised ethicist in the Pennsylvania region.

Now, as someone who, this very week, experienced an adverse reaction to an anaesthetic, I can assure you the idea of personalised medicine is sounding mighty appealing. In my case, the doctors were utterly perplexed by my reaction and, in what could have been a television advertisement for personalised medicine, exclaimed things like 'we've never seen this before' and 'never say never in medicine'.

So if it's sounding like a relief to me, how much more of a relief will it be to those prescribed a cocktail of drugs with no insight into their genetic susceptibilities, perhaps triggering interactions and symptoms which might be misdiagnosed as part of their symptom profile?

All too often, the vulnerable, the mentally ill and the elderly, obediently (and sometimes not so obediently) imbibe drugs with a side effect list the length of your arm, based on best guesses as to their problem, only to feel even worse for the treatment.

Personalised medicine, especially in the area of mental health, seems to me to be a step forward, so let's hope this US study yields some positive results.

Written by Jacqui Hogan