A new treatment for complicated grief

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

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

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

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

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

This is an important finding, given the incidence of complicated grief and its debilitating impact. The authors conclude:

"Our results strongly support the need for physicians and other health care providers to distinguish CG from depression. Given the growing elderly population, the high prevalence of bereavement in aging individuals, and the marked physical and psychological impact of CG, clinicians need to know how to treat CG in older adults."

What's your experience? How often do you encounter complicated grief? Are there other aspects to this discussion that need to be taken into account? As ever, we'd love to hear your views.

Written by Jacqui Hogan

Nibbling away at our understanding of PTSD

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

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

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

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

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

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

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

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

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

Written by Jacqui Hogan

The proven benefits of growing old gracefully

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

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

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

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

Lead author, Becca Levy, Associate Professor and Director of the Social and Behavioural Sciences Division at Yale says that, in her experience, negative age stereotypes can generate stress in older people which, in turn, raises the risk of psychiatric disorders later in life. She comments:

"These results suggest that reducing the negative age stereotypes that are present in media, marketing and everyday conversations could have mental health benefits." 

Well said. While the chances of the media and marketing machine which dominates the culture is unlikely to do an about-face in projecting images which glorify youth and suggest that life on earth is about inexorable decline, we can, at least, do something in our own lives (i.e. 'everyday conversations') to recognise the intrinsic value of the ageing process in moving us towards greater maturity and wisdom.

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

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

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

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


Written by Jacqui Hogan

Get to the art of mental health

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

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

Sarah-Jane knows, from personal experience, just how isolating mental health difficulties can be. She hopes to create a forum in which people can reach out to others and come to understand that they are not the only ones who suffer. She explains:

"Because the group is aimed at people with mental health problems (or people who have in the past experienced them) we won't feel any need to pretend or put on an act, or hide the details of problems we've had..."

She maintains that encouraging participants to make art and craft will, itself, prove therapeutic and promote renewed inspiration and motivation for those whose lives have been disrupted by mental ill health.

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

There has been growing interest in arts-in-health initiatives where 'the creative process' is seen to have therapeutic value in promoting wellbeing. The UK Mental Health Foundation claims on its website:

"International and UK research has found that many people with mental health problems find arts therapies helpful, either on their own or as part of a range of therapies, which may include medication and talking treatments."

Have you worked with arts-in-health initiatives? How successful have they been? Whether you're a therapist or someone with experience as a patient, do post your comments - we'd love to hear from you.

Written by Jacqui Hogan

Mental health and the up-coming general election

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

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

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

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

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

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

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

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

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

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

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

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

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

Written by Jacqui Hogan

Don't lose sleep over this...

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

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

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

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

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

Written by Jacqui Hogan

First aid for mental health

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

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

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

Poppy Jarman is CEO of MHFA England, through which around one thousand instructors have trained over 75,000 people in first aid for mental health since they began operations in 2007. She notes that:

"The fear surrounding mental ill health and the misunderstanding around recovery is one of the biggest barriers for creating mentally fit workplaces. We need to talk about mental health in the same way we do about physical health."

MHFA would like to see every office in the land staffed with somebody trained in mental health first aid and, given the number of people now stepping forward for training, this goal may well be achieved.

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

Anxiety and depression are top of the list of problems they may have to deal with, and psychosis and suicidal crises, though not as common, are also important parts of the training. She says that most workplace mental health problems won't be emergencies and that small acts of compassion by fellow workers are often all that is needed:

"Simple strategies like buddying up for walks in the park or encouraging each other to leave work at a reasonable time can help nip workplace stress in the bud." 

This seems like common sense to me - i.e. to help a colleague battling with stress with practical suggestions. But common sense, it seems, is in increasingly short supply. So, too, is empathy, where the competitive and counter-productive culture of 'me, me, me' (especially in the workplace) can only cause alienation and exacerbate underlying mental health problems.

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

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

Written by Jacqui Hogan