On This Day … 07 March

People (Births)

  • 1924 – Morton Bard, American psychologist (d. 1997).
  • 1978 – Jaqueline Jesus, Brazilian psychologist and activist.

Morton Baird

Morton Bard (07 March 1924 to 04 December 1997) was an American psychologist, known for the research he undertook on the psychology of crime victims. He was a one-time member of the New York Police Department, a psychologist, and a professor who studied the reactions of crime victims.

Bard, in partnership with the police, conducted studies of crime victims (e.g. hostages, rape victims, and the families of murder victims). He published two volumes on domestic violence and crisis intervention. He also is recognised for having laid the foundation of victim-focused training into many law enforcement academies and the FBI National Academy.

In 1979, Bard co-authored The Crime Victim’s Book. This volume provides practical information on how best to identify and support the needs of crime victims. The Crime Victim’s Book was considered a “bible” for not only advocates but also crime victims. He is considered to have been a pivotal critical thinker in the development of the modern discipline of crisis intervention. He also wrote scholarly articles on the training of police officers in the application of different forms of crisis intervention out in the field.

Jaqueline Jesus

Jaqueline Gomes de Jesus (born 07 March 1978) is a Brazilian psychologist, writer, and activist.

Jesus is the daughter of a computer operator and a mining science teacher. She has a sibling, a younger brother. Jesus lived most of her life in Ceilândia. A good student, she studied chemistry, for a year before switching majors. She holds an M.Sc. in Psychology from the University of Brasília, and a PhD in Social Psychology, Work and Organisations from the same institution. She worked at the University of Brasília from 2003-2008 as a diversity adviser and also coordinated a center for black students. She was one of the organizers of Brasilia’s Pride parade, and participated in the development of Brazil’s goals for the UN’s Millennium Dome. Jesus has proactively addressed discriminatory actions, refusing to accept passive prejudice. She began her human rights activism in 1997, with “Estructuración”, a Brasilia homosexual group, serving first as secretary and in 1999, became president. In that period, she worked alongside government and educational institutions, in fighting prejudice and valuing differences, speaking at the opening of the 5th National Conference on Human Rights. Jesus participated in various social movements. In 2000, with Luiz Mott, she cofounded the Academic Association of Gays, Lesbians and Sympathizers of Brazil, serving as general secretary. She was appointed to the editorial board of the Grupo Gay Negro de Bahia; and founded the NGO Acciones Ciudades en Orientación sexual.

On This Day … 06 March

People (Deaths)

  • 1941 – Francis Aveling, Canadian priest, psychologist, and author (b. 1875).

Francis Aveling

Francis Arthur Powell Aveling DD D.Sc PhD DLit MC ComC (25 December 1875 to 06 March 1941) was a Canadian psychologist and Catholic priest. He married Ethel Dancy of Steyning, Sussex in 1925.

Life

Francis Aveling was born at St. Catharines, Ontario 25 December 1875. He went to Bishop Ridley College in Ontario and McGill University before studying at Keble College at the Oxford University, England. Aveling was received into the Roman Catholic Church by Father Luke Rivington in 1896 and entered the Pontificio Collegio Canadese in Rome. There he earned his doctor of divinity degree. He was ordained to the priesthood in 1899, and served as a curate in Tottenham, before becoming first rector of Westminster Cathedral Choir School. He was also a chaplain at the Cathedral, and to St. Wilfrid’s Convent, Chelsea.

In 1910, Aveling obtained a doctor of philosophy degree at the age of 35 from the University of Louvain (his advisor was Albert Michotte), and in 1912 he was recipient of a doctor of science degree from the University of London, and received the Carpenter Medal following his work On the Consciousness of the Universal and the Individual: A Contribution to the Phenomenology of the Thought Process. Subsequently, Aveling received his doctor of letters degree from the University of London.

Career

Aveling taught at University College, London from 1912 as a Lecturer (Assistant Professor), under the leadership of Charles Spearman, until the First World War. During that war he served in France as a chaplain in the British Army, after which he returned to the University of London. In 1922, he transferred to King’s College, London where he was promoted to reader (associate professor), and later to professor of psychology. He was an extern examiner in philosophy at the National University of Ireland; and a lecturer in pedagogical methods for the London County Council.

Aveling authored several books. He was the doctoral advisor of Raymond Cattell From 1926 until 1929, Aveling was also a president of the British Psychological Society. Aveling was a member of the Council of the International Congresses, of the Aristotelian Society, of the council and advisory board of the National Institute of Industrial Psychology, of the council of the British Institute of Philosophical Studies and of the Child Guidance Council.

He was a contributor to the Dublin Review, The American Catholic Quarterly Review, Catholic World, The nineteenth Century, The Journal of Psychology, and the Catholic Encyclopaedia.

Works

  • The Immortality of the Soul (1905).
  • Science and Faith (1906).
  • The God of Philosophy (1906).
  • On the Consciousness of the Universal and the Individual (1912).
  • Personality and Will (1931).
  • An Introduction to Psychology (1932).

What is Virtual Reality Therapy?

Introduction

Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerised CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation.

Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment; and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated, interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating post traumatic stress disorder (PTSD), and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.

Description

VRT uses specially programmed computers, visual immersion devices and artificially created environments to give the patient a simulated experience that can be used to diagnose and treat psychological conditions that cause difficulties for patients. In many environmental phobias, reaction to the perceived hazards, such as heights, speaking in public, flying, close spaces, are usually triggered by visual and auditory stimuli. In VR-based therapies, the virtual world is a means of providing artificial, controlled stimuli in the context of treatment, and with a therapist able to monitor the patient’s reaction. Unlike traditional cognitive behavioural therapy (CBT), VR-based treatment may involve adjusting the virtual environment, such as for example adding controlled intensity smells or adding and adjusting vibrations, and allow the clinician to determine the triggers and triggering levels for each patient’s reaction. VR-based therapy systems may allow replaying virtual scenes, with or without adjustment, to habituate the patient to such environments. Therapists who apply virtual reality exposure therapy, just as those who apply in-vivo exposure therapy, can take one of two approaches concerning the intensity of exposure. The first approach is called flooding, which refers to the most intense approach where stimuli that produce the most anxiety are presented first. For soldiers who have developed PTSD from combat, this could mean first exposing them to a virtual reality scene of their fellow troops being shot or injured followed by less stressful stimuli such as only the sounds of war. On the other hand, what is referred to as graded-exposure takes a more relaxed approach in which the least distressing stimuli are introduced first. VR-exposure, as compared to in-vivo exposure has the advantage of providing the patient a vivid experience, without the associated risks or costs. VRT has great promise since it historically produces a “cure” about 90% of the time at about half the cost of traditional CBT authority, and is especially promising as a treatment for PTSD where there are simply not enough psychologists and psychiatrists to treat all the veterans with anxiety disorders diagnosed as related to their military service.

Recently there have been some advances in the field of virtual reality medicine. Virtual reality is a complete immersion of the patient into a virtual world by putting on a headset with an LED screen in the lenses of the headset. This is different from the recent advancements in augmented reality. Augmented reality is different in the sense that it enhances the non-synthetic environment by introducing synthetic elements to the user’s perception of the world. This in turn “augments” the current reality and uses virtual elements to build upon the existing environment. Augmented reality poses additional benefits and has proven itself to be a medium through which individuals suffering from specific phobia can be exposed “safely” to the object(s) of their fear, without the costs associated with programming complete virtual environments. Thus, augmented reality can offer an efficacious alternative to some less advantageous exposure-based therapies.

Brief History

VRT was pioneered and originally termed by Max North documented by the first known publication (Virtual Environment and Psychological Disorders, Max M. North, and Sarah M. North, Electronic Journal of Virtual Culture, 2,4, July 1994), his doctoral VRT dissertation completion in 1995 (began in 1992), and followed with the first known published VRT book in 1996 (Virtual Reality Therapy, an Innovative Paradigm, Max M. North, Sarah M. North, and Joseph R. Coble, 1996. IPI Press). His pioneered virtual reality technology work began as early as 1992 as a research faculty at Clark Atlanta University and supported by funding from US Army Research Laboratory.

An early exploration in 1993-1994 of VRT was done by Ralph Lamson a USC graduate then at Kaiser Permanente Psychiatry Group. Lamson began publishing his work in 1993. As a psychologist, he was most concerned with the medical and therapeutic aspects, that is, how to treat people using the technology, rather than the apparatus, which was obtained from Division, Inc. Psychology Today reported in 1994 that these 1993-1994 treatments were successful in about 90% of Lamson’s virtual psychotherapy patients. Lamson wrote in 1993 a book entitled Virtual Therapy which was published in 1997 directed primarily to the detailed explanation of the anatomical, medical and therapeutic basis for the success of VRT. In 1994-1995, he had solved his own acrophobia in a test use of a third party VR simulation and then set up a 40 patient test funded by Kaiser Permanente. Shortly thereafter, in 1994-1995, Larry Hodges, then a computer scientist at Georgia Tech active in VR, began studying VRT in cooperation with Max North who had reported anomalous behaviour in flying carpet simulation VR studies and attributed such to phobic response of unknown nature. Hodges tried to hire Lamson without success in 1994 and instead began working with Barbara Rothbaum, a psychologist at Emory University to test VRT in controlled group tests, experiencing about 70% success among 50% of subjects completing the testing programme.

In 2005, Skip Rizzo of USC’s Institute for Creative Technologies, with research funding from the Office of Naval Research (ONR), started validating a tool he created using assets from the game Full Spectrum Warrior for the treatment of posttraumatic stress disorder. Virtual Iraq was subsequently evaluated and improved under ONR funding and is supported by Virtually Better, Inc. They also support applications of VR-based therapy for aerophobia, acrophobia, glossophobia, and substance abuse. Virtual Iraq proved successful in normalization of over 70% of PTSD sufferers, and that has now become a standard accepted treatment by the Anxiety and Depression Association of America. However, the VA has continued to emphasize traditional prolonged exposure therapy as the treatment of choice, and VR-based therapies have gained only limited adoption, despite active promotion by DOD, and despite VRT having much lower cost and apparently higher success rates. A $12-million ONR funded study is currently underway to definitively compare the efficacy of the two methods, PET and VRT. Military labs have subsequently set up dozens of VRT labs and treatment centres for treating both PTSD and a variety of other medical conditions. The use of VRT has thus become a mainstream psychiatric treatment for anxiety disorders and is finding increasing use in the treatment of other cognitive disorders associated with various medical conditions such as addiction, depression and insomnia.

Applications

Psychological Therapy

Exposure Therapy

Virtual reality technology is especially useful for exposure therapy – a treatment method in which patients are introduced and then slowly exposed to a traumatic stimulus. Inside virtual environments, patients can safely interact with a representation of their phobia, and researchers do not need to have access to a real version of the phobia itself. One of the primary challenges to the efficacy of Exposure therapy is recreating the level of trauma existing in real environments inside a virtual environment. Virtual Reality aids in overcoming this by engaging with different sensory stimuli of the patient while heightening the realism and maintaining the safety of the environment.

One very successful example of virtual reality therapy exposure therapy is the PTSD treatment system, Virtual Iraq. Using a head mounted display and a game pad, patients navigate a Humvee around virtual recreations of Iraq, Afghanistan, and the United States. By being safely exposed to the traumatic environments, patients learned to reduce their anxiety. According to a review of the history of Virtual Iraq, one study found that it reduced PTSD symptoms by an average of fifty percent, and disqualified over 75% of participants for PTSD after treatment. Virtual Reality Exposure Therapy (VRET) is also commonly used for treating specific phobias, especially small animal phobia. Commonly feared animals such as spiders can be easily produced in a virtual environment, instead of finding the real animal. VRET has also been used experimentally to treat other fears such as public speaking and claustrophobia.

Another successful study attempted treating 10 individuals who experienced trauma as a result of events during 9/11. Through repeated exposure to increasingly traumatic sequences of World Trade Centre events, immediate positive results were self reported by test subjects. In a 6 month follow up, 9 of the test subjects available for follow up maintained their results from exposure.

VRET offers a wide range of advantages compared to traditional exposure therapy techniques. Recent years have suggested an increase in familiarly and trust in virtual reality technology as an acceptable mirror of reality. A higher trust in the technology could lead to more effective treatment results as more phobics seek out help. Another consideration for VRET is the cost effectiveness. While the actual cost of VRET may vary based on the hardware and software implementation, it is supposedly more effective than the traditional in vivo treatment used for exposure therapy while maintaining a positive return on investment. Future research might pave an alternative to extensive automated lab or hospital environments. For instance, in 2011, researchers at York University proposed an affordable VRET system for the treatment of phobias that could be set up at home. Such developments in VRET may pave a new way of customised treatment that also tackles the stigma attached to clinical treatment. While there is still a lot unknown about the long-term effectiveness of the relatively new VRET, the future seems promising with growing studies reflecting the benefits of VRET to combat phobias.

Virtual Rehabilitation

The term virtual rehabilitation was coined in 2002 by Professor Daniel Thalmann of EPFL (Switzerland) and Professor Grigore Burdea of Rutgers University (USA). In their view the term applies to both physical therapy and cognitive interventions (such as for patients suffering from Post Traumatic Stress Disorder, phobias, anxieties, attention deficits or amnesia). Since 2008, the virtual rehabilitation “community” has been supported by the International Society on Virtual Rehabilitation.

Virtual rehabilitation is a concept in psychology in which a therapeutic patient’s training is based entirely on, or is augmented by, virtual reality simulation exercises. If there is no conventional therapy provided, the rehabilitation is said to be “virtual reality-based”. Otherwise, if virtual rehabilitation is in addition to conventional therapy, the intervention is “virtual reality-augmented.” Today, a majority of the population uses the virtual environment to navigate their daily lives and almost one fourth of the world population uses the internet. As a result, virtual rehabilitation and gaming rehabilitation, or rehabilitation through gaming consoles, have become quite common. In fact, virtual therapy has been used over regular therapeutic methods in order to treat a number of disorders.

Some factors to consider when virtual rehabilitation include cultural sensitivity, accessibility, and ability to finance the virtual therapy.

Advantages

Virtual rehabilitation offers a number of advantages compared to conventional therapeutic methods:

It is entertaining, thus motivating the patient:

  • Potential for involvement of the patients’ stimulus modalities for more realistic environments for treatment.
  • It provides objective outcome measures of therapy efficacy (limb velocity, range of movement, error rates, game scores, etc.).
  • These data are transparently stored by the computer running the simulation and can be made available on the Internet.
  • Virtual rehabilitation can be performed in the patient’s home and monitored at a distance (becoming telerehabilitation).
  • The patient feels more actively involved in the desensitisation.
  • The patient may “forget” they are in treatment or undergoing observation resulting in more authentic expressions.
  • Effective for hospitals to reduce their costs because of lowered cost of medicine and equipment.
  • Great impact of virtual reality on pain relief.

Disadvantages

Despite all the merits of VR therapy as listed in the sections above, there are pitfalls and obstacles in the development of widespread VR solutions.

  • Cost effectiveness:
    • VRET may show promising returns on investment but the fact remains that the true development cost of VRET environments depends heavily on the choice of hardware and software chosen.
  • Treatment effectiveness:
    • For the treatment to take effect, a patient should be able to successfully project and experience their anxiety in a virtual environment.
    • Unfortunately, this projection is highly subjective and personalised per patient; and outside the control of the therapists.
    • This limitation might adversely impact the therapy.
  • Migrating back to reality from virtual reality:
    • Another scepticism is the correlation between virtual reality and actual reality. If a patient successfully combats their phobia in a virtual environment, does that guarantee success in real life too?
    • Further, when treating more complicated ailments such as schizophrenia, there is inadequate projection on how delusions and hallucinations may translate from the real world to the virtual one.
  • VR sickness:
    • Movement in a virtual environment is said to cause visual discomfort.
    • Prolonged periods of exposure to VR may lead to side effects like dry eyes, headaches, nausea and sweating; symptoms similar to motion sickness.
  • Ethical and legal considerations:
    • Since VR is a relatively new technology, its ethical implications are not as comprehensive as other forms of treatment.
    • There is a need to formalize the limits, side effects, disclaimers, privacy regulations as we increase the breadth of impact of VR therapy; especially in matters related to forensic cases.
  • Acceptance by the medical community:
    • As VR-based therapy increases, it might pose a challenge to licenced therapists and medical professionals who may perceive VR as a threat.
    • After all, VR deviates from the pre-established norm of “talking cure”.

Therapeutic Targets

Depression

In February 2006 the UK’s National Institute of Health and Clinical Excellence (NICE) recommended that VRT be made available for use within the NHS across England and Wales, for patients presenting with mild/moderate depression, rather than immediately opting for antidepressant medication. Some areas have developed or are trialling.

At Auckland University in New Zealand, a team led by Dr. Sally Merry have been developing a computerised CBT fantasy “serious” game to help tackle depression amongst adolescents. The game, Sparx, has a number of features to help combat depression, where the user takes on a role of a character who travels through a fantasy world, combating “literal” negative thoughts and learning techniques to manage their depression.

Eating Disorders and Body Dysmorphia

Virtual reality therapy has also been used to attempt to treat eating disorders and body dysmorphia. One study in 2013 had participants complete various tasks in virtual reality environments which could not have been easily replicated without the technology. Tasks included showing patients the implications of reaching their desired weight, comparing their actual body shape to an avatar created using their perceived body size, and altering a virtual reflection to match their actual body size.

Gender Dysphoria

Early research suggests that virtual reality experiences may offer therapeutic benefits to transgendered individuals experiencing gender dysphoria. More experimentation and professional examination is needed before virtual reality could be prescribed as a treatment in practice. However, some transgendered individuals have engaged in what can be characterized as an anecdotally, alleviating form of self-administered, virtual sex reassignment therapy. Digital spaces offer a form of anonymous self-expression that trans individuals, due to exposure of discrimination and violence, are not fully granted to them in real life or IRL. The sophistication of virtual reality expands on these newfound liberties by providing an avenue for those with gender dysphoria to embody their gender identity, if it not accessible for them to do so in their real life. Through use of available VR videogames and chat rooms, those suffering from gender dysphoria can create avatars of themselves, interact anonymously, and work towards therapeutic goals.

Acrophobia

A study published in The Lancent Psychiatry proved that Virtual Reality therapy can help treat acrophobia. Over the course of the study, participants were introduced to intimidating heights in a Virtual Reality environment then asked to complete various activities at those heights while under the supervision and support of a coach. This study, although insufficient in terms of scope and scrutiny for direct adoption into remedial practices, surrounds future research and treatment modelling with promise, as a majority of the participants considered themselves no longer afraid of heights.

Physical Therapy

Stroke

Research suggests that patients who suffered from a stroke found Virtual reality (VR) rehab techniques in their Physical Therapy treatment plans very beneficial. Throughout a rehabilitation programme aimed to restore and/or retain balance and walking skills, patients who have suffered a stroke often must relearn how to control certain muscles. In most physical therapy settings, this is done through high intensity, repetitive, and task-specific practice. Programmes of this type can prove to be physically demanding, are expensive, and require several days of training per week. Additionally, regimens may seem redundant, and produce only modest and/or delayed effects in patient recovery. A physical therapy regimen using VR provides an opportunity to individualise training to fit the specific needs of the patient. While the exercises and movements required for proper motor learning can seem repetitive, using VR adds a level of intrigue and engagement for the patient. Training with VR enhances motor learning by giving the patient opportunities to practice their movements/exercise protocol in different VR environments. This ensures that patients are always challenged and may be better prepared to perform in their environments.

Feedback is an important element of physical therapy for patients recovering from stroke and/or other neuromuscular disorders. Within the scope of motor learning, receiving feedback during performance of a task improves the learning rate. According to a Cochrane Review, visual feedback, specifically, has been shown to aid in balance recovery for patients who have had a stroke. VR can provide continuous visual feedback that a physical therapist may not be able to during their sessions. Results have also suggested that in addition to improvements in balance, positive effects are also seen in walking ability. In one study, patients with VR training coupled with their physical therapy programme had better improvements in walking speed than others not using VR training. The most recent review about the effect of VR training on balance and gait ability showed significant benefits of VR training on gait speed, Berg Balance Scale (BBS) scores, and Timed “Up & Go” Test scores when VR was time dose matched to conventional therapy.

Parkinson’s Disease

Many studies (Cochrane Review) have shown that using VR technology during Physical Therapy treatments for patients with Parkinson’s Disease had positive outcomes. For patients with PD the VR therapy:

  • Increased gait and balance.
  • Improved functions of activities of daily living (ADL’s).
  • Improved quality of life.
  • Improved cognitive function.

It is speculated that these improvements occurred because the VR gave increased feedback to the patient regarding their performance during the VR sessions. VR stimulates a patient’s motor and cognitive processes, both of which may be impaired as a result of the disease. Another benefit of VR is that it replicates real life scenarios, allowing patients to practice functional activities.

Wound Care

Additionally, VR provides beneficial outcomes when it is implemented for patients who are receiving wound care rehabilitation. Studies have speculated that the more immersive the VR, the greater the experience and concentration the patient will have on the virtual environment. Equally important, VR has shown to reduce pain, anxiety and depressive symptoms, as well as an increasing their treatment adherence.

In other studies, the results point to the benefits of VR in relation to increased distraction, and patients reported less time thinking about pain, less intense pain and immersion, which facilitates care such as dressing changes and physiotherapy.

Wound dressing often generates a pain-provoking experience. Therefore, use of VR was related to more efficient dressings, increased distraction from the pain during procedures (e.g. dressing and physical rehabilitation) which reduced the patients’ stress and anxiety.

Cardiovascular

The use of VR and video games could be considered as complementary tools for physical training in patients with Cardiovascular diseases. Certain games designed for exercise have been shown to promote increases in heart rate, fatigue perception, and physical activity. In addition, it has been shown to reduce pain and increase adherence to physical therapy programmes in patients with cardiovascular diseases. Finally, Virtual reality and video games enhance motivation and adherence in cardiac rehabilitation programmes.

Occupational Therapy

Autism

Virtual reality has been shown to improve the social skills of young adults with autism. In one study, participants controlled a virtual avatar in different virtual environments and manoeuvred through various social tasks such as interviewing, meeting new people, and dealing with arguments. Researchers found that participants improved in the areas of emotional recognition in voices and faces and in considering the thoughts of other people. Participants were also surveyed months after the study for how effective they thought the treatments were, and the responses were overwhelmingly positive. Many other studies have also explored this occupational therapy option.

Attention Deficit Hyperactivity Disorder

A clinical trial published in the Journal of Attention Disorders found that school age children with ADHD who underwent a virtual classroom cognitive treatment series were able to achieve the same management of symptoms of impulsivity and distractibility as children who were medicated with a stimulant.

Post Traumatic Stress Disorder

It may also be possible to use virtual reality to assist those with PTSD. The virtual reality allows the patients to relive their combat situations at different extremes as a therapist can be there with them guiding them through the process. Some scholars believe that this is an effective way to treat PTSD patients as it allows for the recreation of exactly what they experienced. “It allows for greater engagement by the patient and, consequently, greater activation of the traumatic memory, which is necessary for the extinction of the conditioned fear.”

Stroke

Virtual reality also has applications in the physical side of occupational therapy. For stroke patients, various virtual reality technologies can help bring fine control back to different muscle groups. Therapy often includes games controlled with haptic-feedback controllers that require fine movements, such as playing piano with a virtual hand. The Wii gaming system has also been used in conjunction with virtual reality as a treatment method.

Chronic and Acute Pain

VR has been shown to be effective in immediately decreasing procedural or acute pain. To date there have been few studies on its efficacy in chronic pain. Such chronic pain patients can tolerate the VR session without the side effects that sometimes come with VR such as headaches, dizziness or nausea.

Rehabilitation

Virtual reality is also helping patients overcome balance and mobility problems resulting from stroke or head injury. In the study of VR, the modest advantage of VR over conventional training supports further investigation of the effect of video-capture VR or VR combined with conventional therapy in larger-scale randomised, more intense controlled studies. It shows the VR-assisted patients had better mobility when the doctors checked in two months later. Other research has shown similarly successful outcomes for patients with cerebral palsy undergoing rehab for balance problems.

Surgery

VR smoothly blurs the demarcation between the physical world and the computer simulation as surgeons can use latest versions of virtual reality glasses to interact in a three-dimensional space with the organ that requires surgical treatment, view it from any desired angle and able to switch between 3D view and the real CT images.

Efficacy

Randomised, tightly controlled, acrophobia treatment trials at Kaiser Permanente provided >90% effectiveness, conducted in 1993-94. Of 40 patients treated, 38 showed marked reduction in phobic reaction to heights and self-reported reaching their goals. Research found that VRT allows patients to achieve victory over virtual height situations they could not confront in real life, and that gradually increasing the height and danger in a virtual environment produced increasing victories and greater self-confidence in the patient that they could actually confront the situation in real life. “Virtual therapy interventions empower people. The simulation technology of virtual reality lends itself to mastery oriented treatment … Rather than coping with threats, phobics manage progressively more threatening aspects in a computer-generated environment … The range of applications can be extended by enhancing the realness and interactivity so that actions elicit reactions from the environments in which individuals immerse themselves”.

Another study examined the effectiveness of virtual reality therapy in treating military combat personnel recently returning from the current conflicts in Iraq and Afghanistan. Rauch, Eftekhari and Ruzek conducted a study with a sample of 42 combat servicemen who were already diagnosed with chronic PTSD (post-traumatic stress disorder). These combat servicemen were pre-screened using several different diagnostic self-reports including the PTSD military checklist, a screening tool used by the military in the determination of the intensity of the diagnosis of PTSD by measuring the presence of PTSD symptoms. Although 22 of the servicemen dropped out of the study, the results of the study concerning the 20 remaining servicemen still has merit. The servicemen were given the same diagnostic tests after the study which consisted of multiple sessions of virtual reality exposure and virtual reality exposure therapy. The servicemen showed much improvement in the diagnostic scores, signalling a decrease of symptoms of PTSD. Likewise, a three-month follow-up diagnostic screening was also administered after the initial sessions that were undergone by the servicemen. The results of this study showed that 15 of the 20 participants no longer met diagnostic criteria for PTSD and improved their PTSD military checklist score by 50% for the assessment following the study. Even though only 17 of the 20 participants participated in the 3-month follow-up screening, 13 of the 17 still did not meet the criteria for PTSD and maintained their 50% improvement in the PTSD military checklist score. These results show promising effects and help to validate virtual reality therapy as an efficacious mode of therapy for the treatment of PTSD.

VR combined real instrument training was effective at promoting recovery of patients’ upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke. In the study, the experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and Box and Block Tests. Patients in the experimental group, but not the control group, also showed significant improvements on the lateral, palmar, and tip pinch power, Box and Block, and 9-HPTs from before to immediately after training.

Continued Development

Larry Hodges, formerly of Georgia Tech and now Clemson University and Barbara Rothbaum of Emory University, have done extensive work in VRT, and also have several patents and founded a company, Virtually Better, Inc.

In the United States, the United States Department of Defence (DOD) continues funding of VRT research and is actively using VR in treatment of PTSD.

Millions of funding is being put towards developments and early trials in the realm of virtual reality as companies race for FDA approval for their medical applications.

BRAVEMIND Software

In 2014, a virtual reality application used as a prolonged exposure (PE) therapy tool for military related trauma called BRAVEMIND was reported BRAVEMIND is as an acronym for Battlefield Research Accelerating Virtual Environments for Military Individual Neuro Disorders. VRET applications have been used to assist civilian populations with anxieties about flying, public speaking, and heights. BRAVEMIND has been studied in populations of military medics as well as survivors of military sexual assault and combat. This technology was developed by researchers at the University of the Southern California in collaboration with the US Army Research Laboratory.

In 2004, reports stated that 40% of military members experience PTSD but only 23% seek medical help. Emory physicians described one of the strongest indicators of PTSD to be avoidance, saying this inhibits those affected from seeking treatment. PE requires that the patient close their eyes and relate the pertinent episode in as much detail as possible. The methodology was based on the concept that in facing the event, the charge of the triggers may be attenuated over time. The VRET application BRAVEMIND differs from PE in that the patient does not reimagine the episode but instead wears a headset that places them in the familiar environment. This headset is equipped with two screens (one for each eye), headphones, and a position monitor that shifts the visual scene to match the patient’s head movements. Depending on the patient’s experience they may be standing or sitting on top of a raised platform with a bass shaker. This allows for vibrations that simulate the experience of riding a military vehicle. Other accessories such as joysticks or mock machine guns are given to the patients, if appropriate, to enhance realism.

The clinician introduces triggers, such as gunfire, explosions, etc. into the virtual environment as they see fit. The clinician can also adapt sound and lighting conditions to match the patient’s description. The researchers who developed the BRAVEMIND system reported that in a 20-patient trial, the patients’ scores on the diagnostic PTSD checklist-military version (PCL-M) dropped from 54.4 pre-treatment to 35.6 post-treatment after eleven sessions. In another clinical trial, consisting of 24 active-duty soldiers, it was reported that after 7 sessions 45% no longer were identified as positive for PTSD while 62% demonstrated symptomatic improvement. These experimental results were compared with those of alternative PE treatments.

The BRAVEMIND software has 14 different environments available including military barracks, Iraqi markets, and desert roads. Included in these are environments specific to military sexual trauma (MST). Designed environments such as US base settings, shower areas, latrines, remote shelters, and others were developed after consulting subject matter experts from Emory University.

Proponents of this research have said that with military based videogames being so prevalent, this technology may be more appealing to patients and reduce the stigma surrounding treatment. They also have argued that as research on PTSD unfolds, possible subtypes may respond to treatments differently, and therefore diversifying treatment options is best. Others have expressed reservations about the capacity to properly personalise VRET for individualised treatment and the use of ethnic stereotyping while developing Arab populated environments.

Treatment for Lesions

Virtual reality therapy has two promising potential benefits for treatment of hemispatial neglect patients. These include improvement of diagnostic techniques and as a supplement to rehabilitation techniques.

Current diagnostic techniques usually involve pen and paper tests like the line bisection test. Though these tests have provided relatively accurate diagnostic results, advances in VRT have proven these tests to not be completely thorough. Dvorkin et al. used a camera system that immersed the patient into a virtual reality world and required the patient to grasp or move object in the world, through tracking of arm and hand movements. These techniques revealed that pen and paper tests provide relatively accurate qualitative diagnoses of hemispatial neglect patients, but VRT provided accurate mapping into a 3-dimensional space, revealing areas of space that were thought to be neglected but which patients had at least some awareness. Patients were also retested 10 months from initial measurements, during which each went through regular rehabilitation therapy, and most showed measurably less neglect on virtual reality testing whereas no measurable improvements were shown in the line bisection test.

Virtual reality therapy has also proven to be effective in rehabilitation of lesion patients suffering from neglect. A study was conducted with 24 individuals suffering from hemispatial neglect. A control group of 12 individuals underwent conventional rehabilitation therapy including visual scanning training, while the VR group were immersed in 3 virtual worlds, each with a specific task. The programmes consisted of

  • “Bird and Ball” in which a patient touches a flying ball with his or her hand and turns it into a bird.
  • “Coconut”, in which a patient catches a coconut falling from a tree while moving around.
  • “Container” in which a patient moves a box carried in a container to the opposite side.

Each of the patients of VR went through 3 weeks of 5-day-a-week 30-minute intervals emerged in these programmes. The controls went through the equivalent time in traditional rehabilitation therapies. Each patient took the star cancellation test, line bisection test, and Catherine Bergego Scale (CBS) 24 hours before and after the three-week treatment to assess the severity of unilateral spatial neglect. The VR group showed a higher increase in the star cancellation test and CBS scores after treatment than the control group (p<0.05), but both groups did not show any difference in the line bisection test and K-MBI before and after treatment. These results suggest that virtual reality programmes can be more effective than conventional rehabilitation and thus should be further researched.

VR Advantages over IVE

The preference of VR exposure therapy over in-vivo exposure therapy is often debated, but there are many obvious advantages of virtual reality exposure therapy that make it more desirable. For example, the proximity between the client and therapist can cause problems when in-vivo therapy is used and transportation is not reliable for the client or it is impractical for them to travel as far as needed. However, virtual reality exposure therapy can be done from anywhere in the world if given the necessary tools. Going along with the idea of unavailable transportation and proximity, there are many individuals who require therapy but due to various forms of immobilisations (paralysis, extreme obesity, etc.) they can not physically be moved to where the therapy is conducted. Again, because virtual reality exposure therapy can be conducted anywhere in the world, those with mobility issues will no longer be discriminated against. Another major advantage is fewer ethical concerns than in-vivo exposure therapy.

Another advantage to virtual reality rehab over the traditional method is patient motivation. When presented with difficult tasks during a prolonged period, patients tend to lose interest in these tasks. This causes a decrease in compliance due to decreased motivation of completing a given task. VR rehab is advantageous in such a way that it challenges and motivates the patient to do more. With simple things like high scores, in-game awards, and ranks, not only are patients motivated to do their daily therapies, they are having fun doing it. Not only is this advantageous to the patients, it is advantageous to the physical therapist. With these high scores, and data the game or application collects, therapists can analyse the data to see progression. This progression can be charted and visually shown to the patient for increased motivation on their performance and the progression they have made thus far in their therapies. This data can then be charted with other participants doing similar tasks and can show how they compare to people with similar therapy regimens. This charted data in the programme or game can then be used by researchers and scientists alike for further evaluation of optimal therapy regimens. A recent study done in 2016 where a VR based virtual simulation of a city named Reh@City was made. This city in virtual reality evoked memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. This study looked at Activities of Daily Living in post stroke patients and found it to have more of an impact than conventional methods in the recovery process.

Concerns

There are a few ethical concerns concerning the use and development of using virtual reality simulation for helping clients/patients with mental health issues. One example of these concerns is the potential side effects and aftereffects of virtual reality exposure. Some of these side effects and aftereffects could include cybersickness (a type of motion sickness caused by the virtual reality experience), perceptual-motor disturbances, flashbacks, and generally lowered arousal. If severe and widespread enough, these effects should be mitigated via various methods by those therapists using virtual reality.

Another ethical concern is how clinicians should receive VRT certification. Due to the relative newness of virtual reality as a whole, there may not be many clinicians who have experience with the nuances of virtual reality exposure or VR programs’ intended roles in therapy. As such, VR technology should only be used as a tool for qualified clinicians instead of being used to further one’s practice or garner an attraction for new clients/patients.

Some traditional concerns with VR therapy is the cost. Since virtual reality in the field of science and medicine is so primitive and new, the costs of VR equipment would be a lot higher than some of the traditional methods. With medical costs growing at an exponential level this would be another cost that is added to the growing list of medical bills for a patients recovery process. Regardless of the benefits with VR rehab, the costs of the equipment and the resources for a VR setup would make it difficult for it to be mainstream and available to all patients including the indigent population. However, a new market of lower cost VR hardware is emerging, specifically with improved head-mounted displays.

In addition there are some issues which are related to VR that can arise from its use such as Social Isolation where the users can become detached from real-world social connections and the overestimation of a person’s abilities where users – especially the young – often fail to distinguish between their feats in real life and VR.

What is the International Journal of Psychoanalysis?

Introduction

The International Journal of Psychoanalysis is an academic journal in the field of psychoanalysis. The idea of the journal was proposed by Ernest Jones in a letter to Sigmund Freud dated 7 December 1918. The journal itself was established in 1920, with Jones serving as editor until 1939, the year of Freud’s death.

Background

The International Journal of Psychoanalysis incorporates the International Review of Psycho-Analysis, founded in 1974 by Joseph Sandler. It is run by the Institute of Psychoanalysis. For the last 95 years, the IJP has enjoyed its role as the main international vehicle for communication about psychoanalysis, enjoying a wide international readership from Europe, the Middle East, Africa, Asia-Pacific, North America, and Latin America. Past Editors of the International Journal have included Ernest Jones, James Strachey, Joseph Sandler, and David Tuckett. In 2015 the IJP had around 9000 subscribers.

Dana Birksted-Breen is the current Editor in Chief of The International Journal of Psychoanalysis. In 2012, she integrated the four regional boards into one large Editorial Board currently composed of over 100 members. There are five Associate Editors from four different geographic regions: Alessandra Lemma (UK), Jorge Canestri (Europe), Lucy LaFarge (North America), Beatriz de León de Bernardi (Latin America), Georg Bruns (representing no region); an Executive Editor, Gráinne Lucey (London); and Editors of specific sections, such as Education, The Analyst at Work, Psychoanalytic Controversies, Book Reviews, and Film Essays.

In recent years, the IJP has worked to strengthen dialogues between different psychoanalytic cultures. 2015 saw the launch of the Spanish edition of the journal – IJP en español. In 2013 the journal established the online open peer review, multi-language site IJP-Open (www.ijp-open.org). With the IJP Annuals (www.annualsofpsychoanalysis.com), each year papers from the journal are selected and translated into eight different languages: French, Spanish, German, Italian, Portuguese, Russian, Greek, and Turkish, with plans to launch a Chinese Annual in 2017.

What is Schema (Psychology)?

Introduction

In psychology and cognitive science, a schema (plural schemata or schemas) describes a pattern of thought or behaviour that organises categories of information and the relationships among them. It can also be described as a mental structure of preconceived ideas, a framework representing some aspect of the world, or a system of organising and perceiving new information. Schemata influence attention and the absorption of new knowledge: people are more likely to notice things that fit into their schema, while re-interpreting contradictions to the schema as exceptions or distorting them to fit. Schemata have a tendency to remain unchanged, even in the face of contradictory information. Schemata can help in understanding the world and the rapidly changing environment. People can organise new perceptions into schemata quickly as most situations do not require complex thought when using schema, since automatic thought is all that is required.

People use schemata to organise current knowledge and provide a framework for future understanding. Examples of schemata include academic rubrics, social schemas, stereotypes, social roles, scripts, worldviews, and archetypes. In Piaget’s theory of development, children construct a series of schemata, based on the interactions they experience, to help them understand the world.

Brief History

“Schema” comes from the Greek word schēmat or schēma, meaning “figure”.

Prior to its use in psychology, the term “schema” had primarily seen use in philosophy. For instance, “schemata” (especially “transcendental schemata”) are crucial to the architectonic system devised by Immanuel Kant in his Critique of Pure Reason.

Early developments of the idea in psychology emerged with the gestalt psychologists and Jean Piaget: the term schéma was introduced by Piaget in 1923. In Piaget’s later publications, action (operative or procedural) schémes were distinguished from figurative (representational) schémas, although together they may be considered a schematic duality. In subsequent discussions of Piaget in English, schema was often a mistranslation of Piaget’s original French schéme. The distinction has been of particular importance in theories of embodied cognition and ecological psychology.

The concept was popularised in psychology and education through the work of the British psychologist Frederic Bartlett, who drew on the term body schema used by neurologist Henry Head. It was expanded into schema theory by educational psychologist Richard C. Anderson. Since then, other terms have been used to describe schema such as “frame”, “scene”, and “script”.

Schematic Processing

Through the use of schemata, a heuristic technique to encode and retrieve memories, the majority of typical situations do not require much strenuous processing. People can quickly organise new perceptions into schemata and act without effort.

However, schemata can influence and hamper the uptake of new information (proactive interference), such as when existing stereotypes, giving rise to limited or biased discourses and expectations (prejudices), lead an individual to “see” or “remember” something that has not happened because it is more believable in terms of his/her schema. For example, if a well-dressed businessman draws a knife on a vagrant, the schemata of onlookers may (and often do) lead them to “remember” the vagrant pulling the knife. Such distortion of memory has been demonstrated. (See Background Research below.)

Schemata are interrelated and multiple conflicting schemata can be applied to the same information. Schemata are generally thought to have a level of activation, which can spread among related schemata. Which schema is selected can depend on factors such as current activation, accessibility, priming and emotion.

Accessibility is how easily a schema comes to mind, and is determined by personal experience and expertise. This can be used as a cognitive shortcut; it allows the most common explanation to be chosen for new information.

With priming, a brief imperceptible stimulus temporarily provides enough activation to a schema so that it is used for subsequent ambiguous information. Although this may suggest the possibility of subliminal messages, the effect of priming is so fleeting that it is difficult to detect outside laboratory conditions.

Background Research

The original concept of schemata is linked with that of reconstructive memory as proposed and demonstrated in a series of experiments by Frederic Bartlett. By presenting participants with information that was unfamiliar to their cultural backgrounds and expectations and then monitoring how they recalled these different items of information (stories, etc.), Bartlett was able to establish that individuals’ existing schemata and stereotypes influence not only how they interpret “schema-foreign” new information but also how they recall the information over time. One of his most famous investigations involved asking participants to read a Native American folk tale, “The War of the Ghosts”, and recall it several times up to a year later. All the participants transformed the details of the story in such a way that it reflected their cultural norms and expectations, i.e. in line with their schemata. The factors that influenced their recall were:

  • Omission of information that was considered irrelevant to a participant;
  • Transformation of some of the details, or of the order in which events, etc., were recalled; a shift of focus and emphasis in terms of what was considered the most important aspects of the tale;
  • Rationalization: details and aspects of the tale that would not make sense would be “padded out” and explained in an attempt to render them comprehensible to the individual in question; and
  • Cultural shifts: the content and the style of the story were altered in order to appear more coherent and appropriate in terms of the cultural background of the participant.

Bartlett’s work was crucially important in demonstrating that long-term memories are neither fixed nor immutable but are constantly being adjusted as schemata evolve with experience. In a sense it supports the existentialist view that people construct the past and present in a constant process of narrative/discursive adjustment, and that much of what people “remember” is actually confabulated (adjusted and rationalised) narrative that allows them to think of the past as a continuous and coherent string of events, even though it is probable that large sections of memory (both episodic and semantic) are irretrievable at any given time.

An important step in the development of schema theory was taken by the work of D.E. Rumelhart describing the understanding of narrative and stories. Further work on the concept of schemata was conducted by W.F. Brewer and J.C. Treyens, who demonstrated that the schema-driven expectation of the presence of an object was sometimes sufficient to trigger its erroneous recollection. An experiment was conducted where participants were requested to wait in a room identified as an academic’s study and were later asked about the room’s contents. A number of the participants recalled having seen books in the study whereas none were present. Brewer and Treyens concluded that the participants’ expectations that books are present in academics’ studies were enough to prevent their accurate recollection of the scenes.

In the 1970s, computer scientist Marvin Minsky was trying to develop machines that would have human-like abilities. When he was trying to create solutions for some of the difficulties he encountered he came across Bartlett’s work and decided that if he was ever going to get machines to act like humans he needed them to use their stored knowledge to carry out processes. To compensate for that he created what was known as the frame construct, which was a way to represent knowledge in machines. His frame construct can be seen as an extension and elaboration of the schema construct. He created the frame knowledge concept as a way to interact with new information. He proposed that fixed and broad information would be represented as the frame, but it would also be composed of slots that would accept a range of values; but if the world did not have a value for a slot, then it would be filled by a default value. Because of Minsky’s work, computers now have a stronger impact on psychology. In the 1980s, David Rumelhart extended Minsky’s ideas, creating an explicitly psychological theory of the mental representation of complex knowledge.

Roger Schank and Robert Abelson developed the idea of a script, which was known as a generic knowledge of sequences of actions. This led to many new empirical studies, which found that providing relevant schema can help improve comprehension and recall on passages.

Modification

New information that falls within an individual’s schema is easily remembered and incorporated into their worldview. However, when new information is perceived that does not fit a schema, many things can happen. The most common reaction is to simply ignore or quickly forget the new information. This can happen on an unconscious level – frequently an individual may not even perceive the new information. People may also interpret the new information in a way that minimizes how much they must change their schemata. For example, Bob thinks that chickens do not lay eggs. He then sees a chicken laying an egg. Instead of changing the part of his schema that says “chickens do not lay eggs”, he is likely to adopt the belief that the animal in question that he has just seen laying an egg is not a real chicken. This is an example of disconfirmation bias, the tendency to set higher standards for evidence that contradicts one’s expectations. However, when the new information cannot be ignored, existing schemata must be changed or new schemata must be created (accommodation).

Jean Piaget (1896-1980) was known best for his work with development of human knowledge. He believed knowledge was constructed on cognitive structures, and he believed people develop cognitive structures by accommodating and assimilating information. Accommodation is creating new schema that will fit better with the new environment or adjusting old schema. Accommodation could also be interpreted as putting restrictions on a current schema. Accommodation usually comes about when assimilation has failed. Assimilation is when people use a current schema to understand the world around them. Piaget thought that schemata are applied to everyday life and therefore people accommodate and assimilate information naturally. For example, if this chicken has red feathers, Bob can form a new schemata that says “chickens with red feathers can lay eggs”. This schemata will then be either changed or removed, in the future.

Assimilation is the reuse of schemata to fit the new information. For example, when a person sees an unfamiliar dog, they will probably just integrate it into their dog schema. However, if the dog behaves strangely, and in ways that does not seem dog-like, there will be accommodation as a new schema is formed for that particular dog. With Accommodation and Assimilation comes the idea of equilibrium. Piaget describes equilibrium as a state of cognition that is balanced when schema are capable of explaining what it sees and perceives. When information is new and cannot fit into existing schema this is called disequilibrium and this is an unpleasant state for the child’s development. When disequilibrium happens, it means the person is frustrated and will try to restore the coherence of his or her cognitive structures through accommodation. If the new information is taken then assimilation of the new information will proceed until they find that they must make a new adjustment to it later down the road, but for now the child remains at equilibrium again. The process of equilibration is when people move from the equilibrium phase to the disequilibrium phase and back into equilibrium.

Self-Schema

Schemata about oneself are considered to be grounded in the present and based on past experiences. Memories are framed in the light of one’s self-conception. For example, people who have positive self-schemata (i.e. most people) selectively attend to flattering information and selectively ignore unflattering information, with the consequence that flattering information is subject to deeper encoding, and therefore superior recall. Even when encoding is equally strong for positive and negative feedback, positive feedback is more likely to be recalled. Moreover, memories may even be distorted to become more favourable, for example, people typically remember exam grades as having been better than they actually were. However, when people have negative self views, memories are generally biased in ways that validate the negative self-schema; people with low self-esteem, for instance, are prone to remember more negative information about themselves than positive information. Thus, memory tends to be biased in a way that validates the agent’s pre-existing self-schema.

There are three major implications of self-schemata. First, information about oneself is processed faster and more efficiently, especially consistent information. Second, one retrieves and remembers information that is relevant to one’s self-schema. Third, one will tend to resist information in the environment that is contradictory to one’s self-schema. For instance, students with a particular self-schema prefer roommates whose view of them is consistent with that schema. Students who end up with roommates whose view of them is inconsistent with their self-schema are more likely to try to find a new roommate, even if this view is positive. This is an example of self-verification.

As researched by Aaron Beck, automatically activated negative self-schemata are a large contributor to depression. According to Cox, Abramson, Devine, and Hollon (2012), these self-schemata are essentially the same type of cognitive structure as stereotypes studied by prejudice researchers (e.g. they are both well-rehearsed, automatically activated, difficult to change, influential toward behaviour, emotions, and judgments, and bias information processing).

The self-schema can also be self-perpetuating. It can represent a particular role in society that is based on stereotype, for example: “If a mother tells her daughter she looks like a tom boy, her daughter may react by choosing activities that she imagines a tom boy would do. Conversely, if the mother tells her she looks like a princess, her daughter might choose activities thought to be more feminine.” This is an example of the self-schema becoming self-perpetuating when the person at hand chooses an activity that was based on an expectation rather than their desires.

Schema Therapy

Schema therapy was founded by Jeffrey Young and represents a development of cognitive behavioural therapy (CBT) specifically for treating personality disorders. Early maladaptive schemata are described by Young as broad and pervasive themes or patterns made up of memories, feelings, sensations, and thoughts regarding oneself and one’s relationships with others. They are considered to develop during childhood or adolescence, and to be dysfunctional in that they lead to self-defeating behaviour. Examples include schemata of abandonment/instability, mistrust/abuse, emotional deprivation, and defectiveness/shame.

Schema therapy blends CBT with elements of Gestalt therapy, object relations, constructivist and psychoanalytic therapies in order to treat the characterological difficulties which both constitute personality disorders and which underlie many of the chronic depressive or anxiety-involving symptoms which present in the clinic. Young said that CBT may be an effective treatment for presenting symptoms, but without the conceptual or clinical resources for tackling the underlying structures (maladaptive schemata) which consistently organize the patient’s experience, the patient is likely to lapse back into unhelpful modes of relating to others and attempting to meet their needs. Young focused on pulling from different therapies equally when developing schema therapy. The difference between cognitive behavioural therapy and schema therapy is the latter “emphasizes lifelong patterns, affective change techniques, and the therapeutic relationship, with special emphasis on limited reparenting”. He recommended this therapy would be ideal for clients with difficult and chronic psychological disorders. Some examples would be eating disorders and personality disorders. He has also had success with this therapy in relation to depression and substance abuse.

On This Day .. 04 March

People (Births)

  • 1916 – Hans Eysenck, German-English psychologist and theorist (d. 1997).

People (Deaths)

  • 1925 – James Ward, English psychologist and philosopher (b. 1843).

Hans Eysenck

Hans Jürgen Eysenck (04 March 1916 to 04 September 1997) was a German-born British psychologist who spent his professional career in Great Britain. He is best remembered for his work on intelligence and personality, although he worked on other issues within psychology. At the time of his death, Eysenck was the living psychologist most frequently cited in the peer-reviewed scientific journal literature. A 2019 study found him to be the third most controversial of 55 intelligence researchers.

Eysenck’s research purported to show that certain personality types had an elevated risk of cancer and heart disease. Scholars have identified errors and suspected data manipulation in Eysenck’s work, and large replications have failed to confirm the relationships that he purported to find. An enquiry on behalf of King’s College London found the papers by Eysenck to be “incompatible with modern clinical science”.

In 2019, 26 of his papers (all co-authored with Ronald Grossarth-Maticek) were considered “unsafe” by an enquiry on behalf of King’s College London. 14 of his papers were retracted in 2020, and journals issued 64 statements of concern about publications by him. Rod Buchanan, a biographer of Eysenck, has argued that 87 publications by Eysenck should be retracted.

James Ward

James Ward FBA (27 January 1843 to 04 March 1925) was an English psychologist and philosopher. He was a Cambridge Apostle.

Apprenticed to a Liverpool architect for four years, Ward studied Greek and logic and was a Sunday school teacher. In 1863, he entered Spring Hill College, near Birmingham, to train for the Congregationalist ministry. An eccentric and impoverished student, he remained at Spring Hill until 1869, completing his theological studies as well as gaining a University of London BA degree.

In 1869-1870, Ward won a scholarship to Germany, where he attended the lectures of Isaac Dormer in Berlin before moving to Göttingen to study under Hermann Lotze. On his return to Britain Ward became minister at Emmanuel Congregational Church in Cambridge, where his theological liberalism unhappily antagonised his congregation. Sympathetic to Ward’s predicament, Henry Sidgwick encouraged Ward to enter Cambridge University. Initially a non-collegiate student, Ward won a scholarship to Trinity College in 1873, and achieved a first class in the moral sciences tripos in 1874.

With a dissertation entitled The Relation of Physiology to Psychology, Ward won a Trinity fellowship in 1875. Some of this work, An interpretation of Fechner’s Law, was published in the first volume of the new journal Mind (1876).

During 1876-1877 he returned to Germany, studying in Carl Ludwig’s Leipzig physiological institute. Back in Cambridge, Ward continued physiological research under Michael Foster, publishing a pair of physiological papers in 1879 and 1880.

However, from 1880 onwards Ward moved away from physiology to psychology. His article Psychology for the ninth edition of the Encyclopaedia Britannica was enormously influential – criticising associationist psychology with an emphasis upon the mind’s active attention to the world.

He was elected to the new Chair of Mental Philosophy and Logic in 1897 and his students included G.E. Moore, Bertrand Russell, Sir Mohammed Iqbal and George Stout.

He was president of the Aristotelian Society from 1919 to 1920; his wife Mary (née Martin) was a lecturer in moral sciences at Newnham College, a suffragist and a member of the Ladies Dining Society in Cambridge.

Ward died in Cambridge, and was cremated at Cambridge Crematorium.

What is Rational Emotive Behaviour Therapy?

Introduction

Rational emotive behaviour therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioural problems and disturbances and to help people to lead happier and more fulfilling lives.

REBT posits that people have erroneous beliefs about situations they are involved in, and that these beliefs cause disturbance, but can be disputed with and changed.

Brief History

Rational emotive behaviour therapy (REBT) was created and developed by the American psychotherapist and psychologist Albert Ellis, who was inspired by many of the teachings of Asian, Greek, Roman and modern philosophers. REBT is the first form of cognitive behavioural therapy (CBT) and was first expounded by Ellis in the mid-1950s; development continued until his death in 2007. Ellis became synonymous with the highly influential therapy. Psychology Today noted, “No individual—not even Freud himself—has had a greater impact on modern psychotherapy.”

REBT is both a psychotherapeutic system of theory and practices and a school of thought established by Ellis. He first presented his ideas at a conference of the American Psychological Association in 1956 then published a seminal article in 1957 entitled “Rational psychotherapy and individual psychology”, in which he set the foundation for what he was calling rational therapy (RT) and carefully responded to questions from Rudolf Dreikurs and others about the similarities and differences with Alfred Adler’s Individual psychology. This was around a decade before psychiatrist Aaron Beck first set forth his “cognitive therapy”, after Ellis had contacted him in the mid 1960s. Ellis’ own approach was renamed Rational Emotive Therapy in 1959, then the current term in 1992.

Precursors of certain fundamental aspects of rational emotive behaviour therapy have been identified in ancient philosophical traditions, particularly to Stoicists Marcus Aurelius, Epictetus, Zeno of Citium, Chrysippus, Panaetius of Rhodes, Cicero, and Seneca, and early Asian philosophers Confucius and Gautama Buddha. In his first major book on rational therapy, Ellis wrote that the central principle of his approach, that people are rarely emotionally affected by external events but rather by their thinking about such events, “was originally discovered and stated by the ancient Stoic philosophers”. Ellis illustrates this with a quote from the Enchiridion of Epictetus: “Men are disturbed not by things, but by the views which they take of them.” Ellis noted that Shakespeare expressed a similar thought in Hamlet: “There’s nothing good or bad but thinking makes it so.” Ellis also acknowledges early 20th century therapists, particularly Paul Charles Dubois, though he only read his work several years after developing his therapy.

Theoretical Assumptions

The REBT framework posits that humans have both innate rational (meaning self-helping, socially helping, and constructive) and irrational (meaning self-defeating, socially defeating, and unhelpful) tendencies and leanings. REBT claims that people to a large degree consciously and unconsciously construct emotional difficulties such as self-blame, self-pity, clinical anger, hurt, guilt, shame, depression and anxiety, and behaviours and behaviour tendencies like procrastination, compulsiveness, avoidance, addiction and withdrawal by the means of their irrational and self-defeating thinking, emoting and behaving.

REBT is then applied as an educational process in which the therapist often active-directively teaches the client how to identify irrational and self-defeating beliefs and philosophies which in nature are rigid, extreme, unrealistic, illogical and absolutist, and then to forcefully and actively question and dispute them and replace them with more rational and self-helping ones. By using different cognitive, emotive and behavioural methods and activities, the client, together with help from the therapist and in homework exercises, can gain a more rational, self-helping and constructive rational way of thinking, emoting and behaving.

One of the main objectives in REBT is to show the client that whenever unpleasant and unfortunate activating events occur in people’s lives, they have a choice between making themselves feel healthily or, self-helpingly, sorry, disappointed, frustrated, and annoyed or making themselves feel unhealthily and self-defeatingly horrified, terrified, panicked, depressed, self-hating and self-pitying. By attaining and ingraining a more rational and self-constructive philosophy of themselves, others and the world, people often are more likely to behave and emote in more life-serving and adaptive ways.

Beliefs about Circumstances, and Disputing the Beliefs

A fundamental premise of REBT is humans do not get emotionally disturbed by unfortunate circumstances, but by how they construct their views of these circumstances through their language, evaluative beliefs, meanings and philosophies about the world, themselves and others. This concept has been attributed as far back as the Roman philosopher Epictetus, who is often cited as utilising similar ideas in antiquity.

In REBT, clients usually learn and begin to apply this premise by learning the A-B-C-D-E-F model of psychological disturbance and change. The following letters represent the following meanings in this model:

  • A – The adversity.
  • B – The developed belief in the person of the Adversity.
  • C – The consequences of that person’s Beliefs i.e., B.
  • D – The person’s disputes of A, B, and C. In latter thought.
  • E – The effective new philosophy or belief that develops in that person through the occurrence of D in their minds of A and B.
  • F – The developed feelings of one’s self either at point and after point C or at point after point E.

The A-B-C model states that it is not an A, adversity (or activating event) that cause disturbed and dysfunctional emotional and behavioural Cs, consequences, but also what people B, irrationally believe about the A, adversity. A, adversity can be an external situation, or a thought, a feeling or other kind of internal event, and it can refer to an event in the past, present, or future.

The Bs, irrational beliefs that are most important in the A-B-C model are explicit and implicit philosophical meanings and assumptions about events, personal desires, and preferences. The Bs, beliefs that are most significant are highly evaluative and consist of interrelated and integrated cognitive, emotional and behavioural aspects and dimensions. According to REBT, if a person’s evaluative B, belief about the A, activating event is rigid, absolutistic, fictional and dysfunctional, the C, the emotional and behavioural consequence, is likely to be self-defeating and destructive. Alternatively, if a person’s belief is preferential, flexible and constructive, the C, the emotional and behavioural consequence is likely to be self-helping and constructive.

Through REBT, by understanding the role of their mediating, evaluative and philosophically based illogical, unrealistic and self-defeating meanings, interpretations and assumptions in disturbance, individuals can learn to identify them, then go to D, disputing and questioning the evidence for them. At E, effective new philosophy, they can recognise and reinforce the notion no evidence exists for any psychopathological must, ought or should and distinguish them from healthy constructs, and subscribe to more constructive and self-helping philosophies. This new reasonable perspective leads to F, new feelings and behaviours appropriate to the A they are addressing in the exercise.

Psychological Dysfunction

One of the main pillars of REBT is that irrational and dysfunctional ways and patterns of thinking, feeling, and behaving are contributing to human disturbance and emotional and behavioural self-defeatism and social defeatism. REBT generally teaches that when people turn flexible preferences, desires and wishes into grandiose, absolutistic and fatalistic dictates, this tends to contribute to disturbance and upset. These dysfunctional patterns are examples of cognitive distortions.

Core Beliefs that Disturb Humans

Albert Ellis has suggested three core beliefs or philosophies that humans tend to disturb themselves through:

“I absolutely MUST, under practically all conditions and at all times, perform well (or outstandingly well) and win the approval (or complete love) of significant others. If I fail in these important—and sacred—respects, that is awful and I am a bad, incompetent, unworthy person, who will probably always fail and deserves to suffer.”“Other people with whom I relate or associate, absolutely MUST, under practically all conditions and at all times, treat me nicely, considerately and fairly. Otherwise, it is terrible and they are rotten, bad, unworthy people who will always treat me badly and do not deserve a good life and should be severely punished for acting so abominably to me.”“The conditions under which I live absolutely MUST, at practically all times, be favorable, safe, hassle-free, and quickly and easily enjoyable, and if they are not that way it’s awful and horrible and I can’t bear it. I can’t ever enjoy myself at all. My life is impossible and hardly worth living.”
Holding this belief when faced with adversity tends to contribute to feelings of anxiety, panic, depression, despair, and worthlessness.Holding this belief when faced with adversity tends to contribute to feelings of anger, rage, fury, and vindictiveness.Holding this belief when faced with adversity tends to contribute to frustration and discomfort, intolerance, self-pity, anger, depression, and to behaviours such as procrastination, avoidance, addictive behaviours and inaction.

Rigid Demands that Humans Make

REBT commonly posits that at the core of irrational beliefs there often are explicit or implicit rigid demands and commands, and that extreme derivatives like awfulising, low frustration tolerance, people deprecation and over-generalisations are accompanied by these. According to REBT the core dysfunctional philosophies in a person’s evaluative emotional and behavioural belief system, are also very likely to contribute to unrealistic, arbitrary and crooked inferences and distortions in thinking. REBT therefore first teaches that when people in an insensible and devout way overuse absolutistic, dogmatic and rigid “shoulds”, “musts”, and “oughts”, they tend to disturb and upset themselves.

Over-Generalisation

Further, REBT generally posits that disturbed evaluations to a large degree occur through over-generalisation, wherein people exaggerate and globalise events or traits, usually unwanted events or traits or behaviour, out of context, while almost always ignoring the positive events or traits or behaviours. For example, awfulising is partly mental magnification of the importance of an unwanted situation to a catastrophe or horror, elevating the rating of something from bad to worse than it should be, to beyond totally bad, worse than bad to the intolerable and to a “holocaust”. The same exaggeration and overgeneralising occurs with human rating, wherein humans come to be arbitrarily and axiomatically defined by their perceived flaws or misdeeds. Frustration intolerance then occurs when a person perceives something to be too difficult, painful or tedious, and by doing so exaggerates these qualities beyond one’s ability to cope with them.

Secondary Disturbances

Essential to REBT theory is also the concept of secondary disturbances which people sometimes construct on top of their primary disturbance. As Ellis emphasizes:

“Because of their self-consciousness and their ability to think about their thinking, they can very easily disturb themselves about their disturbances and can also disturb themselves about their ineffective attempts to overcome their emotional disturbances.”

Origins of Dysfunction

Regarding cognitive-affective-behavioral processes in mental functioning and dysfunctioning, originator Albert Ellis explains:

“REBT assumes that human thinking, emotion, and action are not really separate or disparate processes, but that they all significantly overlap and are rarely experienced in a pure state. Much of what we call emotion is nothing more nor less than a certain kind—a biased, prejudiced, or strongly evaluative kind—of thought. But emotions and behaviors significantly influence and affect thinking, just as thinking influences emotions and behaviors. Evaluating is a fundamental characteristic of human organisms and seems to work in a kind of closed circuit with a feedback mechanism: First, perception biases response, and then response tends to bias subsequent perception. Also, prior perceptions appear to bias subsequent perceptions, and prior responses appear to bias subsequent responses. What we call feelings almost always have a pronounced evaluating or appraisal element.”

REBT then generally proposes that many of these self-defeating cognitive, emotive and behavioural tendencies are both innately biological and indoctrinated early in and during life, and further grow stronger as a person continually revisits, clings and acts on them. Ellis alludes to similarities between REBT and the general semantics when explaining the role of irrational beliefs in self-defeating tendencies, citing Alfred Korzybski as a significant modern influence on this thinking.

REBT differs from other clinical approaches like psychoanalysis in that it places little emphasis on exploring the past, but instead focuses on changing the current evaluations and philosophical thinking-emoting and behaving in relation to themselves, others and the conditions under which people live.

Irrational Beliefs

REBT proposes four core irrational beliefs;

  1. Demands: The tendency to demand success, fair treatment, and respect (e.g. I must be treated fairly).
  2. Awfulizing: The tendency to consider adverse events as awful or terrible (e.g. It is awful when I am disrespected).
  3. Low Frustration Tolerance (LFT): The belief that one could not stand or tolerate adversity (e.g. I cannot stand being treated unfairly).
  4. Depreciation: The belief that one event reflects the person as a whole (e.g. When I fail it shows that I am a complete failure).

Other Insights

Other insights of REBT (some referring to the ABCDEF model above) are:

  • Insight 1:
    • People seeing and accepting the reality that their emotional disturbances at point C are only partially caused by the activating events or adversities at point A that precede C.
    • Although A contributes to C, and although disturbed Cs (such as feelings of panic and depression) are much more likely to follow strong negative As (such as being assaulted or raped), than they are to follow weak.
    • As (such as being disliked by a stranger), the main or more direct cores of extreme and dysfunctional emotional disturbances (Cs) are people’s irrational beliefs – the “absolutistic” (inflexible) “musts” and their accompanying inferences and attributions that people strongly believe about the activating event.
  • Insight 2:
    • No matter how, when, and why people acquire self-defeating or irrational beliefs (i.e. beliefs that are the main cause of their dysfunctional emotional-behavioural consequences), if they are disturbed in the present, they tend to keep holding these irrational beliefs and continue upsetting themselves with these thoughts.
    • They do so not because they held them in the past, but because they still actively hold them in the present (often unconsciously), while continuing to reaffirm their beliefs and act as if they are still valid.
    • In their minds and hearts, the troubled people still follow the core “musturbatory” philosophies they adopted or invented long ago, or ones they recently accepted or constructed.
  • Insight 3:
    • No matter how well they have gained insights 1 and 2, insight alone rarely enables people to undo their emotional disturbances.
    • They may feel better when they know, or think they know, how they became disturbed, because insights can feel useful and curative.
    • But it is unlikely that people will actually get better and stay better unless they have and apply insight 3, which is that there is usually no way to get better and stay better except by continual work and practice in looking for and finding one’s core irrational beliefs; actively, energetically, and scientifically disputing them; replacing one’s absolute “musts” (rigid requirements about how things should be) with more flexible preferences; changing one’s unhealthy feelings to healthy, self-helping emotions; and firmly acting against one’s dysfunctional fears and compulsions.
    • Only by a combined cognitive, emotive, and behavioural, as well as a quite persistent and forceful attack on one’s serious emotional problems, is one likely to significantly ameliorate or remove them, and keep them removed.

Intervention

As explained, REBT is a therapeutic system of both theory and practice; generally one of the goals of REBT is to help clients see the ways in which they have learned how they often needlessly upset themselves, teach them how to “un-upset” themselves and then how to empower themselves to lead happier and more fulfilling lives. The emphasis in therapy is generally to establish a successful collaborative therapeutic working alliance based on the REBT educational model. Although REBT teaches that the therapist or counsellor is better served by demonstrating unconditional other-acceptance or unconditional positive regard, the therapist is not necessarily always encouraged to build a warm and caring relationship with the client. The tasks of the therapist or counsellor include understanding the client’s concerns from his point of reference and work as a facilitator, teacher and encourager.

In traditional REBT, the client together with the therapist, in a structured active-directive manner, often work through a set of target problems and establish a set of therapeutic goals. In these target problems, situational dysfunctional emotions, behaviours and beliefs are assessed in regards to the client’s values and goals. After working through these problems, the client learns to generalise insights to other relevant situations. In many cases after going through a client’s different target problems, the therapist is interested in examining possible core beliefs and more deep rooted philosophical evaluations and schemas that might account for a wider array of problematic emotions and behaviours. Although REBT much of the time is used as a brief therapy, in deeper and more complex problems, longer therapy is promoted.

In therapy, the first step often is that the client acknowledges the problems, accepts emotional responsibility for these and has willingness and determination to change. This normally requires a considerable amount of insight, but as originator Albert Ellis explains:

“Humans, unlike just about all the other animals on earth, create fairly sophisticated languages which not only enable them to think about their feeling, their actions, and the results they get from doing and not doing certain things, but they also are able to think about their thinking and even think about thinking about their thinking.”

Through the therapeutic process, REBT employs a wide array of forceful and active, meaning multimodal and disputing, methodologies. Central through these methods and techniques is the intent to help the client challenge, dispute and question their destructive and self-defeating cognitions, emotions and behaviours. The methods and techniques incorporate cognitive-philosophic, emotive-evocative-dramatic, and behavioural methods for disputation of the client’s irrational and self-defeating constructs and helps the client come up with more rational and self-constructive ones. REBT seeks to acknowledge that understanding and insight are not enough; in order for clients to significantly change, they need to pinpoint their irrational and self-defeating constructs and work forcefully and actively at changing them to more functional and self-helping ones.

REBT posits that the client must work hard to get better, and in therapy this normally includes a wide array of homework exercises in day-to-day life assigned by the therapist. The assignments may for example include desensitisation tasks, i.e. by having the client confront the very thing he or she is afraid of. By doing so, the client is actively acting against the belief that often is contributing significantly to the disturbance.

Another factor contributing to the brevity of REBT is that the therapist seeks to empower the client to help himself through future adversities. REBT only promotes temporary solutions if more fundamental solutions are not found. An ideal successful collaboration between the REBT therapist and a client results in changes to the client’s philosophical way of evaluating himself or herself, others, and his or her life, which will likely yield effective results. The client then moves toward unconditional self-acceptance, other-acceptance and life-acceptance while striving to live a more self-fulfilling and happier life.

Applications and Interfaces

Applications and interfaces of REBT are used with a broad range of clinical problems in traditional psychotherapeutic settings such as individual-, group- and family therapy. It is used as a general treatment for a vast number of different conditions and psychological problems normally associated with psychotherapy.

In addition, REBT is used with non-clinical problems and problems of living through counselling, consultation and coaching settings dealing with problems including relationships, social skills, career changes, stress management, assertiveness training, grief, problems with aging, money, weight control etc. More recently, the reported use of REBT in sport and exercise settings has grown, with the efficacy of REBT demonstrated across a range of sports.

REBT also has many interfaces and applications through self-help resources, phone and internet counselling, workshops & seminars, workplace and educational programmes, etc. This includes Rational Emotive Education (REE) where REBT is applied in education settings, Rational Effectiveness Training in business and work-settings and SMART Recovery (Self Management And Recovery Training) in supporting those in addiction recovery, in addition to a wide variety of specialised treatment strategies and applications.

Efficacy

REBT and CBT in general have a substantial and strong research base to verify and support both their psychotherapeutic efficiency and their theoretical underpinnings. Meta-analyses of outcome-based studies reveal REBT to be effective for treating various psychopathologies, conditions and problems. Recently, REBT randomised clinical trials have offered a positive view on the efficacy of REBT.

In general REBT is arguably one of the most investigated theories in the field of psychotherapy and a large amount of clinical experience and a substantial body of modern psychological research have validated and substantiated many of REBTs theoretical assumptions on personality and psychotherapy.

REBT may be effective in improving sports performance and mental health.

Limitations and Critique

The clinical research on REBT has been criticised both from within and by others. For instance, originator Albert Ellis has on occasions emphasized the difficulty and complexity of measuring psychotherapeutic effectiveness, because many studies only tend to measure whether clients merely feel better after therapy instead of them getting better and staying better. Ellis has also criticised studies for having limited focus primarily to cognitive restructuring aspects, as opposed to the combination of cognitive, emotive and behavioural aspects of REBT. As REBT has been subject to criticisms during its existence, especially in its early years, REBT theorists have a long history of publishing and addressing those concerns. It has also been argued by Ellis and by other clinicians that REBT theory on numerous occasions has been misunderstood and misconstrued both in research and in general.

Some have criticised REBT for being harsh, formulaic and failing to address deep underlying problems. REBT theorists have argued in reply that a careful study of REBT shows that it is both philosophically deep, humanistic and individualised collaboratively working on the basis of the client’s point of reference. They have further argued that REBT utilises an integrated and interrelated methodology of cognitive, emotive-experiential and behavioural interventions. Others have questioned REBTs view of rationality, both radical constructivists who have claimed that reason and logic are subjective properties and those who believe that reason can be objectively determined. REBT theorists have argued in reply that REBT raises objections to clients’ irrational choices and conclusions as a working hypothesis and through collaborative efforts demonstrate the irrationality on practical, functional and social consensual grounds. In 1998 when asked what the main criticism on REBT was, Albert Ellis replied that it was the claim that it was too rational and not dealing sufficiently enough with emotions. He repudiated the claim by saying that REBT on the contrary emphasizes that thinking, feeling, and behaving are interrelated and integrated, and that it includes a vast amount of both emotional and behavioural methods in addition to cognitive ones.

Ellis has himself in very direct terms criticised opposing approaches such as psychoanalysis, transpersonal psychology and abreactive psychotherapies in addition to on several occasions questioning some of the doctrines in certain religious systems, spiritualism and mysticism. Many, including REBT practitioners, have warned against dogmatising and sanctifying REBT as a supposedly perfect psychological panacea. Prominent REBTers have promoted the importance of high quality and programmatic research, including originator Ellis, a self-proclaimed “passionate sceptic”. He has on many occasions been open to challenges and acknowledged errors and inefficiencies in his approach and concurrently revised his theories and practices. In general, with regard to cognitive-behavioural psychotherapies’ interventions, others have pointed out that as about 30-40% of people are still unresponsive to interventions, that REBT could be a platform of reinvigorating empirical studies on the effectiveness of the cognitive-behavioural models of psychopathology and human functioning.

REBT has been developed, revised and augmented through the years as understanding and knowledge of psychology and psychotherapy have progressed. This includes its theoretical concepts, practices and methodology. The teaching of scientific thinking, reasonableness and un-dogmatism has been inherent in REBT as an approach, and these ways of thinking are an inextricable part of REBT’s empirical and sceptical nature.

I hope I am also not a devout REBTer, since I do not think it is an unmitigated cure for everyone and do accept its distinct limitations. (Albert Ellis).

Mental Wellness

As would be expected, REBT argues that mental wellness and mental health to a large degree results from an adequate amount of self-helping, flexible, logico-empirical ways of thinking, emoting and behaving. When a perceived undesired and stressful activating event occurs, and the individual is interpreting, evaluating and reacting to the situation rationally and self-helpingly, then the resulting consequence is, according to REBT, likely to be more healthy, constructive and functional. This does not by any means mean that a relatively un-disturbed person never experiences negative feelings, but REBT does hope to keep debilitating and un-healthy emotions and subsequent self-defeating behaviour to a minimum. To do this, REBT generally promotes a flexible, un-dogmatic, self-helping and efficient belief system and constructive life philosophy about adversities and human desires and preferences.

REBT clearly acknowledges that people, in addition to disturbing themselves, also are innately constructivists. Because they largely upset themselves with their beliefs, emotions and behaviours, they can be helped to, in a multimodal manner, dispute and question these and develop a more workable, more self-helping set of constructs.

REBT generally teaches and promotes:

  • That the concepts and philosophies of life of unconditional self-acceptance, other-acceptance, and life-acceptance are effective philosophies of life in achieving mental wellness and mental health.
  • That human beings are inherently fallible and imperfect and that they are better served by accepting their and other human beings’ totality and humanity, while at the same time they may not like some of their behaviours and characteristics.
    • That they are better off not measuring their entire self or their “being” and give up the narrow, grandiose and ultimately destructive notion to give themselves any global rating or report card.
    • This is partly because all humans are continually evolving and are far too complex to accurately rate; all humans do both self-defeating/socially defeating and self-helping / socially helping deeds, and have both beneficial and un-beneficial attributes and traits at certain times and in certain conditions.
    • REBT holds that ideas and feelings about self-worth are largely definitional and are not empirically confirmable or falsifiable.
  • That people had better accept life with its hassles and difficulties not always in accordance with their wants, while trying to change what they can change and live as elegantly as possible with what they cannot change.

On This Day … 03 March

People (Births)

  • 1883 – Cyril Burt, English psychologist and geneticist (d. 1971).

Cyril Burt

Sir Cyril Lodowic Burt, FBA (03 March 1883 to 10 October 1971) was an English educational psychologist and geneticist who also made contributions to statistics. He is known for his studies on the heritability of IQ. Shortly after he died, his studies of inheritance of intelligence were discredited after evidence emerged indicating he had falsified research data, inventing correlations in separated twins which did not exist.

What is PARfessionals?

Introduction

PARfessionals is an US, Arkansas-based, private research development firm for Peer Support and Recovery Providers in Addictions.

Background

The company was founded in 2011 by Jorea M. Kelley-Hardison She self-published the book “Getting Ahead: An Ex-Offenders Guide to Getting Ahead in Today’s Society”, where she encourages ex-offenders to participate in clinical research trials. She is mentioned in Dr. Jon Marc Taylor’s book “Prisoners’ Guerrilla Handbook to Correspondence Programs in the United States and Canada,” published by Prison Legal News in 2008.

Jorea Kelley-Hardison was taking classes to become a Clinical Research Coordinator (CRC) before she decided to transition into the addiction industry to become an Addictions Counsellor in 2009. Around that time, she received her CCJP – a status from the Texas Certification Board of Addiction Professionals and has been granted numerous credentials from the board, including the Peer Recovery Specialist (PRS), Peer Mentor/Peer Recovery Coach (PM-PRC) and the Associate Prevention Specialist (APS) credentials, but has since retired those credentials.

Jorea Kelley-Hardison earned a B.S. degree in Management in 2009 and has completed degree requirements in order to graduate with a M.A. in Criminal Justice from the American (Military) Public University System. She has also earned a graduate certificate in Applied Forensic Psychology Services from The Chicago School of Professional Psychology. In addition, she has obtained certificates in mental health, non-profit management, applied forensic psychology services, basic clinic research, family and business mediation, substance abuse, as well as emergency management. In addition, she has received training throughout the years in various important topics such as rape/domestic violence crisis intervention, hospice, and health unit coordination from various organizations and colleges including Parkland Health & Hospital System, Brookhaven College, Lakewood College, Centre for Degree Studies, Northwestern University Feinberg School of Medicine, Thomas Edison State College, University of Texas at Arlington-Continuing Education Division, and Richland College.

She is currently a member of the American Association on Intellectual and Developmental Disabilities, NAADAC – The Association of Addiction Professionals, National Alliance for Direct Support Professionals, National Association of Health Unit Coordinators, Psychiatric Rehabilitation Association and the International Association for Correctional and Forensic Psychology.

Brief History

In 2011, the word ” PARfessionals” was created by the company’s founder. In 2012, PARfessionals decided to develop the first peer-based online recovery coach training programme designed for those interested in mentoring individuals into and through long-term recovery from co-occurring disorders and other addictions and addictive behaviours.

In 2013, PARfessionals developed the first Peer Recovery/Addiction Recovery Coach Study Guide, a free Peer Recovery/Addiction Recovery Coach Curriculum Guide, a free Peer Recovery/Addiction Recovery Coach Practicum Guide and an online Peer Recovery/Addiction Recovery Coach Train the Trainers course. Additionally, PARfessionals’ founder and several family members applied for an ACE college credit review with The American Council On Education and then to Distance Education Accreditation Council (DEAC) in August 2015. After being rejected by DEAC, the founder contacted Charter State Oak College who in November 2015 about their program being recognised for college credit under their college assessment programme.

PARfessionals designed a Peer Recovery Facilitator Development e-Course in an effort to support the ongoing efforts of social service agencies, foundations, government agencies, and employers worldwide. This course would also work towards the development of community re-entry programs for inmates and workforce development skills for disadvantaged individuals such as ex-offenders, disabled individuals, low-income communities and minorities.

It was developed in collaboration with post-secondary educators and coaching experts for a diverse population with an array of learning skills who may be teaching, employing or supporting those who may be inmates, ex-offenders, mental health consumers, recovering addicts and individuals with intellectual and developmental disabilities. It provides adult-oriented learning strategies for a diverse group of individuals with different learning abilities.

The online Peer Recovery Facilitator Development e-Course was officially approved in 2014, by the Association for Addiction Professionals, also known as NAADAC.

In 2014, PARfessionals developed the first free Peer Recovery Support Specialist/Addiction Recovery Coach classroom curriculum kits in addition to a home study course, a correctional correspondence course for inmates, research journal, universal Code of Ethics and an international certification board. Additionally, PARfessionals’ founder created an in-house private virtual research institute, the Powell Leary Jacobs (PLJ) Multicultural Institute for Transformation Research in Addictions, to self-fund resources on Peer Recovery and Prevention. It was internally closed in 2014.

From 2013-2014, PARfessionals and its parent organisation, the SJM Family Foundation (which closed in January 2015 through the Texas Secretary of State) provided seven scholarships for eligible candidates from the general public who were devoted to seeking training for addiction treatment and peer recovery services.

Kelley-Hardison also established the International Certification Board of Recovery Professionals (ICBRP), the first ever, peer-run certification board created for peer recovery professionals in the world. The ICBRP’s mission was to be an independent, informal ad-hoc advisory board that provides guidance and accountability for the National Certified Peer Recovery Professionals (NCPRP) credentialing programme. However, it was later dissolved (through the Georgia Secretary of State in March 2015), and merged into PARfessionals’ private corporate structure.

In Spring 2017, The PARfessionals’ Cultural Intelligence in Addictions course supplemental student workbook was included in the German National Library.

As of August 2018, PARfessionals is a private product design and consulting firm doing business as PARfessionals Behavioural Health Research Development Corporation. The founder, Jorea Kelley-Hardison is a nationally certified psychiatric technician and social impact artist that has successfully worked with dozens of licensed professional clinicians and medical staff worldwide, including professionals from Harvard Medical School and the National Institute of Health. to create 45+ PARfessionals’ branded resources, including Peer Recovery Practicum Guide, a Peer Recovery Pre-Certification Review e-Course. a Peer Recovery Supervision Training Course, and Peer Recovery classroom curriculum kits.

In order to accomplish the company’s goals, Kelley-Hardison, along with members of the AR SJM Family, hired and privately paid independent contractors and freelancers, also Ms. Hardison and several of her family members working as volunteers using their own money, and collaborating with a group of qualified contracted experts from across the world that had acquired degrees, held additional credentials and had significant work experience in their own respective fields.

The Definition of “Peer Recovery”

The term peer recovery can be first defined through PARfessionals as “the process of giving and receiving encouragement and assistance to achieve long-term recovery. Peers offer emotional support, share knowledge, teaches skills, provide practical assistance, and connect people with resources, opportunities, communities of support, and other people”.

The Association for Addiction Professionals provides a different definition of recovery. According to William White, MA, “recovery is the experience… through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life”.

The International Certification & Reciprocity Consortium states that “peer recovery is experiencing rapid growth, whether it is provided by a peer recovery coach, peer recovery support specialist, peer navigator, patient navigators, public health learning navigators, behavioural health navigator or peer recovery mentor. Peer support services – advocating, mentoring, educating, and navigating systems – are becoming an important component in recovery oriented systems of care”.

IC&RC credentials and examinations, including Peer Recovery are administered exclusively by various certification and licensing boards in the United States and the world.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the US Department of Health and Human Services that leads public health efforts to advance the behavioural health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

SAMHSA states that:

Peer support services are delivered by individuals who have common life experiences with the people they are serving. People with mental and/or substance use disorders have a unique capacity to help each other based on a shared affiliation and a deep understanding of this experience. In self-help and mutual support, people offer this support, strength, and hope to their peers, which allows for personal growth, wellness promotion, and recovery.

Research has shown that peer support facilitates recovery and reduces health care costs. Peers also provide assistance that promotes a sense of belonging within the community. The ability to contribute to and enjoy one’s community is key to recovery and well-being. Another critical component that peers provide is the development of self-efficacy through role modeling and assisting peers with ongoing recovery through mastery of experiences and finding meaning, purpose, and social connections in their lives.”

Peer Recovery Navigator Academics Programme and (Micro-Certification) Registry

In 2012, PARfessionals developed the first globally recognised online training programme for peer recovery professionals. As of September 2015, PARfessionals offers an online distance learning pre-certification training course, a home study correspondence course and an inmate correspondence course for student-candidates to study at their own pace for global certification in peer recovery. The curriculum is based on proven research in order to make it the most specialised and comprehensive training programme for a new generation of Peer Recovery Professionals for a variety of settings.

Students worldwide have completed the training and shared their satisfaction with PARfessionals training programme.

PARfessionals developed its own exam and credential, NCPRP, which stands for “National Certified Peer Recovery Professional”.

The NCPRP credential and exam primarily emphasize the concept of peer recovery, with the main purpose of providing guidance, knowledge or assistance, especially among those with similar experiences who can meet as equals. The certification was integrated into the academic programme and renamed the PARfessionals’ Peer Recovery Workforce Development Certification Programme.

In Fall 2016, PARfessionals’ founder worked with qualified and licensed clinicians to create and sponsor the world’s first college level peer recovery training course and lifetime credential for the behavioural healthcare workforce, which was submitted and reviewed through the Connecticut Credit Assessment Programme and The Consortium for the Assessment of College Equivalence of Charter State College in Fall 2016.

Global Health Impact

Deloitte provides an annual look at the topics, trends, and issues impacting the global health care sector. According to its 2017 Global Healthcare Sector Outlook Infographic, “Peer support, self-management education, health coaching, and group activities, along with workforce training, and investments in the right technology” are “potential enablers of patient activation and engagement” and “key ingredients for productive health care operations”.

Behavioural Health Educational Mobile Apps

In February 2016, PARfessionals’ founder, Ms. Kelley Hardison started to partner with several independent app developers to develop Behavioural Health educational apps and games for the Addiction Peer Workforce.

Mobile Library Garden and Pocket Park Commemoration

In the fall of 2016, the AR SJM Family distributed two college preparatory guides, PARfessionals’ Peer Recovery/Cultural Intelligence in Addictions and PARfessionals’ Peer Recovery Navigator Practicum Guide to 240,000+ digital libraries and 2,000 digital publishers across the world. In 2017, the successful worldwide distribution was commemorated with a plaque in a mobile library garden and pocket park in Centennial, Texas.

Approvals

PARfessionals is an approved behavioural health training provider recognised by many states, national and international professional associations and state boards.

What is the National Board for Certified Counsellors?

Introduction

The National Board for Certified Counsellors, Inc. and Affiliates (NBCC) is an international certifying organisation for professional counsellors in the United States. It is an independent, not-for-profit credentialing organisation based in Greensboro, North Carolina. The purpose of the organisation is to establish and monitor a national certification system for professional counsellors, to identify certified counsellors, and to maintain a register of them.

NBCC has more than 66,000 certified counsellors across the US and in more than 40 countries. Its examinations for professional counsellors are used by all 50 states, the District of Columbia and Puerto Rico to license counsellors.

Brief History

In December 1979, the American Personnel and Guidance Association (APGA) Board of Directors approved a plan to create a generic counsellor certification registry. In February 1982, the APGA President chose the members of the first NBCC Board, and the board’s first meeting was in April 1982. In July 1982, NBCC was incorporated as a not-for-profit entity separate from APGA. The separation ensured an unbiased certification process and an assumption of liability on the part of NBCC.

The NBCC established and now monitors a national certification system, to identify for professionals and the public those counsellors who have voluntarily sought and obtained certification. Unlike other professional mental health entities such as the American Counselling Association (ACA), the American Psychological Association (APA), and the Association for Counsellor Education and Supervision (ACES), NBCC does not have members. Instead, NBCC sets its own policies and procedures for national certification in professional counselling, administers the National Counsellor Examination to applicants, and keeps a register of counsellors who achieve certification.

Since 2001, NBCC has worked to pass legislation adding licensed professional counsellors (LPC) and marriage and family therapists (MFT) to Medicare. Medicare is the largest health care programme in the United States and currently recognises psychiatrists, psychologists, clinical social workers and psychiatric nurses for outpatient mental health services, but does not reimburse LPCs or MFTs for behavioural health services. As a result, a client who sees an LPC or MFT has to immediately cease therapy at the age of 65, when the government mandates that they must leave their health insurance to enrol in Medicare. NBCC believes that this Medicare exclusion of LPCs and MFTs should be removed, because they can play an important role in a functioning mental health system by maximising the capacity of the behavioural health workforce.

Certifications

The certification programme recognises counsellors who have met predetermined standards in their training, experience, and performance on the National Counsellor Examination for Licensure and Certification (NCE).

National Certified Counsellor (NCC)

NBCC’s flagship certification is the National Certified Counsellor (NCC). The NCC is a generic certification for professional counsellors and does not designate a particular specialty area. Holding an NCC indicates that a counsellor is nationally board certified. There are currently over 63,000 NCCs in the US and many other countries.

The current requirements to become an NCC include:

  • A graduate degree in counselling (or one with a major in counselling) from a regionally accredited college or university.
  • At least 48 semester hours of graduate-level coursework, including at least one course in each of nine specified areas, as well as at least six semester hours of supervised field experience.
  • At least 3,000 hours of post-master’s counselling experience in an applied setting over a minimum of 24 months, 100 of which must be supervised by a qualified supervisor.
  • A passing score on the associated National Counsellor Exam (NCE).

After 01 January 2022, NCC applicants will be required to have a degree from a counsellor education programme accredited by the Council for Accreditation of Counselling and Related Educational Programmes (CACREP), which includes a minimum of 60 semester hours of coursework.

The NCC is the board certification for counsellors. It is not required for supervised or independent practice; it identifies counsellors who have voluntarily sought and met established professional standards, and who continue to fulfil requirements governing continuing education credits and certification renewal. Certification is not a substitute for state-mandated licensure. However, many states use the NCE examination as part of their licensing requirements.

Specialty Certifications

In addition to the NCC, NBCC administers three specialty certifications that each have the NCC credential as a prerequisite, along with other requirements.

  • Certified Clinical Mental Health Counsellor (CCMHC).
  • Master Addictions Counsellor (MAC).
  • National Certified School Counsellor (NCSC).

Affiliates and Divisions

Since its establishment in 1982, NBCC has expanded to include:

  • The Centre for Credentialing & Education (CCE):
    • Created in 1995, CCE provides practitioners and organisations with assessments, business support services, and credentialing in a variety of fields, including counselling supervision, coaching, distance counselling, and human services.
    • CCE manages the Mental Health Facilitator (MHF) programme, which educates community members and leaders in providing basic mental health care and resources to their neighbours, especially in locations where mental health care is difficult to access.
  • NBCC International (NBCC-I):
    • Created in 2003, NBCC-I’s purpose is to promote the counselling profession worldwide.
    • With a focus on cultural sensitivity and understanding, as well as public awareness of the meaning of quality in professional counselling, NBCC-I offers programmes and institutes all over the world. NBCC-I also manages the international portion of the MHF programme.
  • The NBCC Foundation (NBCCF):
    • Created in 2005, NBCCF uses scholarships, fellowships, and capacity-building grants to encourage counsellors and counsellors-in-training to pursue careers as professional counsellors serving high-priority populations.
    • Increasing access to mental health care in rural, military, and minority communities is a major focus for NBCCF.
  • The European Board for Certified Counsellors (EBCC):
    • Created in 2010, EBCC is the hub for NBCC-I’s work in Europe.
    • EBCC provides support for European countries that are developing their own professional counselling efforts.
  • The Professional Counsellor (TPC):
    • Published by NBCC since 2011, TPC is a peer-reviewed, open-access, academic journal.
    • It is published online in a continuous format, and covers a wide range of topics including: mental and behavioural health counselling; school counselling; career counselling; couple, marriage, and family counselling; counselling supervision; theory development; professional counselling ethics; international counselling and multicultural issues; programme applications; and integrative reviews from counselling and related fields.