Tag: Treatment

Book: Mindfulness Meditation in Psychotherapy

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Book Title:

Mindfulness Meditation In Psychotherapy – An Integrated Model For Clinicians.

Author(s): Steven A. Alper, MSW LCSW.

Year: 2016.

Edition: First (1st), Illustrated Edition.

Publisher: Context Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Embodying mindfulness allows both therapists and clients to make the most of treatment sessions. More than just a guide to techniques and benefits, this book provides a comprehensive understanding of mindfulness meditation, and shows how to effectively incorporate mindfulness into every aspect of the therapeutic process.

Mindfulness is not simply a therapeutic tool that can be used at a specific time. If you are a psychotherapist interested in implementing mindfulness practices into your therapy sessions, you must first embody a mindful presence yourself. In Mindfulness Meditation in Psychotherapy, psychotherapist Steven Alper presents the mindfulness pyramid model, an easy-to-use reference approach for integrating mindfulness into the very fabric of your therapy sessions – in every action you take.

A therapist’s mindfulness practice and the mindful activity during sessions forms the foundation of clients’ mindfulness practice. This practical guide will help demystify mindfulness meditation; elaborate on the psychotherapeutic benefits of practices such as body scan, breath awareness, sitting meditation, and lovingkindness; and offer helpful strategies for teaching formal and informal mindfulness skills to clients. This book conceptualises and explores the applicability of mindfulness and delves into the many ways in which mindfulness can manifest in psychotherapy.

This is a must-have resource for any therapist interested in honing their own mindfulness practice and incorporating mindfulness in treatment sessions.

Book: Mental Health and Well-being in Animals

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Book Title:

Mental Health and Well-being in Animals.

Author(s): Dr Franklin D. McMillan (Editor).

Year: 2019.

Edition: Second (2nd).

Publisher: CABI Publishing.

Type(s): Hardcover and Kindle.

Synopsis:

The second edition is fully revised, expanded, and comprehensively updated with the most current knowledge about the full array of mental health issues seen in animals.

Written by key opinion leaders, internationally-recognized experts and specialists, it is comprehensive covering basic principles to mental wellness, emotional distress, suffering and mental illness, through to measurement and treatment.

With even more practical information and clinical pearls, this book remains invaluable to veterinary professionals, animal welfare researchers and advocates, and other animal caregivers.

Book: The Anxiety and Worry Workbook

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300300

Book Title:

The Anxiety and Worry Workbook: The Cognitive Behavioural Solution.

Author(s): David A. Clark and Aaron T. Beck.

Year: 2011.

Edition: First (1st), Illustrated Edition.

Publisher: The Guildford Press.

Type(s): Paperback and Kindle.

Synopsis:

If you are seeking lasting relief from out-of-control anxiety, this is the book for you. It is grounded in cognitive behaviour therapy (CBT), the proven treatment approach developed and tested over more than 25 years by pioneering clinician-researcher Aaron T. Beck.

Now Dr. Beck and fellow CBT expert David A. Clark put the tools and techniques of CBT at your fingertips in this compassionate guide. Carefully crafted worksheets (you can download and print additional copies as needed), exercises, and examples reflect the authors’ decades of experience helping people just like you.

Learn practical strategies for identifying your anxiety triggers, challenging the thoughts and beliefs that lead to distress, safely facing the situations you fear, and truly loosening anxiety’s grip – one manageable step at a time.

Book: Abnormal Psychology

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300300

Book Title:

Abnormal Pyschology.

Author(s): Ronald J. Comer and Jonathan S. Comer.

Year: 2018.

Edition: Tenth (10th).

Publisher: Worth Publihsers.

Type(s): Hardback.

Synopsis:

Taking a look at the field of abnormal psychology, including major theoretical models of abnormality, research directions, clinical experiences, therapies and controversies, this book covers personality disorders, the psychodynamic perspective, neuroscience, the ’empirically-based treatment’ movement, and more.

Medical Students & Doctors: Mental Health & Stigma

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Research Paper Title

Reducing Mental Health Stigma in Medical Students and Doctors towards their Peers with Mental Health Difficulties: A Protocol.

Background

Mental health problems are over-represented in doctors and medical students. However, stigma and ‘a culture of shame’ are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment.

Indeed, a recent study on over 2,100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma.

Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken).

Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psychotic episode. An independent inquiry into Dr Emson’s death concluded that she was the victim of stigma in the National Health Service.

The mental health of medical students and doctors, in all of its aspects, must therefore be addressed with the urgency that it demands. Stephanie Knaak and colleagues conducted a data synthesis of evaluative studies on anti-stigma programmes for healthcare providers and identified six key ingredients one of which was a personal testimony from a trained speaker who has lived experience of mental illness.

In this paper the authors outline a study protocol with the aim of answering the following research question, ‘Does attending an anti-stigma programme comprised of a medic with first-hand experience of a mental health condition cause immediate and sustained reductions in mental health stigma from medical students and doctors towards their peers with mental health difficulties?’

Reference

Hankir, A., Fletcher-Rogers, J., Ogunmuyiwa, J., Carrick. F.R. & Zaman, R. (2020) Reducing Mental Health Stigma in Medical Students and Doctors towards their Peers with Mental Health Difficulties: A Protocol. Psychiatria Danubina. 32(Suppl 1), pp.130-134.

Eating Disorders: Linking Self, Other, & Gaze

Published on by Andrew Marshall1 Comment

Research Paper Title

The Pathogenic and Therapeutic Potential of the Gaze of the Other in the Clinic of “Eating Disorders”.

Background

Building on the optical-coenaesthetic disproportion model of so-called eating disorders, this paper provides a framework for the psychotherapy of people affected by these conditions.

This model characterises “eating disorders” as disorders of embodiment and identity, where a sense of unfamiliarity with one’s own flesh, experienced as shifting and incomprehensible, leads to an impairment in the constitution of the Self and thus of one’s own identity.

Since there is a deficit of the coenaesthetic experience of the embodied Self, greater importance is assumed by body perception conveyed from without. To these persons, their corporeality is principally given as a body-object “to be seen” from a third-person perspective, rather than as a body-subject “to be felt” from a first-person perspective.

The Other’s look serves as an optical prosthesis to cope with dis-coenaesthesia and as a device through which these persons can define themselves. They are unable to accept the hiatus between “being a body” and “having a body,” constitutively present in every human being, forcibly trying to recouple it, and finally ending up objectifying themselves to succeed.

The external foundation of the Self thus takes the form of a constriction one can never be completely free of. Psychotherapy should thus accompany persons affected by eating disorders in their encounter with the miscarried dialectic between feeling oneself from within and seeing oneself from without through the gaze of the Other, so keenly feared by people desperately in search of self-control.

Tactfully, the clinician accompanies the patient in taking a stance towards their symptom as the outcome of this miscarried dialectics, which is one premise for overcoming it.

The clinician’s gaze becomes the herald of recognition, allowing the patient to feel accepted in terms of their individuality. Feeling themselves touched by a gaze that waives its alienating potential in order to signify acceptance reactivates the identity-forming dialectics. Their body is thus revealed as the receiver of gazes, but also rediscovers its own possibility for self-determination starting out from these gazes.

This intersubjective resonance between the clinician’s gaze and the patient reactivates the identity-making dialectics between body-subject and body-object, creating the relational premises for overcoming the symptom.

Reference

Esposito, C.M. & Stanghellini, G. (2020) The Pathogenic and Therapeutic Potential of the Gaze of the Other in the Clinic of “Eating Disorders”. Psychopathology. 1-7. doi: 10.1159/000509625. Online ahead of print.

The Same or Different? Precision vs Personalised Psychiatry

Published on by Andrew Marshall1 Comment

Research Paper Title

‘Precision’ or ‘personalised’ psychiatry: different terms – same content?

Background

Due to the increased lifetime prevalence and personal, social, and economic burden of mental disorders, psychiatry is in need of a significant change in several aspects of its clinical and research approaches.

Over the last few decades, the development of personalised/precision medicine in psychiatry focusing on tailored therapies that fit each patient’s unique individual, physiological, and genetic profile has not achieved the same results as those obtained in other branches, such as oncology.

The long-awaited revolution has not yet surfaced.

There are various explanations for this including imprecise diagnostic criteria, incomplete understanding of the molecular pathology involved, absence of available clinical tools and, finally, the characteristics of the patient.

Since then, the co-existence of the two terms has sparked a great deal of discussion around the definition and differentiation between the two types of psychiatry, as they often seem similar or even superimposable.

Generally, the two terminologies are used indiscriminately, alternatively, and/or separately, within the same scientific works.

In this paper, an overview is provided on the overlap between the application and meaning of the terms ‘precision psychiatry’ and ‘personalised psychiatry’.

Reference

Perna, G., Cuniberti, F. Dacco, S., Grassi, M. & Caldirola, D. (2020) ‘Precision’ or ‘personalized’ psychiatry: different terms – same content? Fortschritte der Neurologie-Psychiatre. doi: 10.1055/a-1211-2722. Online ahead of print.

Examining National Trends in the Care of Different Mental Health Problems & in Different Treatment Settings among Adolescents

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National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.

Research Paper Title

National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.

What is the Role of Telehealth in Reducing the Mental Health Burden from COVID-19?

Published on by Andrew Marshall1 Comment

Research Paper Title

The Role of Telehealth in Reducing the Mental Health Burden from COVID-19.

Background

The psychological impact of the coronavirus disease 2019 (COVID-19) pandemic must be recognized alongside the physical symptoms for all those affected. Telehealth, or more specifically telemental health services, are practically feasible and appropriate for the support of patients, family members, and health service providers during this pandemic. As of March 18, 2020, there were >198,000 COVID-19 infections recorded globally, and 7,900 deaths. Psychological symptoms relating to COVID-19 have already been observed on a population level including anxiety-driven panic buying and paranoia about attending community events. Students, workers, and tourists who have been prevented from accessing their training institutions, workplaces, homes, respectively, are expected to have developed psychological symptoms due to stress and reduced autonomy and concerns about income, job, security, and so on. The Chinese, Singaporean, and Australian governments have highlighted the psychological side effects of COVID-19, and have voiced concerns regarding the long-term impacts of isolation and that the fear and panic in the community could cause more harm than COVID-19.

In the absence of a medical cure for COVID-19, the global response is a simple public health strategy of isolation for those infected or at risk, reduced social contact to slow the spread of the virus, and simple hygiene such as hand washing to reduce the risk of infection. While the primary intervention of isolation may well achieve its goals, it leads to reduced access to support from family and friends, and degrades normal social support systems and causes loneliness, and is a risk for worsening anxiety and depressive symptoms. If left untreated, these psychological symptoms may have long-term health effects on patients and require treatment adding to the cost burden of managing the illness. Clinical and nonclinical staff are also at risk of psychological distress as they are expected to work longer hours with a high risk of exposure to the virus. This may also lead to stress, anxiety, burnout, depressive symptoms, and the need for sick or stress leave, which would have a negative impact on the capacity of the health system to provide services during the crisis.

Treatment protocols for people with COVID-19 should address both the physiological and psychological needs of the patients and health service providers. Providing psychological treatment and support may reduce the burden of comorbid mental health conditions and ensure the well-being of those affected. Our challenge is to provide mental health services in the context of patient isolation, which highlights the role of telehealth (through videoconference, e-mail, telephone, or smartphone apps). The provision of mental health support (especially through telehealth) will likely help patients maintain psychological well-being and cope with acute and post-acute health requirements more favourably.

Examples of and evidence to support the effectiveness of telemental health are fairly diverse, especially in the context of depression, anxiety, and PTSD. Videoconferencing, online forums, smartphone apps, text-messaging, and e-mails have been shown to be useful communication methods for the delivery of mental health services.

China is actively providing various telemental health services during the outbreak of COVID-19. These services are from government and academic agencies and include counseling, supervision, training, as well as psychoeducation through online platforms (e.g., hotline, WeChat, and Tencent QQ). Telemental health services have been prioritised for people at higher risk of exposure to COVID-19, including clinicians on the frontline, patients diagnosed with COVID-19 and their families, policemen, and security guards. Early reports also showed how people in isolation actively sought online support to address mental health needs, which demonstrated both a population interest and acceptance of this medium.

Additional telehealth services have been previously funded by the Australian Government (Better Access Initiative programme), to address mental health needs of rural and remote patients during emergency situations, such as long-term drought and bushfires. In response to COVID-19, the Australian Government has responded with additional funded services through the Medicare Benefits Schedule, enabling a greater range of telehealth services to be delivered, including telehealth consultations with general practitioners and specialists. However, the expanded telehealth programme is restricted to special needs groups and the wider population does not have access to the programme. A major benefit of expanding telehealth, including mental health, with no restrictions would reduce person-to-person contact between health service providers and COVID-19 and reduce the risk of exposure of non-infected but susceptible patients in waiting room areas. To date, most of the Australian Government’s focus has been on managing medical needs of people during the epidemic, rather than providing resources to meet short- and long-term mental health implications. An expansion of access to telemental health support services with a focused public education campaign to promote these services would begin to address this need.

Communication of all health needs is important when patients are having to be isolated. The researchers support the use of telehealth as a valuable way of supporting both physical and psychosocial needs of all patients irrespective of geographical location. Simple communication methods such as e-mail and text messaging should be used more extensively to share information about symptoms of burnout, depression, anxiety, and PTSD during COVID-19, to offer cognitive and/or relaxation skills to deal with minor symptoms, and to encourage access to online self-help programmes. For people with COVID-19, telehealth can be used to monitor symptoms and also to provide support when needed.

While there is growing awareness of mortality rates associated with COVID-19, we should also be cognisant of the impact on mental health – both on a short- and a long-term basis. Telemental health services are perfectly suited to this pandemic situation – giving people in remote locations access to important services without increasing risk of infection.

Reference

Zhou, X., Snoswell,, C.L., Harding, L.E., Bambling, M., Edirippulige, S., Bai, X. & Smith, A.C. (2020) The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine and e-Health. 26(4). https://doi.org/10.1089/tmj.2020.0068.

A Statement on the Mental Health Issues and Psychological Factors in Athletes

Published on by Andrew Marshall1 Comment

Research Paper Title

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance and Prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary.

Background

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes.

This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes.

It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness.

The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport.

Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention.

This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

Reference

Chang, C., Putukian, M., Aerni, G., Diamond, A., Hong, G., Ingram, Y., Reardon, C.L. & Wolanin, A. (2020) Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance and Prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary. British Journal of Sports Medicine. 54(4), pp.216-220. doi: 10.1136/bjsports-2019-101583. Epub 2019 Dec 6.