RxPG News : Psychotherapy

CBT is highly effective in Dental Phobia

Fri, 02 Sep 2011 23:37:56 PST

( from http://www.rxpgnews.com ) People with severe dental phobia may be able to overcome their anxieties with a single session of cognitive behavioural therapy (CBT), research published in the latest issue of the British Dental Journal (BDJ) suggests.

The authors of the study, based on an initial pilot of 60 patients who relied on having intravenous sedation before they could undergo dental treatment, concluded that the benefits were of such significance that they advise dental providers to implement this approach now rather than wait to pursue further research. They point out that patients benefit from not being exposed to the health risks associated with repeated intravenous sedation; and this approach saves money for the NHS.

The initial cohort of 60 patients had all attended a specialist dental clinic in Sheffield for people with severe dental phobia. Half the group were offered CBT, with 21 patients accepting the treatment. Twenty of these went on to have dental treatment without having to be sedated. An audit of these patients a decade later found that of the 19 patients located who had had CBT, none had returned to sedation in the intervening 10-year period.

The benefits of having CBT for severe dental phobia appear to endure over time, the authors of A joint approach to treating dental phobia: A re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on, conclude.

The latest 10-yearly survey on adult dental health published earlier this year by the NHS Information Centre suggests that as many as 12 per cent of people may experience extreme dental anxiety.

Professor Damien Walmsley, the BDA’s scientific adviser, said:

“Dental phobia is a serious problem because it deters some people from ever going to the dentist, except when they are in severe pain. At this stage, they may require more invasive treatment than might be the case if they went to the dentist regularly. Sadly, this cycle of anxiety, non-attendance and pain is often repeated in the children of those with dental phobia, perpetuating the problem and feeding another generation of oral health problems.

“CBT is one of a range of techniques than can be used to make the experience comfortable for patients who feel especially anxious about having dental treatment, and the results of this study look promising for those who experience severe dental phobia.

“All dentists are highly-skilled, caring health professionals who are trained to put patients at ease. Many also undertake additional training in techniques, such as hypnosis, and acupuncture, and of course, CBT.”

Schema therapy offers hope for mental disorder patients

Sat, 21 Nov 2009 12:24:04 PST

( from http://www.rxpgnews.com ) Patients coping with mental disorders can now look forward to major changes in their lives through an innovative treatment called Schema Therapy -.

Schema therapists help patients change their entrenched, self-defeating life patterns - or schemas - using cognitive, behavioural, and emotion-focused techniques.

Three major outcome studies have shown that many patients with 'borderline personality disorder' - can fully recover across the complete spectrum of symptoms.

In one study, ST was shown to be more than twice as effective in bringing about full recovery as a widely-practiced traditional treatment. It was also found to be more cost-effective and to have a much lower dropout rate.

In a second study, group ST led to even stronger outcomes than those in the previous investigation over a briefer period with a zero percent drop out rate and a recovery rate of 94 percent over an eight month period.

A third study, now in press, shows that individual ST can be successfully implemented in regular mental health care settings with no loss of effectiveness.

While other specialised treatments for BPD have demonstrated empirical support, all but ST have serious limitations in their impact on patients' functioning and quality of life, says a release of the International Society of Schema Therapy.

Dutch investigators, including Josephine Giesen-Bloo and Arnoud Arntz, were associated with the study along with Joan Farrell, Ida Shaw and Michael Webber of the Indiana University School of Medicine.

The first of these studies was reported in the Archives of General Psychiatry, published by the American Medical Association, the second published in the Journal of Behavioural Therapy and Experimental Psychiatry and the third will soon be appearing in Behaviour Research and Therapy.

These findings will be published by the Cambridge University Press this year.

Innovative Brain Imaging Identify Brain Abnormalities In Borderline Personality Disorder

Sun, 23 Dec 2007 03:45:04 PST

( from http://www.rxpgnews.com ) Using new approaches, an interdisciplinary team of scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City has gained a view of activity in key brain areas associated with a core difficulty in patients with borderline personality disorder—shedding new light on this serious psychiatric condition.

"It's early days yet, but the work is pinpointing functional differences in the neurobiology of healthy people versus individuals with the disorder as they attempt to control their behavior in a negative emotional context. Such initial insights can help provide a foundation for better, more targeted therapies down the line," explains lead researcher Dr. David A. Silbersweig, the Stephen P. Tobin and Dr. Arnold M. Cooper Professor of Psychiatry and Professor of Neurology at Weill Cornell Medical College, and attending psychiatrist and neurologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Borderline personality disorder is a devastating mental illness that affects between 1 to 2 percent of Americans, causing untold disruption of patients' lives and relationships. Nevertheless, its underlying biology is not very well understood. Hallmarks of the illness include impulsivity, emotional instability, interpersonal difficulties, and a preponderance of negative emotions such as anger—all of which may encourage or be associated with substance abuse, self-destructive behaviors and even suicide.

"In this study, our collaborative team looked specifically at the nexus between negative emotions and impulsivity—the tendency of people with borderline personality disorder to 'act out' destructively in the presence of anger," Dr. Silbersweig explains. "Other studies have looked at either negative emotional states or this type of behavioral disinhibition. The two are closely connected, and we wanted to find out why. We therefore focused our experiments on the interaction between negative emotional states and behavioral inhibition."

Advanced brain-scanning technologies developed by the research team made it possible to detect the brain areas of interest with greater sensitivity.

"Previous work by our group and others had suggested that an area at the base of the brain within the ventromedial prefrontal cortex was key to people's ability to restrain behaviors in the presence of emotion," Dr. Silbersweig explains.

Unfortunately, tracking activity in this brain region has been extremely difficult using functional MRI (fMRI). "Due to its particular location, you get a lot of signal loss," the researcher explains.

However, the Weill Cornell team used a special fMRI activation probe that they developed to eliminate much of that interference. This paved the way for the study, which included 16 patients with borderline personality disorder and 14 healthy controls.

The team also used a tailored fMRI neuropsychological approach to observe activity in the subjects' ventromedial prefrontal cortex as they performed what behavioral neuroscience researchers call "go/no go" tests.

These rapid-fire tests require participants to press or withhold from pressing a button whenever they receive particular visual cues. In a twist from the usual approach, the performance of the task with negative words (related to borderline psychology) was contrasted with the performance of the task when using neutral words, to reveal how negative emotions affect the participants' ability to perform the task.

As expected, negative emotional words caused participants with borderline personality disorder to have more difficulty with the task at hand and act more impulsively—ignoring visual cues to stop as they repeatedly pressed the button.

But what was really interesting was what showed up on fMRI.

"We confirmed that discrete parts of the ventromedial prefrontal cortex—the subgenual anterior cingulate cortex and the medial orbitofrontal cortex areas—were relatively less active in patients versus controls," Dr. Silbersweig says. "These areas are thought to be key to facilitating behavioral inhibition under emotional circumstances, so if they are underperforming that could contribute to the disinhibition one so often sees with borderline personality disorder."

At the same time, the research team observed heightened levels of activation during the tests in other areas of the patients' brains, including the amygdala, a locus for emotions such as anger and fear, and some of the brain's other limbic regions, which are linked to emotional processing.

"In the frontal region and the amygdala, the degree to which the brain aberrations occurred was closely correlated to the degree with which patients with borderline personality disorder had clinical difficulty controlling their behavior, or had difficulty with negative emotion, respectively," Dr. Silbersweig notes.

The study sheds light not only on borderline personality disorder, but on the mechanisms healthy individuals rely on to curb their tempers in the face of strong emotion.

Still, patients struggling with borderline personality disorder stand to benefit most from this groundbreaking research. An accompanying journal commentary labels the study "rigorous" and "systematic," and one of the first to validate with neuroimaging what scientists had only been able to guess at before.

"The more that this type of work gets done, the more people will understand that mental illness is not the patient's fault—that there are circuits in the brain that control these functions in humans and that these disorders are tied to fundamental disruptions in these circuits," Dr. Silbersweig says. "Our hope is that such insights will help erode the stigma surrounding psychiatric illness."

As pointed out in the commentary, the research may help explain how specific biological or psychological therapies could ease symptoms of borderline personality disorder for some patients, by addressing the underlying biology of impulsivity in the context of overwhelming negative emotion. The more scientists understand the neurological aberrations that give rise to the disorder, the greater the hope for new, highly targeted drugs or other therapeutic interventions.

"Going forward, we plan to test hypotheses about changes in these brain regions associated with various types of treatment," Dr. Silberswieg says. "Such work by ourselves and others could help confirm these initial findings and point the way to better therapies."

Support groups don't extend survival of metastatic breast cancer patients, Stanford study finds

Mon, 23 Jul 2007 04:00:00 PST

( from http://www.rxpgnews.com ) A new study from a team of Stanford University School of Medicine researchers led by David Spiegel, MD, shows that participating in support groups doesn't extend the lives of women with metastatic breast cancer. The results differ from oft-cited previous findings by Spiegel that showed group psychotherapy extended survival time.

The newest research did, however, confirm that support groups improved quality of life for the participants, and showed a survival benefit for a subgroup of patients with an aggressive form of breast cancer.

We didn't confirm earlier observations that group psychotherapy extends overall survival for women with metastatic breast cancer, but we did again show a positive effect on mood and pain, said Spiegel, professor and associate chair of psychiatry and behavioral sciences. I still very much believe this type of therapy is crucial to cancer care.

The paper will be published in the Sept. 1 issue of CANCER, the journal of the American Cancer Society, and will appear in the online version of the journal on July 23.

Spiegel is well-known for his work on support groups for cancer patients. His studies and others have previously shown the groups can lead to better coping, improved mood, and reduced pain, depression and anxiety for cancer patients. When Spiegel started his research in the 1970s, virtually no cancer patients were in support groups, he said, but now the therapy is a much more accepted part of cancer care.

Almost every cancer center, including Stanford's, offers some sort of support group, he pointed out.

In 1989, Spiegel garnered the attention of oncologists and others when he published a study in the journal The Lancet showing dramatic benefits of support groups. His study of 86 metastatic breast cancer patients found those women who were randomly assigned to attend support groups for one year experienced less depression and pain and also wound up living 18 months longer (37 vs. 19 months) than those who weren't. We were shocked when we saw the magnitude of the effect, Spiegel told the New York Times that year.

In the years since, numerous researchers have attempted to replicate Spiegel's findings, with mixed results. According to Spiegel, four other published trials found that the therapy produced both psychological and survival benefits; this includes a recently published Journal of Clinical Oncology study with a 10-year follow-up. Six published studies, including a 2001 New England Journal of Medicine study involving 235 metastatic breast cancer patients, found that group therapy helped improve quality of life but did not lengthen survival.

Spiegel launched the latest prospective study in 1991, tracking 125 metastatic breast cancer patients for periods of up to 10 years in an effort to replicate his original findings. The women, whose cancers were comparable in type and prognosis, were randomly assigned to either group support, psychotherapy and educational materials, or to educational materials alone. The 64 women assigned to group support met for 90 minutes once a week for at least one year; some participated for as long as 10 years. Spiegel recalls one participant remarking, This group is the least superficial thing I do in my life.

After tracking the women for more than a decade, Spiegel and his colleagues found an improvement in the therapy participants' level of distress, anxiety and pain. They did not, however, find a difference in overall survival between those women who attended therapy and those who didn't. The women who attended group therapy had a median survival of 31 months, and the group that received education materials alone survived a median of 33 months.

The big question was whether there was an overall survival advantage for those people in therapy, and the answer was no, said Spiegel. I was surprised and a little disappointed by the findings.

One possibility for the difference between his earlier study and this one, Spiegel said, is that both the medical treatments and the emotional climate for breast cancer patients have improved dramatically, making it more likely for patients to live longer even without the benefit of psychotherapy.

Spiegel notes that he and his colleagues did find psychotherapy benefited women with estrogen receptive-negative tumors, an aggressive type of breast cancer that fails to respond to the newest hormonal treatments. These women - who comprised 20 percent of the study group - had a median survival of almost 30 months, which was 21 months longer than those who received educational literature alone.

Had we not found this sub-group effect, I might have said we're done doing research in this area, said Spiegel. But this finding looks really interesting, and it's something to continue studying.

Spiegel said that despite the overall findings on survival, it remains very clear that support groups provide great benefits to cancer patients and should be an important part of treatment. I've never told my patients to join a support group because it makes you live longer - I've said to do it because it helps you to live better, he said.

Study: Discriminating fact from fiction in recovered memories of childhood sexual abuse

Thu, 21 Jun 2007 04:00:00 PST

( from http://www.rxpgnews.com ) A decade or so ago, a spate of high profile legal cases arose in which people were accused, and often convicted, on the basis of "recovered memories." These memories, usually recollections of childhood abuse, arose years after the incident occurred and often during intensive psychotherapy.

So how accurate are recovered memories The answer is not so clear. In fact, this question has lead to one of the most contentious issues in the fields of psychology and psychiatry.

Elke Geraerts, a postdoc of psychology at Harvard University and Maastricht University, the Netherlands, hoped to settle some of the controversy by enacting a large-scale research study examining the validity of such memories.

Recovered memories are inherently tricky to validate for several reasons, most notably because the people who hold them are thoroughly convinced of their authenticity. Therefore, to maneuver around this obstacle Geraerts and her colleagues attempted to corroborate the memories through outside sources.

The researchers recruited a sample of people who reported being sexually abused as children and divided them based on how they remembered the event. The memories were categorized as either "spontaneously recovered" (the participant had forgotten and then spontaneously recalled the abuse outside of therapy, without any prompting), "recovered in therapy" (the participant had recovered the abuse during therapy, prompted by suggestion) or "continuous" (the participant had always been able to recall the abuse).

Once all of the information was gathered, interviewers, who were blind to the type of abuse memory, queried other people who could confirm or refute the abuse events (other people who heard about the abuse soon after it occurred, other people who reported also having been abused by the same perpetrator, or people who admitted having committed the abuse him/herself).

The results showed that, overall, spontaneously recovered memories were corroborated about as often (37% of the time) as continuous memories (45%). Thus, abuse memories that are spontaneously recovered may indeed be just as accurate as memories that have persisted since the time the incident took place. Interestingly, memories that were recovered in therapy could not be corroborated at all.

Although the absence of confirmation that the abuse had happened does not imply that the memory is false, the findings of this study show that memories recovered in therapy should be viewed with a cautious eye, as "the therapy context often involves an explicit effort to unearth forgotten memories and thereby raises the opportunity for suggestion."

Borderline personality disorder shows improvements with transference-focused psychotherapy

Wed, 06 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) An intensive form of talk therapy, known as transference-focused psychotherapy (TFP), can help individuals affected with borderline personality disorder (BPD) by reducing symptoms and improving their social functioning, according to an article in the June issue of the American Journal of Psychiatry, a premier psychiatry journal.

BPD, a chronic and disabling condition affecting about 1% of the United States population, has long defied psychologists and psychiatrists seeking to treat the illness. Affecting day-to-day functions, symptoms of the illness include unstable relations with others, pervasive mood instability, chaotic variation in self-image, self-destructive behavior, impulsive behaviors (such as sexual promiscuity, substance abuse, or gambling), and intense, uncontrolled rages.

In the new study, Mark F. Lenzenweger, distinguished professor of psychology at Binghamton University, State University of New York, and colleagues at the Weill College of Medicine, Cornell University, examined three treatments applied to carefully diagnosed BPD patients for a period of one year.

The treatments included dialectical behavior therapy, supportive psychotherapy, and TFP, a specialized psychodynamic form of talk therapy, pioneered by Otto F. Kernberg, a study co-author and professor of psychiatry at Weill-Cornell, that focuses on dominant emotionally charged themes that emerge in the relationship between patient and therapist.

As the patients moved through the yearlong treatments, they were carefully assessed on a wide range of psychiatric symptom and functioning domains, such as depression, anger, social functioning, suicidal behaviors, impulsivity, social adjustment, and various forms of irritability and aggression.

At the end of the year of treatment, a detailed examination of the change revealed that the BPD patients in the TFP treatment showed improvement in ten out of the twelve domains studied.

"The improvements for the TFP patients were not merely statistically reliable, but they represented fairly impressive scientific effects, not just trivial changes," said Lenzenweger. TFP not only helped reduced suicidal behaviors, but also seemed particularly helpful in reducing irritability and angry behaviors.

Kernberg noted, We are pleased about the progress in the empirical development of a psychoanalytic treatment for borderline patients that focuses on the personality, rather than simply on symptoms, yet also shows improvements in symptoms.

The study also included dialectical behavior therapy (or DBT), which is a cognitively based therapy. Supportive therapy also has its roots in psychoanalytic methods, but differs substantially from TFP.

"This is the first study to compare DBT, considered by many to be the standard, with two psychodynamic treatments," said John F. Clarkin, the lead author on the study and professor of clinical psychology at Weill-Cornell.

A major implication of the study is that all three treatments show some effect in alleviating the impact of BPD. The weight of the evidence in the study importantly suggests that TFP and supportive psychotherapy are both viable alternatives to DBT for the treatment of BPD.

"We hope to explore the results of the study further to determine what factors predicted the best outcomes," said Lenzenweger. "And of course, we hope to use these results to further guide our development of basic studies in the neuroscience and genomics of BPD."

Physiologic measurements suggest biologic component to feelings of empathic connection

Wed, 14 Feb 2007 00:45:11 PST

( from http://www.rxpgnews.com ) Empathy is well known to be an important component of the patient-therapist relationship, and a new study has revealed the biology behind how patients and therapists “connect” during a clinical encounter. In the February Journal of Nervous and Mental Diseases, researchers from Massachusetts General Hospital (MGH) report the first physiologic evidence of shared emotions underlying the experience of empathy during live psychotherapy sessions. The researchers found that, during moments of high positive emotion, both patients and therapists had similar physiologic responses and that greater levels of similarity were related to higher ratings of therapist empathy by patients.

“This research supports brain imaging data that shows humans are literally ‘wired to connect’ emotionally,” says Carl Marci, MD, director of Social Neuroscience in the MGH Department of Psychiatry and the paper’s lead author. “There is now converging evidence that, during moments of empathic connection, humans reflect or mirror each other’s emotions, and their physiologies move on the same wavelength.”

As part of an ongoing study of the role of empathy in psychotherapy, the MGH researchers videotaped therapeutic sessions of 20 unique patient-therapist pairs. The patients were being treated as outpatients for common mood and anxiety disorders in established therapeutic relationships. The participating therapists practiced psychodynamic therapy, an approach that uses the therapeutic relationship to help patients develop insight into their emotions.

Throughout the therapy sessions, patients and therapists were “wired up” to record their physiologic responses using skin conductance recordings. Skin conductance is a commonly used measure of the activity of the sympathetic nervous system, which controls human arousal and provides a physiologic context for emotional experiences. Following the sessions, the videotapes were edited to focus on moments of high and low physiologic concordance – that is, when patients’ and therapists’ levels of nervous system activity were most and least similar. Independent observers, blinded to the study’s goals and methods, reviewed randomly presented video segments to identify the types of emotions being expressed by both patients and therapists.

The observers' data showed that both patients and therapists expressed significantly more positive emotions during moments of high physiologic concordance than during low concordance. In addition, patient’s ratings of therapist empathy corresponded to levels of physiologic concordance during the therapy sessions. Overall, the findings suggest that shared positive emotions and shared physiologic arousal contribute to an empathic connection during psychotherapy.

“We were pleased to find evidence for a biological basis to that feeling of connection,” Marci says. “Taken together with current neurobiological models of empathy, our findings suggest that therapists perceived as being more empathic have more positive emotional experiences in common with patients during the therapy session.” He adds another finding not reported in the published report – that there was much less physiologic concordance when therapists were talking than listening. “That suggests it is hard for clinicians to be empathic when they are talking.”

Psychotherapy may help tinnitus sufferers cope

Sat, 27 Jan 2007 16:27:24 PST

( from http://www.rxpgnews.com ) Psychotherapy may help tinnitus sufferers cope with the life disturbances that sometimes accompany their condition, according to a new review of studies.

Tinnitus is a sensation of ringing or other noise when there is no external cause for the sound. A counseling method called cognitive behavioral therapy or CBT seems to amplify patients’ quality of life, even when the volume of the noise remains the same.

“It’s a way of working on beliefs and changing psychological responses to tinnitus,” said lead reviewer Pablo Martinez-Devesa. “Usually you’d assess the patient’s feelings and perceptions of tinnitus, then introduce education on the possible causes. Then, through several sessions, you would try to change the attitudes of patients toward the tinnitus.”

The review of six small randomized controlled trials gathered data on 285 patients. The article appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Tinnitus affects up to 18 percent of people in industrialized countries, according to the review. The vast majority of people with the condition do not seek treatment but cope with the noise inside their head on their own.

But between 0.5 percent and 3 percent of adults with tinnitus have a chronic condition severe enough to impinge on their life. Among these sufferers, sleep disturbances, anxiety and depression are common.

After participating in CBT, tinnitus sufferers reported greater overall satisfaction with their life, compared to a similar group of patients who did not receive CBT treatment, the Cochrane review found.

Cognitive behavioral therapy is used with good success as a treatment for depression. So Martinez-Devesa and his team thought CBT might lift the mood of tinnitus sufferers. “We were expecting, perhaps, to see a bigger improvement on the symptoms of depression, but we didn’t find it,” he said. Martinez-Devesa said the collected studies included just a small number of people with severe depression, so it may have been difficult to perceive a change in mood.

CBT also failed to produce significant improvements in the subjective [or perceived] volume of tinnitus, the review found.

Tinnitus researcher Robert Folmer said how people react or deal with the perception of sound is what separates a sufferer from someone who is little bothered by tinnitus. Folmer, an associate professor of otolaryngology at Oregon Health and Science University, was not on the Cochrane review team.

Cognitive behavioral therapy, which helps people with life and coping skills, is widely available throughout the United States, but Folmer suspects that few American practitioners are using CBT to treat tinnitus.

“We refer a lot of people for psychological counseling, including CBT, but the problem is we never know what they are going to get when they go there,” Folmer said. “When I say CBT that means something different to everyone. There’s a wide range of what that could be.”

Martinez-Devesa says gold-standard cognitive behavioral therapy would include patient education about the condition. But Folmer said that even without specific knowledge about tinnitus, a CBT provider can still be helpful.

“Even though a therapist doesn’t know anything about tinnitus, if they help the patient with co-symptoms, our studies have shown that the severity of tinnitus goes down, if those other factors improve,” he said.

Often, doctors are at a loss for ways to effectively treat chronic tinnitus. In those cases, helping someone with related conditions like anxiety or sleeping problems becomes the best solution, Folmer said.

Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacity (CREATE) Study Delivers Surprising Results

Thu, 25 Jan 2007 20:51:35 PST

( from http://www.rxpgnews.com ) Nearly twenty percent of cardiac patients suffer from major depression, which may have a significant negative impact on the outcome of the cardiac disease. A Canada-wide study directed by Dr. François Lespérance, professor of psychiatry at the Université de Montréal and head of the Department of Psychiatry at the Centre hospitalier de l’Université de Montréal (CHUM) is the first to assess the value of two treatments available to these patients: SSRI antidepressants and interpersonal psychotherapy. The results, to be published tomorrow in the Journal of the American Medical Association, demonstrate the effectiveness of antidepressants, while showing that psychotherapy has little benefit for depressed heart patients.

“Initially, our results seemed surprising and even disappointing,” Dr. Lespérance reports. “We had expected to find that psychotherapy would have a positive effect. After validation and careful analysis of the data, we could see that psychotherapy was no better than regular clinical control visits in improving depressive symptoms in these patients, but that citalopram, an SSRI antidepressant, was significantly more beneficial than placebo.”

The study’s co-author, Nancy Frasure-Smith, a professor in McGill University’s Department of Psychiatry and researcher at the CHUM and the Montreal Heart Institute, notes that the innovative study is one of the first to evaluate the treatment of major depression in patients with a physical illness. “There have been few studies on how to treat such patients, yet it is clear that physical and mental health influence each other.”

The study, entitled CREATE (Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacity) was funded by the Canadian Institutes of Health Research (CIHR), an independent public agency of the Canadian government, and by the CHUM and Montreal Heart Institute foundations. The study followed 284 coronary heart disease patients who also met the diagnostic criteria for major depression.

All subjects met weekly with a health care professional for an assessment of their condition. Half were chosen at random to receive the SSRI antidepressant citalopram, and half received a placebo. Half of the patients in each of these two groups were also selected at random to take part in to interpersonal psychotherapy, with the others having only the weekly control visits. The psychotherapy sessions were given by psychologists, social workers, and occupational therapists specially trained in interpersonal psychotherapy.

“Regular follow-up by a health care professional had a positive impact on the participants’ condition,” Dr. Lespérance concludes. “In fact, the twenty-minute follow-up visits proved to be just as beneficial as the psychotherapy sessions or even more so.”

“The results of Dr. Lesperance’s team demonstrate the importance of studying mental health problems for people afflicted with a physical disease, ” explains Dr. Rémi Quirion, scientific director of the CIHR Institute of Neurosciences, Mental Health and Addiction. “This project illustrates the importance of adequately funding health research and more specifically research into mental health.”

Psychological treatments improve outcomes for back pain sufferers

Tue, 26 Dec 2006 09:05:57 PST

( from http://www.rxpgnews.com ) Psychological interventions for chronic low back pain are effective, a new review of studies has found. Not only do these approaches improve psychological outcomes such as depression and health-related quality of life, they also reduce patients' experience of pain.

"Because this analysis was both more inclusive and more conservative than previous reviews, we have the best evidence to date that these interventions are helpful," said psychologist and review lead author Robert Kerns, Ph.D., of the VA Connecticut Healthcare System.

Each evidence-based review centers on a specific psychological assessment or treatment conducted in the context of a physical disease process or risk reduction effort.

To evaluate the effects of psychological interventions on pain-related outcomes, Kerns and his team gathered data from 22 randomized trials published between 1982 and 2003. Trials were limited to adults with nonmalignant low back pain that had persisted for at least three months. However, most patients had been living with pain for much longer. The average duration was seven and a half years.

The studies were not limited to any one psychological approach. Included in the review were behavioral and cognitive-behavioral techniques; self-regulatory techniques such as hypnosis, biofeedback, and relaxation; and supportive counseling.

In the broadest analysis, psychological interventions -- alone or as part of a multidisciplinary approach -- proved to be superior to waiting lists or standard treatments on the entire range of pain-related outcomes.

When the researchers analyzed specific outcomes, they found that the largest and most consistent effect was a reduction in pain intensity.

This was somewhat surprising, Kerns said, because when psychologists first began developing interventions for chronic pain several decades ago, the goal was not to reduce pain but to help patients live with their pain more successfully.

"However, a growing body of knowledge suggests that these interventions are actually having a primary effect on people's experience of pain," he said.

The review found that psychological interventions also yielded improvements in health-related quality of life, work-related disability, interference of pain with daily living and depression.

Not all treatments were equally effective. Cognitive-behavioral and self-regulatory treatments seemed to yield the greatest effects, particularly when compared to waiting list control groups. Multidisciplinary approaches that included a psychological component also stood out on some measures, reducing pain interference and work-related disability when compared to other active treatments.

According to Dennis Turk, Ph.D., a professor of anesthesiology and pain research at the University of Washington in Seattle, patients with chronic pain sometimes fail to recognize the value of psychological treatments because they've been set up to expect a cure.

"Even the latest and greatest treatments don't cure people with chronic pain," he said. "Psychological interventions are not cures, but they do reduce pain and improve function and they are important components in the treatment of people with chronic pain."

Turk added that psychological interventions are also cost-effective when compared to other treatments for chronic low back pain -- a key finding, considering that estimates for treatment-related costs range from $20 billion to $80 billion a year in the United States.

"Surgery, opioids, nerve blocks, spinal cord stimulators, implantable drug delivery systems -- every one of those particular alternatives is much more expensive and has poorer or at best equal outcomes compared to rehabilitation programs that include psychological components," said Turk. "The paradox is that, despite data on the effectiveness of psychological interventions, insurers are less willing to pay for them."

Getting the word out that these treatments are effective and cost-effective is a challenge that psychologists will have to tackle head-on, Kerns said.

"We need to specifically target health care system administrators and third-party payers to try to engage them in a more productive dialogue about the importance of these interventions," he said. "We continue to have a huge, very costly problem in our society, but we have an intervention that is effective, and we need to do a better job of creating access to these services."

Schema Therapy fosters full recovery in borderline personality disorder

Wed, 11 Oct 2006 05:30:00 PST

( from http://www.rxpgnews.com ) For the first time, a major outcome study has shown that a high percentage of patients with Borderline Personality Disorder can achieve full recovery across the complete range of symptoms. The controlled study, appearing in a recent issue of the Archives of General Psychiatry published by the American Medical Association, shows that a new approach -- Schema Therapy -- is more than twice as effective as a widely practiced psychodynamic approach, Transference Focused Psychotherapy (TFP). Schema Therapy was also found to be less costly and to have a much lower drop out rate. Borderline Personality Disorder (BPD) has until recent years been considered untreatable, with little scientific justification for longer-term therapy.

This study demonstrates that schema therapy leads to complete recovery in about 50% of the patients, and to significant improvement in two-thirds. The success of the therapy is strongly related to its duration and intensity (two sessions a week for 3 years). The results clearly contradict the prevailing opinion that BPD cannot be fully cured, and that longer-term psychotherapy is ineffective.

According to the National Institute of Mental Health, Borderline Personality Disorder is found in about 1 to 2.5 percent of the general population--about 5.8 to 8.7 million Americans, most of whom are young women. Patients with the disorder live life on the edge: they're typically impulsive, unstable, exquisitely sensitive to rejection, have regular outbursts of anger, and live daily with extreme emotional pain. They often self-mutilate and make repeated suicide attempts. Identity problems, low stress tolerance, and fears of abandonment also make the disorder difficult for patients and for those who live with them. Many with BPD either cannot work or do not function at levels that could be expected in light of their intellectual capacities. As a result, the disorder carries high medical and societal costs, accounting for more than one in every five inpatient psychiatric admissions.

Until recently, psychotherapy offered help for only some of the symptoms of BPD. The best available alternatives, such as Dialectical Behavioral Therapy, relieve many of the self-destructive behavioral symptoms of the disorder but have not been able to reduce many of the other core symptoms, especially those related to deeper personality change.

New York-based psychologist Jeffrey Young, Ph.D. (on the faculty in the Dept. of Psychiatry at Columbia University) began to develop Schema Focused Therapy in the mid-1980s. Encouraged by its success, he established the first Schema Therapy Institute in the mid-1990s in Manhattan. Adopted by many clinicians in the United States, Europe, and Asia, the therapy came to the attention of researchers in the Netherlands who were developing a large-scale study of treatments for Borderline Personality Disorder. The clearly articulated approach of Schema Therapy lent itself well to a controlled outcome study.

In this study, Dutch investigators, including Dr. Josephine Giesen-Bloo and Dr. Arnoud Arntz (the project leader), compared Schema Therapy (also known as Schema Focused Therapy or SFT) with Transference Focused Psychotherapy (TFP) in the treatment of Borderline Personality Disorder. 86 patients were recruited from 4 mental health institutes in the Netherlands. Patients in the study received two sessions per week of SFT or TFP for 3 years. After three years, full recovery was achieved in 45% of the patients in the SFT condition, and in 24% of those receiving TFP. One year later, the percentage fully recovered increased to 52% in the SFT condition and 29% in the TFP condition, with 70% of the patients in the SFT group achieving "clinically significant and relevant improvement". Moreover, the dropout rate was only 27% for SFT, compared with 50% for TFP, indicating that Schema Therapy instilled a greater sense of allegiance among patients.

Patients began to feel and function significantly better after the first year, with improvement occurring more rapidly in the SFT group. There was continuing improvement in subsequent years. Thus investigators concluded that both treatments had positive effects, with Schema Therapy clearly more successful.

Schema Therapy is an integrative approach, founded on the principles of cognitive-behavioral therapy, then expanded to include techniques and concepts from other psychotherapies. Schema therapists help patients to change their entrenched, self-defeating life patterns or schemas -- using cognitive, behavioral, and emotion-focused techniques. The treatment focuses on the relationship with the therapist, daily life outside of therapy, and the traumatic childhood experiences that are common in this disorder. Dr. Young believes that Schema Therapy's greater effectiveness arises in part from its use of "limited reparenting," which is not part of other approaches to BPD.

Both Schema Therapy and Transference Focused Psychotherapy focus on deeper personality change, in comparison to other recent treatments that have been limited to the reduction of specific behavioral symptoms of the disorder, such as self-mutilation. According to Dr. Young: "Other treatments for BPD, such as Dialectical Behavior Therapy, have also led to more effective coping skills and a significant reduction in self-harm. With Schema Therapy, patients are, in addition, breaking free of lives of chaos and misery and making deeper personality changes."

Although the treatment involves many sessions over three years, Schema Therapy is nevertheless cost-effective. An economic analysis conducted by the authors of the study (not included in the Archives article) indicated that, for each year Schema Therapy patients were in the study, Dutch society benefited from a net gain of 4,500 Euros per patient (the equivalent of about 5,700 US dollars), despite the cost-intensive treatment. The savings over the course of several years after the completion of treatment could actually prove to be higher.

Schema therapists and researchers are hoping that this validation of the effectiveness of Schema Therapy for patients with Borderline Personality Disorder -- that for so many years has been considered intractable--will lead to more research studies and will encourage more clinicians to learn Schema Therapy. They also hope that this study will convince healthcare insurers to reimburse the costs of effective longer-term psychotherapy for this painful and costly illness.

The Mental Health Foundation to give free online access to CCBT

Tue, 26 Sep 2006 22:52:00 PST

( from http://www.rxpgnews.com ) From the 1st November to 3rd January, visitors to the Mental Health Foundation's website will be able to get free access to Depression Relief - an online self-help program that uses Cognitive Behavioural Therapy techniques. The program is being made available by Ultrasis, the healthcare company that developed Beating the Blues, the only computer based treatment for depression recommended by the National Institute for Health and Clinical Excellence (NICE) for use in the NHS.

Used by Primary Care Trusts in the United Kingdom and employee healthcare providers in the United States, Depression Relief is suitable for anyone experiencing mild or moderate depression. The confidential program allows users to go at their own pace, learning self-help techniques which can help them manage their condition.

"Cognitive Behavioural Therapy is widely recognised as one of the most effective methods for treating depression, yet there is a major shortage of therapists," said Andrew McCulloch, Chief Executive of the Mental Health Foundation. Most people who want to try Cognitive Behavioural Therapy have to join long NHS waiting lists or pay to see a therapist privately. While online CBT is not a replacement for face-to-face therapy, we need to start investigating other supporting treatments that people with mental health problems can use."

"Mental health problems can have a negative impact on the well being of any one of us. We want people to know that the tools and techniques for prevention and treatment are available without having to wait months to see a therapist," said Nigel Brabbins, Chief Executive of Ultrasis Plc. Cost effective online programs need to be more widely available and we hope to reach as many people as possible through the Mental Health Foundation's website who may want help when NHS services are not available."

Visit www.mentalhealth.org.uk between 1 November 2006 and 3 January 2007 to get free unlimited access for four weeks. You will need broadband access to the Internet. Depression Relief has been designed for those aged 18 and over. The Mental Health Foundation strongly recommends that people should seek professional medical advice if they are concerned about their mental health.

Cognitive Behavioural-Therapy more effective than brief dynamic therapy for avoidant personality disorder

Mon, 10 Jul 2006 18:22:00 PST

( from http://www.rxpgnews.com ) A new study from Holland has found that cognitive-behavioural therapy (CBT) was more effective than brief dynamic therapy, or being on the waiting list, for people with avoidant personality disorder. Brief dynamic therapy was no better than the waiting list control condition.

Until now there have been few controlled trials examining the effectiveness of individual psychotherapy in personality disorders, especially in patients with what are called Cluster C disorders.

These include dependent, obsessive compulsive and avoidant personality disorders. Of all the personality disorders, the avoidant type has been found to be the most persistent, even tending to worsen over time.

Published in the July issue of the British Journal of Psychiatry, the study compared the effectiveness of the two therapies as outpatient treatment for people with avoidant personality disorder with a waiting list control group.

62 patients aged between 24 and 61 who met the criteria for avoidant personality disorder were randomly assigned to 20 weekly sessions of either brief dynamic therapy or CBT over a 6-month period, or they were assigned to the waiting list control group.

After the waiting period, patients in the control group were randomly assigned to one of the two therapies. All groups were followed up at 6 months, and self-reports were completed by patients before treatment, immediately after treatment, and 6 months after the treatment was completed.

It was found that patients receiving CBT showed significantly more improvements on a number of measures, in comparison with those who had brief dynamic therapy or were in the waiting list control group. These results were maintained at follow-up.

The authors of the study comment that it is unclear whether prolonged treatment would have resulted in superior results. Although there have been studies on behavioural treatments for avoidant personality disorders, none have looked at cognitive therapy. Whether cognitive therapy enhances the effects of behavioural therapy deserves further study.

It should be noted that the therapists in this study were experts in their fields, and were selected and trained for this project. It is unknown whether the same results would apply to untrained therapists working in other kinds of community setting.

Given the high prevalence of avoidant personality disorder in the community, the persistence of the disorder, and the high level of functional impairment associated with it, the effectiveness of CBT in treating this condition provides an important step forward for community mental healthcare.

Hypnotherapy improves quality of life for people with Irritable Bowel Syndrome

Wed, 31 May 2006 17:12:00 PST

( from http://www.rxpgnews.com ) Patients with Irritable Bowel Syndrome (IBS) who took part in hypnotherapy sessions reported reduced symptoms and improved quality of life, according to research published in the June issue of Journal of Clinical Nursing.

Dr Graeme D Smith from University of Edinburgh studied 75 patients with IBS - which affects up to one in seven adults - before and after they took part in four to five treatment sessions over three months.

He discovered that before the sessions, women were most concerned with quality of life issues such as diet and energy and that men had the highest levels of anxiety and depression and worried about their physical role.

The 20 men and 55 women who took part in the study reported that hypnotherapy brought about significant improvements in the physical and emotional symptoms related to IBS.

These included a 30 per cent improvement in their emotional quality of life and a 25 per cent improvement in energy levels.

Mental health improved by 21 per cent, sleep by 18 per cent, physical health by 16 per cent and diet by 14 per cent.

The participants also reported that their social role had improved by 20 per cent and their physical role by 18 per cent.

Average anxiety levels fell by 12 per cent and depression fell by four per cent. Men showed higher levels of both problems before the hypnotherapy sessions, but also reported greater improvements than women.

The people taking part in the study also reported a five per cent reduction in abdominal pain and a four per cent reduction in abdominal bloating.

"It is estimated that between 10 to 15 per cent of adults may suffer from IBS and that the physical, emotional, social and economic consequences of the illness can be considerable" says Dr Smith, from the University's School of Health (Nursing Studies).

"Physical symptoms include altered bowel habits, abdominal pain and bloating, together with other non-intestinal problems such as lethargy, problems sleeping and indigestion. Anxiety and psychosocial problems are also common and these can have a detrimental impact on quality of life."

The 75 study participants underwent hypnotherapy sessions that focussed on creating images of their gut symptoms using visualisation techniques in conjunction with relaxation methods.

Self-hypnosis was taught at an early stage and patients were given audio tapes, that reinforced the effects of the hypnotherapy, to use at home.

They also completed detailed questionnaires before and after treatment and kept diary cards during the study

"The patients involved in this study were typical of people seen routinely in gastroenterology clinics, where up to 50 per cent of the referrals are for IBS" says Dr Smith.

"There's no universal agreement about what causes IBS and traditional treatment is often disappointing. This study shows that hypnotherapy can effectively reduce symptoms and improve quality of life and underlines the valuable role that complementary therapies can play in modern healthcare."

Anonymity of Internet aids online counselling

Tue, 25 Apr 2006 20:47:00 PST

( from http://www.rxpgnews.com ) Anonymity can sometimes lead to closer understanding between patient and practitioner in psychotherapy, and therapists are now exploiting this in their work and providing counselling over the Internet.

If the person being talked to is not visible, it is easier for the client to speak about terrible experiences or problems.

"Psychotherapy is treatment for mental or emotional illnesses," explains Fredi Lang of the Association of German Psychologists (BDP) here. Counselling, however, is about providing advice on how to deal with problems.

On the Internet, however, the terms psychotherapy and counselling are often misunderstood to mean the same thing.

The BDP instituted a quality control system five years ago to aid clients seeking online counselling.

Meanwhile, about 20 websites have passed this test and now bear an insignia with the text "Counselling by Psychologists".

To obtain the award, the site's operators must have a diploma in psychology and inform their clients about the limits of online counselling and the necessity of encoding any correspondence by email.

However, this method of quality control is not sufficient, according to Ragnar Beer, psychologist at the University of Goettingen, central Germany.

"Non-verbal communication is missing online. That makes counselling or therapy very difficult," says Beer.

However, a new approach to counselling called Interapy has been developed by researchers at the University of Amsterdam, the Netherlands, as an Internet platform for treating post-traumatic stress disorder.

Interapy involves clients writing about their experiences on the basis of written instructions. Four-fifths of participants were free of symptoms after counselling.

One reason for Interapy's success is the close nature of the relationship between the client and the therapist. "We noticed that from the very beginning there was a very intense form of contact," says Beer. This is due to the anonymity the Internet provides.

"Clients can envisage their therapist according to their own ideal," says Beer and the distance between client and practitioner makes it easier to discuss past experiences.

Psychologists behind the website Theratalk at the University of Goettingen have had a similar experience.

Theratalk went online in 1996, providing online counselling for couples, where the therapist and clients communicate in a secure chat room with a time lag.

"Patients often say they can speak freely because they cannot see the therapist," says Beer who heads Theratalk. This was particularly advantageous in dealing with sexual problems.

Another advantage of the chat room was that all questions and responses could be reread.

However, online counselling has its limits. A patient's mental health must be in stable condition and personality disorders cannot be treated online.

In addition, clients who are experiencing a mental crisis should speak to a counsellor face to face.

Hypnotherapy could help ease gastric acid reflux

Sat, 22 Apr 2006 17:52:00 PST

( from http://www.rxpgnews.com ) Hypnotherapy, a therapy based on or using hypnosis, could provide significant relief from chest pain that is not caused by a heart condition, says a study.

About a third of people who have chest pain have no identifiable cause for the reason. Researchers believe that acid reflux or psychological problems could be to blame - and young women seem to be more prone to getting the pain.

Researchers led by Peter Whorwell at Wythenshawe Hospital in Manchester studied 28 patients and found that 15 people given hypnotherapy reported "significant" relief from pain.

Of people treated with another type of "supportive therapy" and given a placebo, three of 13 people reported relief.

Hypnotherapy also significantly improved the sense of overall well being and reduced the use of painkillers and other drugs needed to control the condition.

Hypnotherapy has also been shown to cut the levels of gastric acid produced by the stomach, the study says.

Previous research by the group has shown that hypnotherapy benefits those with irritable bowel syndrome, with most patients remaining well in the long-term, requiring far less medication and making fewer visits to the doctor.

Brain scans of patients treated with hypnotherapy for other conditions have also shown that it directly affects a region of the brain that processes the emotional reaction to a painful stimulus.

Hypnotherapy helps relieve chest pain

Thu, 20 Apr 2006 16:17:00 PST

( from http://www.rxpgnews.com ) Hypnotherapy seems to relieve severe chest pain that is not caused by a heart condition, known as non-cardiac chest pain, suggests a small study published ahead of print in Gut.

Around a third of patients investigated for chest pain thought to be caused by coronary artery disease have no identifiable cause for their pain. Nevertheless they often continue to be severely incapacitated by it, despite reassurances that there is nothing to worry about. Young women seem to be particularly prone to the condition.

The cause of non-cardiac chest pain is unknown, although several factors have been implicated, including acid reflux and psychological problems. The condition is notoriously difficult to treat.

Researchers randomly divided 28 patients with the condition into two groups. One group received 12 sessions of hypnotherapy over 17 weeks; the other group were given "supportive therapy" plus dummy medicine (placebo).

Of the 15 people treated with hypnotherapy, 80% reported significant pain relief, although there was no change in frequency of bouts of pain, compared with just three of the 13 people treated with supportive therapy and placebo.

Hypnotherapy also significantly improved the sense of overall wellbeing and reduced the use of painkillers and other drugs prescribed to control the condition. By contrast, the group treated with supportive therapy increased their drug intake.

Hypnotherapy did not affect levels of anxiety or depression, however, which remained the same as before.

Brain scans of patients treated with hypnotherapy for other conditions show that it directly affects a region of the brain which processes the emotional content of a painful stimulus. And hypnotherapy can also cut levels of gastric acid produced by the stomach.

The authors acknowledge that hypnotherapy is labour intensive and therefore expensive, but so too are the many investigations and drugs given to patients with non-cardiac chest pain, they say.

And previous research carried out by the same authors on patients with irritable bowel syndrome shows that most of them remain well in the long term, requiring far less medication and far fewer visits to their doctors.