Posted by & filed under Abnormal Psychology, Classification Diagnosis, Clinical Assessment, Clinical Psychology, Intervention: Identifying Key Elements of Change, Legal Ethical Issues, mental illness, Psychological Intervention, Research Methods, Treatment of Psychological Disorders.

Description: Clinical Psychologists who are involved in providing therapy to people have a number of ethical standards to which they must adhere (you can download the Canadian Psychological Association Code of Ethics here: https://www.cpa.ca/docs/File/Ethics/CPA_Code_2017_4thEd.pdf) . One of those standards states that practicing psychologist should Strive to provide and/or obtain the best reasonably accessible service for those seeking psychological services. (paragraph II.18)” Adherence to this part of the ethics code involves assuring that one stays critically informed about the current research looking at therapy approaches, practices, techniques, and outcomes. Basically, being up to date on what works in therapy. Related to this, psychologists are to monitor the effects of their interactions with clients. Basically, so they can see if what they are doing with each of their individual clients is helping make things better for the client. So, how should they do this do you think? It is certainly true that monitoring their client’s psychological processes and progress are core part of the therapeutic connection. However, should individuals in therapy be monitored using status and outcome measures on a regular basis? It has been suggested that a such monitoring (using at least somewhat objective means) will be a prerequisite for the inclusion of psychological therapy as a service within the general health care system in Canada. Sound reasonable? Would it surprise you to hear that such routine status and outcome assessments (think of them as like vital signs such as heart rate, blood pressure or blood sugar levels) are not used by most practicing clinical psychologists? Think about why that might be and think a bit about how this would be measured and then read the article linked below to fond out about British experiences with these questions and about how they may be spreading across Canada.

Source: Rethinking therapy: How 45 questions can revolutionize mental health care in Canada, Erin Anderssen, The Globe and Mail

Date: April 7, 2018

Photo Credit: Ming Wong/The Globe and Mail

Links:  Article Links https://www.theglobeandmail.com/canada/article-rethinking-therapy-how-45-questions-can-revolutionize-mental-health/

While the idea of monitoring psychotherapeutic “vital signs” may seem obvious, straightforward, and desirable some of the concerns raised about the rudimentary and perhaps generic nature of such status and outcome screens are worth thinking hard about. On the other hand, a commitment to regular monitoring of client status and outcomes as a check on the efficacy of therapy is also worth thinking hard about. The observation that it took physician 200 years to incorporate systematic use of the thermometer into their practice is frankly somewhat alarming. At least clinical psychologists have an ethical commitment to staying up to date with current research on therapeutic practice, technique, and client status and outcomes so it is unlikely to take 200 years for these questions about the potential universal use of status and outcome measures to be resolved.

Questions for Discussion:

  1. How to clinical psychologists know if their clients’ issues and symptoms are improving, staying the same or getting worse?
  2. What are some of the advantages and disadvantages of the efficacy monitoring strategies you noted above?
  3. Should clinical psychologists be required to regularly assess the status and outcomes of their therapy clients? Should this be viewed as an issue in practice ethics or as a matter of health care system policy?

References (Read Further):

Davey, Graham C.L. (2014) Are some psychotherapies better than others? Psychology Today, https://www.psychologytoday.com/us/blog/why-we-worry/201409/are-some-psychotherapies-better-others

Castonguay, L. G., & Hill, C. E. (2017). How and why are some therapists better than others?: Understanding therapist effects. American Psychological Association.

Clark, D. M., Canvin, L., Green, J., Layard, R., Pilling, S., & Janecka, M. (2017). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. The Lancet.

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32133-5.pdf

Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2016). A tipping point for measurement-based care. Psychiatric Services, 68(2), 179-188.

https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201500439

Walfish, S., McAlister, B., O’donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110(2), 639-644. http://clinica.ispa.pt/ficheiros/areas_utilizador/user11/43._an_investigation_of_self-assessment_bias.pdf

Posted by & filed under Abnormal Psychology, Child Development, Clinical Assessment, Clinical Psychology, Disorders of Childhood, Health Psychology, Intervention: Children Adolescents, Intervention: Identifying Key Elements of Change, Neuroscience, Psychological Disorders.

Description: So here is a thought: In psychology we typically talk about Attention Deficit Disorder (ADHD) as an unquestionably undesirable thing. Look at its name, we view it as a deficit and a disorder. There is no doubt that there are many situations and circumstances where ADHD would NOT be adaptive (school usually being one of those places). I am not going to be critical of the mighty DSM and its inclusion of ADHD as a disorder. What I am going to do is ask you to step back and consider “ADHD-like” dispositions and behaviors from a bit broader perspective. You may or may not have heard about concerns raised by an apparent HUGE jump in the prescription of AHDH meds for children in the past 15 years. Diagnosis of AHDH in children in the US had increased by 43% since 2003 (https://www.sciencedaily.com/releases/2015/12/151208150630.htm). There is debate about whether there is a trend towards over-diagnosis and over-treatment of ADHD (see articles in further reading below) and there is some discussion of the possibility that children with signs and symptoms of ADHD do better once they get out of school and can “niche-pick” where and how they invest their time. So, what kind of a world and what kind of situations might ADHD tendencies (if not the full diagnostic condition) be an asset rather than a liability? Think about that and then read the article linked below.

Source: In Praise of ADHD, Leonard Mlodinow, Grey Matter, The New York Times.

Date: March 17, 2018

Image Credit: Sarah Mazzetti, The New York Times

Article Link:  https://www.nytimes.com/2018/03/17/opinion/sunday/praise-adhd-attention-hyperactivity.html  

Here is an interesting question to reflect upon. If there has been a huge jump in rates of ADHD while we might want to blame modern life for that is there some of the ADHD rate jump which might reflect adaptation? Of course, it is not an all of one or all of the other possible answer, but it IS worth thinking about. The disorder of ADHD as contained in the DSM is rather clearly defined and, when appropriate assessments are done, is rather consistently defined and diagnosed. However, the larger societal discussion around “ADHD” as a pattern of symptoms is not limited to what would appropriately fit into the DSM. This larger discussion does not conform to clinical (DSM) criteria for defining ADHD, but it is invoking the disorder label regardless and as such should be part of psychologists’ ongoing discussions of what AHDH is (or is seen to be) and how it, and these discussions, are impacting children with attributed ADHD symptomology.

Questions for Discussion:

  1. Are there social situations where a little ADHD might be a good thing?
  2. Are there differences between ADHD disorder and “ADHD-like” symptoms?
  3. How might the idea that ADHD might be adaptive in some situations for some people be affected by a shift away from the use of drugs like Ritalin in the treatment of ADHD?

References (Read Further):

Potter, F. F. E. (2018). A different perspective on why prescriptions of ADHD drugs have soared. Assessment, 15, 43. https://www.pharmaceutical-journal.com/opinion/comment/a-different-perspective-on-why-prescriptions-of-adhd-drugs-have-soared/20200232.article

Davidovitch, M., Koren, G., Fund, N., Shrem, M., & Porath, A. (2017). Challenges in defining the rates of ADHD diagnosis and treatment: trends over the last decade. BMC pediatrics, 17(1), 218. https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-017-0971-0

Harding, B. (2017). The Field Guide to ADHD: What They Don’t Want You to Know. Psychiatry–Theory, Applications and Treatments. Online Submission. https://files.eric.ed.gov/fulltext/ED580887.pdf

Cramond, B. (1995). The Coincidence of Attention Deficit Hyperactivity Disorder and Creativity. Attention Deficit Disorder Research-Based Decision Making Series 9508. https://files.eric.ed.gov/fulltext/ED388016.pdf

Matejcek, Z. (2003). Is ADHD adaptive or non-adaptive behavior?. Neuroendocrinology Letters, 24(3/4), 148-150. https://pdfs.semanticscholar.org/45f5/ef296d600bf30197eb4f703ea69ba631b73e.pdf

Posted by & filed under Consciousness, Language-Thought, Neuroscience.

Description: Your brain is comprised of a bunch of neurons — a BIG bunch but a bunch of simple cells none-the-less. Yet, from the complex interplay of the billions of neurons in your brain complex thinking and decision making arises. How does that work? Well it would be nice if we had a model to organize our thinking as we try to conceptualize the emergence of complex decisions from relatively simple, interconnected components. Hmmmm …  what to use? How about bees? Individual bees just do what they do (build the hive, defend, find pollen, tend offspring…) and yet at some point the whole hive has to decide that it is time to move and to decide which location from the several workers have scouted to choose, move to and construct a new hive. As a collective they “make a decision” and then act on that decision, sort of like how the neurons in your brain work to produce decisions. Got a feel for the analogy? Or perhaps it is a bit more than an analogy. Read the article linked below to see how researchers are talking about this.

Source: Bee Colonies Draw an Uncanny Parallel to the Neurons of the Brain, Sarah Sloat, Inverse.com.

Date: March 27, 2018

Photo Credit: Madhava.com (http://madhavasweeteners.com/u-s-government-announces-new-strategy-and-investment-to-reverse-honey-bee-decline/ )

Article Link:  https://www.inverse.com/article/42890-bees-brain-neurons-psychophysical-laws

How complexity arises out of systems of simple components is a challenging question. How something like “rational” decision making, or perhaps even consciousness, arises out of a system of simple components is hard to conceptualize even as a possibility. We tend to think reductionisticly which leads us to thoughts like “How could a bunch of bees do anything intelligent? Except they DO. They find possible new hive locations and, together, they decide which one to move to and then they do that, move there and build a new hive. Perhaps studying bees (which we have to get working on saving from extinction anyway given our need for pollination to stay alive) might help us gets our heads (brains) around the questions of how complex thinking arises from simple components (be they bees or neurons)!

Questions for Discussion:

  1. So how DO bees decide where to move their hives to?
  2. Can you explain the similarities between bee decisions and human decisions?
  3. Are there other possible models out there for thinking about this complexity out of networked simplicity model?

References (Read Further):

Reina, A., Bose, T., Trianni, V., & Marshall, J. A. (2018). Psychophysical Laws and the Superorganism. Scientific reports, 8(1), 4387. https://www.nature.com/articles/s41598-018-22616-y

McGonigal, J. (2008). Why I love bees: A case study in collective intelligence gaming. The ecology of games: Connecting youth, games, and learning, 199-228. http://faculty.tamucc.edu/ethompson/courses/newmedia/McGonigal_WhyILoveBees_Feb2007.pdf

Haggard, P. (2017). Sense of agency in the human brain. Nature Reviews Neuroscience, 18(4), 196. http://discovery.ucl.ac.uk/1545235/6/Haggard_Sense_agency_human_brain_Suppl.pdf

Posted by & filed under Consciousness, Human Development, Industrial Organizational Psychlology, Industrial Organizational Psychology, Intelligence, Personality, The Self.

Description: In this post I am introducing you to another blog post that has just started under the Psychology Today umbrella. It is written by a couple of profs at George Mason University in Virginia and it is going to focus upon a view of creativity as a craft that can be practiced and honed rather than as some form of divine inspiration or genetic predisposition. I was drawn to the bog by my own interest in Identity development where people often struggle with being counselled to “find and follow your passions” – advice which, like creativity, suggests that it must involve fireworks and instant blinding insights which you either got or you ain’t got. In identity development facilitation work we encourage folks to start with simply being curious and to work at recognizing and moving into things that tweak their curiosity. I find that starting there can lead folks into interesting and engaging life/career pathways and can sometimes ignite into blazing passions along the way (but are interesting and engaging regardless). So, do you think creativity is something that can be nurtured or even learned? Think about your basic assumptions in regard to this question and then read the blog linked below and see what Jeffery and Matthew have to say. Oh, and as they are just getting started on their blog (stay tuned for cool stuff!) I have added a link to another post and to a TED talk by IDEO CEO Tin Brown (who does a wonderful job showing us why we think we are not or cannot be creative – and tells us some things we can do about it).

Source: The Fallacy of the Creative Type, Jeffery Loewenstein and Matthew A. Cronin, The Craft of Creativity, a New Blog! Psychology Today.

Date: March 30, 2018

Photo Credit: Shutterstock and The Conversation (https://theconversation.com/what-creativity-really-is-and-why-schools-need-it-81889)

Links:  Article Links https://www.psychologytoday.com/us/blog/the-craft-creativity/201803/the-fallacy-the-creative-type and https://generalassemb.ly/blog/can-you-learn-creativity/ and https://embed.ted.com/talks/tim_brown_on_creativity_and_play#

The blog linked above is a starting point and the second article and the TED talk are examples of some possible directions in which one could think and over if you were interested in developing your creativity craft. Like identity development and developmental life design (my course on which is coming soon!) the road to “being creative” is just that, a road, a process, and a way of being which starts with a shift in mind set – play and its inherent creativity is not just for children, it is a human process and an invaluable life tool at that, so…. Find ways to play even when you are being serious! And, consider following Jeffery and Matthews new Psychology Today Blog on The Craft of Creativity.

Questions for Discussion:

  1. Are you a creative person?
  2. What are creative people like? Where does creativity come from?
  3. What are some ways we can each nurture our creative skills and craft?

References (Read Further):

Sawyer, R. K. (2011). Explaining creativity: The science of human innovation. Oxford University Press.

Singh, J., & Fleming, L. (2010). Lone inventors as sources of breakthroughs: Myth or reality?. Management science, 56(1), 41-56. https://www.researchgate.net/profile/Jasjit_Singh2/publication/220534425_Lone_Inventors_as_Sources_of_Breakthroughs_Myth_or_Reality/links/0a85e533aca3d2d1e7000000.pdf

Cummings, A., & Oldham, G. R. (1997). Enhancing creativity: Managing work contexts for the high potential employee. California Management Review, 40(1), 22-38.

Elsbach, K. D., & Hargadon, A. B. (2006). Enhancing creativity through “mindless” work: A framework of workday design. Organization Science, 17(4), 470-483. https://www.researchgate.net/profile/Andrew_Hargadon/publication/247824420_Enhancing_Creativity_Through_Mindless_Work_A_Framework_of_Workday_Design/links/54105fa60cf2d8daaad3ca1f.pdf

Shneiderman, B., Fischer, G., Czerwinski, M., Resnick, M., Myers, B., Candy, L., … & Jennings, P. (2006). Creativity support tools: Report from a US National Science Foundation sponsored workshop. International Journal of Human-Computer Interaction, 20(2), 61-77. http://www.cs.umd.edu/hcil/trs/2006-17/2006-17.pdf

 

 

 

 

Posted by & filed under Abnormal Psychology, Anxiety OC PTSD, Assessment: Self-report Projective Measures, Clinical Neuropsychology, Intervention: Adults-Couples, Intervention: Identifying Key Elements of Change, Neuroscience, Prevention, Psychological Disorders, Research Methods, Stress, Stress Coping - Health, Stress: Coping Reducing, Treatment of Psychological Disorders.

Description: Two posts ago I talked about and posted links to a general article about PTSD – about its signs and symptoms and about its treatment, in general terms. In that article the two main approaches to treatment were described as medication and talk therapy. Both approaches most certainly fall in the domains of accepted practice for psychiatrists and clinical psychologist respectively and both are supported by systematic research. However, PTSD treatments do not work for all who struggle with the disorder. As well, an additional issue involves the reticence some people have about seeking treatment and about concerns of stigma or perhaps even organizational backlash would they seek treatment (see links below in Further Reading). Alternative approaches to assistance and perhaps to treatment for symptoms of PTSD do exist. Eye Movement Desensitization and Preprocessing or EMDR is one of these (see links below in Further Reading). Animal assistance or animal therapy is another interesting area of possible support/treatment. You have perhaps run across references to companion animal programs where vertebras or first responders with PTSD issues are provided with a trained dog (usually) companion. The data on the use of companion animals is reasonably consistently positive in terms of it impact upon PTSD symptoms though there is no consensus on just how it is that the dogs produce the results they seem to produce in these studies. As the research article review linked below suggests, involvement with animals in general and with horses in particular seems to provide some short and perhaps longer-term benefits for folks with PTSD symptoms. Leaving riding out of the equation, what do you think it might be about spending time interacting with horses that could have positive effects upon people with symptoms of PTSD?  Once you have your hypotheses in mind have a look at the articles linked below and/or watch the brief video clip of me talking about these things in preparation for a presentation on the topic late last week.

Source: Animal Therapy is Making Strides in the Treatment of Post-Traumatic Stress Disorder, Elements Behavioral Health and Animal Assisted Intervention for trauma: a systematic literature review (full reference below in Further Reading)

Date: March 25, 2018

Photo Credit: https://www.pinterest.com/pin/450852612674613418/?lp=true

Links:  Article Links — https://www.elementsbehavioralhealth.com/trauma-ptsd/animal-therapy-ptsd-treatment/ and https://www.recoveryranch.com/specialized-programs/equine-therapy/  and brief video of Mike Boyes talking about PTSD and animal assisted approaches https://www.youtube.com/watch?v=UXgnbg3ELSA&t=24s .

People who spend time with horses generally will tell you that there is “something about horses” (as in Corb Lund’s song Especially a Paint”). Winston Churchill (and later Ronald Reagan) once said, “There is something about the outside of horses that is good for the inside of man.” Both related statements capture what “horse people” will tell you is simply true, that the connections between people and horses can be elemental and profound. As obvious as that might be, once we try and take up the task of figuring out WHY that is from research perspective, we, to date, have become essentially inarticulate. Data indicating that time with horses my well be beneficial for those with PTSD issues is starting to roll in and it may well be that for now (and especially for folks with PTSD issues) that is enough to support its use as part of approaches to helping people deal with PTSD. Symptom checklists for PTSDA are readily available and are or can be calibrated to so as to be sensitive to changes in symptom patters over relatively small-time frames (such as before and after a single chunk of time spent with a horse or horses). If data were carefully gathered over time we could look at what treatment or support experiences make what sorts of differences for what sorts of people with what sorts of PTSD symptom presentations and profiles and we could look at how positive changes to symptom patterns persist over times between and after both engagements with animals and, perhaps eventually, engagements with other treatment strategies. Data will sort out what works and start to hint, perhaps, at how or why time with horses and other animals may help those with PTSD. More importantly, data will tell us whether those with symptoms of PTSD ARE getting the support and the help they need and deserve. That is why we are planning on trying out more horse related experiences for folks with symptoms of PTSD and before during and after which we will gather a range of data in the hopes that we will get to be able to say some more definitive things about the impact of horse and anal experiences on the symptoms of PTSD.

Questions for Discussion:

  1. What sorts of impact does time with animals (dogs, horses etc. have on the symptoms of PTSD?
  2. How might experiences with horses and other animals be incorporated into PTSD treatment programs/strategies?
  3. What might it be about interacting with horses or about horses themselves that contributes to positive effects on symptoms of PTSD? How should this be applied and assessed/evaluated?

References (Read Further):

O’haire, M. E., Guérin, N. A., & Kirkham, A. C. (2015). Animal-assisted intervention for trauma: A systematic literature review. Frontiers in psychology, 6, 1121.  https://www.recoveryranch.com/specialized-programs/equine-therapy/

Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Pérez, V., & Amann, B. L. (2017). EMDR beyond PTSD: a Systematic Literature Review. Frontiers in Psychology, 8, 1668. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01668

Schumm, J. A., Pukay-Martin, N. D., & Gore, W. L. (2017). A Comparison of Veterans Who Repeat Versus Who Do Not Repeat a Course of Manualized, Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder. Behavior therapy, 48(6), 870-882. https://cptforptsd.com/wp-content/uploads/2017/10/1-s2.0-S0005789417300783-main.pdf

Every, D., Smith, K., Smith, B., Trigg, J., & Thompson, K. (2017). How can a donkey fly on the plane? The benefits and limits of animal therapy with refugees. Clinical Psychologist, 21(1), 44-53. http://www.academia.edu/download/46900959/How_can_a_donkey_fly_on_the_plane_The_be20160629-31059-1uvjiw6.pdf

Glintborg, C., & Hansen, T. G. (2017). How Are Service Dogs for Adults with Post Traumatic Stress Disorder Integrated with Rehabilitation in Denmark? A Case Study. Animals, 7(5), 33. http://www.mdpi.com/2076-2615/7/5/33htm

Coleman, S. J., Stevelink, S. A. M., Hatch, S. L., Denny, J. A., & Greenberg, N. (2017). Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature. Psychological medicine, 47(11), 1880-1892. https://www.researchgate.net/profile/Sharon_Stevelink/publication/315064278_Stigma-related_barriers_and_facilitators_to_help_seeking_for_mental_health_issues_in_the_armed_forces_a_systematic_review_and_thematic_synthesis_of_qualitative_literature/links/59a968aba6fdcc2398416578/Stigma-related-barriers-and-facilitators-to-help-seeking-for-mental-health-issues-in-the-armed-forces-a-systematic-review-and-thematic-synthesis-of-qualitative-literature.pdf

Posted by & filed under Anxiety OC PTSD, Intervention: Adults-Couples, Intervention: Children Adolescents, Intervention: Identifying Key Elements of Change, Moral Development, Prevention, Psychological Health, Serious Physical Illness, Stress, Stress Coping - Health, Stress: Coping Reducing, Treatment of Psychological Disorders.

Description: PTSD is an issue for first responders (Police, fire, ambulance etc.) and for soldiers in the military, right? Well yes, that IS correct, BUT they are not the only ones at risk for developing symptoms of PTSD. If you looked at my previous post about PTSD in general, you will have understood that the signs and symptoms of PTSD reflect the (over-) functioning of areas of our brains that are usually adaptively involved in driving out fight/flight response patterns. Many things such as experiencing or witnessing violent acts can trigger PTSD symptoms as they charge the fight/flight response also refer to as the hypothalamic-pituitary-adrenal axis. While higher centers of the brain (prefrontal cortex) are involved when we anticipate or reflect upon fight/flight responses (though much for slowly than the anticipatory or reactive kicking in of the HPA axis), it is common for us to talk about PTSD being limbic system issue. However, if you think about anxiety and about the hypervigilance associated with PTSD you may be able to see ways in which the reflective and anticipatory thought processes associated with the frontal cortex could play parts in sustaining or even drawing and driving PTSD symptom patters. Think about the string senses of responsibility and duty that first responders and military personal are selected for and trained for and think about how those characteristics could contribute to or even drive PTSD signs and symptoms. OK, now think about parents – specifically about the parents of critically ill children and about how their frontal cortex’s and limbic systems might, over time, react to the situation defined by the critical illness of their child and then listen to the podcast linked below.

Source: My son was in the ICU and I got PTSD: Why the emotional cost of serious illness in rarely treated, Brian Goldman, White Coat, Black Art, CBC Radio

Date: March 24, 2018

Photo Credit: Getty Photograph: Rubberball/Getty Images/Rubberball

Links:  Audio Program Link – https://podcast-a.akamaihd.net/mp3/podcasts/whitecoat-3bpuuRmk-20180323.mp3 from  http://www.cbc.ca/radio/podcasts/current-affairs-information/white-coat-black-art/

So, did you see the ways in which PTSD in parents and in first responders could be seen to be linked? Issues of duty and responsibility can give rise to feelings of uncertainty and guilt that can trigger or otherwise blossom into patterns of PTSD symptomology. It is well worth thinking about what sorts of things we should think about changing or adding to our health care system in order to anticipate and deal with issues of PTSD among family members of child patients.

Questions for Discussion:

  1. What are some of the groups, other than military personnel and first responders, who may be at risk for developing signs and symptoms of PTSD?
  2. How might the frontal cortex be involved in triggering or contributing to signs and symptoms of PTSD?
  3. What sorts of training, programs or other steps might be taken to start to address the issue of PTSD among parents and their family members of children with serous illnesses??

References (Read Further):

Kazak, A. E., Alderfer, M., Rourke, M. T., Simms, S., Streisand, R., & Grossman, J. R. (2004). Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors. Journal of pediatric psychology, 29(3), 211-219. https://academic.oup.com/jpepsy/article/doi/10.1093/jpepsy/jsh022/924603

Kazak, A. E., Boeving, C. A., Alderfer, M. A., Hwang, W. T., & Reilly, A. (2005). Posttraumatic stress symptoms during treatment in parents of children with cancer. Journal of Clinical Oncology, 23(30), 7405-7410. https://scholar.google.ca/scholar?output=instlink&q=info:DIkmsoyJauQJ:scholar.google.com/&hl=en&as_sdt=2005&sciodt=0,5&scillfp=16742552151850343833&oi=lle

Bailey-Pearce, O., Stedmon, J., Dallos, R., & Davis, G. (2017). Fathers’ experiences of their child’s life-limiting condition: An attachment narrative perspective. Clinical child psychology and psychiatry, 1359104517730115. https://pearl.plymouth.ac.uk/bitstream/handle/10026.1/10405/Fathers.Final.pdf?sequence=1&isAllowed=y

Tay, Y. L. (2017). Existential Distress Among Parents of Children with Cancer or Chronic Illness: Screening and a Meaning-Based Intervention (Doctoral dissertation, Murdoch University). http://researchrepository.murdoch.edu.au/id/eprint/36562/1/Tay2017.pdf

Bitton, S., Tuval-Mashiach, R., & Freedman, S. (2017). Distress levels among parents of active duty soldiers during wartime. Frontiers in psychology, 8, 1679. https://www.frontiersin.org/article/10.3389/fpsyg.2017.01679

Posted by & filed under Abnormal Psychology, Anxiety OC PTSD, Clinical Neuropsychology, Intervention: Adults-Couples, Neuroscience, Physiology, Stress, Stress Biopsychosocial Factors Illness, Stress Coping - Health, Stress: Coping Reducing.

Description: You have most certainly heard of PTSD (Post Traumatic Stress Disorder). PTSD is listed as a diagnostic option within the area of the 5th edition of the Diagnostic and Statistical Manual in the section containing Anxiety disorders (many disorders are grouped based on common presenting symptoms rather than underlying neuropsychological commonalities (though there are efforts to change this). PTSD was added to the third edition of the DSM in 1981 which makes it seem like a newly discovered or newly emerging disorder. While this is true in terms of the label and of its appearance in the DSM it is not true of the collection of signs and symptoms of the disorder. Armies in previous world wars knew about it and struggled to deal with what was then called “shell shock” or “battle or combat fatigue” or “battle neurosis” or malingering or desertion. Perhaps you can see in the labels the negative, typically unsupportive view that was taken of the presentation od what would today be called symptoms of PTSD. It goes further back than that. Two Spartan soldiers at the Battle of Thermopylae (yes, the one with King Leonidas depicted in the movie 300) suffered from “acute inflammation of the eyes” labeled tresantes, meaning trembler (link reference below in further reading section). As well a Greek soldier at the battle of Marathon in 490 B.C. went permanently blind when the soldier standing next to him was killed (despite having no wounds on any part of his body that could account for blindness). The current collection of symptoms called PTSD is a human reaction to traumatic events. the article linked below provides an overview of how PTSD is currently understood and characterized within the DSM-5. It will provide you with a basic understanding of how Psychologists and Psychiatrists currently think about PTSD. Have a read through the article and, as you do, think about issues that may affect the prevalence of PTSD in the population and subpopulations. The two posts which follow this one will look at how we might want to expand our thinking about and understanding of the causes, prevalence and possible treatments for the symptoms gathered together under the PTSD banner.

Source: Post-Traumatic Stress Disorder, Psychology Today.

Date: March 5, 2018

Photo Credit: Barends Psychology Practice https://www.barendspsychology.com/mental-disorders-causes-of-ptsd/

Links:  Article Link — https://www.psychologytoday.com/us/conditions/post-traumatic-stress-disorder

 

Much of the recent changes and expansion of focus upon PTSD arose from the efforts of the United States Veterans Administration in the years during and following the Vietnam war. The rate of now called PTSD symptomology jumped dramatically among the veterans returning from the “police action” that was the Vietnam War.  This was partially due to the unconventional nature of the engagements that occurred in the field and the largescale lack of support for the war itself and, by extension, for the returning veterans making it vastly more difficult than in previous wards, for them to find support and opportunities to work on the PTSD symptoms they experienced. As the linked article spells out, it is instructive to note that the brain regions and related physiological responses that drive PTSD symptomology are grounded in fight/flight neurological mechanisms that are, in many circumstances, adaptive. They are also mechanisms that act reactively and quickly (far quicker than mechanisms of cognitive reflection and executive function) in ways that can make coping with their consequences quite difficult. The lifetime prevalence (what percentage of the general population will experience aspects of PTSD at some point in their lives) of PTSD is 7 to 9%. Among those working in medical and other “trauma collecting” areas the provenance is 15 to 20% and among first responders and the military some studies suggest it may be as high as 40% making it more prevalent than depression or cancer. The odds are that every one of us either has or will experienced PTSD symptoms or know one or more people who have or will. We all need to know about this disorder and about what we can do to provide assistance and support for those who are dealing with it (more on this in the next 2 posts).

Questions for Discussion:

  1. What are the primary symptoms of PTSD and why does the prevelance vary so much across subpopulations?
  2. What areas of the brain are involved in PTSD?
  3. What are the standard Psychiatric and Clinical Psychological treatments for symptoms of PTSD?

References (Read Further):

Ancient PTSD https://history.stackexchange.com/questions/12628/did-roman-troops-suffer-from-ptsd

Friedmen, Matthew J., (2016) PTSD History and Overview https://www.ptsd.va.gov/professional/ptsd-overview/ptsd-overview.asp

Psychological First Aid: Field Operations Guide

Van der Kolk, B. (2014). The body keeps the score. New York: Viking. https://www.leslievernick.com/members/wp-content/uploads/2015/12/Book-Review-The-Body-Keeps-the-Score-revised.pdf

PTSD: National Center for PTSD, U.S. Department of Veterans Affairs https://www.ptsd.va.gov/index.asp

 

 

 

 

Posted by & filed under Child Development, Clinical Health Psychology, Early Social and Emotional development, Families and Peers, Human Development, Intervention: Children Adolescents, Intervention: Children and Adolescents, Prenatal Development, Stress Coping - Health.

Description: In the 31 years that I have been teaching courses in child development I have said a number of things that, in the face of more recent research, discussion, and intervention designs and outcomes, have turned out to have been wrong (or at least in need of adjustment). One of these is the statement that infants born to mothers who are addicted to narcotics are essentially born addicted and have to suffer the consequences of withdrawal. One of the consequences of this (not because I said it but because of the medical view of the situation) is that newborns, born to mothers addicted to narcotics have, for years, routinely been separated from their mothers almost immediately after their birth and placed in neonatal intensive care units (NICU’s). One of the consequences of this separation has been the loss, for the infant and the mother of an early opportunity to start to expand upon a relationship that has been building for 9 months. In addition, this practice has meant that the infant has lost the potential maternal connection and support for the short period of time when they are going trough the process of no longer being exposed to the narcotic their mother had been taking during pregnancy. Oh, and do NOT assume that the mothers in question are “street” users of their drugs or that they are inevitably going to be negligent parents unable to connect with their newborns – stigma, stigma everywhere!  What sort of research would we need to see if we are to challenge these beliefs? Well how about an intervention that is spreading across North America that involves having these newborns room-in with their mothers in the first few days after they are born? Listen to the radio piece on this question linked below to hear about this work from the physician who put it together (and who gathered data on the effectiveness of the program).

Source: Separating newborn babies from mothers with addiction does more harm than good, says doctor, The Current, CBC Radio.

Date: March 13, 2018

Photo Credit: Rebecca Dowds, via CBC, The Current

Links:  Article Link – http://www.cbc.ca/radio/thecurrent/separating-newborn-babies-from-mothers-with-addiction-does-more-harm-than-good-says-doctor-1.4572982

Audio Link for the radio program piece: https://podcast-a.akamaihd.net/mp3/podcasts/current-qph4I1cU-20180313.mp3

This is a very good example of what Stigma is and how it can affect the ways in which propel are treated, even in (or especially in) the health care system. Dr. Ron Abrahams, the physician running the program, goes so far as to point out the similarities between the practice of isolating newborns from their addicted mothers at birth and the historical ugliness of residential schools for aboriginal children.  A strong statement to be sure but, on the other side, the cost-benefit analyses (short term so far) suggesting a 4 to 1 advantage in rooming-in for addicted mothers of newborns are very persuasive even before you consider the basic developmental attachment and relationship formation, not to mention maternal self-efficacy considerations. As a result of listening to this story and reading about the program I have revised what I am going to say about this issue the next time I teach a birth and the newborn section of a child development course. Staying current means noticing when tings you have been saying are not just wrong but potentially contributory to problematic issues like stigmatization.

Questions for Discussion:

  1. Does it make sense to say that infants born to mothers who were addicted to narcotics during pregnancy are, essentially born addicted?
  2. How does stigmatization work in relation to addicted mothers and their newborns?
  3. Are there other areas where it might be worthwhile to reconsider our assumptions about people and the things they are dealing with (for example, think about harm reduction approaches to things like addicts and safe injection sites)?

References (Read Further):

Abrahams, R. R., Kelly, S. A., Payne, S., Thiessen, P. N., Mackintosh, J., & Janssen, P. A. (2007). Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Canadian Family Physician, 53(10), 1722-1730. http://www.cfp.ca/content/cfp/53/10/1722.full.pdf

Wong, S., Ordean, A., Kahan, M., Gagnon, R., Hudon, L., Basso, M., … & Farine, D. (2011). Substance use in pregnancy. Journal of Obstetrics and Gynaecology Canada, 33(4), 367-384. http://www.drugsandalcohol.ie/18247/1/Substance_Use_in_Pregnancy.pdf

Hodgson, Z. G., & Abrahams, R. R. (2012). A rooming-in program to mitigate the need to treat for opiate withdrawal in the newborn. Journal of Obstetrics and Gynaecology Canada, 34(5), 475-481. http://comingsoon.jogc.com/article/S1701-2163(16)35245-8/pdf

Strauss, M. E., Lessen-Firestone, J. K., Starr Jr, R. H., & Ostrea Jr, E. M. (1975). Behavior of narcotics-addicted newborns. Child Development, 887-893.

Chasnoff, I. J. (1985). Effects of maternal narcotic vs. nonnarcotic addiction on neonatal neurobehavior and infant development. Consequences of maternal drug abuse, 84-95. https://archives.drugabuse.gov/sites/default/files/monograph59_0.pdf#page=88

Oh and wow! Morgan, M. (2004). The payment of drug addicts to increase their sterilisation rate is morally unjustified and not simply ‘a fine balance’. Journal of Obstetrics and Gynaecology, 24(2), 119-123. https://www.researchgate.net/profile/Matthew_Morgan6/publication/8884036_The_payment_of_drug_addicts_to_increase_their_sterilisation_rate_is_morally_unjustified_and_not_simply_’_A_Fine_Balance’/links/00b4951cff3728c668000000/The-payment-of-drug-addicts-to-increase-their-sterilisation-rate-is-morally-unjustified-and-not-simply-A-Fine-Balance.pdf

 

 

Posted by & filed under Abnormal Psychology, Clinical Neuropsychology, Depression, Health Psychology, Intervention: Adults-Couples, Neuroscience, Psychological Disorders, Psychological Health, Stress Coping - Health, Treatment of Psychological Disorders.

Description: Antidepressants work wonderfully well in the treatment of the symptoms of depression, right? They have saved us from having no treatment that works or from resorting to ECT (Electro-Convulsive Shock Therapy), right? Well, if you believe these statements to be true then you have been paying attention to what the general media has had to say about the efficacy of antidepressants and you have perhaps also read some of the research literature on the topic as well. But, yes but, these statements may not be entirely true. Leaving ECT aside for the time being, the questions of whether antidepressants work, and if so how well, and for who are harder to properly address AND communicate effectively in research and research publications than you might think. Think for a minute about what sorts of issues might make answers to drug efficacy questions unclear or incomplete and then read the article linked below which lays them out quite nicely.

Source: Do Antidepressants Work? Aaron E. Carroll, The Upshot, The New York Times.

Date: March 12, 2018

Photo Credit: Jonathan Nourok/Getty Images

Links:  Article Link – https://www.nytimes.com/2018/03/12/upshot/do-antidepressants-work.html

So, are you surprised by what the article had to say? It is common to say things like “research has shown” or “research indicates,” but it is important to understand the ways in which published research is limited in terms of things like positive results bias and the related “file drawer” issues (where researchers dump study results that are non-existent or negative and thus less likely to be considered publishable). So perhaps the efficacy of antidepressants has been overstated. As well, we can consider additional contextual information. When antidepressants based on SSRI’s (selective serotonin reuptake inhibitors), like Prozac, were first released they were typically described in the media as new, effective treatments for depression. They WERE new but studies at the time indicated they were about as effective as the already available antidepressants. Called “tricyclics” because the existing antidepressants effected levels of three neuro transmitters (serotonin, dopamine and norepinephrine) while SSRI’s impact only one (serotonin). This difference at is at least partially reflected in tricyclics having a more complex side-effect profile than SSRI’s. Fewer side effects meant people tended to stay on the drugs and physicians were possibly less reticent about having patients try out an SSRI. So, more people were prescribed antidepressants. This is interesting given the finding reported in the article that antidepressants seem to have moderate effects in people with severe depression and mild or no effect in people with milder symptoms. It raises questions about what we care calling depression and about when or for whom antidepressants are advisable. Oh, and not to mention the findings suggesting that Cognitive Behavior Therapy (CBT) may well be as effective in treating depression as antidepressants. More to think about!

All that aside, it is VERY important to understand how the current research publication processes can limit the data considered when we are dealing with questions about things like the efficacy of widely used drugs like antidepressants. It is also important to understand the limitations of meta-analytic studies which are often described as the collecting together of multiple studies in order to address big deal questions like drug efficacy once and for all. The article linked above makes it very clear that meta-analytic studies may well NOT decide such questions once and for all, despite what claims the popular media make about such studies. So, the next time you see big claims being made about what research results collectively have to say about an issue or treatment you should, after reading the linked article closely, be able to assess how true or how limited such claims actually may be. In terms of antidepressant medications, well, we have a LOT to think about as the answers to seemingly simple questions like do they work, how well do they work, who do they work for and how long do they work for are actually not that simple at all.

Questions for Discussion:

  1. How well do antidepressant medications work?
  2. What do meta-analytic studies do for us? How are meta-analytic studies looking at things like drug effectiveness limited?
  3. What sorts of things should people considering taking antidepressant medications be thinking about?

References (Read Further):

Global antidepressant use: http://www.businessinsider.com/countries-largest-antidepressant-drug-users-2016-2

Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358(3), 252-260. http://www.nejm.org/doi/full/10.1056/nejmsa065779

Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS medicine, 5(2), e45. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050045

Ioannidis, J. P. (2008). Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?. Philosophy, Ethics, and Humanities in Medicine, 3(1), 14. https://peh-med.biomedcentral.com/articles/10.1186/1747-5341-3-14

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … & Egger, M. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. https://www.sciencedirect.com/science/article/pii/S0140673617328027

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review, 26(1), 17-31. http://johnjayresearch.org/cje/files/2012/08/Empirical-Status-of-CBT.pdf

Berinsky, A., Druckman, J. N., & Yamamoto, T. (2017). Why Replications Do Not Fix the File Drawer Problem: A Model and Evidence from a Large-Scale Vignette Experiment. https://polmeth.polisci.wisc.edu/Papers/repbias_polmeth.pdf

 

Posted by & filed under General Psychology, Genetics: The Biological Context of Development, Human Development, Neuroscience.

Description: First let me explain the form of the title of this post. It is related to the amount of time I spent in the late 1970’s watching the Muppet Shop on TV. (Enough said, but if you actually want to understand the reference watch this https://www.youtube.com/watch?v=YU0rj6drXdI ). OK to continue with the general theme for today of fixing what we thought we knew and/or what the media mis-states about psychological research, consider the “natural experiment” taking two identical twins and sending one of them into space on an extended mission while the other stayed on Earth and then comparing the expression of their genes when the one in space returns to Earth. Like a LOT of research done involving twins it is called a natural experiment because one of the twins was NOT sent into space for the sole purpose of seeing if the experienced changes his gene expression compared to that of his twin. Basically he was going into space anyway, because he is and astronaut, and NASA and other researchers thought to take advantage of that as an experimental opportunity (with no random assignment though, so it is really a natural quasi-experiment). Before reading the blog linked below that talk about this study and its coverage in NASA press releases and other news stories think about this claim: the twin who went into space came back with a DNA profile that was 7% different than that of his identical earth-bound twin brother. Now read the article.

Source: Twins in Space: Learning about space biology and science communication, Jaime Derringer, Why We Vary, Psychology Today.

Date: March 16, 2018

Photo Credit: NASA/Robert Markowitz

Links:  Article Link – https://www.psychologytoday.com/blog/why-we-vary/201803/twins-in-space

OK so, hopefully you are now clear that a 7% difference in the DNA of the space twin compared to the earth twin, would mean that the space twin was no longer human and while that would not be a stretch if this a Star Trek episode it is really just not true. The difference between genes and gene expressions is the key to seeing what was wrong about the 7% change claim. Further, there is no control data to tell us how much expression change their might have been in the space twin if he had stayed in Earth with his brother instead of going into space. We need good foundational “earth” science before we can do sensible “space” science. We (Psychology) has actually figured out that making nature versus nurture statements is wrong headed and that really we need to think and talk in terms of nature and nurture as the Psychology Today blogger, Jaime Derringer makes clear but then, once in a while, a Star Trek plot-like research opportunity comes along and we get a little carried away. Psychological science does not have to stay on Earth, but it does need to keep its feet on the ground (of what we know about how things, like genes, work)!

Questions for Discussion:

  1. What did the early articles talking about the twin in space study get wrong?
  2. What HAD changed in the space twin compared to the earth twin?
  3. What is a natural experiment and what sorts of things do we need to keep in mind inf we are to deal appropriately with the results such studies produce?

References (Read Further):

The effect of  year in space: https://www.livescience.com/62000-scott-kelly-dna-twin-study.html original article

The correction: https://www.livescience.com/62044-scott-kelly-space-genes-not-changed.html

The NASA piece: https://www.nasa.gov/feature/nasa-twins-study-confirms-preliminary-findings

An overview of the media mess-up:  https://arstechnica.com/science/2018/03/scott-kellys-medical-monitoring-has-spawned-some-horrific-press-coverage/

Rutter, M. (2007). Proceeding from observed correlation to causal inference: The use of natural experiments. Perspectives on Psychological Science, 2(4), 377-395. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.649.2804&rep=rep1&type=pdf

McGue, M., Osler, M., & Christensen, K. (2010). Causal inference and observational research: The utility of twins. Perspectives on Psychological Science, 5(5), 546-556. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094752/