On therapy


The American Academy of Sleep Medicine issued the following news release:

Bright light therapy improves sleep disturbances in soldiers with combat PTSD

Study suggests that bright light therapy may be an effective treatment
for combat-related post-traumatic stress disorder

Bright light therapy has significant effects on sleep disturbances
associated with combat-related post-traumatic stress disorder, according
to a research abstract that will be presented Monday, June 7, 2010, in
San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the
Associated Professional Sleep Societies LLC.

Results indicate that bright light therapy produced a significantly
greater improvement than placebo in sleep disturbances specific to PTSD.

Bright light therapy also produced a moderate improvement in PTSD
symptoms and depression.

“Results of this ongoing study show significant effects of bright light
on disruptive nocturnal behaviors associated with combat PTSD, as well
as positive effects of bright light therapy on PTSD symptom severity,”
said study coordinator Shannon Cornelius, PhD, graduate research
assistant for Dr. Shawn D. Youngstedt in the department of exercise
science at the University of South Carolina in Columbia, S.C.

“Because bright light therapy is a relatively simple, self-administered,
inexpensive treatment with few side effects, these results are an
important step to further establish the efficacy of bright light therapy
as an alternative or adjunct treatment for combat-related PTSD.”

The study involved 16 soldiers who returned to the U.S. with combat-
related PTSD after serving in Operation Enduring Freedom or Operation
Iraqi Freedom. Following a one-week baseline, participants were
randomized to one of two four-week treatments.

Eight soldiers received 10,000 lux of bright light therapy for 30
minutes each day. The other eight participants were assigned to the
placebo group and received sham treatment with an inactivated negative
ion generator.

The Clinician-Administered PTSD Scale (CAPS-2) was completed at
baseline and immediately following completion of the study.

At weekly intervals, depression was assessed with the Beck Depression
Inventory (BDI-II), and sleep quality was assessed with the Pittsburgh
Sleep Quality Index (PSQI) with addendum for PTSD (PSQI-PTSD).

Cornelius noted that sleep disturbance is a commonly reported problem
that can play both a precipitating and perpetuating role in PTSD, making
it an important target for therapy.

“Disturbed sleep is known to interact with depression and anxiety in a
vicious cycle,” said Cornelius.

“By reducing the severity and occurrence of sleep disturbances, it may
be possible to reduce the severity of symptoms such as anxiety and
depression in combat-related PTSD.”

The American Academy of Sleep Medicine reports that 70 to 90 percent of
people with PTSD describe subjective sleep disturbance. Recurrent
nightmares of the traumatic event represent one of the most problematic
and enduring symptoms of PTSD.

These nightmares may take the form of a realistic reliving of the
traumatic event or depict only some of its elements.

Bright light therapy exposes your eyes to intense but safe amounts of
light for a specific and regular length of time.

Typically it involves exposure to up to 10,000 lux of light for
scheduled periods of 20 minutes or more using a small light box.

In a 2007 study published in the journal BMC Psychiatry, Youngstedt
reported that bright light exposure may have an anxiolytic effect.

Three hours of exposure to 3,000 lux of bright light for three
consecutive days reduced anxiety in a group of low-anxiety adults.

The University of Rochester Medical Center issued the following news release:

Cognitive behavioral therapy for insomnia significantly improved sleep
for patients with chronic neck or back pain and also reduced the extent
to which pain interfered with their daily functioning, according to a
study by University of Rochester Medical Center researchers.

The study, published online by the journal Sleep Medicine, demonstrates
that a behavioral intervention can help patients who already are taking
medications for pain and might be reluctant or unable to take additional
drugs to treat sleep disturbance.

“This therapy made a major difference to these patients,” said Carla R.
Jungquist, F.N.P., Ph.D., of the Medical Center’s Sleep and
Neurophysiology Research Laboratory, who is the lead author of the Sleep
Medicine article.

(more…)

The new issue of *Behaviour Research and Therapy* (vol. 48, #2, pp.
152-157) includes a study: “When self-help is no help: Traditional
cognitive skills training does not prevent depressive symptoms in people
who ruminate.”

The author is Gerald J. Haeffela.

Here’s the abstract:

[begin excerpt]

A randomized trial was conducted to test the efficacy of three self-
directed prevention intervention workbooks for depression.

Cognitively at-risk college freshmen were randomly assigned to one of
three conditions: traditional cognitive, non-traditional cognitive, and
academic skills.

Consistent with hypotheses, participants who were high in rumination and
experienced stress exhibited significantly greater levels of depressive
symptoms after completing the traditional cognitive skills workbook than
after completing the other two workbooks.

This pattern of results held post-intervention and 4 months later.

These findings indicate that rumination may hinder ones ability to
identify and dispute negative thoughts (at least without the help of a
trained professional).

The results underscore the importance of identifying individual
difference variables that moderate intervention efficacy.

They also raise concerns about the potential benefits of self-help
books, an industry that generates billions of dollars each year.

[end abstract]

Here’s the contact info from the author note: Gerald J. Haeffela,
Department of Psychology, University of Notre Dame, Haggar Hall, Notre
Dame, IN 46556, < g h a e f f e l @ n d . e d u >.

Courtesy of Ken Pope

Next month’s issue of *Clinical Psychology Review* (February 2010,; vol.
30, #1) includes an article: “The efficacy of short-term psychodynamic
psychotherapy for depression: A meta-analysis.”

The authors are Driessen, Ellen; Cuijpers, Pim; de Maat, Saskia C. M.;
Abbass, Allan A.; de Jonghe, Frans; & Dekker, Jack J. M.

Here’s the abstract:

[begin abstract]

Objectives:

It remains largely unclear, firstly whether short-term psychodynamic
psychotherapy (STPP) is an effective treatment for depression, and
secondly, which study, participant, or intervention characteristics may
moderate treatment effects. The purpose of this study is to assess the
efficacy of STPP for depression and to identify treatment moderators.

Results:
(more…)

Next month’s issue of *Clinical Psychology Review (Feb, 2010; vol. 30,
#1) includes an article: “Psychotherapy for chronic major depression and
dysthymia: A meta-analysis.”

The authors are Cuijpers, Pim; van Straten, Annemieke; Schuurmans,
Josien; van Oppen, Patricia; Hollon, Steven D.; & Andersson, Gerhard.

Here’s the abstract:

[begin abstract]

Although several studies have examined the effects of psychotherapy on
chronic depression and dysthymia, no meta-analysis has been conducted to
integrate results of these studies.

We conducted a meta-analysis of 16 randomized trials examining the
effects of psychotherapy on chronic depression and dysthymia.

We found that psychotherapy had a small but significant effect (d =0.23)
on depression when compared to control groups. Psychotherapy was
significantly less effective than pharmacotherapy in direct comparisons
(d =-0.31), especially SSRIs, but that this finding was wholly
attributable to dysthymic patients (the studies examining dysthymia
patients were the same studies that examined SSRIs).

Combined treatment was more effective than pharmacotherapy alone (d
=0.23) but even more so with respect to psychotherapy alone (d =0.45),
although again this difference may have reflected the greater proportion
of dysthymic samples in the latter.

No significant differences were found in drop-out rates between
psychotherapy and the other conditions.

We found indications that at least 18 treatment sessions are needed to
realize optimal effects of psychotherapy.

We conclude that psychotherapy is effective in the treatment of chronic
depression and dysthymia but probably not as effective as
pharmacotherapy (particularly the SSRIs).

[end abstract]

The author note provides the following contact info: <p.cuijpers@psy.vu.nl>.

Courtesy of Ken Pope

The University of Warwick issued a news release:  “Therapy 32 times more
cost effective at increasing happiness than money.”

PLEASE NOTE:  Contact info for the study’s author appears at the end of
the news release.

Here’s the University of Warwick’s statement:

Research by the University of Warwick and the University of Manchester
finds that psychological therapy could be 32 times more cost effective
at making you happy than simply obtaining more money.

The research has obvious implications for large compensation awards in
law courts but also has wider implications for general public health.

Chris Boyce of the University of Warwick and Alex Wood of the University
of Manchester compared large data sets where 1000s of people had
reported on their well-being. They then looked at how well-being changed
due to therapy compared to getting sudden increases in income, such as
through lottery wins or pay rises. They found that a 4 month course of
psychological therapy had a large effect on well-being. They then showed
that the increase in well-being from an ?800 course of therapy was so
large that it would take a pay rise of over ?25,000 to achieve an
equivalent increase in well-being. The research therefore demonstrates
that psychological therapy could be 32 times more cost effective at
making you happy than simply obtaining more money.

(more…)

A short youtube clip from a Toronto therapist explaining from her perspective what happens in therapy – the first session, and overall.  It’s a bit general, but gives you some of the flavour.  Bear in mind that, as she says, all sessions differ.

Here’s the link:

http://www.gotosee.co.uk/healtharticles/2009/03/guide-to-psychotherapy/

When do you stop going to therapy?  An x-ray can tell you that a broken bone is mended and that you can walk on it. But you aren’t a bone.  Here are some ideas to help you decide when you are done with therapy.

All of this assumes that you are working with a therapist who is a good fit for you. You feel you can trust them, you are in agreement on how to address your issues, and on what you are basically doing there. If you are there to understand your marriage and your therapist thinks you are there to feel less anxious, you have a mismatch and need to sort this out right away.  If you want to learn better coping skills and your therapist thinks you are there to understand your dreams… get on the same page.  If you can’t, find someone else.

Ideally you will leave therapy when you’ve accomplished the goals you’ve set for yourself.  When you started, you should have had some sense how you wanted things (you)  to be different when therapy is complete.   You can and should check in from time to time with your therapist about how you are doing and where therapy is going.  I like it when my clients do this.  I like looking for signs of progress, and sharing our insights. You should see signs of progress within one to three months. It might take longer to resolve, but you should not be waiting years to see something happen.

Some issues resolve pretty quickly, others can take a long time. Part of this depends on what level of work you are doing.  If  you are trying to find strategies to deal with  a specific life problem or make a decision, you probably won’t need to go for long.  Changing a specific behaviour might not take that long either,  depending on what it is. If  you are trying to change a part of your personality, this can take quite a while – minimum six months, and it could be years.  Trauma work generally takes a while, and the earlier it began and the longer it lasted, the more time it will usually take. Generally, short-term issues lead to short-term therapy. Long term issues, especially those that began in childhood, generally mean longer therapy to be resolved.

Other clues that you might be done are:

  • When you have made or resolved the life transition that brought you to therapy and you are getting on with life.
  • When you feel that you know how to deal with your feelings and relationships, and the problems life throws at you.
  • When you feel confident in who you are, what you feel, and what you want and you can stand up for these.
  • When you are able to make free, smart, and responsible choices for  yourself out of love and not fear.
  • When you are able to love as freely as you would like, and let others love you.
  • When you have good boundaries with others. You can let them in… or not. You can go along with them… or not.
  • When you are able to feel your feelings and you don’t take your feelings out on others.
  • When you are not in the power of an addiction.
  • When you are not haunted by past events any more.
  • When you have some sense what you want from life and are able to go for your dreams.
  • When you are able to work effectively, but also to have fun, play and relax.
  • When you feel that you now thoroughly know yourself.  You understand the sources of your happiness and unhappiness and know what to do about these.
  • When the problem that brought you to therapy is solved and you have worked through the other issues that came up along the way.

It’s usually not a good idea to stop just because you start to touch uncomfortably strong feelings or issues. Or you get scared of your feelings or impulses that are coming up.   It can be tempting at this point to think that therapy is not working or just making you worse. Strong feelings, including those about the therapy, are actually a great reason to continue. You are now getting ready to do some of the real work, discovery and healing.  The deeper problems are now within reach and are available to be explored.

However, if you are not learning any more, this is a clue that you  could either end therapy or else increase the heat. If you are just chatting session after session, there is something missing. Maybe you are not going deep enough, or maybe you are done and don’t realize it.  Discuss this with therapist. It’s not criticism. Even if it were, the therapist should be able to take it.

I appreciate it when I know we are near the end, and the client doesn’t just stop coming without telling me.  When I know we have just a session or two to go, I have a different focus, and use the sessions accordingly.  There might be a specific piece of work I want to suggest or a skill I’d still like to teach, and if I don’t have warning, this gets lost. An end date might be next week, it might be in 5 months. Some of my long-term clients like to taper off – checking in less often and spreading out the appointments.

If you feel that you’ve accomplished what you wanted to, but your therapist hasn’t said anything, it’s up to you to tell him or her that you are ready to leave therapy.  Then you can discuss it. The therapist may agree and be really pleased for you.  Remember that the therapist’s job is to make him or herself unncessary. Or he or she might be able to point out a possible next step that you overlooked. Then you discuss whether you want to do that piece of work or not.

If you are a bit scared about leaving therapy, remember that you can always go back if you need to.  And it can be nice and affirming to check in some time later, even if it is no longer a necessity.  Because you now know it is not a necessity!

Brian Grady, Ph.D. Registered Psychologist

23 Marchh 2009

I recently came across this article by Dr. Kevin Grold.  Here are some extracts.

————————–

A good therapist for one person is not necessarily the right therapist for another person. You have to find a good match for your personality.

[snip]

THE PROCESS

First, and most importantly, start by finding three therapists to interview for the position of “your therapist.” [snip]

If you have a close friend who … is seeing a therapist who is being helpful, what better recommendation could you receive for the beginning of your search? I would say, “Start with THAT therapist.” [snip]

Let’s say you decide to ask your family doctor for a recommendation. Your doctor probably has one licensed therapist in the office building who he or she uses for cross-referrals.[snip]

Another way to develop your list of three interviewees is to call a referral service.
[snip]

MAKING THE CALL

Next, call your three therapists and say, “I am considering becoming a new client of yours, is there a time we could discuss this for five minutes?” The therapist may be busy at the time you call but this allows him or her to set up another time to have a short phone call with you. Do not expect a full counseling session on the phone, but do expect to be able to say, “Here are the issues I have been facing–do you have any experience in this area?–How would you approach such issues?–What would you consider your therapeutic approach to be?” These questions will help you prioritize your list of three therapists from most to least favorite. If a therapist is not willing to take 5 minutes of time to talk with you over the phone, then you have an easy decision to cross that name off the list.

Next, make an appointment with the therapist with whom you felt most comfortable on the phone. If after the first session, you feel you may have not chosen wisely, do not continue.  Instead, go to the second therapist on your list. Remember that you are making a choice for a life-long companion and guide. Do not take this decision lightly.

the full text is avaiable online at
http://www.1-800-therapist.com/how_not_to_choose_a_therapist.htm

A recent dream:

I am with a homeless man. I take pity on him, and I buy a lottery ticket for him, thinking that if it wins, I’ll give him the winnings. It turns out that the ticket wins $1 million. I give it all to him, but it comes in the form of water. I pour this into a mixing bowl of his. He lets it all slowly run away out of the bowl until there is nothing left. I can’t believe that he’s just let $1 million of water go away.

He tells me, “But it is flowing freely from the sky at all times, in all places, on all people.”  And I am shown an image of rain.

He has no need for me to give this water to him.

Brian Grady, Ph.D.

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