The GoodTherapy Blog

A nationwide study will determine if Abilify (aripiprazole) has the potential to relieve the involuntary muscle movements, or tics, commonly associated with Tourette’s syndrome. Children aged 7 to 17 years old will be recruited for the study, with completion set for August 2013. To be eligible, participants must have a diagnosis of Tourette’s syndrome and tics severe enough to disrupt daily activities. Exclusion criteria include pregnancy, obsessive-compulsive disorder, mood disorder, suicidal thoughts, or another diagnosed mood disorder. As with most clinical trials, researchers have designed the criteria to isolate the condition (Tourette’s) and the intervention (Abilify) to the fullest extent possible.

Participants will be placed into one of four treatment groups. In group one, participants will receive a placebo pill that is indistinguishable from Abilify. Groups two through four will each receive various dosages of the study drug. Doses will be administered once weekly for a period of eight weeks. The Yale Global Tic Severity Scale will be employed at the beginning and end of the study to quantify any symptomatic changes. Study authors believe that both the study drug and experimental procedures represent little or no safety risk to participants. However, parents or guardians must provide informed consent before enrollment.

According to the National Library of Medicine, Abilify belongs to a class of medications known as atypical antipsychotics. Originally, these medications were developed as replacements for the first generation of antipsychotic drugs. Although schizophrenia and other psychotic disorders were the impetus behind the creation of these drugs, research in the last twenty years has revealed that Abilify, and drugs like it, can have beneficial effects on a number of mental health conditions. Abilify works by altering the level of certain chemicals in the brain, and doctors know that Tourette’s syndrome results from an imbalance of brain chemicals. These chemicals, known as neurotransmitters, are responsible for the regulation of mood and movement, among other things. It is believed that Abilify may restore some degree of balance for those experiencing disruptive tics because of Tourette’s syndrome.

Abilify continues to show promise as a multipurpose psychotropic medication. So far, it’s been used to treat bipolar disorder, severe depression, and aggression in autistic children. In cases of severe depression, Abilify is often combined with a standard antidepressant medication. Tourette’s syndrome only affects a small percentage of individuals, but those with severe symptoms often have trouble navigating in daily life. It is hoped that Abilify, combined with various modes of therapy, will improve their experience.

References

Aripiprazole – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/
Efficacy & Safety Study of Once-weekly Oral Aripiprazole in Children and Adolescents With Tourette’s Disorder. (n.d.). ClinicalTrials.gov. Retrieved June 22, 2012, from http://clinicaltrials.gov/ct2/show/NCT01418352?intr=%22Aripiprazole%22&rank=8
Gilles de la Tourette syndrome – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001744/

two drinks at the bar In my practice as an addiction psychologist, it’s probably the most common question I encounter; when it comes right down to it, it’s what most people who are struggling with alcohol really want to know:

“How can I control my drinking or drug use?”

Only a small minority of people come to my practice with the expressed agenda of stopping their drinking altogether. Most seeking psychotherapy for alcohol dependence, misuse, or abuse have experienced some consequences due to their drinking and would like to minimize or stop those consequences but do not want to give up their drinking entirely.

For some drinkers, controlled drinking or moderate drinking is an option, and for a small portion of the population, about 5%, controlled drinking is nearly impossible. While many people believe “once an alcoholic, always an alcoholic,” many people diagnosed with alcoholism can learn to control their drinking and become social drinkers again. That said, if you have been diagnosed with alcohol dependence, most addiction psychologists, psychiatrists, physicians, social workers, and addiction counselors would strongly recommend abstinence. This is always a very personal decision that should be made with careful consideration of the risks and benefits of drinking versus abstinence.

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If one has never exhibited signs of alcoholism, then controlled drinking, a technique or approach that is a form of harm reduction, is a reasonable yet delicate first step. If one wants to pursue this approach, it is best not to go it alone. Talking to an addiction psychologist or other addiction professional can guide you through some generally recommended techniques.

Notice Feelings and Set Limits

Most addiction therapists will recommend two basic procedures that may differ in numerous ways but have the same central premise. The first is that you cut back your use of alcohol in whatever way you decide and that you then pay attention to what thoughts and feelings emerge. The idea here is that alcohol serves to mediate feelings by numbing, dulling, or blocking them entirely, and when you reduce your use or even stop drinking, your feelings will come back. As this happens, it is often recommended that you keep a journal or that you talk to your friends, family, partner, or therapist about these thoughts and feelings.

The well-known acronym “HALT” captures this eloquently. HALT stands for Hungry, Angry, Lonely, and Tired. These are the types of feelings people will experience as they reduce their alcohol or drug use. It reminds us to halt, or stop, and pay attention to what we need. Somehow, we have to cope with those feelings or risk relapse. If you are hungry, then eat. If you are angry, then tell someone, vent, exercise, pound a pillow, or express your anger in a healthy way. If you are lonely, then surround yourself with friends or start the process of finding new ones if all your friends drink. If you are tired, then sleep. Many people with alcoholism have an inability to take care of themselves, and learning this new skill in recovery is essential even with such basic behaviors as eating and sleeping.

A second basic tenet to alcohol counseling for people who are attempting moderate or control their drinking is to pick an amount of alcohol that they will not exceed and to stick with it. The National Institutes of Health recommend that, to maintain “low-risk drinking,” men consume no more than four drinks per day and no more than 14 per week. For women, the number is no more than three per day and seven per week. My personal belief is that this is fairly generous; a man can drink four beers while at a party on Friday or Saturday night, three or four during the football game on Sunday, three or four at bowling or poker night with the guys, and still have two or three with his partner on another day during the week.

When we can learn to stop at the “buzz,” we are well on our way to having our relationship with alcohol fully in check. For most people, three or four drinks make them feel tipsy or buzzed. Alcohol is a central nervous system depressant, yet the initial effects of alcohol in these amounts are more stimulating and euphoric feeling. People tend not to get into serious trouble from these amounts, but since the initial effects feel good, many people continue to drink past these amounts, assuming more alcohol equates to more good. It does not. It takes time for alcohol to work itself into your system, so people don’t realize how drunk they are getting, and in larger amounts alcohol has a depressing effect. The alcohol you drink today can make you feel depressed days and weeks later, and these small amounts can contribute to depressive feelings over time. Rarely has anyone come into my office with concerns about alcohol abuse because of drinking three or four drinks a few times a week.

Other Useful Techniques

To stick to the above drinking goals, there are other moderate drinking techniques that you can employ, such as avoiding hard alcohol and sticking to beer. Beer has lower ethanol content, and the carbonation can fill you up, so it tends to take longer to drink. Switching from alcohol to nonalcoholic drinks and back can slow you down as well. Holding a drink with lime or lemon may deter others from thinking you are not drinking an alcoholic mixed drink, and they may be less likely to offer you another drink. Remember, you are more aware that you are not drinking your normal amount or that you have reduced your consumption, and others probably aren’t even aware that you made any changes.

One technique to help you be honest with yourself is to take four coins (or as many coins as you are planning to have drinks that night) and place them in your back pocket. Each time you take a drink, move one of the coins into your other pocket. This may be more important if you are planning on drinking larger amounts of alcohol, and many of the people I work with start out reducing their drinks per setting with numbers more like from 10 to five or six, for example, so counting drinks becomes more important. This way, when your coins run out, you can be sure not to exceed the previously determined limit that you imposed on yourself.

Many addiction therapists recommend one drink per hour as another way of limiting oneself. Since alcohol leaves the bloodstream at about .02 blood alcohol content (BAC) per hour, this will most likely keep your BAC at a reasonably safe level. In using this technique, it is recommended that you discuss your upper limit with a certified addiction professional or addiction psychologist.

It goes without saying that it’s important to pay attention to drink equivalents. A typical shot equals one 5-ounce glass of wine, which equals one 12-ounce standard beer. If your favorite bartender is pouring your drinks and he knows you are a big tipper who likes to drink, you might need to have a brief conversation with him. Believe me, bartenders are used to these conversations, and they will not hold it against you. In fact, most bartenders will be very respectful and discreet and will keep an eye out for you thereafter. If your buddies are trying to get you drunk, that’s another story. Watch how much they pour. A Long Island Iced Tea counts for three drinks, not one.

Don’t Try to Drink Away Emotional Pain

While I consider myself to be an open-minded therapist, what would an alcohol blog be without a major caution? Here’s my warning: Don’t drink when you are sad, anxious, lonely, worried, or in any negative feeling state. These are times when you should figure out healthy ways of coping. If you drink during these times, you are at high risk for using your drinking as a crutch.

What happens if you can’t control your alcohol use with these techniques? After trying these techniques and determining your level of success, you should be able to assess whether you can be a social drinker. To the extent that you break any of the rules that you set up as an experiment and exceed these drinking limits with resulting consequences, then it is time to reconsider lowering your upper drinking limits and decreasing the frequency, quantity, intensity (alcohol content), or duration of your alcohol use.

If you are wondering whether you have a drinking problem, please read Do I Really Have a Drinking Problem?

An addiction psychologist or other psychotherapist specializing in addiction can help you answer any questions or develop a plan that, over time, will enable you to understand the role that alcohol plays in your life and make decisions about what, if any, changes you are ready to make. You don’t need to figure this out on your own. It takes courage to seek help for alcohol use. If you are reading this, you are well on your way to understanding yourself better and getting what you want and need in life.

Clinicians who practice individual therapy have the responsibility of developing a therapeutic bond with their clients, tracking the progress of their clients throughout therapy, and measuring treatment outcome. Along the way, therapists must ensure that the measures they are using are delivering results, and if not, they must change their approach. These steps become even more daunting when they are undertaken in a group setting. Group therapists have the same responsibility to their clients as do therapists conducting individual therapy; however, they must maintain this responsibility with each and every client in their group.

A team of experienced group therapists recently published an article providing guidance for preparation, evaluation, and conclusion of group therapy for clinicians. Dallas R. Jensen, Assistant Clinical Professor in the Counseling and Psychological Services Department at Brigham Young University, spearheaded the effort and outlined several key components for effectively managing group therapy sessions. The first and most important aspect of accurately assessing group therapy progress is gathering practice-based evidence (PBE). Research has shown that clients are more accurate predictors of treatment outcome than clinicians’ assessments. Therefore, Jensen recommends that therapists use a variety of several well-established tools to determine group member eligibility, progress, and outcome.

The Group Therapy Questionnaire (GTC) is an excellent tool to determine group member readiness. This tool allows therapists to examine the level of willingness of the member, previous group experience, and other factors that could influence participation, such as suicidal ideation, substance dependency, therapy fears, and goals. The Group Readiness Questionnaire (GRQ) is a similar tool often used. Jensen suggests other measures, such as the Working Alliance Inventory (WAI), the Cohesion to Therapist Scale (CTS), Therapeutic Factors Inventory (TFI), and the Group Climate Questionnaire (GCQ) to accurately assess the level of cohesion within the group and gauge group fidelity, tone, trust, and acceptance. Although there are several outcome scales to choose from, Jensen notes that the Outcome Questionnaire-45 (OQ-45) is the most commonly used and can be administered via computer or in person. Group therapy assessment is an area of research that is still relatively new, but is critical to group success. “We further encourage clinicians to share results and lessons learned in the literature and in professional settings, so as to continue developing this burgeoning effort,” concluded Jensen.

Reference:
Jensen, D. R., Abbott, M. K., Beecher, M. E., Griner, D., Golightly, T. R., Cannon, J. A. N. (2012). Taking the pulse of the group: The utilization of practice-based evidence in group psychotherapy. Professional Psychology: Research and Practice. Advance online publication. doi: 10.1037/a0029033

GoodTherapy | 'Bad' Kid or 'Bad' Behavior and How It Shapes a Child’s Self-Esteem I was talking with a new client and he was telling me about his temper when he gets mad and what consequences he receives. As he was talking, he stated, “when I’m bad…” and continued the conversation about his consequences. When he was done, I asked if he thought he was a “bad” kid. He said no. I was glad to hear that because I think overall, we are inherently good. Yes, there are people out there who would fit more in the “bad” category, but that is not what is being addressed.

As parents and disciplinarians, we try to shape our kids to make wise decisions so the negative consequences can be few or needed when necessary. When a kid gets angry and has tantrums and it happens over and over, it can be very frustrating to deal with. When the kid understands the consequence of his behavior but continues to still get angry and throw tantrums, parents may not be sure of what else to do. Parents slip. Teachers slip. The slip is telling the child that he is “bad” even though the behavior that he is doing may be more the focus of “bad.” I do not think that parents or even teachers slip on purpose and telling the kid that he is “bad,” but we are human and make mistakes, and it happens. Repeating this slip impacts the child’s self esteem. Over time, these children may see themselves as “bad” because they keep repeating the “bad” behavior, receiving the consequence, and having parents become frustrated, and a negative self-image begins to form. I know that is not what we as parents want for our kids. We want them to have a good sense of self and know what is “bad” behavior. So, how can this happen?

Here’s an idea: How about getting away from “bad” and “good” behavior. I know it’s hard to do because “good” and “bad” has been around for a very long time; it’s habitual and creating a newer way can be difficult.

What I am suggesting is to name what is “bad.” For example, your child is hitting a younger sibling because the sibling did not want to share a toy with the child. Instead of saying, “that’s bad,” point out that “hitting is bad.” Tell the child, “It’s not okay to hit when you are angry.” When we point out the behavior that is not okay, it helps us to not get into the “good” versus “bad” cycle. Another example: When your child is sitting on the floor and waiting patiently and you tell him “good boy.” Point out the WHAT that he is doing: sitting and waiting patiently. When he knows what he is doing that makes him a “good” boy, he will be able to associate that behavior in other areas and he will know he is doing well.

Objectifying the behavior takes away the “good” or “bad” titles, which decreases the opportunities for us parents to accidentally say that the child is “bad.”

Remember when your child was a baby and you were telling him what type of person he was going to grow up to be? If not, it’s okay. What I am getting at is when a kid is younger, parents may encourage the child a little more than at an older age. We encourage young children to try new foods, feed themselves, and use utensils, and we teach/show them how to do it then praise them for what they learned, even if it may not turn out well. Somehow as the child ages, the cycle of “good” or “bad” begins or replaces the encouraging aspect of parenting. Yes, kids do need to know right from wrong AND they still need to know that they are capable of doing great things.

Objectifying the behavior can help start a different way of helping your child to know how to make healthy choices. Continuing to encourage your child to try new things or to keep trying something can also help. Asking children what they think about their behavior and maybe what they could have done instead to not receive a consequence can also help. The asking can help your child learn how to see the cause and effect of a particular behavior. This can be a great learning and shaping tool for preparing the child to see more cause and effect as he or she ages and matures. Reminding the child that he or she is a wonderful child, has great possibilities, and is loved unconditionally can also reinforce a positive sense of self, regardless of whether the child has made a mistake or chooses wisely.

The goal of parenting is to help shape a child to have a good sense of self, to know how to behave appropriately, and to be able to self correct or recognize when he or she does not make a good choice. When the “bad” behavior is directly addressed, it takes away from parents accidentally slipping and saying that the child is “bad” when the focus needs to be more on the actual behavior.

It takes awareness and practice to create a new way of responding. Hopefully, this article will enlighten and small steps can be made to get out of the good/bad cycle and help the child to still have a good sense of self, even when he or she makes a poor choice.

“It is so difficult to put the complexities of the trauma recovery process into words—artwork does this much better!” – Joan Turkus, M.D.

Posttraumatic stress (PTSD) is a condition that is, unfortunately, quite common in modern society. Statistics show that 70% of adults in the United States have experienced some form of traumatic event at some time in their lives and that up to 20% of this population will go on to develop PTSD. If you have undergone trauma, you are not alone. While many forms of therapy continue to emerge to treat those who have experienced trauma, art therapy is one that has been proven by a number of studies to be effective in dealing with the aftereffects of trauma. Whether you are a survivor of abuse, war, natural disaster, or another traumatic event, art therapy will likely be able to help you heal.

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Breaking the Silence

A common occurrence after a person has experienced trauma is a hesitancy or inability to discuss the incident out loud or verbally, even with a professional therapist. Repressing all thoughts and feelings is one reason this can happen. In expressive arts therapy, words are not necessary; much can be achieved without them. Expressive arts therapy moves the client and therapist from the traditional talk therapy roles and into a process that may be less provocative. The medium serves as a bridge between you and the therapist, allowing exploration to occur at a comfortable pace.

Each medium is carefully selected by the therapist to support giving voice to your experience. You don’t have to strain to say the right thing; the medium can speak for you and act as a support for your experience. Some emotions may be better expressed through art than through verbal language anyway. While you may not be able to put what you feel into words, viewing your work in front of you is something else entirely—something that can lead to your healing.

Journey to the Unconscious

Repression, or the brain’s attempt to send difficult thoughts straight into the unconscious, supports clients in handling their trauma. This phenomenon is observed frequently in trauma victims, who claim to have no recollections of the disturbing events. Many experts view art therapy as a way to tap into these unconscious thoughts and memories and bring them to the surface, so that individuals can heal and reconcile them.

You’re probably familiar with the left-brain and right-brain theory, which has been common knowledge among the general public for quite some time now. The act of creative expression utilizes the right-brain hemisphere. What’s interesting is that the right brain is also where visual memories are stored. Many theorize that the two are therefore very closely linked and that this is one of the reasons that art therapy has been so successful at uncovering repressed, unconscious images.

Helping Children Heal

Although art therapy has been proven to be a successful treatment for people of all ages, research shows that it has been particularly effective in the treatment of children. Various developmental theories claim that children do not fully develop verbal skills until adolescence, and it is therefore no surprise that your child may better respond to a creative outlet for self-expression than a chat with a therapist.

Seeking the right treatment for you or your child following a trauma is often frustrating, particularly when you do not know where to turn. While it is important to read about all of your options, if you or your child has experienced any form of trauma, then art therapy may be helpful.

References:

Art therapy. (2011). Retrieved July 15, 2012, from Trauma Recovery Center: http://www.traumarecoverycenter.com/art_therapy.html
Art therapy. (n.d.). Retrieved July 15, 2012, from Casa Palmera: http://www.casapalmera.com/articles/art-therapy/
Art therapy what is it? (n.d.). Retrieved July 15, 2012, from CRC Health Group: http://www.crchealth.com/types-of-therapy/what-is-art-therapy/
Clatch, M. (2012, January 1). Trauma recovery through art and play therapy. Retrieved July 15, 2012, from Courage to Connect Therapeutic Center: http://www.couragetoconnecttherapy.com/trauma-recovery-through-art-and-play-therapy
Malchiodi, C. (2012, February 22). Art therapy shows promise in treatment of PTSD & trauma. Retrieved July 15, 2012, from Art Therapy: http://www.arttherapyblog.com/ptsd/ptsd-treatment-showing-promise/#more-26
Malchiodi, C. (2012, March 6). Trauma-informed expressive arts therapy. Retrieved July 15, 2012, from Psychology Today: http://www.psychologytoday.com/blog/the-healing-arts/201203/trauma-informed-expressive-arts-therapy
Rosenthal, M. (n.d.). PTSD statistics. Retrieved July 15, 2012, from Heal My PTSD: http://healmyptsd.com/education/post-traumatic-stress-disorder-statistics

Happy young girl with headphones Binaural beat technology (BBT) was discovered in the early 1800s and first described in the popular literature in the early 1970s. In the last four decades, binaural beat audio programs have been touted as tools for reducing stress, improving sleep, enhancing concentration, and even fostering altered states of consciousness. In the ‘70s and ‘80s, BBT audiotapes were primarily found in more esoteric venues, such as New Age bookstores, health food emporia, and retreat centers dedicated to consciousness exploration. One such center, the Monroe Institute in Virginia, is well known for their use of Hemi-Sync recordings, which feature BBT.

Today, BBT has become more commonplace, as one can download MP3s and smartphone applications in a matter of moments. Although the prevalence and popularity of such products has waxed and waned, several studies examining the potential usefulness off BBT have been conducted with a variety of populations.

What is BBT?
The term “binaural beat” refers to the brain’s tendency to hear the difference between two similar tones that are played in opposite ears as one new tone. Our ears hear tones in terms of hertz (Hz), or cycles (the number of times a wave repeats itself) per second. Beats played at frequencies that are characteristic of brain wave frequencies are both audible and thought to facilitate alterations in our predominant brain-wave state.

Types of Brain Waves and Their Associated States
At any given time, our predominant brain wave may be in the frequency associated with deep sleep or deep trance (delta; 1-4 Hz), meditation (theta; 4-8 Hz), relaxed awareness or daydreaming, (alpha; 8-12 Hz), a state of relaxed focus (low-beta, or sensorimotor rhythm [SMR]; 12-15 Hz), alert mental activity/concentration (mid-beta; ~15-18 Hz), anxiety (high-beta; >18 Hz), or high-level information processing (gamma; >30 Hz). Gamma brain-wave states appear to be the least well researched. There is no “best” state to be in; however, at different times we will understandably want to be able to shift into one that is appropriate to the task at hand, whether sleeping, working on a project, or relaxing.

What Type of BBT for Which Conditions?
It has been hypothesized that a number of conditions, including chronic stress, chronic and postoperative pain, migraines and other headaches, problems with attention/concentration or learning, and insomnia, to name a few, reflect an imbalance or irregularity in brain-wave states. The deliberate use of BBT to change the predominant brain-wave state is referred to as brain-wave entrainment (BWE). BWE is not limited to BBT, but discussion of other methods is outside the scope of this article. However, a 2008 review of the BWE literature found that delta stimulation was associated with improvement in migraines and other headaches and reduction in short-term stress. A single session of alpha stimulation was associated with stress reduction in some settings, but not for those undergoing root canal. Alpha stimulation was also linked to pain relief. Beta improved attention, reduced short-term stress, alleviated headaches, reduced behavioral problems, and improved performance on measures of overall intelligence. An alpha-beta protocol improved verbal skills performance and attention, and a beta-gamma protocol showed improved arithmetic skills in children who had learning disabilities or attention-deficit hyperactivity. Most of these studies examined photic stimulation (presented via flashing lights) or combined photic and BBT entrainment rather than BBT alone. Thus, it is difficult to draw a definitive conclusion about the specific utility of BBT from this review.

BBT as a Potential Tool for Reducing Anxiety and Pain
The results of a small pilot study published in 2007 found that listening to an hour-long program emphasizing delta BBT for 60 days was associated with a decrease in self-reported trait anxiety and an increase in quality of life among eight healthy adults. The level of dopamine (an excitatory neurotransmitter) was also decreased significantly and may be related to the decrease in trait anxiety scores. Interestingly, the team assessed changes in the level of growth hormone because the BBT’s producer claimed that listening would increase these levels. Growth hormone decreases with age, and thus, an increase would be considered a potentially beneficial outcome; yet, listening to this BBT program was associated with a significant decrease in growth hormone. Both the reasons for this result and it’s implications are unclear.

Perhaps two of the more intriguing studies about BBT were the following trials with patients undergoing surgery. The first is a 2005 double-blind, randomized controlled trial in which 108 patients undergoing general anesthesia for elective surgeries received either a BBT plus music audio, the same music without BBT, or no intervention other than standard care for a 30-minute period prior to their operations. The BBT audio featured a progressively slowing beat that ended with 10 minutes of delta. No adverse events were noted, and although initial state anxiety scores were higher in the BBT group (prior to the intervention), the most significant decrease in anxiety was also in the BBT group—even after adjusting for the fact that participants in this group on average had higher initial anxiety. Listening to music alone was also associated with a significant decrease in anxiety, but this decrease was of a lesser magnitude than that of the BBT group. This study showed that an inexpensive, one-time intervention of short duration was beneficial despite the stress characteristic of undergoing surgery.

The other study was a randomized controlled trial of 60 patients about to have surgery with general anesthesia. Twenty patients were assigned to each of three conditions: a Hemi-Sync BBT program, listening to the music of their choosing, or listening to a blank audiocassette for 30 minutes prior to surgery. None of the participants was offered any sedative premedication. Stereo headsets from all groups of participants were removed before the patients entered the operating room but were replaced and the respective audio programs restarted after the induction of anesthesia. Headsets were discontinued at the conclusion of surgery. The researchers found that using the Hemi-Sync programs resulted in significantly less intraoperative use of fentanyl (a very potent, synthetic opiate pain medication), lower self-reported pain scores several hours after the surgery, and being discharged from the hospital sooner. Unfortunately, the specific frequency of BBT was not described in this article.

Anecdotally, several months ago I went for my first-ever root canal and noticed considerable anxiety at the thought of having a very sensitive tooth drilled (even with anesthetic). On the way to the endodontist’s office, I listened to both a guided imagery program designed specifically for medical procedures in which one must remain awake (available via HealthJourneys.com) and also to a free delta BBT program (Napuru) I’d downloaded for my iPhone. The delta tones were played against a backdrop of ocean waves. My subjective experience was that the BBT and imagery, combined with mindfulness practice before and during the root canal, reduced my anxiety significantly and enabled me to get through what seemed like an eternity of loud drilling. I cannot say what the most “active” ingredient in this integrative approach was; however, the point is that this nondrug, inexpensive, easy-to-use adjunct was effective for me.

BBT has been around for decades and is now readily and inexpensively available. There are some data to suggest that it may be helpful for relieving anxiety in general and in the context of a stressful event. There is also some evidence that BBT or other methods of brainwave entrainment may help with pain, concentration, headaches, and other issues, and serious risks or side effects have not been reported. The current research does not definitively answer the question of whether there would be a dose-response effect or a benefit from listening to BBT more regularly versus listening once; however, this seems plausible. More research needs to be done to better elucidate whether BBT could be used as an independent therapeutic tool, however. Additionally, assuming BBT is effective, one should not drive or perform tasks requiring sharp focus when listening to delta, theta, or alpha tones, as these may induce a very relaxed state.

For More Information:

Dabu-Bondoc, S., Vadivelu, N., Benson, J., Perret, D., Kain, Z. N. (2010). Hemispheric Synchronized sounds and perioperative analgesic requirements. Anethesia & Analgesia, 110(1), 208-210.
Huang, T. L., Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine, 14(5), 38-50.
Padmanabhan, R., Hildreth, A. J., Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anesthesia for day case surgery. Anesthesia, 60, 874-877.
Wahbeh, H., Calabrese, C., Zwickey, H. (2007). Binaural beat technology in humans: A pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine, 13(1), 25-32.

GoodTherapy | Do Men and Women Have Different Sexual Fantasies?

According to a recent article, men spend a bit more time fantasizing about sex than women do. However, contrary to what some people believe, based on the results of a study conducted by Juan Carlos Sierra Freire and Nieves Moyano Munoz, both of the Department of Personality, Psychological Evaluation and Treatment at the University of Granada in Spain, men and women don’t usually fantasize about sexual encounters with strangers, but with their partners. Sources of entertainment that are focused on fulfilling sexual fantasies, like steamy books, racy movies, and even websites, all sensationalize the stranger fantasy. Whether it is with a hot construction worker or a sexy swimsuit model, some of the most sexually stimulating scenarios involve strangers colliding for a thrilling and fulfilling sexual encounter. But this is not what the majority of people actually fantasize about.

For their study, Freire and Munoz surveyed 2,500 men and women ranging in age from 18 to 73. All of the participants questioned had been in some form of heterosexual partnership in the last year. They were asked whether they had ever had a sexual fantasy and if so, to describe the type of fantasy. The researchers assessed whether the fantasies resulted in negative or positive feelings and explored what characters were most prevalent in the fantasies. They found that almost all of the respondents had fantasized about sex at one time or another. Surprisingly, the majority of them, nearly 80%, reported that they had had at least one negative sexual fantasy. For women, negative fantasies involved forced sexual encounters and for men it involved homosexuality.

The team also found that although men did fantasize more often than the women, both men and women usually fantasized about sex with their partners. Other findings revealed that women had more positive sexual fantasies than the men, and men had more experimental sexual fantasies, including fantasies about threesomes and other group sexual encounters. Overall, the researchers believe that having fantasies about sex “favors some aspects as sexual desire and arousal” and is an area of exploration for therapists working with individuals who have sexual concerns.

Source:
University of Granada (2012, July 18). A study shows that men and women have the same sexual fantasies. Retrieved from http://www.alphagalileo.org/ViewItem.aspx?ItemId=122554&CultureCode=en

Bipolar disorder actually refers to a group of mental health conditions that feature alternating and unpredictable mood states. These conditions are sometimes referred to in terms of the “bipolar spectrum.” Mania, an intensely elevated or euphoric mood, and depression are the mental states typically associated with bipolar disorder. Doctors classify the various subtypes of this disease based upon the severity and occurrence pattern of mania and depression. Bipolar II disorder, for example, entails a higher rate of major depressive episodes, with relatively few instances of mania. Appropriate treatment for all forms of bipolar disorder involves regular cognitive therapy sessions and mood stabilization via pharmaceutical interventions. Doctors may prescribe an indefinite course of psychotropic medications to prevent a patient from lapsing into either depression or mania.

The antidepressant medication Prozac (fluoxetine) is part of a typical treatment plan for those suffering from bipolar II disorder. Prozac works by altering the ratio of certain chemicals within the brain. Rigorous testing has confirmed that this medication is both safe and effective, with relatively minor side effects in most patients. The current guidelines for bipolar II treatment recommend discontinuing Prozac within several weeks of depression remission, because clinicians suspect that prolonged antidepressant therapy may trigger a manic state. The mood stabilizer lithium is therefore preferred for long-term maintenance therapy. A team of clinical investigators set out to challenge the notion of Prozac’s danger, testing Prozac against lithium in a double-blind, placebo-controlled study in a group of individuals with bipolar II disorder.

All participants in the study had recently recovered from a depressive episode with the assistance of Prozac. One group was switched to lithium, one to placebo, and one continued on Prozac. Participants were blind to their treatment condition, and the study moved forward for 50 weeks. Psychiatric interviews and patient self-reporting helped pinpoint relapse events and overall mental health status. The results of the study were surprising even to the researchers. Those taking lithium were 2.5 times more likely to relapse than those taking Prozac. Similarly, the time to relapse, when it did occur, was far longer with Prozac than lithium. Most importantly, episodes of mania in the Prozac group were not significantly greater than either the placebo or lithium group.

Conventional wisdom argues against maintenance treatment with antidepressants for bipolar individuals. However, recent study results have challenged that wisdom, at least in the case of bipolar II disorder. For those suffering from this variety of the disease, long-term treatment with Prozac appears to be safe and effective for both preventing relapse and staving off manic episodes.

References

Amsterdam, J.D. & Shults, J. (2010). Efficacy and safety of long-term fluoxetine versus lithium monotherapy of bipolar II disorder: a randomized, double-blind, placebo-substitution study. American Journal of Psychiatry, 167, (7), 792-800.
Fluoxetine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/

Horse wearing bridle eating grass As you may know, eye movement desensitization and reprocessing (EMDR) is a research- and evidence-based therapy created by Francine Shapiro, Ph.D., over 20 years ago. An integrative model, EMDR is comprehensive, including aspects of multiple psychotherapeutic approaches. With this in mind, equine experiential activities, such as those found in equine-assisted psychotherapy (EAP), support and help to facilitate EMDR’s eight-phased model, while also maintaining fidelity to standard protocol.

The EquiLateral™ protocol is brought with a deep respect and understanding of EMDR but also the power of equine-assisted therapy. I am constantly reminded that EMDR and equine-assisted therapy both have the ability to support and often deepen a client’s ability to access where those traumas are stored. In my 10 years of experience as an EMDR therapist, I am still constantly amazed and inspired by the depth of healing that can be reached through EMDR, let alone through horses, who are often our most powerful and forgiving teachers.

Current research emphasizes the importance of maintaining fidelity to EMDR’s eight-phased approach. Nevertheless, in doing so, EMDR “may be implemented in more than one way as long as the broad goals of each phase are achieved” (www.emdria.org).

EquiLateral™ is the first equine-assisted EMDR protocol. We are still doing EMDR but are incorporating equine-assisted experiences within the eight-phased, three-prong, standard EMDR protocol. For more information on this approach to healing trauma, please visit my website: www.dragonflyinternationaltherapy.com

Horses, Comfort, and PTSD
Horses are prey animals. What this means is that they are highly in tune with their environment, readily noticing changes in the world around them and being able to respond to what they notice and actively seek what horseman Buck Brannaman describes as their wanting to return to “peace.” When in this energetic state, their nervous systems are settled and calm. They can readily focus on just being in the world, in the moment, which for them means grazing, moving 20+ miles a day, and relating with herd members. In contrast, when sensing danger, their peace is threatened, and their nervous system becomes activated enabling them to react, primarily through flight, although sometimes through fight or freeze, for self-preservation.

If you are a trauma survivor or know someone who struggles with posttraumatic stress, perhaps you can relate. Our bodies have the capacity to do as horses do, react, respond, then calm down and return to “peace.” But, we humans often learned to “stuff,” “repress,” “deny” what happened when all the body really wants to do is release and move through those feelings and body sensations. Doing so actually helps the trauma memory settle in, to release the “charge” that the body stores about what happened. By nature, horses, like all animals, know how to do this.

But, when trauma is still locked in the body and blocked, our nervous systems don’t return to a baseline of calm and peace. Instead, the fight, flight, or freeze that was experienced at the time of the event continues to remain activated, leading one to feel on alert, hypersensitive, anxious, easily agitated, or constantly “on,” making it challenging and often nearly impossible to relax.

That said, horses know how to relax. But, they also instinctively know to be alert and flee when threatened. They are preyed upon in the wild and are really in tune to danger, of any kind, including that which threatens their physical and even emotional safety, and that sense of comfort and peace that is their baseline state of being. And if you are a trauma survivor, all you want is peace and comfort as well. And this is just the beginning of why the horse and the trauma survivor may just “get” each other.

In light of the powerful connection between horses and trauma survivors, I am consistently shown the power of horses to help heal humans, especially through the integration of EMDR and equine-assisted therapy via this protocol.

Keep an eye out for the Part 2 of this post coming soon!

People battling cancer often experience fatigue and low energy levels, despite getting adequate rest. Fatigue is one of the largest negative impacts on a cancer patient’s quality of life. In fact, in some surveys, patients identify fatigue as a more bothersome effect of cancer than pain. Treating the secondary effects of advanced disease, including fatigue, is one of the main goals of modern cancer research. Lifestyle interventions, such as physical exercise or group therapy, have yet to demonstrate significant improvement in terms of patient fatigue levels. Pharmaceutical approaches may be most effective in reducing cancer-related fatigue.

Ritalin (methylphenidate) is generally prescribed for attention deficit disorder in children and narcolepsy in children and adults, and it’s available in both immediate and sustained release formulations. There is conflicting evidence as to whether Ritalin might be useful in reducing cancer-related fatigue. While some studies have shown significant improvement in cancer patients’ quality of life after taking this medication, others have produced negative or insignificant results.

With cancer, researchers sometimes have difficulty separating the effects of an experimental treatment from a patient’s routine treatment. The most recent study of Ritalin and cancer fatigue, conducted in part by the Mayo Clinic, showed no significant improvement for all but the most serious cases of tiredness. Participants were placed into drug or placebo groups and administered identical tablets for three weeks. Fatigue and quality of life surveys were conducted at regular intervals. As with all drug research, however, primary effect is not the only consideration; adverse effects must be considered and carefully weighed against the desired outcome.

In the Mayo Clinic study, participants receiving daily sustained-release Ritalin reported nervousness and loss of appetite at a rate far greater than the placebo group. Patients with Stage III or IV cancer and severe fatigue showed the most significant improvement, but they also experienced the most adverse events. Whether or not the potential benefits outweigh risks must be decided on a case-by-case basis. Researchers acknowledged that perhaps immediate release Ritalin could offer greater benefit, and future investigations may take up this line of reasoning. As for now, a non-pharmaceutical approach to managing cancer-related fatigue may still be the safest alternative in most instances.

Fatigue, sleepiness, and even depression often linger for months or years after cancer has gone into remission. In many cases, the effects of cancer treatments are so damaging to healthy cells that full recovery is an uphill struggle. Currently, there is no overwhelmingly effective approach to reducing fatigue in cancer patients and survivors. Ritalin might be useful in advanced stages of the disease, but more study is needed to be certain.

References

Methylphenidate – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 16, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/
Moraska, A.R., Sood, A., Dakhil, S.R., Sloan, J.A., Barton, D., Atherton, P.J., Suh, J.J. et al. (2010). Phase III, Randomized, Double-Blind, Placebo-Controlled Study of Long-Acting Methylphenidate for Cancer-Related Fatigue: North Central Cancer Treatment Group NCCTG-N05C7 Trial. Journal of Clinical Oncology, 28, (23), 3673-3679.

I first met Albert Ellis, the founder of Rational Emotive Behavior Therapy (REBT), about 35 years ago. Soon after I became an Associate Fellow and a Supervisor with the Albert Ellis Institute in New York City, and was a died-in-the-wool devotee for decades.

Al was open to all of us adding or subtracting a variety of techniques, whether meditation, homeopathy, yoga philosophy, or anything else, as he had already incorporated disparate ideas from areas as diverse as Buddhism and behaviorism. He wanted each therapist to put his or her own stamp on their ways of working, although I believe he assumed we would all keep the REBT skeleton beneath whatever robes we draped it in.

Rigid, dogmatic thinking was not the coin of his realm. In fact, he loved to engage in lively discussions of all therapeutic techniques and was happy to incorporate anything he believed would help shift a client to becoming more unconditionally self-accepting.

Of course, like any parent, he was proud and delighted when his baby, REBT (the precursor of cognitive behavioral therapy [CBT]), would be “proven” to be effective in alleviating depression, anxiety, anger issues, or anything else, as it was with 40-plus years’ worth of studies.

This plethora of evidence-based practice studies that have lauded the effects of REBT and CBT is what led to the Swedish government’s decision to invest heavily in training clinicians to provide CBT to people with depression and anxiety and spend no money on training or treatment in other modalities. Naturally, the Swedish government was a bit shocked when a recent study showed that training therapists in and treating clients with CBT had little or no effect.

In response to these findings, Scott D. Miller, Ph.D. wrote: “The widespread adoption of the method has had no effect whatsoever on the outcome of people disabled by depression and anxiety. Moreover, a significant number of people who were not disabled at the time they were treated with CBT became disabled.”

Apparently, this has not deterred the American Psychological Association from resurrecting its plan to draft and promulgate a series of guidelines pushing specific treatments for different mental health issues.

Dr. Miller and his colleagues at the International Center for Clinical Excellence have analyzed many studies showing little difference between treatment approaches in terms of outcome. They argue that all approaches work almost as well, and efforts to target specific treatments for each psychiatric diagnosis are not an effective use of time and money.

Dr. Miller recently talked about what works in behavioral health and recommended shifting the focus to designing client-tailored services rather than spending so much energy on examining specific treatment models and techniques. Meanwhile, Sweden has decided to end the exclusive use of CBT for the treatment of anxiety and depression, realizing that people need to have therapy choices.

As a holistic psychotherapist for almost 40 years, I think it is obvious when treatment is working: people self-report feeling better. They engage in life more fully, sleep better, take better care of themselves, and have more satisfying relationships and more meaningful life experiences.

As much as it can be wonderfully useful to study psychological modalities, theories, and philosophies, at the end of the day it all boils down to whether the person has been helped or not. Using evidence-based practice studies as a Procrustean bed will only cause pain and prolong suffering, just as the original one tried to stretch or shrink people to fit its specifications.

Source:
Miller, S. D. (May 13, 2012). Revolution in Swedish mental health practice: The cognitive behavioral therapy monopoly gives way. Retrieved from http://www.scottdmiller.com/?q=node%2F160&goback=%2Egde_53475_member_125725759

One of the primary goals of successful therapy is the formation of a meaningful and strong therapeutic alliance. This bond between the therapist and client is essential for creating an environment of openness, acceptance, and trust. Therapists are largely responsible for developing this foundation, but clients contribute significantly to the bond as well, even if they are unaware they are doing so. Many clients bring past experiences into therapy. Negative and judgmental encounters with previous therapists can cause clients to be distrusting and fearful in treatment, creating barriers to constructive working alliances. Understanding how clients’ past experiences influence the therapeutic bond, and how therapists can overcome these challenges, was the focus of a recent study conducted by Christian Moltu of the Division of Psychiatry at the District General Hospital of Forde in Norway.

Moltu interviewed a dozen therapists and asked them to describe how they overcame hurdles they experienced with hesitant and resistant clients. The therapists were trained in a range of approaches and yet each described similar methods for interacting with difficult clients. Each therapist stated that he or she achieved a productive working alliance, despite their clients’ reservations, by doing one of three things. The therapists said that successful alliances occurred when clients asked the therapists to help them with the relational challenges they faced. Additionally, therapists noted that bonds were built when they acknowledged the clients’ willingness and courage to overcome existing challenges. Lastly, when clients were unable to move past victimization and suffering, therapists found a way to build a bond with them by recognizing this deficit in their clients and explaining that the goal of therapy was to move from challenging situations to positive outcomes. Moltu added, “We found that participants experienced the client as contributing relationally and that this inﬂuences how the therapists respond and are present in the interaction.” By being attentive to the past experiences a client brings to therapy, a therapist can work with the client to overcome these limitations and ultimately develop a strong and cooperative therapeutic relationship.

Reference:
Moltu, C., Binder, P.-E., Stige, B. (2012). Collaborating with the client: Skilled psychotherapists’ experiences of the client’s agency as a premise for their own contribution in difficult therapies ending well. Journal of Psychotherapy Integration. Advance online publication. doi: 10.1037/a0028010