Science-Based Psychotherapy

1. Insomnia can cause depression.

A collection of research suggests that untreated insomnia doubles the chance of developing depression, as a causal factor (4 sources – one, two, three, four)

 

2. Insomnia often does not resolve once the depression is treated or without focused insomnia treatment (...

posted in depression | insomnia

In a special issue of Behavior Therapy on “The Theory-Practice Gap in Cognitive Behavior Therapy,” Jonathan Abramowitz, PhD, authored an interesting paper on the importance of understanding theory when doing exposure therapy. Dr. Abramowitz is a well-respected OCD researcher, and I was attracted to this article as part of my ongoing interest in exposure therapy.

 

The article is lucid, well-written, and I think would be of value to anyone beginning to work with exposure therapy. He offers anecdotes about where therapists go wrong and makes a good argument for why understanding theory enhances exposure therapy. Dr. Abramowitz writes from a strictly cognitive behavior perspective, so this work does not cover...

posted in exposure | exposure therapy | OCD

A practice I’m seeing more often that concerns me is the addition of antipsychotic medications on top of antidepressants when the antidepressants aren’t working. If someone isn’t showing improvement on an antidepressant alone, a prescriber may add an antipsychotic medication—the idea being it will increase the effectiveness of the antidepressant. The research for this is a little questionable, especially as the side effects for antipsychotics can be pretty bad. I’ve felt strongly enough about this issue that I wrote an editorial about it that the Oregonian published in 2012.

 

Antipsychotics and obsessive-compulsive disorder

In previous post, I wrote about a study that found that giving an antipsychotic in people with...

Understanding factors that contribute to outcome are crucial as we continue to refine treatments and revise the theories that underlie them. In a study published in the Journal of Anxiety Disorders, Norton and colleagues (2011) examined the role of activation and habituation in exposure therapy. The rationale for study was based on the emotional processing theory, which I’ve written about previously.

 

By activation, the authors mean how distressed the person becomes during the exposure exercise. Habituation refers to the reduction in distress when someone is confronted with a fear inducing stimuli. I’ve...

This post was featured on our client-centered blog The Art and Science of Living Well, but I thought it would be of interest to therapists as well.

 

The post is about a finding from a meta-analysis by Cuipjers and colleagues that looked at studies comparing medication against psychotherapy in the treatment of anxiety disorders and depression. For obsessive-compulsive disorder, the researchers found a clear advantage of evidence-based psychotherapy for OCD above medication.

 

You can read the post by clicking here, and it includes links to the original article, which you can download for free.

posted in Medications | OCD

Some of us at Portland Psychotherapy have a new article that was just published in the September 2013 issue Journal of Contemporary Psychotherapy. This has been a 2-3 year work in progress, so we're super excited to see it in print. 

 

It came to fruition from my ongoing interest in the use of exposure in Acceptance and Commitment Therapy.

 

Here's the Abstract:

 

Exposure is considered one of the most effective interventions for PTSD. There is a large body of research for the use of imaginal and in vivo exposure in the treatment of PTSD, with prolonged exposure (PE) therapy being the most researched example. Acceptance and commitment therapy (ACT) has sometimes been called an exposure-based treatment...

posted in ACT | exposure | exposure therapy | PTSD

A picture is worth a thousand words, so I thought as part of my continuing sequence on exposure therapy, I thought I’d share some videos I like.

 

I should offer credit to Kelly Koerner and Gareth Holman at Practice Ground, who introduced me to many of these videos through an excellent online exposure training they offered. I’ve done two online trainings through Practice Ground and they were both excellent—I highly recommend checking them out!

 

Snake Phobia

Anxiety disorder guru David Barlow invited Swedish expert Lars-Göran Öst to Boston to demonstrate his one-shot 3-hour simple phobia treatment for a woman who was extremely afraid of snakes. Öst shows a charming mix of compassion and...

Although it always seems easy enough when I read treatment manuals on exposure-based therapies, I've found in practice that it can be time consuming in session to come up with ideas for exposure-based exercises. Perhaps in part because exposure involves confronting uncomfortable experiences, even really motivated clients can have difficulty  coming up with suggestions on the spot. Moreover, most exposure manuals budget for 60-120 minute sessions, whereas a practicing therapist more frequently must make do with the 45-minutes permitted by insurance companies.

 

Recently, a light bulb went off: Why not simply ask clients to come up with ideas for exposure exercises outside of session? Worst case scenario is that they don't do it, and we're back to where we started. At the very least, the assignment primes clients to think about...

“Insanity - a perfectly rational adjustment to an insane world.”

- R. D. Laing, Scottish psychiatrist

 

When I teach “Abnormal Psychology,” one of the first things I do is tell the students that we will no longer be referring to the class as “Abnormal” psychology but rather, “The Psychology of Human Suffering.” Much of the course focuses on helping students see how those who suffer in ways that happen to be associated with a diagnostic label are not fundamentally different from those who suffer in ways that are yet to be pathologized.  A main message is that mental health is not an “us” versus “them” problem. Rather, we all struggle and suffer. Some forms of suffering we happen to label with names that are written in a book called the DSM and others we label with names that aren’t in that particular book. Usually toward the end of the semester, students are generally on-board with this...

posted in psychosis

The Study
In a study recently published in the journal Headache, preliminary evidence was found to support to use of ACT for chronic headache pain.  The study aimed to examine the efficacy of group-based ACT treatment for reducing the experience of pain, disability, and affective distress due to recurrent episodes of headache pain.  The study sample consisted of outpatient Iranian women.


ACT has been validated through numerous studies to date for chronic pain and has been given the highest grade of evidenced-based backing by APA division 12, ‘strong research support’.  While division 12 includes headache pain within the general category if chronic pain, there has been a gap in the literature to date regarding the...

posted in ACT