MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'behavioral therapy'. Sat, 03 Sep 2011 01:59:50 +0100 http://www.medworm.com/index.php?rid=5174757&cid=t_102395_129_f&fid=27216&url=http%3A%2F%2Flifewithadhd.com%2Fadhd-research%2Fadhd-behavioral-therapy-%25e2%2580%2593-what-can-go-wrong.php Behavioral therapy for ADHD is widely considered to be one of the best treatment methods for managing this very individualistic disorder and is often seen as being infallible by ADHD professionals. And why not, after all it is void the side effect risks, it can be used in conjunction with other safe and effective treatments such as homeopathic ADHD remedies, and best of all ADHD behavioral therapy has one of the best overall success rates of any treatment option. So with all these positives what could possibly go wrong? The truth of the matter is that ADHD behavior modification is only as good as the people involved in it and can be implemented too rigidly if you’re not careful. Why don’t we explore three areas where the best laid plans of ADHD behavioral therapy can go wrong. ... Life With ADHD blogs http://www.medworm.com/rss/comments.php?id=5174757 Sun, 28 Aug 2011 23:00:00 +0100 5174757 http://www.medworm.com/index.php?rid=5140334&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F18%2Feducation-or-a-cognitive-behavioural-approach%2F In this study by Day, Thorn & Kapoor, the two approaches were used with a group of people from a rural area, with relatively low socio-economic status, and a reading grade level of about 8.  Both groups received a group-based programme of 10 sessions of 90 minutes.  They both received a workbook and additional reading material.  The CBT group had home-learning and also participated in behavioural activities such as relaxation in-session, while the education group did not. Interestingly, this study presents qualitative information on how participants experienced the sessions, rather than outcomes measures, so it’s difficult to establish whether pain, disability, mood or acceptance were influenced.  Instead it presents thematic analysis from in-depth interviews of the participa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5140334 Wed, 17 Aug 2011 19:35:42 +0100 5140334 http://www.medworm.com/index.php?rid=5062291&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F25%2Fbps-on-dsm%2F Some of you may be following the development of the forthcoming fifth revision to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the major book used for psychiatric diagnosis. There has been a lot of criticism due to the secrecy of the process this time around, but the British Psychological Society (BPS), the major mental health organization in the UK, is taking an even more interesting and refreshing angle: criticizing the entire current framework of diagnosis. The DSM takes a medical approach to diagnosis. In short, this means that a ‘patient’ is assumed to have an underlying ‘pathology’ that manifests as various ‘symptoms’ that are assessed to make a ‘diagnosis’ and then apply a ‘treatment’ to said diagnosis. ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5062291 Mon, 25 Jul 2011 16:44:58 +0100 5062291 http://www.medworm.com/index.php?rid=5062295&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F24%2Fintegrative-behavioral-couple-therapy-where-acceptance-is-key%2F “There are two sides to every story.” This timeless saying couldn’t be truer when it comes to conflict in a relationship. In fact, it’s how couples therapists Andrew Christensen, Ph.D, and the late Neil Jacobson, Ph.D, start off their 2002 book Reconcilable Differences. Well, actually, they share a third side: their objective take on a couple, which usually includes some truth from both stories. In the late 1990s, Christensen and Jacobson developed a type of couples therapy called integrative behavioral couple therapy (IBCT), which combines techniques from behavioral couples therapy with new strategies to cultivate acceptance. Recently, Christensen, a professor of psychology at UCLA, and colleagues (2010) published their findings from a five-year study that compared the ef... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5062295 Sun, 24 Jul 2011 12:37:14 +0100 5062295 http://www.medworm.com/index.php?rid=4992168&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2011%2F06%2Fcooling-cap-could-provide-insomnia.html (Source: Sleep Education) Sleep Education blogs http://www.medworm.com/rss/comments.php?id=4992168 Thu, 30 Jun 2011 15:52:00 +0100 4992168 http://www.medworm.com/index.php?rid=4975941&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F06%2F28%2Fmarsha-linehan-what-is-dialectical-behavioral-therapy-dbt%2F Last week the New York Times ran a fascinating piece on Marsha Linehan, Professor of Psychology at the University of Washington and the original developer of Dialectical Behavioral Therapy (DBT), a modification of standard cognitive behavioral therapy (CBT), but including elements of acceptance and mindfulness. Her work has been designed specifically for people who harm themselves, for those diagnosed with borderline personality (BPT), and those who suffer from pervasive suicidal thoughts and/or attempts. For the first time in her life, the mental health expert disclosed her own story (that we also discussed on the blog yesterday), which involved hospitalization at the age of 17 that lasted longer than two years. Benedict Carey, author of the interview with Linehan, writes: No one knows h... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4975941 Tue, 28 Jun 2011 14:45:03 +0100 4975941 http://www.medworm.com/index.php?rid=4975944&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F06%2F27%2Fmarsha-linehan-acknowledges-her-own-struggle-with-borderline-personality-disorder%2F Dr. Marsha Linehan, long best known for her ground-breaking work with a new form of psychotherapy called dialectical behavior therapy (DBT), has let out her own personal secret — she has suffered from borderline personality disorder. In order to help reduce the prejudice surrounding this particular disorder — people labeled as borderline often are seen as attention-getting and always in crisis — Dr. Linehan told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17, according to The New York Times. At 17 in 1961, Linehan detailed how when she came to the clinic, she attacked herself habitually, cut her arms legs a... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4975944 Mon, 27 Jun 2011 12:12:20 +0100 4975944 http://www.medworm.com/index.php?rid=4934158&cid=t_102395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fvideogames-as-behavioral-intervention-for-patients-with-chronic-diseases%2F2011.06.16 In recent posts on Web-based and mobile behavioral intervention programs, we reviewed evidence suggesting that social support, in one form or another, can improve participants’ adherence and engagement with the program. That didn’t always mean however, that participants achieved better outcomes as a result. In one study for example, an online community increased engagement with and utilization of a Web-based activity program, but it did not increase participants’ actual activity levels. Another study, slightly older than the ones reviewed above, did show that a Web-based program improved outcomes. In this case, the intervention was an online videogame known as Re-Mission. Since I haven’t touched previously on outcome studies for automated lifestyle intervention tools or videogames ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4934158 Thu, 16 Jun 2011 18:00:43 +0100 4934158 http://www.medworm.com/index.php?rid=4934049&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2011%2F05%2Fadolescent-computing-training-wheels.html My 14 yo's computer skills have continued to be a real strength. Of course, being both 14 and having disabilities in executive function, he does not always use them wisely.Years ago I hoped the iPhone and other iOS devices would provide app-restricted services while limiting web access. Sadly, I've been disappointed by Apple's deceptive iOS "parental controls" [1]. That didn't work very well. On the other hand, monitoring his computer use and punishing misuse isn't working that well either. We can't be looking over his shoulder everywhere -- such as in his school room.So now I'm trying Plan B, an educational program of trial and reward based on techniques that have worked before.I've set up an account on a machine using OS X Parental Controls [2]. I've whitelisted a number of sites he's i... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=4934049 Sat, 07 May 2011 03:27:00 +0100 4934049 http://www.medworm.com/index.php?rid=4794825&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2011%2F05%2Fadolescent-computing-training-wheels.html My 14 yo's computer skills have continued to be a real strength. Of course, being both 14 and having disabilities in executive function, he does not always use them wisely.Years ago I hoped the iPhone and other iOS devices would provide app-restricted services while limiting web access. Sadly, I've been disappointed by Apple's deceptive iOS "parental controls" [1]. That didn't work very well. On the other hand, monitoring his computer use and punishing misuse isn't working that well either. We can't be looking over his shoulder everywhere -- such as in his school room.So now I'm trying Plan B, an educational program of trial and reward based on techniques that have worked before.I've set up an account on a machine using OS X Parental Controls [2]. I've whitelisted a number of sites he's i... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=4794825 Sat, 07 May 2011 03:27:00 +0100 4794825 http://www.medworm.com/index.php?rid=4753984&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F27%2Fworking-inside-the-envelope-or-pushing-the-boundaries%2F This study examines four different treatments carried out in parallel, it’s an unblinded/masked randomised trial designed to establish the effectiveness of these treatments as well as the adverse events associated with each treatment, and reviews the outcomes up to one year after treatment ended. Participants were carefully selected to meet the criteria for a diagnosis of chronic fatigue syndrome, and it’s interesting to see that only 28% of the people initially recruited actually met these criteria, and of this group, only 71% or 641 people actually progressed through to treatment.  Thankfully the CONSORT trial profile included in the paper shows very clearly who was ‘in’ and who was ‘out’ – and why! Clinicians were carefully trained, supervised ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4753984 Tue, 26 Apr 2011 19:35:40 +0100 4753984 http://www.medworm.com/index.php?rid=4615450&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F21%2Fmaking-self-help-more-helpful%2F In this study, Varley, Webb and Sheeran contacted (via email) the students and staff at a university in the UK.  People who were already being treated for anxiety were excluded, and the remaining participants (251 of them) were randomised into three groups.  All of them completed baseline Hospital Anxiety and Depression Scale (HADS, developed by Zigmond and Snaith, 1983) and the state version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, and Jacobs, 1983). One group received no input, while the other two groups were asked to go to a web page where they downloaded a self-help booklet.  Both of the booklets were the same eight-page booklet containing psychoeducation, diary sheets for self-monitoring triggers and feelings, and two relaxation techniques &#... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4615450 Sun, 20 Mar 2011 19:20:16 +0100 4615450 http://www.medworm.com/index.php?rid=4605873&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F03%2F17%2F6-signs-its-time-to-dump-your-therapist%2F Sometimes a therapist just isn’t that into you. After all, a psychotherapy relationship isn’t just about teaching cognitive-behavioral therapy techniques, or analyzing dreams. It’s about a human connection between two people — one person in need, and the other person who is there to act as a wise guide, teacher, and supporter through a process of change. Most therapists are pretty good at what they do. But even a good therapist may not always be the right fit for you. It’s similar to when you interview for a job where you feel like your resume is a perfect fit for the company, yet you don’t get the job. Perhaps the interview didn’t go as well as you thought, because the employer isn’t just looking for the best candidate — they’re ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4605873 Thu, 17 Mar 2011 18:00:03 +0100 4605873 http://www.medworm.com/index.php?rid=4544968&cid=t_102395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fchronic-fatigue-syndrome-can-psychotherapy-and-exercise-help%2F2011.03.03 [Recently] in The New York Times, David Tuller [wrote] about a study published in The Lancet that shows that psychotherapy is an effective treatment for chronic fatigue syndrome. In his article ”Psychotherapy Eases Chronic Fatigue, Study Shows,” Tuller writes: The new study, conducted at clinics in Britain and financed by that country’s government, is expected to lend ammunition to those who think the disease is primarily psychological or related to stress. The authors note that the goal of cognitive behavioral therapy, the type of psychotherapy tested in the study, is to change the psychological factors “assumed to be responsible for perpetuation of the participant’s symptoms and disability.” In the long-awaited study, patients who were randomly assigned to receive c... Better Health blogs http://www.medworm.com/rss/comments.php?id=4544968 Thu, 03 Mar 2011 20:00:00 +0100 4544968 http://www.medworm.com/index.php?rid=4498274&cid=t_102395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdeep-brain-stimulation-experts-raise-alarms-about-aggressive-marketing%2F2011.02.19 A paper published in the February issue of Health Affairs – discussed at length in an article in the New York Times – contains the sort of blunt, plain-spoken language you seldom read in academic journals. The authors, who include some of the most prominent neuroscientists and ethicists in the world, warn that manufacturers are misusing the FDA’s humanitarian device exemption to promote deep brain stimulation as a “treatment” for obsessive compulsive disorder (OCD). In fact, they make clear that deep brain stimulation is very much an experimental procedure. Research is still at an early stage, and the risks to patients are not well defined. When suffering is severe and no other treatment has provided relief, there is value in making available an intervention like deep b... Better Health blogs http://www.medworm.com/rss/comments.php?id=4498274 Sat, 19 Feb 2011 20:00:39 +0100 4498274 http://www.medworm.com/index.php?rid=4450258&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2011%2F02%2Fexpectations-trap.html Four months ago we learned lessons from two family bicycle outings. One was an educational failure. The follow-up was a memorable success.No denying, I was proud of that one. I wouldn't have thought it possible just three years before. If we weren't willing to risk failure, we wouldn't established a new baseline.That's why I was willing to try another crazy idea. This time we tried a mass nordic ski event after dark in unfamiliar territory. This went well beyond last year's Nordic ski resort.We applied what we'd learned. We studied satellite maps of the ski route and the surrounding territory, developing and revising our primary and backup plans. We researched parking in detail. We took a car and drove the route at night -- that's how we learned event map's major parking area was now a m... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=4450258 Tue, 08 Feb 2011 01:15:00 +0100 4450258 http://www.medworm.com/index.php?rid=4411527&cid=t_102395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstress-in-life-respond-differently-and-live-longer%2F2011.01.28 This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up. Definitely less suffering. Maybe less deaths. The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work dist... Better Health blogs http://www.medworm.com/rss/comments.php?id=4411527 Fri, 28 Jan 2011 17:00:39 +0100 4411527 http://www.medworm.com/index.php?rid=4294631&cid=t_102395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-biofeedback-pen-for-managing-stress%2F2010.12.27 Miguel Bruns Alonso, a graduate student at Delft University of Technology in The Netherlands, has developed a pen that detects how much twitching and twirling it’s being put through. People under stress tend to move and shake a pen more than someone who is calm. In order to try to get a therapeutic effect out of the pen, Bruns built in counter motion feedback that makes the pen a bit more difficult to move around. Though initial experiments have shown a marginal benefit, further studies and development may prove the benefit of the technology. From TU Delft: Bruns, who studies industrial design, carried out various experiments during the course of his research, which showed that people tend to play with their pens in their hands when they are tense. It also seems that when they are en... Better Health blogs http://www.medworm.com/rss/comments.php?id=4294631 Mon, 27 Dec 2010 20:00:10 +0100 4294631 http://www.medworm.com/index.php?rid=4294635&cid=t_102395_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fptsd-flashbacks-reduced-by-playing-tetris%2F2010.12.26 Flashbacks are vivid, recurring, intrusive, and unwanted mental images of a past traumatic experience. They are a sine qua non of post-traumatic stress disorder (PTSD). Although drugs and cognitive behavioral interventions are available to treat PTSD, clinicians would prefer to utilize some sort of early intervention to prevent flashbacks from developing in the first place.  Well, researchers at Oxford University appear to have found one. Remarkably, all it takes is playing Tetris. Yes, Tetris! The team responsible for the discovery was led by Emily Holmes. The writeup appears in the November issue of PLoS ONE. Holmes and colleagues had reasoned that the human brain has a limited capacity to process memories, and that memory consolidation following a traumatic experience is typically co... Better Health blogs http://www.medworm.com/rss/comments.php?id=4294635 Sun, 26 Dec 2010 22:00:52 +0100 4294635 http://www.medworm.com/index.php?rid=4203146&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2010%2F11%2Fhardest-behavioral-intervention.html Our Husky mix loves to play hide and seek. She stalks the gate, bolts through an opening, and runs with joy. She races across the neighborhood then hides for the seek. She cannot be seen, she is a natural predator. She'll do this for an hour or so, waiting for us to walk nearby then bolting past us.  Eventually she's sated, and she comes to us. Until recently she got a treat on the return, because our expensive experts told us that's what we needed to do.Running, playing with the pack, eating the treat. Doesn't get better than that. We spent more money than I care to think about on this problem, consulting with the best experts. None of the expert advice worked.Kind of like with our eldest. Almost everything that's worked with him we invented.Lately, we've been trying the hardest behavior... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=4203146 Fri, 26 Nov 2010 02:21:00 +0100 4203146 http://www.medworm.com/index.php?rid=4098058&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F10%2F21%2Fbefore-you-burn-out-%25e2%2580%2593-cbt-for-the-therapist-a-conversation-with-dr-john-ludgate%2F Do you ever wonder about how your therapist does it? If you are a therapist, do you ever have a day when it takes everything in you not to reach over and slap your patient silly? Or raise a white flag in defeat? Occasionally people ask me, “How do you listen to peoples’ problems all day long without becoming depressed yourself?” The answer is the same for whatever the job is: we need to pay attention to balance. I do my best to balance the hours I dedicate to work, for family time, and for just plain old time off and play. But to be perfectly honest, there are those days when I find myself severely stressed out. It could be I’ve over-booked myself too many days in a row, or had a series of challenging sessions or maybe just one person I wonder if I’m really he... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4098058 Thu, 21 Oct 2010 17:46:51 +0100 4098058 http://www.medworm.com/index.php?rid=4018454&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F30%2Fclinicians-and-graded-exposure%2F Some people do, and some people don’t, some of us will, and some of us won’t! Graded exposure can be an uncomfortable experience for both the person who is learning to approach activities that don’t feel very good – and for the clinician! It goes against the grain for some of us to elicit anxiety and see distress as we work with people, after all, our job is to help people feel better isn’t it? There are some consistent findings about clinician anxiety vs patient anxiety when it comes to pain. It seems that clinicians can often be more conservative with regard to what is OK for a person to do than the person can be. This conservatism can be related to clinician’s beliefs about hurt vs harm, clinician’s orientation to a biopsychosocial model –... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4018454 Wed, 29 Sep 2010 17:35:42 +0100 4018454 http://www.medworm.com/index.php?rid=3994369&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F23%2Fworking-with-thoughts-habits-take-time-to-change%2F If only there was a magic wand. I could make millions out of a ‘quick fix’ to changing habits! Unfortunately my magic wand is red and glittery – and plastic. I call it my ‘self management’ wand because it reminds me that self management is no quick fix, and a good deal of the work we need to do is about helping people recognize unhelpful thoughts and behaviors that might work in the short term, but not so in the long term. Changing patterns for sleeping well despite chronic pain is no different – what might have been going on for years isn’t likely to change overnight. Some of the thoughts that people have when embarking on cognitive behavioral therapy for insomnia can be quite unhelpful. One woman I worked with became despondent and eventually gav... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3994369 Wed, 22 Sep 2010 18:35:51 +0100 3994369 http://www.medworm.com/index.php?rid=3953763&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F09%2Fstudy-links-sleeping-pills-to-mortality.html (Source: Sleep Education) Sleep Education blogs http://www.medworm.com/rss/comments.php?id=3953763 Thu, 09 Sep 2010 18:25:00 +0100 3953763 http://www.medworm.com/index.php?rid=3872238&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F08%2Fcpap-for-sleep-apnea-obstructed-by.html (Source: Sleep Education) Sleep Education blogs http://www.medworm.com/rss/comments.php?id=3872238 Mon, 16 Aug 2010 15:21:00 +0100 3872238 http://www.medworm.com/index.php?rid=3854569&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F08%2F10%2Fonline-cbt-effective-for-panic-agoraphobia%2F In the first phase of the Internet in the 1990s, we witnessed how it broke down mental health barriers by providing individuals with information about mental disorders and treatment options. Before 1990 or so, the only way to look up the “official” symptoms for a disorder was either to get to a local library that had a copy of the diagnostic and statistical manual of mental disorders, or ask a mental health professional or advocacy group about the symptoms (and hope they don’t leave out anything). But the Internet broke down the arbitrary wall — that this information was somehow “special” and shouldn’t be given to people directly. People suddenly could learn about depression, or anxiety, or ADHD on their own without ever leaving their home. With gr... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3854569 Tue, 10 Aug 2010 16:05:38 +0100 3854569 http://www.medworm.com/index.php?rid=3718457&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F07%2F01%2Fpsychotherapy-in-your-doctors-office%2F One of the trends that isn’t likely to change significantly much is the fact that most people talk to their primary care doctor or family physician about a mental health problem first. Your family doctor is seen as the expert in all things, even when those things include mental health issues or concerns. So how effective are brief psychotherapy interventions conducted in a primary care setting? Researchers (Cape et al., 2010) looked at the results of 34 studies involving 3,962 patients and found the answer — therapy in a doctor’s office is surprisingly effective. Cognitive-behavioral therapy for anxiety had the most powerful effect size, meaning it’s likely the most effective brief intervention for anxiety disorders. General counseling and problem solving therapy w... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3718457 Thu, 01 Jul 2010 14:18:14 +0100 3718457 http://www.medworm.com/index.php?rid=3702924&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2010%2F06%2Fmanaging-screen-time-limits-new-tactic.html We've had good success with trading time limited computer access for behavioral goals. We've had a problem however when the time is up. It's very hard to stop, especially during a game.I'm sympathetic, but with this sort of thing our son does better with firm boundaries. On the other hand, this has led to some difficult battles. As the #1 son moves further into adolescence, it's harder for Mom to enforce rules.Still, this is a battle worth fighting. Tracking time, recognizing a deadline, then overriding the desire to continue are great executive function exercises. It's push-ups for his frontal lobe.Recently I've had some success with flipping the problem around. As well as punishing him for going past his time limits, I'm rewarding him for finishing early. He gets to rollover unused minut... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=3702924 Mon, 28 Jun 2010 02:53:00 +0100 3702924 http://www.medworm.com/index.php?rid=3633520&cid=t_102395_111_f&fid=39123&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fnursingcomments%2Ftdtc%2F%7E3%2FiVcdCuhLs44%2F           One of the most interesting illnesses I encountered as a psychiatric nurse was obsessive-compulsive disorder (OCD).  It is actually a type of anxiety disorder.  It is not your typical feeling of fear, worry or anxiety; people with obsessive-compulsive disorder will have these normal emotions but take them to extreme.  For example, people with OCD might have thoughts about bad things that could happen.  In addition, OCD patients will have upsetting or scary thoughts or images in their head (obsessions) that are hard to shake.  They may also worry about things being ‘out of order’ or not ‘just right’.  The compulsions enter into the picture when patients feel strong urges to do things repeatedly.  These compulsions give persons with OCD a brief sense of reli... Nursing Comments blogs http://www.medworm.com/rss/comments.php?id=3633520 Sun, 06 Jun 2010 15:08:06 +0100 3633520 http://www.medworm.com/index.php?rid=3549020&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F05%2Fgood-morning-america-dr-cognitive.html (Source: Sleep Education) Sleep Education blogs http://www.medworm.com/rss/comments.php?id=3549020 Mon, 10 May 2010 16:28:00 +0100 3549020 http://www.medworm.com/index.php?rid=3533641&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F05%2Fcbs-2s-sleep-wreckers-are-few-of-common.html (Source: Sleep Education) Sleep Education blogs http://www.medworm.com/rss/comments.php?id=3533641 Wed, 05 May 2010 14:58:00 +0100 3533641 http://www.medworm.com/index.php?rid=3529736&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2010%2F05%2Funderstanding-unusual-mind.html One of the pop-psychology characterizations of autism is that it's a "model of mind" problem. Persons with autism, it is said, cannot "model" the minds of others. This is sometimes associated with claims that autistic brains have "mirror neuron" defects, and that "mirror neurons" are the physiological foundation for "model of mind" functions.I call this "pop psychology" because it's very hard to test this class of theory. We simply don't know enough about how the brain works. My own personal speculation is that brain assembly is always problematic, and in the micro-evolutionary process of adapting brain infrastructure to "reality" various subsystems are repurposed (sacrificed) -- including those involved in modeling other brains.Whatever the eventual utility of the "model of mind" theory, ... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=3529736 Tue, 04 May 2010 03:04:00 +0100 3529736 http://www.medworm.com/index.php?rid=3448814&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2010%2F04%2Fpersuasion-adolescence-and-joys-of.html Low IQ special needs adolescence does not come as a "thief in the night". It comes as a ton of bricks.Behavioral management, which was never terribly effective, has become even less effective. We may still have a "paradoxical permission" effect, whereby when we give permission for an annoying behavior it becomes less attractive. I'm not sure we have even that however.Medications are still available, but of course side-effects may be less tolerated.Which is why I'm turning, with a measure of desperation, to my favorite sales book: Three Steps to Yes: The Gentle Art of Getting Your Way by Gene Bidell. I hope I can use some of Bidell's techniques to change my son's choices.Bidell emphasizes understanding your Prospect's recognized and unrecognized needs and aversions, then figuring ways to me... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=3448814 Thu, 08 Apr 2010 12:48:00 +0100 3448814 http://www.medworm.com/index.php?rid=3411133&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F03%2F26%2Fwelcoming-dr-daniel-tomasulo-to-ask-the-therapist%2F I’m please to introduce our first male therapist — Dr. Daniel J. Tomasulo — to join our Ask the Therapist team, a feature we’ve been running for the past 5 years here on Psych Central. Daniel J. Tomasulo, Ph.D., TEP, MFA is a psychologist, psychodrama trainer and writer on faculty at New Jersey City University and formerly a visiting faculty member on fellowship at Princeton University. He has been in private practice for more than 25 years and works with individuals, couples, and groups, specializing in the use of psychodrama. He developed The HealingCrowd.com, a research and training site devoted to the use of action methods in group psychotherapy. His memoir, Confessions of a Former Child: A Therapist’s Memoir, is his most recent book (Graywolf Press) and chr... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3411133 Fri, 26 Mar 2010 19:24:37 +0100 3411133 http://www.medworm.com/index.php?rid=3291834&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F02%2Fchronic-pain-cognitive-behavioral.html A new study found that cognitive behavioral therapy (CBT) can significantly improve sleep for people with chronic neck or back pain.Many people living with chronic pain have poor sleep hygiene. Common mistakes include sleeping when they are not tired, sleeping in places other than the bedroom and watching TV in bed. These habits may lead to insomnia.People taking medicine for their pain may be unwilling or unable to use sleep aids to treat their sleep problems. CBT provides a safe and effective alternative.The study involved 28 people who experience chronic pain. Participants received eight weeks of therapy from a trained nurse therapist.Therapy sessions established a set number of hours in bed, focused on negative thoughts about sleep and addressed unhealthy sleep behavior. Sleep diaries ... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=3291834 Sun, 21 Feb 2010 12:03:00 +0100 3291834 http://www.medworm.com/index.php?rid=3283501&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2010%2F02%2Fbehavior-motivation-text-message.html One of my charges combines substantial cognitive and psychological disabilities with a profound insensitivity to common motivators. Yes, this is challenging. On the one hand, he has substantial limits. In a modern post-industrial society, he is profoundly disabled. In this he has a lot of company – in our emerging world many neurotypical males with an IQ below 120 have unknowingly joining the world of the effectively disabled. On the other hand, he often performs far below his maximal abilities. Sometimes that’s because his peak performance is very dependent on environmental factors such as medications, time of day, sleep reserves and satiety. Quite often, though, it’s because he doesn’t respond well to any behavioral motivators, including extinction, operant methods/positive reinf... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=3283501 Thu, 18 Feb 2010 14:34:00 +0100 3283501 http://www.medworm.com/index.php?rid=3259299&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F10%2Fan-interview-with-f-sommer-anderson-central-sensitisation-syndromes%2F How many of you have headed off to ‘Therapy Worksheets’ blog? Yes, that’s the one I’ve linked to in my roundup of the best CBT resources on the internet.  Will Baum, the editor of that blog is also the author of where the client is, a blog about professional private practice in mental health care.  Will contacted me the other day and sent me a link to a really interesting interview with Frances Sommer Anderson, a clinical psychologist who works with people experiencing chronic pain.  Her take on chronic pain management is influenced by John Sarno, who has a hypothesis that much chronic pain is influenced by psychological factors (often emotional issues) from childhood.  One of the premises of his approach is that people need to heal their ‘repressed’... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3259299 Wed, 10 Feb 2010 07:45:32 +0100 3259299 http://www.medworm.com/index.php?rid=3220175&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F01%2Fhow-does-yoga-help-you-sleep.html Yesterday the Globe and Mail examined how yoga helps you sleep.Harvard assistant professor Sat Bir Khalsa, PhD, told the Globe and Mail that yoga helps reduce the stress that can hinder sleep.“With time and practice, the stress system begins to quiet down,” he said.What changes occur in the body during yoga? The NCCAM reports that it is unclear. But there is growing evidence that yoga enhances stress-coping mechanisms.One study by Khalsa used yoga to help people with chronic insomnia. They had one in-person training session. Then they practiced yoga on their own for eight weeks. They also had brief follow-ups by phone and in person.Results show that sleep improved in 20 people who completed the study. They fell asleep faster and slept longer.A review he published found that most yoga r... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=3220175 Fri, 29 Jan 2010 00:19:00 +0100 3220175 http://www.medworm.com/index.php?rid=3216221&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2010%2F01%2Fcan-yoga-help-you-sleep-better.html The show eightWest on WOOD TV8 in Grand Rapids, Mich., did a feature on “Yoga for Better Sleep.” The five-minute segment shows some yoga moves that can help you relax for bedtime.So can yoga really help you sleep better?Last year the Sleep Education Blog reported on a small study from Northwestern University. It involved 11 adults with chronic primary insomnia. Sleep improved for those who practiced yoga and meditation for two months.A recent study from India evaluated “cyclic meditation.” This technique combines yoga postures with periods of lying down on your back to rest.Thirty men practiced cyclic meditation twice during the same day. On another day they had two sessions of rest without the yoga postures.The study found that the men had more deep, slow-wave sleep after cyclic m... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=3216221 Wed, 27 Jan 2010 22:28:00 +0100 3216221 http://www.medworm.com/index.php?rid=3212377&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F01%2F27%2Fpsychodynamic-psychotherapys-positive-impact%2F Yesterday, we reported on a new meta-analysis of psychodynamic psychotherapy that demonstrates the effectiveness of this type of therapy. Traditionally, psychodynamic therapy is thought to be “less scientific” than newer, modern psychotherapy treatments, like cognitive-behavioral therapy (CBT). We had previously noted how psychodynamic therapy fared just as well as CBT for anxiety disorders in another robust study. The new research analysis — which reviewed eight meta-analyses of 160 studies of psychodynamic therapy — was published in the American Psychologist and showed robust effect sizes: One major meta-analysis of psychodynamic therapy included 1,431 patients with a range of mental health problems and found an effect size of 0.97 for overall symptom improvement... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3212377 Wed, 27 Jan 2010 12:38:44 +0100 3212377 http://www.medworm.com/index.php?rid=3137486&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2010%2F01%2Flatest-sticker-chart-innovation-dealing.html When one sib is verbally annoying another, the victim gets stickers for non response (self-control). This initiative is a component of our recent "politeness initiative".On the one hand the aggressor does wish to unilaterally reward a sibling with stickers (which are exchanged at a per-column incremenet for hard cash, Amazon credits, and screen time). On the other, the sibling practices self-control.Works well for an Asperger/explosive mix. For the moment. Of course nothing works indefinitely, so we'll rotate it in and out of the mix over time. (Source: Be the Best You can Be) Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=3137486 Sat, 02 Jan 2010 17:40:00 +0100 3137486 http://www.medworm.com/index.php?rid=3115051&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2009%2F12%2Ftagteach-dog-training-for-special-needs.html TAGteach is a training methodology that uses the "clicker" operant conditioning approaches best known from dog training, together with positive reinforcement strategies, to teach special needs and other learners. A Wikipedia article on Karen Pryor provides the best overview. I hadn't realized that the clicker training started out with BF Skinner in the 1930s. My primary exposure to Skinner came in the 1970s when he was terribly unfashionable, it's funny now to realize he pioneered many approaches I currently favor. He was wrong to think that humans were fully environmentally determined (seems silly now), but right that training humans is not much different from training birds, dogs, primates and dolphins.I'm going to start following the TagTeach blog, though I do detect a few reddish flags... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=3115051 Wed, 23 Dec 2009 03:44:00 +0100 3115051 http://www.medworm.com/index.php?rid=3089614&cid=t_102395_180_f&fid=38619&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FALifeCoachsBlog%2F%7E3%2FnTtke109Am0%2F If it wasn’t for bad luck I’d have no luck at all with my teeth. After having a root canal a couple of weeks ago, this morning I managed to break a tooth on a rather large piece of glass. You may be wondering what I was doing with glass in my mouth, but not as much as I was, seeing I was eating toast at the time. As I bit down I felt the tooth go and gingerly spat the unattractive contents of my mouth into my hand to see the cause of my pain To cut a long story short, the glass had been part of the jar that I had just spread strawberry jam onto my toast from. I peered into the empty jar to see a whole in the bottom that definitely shouldn’t have been there. For a moment I was severely pissed off. Another trip to the dentist, another $100 minimum charge, more time off work and no doub... Life Coach Blog: The Discomfort Zone : blogs http://www.medworm.com/rss/comments.php?id=3089614 Mon, 14 Dec 2009 23:37:22 +0100 3089614 http://www.medworm.com/index.php?rid=3033621&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F11%2F27%2Fa-note-to-the-severely-depressed-dont-try-so-hard%2F I don’t know about you, but when I’m severely depressed 90 percent of my negative thinking is based on the fact that I am a failure because all my cognitive-behavioral strategies and positive thinking and mindfulness attempts aren’t working. I discussed this with Dr. Smith yesterday and she reminded me, once more, that severe depression can’t be treated in a mind-over-matter way. Her compassionate logic made me review the pages of my forthcoming book, Beyond Blue, where I list the neurological and scientific reasons why. And I breathed a much-needed sigh of relief. You deserve one too. Here’s my passage: Trying too hard was precisely my problem. It was the mind over matter issue again. In my mind, I was failing because I couldn’t think myself to perfect... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3033621 Fri, 27 Nov 2009 10:23:30 +0100 3033621 http://www.medworm.com/index.php?rid=2977072&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F11%2Fchanging-nightmares-imagery-rehearsal.html “Your Health” columnist Kim Painter reports in USA Today that imagery rehearsal therapy is helping some people change their nightmares.This method is just one form of cognitive behavioral therapy. A variety of CBT techniques have been used to reduce nightmare frequency.One method is to record your nightmares in a diary. Relaxation exercises also may be helpful. Exposure techniques involve “reliving” a nightmare in your imagination during the daytime.Cognitive-restructuring techniques involve changing a nightmare. One technique is lucid dreaming treatment; you change the nightmare as it occurs during sleep.Imagery rehearsal therapy involves changing the nightmare while awake; you “rehearse” the new version in your mind during the day.The first step is to write down a recent nigh... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2977072 Mon, 09 Nov 2009 19:56:00 +0100 2977072 http://www.medworm.com/index.php?rid=2948359&cid=t_102395_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2009%2F11%2F01%2Filluminate-depression%2F QUEST on KQED Public Media. A very good video about the symptoms of depression and antidepressants. It shows how antidepressants are supposed to work with nice graphics. The next topic is Transcranial Magnetic Stimulation or TMS. An option when medication isn’t working. One of 9 options for treatment resistant depression. A treatment is shown with some explanation of how it works. The FDA has approved TMS for depression, but is still costs a lot of money. Personally I am not impressed with the evidence of the efficacy of TMS for depression Also shown is a way to stimulate rodent brains with light using light sensitive proteins in rodents, called optogenetics. It makes a nice model for activity in the brain during depression. It’s an example of how new tools and research are sh... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=2948359 Sun, 01 Nov 2009 13:26:26 +0100 2948359 http://www.medworm.com/index.php?rid=2939257&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2009%2F10%2Fbehavior-management-and-special-needs.html I’m putting together a list of posts and references related to the adaptation of animal training methods to the behavior management of special needs humans … Training exotic animals, husbands and difficult children Changing behavior in children- Kazdin for most and what we do now On dogs and children Not much so far, but I’ll add more. (Source: Be the Best You can Be) Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=2939257 Wed, 28 Oct 2009 20:49:00 +0100 2939257 http://www.medworm.com/index.php?rid=2934969&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F28%2Fhypnosis-response-expectancies%2F Let’s explore the proposed mechanisms in hypnosis as I wander through the subject this week. According to some researchers, response expectancies, or ‘the expectation of one’s own non-volitional reactions to situational cues’ are thought to play a major part in both hypnosis and placebo responding. Let’s translate that: a person’s belief that they will respond to something may lead to them actually responding. Possibly the original ‘mind over matter’! Both hypnosis and placebo (or meaning response – see Dan Moerman for more details on this!) are complex effects that are not yet really understood, except to confound most RCT’s and to provide food for thought for philosophers and psychologists and lay people alike. In this paper, respon... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2934969 Tue, 27 Oct 2009 21:18:05 +0100 2934969 http://www.medworm.com/index.php?rid=2924800&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2009%2F10%2Funexpected-wins-and-special-needs.html I’m reasonably good at predicting what two of my children will like and do. I’m much less accurate at predicting the interests and abilities of my most exceptional son. Sometimes I guess high, but more often I guess low. When we started playing baseball, I never thought he’d be a competitive and eager ballplayer. His recent soccer playing was completely unexpected. Yes, he is the weakest player on his school team – but he continues to go to practices. He’s learned more math than I expected he would. I’m glad I listened to the advice of the mother of a girl with Downs syndrome. She told me her daughter got more out of sitting in mainstream history classes than she’d expected. Today, though, he really surprised me. We’ve had great struggles with him getting off the computer w... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=2924800 Sat, 24 Oct 2009 16:05:00 +0100 2924800 http://www.medworm.com/index.php?rid=2923146&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F10%2Fbiofeedback-to-treat-insomnia.html A recent article from Health magazine describes the use of “biofeedback” to treat insomnia.What’s biofeedback? It’s a form of therapy that gives you visual or auditory feedback for certain body signals. Cues may give you details about your heart rate, blood pressure, breathing or body temperature. Then you learn to control the body in a way that promotes sleep.Author Leslie Goldman describes how for eight years she struggled with sleep. Then she gave biofeedback a try.“The change has been dramatic,” she writes. “After nearly a decade of sleeping for no longer than two hours at a time, I can sleep for four hours straight and doze off again after I wake up.”The AASM recommends biofeedback as an effective treatment for chronic insomnia.Often biofeedback will be combined with o... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2923146 Fri, 23 Oct 2009 21:16:00 +0100 2923146 http://www.medworm.com/index.php?rid=2824180&cid=t_102395_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2009%2F09%2F23%2Fprevention-of-winter-depression%2F Seasonal Affective Disorder (SAD) or Winter Depression can be succesfully treated with bright light therapy. Across studies, 53% of cases of SAD remit with bright light therapy. This involves sitting in front of full-spectrum lights that mimic sunlight on a regular basis — typically for about 30 minutes to 60 minutes each morning. Sometimes one or two weeks is sufficient but some patients will need this for the whole season. This hampers compliance with this therapy, only 41% of patients continued regular light therapy, 59% discontinued light therapy due to ineffectiviness and inconvenience. More important is the prevention of the recurrence of this kind of depressive episodes over subsequent winter seasons. Cognitive behavioral Therapy could represent a more effective, practical, and pa... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=2824180 Wed, 23 Sep 2009 06:44:03 +0100 2824180 http://www.medworm.com/index.php?rid=2761631&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F09%2Fcivilian-life-is-interrupted-by-ptsd.html A new study finds high rates of disturbed sleep among current and former military personnel who served in Afghanistan during Operation Enduring Freedom or Iraq during Operation Iraqi Freedom.Sleep problems were considerably more common and severe among those with post-traumatic stress disorder (PTSD), an anxiety syndrome that occurs after a traumatic event, such as combat or military exposure. Symptoms typically improve after three months of treatment, but for some people the problem continues for the rest of their lives.Data from the Pentagon suggests that up to 20 percent of returning Iraq war veterans suffer from PTSD. Records from the Department of Veterans Affairs show that nearly 76,000 veterans of the current wars were diagnosed with PTSD between 2002 and mid-2008.According to the A... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2761631 Thu, 03 Sep 2009 12:55:00 +0100 2761631 http://www.medworm.com/index.php?rid=2766074&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F09%2F02%2Fa-profile-of-aaron-beck%2F Aaron Beck is probably best known for pioneering the use of cognitive behavior therapy (CBT) — that commonly used modern psychotherapy technique known the world over. He revolutionized psychotherapy in general, by turning toward science — and replicable data — to validate the efficacy of his new therapeutic techniques he pioneered in CBT. He had to, because before Beck came along, studying why psychotherapy worked was done generally only through narrative case reports in the scientific literature. Often interesting and sometimes entertaining, but they completely lacked scientific data outside of subjective observations by the professional. Beck, on the other hand, hand to actually invent the tests to help measure whether his new therapy was working or not. Hence the psych... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2766074 Wed, 02 Sep 2009 18:56:11 +0100 2766074 http://www.medworm.com/index.php?rid=2757405&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F09%2Fchemotherapy-causes-sleep-problems-in.html A study published this week shows that chemotherapy for Breast Cancer, a disease with which approximately 210,000 women are diagnosed each year, impairs sleep-wake cycles in patients. Sleep disturbances can negatively affect treatment and increase risks for other health and mental problems. Results indicate that chemotherapy patients switched from low to high activity about 30 minutes later in the day and decreased their level of activity about 50 minutes earlier at night during their first round of chemotherapy, suggesting that their days were shorter. The study involved 95 women with an average age of 51 years, who were scheduled to receive chemotherapy for stage I-III Breast Cancer. Of the participants, 75 percent were Caucasian, 69 percent were married, 77 percent had at least som... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2757405 Wed, 02 Sep 2009 13:54:00 +0100 2757405 http://www.medworm.com/index.php?rid=2744112&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F08%2F28%2Fcould-depression-be-natures-way-of-saying-think%2F Could depression serve a purpose we hadn’t thought of? Something simple, like thinking? That’s the theory presented by Paul W. Andrews and J. Anderson Thomson, Jr. in a recent article in Scientific American. The scientists point to a couple of points of evidence to support their theory. One, they say, ruminations help people figure out their complex problems, breaking them down into smaller, more digestible components. Such an exercise, they argue, makes a depressed person more able to solve the problems that made them depressed in the first place: This analytical style of thought, of course, can be very productive. Each component is not as difficult, so the problem becomes more tractable. Indeed, when you are faced with a difficult problem, such as a math problem, feeling d... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2744112 Sat, 29 Aug 2009 03:41:07 +0100 2744112 http://www.medworm.com/index.php?rid=2712388&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F19%2Fits-not-what-you-say-its-the-way-that-you-say-it%2F I have a bit of a theme happening – health care interactions. I think it’s because this week I’ve been talking about this with patients, and it seems to be something that either raises the hackles or fills them with gratitude! Anyway, I was glad to find this paper the other day on ‘perceived quality of doctor–patient interaction in rehabilitation’. This is slightly different from the usual focus, which is often on interactions in primary care. It’s an interesting paper written by a group of researchers in Germany. They describe the use of a newly-developed rating instrument, the ‘P.A.Int-Questionnaire’, which stands for (in German) ‘Patient-Arzt-Interaktion’. I’m guessing that’s German for ‘patient-doctor inter... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2712388 Wed, 19 Aug 2009 08:54:41 +0100 2712388 http://www.medworm.com/index.php?rid=2708732&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F08%2Fosteoarthritis-cbt-for-insomnia.html A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine involved 51 older adults with osteoarthritis and insomnia.Twenty-three people received cognitive behavioral therapy for insomnia; they had an average age of 69 years. Each of the eight weekly CBT sessions lasted two hours; class sizes ranged from four to eight people.CBT uses a variety of methods to help you develop positive attitudes and habits that promote a healthy pattern of sleep. One common technique is relaxation training. Results show that CBT improved self-reported sleep quality in people with osteoarthritis and insomnia. After treatment they fell asleep faster; they also spent less time awake during the night. Overall their sleep was much more efficient. CBT also had a long-term effect; they were still sleepin... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2708732 Mon, 17 Aug 2009 17:53:00 +0100 2708732 http://www.medworm.com/index.php?rid=2703778&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F08%2Fcognitive-behavioral-therapy-for.html A recent article in the Louisville Courier-Journal reminded readers that medications aren’t the only insomnia treatment. Cognitive behavioral therapy is a safe and effective treatment option for people who are struggling with ongoing insomnia.CBT uses a variety of methods to help you develop positive attitudes and habits that promote a healthy pattern of sleep. One common technique is relaxation training.“We teach people how to sleep again,” sleep specialist Ryan Wetzler told the Courier-Journal. He has a doctorate in psychology and is certified by the AASM in behavioral sleep medicine. “We want to just figure out why somebody is not sleeping and get them sleeping again as soon as possible.”Wetzler recently led a study of 115 people with insomnia; he presented a study abstract in... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2703778 Sun, 16 Aug 2009 10:36:00 +0100 2703778 http://www.medworm.com/index.php?rid=2695661&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F13%2Fgoals-goals-goals%2F Today I had the challenge of working with a new group of participants in the Pain Management Programme. They’re with us for three weeks, and at the beginning of this time I say to them that if their lives are no different six months from then, it’s not worthwhile attending. Usually they’ll all nod happily in agreement, and I think to myself ‘good, now let’s get on and work out what they want to be different’. After we’ve worked our way through ‘get rid of my pain’ (and I make the quip about the magic wand in my office that’s a self management wand made of plastic), we start to work on goals. My first step is to ask people to go through a list of possible areas that people with pain often want to focus on – things like learni... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2695661 Wed, 12 Aug 2009 19:33:47 +0100 2695661 http://www.medworm.com/index.php?rid=2685388&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F10%2Fthinking-about-thinking%2F For a long time I thought everyone thought about what they think about, how they think about it, and what their thinking concluded – now I know that some people never do this and live on simply following the rules (and probably having a fun and relaxed time of it!).  I, on the other hand, have always spent time at the end of the day thinking about my thoughts and what they mean and how I come up with them.  The technical term for this is ‘metacognition’, or ‘thinking about thinking’, and it’s a strategy that can be really useful in cognitive therapy as well as pain management – and even more useful in your professional work as a therapist. I started writing this post after reading this from the Skeptical Methodologist… in it The Skeptical M... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2685388 Sun, 09 Aug 2009 20:05:45 +0100 2685388 http://www.medworm.com/index.php?rid=2685242&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F08%2F09%2Fpsychodynamic-therapy-vs-cbt-smackdown-for-anxiety%2F This study used seven different measures, not only at the end of treatment, but at a 6-month followup (something else many drug studies fail to do). Virtually of the measures employed showed significant improvement on anxiety and depression measures, not only at the end of treatment, but also virtually unchanged at the 6-month followup (e.g., the treatment was long-lasting). This study demonstrates that psychodynamic psychotherapy is an effective alternative for the treatment of generalized anxiety disorder, when compared to the more commonly-used CBT. The researchers encourage more studies like this one, and I couldn’t agree more. It’s a timely reminder of the value of the different types of psychotherapies available, not just the kind that might be in vogue at the moment. Ref... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2685242 Sun, 09 Aug 2009 15:08:31 +0100 2685242 http://www.medworm.com/index.php?rid=2674528&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F06%2Flearning-cognitive-behavioural-therapy-an-illustrated-guide%2F Despite this book being unrelated to pain management, I can’t go past this one for learning how to develop the basic skills in cognitive behavioural therapy. It’s (you guessed it!) ‘Learning cognitive behavior therapy: An illustrated guide’ written by JW Wright, MR Basco & ME Thase, published by American Psychiatric Publishing, Inc, Washington, 2006.  It is one of the titles included in the ‘Core Competencies in Psychotherapy’ series, and was written to provide ‘an immersion in the fundamentals of each form of psychotherapy and explicitly addresses the seix core areas of competency needed in medical practice as outlined by ACGME and the American Board of Medical Specialties’. More importantly for me, it’s a really clear guide, base... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2674528 Thu, 06 Aug 2009 08:32:23 +0100 2674528 http://www.medworm.com/index.php?rid=2671122&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F05%2Fdevelop-your-skills-in-cbt-for-chronic-pain%2F I’ve never found one single book that covers all the areas I think are important for chronic pain management, but today I want to review one that I have found helpful – and I’ll review another tomorrow! I got this one about two years ago, and I’ve referred to it quite often, especially for worksheets. The book is Cognitive behavioural therapy for chronic illness and disability by Renee Taylor (2006), published by Springer, New York. I got mine from University Bookshop (another wicked place…) for NZ$125 , but as you can see it’s available from Amazon as well. Renee Taylor is a clinical psychologist, but one with a unique twist – she’s based in the Department of Occupational Therapy, University of Illinois, Chicago, and her book reflects the or... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2671122 Wed, 05 Aug 2009 08:43:40 +0100 2671122 http://www.medworm.com/index.php?rid=2667759&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F04%2Ffacilitating-a-group%2F Group-based approaches to pain management are common. They’re used not just for cost-effectiveness (because there are some ‘hidden’ costs to groupwork such as screening participants and team meetings), but also because some processes are better conducted in a group setting – such as observing others ‘well’ behaviours, learning vicariously from others’ experiences – and because experiential learning in a group setting replicates many of the work and family settings that people who experience pain will need to function in. I use experiential learning, that is, the idea that change and growth take place when people are actively (physically, socially, intellectually, emotionally) involved in their learning rather than just being receivers of info... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2667759 Tue, 04 Aug 2009 10:10:08 +0100 2667759 http://www.medworm.com/index.php?rid=2664133&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F03%2Fa-week-of-book-reviews%2F This week I’ve decided to review some of the books that I’ve recently bought for my bookshelf (not that they stay there!). Anyone who knows me will agree that I’m a bookworm, and the two most horrible websites (at least to my bank balance) are Amazonand Fishpond! Onto today’s book – just arrived, although not a new book, published in 2006, it’s called ‘Cognitive behavioural therapy in groups’, written by Peter J. Bieling, Randi E. McCabe and Martin M. Antony. It’s published by Guilford Press, and I got mine from Fishpond at a cost of $58.25. The reason I’m so pleased with this book is that for ages I’ve been looking for something to help with group processes and carrying out cognitive behavioural therapy. While groupwork wa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2664133 Mon, 03 Aug 2009 10:21:18 +0100 2664133 http://www.medworm.com/index.php?rid=2657926&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F07%2F31%2Fseeing-people-progress%2F A quick post this morning before I search for some Friday funnies! I saw a few patients this week after having had just over a fortnight off work – and you know how sometimes working in pain management can seem unrewarding, progress can be incredibly slow, one step forward, two sideways… Well here are some progress reports from some of the people I’ve been seeing (names and details changed to protect identities). Hypnosis for intermittent phantom pain First up is a man with a 10 year history of below knee amputation. He wears a prosthesis, is fit and active, and until late last year was working full time. Over the latter half of last year he developed intermittent severe stabbing phantom pain (prior to this he had phantom sensation with some stump pain but never phantom p... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2657926 Thu, 30 Jul 2009 19:39:40 +0100 2657926 http://www.medworm.com/index.php?rid=2649315&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F07%2F29%2Fnz-pain-society-annual-scientific-meeting%2F Well, and now I’m back down to earth after spending a fortnight experiencing acute pain (and they’re STILL sore) and then talking pain at the Conference. Not a major post today, just some links from the conference that might be worthwhile looking at. First of all, Prof Mike Chester spoke about angina pain, and has an extensive website on managing refractory angina at this site. Take a look at the resources! Wow! The care pathway is a comprehensive guideline for systematically managing the problem of persistent angina (oh and much of it could also apply to persistent noncardiac chest pain). I especially appreciate the chapters on management that include the patient centred model, something that acknowledges that if a person is given adequate information about their treatment opt... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2649315 Wed, 29 Jul 2009 05:38:12 +0100 2649315 http://www.medworm.com/index.php?rid=2613659&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F07%2Fsleep-music-jewel-lullaby-relaxation.html The new 15-track CD “Lullaby” from three-time Grammy nominee Jewel is an acoustic ode to sleep.Released in May, the self-produced release features 10 original songs such as “Sweet Dreams.” The other songs are classic lullabies such as “Twinkle, Twinkle” and “Brahms’ Lullaby.”“This isn’t just a ‘kids’ album, it’s really a mood album – perfect to relax to at the end of a long day,” Jewel said in a prepared statement. “It will soothe and lull children, but was also written and sung for adults to enjoy and unwind with.”Currently the CD is the top-selling compilation of lullabies on Amazon.com. But it’s not just parents who are hoping that music can promote a good night of sleep. Two of the top five recordings on Amazon’s best-selling “Self-Help” list... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2613659 Sat, 18 Jul 2009 10:12:00 +0100 2613659 http://www.medworm.com/index.php?rid=2580019&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F07%2Fonline-cbt-for-insomnia-using-internet.html Research continues to show that online cognitive behavioral therapy may be an effective treatment for adults with ongoing insomnia.A new study involved 44 people with an average age of 45 years. They had struggled with insomnia for an average of more than 10 years; most of the participants were women.Half of the group was put on a wait list as a control; the other half completed a nine-week, online CBT program called “Sleep Healthy Using the Internet” – or SHUTi.Results show that insomnia severity improved significantly for the Internet group; there was only a slight improvement for the control group. Members of the treatment group spent less time awake during the night. Their sleep also was more efficient; a higher percentage of their total time in bed was spent sleeping.The online ... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2580019 Tue, 07 Jul 2009 17:43:00 +0100 2580019 http://www.medworm.com/index.php?rid=2570606&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F07%2F03%2F6-quick-sanity-tricks%2F Awhile back I asked you for your sanity tricks, techniques that help you fight the forces of the dark side. Here are some of the gems. 1. Learn the alphabet. Do you know why the vowel “I” comes well before the vowel “U”? Because a person must take care of herself before trying to help someone else or the world. It’s the same logic that flight attendants use when they swear to you that your plane isn’t going to crash, but in the event that it does, you’d be smart to fasten your own oxygen mask before helping the kiddies. Do it in reverse, and you’ll all run out of air. 2. Stop the singing lessons. I could have used this one a long time ago: “Never try to teach a pig to sing. It wastes your time and annoys the pig.” In other words, ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2570606 Fri, 03 Jul 2009 10:02:06 +0100 2570606 http://www.medworm.com/index.php?rid=2510357&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2009%2F06%2Fbehavioral-therapy-for-emotional.html This NYT article was about behavioral therapy for so-called "borderline personality disorder", which could better be renamed "emotional disruption disorder" ...Personal Health - An Emotional Hair Trigger, Often Misread - NYTimes.com... Dialectical behavior therapy, a derivative of cognitive behavior therapy, helps patients identify thoughts, beliefs and assumptions that make their lives challenging and then learn different ways of thinking and reacting.In effect, Dr. Linehan tells patients, “Your problem is that you don’t know how to regulate yourself, and I can teach you how.” She said thousands of therapists have been trained in dialectical behavior therapy, and many others practice it without special training...I'm generally sympathetic to cognitive therapy approaches. I like the ... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=2510357 Wed, 17 Jun 2009 04:33:00 +0100 2510357 http://www.medworm.com/index.php?rid=2477578&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2009%2F06%2Fearly-intensive-intervention-in-autism.html In the past six months I've been repeatedly reading about the immense value of intensive early intervention in the outcome of children with cognitive disorders and autism.This surprised me. I follow the literature from a distance, and I don't remember a landmark study that defined the clinically significant (rather than statistically significant) benefits of intense early intervention. I especially don't remember a study describing the kind of early intervention.I figured I'd missed something, so I did a quick review and found these studies ...One-year follow-up of the outcome of a randomized ...[Child Care Health Dev. 2009]How can early intensive training help a genetic disorder?Cochrane review of parent-mediated early intervention (2003)Behavioural and developmental interventions for aut... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=2477578 Sun, 14 Jun 2009 23:11:00 +0100 2477578 http://www.medworm.com/index.php?rid=2470012&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F11%2Fwhen-to-start-self-management-for-chronic-pain%2F There’s no doubt that early self management for chronic pain is a good thing – but in our facility, we’ve always had a rather mixed feeling about introducing self management while people are still receiving medical treatment for their pain. Our experience has been that few patients are really committed to learning how to modify their lives when just around the corner there could be a procedure that will ‘fix’ the pain. So I was interested to read about this study, published last year, about a four-week programme self management programme for people who are still undergoing medical treatment. A couple of interesting points from this study:  participants were carefully selected; the programme was brief; and participants were involved in the programme from aroun... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2470012 Wed, 10 Jun 2009 19:10:45 +0100 2470012 http://www.medworm.com/index.php?rid=2470013&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F10%2Fchronic-disease-management-follow-up-and-support-needs-from-diabetes-is-this-a-model-for-pain%2F Self management for chronic pain is not the only area in which self management has been introduced. Heart disease, obesity and diabetes are all very commonly managed with a combination of biomedical and self management strategies. While reviewing different ways to provide support for people who have newly developed coping strategies, I have found a fairly limited number of studies directly examining varying options for providing follow-up. This paper by Fisher, Brownson, O’Toole and Anwuri (2007), while not an empirical study itself, does draw on the experiences of fourteen self management programmes for diabetes management that have been studied under the auspices of the Diabetes Initiative of the Robert Wood Johnson Foundation in St Louis, Missouri. I’m not suggesting that pa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2470013 Wed, 10 Jun 2009 05:29:23 +0100 2470013 http://www.medworm.com/index.php?rid=2468768&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F06%2Ftreating-insomnia-with-yoga-meditation.html A study being presented today at SLEEP 2009 in Seattle, Wash., reports that an effective treatment for insomnia may be “Kriya Yoga.” This is a type of meditation that combines different yoga techniques.The small pilot study involved 11 adults with chronic primary insomnia. They were between the ages of 25 and 45 years. Seven of them practiced Kriya Yoga for two months; four of them only received health education that included tips to improve their sleep hygiene.Results show that there were significant improvements for members of the meditation group. They fell asleep faster and slept longer. They spent less time awake in bed during the night. Their sleep efficiency and sleep quality improved. They even had fewer symptoms of depression. Only total sleep time improved for the control gro... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2468768 Tue, 09 Jun 2009 11:01:00 +0100 2468768 http://www.medworm.com/index.php?rid=2464478&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F09%2Fself-management-follow-up-a-focus-group-study%2F In this study, the focus group participants were only those who had received the stepped care approach. The groups were moderated by an external facilitator, and a simple open-ended semistructured discussion was conducted. Members of the research group were also present to code responses. Although the questions were not specifically about the relationships that people had formed with the care manager or GP, the groups are reported to have raised this relationship often during the course of the discussion. Typically the participants were less than happy with the pain management they had received from their GP, and much more satisfied with the pain management provided during the self management programme. Now, the key differences between the two approaches are summed up as these: time acces... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2464478 Mon, 08 Jun 2009 19:04:31 +0100 2464478 http://www.medworm.com/index.php?rid=2453264&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F03%2Fsupported-self-management-new-but-old%2F I attended a workshop today on supported self management for chronic health conditions.  It’s something the New Zealand Ministry of Health are keen to support, it’s popular in the US and UK – hopefully will save money, because it’s all about what the person with the health condition does, it’s a bit of a buzz-word. Some of the other buzz words for the day: biopsychosocial model; health literacy; cognitive behavioural therapy; and patient-centred. I was pleased to see so many people from a diverse range of practice settings all keen to hear about new ways of delivering health.  It was exciting to see people given hard evidence that self management in a condition such as refractory angina actually works.  It does cost less to help someone do some daily exerci... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2453264 Wed, 03 Jun 2009 09:11:31 +0100 2453264 http://www.medworm.com/index.php?rid=2456970&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F06%2Finternet-intervention-online-cognitive.html Research has shown that cognitive behavioral therapy is an effective treatment option for chronic insomnia. But can online CBT help you sleep better?Some health insurers think so. In November the L.A. Times reported that online CBT for insomnia is covered by some insurance providers.Now a new study published today in the journal Sleep adds to the evidence supporting online CBT for insomnia. Results show that a five-week, online CBT program helped most people in the treatment group; 81 percent reported at least mild improvement in their sleep.A TIME article reported today that there are many positive aspects of online CBT. It can be available to anyone with Internet access. Users also may be able to proceed at their own pace and repeat material as needed.But some people may fail to follow t... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2456970 Mon, 01 Jun 2009 21:13:00 +0100 2456970 http://www.medworm.com/index.php?rid=2441697&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F05%2F23%2Fvideo-change-your-thoughts-change-your-brain%2F Sharon Begley, author of “Train Your Mind, Change Your Brain” explains how training your thoughts actually changes the hard matter of your brain. She writes, “Something as seemingly insubstantial as a thought can affect the very stuff of the brain, altering neuronal connections in a way that can treat mental illness, or perhaps, lead to a greater capacity for empathy and compassion. It may even dial up the supposedly immovable happiness set point.” In this video I demonstrate, as usual. Click through to watch the video. (Source: World of Psychology) World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2441697 Sat, 23 May 2009 15:15:43 +0100 2441697 http://www.medworm.com/index.php?rid=4060684&cid=t_102395_109_f&fid=34859&url=http%3A%2F%2Fblog.davemsw.com%2Farchives%2F2009%2F05%2Fhow_do_you_inspire_a_client_to_believe_in_therapy.php Image via Wikipedia Recently, I exchanged messages with Michele Rosenthal, author of the blog, Parasites of the Mind. She asked me a very good question, one that is so much a part of my everyday work, a good long contemplation was needed just to tease out a good answer. "Speaking of inspiring, how do you inspire a client to believe in what he/she is doing? It's so difficult to believe in anything when PTSD has settled its big black cloud on your head. Any general rules of the game for (self) empowering belief?" Another therapist, Mary Redoutey, joined our discussion and attempted to answer this question. She took the conventional route. "All therapy in essence is self empowered therapy.... The therapist is the partner in the process. I can sit in the chair in my office, can make su... Ψ Dare To Dream... blogs http://www.medworm.com/rss/comments.php?id=4060684 Wed, 20 May 2009 21:14:30 +0100 4060684 http://www.medworm.com/index.php?rid=2427576&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F05%2Fcombining-cognitive-behavioral-therapy.html For people with insomnia, taking a medication can help break the cycle of sleepless nights. And cognitive behavioral therapy can lead to long-lasting improvements with little risk of side effects. But what happens when you combine these two treatments?A new study helps to answer this question. The results were published today in The Journal of the American Medical Association.The study involved 160 adults with chronic insomnia. For six weeks they were treated with either CBT or CBT combined with 10 mg of zolpidem at bedtime. Zolpidem is the generic name for Ambien.Then the study continued for six months. Some of the people treated with only CBT attended monthly treatment sessions; others had no further treatment. Some participants in the combined treatment group continued with CBT and zolp... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2427576 Wed, 20 May 2009 14:44:00 +0100 2427576 http://www.medworm.com/index.php?rid=2417173&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F19%2Fgoal-intentions-or-implementation-intentions-which-one-works%2F This study, which isn’t recent, examined goal intentions – or ‘what people want to do within a certain time period’ – and implementation intentions – or ‘action plans’ refer in more detail to the when, where, and how of future action. People do not forget their implementation intentions easily when they are specified in a when, where, and how manner, and an implementation intention is thought to be more proximal to (ie occur closer to the time when) behaviour or action than goals. The setting for this study was an outpatient physiotherapy centre where patients were attending daily treatment sessions with the expectation of returning to full fitness. Participants had a range of musculoskeletal conditions, and were assessed for this study after... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2417173 Mon, 18 May 2009 19:25:56 +0100 2417173 http://www.medworm.com/index.php?rid=2415871&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F18%2Fwhy-i-didnt-make-it-goals-and-reasons-for-nonachievement%2F Part of most therapy, especially in chronic pain, involves setting goals. A major part of moving from ‘patient’ to ‘person’ means refocusing life from a round of appointments ‘to get better’ to actually doing things that matter in life – being ‘better’. Some of the people we work with achieve these goals and feel more in control, start to focus on interesting things in life rather than pain, and hopefully won’t need to come back and see us again! Others find it much more difficult to achieve the goals they’ve set and need more intervention. This paper explores the reasons people gave for not achieving goals in various domains. The goals were set in the last week of an interdisciplinary pain management programme, and follow-u... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2415871 Sun, 17 May 2009 19:34:27 +0100 2415871 http://www.medworm.com/index.php?rid=2406266&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F14%2Fsome-awesome-cbt-worksheets-and-resources%2F If you’re like me, you probably want to be able to put your hands on some easy-to-use worksheets for use with clients.  While I’m happy to make up my own, it’s nice to find some resources on the web – so thanks to therapyworksheets I’m linking to some of the worksheets I like from this blogsite.  These are NOT pain-related ones, sorry, they’ll be on here later in the year. First up is Lynn Martin’s CBT worksheet page.  Lynn has a whole raft of professional qualifications, but her original training is as a registered nurse.  Her site also contains a couple of concise summaries on CBT, and links to resources.  To use her worksheets you’ll need to cut and paste (and then probably reformat) into another document – but that’s hard... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2406266 Thu, 14 May 2009 08:22:37 +0100 2406266 http://www.medworm.com/index.php?rid=2414364&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F05%2Faccording-to-u.html According to the U.S. Department of Homeland Security, your brain has its own music soundtrack. And this “brain music” just might help you sleep better.The DHS wants to help emergency responders sleep well when they end a stressful shift. So it is studying the use of “brain music.”How is this music recorded? The Loudoun Times-Mirror in Virginia reports that you wear a skullcap that contains EEG sensors. For about five minutes these sensors record your brain waves.Then a computer analyzes the data. It finds the rhythm of your brain waves and transforms the unique pattern into two musical compositions. One has a fast tempo to boost alertness; the other has a slow tempo to promote relaxation.You listen to this music at scheduled times according to your needs. It is believed that this ... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2414364 Tue, 12 May 2009 19:50:00 +0100 2414364 http://www.medworm.com/index.php?rid=2406270&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F12%2Fhow-to-talk-about-psychosocial-issues-with-people-experiencing-chronic-pain%2F If you’ve been following the discussion on my last post about selecting the right person to receive spinal injections (see here), you’ll see a doctor challenged with how to begin to talk about psychosocial issues with patients without the patient thinking ’she thinks it’s all in my head’! It’s a really common problem, IMHO. How to communicate to a person who feels anxious, somewhat disbelieved, and definitely fearful that someone, somewhere is going to suggest that if they ‘pull themselves together’ they’ll be all right! The problem is that I haven’t found a lot of very good evidence to provide direction as to the best way to actually DO this, so I’m going to rely on a few years of experience – and invite you to have a... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2406270 Mon, 11 May 2009 19:10:46 +0100 2406270 http://www.medworm.com/index.php?rid=2390473&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F06%2Fwhere-pain-management-meets-vocational-rehabilitation%2F I had a conversation with a case manager yesterday.  The pain management team had asked for the inclusion of several sessions with me to look at coping with pain at work, along with some anxiety management and some exercise extension for a chap who has been off work for about two years with chronic low back pain.  The case manager seemed mystified as to why I might need to work with this man, saying ‘but we’ve already got a vocational plan in place’. I asked about the plan they had - it involved developing a good working CV/resume, obtaining a work trial, supervising that work trial, helping him develop effective interview skills, and getting him used to the routine of working again.  A good plan for returning to work. Let me backtrack for a moment to take you throug... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2390473 Tue, 05 May 2009 20:59:49 +0100 2390473 http://www.medworm.com/index.php?rid=2389935&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F05%2F05%2Fsleep-and-your-sanity%2F With everything that’s going on these days from recession worries to epidemic scares, it’s not surprising a lot of people are reporting sleep problems. Sleep is essential to our health generally, our sanity in particular. Interrogators know, if you want to break someone down, deprive them of sleep. I didn’t appreciate how important sleep was until I became sleep deprived myself about six years ago. The anxiety that fed my insomnia that fed my anxiety was driving me crazy and drove me, literally, to my doctor’s office. Surely something was very wrong with my thyroid or maybe I had a brain tumor. After a complete workup that took two days and many little tubes of blood I met with my medical specialist, an endrocrinologist. With unforgettable kindness he asked what was... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2389935 Tue, 05 May 2009 09:00:26 +0100 2389935 http://www.medworm.com/index.php?rid=2386953&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F05%2F03%2F6-ways-to-prepare-for-withdrawal-from-an-antidepressant%2F This year, I celebrated my 2nd anniversary of being Paxil-free. (The “hurray!” I feel compelled to type here is a complete understatement of my joy.) Back in 2004, I started taking the drug under the advice of my primary care physician for panic attacks and anxiety. After growing (very) disenchanted with its frustrating side effects, I decided to quit. A row of split and shaved Paxil fragments, lined up in descending size, that I took near the end of my taper. Here’s the CliffsNotes version of my withdrawal attempts. First attempt: Cold turkey. (Bad idea.) Second attempt: Wean by 50% each week by splitting pills into halves and quarters until I’m down to zero within a month or two. (Also a bad idea.) Third attempt: Wean at 10%-25% dosage by splitting/shaving pills ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2386953 Sun, 03 May 2009 16:03:09 +0100 2386953 http://www.medworm.com/index.php?rid=2375926&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2009%2F04%2Fsalon-autism-is-not-disorder.html Salon has an article on the autism is not a disorder movement, sometimes called the “neurodiversity” movement. I don’t like to surrender the term neurodiversity, so I’ll call this the “autism is ok” movement. We’ve been through this sort of thing a few times. Famously, some deaf people resent the use of nerve implants that diminish the appeal of sign language. On another front lesbians and gay men successfully transformed same gender sexual preference from a disease to a trait. These examples are well known, but there’s a third example that’s been forgotten. In the 1970s it was a fad for a while to consider schizophrenia to be just another worldview; and that the disease was an biased social construction. That idea was, how shall I say, bull poop. Reality is a lot messier... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=2375926 Mon, 27 Apr 2009 03:34:00 +0100 2375926 http://www.medworm.com/index.php?rid=2367528&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F04%2F25%2Fvideo-sticky-thoughts%2F I am at war against my thoughts most of the day. “I stink at this. She hates me. I’m a bad mom.” Blah. Blah. Blah. So, much of my therapy involves finding tools to help me filter and let go of negative thoughts so that my day isn’t ruined by them. A visualization to the rescue yet again! Actually two. I hope these help you as much as they have helped me in the last few weeks. Summary 1: Don’t be a sucker. Summary 2: Let it go. You’ll see what I mean. Click through to view the video… (Source: World of Psychology) World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2367528 Sat, 25 Apr 2009 10:00:39 +0100 2367528 http://www.medworm.com/index.php?rid=2346994&cid=t_102395_146_f&fid=38266&url=http%3A%2F%2Fsleepeducation.blogspot.com%2F2009%2F04%2Fi-have-no-control-over-my-racing-mind.html Many people with insomnia complain that their thoughts race out of control at bedtime. This complaint is typical of psychophysiological insomnia.This form of insomnia involves a state of “hyperarousal” at bedtime. Often your thoughts focus on your inability to sleep. As a result you may try harder to fall asleep. But this effort may cause you to stay awake even longer.But the belief that you have no control over a racing mind is one myth about insomnia. You can learn how to relax your mind and your body when you are in bed. Part of this process involves setting aside time to reflect on the day’s events and plan for what lies ahead.Cognitive behavioral therapy also can help put the brakes on your racing thoughts. It helps you develop positive attitudes and habits that promote a health... Sleep Education blogs http://www.medworm.com/rss/comments.php?id=2346994 Sun, 19 Apr 2009 11:01:00 +0100 2346994 http://www.medworm.com/index.php?rid=2313545&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F04%2F04%2Fvideo-5-forms-of-distorted-thinking%2F A video including all the forms of my distorted thinking would be too big to store on You Tube. So I’ll present my top five: ways I torture myself upstairs. The good news? Then I can untwist the distortions and try, ever so bravely, to walk toward REALITY. (Source: World of Psychology) World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2313545 Sat, 04 Apr 2009 12:40:20 +0100 2313545 http://www.medworm.com/index.php?rid=2293092&cid=t_102395_122_f&fid=36582&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSharpBrains%2F%7E3%2FGdpba4jkjjY%2F What started as an academic dispute regarding disclosure of conflict of interest is now snowballing into the mainstream media, due to the over-reaction by JAMA editors as reported in this Wall Street Journal blog post, JAMA editor calls Critic a "Nobody and a Nothing" In summary, Dr. Jonathan Leo, the "Critic", dared to draw attention to 2 important points regarding a study comparing the efficacy of therapy vs. medication published in the Journal of the American Academy of Medicine (JAMA) - one of the most prestigious scientific publications: 1) The study results were presented and reported in a biased way, since they favored one specific intervention, a drug, while ignoring another one, therapy-based, that had equally statistically significant effects. 2) Both the lead... SharpBrains blogs http://www.medworm.com/rss/comments.php?id=2293092 Tue, 24 Mar 2009 16:44:41 +0100 2293092 http://www.medworm.com/index.php?rid=2281928&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F03%2F18%2Fself-management-support-what-patients-really-want%2F In this study, participants from a combined chronic pain and depression management programme were involved in focus groups to discuss their experience of the two health providers. The self management programmes some of the participants were involved with included six sessions of education, goal setting, exercises, relaxation techniques and methods to overcome fear of reinjury and negative emotions. In chronic pain management terms, this is pretty standard self management but compared with an intensive cognitive behavioural approach for chronic pain, was probably a little on the light side. Other participants had routine care through a physician. The methodology of focus groups has some good points and some not so good points - good points are that, as these authors point out, ‘collec... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2281928 Tue, 17 Mar 2009 18:27:46 +0100 2281928 http://www.medworm.com/index.php?rid=2256049&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2009%2F03%2Fteaching-perseverance.html We haven't figured out even half the answers for #1, but we're in a bit of a pause. Familiar patterns, familiar problems, familiar management.On the other hand, #2 is raising new questions. He's fairly "classic" Asperger's (which is a bit like saying someone is a "jock", meaning there's a lot of latitude in there), and has a typically low tolerance for challenges.Some people seek out the hard stuff, because they enjoy the struggle for mastery. The easy stuff isn't interesting.He's not like that.If something's not fairly easy, he doesn't like it. Struggle is not his thing. Perseverance is illogical.That's not a recipe for living well in a world that's usually outside his comfort zone.So how do we teach "frustration management" and strengthen his limited ability to persevere?Some quick web s... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=2256049 Mon, 09 Mar 2009 01:33:00 +0100 2256049 http://www.medworm.com/index.php?rid=2235676&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F03%2F04%2Fmy-pain-is-no-different-but-i-feel-differently-about-it%2F Anyone who works in pain management knows that sense of profound satisfaction when someone says ‘My pain is no different, but I feel differently about it’.  It’s a sign that something has shifted for the person, that they’ve started to move towards accepting it, taking charge of life again instead of waiting for, hoping for something to take it all away. After working for about 12 weeks with one man, yesterday was the last session.  We reviewed his formulation together - looking not so much at how his pain arose (it’s neuropathic post-surgical pain), but the influences on his experience of his pain.  We looked at the problems he was having with his pain - poor sleep, feeling unwell and nauseous when it spiked, trouble concentrating and managing work, feelin... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2235676 Tue, 03 Mar 2009 18:17:42 +0100 2235676 http://www.medworm.com/index.php?rid=2212643&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F25%2Fan-illustration-of-therapist-drift%2F To recap, over the past couple of days I’ve written about how therapists can contribute to ineffective treatment.  These factors include our bias toward thinking that our therapy is working and we’re doing it well, while attributing failure to patient motivation or recognising small changes as much more important than they are. In addition, we can be fearful of ‘pushing’ our clients into behaviours that increase their distress in the short-term (even when this helps them develop long-term changes), we can get fatigued because of workload so we don’t plan or can’t be flexible during sessions, and we can avoid the ‘hard’ parts of therapy especially behaviour change. I’ve referred to Waller’s (2009) paper ‘Evidence-based treat... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2212643 Wed, 25 Feb 2009 07:32:52 +0100 2212643 http://www.medworm.com/index.php?rid=2212644&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F24%2Fdrifting%25e2%2580%25a6-from-the-plan-evidence-based-treatment-and-therapist-drift%2F Yesterday I looked at some of the points made by Waller in his paper on Evidence-based treatment and therapist drift (2009) when I discussed times when therapists contribute to poor outcomes from treatment.    I started looking at this when I was thinking about the distinction between ‘teaching’,  ‘education’ or ‘information’ and helping someone reconceptualise their pain and start to take steps to manage it. Sometimes the ‘therapy’ is given the blame for the person not managing their situation.  Sometimes the ‘patient’ is identified as ‘the problem’, they’re not doing the therapy, not motivated, have another agenda.  But it’s not so often we think of the way that we’re doing the treatment as pa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2212644 Tue, 24 Feb 2009 08:33:24 +0100 2212644 http://www.medworm.com/index.php?rid=2205964&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F23%2Feducation-information-and-a-cognitive-behavioural-approach-to-pain-management%2F For over 10 years now, I’ve winced every time someone has suggested that I’m ‘teaching’ when I facilitate pain management groups.  Something about the word ‘teach’ gives me the heebie-jeebies - and I have nothing against teachers! I think it’s the flavour of me being some sort of ‘expert’ giving information or education to others.  I resist it as much as I can! Using a cognitive behavioural approach seems to me, at least, to be something different from ‘teaching’, or ‘informing’.  So over the next few days I want to wander through some of the distinctions that I feel, and at least clarify it to myself! The basic tenets of a cognitive behavioural approach to chronic pain management are that That clients can le... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2205964 Sun, 22 Feb 2009 22:09:56 +0100 2205964 http://www.medworm.com/index.php?rid=2192399&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F17%2Fcomprehensive-intensive-pain-management-is-cost-effective%2F This study by a group of researchers in Sweden has found that even after seven years, an intensive multidisciplinary pain management programme with a cognitive behavioural approach to self management, reactivation and return to work was more effective than a lower intensity manual therapy (physiotherapy) programme. There were some other bells and whistles to the intensive programme, which also included post-programme follow-up such as workplace intervention, training and support; and the manual therapy approach also included work-related intervention within the workplace, but did not include the cognitive therapy elements. Some interesting differences were evident between the two groups - people on the intensive programme were more likely to be smokers, female and to be foreign to Sweden.�... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2192399 Tue, 17 Feb 2009 06:59:37 +0100 2192399 http://www.medworm.com/index.php?rid=2108598&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F16%2Fpain-catastrophizing-and-pain-related-fear-in-osteoarthritis-patients-relationships-to-pain-and-disability%2F This study by Somers, Keefe and Pells et al. (2008) explores the influence of pain catastrophising and pain-related fear/anxiety on walking speed in a group of people with osteoarthritis of the knee. The authors used walking speed because it is one of the key areas of disability for people with OA of the knee, and they also studied obese patients because as a group, they present with more pain and more disability than people with a BMI of less than 24. ‘The inclusion criteria for the study were: Patients were included if 1) they reported knee pain on most days of the month for at least the prior six months, 2) were overweight or obese (BMI between 25 and 42 kg/m2), 3) met the American College of Rheumatology criteria for OA and had radiographic evidence of OA affecting one or both kn... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2108598 Thu, 15 Jan 2009 20:38:36 +0100 2108598 http://www.medworm.com/index.php?rid=2102385&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F14%2Fbiofeedback-races-an-activity-to-develop-self-regulation%2F I’ve written once or twice on biofeedback as I’ve used it, but I thought today I’d share an exciting idea that one of my colleagues (you know who you are!) came up with to help participants on our pain management programme get practice using their skills in a fun sort of way. We’re a bit lucky in some ways, we have about 8 different portable biofeedback units - some monitoring EMG, and a couple of others monitoring heart rate and galvanic skin response. In the past we’ve taken our participants to the occupational therapy home unit to try out various household tasks while wearing the biofeedback units - but frankly, the men have switched off. Now I don’t know what this says about Kiwi males, but I do know it made the sessions really challenging. So as a t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2102385 Wed, 14 Jan 2009 04:42:43 +0100 2102385 http://www.medworm.com/index.php?rid=2098682&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F13%2Fsetback-planning-worksheet-for-chronic-pain%2F We have all had them - moments when we know what we shoulda-coulda-oughta — but didn’t.  And it’s even more common when we’re trying to change a habit, or in the case of chronic pain management and healthy skills, develop a new way of responding.  We can call this ‘relapse’, which works for alcohol and drug use, but in chronic pain I think it’s more helpful to refer to ’setbacks’. A setback can be a time when things just don’t go as planned, perhaps when unexpected or out of the ordinary events happen (like Christmas!), or when pain intensity fluctuates.  Usually pain increases are called ‘flare-ups’ to avoid the possibility of people thinking they are ‘having another injury’.  The point of setback plan... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2098682 Tue, 13 Jan 2009 07:57:18 +0100 2098682 http://www.medworm.com/index.php?rid=2096209&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F12%2Freflections-on-act-case-formulation-in-chronic-pain%2F I’ve been reviewing ACT and contextual cognitive behavioural therapy in chronic pain management over the past year or so, and it’s really interesting reflecting on the different way in which I see people after being exposed to the ACT approach. Just to recap, some of the main precepts of ACT and CCBT are: people’s attempts to control their negative emotions lead them to avoid encountering these emotions but in doing so they often increase the intensity and frequency with which they experience them and their attempts to avoid the experiences also lead them away from pursuing activities that enable them to achieve things that are important to them (eg values) this becomes evident through ‘cognitive inflexibility’ or the difficulty to do things in different ways... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2096209 Mon, 12 Jan 2009 09:19:10 +0100 2096209 http://www.medworm.com/index.php?rid=2095850&cid=t_102395_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F01%2F11%2Fmindfulness-meditation-reducing-anxiety-by-focusing-on-the-present-moment%2F I’m going on my very first cruise in April, and I’m a little worried about the incidental expenses. I’ve heard horror stories from other recent college grads (read: other folks like me who count their pocket change) who’ve gotten huge bills on their final day for alcohol, food, and other services they’d assumed would be free on their (supposedly) all-inclusive vacation. And last night, appropriately, I dreamed that it cost twenty-five cents to walk through any and all doorways on our cruise ship. I’d walk into the restroom, and I’d be forced to shell out a quarter. I’d walk out, and it would cost another quarter! Quarters for entering and exiting restaurants; quarters for the pleasure of visiting the ice machine or the game room. I needed r... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2095850 Mon, 12 Jan 2009 01:30:40 +0100 2095850 http://www.medworm.com/index.php?rid=2085009&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F07%2Fpractical-action-plans-and-a-worksheet-for-problem-solving-when-the-actions-get-stuck%2F The cognitive behavioural approach to pain management is marked by not just working through ‘education’ or ‘information’, not simply being about ‘psychotherapy’ and ‘cognitive therapy’ - but also about moving from being a patient to whom things are done to being a person who does things. This means goal setting and problem solving are almost compulsory components to a good cognitive behavioural pain management programme. The main problem I’ve had is finding suitably simple worksheets for the people I see who, by and large, are not ‘pen and paper’ people!  Not that they all have learning disorders, but many are just not conversant with written work, and they don’t respond well to screeds of paper and words (unlike me!)... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2085009 Wed, 07 Jan 2009 04:29:02 +0100 2085009 http://www.medworm.com/index.php?rid=2081795&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F01%2F06%2Foh-no-here-we-go-again-the-meaning-of-pain%2F I spent a busy day at work today, which is fine but a bit daunting so early in the New Year! It seemed that everyone I saw had experienced a flare-up and their immediate thought was ‘Oh no, here we go again…’. Superficially I suppose it could look a little repetitive, but this is the magic of pain management: every person’s interpretation of their situation was different!  The words might be the same, but the meaning of that pain experience is not.  (Before I go through these scenario’s, remember I don’t use real names, and these patients represent ‘types’ of people rather than individuals to protect identities). Jamie  is a bit of a man’s man.  He’d always been a fit man, and healthy, until he developed intermittent chest pai... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2081795 Tue, 06 Jan 2009 06:34:38 +0100 2081795 http://www.medworm.com/index.php?rid=2074163&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2008%2F12%2Fguanfacine-tenex-for-adhd-more-good.html These results are gratifying, but not surprising ...Guanfacine Extended Release in Children and Adoles...[J Am Acad Child Adolesc Psychiatry. 2008] - PubMed Result.... Guanfacine extended-release was effective in reducing symptoms of ADHD. Adverse events were mild to moderate, did not interfere with improvements in attention, and rarely led to discontinuation....Guanfacine is a curious and perhaps powerful drug, so we need to treat it with cautious appreciation. The value comes because it's complementary to methylphenidate (Ritalin); it works by different mechanisms and the two seem to mesh well. Although Ritalin is exceedingly safe, it has some street value and can be problematic with adolescents. Ritalin can also exacerbate OCD symptoms and tics; Guanfacine doesn't seem to.Even more inte... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=2074163 Sun, 28 Dec 2008 23:46:00 +0100 2074163 http://www.medworm.com/index.php?rid=4060691&cid=t_102395_109_f&fid=34859&url=http%3A%2F%2Fblog.davemsw.com%2Farchives%2F2008%2F12%2Fclients_not_practitioners_make_therapy_work.php Image via Wikipedia I have been really enjoying my access to a large number of professional journals over the past couple years. Working at a teaching hospital definitely has it's academic perks. I've been particularly gratified to see a growing sophistication in research methods, creative approaches and a maturing view of results. Until recently, practice based research articles have often taken the form of providing some support for a therapist preferred approach to therapy. I can understand that, for I am too, highly invested in how I do and why I do it. But many if not most therapy based research describes a new fangled therapy with a new name. This sort of research seems to me to be more self-serving and contributing to a ever fracturing of psychological science. There are so many ... Ψ Dare To Dream... blogs http://www.medworm.com/rss/comments.php?id=4060691 Sun, 28 Dec 2008 18:27:48 +0100 4060691 http://www.medworm.com/index.php?rid=2063094&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F24%2Fchristmas-eve-a-night-of-expectation%2F Do you remember Christmas Eve when you were a kid?  Hard to go to bed because Santa Could Be Landing On The Roof!! Today it’s Christmas Eve and I’m holding my breath for the New Year with the same sort of excitement I had for Christmas when I was a child…like a wonderful new blank book to write in, all clean and fresh!  This coming year holds all that, and more. I’m hoping for a few things to come to pass - peace, yes, rest for the weary, giggles for the sad, and fulfilment for the empty.  And for me? More to learn, more to question, more fun! Three things to look forward to for me: Getting my PhD interviewing done, so I can start to analyse the things people say and do when they live a full and rich life despite experiencing chronic pain. Developing a brand new... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2063094 Wed, 24 Dec 2008 03:49:11 +0100 2063094 http://www.medworm.com/index.php?rid=2063095&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F23%2Fthree-things-i-learned-about-in-2008%2F I learned more about ACT, or Acceptance and Commitment Therapy, and its value in pain management, at least for some people.  There are some things about this approach that really appeal to me, especially the mindfulness part (noticing myself becoming aware without judging or critiquing).  The action part may not always be so helpful for people who possibly need to become aware of how to lighten up a little, but perhaps that’s just because I need to learn more about that part.  Great sites for this are: Live Mindfully, ACT Mindfully, and the grand Association for Contextual Behavioral Science I reviewed some of my basic scientific methodology (but not the statistics part - yet!).  It’s good to revisit why a certain approach to ‘truth’ or ‘reality’ ha... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2063095 Tue, 23 Dec 2008 04:57:05 +0100 2063095 http://www.medworm.com/index.php?rid=2056688&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F22%2Fseven-things-that-made-me-go-gggrrrrrrrr-in-2008%2F It’s the time of year to reflect and review, so today I’m going to look at some of the stand-out events and issues that got me riled.  You might, after reading these, think that a kind of theme fits these things but as I write them I promise I’m not choosing them to fit any preconceived ideas!  They appear in no particular order, either… Health professionals ‘turf protecting’ - it could be occupational therapists holding out to be ‘the only ones who do goal-setting’; clinical psychologists saying ‘but we’re the only ones who can really do CBT’; physiotherapists proclaiming ‘but only we can do talk about posture’; anyone who says ‘but I don’t want to do generic case work because I’m special&#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2056688 Mon, 22 Dec 2008 08:42:40 +0100 2056688 http://www.medworm.com/index.php?rid=2042734&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F18%2Fcoping-strategies-survey-the-results-3%2F Today’s post completes the results from my coping strategies survey by identifying how important the skills are in the respondent’s view. Remember these are all health professionals who work in pain management, and the questionnaire was completed online and confidentially. What you can see there is that the most important skill, as identified in this survey, is ‘Working with realistic thoughts’. What’s surprising about this is that respondents were not ALL psychologists! In some ways, this is probably one of the most important components in pain management because it encompasses all the cognitive elements involved in reconceptualising chronic pain from something that represents alarm and harm, into something that is simply ‘noise in the system’. S... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2042734 Wed, 17 Dec 2008 18:18:52 +0100 2042734 http://www.medworm.com/index.php?rid=2042735&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F16%2Fcoping-strategies-survey-the-results-2%2F Yesterday I started reviewing the coping strategies survey I’ve been running. 33 participants, a mix of health professionals - and some interesting results. Today I’m looking at when to use pain management strategies, and why. Question 1 - Reducing pain behaviour has been recommended as a part of effective pain management. When do you think it should be encouraged? 24.1% When the person’s pain is at a ‘usual’ daily level 69.0% At all times, even during a flare-up of pain 6.9% When the person is around other people Further comments: As often as the person can sustain the focus without stressing out Interesting responses to this question - I’m curious because I don’t read much specific information about how therapists typically address reducing pain beh... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2042735 Tue, 16 Dec 2008 06:39:02 +0100 2042735 http://www.medworm.com/index.php?rid=2022737&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F09%2Fwhen-patients-set-the-goals-of-therapy%2F This study was carried out in The Neurological Rehabilitation Unit at the National Hospital for Neurology and Neurosurgery, London, UK, and involved 200 in-patients, half of whom were involved in ‘normal practice’ and the other half were involved in a programme where increased participation in goal-setting was encouraged.  The patients had a range of neurological conditions including stroke, multiple sclerosis, spinal cord lesions, and a variety of other less common conditions like peripheral nerve disease and central nervous system tumours. This Unit has a care pathway, which is a set of interlinked goals relating to five main dimensions: (1) health maintenance, (2) cognitive functioning, (3) personal activities of daily living, (4) participation and (5) communication. Method... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2022737 Tue, 09 Dec 2008 07:17:52 +0100 2022737 http://www.medworm.com/index.php?rid=2019236&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F04%2Fa-momentary-detour%2F Just taking a tiny detour from our journey through goals and use of goals in pain management today, to take a quick look at a couple of ways of measuring progress in pain management that can help personalise the outcomes. The first is a likert-type scale from 0 - 10 (or any number, really), where the anchors relate to goal performance. Take a specific functional goal (for example, to hang out a whole load of washing). Make sure it’s a specific, measurable goal! The degree to which the person can manage that goal at time 1 is then equal to zero, and becomes the least anchor. The degree to which the person wants to achieve the goal is then equal to 10, or the end point. Each time the person’s level of achievement is measured it is then recorded against the scale, with an objectiv... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2019236 Thu, 04 Dec 2008 08:49:22 +0100 2019236 http://www.medworm.com/index.php?rid=2008134&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F03%2Fwhat-happens-when-you-cant-do-what-you-want-to%2F Intendus interruptus, or ‘I want to but I can’t do it’ There is no doubt that having chronic pain stops many people from working towards things they want in their life.  At least for some of the time, especially during the early phases of their experience, people tend to focus on obtaining a diagnosis, then either a cure or some form of pain reduction.  Comments from people during this time are ‘I put my life on hold’, ‘I’m just focusing on getting through each day’. What we then see, as chronic pain persists, is a gradual reduction of engagement in firstly leisure activities, then work activities (however you construe this), and finally self care activities. Over time, as Paul Karoly puts it, they develop ‘… a self-defeating r... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2008134 Wed, 03 Dec 2008 05:20:39 +0100 2008134 http://www.medworm.com/index.php?rid=2008135&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F02%2Fmeeting-needs-and-making-meaning-the-pursuit-of-goals%2F Goals: setting them, working towards them, achieving them - they’re part of being human or so Brian Griffith and Catherine Graham say. In this article, they explore the Adlerian interpretation of goals as embodying the meaning of human life saying ‘goals reflect core values, reinforce an image of the ideal self, compensate for inferiority feelings, guard against pain, provide meaning in the present, and promote hope for the future.’(Griffith & Graham, 2004). I was searching for some of the theoretical background to goal setting and came across this paper, which although is really a philosophical exploration of some of the models that occupational therapists drew on early in the development of the profession, also contains some references to more empirical and modern w... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2008135 Tue, 02 Dec 2008 07:27:43 +0100 2008135 http://www.medworm.com/index.php?rid=2000261&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F12%2F01%2Fgoals-and-goal-setting-in-pain-management%2F This is the first of a couple of posts about goals and goal setting in pain management. I’ve been curious about the use of goals in pain management, because although in New Zealand under ACC contracts, goals are required for every pain management programme, it’s not a direct requirement for treatments provided to non-ACC patients.  And I haven’t been sure of the literature about the use of goals and goal setting for people with chronic pain, and have wondered whether it’s something like the assumption that ‘doing activity is good’ or ‘pacing is good’ - thought to be ‘a good thing’ but not actually ever empirically tested. Well, I’m happy to report that there is some specific research on goals and goal setting in chronic pai... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2000261 Mon, 01 Dec 2008 07:59:12 +0100 2000261 http://www.medworm.com/index.php?rid=1985783&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F24%2Fpacing-whats-the-evidence-for-it%2F Pacing is one of those words: almost every person who has been through a pain management programme of any sort will roll their eyes and groan ‘pacing’ when asked about one of their least favourite strategies. I have long disliked the word because of the mixed ways in which therapists (and patients) interpret what it actually means, not to mention my own challenges to actually DO it when I’ve needed to! The term can mean anything from taking a break ‘before it hurts’, ‘breaking a task down into achievable chunks’, starting at ‘what you can do on a bad day, and increasing by 10%’, ‘working at 80%’ - well, you can see my point huh?! I was delighted to read some time ago, a paper by Birkholtz, Aylwin and Harman (2004) in which t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1985783 Mon, 24 Nov 2008 06:37:14 +0100 1985783 http://www.medworm.com/index.php?rid=1982188&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F23%2Fmaking-the-most-of-a-referral-for-pain-management%2F This is a post for people who may refer someone for pain management, or someone who is personally being referred. When I talk about pain management, I’m meaning a multidisciplinary or interdisciplinary pain management programme where participants learn about their pain, develop strategies to cope with life despite their pain, and get involved in reactivation. The contents of a cognitive behavioural pain management programme (eg INPUT, ADAPT, vary considerably - it’s essential that the approach includes these concepts: That clients can learn to accept the chronicity of their pain. That clients can change their relationship to their pain in a way that allows them to broaden their sense of identity/self beyond the pain to that of “a well person with pain”. That clients... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1982188 Sun, 23 Nov 2008 06:57:25 +0100 1982188 http://www.medworm.com/index.php?rid=1980678&cid=t_102395_87_f&fid=34925&url=http%3A%2F%2Fbestyoucanbe.blogspot.com%2F2008%2F11%2Fwarner-on-risperdal-use-in-children.html The NYT's Judith Warner meant well with a recent blog post about Risperdal use in children with "bipolar disorder" but she was ill-served by the research psychiatrists she interviewed.Here are some excerpts of her writing, with the less sensible parts removed ...Tough Choices for Tough Children - Judith Warner Blog - NYTimes.comIt was disturbing to read in The Times this week that the “atypical” antipsychotic Risperdal, a tranquilizing whopper of a drug with serious, sometimes deadly side effects, is now being widely prescribed to children with attention deficit hyperactivity disorder. .. why, according to new Food and Drug Administration data on doctors’ prescribing practices, were 16 percent of the pediatric users of Risperdal over the past three years children with A.D.H.D.?... T... Be the Best You can Be blogs http://www.medworm.com/rss/comments.php?id=1980678 Fri, 21 Nov 2008 23:30:00 +0100 1980678 http://www.medworm.com/index.php?rid=1977374&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F21%2Fwork-conditioning-work-hardening-and-functional-restoration-for-workers-with-back-and-neck-pain%2F In New Zealand most people who have been off work with chronic pain, and receive compensation from ACC, will have been a participant in some sort of fitness programme.  It’s almost a rite of passage for people to have a programme of functional restoration before or during an attempted return to work once the person has been off work for around 3 - 6 months. There are a lot of different types of programme available: two of the Prof Mick Sullivan’Goal attainment’ programmes for sub-acute pain, Functional restoration programme - for sub-acute pain, involving activity with some ‘education’ Pain management psychological services - for psychological strategies for pain management Activity focus programme - for chronic pain, involving activity and cognitive behavio... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1977374 Thu, 20 Nov 2008 19:11:35 +0100 1977374 http://www.medworm.com/index.php?rid=1977375&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F20%2Facceptance-musings%2F I asked the participants in the pain management group to think about the words ‘acceptance’ and ‘change‘ yesterday.  One person asked whether you had to ‘give up hope’ to accept chronic pain, and another said he could ‘never accept that things wouldn’t return to normal, I don’t want this change’. At the time I didn’t want to add my own thoughts about acceptance, but as I mulled over the words myself, I found myself trying to define acceptance - and kept coming up with phrases that included the word ‘change‘ every time. According to wikipedia (oh yes, the font of all wisdom!), ‘Acceptance usually refers to cases where a person experiences a situation or condition (often a negative or uncomfortable situation... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1977375 Wed, 19 Nov 2008 18:28:07 +0100 1977375 http://www.medworm.com/index.php?rid=1970820&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F19%2Fcarrying-on-with-self-management-strategies-doesnt-make-a-difference%2F Continuing in the vein of yesterday’s post where I discussed a study showing no additional benefit from adding graded exposure or graded activity to treatment by classification, today I want to discuss a recent finding showing that all the hard work put into helping people develop and use self management may not make a difference to their recovery in the end.  It’s this study (doi:10.1016/j.ejpain.2008.06.009) by Charlotte Curran, Amanda C. de C. Williams, and Henry W.W. Potts - Cognitive-behavioral therapy for persistent pain: Does adherence after treatment affect outcome?  European Journal of Pain What?! Shock and panic around the world! Pain management skills are not used! The whole basis of self management lies with the idea that people develop practical skills they can... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1970820 Tue, 18 Nov 2008 19:23:28 +0100 1970820 http://www.medworm.com/index.php?rid=1970821&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F18%2Fadding-graded-exposure-or-graded-activity-makes-no-difference%2F This study by George, Zeppieri, Cere et al. (2008) looks at a clinical trial comparing the effectiveness of treatment-based classification (TBC) physical therapy alone to TBC augmented with graded activity (GA) or graded exposure (GX) for patients with acute and sub-acute LBP. ‘Graded exercise and graded exposure are specific behavioral interventions that dose exercise and activity parameters on factors other than pain intensity. Briefly, graded exercise uses a quota system to progress subjects’ therapeutic exercise and activity. In contrast, graded exposure hierarchically exposes subjects to specific situations of which they are fearful by starting with exercise or activity that elicits minimal amounts of fear, and then gradually increasing to situations that elicit larger amounts... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1970821 Tue, 18 Nov 2008 00:34:45 +0100 1970821 http://www.medworm.com/index.php?rid=1956521&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F13%2Fpain-related-anxiety-and-avoidance-a-practical-application-of-theory-and-research-to-clinical-practice%2F In 1995 I started work at the Burwood Pain Management Centre.  It wasn’t my first foray into pain management, but it was the first time I had worked in a fully integrated interdiscipinary team environment.  It was also significant because of the use of the words ‘fear-avoidance’, ‘guarding’ and ‘anticipatory anxiety’. What the team had observed was that there were a specific group of patients who were not just worried about experiencing pain, but were also showing the signs of increased physiological arousal, avoidance of specific activities, and firm beliefs about harm, reinjury, or doing further damage. At the time we used an operant conditioning model (based on Fordyce, 1971 & 1976), along with graded reactivation using a physical conditio... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1956521 Thu, 13 Nov 2008 08:55:51 +0100 1956521 http://www.medworm.com/index.php?rid=1953267&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F13%2Ftheory-and-really-practical-clinical-reasoning%2F I’ve been mulling over my delight and joy in theory, and wondering whether this turns people off reading my blog.  So today I thought I’d draw a link between theory and everyday work in pain management. Theory and models really matter!  They form the organisational framework for the data we collect (ie the things we look for when we assess people), from the models we use, we develop hypotheses, or potential explanations for the way the person presents. It’s these hypotheses we test when we actually carry out therapy: to confirm our predictions.  If our predictions don’t hold, we’ve probably got the wrong explanation and need to look for another one, if they do hold, we can probably work with the underlying theory or model to develop other hypotheses or inte... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1953267 Wed, 12 Nov 2008 18:31:02 +0100 1953267 http://www.medworm.com/index.php?rid=1947960&cid=t_102395_122_f&fid=36582&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSharpBrains%2F%7E3%2F447995271%2F My apologies for not writing in a few days...the Global Agenda Summit in Dubai has required all my attention - I will summarize the great experience when I land back in San Francisco tomorrow night. The concepts of night and day do become challenging when working for a few days in a place with a 12-hour time difference with one's home base. Sleep is indeed very important to maintain top cognitive shape...which leads me to a fascinating news announcement: Health insurance firms offering online cognitive therapy for insomnia (Los Angeles Times) - "helping consumers get a good night's sleep has become a priority for most of the top-tier U.S. health insurance companies, including WellPoint, Aetna, Cigna, Kaiser Permanente and several Blue Cross plans. Their new programs don't involve slee... SharpBrains blogs http://www.medworm.com/rss/comments.php?id=1947960 Mon, 10 Nov 2008 03:52:44 +0100 1947960 http://www.medworm.com/index.php?rid=1931405&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F05%2Fdecision-making-and-cognitive-psychology%2F How do we make decisions about treatment? What errors are we likely to make and can we counter those errors? These are really important questions to ask ourselves as clinicians if we want to avoid leaping into decisions that won’t stand up to scrutiny. Unfortunately it does mean we need to learn a bit about our human fallibility - oh and something about cognitive psychology. And the latter means reading some fairly intense material! Thankfully the paper I’m discussing to day helps to unpack some of the cognitive psychology literature into a form that I can make sense of… This is a paper by Abraham Schwab, who is based in the Philosophy Department of Brooklyn College. That in itself is interesting - philosophy being about reasoning… Anyway, he has summarised some of ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1931405 Tue, 04 Nov 2008 18:26:40 +0100 1931405 http://www.medworm.com/index.php?rid=1928159&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F11%2F04%2Fbasic-biofeedback-in-pain-management%2F I’m no techno-whizz in biofeedback - you have to speak to one of my colleagues (she knows who she is!) to get the technical data on things like heart rate variability - but I do use several modalities reasonably often. So today I thought I’d discuss some of the ways I use biofeedback with the people I work with. Biofeedback basically provides visual or auditory information about normally undetectable physiological processes. It ranges from temperature sensors through to skin conduction (galvanic skin response), and includes surface EMG, respiration, blood volume pulse and sometimes these are put together to provide feedback on heart rate variability. I’m not going into HRV yet, that’s for another day! The most common sensors I use everyday are GSR, which is a reaso... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1928159 Mon, 03 Nov 2008 18:11:15 +0100 1928159 http://www.medworm.com/index.php?rid=1924708&cid=t_102395_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F437368122%2F Using a combination of cognitive behavioral therapy and Pfizer’s antidepressant dramatically reduced the severity of anxiety disorders in children compared with either treatment alone, according to a study in The New England Journal of Medicine. The findings are likely to add to the ongoing controversy about giving antidepressants to children. In 2004, the FDA required drugmakers to add Black Box warnings to antidepressants concerning suicide and suicidal thoughts in children. That led to yet another controversy that some doctors stopped prescribing the meds as often, leading to a rise in teen suicides (back story). In the study, which was funded by the National Institutes of Mental Health and involved 488 kids between ages 7 and 17, none of the children committed suicide, and there ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1924708 Thu, 30 Oct 2008 21:39:28 +0100 1924708 http://www.medworm.com/index.php?rid=1902633&cid=t_102395_133_f&fid=37107&url=http%3A%2F%2Fwww.aspieweb.net%2Fdan-releases-video-documentry%2F Dr. Doreen Granpeesheh and Defeat Autism Now have created a new video documentry which is planned to be revealed as part of the national Defeat Autism Now (DAN!) national conference in San Diego, CA.  The film tells the story of four children diagnosed with autism, who achieved success using treatments rooted in Applied Behavior Analysis. [...] (Source: AspieWeb.net) AspieWeb.net blogs http://www.medworm.com/rss/comments.php?id=1902633 Thu, 23 Oct 2008 13:34:52 +0100 1902633 http://www.medworm.com/index.php?rid=1892587&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F21%2Fif-youre-new-to-pain-management-i%2F I posted last week on some of the basic domains of knowledge that I personally think are important when you’re new to pain management.  For more detailed curricula, the best place to go is IASP, where you can see some older but still relevant examples of curricula such as this one for occupational therapy and physiotherapy. To break the area down a bit, because it really is quite a daunting list of topics, I thought about some of the basic conceptual material as being quite helpful to organise learning.  The first topic that I think is fundamental to understanding pain is the biopsychosocial model, and a quite nice summary of the model is this one by Dr Shaheen Lakhan.  A lightly longer, albeit older couple of papers are here.  A much more recent paper is briefly summarised here,... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1892587 Mon, 20 Oct 2008 18:17:02 +0100 1892587 http://www.medworm.com/index.php?rid=1881387&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F16%2Fif-youre-new-to-pain-management%2F This is just a brief foray into thinking about what people new to pain management might need to know in the first few months.  I’m definitely not being academic about this, and I don’t have any references - it’s my reflections on seeing people starting in the field looking a bit like a possum in the headlights!  (For non-kiwi’s, the possum is high on cuteness, and more than high on destructiveness - and one of the best ways to catch a possum is to go spotlighting!) There are no easy ways to learn about chronic pain management - as a field it’s huge and I think the complexity of it needs to be acknowledged.  I don’t, for example, think it’s the best field for a new graduate occupational therapist, physiotherapist, nurse or psychologist to work i... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1881387 Wed, 15 Oct 2008 18:31:06 +0100 1881387 http://www.medworm.com/index.php?rid=1877199&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F15%2Foccupational-therapists-unite-wiihabilitation-is-more-fun-than-prescribed-exercises%2F As the proud possessor of a brand new Wii and WiiFit, I’m a convert to the addictive powers of the Wii.  I’m not the only, and certainly not the first person to think of the rehabilitative potential of the Wii - in fact it’s been one of the most successful ‘cross-over’ toys that the computer geeks have come up with. I am planning to use the Wii and WiiFit to study whether it can help develop balance, activity tolerance and especially increase proprioceptive awareness in people experiencing persistent pain and complex regional pain syndrome.  There are clinical guidelines I’ve just discovered here at RehabCare who have produced a podcast covering clinical practice guidelines for using the Nintendo Wii.  And I’ve just found an occupational therapi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1877199 Wed, 15 Oct 2008 05:09:04 +0100 1877199 http://www.medworm.com/index.php?rid=1877200&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F15%2Fcue-cards-for-coping%2F One problem people have when learning coping skills is remembering what to do and when to do it.   In the heat of the moment it can be really difficult to recall exactly what the new strategy is!  We also know that pain interferes with recall because of the disruptive effect on attention, and this effect is heightened when people are anxious about their pain.  One good measure for whether attention and thinking processes are disrupted is the Pain Anxiety Symptoms Scale (McCracken & Dhingra, 2002). There are a few techniques for helping people to remember what to do - including some of my favourites like a sticker on a doorframe, post-it notes on the computer or dashboard of the car, or reminders on a cellphone or computer.  But one way that has been helpful for several reasons is ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1877200 Tue, 14 Oct 2008 18:16:08 +0100 1877200 http://www.medworm.com/index.php?rid=1871454&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F14%2Fa-couple-of-interesting-podcasts%2F If you haven’t ever listened to a podcast, maybe today’s post will be an eye-opener.  PainAwareness was set up during the month of September which is Pain Awareness month, but has extended beyond that.  While the content is a little limited at present, there is an interesting podcast about chronic pain (three, actually!).  While it has been sponsored by Ortho-McNeil-Janssen, the emphasis is on exercise and chronic pain.  People from the US will recognise the Olympian Nikki Stone who features on the podcast and experiences chronic pain herself.  This is a good mode for providing patients with a positive message about the usefulness (and safety) of exercise despite experiencing ongoing pain. Also on the site is an audio podcast about psychological approaches to chronic pain ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1871454 Mon, 13 Oct 2008 17:56:42 +0100 1871454 http://www.medworm.com/index.php?rid=1871455&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F13%2Fpain-management-strategy-worksheet-and-activity%2F It’s been a while since I directly posted on practical pain management strategies that can be used as part of activity.  A while ago I developed an activity to use with our pain management programme that involves identifying the skills you might use during three common activities.  I’ve uploaded it here for you to use. Be aware that the photographs are from Google images, so are both of variable quality and some may be copyright. The way you can use this activity is to ask the person to match the title to the definition of the coping strategy (and yes, there are a lot of debates about the definitions so they are by no means definitive!).  You could ask the person to talk you through the strategies he or she uses, or you could use it during assessment as a means of identifyin... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1871455 Sun, 12 Oct 2008 18:04:19 +0100 1871455 http://www.medworm.com/index.php?rid=1845866&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F03%2Fwhy-am-i-doing-this%2F This is not a whining post, just that I thought it was time I mentioned why I write this blog. I looked on the internet for ages to find a resource that gave me good information about nonmedical approaches to managing chronic pain and other chronic disorders. If you use a search engine to look for ‘chronic pain’ or ‘back pain’ you’ll find endless listings for organisations (I used Google just now and found 8,320,000 in 0.34 seconds!)  and many of them are designed for patients, but not a lot for the nonmedical treatment providers who work with them! And we need to remember that the majority of health care providers working with people with chronic pain are nonmedical. We don’t prescribe! You’ll see I also wrote ‘good information’.  Th... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1845866 Thu, 02 Oct 2008 19:15:25 +0100 1845866 http://www.medworm.com/index.php?rid=1845867&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F02%2Fcase-formulation-a-simplified-example-continues%2F My final post on case formulation illustrates the slightly simplified case study that I presented here. I will be simplifying his presentation again today, to make sure this post isn’t too enormous! Firstly, we identify the relatively stable phenomena: Pain-related anxiety and avoidance Work disability Depression Pain behaviours Selected biophysical contributing factors: Initial scaphoid fracture Complex regional pain syndrome type i Reduced range of movement and strength Central sensitisation Selected psychological contributing factors: Unhelpful beliefs about pain and activity Negative reinforcement from avoiding movements anticipated to be painful Catastrophising Nonadherence to treatment recommendations Anxiety/stress about financial situation and employment Selected socia... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1845867 Thu, 02 Oct 2008 07:02:18 +0100 1845867 http://www.medworm.com/index.php?rid=1841978&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F10%2F01%2Fcase-formulation-a-simplified-example%2F Over the past few days I’ve been posting about case formulation. While I’ve presented the abductive theory of method (ATOM) which is a process of inferring from phenomena to underlying causal mechanisms, it’s not the only way to develop a formulation.  I posted on some of the other ways formulations can be developed, and today I’m going to describe a simplified formulation to show how it can work in practice. Don’t forget that when I write about patients I make sure details that can identify the individual are changed - or I describe a composite of several patients. Robert is a 39 year old previously self-employed electrician who sustained a fracture of a his nondominant hand when he fell from a ladder two years ago.  This fracture developed into a complex r... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1841978 Wed, 01 Oct 2008 07:43:29 +0100 1841978 http://www.medworm.com/index.php?rid=1838589&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F30%2Fcase-formulation-the-next-few-steps%2F Over the past few days I’ve been writing about case formulation because in pain management, it’s rare to find only one single causal factor that is influencing either the pain or the disability. Most times we are looking at many factors coming from all three areas of the biopsychosocial model. In each person, the relationships between and combinations of these factors will be unique. And that’s the value of a case formulation as opposed to a diagnosis, which is more like ’shorthand’ for a group of symptoms that go together and are supposedly linked by a causal mechanism (in the case of non-mental health problems). After identifying stable phenomena (symptoms that are present over time and in different places), the next step is to identify the underlying biopsy... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1838589 Tue, 30 Sep 2008 08:54:55 +0100 1838589 http://www.medworm.com/index.php?rid=1838590&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F29%2Fsome-readings%2F Here are a couple of readings on case formulation… Enjoy ‘em! This one is a chapter from a book ‘Cognitive Behavioural Therapy in Mental Health Care’, this chapter is written by Alec Grant, Jem Mills, Ronan Mulhern and Nigel Short, and discusses cognitive behavioural case formulation as a method for strengthening the therapeutic relationship, as well as describing some of the models used in cognitive behavioural therapy for mental health. This paper is written by Eoin Stephens, from PCI College & Centre for Sexual Addictions.  It discusses some of the pro’s and con’s of the approach. And this presentation is about clinical reasoning, written by PA Mabe, Medical College of Georgia.  It suggests that problem-based learning may provide a somewhat easi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1838590 Mon, 29 Sep 2008 08:19:05 +0100 1838590 http://www.medworm.com/index.php?rid=1838591&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F29%2Fcase-formulation-a-diagram-illustrating-the-first-stage%2F This is an illustration of the first step of case formulation - identifying patterns from the data collected, using a range of ways to obtain the information so that it can be relied upon for both accuracy and to cover the range of possible features of the person’s presentation. In this case, I’ve shown some of the ways we collect information in the centre I work - from interview, observation, clinical testing, questionnaires, and other team members.  We use a semi-structured interview that allows the clinician to explore relevant areas in more detail through the interview.  If we have questionnaire results before the interview, we’re able to enquire about areas that these suggest could be problematic.  At the conclusion of our assessment morning, the team meets to dis... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1838591 Mon, 29 Sep 2008 07:34:31 +0100 1838591 http://www.medworm.com/index.php?rid=1834934&cid=t_102395_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2008%2F09%2F29%2Fcase-formulation-abductive-reasoning-applied%2F Before moving on any further with the ATOM (abductive theory of method) as used in case formulation, I need to define what is data and what is phenomenon. Haig defines data as individual pieces of information, often unique to the person or situation, whereas phenomenon are patterns amongst those pieces of data that form distinctive features. For example, difficulty getting off to sleep, lack of energy and poor appetite are data; when they’re tied together with tearfulness and feelings of guilt and poor concentration, and occur over the period of at least two weeks and are causing problems in work, home and social life, we can call it part of a pattern that we recognise as depression. Data are the evidence for the underlying phenomenon, they’re visible or reportable, but in them... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=1834934 Sun, 28 Sep 2008 18:34:51 +0100 1834934