Bernards Voices

December 23, 2009: Neuropod podcasts.

At minute 17:53 in the podcast, there is an interest discussion on how fear memories can be replaced with safer memories. This relates to future, cognitive behavioral therapies, for disorders like PTSD.

Here is a link to the related article in 12/9/09 Nature.

The authors tweaked the timing of extinction therapy so they could take advantage of the fragile reconsolidation period — a window of malleability that opens about three minutes after the memory is reactivated, but closes a few hours later.

Meanwhile, people who got the extinction training 6 hours — instead of 10 minutes — after the reminder, or who got no reminder at all, still showed a significant fear response the next day and the next year.

Outreach follows Bernardsville tragedy – Recorder Community Newspapers: Bernardsville News.

Jacob Perry does a good job interviewing myself and Lauren Luik about our activities in the Healthy Outcomes Partnership to raise awareness in our community. The article made the front page of the March 10, 2011 edition, and has a been recently uploaded to the paper’s website.

HOP will be hosting its second annual Mental Health Week, a week-long information event focusing on mental health, from May 9 to 13 at the YMCA at 140 Mount Airy Road. The event will include numerous talks, workshop and exhibits.

“A tragedy like this is shocking to all of us,” said Lauren Luik, HOP’s Steering Committee chair and a member of the YMCA Board of Directors. “It shakes our core, especially in a community like ours where there is a general appearance of well-being and happiness.

“Asking for help in times of distress can be very difficult, and that’s why the HOP coalition is rolling out programs to support the community by making that first call for help as easy as possible,” she said.

HOP is also launching a mental health first aid program in which two Y employees will receive 40 hours of training. The two employees, in turn, will offer a 12-hour training course to the general public.

Kimzey expressed hope that many people will pursue the training. He said that when an individual slips into a depression, the only ones in a position to see the change are those in day-to-day contact with the individual, such as co-workers, close friends or family members.

The paper editorialized, as well, on the tragedy, and mentioned our efforts at HOP.

Related: Susan Visser and Sue Diebold have just completed the Mental Health First Aid instructor training. “The MHFA movement is so much bigger than I even thought it was,” Susan said in an email today, “and I am excited to be one almost 1,000 instructors nationwide.”

The Wrong Type of Talk Therapy – NYTimes.com.

Consumers can review their therapists on sites like Yelp.  Keely Kolmes, a psychologist, responds with a NYT op-ed.  Personally I haven’t found those consumer reviews helpful–maybe with the exception of Zagats for restaurants.

–patients’ experiences in psychotherapy are more subjective. A certain treatment might help one person but not another. Something that works for one patient at a particular point in therapy might not work for him later, when his needs change. What makes one patient upset enough to write a bad review might not bother — in fact, might even help — another.
And psychotherapy can often bring up upsetting emotions. It’s important for patients to discuss their reactions, positive and negative, directly with their therapists.

In a family interview reviewed by Dr. Walsh in a recent paper, one mother said that the best way to end an argument between siblings was to bark, “Stop fighting, you’re upsetting Barkley!” “This is always more effective than saying, ‘Stop hitting your brother,’ ” the mother said. (Barkley made no comment.)

via Emotional Power Broker of the Modern Family – NYTimes.com.

“The word ‘pet’ does not really capture what these animals mean in a family, first of all,” said Froma Walsh, a psychologist at the University of Chicago and co-director of the Chicago Center for Family Health. The prevalent term among researchers is now “companion animal,” she said, which is closer to the childlike role they so often play.

In the March 5th, New York Times, Gardiner Harris, reports that insurance does not pay enough to justify a psychiatrist providing talk therapy.

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

When Dr. Levin began his practice in 1972:

he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart.

The article seems to deal, first, with the impact on the doctor–the loss of intimacy and connection he feels with his patients. But that it is insignificant, I feel, compared to the loss to the patients. Many studies conclude that medications, when necessary, combined with talk therapy provide the best results.

I’m not implying that Dr. Levin isn’t recommending talk therapy, he is, but finding a second doctor, either in-network, or paying for it out of pocket, or the patient filling out his own paperwork to get partially reimbursed for the therapy, just adds more and more obstacles to getting care. And many people don’t follow through. If you are suffering, maybe you’re depressed, anxious … just how many hoops are you going to jump through?

“Medication is important,” [Dr. Louisa Lance] said, “but it’s the relationship that gets people better.”

Harris makes a tricky little point below by conflating social workers and psychologists. Psychologists with PhDs or PsyDs have invested quite a lot of money as well, and do more training than social workers. I doubt they are very happy, actually I know from experience, that they aren’t happy with the reimbursement rates from insurers either.

Competition from psychologists and social workers — who unlike psychiatrists do not attend medical school, so they can often afford to charge less — is the reason that talk therapy is priced at a lower rate. There is no evidence that psychiatrists provide higher quality talk therapy than psychologists or social workers.

Here is a related post, from March last year. And another post, from January last year.

Greenhouse Projects in New Jersey That Nurture Produce and Workers – NYTimes.com.

Mr. Brusberg’s colleagues in the greenhouses include men and women who have dealt with autism, cerebral palsy, strokes, traumatic brain injury, Huntington’s disease and severe bipolar disorder.

When graduates are hired in the program’s greenhouses, their hourly pay rate can range from $7.45 to $13, depending on their responsibilities.

Psychotherapy Eases Chronic Fatigue, Researchers Say – NYTimes.com.

Good news: cognitive behavioral therapy works!

In the long-awaited study, patients who were randomly assigned to receive cognitive behavioral therapy or exercise therapy, in combination with specialized medical care, reported reduced fatigue levels and greater improvement in physical functioning than those receiving the medical care alone — or getting the medical care along with training in how to recognize the onset of fatigue and to adjust their activities accordingly.

But some patients would prefer believing it is a viral infection, David Tuller reports, and treated (for a lifetime) with anti-viral medications.  And the researchers have some financial ties to medical insurers.  So dismiss the study immediately?

A major difficulty with conducting studies on the syndrome is that there are several different ways of defining and identifying the illness. These variations have led to a wide range of estimates of its prevalence.

For Some Troops, Powerful Drug Cocktails Have Deadly Results – NYTimes.com

Another recent article on our vets.

In his last months alive, Senior Airman Anthony Mena rarely left home without a backpack filled with medications.

He returned from his second deployment to Iraq complaining of back pain, insomnia, anxiety and nightmares. Doctors diagnosed post-traumatic stress disorder and prescribed powerful cocktails of psychiatric drugs and narcotics.

Yet his death was no suicide, the medical examiner concluded. What killed Airman Mena was not an overdose of any one drug, but the interaction of many. He was 23.

War Veterans and Civilians in Dialogue – NYTimes.com

The three-hour [group] session was intended to strengthen relationships between members of the armed services who have returned home and civilians.

The project was developed by two men, both psychotherapists: Lawrence J. Winters, a Vietnam veteran and an author; and Scott Thompson, a staff member at Intersections International and a former Army chaplain. The dialogue on Friday was the 20th in a series that began two and a half years ago: there have been similar events in Seattle, Indianapolis and on the Internet, via the virtual world Second Life. They are free and open to the public, but reservations are required. In the coming months, Mr. Winters and Mr. Thompson said, they hope to find partners who can use the model in other communities.

“The goal,” Mr. Winters said, “is to create a space for a story to be told, to try to counter isolation.”

Should HOP be a partner for this project in our community?

In the last two weeks, three more contributions have come in, and 1 additional corporate match has been applied for: totaling 30 individual contributions and 2 corporate match applications.

Like last time, I will send out an email to the new contributors so that they will know their contribution found the right home.  (Emailed Monday morning.  Happy Valentine’s Day.)

Two Y employees, Susan Visser, HOP coordinator, and Sue Diebold, Sr. Sports and Wellness Director, have been accepted for Mental Health First Aid Training training in mid March.   Some of your contributions are already at work covering tuition.  The timing is good.  We hope that we can launch training for the public during May’s mental health awareness week.