All posts by John pullyblank

M. Jackson Group Update – July 2019 – Finding More Happiness at Work

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
The New York Times includes an article: “A Deceptively Simple Way to Find More Happiness at Work” by By Tim Herrera.
 
Here are some excerpts:
 
[begin excerpts]
 
Do you like what you do?
 
Now, I don’t mean that in the broad sense of wondering whether you’re on the right career path. I mean on a day-to-day basis, if you thought about every single task your job entails, could you name the parts that give you genuine joy? What about the tasks you hate?
 
<snip>
 
We don’t often step back to ask whether the small, individual components of our job actually make us happy.
 
But maybe we should. 
 
As many as a third of United States workers say they don’t feel engaged at work. The reasons vary widely, and everyone’s relationship with work is unique. But there are small ways to improve any job, and those incremental improvements can add up to major increases in job satisfaction.
 
A study from the Mayo Clinic found that physicians who spend about 20 percent of their time doing “work they find most meaningful are at dramatically lower risk for burnout.” 
 
But here’s what’s fascinating: Anything beyond that 20 percent has a marginal impact, as “spending 50 percent of your time in the most meaningful area is associated with similar rates of burnout as 20 percent.”
 
In other words: You don’t need to change everything about your job to see substantial benefits. A few changes here and there can be all you need.
 
“When you look at people who are thriving in their jobs, you notice that they didn’t find them, they made them,” said Ashley Goodall, senior vice president of leadership and team intelligence at Cisco and co-author of the book “Nine Lies About Work.”
 
“We’re told in every commencement speech that if you find a job you love you’ll never work a day in your life. But the verb is wrong,” he said, adding that successful people who love their jobs take “the job that was there at the beginning and then over time they transform the contents of that job.”
 
To be sure, transforming your job isn’t easy. But you have to start somewhere, and there’s a wonderfully simple but surprisingly revealing trick that can help.
 
For a full week, carry a notepad at all times. Draw a line down the center of a page and label one column “Love” and the other column “Loathe.” Whenever you perform a task, no matter how small, be mindful of how it makes you feel. Are you excited about it? Do you look forward to it? Does time fly when you’re doing it? Or did you procrastinate, dreading every moment and feeling drained by the time you’re done?
 
<snip>
 
[T]his exercise — which Mr. Goodall and his co-author, Marcus Buckingham, co-head and talent expert at the A.D.P. Research Institute, write about in their book and practice in their lives — can show you hidden clues and nuances about work.
 
“It’s a beautifully simple way to inventory your emotional reactions to the reality of your day or week at work,” Mr. Buckingham said. “Understand what it is that lights you up. Understand what you run toward. Understand where you are at your most energetic, your most creative, your most alive, and then volunteer for that more and more and more,” he added.
 
This is, of course, just a starting point. You won’t instantly be happier at work once you have a list of things you dislike about your job. But this exercise gives you a road map about how to focus your time and energy on the things that get you excited. Rather than trying to get better at things you hate doing and know you’re not great at, reframe the issue and try to do more things that energize you and that you excel at. 
 
No one can tell you what those things are, and discovering them can be transformative.
 
“If you don’t know what you’re like when you’re in love with your work, no one can do that for you,” Mr. Buckingham said. “This has always been in your hands, and it cannot be in anyone else’s.”
[end excerpts]
The article is online at:
Ken Pope
ADAMES, CHAVEZ-DUEÑAS, & POPE: “TARGETED: SURVIVING SOCIAL MEDIA ATTACKS”
POPE: PSYCHOLOGY, ETHICS, & HUMAN RIGHTS—
EUROPEAN PSYCHOLOGIST (in press)
POPE & VASQUEZ:  ETHICS IN PSYCHOTHERAPY & COUNSELING: 
A PRACTICAL GUIDE (5th EDITION)—John Wiley & Sons
Print—Kindle—Nook—eBook—Apple iBook—Google Book
 
“We’re all going to die, all of us, what a circus!  That alone should make us love each other but it doesn’t. We are terrorized and flattened by trivialities, we are eaten up by nothing.”
—Charles Bukowski

M. Jackson Group Update – June 2019 – Failings of the Biological Model of Mental Illness

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
Next month’s issue of The Atlantic includes an article: “Psychiatry’s Incurable Hubris: The biology of mental illness is still a mystery, but practitioners don’t want to admit it” by Gary Greenberg.
 
Here’s the author note: “Gary Greenberg, a practicing psychotherapist, is the author of The Book of Woe: The DSM and the Unmaking of Psychiatry.”
 
Here are some excerpts:
 
[begin excerpts]
 
In 1886, Clark Bell, the editor of the journal of the Medico-Legal Society of New York, relayed to a physician named Pliny Earle a query bound to be of interest to his journal’s readers: Exactly what mental illnesses can be said to exist? In his 50-year career as a psychiatrist, Earle had developed curricula to teach medical students about mental disorders, co-founded the first professional organization of psychiatrists, and opened one of the first private psychiatric practices in the country. He had also run a couple of asylums, where he instituted novel treatment strategies such as providing education to the mentally ill. If any American doctor was in a position to answer Bell’s query, it was Pliny Earle.
 
Earle responded with a letter unlikely to satisfy Bell. “In the present state of our knowledge,” he wrote, “no classification can be erected upon a pathological basis, for the simple reason that, with slight exceptions, the pathology of the disease is unknown.” Earle’s demurral was also a lament. During his career, he had watched with excitement as medicine, once a discipline rooted in experience and tradition, became a practice based on science. Doctors had treated vaguely named diseases like ague and dropsy with therapies like bloodletting and mustard plasters. Now they deployed chemical agents like vaccines to target diseases identified by their biological causes. But, as Earle knew, psychiatrists could not peer into a microscope to see the biological source of their patients’ suffering, which arose, they assumed, from the brain. They were stuck in the premodern past, dependent on “the apparent mental condition [his emphasis], as judged from the outward manifestations,” to devise diagnoses and treatments.
 
<snip>
 
The protracted attempt to usher psychiatry into medicine’s modern era is the subject of Anne Harrington’s Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness. As her subtitle indicates, this is not a story of steady progress. Rather, it’s a tale of promising roads that turned out to be dead ends, of treatments that seemed miraculous in their day but barbaric in retrospect, of public-health policies that were born in hope but destined for disaster.
 
Some of the episodes Harrington recounts are familiar, such as Egas Moniz’s invention of the lobotomy, which garnered him a Nobel Prize in 1949, at just about the same time that the psychiatrist Walter Freeman was traveling the United States using a surgical tool modeled on an ice pick to perform the operation on hapless asylum inmates. She has retrieved others from history’s dustbin. In the 1930s, for example, insulin was used to render mental patients comatose in hopes that they would wake up relieved of their psychoses. 
 
And in at least one case—the deinstitutionalization of mental patients in the 1960s and ’70s—she has given an old story a new twist. That movement, she argues convincingly, was spearheaded not by pill-happy psychiatrists convinced that a bit of Thorazine would restore their patients to full functioning, but by Freudians. They saw the antipsychotic drugs invented in the 1950s as a way to render patients suitable for the outpatient treatment that psychoanalysts were equipped to provide.
 
From ice baths to Prozac, each development Harrington describes was touted by its originators and adherents as the next great thing—and not without reason. Some people really did emerge from an insulin coma without their delusions; some people really are roused from profound and disabling depressions by a round of electroconvulsive therapy or by antidepressant drugs. But in every case, the treatment came first, often by accident, and the explanation never came at all. The pathological basis of almost all mental disorders remains as unknown today as it was in 1886—unsurprising, given that the brain turns out to be one of the most complex objects in the universe. Even as psychiatrists prescribe a widening variety of treatments, none of them can say exactly why any of these biological therapies work.
 
It follows that psychiatrists also cannot precisely predict for whom and under what conditions their treatments will work. That is why antipsychotic drugs are routinely prescribed to depressed people, for example, and antidepressants to people with anxiety disorders. Psychiatry remains an empirical discipline, its practitioners as dependent on their (and their colleagues’) experience to figure out what will be effective as Pliny Earle and his colleagues were. Little wonder that the history of such a field—reliant on the authority of scientific medicine even in the absence of scientific findings—is a record not only of promise and setback, but of hubris.
 
That word does not appear in Mind Fixers, despite its repeated accounts of overreach by enthusiastic doctors who are often the last to recognize the failure of their theories. As Harrington tells us at the outset, she is committed to restraint. “Heroic origin stories and polemical counterstories may give us momentary emotional satisfaction,” she writes. But the result—“tunnel vision, mutual recrimination, and stalemate”—is not very useful. By presenting a just-the-facts narrative of the attempt to find biological sources of mental suffering, particularly in the brain, she hopes to get the “fraught” enterprise of psychiatry back on the path to progress.
 
Harrington is right to sigh over what has too often proved to be a yelling match between equally deaf opponents—members of an ambitious profession convinced that psychiatry is making strides toward understanding mental illness, and critics who believe it is at best a misguided attempt to help suffering people and at worst a pseudoscience enabling social control at the expense of human dignity. Indeed, since the sides first squared off, more than half a century ago, they seem to have learned little from each other.
 
As Harrington ably documents, a series of fiascoes highlighted the profession’s continued inability to answer Clark Bell’s question. Among them was the 1973 vote by the American Psychiatric Association declaring that homosexuality was no longer a mental illness. The obvious question—how scientific is a discipline that settles so momentous a problem at the ballot box?—was raised by the usual critics. This time, insurers and government bureaucrats joined in, wondering, often out loud, whether psychiatry warranted their confidence, and the money that went along with it.
 
The association’s response was to purge its Diagnostic and Statistical Manual of Mental Disorders (DSM) of the Freudian theory that had led it to include homosexuality in the first place. When the third edition of the DSM came out, in 1980, its authors claimed that they had come up with an accurate list of mental illnesses: Shedding the preconceptions that had dominated previous taxonomies, they relied instead on atheoretical descriptions of symptoms.
 
But as Harrington points out, they did have a theory—that mental illness was no more or less than a pathology of the brain. In claiming not to, she argues,
 

they were being disingenuous. They believed that biological … markers and causes would eventually be discovered for all the true mental disorders. They intended the new descriptive categories to be a prelude to the research that would discover them. The DSM-3’s gesture at science proved sufficient to restore the reputation of the profession, but those discoveries never followed. Indeed, even as the DSM (now in its fifth edition) remains the backbone of clinical psychiatry—and becomes the everyday glossary of our psychic suffering—knowledge about the biology of the disorders it lists has proved so elusive that the head of the National Institute of Mental Health, in 2013, announced that it would be “re-orienting its research away from DSM categories.”

 
The need to dispel widespread public doubt haunts another debacle that Harrington chronicles: the rise of the “chemical imbalance” theory of mental illness, especially depression. The idea was first advanced in the early 1950s, after scientists demonstrated the principles of chemical neurotransmission; it was supported by the discovery that consciousness-altering drugs such as LSD targeted serotonin and other neurotransmitters. The idea exploded into public view in the 1990s with the advent of direct-to-consumer advertising of prescription drugs, antidepressants in particular. Harrington documents ad campaigns for Prozac and Zoloft that assured wary customers the new medications were not simply treating patients’ symptoms by altering their consciousness, as recreational drugs might. Instead, the medications were billed as repairing an underlying biological problem.
 
The strategy worked brilliantly in the marketplace. But there was a catch.
 
 “Ironically, just as the public was embracing the ‘serotonin imbalance’ theory of depression,” Harrington writes, “researchers were forming a new consensus” about the idea behind that theory: It was “deeply flawed and probably outright wrong.” Stymied, drug companies have for now abandoned attempts to find new treatments for mental illness, continuing to peddle the old ones with the same claims. And the news has yet to reach, or at any rate affect, consumers. At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success.
 
Harrington’s dispassion as she chronicles the rise and fall of various biological theories of mental illness will make this book of value to historians of medicine. It may even allow critics and advocates of biological psychiatry alike to gain a deeper appreciation of the historical stream in which they are swimming, and to stop trying to drown one another.
 
But her restraint carries a risk: that she will underplay the significance of the troubles she is reporting.
 
Modern medicine pivots on the promise that portraying human suffering as biological disease will lead to insight and cures. Inescapably, this enterprise has a sociopolitical dimension. To say which of our travails can (and should) come under medicine’s purview is, implicitly if not explicitly, to present a vision of human agency, of the nature of the good life, of who deserves precious social resources like money and compassion. 
 
<snip>
 
By virtue of its focus on our mental lives, and especially on our subjective experience of the world and ourselves, psychiatry, far more directly than other medical specialties, implicates our conception of who we are and how our lives should be lived. 
 
It raises, in short, moral questions. If you convince people that their moods are merely electrochemical noise, you are also telling them what it means to be human, even if you only intend to ease their pain.
 
In this sense, the attempt to work out the biology of mental illness is different from the attempt to work out the biology of cancer or cardiovascular disease. The fact that the brain is necessary to consciousness, added to the fact that the brain is a chunk of meat bathing in a chemical broth, does not yield the fact that conscious suffering is purely biological, or even that this is the best way to approach mental illness. 

Those unresolved, and perhaps unanswerable, moral questions loom over the history that Harrington traces here. The path she has chosen may require her to steer clear of such knotty concerns as the relationship of mind to brain or the relationship of political order to mental illness. But her account doesn’t just skirt the polemics she decries. It also overlooks the consequences of psychiatrists’ ignoring those questions, or using scientific rhetoric to conceal them.
 
At the risk of being polemical, let me suggest that Harrington’s word disingenuous fails to describe the cynicism of Robert Spitzer, the editor of the DSM-3, who acknowledged to me that he was responding to the fact that “psychiatry was regarded as bogus,” and who told me that the book was a success because it “looks very scientific. If you open it up, it looks like they must know something.” 
 
Nor does ironic accurately describe the actions of an industry that touts its products’ power to cure biochemical imbalances that it no longer believes are the culprit. Plain bad faith is what’s on display, sometimes of outrageous proportion. And like all bad faith, it serves more than one master: not only the wish to help people, but also the wish to preserve and increase power and profits.
 
Harrington ends her book with a plea that psychiatry become “more modest in focus” and train its attention on the severe mental illnesses, such as schizophrenia, that are currently treated largely in prisons and homeless shelters—an enterprise that she thinks would require the field “to overcome its persistent reductionist habits and commit to an ongoing dialogue with … the social sciences and even the humanities.” 
 
This is a reasonable proposal, and it suggests avenues other than medication, such as a renewed effort to create humane and effective long-term asylum treatment. 
 
But no matter how evenhandedly she frames this laudable proposal, an industry that has refused to reckon with the full implications of its ambitions or the extent of its failures is unlikely to heed it.
 
[end excerpts]
 
The article is online at:
 
Ken Pope
 
ADAMES, CHAVEZ-DUEÑAS, & POPE: “TARGETED: SURVIVING SOCIAL MEDIA ATTACKS”
INSIDE HIGHER EDUCATION
 
POPE: PSYCHOLOGY, ETHICS, & HUMAN RIGHTS—
EUROPEAN PSYCHOLOGIST (in press)
 
POPE & VASQUEZ:  ETHICS IN PSYCHOTHERAPY & COUNSELING: 
A PRACTICAL GUIDE (5th EDITION)—John Wiley & Sons
Print—Kindle—Nook—eBook—Apple iBook—Google Book
 
“It is not the answer that enlightens, but the question.”
—Eugene Ionesco (1912-1994) 

M. Jackson Group Update – May 2019 – Responding to Suicide Risk

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
NPR released an article: “Reach Out: Ways To Help A Loved One At Risk Of Suicide” by Rhjitu Chatterjee.
 
Here are some excerpts:

[begin excerpts]
 
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
If you know someone struggling with despair, depression or thoughts of suicide, you may be wondering how to help.
 
<snip>
 
You don’t have to be a trained professional to help, says Doreen Marshall, a psychologist and vice president of programs at the AFSP.
 
“Everyone has a role to play in suicide prevention,” she says. But “most people hold back. We often say, ‘Trust your gut. If you’re worried about someone, take that step.’ “
 
And that first step starts with simply reaching out, says Marshall. It may seem like a small thing, but survivors of suicide attempts and suicide experts say, it can go long way.
 
Simple acts of connection are powerful, says Ursula Whiteside, a psychologist and a faculty member at the University of Washington.
 
“Looking out for each other in general reduces [suicide] risk,” says Whiteside. “Because people who feel connected are less likely to kill themselves.”
 
And “the earlier you catch someone,” she adds, “the less they have to suffer.”
 
Here are nine things you can do that can make a difference.

1. Recognize the warning signs

Signs of suicide risk to watch for include changes in mood and behavior, Marshall says.
 
“For example, someone who is usually part of a group or activity and you notice that they stop showing up,” explains Marshall. “Someone who is usually pretty even-tempered, and you see they are easily frustrated or angry.”

Other signs include feeling depressed, anxious, irritable or losing interest in things.
 
Pay attention to a person’s words, too.
 
“They may talk about wanting to end their lives or seeing no purpose or wanting to go to sleep and never wake up,” says Marshall. “Those are signs that they may be thinking about [suicide]. It may be couched as a need to get away from, or escape the pain.”
 
According to the AFSP, people who take their own lives often show a combination of these warning signs.
 
And the signs can be different for different individuals, says Madelyn Gould, a professor of epidemiology in psychiatry at Columbia University who studies suicide and suicide prevention.
 
“For some people, it might be starting to have difficulty sleeping,” she says. Someone else might easily feel humiliated or rejected.
 
“Each one of these things can put [someone] more at risk,” explains Gould, “Until at some point, [they’re] not in control anymore.”

2. Reach out and ask, “Are you OK?”

So, what do you do when you notice someone is struggling and you fear they may be considering suicide?
 
Reach out, check in and show you care, say suicide prevention experts.
 
“The very nature of someone struggling with suicide and depression, [is that] they’re not likely to reach out,” says Marshall. “They feel like a burden to others.”
 
People who are having thoughts of suicide often feel trapped and alone, explains DeQuincy Lezine, a psychologist and a member of the board of directors of the American Association of Suicidology. He is also a survivor of suicide attempts.
 
When someone reaches out and offers support, it reduces a person’s sense of isolation, he explains.
 
“Even if you can’t find the exact words [to say], the aspect that somebody cares makes a big difference,”says Lezine.
 
Questions like “Are you doing OK?” and statements like “If you need anything, let me know” are simple supportive gestures that can have a big impact on someone who’s in emotional pain, explains Julie DeGolier, a medical assistant in Seattle and a survivor of suicide attempts. It can interrupt the negative spiral that can lead to crisis.
 
The website for the National Suicide Prevention Lifeline has a list of do’s and don’ts when trying to help someone at risk.
 
<snip>

3. Be direct: Ask about suicide

“Most people are afraid to ask about suicide, because they [think they] don’t want to put the thought in their head,” says Marshall. “But there’s no research to support that.”
 
Instead, she and other suicide prevention experts say discussing suicide directly and compassionately with a person at risk is key to preventing it.
 
One can ask a direct question like, “Have you ever had thoughts of suicide?” says Marshall.
 
More general questions like, “What do you think of people who kill themselves?” can also open up a conversation about suicide, says Gould. 
 
“Now they are talking about it, when you might not have had the conversation before.”

4. Assess risk and don’t panic: Suicidal feelings aren’t always an emergency

Say a loved one confides in you that they have been thinking about suicide. What do you do then?
 
“Don’t let yourself panic,” says Whiteside.
 
People often believe that a person considering suicide needs to be rushed to the hospital. But “not everyone who expressed these thoughts needs to be hospitalized immediately,” says Marshall.
 
 
But how do you know whether your loved one’s situation is an immediate crisis?
 
Whiteside suggests asking direct questions like: “Are you thinking of killing yourself in the next day or so?” and “How strong are those urges?”
 
For help with this conversation, psychiatrists at Columbia University have developed the Columbia Protocol, which is a risk-assessment tool drawn from their research-based suicide severity rating scale. It walks you through six questions to ask your loved one about whether they’ve had thoughts about suicide and about the means of suicide and whether they have worked out the details of how they would carry out their plan.
 
Someone who has a plan at hand is at a high risk of acting on it — according to the Suicide Prevention Resource Center, about 38 percent of people who have made a plan go on to make an attempt.

5. If it’s a crisis, stick around

So what if you’ve assessed risk and you fear your loved one is in immediate crisis? First, request them to hold off for a day or so, says Whiteside, at the same time being “validating and gentle.”
 
The kind of intense emotions that might make someone act on an impulse, “usually resolve or become manageable in less than 24 or 48 hours,” she says. If you can, offer to stay with them during that time period, she adds. Otherwise, help them find other immediate social support or medical help. They shouldn’t be alone at these times of crisis.
 
Ask whether they have any means of harming themselves at hand and work with them to remove those things from their environment. Research shows that removing or limiting access to means reduces suicide deaths.
 
The National Suicide Prevention Lifeline offers this guide to the five action steps to take if someone you know is imminent danger.
 
If you don’t feel confident about helping someone through a crisis period, call the National Suicide Prevention Lifeline, says Gould.

6. Listen and offer hope

If the person is not in immediate risk, it is still important to listen to them, say survivors of suicide attempts like Lezine and DeGolier.
 
“The biggest thing is listening in an open-minded way, to not be judgmental,” says DeGolier.
 
“Don’t tell a person what to do. They’re looking to be heard, to have their feelings acknowledged.”
 
The next step is to offer hope, says Whiteside. It helps to say things like, “I know how strong you are. I’ve seen you get through hard things. I think we can get through this together,” she explains.
 
One of Lezine’s closest friends in college did just that during his suicidal phases, he says.
 
“For one thing, she never lost faith in me,” says Lezine. “She always believed I have a positive life possible and I would achieve good things.”
 
He says her faith in him kept him from giving in to his despair completely.
 
“Having somebody, a confidante who absolutely believed as a person in [my] ability to do something meaningful in life” was instrumental in his recovery, he says.

7. Help your loved one make a safety plan

When a person is not in immediate risk of attempting suicide, it’s a good time to think about preventing a future crisis.
 
“That’s where we want to make help-seeking and adaptive coping strategies a practice,” says Gould.
 
Suicide prevention experts advise people develop what’s known as a safety plan, which research has shown can help reduce suicide risk. It’s a simple plan for how to cope and get help when a crisis hits, and typically, an at-risk person and their mental health provider create it together, but a family member or friend can also help.
 
The American Foundation for Suicide Prevention has a template for creating a safety plan. It includes making a list of the person’s triggers and warning signs of a coming crisis, people they feel comfortable reaching out to for help and activities they can do to distract themselves during those times — it can be something simple as watching a funny movie.
 
Safety planning includes helping your loved one make their environment safer. This is one of the most important steps to preventing suicide, says Marshall. That involves a conversation about lethal means.
 
“If you ask what kinds of thoughts you’re having, they may tell you the means,” she says.
 
If they don’t volunteer that information, it’s worth asking them directly, she adds. Once they say what means they have thought of using, one can discuss with them how to limit their access to it.
 
“The more time and space you can put between the person and harming themselves, the better,” says Marshall. “If this is someone who is a firearm owner, you may talk with them to make sure they don’t have ready access to firearm in moments of crisis.”
 
<snip>

8. Help them tackle the mental health care system

When someone is in urgent crisis mode, it’s often not the best time to try to navigate the mental health care system, says DeGolier. But to prevent a future crisis, offer to help your loved one connect with a mental health professional to find out whether medications can help them and to learn ways to manage their mood and suicidal thinking.
A kind of talk therapy calleddialectical behavior therapy, or DBT, has been shown to be effective in reducing risk of suicide. It teaches people strategies to calm their minds and distract themselves when the suicidal thoughts surface.
 
It can be hard for someone who’s struggling with negative emotions to get and keep a mental health appointment. Family members and friends can help, notes Whiteside.
 
“Know that it takes persistence,” she says. “You don’t stop until you have an appointment for them. That may mean you call 30 people until you find someone who has an availability. You take the day off from work, go with them.”
 
Lezine says he was fortunate to have had that kind of help and support from his college friend when he was struggling.
 
“One of the things that was helpful … was she went with me [to my appointment],” he says. “When you’re feeling really down and feeling like you don’t matter as much, you might not want to take time, or think that it’s worth the time, or feel like I don’t want to go through this.”
 
Many people don’t make it to their first appointment, or don’t follow up, he says. Having a person hold your hand through the process, accompany you to your appointments can prevent that.
 
“If somebody is sitting there with you, you can have eye contact, touch contact,” says Lezine. “It does make a difference, making you feel like you have another person who cares.”

9. Explore tools and support online

For those struggling to access mental health care there are some evidence-based digital tools that can also help.
 
For example, there’s a smartphone app called Virtual Hope Box, which is modeled on cognitive behavioral therapy techniques. Research shows that veterans who were feeling suicidal and used the app were able to cope better with negative emotions. 
 
Whiteside and her colleagues started a website called Now Matters Now, which offers videos with personal stories of suicide survivors talking about their own struggles and how they have overcome their suicidal thoughts. Stories of survival and coping with suicidal thoughts have been shown to have a positive effect on people at risk of suicide.
 
The website also has videos that teach some simple skills that are otherwise taught by a therapist trained to offer DBT.
 
Those skills include mindfulness and paced breathing, which involves breathing with exhales that last longer than the inhales. Whiteside explains that this can calm the nervous system. Similarly, a cold shower or splashing ice water on one’s face or making eye contact with someone can distract and/or calm the person who is at immediate risk of taking their own life.
 
Surveys show that people who visit the website and watch the videos have a short-term reduction in their suicidal thoughts, she says.
[end excerpts]
The article is online at:
Ken Pope
ADAMES, CHAVEZ-DUEÑAS, & POPE: “TARGETED: SURVIVING SOCIAL MEDIA ATTACKS”
INSIDE HIGHER EDUCATION
POPE: PSYCHOLOGY, ETHICS, & HUMAN RIGHTS—
EUROPEAN PSYCHOLOGIST (in press)
POPE & VASQUEZ:  ETHICS IN PSYCHOTHERAPY & COUNSELING: 
A PRACTICAL GUIDE (5th EDITION)—John Wiley & Sons
Print—Kindle—Nook—eBook—Apple iBook—Google Book
 
“We are all in the same boat, in a stormy sea, and we owe each other a terrible loyalty.”
—G. K. Chesterton (1874-1936)

M. Jackson Group Update – April 2019 – The Placebo Effect

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
The British Psychological Society’s Research Digest includes an article: “The Placebo Effect, Digested – 10 Amazing Findings” by Christian Jarrett.
 
Here are some excerpts:
 
[begin excerpts]
 
The placebo effect usually triggers an eye-brow raise or two among even the most hard-nosed of skeptics. We may not be able to forecast the future or move physical objects with our minds, but the placebo effect is nearly as marvellous (Ben Goldacre once called it the “coolest, strangest thing in medicine”).
 
The term “placebo effect” is short-hand for how our mere beliefs about the effectiveness of an inert treatment or intervention can lead to demonstrable health benefits and cognitive changes – an apparently incontrovertible demonstration of the near-magical power of mind over matter. 
 
<snip>
 
Our beliefs are the subjective echo of physical processes in the brain – and it’s this constellation of neurochemical and electrical events , and their downstream effects, that underlies the placebo phenomenon (in some cases the placebo effect can also be interpreted as a form of conditioned response, in which a learned physiological reaction occurs in the absence of the original trigger).
 
<snip>

Here, in a celebration of the mysterious and maddening placebo effect, and to help inspire future research into this most fascinating aspect of human (and animal) psychology, we digest 10 amazing placebo-related findings:
 
The Placebo Effect Works Even When You Know It’s A Placebo
 
For the placebo effect to occur, it’s usually considered that deception is required – tricking the patient into thinking that an inert treatment is actually a powerful drug or similar. It’s this need for trickery that has long meant the deliberate inducement of placebo effects in mainstream medicine is seen as unethical. Nearly ten years ago, however, researchers showed that people with irritable bowel syndrome showed greater improvement after being given a so-called “open placebo” that they were told was completely inert, as compared to receiving no treatment. Presumably some residual belief and expectation of an effect survives being told that the treatment is physically impotent (or there is a condition response to the placebo that does not require positive beliefs). More recent research has since shown benefits of open placebos for many other conditions including back pain and hay fever. Open placebos “bypass at least some of the conventional ethical barriers” to the clinical use of placebos, according to some experts. Others however have highlighted the lack of suitably robust research in this area, and it’s worth noting there have been some null findings – for instance, open placebos failed to speed up wound healing.
 
Branding, Colours and Medical Paraphernalia Can All Boost The Placebo Effect
 
Putting aside open placebos, there’s evidence that different forms of deceptive placebo vary in their effectiveness. The more powerful we imagine their effect will be, the larger the benefit. This means that four placebo pills have a larger effect than two; and placebo injections (filled with nothing other than saline solution) are more powerful than pills (in fact, in the context of osteoarthritis, a placebo injection was found to be more effective than a real drug). Also – depending on the condition being treated – pills of certain colours and descriptions are more effective than others, such as blue placebo pills making better sedatives than pink ones, and branded placebo pills being more effective than those without any labelling. The influence of the credibility of a given placebo on its subsequent effectiveness may help explain one of the most astonishing demonstrations of the placebo effect that I’ve come across. It involved “placebo brain surgery” – and what could elicit a greater hope for a treatment effect than the elaborate paraphernalia and protocols involved in experts operating on your brain? Specifically, the research showed that patients with Parkinson’s Disease who undertook a form of placebo brain surgery (supposedly, but not really, involving the injection of stem cells) showed greater symptom improvements than those patients who received the stem cell treatment, but didn’t think they had. “The placebo effect was very strong in this study,” the researchers said, “demonstrating the value of placebo-controlled surgical trials.”
 
Some People Are More Prone To The Placebo Effect Than Others
 
Certain personality traits are associated with it being more likely that a person will experience the placebo effect. This is logical since the placebo effect depends on our beliefs and expectations, which some of us may subscribe to more readily and enthusiastically than others. Among the results in this area, optimists are more responsive to analgesic placebos, as are people who score higher for emotional resilience and friendliness (this last finding may relate to the social dynamic involved in the elicitation of the placebo effect by physicians). 
 
<snip>
 
Some Doctors Are Better At Inducing The Placebo Effect Than Others
 
As placebo effects depend on the patient believing in the power of the treatment being given to them, it follows that some doctors will be better placed to reinforce this hope and expectation than others. Research backs this up: a study that involved a placebo injection for the treatment of an allergic reaction found that symptom improvement was greater when the injection was given by a doctor conveying warmth and confidence. Feelings of similarity toward one’s doctor may also be relevant: another study found that subjective pain was lower after a medical procedure when participants thought they’d been paired with a doctor who shared the same values and personal beliefs as them.
 
The Placebo Effect Isn’t Just About Pain Reduction – It Can Boost Creativity And Cognitive Performance Too
 
We usually think of the placebo effect in the context of medical interventions and especially pain relief. However, there is growing evidence that the effect can also work in other ways, including enhancing our physical and mental performance. In terms athletic abilities, various studies have shown placebo effects on speed, strength and endurance (in one placebo-like study, researchers asked cyclists to train to complete exhaustion and found they were able to persist significantly longer when their clocks had been secretly tampered with to make them run slow).
 
In relation to creativity, one study found that people who smelt an odour that they were told boosts creativity went on to excel at tests of their creative performance as compared with a control group who smelled the same odour but weren’t told it had any special benefits. Another experiment involved participants receiving placebo non-invasive brain stimulation and performing a learning task. The placebo group thought their brains had been stimulated by a mild electrical current – in reality they hadn’t – and they were led to believe that this stimulation would boost their mental function. The placebo participants were subsequently more accurate in the learning task, and showed steeper reductions in their reaction times than control participants. 
 
<snip>
 
There’s Even Such A Thing As Placebo Sleep
 
There is almost no end to the ways that the placebo phenomenon can manifest. In one particularly novel instance researchers tricked participants into thinking they’d had more sleep than they actually had, and then observed how this affected their performance the next day. The researchers achieved this deception by wiring their participants up to various physiological measures and then giving some of them false feedback on how much REM sleep they’d had. After hearing that they’d had an impressive amount of sleep, participants performed better on tests of language and arithmetic. 
 
<snip>
 
Animals Seem To Experience The Placebo Effect Too
 
It is common in drug trials involving animals to compare an active treatment against a placebo, similar to the procedure in human drug trials. And when this is done, researchers have often observed that a significant number of animals in the placebo group show a treatment response, such as happened in a trial of an anti-seizure medication for dogs, and in a dietary intervention for muscle stiffness in horses. The problem with interpreting these kind of findings is that it’s possible the placebo effect really lies with the owners, who may interact with their animals differently when they believe they are receiving medial care or nutritional supplements.
 
<snip>
 
The Placebo Effect Has An Evil Twin
 
If the placebo effect occurs simply because you believe a given treatment will be beneficial, it follows that if you have negative expectations, this could result in a worsening of your symptoms. That’s exactly what researchers have found and they’ve called this the “nocebo effect”. The placebo effect’s twin is not to be sniffed at either. A meta-analysis in the context of analgesia (in which some participants are told that an inert cream or pill leads to increased pain in some people) found that the nocebo effect is roughly similar in size to positive placebo effects.
 
Intriguingly, nocebo effects can even occur in the presence of real pain-relieving medications, not just inert treatments – in one study, participants were told that their pain would increase after an analgesia treatment was stopped. The physiological effect of the analgesia would normally persist, however in these participants it ended abruptly, as if the negative expectations had cancelled out the genuine analgesic effect. The real-life implications of these kind of findings are obvious – if nothing else, it’s probably worth taking care when you read the side-effects leaflet that came with your latest prescription.
 
The Placebo Effect Is A Bit Of A Pain For Many Psychology Researchers
 
The placebo effect is fascinating in its own right, but for researchers interested in establishing the efficacy of psychological interventions, it can be maddening. The influence of expectations on our thoughts, feelings and behavior is so powerful and pervasive that it complicates the interpretation of many studies, unless they are very carefully designed. In their 2013 paper titled “The Pervasive Problem With Placebos In Psychology“, a team led by Walter Boot at Florida State University argued that in fact many psychology studies (on things like brain training, expressive writing and internet therapy) do not do enough to match participants’ expectations across different conditions. They explain that simply having an active control condition is not adequate if participants in the control group do not expect it to have as beneficial or powerful an effect as participants in the intervention condition expect of their experience. The way around this, Boot and his colleagues explained, is to measure participants’ expectations and take steps to try to match them across control and intervention conditions as much as possible. “‘We are hopeful that, with better designs and better checks on placebo effects, future research will provide more compelling evidence for the effectiveness of interventions,’ they concluded.
 
The Placebo Effect Appears To Be Getting Stronger
 
Curiously, it’s become apparent in recent years that the placebo effect is getting stronger – this has been shown for placebo antipsychotic medications, placebo anti-depressants, and – in the US only – for placebo analgesics. With regards to that last finding, research team leader Jeffrey Mogil told Nature News, “We were absolutely floored when we found out”. Specifically, in the 90s, they found that participants receiving an active drug reported 27 per cent greater pain relief than participants receiving placebo, but by 2013, the difference was just 9 per cent. One explanation is that drug trials have become larger and more elaborate, especially in the US, thus increasing the drama and intensity of the experience for participants only receiving placebo.
 
Another possibility is that the general public has become more aware of the placebo effect – and of the idea that its impact on symptoms can be real (as reflected in less pain-related brain activity, for instance) and not merely illusory. That was the argument put forward by anesthesiologist Gary Bennett in the journal Pain last year. In fact, Bennett goes so far as to suggest that, because the term placebo now elicits such a strong placebo effect, its use should be dropped from drug trials. “The word ‘placebo’ should be avoided in all information and instructions given to the patients,” he advises. “Patient instructions should have the goal of forcing the patient’s expectations to the form: ‘I may receive pain relief’ vs. ‘I will not obtain pain relief’.”
 
[end excerpts]
 
The article is online at:
 
Ken Pope
 
ADAMES, CHAVEZ-DUEÑAS, & POPE: “TARGETED: SURVIVING SOCIAL MEDIA ATTACKS”
INSIDE HIGHER EDUCATION
 
POPE: PSYCHOLOGY, ETHICS, & HUMAN RIGHTS—
EUROPEAN PSYCHOLOGIST (in press)
 
POPE & VASQUEZ:  ETHICS IN PSYCHOTHERAPY & COUNSELING: 
A PRACTICAL GUIDE (5th EDITION)—John Wiley & Sons
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“[Danish physicist Niel Bohr, recipient of the Nobel Prize for Physics] used to tell the story of a visitor to his country home who noticed a horseshoe hanging over the entrance door.  Puzzled, he asked Bohr if he really believed that this brought luck.  Bohr replied: ‘Of course not!  But I’m told you don’t have to believe in it for it to work.'”
—Daniel R. Bes in Quantum Mechanics: A Modern and Concise Introductory Course, Second, Revised Edition 

M. Jackson Group Update – March 2019 – How To Be a Better Talker

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
The Wall Street Journal includes an article: “No One Listening? Maybe You’re the Problem; Listeners typically shoulder the blame for disconnected conversations, distracted by screens and multitasking. But communication experts say talkers should examine their own actions, too” by Elizabeth Bernstein.
 
Here are some excerpts:
 
[begin excerpts]
 
A good friend called me recently to say hello. We chatted about his kids, a problem he was having at work, and his recent vacation.  When he asked how I was doing, I mentioned a big work project.  “The deadline is bearing down on me and I am stressed,” I said.
 
There was more silence.  Then my friend—who had woken me up at 6 a.m. to talk—blurted out: “Oh darn, I missed one!  I’m taking this online training course for work and just messed up the last answer.”
 
Ever feel like someone you’re talking to isn’t listening?  You’re not alone.  Listeners estimate that they tune out during conversations about 30% of the time, according to research from Harvard Business School, presented in its preliminary stage earlier this month at the annual conference for the Society for Personality and Social Psychology.
 
<snip> 
 
The blame is usually placed on the shoulders of the listener, distracted in the smartphone era by multiple screens and multitasking.  Solutions have concentrated on how to listen better: Put down your phone.  Make eye contact.  Ask open-ended questions.  Encourage the other person to elaborate.
 
But now communication experts say we need to focus on what the talker is doing wrong, too.  Often, they say, talkers engage in a monologue rather than a dialogue.  They drone on and ignore the listener’s cues that he or she is disengaged.  They sometimes accuse the listener of spacing out, causing hurt feelings or starting an argument.  They don’t let the listener get a word in.
 
“Usually, talkers are too active,” says Traci Ruble, a couples therapist and communication consultant in San Francisco, who is the founder of Sidewalk Talk, a nonprofit that sends groups of trained volunteers into the streets to talk with strangers.  
 
“The talker starts on a roll and never checks to see if they are being listened to, and the listener starts to feel objectified and thinks: ‘Do you even notice that I am here or are you just anxiously pouring out all your thoughts?’”
 
Ms. Ruble, who estimates that she’s trained about 8,000 people to communicate, says that talkers need to engage in “connected talking.” 
 
Connected talkers focus on four actions, she says.  They are aware of the listener and value what that person brings to the conversation.  They pay attention to what it feels like to be listened to and don’t get lost in their own head.  They feel gratitude for the listener.  And they are aware of the well-being of the listener, asking: “Am I overwhelming or losing the person?”
 
How do you put this into practice? Don’t just launch in. Ask the other person if they have time to chat. Then give them a hint of the emotional tenor of the conversation. You can say: “Hey, I’ve got some good news to share,” or “I’m falling apart, I could use some advice.” “Maybe people have time for a happy story but don’t have time to console you…,” Ms. Ruble says.
 
Next, be clear about what you need. Do you want advice, empathy, someone to hold your hand and just listen? Being open about what you want will help both you and the listener stay focused.
 
It’s important to pay attention to how much you appreciate the listener. Doing this will help the talker feel more heard.
 
You’ll also need to slow down your talking, make eye contact, pay attention to the other person’s responses and let the other person talk. Be aware of “anxious talking,” when you’re rambling on about anything that comes into your head. If that happens, ask yourself why you’re anxious. Sharing your worry can help the person feel more connected, too.
 
If the other person seems distracted or disengaged, don’t take it personally. Politely ask if there is something wrong or if they prefer to talk another time. And accept the answer. “If your listener doesn’t feel strong-armed into listening, then when they are listening they are really with you,” says Ms. Ruble.
 
<snip>
 
How to Be a Better Talker
 
Here are some tips from Traci Ruble, a couples therapist in San Francisco and founder of Sidewalk Talk, a nonprofit that sends groups of trained volunteers into the streets to talk with strangers.
 
Don’t just launch in. Ask the other person if it’s a good time to chat.
 
Be clear about what you need from your listener—advice, empathy, an ear or a hug. Explain this.
 
Don’t take it personally if the listener can’t talk at that moment. Ask to chat at a better time.
 
Slow down. Breathe. Make eye contact. Let the other person talk, too.
 
Don’t ramble. If you do, get yourself back on track by saying: “My intention for sharing this with you right now is…” “It’s the ultimate gut check so you can be clear why you are sharing,” Ms. Ruble says.
 
If you sense the other person isn’t listening, politely ask what is going on or if there is a better time to talk. You may need to switch environments—move to another room, say—to remove distractions. If not listening is a pattern, discuss that and explain how this makes you feel.
 
Practice appreciating the listener more. This will help you feel more heard.
 
[end excerpts]
 
The article is online at:
 
Ken Pope
 
POPE & VASQUEZ:  ETHICS IN PSYCHOTHERAPY & COUNSELING: 
A PRACTICAL GUIDE (5th EDITION)—John Wiley & Sons
Print—Kindle—Nook—eBook—Apple iBook—Google Book
 
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POPE: PSYCHOLOGY, ETHICS, & HUMAN RIGHTS—
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“We’re all just walking each other home”  
—Harvard Psychologist Richard Alpert, later aka Ram Dass 

M. Jackson Group Update – February 2019 – Limits on Self-Care

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
Current Affairs includes an article: “Self-Care Won’t Save Us” by Aisling McCrea.
 
Here are some excerpts:
 
[begin excerpts]
 
They’re usually painted in comforting primary colors or pastels, featuring simple illustrations, accompanied by text in a non-threatening font. They invite you to practice “self-care”, a term that has been prominent in healthcare theory for many decades but has recently increased in visibility online. The term generally refers to a variety of techniques and habits that are supposed to help with one’s physical and mental well-being, reduce stress, and lead to a more balanced lifestyle. “It’s like if you were walking outside in a thunderstorm, umbrella-less, and you walked into a café filled with plush armchairs, wicker baskets full of flowers, and needlepoints on the walls that say things like ‘Be kind to yourself’ and ‘You are enough,’” says the Atlantic. 
 
Though the term has a medical tinge to it, the language used in the world of self-care is more aligned with the world of self-help, and much of the advice commonly given in the guise of self-care will be familiar to anyone who has browsed the pop-psychology shelves of a bookstore or listened to the counsel of a kindly coworker—take breaks from work and step outside for fresh air, take walks in the countryside, call a friend for a chat, have a lavender bath, get a good night’s sleep. Light a candle. Stop being so hard on yourself. Take time off if you’re not feeling so well and snuggle under the comforter with a DVD set and a herbal tea. 
 
Few people would argue with these tips in isolation….  We should all be making sure we are well-fed, rested, and filling our lives with things that we enjoy.
 
In a time where people—especially millennials, at whom this particular brand of self-care is aimed—are increasingly talking about their struggles with depression, anxiety and insecurities, it’s no wonder that “practicing self-care” is an appealing prospect, even if it does sometimes seem like a fancy way to say “do things you like.” 
 
What is concerning is the way that this advice appears to be perfectly designed to fit in with a society that appears to be the cause of so much of the depression, anxiety, and insecurities. By finding the solution to young people’s mental ill-health (be it a diagnosed mental health problem or simply the day-to-day stresses of life) in do-it-yourself fixes, and putting the burden on the target audience to find a way to cope, the framework of self-care avoids having to think about issues on a societal level. 
 
In the world of self-care, mental health is not political, it’s individual. Self-care is mental health care for the neoliberal era.
 
As I write, the U.K. Prime Minister, Theresa May, is tweeting about World Mental Health Day and suicide prevention. She is not the only one; scrolling through the trending hashtags (there are several) one can find lots of comforting words about taking care of yourself, about opening up, confiding in a friend, keeping active, taking a breath. One such tweet is a picture of an arts-and-craftsy cut-out of a bright yellow circle behind dull green paper, designed to look like a cheerful sun. Printed on the sun are the words “everything will be so good so soon just hang in there & don’t worry about it too much.” All of us have probably seen some variation of these words at many points in our lives, and probably found at least a little bit of momentary relief in them. 
 
But looking through other tweets about World Mental Health Day reveals a different side of the issue. People talk about the times they did try to seek help, and were left to languish on waiting lists for therapy. 
 
They talk about the cuts to their local services (if they’re from somewhere with universal healthcare) or the insurance policies that wouldn’t cover them (if they’re in the United States). 
 
They talk about the illnesses left cold and untouched by campaigns that claim to reduce stigma—personality disorders, bipolar disorder, schizophrenia. 
 
They talk about homelessness and insecure housing and jobs that leave them exhausted. 
 
They talk about loneliness. 
 
<snip>
 
These are deep material and societal issues that all of us are touched by, to at least some degree. We know it when we see people begging in the streets, when we read yet another report that tells us our planet is dying, when we try to figure out why we feel sad and afraid and put it down to an “off day”, trying not to think about just how many “off days” we seem to have. We turn to our TVs, to our meditation apps, and hope we can paper over the cracks. 
 
We are in darkness, and when we cry out for light, we are handed a scented candle.
 
A common sentiment expressed in the world of self-care is that anyone can suffer from mental ill-health. This is true, but it’s not the entire story. 
 
In fact, mental health problems are strongly correlated with poverty, vulnerability, and physical health conditions (with the causation going both ways). 
 
Furthermore, there is a big difference between those of us who are fortunate enough to be able to take time off work for doctor’s appointments and mental health days, and those who can’t; those of us who have children or other dependents to take care of, and those who don’t; those of us who have the financial independence to take a break from our obligations when we need to, and those who don’t. 
 
Not all people have the same access to help, or even access to their own free time—employers increasingly expect workers to be available whenever they are needed, both in white-collar jobs and precarious shift work. 
 
Add in the (heavily gendered) responsibilities of being a parent, studying, a night-time Uber gig to cover the bills, or a long commute from the only affordable area in the city, and the stress of life will pile on even as it soaks up the time you’re supposed to set aside to relieve that stress.  
 
Funding cuts are in fashion across a plethora of Western countries, both to healthcare and to other services that indirectly affect our health, especially the health of people who need additional support to lead the lives they wish to live, or even just to survive. 
 
The rhetoric around self-care is flattering but flattening, treating its audience as though the solution to their problems is believing in themselves and investing in themselves. 
 
This picture glosses over the question of what happens when society does not believe or invest in us.
 
Even for those of us who are relatively lucky in life, self-care does not solve our problems. “It’s okay if all you did today was breathe,” promises a widely-shared image macro of a gentle talking pair of lungs. Well, I hate to break it to you, talking lungs, but it’s 2018. We’re supposed to be walking powerhouses of productivity, using every minute of our time to its best effect. In an economic environment where careers are precarious and competitive, young people are increasingly pressured to give up their free time to take on extracurriculars and unpaid projects “for their resume,” produce creative content “for exposure,” learn skills such as coding, scout for jobs on LinkedIn, write self-promoting posts about their personal qualities, and perhaps worst of all, attend godawful networking events, some of which don’t even have free canapés. Taking part in all this sounds unfair and exploitative, but you’re in a world where solidarity is just the name of a song from the Billy Elliot musical; if you won’t go along with it, there’s a line of brilliant, hungry graduates from top-name schools right behind you who will. 
 
It doesn’t stop with work either. This way of thinking about ourselves—constantly in need of self-improvement, constantly aware of our need to market ourselves as premium humans—seeps into our personal lives as much as our professional lives. On your way home from the office, perhaps you’ll flick through the apps on your smartphone, doing all the tasks you’ve assigned to yourself so you can be stronger, smarter, more attractive. Have you walked the 10,000 steps today mandated by your Fitbit? Have you done your Duolingo practice? You’re falling behind with learning French. Learning French will make you more appealing to employers, and might also make you look sexy and mysterious on dates. Have you responded to that Tinder message? It wasn’t very interesting, but you can’t remember the last time you met a romantic prospect organically so you should really get around to responding. You need to think of a good joke first, though; if you come off as too generic they’ll be on to the next candidate. Have you finished that book for your book club? You’ll look like an idiot if you don’t know how it ends. Did you play the guitar today? Creativity is important. Have you checked the news? What if someone asks you about the situation in Myanmar? How’s your posture? Is it upright? Check your reflection in the window. Why are you slouching? Why are you so pale? Why are you so tired? Who is this person?
 
It’s harder, too, if you’re a woman. (Copy and paste this sentence and stick it into any article you like, it’ll work.) 
 
The standard pressures from the advertising industry have only ramped up as we’ve turned away from traditional media, insinuating their way into social media under the same guise of aspirational content, but this time smiling with the face of a friend. Youtube and Instagram stars draw you in with viral content and enviable abs, promising you that if you drink the juice, do the workout routine, learn how to use a hairdryer with perfect salon technique (and if you’re finding it difficult this new product makes it SO much easier, use my code for a 15 percent discount!) you can be the best version of yourself you can be. 
 
This is a lie, of course—the goal is not to be you, it’s to be them.  You know this, and know it isn’t what you should think, but you cannot help how you feel. The insecurities burrowing deep under your skin and planting the desire to be someone else don’t even have to be internally consistent. 
 
Being a woman means you can stand in front of a mirror and simultaneously be upset that you’re not as skinny as a sportswear model and as curvaceous as a 1950s pinup girl. Your phone is filled with updates from the lives of beautiful women you do not know. Flick to the next image in your feed, past the girl with the Photoshopped manicure (perhaps in reality, her nails, like yours, are bitten down). The next post is about self-care. There’s a link to buy bath oils in the description.
 
On social media sites such as Instagram and Pinterest, pictures exhorting us to set aside an evening to relax sit alongside images of gorgeous people we will never look like (but will spend hundreds of dollars and hours trying to emulate), images of locations we will never travel to (but will keep for years on our bucket lists), images of top 10 tips from successful entrepreneurs (whose life advantages and luck cannot be guaranteed, but who we will continue to hold up as experts in how they attained their position in life). 
 
Ironically, in telling us to take the pressure off ourselves, self-care discourse can feel as though it’s doing the exact opposite—adding “taking care of our mental health” as yet another task to put onto our plates, alongside finding a fulfilling, well-paid career, doing overtime to prove our worth, networking to maximize our chance of success, getting to the gym five times a week, finding the perfect skincare routine, practicing an interesting and resume-friendly hobby, seeing friends in a variety of glamorous locales, finding a partner, and creating an original yet classic décor theme for our homes. 
 
If it’s too hard, and you need something easier for a little bit, you are invited to seek solace in consumption. Watch Netflix, watch Amazon Prime—put a little more change in the pocket of the world’s richest man, in exchange for a couple of hours’ distraction. Get delivery food from an app that uses poorly-paid “independent contractors”, the bulk of them time-poor, cash-poor millennials like you. Squash down the wave of guilt—guilt at spending too much money, at using services you don’t support, at ordering the chicken when you swore you’d go vegan months ago. You’re feeling constantly guilty about something or other anyway, so one more thing to feel guilty about barely registers. After eating, you curl up on the couch, hugging your knees with your arms, small. You are taking up the most minimal space; even in our darker moments, we feel a need to exist in the most efficient way possible.
 
Why are these feelings familiar to so many of us, yet we feel so alone? We are atomized, individualized, struggling under the same system but struggling inwardly and separately. Self-care slots in neatly with capitalism, treating mental ill-health as an individual problem divorced from material and political context, to be solved by pulling ourselves up by our bootstraps and maybe spending a little money on the way. We are invited to draw inwards, shut our curtains; pull ourselves into movies and food and warm water and blankets as a means of escaping our problems without solving them. We are encouraged to “reach out” to others, if we feel able to, but our relationships to others in the language of self-care appears to be as mutual conduits for pressure relief; “reaching out” always seems to mean drawing someone into the blanket with you rather than throwing the blanket off.
 
<snip>
 
But what if there was an alternative? What if you didn’t have to worry about your insurance covering a therapist, because everyone had universal coverage? What if you weren’t exhausted from balancing your job and your family, because you had affordable daycare, decent parental leave, and six weeks’ paid vacation? What if you didn’t have to spend every waking moment optimizing yourself for the job market, because we had built an economy that did not put disproportionate power in the hands of employers? 
 
What if we stopped thinking of ourselves as being constantly in competition with each other, because we realized it was more a source of misery than success? What if we didn’t feel a nagging sense of doom every time we looked at the news, because we were actually on the road to making things better? What if we built something different? What if we did it together?
 
All of us need to take pleasure in things we enjoy. It’s important to take care of our needs and smell flowers and eat cheesecake. But if our deeper anxieties are at least in part caused by our conditions, then maybe our solution lies in fixing our conditions. 
 
Instead of commiserating with coworkers on a poor working environment, imagine organizing with them. Imagine connecting with other people in your community over things that matter to all of you; whether that’s saving a treasured park or bringing attention to a local crisis. Going door-to-door, meeting people you’ve been living next to this whole time, hearing their voices, hearing your collective voice get a little louder every time someone joins you. Imagine what putting faith in solidarity could do at a local level, or a national level. How would it feel to take back power, to have agency? Developing bonds with people over something that matters can be electrifying, and of course if you win, that’s a real change to the world you live in, for you and the people around you! 
 
Even if you don’t win, all is not lost, because you created a possibility—the possibility that future victories might come, that other people might be inspired by what you did, that you could return to try again, that there’s a better thing to be created. Most importantly of all, there’s hope, perhaps the most powerful force in life. No bubble bath can give us that. Maybe that’s a gift we give ourselves.
 
[end excerpts]
 
The article is online at:
 
Ken Pope
 
PSYCHOLOGY, ETHICS, & HUMAN RIGHTS—EUROPEAN PSYCHOLOGIST, PUBLISHED ONLINE NOVEMBER 19, 2018
THE AMERICAN PSYCHOLOGICAL ASSOCIATION OUTSOURCES ADJUDICATION OF ETHICS COMPLAINTS: 
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POPE & VASQUEZ:  ETHICS IN PSYCHOTHERAPY AND COUNSELING: A PRACTICAL GUIDE (5th EDITION)—John Wiley & Sons
Print—Kindle—Nook—eBook—Apple iBook—Google Book
 
“I’ve coined the word stressism to describe the current belief that the tensions of contemporary life are primarily individual lifestyle problems to be solved through managing stress, as opposed to the belief that these tensions are linked to social forces and need to be resolved primarily through social and political means. Analysis of stressism brings into sharp focus significant polarities in Western thought, principally the sharp divisions between mind and body, health and illness, public and private, social responsibility and individual self-actualization. Examining stress brings to light many of our cherished cultural preoccupations and predispositions, exposing existing tensions and inequities related to class and gender; and our increasing dependence on stress to explain our lives has consequences for the way we see ourselves and the world, the way we act, and the world we create as a consequence of that vision and those actions.”
—Dana Becker in One Nation Under Stress: The Trouble with Stress as an Idea

M. Jackson Group Update – January 2019 – Getting Fit

Happy New Year!!
 
This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
For those (including your clients) looking for New Year’s resolutions or ways to begin today doing mre good things for health, the suggestions in this article (“The perfect ways to get fit – in 20 seconds, an hour or six months—Making time for exercise can be difficult because of work, family commitments or cost. Here’s how to squeeze it in, whatever your schedule” by Poppy Noor) in the UK Guardian may be helpful. Ken
 
Here are some excerpts:
 
[begin excerpts]

Thirty seconds

Planking engages a number of muscles in the shoulders, back and stomach. Achieving a non-stop 30-second plank is harder than it looks, but planking helps to build a stronger core and improve posture and even flexibility. Muscle burns more calories than fat, so planking can help you to burn more calories even when you are not working out.
A woman planking in a gym
 Planking will help you build a stronger core. Photograph: Undrey/Getty Images/iStockphoto
<snip>

One minute

Sprinting for as little as a minute each day can reduce body fat, build muscle and increase the rate at which your body burns calories while resting. Marathon runners regularly incorporate short bursts of sprinting into training, as in the Swedish technique fartlek, because it drastically improves speed and cardiovascular fitness so that people can exercise longer. Sprints should be broken into 20-second bursts, so that you are working flat out. One study of obese men showed that they improved leg power and oxygen uptake in only two weeks.

Another found that one minute of sprint interval training, three times a week, had the same health benefits as 50 minutes of continuous moderate exercise, despite a five-fold lower time commitment (when taking into account the warm-up and cool-down). It is also one of the best abdominal workouts you can do – raising your leg at the 45-degree angle required for a proper sprint is equivalent to doing a crunch, and sprinters repeat this movement about 60 times in a 100-metre sprint.

Three minutes

If your goal is to one day do a pull up, starting with your grip strength could be an idea, because it is what determines whether you fall off the bar. “There’s nothing to stop you from picking up dumbells and going for a walk,” says Kamb. He suggests carrying them like suitcases at your side, an exercise known as “the farmer carry”. 

<snip>

Four minutes

A four-minute workout could help you to silence the voice in your head that says: “I don’t want to work out.” Tabata workouts are made up of 20-second intervals of intense exercise followed by 10 seconds of rest, repeated eight times, totalling four minutes. “Often when people miss one workout, they feel they’ve lost all their gains. Tabata keeps up momentum and will sustain your muscle growth even when you can’t make it to the gym,” says Kamb.
 

Raising your leg at the 45-degree angle required for a proper sprint is equivalent to doing a crunch

Five minutes

Get ready for tomorrow’s workout tonight. “Put your alarm clock against the other side of the room, a glass of water by your bed, sleep in your gym kit and put your shoes by your bed,” says Kamb. His reasoning? Everyone wants to be as lazy as possible when it comes to exercising – if you are already in your workout clothes when you wake up, you have eliminated a major hurdle.

Ten minutes

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Take the stairs – it is great for you. Research shows that stair-climbing improves cardiovascular health and fitness, reduces “bad” cholesterol and can result in moderate weight loss. “You are raising your weight against gravity. Even going slowly, it’s as intense as jogging,” says Dr Frank Eves, a senior research fellow in sport, exercise and rehabilitation sciences at the University of Birmingham. “Climbing four flights of stairs will get your heart rate working at up to 80% of its maximum capacity. When you’re feeling breathless, surprisingly, it’s because your muscles just got a little bit fitter. Do that regularly and you’ll start to see bigger increases.”
But make sure you walk up – not down, he says: “We did a study where we put signs up saying ‘Take the stairs’ – but people just walked down. That defeats the point – climbing stairs is two to three times more strenuous.” Research has shown the health benefits for sedentary people of climbing 13 floors a day. Eves suggests spreading them throughout the day, at home or in coffee breaks at work.

Thirty minutes

Get off the bus or train a stop early and walk home. Researchers from Sheffield Hallam university looked into the benefits of walking for 30 minutes a day in three 10-minute bursts, compared with people fitting in the often recommended 10,000 steps a day. The 3,000-step walkers fared better. The researchers put this down to the intensity of the walks – so make sure your walk home is a brisk one.

Forty-five minutes

“Low-intensity steady state” cardio exercise (Liss) is essentially the opposite of high-intensity interval training (Hiit). It has cardiovascular benefits, as well as increasing and strengthening the legs. The advantange over Hiit is that you can do it for longer.

One hour

Health is as much about what you put in your mouth as it is how you move. Batch-cook your lunches for the coming week if you want to get ahead – when you are not hungry or rushed you will make healthier choices.

Nine weeks

This is enough time to complete the NHS’s Couch to 5K programme for absolute beginner runners. The programme builds up from walking to running 3.1 miles through three structured commitments a week and comes with a great podcast to keep you going.

Sixty-six days

It is often said it takes 21 days to form a habit. In fact, researchers at University College London who studied habit formation found that the average time for behaviour to become automatic was 66 days. 

<snip>

Sixteen weeks

If you can run 5km fairly easily, that is a good base to start training for a half-marathon. Training programmes tend to focus on building up to 13 miles over 12 to 16 weeks. Cancer Research UK has published various training timetables, starting with 20-minute runs. The developers of the Couch to 5K app have also created an app for first-time marathon runners called 26.2 Marathon Trainer.

Six months to one year

If applicable, quit smoking. Your lung capacity is a key part of exercising, as is your heart function and the transportation of oxygen through your blood – all of which are affected by smoking. It may take time – some research says quitters try an average of 30 times before stopping successfully – but it will be worth it. The risk of heart disease halves after a year without smoking and your lung function will improve, too.
 
[end excerpts]
The article is online at:
 
Ken Pope
 
PSYCHOLOGY, ETHICS, & HUMAN RIGHTS—EUROPEAN PSYCHOLOGIST, PUBLISHED ONLINE NOVEMBER 19, 2018
THE AMERICAN PSYCHOLOGICAL ASSOCIATION OUTSOURCES ADJUDICATION OF ETHICS COMPLAINTS: 
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M. Jackson Group Update – December 2018 – Sex Differences and Autistic Traits

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
The University of Cambridge issued the following news release:
 
Largest ever study of psychological sex differences and autistic traits 
 
Scientists at the University of Cambridge have completed the world’s largest ever study of typical sex differences and autistic traits.  
 
They tested and confirmed two long-standing psychological theories: the Empathizing-Systemizing theory of sex differences and the Extreme Male Brain theory of autism.
 
Working with the television production company Channel 4, they tested over half a million people, including over 36,000 autistic people.  The results are published today in the Proceedings of the National Academy of Sciences.
 
The Empathizing-Systemizing theory predicts that women, on average, will score higher than men on tests of empathy, the ability to recognize what another person is thinking or feeling, and to respond to their state of mind with an appropriate emotion.  Similarly, it predicts that men, on average, will score higher on tests of systemizing, the drive to analyse or build rule-based systems.
 
The Extreme Male Brain theory predicts that autistic people, on average, will show a masculinised shift on these two dimensions: namely, that they will score lower than the typical population on tests of empathy and will score the same as if not higher than the typical population on tests of systemizing.
 
Whereas both theories have been confirmed in previous studies of relatively modest samples, the new findings come from a massive sample of 671,606 people, which included 36,648 autistic people. They were replicated in a second sample of 14,354 people. In this new study, the scientists used very brief 10-item measures of empathy, systemizing, and autistic traits.
 
Using these short measures, the team identified that in the typical population, women, on average, scored higher than men on empathy, and men, on average, scored higher than women on systemizing and autistic traits. These sex differences were reduced in autistic people. On all these measures, autistic people’s scores, on average, were ‘masculinized’: that is, they had higher scores on systemizing and autistic traits and lower scores on empathy, compared to the typical population.
 
The team also calculated the difference (or ‘d-score’) between each individual’s score on the systemizing and empathy tests. A high d-score means a person’s systemizing is higher than their empathy, and a low d-score means their empathy is higher than their systemizing.
 
They found that in the typical population, men, on average, had a shift towards a high d-score, whereas women, on average, had a shift towards a low d-score. Autistic individuals, on average, had a shift towards an even higher d-score than typical males. Strikingly, d-scores accounted for 19 times more of the variance in autistic traits than other variables, including sex.
 
Finally, men, on average, had higher autistic trait scores than women. Those working in STEM (Science, Technology, Engineering and Mathematics), on average, had higher systemizing and autistic traits scores than those in non-STEM occupations. And conversely, those working in non-STEM occupations, on average, had had higher empathy scores than those working in STEM.
 
In the paper, the authors discuss how it is important to bear in mind that differences observed in this study apply only to group averages, not to individuals. They underline that these data say nothing about an individual based on their gender, autism diagnosis, or occupation. To do that would constitute stereotyping and discrimination, which the authors strongly oppose.
 
Further, the authors reiterate that the two theories are applicable to only two dimensions of typical sex differences: empathy and systemizing. They do not apply to all sex differences, such as aggression, and to extrapolate the theories beyond these two dimensions would be a misinterpretation.
 
Finally, the authors highlight that although autistic people on average struggle with ‘cognitive’ empathy – recognizing other people’s thoughts and feelings – they nevertheless have intact ‘affective’ empathy – they care about others. It is a common misunderstanding that autistic people struggle with all forms of empathy, which is untrue.
 
Dr Varun Warrier, from the Cambridge team, said: “These sex differences in the typical population are very clear. We know from related studies that individual differences in empathy and systemizing are partly genetic, partly influenced by our prenatal hormonal exposure, and partly due to environmental experience. We need to investigate the extent to which these observed sex differences are due to each of these factors, and how these interact.”
 
Dr David Greenberg, from the Cambridge team, said: “Big data is important to draw conclusions that are replicable and robust. This is an example of how scientists can work with the media to achieve big data science.”
 
Dr Carrie Allison, from the Cambridge team, said: “We are grateful to both the general public and to the autism community for participating in this research. The next step must be to consider the relevance of these findings for education, and support where needed.”
 
Professor Simon Baron-Cohen, Director of the Autism Research Centre at Cambridge who proposed these two theories nearly two decades ago, said: “This research provides strong support for both theories. This study also pinpoints some of the qualities autistic people bring to neurodiversity. They are, on average, strong systemizers, meaning they have excellent pattern-recognition skills, excellent attention to detail, and an aptitude in understanding how things work. We must support their talents so they achieve their potential – and society benefits too.”
 
Ken Pope
 
PSYCHOLOGY’S CONTINUING ETHICS CRISIS—REVISED, UPDATED, ACCEPTED FOR PUBLICATION
THE AMERICAN PSYCHOLOGICAL ASSOCIATION OUTSOURCES ADJUDICATION OF ETHICS COMPLAINTS: 
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M. Jackson Group Update – November 2018 – Can’t Stop Worrying

This month’s post is again from British Psychological Society Research Digest. 

The reasons why, once we start worrying, some of us just can’t stop

By Christian Jarrett

A certain amount of worrying is a normal part of life, especially these days with barely a moment passing without a disconcerting headline landing in your news feed. But for some people, their worrying reaches pathological levels. They just can’t stop wondering “What if …?”. It becomes distressing and feels out of control. In the formal jargon, they would likely be diagnosed with Generalised Anxiety Disorder, but excessive worrying is also a part of other conditions like panic disorder. There are many factors that contribute to anxiety problems in general, but a new review in Biological Psychology homes in on the cognitive and emotional factors that specifically contribute to prolonged bouts of worry. Its take-home points make an interesting read for anyone who considers themselves a worrier; and for therapists, the review highlights some approaches to help anxious clients get a hold of their excessive worrying.

The review authors, Graham Davey and Frances Meeten at the University of Sussex and the Institute of Psychiatry, Psychology and Neuroscience, explain that what gets many pathological worriers worrying in the first place is that they seem to be highly vigilant to any sources of threat and danger, and if there’s any ambiguity about whether a situation is threatening or not, they will tend to interpret it as being dangerous. If they haven’t yet heard from their daughter today, for instance, the problem worrier will not only notice this fact, they will also contemplate that it’s because she’s in trouble, rather than simply busy.

Studies have shown the causal role that these attentional biases seem to have by testing what happens when people are trained instead to pay more attention to positive aspects of situations, or to interpret ambiguous situations more positively. Asked to spend time after the training sitting quietly, focused on their breathing, worriers who’ve had the training report fewer intrusive worries compared with control participants.

Once a worry bout kicks in, one of the things that keeps it going in problem worriers is their deep held belief that worry is actually a good thing. This doesn’t make much sense at first. How can excessive worriers think worry is good when they find it so distressing? But while they find the worrying distressing and upsetting, and it feels out of control, research shows they also believe that it can help prevent bad things from happening, that it will help them be prepared for bad outcomes, and that it aids problem solving.

Related to this, problem worriers tend to have a kind of perfectionist approach to worrying. They think they can’t stop worrying until they’ve finished, in the sense of working through every eventuality and solving every problem. Less anxious people, in contrast, will tend to follow a principle of stopping worrying once they don’t feel like it anymore. Teaching pathological worriers to change their approach, to learn to stop worrying once they had enough of it, has been shown to prevent them from getting stuck in such long worry bouts.

Another key factor is low mood. Problem worriers tend to experience more negative moods, which are known to encourage a more analytical thinking style. In turn, this lays the ground for an overly zealous, perfectionist worry style that is in a sense impossible satisfy and leads to more distress and anxiety. Pathological worriers also tend to use their ongoing negative mood as a barometer for whether their worrying has been successful. The fact that they still feel down and anxious tells them that they’ve yet to anticipate or prepare for every disconcerting eventuality. Using “mood as information” in this way creates a kind of cognitive and emotional trap that propagates yet more worry.

You should seek professional help if you feel your worrying is becoming a problem, but the review offers some simple take-aways for breaking out of occasional uncontrolled worry bouts or preventing them happening in the first place. Because of the way that negative moods contribute to the perseveration of worry bouts, for instance, simply trying to combat a generally low mood is likely to help. This may be easier said that done, but if you can lift your mood (for example through going for regular walks), the evidence suggests a knock-on benefit will be less prolonged worrying.

It sounds ridiculously simple, but also thinking about the idea of stopping worrying when you’ve had enough of it, rather than when the worrying is somehow “finished” or “complete”, could be beneficial. In fact, earlier research has shown that merely learning about the cognitive and emotional factors that feed excessive worry can help some people.

From a therapeutic perspective, the review suggests that attentional training programmes (including “cognitive bias modification“) are likely to help prevent worry bouts from starting in the first place. Therapists could also consider engaging with anxious clients’ explicit beliefs about worrying, such as that it can prevent bad things happening or that they need to continue worrying until they’ve covered all the issues. Meanwhile, acceptance- or mindfulness-based approaches could help alleviate clients’ distress about worry, which in turn would help reduce the part that negative mood plays in prolonging a worry bout. As for where our deep-seated and sometime unhelpful beliefs about worry come from in the first place, Davey and Meeten said this is something awaiting further research.

The perseverative worry bout: A review of cognitive, affective and motivational factors that contribute to worry perseveration

Christian Jarrett (@Psych_Writer) is Editor of BPS Research Digest

M. Jackson Group Update – October 2018 – Managing Chronic Pain

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
 
The Agency for Healthcare Research and Quality released an article: “Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review.”
 
The authors are  Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Winter C, Ferguson AJR.
 
Here are some excerpts:
 
[begin excerpts]
 
Using predefined criteria, we selected randomized controlled trials of noninvasive nonpharmacological treatments for five common chronic pain conditions (chronic low back pain; chronic neck pain; osteoarthritis of the knee, hip, or hand; fibromyalgia; and tension headache) that addressed efficacy or harms compared with usual care, no treatment, waitlist, placebo, or sham intervention; compared with pharmacological therapy; or compared with exercise. 
 
Study quality was assessed, data extracted, and results summarized for function and pain.  Only trials reporting results for at least 1 month post-intervention were included. 
 
We focused on the persistence of effects at short term (1 to <6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).
 
<snip>
 
Chronic low back pain: At short term, massage, yoga, and psychological therapies (primarily CBT) (strength of evidence [SOE]: moderate) and exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation (SOE: low) were associated with slight improvements in function compared with usual care or inactive controls. Except for spinal manipulation, these interventions also improved pain.
 
Effects on intermediate-term function were sustained for yoga, spinal manipulation, multidisciplinary rehabilitation (SOE: low), and psychological therapies (SOE: moderate). Improvements in pain continued into intermediate term for exercise, massage, and yoga (moderate effect, SOE: low); mindfulness-based stress reduction (small effect, SOE: low); spinal manipulation, psychological therapies, and multidisciplinary rehabilitation (small effects, SOE: moderate). For acupuncture, there was no difference in pain at intermediate term, but a slight improvement at long term (SOE: low). 
 
Psychological therapies were associated with slightly greater improvement than usual care or an attention control on both function and pain at short-term, intermediate-term, and long-term followup (SOE: moderate). At short and intermediate term, multidisciplinary rehabilitation slightly improved pain compared with exercise (SOE: moderate). 
 
<snip>
 
Chronic neck pain: At short and intermediate terms, acupuncture and Alexander Technique were associated with slightly improved function compared with usual care (both interventions), sham acupuncture, or sham laser (SOE: low), but no improvement in pain was seen at any time (SOE: llow). Short-term low-level laser therapy was associated with moderate improvement in function and pain (SOE: moderate). Combination exercise (any 3 of the following: muscle performance, mobility, muscle re-education, aerobic) demonstrated a slight improvement in pain and function short and long term….
 
<snip>
 
For knee osteoarthritis, exercise and ultrasound demonstrated small short-term improvements in function compared with usual care, an attention control, or sham procedure (SOE: moderate for exercise, low for ultrasound), which persisted into the intermediate term only for exercise (SOE: low). Exercise was also associated with moderate improvement in pain (SOE: low). Long term, the small improvement in function seen with exercise persisted, but there was no clear effect on pain (SOE: low). Evidence was sparse on interventions for hip and hand osteoarthritis. Exercise for hip osteoarthritis was associated with slightly greater function and pain improvement than usual care short term (SOE: low). 
 
<snip>
 
Fibromyalgia: In the short term, acupuncture (SOE: moderate), CBT, tai chi, qigong, and exercise (SOE: low) were associated with slight improvements in function compared with an attention control, sham, no treatment, or usual care. Exercise (SOE: moderate) and CBT improved pain slightly, and tai chi and qigong (SOE: low) improved pain moderately in the short term. At intermediate term for exercise (SOE: moderate), acupuncture, and CBT (SOE: low), slight functional improvements persisted; they were also seen for myofascial release massage and multidisciplinary rehabilitation (SOE: low); pain was improved slightly with multidisciplinary rehabilitation in the intermediate term (SOE: low). In the long term, small improvements in function continued for multidisciplinary rehabilitation but not for exercise or massage (SOE: low for all); massage (SOE: low) improved long-term pain slightly, but no clear impact on pain for exercise (SOE: moderate) or multidisciplinary rehabilitation (SOE: low) was seen. 
 
<snip>
 
Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation slightly improved function and moderately improved pain short term versus usual care, and laser acupuncture was associated with slight pain improvement short term compared with sham (SOE: low).
 
<snip>
 
Conclusions. Exercise, multidisciplinary rehabilitation, acupuncture, CBT, and mind-body practices were most consistently associated with durable slight to moderate improvements in function and pain for specific chronic pain conditions. 
 
Our findings provided some support for clinical strategies that focused on use of nonpharmacological therapies for specific chronic pain conditions. 
[end excerpts]
 
The article is online at:
 
Ken Pope
 
POPE: THE AMERICAN PSYCHOLOGICAL ASSOCIATION OUTSOURCES ADJUDICATION OF ETHICS COMPLAINTS—5 FAR-REACHING CONSEQUENCES
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“The greatest weakness of most humans is their hesitancy to tell others how much they love them while they’re still alive.”  
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