Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. Tim Brunson, PhD

Psychiatric morbidity and marital satisfaction among spouses of men with alcohol dependence.



BACKGROUND: Alcohol dependence has adverse health and social consequences; Alcohol related problems primarily occur within the family context and maximum impact is felt on spouses, given the intimate nature of their elationship. Spouses play an important role in treatment programs related to alcohol. There is thus a need to study psychiatric morbidity and marital satisfaction in spouses of alcohol dependent patients in order to understand and address such issues. AIMS: The aim of this study was to assess the pattern of psychiatric morbidity, marital satisfaction in spouses of men with alcohol dependence syndrome and explore the association. MATERIALS AND METHODS: For psychiatric morbidity, 60 spouses of men with alcohol dependence syndrome were evaluated. Marital satisfaction was assessed using the marital satisfaction scale. Severity of alcohol dependence in the husbands and consequences of drinking was assessed using short alcohol dependence data and drinkers inventory of consequences respectively. RESULTS: More than half of the spouses (65%) had a psychiatric disorder. Primarily mood and anxiety disorder were present. Major depressive disorder was present in 43%. Psychiatric morbidity, marital dissatisfaction in spouses and higher adverse consequences alcohol dependence in their husbands, were found to be significantly correlated with each other and their association was robust particularly when problems in the physical, interpersonal and intrapersonal domains were high. CONCLUSION: Psychological distress and psychiatric morbidity in spouses of alcohol dependent men is high, with marital satisfaction being low. Addressing these issues will be beneficial as spouses are known to play an important role in the treatment of alcohol dependence syndrome.

Indian J Psychiatry. 2013 Oct;55(4):360-5. doi: 10.4103/0019-5545.120557. Kishor M, Pandit LV, Raguram R. Department of Psychiatry, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.

Emetophobia: A fear of vomiting.



Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing or hearing another person vomit, or seeing vomitus itself. It may occur at any age and we need to understand its symptomatology. We report a case of emetophobic child whose fear of vomiting started after an attack of acute appendicitis. In the initial stage, fear was limited to vomiting, later it became generalized to a fear of seeing the vomitus, worries that parents may suffer vomiting, fear of vomiting in public places followed by avoiding social activities. Patient improved on short course of anti-anxiety drugs and Graded Exposure Therapy.

Indian J Psychiatry. 2013 Oct;55(4):390-2. doi: 10.4103/0019-5545.120556. Faye AD, Gawande S, Tadke R, Kirpekar VC, Bhave SH. Department of Psychiatry, N. K. P. Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India.

A case of Hallervorden-Spatz disease presenting as catatonic schizophrenia.



Hallervorden-Spatz disease belongs to a group of disorders characterized by predominant involvement of basal ganglia. These cases may present to the psychiatrist with symptoms of depression, nervousness and rarely other psychotic symptoms. Very few cases of this disease have been reported from India. We report a case of Hallervorden-Spatz disease that presented to the psychiatry outpatient department with catatonia. This case highlights how presentation of Hallervorden-Spatz disease may overlap with catatonic symptoms and hence a high index of suspicion is required to make an accurate diagnosis.

Indian J Psychiatry. 2013 Oct;55(4):386-9. doi: 10.4103/0019-5545.120553. Pawar Y(1), Kalra G(2), Sonavane S(1), Shah N(1). (1)Department of Psychiatry, Lokmanya Tilak Medical College and Sion Hospital, Sion, Mumbai, India. (2)M.G.M. Institute of Health Sciences, M.G.M. University of Health Sciences, New Mumbai, Maharashtra, India.

A neurobiological approach to the cognitive deficits of psychiatric disorders.



Deficits in brain networks that support cognitive regulatory functions are prevalent in many psychiatric disorders. Findings across neuropsychology and neuroimaging point to broad-based impairments that cross traditional diagnostic boundaries. These dysfunctions are largely separate from the classical symptoms of the disorders, and manifest in regulatory problems in both traditional cognitive and emotional domains. As such, they relate to the capacity of patients to engage effectively in their daily lives and activity, often persist even in the face of symptomatically effective treatment, and are poorly targeted by current treatments. Advances in cognitive neuroscience now allow us to ground an understanding of these cognitive regulatory deficits in the function and interaction of key brain networks. This emerging neurobiological understanding furthermore points to several promising routes for novel neuroscience-informed treatments targeted more specifically at improving cognitive function in a range of psychiatric disorders.

Dialogues Clin Neurosci. 2013 Dec;15(4):419-29. Etkin A(1), Gyurak A(2), O'Hara R(1). (1)Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA. (2)Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA, Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.

Socio-demographic and clinical predictors of absenteeism...



Full title: Socio-demographic and clinical predictors of absenteeism - A cross-sectional study of urban industrial employees.

CONTEXT: Public sector undertakings are facing a threat of privatization due to unsatisfactory performance putting pressure on management and in turn to employees. There is an increasing trend of absenteeism observed amongst employees citing job stress. AIM: To find an association between job stress and absenteeism in relation to socio-demographic and clinical profile. MATERIALS AND METHODS: The study was conducted in an urban aeronautical industry with 68 employees who mentioned stress at workplace during evaluation. Job stress was assessed using Professional Life Stress Scale (David Fontana). Those who scored more than 30 (n = 43) were taken up for the study after an informed consent. A semi-structured questionnaire was administered to find socio-demographic and clinical profile. Employees who reported taking leave in last six months just to avoid work or workplace constitute the "absenteeism" group. The absenteeism group was compared to non-absenteeism group using Fisher exact/Chi-square test or independent t-test depending on type of variables. RESULTS: Out of 43 subjects, 18 had absenteeism while 25 did not have absenteeism. Comparing the two groups, interstate migration, having more than one previous job, commuting time more than an hour, co-morbid anxiety/depression, and alcohol abuse were significantly associated with absenteeism (P < 0.05). Absentees complained more about fatigue and relationship problem with colleagues than non-absentees (P < 0.05). Factors like age, sex, marital status, education, gross pay, job tenure, past or family history of psychiatry illnesses had no significant association with absenteeism (P > 0.05). CONCLUSION: In absenteeism research, one of the widely accepted models is Steerand Rhode's "Process model of absenteeism." The model postulates job stress as one of the barriers for attendance. Thus, knowing the factors for absenteeism would help in preventing absenteeism.

Ind Psychiatry J. 2013 Jan;22(1):17-21. doi: 10.4103/0972-6748.123589. Chakraborty S, Subramanya AH. Department of Psychiatry, Hindustan Aeronautics Limited Hospital, Bangalore, Karnataka, India.

Depression and experience of vision loss in group of adults in rehabilitation setting...



Full title: Depression and experience of vision loss in group of adults in rehabilitation setting: Mixed-methods pilot study.

There is a paucity of literature regarding the relationship between the experience of vision loss and depression. Therefore, the current pilot study aimed to explore whether significant differences existed in levels of depression between adults with different vision loss experiences. A group of adults aged between 20 and 65 yr old with irreversible vision loss in a rehabilitation setting was interviewed. Semistructured interviews were conducted in order to explore patients' experience of vision loss. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive levels; 39.5% (n = 15) of patients met CES-D criteria for depression. In addition, higher levels of depression (p < 0.05) were identified in patients whose interviews revealed greater self-awareness of impairment, inadequate social support, and longer rehabilitation stay. Current findings draw attention to variables such as self-awareness of impairment and perceived social support and suggest that depression following vision loss may be related to patients' emotional experiences of impairment and adjustment processes.

J Rehabil Res Dev. 2014 Jan;50(9):1301-14. doi: 10.1682/JRRD.2012.08.0138. Senra H, Vieira CR, Nicholls EG, Leal I. University of Deusto, Faculty of Psychology, Avenida de las Universidades 24, 48007 Bilbao, Spain. 23/Jan/2014 17:0123/Jan/2014 17:01 hugo_senra@hotmail.com.

Impacts of mustard gas exposure on veterans mental health: A study on the role of education.



BACKGROUND: The mustard gas (MG) exposure can impair physical health and therefore increase the probability of the posttraumatic stress disorder (PTSD) and psychological disorders. AIM: The aim of this study was to investigate long-term effects of MG exposure on veterans' mental health. MATERIALS AND METHODS: This was a cross-sectional study. In order to assess prevalence of mental health and PTSD of 100 MG victims 25 years after the exposure to MG in Iran-Iraq conflict, the general health questionnaire (GHQ-28) and Impact of Event Scale-Revised, respectively was administered. RESULTS: The mean (±standard deviation (SD)) age of participants was 40.63 (±5.86) years. The mean GHQ-28 (47.34) of the study group was higher compared to standardized cutoff point (23) of the Iranian community. Also, it was found that 38 participants (38%) suffer from PTSD. The results of this study showed that academic education in the PTSD group was less than that in the non-PTSD group (P=0.03). In addition, in multivariate analysis it was found that only education level of the veterans and their wives were effective on the mental health score (adjusted P=0.036 and 0.041, respectively). The mean score of depression and psychosocial activity subscale in patients at higher education level was lower than patients at lower education level (P<0.05). CONCLUSION: This study found that sulfur mustard (SM) exposure can be effect on mental health even 25 years after exposure. Therefore, the psychological state should be more considered in chemical injured veterans and it is important that providing more mental health centers for this community.

Ind Psychiatry J. 2013 Jan;22(1):22-5. doi: 10.4103/0972-6748.123604. Karami GR(1), Ameli J(2), Roeintan R(3), Jonaidi-Jafari N(4), Saburi A(5). (1)Department of Psychiatry, Baqiyatallah University of Medical Sciences, Tehran, Iran. (2)Department of Neurology, Baqiyatallah University of Medical Sciences, Tehran, Iran. (3)Department of Neurosurgery, Baqiyatallah University of Medical Sciences, Tehran, Iran. (4)Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. (5)Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Mollasadra St, Vanak Sq, Tehran, Iran ; Atherosclerosis and Coronary Artery Research Centre, Birjand University of Medical Sciences, Vali-e-Asr Hospital, Ghaffari St, Birjand, Iran.

"I Just Have to Stick with It and It'll Work": Experiences of Adolescents and Young Adults...



Full title: "I Just Have to Stick with It and It'll Work": Experiences of Adolescents and Young Adults with Mental Health Concerns.

Mental health issues are common among adolescents and young adults but service utilization in this group is low. This study aimed to better understand the experiences of older adolescents and young adults who were experiencing symptoms of depression or anxiety, including the factors that affected their decision to seek treatment and their feelings about their experience of mental health issues. We conducted semi-structured interviews with 37 older adolescents and young adults. Participants tended to have a sophisticated understanding of the causes of mental disorders, but to have been unsure about whether their own experiences of depression or anxiety were the result of a mental disorder, or just "normal" experiences. They reported concerns about taking medication and about keeping information about their condition private. They also felt that it was important to them to be active participants in their own care.

Community Ment Health J. 2014 Jan 24. [Epub ahead of print] Bluhm RL, Covin R, Chow M, Wrath A, Osuch EA. Department of Philosophy and Religious Studies, Old Dominion University, Norfolk, VA, USA.

Depression during pregnancy: Prevalence and obstetric risk factors among pregnant women...



Full title: Depression during pregnancy: Prevalence and obstetric risk factors among pregnant women attending a tertiary care hospital in Navi Mumbai.

CONTEXT: Depression affects about 20% of women during their lifetime, with pregnancy being a period of high vulnerability. Prevalence of depression during pregnancy ranges from 4% to 20%. Several risk factors predispose to depression during pregnancy including obstetric factors. Depression during pregnancy is not only the strongest risk factor for post-natal depression but also leads to adverse obstetric outcomes. AIMS: To study the prevalence of depression during pregnancy and its associated obstetric risk factors among pregnant women attending routine antenatal checkup. SETTINGS AND DESIGN: Cross-sectional observational survey done at the outpatient department (OPD) of the department of obstetrics of a tertiary care hospital in Navi Mumbai. MATERIALS AND METHODS: One hundred and eighty-five pregnant women were randomly administered the Beck Depression Inventory (BDI) for detecting depression. Additional socio-demographic and obstetric history was recorded and analyzed. RESULTS: Prevalence of depression during pregnancy was found to be 9.18% based upon BDI, and it was significantly associated with several obstetric risk factors like gravidity (P = 0.0092), unplanned pregnancy (P = 0.001), history of abortions (P = 0.0001), and a history of obstetric complications, both present (P = 0.0001) and past (P = 0.0001). CONCLUSIONS: Depression during pregnancy is prevalent among pregnant women in Navi-Mumbai, and several obstetric risk factors were associated to depression during pregnancy. Future research in this area is needed, which will clearly elucidate the potential long-term impact of depression during pregnancy and associated obstetric risk factors so as to help health professionals identify vulnerable groups for early detection, diagnosis, and providing effective interventions for depression during pregnancy.

Ind Psychiatry J. 2013 Jan;22(1):37-40. doi: 10.4103/0972-6748.123615 Ajinkya S(1), Jadhav PR(2), Srivastava NN(3). (1)Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India. (2)Department of Pharmacology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India. (3)MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India.

Recovery from sleep disturbance precedes that of depression and anxiety...



Full title: Recovery from sleep disturbance precedes that of depression and anxiety following mild traumatic brain injury: a 6-week follow-up study.

OBJECTIVES: The detailed course of mental disorders at the acute and subacute stages of mild traumatic brain injury (mTBI), especially with regard to recovery from sleep disturbances, has not been well characterised. The aim of this study was to determine the course of depression, anxiety and sleep disturbance, following an mTBI. SETTING: We recruited patients with mTBI from three university hospitals in Taipei and healthy participants as control group for this study. PARTICIPANTS: 100 patients with mTBI (35 men) who were older than 20 years, with a Glasgow Coma Scale score of 13-15 and loss of consciousness for <30 min, completed the baseline and 6-week follow-up assessments. 137 controls (47 men) without TBI were recruited in the study. None of the participants had a history of cerebrovascular disease, mental retardation, previous TBI, epilepsy or severe systemic medical illness. PRIMARY OUTCOME MEASURES: The Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) were assessed for the patients with mTBI at baseline and 6 weeks after mTBI and for the controls. RESULTS: The ESS scores were not significantly different between the mTBI at baseline or at 6 weeks after mTBI and controls. Although the BAI, BDI and PSQI scores of the mTBI group were significantly different than those of the control group at baseline, all had improved significantly 6 weeks later. However, only the PSQI score improved to a level that was not significantly different from that of the control group. CONCLUSIONS: Daytime sleepiness is not affected by mTBI. However, mTBI causes depression and anxiety and diminished sleep quality. Although all these conditions improve significantly within 6 weeks post-mTBI, only sleep quality improves to a pre-mTBI level. Thus, recovery from mTBI-induced sleep disturbance occurs more rapidly than that of mTBI-induced depression and anxiety.

BMJ Open. 2014 Jan 23;4(1):e004205. doi: 10.1136/bmjopen-2013-004205. Ma HP, Ou JC, Yeh CT, Wu D, Tsai SH, Chiu WT, Hu CJ. Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Prevention of Post-Stroke Generalized Anxiety Disorder, Using Escitalopram...



Full title: Prevention of Post-Stroke Generalized Anxiety Disorder, Using Escitalopram or Problem-Solving Therapy.

This study examined the efficacy of antidepressant treatment for preventing the onset of generalized anxiety disorder (GAD) among patients with recent stroke. Of 799 patients assessed, 176 were randomized, and 149 patients without evidence of GAD at the initial visit were included in this double-blind treatment with escitalopram (N=47) or placebo (N=49) or non-blinded problem-solving therapy (PST; 12 total sessions; N=53). Participants given placebo over 12 months were 4.95 times more likely to develop GAD than patients given escitalopram and 4.00 times more likely to develop GAD than patients given PST. Although these results should be considered preliminary, the authors found that both escitalopram and PST were effective in preventing new onset of post-stroke GAD.

J Neuropsychiatry Clin Neurosci. 2014 Jan 23. doi: 10.1176/appi.neuropsych.11020047. [Epub ahead of print] Mikami K, Jorge RE, Moser DJ, Arndt S, Jang M, Solodkin A, Small SL, Fonzetti P, Hegel MT, Robinson RG.

An analysis of paramilitary referrals to psychiatric services at a tertiary care center.



BACKGROUND: There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist's clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. MATERIALS AND METHODS: A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out. RESULTS: Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. CONCLUSION: There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the cases being undiagnosed or improperly diagnosed.

Ind Psychiatry J. 2013 Jan;22(1):54-9. doi: 10.4103/0972-6748.123622. Verma R(1), Mina S(1), Deshpande SN(2). (1)Department of Psychiatry, Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi, India. (2)Departments of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Group psychotherapies for depression in persons with HIV: A systematic review.



Studies investigating effectiveness of group psychotherapy intervention in depression in persons with HIV have showed varying results with differing effect sizes. A systematic review of randomized controlled trials of group psychotherapy in depression in persons with HIV has been conducted to present the best available evidence in relation to its effect on depressive symptomatology. Electronic databases were searched to identify randomized controlled trials. Selected studies were quality assessed and data extracted by two reviewers. If feasible, it was planned to conduct a meta-analysis to obtain a pooled effect size of group psychotherapeutic interventions on depressive symptoms. Odds ratio for drop out from group was calculated. The studies were assessed for their quality using the Quality Rating Scale and other parameters for quality assessment set out by COCHRANE. The quality of reporting of the trials was compared against the Consolidated Standards of Reporting Trials (CONSORT) checklist for non-pharmacological studies (CONSORT-NPT). Four studies met the full inclusion criteria for systematic review. The trials included in the review examined group interventions based on the Cognitive behavioral therapy model against other therapeutic interventions or waiting list controls. In all four studies, group psychotherapy was an effective intervention for reducing depressive symptoms in persons with HIV in comparison to waiting list controls. The reported benefits from the group psychotherapy in comparison to active controls were less impressive. There were no statistically significant differences in drop outs at post treatments across group psychotherapy, wait list control, and other active interventions. The methodological quality of the studies varied. The quality of reporting of the studies was sub-optimal. The results of this systematic review support that group psychological interventions for depression in persons with HIV have a significant effect on depressive symptomatology. This review also indicates that group cognitive behavioral therapies are an acceptable psychological intervention for persons with HIV and comorbid depression.

Indian J Psychiatry. 2013 Oct;55(4):323-330. Honagodu AR(1), Krishna M(2), Sundarachar R(3), Lepping P(4). (1)Department of Psychiatry, Chethana Trust, Mysore, Karnataka, India. (2)Holdsworth Memorial Hospital Mandi Mohalla, Mysore, Karnataka, India ; Department of Biostatistics, University of Edgehill, Lancashire, UK. (3)Holdsworth Memorial Hospital Mandi Mohalla, Mysore, Karnataka, India. (4)BCULHB Department of Psychiatry, Centre for Mental Health and Society, Bangor University, UK.

Group psychotherapies for depression in persons with HIV: A systematic review.



Studies investigating effectiveness of group psychotherapy intervention in depression in persons with HIV have showed varying results with differing effect sizes. A systematic review of randomized controlled trials of group psychotherapy in depression in persons with HIV has been conducted to present the best available evidence in relation to its effect on depressive symptomatology. Electronic databases were searched to identify randomized controlled trials. Selected studies were quality assessed and data extracted by two reviewers. If feasible, it was planned to conduct a meta-analysis to obtain a pooled effect size of group psychotherapeutic interventions on depressive symptoms. Odds ratio for drop out from group was calculated. The studies were assessed for their quality using the Quality Rating Scale and other parameters for quality assessment set out by COCHRANE. The quality of reporting of the trials was compared against the Consolidated Standards of Reporting Trials (CONSORT) checklist for non-pharmacological studies (CONSORT-NPT). Four studies met the full inclusion criteria for systematic review. The trials included in the review examined group interventions based on the Cognitive behavioral therapy model against other therapeutic interventions or waiting list controls. In all four studies, group psychotherapy was an effective intervention for reducing depressive symptoms in persons with HIV in comparison to waiting list controls. The reported benefits from the group psychotherapy in comparison to active controls were less impressive. There were no statistically significant differences in drop outs at post treatments across group psychotherapy, wait list control, and other active interventions. The methodological quality of the studies varied. The quality of reporting of the studies was sub-optimal. The results of this systematic review support that group psychological interventions for depression in persons with HIV have a significant effect on depressive symptomatology. This review also indicates that group cognitive behavioral therapies are an acceptable psychological intervention for persons with HIV and comorbid depression.

Indian J Psychiatry. 2013 Oct;55(4):323-330. Honagodu AR(1), Krishna M(2), Sundarachar R(3), Lepping P(4). (1)Department of Psychiatry, Chethana Trust, Mysore, Karnataka, India. (2)Holdsworth Memorial Hospital Mandi Mohalla, Mysore, Karnataka, India ; Department of Biostatistics, University of Edgehill, Lancashire, UK. (3)Holdsworth Memorial Hospital Mandi Mohalla, Mysore, Karnataka, India. (4)BCULHB Department of Psychiatry, Centre for Mental Health and Society, Bangor University, UK.

UK population norms for the modified dental anxiety scale with percentile calculator...



Full title: UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results.

Free calculator to provide a read out for a patient's dental anxiety score (www.st-andrews.ac.uk/dentalanxiety/).

Br Dent J. 2014 Jan 23;216(2):77. doi: 10.1038/sj.bdj.2014.12.

Treatment of Functional (Psychogenic) Movement Disorders.



Functional (psychogenic) movement disorders are a common source of disability and distress. Despite this, little systematic evidence is available to guide treatment decisions. This situation is likely to have been influenced by the "no man's land" that such patients occupy between neurologists and psychiatrists, often with neither side feeling a clear responsibility or ability to direct management. The aim of this narrative review is to provide an overview of the current state of the evidence regarding management of functional movement disorders. This reveals that there is some evidence to support the use of specific forms of cognitive behavioral therapy and physiotherapy. Such treatments may be facilitated in selected patients with the use of antidepressant medication, and may be more effective for those with severe symptoms when given as part of inpatient multidisciplinary rehabilitation. Other treatments, for example hypnosis and transcranial magnetic stimulation, are of interest, but further evidence is required regarding mechanism of effect and long-term benefit. Though prognosis is poor in general, improvement in symptoms is possible in patients with functional movement disorders, and there is a clear challenge to clinicians and therapists involved in their care to conduct and advocate for high-quality clinical trials.

Neurotherapeutics. 2013 Dec 20. Ricciardi L, Edwards MJ. sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.

A neurobiological approach to the cognitive deficits of psychiatric disorders.



Deficits in brain networks that support cognitive regulatory functions are prevalent in many psychiatric disorders. Findings across neuropsychology and neuroimaging point to broad-based impairments that cross traditional diagnostic boundaries. These dysfunctions are largely separate from the classical symptoms of the disorders, and manifest in regulatory problems in both traditional cognitive and emotional domains. As such, they relate to the capacity of patients to engage effectively in their daily lives and activity, often persist even in the face of symptomatically effective treatment, and are poorly targeted by current treatments. Advances in cognitive neuroscience now allow us to ground an understanding of these cognitive regulatory deficits in the function and interaction of key brain networks. This emerging neurobiological understanding furthermore points to several promising routes for novel neuroscience-informed treatments targeted more specifically at improving cognitive function in a range of psychiatric disorders.

Dialogues Clin Neurosci. 2013 Dec;15(4):419-29. Etkin A(1), Gyurak A(2), O'Hara R(1). (1)Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA. (2)Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA, Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.

Post-stroke depression and lesion location: A hospital based cross-sectional study.



BACKGROUND: Depression is a common neuro-psychiatric consequence of stroke, affecting approximately 40% of the patients. Many studies show that in addition to the psychosocial stress, neurobiological factors such as site of infarct and brain atrophy may also be related to Post Stroke Depression (PSD). There are conflicting results in this area of research and paucity of such data in Indian literature. Thus the aim of this study is to weigh the importance of lesion location in PSD. MATERIALS AND METHODS: Sixty two subjects with their first ever stroke were interviewed using a semi-structured proforma and PSD diagnosed using MINI Plus interview. Scales of Beck Depression Inventory and Montgomery Asberg Depression Rating Scale were used to assess severity of depression. Mini mental state examination was used to assess cognitive impairment and Barthel Index to measure Activities of Daily Living. Neuro-imaging provided information on site and side of lesion. Collected data was analysed using SPSS version 15.0. RESULTS: PSD was diagnosed in 28 subjects, amongst who 19 had left sided lesions. Left sided cortical infarcts and sub cortical infarcts showed statistically significant association with PSD. CONCLUSION: Results are in keeping with previous landmark studies. Differences in emotional reactions depending on hemisphere and site of the infarct as shown in this study suggest organic biological basis for post stroke depression. Understanding the etiological basis would allow clinicians to monitor patients at risk of developing PSD, enabling early detection and treatment thus improving their quality of life and rehabilitation.

Indian J Psychiatry. 2013 Oct;55(4):343-8. doi: 10.4103/0019-5545.120546. Rajashekaran P(1), Pai K(1), Thunga R(1), Unnikrishnan B(2). (1)Department of Psychiatry, Kasturba Medical College, Mangalore, Karnataka, India. (2)Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka, India.

Disorders of memory and plasticity in psychiatric disease.



Plasticity is found throughout the nervous system and is thought to underlie key aspects of development, learning and memory, and repair. Neuropiastic processes include synaptic plasticity, cellular growth and remodeling, and neurogenesis. Dysregulation of these processes can contribute to a variety of neuropsychiatric diseases. In this review we explore three different ways in which dysregulation of neuropiastic and mnemonic processes can contribute to psychiatric illness. First, impairment of the mechanisms of plasticity can lead to cognitive deficits; this is most obvious in dementia and amnesia, but is also seen in more subtle forms in other conditions. We explore the relationship between stress, major depression, and impaired neuroplasticity in some detail. Second, enhanced memories can be pathogenic; we explore the example of post-traumatic stress disorder, in which intrusive trauma associated memories, accompanied by hyperactivity of the normal fear learning circuitry, are core aspects of the pathology. Third, impaired modulation of the relationship between parallel memory systems can contribute to maladaptive patterns of behavior; we explore the bias towards inflexible, habit-like behavior patterns in drug addiction and obsessive-compulsive disorder. Together, these examples illustrate how different abnormalities in the mechanisms of neuroplasticity and memory formation can contribute to various forms of psychopathology. It is hoped that a growing understanding of these relationships, and of the fundamental mechanisms underlying neuroplasticity in the normal brain, will pave the way for new understandings of the mechanisms of neuropsychiatric disease and the development of novel treatment strategies.

Dialogues Clin Neurosci. 2013 Dec;15(4):455-63. Pittenger C. Yale OCD Research Clinic, Yale University School of Medicine, New Haven, Connecticut, USA.

Waking self-hypnosis efficacy in cognitive-behavioral treatment for pathological gambling...



Full title: Waking self-hypnosis efficacy in cognitive-behavioral treatment for pathological gambling: an effectiveness clinical assay.

Cognitive-behavioral therapy for pathological gambling has a long-term success rate of more than 50%. This study evaluated the effect of self-hypnosis in cognitive-behavioral treatment of pathological gamblers. Forty-nine participants were assigned to 2 groups. Both groups received a cognitive-behavioral protocol, and Group 1, the no-hypnosis group, received an 11-session intervention and Group2, the hypnosis group, received 7 sessions that included self-hypnosis. Both groups were equal in gambling chronicity, frequency, intensity, change motivation, and problems derived from gambling. All participants reported significant improvement in gambling behavior and consequences at both treatment end and 6-month follow-up. Data show no differences between the interventions in abstinence, therapeutic compliance, fulfillment, and satisfaction. Results suggest that self-hypnosis reinforces treatment and can be a supportive technique for future brief interventions.

Int J Clin Exp Hypn. 2014;62(1):50-69. Lloret D, Montesinos R, Capafons A. a Miguel Hernández University , Alcante , Spain.

Non-Alzheimer's disease-related memory impairment and dementia.



Although Alzheimer's disease (AD) is a common cause of memory impairment and dementia in the elderly disturbed memory function is a widespread subjective and/or objective symptom in a variety of medical conditions. The early detection and correct distinction of AD from non-AD memory impairment is critically important to detect possibly treatable and reversible underlying causes. In the context of clinical research, it is crucial to correctly distinguish between AD or non-AD memory impairment in order to build homogenous study populations for the assessment of new therapeutic possibilities. The distinction of AD from non-AD memory impairment may be difficult, especially in mildly affected patients, due to an overlap of clinical symptoms and biomarker alterations between AD and certain non-AD conditions. This review aims to describe recent aspects of the differential diagnosis of AD and non-AD related memory impairment and how these may be considered in the presence of memory deficits.

Dialogues Clin Neurosci. 2013 Dec;15(4):465-73. Arlt S. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Pediatric emotional dysregulation and behavioral disruptiveness treated with hypnosis...



Full title: Pediatric emotional dysregulation and behavioral disruptiveness treated with hypnosis: a time-series design.

A case of pediatric oppositional defiant disorder (ODD) with concomitant emotional dysregulation and secondary behavioral disruptiveness was treated with hypnosis by means of the hypnotic hold, a method adapted by the authors. An A-B-A-B time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of emotional dysregulation with accompanying behavioral disruptiveness. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Follow-up at 6 months indicated a significant reduction of the frequency of targeted episodes of emotional dysregulation and behavioral disruptiveness at home.

Int J Clin Exp Hypn. 2014;62(1):70-83. Iglesias A, Iglesias A. a Private Practice, Palm Beach Gardens , Florida , USA.

Randomized Controlled Trial of a Cognitive-Behavioral Therapy...



Full title: Randomized Controlled Trial of a Cognitive-Behavioral Therapy Plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer.

PURPOSE: The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group. PATIENTS AND METHODS: Patients (n = 200) were randomly assigned to either the CBTH (n = 100; mean age, 55.59 years) or attention control (n = 100; mean age, 55.97 years) group. Fatigue was measured at four time points (baseline, end of radiotherapy, 4 weeks, and 6 months after radiotherapy). Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) -Fatigue subscale and Visual Analog Scales (VASs; Fatigue and Muscle Weakness). RESULTS: The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13). CONCLUSION: The results support CBTH as an evidence-based intervention to controlfatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.

J Clin Oncol. 2014 Jan 13. Montgomery GH, David D, Kangas M, Green S, Sucala M, Bovbjerg DH, Hallquist MN, Schnur JB. Guy H. Montgomery, Daniel David, Sheryl Green, Madalina Sucala, and Julie B. Schnur, Icahn School of Medicine at Mount Sinai, New York, NY; Daniel David and Madalina Sucala, BabeS-Bolyai University, Cluj-Napoca, Romania; Maria Kangas, Macquarie University, Sydney, New South Wales, Australia; Dana H. Bovbjerg, University of Pittsburgh Cancer Institute, University of Pittsburgh; and Michael N. Hallquist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA.

Neurophysiological correlates of dissociative symptoms.



OBJECTIVE: Dissociation is a mental process with psychological and somatoform manifestations, which is closely related to hypnotic suggestibility and

essentially shows the ability to obtain distance from reality. An increased tendency to dissociate is a frequently reported characteristic of patients with functional neurological symptoms and syndromes (FNSS), which account for a substantial part of all neurological admissions. This review aims to investigate what heart rate variability (HRV), EEG and neuroimaging data (MRI) reveal about the nature of dissociation and related conditions. METHODS: Studies reporting HRV, EEG and neuroimaging data related to hypnosis, dissociation and FNSS were identified by searching the electronic databases Pubmed and ScienceDirect. RESULTS: The majority of the identified studies concerned the physiological characteristics of hypnosis; relatively few investigations on dissociation related FNSS were identified. General findings were increased parasympathetic functioning during hypnosis (as measured by HRV), and lower HRV in patients with FNSS. The large variety of EEG and functional MRI investigations with diverse results challenges definite conclusions, but evidence suggests that subcortical as well as (pre)frontal regions serve emotion regulation in dissociative conditions. Functional connectivity analyses suggest the presence of altered brain networks in patients with FNSS, in which limbic areas have an increased influence on motor preparatory regions. CONCLUSIONS: HRV, EEG and (functional) MRI are sensitive methods to detect physiological changes related to dissociation and dissociative disorders such as FNSS, and can possibly provide more information about their aetiology. The use of such measures could eventually provide biomarkers for earlier identification of patients at risk and appropriate treatment of dissociative conditions.

J Neurol Neurosurg Psychiatry. 2014 Feb;85(2):174-9. van der Kruijs SJ, Bodde NM, Carrette E, Lazeron RH, Vonck KE, Boon PA, Langereis GR, Cluitmans PJ, Feijs LM, Hofman PA, Backes WH, Jansen JF, Aldenkamp AP. Epilepsy Centre Kempenhaeghe, , Heeze, The Netherlands.

Hypnotic suggestion: opportunities for cognitive neuroscience.



Hypnosis uses the powerful effects of attention and suggestion to produce, modify and enhance a broad range of subjectively compelling experiences and behaviours. For more than a century, hypnotic suggestion has been used successfully as an adjunctive procedure to treat a wide range of clinical conditions. More recently, hypnosis has attracted a growing interest from a cognitive neuroscience perspective. Recent studies using hypnotic suggestion show how manipulating subjective awareness in the laboratory can provide insights into brain mechanisms involved in attention, motor control, pain perception, beliefs and volition. Moreover, they indicate that hypnotic suggestion can create informative analogues of clinical conditions that may be useful for understanding these conditions and their treatments.

Nat Rev Neurosci. 2013 Aug;14(8):565-76. doi: 10.1038/nrn3538. Epub 2013 Jul 17. Oakley DA, Halligan PW. Division of Psychology and Language Sciences, University College London, WC1H 0AP, UK. d.oakley@ucl.ac.uk

The effective use of hypnosis in schizophrenia: structure and strategy.



Many schizophrenia patients seek hypnosis when they have not improved with psychopharmacological therapy. However, there has been controversy regarding the use and effectiveness of hypnosis in schizophrenia. Hypnotherapeutic methods such as direct and indirect suggestions, psycho-strengthening suggestions and imagery, hypnoprojective restructuring, guidance, and neutralization of affect associated with delusions have been effective in selected highly hypnotizable patients. Details of the hypnotherapeutic structure and strategy used for managing delusions in schizophrenia are presented with representative cases.

Int J Clin Exp Hypn. 2013;61(4):388-400. doi: 10.1080/00207144.2013.815059. Pyun YD. a Pyun Neuropsychiatric Clinic , Seoul , South Korea.

The effects of hypnosis on anxiety, depression, fatigue, and sleepiness...



Full Title: The effects of hypnosis on anxiety, depression, fatigue, and sleepiness in people undergoing hemodialysis: a clinical report.

This study investigated the effect of hypnosis on anxiety, depression, fatigue, and sleepiness in hemodialysis patients. Twenty-nine patients participated in the 15-day study. A single hypnosis session was performed on Day 8. Anxiety, depression, fatigue, and sleepiness were measured at baseline, on Day 8, and on Day 15 (HADS, MFI, ESS). Daily fatigue was also measured numerically. Anxiety, depression, and sleepiness significantly decreased after hypnosis. Weekly measures of fatigue remained stable; however, daily fatigue decreased.

Int J Clin Exp Hypn. 2013;61(4):475-83. doi: 10.1080/00207144.2013.810485. Untas A, Chauveau P, Dupré-Goudable C, Kolko A, Lakdja F, Cazenave N. a Paris Descartes University, Sorbonne Paris City , France.

Hypnotic suggestibility predicts the magnitude of the imaginative word blindness suggestion...



Full title: Hypnotic suggestibility predicts the magnitude of the imaginative word blindness suggestion effect in a non-hypnotic context.

This study sought to explain if the level of imaginative word blindness varied based upon what is believed to be a person's hypnotic suggestibility. A non-post-hypnotic suggestion (i.e. imaginative suggestion) was given. The authors claim to have shown a linear relationship between imaginative word blindness and hypnotic suggestibility. They claim that the more suggestible the subject, the more likely they were to encounter word blindness. They also claim that they did not observe similar results should the subject have a negative attitude about hypnosis.

Conscious Cogn. 2013 Jun 15;22(3):868-874. doi: 10.1016/j.concog.2013.05.009. Parris BA, Dienes Z. Psychology Research Centre, School of Design, Engineering and Computing, University of Bournemouth, United Kingdom. Electronic address: bparris@bournemouth.ac.uk.

right hemisphere safety backup at work: Hypotheses for deep hypnosis, post-traumatic stress...



Full title: right hemisphere safety backup at work: Hypotheses for deep hypnosis, post-traumatic stress disorder, and dissociation identity disorder.

This study addresses an interesting phenomenon regarding which part of the brain is more active during a hypnotic trance versus when trance is not present. When faced with one of six key problem areas of living, should the subject hypnotized, the right hemisphere tends to be more dominant. The opposite is true for a non-hypnotic subject.

Predominantly, two problems were addressed. These were raising hope of certainty about the environment, which activated the right hemisphere, and raising the hope of freedom or power of control, which dealt with the left hemisphere. The hypothesis is that during deep hypnosis this normal association is switched. This is also believed to be the case when dissociated identity disorder (DID) or PTSD is involved.

Med Hypotheses. 2013 Jun 19. pii: S0306-9877(13)00267-3. doi: 10.1016/j.mehy.2013.05.026. Burnand G. New University of Buckinghamshire (Retired), High Wycombe, Buckinghamshire, United Kingdom. Electronic address: burnand.gordon@gmail.com.

A systematic review of stress-management programs for medical students.



OBJECTIVE: Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.

METHOD: The authors searched the published English-language articles on PsycINFO and PubMed, using a combination of the following search terms: stress-management, distress, burnout, coping, medical student, wellness. Both randomized, controlled trials and controlled, non-randomized trials of stress-management programs were selected and critically appraised.

RESULTS: A total of 13 randomized, controlled trials or controlled, non-randomized trials were identified. Interventions included self-hypnosis, meditation, mindfulness-based stress-reduction, feedback on various health habits, educational discussion, changes in the length and type of curriculum, and changes in the grading system. Only one study was identified to be of very high quality, although several had described group differences at baseline, used blinding, had good follow-up, and used validated assessment tools. There was a wide heterogeneity of outcome measures used. Interventions that were supported by a reduction in stress and anxiety in medical students included mindfulness-based stress-reduction or meditation techniques, self-hypnosis, and pass/fail grading.

CONCLUSIONS: Significant opportunities to advance educational research in this field exist by developing more high-quality studies with particular attention to randomization techniques and standardizing outcome measures.

Acad Psychiatry. 2013 May 1;37(3):158-64. doi: 10.1176/appi.ap.12010003. Shiralkar MT, Harris TB, Eddins-Folensbee FF, Coverdale JH. Baylor College of Medicine, Houston,TX, USA. shiralka@bcm.edu

Addiction and the Brain - drug or alcohol abuse is a disease.



The Value of a Healthy Ego



by Tim Brunson, PhD

Over the past several years too many people have had to cope with the stress of financial difficulties. Very rarely have these situations been the consequence of poor decisions on the part of the affected individuals. Yet, it is so difficult for someone undergoing such stresses and strains to convince themselves that they are not at fault.

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ISEPP denounces DSM-V



by John Freedom, CEHP

The International Society for Ethical Psychology and Psychiatry's (ISEPP) has denounced the upcoming DSM-5. Thomas Insel, the director of the National Institutes of Mental Health has announced that the federal agency – which provides grants for research on mental illness – will be "re-orienting its research away from DSM categories." Thomas Insel's statement comes just weeks before the scheduled publication of the DSM-V, the fifth edition of the Diagnostic and Statistical Manual.

Insel writes:

"While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been 'reliability'– each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better."

Insel said that the NIMH will be replacing the DSM with the "Research Domain Criteria (RDoC)," which define mental disorders based not just on vague symptomology but on more specific genetic, neural and cognitive data. But then, immediately after making this dramatic announcement, Insel added that "we cannot design a system based on biomarkers or cognitive performance because we lack the data."

Insel's statement is also an implicit admission that there is no real theoretical basis for drug treatments for mental illness.

See: http://blogs.scientificamerican.com/cross-check/2013/05/04/psychiatry-in-crisis-mental-health-director-rejects-psychiatric-bible-and-replaces-with-nothing

John Freedom, CEHP, is the Chair of the ACEP Research Committee. For more information visit: EnergyPsych.org

Mind-Body Medicine for Schizophrenia and Psychotic Disorders.



Over half of psychiatric patients use some kind of Complementary and Alternative Medicine, with Mind-Body Medicine (MBM) being the most commonly used collective modality. To date however, to our knowledge, no overarching review exists examining MBM for psychotic disorders. Thus the purpose of this paper is to present the first review in this area. A MEDLINE search was conducted of articles written in English from 1946 up to Jan15 2011 using a range of MBM and psychotic disorder search terms. Human clinical trials, and where available, pertinent meta-analyses and reviews were included in this paper. Forty-two clinical studies and reviews of MBMs were located, revealing varying levels of evidence. All studies included used MBMs as an adjunctive therapy to usual care, including medication. Overall supportive evidence was found for music therapy, meditation and mindfulness techniques. Some positive studies were found for yoga and breathing exercises, general relaxation training, and holistic multi-modality MBM interventions. Due to insufficient data, a conclusion cannot be reached for hypnosis, thermal or EMG biofeedback, dance or drama therapy, or art therapy. No clinical trials were found for guided imagery, autogenic training, journal writing, or ceremony practices. For many techniques, the quality of research was poor, with many studies having small samples, no randomization, and no adequate control. While the above techniques are likely to be safe and tolerable in this population, based on current data, more research is required to decisively assess the validity of applying many MBMs in the mainstream treatment of psychotic disorders.

Clin Schizophr Relat Psychoses. 2013 Feb 21:1-29. Helgason C, Sarris J. Department of Psychiatry, University of Nebraska, College of Medicine, Omaha, Nebraska.

A Systematic Review of Stress-Management Programs for Medical Students.



Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions. METHOD The authors searched the published English-language articles on PsycINFO and PubMed, using a combination of the following search terms: stress-management, distress, burnout, coping, medical student, wellness. Both randomized, controlled trials and controlled, non-randomized trials of stress-management programs were selected and critically appraised. RESULTS A total of 13 randomized, controlled trials or controlled, non-randomized trials were identified. Interventions included self-hypnosis, meditation, mindfulness-based stress-reduction, feedback on various health habits, educational discussion, changes in the length and type of curriculum, and changes in the grading system. Only one study was identified to be of very high quality, although several had described group differences at baseline, used blinding, had good follow-up, and used validated assessment tools. There was a wide heterogeneity of outcome measures used. Interventions that were supported by a reduction in stress and anxiety in medical students included mindfulness-based stress-reduction or meditation techniques, self-hypnosis, and pass/fail grading. CONCLUSIONS Significant opportunities to advance educational research in this field exist by developing more high-quality studies with particular attention to randomization techniques and standardizing outcome measures.

Acad Psychiatry. 2013 Feb 27. doi: 10.1176/appi.ap.12010003. Shiralkar MT, Harris TB, Eddins-Folensbee FF, Coverdale JH.

Overcoming Negativity in Healing



by Tim Brunson, PhD

Albert Einstein once said that you can never solve a problem while being in the same state in which you created it. While he most likely was not talking about helping therapy clients or the treatment of medical patients, he very well could have been. When people seek professional help for resolving a mental or physical condition they often seem to be mired in excessive negativity. Somehow they expect respite despite their obsession with associating fully into the condition that they are hoping to escape. Unfortunately, what they are doing is further reinforcing their problems. Breaking this pattern is the major role of the healer.

Recently I saw a very interesting lady. She was morbidly obese and had breathing problems as well as a host of stress-related issues and a plethora of medical concerns. Although she was several years younger than me, she appeared to be my senior by at least a decade. She was officially drawing disability payments. On top of that she had a life-long severe smoking addiction – which was the presenting problem that prompted the appointment.

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Suggestion in the treatment of depression.



Meta-analyses consistently reveal that most of the response to antidepressant treatment can be obtained by placebo, and the difference between response to the drug and the response to any treatment is not clinically significant for most individuals diagnosed with major depressive disorder. Furthermore, the best predictor of antidepressant efficacy is the response to placebo during the so-called placebo run-in period. It can also be shown that a significant portion of the placebo effect is expectancy. These data thus indicate that suggestion is a central factor in treating depression. Therefore, the use of hypnosis, which is based on suggestion, as a treatment adjunct can be expected to enhance treatment outcome.

Am J Clin Hypn. 2013 Jan;55(3):221-9. Kirsch I, Low CB. University of Plymouth, Plymouth, United Kingdom. i.kirsch@hull.ac.uk

Antidepressants in the treatment of depression: the clinician and the controversy.



This article considers the controversy over the effectiveness of treatment with antidepressant medication versus placebo. In this journal issue, Kirsch and Low find that antidepressants were not clinically significantly more effective than placebo except possibly for persons with severe depression, as measured by score changes on the Hamilton Rating Scale for Depression (HAM-D). The present article summarizes some selected research studies that reach different conclusions, finding effective treatment outcomes with use of antidepressants, including a different meta-analysis of antidepressant drug trials that showed medication has a small, but nevertheless clinically significant effect over placebo use. Also briefly reviewed are selected studies that compare the effects of combined treatment using anti-depressants and psychotherapy, vs. placebo, compared to the use of medication alone.

Am J Clin Hypn. 2013 Jan;55(3):230-5. Hollander HE. harriethollander@msn.com

Feasibility of clinical hypnosis for the treatment of Parkinson's disease: a case study.



Parkinson's disease is a severe neurodegenerative disorder with a prevalence rate of approximately 1.6% in elderly Americans. This case study reports on a 51-year-old male Parkinson's patient who received 3 weekly sessions of a hypnosis intervention, as well as instruction in self-hypnosis. Actigraphy was used to assess rest-tremor severity. Results revealed a 94% reduction in rest tremors following treatment. Self-reported levels of anxiety, depression, sleep quality, pain, stiffness, libido, and quality of life also showed improvements. The patient reported a high level of satisfaction with treatment. These findings suggest clinical hypnosis is potentially feasible and beneficial treatment for some Parkinson's symptoms. Further investigation with diverse samples and an ambulatory monitoring device is warranted.

Int J Clin Exp Hypn. 2013 Apr;61(2):172-82. doi: 10.1080/00207144.2013.753829. Elkins G, Sliwinski J, Bowers J, Encarnacion E. Department of Psychology and Neuroscience, Baylor University, Waco, TX 76798, USA. Gary_Elkins@baylor.edu

The power of belief and expectancy in understanding and management of depression.



This article examines how beliefs can influence the definition, classification, understanding, and treatment of depression. It is organized in five parts: The first part critically reviews the definition of depression; the second part explores the medicalization of depression; the third part examines the role of the pharmaceutical industry in the promotion and marketing of antidepressant medications; the fourth part surveys the psychological therapies for depression and examines the role of expectancy in outcome; and the last part looks at the mechanisms involved in the placebo effect. A list of evidence-based strategies, including hypnosis, are discussed in the context of cognitive hypnotherapy for depression to illustrate how expectancy effect can be maximized in psychotherapy.

Am J Clin Hypn. 2013 Jan;55(3):249-71. Alladin A. University of Calgary, Calgary, Alberta, Canada. assen.alladin@albertahealthservices.ca

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