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Psychology

02 November 2011

New Hope for Treatment Resistant Depression.

Depression can affect anyone. Unfortunately once you’ve had one bought of depression, you are more likely to have a second. Quickly your condition can become chronic. Although standard psychological and medical methods can help most people with chronic depression, there is a hard core of people who are ‘treatment resistant’. Whatever we do simply doesn’t seem to work. As many as 30% of chronic depression cases fall into this category.

Exciting new research by Professor Thomas Lynch of Southampton University and his collaborators promises to offer insight into the world of people with chronic treatment resistant depression, and possibly offer a solution.

What Professor Lynch has found is that many people with treatment resistant depression are emotionally over controlled. Emotional control is best seen as a continuum. At one end are people who are not very good at controlling their emotions. They are life’s ‘drama queens’, and have learnt that they are more likely to get what they want if they escalating their emotion. At the other end of the spectrum are people who are extremely good at regulating their emotion, in fact they are so good at it hardly anything slips through. They are lifes cool guys, and have learnt that they are more likely to get what they want if they withhold their emotional expression.

Of course being able to control one’s emotion in many situations is a good thing. What Professor Lynch and colleagues have found, however, is that if you withhold too much emotion, this creates mistrust in other people. Basically if you don’t show an appropriate socially acceptable amount of emotion, other people don’t like you. And this is the problem for many treatment resistant depression patients. They are so good at regulating their emotional expression they do it inappropriately. This makes them unpopular. As a consequence of this they become socially withdrawn. Of course if you do not connect effectively with people you can become vulnerable to depression.

Professor Lynch’s approach to treatment resistant depression is therefore quite radical. He does not treat depression as the primary problem. Rather his treatment strategy is to target emotional over control itself. By helping patients to communicate their emotions more appropriately, this enables them to get closer to other people; they become more popular, and as a consequence, social isolation and the vulnerability to depression decrease.

Does it work? Well preliminary findings suggest this approach may well be effective in helping patients with treatment resistant depression. The findings have been so good in fact it has led to a full scale clinical trial over the next five years. The project is called REFRAMED. If you feel this approach might be appropriate for you, you don’t have to wait until these results become available. Professor Lynch is starting to roll out his ideas to other therapists. You might not be able to get on the clinical trial, but you could well be able to access something very similar.

Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK. He offers:

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Posted by Dr Phil Tyson on 02 November 2011 at 05:34 PM in Academic, Depression, Mental Health, Psychology | Permalink | Comments (0) | TrackBack (0)

01 September 2011

We Move Furthest by Standing Still.

Most of us have an idea of the kind of person we would like to become. We want to be happier, more successful, have great relationships, etc. There is nothing wrong with having goals in life; the problem is usually in following through on them. It is as if every effort to change is greeted by an equal and opposite resistance to doing anything about it.

We are all familiar with this phenomenon. We resolved to lose weight, but despite our best intentions, we find ourselves eating just as much as we did before, and our attempts exercise never advanced further than a good idea.

It is as if we 100% want to change, and 100% don't want to change. In therapy, it is important to understand the nature of our resistance. Even people who are deeply unhappy seem to lack the motivation to get out of it.

One of the problems is the goal driven nature of the change we want to make. We become so fixated with what we want, we lose touch with where we actually are. Of course all journeys start from where we are, but few of us take time to really understand where we are starting from. We may have low self-esteem, for example, but spend all of our time running from our experience, rather than staying with it.

At one level this is understandable; we don't like to stay with difficult feelings. So we focus on what will make us happy rather than understanding our unhappiness.

One of the paradoxes of personal growth is that if we abandon our goals and come back to our experience of ourselves in the moment, we stand to make the most progress. This means if we are depressed, being curious about our experience, staying with it, observing it, being it. Fully experiencing ourselves as a person who is doing depression right now.

The mind, of course, simply cannot remain still. Our awareness transforms our experience of who we are. We cannot help but change. We might not get the change we want, but we will get the change we need.

Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK. He offers:

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Posted by Dr Phil Tyson on 01 September 2011 at 04:39 PM in Meditation/Mindfulness, Psychology | Permalink | Comments (0) | TrackBack (0)

12 July 2011

The National Lottery as a Psychological ‘Escape Route’.

When I was in my 20s I fell seriously ill. Suddenly and unexpectedly I was rendered bedbound for months and unable to work for considerably longer. My world had stopped turning up on its axis, and I was fearful I would lose my job and my home.

One of the ways I coped with these events was to play the National Lottery. I had a "magic number bowl", from which I chose the numbers each week, and an elaborate list of spending plans should I win. I even traded with God to give a proportion of my winnings to charity should He intervene on my behalf!

Of course I was very ill and very vulnerable. I quickly realised, though, that playing the lottery was only compounding my difficulties. The spending of the millions in my imagination wasted my time, and I found the weekly disappointment more than I could bear at an already difficult time. I had, however, gained an insight into the National Lottery as an "escape route".

In therapy, we often talk about three psychological "escape routes" people think about taking. The first is to go mad. The second is to kill someone. The third is to kill oneself. The thing that unites these three areas with the National Lottery is they all become an increasingly cumbersome fantasy about how, if we simply went mad/killed someone/killed myself/won the lottery ... all our problems would go away. Life is never this straightforward. Besides, the fantasy itself often becomes the problem.

The person for whom I saw this most completely was a young man who was on benefits and worked as a male escort to significantly boost his income. He spent all the money he earned on the National Lottery, often hundreds of pounds a week. He did this despite living in a flat with no carpets, and little by way of furniture. For this man, the fantasy of the millionaire lifestyle had completely taken over his life. Instead of equipping himself to compete effectively in the real world, he spent his time selling sex and buying lottery tickets to support his fantasy world.

Of course we can all view the absurdity of this man's choices. In extremis the National Lottery fantasy obscures and suffocates life, it doesn't enhance it. However much time you invest in the National Lottery big win fantasy, my challenge to you is that it does the same to your life as it did to this man's. It ultimately serves as a psychological escape route, and stops you from dealing with the reality of your life more effectively.

Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK. He offers:

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Posted by Dr Phil Tyson on 12 July 2011 at 06:33 PM in Psychology | Permalink | Comments (0) | TrackBack (0)

09 June 2011

Depression as “Learned Helplessness”.

In the beginning there was Freud and he was big. So big, in fact, that many people still confuse psychology with his brainchild, psychoanalysis. Freud's great insight was that if you ask patients about their mental health problems they often have good reasons for behaving the way they do. In some ways psychotherapy is still a working out of what this means in practice.

Freud had a lot to say about depression, or melancholia as it was known at the turn of the 20th century. The enduring ideas from psychoanalysis is that depression is anger turned in against oneself. The idea is that the depressed person is angry at the world and, for whatever reason, can't express their anger, so it is turned inward. For some people, this view of depression makes sense, but it does not capture everybody who gets down. In fact with many men the opposite is true. They get depressed but actually "act out" their depression as anger. As a man, if you are getting irritable and aggressive, you may well in fact be depressed.

A second wave of psychology threw out the Freudian ideas and decided that the only scientific way to study human beings was to look at their behaviour. On the "behaviourist" view whatever the individual was thinking or feeling was simply irrelevant to understanding their behaviour. This led to a lot of animal studies, particularly on how animals learn, and generalising from these to human beings.

One early influential theory of depression made just that these moves. In one study, a dog was placed in a cage with two compartments divided by a small wall. If the dog was given an electric shock in compartment A it naturally jumped into compartment B to escape the shock. Similarly if given an electric shock in compartment B, the dog jump back to compartment A. If the dog was given electric shocks in both compartments A and B and had no route of escape, the dog simply endured the shock and took on the manner of a depressed person. The dog looked forlorn and sorry for itself. If the paradigm changed and the dog could escape, the researchers found that the dog still remained immobile and sorry for itself and simply continued to endure the shock. The dog had learned that escape was futile, so gave up trying.

The theory of depression that evolved from these studies was known as "learned helplessness". The idea is that people, when faced with overwhelming stress, simply give up trying. People have learned to be helpless, they have “given up”, and become gripped with depression and a feeling of hopelessness. Furthermore, they remain depressed even when the objective circumstances of their lives move on and trying to bring about useful changes would be possible and helpful.

This model of depression has many advantages to the psychodynamic view not least because it is more widely applicable, but also because it accounts for the cynicism, pessimism and hostility to living that many depressed people experience. It also accounts for why "behavioural activation", gently encouraging depressed people to re-engage with life, is so successful.

Is learned helplessness enough to explain depression? Well clearly not. It does not account for why some people retreat into depression as a first line of defence against stress, and why other people can endure even the most evil of circumstances, like the concentration camps, with some degree of good cheer.

What it does tell us, however, is that at a profoundly deep level, you can escape depression by opening up to the choice to be different – to re-engage with life. Of course when you feel so down this is an extremely difficult choice to make, but even the most profoundly depressed person can make it if they want to. They will need support to start re-engaging with life, and a therapist is a good person to help you start to do that. If you want to try on your own I can recommend "Overcoming Depression One Step at a Time" by Christopher Martel and Michael Addis.

Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK. He offers: