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Tuesday, 17 May 2016

MORE EFFECTIVE TREATMENTS NEEDED FOR DEPRESSION - DRUGS HAVE LOWER EFFECT SIZE THAN HOPED - COURTESY OF MADINAMERICA WEBSITE


The unfulfilled promise of the antidepressant medications

Christopher G Davey and Andrew M Chanen in the Australian Medical Journal

Summary
  • Australia has one of the highest rates of antidepressant use in the world; it has more than doubled since 2000, despite evidence showing that the effectiveness of these medications is lower than previously thought.
  • An increasing placebo response rate is a key reason for falling effectiveness, with the gap between response to medications and placebo narrowing.
  • Psychotherapies are effective treatments, but recent evidence from high-quality studies suggests that their effectiveness is also modest.
  • Combined treatment with medication and psychotherapy provides greater effectiveness than either alone.
  • The number of patients receiving psychotherapy had been declining, although this trend is probably reversing with the Medicare Better Access to Mental Health Care initiative.
  • Antidepressant medications still have an important role in the treatment of moderate to severe depression; they should be provided as part of an overall treatment plan that includes psychotherapy and lifestyle strategies to improve diet and increase exercise.
  • When medications are prescribed, they should be used in a way that maximises their chance of effectiveness.
We need more effective treatments for depression, because current treatments avert less than half of the considerable burden caused by the illness.1 Antidepressants are the most commonly used medications, taken by 10% of adult Australians each day, and at a rate that has more than doubled since 2000 to be among the highest in the world.2 Two broad forces have been argued to have driven this trend — in Australia, as in other economically developed countries. First was the broadening of the diagnostic concept of depression with publication of the Diagnostic and statistical manual of mental disorders, third edition (DSM-III) in 1980. Previously, depressive illness was considered to have two subtypes — a “neurotic” illness that responded to psychological therapies and a rarer melancholic depression that had a biological cause and responded to medications. But starting with the DSM-III, the distinction was dropped and the categories were collapsed into the broader “major depressive disorder”. This was followed shortly afterwards by the release of the first selective serotonin reuptake inhibitors (SSRIs) — the short-lived zimelidine in 1982, and then fluoxetine in 1986 — and the ensuing cultural phenomenon that encouraged us to think of depression as resulting from a chemical imbalance that could be corrected with medication. Evidence for depression being caused by a serotonin deficiency is inconclusive and contested.3
The use of antidepressants has continued to rise despite accumulating evidence that they are not as effective as was previously thought. Recent meta-analyses show a modest overall effect size of about 0.3 (although it is larger in severe depression compared with mild depression).4 The overall effect size, while modest, is similar to that of other treatments in medicine: of similar magnitude, for example, to corticosteroids for chronic obstructive pulmonary disease.5 Earlier studies had reported much larger effect sizes for the medications, in part driven by the influences of the pharmaceutical industry on selective publishing of positive results, and the substitution of outcome measures to report ambiguous findings as positive.6 Revelations of these publication strategies have done significant damage to the reputation of the medications and to the pharmaceutical companies who make and market them.7
Antidepressant use in children and adolescents has increased over the past two decades in the same way as it has for the population in general,8 and similarly, meta-analyses of their use in this group have shown smaller effect sizes than had previously been reported.9Reanalysis of previously published trial data has shown how it was manipulated to inflate the effectiveness of the medications — by substituting pre-specified outcome measures with those more favourable to the trial medications.10 However, just as significantly, meta-analytic approaches have confirmed what had previously been suspected clinically: that antidepressants can induce an increase in suicidal thoughts and behaviours (although not completed suicides) in some young patients.9 A recent study reported that antidepressants can also cause an increase in aggressive behaviour in children and adolescents.11Both problems are likely to be mediated by the capacity of antidepressants to cause increased agitation in some young people. Although these problems are not common (the number needed to treat for antidepressants in youth depression is 10, while the number needed to harm, in terms of increased suicidal thoughts and behaviours, is 1129), they should be considered when assessing the potential benefits and risks of using these medications in young patients.

The increasing power of placebos

Much effort has gone into delineating the reasons for the apparent falling effectiveness of antidepressants. There are likely to be multiple reasons, including the unearthing of unpublished negative trial results for inclusion in meta-analyses, thereby diluting the positive outcomes from published studies,6 and the inclusion of more “real world” patients (those with comorbid conditions and clinical complexity) in effectiveness trials. Perhaps the culprit given most attention, however, is the increasing rate of response to placebo, which is particularly high in young people. The proportion of patients responding to placebo has increased steadily over the past two decades, leading to a narrowing of the gap between response to medication and placebo.12 The placebo response is a complicated phenomenon. In part, it is driven by a positive expectation bias, but it also illustrates the statistical concept of regression to the mean, whereby patients with depressive symptoms at baseline tend to recover over time irrespective of treatment.
Why should these properties of the placebo be becoming more powerful? It is not clear. One hypothesis is that since the broadening of the diagnostic criteria for depression in the DSM-III, patients with less severe symptoms have been enrolled in treatment trials, and such patients are more susceptible to the placebo response. While there is some evidence for this,4 an analysis of severity cut-offs for study entry showed that where these were higher (ie, when depression had to be more severe for patients to be included), the placebo response rate was even greater.13An alternative explanation is that patients in more recent trials have had a greater expectation that they will get better with medication: the placebo response rate is greatest in trials when the chance of receiving placebo is low (ie, in multi-arm trials), and lowest in two-arm trials when the chance is high, lending weight to this theory.14 The factors behind the increasing rate of response to placebo, and consequent decreasing effectiveness of medications, are evidently complicated.

Modest effect sizes are not confined to antidepressants

Despite these concerns, antidepressant medications are effective, even if only modestly so. Other treatments for depression are also effective, although the most studied of these — the psychotherapies — also have evidence of declining effectiveness in more recently published trials.15Two particular psychotherapies have the most favourable evidence: cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT). Both are structured, time-limited therapies that directly address the core features of depression. While both psychotherapies are effective, meta-analyses have shown that early studies reported inflated effect sizes.16,17 The reasons for this are clearer for psychotherapies than for medications. Many psychotherapy trials, especially those conducted earlier, adopted low-quality methods that were biased towards overestimating the interventions’ effects. Many therapy trials enrolled non-clinical participants (previously undiagnosed patients who scored above a threshold on a rating instrument), used non-active control conditions (eg, patients on a waiting list), analysed only participants who had completed treatment (rather than using the more rigorous intention-to-treat principle), or did not use blinded assessors.16,17 The effect size of high-quality psychotherapy trials (d = 0.2) is, consequently, less than a third of the effect size for low-quality trials (d = 0.7), and similar in magnitude to the effect size for antidepressants.17
There has been a recent focus on exercise and diet as potential interventions. While it is clear that exercise and healthy eating are associated with good mental health, it is less clear that they are effective interventions for depression.18,19 One reason for this is that adherence to exercise and diet plans is often insufficient to produce improvement,19and even when they are adhered to, the effect sizes for such non-specific interventions are unlikely to be large. While there is yet insufficient evidence to suggest that exercise and dietary interventions can be effective as stand-alone treatments, they are still worth pursuing as adjunctive treatments — and the evidence suggests that clinicians do not recommend them often enough.20

Combined treatments

The modest effect sizes for depression treatments — and there are no well-studied treatments for depression that have large effect sizes — suggest that combining treatments might provide the best outcomes for patients. The combination of psychotherapy and medication is more effective than either alone. In adults, the effect of combined treatment compared with placebo is about twice that of medication only compared with placebo.21 Combined treatment also seems to be more effective in children and adolescents,22 although there have been fewer studies in these groups. The effects of psychotherapy and medication appear to operate independently of each other,21 providing a good rationale for their combination.
Despite the evidence of superior effectiveness for combined treatments, recent reports suggest that psychotherapy is being offered less rather than more often, at least in the United States. In the decade from 1998 to 2007, the percentage of adult patients with depression who were treated with psychotherapy declined from 54% to 43%.23 A similar decline was noted in children and adolescents, although more recent evidence suggests that this has been reversed with the increasing concerns about the safety of medications.8 In Australia, while we have clear evidence that the rate of antidepressant use is increasing, we lack comparable data for the use of psychotherapy. There are some promising signs that it is becoming easier to access psychotherapy. The federal government’s Better Access to Mental Health Care scheme was introduced in 2006, and allows general practitioners to refer depressed patients to qualified therapists for up ten sessions of Medicare-funded treatment. It has led to significant uptake and is helping to reverse the trend,24 albeit with demographic distortions in the groups who access the scheme. The uptake of psychotherapy is disproportionately higher in wealthier suburbs, and lowest in outer suburban and regional communities where rates of depression are highest.24 And although the gender gap is narrowing, use of psychotherapy is still disproportionately higher among women.25 While there is evidence that access to therapy is improving, we are yet to see whether this is translating into a reduction in the prevalence of depression.
An unfortunate nexus has developed between the diagnosis of depression of any severity and the reflexive prescription of medications as monotherapy, for which the medical profession must accept some responsibility. There is a long tradition of medical psychotherapy — important psychotherapies were developed by medical practitioners such as Sigmund Freud, Aaron Beck (CBT), and Gerald Klerman (IPT) — that seems to be in decline. Fewer doctors now have the expertise to deliver psychotherapy, the teaching of which has been de-emphasised in psychiatry training,26 and psychotherapy is now largely the domain of psychologists, social workers, and other health professionals. This appears to have had the effect of encouraging psychiatrists and other doctors to consider medication, which is their area of expertise, rather than psychotherapy as the first-line treatment for depression.

Future directions

The pharmaceutical industry has scaled back investment in developing new drugs for mental illnesses, mainly because of so many development failures,27 and it is unlikely that we will see new medications with substantially greater effectiveness in the coming years. The psychotherapies too have their limitations, and while they can be made more available, it is unlikely that new forms of psychotherapy will be developed that will have substantially greater effectiveness than existing therapies.
Some psychiatrists and researchers argue that reinstating melancholia as an illness, separate from neurotic depression, provides a solution to refining treatments.28 They argue that melancholic depression shows a distinct and selective response to antidepressant medications. Differentiating the illness subtypes, however, was never as clear in practice as some now argue. Australian psychiatrist, Sir Aubrey Lewis, pointed out in 1934 that the separation between the two was arbitrary — “a setting up of types or ideal forms, a concession to the requirements of convenient thinking in categories”29 — with most patients showing aspects of both. The belief that melancholia responds much better to medications has also not been reliably confirmed. A recent large study could find no difference in medication response between those with and without melancholic symptoms.30
Major depressive disorder is undoubtedly a heterogeneous disorder, and clearer distinctions between subtypes would make it easier to target treatments, but there is little at present to guide us as to how best to make such divisions. There is, however, a significant research effort aimed at characterising treatment biomarkers — genetic, brain imaging and neuropsychological parameters that might predict a patient’s response to particular treatments. With no likelihood that significantly better treatments for depression will emerge in the near future, better targeting of existing treatments towards patients who are most likely to respond to them is probably our best hope for improving treatment outcomes.

Treatment recommendations

While recent evidence might have tempered the initial enthusiasm for antidepressants, these agents still have a role in treating depression. Some patients show particularly strong responses to the medications31(although we are not reliably able to predict who they will be), and there is good evidence that antidepressants are effective in preventing relapse of depression.32 The task for medical practitioners now is to place antidepressant medications in an overall treatment framework.
All patients should be offered psychotherapy where it is available, and medication should be considered if
  • the depression is of at least moderate severity;
  • psychotherapy is refused; or
  • psychotherapy has not been effective.
When medications are prescribed, they should be used in a way that maximises their chance of effectiveness. The dose should be increased if there has been no improvement after 4 to 6 weeks. The medication should be changed if there has been no improvement after a subsequent 6 weeks. Usually, the medication should be changed to another within the same class in the first instance (eg, from an SSRI to an alternative SSRI), and to an antidepressant of an alternative class (eg, from an SSRI to a serotonin-noradrenaline reuptake inhibitor, such as venlafaxine) if a second change is required. If this strategy is ineffective, more expert guidance is indicated: this might include considering augmentation strategies, such as lithium, or the use of neurostimulation (electroconvulsive therapy and transcranial magnetic stimulation).33 At all stages, therapy with ineffective medications should be ceased and unnecessary polypharmacy avoided. Alongside these treatment strategies, we should continue to recommend and encourage good eating and exercise, both of which are likely to help engender a healthy mind and a healthy body.
Provenance: 
Commissioned; externally peer reviewed.

Saturday, 16 April 2016

INTERESTING PERSPECTIVE - Victim Blaming: Childhood Trauma, Mental Illness & Diagnostic Distractions? + LONG TERM PSYCHOLOGICAL ENTRAPMENT - MADINAMERICA WEBSITE

INTERESTING PERSPECTIVE - Victim Blaming: Childhood Trauma, Mental Illness & Diagnostic Distractions? 



Liz MullinarLiz Mullinar







In preparing this blog, I asked a friend and colleague, Matt Britts, who works with traumatized youth for her input. He sent me the response below, a response that yet again left me dismayed with the ways in which so many services end up failing people with mental illness and trauma histories. His response left me asking the same questions I have asked myself many times before:
Why, despite the fact that the vast majority of people diagnosed with a mental illness have suffered from some form of childhood trauma, is it still so difficult to talk about? Why, despite the enormous amount of research about the impact of trauma on the brain and subsequent effect on behaviour, does there seem to be such an extraordinary refusal for the implication of this research to change attitudes towards those who are mentally ill? Why, when our program and others like it have shown people can heal from the effects of trauma, are so many people left with the self-blame and the feeling they will never get better that my colleague writes about below?
***
I recently had a conversation with a sixteen-year-old client about the origins of her "mental illness". Or, to put it more accurately, I recently held my tongue and denied this young woman an explanation as she cried and helplessly demanded, why? Why was she suffering when no one else in her family had a history of depression? Why couldn't she manage her emotions, except by cutting herself? Why was she so filled with self-hatred and pain that the only solution she could see was suicide? Why her? What's wrong with me, she repeatedly asked. She asked, and I couldn't point to the sexual and emotional abuse she had been subjected to because of deep-seated organisational fears that the mere mention of childhood trauma would open a Pandora's box of further distress. Further dysfunction, probably further diagnoses.
Despite the very large advances that have been made in combating the stigma surrounding mental illness, the stigma of childhood trauma still looms silently in the background. In the 1950's, Bowlby and Ainsworth began the attachment research that would eventually  demonstrate the key role our early infant relationships play in shaping all our future ones. The most important point being that insecure attachment to primary caregivers becomes an enduring interpersonal pattern of dysfunctional relationships that persist throughout the lifespan. In 1998, Felitti et al. published the first peer-reviewed paper describing results from the Adverse Childhood Experiences (ACE) Study. Almost ten years ago, this seminal research analysed data from over 8000 adult participants to demonstrate an undeniable link between childhood trauma and adulthood risk of suicide, depression, alcoholism and drug abuse (Felitti et al., 1998). Since then the body of literature on the subject has grown exponentially. Data from the ACE study has also provided evidence for a dose-dependent relationship between exposure to childhood abuse and poor adulthood mental health outcomes (Edwards, Holden, Felitti & Anda, 2003). More recently, a longitudinal study in New Zealand showed similar relationships between childhood sexual abuse and mental health outcomes, psychological well-being and socio-economic status (Fergusson, McLeod & Horwood, 2013). Notably, 95% of the participants who experienced sexual abuse involving penetration reported, at least, one adverse mental health outcome, compared to only 56% of participants that did not experience sexual abuse in childhood (Fergusson et al., 2013).    
Yet all these scientific advances would appear to have had little impact on the deeply flawed mental illness discourse that is so omnipresent among the general public and scientific community alike. We still live in a society where many believe that hitting a child is an appropriate form of discipline. When these children hit another child on the playground, we don't call it a learned behaviour. We call it a conduct disorder. When these children grow up and physically abuse their spouses, we call it an antisocial personality disorder, an intermittent explosive disorder. The same is true of the child subjected to emotional abuse or neglect. When they inevitably fail to function adaptively within relationships, to regulate their own emotions or develop a coherent sense of self, we don't ask 'what happened to you?'. We ask 'what's wrong with you?', consult the Diagnostic and Statistical Manual of Mental Disorders, and conclude what is wrong is a form of innate characterological dysfunction termed borderline personality disorder. By the way, the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012). Individuals with psychiatric illnesses and a history of trauma also appear to display significantly higher functional impairment than the remainder of the sample (Cotter, Kaess & Yung, 2015).
This is a conversation that has been suppressed since Freud very briefly suggested the neuroses and hysteria he saw in his clients were a result of familial sexual abuse. In response to immense professional pressure, Freud reformulated his ideas into more socially palatable theories that essentially blamed the victim. The psychology of the 19th century had the Oedipus and Electra complexes as a convenient distraction from uncomfortable truths. Today's psychology has antisocial, narcissistic and borderline personalities. Today's solution should be readily available in a model of trauma-informed care that addresses the core issue behind the symptoms. Because questions of causation aside, the fact remains that individuals diagnosed with mental illness who receive treatment for their traumatic childhood experiences improve more than those who don’t (Bohus et al., 2013; Roberts, Roberts, Jones & Bisson, 2015; Van Minnen, Zoellner, Harned & Mills, 2015).  

REFERENCES
Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C., ... & Steil, R. (2013). Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial.Psychotherapy & Psychosomatics82(4), 221-233.
Cotter, J., Kaess, M., & Yung, A. R. (2015). Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature. Irish Journal of Psychological Medicine32(01), 21-30.
Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the adverse childhood experiences study. American Journal of Psychiatry160(8), 1453-1460.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine14(4), 245-258.
Fergusson, D. M., McLeod, G. F., & Horwood, L. J. (2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect37(9), 664-674.
Larsson, S., Andreassen, O. A., Aas, M., Røssberg, J. I., Mork, E., Steen, N. E., ... & Melle, I. (2013). High prevalence of childhood trauma in patients with schizophrenia spectrum and affective disorder.Comprehensive Psychiatry54(2), 123-127.
Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clinical psychology review38, 25-38.
van Minnen, A., Zoellner, L. A., Harned, M. S., & Mills, K. (2015). Changes in comorbid conditions after prolonged exposure for PTSD: A literature review. Current psychiatry reports17(3), 1-16.
Yen, S., Shea, M. T., Battle, C. L., Johnson, D. M., Zlotnick, C., Dolan-Sewell, R., ... & Zanarini, M. C. (2002). Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: Findings from the collaborative longitudinal personality disorders study. The Journal of Nervous & Mental Disease190(8), 510-518.
Liz Mullinar
Founder and Volunteer CEO of Heal for Life Foundation (Mayumarri Centres), Liz Mullinar is a survivor of incest, sexual abuse and cult abuse. Liz has been utilizing her innate knowledge as a survivor to empower others to heal themselves for 17 years. She has authored two booksBreaking the Silence and The Liz Mullinar Story, published by Hodder Headline.
Matthew Britts
Matt is a survivor of child abuse and has been working with other survivors for ten years. Matt is currently completing a PhD investigating psychological treatments for adult survivors of childhood trauma and has previously attained a Bachelor of Psychology with Honours. Matt also works with traumatised young people in residential out-of-home-care.

Wednesday, 30 March 2016

Sunday, 14 February 2016

EMPOWERING NEW MINDSETS IN YOUNG PEOPLE – A trilogy of hopeful constructs. A new opinion piece by Dave Traxson, Educational Psychologist U.K.



EMPOWERING NEW MINDSETS – A trilogy of hopeful constructs.

“Self should not be the harsh dictator within but rather the gentle facilitator for controlling all the responses to the forces without.”     Dave Traxson  2016

We, humanistic psychologists, look to harness the inner potentials that all human beings possess as we are often all too aware that they are being under utilised. I feel there are three key psychological constructs that help us to understand these fulfilling processes better.

CHOICE

“When we are no longer able to change a situation, we are challenged to change ourselves.” Viktor E. Frankl, in ‘ Man's Search for Meaning.’

No one should know better than Frankl the importance of choice as a human construct as he witnessed many examples in the darkest depths of man’s inhumanity to man, the concentration camps, where individuals made small but very significant choices that helped to keep them alive mentally and physically in some cases. The sense of personal power this gave them helped them to deal to some degree with the overwhelming hostility and to be better placed to show resilience and thus survive longer term. Choosing when to eat a crust of stale bread, who to share it with and what to maintain of some chosen relationships with those around you in any place. These all demonstrated the essential resilience building power of choice and self-efficacy. Frankl again:

Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” 

So what of the here and now, we also are empowered by exercising many choices personal, family, community and democratic. We all must have sensed at some point the rush of energy that this gives and the new mind-set that this facilitates which can last for extended periods.

As Madiba said so wisely,

Our deepest fear is not that we are inadequate. 
Our deepest fear is that we are powerful beyond measure.
It is our light, not our darkness that most frightens us.
We ask ourselves,                                                                                     
Who am I to be brilliant, gorgeous, talented,fabulous?                                                                
Who am I not to be?” 

Control

“You have power over your mind - not outside events. Realize this, and you will find strength.” ― Marcus Aurelius, ‘Meditations.’

A metaphor, ‘A Car for Life,’  that we have successfully used with many young people may give us a useful insight here. Their ‘engine’ is their wants, needs of all types and their ambitions and when sitting in the ‘driving seat’ they can control their front wheels of ‘thoughts’ and ‘actions’ but it is harder to control their fixed back wheels of ‘physiology’ ( including genes) and ‘feelings.’ They have a real choice to ‘accelerate’ on various courses of action or to ‘apply the brakes’ hence showing some early stages of Self-Control or indeed 'learning to drive more carefully’ and find ‘safe roads’ and interesting ‘laybys’ or resting places. What we have demonstrated conclusively is that when a young person learns to use these metaphorical pedals judiciously then that gives them amazing personal power that can be generalized to other key areas of their future life. So learning to ‘put the brakes on’ in terms of using more acceptable language, for example or more powerfully reducing their levels of physical aggression with others in a range of settings then this can be generalized to controlling drinking behaviour or a range of other self-harming behaviours etc. etc. 

These methods are loosely classified as Cognitive Behavioural Techniques. Cognitive Behaviour Therapy’s efficacy has been endorsed on grounds of evidence based practice by the National Institute of health and Clinical Excellence (NICE), the medical professionals regulating body for drugs and interventions.

“He who controls others may be powerful, but he who has mastered himself is mightier still.”  Lao Tzu
“Ultimately, the only power to which person should aspire is that which they exercise over themself.”  Elie Wiesel

Compassion

Compassion literally means “to suffer together.” Among Humanistic Psychologists, it is defined as the feeling that wells up when another’s suffering or difficulties are shared and one feels motivated to help to resolve the situation.


Compassion is not the same as empathy or altruism, though the concepts are intertwined. While    empathy refers more generally to our ability to take the perspective of and feel the emotions of        another person, compassion is when those feelings and thoughts include the desire to directly help the other human being. Altruism, in turn, is the kind, very selfless behaviour often prompted by feelings of compassion, though one can feel compassion without acting on it.

We usually think of the focus of compassion being to others, as above, and there is another equally important form of compassion to oneself which we call developing a 'Kind Mind,' to one's actions, thoughts and feelings. It is fundamentally about being reasonable to oneself as well as to others both in terms of expectations, deeds and 'positive self-talk.'
“Take positive care of your mind, and it would surely take positive care of your life.”  Edmond Mbiaka

We have to been kind and tolerant about the unique characteristics of ourself in order to be able to be giving and successful in our interactions with others. So developing a 'kind mind' to ourselves develops a reservoir of positive energy that we can use rather than having it all leach away through the unproductive mental processes of shame and guilt.
While cynics may dismiss compassion as touchy-feely or irrational, scientists have started to map the biological basis of compassion, suggesting its deep evolutionary purpose. This research has shown that when we feel compassion, our heart rate slows down and we secrete the “bonding hormone” oxytocin.

So this important positive trilogy of humanistic constructs are pivotal to assessing if interventions are likely to  be effective for individuals young the people specifically and all human beings generally. Basically will the proposed strategy increase the client’s feelings of having more choice and self-efficacy, increase their ability to use their internal locus of control and also to behave in a compassionate way to the individual.


So a personalized blend of these three humanistic constructs may indeed be able to maximize a sense of empowerment and increase the longer term possibilities of personal growth and hopefully eventual transformation.

Friday, 5 February 2016

VICTORIA DERBYSHIRE SHOW - BBC-2 - 2-02-16 - Dave Traxson,Educational Psychologist promotes multi-agency collaboration and holistic assessment for Autism following NICE Guideline 2009


Dave Traxson,Educational Psychologist promotes multi-agency collaboration and holistic assessment for Autism –


Use slider bar to go 1hr 05 min into programme after 10 am sports news look for the pink shirt!


VICTORIA DERBYSHIRE SHOW  BBC 2 – 2-02-16 - Joanna Gosling presents the daily news and current affairs programme. Jean Mackenzie speaks to 10-year-old Becky, who had to wait six years for a diagnosis of autism