Spiritually-Integrated Psychotherapy as Effective as Meds for Longterm Relief from Depression, Says Lancet

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Researchers in the U.K. have found that mindfulness-based cognitive therapy (MBCT) may offer just as much protection from depression relapse as antidepressants, with no significant difference in cost, according to a new study published in the journal The Lancet

“Depression is a recurrent disorder. Without ongoing treatment, as many as four out of five people with depression relapse at some point,” said Dr. Willem Kuyken, lead author and professor of clinical psychology at the University of Oxford.

What is MBCT?

MBCT teaches people with recurrent depression to recognize and respond constructively to the thoughts and feelings associated with depression relapse, thereby preventing a downward spiral into depression.  It is often considered a more spiritual approach than traditional cognitive therapy because it employs meditation-based practices to teach clients how to step outside of their emotional experiences, observe their circumstances in non-judgmental fashion and, as a result, respond more proactively (rather than reactively) to stressful circumstances.

According to Dr. Richard Byng, from the Plymouth University Peninsula Schools of Medicine and Dentistry, while medication is the most common method of keeping depression at bay, “there are many people who, for a number of different reasons, are unable to keep on a course of medication for depression. Moreover, many people do not wish to remain on medication for indefinite periods, or cannot tolerate its side effects.”

How Effective Is It?

The study involved 424 adults with recurrent major depression who were taking maintenance antidepressant medication. Participants were randomly assigned to come off their antidepressant medication slowly and receive MBCT (212 participants) or to stay on their medication (212 participants).

MBCT participants attended eight 2-¼ hour group sessions and were given daily home practice. They took part in guided mindfulness practices, group discussion and other cognitive behavioral exercises.  After the group, they had the option of attending four follow-up sessions over a 12-month period. Participants in the maintenance antidepressant group kept taking their medication for two years.

Over two years, relapse rates in both groups were similar (44 percent in the MBCT group vs. 47 percent in the maintenance antidepressant medication group).

“As a group intervention, mindfulness-based cognitive therapy was relatively low cost compared to therapies provided on an individual basis and, in terms of the cost of all health and social care services used by participants during the study, we found no significant difference between the two treatments,” said study co-author Dr. Sarah Byford, from the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, U.K.

Christian Concerns Over MBCT

Many Christians approach MBCT with caution or even suspicion because many clinicians use eastern-based approaches to meditation to teach MBCT skills, but MBCT does not necessitate indoctrination in non-Christian spiritualities.  MBCT experts correctly note that every major spiritual tradition has its own meditative practices which can be respectfully and effectively employed to teach MBCT skills. For instance, in my own tele-counseling practice, where I work with a primarily Catholic population,   I employ approaches to meditation developed and taught by St. Ignatius of Loyola.  Because St Ignatius’ work is greatly respected by Christian spiritual directors and is completely orthodox, by using his teachings, I am able to offer my clients the opportunity to benefit from MBCT in a manner that is completely respectful of their own spiritual heritage.  I discuss some of these approaches to treating depression and anxiety in my book, God Help Me,  This Stress is Driving Me Crazy!  as well as in my upcoming book, Broken Gods: Hope Healing, and the Seven Longings of the Human Heart.

The Takeaway

Medication is often a helpful component to depression-recovery but, at best, it treats one dimension of depression–the physical.  Depression, as a syndrome, doesn’t just attack the body.  It attacks the mind, our spirits, and our relationships as well.  Spiritually-integrated approaches to psychotherapy like MBCT enable clients to achieve healing on every level and experience the emotional freedom they deserve.  If you or someone you love is struggling with emotional difficulties, be sure to take advantage of all treatments that can help you build the life you were created to live–physically, emotionally, relationally, and spiritually.

All Shook Up: “Therapy Better than Meds for Overcoming Anxiety.” Says Major Study

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About a week-and-a-half ago, I taped a series on Women of Grace with Johnnette Benkovic on anxiety and my book, God Help Me, This Stress Is Driving Me Crazy!  Finding Balance through God’s shutterstock_174459824 Grace.  At the time, I asserted that while most people only receive medication by way of treatment for anxiety disorders, medication is simply less effective than therapy.  On the show, I said that anyone who has an anxiety disorder and is not receiving therapy is not receiving the best standard of care and may be unnecessarily prolonging their suffering.  A new study in the prestigious journal, The Lancet Psychiatry completely endorses the position I took on the program.  According to the new study…

While antidepressants are the most commonly used treatment for social anxiety disorder, new research suggests that cognitive behavioral therapy (CBT) is more effective and, unlike medication, can have lasting effects long after treatment has stopped.

Social anxiety disorder is a psychiatric condition characterized by intense fear and avoidance of social situations and affects up to 13 percent of Americans and Europeans. Most people never receive treatment for the disorder. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists.

The findings of the study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, are published online Sept. 26 in The Lancet Psychiatry.

“Social anxiety is more than just shyness,” says study leader Evan Mayo-Wilson, DPhil, a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. “People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction. The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering.”

[The researchers] analyzed data from 13,164 participants in 101 clinical trials. The participants all had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo pill, and more than 4,000 received a psychological intervention. Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone.   READ MORE

If you or a loved one is struggling with problems related to anxiety, I encourage you to learn more about the Pastoral Solutions Institute’s Catholic tele-counseling practice.  We can help you apply both the timeless wisdom of our Catholic faith and insights from counseling psychology to overcome the anxiety you’re facing.  Learn more at our website or by calling 740-266-6461 to make an appointment to speak with a counselor.

 

The Serotonin Myth Continued: What You Need To Know About Depression

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A few weeks back, I reported on a new study that pounded yet another nail in the coffin of the theory that depression is caused by low serotonin.   You can read that original post here as well as the follow shutterstock_217156765up post wherein I responded to a question from a reader asking if I was trying to say that people who suffered with depression were to blame for their struggles (short answer:  no.)

Over at PsychCentral, one of the most popular psychology news portals on the web, the director, Dr. John Grohol has an excellent piece summarizing the growing case against the low serotonin theory of depression.  He writes….

Back in 2005, Lacasse and Leo pointed out in the journal PLOS Medicine that there was a huge disconnect between what we knew about serotonin’s role in depression from the medical research, and what pharmaceutical advertisements were claiming we knew:

Regarding SSRIs, there is a growing body of medical literature casting doubt on the serotonin hypothesis, and this body is not reflected in the consumer advertisements. In particular, many SSRI advertisements continue to claim that the mechanism of action of SSRIs is that of correcting a chemical imbalance, such as a paroxetine advertisement, which states, “With continued treatment, Paxil can help restore the balance of serotonin…” [22].

Yet […] there is no such thing as a scientifically established correct “balance” of serotonin. The take-home message for consumers viewing SSRI advertisements is probably that SSRIs work by normalizing neurotransmitters that have gone awry. This was a hopeful notion 30 years ago, but is not an accurate reflection of present-day scientific evidence.

New research that we reported on last month confirms the role of serotonin in depression is not well-understood. In that mice study, removing the stuff in the brain that creates serotonin2 did not create a bunch of depressed mice.

Other research confirms it’s not as simple as a serotonin deficit. As Whitaker (2010) noted, the 1976 Asbert study is still relevant. Asbert looked at levels of a metabolized result of serotonin (something called 5-HIAA) in spinal fluid. If low-levels of serotonin cause depression, then all people suffering from depression should have significantly lower levels of 5-HIAA in their spinal fluid than people without depression.

What Asbert found, however, wasn’t a clean result. In fact, it clearly shows how complicated depression as a disease process is. In both groups of people studied — both a depression group and a control group — about 50 percent had “regular” levels of 5-HIAA, about 25 percent had really low levels, and another 25 percent had really high levels.

If serotonin were really an important part of the picture in depression, we’d expect that group to look significantly different than the control group. In this study, at least, the two groups looked largely the same.

As we said back in 2007, serotonin may play some small, not-yet-well-understood role in depression. But if it does, it looks nothing like the simplistic “low levels of serotonin cause depression” hypothesis that was all the rage ten to twenty years ago.  READ MORE.

Of course, none of this means that depression medication can’t be helpful but only, as I reported before, that it should never be the first course of treatment for depression. Research shows that meds are best when they play a supportive role to therapy.   Meds alone do not represent the best standard of care for treating depression.  If you are on medication for depression but not currently in counseling, talk to your doctor about getting a referral to a therapist in your area, or contact the Pastoral Solutions Institute to learn more about you can benefit from our Catholic-integrated, telephone counseling practice.  Let us help you find effective, faithful solutions to the tough emotional challenges you are facing.

Setting the Captive Free! New Research Illustrates our Power to Overcome Depression

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In response to my post linking the new study questioning the serotonin-deprivation theory of depression, I received a very thoughtful email from a reader who wrote, shutterstock_212803426

“Dr. Popcak, some of my friends who suffer with depression are saying that in this article you are blaming them for their depression. Can you explain further?”

Blaming the Victim?  A Response

I am grateful for her question because I would never want anyone to think that I was blaming sufferers of depression for being depressed. She was referring, I suspect, to this part of my post where I addressed the notion that depression is caused by a chemical imbalance.  I wrote, “every choice you make, every behavior you exhibit sends a wash of chemicals through your body.  It stands to reason that healthy thoughts, choices, and behaviors would facilitate a healthy chemical balance and unhealthy thoughts, choices, and behaviors would increase the likelihood of an unhealthy chemical imbalance.”

As I assured my correspondent in the comments section of that post, it was not my intention to blame depression sufferers, rather it was (and is) my intention to show depression sufferers that they don’t have to be passive victims of this horrible disease, that there is a lot that they can do to contribute to their healing.

Depression: No One’s Fault.

It is not the depression-sufferers “fault” that they think the way they do, approach problems they way they do, or have some of the unhealthy habits and/or relationship patterns they have.  For the most part these things were taught and modeled and “caught” unconsciously in one’s family-of-origin over the course of tens of thousands of interactions between parents and children and grandparents and siblings and the community and the belief system one is raised in.  No one person could possibly be personally responsible for all that, but it still impacts us mightily.

How Environment Influences Depression Gene Expression

On top of all this, biology certainly is a factory, but it isn’t as straightforward as saying, “depression is caused by genetics and biology.”  In the first place, depression is not so much genetic as it is an epigenetic illness.   Epigenetics studies how environment effects the expression of certain genetic traits and profiles.  Certain genes won’t “turn on” if the environmental conditions aren’t right. Depression has genetic and biological components, yes,  but those components, by and large, won’t come online unless the environment tells them to.  And, curiously enough, once our life experiences activate our genes they can be passed on to the next generation, communicating positive and negative environmental experiences from parents to children through genetic encoding, which is why depression tends to run in families.

Victim No More

The good news is, we don’t have to be passive victims of any of the “bad programming” from these environmental and epigenetic triggers that cause poor thinking habits, unhealthy attitudes, and destructive approaches to life.  Medication can certainly take some of the edge off the worst of it, but counseling can help us make dramatic changes in our thoughts, behaviors, and relationships that not only help us feel better emotionally, but rewire our biological and genetic programming, bringing healing both to us and the next generation.  With God’s grace and consistent effort, we can master the environmental programming–even the environmental programming that triggers certain biological responses–that causes depression and other emotional illnesses.

A Light in the Darkness

To my way of thinking, that is anything but “blaming the victim.”  That is a tremendously liberating and hopeful idea, a light that shines the way out of the terrible darkness that is depressive illness.

If you would like to learn more about faithful and effective treatments for depression and other emotional and relational problems, visit the Pastoral Solutions Institute’s website (or call 740-266-6461) to learn more about how our Catholic telecounseling practice can help you set you free.

 

 

Dealing With Depression: Getting the Right Kind of Help Matters

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The news of Robin Williams’ suicide has brought the insidious nature of depression front and center.  
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I know too many Christians who believe that they should be immune from depression because they are Christian.   While research shows that some believers can be more resistant to depression and have a somewhat easier time bouncing back when they do get depression, it is also true that some approaches to religion can be associated with higher rates of depression and emotional problems.  When evaluating the power of belief to protect against emotional problems, the research seems to show that the question isn’t “do you believe?”  but rather what do you believe, how, and why?

The bottom line is that, by and large,  Christians experience depression at rates that are similar to the general population.  Twenty-Six percent of adults in the US have depression.  The World Health Organization estimates that by 2020 depression will be the second leading cause of disability after heart disease.

Does Treatment Work?

The good news is that depression is very treatable.  Sadly, many comments I am reading on the internet seem to suggest that seeking help must be pointless because if Robin Williams, who arguably had every resource in the world available to him, couldn’t get adequate care who can?  First, we don’t know all the details of Robin Williams situations and we never will.  Secondly, what we do know points to a much more complicated clinical picture than what most people experience.  Robin Williams’ history was not with depression but with Bi-Polar Disorder, which can be characterized by dramatic mood swings and is somewhat more difficult to treat than depression.  This, combined with his long struggle with substance abuse and the unique pressure a person in his position faces,  should remind everyone to resist the temptation to draw broader conclusions about the effectiveness of depression treatment based on the tragic outcome of William’s particular story.

What’s the Best Treatment?

As I mentioned, depression is very treatable.  80% of people who seek help report that they experience significant or even total relief from their depressive symptoms.  That’s a tremendous success rate.

What is the best treatment for depression?  Studies of evidenced-based approaches to treatment show that psychotherapy alone should be the primary method of treatment.  This approach has the highest success rate, the longest-term recovery rates,  the lowest negative effects and the lowest drop-out rate.  For patients who need additional support, adding medication to psychotherapy is the best approach.

Interestingly, despite what all the TV commercials tell you, research seems to show that the least effective approach is medication alone because of the relatively lower rate of effectiveness (about 50%), lower rate of symptom relief (about 30%), higher side-effect profile, greater likelihood of post-treatment relapse, and greater treatment drop-out rate.  Bottom line?  If you have been diagnosed with depression and are not in ongoing psychotherapy, you are not undergoing the best course of treatment. Period.

How Do You Know If It’s Time to Seek Help?

Everyone experiences sadness, but its important not to dismiss depression as mere sadness.  If you are experiencing a period of sustained sadness that lasts for at least 2 weeks and is accompanied by any of the following: a change in eating habits (either eating more or less), sleeping habits (either more or less), withdrawing from social engagements, decreased enjoyment of previously enjoyable activities, feelings of worthlessness or guilt, or especially, thoughts of dying, death, or harming oneself, it’s time to seek help.

How Do We Cope?

Our ability to resist depression or recover efficiently from it tends to depend a great deal on the coping strategies we use to deal with stress in general.  In my next post, I’ll look at healthy versus unhealthy coping styles and offer specific suggestions for coping more effectively with all the challenges in your life.  For now, just know that if you or a loved one is struggling with feelings of sadness or despair that you think might be depression,  getting help early is key.  If you aren’t sure if it’s depression, that’s a good enough reason to get an evaluation (i.e., If you have to ask…). Talk to your doctor or contact a licensed psychotherapist who can help you clarify the nature of the problem you are facing and the best means of resolving it.  Getting help early is the best way to increase both the likelihood of a full recovery and your ability to experience the life God has given you as the gift that it is–even when that gift gets complicated.

For more information on faithful approaches to treating depression and other emotional problems, check out the Pastoral Solutions Institute’s Catholic Tele-Counseling Practice by visiting us online or calling 740-266-6461 to make an appointment to speak with a professional Catholic counselor.  Let us help you integrate the wisdom of our faith with contemporary insights from counseling psychology to help you develop the most comprehensive response to the challenges in your life.

 

 

Inconsistent Home Life/Common Family Problems May Increase Risk of Brain Disorders by Up To 60%

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Because parents don’t have enough to worry about, two new studies point to the impact of a child’s home life on brain development.

The first study looks at how common family problems like lack of affection, poor communication, parental arguments and the like actually resulted in children developing a smaller cerebellum than children who did not experience the same type of common family problems.

The study led by Dr Nicholas Walsh, lecturer in developmental psychology at the University of East Anglia (UEA), used brain imaging technology to scan teenagers aged 17-19. It found that those who experienced mild to moderate family difficulties between birth and 11 years of age had developed a smaller cerebellum, an area of the brain associated with skill learning, stress regulation and sensory-motor control. The researchers also suggest that a smaller cerebellum may be a risk indicator of psychiatric disease later in life as it is consistently found to be smaller in virtually all psychiatric illnesses.

Previous studies have focused on the effects of severe neglect, abuse and maltreatment in childhood on brain development. However the aim of this research was to determine the impact, in currently healthy teenagers, of exposure to more common but relatively chronic forms of ‘family-focused’ problems. These could include significant arguments or tension between parents, physical or emotional abuse, lack of affection or communication between family members, and events which had a practical impact on daily family life and might have resulted in health, housing or school problems.

“We show that exposure in childhood and early adolescence to even mild to moderate family difficulties, not just severe forms of abuse, neglect and maltreatment, may affect the developing adolescent brain. We also argue that a smaller cerebellum may be an indicator of mental health issues later on. Reducing exposure to adverse social environments during early life may enhance typical brain development and reduce subsequent mental health risks in adult life.  READ MORE.

This study could go a long way to explaining the significantly higher rates of ADHD, childhood depression, anxiety,  and other emotional problems in the last 20 years.

The second study is even more shocking.  It shows that frequent school moves increase a child’s risk of adolescent psychosis by up to 60%.

“Changing schools can be very stressful for students. Our study found that the process of moving schools may itself increase the risk of psychotic symptoms — independent of other factors. But additionally, being involved in bullying, sometimes as a consequence of repeated school moves, may exacerbate risk for the individual.”  At the age of 12, participants in the study were interviewed to assess for the presence of psychotic-like symptoms including hallucinations, delusions and thought interference in the previous six months. Those that had moved school three or more times were found to be 60% more likely to display at least one definite psychotic symptom.  READ MORE

What’s the takeaway?  That being a consistent, extravagantly affectionate, radically attached parent who works hard on your marriage is the best way to give your child everything he or she needs to be mentally and emotionally healthy, not just from a psychological perspective but from a neurophysiological perspective as well!

For more information on how you can give your child every emotional and psychological advantage in life, check out Parenting with Grace:  A Catholic Parents’ Guide to Raising (almost) Perfect Kids (2nd ed rev.) and Beyond the Birds and the Bees:  Raising Sexually Whole and Holy Kids today!