Could we devise one mental health treatment for many counseling problems? Given that so many problems have similar symptoms (anxiety, mood dysregulation, vigilance, intrusive and unwanted thoughts, etc.) and appear to involve common neurobiological processes (limbic systems), might we be able to find a single treatment for multiple expressions of problems?
David Barlow and others say yes.
The Renfrew Center (an eating disorder clinic) publishes Perspectives: A Professional Journal of the Renfrew Center Foundation, a free journal. In their Winter 2011 issue they have a brief article by David Barlow and Christina Boisseau about a new “transdiagnostic unified treatment protocol” (UP) that can be applied to all anxiety and depressive (and eating) disorders. Let me summarize a few points from the article:
- 70 to 80% of clients with eating disorders also have anxiety disorders, 50% meet criteria for depression
- A number of anxiety and depressive disorders have emotional dysregulation as a central theme
- Etiology of these diagnoses may be best accounted for by “triple vulnerability theory”: biological vulnerability to negative mood…early negative childhood experiences due to attachment issues or unpredictable environment leading to an elevated sympathetic nervous system…and psychological learning from an event focusing on a particular issue (anxiety, panic, observation of parent’s panic, etc.)
- The Unified Protocol (UP) focuses on “the way that individuals with emotional disorders experience and respond to their emotions” (p. 3). UP consists of 5 core modules
- emotional awareness training (focus on “nonjudgmental present-focused awareness”)
- cognitive reappraisal (“identifying and subsequently challenging core cognitive themes”)
- emotion driven behaviors (EDB) and emotional avoidance (identifying maladaptive EDBs, learn new responses and avoid avoiding emotions)
- awareness and tolerance of physical sensations (self-explanatory…as they relate to emotions)
- emotion exposure (“…goal is to help patients experience emotions fully and reduce the avoidance that has served to maintain their disorders(s)”)
- These modules are flexible and shaped to the individual needs of the client
Obviously, there is much work to be done to validate this protocol but it makes sense. You can see the CBT foundation but also a greater focus on emotion rather than cognition.
Those interested in the full text and references can find it here!
Hadn’t read my Monitor on Psychology (Feb 2011 edition) til this morning and saw that the cover story is on the possible rise of narcissism in young folk these days. Now, this magazine is popular and doesn’t go too deep into reporting on research…and I haven’t followed up on the studies to read them for myself, but…
- one study has 80% of middle school students scoring higher on self-esteem in ’06 than ’88
- Another shows an increase in the lifetime prevalence of NPD
- However, no nationally representative samples comparisons have been done to really shed light on whether a rise is truly taking place
- One meta study of 85 studies (between ’82 and ’06) suggests an increase of narcissism among college students
The article goes on to muse about whether materialism and social networking lead the way toward narcissism but also wonders whether the decrease in availability to easy credit will lower the self-promoting trend a bit.
In an ironic twist, it appears that the DSM 5 may not include NPD as a diagnosis. Rather. It will include a more general diagnosis (see below taken from the DSM5.0rg site). Strangely, one of the “types” is NOT narcissism.
The essential features of a personality disorder are impairments in identity and sense of self and in the capacity for effective interpersonal functioning. To diagnose a personality disorder, the impairments must meet all of the following criteria:
A. A rating of mild impairment or greater in self and interpersonal functioning on the Levels of Personality Functioning.
B. Associated with a “good match” or “very good match” to a personality disorder type or with a rating of “quite a bit like the trait” or “extremely like the trait” on one or more personality trait domains.
C. Relatively stable across time and consistent across situations.
D. Not better understood as a norm within an individual’s dominant culture.
E. Not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
A student of mine (thanks Andrew!) pointed out this essay about the future DSM in Wired magazine. Sometime in the next 2 years the American Psychiatric Association hopes to release version 5 to replace version IV-TR. Yes, they are doing away with roman numerals.
For those of you not in the counseling world, the DSM is what professionals use to diagnose mental health disorders. The original DSM was first published in 1952 and totaled 132 pages including appendices. Version IV-TR totals a whopping 942 pages. In it’s best form, the document enables professionals to communicate to each other about the symptoms of their clients. Further, individuals with a combination of symptoms may find that diagnostic criteria helps them understand that others have similar problems and can give some hope to finding effective treatments. From an economic standpoint, receiving an axis one diagnosis enables those with insurance benefits to receive some financial assistance in their treatment.
And while this document is founded upon scientific research and years of clinical expertise, the DSM is in no way free from politics. When the DSM moved from a psychodynamic view of illness (illnesses were couched in terms of their “reactions” from problems) to a supposed atheoretical, descriptive view of illness, certain diagnostic labels were kept. In the words of Theodore Millon (said at a seminar I attended), labels such as Borderline Personality Disorder were kept because, “We’d taken everything else from the analysts and so we kept that unfortunate label so they wouldn’t feel so bad.”
So, with the above in mind, take a read of the current political controversies surrounding new diagnoses and the problems with pediatric bipolar diagnoses. If you haven’t time to read the whole article, be sure to skip to the bottom and start reading after the photo of artistic renderings of heads. Read from there to the bottom. It gives you a view of the controversy.