Health Practitioners

Why we need our 40 winks.

 

young sleeping woman seeing sweet dreamsProlonged loss of sleep either from anxiety or shift work is one of the prime causes of depression. Insomnia is also a major symptom of the disorder.

 

It is thought that all animals sleep, although some marine mammals such as the Porpoise, Bottlenose Dolphin, Beluga Whale and Pilot Whale and a variety of birds can put one side of their brain to sleep whilst the other remains active.

 

During sleep most animals are in an increased anabolic state with increased growth and rejuvenation of the immune, skeletal, muscle and nervous systems.

 

It is also thought that sleep is also a very important step in the process of  allowing new memories from the day to be laid down into storage.

 

 

Another reason has been found and reported in Science in October 2013.

 

Researchers showed that’s during the day waste products build up in the spaces between brain cells. These include proteins such as amyloid and tau proteins which are associated with neurodegenerative diseases such as Alzheimer’s Disease

 

Their study showed that in mice the flow of Cerebral Spinal Fluid (CSF) through the brain is increased by 60% during sleep thus bringing about an greater reduction in these dangerous wastes.

 

 

 

Science. 2013 Oct 18;342(6156):373-7. doi: 10.1126/science.1241224.

Sleep drives metabolite clearance from the adult brain.

Xie L1, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O’Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M.

 

 

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The Effectiveness of Internet CBT

The Effectiveness of Internet CBT

The Effectiveness of Internet Cognitive Behaviour Therapy (iCBT) for depression in Primary Care : A Quality Assurance Study

Alisha Williams Gavin Andrews.
PLoS ONE 8(2): e57447. Doi:10.1371/journal.pone.0057447

There are at least 25 controlled trials that show the efficacy of internet CBT.
Meta analyses of RCTs of iCBT for depression have shown evidence that it is comparable to best practice face-to-face CBT.

The Williams and Andrews research, which was carried out at St Vincent’s Hospital Sydney, looked at whether iCBT was effective in clinical primary care practice, not just in the confines of randomised control trials.

Patients were referred by their GPS to enrol in the Sadness Program of the CRUfAD clinic. Approximately 75% of referrals comprised mild to moderate levels of depressed mood as the doctors were advised the program was less likely to benefit patients with very severe presentations (depression, persistant suicidal thoughts, drug and alcohol dependence, schizophrenia, bipolar disorder and those taking benzodiazepines or atypical antipsychotics).

The doctor was alerted if the patients’ Kessler-10 (K10) Psychological Distress Scale indicated elevated distress or the patient indicated suicidality on the Patient Health Questionnaire (PHQ).

The Sadness Program consists of 6 online lessons of best practice CBT and regular homework and access to other resources. Within the program the patient has to complete a lesson before moving onto further lessons, then wait 5 days to complete homework tasks and review the materials. All patients have 10 weeks to complete the program and are encouraged to complete the lessons at a pace of one lesson per fortnight.

Data was collected from 359 patients between October 2010 and November 2011. The mean age was 41.59 years and 59% were female. 54% were from a rural or remote community.

Outcome was measured using the Patient Health Questionnaire (PHQ-9), Kessler-10 (K10) Psychological Distress Sacle and the WHO Disability Assessment Schedule (WHODAS-II). Clinically significant change was defined in 3 ways.

1. Remission when a post treatment score was below the cut off for probable diagnosis of depression.
2. Recovery when there was reduction of at least 50% of pre-treatment PHQ-9 score.
3. Reliable improvement, which was defined as a decrease of at least 5 points and a change of severity category such from moderate to mild.

RESULTS

359 patients enrolled

26.5% were within the 0-9 sub-threshold range
26% were mild
23% were moderate
17% severe
7.5% very severe.

194 (54%) completed all the 6 lessons.
113 (32%) completed 4 lessons (Non completers)
52 (15%) completed 1-3 lessons , (Dropouts).

The risk of non completion was not related to gender of the patient, the profession of the referrer (e.g.GP, Psychologist, Nurse), or to the geographical location of the patient . Completion was however related to the age of the patient where the older the patient the more likely s/he was to complete the program.

There was a significant reduction in scores in all 3 measures for those who completed the course.

• 112 (31%) of patients admitted to suicidal thoughts during the program. The majority of these 53% completed the program. 68% completed at least 4 lessons. Suicidal thoughts were not found to be a barrier for improvement from treatment.
• 91 of 144 (63%) patients who met the criteria for depression (PHQ9 >9) who completed all six lessons reached remission .
• 71 of 144 (49%) patients showed evidence of recovery (at least 50% reduction in PHQ-9 baseline score)
• 77 of 144 ( 54%) showed evidence of clinically reliable change.

The greatest reduction on K10 scores occurred within the first 4 lessons.
Almost half of the patients (44%) who dropped out after lesson 4 managed to benefit from the program despite non-completion.

This study certainly clarifies the effectiveness of Internet-based CBT. These programs have comparable rates of engagement and outcome and are a very good treatment option in primary care.

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Connecting to Social Groups Alleviate Depression

art classA new research study has shown that developing a strong connection to a social group can help adults to reduce their depressive symptoms and to prevent them from experiencing relapse. This adds on to past research that advocates for interpersonal relationships for improved mood and managing depressive symptoms.

That is, having a sense of group identity (i.e. belonging to a group) as well as engaging in interpersonal relationships will greatly improve your recovery from depression as well as reducing the likelihood of you experiencing depressed mood again.

Haslam, Cruwys and colleagues (in press Journal of Affective Disorders) from the University of Queensland had depressed and anxious patients join groups in the community that focused on activities such as sewing, yoga, sports, art and group therapy. Patients who reported that they did not identify strongly with the social group had approximately 50% likelihood of continued depression one month later. However, those who developed a stronger connection to the group reported that they felt supported by the group and that they were “in it together”. Less than one third of these connected patients continued to experience clinical symptoms of depressed mood.

Know what to do to reduce depressive symptoms? Connect in with your community! It is not only important to relate to other people on an interpersonal level but also to join a group and develop a sense of group identity.

 

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Are you contributing to your community?

aus flagWith it being Australia Day yesterday I thought it timely to write a piece on community and it’s direct relationship on happiness.

International research has shown that happiness can be improved by contributing towards others and the local community. Not only does contributing to the community bring about a greater sense of belonging, it assists in the development of life purpose and meaning. Egocentrism and self preoccupation on the other hand dramatically impacts on negative mood states for the individual and everyone around them.

Many of us contribute to the life of those directly around them including family and friends by offering their services, giving them a helping hand and socially connecting and checking in about how they are going but how many of us contribute to the larger community?

You can belong to 1) yourself, 2) a family, 3) a social network, 4) a workplace or educational institution, 5) a community group, 6) a national community and 7) to the world.

While contributing to the community should not be at the detriment of your mental and physical well-being, finding a way to contribute in a meaningful way without too much consequence is important to well-being and long-term happiness and meaning.

What ways can you contribute to your community? It may be by attending and participating in a community event, it may be about contributing financially to a charity or not for profit organisation or volunteering your services to an organisation or educational institution for an event or on an ongoing basis. At the very least for those that are time or money poor, help someone across the street that needs it or take unwanted clothing to the community clothes bins for people less fortunate.

If you already contribute to your community! Well done and keep it up. The world needs more people like you.

 

 

 

 

 

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The Do’s and Don’ts of New Year Resolutions

New year resolutionNew Year Resolutions are commonly considered and rarely followed through. While New Year resolutions are driven by positive qualities of hope and optimism, they can also be related to a belief that the year brings a “fresh slate” to work from. Common resolutions include saving money and budgeting more effectively, losing weight and/or getting fitter, stopping smoking and attending more to meaningful relationships.

In saying this, resolutions and goals are a worthwhile concept- if considered realistically and with good levels of insight and motivation for change. Cloud Clinic provide the following recommendations for identifying New Year Resolutions that increase the likelihood of change.

  1. Start with reflection and insight: Before planning for the future, reflect on the past year in each important part of your life. For example, taking a “helicopter” perspective, consider your year in the key areas of physical and mental well-being, relationships with important others, work, financial stability, education, etc. Note some positives in your achievements in each of these areas and then list 1-2 areas that require attention or haven’t gone so well.
  2. List possible goals for the New Year: on a separate piece of paper write a list of possible New Year resolutions/goals to be considered from each area of your life.
  3. Consider your motivation for each goal and barriers to change: For each possible goal make notes of the advantages and disadvantages of change in these areas and also make a note about your motivation to change. There is a difference between thinking that it is important to work on this and being ready to commit yourself to action. In fact, research demonstrates that motivation to change happens in different stages that include precontemplation ( limited insight and thought about changing), contemplation (considering the importance of this), preparation (making plans for change), action (implementing the plan) and maintenance (continuing to implement behaviours post the change occurring to make it a routine and way of life). Most people reach the contemplation and preparation stage at New Years without moving it into action and then maintenance. In this section, also consider things that may get in the way (barriers) to changing. These may include finances, a long history of problematic behaviour, dependence on others for support, addiction.
  4. New Behaviours and Routines take months to make: It takes consistency over a period of approximately 3 months to form new routines. For those who do reach ‘action’ stage, most do not continue to implement these changes for long enough for the efforts to pay off. If you are motivated for change, ensure that you are motivated for change over a period of months, rather than thinking that you can take it one day at a time.
  5. Choose 2 goals from your list that a) have good benefits, b) that you are motivated to change, c) that have few barriers and that d) you believe are realistic for you to expect of yourself. Also ensure that these goals are ones that you are willing to follow through on over a period of months.
  6. It is ok to not make resolutions: if the resolution activity is too overwhelming and leaves you feeling anxious, make a more general commitment to a short-term task such as reading a self-help/happiness book, to setting up reminders in your phone to remind you to reflect and do the best that you can do in each area of your life, to calling a friend or contributing to the community for one day, to starting your year off with a clean bedroom, to telling the people that you love that you love them.
  7. Maximise each day for what it brings: the best approach to happiness and well-being is to do the best you can do on each day. Face the challenges that the day brings and approach it with curiosity and willingness to ride any negativity that comes with it. Knowing what is important to you and doing the best that you can will bring about success and well-being.
  8. Remember it doesn’t have to be New Years to set goals for yourself: successful and happy people remain insightful throughout the year and consistently work on the areas that are important to them. Reflect throughout the year and be willing to set goals for yourself as they come up if they are realistic and achievable for where you are at that time in your life.

Cloud Clinic wish you a Happy and Fulfilling New Year!

 

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Older Veterans Benefit from CBT Intervention for Depression

war veteran

The US Department of Veteran Affairs have published a study this month (Nov, 2013) that demonstrates the comparable efficacy for older veterans in the management of depression through CBT as the younger veteran population aged 18-65 years.

This study included 100 older veterans and 764 younger veterans and there were similar outcomes for both populations suggesting an approximate 40% reduction in depression symptoms and scores.

Depression in the older population is associated with reduced quality of life, increased mortality, increased risk and difficulties associated with medical illness and social and environmental difficulties.

Adults from 18 years to well above 65 years benefit from CBT therapy for the management of depressed mood, including in the Veteran population. Motivating the older adult population to seek psychological treatment of depressed mood is a worthwhile goal both for the veteran and general community.

Karlin, B.E., Trockel, M., Brown, G.K., Gordienko, M., Yesavage, J., & Taylor, C.B. (2013). Comparison of the effectiveness of cognitive behavioral therapy for depression among older versus younger veterans: Results of a national evaluation. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences

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THE BLUE BRAIN PROJECT

 

Dr Keith Roberts recently attended the ENCP ( European College of Neuropsychopharmacology) Congress in Barcelona.

 

Researchers and clinicians from around the world gathered to hear the results of some of the most advanced research in neuroscience.

 

The keynote speech was given by Prof Henry Markram from the Blue Brain Project of the École Polytechnique Fédérale de Lausanne Switzerland.

Henrymarkram
This project aims to reconstruct the brain using supercomputers.

The project started in 2005 and as the first step the project succeeded in simulating a rat cortical column. These neuronal networks consist of approximately 10,000 neurons. They are around the size of a pin head. They occur repeatedly throughout the brain. A rat brain has around 100,000 columns. The human brain has many many more.

 

Each cortical column appears to be allotted a single simple role. For example in the rat brain one specific column is devoted to each whisker.

 

It takes 20,000 experiments to map a neural circuit. The human brain consists of around 86 billion neurons with 100 trillion synaptic connections. It would be impossible to map these out using routine experiments.

 

What the Blue Project intends to do is to understand the building blocks of the brain, the neuronal columns, and using statistical simulations predict the way the neurons combine and function, and compare these simulations against real data from biology.

 

Many in the field doubted whether this was possible or realistic but recently the Blue Brain project was funded by the European Union to the tune of 100 million Euros.

 

The aim of the research is further understanding of the brain.

This, it is hoped, will lead to better medications and treatments for brain illnesses including addictions, depression and schizophrenia.

 

There is also another thread of research that hopes to point in another direction. That is to change the architecture of computers to be more like a brain, with the aim of producing a computer which works much quicker than a brain but uses far less energy than today’s supercomputers.

 

 

The Blue Brain Project can be compared to the Human Genome Project, which mapped 3.3 billion base pairs making the 20,000 to 25,000 genes within our chromosomes. This too was initially thought to be overly ambitious. However the task was completed 5 years ahead of target and costs involved dropped significantly. Much basic science has been discovered about our genes but the hope for personalised medicine held out by many is still some way off in the future. Probably the benefits of the Blue Brain Project will be profound but distant.

 

 

There was recently  a very informative newspaper article in “The Guardian” about Prof. Markram and the Blue Brain Project.

http://www.theguardian.com/science/2013/oct/15/human-brain-project-henry-markram

The Blue Brian project made an introductory video to explain their work.

 

HBP-videoverview from Human Brain Project on Vimeo.

There is also a 10 year project to make a series of documentary films on the project.

Currently the latest film is “Year Three”

http://bluebrainfilm.com

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Accepting what you can’t change- managing stress

acceptanceTrying to fix a problem isn’t always the right approach! While problem solving is a good approach based coping style for situations within your control, preoccupying your mind and efforts with a need for change in situations outside of your control is not helpful!

That is, change the situations that you can but work towards accepting the situations that you can’t! Perseverating on issues outside of your control with negative thoughts and ongoing efforts for change will only reinforce a sense of hopelessness and negativity.

Accepting a situation doesn’t mean that you are ok with it happening in the first place. It simply means that you are acknowledging that it has either happened or that it is happening outside of your control and that given that there is nothing you can do about it, there is no positive function of getting emotionally involved and enmeshed with it.

Focus your attention on the things that you can change! Remember that goals for change should follow the SMART acronym that includes the goal being achievable.

What is going on in your life that you would be best accepting rather than ruminating negatively about? Maximise the potential of your day by not involving your mind in negative situations or stressors and focusing on being calm and accepting that situations happen outside of your control.

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Thinking Errors that Impact on Negative Mood

sad face

The Cognitive Model of depression states that it is not necessarily the situation that affects the way we feel and behave but our thoughts about it. Challenging our thoughts about a situation so that they are both rational and healthy has been found to significantly improve mood and better manage depressive symptoms.

Below is a list of the thinking errors that individuals tend to make when evaluating a situation. Read through the list and identify 2-3 thinking errors that you tend to make the most. Next time you are feeling depressed, anxious or angry, identify your thoughts about the situation and the types of thinking errors that you have made.

Awareness is the first step towards change!

Mental Filtering: Focusing on the negatives and filtering out the positive
Catastrophising: Over-exaggerating in a situation
Black and White Thinking: People who are black and white (all or nothing) in their thinking might see a situation as being either good or bad, positive or negative.
Can’t Standitis: Inability to tolerate situations that are either undesireable or unpleasant.
Personalising: Blaming yourself for a negative situation
Mind Reading: Thinking that you know what people are thinking
Labelling: Calling yourself negative and unhelpful names instead of focusing on the facts of the situation.
Unfair Comparisons: Comparing your own situation to someone elses that has some kind of advantage or better situation than you do.
Overgeneralising: Drawing an overall negative conclusion based on one specific situation. An overgeneraliser will often make comments in terms such as “always”, “never” when really only referring to one specific piece of evidence about one isolated situation.
Emotional Reasoning: Emotional reasoning refers to the tendency to believe that if one feels a certain way it must be true.
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Core Strength for Emotions- Attending to the Basics for Greater Emotional Resilience

family at beach

This week I am on the Gold Coast with my family, a place I visit 3 or more times a year during school holidays. Aside from the convenience of the short 1 hour flight with two children under the age of 4, my husband and I have developed an appreciation for everything that the Gold Coast offers us- and most of it comes down to simplicity and calmness. We both live very busy lives parenting two young children and working full time hours and holidays are always a time where we need to maximise the break and our ability to refuel.

Today’s society works harder than ever before. Working hours are longer, the drive to succeed seems stronger and the juggle of career, health, family, friendships is increasingly more hectic. Stress, anxiety and depression rates have hit world record highs with more than 50% of the population experiencing emotional difficulty at some point in their life.

Substantiated in International research is the evidence that as humans we cannot be emotionally resilient and well if we are not attending to our basic primal and physiological needs. That is, without adequate nutrition, sleep and physical health we cannot survive, let alone be emotionally well.

I come home from the Gold Coast after each trip being at my peak of emotional resilience. I would like to share with you my own personal holiday formula for emotional resilience because I think it is embedded in International research and is what underpins a lot of the work that I do with my clients experiencing significant levels of stress, anxiety and/or depressed mood. It is usually the base from which deeper and effective therapy can work successfully.

  1. Focus on the Basics- a simple life: Satisfaction and positive emotion can come from the simple things in life. You don’t need a huge achievement or a new asset to be happy. The basics of the Gold Coast that I enjoy most are: moving at a slower pace, the sun, swimming in the ocean, a fresh meal, watching my children play in the sand, having time to connect with quality to the people I love
  2. Physical Health: exercise directly impacts on mood management and significantly reduces stress and anxiety and improves mood. Exercise obviously needs to be tailored to your individual ability- with the Gold Coast having nice flat paths along the ocean, I am enjoying a 25-30 minute jog along the beach each morning. While I like to jog, a walk would be just as helpful!
  3. Nutrition: I don’t believe in an all or nothing approach to health as it is unsustainable and unrealistic. A very clever woman called Teresa Cutter (The Healthy Chef) talks about an 80/20 approach to nutritional health that I adopt as being ideal. That is, 80% of the time eat the foods that fuel your body and 20% of the time allow yourself to indulge in the foods that you like that might not be so healthy. For example, my dinner last night was a fresh piece of fish with salad and chips. From my perspective the nutrition goal for emotional health is not to be strict and eat to lose weight but rather to eat the foods that will appropriately fuel your body and give you the energy to engage in activities and be well.
  4. Sleep: Sleep also directly impacts on emotional resilience and is a significant contributor to depression, anxiety and stress. I once came across a graph that suggested that the first 6 or so hours of your sleep are designed to refuel your physical health and the last 2 hours assist in emotional health and refueling. While I am away on leave I aim to get 9 hours sleep (rather than my 8 hours at home) in an attempt to rest as much as possible. It is important to add however that oversleeping can also negatively affect mood- 8-9 hours is ideal for adults.
  5. Connecting to Family and Close Friends: Research consistently demonstrates how important unconditional love is for psychological wellness. Love can come from your biological or other family, from your partner, with your children, with friends, etc. Many of my clients struggling with their mood want something more in their relationships- either with the people they are in a relationship with or that they want new relationships formed. While there will always be an ideal, maximising the relationships you have and care about is important- it might be with a niece or nephew, with a parent, a friend, your partner or a cousin. On the Gold Coast I am keen to maximise my relationship and connection with my husband, my two children and a few friends that are meeting us on our holiday. This connection doesn’t need to be out doing something exciting- so far on this trip my most successful connection moment has been sitting on the beach all digging a sand pool for the little ones to paddle around in.

Emotional resilience requires a base of physical wellness and connection with others. Start your journey of wellness by focusing on the simple things in life that are essential to life including sleep, exercise, nutrition and connecting with others. This will be the platform from which better self-esteem, life enjoyment, excitement, deep relationships and success can spring from.

 

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