Posted in advocacy, psychology, science

Mental Health Month: OCD and Related conditions

We’re in day two of our Mental Health Month series where we discuss different DSM-5 diagnoses and the research behind them. Today we’re talking about Obsessive Compulsive and Related Disorders, including Body Dsymorphic Disorder.

What is Obsession?

Let’s distinguish the difference between being obsessed with something and obsession ruling your life.

If you have an obsession with Michael Kors, you probably don’t have a condition.

If you have an obsession with, like, that one show that, like, you stream on Netflix, you probably don’t have a condition.

If you had to touch all of the buttons, one by one, on the television, the remotes, the kitchen appliances, the computer, before you leave the house to prevent a house fire, and this becomes so disruptive you leave the house only twice a week for essentials (even when NOT in a pandemic), then you might think about searching for some support.

But OCD (obsessive-compulsive disorder) is not the only condition that exists under this category. There is also:

1.Body Dysmorphic Disorder

2.Hoarding Disorders

3.Trichotillomania (hair pulling)

4. Excoriation (skin-picking)

5. Substance/medication-induced obsessive compulsive and related

6.Obsessive-compulsive and related disorder due to another medical condition.

7. unspecified obsessive-compulsive and related disorder (like obsessional jealousy).

Is Hoarding Like That T.V Show?

Hoarding gained a lot of popularity after A&E came out with their show HOARDERS, which follows the lives of extreme hoarders, often living in squalor beneath their belongings. The people featured are often reluctant to get rid of their material items because of an obsessive emotional attachment to them. This doesn’t just extend into beautiful or valuable items, like a porcelain doll or an antique speaker; most people will be hard-pressed to give away something that has some semblance of importance or function. For the people on hoarders, even garbage or blankets covered in rat droppings and urine are part of their livelihood, either because of memories or because of the simple fact that that item, along with all the other items in the house, fills a void.

Indeed, those with Hoarding Disorder have “persistent difficulty discarding or parting with possessions, regardless of their actual value”, per the criteria of the diagnosis. That difficulty leads to an “accumulation of possessions that congest and clutter active living areas”, much like what you see on Hoarders. This causes “distress or impairment” in all areas of functioning.

We also see a variety of personalities on Hoarders. Some people have what the DSM calls “good or fair insight”. They recognize their hoarding has been causing problems, but feel both trapped and safe among their things. Some people have “poor insight”, in that the clutter isn’t viewed as problematic. As we see in the television show, some people with this level of insight will accept help but fight against losing too much stuff. Some revert back into their old ways after the trauma of losing things all over again. Those with “absent insight/delusional beliefs”, are absolutely convinced nothing is wrong–yes, to the extent of delusion. These are the people you see who halt the process in the show, and the house or yard is cleaned only in a hundred square feet or so.

These behaviors may be related to the temperament of the person, indecisiveness being a leading trait, and also related to some traumatic or stressful event that exacerbates the behavior. Let me give a personal example.

When I was 11, we lived in a two story, two bedroom apartment next to a registered sex offender and across from a drunken, drug-addled manager. My dad, a musician, also spent most of his free time drinking or working on cars, and it was only a matter of time before him and the manager got into an irreparable fight. The problem is, she was the manager and we were the tenants; her words against ours to property management meant nothing. We were evicted.

My parents’ credit was in the tank, and we were not rich, so no other apartments in town would take us and we bounced around from hotels, to a tent, to rooms in houses of family friends—that doesn’t sound terrible, but three years of much more drugs, alcohol, and uncertainty (in every place we stayed) isn’t all that fun.

A two-story, two bedroom apartment can hold a lot of stuff. Everything in my room except important papers and one hand-me-down banana republic plastic shelf went in the dump–bed included. We didn’t have enough space for all my stuff and my parent’s stuff in the small storage locker we rented, so we sacrificed most of our belongings.

I noticed I started clinging to things later when we finally got another apartment. I picked up stuff from the street I didn’t need–like broken street signs, discarded car review mirrors, desks, and even a bent reflector. I kept that bent reflector for ten years. In fact, I kept all of it for ten years. My closet is still full of junk I picked up from the street or things I thought were valuable from the dump. My room itself is cluttered, disorganized, and it took three years of picking through invaluable things with perceived value to keep at least two feet of walk space from my bed to the door. I still haven’t learned how to organize.

This example doesn’t mean I have Hoarding Disorder. I only share this to show that obsessions with material items don’t make people vain or stupid or rude. Loss and grief of any kind can make us cling to whatever solid, certain, undying thing we can find.

I don’t know how much of A&E’s Hoarders is dramatized for television. Sometimes it seems the film is edited to make the people look disgusting and defeated, and then a sob story told to make us feel pity. At the end we’re supposed to feel amazed the house is clean or disappointed in the person if it’s not, without recognizing the uniqueness of each individual’s process. All in all, the people are real. I don’t know about the show, though.

Is Body Dysmorphic Disorder Real?

Yes.

In fact, it’s the first disorder listed in the category. People struggling with this perceive a defect or flaw in their appearance that seems slight to every one else but causes severe preoccupation for the sufferer. This could cause people to go to drastic measures to fix this flaw–which may include several cosmetic plastic surgery interventions, or cause them to remain indoors, trapped behind the fear that everyone will see, ridicule, and be disgusted by their flaw. This is not the same as being preoccupied with ones weight, and it cannot be Body Dysmorphia if the symptoms of an eating disorder are present.

This is linked to people who have relatives with OCD, and has been seen correlated with high rates of childhood neglect and abuse. Females are more likely to have a co-morbid (occuring at the same time) eating disorder and males are more likely to be preoccupied with their genital region. What does all of this mean?

It means life is a living hell. Being in the view of others causes such distress there are people who hide behind their curtains, in their house, for years. And this is, again, not a vain “omg nobody look at me”. This is such a level of heightened anxiety that an entire life is disrupted. I feel that many obsessive conditions get looked at as people being selfish: the person living with OCD can’t take care of their child because the compulsions take up most of the day–that means they don’t care about their kid enough. Or the people with Trichotillomania has pulled a bald spot on their head, but then complains about being nervous of others seeing the bald spot–they need to just stop pulling their hair. And things just aren’t that simple. None of this is vanity or selfishness, it’s anxiety, it’s stress, it’s trauma response.

Here is a great Ted Talk by Meredith Leston that highlights how body image is spread in the world and how troublesome views can lead to great distress and disruptive conditions for some people. Let’s remember: our environment plays a huge role in dictating which genes turn on and off. Everyone has the potential to develop a mental condition at some pointing their life. Why it happens to some and doesn’t to others not only depends on environment, but social factors and genetic make up too. Not so much brain chemistry.

If anyone watched Barcroft on Youtube, you might like this clip on Body Dysmorphia and OCD. I tend not to watch them too often, but sometimes they have okay material. Let me know how real or not real this is.

What Kind of Treatment is Available?

For some of these conditions, like Trichotillomania, there are no drugs that reduce symptoms. Even in cases of severe OCD, psychotropic medications fail miserable. This is a testament to how much we still don’t know and why some researchers are putting more weight on alternative treatments and Cognitive Behavioral Therapy, the only psychotherapy which has been tested (with high reliability AND validity) and proven to change the course of people’s thoughts.

This Double-blind, placebo controlled, Cross-over study examined the possibility for Milk Thistle as a treatment for Trichotillomania. They concluded their sample size too small to yield any confident results, and that their evidence only weakly supported the use for Milk Thistle.

This placebo study with Trichotillomania only further showed that 1) change is possible depending on expectations of the participant and 2) easy access, simple treatments for this condition remain elusive and the condition reminds misunderstood on a clinical level.

I will say that OCD itself gets a lot of research while these other disorders fall short of people interested in finding treatments. For OCD there is a long list of possible SSRI treatment, ECT treatment (if you don’t mind losing your memory), different therapies, stimulants, and even EMDR. This is why I speak on the disorders we don’t hear much about. Because for the rest of these unknown, quiet, hidden disorders, sloppy therapy and hopeful medication are thrown at patients. Many suffer in silence.

For a condition like Body Dysmorphic Disorder, other alternatives are being studied too. This experiment examines whether an intranasal dose of Oxytocin could cue a helpful response for BDD. This too failed. It increased self-blame and “other-directed blame”, and the researchers “advise against the use of Oxytocin in BDD patients”. Glad science kept us from THAT mistake.

But, for those diagnosed with BDD and Social Anxiety disorder, this study found that Cognitive Behavioral Therapy and attention retaining significantly improved the Body Dysmorphic aspect of the participants life.

There is some progress.

What can we do?

If someone comes to you and tells you they have been struggling with one of these conditions, withhold whatever your initial reaction is. Remind yourself that many who struggle with these types of conditions blame themselves enough. Even those who don’t blame themselves may still feel guilty for the disruption it causes their lives. I feel guilty sometimes for the disruptions my anxiety and Schizoaffective-ness has caused in my life and others lives.

Remember that they are not disgusting or vain or weird. Remember that there may be a whole list of trauma you’ve never learned about. Remember that even clinicians don’t understand this, probably because they’re trying to understand it on a biological level too much–some things need a different perspective in life.

So, this Mental Health Month, let’s keep in mind that there is a lot of suffering going on right now. Let’s not compare our pain to others, but instead use that energy to remind each other we’re not as alone as we feel. If you are suffering in silence, may this space give you the extreme–almost inhumane it feels sometimes– courage it takes to send a text, or call to someone you can trust. You can comment on this blog even, or contact me on my home page; eventually the burden of silence will hurt your back. It’s damn near broke mine before.

I write these posts in this format because I’m tired of articles listing symptoms, bland, over-used, understudied treatments, and urging people to talk to their doctor. It’s a good idea sometimes to seek professional help, but to do so uneducated and so desperate for relief that you’re unable to look at things critically will only trap you in the quantum loop that is the mental health system, especially if you’re in America. Mental Health Month is about education and reducing stigma. We can’t do that if we don’t preach from the side of lived experience AND scientific research.

Tomorrow we cover: Trauma and Stressor related DIsorders.

Next week, we cover: Schizophrenia, Bipolar, and Dissociative disorders. If you’d like to submit your story for any of these, please contact me HERE, or on my social media handles below:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.

Posted in advocacy, Community, Peer Support, Supporting Friends/Family, Voices

Broken and Crippled by Mental Illness

*A featured personal story for this MENTAL HEALTH MONTH series.

Some months after my relationship with the boys’ dad ended, I had what can only be described as a ‘break down‘. And that’s exactly what it felt like because, both physically and mentally, I was broken.

Anxious About Anxiety

I started to get these odd sensations; I could feel my heart thumping out of my chest and could hear it pounding in my ears. Lots of jumbled and disturbing thoughts races around in my head and I felt scared all the time, so I was constantly jittery. I was anxious about being anxious again and much of the time I felt like I was on the world’s longest and biggest rollercoaster.

Sometimes, there was so much adrenaline buzzing through my body, my nerves were jangling, and I couldn’t sit still, so I’d pace around my home. At other times, I felt exhausted or gripped vice-like with sheer terror so I couldn’t move.

Drowning in Quicksand

I was having what I now know to be panic attacks – throughout the day and particularly at night keeping me awake until it was time to get the boys ready for school. It felt like how people explained having a heart-attack. My fingers and toes were tingling, and I could feel the colour drain from my face. I was finding it hard to catch a breath it felt like I was drowning in quicksand, so I’d lie rigid until it passed, knowing it would be followed by another, and another.

It was torturous, twenty-four-seven, week on week and with no end in sight, I wished I was dead. Although close friends and family were aware of the break-up, I couldn’t tell anyone what was going through my head, scared they’d think I was mad and that I should be locked away. This was to continue for around eighteen months.

Help was on it’s Way

I’ll be eternally grateful that our GP eventually noticed and taking me aside, he urged “Tell me, what’s the problem? You’ve lost so much weight and though you smile, I think you are very sad.” Once I’d explained and told him that I was devastated by the break-up, he was able to get me to immediate counselling. He actually drove me to our local hospital where he knew the Psychiatric Team.

Fortunately, although I had suicidal thoughts, the psychiatrist and his team were confident that I had no intention of killing myself. I’d told them I knew I couldn’t do that to my sons. I couldn’t possibly leave them with that legacy. Three years of painful weekly counselling followed.

Return to Study

I was on the road to recovery when I realised I wanted to study but I wasn’t sure I was clever enough and I wasn’t sure what to study. I thought I’d test the water and start small, so I took evening and weekend courses in Shiatsu. This was quickly followed by Swedish Massage, Seated Massage, Aromatherapy and finally, Indian Head Massage, where I was trained by the blind guy who invented it (Narendra Mehta). I loved it and so too did my family and friends who I practised on.

I had the massage table, the massage chair, lots of fluffy white towels and a full kit of aromatherapy oils. However, despite passing my exams with distinction in all the above types of massage, I just couldn’t charge anyone. I didn’t like asking for money so all I asked in return was a fluffy towel or an aromatherapy oil.

In February 1997 I learned I was about to be made redundant again, which was fantastic as I’d seen a large advert in the Evening Standard looking for General Nurses to study at my local University and Hospital. This didn’t so much interest me but, right at the bottom of the ad, there was a few lines about becoming a Mental Health Nurse. It felt right, and I believed that my own experience of mental illness would help to make me a good mental health nurse.

My Recovery

So, during my recovery from, what I learnt was, a lengthy psychotic depression, anxiety, panic attacks, and anorexia, I applied to train as a Mental Health Nurse. After three long years of study, I worked successfully as a Mental Health Nurse in various settings before becoming a Ward Manager. I had the honour of meeting thousands of people who shared their chaotic and difficult life stories with me, possibly for the first time ever. I always felt humbled by their often-fraught experiences and journeys through mental illness.

Now Physically Disabled:

I remain extremely passionate about raising mental health awareness, I’m a determined advocate of mental illness and continue to fight the stigma, the social exclusion and discrimination that come with it.

As one person I cannot change the world, but I can change the world of one person.” – Paul Shane Spear

“Think of the enormous impact if just ONE PERSON improved the world of just ONE PERSON. That alone might change the world. And everyone in the world would be part of the change.” – Samuel Rozenhider

A big THANK YOU to Caz for her willingness to share her story about moving through anxiety. Catch her at THESES LINKS:

For tips on anxiety and panic attacks, you can use my link, here: https://mentalhealthfromtheotherside.com/2020/01/17/10-quick-and-easy-coping-techniques-for-anxiety-and-panic-attacks/

Or use my home page, here: https://mentalhealthfromtheotherside.com/

My twitter feed, here: https://twitter.com/hannahsmiley

Pinterest boards, here: https://www.pinterest.co.uk/pin/800444533760600123/

Read more about today’s anxiety diagnosis and research post for Mental Health Month

Posted in advocacy, Community, psychology, science

Mental Health Month: Anxiety Disorders

Today we start our Mental Health Month series. As a short recap: every Thursday, Friday, and Saturday this month we will be covering different DSM-5 diagnoses, recent research, and featuring personal stories from YOU. This week we’re covering Anxiety disorders, OCD and Related Disorders, and Trauma and Stressor Related Disorders. If you want the FULL LINE UP, click HERE. If you want to submit your story, CONTACT ME, or find my social media handles below.

Now that that’s over, let’s get into today’s topic: ANXIETY DISORDERS.

What Is Anxiety?

We all know feeling anxious isn’t uncommon. It’s simply our body’s natural response to stress. If you look at the state of the world right now, it’s not surprising pharmacies were running out of anxiety medications.

So far, we believe this stress response prompts waves of catecholamines (neurotransmitters like dopamine and epinephrine) which give rise to our flight-or-fight response. From an evolutionary standpoint, this may come in handy if you’re scrounging for food in tiger territory. From a modern standpoint, our sympathetic nervous system is constantly bombarded with new information and new things to worry about. From an epigenetic standpoint, your resulting anxiety from this overstimulation influences the on-off switch in the genes of your child, creating a world of ever-more-anxious, alert, frightened children.

There’s no definitive proof for any of these hypotheses. There is evidence suggesting all sides, and more, but studying humans is hard and concluding one idea over the other might not be practical. Please do not take this ambiguity lightly. Most people want to agree with one of the three hypotheses listed above because it just makes sense to them. This is a trap of confirmation bias.

I find that anxiety becomes a fear of the future, a fear that the present could not possibly (or will exactly) lead to the future, and a fear that the past has ruined the future; anxiety, today, is a summation of fears.

Let’s talk about what happens when this becomes debilitating.

What Is An Anxiety Disorder?

Let’s first consult the DSM-5:

It states, “Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances.”

Not vague at all, right? You’ll learn much of the DSM is vague and simple in a convoluted way that makes diagnosis tricky: much of it is based on the subjective interpretation of the clinician.

There are 11 total anxiety diagnoses in the DSM-5:

1. Separation Anxiety Disorder

2. Selective Mutism

3. Specific Phobia

4. Social Anxiety Disorder

5. Panic Disorder (with panic attack specifier)

6. Agoraphobia

7. Generalized Anxiety Disorder

8. Substance/medication-induced anxiety disorder

9. Anxiety disorder due to another medical condition.

10. Other specified anxiety disorder

11. Unspecified Anxiety disorder

For the sake of the attention span of the average person (including me), we’re going to list the criteria of two of these diagnoses in depth so that you may see how they are broken down.

Let’s run through criteria, and then we’ll talk “causes” and treatment.

Selective Mutism

For this diagnosis, you must have the following (criteria summarized for all of our sake):

A) Consistent failure to speak in situations where there is expectation to do so, like at school.

B) Interferes with education, occupational, social achievement and communication

C) Lasts at least one month.

D) Not attributed to a lack of knowledge or comfort with the spoken language.

E) Not better explained by a communication disorder and does not occur during the course of autism, Schizophrenia, or another psychotic disorder.

These kids will speak in their homes with their immediate family but not with close friends or second-degree relatives—like grandparents. They “refuse” to speak at school, so says the DSM, although I’d argue it’s much more like an anxious reflex, this coming from someone who had this diagnosis; the anxiety is so severe the only option is for the child to shut down.

This also can include “excessive shyness, fear of social embarrassment, social isolation, and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or mild oppositional behavior.” It is a “relatively rare disorder”, usually appears before 5 years old, but it may not be obvious until the child enters school. The long-term of this disorder is unknown, and “clinical reports suggest that individuals may ‘outgrow’ selective mutism.”

This next line is what happened to me: “In some cases, particularly in individuals with social anxiety disorder, selective mutism may disappear, but symptoms of social anxiety disorder remain.”

Temperamental factors are not well identified. Environmental factors, such as parents modeling social reticence, can contribute to the development of selective mutism. This may include controlling parents or overprotective parents.

Genetic factors: nothing identified.

Social Anxiety Disorder

For this diagnosis, it’s exactly what you think and some of what you may not have thought of. These criteria have a longer list, so I will summarize in a paragraph:

There must be obvious anxiety about social situations when the person is exposed to possible scrutiny of others, like meeting with unfamiliar people. In children this must be observed with peers and not just adults. The person fears showing anxiety symptoms which could be judged negatively. Social situations always provoke fear. In children, this maybe seen as crying, freezing, tantrums. These situations are avoided or endured terribly—very terribly.

Of course the fear must be deemed out of proportion to the actual threat of the social situation. This lasts for six months or more (like my entire life) and influences impairment in social, occupational, and other areas of life. It’s not attributed to substance use or other medical conditions, and can’t be explained with another disorder.

Apparently, “the duration of the disturbance is typically 6 months” and so I would like a refund please—24 years and counting.

It’s seen that individuals with this disorder might be poorly assertive or excessively submissive or even highly controlling of the conversation. They might not use a lot of eye contact—so parents, don’t worry, your anxious child probably does NOT have autism. They may be withdrawn, and disclose very little about themselves, or speak with an overly soft voice.

They may live at home longer.

Self-medication is common.

The median age of onset is 13 years old. If that average were taken with kids also diagnosed with Selective Mutism, the median age, I’m speculating, would be much lower.

Temperament: The trait of behavioral inhibition (shrinking away from unfamiliar situations) has been linked to the development of this disorder.

Environmental: No increased rates of childhood maltreatment in the development of this disorder, BUT maltreatment is a risk factor.

Genetic: Traits, like behavioral inhibition, are genetically influenced. Social anxiety is heritable (NOT inherited). No specific genetic factors have been identified.

So What Causes Anxiety Disorders?

What’s the first thing that comes to your mind? Trauma? For those of us who have been ingrained in the mental health system for a while, you might think “chemical imbalance”. Not even the DSM endorses that as absolute. You will find that genetic factors are no where near being identified, much less a chemical imbalance.

When tackling this, we must remember that your genes, your body, your cells, your thoughts, are incredibly malleable. When we talk about “predisposition” in relation to genes, we’re talking about the propensity for them to switch on and off. For example, it seems that some genes are more likely to, in response to a traumatic event, turn on.

Every cell in your body is influenced by your environment. This makes it extremely difficult to confirm what is solid at birth—were you doomed to live with anxiety?—and what is developed after birth. In fact, we may never know.

If you Google “what causes anxiety”, you will be lead to proper links citing similar things as the DSM: personality traits with an unknown genetic basis has a large influence.

If you Google “what causes anxiety disorders”, you will be fed a mix of “chemical imbalance like diabetes” and “stress”.

If Anxiety, or any mental health condition, was a chemical imbalance like diabetes, we’d have a psychotropic equivalent to insulin.

If you search for a similar phrase in psychology databases, you won’t find what you’re looking for.

I managed to find an article entitled “Biological markers for anxiety disorders, OCD, and PTSD: a consensus statement. Part 2: Neurochemistry, Neurophysiolgy,, and neurocognition”. If you are interested in it, I only have access through a database, so I can email you the full text.

This paper from the World Journal of Biological Psychiatry summarizes all the current biomarkers (as of 2017) for anxiety disorders, OCD, and PTSD. They state “none of the putative biomarkers is sufficient and specific as a diagnostic tool, [but] an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD, and PTSD.” It cites Serotonin precursors, GABA, Dopamine, Neuropeptides, and even Oxytocin the love neurotransmitter.

My criticism for this starts with their PTSD makers. It states: “Compared with control subjects, PTSD patients showed significantly elevated platelet-poor plasma NE (norepinephrine) levels and significantly higher mean 24 hour urinary excretion of all three catecholamines (NE, Dopamine, HVA).” It cites another study as the source for this, which I can’t find yet. What could other factors be for this rise in stress neurotransmitters? My point: you couldn’t possibly pinpoint this particular rise in catecholamines to PTSD alone because we can’t isolate the PTSD from the rest of the body/brain. Take everything with a grain of salt.

Biomarkers are real. We ARE biological beings, and to ignore that would be, well, ignorant. However, the lack of understanding for how our biology transforms through life means attributing brain states to only chemical differences without connecting the body’s experience of physical life is just as ignorant.

So, we ask, are anxiety disorders a chemical imbalance? The answers is: we don’t know. And we may never know.

Anxiety Disorder Treatments

Medication has been a go-to for years. Benzodiazepines, dangerously addictive and physiologically dependent in a short amount of time (2-4 weeks) do well at cutting panic attacks down for size. Valium, Ativan, and Klonopin have saved me more than once. SSRI’s and SNRI’s, researched for depression and sold for everything else without care, can sometimes help calm anxiety. Lexapro, Effexor, Zoloft, and Trintellix—honestly I couldn’t tell if they did anything at all to my anxiety. But for some people, they work.

Some antipsychotics like Abilify (some, again, sold against the label) are added on to antidepressants with the purpose of easing depression, but can also inadvertently help anxiety and there’s no rhyme or reason for it. It can probably be dedicated to the sedating effect.

Certain therapies, however, have been proven time and time again to be more potent than medication for SOME disorders, and many experiments show a combination of therapy and medication is better than mediation alone or therapy alone. These studies must be scrutinized with care however: some of them have no control group or comparison treatment.

For example, Cognitive Behavioral Therapy has been shown to significantly reduce distress in Panic Disorder and PTSD when compared to medication and no treatment. What will work depends on your willingness to throw yourself into the process. I’ve done much CBT and found that it only started working after I stopped putting off the homework. There are also personalities and onset of the condition that affect this, which you can read about here.

Other treatments are being studied too. We talked about Freespira here, the medication free treatment that is entirely invalid.

There is study going into Chamomile treatment for Generalized Anxiety Disorder. This study concludes there was non-significant reduction in GAD relapse but significantly better GAD symptoms and improved psychological well-being. Part of their funding came from the Nations institutes of health and a cancer center, and the authors have no conflicts of interest. It was a randomized clinical trial. Read it here.

Naturopathic care, including certain vitamins, need more research, but has some success in this article. My criticism is that if the participants were aware that anxiety was being studied, the placebo effect could be huge. I didn’t read through the entire study, admittedly, but if YOU find whether participants were aware or if they were deceived as they should have been, let us know.

Where Can I Get Help?

If you feel you are struggling with anxiety, please reach out. If you don’t have close friends or family, message me.

If you want to speak with someone anonymously, I recommend Peer Support warmlines. These are not hotlines for crisis, but for meaningful conversation with someone who has been there. There is a list at this link. Those are for California, but anyone can call from anywhere. I’ve spoken to people from England before. You can search for some in your own state or region as well.

If you don’t trust any of those, give us a call at 831-688-0967. We are also a peer warm line service where I work, and have gotten calls from people throughout the country. We are open right now, 24/7. We try and keep conversations to twenty minutes, but I’ve been known to stay on longer if nothing else is going on in the house and the person is really needing support. *I will say I won’t necessarily be the person to pick up. We have other staff members.* If something comes up in the house, our current guests are a priority and we may need to get off the phone.

If you choose Therapy, online or otherwise, is another option. I recommend Psychology Today to find a therapist near you, or your health insurance website.

Your general practitioner may also have suggestions. If you choose the medication route, I suggest researching a good psychiatrist, reading your OWN research, and not allowing your general practitioner to run your psychotropic medication case. They are not trained for that.

Our Mental Health Month Featured story is at THIS LINK: Read about Caz and her journey through anxiety and into a mental health nurse career.

For updates, support, or to submit your story, follow me:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you enjoyed this post, please share, like, and follow ThePhilosophicalpsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.

Posted in science

A Medication-Free Anxiety Treatment

Briefly last week, I considered getting back on medication. My panic attacks have been relentless, my voices have been annoying, my thoughts have been in and out of this world. I went as far as going online to a pain center my previous psychiatrist worked at. She is long gone, but there are other great doctors there, and I have nothing bad to say about this particular institution of health professionals. They were informative, kind, and their offices are quiet, clean, bright, and overlook trees even though they’re one hundred feet from a freeway entrance.

While browsing their website to see if they conducted Telehealth appointments, I found a tab specified for panic disorder and within that tab they listed a new, medication-free treatment for anxiety. Curious, I investigated.

What is the treatment?

This treatment is the FDA approved “Freespira” developed by Palo Alto Health Sciences. For this section, I’ll be getting my information from the Freespira website and this patient brochure.

Firstly, Freespira is a breathing trainer. You receive a special Freespira tablet and medical censor that tracks your breathing rate and your Carbon Dioxide output. The hypothesis here is that those of us who panic have irregular breathing patterns even when we aren’t panicking. When we do get anxious, our breathing rate becomes even more so arrhythmic and we aren’t outputting as much carbon dioxide as is healthy. This physiological response cannot be addressed by therapy or drugs, and this is the response Freespira targets. The device teaches you how to regulate your breathing so that you exhale the proper amount of carbon dioxide. Their website says “by training panic suffers to permanently change their breathing patterns, panic attacks are dramatically reduced and, in many instances, completely eliminated.”

This takes a set amount of sessions over the course of a few weeks.

Why This Was Exciting

As a desperate panic sufferer, I know all too well of the tingling in the limbs, the racing heart, the feeling that death is imminent. I lost count how many times I’ve went into the ER because my hyperventilation threatened my consciousness. I won’t spend breathless paragraphs reiterating the doctors who accused me of drug use, who almost refused me treatment, who took my blood without consent to test for meth. The idea of an anxiety treatment that doesn’t including putting poorly tested chemicals in my body daily, or risking “as needed” medication becoming “need” medication and eventually, if not severe physiological dependence, than addiction, almost made me cry.

The statistics are promising. Their website states clinical results are as followed:

Protocol Adherence (meaning participants followed instructions correctly): 83%

Panic-Free immediately post treatment: 85%

Panic-Free 12 months post treatment: 81%

Reduction in panic symptoms 12 months post treatment: 94%

A Stanford trial in 2008 showed “positive changes in respiratory physiology, and strong evidence for safety and tolerability”. 68% of participants were panic free, 93% had a reduction in symptoms after 12 months.

Another trial showed similar results, with protocol adherence and freedom from panic ranging from 71% to 88%.

The last study they cite has no verifiable link on google.

These results are pale in comparison to those reflected by drug therapies and every other talk therapy except Cognitive Behavioral Therapy for panic disorders. It is easy, quick, self-administered, and finally puts to use all those breathing techniques you learned that felt useless. Suddenly, they’re not so useless because you have a tablet and sensor telling you they’re not.

So what’s the truth?

I hope you don’t feel as let down as I did.

In my excitement, I didn’t fall blind to the fraudulent world of psychology research. And so, I researched. My first hint that something was off came from the website healthnewsreview.org, a website dedicated to “improving your critical thinking about health care”.

Some of the noteworthy things they mentioned, briefly summarized because I love you guys, are:

1: The cost treatment is not discussed. In 2015, a news story reported the monthly cost as $500.*

2: No absolute numbers are released, just overall percentages states on the website.

3: No mention of what the harms could be, if any, and there were no links to the studies mentioned on the website. We’ll come back to this.

4: one of the most IMPORTANT: Freespira website DOES NOT discuss or post who funded these studies. We’ll come back to this too.

5: No alternatives discussed. I mentioned CBT earlier in this article, as it is one of the leading and most proven methods for treating panic disorder. A comparison is no where mentioned.

*link to the ‘news story’ on healthreview.org

By this point, I’d lost hope.

And so, I’ve done the nice, hard work of finding the studies Freespira reports as their evidence. They did indeed provide citations eventually of their sources, but I could only find them when I switched from desktop view to mobile view. I have linked them above.

The Results?

The “Stanford Study”

Let’s remember How to Read a Research Paper before continuing. I don’t know if this was actually conducted at Stanford, but Freespira lists this citation as the Stanford study they mentioned.

Not Freespira specific, but tested for the effectiveness of capnometry-assisted breathing therapy, the type of device freespira is purporting to be.

Methods and participants: 37 participants, 31 with panic disorder and agoraphobia, 6 with panic disorder and NO agoraphobia. 20 were randomly assigned to the treatment, 17 were wait-listed as a control group. Recruiting happened with community advertisements. You can read the study for more in depth description of the participants.

Treatment: educating patients on breathing, showing them problematic respiratory patterns, having them perform breathing maneuvers with feedback, teaching ways to control carbon dioxide levels, and having them practice breathing exercises daily. Twice daily, 17 minutes, at home. Read for more in depth description.

Results: Low attrition (drop out rate). 40% experienced no more panic attacks during the four weeks. 2 month follow up, 62% had experienced no further attacks, and 68% were panic free at 12 months. This shows brief capnometry breathing therapy can be therapeutic. Improvements were seen in the treated but not untreated participants and success improved as time passed. Non-respiratory mechanisms, such as treatment rationale (meaning they told the participants the point of the study) let the patients develop cognitive components needed to avoid catagstrophic thinking and gave patients a sense of control–one thing we lose in panic attacks. The breathing exercises triggered sensations similar to those we experience in panic attacks, and desensitization may have occurred to the bodily clues rather than respiratory changes being the sole drive. Need future studies testing viability (success of the treatment).

Limitations: The first thing you learn in an introductory research course is that when you are studying treatments for mental health disorders, you can’t simply pair the treatment with an untreated population. In order to test for something like viability, you need to compare your treatment to other treatments. This study did not do that, and lists it in their limitations section.

This study was supported by the NIMH.

The Multi-Center Trial

Freespira specific.

Methods and Participants: Primary diagnosis of Panic Disorder, 18-65, moderately ill or greater based on the Clinician Global Impression Scale, and were off medication or had been stable on medication for 3 months. Conducted at multiple non-academic clinical sites with different clinicians at different levels of expertise.

Procedure/Treatment: 4 weeks. Breathing sessions 17 minutes long with baseline stage (sitting quietly with eyes closed for 2 minutes), a pacing stage (monitoring of Carbon dioxide levels with breathing at a specific rate for ten minutes), and a transition stage (patient maintains breathing pattern with feedback for 5 minutes).

Results/discussion: 20% dropped out. Significant decrease in panic disorder severity over four weeks, early identical results to the previous study. Patient compliance was high as well as patient satisfaction. This treatment can be made largely available at a low cost. Side effects were rare, like mild dizziness or lightheadedness in the beginning training sessions.

Limitations: Again, no control group, not even a wait list. The study itself says “these results cannot be considered a definitive documentation of efficacy”, but instead “extends [the previous studies’] findings to document feasibility and utility in more naturalistic treatment settings.” It discusses no alternative reasons for why they may have seen significant results and a decrease in panic symptoms.

This study was funded by Palo Alto Health Sciences, the developers of Freespira.

Several of the doctors on this so-called study have received research grants and/or consulting fees from PAHS and Merck. This is listed as the Conflicts of interest. For obvious reasons.

Should You Try Freespira?

Results show the need for many, many more studies, but no real evidence of efficacy.

Try at your own risk. Especially if it means you’re paying out of pocket.

If you go in thinking it will work, it will probably work. if you go in remembering this evidence, it probably won’t.

If you have tried Freespira and it worked for you, leave your experience below or message me and let’s write about it! The same applies for if you have tried Freespira and it hasn’t worked for you.

Also, notice the degree of ethical practice reduces when the study is funded by the developer of the treatment. Keep that in mind for when we discuss the studies of psychotropic medications.

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Posted in Community, science

Our Scientific Crisis

In the wake of this lighting striking all over the world, there’s been a level of social (media) distancing I can appreciate. I haven’t written since my break because I don’t just want to talk about COVID. It’s just that everything else seems so irrelevant now. So, I have something very simple to say.

We are in a SCIENTIFIC CRISIS.

What does this mean?

It means we’re not focused on the task at hand: containing a rapidly spread, generally mild but sometimes very severe illness. Instead, we’re focused on our infrastructure, media reporting, fear mongering, and blame-gaming.

How many people have actually went to the CDC website and read up on what a Coronavirus is versus how many people went out and hoarded N95 masks to the point healthcare workers are falling short of the protection they need? I’m not saying self-preservation is bad. I’m saying stupidity is bad.

I’m sick of the fear mongering, in particular. I follow The Mighty, although I’ve never been published by them, probably because for my previous blog Mental Truths I email-interviewed the C.E.O pertaining to questions about the outrageous amount of funding they suck down from pharmaceutical companies in exchange for all the pro-medication ads on their website. If you want to know my stance on biological treatment, give this and this a read (i’m not against it). In my email this evening, a new article came in from one of The Mighty’s editors, summarizing this idea that doctors across the states are considering DNR’s for all COVID patients.

CHRIST! A title like that would scare me too. If I didn’t know any better. The comments were full of immuno-compromised and chronically ill people TERRIFIED. Utterly TERRIFIED. And for GOOD REASON! A breakdown of ethics of THAT magnitude would mean all hope is lost.

Doctors have indeed been discussing DNR’s in relation to those having severe respiratory reactions to COVID. These matters are discussed on a case-by-case basis with the family as they have always been since the dawn of DNR in western medicine. There are no current guidelines for COVID treatment, one of the reasons this has become such a scary time. What makes it scarier is when a website dedicated to chronically ill and vulnerable people can’t cite their sources or present an argument objectively, not even when the argument pertains to peoples’ livelihood, health, and well-being.

I’m seething behind my keyboard.

As other doctor’s have stated (you can find the quotes in that linked CNN article above), the DNR discussions have not been blanket DNR’s–essentially the statement “every COVID patient who’s respiratory system has failed will be left to die for the sake of health care workers and other patients” is the message The Mighty and other media giants like The Washington Post have been spreading. While it IS a concern for a healthcare worker to climb on a failing patient and give mouth-to-mouth when they’ve tested positive for COVID, killing all respiratory distressed COVID patients not only isn’t practical, it’s reprehensible. Two good reasons why it would never happen.

Okay, there is ONE CASE in which this would become a reality in the United States: hospitals in all states are overrun with the infectious disease, there aren’t enough doctors to care for patients because ALL the doctors are sick too, and bodies are piling up in the street. Then it’s safe to say ethics are out the window and the survival of those well enough to survive become precedent because it would be happening in all other countries as well. Luckily, COVID is not going to be the virus to drive us to extinction. Imagine more of a virus that causes the symptoms of Ebola but spreads like the Bubonic Plague. That will be our demise, surely.

What’s going on in Italy and Spain are examples of this: overrun hospitals, bodies having to be stored in people’s quarantined homes (Italy) and on ice rinks (Spain) because there is just no safe way to handle them, or any businesses open to do so. Will this be a reality for the entire world? I strongly doubt it. Is this reality for those countries horrible? I couldn’t even put into WORDS how absolutely sorrowful their experiences are right now.

We are in a SCIENTIFIC CRISIS because funding has been cut to the CDC, the WHO has made countless mistakes, researchers are ignored in favor of big business, and NOW, in the quarantine, people are forced online and what’s online? Secondary, third, fourth, fifth sources that are easy to read but entirely misinformed and not very analytical. People aren’t paying attention to the exponential growth curve of the spread of COVID, nor have they reasoned that the lack of tests (one of the reasons we in the U.S have now become the leader in contracting COVID cases) means many more people have the disease and many more people have recovered at home.

I suggest staying off of Apple News and instead read updated information on the CDC website. I suggest reading your own county information in your own state (if you’re in the U.S). I suggest straying from Instagram, Facebook, or Twitter for reliable pandemic information. I also HIGHLY SUGGEST JAMA Network, a website of specialty journals that are consistently uploading studies and scientific information about SARS-CoV-2, aka COVID-19. If you struggle reading this kind of technical information, read this about how you don’t need to be medicine-inclined to get something reliable and important out of these studies. The reason why the media is so misinformed is because the people who report on experiments do so incorrectly, misunderstand conclusions, and often know nothing about the scientific process. That article will give you just enough basics to read a scientific paper, think critically, and extract the important information. It’s a lot easier than it sounds. And this time, the life of your mother, father, aunt, uncle, and cousin with or without underlying health conditions may be on the line. That’s some good encouragement to READ.

Want some information NOW? Read this article published by Louisiana State University that, with further research, may help us understand why “underlying conditions” can post a threat for coronavirus patients. Hint: it has more to do with the medications they are taking than the actual conditions.

Many people are unaware of what the tiniest bit of misinformation can do in this pandemic: it WILL make or break us. If we are not informed, if we are not reasonable, panic will consume us and all the N95 masks. Please, for the sake of your neighbors, for your coworkers, for your kids, your family, yourself, for my dad who struggles with high blood pressure, seizures, COPD, and congestive heart failure, keep yourself informed, stay indoors, limit or eliminate your contact with non-essential people, and wash your hands. If you’ve ever needed a purpose, this is a time for you to contribute to the health of the globe. You make the difference.

If something in this article hit home for you, if you want others to inform themselves about this pandemic and stay on top of relevent information, please share on your Facebook, Instagram, Twitter and any other social media. The people who look to those sites for information could use this more than you, perhaps.

Stay healthy everyone, please. Someone in the world dearly misses their loved ones because action was not swift enough, because people thought this was the flu, because people didn’t take this seriously. Let’s not make the same mistake twice.

I’m not putting my normal blurb at the end of this article. The only thing I ask is that you share this and think scientifically.

If you have a surplus of PPE or N95 masks, gloves, or disinfectant wipes, please donate some to your local medical facility. Check your county website to see if they have set up protocol for donations. Mine has.

Be safe, stay home, and stay informed.

Posted in Community, science, Therapy

A Broken System: What We Can Do.

I cited an alarming statistic in my post Is Psychology A Science Part 1 (which you can read at the given link) that one of my research professors cited: there are about 40,000 psychological research papers published each year, and, on average, clinical psychologists read about 1 a month. That’s .03% of all research papers. I unfortunately don’t have a statistic for psychiatrists. I’ll work on getting one.

If our doctors are not keeping up with current successful treatments, it means they are also not keeping up with current unsuccessful treatments, which get weeded out in research as well. Remember, the whole point of science is to prove ourselves wrong so we may find what is right. But if we go around thinking we know what’s right (i.e, relying solely on intuition and clinical arrogance), we’ll never investigate what’s wrong. And that’s so backward.

And so the question becomes what can we do to make up for this deficit?

Possible Options:

Educate Ourselves:

This requires us to think differently. Many of us are deep in our pain, and that’s okay. It’s okay to hurt, it’s okay to lack the ability (right now) to do everything you need for yourself. Your goal, at this very moment, is to be kind and compassion to your needs.

Part of being compassionate to your needs is caring for your health. And in order to do that, we often rely on the knowledge of our doctors. This can be more unhealthy behavior however, because it’s giving up our sense of independence and ability to navigate our mind by ourselves.

Some of us don’t have any other option at the moment and I recognize this. When I got released from the hospital, I needed my doctors to listen and manage my medication. They at least managed my medication. This was productive for a crisis. But not sustainable as long-term treatment. It’s not studied for long-term treatment.

Educating ourselves and participating in our treatment can enhance our wellness. If you have access to a college student, or are a college student, primary sources are the best form of knowledge. If this is unfamiliar territory to you, take a quick glance at one of my other posts How To Read A Psychological Research Paper.

If you are not a student and don’t know a student or professional with access to journals, contact me if you want articles on a specific topic. I can provide some.

Secondary sources like textbooks and articles online (including mine) can be okay as long as you take careful note of their references and click on the primary sources they’ve cited. If they haven’t cited primary sources or don’t include references, there’s a good chance the information isn’t reliable.

Any researched information you can present to your doctors and psychologists as ways to participate in your treatment.

Social Media:

This is a strange option because there’s a lot of unreal, invalid information on Social Media. But there’s quite a large mental health community on social media, particularly Twitter and Instagram. Facebook, I’m sure, has one as well. There are researchers who post relevant articles and information which you can investigate.

I don’t suggest spending a lot of time on social media if you are prone to depression. There has been lively debate on whether people spend more time online because they are depressed or if being online too much makes people depressed. Studies are showing more and more that feelings of isolation are increased by online use, not the other way around. Here’s one study. I’m sure there are many more.

If you can balance your health and internet usage, I’d suggest finding people online who model wellness. Not only can you find people who have experienced what you experience, but you can find people who have tried different avenues of treatment and have other perspectives. One of the worst things we can do for ourselves is allow our mindset to be fixed on one perspective.

On social media, there are advocacy groups and pages. You can find programs near you, conventions near you (if that’s something you’re into you), and you can get involved. Giving back can restore a sense of purpose for us, and that is a step in renewing self-esteem.

Think Outside of The Box:

Investigate different perspectives. Build the courage to try new things, not only in treatment but in your everyday experience. For example, my hair was always long, curly, frizzy, and a nice shield between me and the world. I hid behind it in grade school, along with bundling in thick sweaters and baggy jeans, even in the summer. I needed to protect myself because I felt unsafe everywhere and around everyone. When I started shedding sweaters for T-Shirts, I gained a sliver of confidence from it; I was more open and people could sense that. Because people sensed that, they were more likely to smile and/or talk to me.

This month, I chopped off all my hair. The sides are shaved, and the top is a cute, curl-hawk. For me, it symbolized my need to stop hiding. I have to put myself out there, experience new things, make rash decisions, make planned decisions, and enjoy my life. It took 8 solid years of mental health work, psychosis, depression, and deep pain to reach a point in life where I had enough confidence to do this.

And so I encourage all of us to remember if something isn’t working, don’t keep doing. If you are someone who wants to stay on medication and your current medication isn’t working, the next logical step is to try a new one, correct? Treat other therapeutic options the same way. If one type of therapy or therapist or psychiatrist isn’t working, try a different one. If no medication has ever worked, try another option. If you’re tired of living one way, live another.

There is nothing that says we must stay stagnant. There is nothing that says we must endure the same pain over and over again. The only people placing limitations on us is us.

These are only a few things we can do as consumers to promote our own wellness while navigating a system filled with cracks. Feel free to post your own ideas in the comments bellow, or contact me on social media/email. People seem to like DMs on Instagram the best.

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Posted in science, Therapy, Voices

Where Research In Re-Framing Our Thoughts Could Take Us

We get consistent word from our therapists that if we re-frame our thoughts, we can change the way we think, the way we perceive things, and that will ultimately help us cope with life. This is often done with Cognitive Behavioral Therapy, which is a very proven (as in scientifically) therapeutic method.

There are people who praise this method for saving their lives and others who don’t, and CBT takes a lot of work–a hell of a lot of work. You won’t see results if you don’t take it seriously, and if you’re anything like me, it’s hard to take it seriously when you’re heavily depressed or so anxious you want to jump from your skin. Let me give some background on why this topic is so interesting today.

Amidst all the anxiety this morning, I spiraled down with thoughts of failure, pain of where I am in my life right now versus where I could be, and felt out of place in the classroom; other students whispered about me, and thought very loudly about me. I lost focus in the lecture and I felt bad about that.

The professor popped a meme up on the screen of some woman with a stack of papers at work scribbling maddeningly and saying “this is a two-cupcake Friday”.

I don’t remember what this portion of lecture was about, or if the meme was even relevant, but through all my cloudy thoughts and thoughts of the students around me, one of my voices said calmly “you’re having a bad day.”

And I was. But the significance of this is far greater than just that realization.

Another thing therapy shoves down our throat is that our problems which feel permanent and hopeless are often temporary and malleable. In the moment, I felt miserable. I thought I was falling into another depression, that I’d spent the last year and a half off meds and this day, today, was going to be the day I decided to go back on them because I just couldn’t take the pain anymore.

It’s been a hard three weeks, and to ignore all of those factors and conclude “it’s just my brain making me mental again” would be foolish. I’ve been stressed, and today has been particularly difficult: I had a bad day. There’s nothing else to look at.

Multiple things came to mind as a result of this voice presenting his softer side. The first was–I tell myself the very same thing all the time. I’ll say to myself, “Ugh, today is a bad day.” And I’ll recognize it, but the reality doesn’t always sink in. And so I thought, as I sat through my second course more invigorated and positive, are we more likely to believe others about our true state of self, of being, than we are to believe ourselves?

Let’s look at this through two lenses:

The Theory Behind It All:

  1. Personality Research Shows that friends/family are more accurate in describing things we may be good at, like school/work. (Look up INFORMANT JUDGEMENTS and studies by Connolly (2010).)
  2. Research in this area also shows friends/family are better than us at predicting our personality traits like contentiousness and openness.
  3. Some personality researchers focus only on showing how much we DON’T know about ourselves (like WHY we think the way we do, or WHY we did something/feel something).
  4. Researcher Carol Dweck studied growth/fixed mindset and the influence on intelligence. In her study, children were influenced with praise on their intelligence versus praise on their effort. The study didn’t have anything to do with the effect of the words, but the outcome. Still, the words had a great effect on the thoughts of the children.

The Questions That Now Arise:

1.We are our largest critics, so they say. Why does it seem we doubt the POSITIVE things we tell ourselves, but are convinced of the NEGATIVE things about ourselves?

2. Can we use this possibility to our advantage?

3. For those of us who hear voices, can we train our voices to re-frame their approach, or do they naturally mature as emotional stability improves and coping mechanisms enhance state of living/being?

4. What makes us more likely to believe NEGATIVE things about ourselves versus POSITIVE things?

5. What makes us put more weight on OTHERS words versus our own?

6. How could research in this area of behavior and cognition help further treatment and therapies for psychosis?

These are passing thoughts I had during my second and last lecture. I wondered about it because I had been soothing myself all morning, giving myself reminders that my anxiety is bad, I’m not having a heart attack, that I’m just having a bad day. The moment my voice reiterated that, relief washed over my body. Suddenly, my heart rate slowed and I could focus in class. My head wasn’t as clouded and I went to my second lecture in a great mood–partly because I was fascinated at the effect he had on me.

And so the wonder continues: there is no argument that when a voice tells you you’re worthless, or stupid, or that you’re going to die, you feel immediate dread, sadness, anger. Therefore, were one to tell you something positive, it seems reasonable the same intensity, but positive (happiness, comfort, contentment) has the potential to flow through you. The problem is there isn’t a lot of research in helping people unite with their voices, nor with themselves, regardless of whether they hear voices or not.

When I attended a Hearing Voices Workshop in San Francisco, the man in the couple leading the discussion heard voices and had just been diagnosed with dementia. They’d been spending time training his voices to remember things for him. According to his self-report, and his wife’s informant judgement, it had been working.

This would be regarded as a case study and we can’t put a lot of weight on those scientifically. But it can be a catalyst for real research and potentially a new therapeutic avenue for soothing psychosis.

It seems that we need affirmation when it comes to positive things about ourselves. It seems we need someone to agree with us, or remind us, that yes, we are safe. Yes, we are okay. Yes, this too shall pass. Yes, you are strong, yes you are this, yes you are that. It’s as if we have the inability to create that foundation for ourselves and truly believe it.

But when it comes to the negative things, our failures or short comings, we take them at face value. We don’t need someone telling us “yeah dude, you failed”, for us to think of ourselves as a failure. In fact, someone affirming our negative beliefs about ourselves seems to make it more likely we’ll believe that in the future, whereas someone affirming our positive traits/beliefs doesn’t.

What could this mean? How could we study it?

Many of us may internalize what trauma we’ve experienced as children or adults and so the automatic sense of “everything is horrible” may influence our natural thought. But even among memories of trauma and experiences of trauma, we had moments of great fun. I grew up with my dad being violent and using drugs, terrorizing my house. But I have equally intense, positive memories of being out in the garden with him, planting tomatoes and helping him work on his cars.

Why is it that the negative becomes the basis of my emotional foundation? And can we use what we know (and can still learn ) about this very automatic bias to creative equally positive, habitual thoughts?

I suppose it’s worth mentioning that since one of my False Angels reminded me I’m “just having a bad day”, I haven’t heard anyone else talking, my anxiety is at a steady, manageable level, and I’m more motivated than ever to finish this degree and research.

And to think: I’ve ignored them for SO long.

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Posted in advocacy, science, Supporting Friends/Family, Voices

Hearing Voices: Internal versus External

Something people who don’t hear voices misunderstand about hearing voices is that it’s not like sitting next to a party of five in a restaurant where you can generally tune out all the giggles and unrelated conversation and focus on the person in front of you. It’s more like that party of five arranged their chairs around you and take turns commenting on your posture, your date’s violent sexual thoughts, your wants you didn’t know you had, while also occasionally blurting a sentence that doesn’t make any sense, like “put that burrito on reservation.”

My point here is that ignoring it isn’t always the easiest or most necessary option. And to understand why this is a fact, we need to understand a little more about this.

Some people are really obvious about their inner experiences. They’ll be talking out loud or gesturing to no one. They might be laughing or crying or whispering. This is what scares people, both people, and what can make getting acquainted with our voices such a daunting experience; we’re aware (some of us) how we appear and that judgement is enough to warrant withdrawal. This tends to make things worse.

But let’s be clear: screaming at yourself at 3am probably isn’t the best way for your roommates to get to know you, nor is it a good way to get to know your voices.

It’s kind of a novel idea, to promote the “getting to know” process of things that don’t exist. But they do exist; they speak, they can have names, we can even have images to describe their non-existent physical features. They may not exist for your little brother or your mom or dad, but they exist for you and that’s still valid.

Psychiatrists and therapists aren’t trained in helping you with this process because school will tell them not to entertain delusions and to teach their clients how to cope with voices by ignoring them. This may be helpful for the clinician so they have a reason not to feel guilty when their client doesn’t remarkably improve, but it’s not always helpful for the client.

Ignoring needs to happen sometimes. But as a primary coping mechanism it sucks.

And so there’s something called “dialoging”, which I didn’t know about until attending a hearing voices workshop put on by the Hearing Voices Network. This is essentially someone on the outside speaking with your voices, getting to know them, their motives, their personality, and validating their existence. It’s for the voice hearer as well, so they can participate in a conversation instead of a shouting match. Because, again, what happens when you shout at someone? They shout back.

It’s also a common misconception, especially in clinical practice, that everyone who hears voices hears them externally.

I read a report of an experiment which examined this. They say that external voices have always been thought to represent more “severe” psychopathology, and to be more common, but that “empirical evidence has been equivocal”, meaning ambivalent. You can read for yourself at this link.

To summarize their study:

  • Some people experience only internal (coming from inside the head) voices
  • Some people experience only external( perceived as outside the head) voices .
  • Some people experience both.
  • In 1996 it was thought external voices were more severe. This project suggests, from observations, that internal ones can be more “disturbing, negative, persistent, involving, and commanding”.
  • Voices commenting and conversing observed (reported as) more internal.
  • “…no differences have been identified between internal vs. external hallucinators in other symptoms or levels of overall psychopathology.”
  • Another study, (cited Stephane et. al 2010) “found that schizophrenia patients with only internal hallucinations performed more poorly than those with only external hallucinations on an internal ‘say/think’ source memory task, suggesting that internal hallucinators may be less able to discriminate between internal versus externalized stimuli…”
  • Those with internal voices were observed to have more insight into the self-generated nature of their voices.

Why is any of this important? Well, it’s important for clinicians to read these kinds of findings and realize that experiences vary, and that one-shot generalized treatment WILL NOT work.

But it’s also important for those of us who do hear internal voices. First of all, it’s validation. Maybe you’ve been disregarded in the mental health system because your experience is perceived as “lesser”. Remember when we talked about the Soggy Boxes and the hierarchy of the mental health system? If you don’t, take a quick read at an older post of mine entitled The Soggy Boxes and The Variation of Us.

I’ve personally been reluctant to ever tell anyone about the internal half of me, because I knew the standard the system held. I also didn’t know they were voices. I did, but I didn’t.

So all this really does is remind us how different and similar we can be with each other. It also proves that the stale mental health system needs to readjust its understanding of life, of humanity, and experience in order to catch up with where we are. They’re behind US. It’s not the other way around.

If you are struggling with this currently, I’d encourage you to reach out to someone you can trust. If you trust no one, find the person you can trust the most. If you know someone who has been through similar things, reaching out to them may be the most helpful. If your options are limited, feel free to email me (info here). People seem to like connecting on Instagram better lately, so you can also reach me via my social media handles (info below).

People are fearful because they don’t understand. The nice thing is that there are many people who will make an effort to understand if you can have the patience to teach.

If you are a voice hearer and are comfortable with sharing your experience, pop it down in the comments below. If it’s a long story and you’d like a guest blog post spot, contact me! I’d love to feature your story on here.

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Posted in advocacy, science

How Important Are Your Psychiatric Medications?

This question is for all of us, including myself, without much judgement. There are those who quit their medication and are fine, those who quit and are not fine, those who want off but are worried about withdrawal (which can trigger an upswing of serious symptoms again), and there are those who want off but their doctors disagree.

For those with any diagnosis related to psychosis, one thing you’re told especially is to stay on your meds. The reasons for why are a little less clear. This is what research says.

The Papers:

I found two articles on this topic, both Meta-Analysis (they’ve collected a group of studies and used statistics to quantify the average results of all the studies)

They both discuss studies assessing whether long term antipsychotic treatment maintains sufficient and healthy remission for individuals experiencing first-episode psychosis. There are two conclusions you will often find when searching databases for this kind of research: 1) long term medication works and 2) long term medications interferes with progress. One of these analyses kinds of lands in the middle, and the other is 100% supportive of medication.

We’ll discuss possible reasons why both valid analyses come to such different conclusions, and what this means for us.

1. Maintenance Antipsychotic Treatment Versus Discontinuation Strategies Following Remission From First Episode Psychosis: Systematic Review.

This analysis follows studies which look to understand the risks of maintenance (Long-Term usage) compared to risks of discontinuing medication AFTER remission in first episode psychosis. Seven studies were included.

Now, they looked for specific things, particularly comparing hospital relapse rates and hospital admission rates of those First Episode Psychosis individuals who maintained antipsychotic medication to those who were discontinuing their medication. For the studies which used an intermittent treatment approach, the participants medication was discontinued by 50% every two weeks. For those exhibiting prodromal symptoms, medication was reintroduced. In the crisis-based approached, medication was only reintroduced upon a full-blown episode.

Ultimately, higher relapse rates and hospitalization rates were seen in those discontinuing medication.

Two of the studies provided information on psychosocial outcomes like employment status or quality of life measurement.

I encourage you to read the analysis for yourself. I found it shocking that things like an individual’s place in society, their level of function in their community, their sense of purpose, the amount of support available, was not included. Yes, medication discontinuation seems to increase the likelyhood of relapse according to this analysis, but what could be the reason for this? Only medication? Or what about lack of support? What about the fact that tapering off medication with 50% of the dosage broken down every two weeks is indeed quite fast? Perhaps the speed effected the results of that one study.

Another rather glaring fact which makes me worry for the integrity of the analysis is the possible bias of the authors. One of them recieved support from Janssen-Cilag (think Haldol) and Otsuka Pharmaceuticals (think Abilify). This author also was an investigator on trials funded by AstraZeneca (think Seroquel) and Janssesn-Cilag. He holds a Pfitzer (think Prozac) Neurosciences Research grant.

Another author received sponsorship from Otsuka to attend a conference, and has shares in GlaxoSmithKline (think Paxil) and AstraZeneca. The last author attended meetings supported by Sunovion Pharmaceuticals (think Lunesta).

The only inherent problem with this is conflict of interest. There are times many researchers have been caught falsifying data or misreporting data with the agreement that they would get paid extra by the pharmaceutical companies funding their research. This is also common in the world of regular medical science and was particularly a catalyst for the Opiate Epidemic. Think Purdue Pharma.

This is the largest issue medical science faces today.

2.Improving Outcomes of First-Episode Psychosis: an Overview

This overview looks at possible prevention of psychosis, which is curious in itself. You can read in the paper all the different steps and stages they present which could, with further study, advance the way psychosis is treated and/or identified in an individual. They acknowledge that despite all the preventative strategies currently in place, often people will fall back into old symptoms following their first episode.

They updated a 3-trial meta-analysis to 12 trials and found that relapse rates while undergoing preventative care strategies were, on average, lower than relapse rates of those undergoing standard treatment. However, they found that there was no substantial meta-analysis support that showed integrative preventative strategies significantly improved anyone’s potential rate of relapse in comparison to a standard level of care.

They also found that the hypothesis that each new psychotic episode “damages” the brain or is “neurotoxic” to the brain and therefore “progresses the disease” has no significant empirical evidence to support it. This hypothesis is known as the “neurotoxic hypothesis of psychosis” and I’ve heard people cite it quite often.

The overview goes on to discuss future studies and cannot conclude that any one way is the correct way. They advise against using certain medical strategies that observe and study physical illness to observe, study, and treat mental health conditions; the brain varies more so than the body in more ways than one, and to assume that both can be treated equally is pretty far fetched.

There is a lot of theory in this overview and I’m not sure how much of it could be put into practice. They discuss some ways in the article, if you’re interested, including areas of support. Accordingly, their authors were not previously supported by any pharmaceutical companies.

And so where does this leave us? We have empirical evidence that medication can halt a crisis, but it is unclear, according to the second study, if we’re simply prolonging the inevitable or helping cease the progression of something. In the case of prolonging the inevitable, it would seem more humane to let people ride through the torture and support them in other ways. In the case of ceasing the progression of something–well, it seems like we’d have more reliable and verifiable data if that were the reality.

I stopped medication because I don’t like uncertainty. And the truth of medication is uncertain. I stopped medication because I don’t like being lied to. And much of medication research and marketing is based in lies, even small ones.

This may not be the path for you. What makes your medication important to you? What makes it torturous for you? Do the risks outweigh the benefits? Would you like to discontinue them some day?

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Posted in Peer Support, psychology, science, Therapy

How To Read A Psychological Research Paper

One thing I notice a lot of advocacy websites falling victim to is citing research without really understanding what that research means. A lot of the time they’re pulling from secondary, third, fourth, or fifth resources because the information they get comes from news reports that are also reporting information from secondary, third, fourth, or fifth resources. A secondary resource, for example, would be a textbook or another article describing the research findings.

The issue with this is very rarely do these articles go into detail about the research procedure, the methods, or any resulting confounding variables. The issue with THAT is the only information YOU receive are the results. And when the results say something like “Eating a Grapefruit Everyday Will Cure Your Anxiety”, you want to believe it. What you’re missing is that the study had 20 subjects, no control variable, and the subjects–by the way–were worms.

I’ll cover some basic ways to judge whether or not a paper you read–and you should be reading the actual paper–is a valid result or something that needs a lot more investigation.

First, if you haven’t yet read any of the series Is Psychology A Science posted here on this website, you can find the first in the 4-article series right here at this link. It will give you background information on why this is important from a scientific perspective.

Contrary to what you may believe, you don’t need to be a seasoned researcher to read these papers. You don’t need to know how to do an ANOVA test or a Chi Squared test. You don’t need to know what p <.05 really means. You don’t even need to know a lot on the subject the paper reports on. All you need is some basic knowledge. Let’s go step by step.

What does a paper consist of?

What’s great about research papers is that you always know what to expect. There will be the first paragraph, which is called an Abstract that tells you what the paper is about and often contains one sentence describing the results.

Often a full-length introduction is followed. This is important when the study is backed by, or has a lot of reference for, other experiments. Here you will find the importance of the subject and what other researchers have found and how this study will differ.

Next commonly comes Methods. This is where all the materials are listed and the procedure (including participants) are described. This is done in great detail so that peer review and (if/when published) practitioners and psychologists and everyone who SHOULD be reading the study, can determine validity. Here, you will learn the ins and outs of the experiment and/or the outside resources used to gather data.

The Results follow. Here you find the final statistics. You will find step-by-step results for how each participant (or group of participants) and sometimes you will see charts, graphs, info-graphics of all types that represent the data.

Discussion comes last. Here you find what those results mean and any recommendations for further research. This is where you will find confounding variables (discussed below) and another place to scrutinize the validity of the study.

Afterward comes acknowledgements, often who financially supported the research. This can be particularly important when reading studies about medication; if the pharmaceutical company that makes Risperdal (Johnson & Johnson) is providing funding for Risperdal research, the paper is subject to publication bias. This can be harder to detect and won’t be discussed here. I will be writing a separate post on this.

Then the reference list, which are other studies cited in the paper.

This layout is important. If the paper you’re reading isn’t like this, it’s not a research paper and what you’re reading is a secondary source, meaning a summation of the original research. This could be so far from the actual research finding, that it’s completely useless.

Is this studying what the researchers meant to study?

When reading a paper, it’s important to sniff out whether what’s been observed is what was actually meant to be observed.

This is known as construct validity. Research in psychology can be tricky because most of the time you’re observing behavior and behavior can be caused by many factors. For example, if we’re trying to study whether or not television violence influences real violence in young children, we need to define what violence is and what constitutes aggressive behavior. If we don’t, trying to find a relationship between behavior and the amount of violent television being watched will be hopeless; you won’t see any relationship, you’ll just see aggressiveness and violent television as separate entities. They may look correlated, but when properly studied you may see different results.

If a paper related to television violence and children do not have operational definitions (the definitions of the behavior we’re looking for), than it’s safe to say that paper isn’t really showing much.

A lot of the time this gets twisted in the media. For example, you’ll read statistics everywhere that those labeled with schizophrenia have a shorter life span of about ten years. A lot of people take that as “schizophrenia kills”. But is that really what reports and studies are saying?

No. There are other factors: taking hardcore, organ-destroying medication for decades is one of them. Less access to proper healthcare–many with the label are homeless and struggling with drugs or just at the mercy of their mind. Disability money doesn’t necessarily fund a heart healthy, body healthy diet either; most organic foods and healthy foods are hard to sustain for those on limited income and no support. Suicide rates are also higher. So this idea that some mythical chemical imbalance causes some mythical disease that slowly kills the brain like some kind of hallucinogenic Alzheimer’s is incorrect. Or rather, it’s never been proven.

This leads us into:

What Are The Confounding Variables?

These are factors which could muck up research findings.

For example, a lot of the papers I referenced in Is Schizophrenia a Brain Disease? had their confounding factors clearly listed. They said blatantly that much of their research has no definitive results. One paper even urged people not to take their results as proof that a chemical imbalance explains what people experience. So where does this idea that this label is a disease come from?

From people taking the one line of results and posting it in the New York Times or a CNN reporter giving a brief run-down of the study on national television. Belief is where this idea comes from. Science says otherwise.

I think one of the most famous incidents of this is the idea of the schizophrenogenic mother.

There was a time doctors and patients believed it was the mother’s bad parenting that created the experiences now labeled as schizophrenia. To test this, one researcher took a group of mothers who had children who matched the diagnosis and studied how they interacted.

She concluded a mother’s behavior can create ‘schizophrenic behavior’. Then she listed that in order to be an official and valid study, she would have to also study mothers who don’t have labeled children and their interactions; her confounding variable was no control group.

So what happened? The results were taken and spread to newspapers, to doctors, to psychologists and psychiatrists and for a while people really believed the mother was to blame for madness.

Because the general public, and even some doctors, didn’t understand how to read research papers. And also because it was an answer and they didn’t have any other answers. Rather than be scientific, they followed their intuition. It’s something that still plagues psychology today.

That’s why

Control Groups

Are super important.

Say you’re reading a paper on the medication Abilify and its relation to a reduction in psychotic symptoms at a dosage of 20mg. You read in the procedure section that thirty five people (an okay sample size) were recruited and given Abilify and you read in the Results section that 89% of the participants reported a reduction in symptoms within the four week time period. You also read in the discussion section that the researchers conclude Abilify has effectiveness at the dosage of 20mg on psychosis.

This sounds legitimate. And any average person who read that paper would probably feel that Abilify really does have an effectiveness on psychosis at 20mg.

What would be some problems with this, though?

One striking thing would be–where is the comparison? In order to see any level of effectiveness, we need to compare it to a group that doesn’t receive the treatment, a group that isn’t manipulated. This is a control group.

We’d also need to know how the participants were randomly chosen. We’d need to know the symptoms which were reduced and whether that was sustained. I’d criticize the four week trial period. Was there also a follow up? If so, what were the results? And, if you are like me and extra-critical, you’d wonder why they didn’t cite all the research in the introduction which says there is no efficacy for an Abilify dose over 10mg.

This can make certain things hard to study ethically and practically. There are many ways around that, but we won’t discuss all that here. If you are reading a paper and have trouble finding what they compared their manipulated variable to, or if their comparison group seems shoddy, search for some more research.

I’d like to point out had that research example I gave above actually been published, hell would have frozen over. There are some shoddy papers out there, but a lot are caught in peer review.

Last but not least:

Results are results. Interpretation is interpretation. Secondary sources are not results.

Media attempts to get things right. But often they don’t.

If you are on an advocacy site for mental health and you read a sentence that says “research shows”, and they don’t list a reference, ask for it. If they do list a reference, click on that reference. If that reference is another secondary source, and that secondary source doesn’t list a primary source, like the actual research paper, than you can’t be sure how accurate that “research shows” statistic is.

I’m not saying we should start mistrusting our fellow advocates. I’m saying as advocates the information we should put out must be backed by facts, not opinion or interpretation. Most of us who advocate are peers, meaning we have lived mental health experience. Great! We already have an advantage by having inside knowledge on experiences that most doctors don’t. Let’s boost that advantage with also having scientific knowledge and thinking critically.

Even I’m guilty of saying “research shows” in previous posts on my old blog and perhaps even this one already. It’s hard work finding these papers and reading them and citing them and analyzing them. But did anything come from soft work? No.

If you want to advocate, help empower us by criticizing research, reading research, and sharing research. Open a discussion about what’s being studied. Push clinical psychologists and psychiatrists to actually read what’s been coming out.

Together, we can change the perspective of mental health in society.

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