Recovery Michigan

Motivating willingness to change is important in treating a person with severe worry. For this, integrating motivational interviewing (MI) techniques into the commonly practised cognitive behavioral therapy (CBT) is the ideal option, a study led by a York University researcher reveals.

"Our research shows that therapists need to have two sets of skills - to help people become ready for change, and then to help them accomplish that change," says Dr. Henny Westra, a psychology professor in the Faculty of Health at York U. "The study results suggest that integrating motivational interviewing (MI) with CBT is more effective than CBT alone for long-term improvement."

It is normal to feel conflicted about change, and motivational interviewing is an approach that therapists can use to help patients understand and validate the fear of change. It offers a patient-centered way of helping individuals work through their conflicting feelings in order to enhance motivation for change.

"Because MI is focused on listening and drawing out client ideas, patients feel more confidence in coping with issues facing them even after therapy ends in contrast to having to rely on the therapist's expertise," says Dr. Westra, who led the study with Ryerson University Professor Dr. Martin Antony and Professor Dr. Michael Constantino, University of Massachusetts Amherst.

Although the participants responded well to both the motivationally enhanced CBT and standard CBT during the 15-week treatment phase, those who received the motivationally enhanced treatment continued to improve, the results indicate. Those in the MI-CBT were five times more likely to be free of the diagnosis of generalized anxiety one year after treatment ended.

According to Dr. Antony, "this study highlights the importance of studying the long term impact of our treatments, as the enhanced improvements seen in people who received the integrated MI and CBT treatment were greatest sometime after treatment had ended."

The Jerry Greenspan Student Voice of Mental Health Award is an annual award honoring a student who is reducing prejudice around mental illness, raising awareness of mental health issues on campus, and encouraging help-seeking among their peers. It was established in 2008 through a contribution made by Carol Ullman and the late Joseph Greenspan, in memory of their son, Jerry Greenspan.

This award is designed to encourage dialogue about mental health on campuses, reduce prejudice around emotional disorders, and raise visibility of the outstanding students who are tackling these issues at schools across the country.

The college student* selected for this award receives:

• A $3,000 cash scholarship
• Recognition on The Jed Foundation’s website
• A trip to New York to attend The Jed Foundation’s Annual Gala to receive the award on Tuesday, June 7th, 2016

APPLICATION PROCESS IS OPEN NOW UNTIL 10AM EST ON MARCH 25TH, 2016. 

There needs to be ongoing support, folks, not abandonement....

Researchers looking into mortality trends and autism have made a troubling discovery: People on the autism spectrum are dying young – some 12 to 30 years earlier than might otherwise be expected.

The analysis, conducted by Sweden’s Karolinska Institute and published in the British Journal of Psychiatry, found that the leading cause of premature death in autistic adults isn’t due to diseases, such as heart ailments or cancer, that are the main killers in the general population. It’s suicide.

The data, which include information on 27,000 people with the social-communication disorder and about 2.5 million who do not have the diagnosis from Sweden’s national registries, found that, on average, autistic adults die 18 years younger than their non-autistic counterparts.

An autistic person’s age at death also appeared to be affected by cognitive ability. Those with autism and a learning disability died 30 years earlier on average while those without intellectual impairment died 12 years earlier.

 The observed reductions in endocannabinoids might account for the increased inflammatory state as well as for the failure to extinguish fear memories observed in PTSD. Our findings add to the accumulating evidence suggesting the endocannabinoid system as a target for pharmacological enhancement of exposure-based psychotherapy for PTSD.

Slowly but surely, America is winning its war on smoking. In 1970, 37% of all Americans smoked cigarettes. Today, it's less than half of that. Every segment of the population is smoking less, except for one: the severely mentally ill. Of the 13.6 million Americans suffering severe mental illnesses including schizophrenia, major depression, and acute bipolar disorder, an astonishing 80%smoke. People with severe mental illnesses are believed to consume one out of every three cigarettes sold in this country.

Funded by the National Institute of Drug Abuse, Learn to Quit is the first mobile app that has been specifically designed to help the severely mentally ill quit smoking. It was developed by Smashing Ideas, a Seattle-based digital design firm, and Roger Vilardaga, a professor at the University of Washington's department of psychiatry and behavioral sciences. Here's how they tweaked the design to suit the needs of their unique user base.

Just like patients with full PTSD, those with subclinical PTSD have experienced a traumatic event and are regularly re-experiencing it, often in nightmares or flashbacks. Patients with full PTSD also experience hyperarousal (i.e., they are easily startled) and avoid reminders of the event, for example by withdrawing from social interaction or turning to substance abuse. In addition re-experiencing the event, patients with subclinical PTSD may exhibit either hyperarousal or avoidance, but not both.

Psychologists began noticing this pattern more frequently in the nineties in veterans returning from the first Iraq War, and even more frequently in veterans returning from Iraq and Afghanistan in the last decade. As researchers have learned more about these patients over time, varying and sometimes conflicting symptoms have provided an incomplete picture of the disorder and how to treat it. Further confounding the issue is that those with subclinical PTSD are often excluded from clinical trials testing treatments for PTSD--patients with only some symptoms of PTSD commonly aren't included in the healthy control group or in the group with full PTSD. As a result, there is still no standard psychotherapy for treating subclinical PTSD as there is for full PTSD.

The researchers devised an intuitive approach -- Why not treat subclinical PTSD patients with one of the standard evidence-based psychotherapy tools already being used in PTSD patients? They enrolled 200 patients with combat-related PTSD symptoms from the Ralph H. Johnson VA Medical Center located adjacent to MUSC, identifying those with either subclinical or full PTSD. For eight weeks, patients received intensive weekly sessions of behavioral activation and therapeutic exposure therapy, designed to lessen their PTSD symptoms by helping them safely re-experience and resolve elements of the original trauma. Psychologists rated the patients' PTSD symptoms and had patients rate their own symptoms before, during, and after the eight weeks.

The results were encouraging. Those with subclinical or full PTSD each experienced a real drop in PTSD symptoms after treatment. The striking result was in how much those symptoms dropped: 29% in those with subclinical PTSD as compared to 14% with full PTSD.

As part of the U.S. government's urgent response to the epidemic of overdose deaths, the Centers for Disease Control and Prevention (CDC) today is issuing new recommendations for prescribing opioid medications for chronic pain, excludingcancer, palliative, and end-of-life care. The CDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016 will help primary care providers ensure the safest and most effective treatment for their patients.

The guideline provides recommendations on the use of opioids in treating chronic pain (that is, pain lasting longer than three months or past the time of normal tissue healing). Chronic pain is a public health concern in the United States, and patients with chronic pain deserve safe and effective pain management. This new guideline is for primary care providers - who account for prescribing nearly half of all opioid prescriptions - treating adult patients for chronic pain in outpatient settings. It is not intended for guiding treatment of patients in active cancer treatment, palliative care, or end-of-life care.

While prescription opioids can be part of pain management, they have serious risks. The new guideline aims to improve the safety of prescribing and curtail the harms associated with opioid use, including opioid use disorder and overdose. The guideline also focuses on increasing the use of other effective treatments available for chronic pain, such as nonopioid medications or non-pharmacologic therapies.

By using the guideline, primary care physicians can determine if and when to start opioids to treat chronic pain. The guideline also offers specific information on medication selection, dosage, duration, and when and how to reassess progress and discontinue medication if needed. Using this guideline, providers and patients can work together to assess the benefits and risks of opioid use.

Among the 12 recommendations in the guideline, three principles are key to improving patient care:

• Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
• When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose.
• Providers should always exercise caution when prescribing opioids and monitor all patients closely.

An exercise programme devised by researchers at the University of Manchester has dramatically reduced symptoms among young people with first-episode psychosis.

The long-term prospects for young people who are diagnosed with psychosis are typically poor, with high rates of relapse, unemployment and premature death. The antipsychotics they are prescribed also cause rapid weight-gain.

Although exercise has been shown to be an effective treatment for people with long-term schizophrenia, no studies have assessed its effects on psychiatric symptoms in young adults with early psychosis, until now.

The University of Manchester study recruited 31 people aged 18-35 who had been referred to local mental health trusts for treatment. With the participants help, the team designed personalised exercise regimes which were carried out under the supervision of a researcher for ten weeks at local leisure centres.

Joseph Firth, the lead author on the study, said: "Establishing an exercise regime for people with psychosis is likely to be much more effective when they are younger, and in the earliest stages of treatment. Getting people into a routine early on also helps set habits for life, which can make a huge difference to their long-term physical and mental health."

The participants in this study actually exceeded the target amounts of exercise; achieving 107 minutes of vigorous exercise training each week for 10-weeks.

This compares favourably with exercise programmes in healthy populations as well as in schizophrenia.

"Personalising exercise training to the activities which patients find most motivating helps them stick to their programme."

At the end of the 10-week period, the participants completed a variety of standardised mental and physical health tests. As a control group, seven people who were treated by mental health services without an exercise programme were also tested.

On the standardised tests, the exercise group displayed a 27 percent reduction in psychiatric symptoms, which was significantly better than the control group. Their brain functions also improved, and they achieved a slight reduction in body weight - going against expected weight gain from normal treatment.

Medical students are more prone to alcohol abuse than their peers not attending medical school, especially if they are young, single and under a high debt load. That's according to a study on medical student burnout by researchers at Mayo Clinic. The findings appear in the journal Academic Medicine.

"Our findings clearly show there is reason for concern," says Liselotte Dyrbye, M.D., Mayo Clinic internist and senior author of the paper. "We recommend institutions pursue a multifaceted solution to address related issues with burnout, the cost of medical education and alcohol abuse."

Mayo researchers surveyed 12,500 medical students, and one-third of those students responded. Approximately 1,400 of that subgroup experienced clinical alcohol abuse or dependence. Nationally, that translates to about one-third of those responding, compared to only 16 percent of peers not in medical school, and double the rate of alcohol abuse or dependence of surgeons, U.S. physicians or the general public based on earlier research by this team.

Burnout factors such as emotional exhaustion or feelings of depersonalization were all highly associated with alcohol abuse or dependence among the medical students. Three other factors were independently associated:

• A younger age than most peers in medical school
• Being unmarried
• Amount of educational debt

No statistical difference was found between differing years of medical school or between men and women.

Researchers say the average cost of medical school from 1995 to 2014 increased by 209 percent at private colleges and 286 percent at public schools. They say physicians graduating with a medical degree in 2014 had an average of $180,000 in educational debt.

Brooding, which is known among cognitive scientists as morbid rumination, is a mental state familiar to most of us, in which we can’t seem to stop chewing over the ways in which things are wrong with ourselves and our lives. This broken-record fretting is not healthy or helpful. It can be a precursor to depression and is disproportionately common among city dwellers compared with people living outside urban areas, studies show.

Perhaps most interesting for the purposes of Mr. Bratman and his colleagues, however, such rumination also is strongly associated with increased activity in a portion of the brain known as the subgenual prefrontal cortex.

If the researchers could track activity in that part of the brain before and after people visited nature, Mr. Bratman realized, they would have a better idea about whether and to what extent nature changes people’s minds.

As might have been expected, walking along the highway had not soothed people’s minds. Blood flow to their subgenual prefrontal cortex was still high and their broodiness scores were unchanged.

But the volunteers who had strolled along the quiet, tree-lined paths showed slight but meaningful improvements in their mental health, according to their scores on the questionnaire. They were not dwelling on the negative aspects of their lives as much as they had been before the walk.

They also had less blood flow to the subgenual prefrontal cortex. That portion of their brains were quieter.

These results “strongly suggest that getting out into natural environments” could be an easy and almost immediate way to improve moods for city dwellers, Mr. Bratman said.