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September 09 2015

Friday Factoids: Promising Long-Term Treatment for PTSD

Author Susan Vaught Categories Blog, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns 0 Comments

 

Post-traumatic stress disorder (PTSD) can result from being the victim or witness to a number of traumatic events including war, an automobile accident, physical abuse, assault, homicide, and other difficult or devastating experiences. It is an equal opportunity disorder and affects men, women, and people of all cultures similarly. In the United States, PTSD has been thrown into the limelight due to the number of service men and women who are returning from active duty with this condition. The current publicity around PTSD has left many in the medical and mental health fields looking to and for variations of treatment in hopes of finding more effective, longer-lasting methods to treat this illness.

 

One of the more promising treatments, currently in Phase 2 of 3 in testing, is MDMA-Assisted Psychotherapy. MDMA (3,4-methylenedioxymethamphetamine) is a psychedelic, synthetic substance noted for its capability to help patients delve into their excruciating memories. The drug reportedly facilitates trust and compassion between the patient and therapist, all the while greatly reducing the patient’s feelings of defensiveness and terror while in session. It is believed that MDMA is able to offer this therapeutic safe haven by stimulating the release of hormones (prolactin and oxytocin) linked to bonding and trust which comforts the patient and reduces symptoms of avoidance and panic.

 

According to the research data, an astounding 83% of participants who received the treatment no longer met the guidelines for PTSD while in Phase 2 of the study.  Additionally, many of those participants reported the results lasted 3 ½ years or longer. So, why is this treatment not already approved and readily available for those who so desperately need it?

 

One potential answer to that question could be the stigma surrounding MDMA.  Most all of you have heard it referred by it street names of “Molly” or  “ecstasy.” And given so, some will not be comfortable using it as an aid during therapy even in a controlled setting providing such positive, long-term results. Secondly, the cost and time frame for each individual trial is fairly massive.  The End of Stage 2 meeting is estimated to take an additional 3 years and $2.3 million before presenting results to the FDA. Afterwards, Stage 3 is speculated to have a price tag of $15.8 million and spanning 5 years until the treatment is fully available for use with the public.

 

References
MDMA-Assisted Psychotherapy. (n.d.). Retrieved September 9, 2015, from http://www.maps.org/research/mdma

 

Treating PTSD with MDMA-Assisted Psychotherapy – Home. (n.d.). Retrieved September 8, 2015, from http://www.mdmaptsd.org/index.html

 

Crystal K. Bray, B.S.
WKPIC Doctoral Intern

September 09 2015

Friday Factoids (Catch-Up): Special K–Are There Any Positives?

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Friday Factoids, Resources for Interns 0 Comments

 

It was not the beginning of the zombie apocalypse that we were witnessing on the news a couple of years ago. Believe it or not, it was worse. Apparently, possible consumption of human flesh is one of the many unwanted side effects of abusing the anesthetic, Ketamine. “Special K”, as it is known on the streets, underwent a transformation into the new party drug, and it has been taking its place alongside opiates, benzodiazepines, and marijuana with teens and twenty-somethings since about 2010. Since that time, this once surgically “essential” and publically unknown drug has been drawing vast amounts of negative media, criminal and medical attention—but are there any positives associated with this drug?

 

Recently, scientists, mental health and medical professionals have discovered that medically controlled doses of Ketamine are very beneficial in treating Major Depressive Disorder and Bipolar Disorder. Yes, the same medication approved as an anesthetic in 1970, the same drug that has been abused to get high since the 2010’s, is providing evidence-based results that it does, in fact, reduce depression and regulate mood. Studies have shown that it produces significant results within a matter of minutes to hours instead of 2-3 weeks, which is the window within which standard pharmacological treatments for mood typically show benefits. Additionally, patients suffering from suicidal ideation who were treated with a “medically controlled dose” of Ketamine (medically controlled dose being key) reported their symptoms drastically reduced in 40 minutes, with gains lasting about 4 hours. Clinics around the U.S. are even currently treating patients suffering from depression and mood disorders using controlled amounts of Ketamine (yes, this is legal).

 

So Ketamine does appear to have some positives with respect to potential uses in the treatment of both unipolar and bipolar mood issues. It potentially provides treatment results, time frames and options for practitioners and patients, but the key appears to be the controlled dosing.

 

Reference
DiazGranados, N., Ibrahim, L., Brutsche, N., Ameli, R., Henter, I., Luckenbaugh, D., . . . Zarate, JR, C. (n.d.). Rapid Resolution of Suicidal Ideation after a Single Infusion of an NMDA Antagonist in Patients with Treatment-Resistant Major Depressive Disorder. J Clin Psychiatry., 71(12), 1605-1611. Retrieved September 7, 2015, from https://nebula.wsimg.com/5f3b6cc5e31881bab9f0fb5d070d35d2?AccessKeyId=98358B1A7BDF604FD210&disposition=0&alloworigin=1

 

Ketamine Facts, Effects and Treatment | Ketamine Clinics – Los Angeles, CA. (n.d.). Retrieved September 9, 2015.

 

Crystal K. Bray, BS
WKPIC Doctoral Intern

 

August 08 2015

Friday Factoids: Abandonment

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Friday Factoids, Resources for Interns 0 Comments

Research has shown that therapists view termination as a complex stage of psychotherapy (Gelso & Woodhouse, 2002, as cited in Hardy & Woodhouse, 2006), though client responses are variable.

 

As cited by Hardy and Woodhouse (2006) clients often report positive feelings regarding termination, to include:  pride, health, a sense of accomplishment, independence, cooperative, calmness, alive, agreeable, friendly, good, healthy, thoughtful, and satisfied.  Interestingly, Hunsely, Aubry, Verstervelt, and Vito (1999) reported that 38.6% of clients attributed termination as a successful achievement of goals.  Thus, Hardy and Woodhouse (2006) note that therapists may underestimate client perception of growth.

 

It is important that therapists become aware of these positive reactions, as psychotherapists may attribute more negative emotional reactions to termination.  Additionally, understanding the difference between termination and abandonment is essential to ethical practice.  Termination is a clinical decision based on competent practice.  Per the ethics code, termination becomes clear when the client no longer needs services, is not likely to benefit, or is being harmed by continued service (American Psychological Association [APA], 2010).  The latter may occur when a psychologist is not working within his or her boundaries of competence.  Abandonment is an inappropriate termination (Behnke, 2009).  Again, sound clinical thinking and consultation/supervision may help guide the decision process to ensure ethical termination. Yet, unfortunately termination can be more abrupt, such as in forced termination for interns (end of rotation)?

 

Often with forced termination, the goals of therapy have not been met and the provider may not handle the termination in an appropriate manner.  Such may be due to lack of training.  For instance, Zuckerman and Mitchell (2004) found that pre-doctoral interns reported they felt less than adequately prepared for forced termination.  Thus, Hardy and Woodhouse (2006) highlight the need for focused training, specific to forced termination.  According to the ethics code, pre-termination counseling is recommended (APA, 2010).  With forced termination, often the end of services is known, therefore one should be proactive and notify the client in an appropriate manner.   In other words, with termination, preparation of the client is necessary.  When it is appropriate and after sound clinical decision-making and supervision, all efforts should be made to ensure an ethical termination and transfer to another provider occurs.  Taking such care will help minimize harm and promote ethical practice.

 

References
American Psychological Association. (2010). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code/

 

Behnke, S. (2009). Termination and abandonment: A key ethical decision. Retrieved from http://www.apa.org/monitor/2009/09/ethics.aspx

 

Hardy, J. A. & Woodhouse, S. S. (2008, April). How We Say Goodbye: Research on Psychotherapy Termination. Retrieved from http://societyforpsychotherapy.org/say-goodbye-research-psychotherapy-termination

 

Hunsley, J., Aubry, T. D., Verstervelt, C. M., & Vito, D. (1999). Comparing therapist and client perspectives on reasons for psychotherapy termination. Psychotherapy, 36, 380-388.

 

Zuckerman, A., & Mitchell, C. L. (2004). Psychology interns’ perspectives on the forced termination of psychotherapy. The Clinical Supervisor, 23, 55-70.

 

Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
WKPIC Practicum Trainee

 

August 08 2015

Friday Factoids Catch-Up: Is Stress Contagious?

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns, Social 0 Comments

Research is demonstrating that stress can be contagious across various populations. In a study completed by Waters, West, and Mendes (2014) results indicate that babies quickly pick up their mother’s stress and show corresponding physiological (cardiac) changes. West et al. (2014) findings demonstrate that emotions may be communicated through a variety of channels, such as odor, vocal tension, facial expression, or touch.  This leads to questions of whether these findings are applicable to adults or among strangers? Can stress still be contagious beyond the intimate bond of mother and child?

 

Findings from Engert, Plessow, Miller, Kirschbaum, and Singer (2014) show that observing others in a stressful situation can make your body release the stress hormone cortisol.   The results show that being around a loved one or a stranger that is stressed results in quantifiable stress reactions.  This study involved having subjects paired with loved ones and strangers of the opposite sex, and then divided participants into two groups.  One group underwent challenging math questions and an interview to emulate a stressful situation, whereas the other group of 211 participants observed the test.  Only 5% of the participants that were involved in the stressful situation remained calm, while the other 95% showed signs of stress. Interestingly, 26% of observers had increased cortisol indicating empathetic stress.  When directly observed, empathetic stressed increased significantly when the observer watched a loved-one experience stress.  Additionally, empathetic stress increased when observers watched a stranger in a stressful situation via video transmission.

 

Overall, stress is a major health threat in today’s society; even still, the likelihood of coming into contact with stressed individuals is also prominent (Max-Planck-Gesellschaft, 2014).  Thus understanding the impact of stress and empathetic stress is important for developing prevention and/or intervention strategies.   As Engert et al. (2014) suggest, we should be cautious of watching or observing stressful shows or other stimuli, as this may transmit stress to the viewers (Max-Planck-Gesellschaft, 2014).  Also, the results of the study show that emotional closeness is a facilitator but not necessary to the experience of empathetic stress.  Respective of these studies, the authors conclude “stress has enormous contagion potential” (Max-Planck-Gesellschaft, 2014).

 

References
Engert, V., Plessow, F., Miller, R., Kirschbaum, C., & Singer, T. (2014). Cortisol Increase in empathic stress is modulated by social closeness and observation modality. Psychoneuroendocrinology, 45, 192-201. DOI: 10.1016/j.psyneuen.2014.04.005

 

Waters, S. F., West, T. V., & Mendes, W. B. (2014).  Stress contagion: Physiological covariation between mothers and infants. Psychological Science, 25(4), 934-942. doi:  10.1177/0956797613518352

 

Max-Planck-Gesellschaft. (2014).  Your stress is my stress. Retrieved from http://www.mpg.de/research/stress-empathy

 

Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
WKPIC Practicum Trainee

 

 

August 08 2015

Managing My Illness?

Author Susan Vaught Categories Continuing Education, Information About Peer Specialists, Mental Health and Wellness, Resources for Interns 0 Comments

How do I manage my illnesses?  I go to my psychiatrist for tune-ups when I need it, and otherwise keep regular appointments with her.  I go to my therapist as needed, and at one time was going weekly after my last hospitalization.  The truth is…I don’t do all that I’m supposed to do all of the time.  Why not?  Because LIFE.  I’m honest about it. I know what I’m SUPPOSED to be doing.  I know what I did to get healthy. I know what I have to do to stay healthy….just sometimes, I don’t do those things, for various reasons. It shows up in my mental health.

 

As patients come in and out of the hospital, it may be frustrating to see the cycle.  It may seem so simple to the average person.  Just take your medicine.  Go to your doctors.  Why is it so hard?  Because LIFE.  I understand this.  I am married to a very supportive person.  He takes over the household responsibilities when I’m not doing well.  If I have an exhausting day, he’s there to cook dinner for my two children, while he gives me time to rest.  Not everyone has that.

 

I don’t always eat healthy meals, like I’m supposed to. The other day, I ate an Arby’s sausage biscuit for breakfast, a double cheeseburger from McDonald’s for lunch, and Taco Bell for supper.  I’m still alive somehow.  I don’t always get enough sleep, like I’m supposed to.  I get too busy to make appointments with my therapist when I need to go.  I try to be Super Mom to my kids, a Band Mom to 48 high school band kids, and work full time.  Who has time to go to doctors, even if the therapist will see me on Saturday, which he will? That’s not an excuse, or shouldn’t be for me.  It is incredibly easy to forget that I am not quite like everybody else, as much as I like to feel like I am.  I can’t short-cut my health, or I might end up hospitalized again.  Bipolar I is a serious mental illness, and I have it.

 

Medicine gets stolen (truly).  Cars get flat tires and appointments are missed.  Life gets overwhelming, especially when the mentally ill person has no one supporting them.  It takes work to be a productive person who lives a self-directed life if one has a serious mental illness.  Sometimes, despite good intentions and efforts, forces beyond the person’s control may keep the person from doing what he or she needs to do to become healthy.  If you know someone with a mental illness, giving them a little support might make a world of difference.

 

Rebecca Coursey, KPS
Peer Support Specialist

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