Wonderful ideas can come from anywhere. Sometimes you make a mistake,
or break something, or lose a hat, and the net thing you know, you get
a great idea.

--Maira Kalman

The April 2005 issue of the Harvard Mental Health Letter provided an overview of ways in which mental-health practitioners are incorporating mediation and meditative techniques into their services. One study showed that longtime practitioners of meditation showed a high proportion of a type of brain wave that reflects large-scale coordination of neural circuits. Another study showed persistent, increased activity on the left side of the prefrontal cortex, which is associated with joyful and serene emotions, after only four months of mindfulness meditation.

Some counselors are calling the merger between meditative techniques and cognitive techniques as the "third wave" of cognitive-behavioral therapy.

This overview reaffirms the need for wellness programs that focus on training. In order to reap the benefits of these findings about meditation, people need to be taught the techniques, they need time and space to "practice," and they need to understand how important "mastering the skill" is to how well they feel in the long run. Please contact me to discuss further my work with mindfulness training.

Additional Resources:

• Acceptance and Commitment Therapy: the Web Site
• Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School
• Mind/Body Medical Institute
• National Center for Complementary and Alternative Medicine, National Institutes of Health

An experiment recently conducted at the University of Texas shows that having protective reassurance during anxiety treatment (avoiding the perceived danger by checking a pulse, constantly asking for reassurance, or carrying medication or a cell phone wherever they go) prevents recovery, whether the protection is used or not.

Seventy-two undergraduates with claustrophobia were assigned at random to one of five groups, three of which received exposure treatment (education and gradual exposure to small chambers while practicing relaxation). The first group was given no way out (standard exposure treatment). In the second group, subjects were told that they were expected to open the door or window to talk to an experimenter by radio. Members of the third group were told to contact experimenters "only if you must." The fourth group received a placebo (listening to sounds using headphones while watching colored lights), and the fifth group was placed on a waiting list.

In the first group, 94% improved significantly. In the groups provided with loopholes, the improvement rate was 45%. In the placebo group, it was 25%, and there was no change to those on the waiting list. Relapse rates were low and statistically similar across groups.

Most effective interventions for emotional well being require a teaching component and a way for people to apply new skill within the context of their everyday lives. Contact me for more information about my education and skills-building approaches to emotional wellness.

Author Sami Timimi, a consultant to Britain's National Health Service, can recall only a few instances of having prescribed antidepressants for children, and he doubts that childhood depression even exists. In his book, Pathological Psychiatry and the Medicalization of Childhood, the author argues persuasively that we have medicalized a growing epidemic of childhood unhappiness.

Citing one very alarming statistic, between 1992 and 2001, the prescription rate for antidepressants among children under 18 in the United Kingdom rose tenfold from .5 children out of 1,000 to 4.6 out of 1,000. "Either we have a lower threshold or a different interpretation of abnormality, or there's been a genuine increase in these types of behaviors." Writing in the December 11th issue of the "British Medical Journal," Timimi says that the answer is a little of both.

Timimi cites very familiar culprits to this increase in childhood unhappiness: the shrinking of extended families, exhausted parents, the breakdown of communities, and the exploding consumer economy (which encourages children to focus on what they have or don't have, as opposed to who they are). When providing assistance to such children, in addition to standard psychotherapeutic techniques (family therapy, individual narrative counseling, solution-focused, or psychodynamic counseling), he also applies lifestyle assistance with exercise, diet, or changes in sleep routines. Sometimes, Timimi says, "I just allow children to solve their own difficulties by pointing out to them their positives and strengths that they may have forgotten about."

One of the striking aspects of Timimi's approach is that he refused to lock himself into one, strongly-defended point of view about what is happening with children ("it's a chemical imbalance...medicate!"). Building skill in accessing multiple points of view is critical not only for the child who is out of touch with her or his strengths, but it is vital for professional helpers, as well. Contact me for more information about how point-of-view exercises and "reframing" are essential parts of my therapeutic teaching work.

To be without some of the things you want is an indispensable part of happiness.

--Bertrand Russell

The April 2005 issue of the Harvard Mental Health Letter reviewed current thinking on conduct disorder. Conduct disorder is a persistent and repetitive pattern, beginning at an early age of childhood, of impulsive, aggressive, and deceitful behavior that involves violating basic social rules and the rights of others.

The article cites that typical methods of mental-health treatment have not had promising results with conduct disorder (individual psychotherapy, boot camps, group therapy, reform schools, and behavior therapy. Although, in theory, problem solving and social skills may work, it is untested. The article states that the most promising approach to this problem is parent-management training. Parents are taught to issue and enforce stable rules, negotiate compromises with older children, and substitute discipline for inconsistent harshness.

This is another instance of an emphasis on teaching. Also, it is important to assist people within the context of their lives (work with the parents and families of children who have conduct disorder) instead of providing emotion-expressive-centered treatment in a vacuum (many forms of individual psychotherapy).

Additional Resources:

• American Academy of Child and Adolescent Psychiatry
• Center for the Study and Prevention of Violence Institute of Behavioral Science, University of Colorado, Boulder
• Child Conduct Clinic, Yale Child Study Center
• Family Studies Program and Clinic, Duke University Medical Center
• Parenting Clinic, University of Washington School of Nursing
• Research and Training Center on Family Support in Children's Mental Health, Portland State University, Oregon

The January 2005 issue of the Harvard Mental Health Letter provides an overview of treatments for opiod addiction other than methadone treatment. It points out that individual psychotherapy is never recommended as the main treatment for opiate addiction and that it be used in a secondary role.

The most recommended forms of treatment include group therapy (it makes use of the need to belong, the healing power of connections, and the ability of group members to confront one another from a place of "having been there"), behavioral treatment ("contingency management"), residential treatment, support groups, and family counseling (as an adjunct, which can possibly assist the client in learning cognitive-behavioral techniques). Also, the article states that the use of "stages of change" theory can greatly assist treatment. The article concludes that methadone is the most effective treatment for opiate addiction, based on the criteria of "not relapsing with the abused opiate" (such as heroin).

I have two thoughts about this article. The first is that it seems odd to me that they consider being addicted to a drug (methadone) to be "successful treatment" of abusing a different drug (heroin). It seems to me as if the client has just traded one addiction for a less dangerous addiction. Progress, yes? But is it successful treatment?

Second, it echoes the familiar theme about clients learning skills, and the challenge of assisting people in a learning process that can facilitate mastery. It is my hope that my new, combined approach of classroom teaching (to teach content), follow-up support groups, and individual tutoring is a way to assist people in making use of skills a daily part of their ever improving lives.

Additional Resources:

• American Society of Addiction Medicine
• Buprenorphine Information Center
• Narcotics Anonymous World Services
• National Institute on Drug Abuse
• Smart Recovery
• Substance Abuse and Mental Health Services Administration (SAMHSA)