Stress Therapy Offer To Ill Jobless: Really?

Submitted by tonyplant on July 6, 2006 - 07:29.

According to The Guardian, the government is about to offer stress therapy to people who have had to quit work because of stress or depression.

So, would this be a separate plan to the Layard proposal for enhanced access to cognitive-behavioural therapy? Or is this a separate proposal? If so, is this a well-researched and validated programme? Or is it a nice, worthy sounding initiative that is not expected to go anywhere?

Why focus on stress therapy? Has anyone looked at the possibility of focusing on people's character strengths and virtues and using those to help someone to help themselves? Has there been any investigation of resilience work that would not only relieve stress in the short-term but sustain it? Is accepting the health benefits of positive emotion still too much of a leap of faith?

Copyright 2006, Tony Plant Happystance Project

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The Relief of Like Minds

Submitted by tonyplant on May 18, 2006 - 17:28.

The notion that happiness can be taught sometimes leave people feeling baffled by the language (like the translations in the accompanying photograph) or even outraged. I participated in a fascinating Like Minds event last night. I had the opportunity to present some of the work that I do with positive psychology to an audience of battle-hardened GPs, Community Mental Health workers, psychiatrists and even a Mental Heath Commissioner (I think; he was up until last Friday, but from bits and pieces last night it seems as if he was so successful and innovative there that he has been appointed to a different post).

The GPs were concerned with the medicalisation of unhappiness and patients' requests for anti-depressant medication. There was some discussion of claims that GPs don't know how to make appropriate referrals for depression. The GPs felt that they had limited resources rather than limited knowledge: in terms that were reminiscent of Dr. Crippen they felt that they were being treated like the dinosaurs of medicine and asked to become more and more remote from their patients rather than giving them the one-on-one time that so many of them need.

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Dr Serani's 6 Myths About Stress

Submitted by tonyplant on April 25, 2006 - 13:33.

 

Psychologist Dr Deborah Serani dispels six myths about stress in the hope of promoting greater understanding. It sounds a lot like being aware of the allostatic load of your life. I've borrowed this following explanation of allostasis from Dr. Salt's summary of a classic paper:

[stress has] many mechanisms, but among the most prominent are the manifestations of physiological stress responses as a result of living and working conditions, inter-personal conflict, as well as the sense of control of one’s environment and optimism/pessimism toward the future. "Allostatic load" refers to the cost of adaptation to a stressful environment, which elicits repeated and sometimes prolonged adaptive responses ("allostasis") that preserve homeostasis in the short run but can cause wear- and-tear on the body and brain. Functional symptoms and syndromes, decreased cognitive function during aging, abdominal obesity, increased risk for hypertension and cardiovascular disease, insulin-dependent diabetes and decreased immune responses are all manifestations of allostatic load.

We have powerful ways of modulating the harmful output of the stress response systems that include belief systems and behaviors. An important quote attributed to Dr. McEwen is, "We must also remember that the biggest problems for the human race in the future are those associated with our own behavior and misbehavior and the impact of the social and physical environment on our bodies and brains."

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Stress, Anxiety and Depression: diverse findings from mice and stressed people

Submitted by tonyplant on April 19, 2006 - 14:18.

There is a lot of disagreement about anxiety and depression among professionals. Some argue that they are discrete categories. Others say that they tend to co-exist. There is disagreement about whether the anxiety that often accompanies chronic depression is a cause or effect of the illness.

Research in mice suggests that chronic stress as a precursor of anxiety may be a trigger for -- rather than a symptom of -- depression. People with depression typically have measurably higher levels of cortisol (stress-fighting, anti-inflammatory hormone), but researchers disagree whether this is a cause or effect of depression. The findings of the mouse research indicate that chronic exposure to cortisol may contribute to the development of depression.

The mice were acutely (24 hours) and chronically (17 to 18 days) dosed with their stress hormone. They mice were then given a common behavioural test for anxiety in animals: researchers measured how much time it took to leave a small dark enclosure for a brightly lit, open field. The research reports that the mice exposed to chronically raised levels of stress hormones were more hesitant less to explore their new environment and more fearful.

The research also indicates that the mice with chronic exposure responded with dulled reactions to being startled: an indication that their nervous system might be overwhelmed.

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The Heart of the Matter: Why Context Rules

Submitted by tonyplant on February 23, 2006 - 14:52.

GeekNurse has posted a tracing of a baby’s heart activity. It’s one of those occasions where a straight reading might have prompted concern that there was a major cardiac problem. However, with the nurse’s special understanding of the context, the trace is correctly interpreted as innocent of any sinister problem (I’m not giving the solution here, it’s a nice surprise). [April 2006 edit. Sadly, this excellent blog has been taken down so this example is no longer available. The solution was that the nurse had been present when the baby hiccoughed, causing the irregularity in the trace.]

I’m attracted to this example because it is a striking instance of the need to understand the full context of data before interpreting it appropriately. And this is yet another re-working of my continued thinking on the topic of whether unhappiness is a symptom or a passing phase.

Unhappiness is inevitable as a response to life events: it is appropriate in the current context of that life. There may come a point when the degree of unhappiness paralyses a person’s ability to function on many levels, both socially and economically. Somewhere on that continuum unhappiness became a symptom in need of a remedy or intervention, whether pharmacological or psychosocial. Identifying that point of cross-over seems to be an art-form.

Positive psychology emphasises the many benefits of positive emotions, from greater personal success to better immune systems and improved longevity. One of the most repeatable findings seems to be that unhappiness is inevitable, but it is our resilience to life events and circumstances that governs our outcomes. It seems that we can cultivate resilience by cultivating positive emotions.

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Is Unhappiness A Symptom Or A Passing Phase?

Submitted by tonyplant on February 12, 2006 - 20:26.

I am troubled by a recurrent practice in the popular literature on the theme of happiness and the economics of happiness. It’s an intellectual sloppiness that I try to guard against but it happens from time to time. The practice is this. There are many articles that comment on happiness by dragging in statistics about anxiety and depression to bolster the perception/argument that unhappiness is endemic. One proof that is frequently aired is the sheer volume of prescriptions for anti-depressants and anti-anxiety medications that is dispensed in the UK, US, name the country under discussion.

Horwitz and Wakefield have offered an excellent overview of what my wife would refer to as the semantic shift of the word depression and what used to be understood by it. Apparently, 300 years ago silly used to mean innocent or blessed rather than its current connotations. In a much faster variation of this process, depression seems to have shifted from a medically defined term to one that is readily used (almost as a metaphor in its own right) to describe any negative emotional state: no matter how appropriate that reaction might be under the circumstances.

It is not unusual to come across reports that claim more than half of the population will develop a mental disorder at some time over the course of life. This immediately raises the issue of what constitutes mental health and mental illness. Although there are internationally standardised criteria for the latter, their application varies enormously. And even psychiatrists can not provide a united front as to where the boundary lies.

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BACP On Disagreeing With Layard's Proposals

Submitted by tonyplant on February 12, 2006 - 18:03.

A while ago the British Association for Counselling and Psychotherapy issued a press release that criticised some of the Layard proposals: specifically those calling for the training of more therapists (BACP argues that a sufficient number already exist), and those that emphasis the importance of the cognitive behavioural therapy approach above other strategies.

Economists argue that anxiety and depression are a burden on the economy. Mental Health specialists (among others) counter that they are an unaffordable burden on society. Layard says that happiness should be seen as more than a health issue. The BACP unhelpfully offers the counter-claim that

Unhappiness is the consequence of more than a diagnosed condition and always arises from a life situation.

And they offer counselling etc. as part of the solution. Which still looks like medicalisation of a psychosocial issue to me. I will put more about this in another post.

 

Copyright 2006, Tony Plant Happystance Project

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A Quiet Crisis of Unhappiness

Submitted by tonyplant on January 23, 2006 - 15:03.

There’s an interesting piece about the political need to address optimism and happiness in today’s Guardian. Jackie Ashley quotes from a report by Mulgan and Buonfino of the Young Foundation who conclude that british social fabric has been bruised over the last few decades and that Britain is suffering “a quiet crisis of unhappiness”.

Many of the issues are the same ones that I’ve been writing about in my attempt to explore what would make Harlow happy. Similarly, one of the issues that Ashley refers to is the ready deprecation of happiness as an optional extra. Both as individuals and communities, we seem to be in the grip of the same psychological process. We are deferring our happiness ‘until’ other things are achieved first: in transactional analysis terms, this is known as running an until script. Sometimes, the shopping list of what must be sorted first keeps growing to ensure that it will never be the right time to address the outstanding issue. Or we pack out our list of ‘to-be-dones’ with wicked problems that can never be resolved satisfactorily.

A common finding in transactional analysis is that the until script often runs concurrently with the injunction “Don’t have fun”. Fun is too frequently seen as equivalent to play, and therefore the opposite of work, achievement and productivity. However, Pat Kane argues for a play ethic that is essential for us to maintain “our adaptability, vigour and optimism in the face of an uncertain, risky and demanding world”. Kane quotes Brian Sutton-Smith: “The opposite of play isn’t work. It’s depression”. It’s a startling observation that seems to have a remarkable amount of validation in the world around us, whether that is at work, school, college or our homes.

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