Psychological treatments: A call for mental-health science

Psychological treatments: A call for mental-health science

Emily A. Holmes Michelle G. Craske& Ann M. Graybiel

But evidence-based psychological treatments need improvement. Although the majority of patients benefit, only about half experience a clinically meaningful reduction in symptoms or full remission, at least for the most common conditions. For example, although response rates vary across studies, about 60% of individuals show significant improvement after CBT for OCD, but nearly 30% of those who begin therapy do not complete it3. And on average, more than 10% of those who have improved later relapse4. For some conditions, such as bipolar disorder, psychological treatments are not effective or are in their infancy.

Moreover, despite progress, we do not yet fully understand how psychological therapies work — or when they don’t. Neuroscience is shedding light on how to modulate emotion and memory, habit and fear learning. But psychological understanding and treatments have, as yet, profited much too little from such developments.

It is time to use science to advance the psychological, not just the pharmaceutical, treatment of those with mental-health problems. Great strides can and must be made by focusing on concerns that are common to fields from psychology, psychiatry and pharmacology to genetics and molecular biology, neurology, neuroscience, cognitive and social sciences, computer science, and mathematics. Molecular and theoretical scientists need to engage with the challenges that face the clinical scientists who develop and deliver psychological treatments, and who evaluate their outcomes. And clinicians need to get involved in experimental science. Patients, mental-health-care providers and researchers of all stripes stand to benefit.

This article calls for collaboration between neuroscientists and clinicians for a truly interdisciplinary approach to mental health. The authors argue that by doing so we can learn more about how and why psychological treatments work, which will ultimately lead to better outcomes for patients.

I highly recommend this article and I am completely persuaded by their argument. I’m always a fan of interdisciplinary approaches and in the case of mental health it is clearly not happening at present. As a mental health patient myself, it would be great for there to be solid research around both psychological and pharmaceutical treatments. Hell, more research into mental health in general since we currently have such little knowledge about causation and treatment.

Stories

“We read books to find out who we are. What other people, real or imaginary, do and think and feel – or have done and thought and felt; or might do and think and feel –  is an essential guide to our understanding of what we ourselves are and may become.

And a person who had never listened to, nor read a tale or myth or parable or story, would remain ignorant of his own emotional and spiritual heights and depths, would not know quite fully what it is to be human. For the story – from Rumpelstiltskin to War and Peace – is one of the basic tools invented by the mind of man, for the purpose of gaining understanding.”
– Ursula K. Le Guin 1

Books, novels, comics, games, movies, web series, blogs and oral storytelling are all mediums that we use to tell a story. Each medium allows a unique tale to be told in a way that reaches different people and touches them differently. I love stories and I love them in all their forms, however my favourite way to engage with stories is through reading books.

My beliefs about the power and usefulness of stories has been shaped by the ideas expressed by Ursula K. Le Guin (above) and other writers. While I enjoy novels and short stories as entertainment, their greatest value is in facilitating understanding. By which I mean that they help us understand ourselves, others and the world at large by making us think and feel. We become empathetic by seeing the world through the character’s eyes and gaining an insight into how other people think. What other way is there to do this, but in stories? The best books, the ones that stay with you the longest, are the ones that make you think, reflect or see things differently. Nor do these texts need to depict an ideal – many authors, such as Joe Abercrombie, create dark and gritty realms and often depict unsavoury characters.2 In some ways, I love these kinds of novels even more because I am given access to the thoughts and motivations of people I least understand.2

Growing up I mostly read science fiction and fantasy (predominately fantasy), and this still constitutes a large part of my reading life. Precisely because it is set apart from reality, fantasy is an excellent genre to explore the human condition, the norms of our society, and our cultural beliefs and values. We are able to envision a completely (or slightly) different reality, where we are invited to contemplate, in depth, theoretical people and societies: to analyse their structure and morals, and to compare them against our own.

Stories that are well-researched can also give you general knowledge – so many times someone’s asked me how I know something and my response has been that I read it somewhere. Of course not everything you read is true, but learning to analyse what you read gives you good critical thinking skills. Indeed, storytelling is a valued teaching tool; the Bible, for example, is full of parables.

Storytelling has always been a part of human culture and I imagine it always will be, albeit in different forms. Stories are so inherent to humans, so necessary, that it makes sense that we experience our world and process our understandings through them.

1 Le Guin, Ursula K., from ‘Prophets and Mirrors: Science Fiction as a Way of Seeing,’ The Living Light 7 (1970) quoted in The Language of the Night: Essays on Fantasy and Science Fiction (1979) Putnam Pub Grou
2 For example, his First Law trilogy: The Blade Itself, Before They Are Hanged and Last Argument of Kings.

Perfection: my never-ending quest

Given the subject matter of this post, it’s not surprising that’s taken me 2+ weeks to actually finish writing and publish it. In fact, that is and will continue to be the case with the majority of my posts.

I am a perfectionist. I want everything to be just-so, and I want to do well in everything. I am obsessed with perfection.

Throughout my life, my desire for everything to be ‘perfect’ (or what I perceived as perfect at the time) has created a lot of emotional distress and anxiety. And I do mean everything: when I was young I needed my hair and shoes to be tied tightly, my underwear to be very tight fitting (I guess I was worried that they would fall off?) and sandwiches to be composed in a certain manner and could not fall apart, otherwise I would cry. Now I get upset if dinner isn’t right or if I’ve prepared something wrongly, I stopped learning cello after 6 months because I was struggling and you know learning; I get stressed when I’m not good enough at games; and most of all I strive for academic excellence. In academic terms I’m a high achiever and writing is very difficult for me because I struggle to allow myself to think and write – because what I write initially isn’t ‘perfect’, it’s not good enough.

I began to examine my self as a perfectionist recently because of the distress created by my self-imposed, impossibly high academic standards. I received my Honours results, (objectively) I did extremely well: my thesis was awarded 86 and my overall Honours mark is 87.*  My initial reaction was disappointment, I was still not good enough.  

And so we come to the problems caused by having such high expectations and holding yourself to an impossible standard. An obvious and very harmful issue is that you are never happy and always disappointed with yourself.  This leads to an inability to enjoy or savour any achievements, because they don’t feel like achievements at all: it’s still not good enough. Another, more minor problem, is that other people don’t understand what’s wrong. To them you’ve done a wonderful job and you’re either being modest or somehow ungrateful if you’re not happy with your results. I also have an ‘all or nothing’ idea – if it can’t be perfect, why bother? This thought pattern is extremely damaging, it stops me from doing a lot of things including, at times, even basic housework.

The biggest problem is that I don’t even know what I mean by ‘perfect.’ I don’t know what ‘perfect’ would look like, I don’t know what I would have to do to achieve or become ‘perfect’. It’s literally an impossible ideal. Every time I think if I just achieve x then I will feel/be y, I’m setting myself up to fail, because life doesn’t work like that. My thought patterns are so ingrained that I don’t know how to think otherwise. It’s something I’m working on with my therapist, but as we all know changing the way you think is very difficult.  I want to be a high achiever, I want to do well, I want to succeed, but I need to learn the difference between success and being perfect.

 

*For those unfamiliar, 80+ is classified as First Class, 90 and above may be awarded First Class with University Medal.

Little Bit of Sunshine

I usually don’t get much exposure to natural light; my working day doesn’t leave much time for day light, and when I’m not working I struggle to leave the house. The past couple of days I’ve made the extra effort to go outside on my lunch break and get some sun. I find a little patch of sunlight (not much to find in Sydney CBD during winter) and stand there; I absorb the warmth and light. It’s definitely helping to improve my mood at work, I’m reminded that things aren’t so bad after all – at least I’m warm in the sun.