Medical News: Behavior Therapy Plus Drugs Best for Pediatric OCD - in Psychiatry, General Psychiatry from MedPage Today

Cognitive Behavioural Therapy and Behavioural Therapy are again found to be effecting in dealing with children and adolescents with OCD.

Medical News: Behavior Therapy Plus Drugs Best for Pediatric OCD - in Psychiatry, General Psychiatry from MedPage Today

Adding cognitive behavioral therapy (CBT) to pharmacologic treatment for obsessive-compulsive disorder (OCD) in young patients enhanced response, researchers found.
Click here for the full story: http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/28628
This study showed that in a randomized controlled trial, significantly more patients on the combination were considered responders than those who had drug therapy alone, or drug therapy plus “brief” CBT.
Children with OCD are currently treated with serotonin reuptake inhibitors, the researchers said. Yet the majority have only a partial response, so some argue that augmenting drug therapy with short-term, OCD-specific CBT may add benefits.
Franklin and colleagues found that the combination therapy of medication plus CBT was superior to the other two strategies on all outcome measures.
They estimated the number of weeks needed to treat with the drug and CBT combination therapy versus medication alone to be three, which was the same when comparing the full combination with drug-plus-brief-CBT.
When comparing the drug-plus-brief-CBT with medical management alone, the estimated number needed to treat rose to 25, Franklin and colleagues reported.
Though the study may be limited in generalizability because it didn’t include many minority participants, the researchers still concluded that the findings “highlight the importance of disseminating CBT for pediatric OCD into community settings so that affected children have options beyond medication management alone.”

Skills for Dealing with Depression

Depression is one of the main focuses of research into the effectiveness of Cognitive Behavioural Therapy (CBT). CBT has been found to be very effective, and in some cases as effective or more effective than medication. The gold standard for the treatment of depression (especially moderate to severe depression) remains a combination of medication and Cognitive Behaviour Therapy.

Over the past few weeks I've gone into some details about Cognitive Behavioural Therapy self-help programs that are available for individuals with Anxiety or Depression to use, either on their own or with the support of their therapist or counsellor. One of the programs I've recommended is the Desling with Depression books available from the Minsitry of children and Family Services, or from www.heretohelp.ca.

These are excellent, short, easy to use, step-by-step books that guide you through the therapeutic process. Several people have asked me about the major three skills and how I teach them. It would be inappropriate to go into any detail here, you either should be using these books on your own or with the help of a therapist, and internet questions and answers are no replacement for a proper medical/psychological diagnosis and treatment. (Remember: ALWAYS start by seeing your medical doctor! Sometimes what we think is depression, and what looks like depression, is really something physical. Go to your family doctor, or a walk-in clinic and get a good check up.) However, I will go over the three "antidepressant Skills" that most of these programs discuss. You should make sure your plan for dealing with depression includes these.

1) Realistic Thinking.  Much of what Cognitive behavioural Therapy is about is "Realisitic Thinking." This is a process you will review and PRACTICE again and again in many settings and situations. You will learn to spot depressive thoughts that lead to depressed moods; challenge those depressive thoughts; come up with realistic thoughts; and then practice this realistic thinking. These are not happy thoughts, it's not about "positive thinking," or some other simplistic distraction from reality. It's about learning to think "realistically" even when your brain, your mood and the situation want to keep you from doing that.

2) Problem Solving. Problem solving is the next skill you will learn in Cognitive Behavioural Therapy (CBT).  Through exercises, worksheets and face-to-face practice you will learn to: Better understand the problems your dealing with- because they are real and have real effects; come up with several different solutions to those problems; and then select the best solution and start the problem solving process. Sounds easy, but often this is difficult in a time of crisis, depressed mood or anxiety.

3) Goal Setting. Goal setting is about moving from a position of knowing what your going to go to planning how your going to do it. Once you know what you want, unless you have a good plan, your just going to be waiting for it to come to you unless you have a plan. In goal setting sessions you will: Learn to set goals that are important to you; make goals that are likely to succeed; and move on to new goals. 

Some of the other things we do in face-to-face sessions for depression are: dealing with sleep issues, dealing with anxiety, learning to cope with intrusive negative thoughts (thought stopping), learn how to relax by using external cues, examine our diets and....sorry...making sure you are exercising enough. Studies show that moderate exercise (under the supervision of your doctor) is one of THE most effective tools you have to deal with depression.

As I look over this list it seems simple, easy, and you wonder why anyone needs a therapist ..or even a book? Well, these things are not so easy to do when you are suffering from depression and anxiety. Thinking clearly, which is something we all need to do to do this right, is difficult at these times. Support and advice help to keep you on track and monitor your progress. And much of what we have discussed here is really about learning to think differently than you do now. In the early days of Cognitive Behavioural Therapy (CBT), when it was called Rational Emotive Behaviour Therapy (REBT) this learning how to think differently was called "the disputation," because, in effect your therapist disputes your irrational thoughts and makes you defend them...or pick new thoughts that can be defended. This is a critical part of the process.

So, to sum up, CBT for Depression focuses on three areas: Realistic Thinking; Problem Solving; and Goal Setting. In addition to that several very specific skills are taught to address intrusive thoughts, sleep problems and other specific symptoms giving you difficulty. I hope this addresses the questions people emailed.

For more information about the services I provide my web page can be found at www.relatedminds.com, http://www.relatedminds.com/depression. Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682, http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche

Help in Preventing Relapse of Depression

On my web site I've just added a useful link for those with a history of depression interested in relapse prevention. I often recommend "Mindfulness Training" for relapse prevention, however  this is a short workbook, easy to follow and evidence based workbooks for those with depression. Visit my site's Depression page to find links to these effective and free materials that are primarily designed to use on your own.

For the link, click here: www.relatedminds.com/depression

Self-Help Books for Depression?

In my practice I almost always provide some sort of self-help materials for depression. This might include a book, audio tape or CD and on occasion a video. One of the problems is that the best books I can recommend (Mind Over Mood and The Feeling Good Handbook - you can read more about these on my Resource page) are often too long for individuals with significant depression. There is, however, a great alternative to these lengthy books, and these alternative are free. They include downloadable workbooks, on-line workbook pages for practice, and some excellent video recordings that go along with these materials that specifically address Depression. They are also made right here in BC in Vancouver and Burnaby at Simon Frasier University.

The First is the Antidepressant Skills Workbook.
The Antidepressant Skills Workbook starts by giving you an overview of depression, explains how it can be effectively managed using Cognitive Behavioural Therapy (CBT) and Behavioural techniques and is based on the best available research. This workbook gives a step-by-step guide to changing patterns that trigger depression, it shows how to use cognitive and CBT and behavioural methods to make important changes in thinking and actions that can help you emerge from depression and make it less likely to recur. These methods can be used in combination with depression treatments, increasing their effectiveness. As the authors of these workbooks note, "for most people with serious depression, use of this self-help guide alone will not be sufficient to resolve the depression". People with serious depression should get treatment with antidepressant medication or Cognitive Behavioural Therapy (CBT) from a specially trained therapist (I hold an Advanced Certificate in Cognitive Behavioural Therapy or CBT from the Albert Ellis Institute in New York, and have been practicing CBT for over 20 years).

Here is the website to download this workbook for depression:
http://www.comh.ca/antidepressant-skills/adult/

You will find another excellent workbook to help with depression in the workplace. These together, especially with the help of a therapist who has expertise in treating depression with CBT or Cognitive Behavioural Therapy is a great place to start.

I am often asked: "How do I know if I have depression?" Well one place to start is by asking a professional. While a psychologist (like myself) offer diagnostic services, they are not covered by MSP. The are often covered by extended health care plans, but each plan is different and you need to check with your plan before making a decision. Psychologists have the expertise to make a diagnosis of depression. For locating psychologists in Burnaby, New Westminster, Coquitlam, Vancouver or anywhere in BC just contact the British Columbia Psychological Association (BCPS). They can direct you to a psychologist who has expertise in this field, and is located near you. Fees for psychologists range from $60 -$175.00 per session.

Another simple and cost effective choice, if cost is an issue, is simply talking to your family doctor. While a family doctor may not have time to see you repeatedly, and usually doesn't provide therapy, they are able to make a diagnosis and a referral. They can also refer you to a psychiatrist if need be, who is covered by MSP.

There are other mental health practitioners in BC, including MFTs and "Registered Counsellors." These individuals are not usually trained to make a diagnosis, and have less training and fewer hours of supervision than a psychologist or medical doctor. Additionally, while they call themselves "Registered Counsellors" they are not really regulated by a registration board (Called a "College" in BC). Some of these individuals are excellent therapists, but you need to check their credentials. Finally, Registered Social Workers are often highly trained in providing therapy/counselling and often work with government agencies and in private practice here in BC. They too can be an excellent choice.

If you feel depressed, and wonder if you need help working out your depression, start by talking to your family doctor (or any doctor in a walk in clinic). They are a great place to start.

For more information about the services I provide my web page can be found at www.relatedminds.com, http://www.relatedminds.com/depression. Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682, http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche

Self-Help Book for Relationships and Couples

I thought it might be a good idea to repost this blog about self-help books for couples:


If your looking for a good self help book instead of marriage counselling, here is one I can recommend: Why Marriages Succeed and Fail: And How You Can Make Yours Last by John Gottman. Many couples need the help of a registered marriage and family therapist, but this book is useful for anyone, including those who decide to see  therapist of counsellor. Here is the book at Amazon.ca:

<a href="http://www.amazon.ca/Why-Marriages-Succeed-Fail-Yours/dp/0684802414/ref=pd_sim_b_1/701-7522828-1360365?ie=UTF8&qid=1189021726&s">http://www.amazon.ca/Why-Marriages-Succeed-Fail-Yours/dp/0684802414/ref=pd_sim_b_1/701-7522828-1360365?ie=UTF8&qid=1189021726&s</a>

The book is by marriage researcherDr. John Gottman. It's described as "upbeat, easy-to-follow manual based on research into the dynamics of married couples. Gottman describes his studies as being akin to a CAT scan of a living relationship and asserts that he's been able to predict the future of marriages with an accuracy rate of over 90 percent. In 1983 and 1986, his research team monitored more than a hundred married couples in Indiana and Illinois with electrodes, video cameras, and microphones as they attempted to work out real conflicts. Using the information derived from these sessions, Gottman concludes here that a lasting relationship results from a couple's ability to resolve conflicts through any of the three styles of problem-solving that are found in healthy marriages- -validating, conflict-avoiding, and volatile. Numerous self-quizzes help couples determine the style that best suits them. Gottman points out, however, that couples whose interactions are marked by four characteristics--criticism, contempt, defensiveness, and withdrawal--are in trouble, and he includes self-tests for diagnosing these destructive tactics, as well as steps for countering them. Interestingly, Gottman asserts that the basis of a stable marriage can be expressed mathematically: the ratio of positive to negative moments must be at least 5:1--and he offers a four-step program for breaking through negativity and allowing one's natural communication and problem-solving abilities to flourish. Mathematics and science aside, there's plenty of old- fashioned, helpful, and worthwhile advice here about gender differences, realistic expectations, love, and respect--advice that may appeal especially to those who enjoy taking quizzes and analyzing relationships."

If you love your mate, and your relationship just seems to be going off track, and becoming less and less important to you, this is THE book for you. As the author above describes, Gottman's book is one of the very few relationship books that is actually based on science. There are many theories, but most are ...it may seem hard to imagine...just made up! Yes, people look at a situation and develop a theory, and then a practice, on what they think is right, with no research to back up their ideas, or the treatment you are exposed to. Gottman bases his suggestions on scientific observations and years of research. The ideas on how to strengthen your relationship are easy to follow, clearly laid out and presented in a step by step manner. Those of us who practice marriage and family therapy often use both his books and his many packets of clinical material to help guide couples through this learning process in a supportive and direct manner.  In the book you will learn: That more sex doesn't necessarily improve a marriage, Frequent arguing will not lead to divorce, Financial problems do not always spell trouble in a relationship, Wives who make sour facial expressions when their husbands talk are likely to be separated within four years, There is a reason husbands withdraw from arguments -- and there's a way around it

Dr. Gottman tells you how to recognize attitudes that doom a relationship, which he calls "The Four Horsemen" - contempt, criticism, defensiveness, and stonewalling, and provides you with readings, exercises, role plays, tips and easy to use techniques that will help you understand and make the most of your relationship. Through reading and practicing his suggestions you can avoid patterns that lead to divorce.

About Dr. Roche:
Dr. Jim Roche is a Registered Psychologist and a Registered Marriage and Family Therapist with offices in Vancouver and Burnaby, BC. He has been in practice for over 25 years and uses Dr. John Gottman's programs and techniques, as well as Cognitive Behavioural Therapy, when working with couples and families. For more information about his marriage therapy practice check out his web page at: http://www.relatedminds.com/couples-therapy/

Other information about Dr. Roche can be found at:  <a href="http://relatedmnds.com">www.relatedminds.com</a> or <a href="http://www.relatedminds.com/adhd">www.relatedminds.com/adhd</a>. Other information on my practice can be found at: <a href="http://Therapists.Psychologytoday.com/70682">http://Therapists.Psychologytoday.com/70682</a>, http://www.bcpsychologist.org/users/jimroche or <a href="http://psyris.com/drjimroche">http://psyris.com/drjimroche</a>.