Book review: Why Zebras Don’t Get Ulcers

We each have different ways of managing the stress in our lives. Make no mistake, we all have some stress to deal with. Most of us have been through times when the stress in our lives felt overwhelming. For many of us, these times are few and far between. But for some people, stress can feel overwhelming on a chronic basis.

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OCD Treatment That Works

“CBT, accompanied by medication, is the only treatment for OCD that is supported by scientific evidence.  At this time, there is insufficient evidence to support the use of treatments such as hypnosis, herbal or homeopathic remedies, psychoanalysis, relaxation therapy, eye movement desensitization reprocessing (EMDR) or dietary changes… there are a number of excellent tools for reducing anxiety that may be used to supplement CBT and medication, including yoga, exercise, and meditation.” — Relief from OCD, from the people at (retrieved 2009).

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Mental Health Parity Law

With the recent passage of the federal bailout of the financial industry, a groundbreaking piece of legislation was passed that will significantly affect mental healthcare in the U.S. This bill stipulates that mental health conditions must receive the same insurance coverage as physical health conditions. Thus, treatment for schizophrenia or OCD will not be covered with different annual limits, co-payments, and deductibles than those for, say, arthritis.

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September 11th and Anxiety

For those of us who were living in New York or Washington on September 11th, 2001, and for those of us who were otherwise affected by the events of that day, each anniversary of that date can bring its own difficult memories. It is not uncommon for those who were affected by 9/11 to experience an increase in certain unpleasant symptoms on anniversaries of 9/11/01.

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CBT becoming more available in the U.K.

Starting in 2006, the British government undertook an initiative to make high quality psychotherapy more widely available for people suffering from depression, anxiety, and related problems. While many different types of psychotherapy were already available, the government chose to make therapies proven to be effective available to as many patients as possible.

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Treatment for OCD

Did you know that good treatment for obsessive-compulsive disorder is just as likely to include cognitive-behavioral therapy as medication?  The National Institute for Health and Clinical Excellence in the UK recommends that adults with mild to moderate symptoms of OCD be offered either cognitive-behavioral therapy or an antidepressant medication (SSRI). 

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Mindfulness in Therapy

An article in the New York Times health section today, entitled “Lotus Therapy,” describes the increasingly prevalent use of mindfulness techniques in psychotherapy over the past ten years. The article describes the state of research on the use of mindfulness meditation as “thin,” and indeed the evidence for the effectiveness of mindfulness’ use for anxiety and depression is not as substantial as the evidence for cognitive-behavioral therapy or antidepressant medication.

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Meditation Brain Research

recent meditation study out of California has recently garnered significant publicity.

meditation brain research

It should be no surprise to anyone that the brain is the most complex organs in the body, and the most difficult to understand. Despite the frequent headlines about scientific advances, researchers have only a relatively primitive understanding of how the brain works.

Some areas are well understood as very important to, say, breathing or balance. However, much “higher-order” cognitive functioning is very difficult to pin down in the brain. For example, long term memory does not appear to be localized to one part of the brain; rather, your brain uses many different locations in the supremely complex task of storing long-term memory.

It is also important to note that many aspects of brain functioning are not localized to one patch of gray matter. Research has revealed that many aspects of our cognitive functioning make use of “circuits” in the brain comprised of nerve cells reaching from one end of the brain to the other.

In the study described above, researchers at UCLA did two studies on emotional processing in the brain. They used functional magnetic resonance imaging (fMRI) to study which parts of the brain were more active during separate tasks. This method of studying the brain is one of the most complex and accurate methods currently available. One of their reported results was that people who were more “mindful” displayed different brain functioning than those who were not. Here the word “mindful” refers to those traits that are associated with long-term experience with meditation.

One result the researchers found was that people who were more mindful displayed more of the brain patterns found in people who are good at “putting feelings into words.” This result may be partly explained by the fact that a tendency to label one’s emotions is often included in descriptions of mindfulness. However, it is possible that this study illuminates an important difference in brain functioning between people who are mindful and those who are not.

We should beware the headlines that often accompany articles like this one. The above URL links to an article whose headline reads, “Brain Scans Reveal Why Meditation Works.” On one hand, this seems like a gross exaggeration. The uninformed reader may glance at this and conclude, “Hey, how about that, those scientists cracked another mystery. Case closed.” However there is much about meditation and much about the brain that is poorly understood by scientists. The recent trend to explain the subjective and objective effects of meditation in terms of neurobiological functioning is a welcome one, to this writer, but we have a long way to go before the mysteries of “why meditation works” can be considered “cracked.”

How to Deal with OCD

Should I seek therapy or medication for OCD treatment?

medication - one form of OCD treatment

Did you know that good OCD treatment is just as likely to include cognitive-behavioral therapy as medication? 

The National Institute for Health and Clinical Excellence in the UK recommends that adults with mild to moderate symptoms of OCD be offered either cognitive-behavioral therapy or an antidepressant medication (SSRI). The recommendation for adults with severe symptoms is that they undertake both treatments.

This is because both options are safe and effective, and perform similarly to in research studies.  Some people prefer to not use medication in their OCD treatment, and some prefer to use it; both options are realistic for most people.

National Institute for Health and Clinical Excellence.  (2006). Obsessive-compulsive disorder. London: British Psychological Society and the Royal College of Psychiatrists.

New Research on Treatments for Depression

A recent study in the Archives of General Psychiatry examined the relationship between our thoughts and our mood. In the July 2006 issue, Zindel Segal and colleagues from the University of Toronto and the Centre for Addiction and Mental Health in Toronto write about a study they conducted on people with a history of recurrent depression. Their results showed that for those with recurrent depression but who are currently not depressed, the more a sad mood influences their thought patterns, the more vulnerable they will be to further depression.

An Impact of Cognitive-Behavioral Therapy

Participants in this research study were randomly assigned to receive either antidepressive medication or cognitive-behavioral therapy. One interesting result the study’s authors found was that those participants receiving the cognitive-behavioral therapy had less “cognitive reactivity” to sad mood than those participants who received medication. This means that for those people receiving the cognitive-behavioral therapy, their thoughts were less influenced by a sad mood than was the case for those who received the antidepressant treatment.

depressed woman

CBT vs Antidepressant Medication

It is generally accepted that cognitive-behavioral therapy or antidepressant medication, or both, are effective treatments for depression. However, the choice between these two treatment options can be difficult for many people. Often it comes down to personal preference. Some people are reluctant to go on medications for various reasons. Others are reluctant to enter psychotherapy. Research has shown both types of treatment to be effective for depression, and can help people struggling with depression to create some positive changes in their lives.

The above-mentioned study found an interesting difference between these two treatments: people who received antidepressant medication experienced greater changes in their depressive thoughts than those who had received the cognitive-behavioral therapy.

Thoughts Affect Mood

This is a relevant finding because we know that depressive thought content is very relevant to depressed mood. Thoughts can make depression worse. For example, if someone is often having thoughts like “I’m a bad person” or “I’m no good at anything” or “Something is bound to go wrong today,” these thoughts will quite likely have an eventual effect on the person’s mood. This effect can be greater or lesser depending on the exact content of the thoughts, and other factors.

One of these “other factors” involves the beliefs or self-image that underlie the negative thoughts. In CBT, a therapist will sometimes explore these beliefs using various techniques such as the downward arrow technique. The goal of such techniques is to make the relevant aspects of self-image apparent to both therapist and client, so they can be discussed directly.

Mood can also affect thinking

If a brief sad mood effects your thought patterns significantly, you may be more likely to experience a relapse of depression. This is especially true if you have a history of depression.

An Insight Into How CBT Works

This study suggests that those participants who received the cognitive-behavioral therapy were more resistant to negative changes in their thought patterns. While the study did not investigate why people in cognitive-behavioral therapy fared better in this way, it does make some intuitive sense. Cognitive-behavioral therapy teaches how to recognize and rationally evaluate thoughts that may be contributing to depression (or anxiety). It may be that the people who received cognitive-behavioral therapy were better able to recognize early changes in thought patterns, and prevented those changes from becoming more pronounced by taking a more balanced perspective on the depressive thoughts.