Tuesday, April 27, 2010

Some Mild Advertising for the Psychology "Industry"

Whenever a pharmaceutical company finds a new a drug that works (even mildly), they follow up with a marketing campaign. This is understandable in the sense that they devote money to research and development, and they are in the business of making profits, so they have to get a return on their investment. The conflict of interest inherent between (1) needing to make money, and (2) helping and protecting the public at large, is another issue altogether and won't be addressed here.

Their system is so very effective. Psychology on the other hand, is near immobile in comparison. This is not to say that psychological treatments are not as effective. Quite the contrary. In fact, psychological treatments often work as well as, if not better than medications. Unfortunately, you'll rarely hear about this.

The field of psychology is not well understood by the general population to begin with. Many people make assumptions based on popular media (laying on couches and spouting Freudian theories that blame your mother). As such, for those readers who might not be aware, I'd like to briefly compare psychology and pharmaceutical research.

First, both types of research make use of randomized controlled trials to test the relative efficacy of their treatments. When testing a drug, you can compare the drug's efficacy to a placebo (a substance that appears to be a drug, but actually has no effect). Similarly, psychologists will often compare treatments to either no-treatment groups (ex: people on wait-list for treatment), or people who receive basic counseling (simply talking about problems). This allows psychologists to assess whether the new treatment is an improvement over a basic standard.

Now, what kind of new treatments do psychologists develop? Well, every year millions of dollars are spent by psychological researchers on basic research examining all aspects of human psychology. Researchers study things like attention and memory biases, personality traits and genetics, emotion regulation, behavioural principles, etc. This basic research can then be used to expand upon existing treatments, or generate new ones. Cognitive-Behavioural Therapy is a treatment that is always being studied and modified in order to improve treatment outcomes.

Thus, psychologists conduct basic research and outcome trials similar to pharmaceutical companies. And what you find is that psychological treatments are often just as effective as medications for disorders such as depression, PTSD, Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, and OCD. In fact, there is research showing that psychological treatments are superior to drugs in some ways. For example, when people with depression stop taking their medication, they are more likely to relapse compared to when they have stopped seeing their psychologist.

Also, psychological treatments don't have the side effects that drugs have. Furthermore, some people who take SSRIs to treat depression sometimes become worse with each new drug they take. Or, if they take benzodiazepenes for anxiety, they can become addicted to this medication.

Needless to say, seeing a psychologist can offer just as many benefits, if not more than taking medication for mental health problems. Unfortunately, most people don't know about it. Psychologists do not have the resources to advertise their findings. When Pfizer develops a new drug, you'll know. When psychologists develop a new treatment, you'll rarely hear about it. When was the last time you saw this in the newspaper: "Psychologists Find Highly Effective Treatment for OCD!" This headline is true. Exposure and response prevention is a highly effective treatment for OCD -- as effective as medication. But no one knows this.

So, whenever I see a client for 12 sessions and successfully treat their Depression or Anxiety Disorder, they are often surprised. They might say "I've tried 5 different drugs for the past 10 years, and now I get better after 3 months of CBT!"

Anyway, I know this blog is not exactly Time Magazine, but it's at least one more resource for people who may not know about the benefits of working with a psychologist.

Dr. Roger Covin
Montreal Psychologist


Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.

DeRubeis, R.J., Gelfand, L.A., Tang, T.Z., Simons, A.D., 1999. Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. Am. J. Psychiatry 156, 1007–1013.

DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D., Shelton, R.C., Young, P.R., Salomon, R.M., et al., 2005. Cognitive therapy vs. medications in the treatment of moderate to severe depression. Arch. Gen. Psychiatry 62, 409–416.

Imel, Z.E. et al. (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders, 110, 197-206.

Leykin et al. (2007). Progressive Resistance to a Selective Serotonin Reuptake Inhibitor but Not
to Cognitive Therapy in the Treatment. Journal of Consulting and Clinical Psychology, 75, 267-276.

Thursday, April 22, 2010

Well Done Sigmund Freud -- Sort of...

If you've ever taken a psychology course where Sigmund Freud's theories are discussed, there's a decent chance that your professor spent some time highlighting all the problems with his theory. Although Freud is the most recognizable name in the profession of psychology/ psychiatry, his theories have been criticized and even mocked by some contemporary psychologists.

In some cases, it is quite appropriate to criticize many aspects of his theories. But that's to be expected - he did not have the luxury of the scientific data we modern psychologists have access to. If Freud were alive today, he would surly take time to read what's happened in the 80 or so years since his death, and revise his theory. For the many criticisms I have of Freud's work, I must admit there some elements of his theory that appear to be fairly accurate (ex: the notion of defense mechanisms). In particular, it is his ideas about the unconscious that are quite impressive.

Freud believed that the brain operated at levels we were aware of (consciousness) and those we were unaware of (unconscious). Throughout history , many professionals and lay people have questioned this belief. However, the past 20-30 years of research, particularly in the fields of cognitive and social psychology, have really supported the idea that we have unconscious thinking.

Based on the wealth of scientific research in this area, psychologists now believe there are two types of thinking: automatic and controlled. Automatic thinking (also called implicit cognition) requires no effort or motivation on the part of the person. This is simply the brain processing information on its own. Controlled thinking is the type of thinking we're all used to -- the deliberate kind. This is when we take the time to think about things intentionally.

Clinical psychologists observe these two kinds of thoughts in therapy all the time. I will illustrate with an example. Imagine you see a spider scurry across your kitchen floor. It's a tiny spider that is obviously quite harmless. Yet, many people would be inclined to take a step back and feel a bit anxious. You might think "I hate spiders!" However, if someone asked you if the spider was harmful or dangerous, you'd probably say "no -- I know it's not harmful, but I just don't like them." What's going on here?

Well, it seems that automatic thinking is based on associative connections in the brain. An associative connection is a neural link between two concepts or ideas. For example, what word comes to mind when you read the following:

Bacon and ______

Did you think car? Horse? Probably not.

Most people think eggs.

Why? Because eggs and bacon are often paired together -- in meals and in sentences or expressions. So, over time we associate these to things together. Over time, you could create a whole network of associations. For example, eggs, bacon, toast and coffee and more likely to be associated than things like car and grass. This means that thinking of one thing (ex: bacon) makes it more likely for something related to come to mind (ex: eggs or toast).

Well, we can and do build associative networks for all kinds of things -- like spiders. Throughout your life, spiders have probably been associated with more bad than good. You might have seen your mother jump in fear at the sight of spiders. You might have watched a show on the discovery network showing them trap, kill and eat insects. You've probably heard how some are deadly. In any case, most people make connections between spiders and negative things. Therefore, many people have at least a little bit of a spider fear. When you see a spider, it activates the other negative associations, and we're often left with a negative feeling of some sort -- a discomfort or feeling of anxiety.

This is a very basic example of automatic thinking, but it shows the process of how thinking can be unconscious:
        (1) A network of associations was created in the brain,
        (2) They get activated when you see a spider
        (3) They cause an emotional reaction without the person thinking about it.

Usually, people are only aware of the emotion at the end of this process. The creation and activation of the network are automatic, and usually outside of the person's awareness -- hence, it can be considered unconscious processing. 

In the example I used earlier, the person didn't want to go near the tiny spider despite knowing it was harmless. Here you have a battle of thinking -- automatic thoughts versus controlled thinking. I sometimes see this with clients. For example, I will hear someone say the following:

"I know I'm a very successful person, but I FEEL like a failure."

Here, there is a battle between an automatic thought process ("I feel like a failure" or "thoughts of being a failure keeping popping into my head") and a controlled thinking process ("When I take the time to examine the evidence, I realize I'm not a failure").

Here's a piece of advice: when you have two competing thoughts, go with the controlled thinking -- the one with the evidence.

It is more likely that the automatic thought is not correct. Here's a simple example to highlight how automatic thinking can lead you astray:

I want you to remember the first word that comes to mind after reading the following question?

What do cows drink?

How many of you thought water?

The most common thought that comes to mind is milk, which is obviously wrong. Automatic thoughts can be useful in many situations, but we have to keep an eye them. This is actually an important part of Cognitive Behaviour Therapy.

So, getting back to Freud and the unconscious. This explanation and these examples are very simplified ways of highlighting how the brain can have two minds. Things get much more complex when you factor in associations involving trauma, traits, beliefs, social values, etc. Psychologists have a long way to go to fully understand how the brain organizes its network of thoughts, and how these networks affect our emotions and behaviour.

Freud may have been wrong about how the unconscious mind worked, but you have to give him kudos for being able to see it operating in patients on some level.

Dr. Roger Covin
Montreal Psychologist

Tuesday, April 6, 2010

Emotional Support Decreases Pain of Rejection

An interesting study in a recent issue of the journal Social NeuroScience demonstrates how social support can decrease feelings of social pain. In a previous post, I noted how researchers had identified regions of the brain that become activated when people are rejected by others. One of these regions in the brain (ACC) was examined by the researchers in this new study. Here's what they did:

They had research subjects perform a task (like a game), where they were made to feel rejected. Later on in this game, they were offered some emotional support. What the researchers found was that the area of the brain associated with pain (ACC) decreased in activation when the subjects were being emotionally supported.

What does this mean? It means people have the ability to cause us serious pain...but they can also give us reprieve from pain. Like a drug.

These results help explain why talking about problems can be helpful. For example, it seems that talking to a friend following a break-up can decrease the level of activation in the brain responsible for the pain....which could speed up the emotional healing process.

Prior to this study, psychologists already knew that emotional support had positive effects on physical pain.

For example, pain researchers have found that pain thresholds increase (ex: people can keep their hand in a bucket of ice water for longer periods of time) when a loved one is standing next to them and offering support.

It was always assumed that emotional support decreased both social pain and physical pain. However, this study offers clear scientific support for this assumption.

The lesson? If you're feeling hurt, rejected or alienated -- talk to someone to get emotional support. It's like taking aspirin for headache!

Dr. Roger Covin
Montreal Psychologist

Thursday, April 1, 2010

Confusing Wealth and Beauty with Happiness

An opinion piece in the Montreal Gazette today inspired this next post. The article discussed research on happiness. Specifically, it detailed how research generally shows that happiness is best achieved through the creation and maintenance of interpersonal relationships. Things like money and success can be predictors of happiness, but having healthy relationships is an even better predictor of happiness.

This kind of research can surprise a lot of people...primarily because people often mistake the method for the goal.

"The method for the goal?...what does this mean?"

As I discussed in an earlier blog, the need to be liked and avoid rejection is one of the most fundamental human needs. It is a goal we all strive for, either consciously or unconsciously. There are different methods we can use to accomplish this goal. Here are some of the more common methods in Western society:

(1) Maximize your level of physical attractiveness. People have an inherent preference and positive bias for attractive people, so looking good can help.

(2) Increase the amount of money you have. This can help in multiple ways. Money can help improve social status, which is an attractive quality.

(3) Attain success in your career to earn power and respect. Again, success and power are qualities that are well respected in Western society.

(4) Try to become popular. Popularity can work as a symbol or proxy for likeability. If people know that other people know you, this could mean you are likeable. 

Obviously, there are other ways to get people to like you, and I am only focusing on the more superficial methods to being liked. But I'm doing this to help make a point. Nevertheless, I am being serious when I say that each of the aforementioned methods has the potential to improve one's interpersonal life.

Unfortunately, people often forget -- or in some cases are unaware --  why they are using these methods in the first place. Consequently, the methods are rendered useless because they are not used properly.

I've worked with a number of people who successfully used many of the above-mentioned methods. They were quite wealthy and successful, and well-known in their community. Or they were quite wealthy and very attractive and popular. Or they were very attractive and popular...anyway, you get the point.

But each one was unhappy. They were unhappy because of problems in their interpersonal lives. They either had an attachment(s) that was not going well ( ex: divorce), or they had no significant attachment (ex: a classic example is someone who has many acquaintances, but no serious relationships).

It was as if each of them were saying, "OK, now that I have (attractiveness; popularity; success; money) I should be happy."

This is like having a shed full of garden tools and saying "OK, now that I have all the tools to grow food, I should not feel hungry."

Collecting tools and trophies to attract and impress people is fine. But you have to constructively use them to get benefits. Use your money, popularity, success, and attractiveness to create and maintain healthy relationships.

It's quite sad when someone spends their whole life stocking the toolshed, only to end up starving.

Dr. Roger Covin
Montreal Psychologist