Archive for August, 2008


Traumatized children living in Kosovo experienced significant reductions in post-traumatic stress disorder (PTSD) symptoms when treated with a mind-body program according to a new study published in Journal of Clinical Psychiatry (8/12/08. PTSD is an anxiety disorder that can occur in response to traumatic events. Common symptoms include flashbacks, nightmares or difficulty sleeping, feeling emotionally numb, being easily startled and difficulty concentrating.

The mind-body techniques used in the study were developed by the Center for Mind-Body Medicine (CMBM) and included meditation, biofeedback, breathing techniques, guided imagery and self expression. Eighty-two high school students diagnosed with PTSD were included in the three-month long study. Instructors trained in the CMBM program provided 12 sessions, in small educational settings.

Patients in the mind-body group experienced a significant improvement in PTSD symptoms compared to the control group. The number of children with PTSD symptoms decreased from 100 percent to 18 percent by the end of the study. The techniques reduced stress and symptoms of withdrawal, as well as decreased the frequency of flashbacks and nightmares. The effects were maintained three months after the study.

This mind-body technique is currently being used to treat people in Israel and Gaza who are traumatized by war, as well as those traumatized by Hurricane Katrina in southern Louisiana. It is also used to treat depression in the United States and has been added to a stress reduction program in several U.S. medical schools.

The study, published in the Journal of Clinical Psychiatry represents the first randomized controlled trial of any intervention in war-traumatized children.

An article in the August 4th, 2008 Washington Post describes how health and life insurance companies are now accessing databases of individuals’ personal prescription records to rate their relative risk.

They note that consumers authorize the data release and that the services can save insurance companies millions of dollars and benefit consumers anxious for a decision. 

Why are we so focused on saving the insurance companies millions of dollars?  I frequently encounter requests from certain pharmaceutical benefit plans requesting that I change a patient from a medication, that they are usually doing well on, to one that is truly not a generic equivalent, for the sole purpose of saving money.  However, when examined more closely, it only serves to save the insurance plan money.  

 

More and more, I find myself concerned about the future of for-profit, insurance-driven medicine.  It seems too problematic to have such divergent interests working together:  serving the health care needs of the individual (providing quality care) and the business goals of the insurance company (minimizing costs).  We have already experienced the deterioration of the doctor-patient relationship due to time constraints that exist (de-facto) due to the insurance paradigm.  Now we are seemingly at the edge of a more efficient means of maximizing profits for the insurers by mitigating risk:  unfortunately, the risk that is avoided is providing healthcare to those who might actually need it.  What types of conditions will be considered too high a risk: diabetes, depression?  What happens to those individuals when they are excluded or have to pay rates that are cost prohibitive?  It is an unfortunate, and perhaps unforeseen by-product of the move to computerize our health records.  I am entirely in favor of information, but not at the expense of privacy violations or corporate profiteering.

Self-Disclosure in Therapy

One area that is sometimes contentious in therapy is that of self-disclosure. In traditional psychoanalysis, analysts deliberately refrain from revealing anything about themselves.  However, my therapeutic approach is that of Cognitive Behavioral Therapy (CBT).  There is no such prohibition in CBT and I find that I tend to do a lot of self-disclosure with patients whom I think will benefit from it.  I do, however, think it is important to differentiate between self-disclosure for the therapeutic benefit of the patient verses the burdening of the patient by unloading the therapist’s own baggage.  As one of my mentors, Dr. Murali Krisha once shared, “Never share things with patients that would add to their sorrow or cause them to worry about us.”

 

Examples of therapeutic self-disclosure may range from addressing issues that patients may have with unrealistic, perfectionistic standards through relating the standards and expectations I have of my own life to helping those who are struggling with feeling of frustration or low self-esteem by sharing how I motivate myself by “giving credit” or other such techniques I have used in my own life with success.

 

I don’t use self-disclosure with every patient but it does happen frequently. Self-disclosure is a way to give people a different perspective—a different way of thinking about their problems.   I have also found that it goes a long way in strengthening the therapeutic relationship when patients recognize that I am a human being who is willing to share something of myself to help them.