Mindfulness as good as pills for treating recurrent depression

Medical best practice is for people with history of depression to take antidepressants for two years – but cognitive therapy may be equally effective

Credit: chr1sl4i via Compfight cc

Patients with a history of depression are currently advised to remain on antidepressant pills for at least two years. 

Mindfulness-based cognitive therapy may be as good as pills at stopping people relapsing after recovering from major bouts of depression, according to a study.

Mindfulness-based cognitive therapy (MBCT) was developed from mindfulness techniques, which encourage individuals to pay more attention to the present moment, combined with cognitive behaviour therapy (CBT), specifically to try to help people who have recurring depression.

It teaches people to recognise that negative thoughts and feelings will return, but that they can disengage from them. Rather than worrying constantly about them, people can become aware of them, understand them and accept them, and avoid being dragged down into a spiral leading back to depression.

Current best practice, endorsed by Nice (the National Institute for Health and Care Excellence) is to encourage people with a history of recurrent depression to remain on antidepressants for at least two years.

However, some are very reluctant to keep taking pills, while others find their depression comes back when they finally stop using the tablets.

The trial, published in The Lancet, a medical journal, involved a group of 424 adults from GP practices in the south-west of England, who were willing to try either the pills or the therapy. Half were randomly allotted to each. Those assigned to mindfulness had eight group sessions of more than two hours plus daily home practice and the option of four follow-up sessions over a year. The course involved mindfulness training, group discussion and cognitive behaviour exercises. The patients gradually came off their medication. Those assigned to the other group stayed on the tablets for two years.

The relapse rates in the two groups were similar, with 44% in the mindfulness group and 47% for those on the drugs. In each group there were five adverse events, including two deaths.

The researchers had thought the study might show that therapy was more effective than pills, based on their earlier work. Lead author Willem Kuyken, a professor of clinical psychology at the University of Oxford, said: “That was our hypothesis. It was based on our pilot study in 2008. There was a suggestion that MBCT might do better than medication. The reality is that it was not superior to medication.”

However, they established that mindfulness-based therapy is equally as good as drugs, which could offer a new option for those who do not want to be on medication for years. Co-author Prof Richard Byng, from the Plymouth University Peninsula Schools of Medicine and Dentistry, said: “Currently, maintenance antidepressant medication is the key treatment for preventing relapse, reducing the likelihood of relapse or recurrence by up to two-thirds when taken correctly.

“However, there are many people who, for a number of different reasons, are unable to keep on a course of medication for depression. Moreover, many people do not wish to remain on medication for indefinite periods, or cannot tolerate its side-effects.”

Nigel Reed, from Sidmouth, Devon, who took part in the trial, said: “Mindfulness gives me a set of skills which I use to keep well in the long term. Rather than relying on the continuing use of antidepressants, mindfulness puts me in charge, allowing me to take control of my own future, to spot when I am at risk and to make the changes I need to stay well.”

The study also showed that the therapy might work better than pills for those who have some of the most troubled histories and are at the highest risk of relapse. It was found to have protected people with increased risk because of a background of childhood abuse. The paper said: “Perhaps MBCT confers resilience in this group at highest risk because patients learn skills that address some of the underlying mechanisms of relapse or recurrence.”

Kuyken said he expected Nice to look at the study when it convenes shortly to revise its guidelines on recurrent depression.

In a commentary with the study in The Lancet, Prof Roger Mulder, from the University of Otago in New Zealand, said the findings had substantial significance. He suggested that because it is group therapy, which reduces the costs involved, it may be possible to offer MBCT as a choice to GP patients. He said: “We ... have a promising new treatment that is reasonably cost-effective and applicable to the large group of patients with recurrent depression.

“Depression remains a disabling condition with high prevalence and a large clinical burden. Despite the increased use of drugs, the long-term outcome of mood disorders has not improved in the modern era. Having an alternative non-medication strategy to reduce relapse is an important means to help patients with depression.”

"Discussing Drugs & Alcohol With Your Child: A Parent Evening with Substance Abuse Expert, Dr. Kevin Mulvey".

Parent Education Evening: Wednesday, April 8th from 6:00pm to 7:30pm in the MPR 

ISHCMC is proud to present "Discussing Drugs & Alcohol With Your Child: A Parent Evening with Substance Abuse Expert, Dr. Kevin Mulvey".

Just to whet your appetite for this important evening I thought I'd share this article from Harvard Medical School about what some regard as a harmless drug; marijuana

Teens who smoke pot at risk for later schizophrenia, psychosis

"Teenagers and young adults who use marijuana may be messing with their heads in ways they don’t intend.

Evidence is mounting that regular marijuana use increases the chance that a teenager will develop psychosis, a pattern of unusual thoughts or perceptions, such as believing the television is transmitting secret messages. It also increases the risk of developing schizophrenia, a disabling brain disorder that not only causes psychosis, but also problems concentrating and loss of emotional expression.

In one recent study that followed nearly 2,000 teenagers as theybecame young adults, young people who smoked marijuana at least five times were twice as likely to have developed psychosis over the next 10 years as those who didn’t smoke pot.

Another new paper concluded that early marijuana use could actually hasten the onset of psychosis by three years. Those most at risk are youths who already have a mother, father, or sibling with schizophrenia or some other psychotic disorder.

Young people with a parent or sibling affected by psychosis have a roughly one in 10 chance of developing the condition themselves—even if they never smoke pot. Regular marijuana use, however, doubles their risk—to a one in five chance of becoming psychotic.

In comparison, youths in families unaffected by psychosis have a 7 in 1,000 chance of developing it. If they smoke pot regularly, the risk doubles, to 14 in 1,000.

For years, now, experts have been sounding the alarm about a possible link between marijuana use and psychosis. One of the best-known studies followed nearly 50,000 young Swedish soldiers for 15 years. Those who had smoked marijuana at least once were more than twice as likely to develop schizophrenia as those who had never smoked pot. The heaviest users (who said they used marijuana more than 50 times) were six times as likely to develop schizophrenia as the nonsmokers.

So far, this research shows only an association between smoking pot and developing psychosis or schizophrenia later on. That’s not the same thing as saying that marijuana causes psychosis.

This is how research works. Years ago, scientists first noted an association between cigarette smoking and lung cancer. Only later were they able to figure out exactly how cigarette smoke damaged the lungs and other parts of the body, causing cancer and other diseases.

The research on marijuana and the brain is at a much earlier stage. We do know that THC, one of the active compounds in marijuana, stimulates the brain and triggers other chemical reactions that contribute to the drug’s psychological and physical effects.

But it’s not clear how marijuana use might lead to psychosis. One theory is that marijuana may interfere with normal brain development during the teenage years and young adulthood.

The teenage brain is still a work in progress. Between the teen years and the mid-20s, areas of the brain responsible for judgment and problem solving are still making connections with the emotional centers of the brain. Smoking marijuana may derail this process and so increase a young person’s vulnerability to psychotic thinking. (You can read more about how the adolescent brain develops in this article from the Harvard Mental Health Letter.)

While the research on marijuana and the mind has not yet connected all the dots, these new studies provide one more reason to caution young people against using marijuana—especially if they have a family member affected by schizophrenia or some other psychotic disorder. Although it may be a tough concept to explain to a teenager, the reward of a short-time high isn’t worth the long-term risk of psychosis or a disabling disorder like schizophrenia."

http://www.health.harvard.edu/blog/teens-who-smoke-pot-at-risk-for-later-schizophrenia-psychosis-201103071676

This is what happens to your brain and body when you check your phone before bed

Staring at screens right before sleep turns out to be a lot worse than previously thought. Dr. Dan Siegel, clinical professor of psychiatry at the UCLA School of Medicine, lays out all of the negative effects bedtime screen viewing can have on the brain and body.

The Difference Between Praise That Promotes Narcissism vs. Healthy Self-Esteem

Hans Pama/Flickr

By Poncie Rutsch, NPR

When a kid does something amazing, you want to tell her so. You might tell her that she’s very smart. You might tell her that she’s a very special kid. Or you might say that she must have worked really hard.

On the surface, they all sound like the same compliments. But according to Brad Bushman, a communications and psychology professor at Ohio State University, the first two increase the child’s chances of becoming a narcissist. Only the last one raises the child’s self-esteem and keeps her ego in check.

Bushman and a group of collaborators surveyed parents to see how they show warmth and value their child’s accomplishments. They then compared those findings to the children’s levels of self-esteem and narcissism. The results were published Monday in the Proceedings of the National Academy of Sciences.

Of course, self-esteem and narcissism are two very different things. The difference has to do with how you value yourself compared to other people. “Self-esteem basically means you’re a person of worth equal with other people,” Bushman tells Shots. “Narcissism means you think you’re better than other people.”

And not in a good way.

“Narcissism is a somewhat toxic personality trait,” Jean Twenge, author of The Narcissism Epidemic and psychology professor at San Diego State University, tells Shots. Narcissists tend to overestimate their abilities, take too many risks and mess up their relationships, she says. Some people see narcissists hurting the people and society around them, but they hurt themselves, too. “In the long term it tends to lead to failure,” Twenge says.

While narcissists tend to have high self-esteem, not all people with high self-esteem are narcissists. Bushman needed to separate the two. So he asked children ages 7 to 12 years old how they felt about statements like “Some kids like the kind of person they are,” or “Kids like me deserve something extra.” The first statement measures self-esteem; the second, narcissism.

Bushman made sure to focus on children between 7 and 12 years old, so that by the time the study finished all of them would be older than 8. “You can’t measure narcissism in children before age 8, because every child is a narcissist,” he says. If you ask younger kids in a classroom if they are good at math or good at baseball, Bushman says all the kids will raise their hands.

Then he surveyed the children’s parents, asking them to respond to statements to determine whether they overvalued their children. For example, “I would not be surprised to learn that my child has extraordinary talents and abilities,” or “Without my child, his/her class would be much less fun.” And he asked how they expressed warmth toward their child by measuring how strongly they agreed with statements like “I let my child know I love him/her.”

When he analyzed the results from the surveys, Bushman found that the more narcissistic children had parents who consistently overvalued their accomplishments. He ran additional tests to make sure that the parents weren’t narcissists, too — after all, it’s possible that the children could be mirroring narcissistic behavior. But statistically, the children of narcissists aren’t more likely to be narcissists themselves.

The research team continued to survey the same group of 565 children and their parents for a year and a half. They watched the children develop, and they could link each child’s tendency toward self-esteem or narcissism back to what the parents had told them six months earlier.

“We’re not just measuring their narcissism at time one; we’re using these measures to predict the behavior a year and a half later,” says Bushman. “Parental warmth doesn’t predict it. Parental narcissism alone doesn’t predict it. But parental overvaluation alone does predict it.”

Bushman is particularly worried about narcissism because both he and other researchers have linked it to aggressive and violent behavior. He thinks it’s partly because narcissists are less likely to feel empathy toward others.

“Empathy involves putting yourselves in other people’s shoes, but narcissists have a very difficult time putting themselves in other people’s shoes,” Bushman says. Plus, he says that narcissists respond poorly when they don’t get special treatment. “Whenever people have this sense of superiority, then they lash out at others in an aggressive way.”

Of course, someone who appears more narcissistic at age 10 isn’t necessarily going to grow up to be a narcissistic adult, let alone aggressive. And the results of this study hinge on a handful of short surveys — no extensive personality testing here.

“There are definitely going to be things that influence the personality after that stage,” says Twenge. “Those [narcissistic] tendencies may start to show up around then, but will continue to be influenced by parenting and environment throughout adolescence.”

But this study has Bushman thinking about the way he praises his own children. “It’s a lot better to say ‘You worked really hard’ than ‘You must be really smart,’ ” he says, “because if you tell the kid that they’re smart and then if they fail they think ‘Oh I’m stupid.’ ” If the praise relates to effort, a child who fails will work harder next time.

Bushman is also trying to cultivate self-esteem in his children, because people with high self-esteem tend to have lower levels of anxiety and depression over time. Based on Bushman’s research, parents can raise their children’s self-esteem just by expressing more warmth.

Both researchers agree that voicing the connection you feel to your children really helps. “If you want to look for a substitute for ‘You’re special,’ just say ‘I love you,’ ” says Twenge. “It’s what you mean, and it’s a much better message.”
http://ww2.kqed.org/mindshift/2015/03/10/the-difference-between-praise-that-promotes-narcissism-vs-healthy-self-esteem/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+kqed%2FnHAK+%28MindShift%29

10 Ways to Help Your Kid Get a Good Night's Sleep

Essential tips for managing TV, tablets, phones, and more so your kids (and you) can get to sleep -- and stay asleep.

Parents know firsthand the impact a poor night's sleep has on kids. Lack of sleep can contribute to crankiness, problems with attention and learning, behavior issues, and even health problems such as obesity. Though the reasons for poor sleep vary, many parents worry that media and technology interfere with bedtime routines and sleep.

Studies on how media use affects kids' sleep aren't conclusive. But they do highlight certain behaviors that are associated with poor sleep. We've put together a list of tips for ways your family might manage tech use to help your kids (and you!) sleep better. We hope you find something that works for you.

Encourage physical activity instead of screen time after school. After a long day at school, many kids just want to plop down in front of a computer or TV and veg out. Although kids definitely deserve a break, studies show that increasing physical activity during the day can lead to better sleep.

Keep devices off the bed. It's possible that the blue light emitted from laptops, tablets, and smartphones interrupts sleep patterns. Set up other comfy spots in the living room or on the bedroom floor for tweens and teens to do computer work or just enjoy their screen time.

Try white-noise apps to calm babies and toddlers. With bedtimes for young kids starting as early as 6:30 or 7 p.m., you may find it hard to provide a quiet environment for sleeping babies. Apps such as White Noise (iOS/Android, $1.99) or White Noise Baby (iOS/Android, $0.99) can help soothe little ones to sleep while the rest of the family carries on with regular evening activities.  

Limit young kids' exposure to violent content. Especially for kids under 8, seeing violence in videos, on TV shows, in video games, and in movies can directly affect quality sleep. Exposure to media violence can increase kids' anxiety and lead to nightmares that interrupt the sleep cycle.

Keep TVs out of the bedroom. The connection between bedroom TV and poor sleep is well established. Kids don't sleep as well or as long with a TV present.

Make the bedroom a "no-connection" zone. The growing trend of sleep-texting is a disturbing enough reason to play it safe. Confine online activity to common areas such as the dining room or living room and have kids charge their phones in another room at night.

Minimize screen time right before bed. Try to establish the hour or so before bed as a screen-free time for kids to wind down. A calming routine such as a bath followed by quiet activities or reading will help young kids make the transition more easily. Getting teens to "unplug" before bed will help them disconnect from the excitement and drama happening online.

Introduce your kids to meditation or calming apps. Meditation apps can be a quieting addition to kids' bedtime routines. Stop, Breathe & Think (iOS, free) offers 15 guided meditations that encourage kids to take stock of their mental and emotional states.

Set up a phone/iPod charging station in the family room. Some studies suggest that simply sleeping near small devices such as phones is associated with poorer sleep. With notifications and texts coming in at all hours, tweens' and teens' sleep will get fewer interruptions if they leave their phones in the living room or kitchen for the night.

Model healthy sleep habits. No matter which ground rules and routines you put in place for your family, it will be a hard sell if you don't practice what you preach. Young kids emulate their parents, and tweens and teens will question your rules if you don't follow them yourself.

https://www.commonsensemedia.org/blog/10-ways-to-help-your-kid-get-a-good-nights-sleep?utm_source=032615+Ages+2-6&utm_medium=email&utm_campaign=weekly

Why “Me Time” Matters: 5 Reasons To Treasure Solitude

 

Life has a habit of passing us by; too many moments slip away without being seized. We spend the majority of our time working stressful jobs (and that’s without even counting how often we check our emails at home). What’s more, we spend a good proportion of our free time worrying about the future or lamenting the past and, all too soon, we’ve forgotten how to live in the here and now. Hours pass like minutes, days go past unnoticed, and weeks undifferentiated.
Living in the present moment is essential for our happiness and well-being. Research shows that when we are completely present – when we really appreciate our current experiences – external worries melt away. In fact, “me time” is so important for our minds, that we’re asking you to put yourself back on to your priority list…
“Me time” is a holiday for the soul and if you’re not already doing it, start learning to create little islands of solitude in your daily life. Not only will it help you to get in touch with yourself, it also has other benefits, like making us better at sleeping through the night, and enjoying the company of others more… Take heed and follow these 5 steps!

1. It Teaches Us To Enjoy Our Own Company

Being alone doesn’t equate to being lonely. In fact, you can have just as much fun alone as you do with friends. Engaging in “me time” experiences puts us in touch with our own interests and reminds us that we have the power to make ourselves happy. So, put some time aside this week for having a date with yourself!

2. It Can Make Us More Positive

Everyone gets stressed, sometimes – c’mon, we’ve all been there! But thankfully, “me time” means we can actively process our emotions and keep a stress overload at bay. With alone time, you can try and make sense of what you’re thinking and – just by making yourself aware of certain negative feelings, you’ll be able to steer clear of the situations that created them.

3. It Helps Us Sleep Better

When we sleep, our brains process the day’s events and digest emotions. But when our mind’s are running rampant, we all know it can be tough to fall asleep. Taking an hour of “me time” before bed can improve our sleep by eliminating stress and preparing our minds for rest, so try painting your nails, reading a book, or another calming activity.

4. It Gives Us A Sense Of Accomplishment

By making sure we take daily “me time,” we often find that we’re able to start crossing things off our to-do lists, like cooking that recipe we’ve always wanted to try! When we do this, we begin to feel daily senses of accomplishment, and accomplishment is intrinsically tied to boosting confidence and self-worth. As best-selling author Chris Guillebeau says, “It just feels good to tick things off.”

5. It Improves Our Focus

We’ve all heard about the importance of being “mindful,” but what does that mean? Well, simply put, it’s thinking only about what you’re doing as you’re doing it. So, if you use your “me time” to try and maintain your focus on what you’re doing, the theory is that it will relax you, preparing you for times of stress and help you to savor life’s little pleasures!
So, are you convinced of the benefits of “me time,” now? Then start by making a date with yourself! Why not join Amazers’ latest challenge and make a weekly “me time” appointment; a solo expedition to a place that interests you, whether that’s an art gallery, a favourite restaurant, or the top of a mountain. The point is not to accomplish anything per se, it’s simply to have fun – alone!

Lessons Learned:

• Our stressful lifestyles often mean that we’re not really appreciating what we could.
• Living in the moment sometimes is essential for our well-being.
• Learn to treasure the small nests of “me time” around you… It’s worth it!

Why Children Need Chores

Daddy-David via Compfight cc

Doing household chores has many benefits—academically, emotionally and even professionally

Chores also teach children how to be empathetic and responsive to others’ needs, notes psychologist Richard Weissbourd of the Harvard Graduate School of Education. In research published last year, he and his team surveyed 10,000 middle- and high-school students and asked them to rank what they valued more: achievement, happiness or caring for others.


Almost 80% chose either achievement or happiness over caring for others. As he points out, however, research suggests that personal happiness comes most reliably not from high achievement but from strong relationships. “We’re out of balance,” says Dr. Weissbourd. A good way to start readjusting priorities, he suggests, is by learning to be kind and helpful at home.


The next time that your child asks to skip chores to do homework, resist the urge to let him or her off the hook, says psychologist Madeline Levine, author of “Teach Your Children Well.” Being slack about chores when they compete with school sends your child the message that grades and achievement are more important than caring about others. “What may seem like small messages in the moment,” she says, “add up to big ones over time.”


Here are some of the best ways to get your children properly motivated to do chores:

• Watch your language. In a study of 149 3-to-6-year-olds in the journal Child Development last year, researchers found that thanking young children for “being ahelper,” as opposed to “helping,” significantly increased their desire to pitch in. They were motivated by the idea of creating a positive identity—being known as someone who helps.
• Schedule chore time. Write chores into the calendar, right next to the piano lesson and soccer practice, to maintain consistency.
• Game it. Like a videogame, start small and have young children earn new “levels” of responsibilities, like going from sorting clothes to earning the right to use the washing machine.
• Keep allowances and chores separate. Research suggests that external rewards can actually lower intrinsic motivation and performance. With chores, psychologists say that money can lessen a child’s motivation to help, turning an altruistic act into a business transaction.
• Types of tasks matter. To build prosocial behavior like empathy, chores should be routine and focused on taking care of the family (like dusting the living room or doing everyone’s laundry), not self-care (tidying one’s bedroom or doing personal laundry). Psychologists add that involving children in choosing the tasks makes them more likely to buy in.
• Talk about chores differently. For better cooperation, instead of saying, “Do yourchores,” Dr. Rende suggests saying, “Let’s do our chores.” This underscores that chores are not just a duty but a way of taking care of each other.
• Give chores a PR boost. Don’t tie chores to punishments. Keep any talk about chores, including your own, positive or at least neutral. If you complain about doing the dishes, so will your children.

http://www.wsj.com/articles/why-children-need-chores-1426262655