Category Archives: Therapy

How To Get Better Results From Treatment

Fake pills and treatments are such wonderful things.

They work roughly 30% of the time, on almost anything.

With the technical term of ‘placebos’ they are the gold standard treatment against which every other treatment is measured.

And the whole field is shrouded in mystery.

Why do blue placebos make people more sleepy, while red placebos keep people more awake?

How can fake pills work even when you know there is no active ingredient in them?

How can they work no matter what level of intelligence you do or don’t have?

Well it’s still largely guesswork, because we don’t know why or how they work but they certainly do. Study after study has shown the effectiveness of variations of placebos.

Here is one more thing that has been recently uncovered about placebos – they work better if they cost more!

Dr. Ariely, a behavioral economist at MIT’s Media Lab, and his colleagues had two groups of people receive electrical shocks to their wrists.

They were told this was for a research into a new painkiller called Velodone.

When they were given the medication one group was told the price of the medication was $2.50 a pill and others were told the cost was discounted to just 10 cents a pill.

Those who got the “more expensive” pill had significantly better pain reduction than those who thought they were getting the discounted version.

This is actually important.

Drug companies often bring out drugs that besides being new, are often more expensive too. How much of the patient’s results is simply based on the added expense, rather than having a better chemical.

Also, this effect may indeed make brand-name medications more powerful than generic brands.

So one way to get better results from your treatment is to pay more for it.

As a side note, Dr Dan Ariely has a book just published about these and other psycho-illogical phenomena. It’s called “Predictably Irrational: The Hidden Forces That Shape Our Decisions”.

My main thought is whether people who buy the more expensive hardcover version will rate the book better than those who buy the cheaper paperback.

It wouldn’t surprise me, or Dan I suspect, in the least.

-Dr Martin Russell

Shake-up Or Wake-Up

The commotion over the study that said anti-depressants are a waste of time for all but the most severely depressed people, has continued to escalate.

It hit the middle editorial pages of my local city’s newspaper, and that means the story is big!

Much of the criticism that I have read of this study has been badly unscientific. A number of medical authorities seem to have come out with rather rash and half-baked defenses of their position.

Meanwhile there is a small debate building around the actual study itself which was published online in a format that allows comments.

For reference you can find the original study here:

Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

This is an excerpt from my comments on the site:

It is interesting to see the commotion this study has caused, and rightly so.

Even more interesting has been the media reporting. They have been talking about the biological description of depression (eg biochemical imbalance in the brain) even as they are reporting that the drugs don’t work to anywhere near the level previously promoted.

The media is brainwashed to parrot what it has been told, even when there is a gaping hole in the theory.

Brain chemistry is not like insulin for diabetics.

It is also interesting to hear people who have received anti-depressants, and clinicians who prescribed them, somehow thinking they could not be responding to a placebo.

“All this evidence I have seen with my own eyes can’t be wrong” had been the catch-cry of quacks and the quasi-scientific, but it seems it is just the same here. Too many doctors, and patients, are not going about this scientifically.

If this paper is right then it says these drugs should not have gotten onto the market in the first place…

… We can’t offer talk therapy to all of the 5-15% of the western world that is supposedly “depressed”, but it’s no value overstating the benefits of medication either.

Far from being a step backwards I would like to see medicine, and psychiatry in particular, take this as a giant wake-up call for the 21st Century.

Hey, well I’m a wishful thinker 🙂

You can find all the direct comments on this landmark study here.

-Dr Martin Russell

The End Of The Anti-Depressant Era?

Good to see the recent spate of publicity for a study that hacks the legs out from under the antidepressant medication industry.

Currently the most viewed health article from the Washington Post website is about this study: “Only Severely Depressed Benefit From Antidepressants: Study“, and if you search Google News for the study’s author, Irving Kirsch, you find dozens of stories in the last 48 hours. It’s gone hot, and rightly so.

The whole 50 years of the Serotonin hypothesis that justifies these medications is a minefield of dressed-up science and warped philosophy.

It’s just over 20 years since the wonder drug Prozac came onto the market, and the field has just kept expanding with new variations on the theme.

All this was meant to be backed up by highly rigorous and validated science.

Well it was only last month that a study into the reporting of those research findings showed that the benefits of antidepressants was universally less than claimed. In some cases more than half of the reported benefit of a particular anti-depressant was shown to be due to selective reporting of the available research.

The current study goes even further and questions whether there is any benefit at all in anti-depressant except in severe cases of depression, and even in these cases there was very little effect.

As disheartening as this is for people who are depressed, I hope this study really starts to clear the air on this topic.

But a note…

What if you are currently taking ‘anti-depressants’? – or whatever these drugs should now be named instead.

Keep taking them for the moment at least.

Discuss with the person who prescribed them for you, and make sure you have alternative plans for managing your mood, and that you understand the process for weaning off the medication.

If you think there is nothing else that can help your depression, you might find new choices with this:

http://www.SelfHelpMeeting.com

-Dr Martin Russell

It’s All In Your Head

A man came to me for hypnotherapy because he was vomiting. Not just any vomiting either. He had had to be hospitalized and rehydrated.

His doctor’s couldn’t find a cause, so they did what doctor’s do when they can’t explain something. They suspect it’s in your head, give it an impressive label like psychogenic hyperemesis, and then they send you off to someone like me.

I did no hypnotherapy in the first session with him. Instead I took a detailed history and asked him, and his wife who came with him, as many questions as I could.

In the end I explained to them that although I could give hypnotherapy a go, I could find no clear psychological reason why he would be vomiting. I had no other explain for why he was vomiting, but as far as I could work out it was not in his head.

His wife and he went away disappointed.

Later that year I was at the only counseling conference I have bothered to go to since I started my counseling work, and someone happened to present a series of cases of vomiting of unknown origin. My ears pricked up. The extra factor was that the people in each case needed to take lots of really hot showers or baths, up to 10-15 times a day so they could feel better.

The connection was found to be chronic high-dose marijuana use and severe, hospitalizing vomiting was a newly reported side-effect of cannabis!

Bingo!

I phoned up the man who had come to see me earlier that year and spoke to his wife.

Turned out he was in hospital again for dehydration and even worse than ever. So I arranged to go and visit him in hospital, and just in case he was going to deny any drug use I didn’t mention it on the phone.

When I got to the hospital I spoke to the doctors looking after him and they listed the battery of tests that they had run on him in this admission and previous ones. I was horrified to discover that they had already done a general drug screen, and it was negative for cannabis. My big idea was shattered.

I went in and spoke to the man and his wife, but it was true. He had no interest in hot showers. In fact he said to me he wished he did because then he could have been cured by simply stopping smoking. He was looking in particularly bad shape and was looking for any cure. I sat down and tried a little relaxation hypnosis with him, but it didn’t seem to help either of us.

About 6 months later I got a call from his wife. She was calling to let me know that her husband had died, and to say thankyou to me for my efforts.

A couple of months before his death they had in fact found a diagnosis. I think it was amyloidosis. I just remember the wife saying that the diagnosis had come up twice on episodes of the TV show “House”.

But instead of diagnosis in days like on TV, her husband’s diagnosis took years and by then it was too late stage.

I was very glad to get the feedback about what really happened.

I got feedback. She got a prematurely dead husband.

That’s all that is in my head now.

-Dr Martin Russell

Do You Have A Healthy Relationship With Your Emotions?

When people come to me with problems often they think of their problems as “irrational”.

The really interesting part is that their emotional response is always the bit that is irrational.

It doesn’t enter their minds that perhaps the most irrational part of what is going on is that they are they are believing their logical thinking.

Human beings are remarkable poor at using logic, despite all our efforts. We are incredibly self-deluding, and disturbingly unaware of most of what goes on in our lives.

So give your emotions a break.

Here is a first step to making sure you have a health relationship with your emotions.

Check for any emotional reactions that you think are “irrational”, or that you are “battling”.

I’m not going to try to convince you that your emotions are correct or that you should give in to them. I don’t know you or your emotions, and yes emotions aren’t always the most accurate guide either.

But here is the question.

Can you think of a time when that emotional reaction WOULD be exactly what you want to have happen in your life?

Emotions are part of the range of being human, so where do they fit appropriately into your life, even if only in rare circumstances.

If you are doing this as an academic exercise and don’t have a personal example, then let me set a few challenges for you.

Where would you like to have a phobia in your life?

Where would you like to hesitate more, or be confused?

Where would it be appropriate to have a craving in your life?

Where would you like to be more stubborn?

All these emotions have a place in a healthy human being. Rather than avoid them, how about figuring out where they fit for you?

-Dr Martin Russell

The Other Forgiveness

In my therapy work I have pretty much given up using the word forgiveness.

Not because it is a bad idea – heck no. Forgiveness is a key self help skill for being an effective human being.

It’s just that the people who most need to use forgiveness in their lives, have also been the ones who have the most terrible and dangerously twisted misconceptions about what the term means.

It does NOT mean to continue to accept harm or damage to yourself.

It does NOT have anything to do with losing face, “weakening”, or giving in to someone.

I don’t suggest you have anything to do with that sort of corruption of “forgiveness”.

I am speaking to you direct.

If your first reaction to the idea of forgiveness is that is unsuitable or dangerous in your particular situation, then let me give you my firm opinion based on all my years of counseling…

  • You are EXACTLY the person who needs to understand what real forgiveness is, and you are wasting your life and knee-capping your chances of helping yourself, if you don’t get started on doing it correctly ASAP.

Here’s all the instruction manual you need to get started and done…

http://www.jamesbrausch.org/forgiveness/

-Dr Martin Russell

The Gambler’s Delusion And Anti-Depressants

The first time I ever remember hearing about gambling was when I was given a Christmas present bought from a year’s worth of horse race winnings.

Later my parents explained to me that they were going along with the gift to please the person who gave it, but that the “winnings” weren’t actually that.

Basically there was a bank account specifically for the winnings, but any loses were not taken out, and neither were the original stakes.

So every Christmas it seemed like there had been a successful year.

Even “professional” gamblers don’t like to answer the question of how much money (or time and effort) it took to get the winnings they talk about.

However this bias doesn’t just apply to gambling.

It applies in scientific research as well.

The most recent publication from the prestigious New England Journal of Medicine (NJEM) includes a paper titled: “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy”

The idea is that pharmaceutical companies are finding ways to hide or ignore research that doesn’t show their drugs are great.

This is nothing new.

Promote the good studies, downplay the bad ones.

Tobacco companies have been repeatedly accused of this type of publication bias. If they don’t like the results of a study, then it can be simpler to just never publish it.

The public is none the wiser.

However researchers have been honing in on this problem over the past few years.

This particular piece of research from the NEJM is very nice.

The researchers found that 37 out of 38 positive studies were published, but pf another 36 negative studies, 22 were not published, and at least 11 of the remaining 14 presented a negative study as a positive one.

All of the 12 different anti-depressants drugs from 7 different drug companies were helped by this positive bias.

Some of the drugs seem to be over 200% better than they would be if the negative studies had been included. This is not a trivial error.

The evidence suggests massive and systematic bias, but is it self-delusion like a gambler, or cynical manipulation?

Either way I don’t suggest anyone rely on anti-depressants to create their happiness.

This research paper even triggered a well-written article in The Wall Street Journal so I’m sure there will be much more to come on this issue.

-Dr Martin Russell

Tim Ferriss On Weaknesses

In many ways this self help site is about bridging the divide between psychiatry and personal growth/self improvement.

So I watch the extremes of medical psychiatry, but I also watch the extremes of self improvement too. Tim Ferris is an example of the latter.

Tim Ferriss, author of the “4-Hour Work Week” is a really interesting guy, with a really interesting blog. The title of the blog is “Experiments in Lifestyle Design”. He literally means it.

Wacky, sometimes even wacko, and ruthlessly determined to take personal life to it’s limits.

The result?

Many things that will not suit most people, but here’s one I heartily endorse.

I use a variation of this technique when I work with people who are “stuck” in their lives.

To set the scene for this 3-step process, Tim is talking about the issue of starting up a company from scratch.

Perhaps that isn’t an issue in your life, but the steps are the same for anything that seems overwhelming or unachievable, and where pumping up the positives ain’t working for you.

How to re-evaluate your “weaknesses”?

1. Write down the positives of whatever you’ve been viewing as a negative. Don’t know anyone? You’ll be a fresh face and won’t have any strikes against you. No funding? It will force you to find the neglected options and set trends instead of following them.

…Hunger and desperation can be good things.

2. Consider the negatives of the opposites. What if you had too much funding? It would create a false sense of security and breed complacency, both of which are more fatal to a start-up than bootstrapping. It could also overexpose you before your product or service is ready. It could give investors too much influence over big decisions. Don’t assume more of something is 100% positive. It never is.

3. Look for dark horse role models.
“I can’t start a company — I’m too old.” Coronel Sanders started KFC after 40. The excuse doesn’t hold up. Can’t compete in sports because of a bum leg? Sprinter Oscar Pistorius has no lower legs and is aiming for the Olympics. You? For each reason for inaction you come up with, ask: has anyone overcome these or worse circumstances to do what I want to do? The answer is: of course.

Embrace your lack of resources, your weaknesses.

Far from a handicap, these are often the pressure points that will take you the furthest… if you’re able to use them instead of excuse them.

I know many of you will be cynical about doing such an obviously distorted exercise.

In fact I suggest you read Tim’s whole post to flesh out these ideas a bit more:

http://www.fourhourworkweek.com/blog/2008/01/06/from-shanghai-to-silicon-valley-3-tips-for-turning-lack-of-resources-into-strength/

In some forms of therapy they would try and explain to you the distortion was really in your original thinking, not in these new perspectives.

When I work with people who have become “stuck” in some aspect of their lives, whether or not they have psychiatric labels such as depression or anxiety, I want you to know that I have not found this technique alone to be enough.

So if you are cynical, it’s probably because a part of you has recognized that this is not a complete piece of change-work.

Well spotted.

BUT… it is the best way I know of to loosen a “stuck” situation so that any and all other changes happen so much more easily.

So pick something you are “stuck” about, stick the cynicism in the back pocket for a moment… it will still be there for you when you’re done… and go back up and write out your responses to the steps above.

-Dr Martin Russell

Procrastination Case Study

A University student in her early 20’s came to me for a few things including for hypnosis to stop her from procrastinating.

She was studying pharmacy and part of her being a high achiever was that she was always leaving her exam studies until the last days and cramming like mad.

She was becoming bothered by it and had finally come for help.

Now before I say any more, let me ask you.

What would you recommend for this young woman?

Even if you know nothing about hypnosis, what would you suggest she change?

I didn’t end up using hypnosis, and in fact this particular change was done in a single session.

Would you have done what I did?

I’ll continue…

I checked a few extra things.

First of all I checked what her results were. She was getting either distinctions or at worst credits for all her results.

Next I asked her what exactly was bothering her about her procrastination.

She told me that her friends and even some of her family were pointing out to her how bad it was that she was cramming like this.

So I enquired further how bad it was, and it turned out that she was putting her head into her studies for all the hours she was awake for about 48 hours before the exam. No other life at all.

She was getting very stressed about this behavior during the cramming. She was also worrying about this at other times during the university term too, and more and more this was playing on her mind. She had tried to set up better , more consistent study habits but with no success.

However she was otherwise healthy, happy and social, and she was not taking drugs, going without sleep, or doing anything else that might be damaging.

At this point I asked her the key question…

“Are the people who are telling you how bad your cramming is, getting better grades than you?”

Her answer came back, “No. They certainly aren’t.”

At this point I started to describe the antics of some of the people I studied with when I went to medical school, and what some of the top achievers were doing to get their amazing results.

I gave her my assessment.

Could she have better study habits?

Probably. But she was getting good results from her current ones, and her future plans probably only required the level of results she was getting at the moment.

Was her problem procrastination?

Not right now it wasn’t. Her problem was that she was taking advice from people who’s performance wasn’t as good as her own. If she followed their advice and did what they recommended she would likely end up with their results.

Should she ever change what she was doing?

If she wanted to, yes certainly. My suggestion was that she have a think about whether SHE was unhappy with the effects of the way she studied. If she was, then we could do something about it. In the meantime she could decide what advice to listen to by checking what results the person was getting.

She came back a week later, much less stressed, and not wanting any changes in this area.

What have people advised you about the suitability or otherwise of procrastination in your life?

What would you have done differently for this woman?

-Dr Martin Russell

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