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Helping Patients Suffering from Trauma using Eye Movement Desensitization and Reprocessing

March 9th, 2015

Introduction to EMDR

The precise neural mechanism for how eye movements affect emotional status is unclear, but the fact is they do. It is almost as though a broad view of the horizon from left to right, and right to left also helps the mind to place events within the broader context, or for both hemispheres of the brain to work together.

Iemdr-eye-movementn some respects this is nothing new. We have all experienced the calming effects on a stressful day of going for a stroll in the countryside, enjoying the view from a hill-top or from looking out over the sea. However, in some instances such as child abuse, sexual assault, physical assault or other severe traumatic events the experience can become mentally ‘blocked’, and unless worked through – or ‘processed’ can become utterly debilitating.

EMDR now has an excellent evidence-base for demonstrating its effectiveness, in the right safe, therapeutic environment for treating patients who have suffered from these forms of trauma. Some senior psychologists have explained the therapeutic effect of eye movement in technical terms such as, “tasks, such as eye movements, that tax working memory during recollection of stressful memories attenuate their vividness and emotionality during subsequent recollection”. In plain English this means that EMDR therapists can help their patients to re-visit the situation without causing undue stress.

Is EMDR really different from CBT?

The World Health Organization (WHO) describes the difference between Cognitive Behavioural Therapy (CBT) and EMDR. As EMDR is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories, treatment involves focusing simultaneously on the following:

  • Spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and,
  • Bilateral eye stimulation.

In this way EMDR reduces distress whilst also strengthening positive attributes that are related to the traumatic event. However, unlike CBT, EMDR does not involve detailed descriptions of the event, direct challenging of beliefs or extended exposure, or even the need for homework. Read the rest of this entry »

Gifting Connectedness

December 2nd, 2014

First prize: Help those less fortunate

 

season-to-giveAn extraordinary Catholic priest in Australia, Father Bob Maguire, is running a competition with a top prize that ‘guarantees happiness.’ 

See: http://www.theguardian.com/australia-news/2014/nov/24/father-bob-offers-people-chance-to-win-happiness-guaranteed

He is is offering a third-placed prize of five nights in a chain of high-end hotels, with the second-placed prize being five flat-screen TVs. However, it’s the top prize that we applaud, and which resonates so strongly at this time of year:

The chance to work in one of the soup kitchens run via the Father Bob Foundation, which aims to feed and provide educational support to the homeless and disadvantaged.

 

Genius! Although the initiative is meant to draw attention to the serious homelessness problems in wealthy nations like Australia, there is also, within it, a timely acknowledgement of the value of getting out there and helping someone.

This is something we weave into the very essence and grammar of our work with our patients at PROMIS: meaningful, rewarding connection with others as the sunlight ready to break through the clouds of isolation and a sense of worthlessness.

 

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Movember shines a light to another worthy but unspoken cause

November 3rd, 2014

We are delighted to hear that the organiser’s behind the Movember movement are turning their focus this year to men’s Mental Health. See http://www.bbc.co.uk/news/health-29841063

It is our considerable experience that physical and mental health are not separate matters but two aspects of well-being and resilience that overlap and have a clear cause and effect relationship; they affect and contribute to each other.

In building resilience to mental health, and in treatment for Mental Disorders, we need to accept that both areas of our lives need focus and attention. Poor physical health increases the risk of people developing mental health problems, while poor mental health is associated with an increased risk of diseases such as cardiovascular disease, cancer and diabetes.

Hence our enthusiastic support of Movember’s excellent decision to include men’s mental health within the focus of a charity dedicated to men’s health. Read the rest of this entry »

“Nothing About Us Without Us!” – Moving Away From Criminalisation Of Addiction

October 30th, 2014

Addiction in the NewsIt has been impossible, today, to ignore the important findings of a recent Home Office report, which compared the UK’s approach to drug misuse with that of 13 other countries and concluded that there is no evidence that the criminalisation of drug use leads to a reduction in the problem. See, for example, http://www.bbc.co.uk/news/uk-29824764.

In simple terms, there is no evidence that punishing people for having a drug problem will actually stop them using. Those of us who work in this field have a responsibility to those who suffer from addiction, and their loved ones and our communities, to focus the debate on what does work.

Awareness, understanding, tackling the grass roots of addiction in our homes, schools and towns must not be derailed, and works, but, as we all know, so does treatment.

 

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Looking In From the Outside

January 19th, 2014

An experienced Recovery Coach from the States paid our Hay Farm clinic a visit and gave us an account of his observations that we are happy to share with you. We thank Dr. Ronald W. Hill for his kind and insightful thoughts.

ReHayFarmcently I had the privilege and pleasure of visiting the PROMIS residential treatment facility in rural Kent. As a counselor from New York City, I was curious about how drug and alcohol treatment was approached and carried out in the UK, as compared to treatment in the United States. I was delighted at what I witnessed at PROMIS for several reasons. However, before I go into the details of my experience at PROMIS, permit me to digress a little to give some idea of my background, working in treatment.

 

During my 20 year career I worked in a variety of treatment centers, with diverse patient populations. Those treatment centers included Hazelden and Cornerstone Medical Arts in Manhattan. Before moving to New York I worked in Portland, Oregon on the west coast at Lakeside-Milam, The Springbrook Institute and the DePaul Center. I also spent 3 years as a counselor at a treatment center located inside a prison, and 3 years as an Assessment Specialist for NADAP, also in Manhattan. I mention these treatment centers to indicate that I have had quite a variety of experiences working in treatment.

 

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Horticultural Therapy

March 26th, 2013

Orange tulipsSpring is hopefully just around the corner and so is a great prompt to introduce Horticultural Therapy to Hay Farm. We have such a beautiful setting here, with 12 acres of farm land, so it is perfect for those who feel that this therapy might help them.

Horticultural Therapy is an active process which engages individuals to connect with nature as a way of healing themselves. It is the use of gardening as a client-centred therapeutic tool to promote physical, cognitive, emotional and spiritual well-being.

Throughout time, gardens have always been revered as a place of tranquility and peace and also considered as aesthetic expressions of beauty through art and nature. Just as we feel refreshed when walking through a forest or a field of flowers and experience a sense of joy when spring blooms, it is not hard to imagine how helping things grow and transforming an empty pot, field or land to a place of beauty can be very rewarding.

Among the many listed benefits of Horticultural Therapy such as enhancing positive mental attitude, reducing stress, alleviating depression, enhancing self-confidence, promoting gratification, developing cognitive skills and improving decision making, you are sure to discover your own unique benefits. Read the rest of this entry »

Hope for Depressed Addicts

December 27th, 2012

Not so long ago Alcoholics Anonymous was regarded with condescension by many professionals working in the addiction field. A common view was that science-based techniques, like Cognitive Behaviour Therapy (CBT) had made the Anonymous Fellowships seem like a quaint and outmoded quasi-religious cult.

At the same time, there were encouraging signs of scientific method being employed in the evaluation of both AA’s effectiveness, and of the value of the 12-step based Minnesota Method as practised in many treatment centres (Cook, 1988; McCrady & Miller, 1993). But the critical event leading to greater respect from the scientific establishment for the practices of AA was the publication of the results of Project Match in the 1990’s. This large-scale definitive study found that teaching alcoholics the basic tenets of AA philosophy and practice and encouraging participation in AA was at least as effective in facilitating recovery as was CBT. Subsequently, research into how AA works has continued unabated, and I wish now to highlight in particular a recent study from the USA that has examined the role of 12-step attendance with respect to current concern with the problem of “co-morbidity” – that is, the presence in an individual of a psychiatric condition like major depression alongside that of drug/alcohol addiction.

It’s now generally recognised that addicts with a “co-morbid” diagnosis of major depression present a particular challenge in treatment. Participation in AA/NA was shown in 2003 to have a beneficial effect on abstinence, whether or nor co-morbid depression was evident (Kelly et al 2003). A very recently published study shows just how important attendance can be for clients with both diagnoses (Worley et al 2012). 12-step treatment of co-morbid substance use and major depression was investigated,
in comparison with use of CBT. This study shows that 12-step attendance in itself, regardless of strength of affiliation, mediated a significant reduction in depression. In turn, the lower depression mediated an improvement in substance use. The improvement in depression in those treated by 12-step facilitation (TSF) actually exceeded that in a CBT group. Moreover, the beneficial effects of 12-step attendance on depression were also evident in those clients in the CBT treatment group who chose to attend the 12-step meetings. In summary, major depressive disorder is not an exceptional problem for those attending 12-step groups because AA attendance itself has a beneficial effect on depression, and lower depression leads to successful recovery from addiction. Read the rest of this entry »

‘Natural Recovery’ from Addiction: Implications for Treatment

October 15th, 2012

‘Natural recovery’ is a term used to describe recovery from addiction without the help of professionals. It’s a term that rather implies there’s something unnatural about the professional or even AA route. However, other terms that have been used are also problematic, given that they all embody an explanation of the phenomenon that is open to question. For example, Tuchfield (1981) was one of the first to describe what he called “spontaneous recovery”, although the recovery his alcohol dependent respondents described were generally the product of a sense of shame that had grown over a long period of time, even if the ultimate decision was sudden. Winnick (1962) described a process of “maturing out” in a group of nearly 17,000 opiate addicts registered as such in the USA in 1954-55, two-thirds of whom failed to appear on the Register over a period of 5 to 6 years. “Self-change” is now frequently used to describe recovery without professional help, but surely all change is self-change, professionally assisted or not.

Whatever the term used to describe the process, recovery without recourse to professional help has repeatedly been shown to account for a greater degree of success than is achieved in clinical populations (Klingemann, 2001). This has encouraged those who question the efficacy of the recovery movement and the mutual help practices of AA; and the suggestion that promoting self-change in the community should take priority as a treatment strategy has put the treatment community somewhat on the defensive. However, the justification for a mutual stand-off is slender, because self-change on the one hand, and professional treatment on the other, are not strictly speaking, antagonistic methodologies. Rather, they are complementary. Those who come for treatment presumably view it as being of value in their personal quest for self-change, so no controlled comparison of self-change and professional treatment is feasible, even in principle.

It is, of course, likely that those who seek treatment, or are encouraged to undergo treatment, are at the serious end of the addiction dependence continuum. Whilst this has been generally acknowledged to be a plausible assumption, there are two questions arising that need to be addressed. The first concerns the ability of those with more serious conditions to recover by themselves. The second concerns the extent to which professional treatment actually improves the prospects of more seriously dependent persons.

The first question has recently been addressed in an important Dutch study (Boschloo 2012). The data reported come from the ‘Netherlands Study of Depression and Anxiety’ (NESDA), which aimed to follow up the long-term consequences of depressive and anxiety disorders in a total of 2981 people, about half of whom had experienced an anxiety and depressive disorder, or symptoms of anxiety and depression.  253 of the participants had a diagnosis of remitted Alcohol Dependence  (AD) or current AD (assessed in terms of (DSM IV ) at baseline and were followed up over a period of two years. Read the rest of this entry »

Pure White and Deadly – Why addicts should be avoiding Sugar!

September 26th, 2012

Can something so seemingly harmless and widely available really be so bad for us? The answer is yes. Sugar is not just bad for us; in reality eating too many refined sugars too often is one of the root causes of many of the chronic health conditions hitting new heights in western cultures including type II diabetes, heart disease, obesity and certain cancers. The physical implications of eating too many refined sugars too often are obvious and common knowledge to most people, however what is often overlooked is the extremely negative impact these ‘substances’ can play on one’s mental health. The truth is sugar and refined, processed carbohydrates can also be addictive and disruptive to one’s life due to the way they disrupt brain chemistry and fuel addictive patterns. Sugar influences the same ‘feel good’ brain chemicals, including serotonin and dopamine, in exactly the same way as most hardcore illicit drugs – creating a quick false sense of pleasure followed by a rapid crash and the need for another ‘fix’ of a stimulating substance. Dangerous ground for an addict of any nature!

Low blood sugar, or ‘hypoglycaemia’ is caused by either not eating frequently enough or by eating foods that release too much sugar too fast into the blood stream, causing a rapid rise in blood sugar levels quickly followed by a huge crash. Additionally, when levels of glucose in the blood are low, stress hormones are released into the system by our adrenal glands. This results in increased production of our natural ‘fight or flight’ hormones called adrenaline and cortisol, which induces feelings of anxiety, stress, irritability, nervousness and desperation. This mental state inevitably sends the brain in search of something else sugary for a quick ‘pick me up’, however for an alcoholic or drug abuser – this can often be the trigger causing them to pick up another substance to get their ‘fix’. Uncontrolled blood sugar levels are so disruptive to the nervous system that in reality the feeling of having a panic attack may actually be the result of low blood sugar! As anxiety, stress and desperation are some of the most common drivers among most substance abusers, proper blood sugar control is beneficial and recommended for addicts during treatment and for the best chance of sustained, successful abstinence. Read the rest of this entry »

Self-licensing: A Route to Addiction

September 5th, 2012

A couple of weeks ago (16th August, on BBC3; “Russell Brand: From Addiction to Recovery”),  Russell Brand launched a hard-hitting attack on conventional approaches to drug addiction: first, he lambasted the view of right wing tabloid commentators who favour the view that addicts recklessly and freely abuse drugs, and could as easily choose differently. And second he castigated, even more passionately, the medical establishment that accepts the apparent inability of addicts to desist voluntarily, and compounds the felony by prescribing medically sanctioned (but perhaps equally, if not more, addictive) substitute drugs.

Brand believes, and he is hardly alone in this, that individuals should not be blamed for their addiction, but that theirs is a lifestyle that can be transformed. The alternative – harm reduction via the use of medically authorised drugs – he regards as a dreary, unremitting failure of nerve that leaves addicts psychologically no better, and maybe worse off.

His version of the disease of addiction – echoing that of 12-step based treatments – suggests that choice is, indeed, important, in fact is fundamental, to recovery. However, his preferred alternative route is not offered to clients in routine medical practice. Providing a residential context in which an extended abstinent way of life is elicited that enables clients to explore potential for reformation, is expensive, and available only to those who can afford to pay for it. Ironically, as Russell Brand reminded us, those compulsorily detained in Her Majesty’s prisons may have this privilege offered to them cost free.  And reconviction rates after discharge are significantly lowered in those taking advantage of the offer – indicating that the financial costs of this treatment may pay substantial economic dividends in the longer term.

We know that lives can frequently be transformed when the residential alternative is appropriately offered and taken up. But even so, individuals’ resistance to personal reform is frequently intense, even amongst those offered the best of circumstances in which to achieve change. And we know that of the many who may start attending meetings of the 12-step based Anonymous Fellowships only a minority succeed in achieving their goals.  So why is it so difficult for addicts to face the imperative of making and maintaining the decision to recover? Read the rest of this entry »



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