» » » DO SPECIFIC SYMPTOMS REQUIRE SPECIFIC TREATMENT

DO SPECIFIC SYMPTOMS REQUIRE SPECIFIC TREATMENT

There are a fair number of therapists reading this blog. Rather, I should say of the very few people who read my rants, several are therapists. But enough sniveling.

On a Positive Psychology discussion group the following question was posted:

Hi all!
Is anyone familiar with research which has been done to treat people with generalized or other types of anxiety disorders using pp interventions?
Thanks for your help!

So I said:
I don’t know, but there is an unexamined assumption behind your question, that the diagnosis is related to the treatment. That isn’t necessarily so. Years ago David Barlow found patients with different diagnoses, depression or anxiety, and Barlow designed two specific programs, one for depression and one for anxiety. He varied the presentation. Half got the anxiety component first, half got the depression component first. They reversed at something like six weeks. Or so.

His prediction: patients with anxiety would do best with the targeted treatment for anxiety, but wouldn’t do well with depression-focused treatment first. And vice-versa. So some anxious patients started with depression treatment, some depression patient started with anxiety treatment, and some started with the treatment to match their complaints. Barlow was sure that matching treatment program to type of complaint would give the best results.

Results: opposite. Everyone improved, at equal rates. Targeting symptoms was not helpful.

There is no data I know of that demonstrates diagnosis-treatment specificity.

Those of us trained in psychoanalytic psychotherapy OR in solution-focused therapy always believed that. Only the behavioral and cognitive schools seemed to believe that different conditions required
different treatments.

Now as to Positive Psychotherapy and treatment specificity. I myself have pondered this a good deal. I no longer think there is anything to it. Improving quality of life reduces symptoms. Acacia Parks was recently an author in a study on schizophrenia-diagnosed patients. They simply did a package of treatments from Positive Psychotherapy like expressing gratitude and using strengths, and not only did the depression in these patients go down, but also there was a reduction in psychotic symptoms. They didn’t target any symptoms.

Quality of Life Therapy(QOLT, created by Mike Frisch at Baylor) has been compared with Cognitive Behavioral Therapy and seems to come out a bit more effective, p

So I would suggest you check your premises! Review the Dodo Bird Hypothesis ca 1930 and shown over and over to fit the data best. “Everyone has won and all must have prizes.” See “The Great Psychotherapy Debate” by Wampold, a book reviewing all that evidence.

Psychotherapy effect is as much about what is in our hearts as what is in our heads. Probably more, much more. Alliance and hope fill two of St.Paul’s three critical factors. I suppose I must have faith in my system of therapy so as to offer hope; thus St. Paul can rest easy.
Lynn
I could say a bit more about this. (Shocked?) In medical treatment, specificity of treatment is a sine qua non, which means “Even the French do it.” Or something like that. But in treating emotional issues, we are treating the soul, and we need St. Paul’s Faith, Hope, and Charity/Love. So in working with people having difficulties in living, we aren’t working with a pathogen or a diseased organ. There is no appendix to remove. There is no antibiotic targeting the specific germ. Placebos work almost as well as antidepressants, and frankly, no one really seems to know why either work. The antidepressants are not working in the way the drug companies have been telling us, that is for sure.

In the Greatest Movie Ever Made, which is of course, Joe Versus the Volcano, Patricia Graynamore says to Joe Banks, “I don’t know what your situation is but I wanted you to know what mine is not just to explain some rude behavior, but because we’re on a little boat for a while and… I’m soul sick. And you’re going to see that.”

We can become soul sick, and techniques are something that can help, but really, faith in a higher power, hope that such a higher power can restore us and redeem us, and love towards others are always the cure to soul sickness. In the 1930s there was an article about this, suggesting all different forms of psychotherapy got essentially the same outcomes, and that has been shown to be true over and over. That is why it is called the “Dodo Bird Hypothesis” or the “Dodo Bird Verdict.” In Alice in Wonderland, the dodo is asked which animal won a race in which they ran in various directions for different amounts of time, and the dodo wisely says, “Everyone has won and all must have prizes.”

Run your race with faith, hopeful of everyone having prizes. Run with love towards all those who run with you. Your race will count. You will finish well.

Share Button

19 Responses

  1. Paul Koppel
    | Reply

    Great article. CBT is the best effective way to lower the anxiety symptoms. CBT observes how we are behaving according to the situation and how we act o the situation. The main goal of cbt is to reduce anxiety and stressful thoughts. Many researches have proved that it effectively works in treating the anxiety, depression, mood disorders and anger problems.

  2. Dr.J
    | Reply

     

    This is pretty much all I write, and many thanks for your kind comments. I don’t facepage or twitter or anything. We can Link Up in LinkedIn, but I don’t know what to do with it. I am ignorant about these things.

    Lynn

  3. laptop case
    | Reply

    Wow that was odd. I just wrote an extremely long comment but after I
    clicked submit my comment didn’t appear. Grrrr…
    well I’m not writing all that over again. Anyhow, just wanted to
    say wonderful blog!

    • Dr.J
      |

      Many thanks for your effort. I appreciate you stopping by.

      Lynn

  4. Rachel
    | Reply

    Tayyab Rashid sent me a rough draft that I worked through, but also said that the manual above would be in print soon. It is now, as you can see. I haven’t ordered it simply because I can’t really tell if it is more about PP than actual things to use in groups.
    Bill O Hanlon has a workbook which as all the stuff we might like to use in groups, but I haven’t seen it, on Amazon you can’t search inside it, and there are no reviews. If you happen to find something else, I’d be happy to hear about it.

  5. Rachel
    | Reply

    Mary,
    Sorry it took me to long to write back.
    Here’s the link to get it on Amazon.
    http://www.amazon.com/Therapists-Psychological-Interventions-Practical-Professional/dp/0123745179/ref=sr_1_1?ie=UTF8&qid=1342301198&sr=8-1&keywords=therapists+guide+to+positive+psychological

    • Dr.J
      |

      Many thanks for your generous attitude. It is heart-warming.
      Lynn

  6. Mary C. Frantz
    | Reply

    I read with interest Rachel’s comment about a group format using PP. I lead groups in an Intensive Outpatient Program, and would be very intersted in finding that format. Is it published anywhere?

  7. Rachel
    | Reply

    ***clinic, you***

  8. Rachel
    | Reply

    Dr. J, you probably don’t recall but when you came to Boise a couple years ago, and I told you I wanted to do PP in my intensive outpatient clinic. You recommended I call back east and Acacia Parks got me a group format. I think I did email you that?? We did start it, and people loved the group. Guess who didn’t. The insurance company. It was so aggravating. So, the group as a formal part of IOP isn’t happening, but you can bet I use the principles because I do think they’re effective.

  9. Right now, the science of PP probably isn’t robust enough to answer this question, but we do start to see some signs that broad-brush isn’t cutting it. For example, men and women respond differently to gratitude (http://mason.gmu.edu/~tkashdan/publications/gratitude_genderdiff_JP.pdf) so does it make sense to “prescribe” gratitude to everyone? Maybe not.

    We also see that people with high vs. low self-esteem respond differently to self-affirmations (Hames, J. L., Joiner, T. E. (2012). Resiliency factors may differ as a function of self-esteem level: testing the efficacy of two types of positive self-statements following a laboratory stressor. Journal of Social and Clinical Psychology 31.6, 641-662.)

    So could it be that PP will evolve to treat specific symptoms? yes, maybe. It could also be that, since PP looks forward and builds on what works, that it might be subject to a different paradigm than “psychology as usual” looking backwards and fixing what’s broken (as a huge simplification of a very complex subject).

    I think the bottom line is that we just don’t know yet – and that’s what we have science for.

  10. Donna Gill
    | Reply

    I work in a program with a large variety of people with various diagnoses. We run groups that are beneficial for all sorts of issues and PP seems to impact people across the spectrum. We try to be “person-centered” and not “diagnoses-centered.” This is the most humane way to view people and to get positive results. PP is a wonderful addition to our program. Thank you! (Expressing gratitude)

    • Dr.J
      |

      It is a thrill to hear your report. Many thanks to you and for your example.
      Lynn

  11. Leonard
    | Reply

    Dr. J,

    I must express my gratitude for being exposed to the basic concepts of PP at your recent seminar in Jackson, MS. Personally and professionally. In short order, as promised, my outlook and mood have improved and my patients likewise seem to be benefiting. Together we are walking the the walk. And I’m just scratching the surface.Honestly, I was just after some CEU’s before a deadline but I now describe it as a life changing experience.

    Tomorrow, I will introduce a recently purchased set of bongo drums as a group topic/prop to discuss such things as joy, heartbeats, and being kind to oneself and others. Wake up, indeed!

    There are no Happy Hermits!

    • Dr.J
      |

      Bongos? Brilliant.

  12. Paul
    | Reply

    I tend to agree that a huge number of complaints respond to similar “treatment.” it would seem to especially apply most in psychological complaints, where the diagnosis is often really just a description of symptoms (ie DSM checklist) rather than a pathologically or physiologically based condition (ie ‘shortness of breath’ rather than ‘pneumonia’)
    We’ve had enough exposure to drug company literature that many of us have started to think of psych diagnoses as physiologic (depression = “chemical imbalance”) but the evidence is poor.
    Even if it IS a chemical problem the outcome is often the same — unhappy life. And regardless of the cause many patients have the same complaints – unhappy, fearful, lonely, misunderstood, under appreciated, can’t sleep, no connections etc.
    Even among those who don’t seek help there are a lot of these unhappy symptoms.
    So as a physician I am a big fan of PP for all comers almost regardless of complaint.
    I’m not as opposed to meds as DrJ – I’ve seen them be very helpful to people but wish more were open to PP and it was easier to use in brief encounters

    • Dr.J
      |

      I consulted with a mental health center where the psychiatrist refused to attend my sessions. He said (reportedly!) “I give drugs, not hugs.” Paul, you are the opposite of that MD, using all the tools, not just the prescription pad. Bless you!

  13. Rachel
    | Reply

    My experience is depression and anxiety are so closely tied that if you treat one, the other naturally improves. But, if it were schizophrenia and an eating disorder, I think the results might not be as effective. There is room for diagnosis-specific treatment.
    I DO agree that what works is that the patient/client feels understood-that we stand with them in their struggle, that we witness with them the struggle toward growth/change.
    I think what you’re getting at a general tone with clients, perhaps across treatment modalities? Can we do PosPsych work while also doing CBT?

    • Dr.J
      |

      We can’t say for sure, but it appears that using Pos Psych to treat schizophrenia is very promising. The new study showing a decrease in both positive and negative symptoms of schizophrenia, when the patients followed a quality of life series of interventions, shows that generally raising happiness works.

      With eating disorders, I don’t have enough experience. I wonder if the 3:1 principle (make sure one has 3 positive thoughts / feelings for each negative thought or feeling) might help a person lose interest in being so obsessed with eating or not eating. If you have a practice centered on that, you can do us all a lot of good by researching the question.

Leave a Reply

Complete the equation (this is to prevent spam). * Time limit is exhausted. Please reload CAPTCHA.