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March 27, 2015 by Kathy Brous

What is EMDR – and Why is it So Effective?

lockridge-pastor-dave-150x150During REM sleep, the brain is attempting to process survival information until it’s resolved.

Eye Motion Desensitization and Reprocessing (EMDR) is a potent trauma treatment developed by Dr. Francine Shapiro (left), a literature professor who was diagnosed with cancer.  The shock of suddenly finding her survival was under threat, affected her so strongly that Dr. Shapiro mindfully paid attention to how her body was reacting.

She discovered by accident that when the survival fear got intense, her eyes would sometimes move back and forth diagonally or from side to side, as if in dreaming – following which she felt less upset, much to her surprise.

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March 13, 2015 by Kathy Brous

A Pastor’s Battle with Childhood Trauma

lockridge-pastor-dave-150x150[This week we have “Overcoming Adverse Childhood Experiences” (ACEs), a guest blog by Pastor Dave Lockridge of northern California (left). What a story, and what a persistent heart! – Kathy]

From the Merced Sun Star, Merced County, CA:

When I became a pastor as a young man, I was prepared to minister to my congregants through all phases of their lives. I expected to spend my time welcoming new babies into the world, sharing biblical principles with thriving families, and ministering to our elders in their last days. I knew I would be called upon to offer comfort through hard times, illness and loss.

What I didn’t expect to do much of was bury parishioners in their 40s and 50s, or even in their teens – men, women and children who died from everything from heart attacks to lung disease to suicide; parishioners who were suffering mightily from a lifetime of seemingly bad choices.

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March 12, 2015 by Bob Nikkel, MSW

Balancing Our Recovery Ecosystem

hawaiian cliffsI have some trepidation, as a social worker, venturing into the world of ecology and biodiversity but during my recent visit to Hawaii, I began to realize there are some parallels in that world and ours. Bear with me for some quick background.

Hawaii is a long ways from every other land mass in the world–the most isolated place with mountains nearly 13,000 feet in elevation on the Big Island and still growing its coastline there. Human settlement didn’t take place until probably 300 AD or so. What the early Polynesians found was a unique natural environment that had plants and other living things that had developed in isolation for probably millions of years. Today, 90% of the indigenous plants are still around, although they constitute now only 10% of the total plant species around the islands.

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March 11, 2015 by Gina Nikkel, PhD

A Conversation with Gail Hornstein and Jacqui Dillon

Jacqui-GailJacqui Dillon is National Chair of the Hearing Voices Network, England, and Gail Hornstein, PhD, is an author and Professor of Psychology at Mount Holyoke College. They are advisors to the Hearing Voices Research & Development Fund at the Foundation for Excellence in Mental Health Care.

Interview by Gina Nikkel, PhD

Q. Gail & Jacqui, it is fantastic news that the Hearing Voices Research and Development Fund has received $250,000 in new funding. What is your long term vision for the Fund?

A. We have been building the infrastructure for the Fund and planning this project for several years and are delighted now to be able to move forward. Our long-term vision is to enable people all over the United States to have access to hearing voices peer-support groups the way people in Britain and Ireland and Australia and Denmark and 25 other countries around the world currently do.

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March 2, 2015 by Sandra Steingard, MD

Stimulants and Food

Sandra-SteingardThe FDA recently approved lisdexamfetamine (LDF) for the treatment of the newly minted DSM-5 diagnosis of Binge Eating Disorder. This caused me some consternation and this blog will be as much about my reaction to this news as to the news itself.

The use of stimulants to curb appetite is nothing new. This was a common practice in the 60’s and 70’s and then it was shunned in respectable medical circles because we “knew” amphetamines were dangerous drugs.  We also knew that their effects on dampening appetite tended to wear off over time. This is commonly cited as a reason not to be concerned about their use in youth.

I was introduced to these drugs as being addictive substances that were used to create animal models of psychosis. Yet, there has been an expansion of the use of stimulants in the past decade with very little discussion of the possible risks entailed. Their approval for the treatment of “binge eating disorder” follows the expansion of ADHD from childhood into adulthood. I doubt it is a coincidence that this happened at the time when most of the antidepressants went off patent.

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February 27, 2015 by Kathy Brous

The Adult Attachment Interview (AAI) (Pt.2 of 2)

Mary Main’s Scary Parent Study

Dr. Mary Main

Scary Parents
My last blog Jan. 23 concluded that by 1978, Dr. Mary Ainsworth’s estimate for U.S. babies was (B) Securely Attached 69%, (A) Avoidant 23%, (C) Ambivalent 8%.  In the next 10 years, Ainsworth’s Strange Situation study was done worldwide — with the same three categories — on 2,000 infant-parent pairs in 32 different studies, in 8 countries. Some countries’ results varied, but the global results averaged out the same as Ainsworth’s 1970s studies.1

In 1973, Mary Main became Ainsworth’s grad student at Johns Hopkins in Baltimore, working on the Strange Situation experiments from the start. After her doctorate, Main moved to Berkeley, to see if Ainsworth’s Kampala and Baltimore findings would replicate.8  In 1978, she ran a Strange Situation study of 189 Bay Area infant-parent pairs and had the same findings, reported in Ainsworth 1978.10

But by 1979, Dr. Main was making her own discoveries—out of concern about the parents. “In none of Ainsworth’s original observations was the possibility considered that some mothers… could also be frightening,” Main notes. “For my dissertation at Johns Hopkins, I watched 50 children in the Strange Situation… Using Ainsworth’s three-part classification (secure, avoidant and ambivalent), I found at least five infants could not be classified.”  Ainsworth was concerned, too; in fact, she’d left some babies in her Secure set only since they didn’t fit her other two sets.8

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February 13, 2015 by Kathy Brous

The Adult Attachment Interview (AAI) (Pt.1 of 2)

Mary Ainsworth’s Strange Situation

Mary Main & Dan Siegel December-2010-UCLA

Dr. Main with Dr. Daniel Siegel

Only 55% of us have “secure attachment”– a number which would worry us all if we knew what it meant — according to 1970-1996 research on over 2,000 infant-parent pairs. And the level of attachment we get as infants continues all our lives in our relationships.

The math says the other 45% of us suffer “insecure attachment.”  That means 45% can’t handle a committed, stable relationship with anyone, from childhood to the rest of our lives, as of 1996.  We also pass this emotional pain to our children, who turn out similarly.  A National Institute of Health article summarizes the secure rate:  “Infants with secure attachment greet and/or approach the caregiver and maintain contact but are able to return to play, which occurs in 55% of the general population.” 1

This is the blockbuster result of Dr. Mary Ainsworth’s 1970-1978 “Strange Situation” study of babies.  The work was completed by her student Mary Main, and Main’s research led to shocking conclusions.

Main discovered so many babies were peculiar, she got concerned about the parents. So in 1982, she created the Adult Attachment Interview (AAI) to study the adults, releasing results 1984-96.

Her journey was so “strange” and involved, that it got published in language hard to decipher (or even google) for most folks. The tale took me weeks to unravel (footnotes below).

This huge “insecure” figure is a predictor of broken homes and broken hearts for half the nation. It starts to explain why we’ve got a 50% divorce rate. If you’re like me and have tried “over 40” internet dating after a divorce, it won’t surprise you to hear that science shows 50% of adults out there can’t carry on a secure, committed, loving relationship. You’ve already experienced it.

And if 45% of us were “insecurely attached” in 1996, what’s the percent in 2014?  In 1996 most of us hadn’t heard of the Internet. In almost 20 years since, email, texting, and so on have further trashed our ability to relate in person. Several psychotherapists interviewed for this blog said that a round number of “about 50%” is a  conservative estimate for how many Americans lack secure attachment today. Many believe it’s much higher.

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February 4, 2015 by Sandra Steingard, MD

Drugs and Dementia


This study of the risks of developing dementia among those who take anticholinergic drugs has serious implications for psychiatry.

This week, JAMA Internal Medicine published online an interesting paper, “Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study.” They found that exposure to anticholinergic drugs significantly increased the risk of developing dementia. This study has important implications for those who prescribe and take psychiatric drugs, but it is worthwhile describing the study in some detail before discussing those implications.

First, some context. Acetylcholine (ACh) is a neurotransmitter (a chemical that propagates a nerve signal from one cell to the next) that is found throughout the body. It is involved in gut motility, visual acuity, heart rate, and secretions. In the brain, its activity is linked to memory and movements. There are many drugs that block ACh receptors (the proteins that allow nerve transmission to occur). In psychiatry, anticholinergic drugs are used to combat some of the neurological effects of the neuroleptic drugs such as muscle stiffness and tremor. But there are also many drugs used to treat depression and psychosis that have anticholinergic effects.

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January 30, 2015 by Bob Nikkel, MSW

Why Mental Health Systems Should Be Organized Under Alcohol and Drug Systems

bnikkel_miaceWhile I was in charge of the public systems for both mental health and addictions in Oregon, I found it a challenge to maintain an equal focus on alcohol/drug problems compared to mental health. One big reason for the emphasis on mental health was that the mental health budget was big, about 6 times greater than that for addictions. And that doesn’t even count the hidden funding for psychiatric drugs which probably added another 30 or 40% to mental health—atypical antipsychotics are a lot more expensive than Antabuse.

Although there was a huge difference in state financial support for the two areas, it always seemed to me that the social consequences were just as large and challenging in addictions as in mental health. Partly for that reason, when asked to recommend a new name for an integrated office blending the two previously separated program areas, I chose to put addictions first–the Addictions and Mental Health Division. The state legislature agreed and it became the agency’s name and, at least for the time being, still is. It may have been only symbolic but it was an attempt to stop seeing alcohol and drug services as the “little brother.”

Having stepped back and out of the line of fire now for several years, I’ve become more aware of the ways in which addictions may be a better conceptual umbrella than I’d considered in the naming process. Consider that the dynamics of “denial” and “enabling” are powerful themes in addictions treatment. Denial is the marked tendency for people struggling with addictions to believe that their drinking or drug use is really under control and that everyone around them is over-reacting. Enabling is the flip side of that coin in which those around them unwittingly play into the denial and without consciously trying actually make it easier for the addicted person to keep using.

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January 29, 2015 by Larry Davidson, PhD

Yale Symposium April 24, 2015

Larry-Davidson-PhDOn April 24th, the Foundation for Excellence in Mental Health Care is sponsoring an all-day symposium at Yale University entitled “New Data and New Hopes Call for New Practices in Clinical Psychiatry.” The symposium is co-sponsored by the Yale Program for Recovery and Community Health and the Department of Mental Health and Addiction Services for the State of Connecticut. Speakers include scientific advisors and board members of the Foundation, Yale Psychiatry faculty, and leading researchers and thought leaders from the U.S. Substance Abuse and Mental Health Services Administration, the University of Groningen in the Netherlands, and several other American universities.

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