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Why the Mental Health System Is Failing Us | Psychology Today

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In the 13th century, medics commonly treated mental illness by drilling a hole into a person's head, thus releasing demons and evil spirits, in the hopes of "curing" the person.

Up until the 19th century, medics also believed that if bodily fluids got out of balance, physical and mental illness would be the result. People with mental health challenges were subjected to bloodletting, purging, and induced vomiting to "re-establish the balance."

Today, we smirk at such ignorance. Such practices have been abolished in the developed world and are widely understood to be harmful charlatanerie.

And yet, I have no doubt that future generations will look back at us today, shake their heads in disbelief, and smirk at our stupidity. I think even ordinary people will see the primitive ideas that drive our current mental health practices.

The Problem With Our Mental Health System

We currently practice mental health care inside one of two classification systems: The Diagnostic Statistical Manual ( DSM) or the International Classification of Diseases (ICD). Both have been revised multiple times over the decades to keep up with advances in clinical science and cultural developments.

The way the system works is simple: A person who is feeling unwell comes to the therapist and tells them about their complaints. The therapist in turn checks off a list of symptoms. Enough symptoms of a specific kind, and the person gets a label of a specific psychological disorder. It's like a game of pattern recognition, but instead of shouting "BINGO" in excitement, the therapist states "You have Major Depression" or "You have Panic Disorder."

The assumption behind both classification systems is the same: There are underlying latent diseases slumbering inside of us hidden behind groups of symptoms. Although we cannot see them directly, these entities affect our mood, our emotions, our thoughts, and our behavior.

After half a century of trying, and many billions spent, such classification schemes have not led to functional groupings of etiology, course, and response to treatment. Not even one. Instead, the DSM or ICD labels heterogeneous patterns using arbitrary guidelines and cut-off points. The classification system crams individual human lives into made-up collective boxes that ride roughshod over life as it is lived. It is no surprise that most people deal with "comorbidities" (aka multiple conditions), and that the most common diagnosis is "not otherwise specified." The reason is a simple truth: In the main, human misery does not arise from latent diseases hidden inside our minds.

We need to do better. We need an alternative to the syndromal classification system. We need a system that doesn't treat people as labels, but as individuals with individual challenges, yearnings, skills, and aspirations.

Who Mental Health Care Is Really For

In truth, mental health care is not just for the 1 out of 5 that have been labeled as having a "disorder" by a sad syndromal diagnostic system. Instead, it's for the 5 out of 5 folks who face mental health challenges: You, me, and everyone else.

In this era of COVID-19, it is obvious that we all face mental health challenges on a regular basis. All of us. And we can all benefit from tending and caring for our mental health-just as we do for our physical health.

You would never say to a person, "Hey you have developed a physical health problem... gee, I guess now you have to start to exercise," while saying to everyone else, "Do whatever, but pity those poor people with physical health problems-they have to exercise."

Of course, you would not say something like this, because exercise is good whether or not you struggle with a physical health problem. And yet, it's exactly what we're doing with "mental" challenges because our underlying models are driven by the delusion of latent diseases hiding inside syndromes.

Enough of it. Time's up! It's time to rethink mental health and to give up on labeling people inside failed syndromal classification systems.

We need to start caring for our mental health by learning and deploying effective skills and practices. Behavioral science has identified dozens of them. We need to learn and to practice those skills-and not just when things have gone wrong, but all the time.

There are no demons in the body, no bodily fluids off balance, and no latent diseases in the mind. Just people, with real mental health challenges that can be addressed by developing needed evidence-based psychological skills.

Working on our health, physical and mental, is for all of us, all of the time.
LinkedIn Image Credit: Syda Productions/Shutterstock

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Why the Mental Health System Is Failing Us

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In the 13th century, medics commonly treated mental illness by drilling a hole into a person's head, thus releasing demons and evil spirits, in the hopes of "curing" the person. Up until the 19th century, medics also believed that if bodily fluids got out of balance, physical and mental illness would be the result.

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Sherwin Nuland: How electroshock therapy changed me

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Surgeon and author Sherwin Nuland discusses the development of electroshock therapy as a cure for severe, life-threatening depression -- including his own. It's a moving and heartfelt talk about relief, redemption and second chances.

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Sangu Delle: There's no shame in taking care of your mental health

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When stress got to be too much for TED Fellow Sangu Delle, he had to confront his own deep prejudice: that men shouldn't take care of their mental health. In a personal talk, Delle shares how he learned to handle anxiety in a society that's uncomfortable with emotions.

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A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.

The study, led by researchers from the University of Liverpool, involved a detailed analysis of five key chapters of the latest edition of the widely used Diagnostic and Statistical Manual (DSM), on 'schizophrenia', 'bipolar disorder', 'depressive disorders', 'anxiety disorders' and 'trauma-related disorders'.

Diagnostic manuals such as the DSM were created to provide a common diagnostic language for mental health professionals and attempt to provide a definitive list of mental health problems, including their symptoms.

The main findings of the research were:

* Psychiatric diagnoses all use different decision-making rules

* There is a huge amount of overlap in symptoms between diagnoses

* Almost all diagnoses mask the role of trauma and adverse events

* Diagnoses tell us little about the individual patient and what treatment they need

The authors conclude that diagnostic labelling represents 'a disingenuous categorical system'.

Lead researcher Dr Kate Allsopp, University of Liverpool, said: "Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences."

Professor Peter Kinderman, University of Liverpool, said: "This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as 'real illnesses' are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal."

Professor John Read, University of East London, said: "Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed."

Reference: Allsopp, K., Read, J., Corcoran, R., & Kinderman, P. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research, 279, 15-22. https://doi.org/10.1016/j.psychres.2019.07.005

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

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Psychiatric Diagnoses Found to Be "Scientifically Meaningless"

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A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders. The study, led by researchers from the University of Liverpool, involved a detailed analysis of five key chapters of the latest edition of the widely used Diagnostic and Statistical Manual (DSM), on 'schizophrenia', 'bipolar disorder', 'depressive disorders', 'anxiety disorders' and 'trauma-related disorders'.

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There’s a common misconception that if you like to meticulously organize your things, keep your hands clean, or plan out your weekend to the last detail, you might be OCD. In fact, OCD (Obsessive Compulsive Disorder) is a serious psychiatric condition that is frequently misunderstood by society and mental health professionals alike. Natascha M. Santos debunks the myths surrounding OCD. [Directed by Zedem Media, narrated by Addison Anderson].

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Depression is the leading cause of disability in the world; in the United States, close to ten percent of adults struggle with the disease. But because it's a mental illness, it can be a lot harder to understand than, say, high cholesterol. Helen M.

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How risk-taking changes a teenager’s brain

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Why do teenagers sometimes make outrageous, risky choices? Do they suddenly become reckless, or are they just going through a natural phase? To find out, Kashfia Rahman -- winner of the Intel International Science and Engineering Fair (and a Harvard freshman) -- designed and conducted an experiment to test how high school students respond to and get used to risk, and how it changes their still-developing brains. What she discovered about risk and decision-making could change how we think about why teens do what they do.

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A fast acting ketamine-like anti-depressant spray that can lift mood within hours has been rejected by the NHS healthcare watchdog.

The National Institute for Health and Care and Excellence (NICE) says there are too many uncertainties about the correlation between the price and clinical benefits of esketamine.

It is licensed as a therapy for people with hard-to-treat depression.

But it costs about £10,000 per patient for a single course of treatment.

Mixed reactions

Some people already prescribed it - as part of a trial, for example - will be able to continue on the treatment if their doctor says it is appropriate to do so, the NICE's draft recommendation for England and Wales says. Scotland is yet to issue guidance.

Experts have expressed mixed reactions to NICE's decision.

Dr Sameer Jauhar, at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, said NICE had made the call because there was not yet enough long-term evidence to support the use of nasal esketamine alongside another anti-depressant.

Consultant psychiatrist Dr Paul Keedwell, at Cardiff University, said patients would be disappointed by a decision based largely on cost rather than lack of effectiveness.

'Deeply disappointing'

Marjorie Wallace, chief executive of mental health charity Sane, said: "People with depression are currently relying on medications that are 30 years old.

"Although these drugs can be life-saving for some people, they can have unpleasant side-effects and do not work for everyone.

"It is therefore deeply disappointing that the first new compound that works in a fundamentally different way on the brain should not have passed this hurdle.

"This is especially so because people can take as much as six to eight weeks to feel the full effects of most anti-depressants.

"We hope this setback will serve only to inspire pharmaceutical companies, researchers and others to discover new ways of treating serious depression."

Recreational misuse

Ketamine is used in medicine to numb the body or induce sleep and sometimes prescribed for depression.

But the drug also has a reputation for recreational misuse.

Esketamine, also called Spravato and made by Janssen, is a form of ketamine that targets glutamate, a chemical linked with learning and memory.

The spray is absorbed through the nose into the blood stream.

The draft guidance from NICE is open for consultation until 18 February 2020.

Janssen said it was deeply disappointed about the draft decision but still hoped to ensure patients could access esketamine in the future.

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Anti-depressant spray not recommended on NHS

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A fast acting ketamine-like anti-depressant spray that can lift mood within hours has been rejected by the NHS healthcare watchdog. The National Institute for Health and Care and Excellence (NICE) says there are too many uncertainties about the correlation between the price and clinical benefits of esketamine.

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A study has linked a spike in mental-health problems among the unemployed with the rollout of universal credit and other government welfare changes.

The number of unemployed people with psychological distress rose 6.6% between 2013 and 2018, it suggests.

And this represents an extra 63,674 people in England, Wales and Scotland - 21,760 of whom became clinically depressed over the period.

The government highlighted the study found no causal link.

'Mounting evidence'

Prof Dame Margaret Whitehead, of the University of Liverpool, who co-authored the Lancet Public Health Journal study, said it had found "observational associations" rather than "cause and effect".

The spike in mental-health cases could also have been influenced by the broader range of welfare changes, she said.
What is universal credit? Benefits officials' apology over death Universal credit claimants 'struggling to cope'
But the study added to the "mounting evidence of substantial mental-health harms related to universal credit".

And it was crucial the government conducted robust health-impact assessments of all welfare changes, including universal credit.

Long delays

The researchers found no links to any impact on physical health, however, or any evidence universal credit had led to an increase in the number of claimants finding jobs.

Launched in 2013, universal credit, which combines six benefits into one, was an attempt to simplify the welfare system and get more people into work.

But its implementation has been criticised for introducing long delays and a tougher use of sanctions.

Numerous concerns have been raised by MPs, charities and select committees and there have been several cases of vulnerable individuals killing themselves after having problems with the new system.

The researchers followed more than 52,000 working-age people between 2009 and 2018, who were taking part in Understanding Society, the UK Household Longitudinal Study.

A Department for Work and Pensions spokesman said: "People coming into the job centre are often doing so at a difficult time in their lives and there is a range of support available for those with mental-health conditions."

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Depression cases 'linked to universal credit'

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A study has linked a spike in mental-health problems among the unemployed with the rollout of universal credit and other government welfare changes. The number of unemployed people with psychological distress rose 6.6% between 2013 and 2018, it suggests. And this represents an extra 63,674 people in England, Wales and Scotland - 21,760 of whom became clinically depressed over the period.

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Antidepressants Can Cause Intense Withdrawal-Like Symptoms That Can Trigger Dependence

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Researchers are warning about an overlooked side effect of long-term antidepressant use, a condition called antidepressant discontinuation syndrome.

Symptoms include nausea, agitation, headaches, and flu-like symptoms, which may deter people from coming off their antidepressants.

The team urged doctors to better advise their patients on non-medication techniques for managing their depression.

Visit Business Insider's homepage for more stories.

More people than ever before are taking antidepressant medication to manage their depression symptoms, but a new study warns about an overlooked side effect of long-term antidepressant use: something similar to withdrawal symptoms.

Reviewing six decades of data, three Chicago researchers found persistent evidence that, when a person abruptly stops taking their antidepressant medication, they can experience symptoms like headaches, insomnia, agitation, diarrhea, anxiety, fatigue, and flu-like symptoms.

The condition - known as antidepressant continuation syndrome - isn't the same thing as drug addiction, because users don't take the drugs to get a "high."

"However," the authors write in a clinical review in The Journal of the American Osteopathic Association, "with extended use, [antidepressants] can be notoriously difficult to quit because they can produce a state of physical dependence."

Doctors often over-prescribe antidepressants and don't have advice patients on how to best wean themselves off the drugs over time, which leads to patients becoming dependent on them, the authors warn.

"I understand that many people feel safe in that their depression or anxiety is continuously managed by medication. However, these are mind-altering drugs and were never intended as a permanent solution," Mireille Rizkalla, PhD, the lead author of the review, said in a press release.

An increasing number of American are using antidepressants for long periods

According to 2017 CDC data, 12.7% of Americans who are 13 or older take antidepressant medication on a monthly basis. This compares to 1999, when an estimated 7.7% of people used antidepressants.

Additionally, a quarter of all antidepressant users have taken their medications for 10 or more years.

The study warns that long term use increases patients' risk of developing antidepressant discontinuation syndrome.

Their body is so accustomed to the medication, it makes it even more difficult for patients to come off of their medication because they want to avoid those side effects.

Doctors play an important role in weaning patients off antidepressant medication

The review authors said that one reason patients become dependent on antidepressant medication is because doctors often don't equip them with plans for eventually weaning themselves off of the medication.

"I think we have a real problem with patient care management, when it comes to prescribing antidepressants," Rizkalla, of Midwestern University, said. "We tend to put patients on an SSRI and more or less forget about them." SSRIs, or selective serotonin reuptake inhibitors, are a class of antidepressant drugs that help boost the brain's production of the hormone serotonin.

According to Rizkalla, doctors who prescribe a patient these drugs should also provide them with a plan for eventual discontinuation as well as suggestions for promoting their mental health with non-drug methods, like therapy, exercise, or meditation.

In their review, the researchers offered recommendations for how patients should, with the assistance of their doctors, taper their antidepressant use to avoid dependence and antidepressant discontinuation syndrome-related side effects.

They suggested that people who take tricyclic antidepressants gradually lower their dosage over three months, and people who use the SSRI paroxetine take 10 milligrams fewer of their medication every five to seven days, for example.

In doing this, the hope is fewer people become dependent on their medication long term and avoid nasty antidepressant discontinuation syndrome symptoms.

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Antidepressants could lead to lifelong dependence, doctors warn, since going off them can trigger agitation, headaches, and flu-like symptoms

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Researchers are warning about an overlooked side effect of long-term antidepressant use, a condition called antidepressant discontinuation syndrome. Symptoms include nausea, agitation, headaches, and flu-like symptoms, which may deter people from coming off their antidepressants. The team urged doctors to better advise their patients on non-medication techniques for managing their depression.

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When the letter came through the post, its content was of no surprise to me. I'd experienced depression and anxiety several times at various points throughout my life, so when a psychotherapist wrote to me to discuss the next steps in treatment, it no longer felt as if I were being labelled 'crazy'. I'm not a modern day Sylvia Plath; I'd just go about my usual life, only now, when I cried spontaneously, I had a clearer reason why.

Everyone can experience low moods but for me, depression and anxiety can be almost debilitating. It's the constant knotted stomach, waking up crying because I can't get out of bed, or the nagging feeling of failure. It's avoiding going outside because the colours seem overwhelmingly bright, feeling disproportionate amounts of anger or listening to my inner voice telling me I'm an idiot.

Prior to each episode up to this point, I'd ignored the early warning signs and left myself to slowly spiral. My mental health has forced me to quit jobs and end relationships when my partner at the time grew too exasperated at the thought that they couldn't make me happy. I often felt like a broken doll that people tried and failed to fix. It's only now, in my late 20s, that I've come to see that only I have the ability to fix my unhappiness.

What made accepting my mental health problems considerably harder as I navigated growing up was that I always had a direct comparison standing right next to me: my identical twin sister, Kirsty.

In many ways we were similar; we both had a crush on Peter Andre during his "Mysterious Girl" days and we both found it socially awkward to mix with other kids around the pool on family holidays. But when it came to our mental health, we couldn't be more different. "I think we are like yin and yang," she told me. "I am more optimistic and idealistic, you're more pessimistic and pragmatic."

Unlike with other siblings, it's often more difficult for twins to create healthy, separate identities. From the get-go, people are fascinated by your ability to be so alike. When we were younger, we sometimes dressed in the same clothes; we were given shared presents on birthdays, and always asked whether we'd ever secretly swapped boyfriends (the answer is no, if you were wondering). When we were babies, we were so alike that on some old photographs, I honestly don't know which twin I am.

The real intrigue for many, though, comes when the differences form. Twins can often become the antithesis of one another as they strive to carve out their own sense of self.

Kirsty had always assumed the role of the happy twin. Growing up she loved pink, chocolate and rom-coms, whereas I'd sway more towards black, vodka and toxic relationships with men. Kirsty was always more cheerful, more easily pleased. I, on the other hand, was the wayward sister brooding in the corner. These were our default characters and it felt as if we couldn't defer from them in case it threatened our sense of individuality.

But if identical twins are supposed to be genetically so alike, why is it that only I suffer with poor mental health? According to Dr Joe Oliver, a consultant clinical psychologist, "where one twin doesn't develop depression, it could be for a range of factors, including greater resilience to stress, better social networks or reduced contact with life pressures."

Depression and anxiety naturally became part of my everyday life but my moments of difficulty have been etched in my twin's memory, too. "I remember standing outside a pub while you went in for a [job] interview because you were too anxious to go alone," she recalls. "And I remember getting a letter from you when I lived in Paris to tell me you felt down. You hadn't spoken to me in weeks and then it was difficult because there was nothing I could do."

Times like these have always been part of our relationship. I was the twin who old creepy men would tell to smile on the street while I watched Kirsty live, laugh, love and dance like no one was watching. I used to feel as if my mental health issues only affected me, but they actually have the potential to affect her even more so because we are twins.

"Depression is multi-causal," explains Dr Oliver, "but the risks dramatically increase for a twin when the other twin becomes depressed (over 70% likelihood by some estimates)."

Over the years my depression had caused me to be so introspective that I'd selfishly assumed my low moods only impacted me.

"Sometimes it makes us closer and sometimes it can be a strain," Kirsty admits. "I don't know if it is because we are twins but I feel more responsible for your suffering and I can almost take on some of your emotions, a bit like a shadow emotion."

Thankfully, Kirsty remains resilient against absorbing my emotional offcuts. I, however, will most likely experience waves of depression and anxiety for the rest of my adult life. That I must be the one to battle poor mental health, when my twin and I come as a genetic pair, will forever be a difficult pill to swallow.

But as the years have passed, I've begun to view my twin's good mental health as an example of what to work towards, rather than a slap in the face from the universe. Comparing ourselves to those around us or those we scroll past on social media is something we could all stand to do less often. If my twin and I are anything to go by, then being the absolute equal to another doesn't guarantee you'll live an identical life. But if we are as equal as biology would claim, then I have the potential to live as content a life as she does. One day maybe I will.

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I Have Depression, My Identical Twin Doesn't

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When the letter came through the post, its content was of no surprise to me. I'd experienced depression and anxiety several times at various points throughout my life, so when a psychotherapist wrote to me to discuss the next steps in treatment, it no longer felt as if I were being labelled 'crazy'.

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Human serotonergic neuron projections (red) and cell bodies (green). Credit: Salk Institute
By studying the biochemistry and growth patterns of serotonergic neurons induced from skin cells of people with differential responses to antidepressants has provided possible reasons as to why some depressed individuals do not respond to treatment.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medication for major depressive disorder (MDD), yet scientists still do not understand why the treatment does not work in nearly thirty percent of patients with MDD. Now, Salk Institute researchers have discovered differences in growth patterns of neurons of SSRI-resistant patients.

The work, published in Molecular Psychiatry on March 22, 2019, has implications for depression as well as other psychiatric conditions such as bipolar disorder and schizophrenia that likely also involve abnormalities of the serotonin system in the brain.

"With each new study, we move closer to a fuller understanding of the complex neural circuitry underlying neuropsychiatric diseases, including major depression," says Salk Professor Rusty Gage, the study's senior author, president of the Institute, and the Vi and John Adler Chair for Research on Age-Related Neurodegenerative Disease.

"This paper, along with another we recently published, not only provides insights into this common treatment, but also suggests that other drugs, such as serotonergic antagonists, could be additional options for some patients."

The cause of depression is still unknown, but scientists believe the disease is partly linked to the serotonergic circuit in the brain. This is largely because SSRIs, which increase levels of the neurotransmitter serotonin at neuron connections, help alleviate the symptoms of many people diagnosed with depression.

Yet, the mechanism of why some people respond to SSRIs, while others do not, remains a mystery. Unraveling the puzzle of SSRI resistance has been challenging because it requires studying the 300,000 neurons that use the neurotransmitter serotonin for communication within a brain of 100 billion total neurons. One way scientists have recently overcome this obstacle is to generate these serotonergic neurons in the lab.

The team's previous paper in Molecular Psychiatry showed that SSRI non-responders had increased receptors for serotonin, which made the neurons hyperactive in response to serotonin. The current paper wanted to examine SSRI non-responders from a different angle.

"We wanted to know if serotonin biochemistry, gene expression and circuitry were altered in SSRI non-responders compared to responders using serotonergic neurons derived from MDD patients," says Krishna Vadodaria, a Salk staff scientist and first author of the new paper. "Using neurons derived from actual MDD patients provides a novel representation of how SSRI responders compare to non-responders."

From a large-scale clinical study of 800 MDD patients, the researchers selected the most extreme cases of SSRI response-patients who drastically improved when taking SSRIs, and patients who saw no effect. The team took skin samples from these patients and reprogrammed the cells into induced pluripotent stem cells (iPSCs) in order to create serotonergic neurons that they could study.

The scientists examined serotonin targets in patient serotonergic neurons, including the enzyme that makes serotonin, the protein that transports it, and the enzyme that breaks it down, but found no differences in biochemistry interactions between groups. Instead, the researchers observed a difference in how the neurons responded based on their shape.

Neurons from SSRI non-responders had longer neuron projections than responders. Gene analysis revealed that the SSRI non-responders also had low levels of key genes (protocadherins PCDHA6 and PCDHA8) involved in forming neuronal circuits.

When these genes were made non-functional in serotonergic neurons (mimicking the low gene levels previously observed), the neurons developed the same unusually long projections in the SSRI non-responders. These abnormal features could lead to too much neuronal communication in some areas of the brain and not enough in other parts, altering communication within the serotonergic circuitry and explaining why SSRIs do not always work to treat MDD.

"These results contribute to a new way of examining, understanding, and addressing depression," says Gage.

The next step is to examine the protocadherin genes to better understand the genetics of SSRI non-responders.

This article has been republished from materials provided by the Salk Institute. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference:

Vadodaria K. C., et al. (2019). Altered serotonergic circuitry in SSRI-resistant major depressive disorder patient-derived neurons. Molecular Psychiatry

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Why Antidepressants May Not Work for Some People

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Human serotonergic neuron projections (red) and cell bodies (green). Credit: Salk Institute By studying the biochemistry and growth patterns of serotonergic neurons induced from skin cells of people with differential responses to antidepressants has provided possible reasons as to why some depressed individuals do not respond to treatment.

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Hypnosis Overcomes the Unthinkable - Phobias Cured Before Your Eyes

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I had a black dog, his name was depression

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Giving patients a dose of anaesthetic could help them to recover from past trauma or even cure phobias, a new study has suggested.

If people are asked to recall painful memories shortly before being knocked out by the drug propofol, scientists found those memories were noticeably weaker the next day.

Anything from a fear of spiders to post-traumatic stress disorder could potentially be relieved if researchers can work out how to harness this effect in patients.

Scientists used to assume that once a memory had formed in someone's mind, it was virtually impossible to target and eliminate.

Experiments in rodents gradually revealed this was not the case, but the procedures being used - such as injecting substances into rats' brains - were not suitable for humans.

Firing electric shocks through the heads of people with severe depression turned out to be an effective way to erase bad memories, but this too was not ideal.

"Electroconvulsive therapy is a very invasive treatment, so if you're thinking long-term of how to selectively target emotional memories that produce problems, and we can do something simpler - that would be better," Dr Bryan Strange of the Polytechnic University of Madrid told The Independent.

As people undergoing such treatments are also given anaesthetic drugs, Dr Strange and his team wondered if these were playing a role in the selective memory loss.

When sedated in hospitals, he noted that patients show some amnesia for the period before their procedure, although this memory loss does not extend to their wider lives.

To test the idea, the team began by asking 50 participants to watch slideshows telling emotional stories, including a boy involved in a car accident and an attack on a young woman.

After a week had passed, they were shown parts of the slideshow to jog their memories, before being injected with propofol.

Half of the subjects were then asked to recall the story 24 hours later, as well as a story that had not been "reactivated" in their minds prior to sedation.

The researchers found that those participants could not remember the reactivated as well as the non-reactivated story.

"What was interesting about the effects of propofol was that it was very selective for the emotional component of the story," said Dr Strange, noting it was the moments of violence or injury that proved harder to recall.

If unpleasant memories can be isolated, potentially using virtual reality, he said phobias that can be traced to specific events - such as crashing a car - could also be isolated and dealt with.

"It's certainly worth a try," said Dr Strange.

Dr Ravi Das, who is undertaking similar research at University College London but was not involved in the current study, said the paper was an interesting development in a growing area of research.

"We know the unhelpful memory process is a core part of things like PTSD and also addictive disorders as well," he said.

However, with no treatments that directly weaken memories ready to use in patients just yet, he said this goal was still a "blue sky aim".

Besides propofol, Dr Das noted that other drugs, including ketamine, were being considered in the development of such treatments.

The new findings were published in the journal Science Advances.
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Anaesthetic could be used to wipe bad memories and phobias from people's minds

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Giving patients a dose of anaesthetic could help them to recover from past trauma or even cure phobias, a new study has suggested. If people are asked to recall painful memories shortly before being knocked out by the drug propofol, scientists found those memories were noticeably weaker the next day.

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Psychologist discusses mental illness in the movies 

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Psychologist discusses mental illness in the movies 

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Real Psychologist Reviews Mental Illness In Movies

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From the way you move and sleep, to how you interact with people around you, depression changes just about everything.
It is even noticeable in the way you speak and express yourself in writing. Sometimes this "language of depression" can have a powerful effect on others. Just consider the impact of the poetry and song lyrics of Sylvia Plath and Kurt Cobain, who both killed themselves after suffering from depression.

Scientists have long tried to pin down the exact relationship between depression and language, and technology is helping us get closer to a full picture. Our new study, published in Clinical Psychological Science, has now unveiled a class of words that can help accurately predict whether someone is suffering from depression.

Traditionally, linguistic analyses in this field have been carried out by researchers reading and taking notes. Nowadays, computerised text analysis methods allow the processing of extremely large data banks in minutes. This can help spot linguistic features which humans may miss, calculating the percentage prevalence of words and classes of words, lexical diversity, average sentence length, grammatical patterns and many other metrics.

So far, personal essays and diary entries by depressed people have been useful, as has the work of well-known artists such as Cobain and Plath. For the spoken word, snippets of natural language of people with depression have also provided insight. Taken together, the findings from such research reveal clear and consistent differences in language between those with and without symptoms of depression.

Content

Language can be separated into two components: content and style. The content relates to what we express - that is, the meaning or subject matter of statements. It will surprise no one to learn that those with symptoms of depression use an excessive amount of words conveying negative emotions, specifically negative adjectives and adverbs - such as "lonely", "sad" or "miserable".

More interesting is the use of pronouns. Those with symptoms of depression use significantly more first person singular pronouns - such as "me", "myself" and "I" - and significantly fewer second and third person pronouns - such as "they", "them" or "she". This pattern of pronoun use suggests people with depression are more focused on themselves, and less connected with others. Researchers have reported that pronouns are actually more reliable in identifying depression than negative emotion words.

We know that rumination (dwelling on personal problems) and social isolation are common features of depression. However, we don't know whether these findings reflect differences in attention or thinking style. Does depression cause people to focus on themselves, or do people who focus on themselves get symptoms of depression?

Style

The style of language relates to how we express ourselves, rather than the content we express. Our lab recently conducted a big data text analysis of 64 different online mental health forums, examining over 6,400 members. " Absolutist words " - which convey absolute magnitudes or probabilities, such as "always", "nothing" or "completely" - were found to be better markers for mental health forums than either pronouns or negative emotion words.

From the outset, we predicted that those with depression will have a more black and white view of the world, and that this would manifest in their style of language. Compared to 19 different control forums (for example, Mumsnet and StudentRoom), the prevalence of absolutist words is approximately 50% greater in anxiety and depression forums, and approximately 80% greater for suicidal ideation forums.

Pronouns produced a similar distributional pattern as absolutist words across the forums, but the effect was smaller. By contrast, negative emotion words were paradoxically less prevalent in suicidal ideation forums than in anxiety and depression forums.

Our research also included recovery forums, where members who feel they have recovered from a depressive episode write positive and encouraging posts about their recovery. Here we found that negative emotion words were used at comparable levels to control forums, while positive emotion words were elevated by approximately 70%. Nevertheless, the prevalence of absolutist words remained significantly greater than that of controls, but slightly lower than in anxiety and depression forums.

Crucially, those who have previously had depressive symptoms are more likely to have them again. Therefore, their greater tendency for absolutist thinking, even when there are currently no symptoms of depression, is a sign that it may play a role in causing depressive episodes. The same effect is seen in use of pronouns, but not for negative emotion words.

Practical implications

Understanding the language of depression can help us understand the way those with symptoms of depression think, but it also has practical implications. Researchers are combining automated text analysis with machine learning (computers that can learn from experience without being programmed) to classify a variety of mental health conditions from natural language text samples such as blog posts.

Such classification is already outperforming that made by trained therapists. Importantly, machine learning classification will only improve as more data is provided and more sophisticated algorithms are developed. This goes beyond looking at the broad patterns of absolutism, negativity and pronouns already discussed. Work has begun on using computers to accurately identify increasingly specific subcategories of mental health problems - such as perfectionism, self-esteem problems and social anxiety.

That said, it is of course possible to use a language associated with depression without actually being depressed. Ultimately, it is how you feel over time that determines whether you are suffering. But as the World Health Organisation estimates that more than 300m people worldwide are now living with depression, an increase of more than 18% since 2005, having more tools available to spot the condition is certainly important to improve health and prevent tragic suicides such as those of Plath and Cobain.

Mohammed Al-Mosaiwi, PhD Candidate in Psychology, University of Reading

This article was originally published on The Conversation. Read the original article.
If you have been affected by this article, you can contact the following organisations for support: beateatingdisorders.org.uk nhs.uk/livewell/mentalhealth mentalhealth.org.uk switchboard.lgbt samaritans.org More: Stephen Hawking had perfect advice for people with depression More: This story about depression is the most important thing you'll read today

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People with depression use language differently - here's how to spot it

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From the way you move and sleep, to how you interact with people around you, depression changes just about everything. It is even noticeable in the way you speak and express yourself in writing. Sometimes this "language of depression" can have a powerful effect on others.

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Some said they were a lifesaver; others dismissed them as unremarkable; still others said they just made things worse.

When the Guardian asked readers of five European newspapers to share their experiences of antidepressants for our series, we were unsure what we'd get. More than 3,000 responses later, the feedback from the UK, Germany, France, Spain and Italy was illuminating and moving.

And although statistically it is hard to draw conclusions from such a self-selecting group of Europeans, the overwhelming sense was that respondents felt that antidepressants had helped them - particularly when twinned with some kind of talking therapy. A smaller but not insignificant number of respondents reported no effect at all with others describing very negative experiences.

If there's one thing we can be certain of from our survey it's that people are keen to share their story, but on the condition that we didn't reveal their identity.

Megan described how after seeking help from her childhood doctor, the antidepressant fluoxetine "gave a break from the relentless and oppressive darkness. It didn't make me happy, it gave me perspective, which was the most valuable thing I could have had. I'd previously suffered lows, but this one was different. I was miserable in my job and working for a horrible boss and just couldn't climb out as I had previously. My mum has suffered with anxiety and depression and it was a call with her, in the middle of the day, in public that I burst into tears and asked how she knew she was ill."

Lou also described her positive experience of taking citalopram after being diagnosed with depression and body dysmorphic disorder. "I was offered cognitive behavioural therapy, but didn't think it would help me. I was astounded that something so small and innocuous as a little white tablet could affect me so much. I felt like a new person. I finally felt like myself again; although it's a cliche, I genuinely felt like a cloud had been lifted.

"I still have what I call 'wobbles', but only once every four or five months. Since I have been taking medication, people comment on how much happier, calmer and more confident I am. I have stopped self-harming, I no longer miss work or university due to depression, and I can get to sleep easily at night. I honestly think I would be dead if it hadn't been for antidepressants."

But Lou realises that she was incredibly lucky to have had such a positive reaction: "I know several people who have been prescribed antidepressants and have suffered very negative side-effects. I was also lucky that the first one I was prescribed worked so well for me, and that I didn't have to endure months of trial and error with other drugs."

"I can't imagine why doctors don't try patients on different brands more regularly," said Andrew who tried two types of antidepressant before finding relief in fluoxetine. "With citalopram there was no difference whatsoever and I stayed on them for two years at the maximum dose. The doctor convinced me I'd feel worse off them, but I didn't. I found some stabilisation of mood with escitalopram but fluoxetine was absolutely life-changing. I wish I didn't have to take them, but I know they stop me spiralling into a low. "

Andrea, who lives in Germany, was one of those who had a very negative reaction to Effexor, which he started to take after suffering a breakdown. "I sought out therapy on my own, but I felt the medication wasn't good for me. My dosage was eventually upped to 300mg. But the side-effects were severe. They eased the depression, but only for a time. I experienced profuse sweating, restless legs, tremors, forgetting words, a weird chill rushing up my legs, back and arms, dizziness, and more. I gained over 20kg in a year, which has devastated my self-esteem. I am jogging to try to lose the weight, but the medication has changed my metabolism, it seems. None of my clothes fit, and I refuse to buy a new wardrobe. I am free of medication now, but it feels like it will be many months until my body recovers. I feel damaged, to tell the truth."

Like Andrea, a significant percentage of people described how access to talking therapies had aided their recovery. Some 51% of respondents in Germany, the highest percentage of the six countries surveyed, said they were offered alternative therapies. But in Spain just 34% reported that they were offered alternative treatments with 35% in France, 45% in the UK and 50% in Italy.

Jon believes that the 20mg of fluoxetine that he took for four years helped him to benefit from therapy. "They helped me to a sense of reality. In other words, they prevented me from getting too negative when talking about really sensitive childhood abuse. Initially antidepressants took control of the really low emotions and prevented them getting the better of me. From my experience, I would never suggest someone takes them without considerable therapeutic support."

Diagnosed with clinical depression after a stressful period with work and private life, Emma was not directly offered counselling but was happy to be prescribed antidepressants. "I do think that talking therapies have a massive part to play in recovering from depression and encouraging positive mental health. When I encountered another period of low mood, I actively sought cognitive behavioural therapy before it got to the point where I felt I would need medication. I wouldn't hesitate to take medication in the future if I felt I needed to, but would also try to address things with talking therapies."

Katie was offered a combination of medication and therapy but initially chose just medication for the first few months as she felt unable to undertake therapy. "One thing I have experienced is that people assume that doctors just prescribe antidepressants without looking into alternatives. I've not found that to be the case at all during my experiences with the NHS. Doctors are trying their best to help a set of complicated illnesses, and there's a huge amount of variation between how these illnesses affect different people. I chose antidepressants initially, because I felt that was the best option, but I felt in no way pressurised into making that decision."

But there were reports of long waiting lists for cognitive behavioural therapy on the NHS in the UK, as Siobhan experienced, yet she was lucky enough to secure a short course of counselling sessions through her university. But this she says was only moderately helpful and may not have worked without the help of antidepressants "providing the necessary chemical jolt and support to get you back to a position where you can really address the root causes of your problems. They are not a long-term solution however, and GPs need to be mindful of such."

Anabelle from France was also prescribed medication as "more of an 'as well as' than an alternative". After three months, she decided to stop the prescription - 20mg of paroxetine. "It was helping a lot with the depression, but not with the anxiety. I felt like I had more energy, was more sociable, and had more motivation to do things. I felt an obvious lift in mood. But at times it felt like I had too much energy, and I felt very hyper. I was agitated, felt a constant need to move, and very anxious. At its worst it was difficult to hold a thought for more than a few seconds, and I felt almost paralysed in fear. Although this never lasted for more than a few days at a time, the last time this happened was so frightening that I decided to stop taking it."

But that didn't stop the negative side effects. "For about two weeks, I felt almost constantly dizzy. Every time I moved my eyes from side to side, I could hear a loud whooshing sound. I've never experienced dizziness to that degree before, and it would put me off of taking paroxetine in the future, even at a lower dose. There were a few moments when I thought about starting it again, just to get rid of the horrendous dizziness. I'd say they helped me, but not without consequences. I would consider taking a different type of antidepressants again to get me out of a severe depression, but I think talking therapies are better for the long term."

John, who grew up in Germany, believes that neither medication nor therapy helped him but a change in circumstance. "I experienced high levels of social withdrawal at school and high levels of anxiety. I refused to attend school and was brought to the doctor by my parents. I was prescribed antidepressants by a psychiatrist with approximately 12 sessions of cognitive behavioural therapy. After three months, I felt much better with lower levels of depression and anxiety but I had extreme dizziness when standing up, 'electric shock' sensations going through my head when I moved it suddenly, and within the first week my mood worsened severely. I experienced very dark and disturbing thoughts, which had never been an aspect of my depression previously. I feel my progress had little to do with the prescribed antidepressants and was more the result of attending school again and feeling more self-assured."

We received stories from people who feel they were given antidepressants unnecessarily. Elsie, from Belgium, visited her doctor in 2007 as she was unable to sleep. Her doctor prescribed trazodone, Lerivon, Remeron and Effexor over a period of time. "I was told I suffered from depression because I couldn't sleep and that I needed to be drugged to get better. On top of the antidepressants, I was also given seven different benzodiazepines and four antipsychotics, usually in cocktails of two to four pills. I got all the side-effects except the one that I needed, namely sleep. I was constantly switched, lowered, raised and multiple times taken off all meds at once. I had pain everywhere, [an] endless list of physical and psychological symptoms that I most certainly did not have before being drugged. It was the worst experience of my life."

People's experiences of taking antidepressants vary from positive to extremely negative, and it's hard to say who will and who won't find them helpful.

But what is certain is that the use of antidepressants is on the rise with prescriptions in some countries having more than doubled in the last decade. Around one in 10 European adults are estimated to have taken pills, and in England alone more than 50 million antidepressant prescriptions were issued last year.
Have you ever taken antidepressants? Share your experiences Topics

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Some said they were a lifesaver; others dismissed them as unremarkable; still others said they just made things worse. When the Guardian asked readers of five European newspapers to share their experiences of antidepressants for our series, we were unsure what we'd get.

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This revolution in our understanding of depression will be life-transforming | Edward Bullmore

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The discovery of genes that are linked to the crippling condition throws up exciting new possibilities for its successful treatment

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Snake Phobia Behavioral (Exposure) Therapy

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Brilliant read (Sept 2017)

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In a girls' school on the fringes of London, the headteacher and her deputy are contemplating the challenges their pupils face, and the toll it takes on them every day. They describe self-harm, eating disorders, depression, panic attacks, school refusal and attempted suicide.

Where do the roots of the problem lie? "I've been in teaching 40 years," says the headteacher. "I've never known this level of dysfunction in society."

This is a comprehensive state school with a good reputation. It gets good results and has a typically mixed intake of pupils. But like many other schools, it is increasingly being called on to support children with mental health issues. And, like many others, its staff are warning that the squeeze on their budgets is leading to cuts in vital pastoral support.

The head agrees to talk on condition of absolute anonymity for fear of being branded "the school with all the problems". But she says these issues will affect every school in the country, "regardless of what they say".

Many of the girls have complex home lives that are affected by unemployment, housing, relationship breakdown, domestic violence, parental neglect, bereavement, and substance abuse including drugs and alcohol.

Cases include fathers arrested for looking at child pornography on the internet, arrests for drug dealing, mothers taking daughters to a refuge to escape a violent partner and Muslim parents struggling with girls who want more freedom. "All these external pressures start early," says the head. "They are carrying all that with them, and then we expect them to sit in classrooms and learn."

Self-harm is one of the methods girls are using to cope with their distress. "We have girls who scratch and cut; we have girls who pull out their hair and their eyelashes. Traditionally, it used to be wrists they cut. It's thighs now, and tummies ... anywhere which can't be seen." Their weapons of choice may be the contents of their pencil case: compass points, the blades from pencil sharpeners, paper clips.

It can start young. In a discussion about mental health with a group of students, one girl described going to her kitchen at midnight, taking out the knives and forks and scraping her arms and legs until she bled. She was still in primary school. "I felt like I deserved to hurt myself."

Many of those who took part in the discussion had self-harmed; some girls posted pictures on social media of their wounds. Others describe feeling depressed, having extreme anxiety and suffering panic attacks. It's hard to keep in mind that the majority of pupils here - like elsewhere - are happy and secure most of the time.

"The one girl I'm thinking of used to pull her eyelashes out and clumps of hair," says the deputy head. "She was quite young at the time. She had just come to us from primary. In her case it was [due to] a separation of parents," he says by way of explanation. "She was living between mum and dad - the usual acrimonious divorce."

We move on to eating disorders. "We've got a girl who has just returned to school," says the head. "She was in hospital with anorexia which set in after the death of her father. She's a really high achiever. Our highest achievers are sometimes the ones you have to look out for the most. They don't know how to fail.

"We seem to have a ridiculous number of parental deaths at the moment," she adds as an afterthought, which adds to her concerns about the lack of nurture in some of the girls' lives. "Sometimes we find the girls coming in and wanting attachment to whoever it might be - a male or female member of staff - because that's lacking in their lives. The fact that schools now have to form 'nurture groups' speaks volumes," she says.

The head and her deputy estimate that around 25-30% of their girls are suffering from mental health issues of one kind or another. At the most severe end of the scale they have two girls who are sectioned and in hospital after trying to kill themselves as a result of an internet suicide game.

There's a girl in year 7 who thinks she's ugly. There's confusion over gender and sexuality, and incidents on social media can send an entire year group into a tailspin - a controversial video posted by one of the girls, a vicious cycle of hurtful and offensive comments, nude photos shared in confidence then spread far and wide, rated and commented on. Everyone gets to know, friendships are broken, and girls end up too scared to go into class. "The concept of a best friend is disappearing," says one head of year, "now you need a squad."

Social media presents an endlessly shifting landscape, with new crazes rapidly taking hold in classrooms and staff lagging weeks behind. Right now it's an app called Sarahah that allows you to receive messages from friends and strangers anonymously.

It is marketed as an app to "improve your friendship by discovering your strengths and areas for improvement". The girls are seeking validation and approval, hoping for kind and flattering comments, but often they are cruel and hurtful. The X game, in which a group picks someone to send insulting messages to on Snapchat, is another such vehicle. And girls who have been persuaded to send intimate photos of themselves can find their image shared in online "baiting" groups.

The girls describe the impact the negative comments have on their self-esteem - slut, slag, lesbo, biggest slag in the school, and worse. One girl suggests they've all done it themselves. "We've all said horrible things to each other." Why? "Because no one can tell it's you."

There are not many pregnancies now; teenage conception rates are at an all-time low. Some girls are having sex - the talk is mainly of anal or oral - and the girls describe the pressure from porn. They say both boys and girls watch it, but the boys want them to look and perform like porn stars. "You're supposed to have big boobs and big butts, but that's porn. That's not us," says one girl.

The pressures of school play a part. The changes in education with the introduction of new GCSEs has put pressure on teachers which in turn impacts upon pupils. "School's OK, but sometimes the stress can get to you as well - the levels of homework, it's crazy," says one girl. "I found myself working till 1am," says another. "I've been in year 11 for 20 days and I've cried 20,000 times."

The head and her deputy describe children who are simultaneously cosseted by their parents and emotionally neglected. "Your typical girl, from the age of 13, will come home from school, go straight up to her bedroom and can quite easily spend the next five hours there," says the head, adding later: "The kids are not as tough as they used to be. They are not resilient enough to deal with things themselves."

To tackle the mental health needs of their pupils, this school invests in a highly qualified behavioural psychologist who works as a counsellor for two days a week, often seeing girls and their parents at 6am, working 12-hour days to meet demand. In addition, the heads of year are non-teaching staff who provide full-time pastoral support.

"These systems really help, but they cost money," says the head. "These are the kind of roles that will be under threat if funding cuts continue."

The government has stated that mental health is a key priority and says it has invested £1.4bn in children's mental health services, with strengthened links between mental health staff and schools. It is offering mental health first aid training to every secondary school, but the head says it is simply not enough.

Tom Madders, campaigns director at the mental health charity YoungMinds, says many teachers are reporting a rise in rates of depression, anxiety and self-harm among their students. "While schools shouldn't be expected to replace specialist mental health services, they can play a crucial role in promoting good mental health and in intervening early when there are problems.

"But funding constraints, coupled with a lack of prominence given to wellbeing in the Ofsted framework, mean that when schools face tough decisions about which services to cut, they are under pressure to prioritise other areas."
In the UK, Childline can be contacted on 0800 1111, and in Republic of Ireland ISPCC Childline can be contacted on 1800 66 66 66. In the UK and Republic of Ireland, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-TALK. In Australia, the crisis support service Lifeline is on 13 11 14.

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Schools fear impact of budget cuts amid girls' mental health crisis

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In a girls' school on the fringes of London, the headteacher and her deputy are contemplating the challenges their pupils face, and the toll it takes on them every day. They describe self-harm, eating disorders, depression, panic attacks, school refusal and attempted suicide. Where do the roots of the problem lie?

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Influential psychiatrist calls for campaigning rethink | MHT

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Influential psychiatrist calls for campaigning rethink.

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Assume you are a therapist doing what is known as ' talk therapy.' A client presents the following issue:
"I am constantly bothered by this colleague at work. I'm totally disgusted and frustrated by her. I try to ignore and avoid her but I just cannot escape her screeching voice and loud laugh around the office. I am sure that everybody can tell I hate her. But I can't help reacting negatively to everything she does."
What would you make of this complaint? And how would you respond?

The answer will depend in part on how you believe talk may heal human suffering. And, as it turns out, psychologists differ on this question.

To understand the different perspectives on how talking may cure we first need to think a bit about words in general. Language is a dynamic, evolving communication system that uses a set of symbols with shared meaning. On the bright side, talk helps us to connect with others, form and maintain strong social and interpersonal relationships, communicate, and cooperate -all of which are essential for human survival. On the dark side, words can be used to obscure rather than clarify meaning; increase distance rather than facilitate closeness; mislead rather than guide; hurt rather than soothe; create conflict rather than solve it, etc.

So words are powerful. But how should that power be harnessed in the context of talk therapy? The term "talking cure" was in fact coined by Freud's famous patient Anna O. (real name: Bertha Pappenheim), who used it to refer to her habit of making up stories and fairytales to soothe her symptoms of hysteria. Freud, of course, was early to recognize the power of words: "With words one man can make another blessed, or drive him to despair... Words call forth effects and are the universal means of influencing human beings. Therefore let us not underestimate the use of words in psychotherapy." 1

Freud believed that our conscious lives-what we say and do and the reasons we give for what we say and do-are actually shaped by unconscious motives and conflicts that operate outside our awareness. Therefore, people's surface expressions (their actions and words) often are coded messages from the unconscious. The work of therapy is to decode the surface expressions and reveal their true deep meaning, to make the unconscious conscious, so that one's inner conflicts may be observed and resolved.

Words therefore cannot be taken at face value. Instead they should be examined for the unconscious, symbolic meaning they convey. For example, if a client notes that a person looking after a sick dog could get bitten, get infected, and possibly die, a Freudian therapist might interpret this as a symbolic expression of an unconscious concern: The client fears that she will damage the therapist, that her problems are contagious.

For Freud, nothing we say is incidental or random. The content and process of speech, as well as the inability to speak, signal hidden underlying desires, fears, and conflicts. This notion is exemplified by the idea of the 'slip of the tongue' which Freud saw as unconscious processes interfering with the conscious intent of speech. "It is...the influence of thoughts that lie outside the intended speech which determines the occurrence of the slip and provides an adequate explanation of the mistake." 2

One famous example:

She: What would you like, bread and butter or pancake?

He: Bed and butter

Clearly, argues Freud, the speaker has something other than breakfast on their unconscious mind.

Words represent and illuminate (bring into awareness) the deep unconscious processes that shape our mental state. According to Freud, speech, "brings material in the ego into a firm connection with the...residues of visual, but more particularly of auditory, perceptions." 3. In other words, the mind assimilates perceptual information through language. We are able to make sense of our perceptions by putting them into words.

Words perform the magic of turning one thing into something else, making the invisible visible. They give us the power to see hidden wounds, and treat them. "A layman will no doubt find it hard to understand how pathological disorders of the body and mind can be eliminated by 'mere' words. He will feel that he is being asked to believe in magic. And he will not be so very wrong, for the words which we use in our everyday speech are nothing other than watered-down magic. But we shall have to follow a roundabout path in order to explain how science sets about restoring to words a part at least of their former magical power." 4

Emerging in the 50s and 60s in part as an alternative to-and a rebuke of-Freudian formulations, the Humanistic perspective focuses on conscious, subjective experience, emphasizing the uniquely human qualities of free will, freedom of choice, courage, and self realization. The humanistic approach focuses on health, not sickness, emphasizes the present and future, rather than the past, and privileges self-knowledge and self-direction over statistical prediction or expert opinion. The most influential therapist in this tradition was Carl Rogers, and his view of the uses of language in therapy differed markedly from Freud's view.

Unlike the dark, deterministic Freud, Rogers believed that human beings are at their core rational, trustworthy, and well meaning. "The core of man's nature is essentially positive." 5. Rogers saw the drive toward self-actualization as the singular "force of life," a built-in motivation present in every life form to develop its potentials to the fullest extent possible. "The organism has one basic tendency and striving - to actualize, maintain, and enhance the experiencing organism." 6

Rogers used the term "Organismic Valuing Process" to refer to the internal voice that allows the individual to know whether an experience is in line with the self-actualizing tendency.

Rogers valued experience above any other way of figuring out a person's way in the world. "Experience is, for me, the highest authority... No other person's ideas, and none of my own ideas, are as authoritative as my experience...Neither the Bible nor the prophets -- neither Freud nor research...can take precedence over my own direct experience." 7

For Rogers, the aspect of your being that is founded in the actualizing tendency and follows the organismic valuing process is your "real self." Your "ideal self," on the other hand, is your sense of how you wish to be, and it is prone to societal influence. When social dictates about how you should be are out of synch with your actualizing tendency, a gap, which Rogers called "incongruence," opens between the real self and the ideal self, the "I am" and the "I should be." "If the individual dimly perceives such an incongruence in himself, then a tension state occurs which is known as anxiety." 8

Mental health, for Rogers, is the process of active participation in the discovery of one's actualizing tendency. "This process of the good life is not, I am convinced, a life for the faint-hearted. It involves the stretching and growing of becoming more and more of one's potentialities. It involves the courage to be. It means launching oneself fully into the stream of life." 9. Therapy works to facilitate this difficult process.

Rogers called his approach "Person-Centered Psychotherapy," asserting that the client is the expert on their problems and the solutions. "It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried." 10

Rogers was one of the first to study the therapeutic exchange scientifically, by recording his sessions and pouring over transcripts of these recordings to gleam patterns and dynamics. Rogers concluded that for change to happen in therapy, the therapist must possess three core qualities: Empathy (the ability to sense the client's private world as if it were your own); Unconditional Positive Regard (extending a warm acceptance to each aspect of the client's experience); and Congruence (being genuine, real, honest, and open).

In therapy, Rogers would avoid diagnosis, advice, judgment, education, or labeling, relying instead mainly on the technique of reflection, or verbal mirroring, in order to achieve an accurate understanding of the client's inner world and the emotions being conveyed and create an atmosphere of acceptance, safety, and understanding. Therefore for Rogers, the client's words are more curative than the therapist's, since it is the client who's the expert, and has the knowledge of how to proceed toward their truth. Specifically for Rogers, the client's words heal when they are listened to intently. "When a person realizes he has been deeply heard, his eyes moisten. I think in some real sense he is weeping for joy. It is as though he were saying, 'Thank God, somebody heard me. Someone knows what it's like to be me'....It is astonishing how elements that seem insoluble become soluble when someone listens, how confusions that seem irremediable turn into relatively clear flowing streams when one is heard. I have deeply appreciated the times that I have experienced this sensitive, empathic, concentrated listening...When I have been listened to and when I have been heard, I am able to re-perceive my world in a new way." 11

Cognitive Therapy, a more contemporary approach to talk therapy, operates on the assumption that how you think shapes your feelings and actions. According to Albert Ellis, one of the founding fathers of the cognitive approach, "psychotherapy starts with the hypothesis that human emotion is caused and controlled in several major ways and that for all practical purposes, the most important of these is usually by thinking." 12

Distorted thinking habits need to be identified, challenged, and replaced. Cognitive therapy, according to another founding father, Aaron Beck, "seeks to alleviate psychological stresses by correcting faulty conceptions and self-signals. By correcting erroneous beliefs we can lower excessive reactions." 13

The cognitive approach to therapy minimizes exploration of childhood, explors daily concerns, and focuses on the direct, common sense meaning of problems rather then relying on symbolism. It places primary importance on thinking processes, not unconscious motives or drives.

Our cognitive architecture according to Aaron Beck has several components: Core Beliefs - unconditional beliefs that serve as a basis for evaluating experiences (for example, "I'm no good." "Others can't be trusted."). Dysfunctional Beliefs - conditional beliefs that shape one's response to experiences (for example, "If someone gets close to me, they will discover the 'real me' and reject me."). Interpersonal Strategies - underlying assumptions about ways to influence others (for example," "If I want someone to like me, I must be nice to them."), and Automatic Thoughts - the cognitions that spontaneously flow through one's mind in the moment (for example, "Oh crap! Now I'm really screwed."). Together, those elements of the mind make up the client's basic 'self-Schema.'

According to Beck, one goal of therapy is to challenge and neutralize common "cognitive distortions" that serve to protect faulty, self-defeating schemas by canceling out any information that is contrary to core beliefs, leaving the person in the dark about any disconfirming evidence from the environment.

Such Cognitive Distortions include:

1. ALL-OR-NOTHING THINKING: You see things in black-and-white. If your performance falls short of perfect, you see yourself as a total failure.

2. OVER-GENERALIZATION: You see a single negative event as a never-ending pattern of defeat.

3. MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

4. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they "don't count" for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.

5. MAGNIFICATION OR MINIMIZATION: You exaggerate the importance of things (such as your goof-up or someone else's achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections).

7. EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true!"

8. 'SHOULD' STATEMENTS: You try to motivate yourself with shoulds and shouldn'ts, as if you had to be whipped and punished before you could be expected to do anything.

Working with similar assumptions about the centrality of thought to mental health, Albert Ellis (1913-2007) popularized The A-B-C Model of cognitive therapy, in which A stands for Antecedents (events that happen in the environment), B stands for Beliefs (interpretations, self talk, thoughts), And C stands for Consequences (how you feel and what you do). According to Ellis, A doesn't cause C. B causes C. In other words, we react not to events, but to our interpretation of events, and those interpretations are often irrational, nonsensical, and rooted in what he called "Common Irrational Beliefs," ideas that make people who hold them miserable, among them:

* I should be thoroughly competent at everything.

* It catastrophic when things are not the way I want them to be.

* I have no control over my happiness.

* I need someone stronger than myself to be dependent on.

* My past history greatly influences my present life.

* There is a perfect solution to human problems, and it's a disaster if I don't find it.

Cognitive Therapy in the tradition of Beck and Ellis teaches the client to think about their own thinking, looking for distortions and false beliefs that may skew their interpretations of the events of their lives. Clients learn to treat their thoughts as hypotheses, not facts, and as mind events not world events. They are taught to identify automatic thoughts habits ("What am I telling myself that is making me react in this way?"); generate alternatives ("What else can I tell myself here?"); compare, based on evidence ("Which one of the thoughts I have is more likely to be true?"); pick the thought that is backed by evidence, and act from the chosen thought. The words that matter most, in this approach, are those we tell ourselves. To heal, we need to recognize our inner speech habits and learn to practice sound 'mental hygiene' by making sure what we tell ourselves is likely to be true, and has some evidence to back it up.

Having said all this, let's return to our initial challenge. How would you respond to the client's complaint?
"I am just so bothered by this woman at work. It's total disgust and frustration. I try to ignore and avoid her but I just cannot escape her screeching voice and loud laugh around the office. I am sure that everybody can tell I don't like her. But I can't help reacting negatively to everything she does."
Clearly, the three perspectives will have different answers. For the Freudians, words matter as symbols. Their unconscious meaning, decoded in therapy, will reveal to us the true source of our problems, thus providing the insight and emotional relief necessary for change and healing to occur. A Freudian therapist may suspect that the client's aversion to the woman is due to the fact that she is giving expression to unconscious needs the client himself has but is afraid to own; or wonder whether the woman's behavior elicits echoes of the client's own mother, toward whom he feels suppressed anger.

For the Rogersian Humanists, words matter as means of encouragement and support, as well as self-exploration. To the extent that talking is based in acceptance and leads to empathic understanding, it may create an environment in which we will feel safe enough to experience and express ourselves authentically, and figure out how to change, grow, and heal ourselves. Rather than offering interpretations, the humanist therapist is more likely to reflect the client's words and emotions back to them: "So you are very perturbed by this woman at work. Her presence upsets you. You feel like you cannot control your negative reaction to her. And you feel that others are noticing your dislike of her." The client, feeling safe and understood, will then proceed to figure out for himself what it is that makes him react the way he does.

For Cognitive psychologists, words matter mostly as they constitute our "self talk," the thinking habits that determine our actions and emotions. Therapy helps us examine our own thinking process to identify and change self-talk habits that are distorted or destructive. The cognitive therapist will inquire with the client about his thought process upon encountering the woman. "What do you tell yourself when you hear her laugh?" Or, "Let's assume you cannot manage this stress at work, what will happen then?" Once the client reveals his catastrophic thoughts ("I will go crazy and end up in a mental hospital") the therapist may then move to challenge these catastrophic predictions ("What are the real odds of this happening? What else may happen?"). As the client learns to replace catastrophic predictions with more rational ones ("This situation is more of a nuisance than a crisis"), their mood and behavior will change for the better.

So, what kind of therapist would you be? What kind would you want to have?

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Assume you are a therapist doing what is known as ' talk therapy.' A client presents the following issue: "I am constantly bothered by this colleague at work. I'm totally disgusted and frustrated by her. I try to ignore and avoid her but I just cannot escape her screeching voice and loud laugh around the office.

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Global Mental Health

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Vikram Patel, The Life Scientific - BBC Radio 4

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Jim Al-Khalili discusses global mental health with psychiatrist Prof Vikram Patel.

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The group come from all over the country to meet for the first time at a training camp.

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Bacillophobia- Fear of microbes.
Bacteriophobia- Fear of bacteria.
Ballistophobia- Fear of missiles or bullets.
Bolshephobia- Fear of Bolsheviks.
Barophobia- Fear of gravity.
Basophobia or Basiphobia- Inability to stand. Fear of walking or falling.
Bathmophobia- Fear of stairs or steep slopes.
Bathophobia- Fear of depth.
Batophobia- Fear of heights or being close to high buildings.
Batrachophobia- Fear of amphibians, such as frogs, newts, salamanders, etc.
Belonephobia- Fear of pins and needles. (Aichmophobia)
Bibliophobia- Fear of books.
Blennophobia- Fear of slime.
Bogyphobia- Fear of bogeys or the bogeyman.
Botanophobia- Fear of plants.
Bromidrosiphobia or Bromidrophobia- Fear of body smells.
Brontophobia- Fear of thunder and lightning.
Bufonophobia- Fear of toads.

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Bacillophobia- Fear of microbes. Bacteriophobia- Fear of bacteria. Ballistophobia- Fear of missiles or bullets. Bolshephobia- Fear of Bolsheviks. Barophobia- Fear of gravity. Basophobia or Basiphobia- Inability to stand. Fear of walking or falling.Bathmophobia- Fear of stairs or steep slopes. Bathophobia- Fear of depth. Batophobia- Fear of heights or being close to high buildings.

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Part 2 of 2

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Obsessive Compulsive Cleaners S04E01 Country House Rescue

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Extreme OCD Camp Episode 2 2013 BBC Three Documentary Trekking into the americal forest

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Extreme OCD Camp Episode 2 BBC trek deep into the American forest;

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Part 1 of 2

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Obsessive Compulsive Cleaners S04E01 Country House Rescue

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Extreme OCD Camp Episode 1 BBC documentary 2013  journey to the American wilderness

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Extreme OCD Camp Episode 1 Documentary following six British teens and young adults with obsessive-compulsive disorder as they embark on an incredible journey to the American wilderness for treatment. During the week-long intensive camp, the group undergo exposure therapy, where they are challenged to confront their greatest fears.

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Part 5 of 5

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Part 5 Primal Fears - BBC Explorations | Storyteller Media

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Jackie is petrified of feathers, Ryan cant fly, and Trevors scared of heights. Irrational phobias are damaging their lives. Will the latest treatments help like dropping them in at the deep end? When fear goes wrong it can turn into a phobia an irrational fear so strong it sometimes ruins lives.

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Part 3 of 5

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Part 3 Primal Fears - BBC Explorations | Storyteller Media

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Jackie is petrified of feathers, Ryan cant fly, and Trevors scared of heights. Irrational phobias are damaging their lives. Will the latest treatments help like dropping them in at the deep end? When fear goes wrong it can turn into a phobia an irrational fear so strong it sometimes ruins lives.

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Part 2 of 5

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Part 2 Primal Fears - BBC Explorations | Storyteller Media

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Jackie is petrified of feathers, Ryan cant fly, and Trevors scared of heights. Irrational phobias are damaging their lives. Will the latest treatments help like dropping them in at the deep end? When fear goes wrong it can turn into a phobia an irrational fear so strong it sometimes ruins lives.

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Part 1 of 5

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Part 1 Primal Fear - BBC Explorations | Storyteller Media

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Jackie is petrified of feathers, Ryan cant fly, and Trevors scared of heights. Irrational phobias are damaging their lives. Will the latest treatments help like dropping them in at the deep end? When fear goes wrong it can turn into a phobia an irrational fear so strong it sometimes ruins lives.

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Psychologists use the term "automatic negative thoughts" to describe the ideas that pop into our heads uninvited, like burglars, and leave behind a mess of uncomfortable emotions. In the 1960s, one of the founders of cognitive therapy, Aaron Beck, concluded that ANTs sabotage our best self, and lead to a vicious circle of misery: creating a general mindset that is variously unhappy or anxious or angry (take your pick) and which is (therefore) all the more likely to generate new ANTs. We get stuck in the same old neural pathways, having the same negative thoughts again and again.

Happily, increasing evidence of the brain's plasticity suggests that we can disrupt this poisonous cycle and put in place something much more healthy. Brains don't stop developing in childhood, as was previously believed: studies of London cabbies doing "the knowledge" of the city's layout have found a redistribution of grey matter, and individuals who sustained massive brain damage have been shown to develop workarounds using undamaged parts. So we can learn to stop our thoughts travelling down the well-trodden neural pathways by creating entirely new ones.

The first step is to become aware of your automatic negative thoughts - and for me, anyway, that's much easier (and more fun, actually) if I personify the inner critic, with a sketch, and give him/her a voice. By doing that, I externalise the thoughts: they're no longer coming from me. And it seems I'm not the only one who likes working that way.

Personal negativity

I don't know what yours is like, but I imagine my inner critic as small with a shaved head, and dark shadows under his bulging eyes. He generally looks worried, and avoids eye contact, but sometimes he stares boldly, his face contorted into a disbelieving sneer.

The description is based on drawings I've made of him. And having determined his appearance, I gave him a name: Uriah, because like the Dickens character my inner critic is "ever so 'umble".

He's determined to keep me that way, too. Whenever I'm about to do something exciting - that's when Uriah pops up. And in the privacy of my own head he says things like this: You're not ready. Nobody wants that anyway. You're too old. It's not going to make any difference. Nobody is listening to you. You will never be successful. You don't work hard enough. It is painful.

I knew nothing about my inner critic until a couple of years ago, when a friend was training as a life coach, and asked me to be her guinea pig. At the time, I thought life coaching sounded a bit odd and - well, Californian. I didn't expect much. But I trusted my friend, and found the experience so helpful that I decided to train as a life coach myself - not a therapist, any more than a football coach is a therapist, but a conversational partner who uses insights from psychology occasionally to be supportive and challenging at the same time. (The company that trained us both, Coaches Training Institute, did indeed turn out to be Californian.)

Until then I had assumed - like most people, it seems - that when a negative thought popped into my head it was just an accurate reflection of the way things really are. But I've since come to see that the inner critic only ever promotes a point of view. And there's always another point of view available if we choose to look for it.

Finding your inner critic

Not long ago, I was running a workshop on creativity for a group of about 30 adults who, for a variety of reasons, had lost the free spirit of creativity they'd had as children.

So I decided to show them my drawing of Uriah, with speech bubbles coming out of his head to show the specific, shameful thoughts that trouble me. I have to tell you that it made me extremely uncomfortable to hold up that picture in front of these strangers, and to read out those horrible specimens of self-criticism. ("Tell them I'll never be successful! I'm too old! I can't do that!")

But as I did it, I looked around at the faces before me and I realised that they weren't especially interested in my inner critic - they were much more interested in uncovering their own. (What's more, my own anxiety about this shameful secret substantially disappeared as soon as the words left my mouth.)

So, having shared my own self-critical thoughts, I invited everybody else to take a pen and paper and write down the kinds of thoughts that pop into their own heads.

The room went very quiet.

Then I asked them to imagine about the kind of person who might say those mean-spirited things, and to draw him, or her. (It doesn't have to be a "good" drawing.) Some drew a picture of their old headteacher, others drew a parent, or somebody at work. I asked them to give the character a name, and to draw speech bubbles containing all those horrid sentences.

When working with people like this, I ask them to notice, in future, whenever these characters come into their heads. To be really curious. How often does it happen? What's the trigger? What emotional state does it leave you in? How strong is that emotional state, from one (low) to 10 (high)?

And after noticing, I invite them to argue back with their inner critic. "If it helps," I might say, "think of somebody you admire for whatever reason, and imagine that person is beside you now, offering support. If they were arguing for you, what might they say?"

Answers don't always come easily. Some people are just too afraid of the negative thoughts. But that usually passes. Others might think the exercise is silly. So I lay it on thick about the science: psychologists, automatic negative thoughts, and neural plasticity. But either way, it basically comes down to the same thing: moving beyond the negative chatter in your head, and putting your inner critic back inside his box. And as many coaches, and cognitive behavioural therapists, can confirm - getting acquainted with your inner critic can be remarkably helpful.

Categories

We all have our own particular set of automatic negative thoughts, but they tend to fall into broadly similar categories.

Black and white thinking, with no grey areas: "I've completely failed." "Everyone else can do it".
Mind reading other people: "They think I'm boring." "People must think I'm stupid."
Crystal-ball gazing: "There's no point in trying. It won't work."
Over-generalisation: "This relationship ended, so I won't ever meet anybody."
Disqualifying the positive: "I may be a good mother, but anybody can do that."
Drama queen: "I can't find my purse. I'm going senile."
Unrealistic expectations: "I should keep going, even when I'm tired."
Name calling, to self an others: "Silly fool."
Self-blame: "She looks cross. It must be my fault."
Catastrophising: "Nothing is ever going to work for me."
John-Paul Flintoff is the author of How To Change The World, published by Macmillan. Interested in finding out more about how you can live better? Take a look at this month's Live Better challenge here. The Live Better Challenge is funded by Unilever; its focus is sustainable living. All content is editorially independent except for pieces labelled advertisement feature. Find out more here.
* This article was amended on 14 August 2014. An earlier version stated that John-Paul Flintoff trained with Coaches Training International. In fact he trained with the Coaches Training Institute.
Topics

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Psychologists use the term "automatic negative thoughts" to describe the ideas that pop into our heads uninvited, like burglars, and leave behind a mess of uncomfortable emotions.

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Cognitive-behavioural therapy for the treatment of depression in children and adolescents

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Rational emotive behavior therapy, also known as REBT, is a type of cognitive-behavioral therapy developed by psychologist Albert Ellis. REBT is focused on helping clients change irrational beliefs.

Let's take a closer look at how rational emotive behavior was developed and how it works.

History of Rational Emotive Behavior Therapy

As a young man, Ellis found himself longing for companionship yet experienced a severe fear of talking to women.

In order to tackle his fear, Ellis decided to perform an experiment. For a month, his visited a nearby park and forced himself to talk to 100 different women. Over time, Ellis found that his fear of speaking to women had diminished considerably. Ellis later explained that this experience served as a basis for developing his approach to therapy, combining behavioral strategies with assessing underlying thoughts and emotions.

Ellis had trained as a clinical psychologist. As he treated patients, he became increasingly dissatisfied with the results offered by the traditional psychoanalytic approach to therapy that he was using at the time. He noted that while his patients were able to become aware of their underlying problems, their behavior did not necessarily change as a result. Simply becoming conscious of the problem was not enough to lead to actual changes in behavior, he concluded.

By the 1950s, Ellis had started experimenting with other types of psychotherapy and was heavily influenced by philosophers and psychologists including Karen Horney and Alfred Adler as well as the work of behavioral therapists.

Ellis's goal was to develop what he viewed as an action-oriented approach to psychotherapy designed to produce results by helping clients manage their emotions, cognitions, and behaviors.

According to Ellis, "people are not disturbed by things but rather by their view of things." The fundamental assertion of rational emotive behavior therapy (REBT) is that the way people feel is largely influenced by how they think.

When people hold irrational beliefs about themselves or the world, problems can result. Because of this, the goal of REBT is to help people alter illogical beliefs and negative thinking patterns in order to overcome psychological problems and mental distress.

Rational emotive behavior therapy was one of the very first types of cognitive therapies. Ellis first began developing REBT during the early 1950s and initially called his approach rational therapy. In 1959, the technique was redubbed rational emotive therapy and later rechristened rational emotive behavior therapy in 1992. Ellis continued to work on REBT until his death in 2007.

The ABC Model

Ellis suggested that people mistakenly blame external events for unhappiness. He argued, however, that it is our interpretation of these events that truly lies at the heart of our psychological distress. To explain this process, Ellis developed what he referred to as the ABC Model:

A - Activating Event: Something happens in the environment around you.

B - Beliefs: You hold a belief about the event or situation.

C - Consequence: You have an emotional response to your belief.

The events and situations that people encounter throughout life are only one piece of the puzzle.

In order to understand the impact of such events, it is also essential to look at the beliefs people hold about these experiences as well as the emotions that arise as a result of those beliefs.

The Basic Steps in Rational Emotive Behavior Therapy

In order to better understand how REBT looks, it is important to take a closer look at how the therapeutic process itself.

1. Identify the Underlying Irrational Thought Patterns and Beliefs

The very first step in the process is to identify the irrational thoughts, feelings, and beliefs that lead to psychological distress. In many cases, these irrational beliefs are reflected as absolutes, as in "I must," "I should," or "I cannot." According to Ellis, some of the most common irrational beliefs include:

Feeling excessively upset over other people's mistakes or misconduct.

Believing that you must be 100 percent competent and successful in everything to be valued and worthwhile.

Believing that you will be happier if you avoid life's difficulties or challenges.

Feeling that you have no control over your own happiness; that your contentment and joy are dependent upon external forces.

By holding such unyielding beliefs, it becomes almost impossible to respond to situations in a psychologically healthy way. Possessing such rigid expectations of ourselves and others only leads to disappointment, recrimination, regret, and anxiety.

2. Challenge the Irrational Beliefs

Once these underlying feelings have been identified, the next step is to challenge these mistaken beliefs. In order to do this, the therapist must dispute these beliefs using very direct and even confrontational methods. Ellis suggested that rather than simply being warm and supportive, the therapist needs to be blunt, honest, and logical in order to push people toward changing their thoughts and behaviors.

3. Gain Insight and Recognize Irrational Thought Patterns

As you might imagine, REBT can be a daunting process for the client. Facing irrational thought patterns can be difficult, especially because accepting these beliefs as unhealthy is far from easy. Once the client has identified the problematic beliefs, the process of actually changing these thoughts can be even more challenging.

While it is perfectly normal to feel upset when you make a mistake, the goal of rational emotive behavior therapy is to help people respond rationally to such situations. When faced with this type of situation in the future, the emotionally healthy response would be to realize that while it would be wonderful to be perfect and never make mistakes, it is not realistic to expect success in every endeavor. You made a mistake, but that's okay because everyone makes mistakes sometimes. All you can do is learn from the situation and move on.

It is also important to recognize that while rational emotive behavior therapy utilizes cognitive strategies to help clients, it also focuses on emotions and behaviors as well. In addition to identifying and disputing irrational beliefs, therapists and clients also work together to target the emotional responses that accompany problematic thoughts. Clients are also encouraged to change unwanted behaviors using such things as meditation, journaling, and guided imagery.

A Word From Verywell

REBT can be effective in the treatment of a range of psychological disorders including anxiety and phobias as well as specific behaviors such as severe shyness and excessive approval-seeking.

Sources:
Ellis, A. Reason and emotion in psychotherapy. New York: Carol; 1991. Ellis, A. Reflections on Rational-Emotive Therapy. Journal of Consulting and Clinical Psychology, 61, 199-201; 1993. Ellis, A & Dryden, W. The Practice of Rational Emotive Behavior Therapy. New York: Springer Publishing Company, Inc.; 1997.

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How Does Rational Emotive Behavior Therapy Work?

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Rational emotive behavior therapy, also known as REBT, is a type of cognitive-behavioral therapy developed by psychologist Albert Ellis. REBT is focused on helping clients change irrational beliefs. Let's take a closer look at how rational emotive behavior was developed and how it works.

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How well can psychotherapists and their clients judge from personal experience whether therapy has been effective? Not well at all, according to a paper by Scott Lilienfeld and his colleagues. The fear is that this can lead to the continued practice of ineffective, or even harmful, treatments.

The authors point out that, like the rest of us, clinicians are subject to four main biases that skew their ability to infer the effectiveness of their psychotherapeutic treatments. This includes the mistaken belief that we see the world precisely as it is (naive realism), and our tendency to pursue evidence that backs our initial beliefs (the confirmation bias). The other two are illusory control and illusory correlations - thinking we have more control over events than we do, and assuming the factors we're focused on are causally responsible for observed changes.

These features of human thought lead to several specific mistakes that psychotherapists and others commit when they make claims about the effectiveness of psychological therapies. Lilienfeld's team call these mistakes "causes of spurious therapeutic effectiveness" or CSTEs for short. The authors have created a taxonomy of 26 CSTEs arranged into three categories.

The first category includes 15 mistakes that lead to the perception that a client has improved, when in fact he or she has not. These include palliative benefits (when the client feels better about their symptoms without actually showing any tangible improvement); confusing insight with improvement (when the client better understands their problems, but does not actually show recovery); and the therapist's office error (confusing a client's presentation in-session with their behaviour in everyday life).

The second category consists of errors that lead therapists and their clients to infer that symptom improvements were due to the therapy, and not some other factor, such as natural recovery that would have occurred anyway. Among these eight mistakes are a failure to recognise that many disorders are cyclical (periods of recovery interspersed with phases of more intense symptoms); ignoring the influence of events occurring outside of therapy, such as an improved relationship or job situation; and the influence of maturation (disorders seen in children and teens can fade as they develop).

The third and final category of errors are those that lead to the assumption that improvements are causes by unique features of a therapy, rather than factors that are common to all therapies. Examples here include not recognising placebo effects (improvements stemming from expectations) and novelty effects (improvements due to initial enthusiasm).

To counter the many CSTEs, Lilienfeld's group argue we need to deploy research methods including using well-validated outcome measures, taking pre-treatment measures, blinding observers to treatment condition, conducting repeated measurements (thus reducing the biasing impact of irregular everyday life events), and using control groups that are subjected to therapeutic effects common to all therapies, but not those unique to the treatment approach under scrutiny.

"CSTEs underscore the pressing need to inculcate humility in clinicians, researchers, and students," conclude Lilienfeld and his colleagues. "We are all prone to neglecting CSTEs, not because of a lack of intelligence but because of inherent limitations in human information processing. As a consequence, all mental health professionals and consumers should be sceptical of confident proclamations of treatment breakthroughs in the absence of rigorous outcome data."

_________________________________ Lilienfeld, S., Ritschel, L., Lynn, S., Cautin, R., & Latzman, R. (2014). Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness Perspectives on Psychological Science, 9 (4), 355-387 DOI:
10.1177/1745691614535216

--further reading--
When therapy causes harm

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

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bps research digest: the mistakes that lead therapists to infer psychotherapy was effective

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The mistakes that lead therapists to infer psychotherapy was effective, when it wasn't

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How well can psychotherapists and their clients judge from personal experience whether therapy has been effective? Not well at all, according to a paper by Scott Lilienfeld and his colleagues. The fear is that this can lead to the continued practice of ineffective, or even harmful, treatments.

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Anxiety disorders are to do with feelings of fear, apprehension and tension that people experience. Everybody experiences anxiety at some time in their life, a threat will cause a person to be...

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Extra features include; faster download speeds, the option to preview most of the resources on the site prior to downloading them, the ability to send private messages to all users, online chat, a private PLUS forum and the option to send private files.

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Behaviorism as a movement in psychology appeared in 1913 when John Broadus Watson published the classic article psychology as the behaviorist views it.

John Watson proposed that the process of classical conditioning (based on Pavlov's observations) was able to explain all aspects of human psychology.

Everything from speech to emotional responses was simply patterns of stimulus and response. Watson denied completely the existence of the mind or consciousness. Watson believed that all individual differences in behavior were due to different experiences of learning. He famously said:

"Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I'll guarantee to take any one at random and train him to become any type of specialist I might select - doctor, lawyer, artist, merchant-chief and, yes, even beggar-man and thief, regardless of his talents, penchants, tendencies, abilities, vocations and the race of his ancestors" (Watson, 1924, p. 104).

Classical Conditioning Examples

Classical conditioning theory involves learning a new behavior via the process of association. In simple terms, two stimuli are linked together to produce a newly learned response in a person or animal. There are three stages of classical conditioning. At each stage the stimuli and responses are given special scientific terms:

Stage 1: Before Conditioning:

In this stage, the unconditioned stimulus (UCS) produces an unconditioned response (UCR) in an organism. In basic terms, this means that a stimulus in the environment has produced a behavior / response which is unlearned (i.e., unconditioned) and therefore is a natural response which has not been taught. In this respect, no new behavior has been learned yet.

For example, a stomach virus (UCS) would produce a response of nausea (UCR). In another example, a perfume (UCS) could create a response of happiness or desire (UCR).

This stage also involves another stimulus which has no effect on a person and is called the neutral stimulus (NS). The NS could be a person, object, place, etc. The neutral stimulus in classical conditioning does not produce a response until it is paired with the unconditioned stimulus.

Stage 2: During Conditioning:

During this stage a stimulus which produces no response (i.e., neutral) is associated with the unconditioned stimulus at which point it now becomes known as the conditioned stimulus (CS).

For example, a stomach virus (UCS) might be associated with eating a certain food such as chocolate (CS). Also, perfume (UCS) might be associated with a specific person (CS).

Often during this stage, the UCS must be associated with the CS on a number of occasions, or trials, for learning to take place. However, one trail learning can happen on certain occasions when it is not necessary for an association to be strengthened over time (such as being sick after food poisoning or drinking too much alcohol).

Stage 3: After Conditioning:

Now the conditioned stimulus (CS) has been associated with the unconditioned stimulus (UCS) to create a new conditioned response (CR).

For example, a person (CS) who has been associated with nice perfume (UCS) is now found attractive (CR). Also, chocolate (CS) which was eaten before a person was sick with a virus (UCS) now produces a response of nausea (CR).

Little Albert Experiment (Phobias)

Ivan Pavlov showed that classical conditioning applied to animals. Did it also apply to humans? In a famous (though ethically dubious) experiment, Watson and Rayner (1920) showed that it did.

Little Albert was a 9-month-old infant who was tested on his reactions to various stimuli. He was shown a white rat, a rabbit, a monkey and various masks. Albert described as "on the whole stolid and unemotional" showed no fear of any of these stimuli. However, what did startle him and cause him to be afraid was if a hammer was struck against a steel bar behind his head. The sudden loud noise would cause "little Albert to burst into tears.

When Little Albert was just over 11 months old, the white rat was presented, and seconds later the hammer was struck against the steel bar. This was done seven times over the next seven weeks, and each time Little Albert burst into tears. By now little Albert only had to see the rat and he immediately showed every sign of fear. He would cry (whether or not the hammer was hit against the steel bar) and he would attempt to crawl away.

In addition, the Watson and Rayner found that Albert developed phobias of objects which shared characteristics with the rat; including the family dog, a fur coat, some cotton wool and a Father Christmas mask! This process is known as generalization.

Watson and Rayner had shown that classical conditioning could be used to create a phobia. A phobia is an irrational fear, i.e., a fear that is out of proportion to the danger. Over the next few weeks and months, Little Albert was observed and ten days after conditioning his fear of the rat was much less marked. This dying out of a learned response is called extinction. However, even after a full month it was still evident, and the association could be renewed by repeating the original procedure a few times.

Classical Conditioning in the Classroom

The implications of classical conditioning in the classroom are less important than those of operant conditioning, but there is a still need for teachers to try to make sure that students associate positive emotional experiences with learning.

If a student associates negative emotional experiences with school, then this can obviously have bad results, such as creating a school phobia.

For example, if a student is bullied at school they may learn to associate the school with fear. It could also explain why some students show a particular dislike of certain subjects that continue throughout their academic career. This could happen if a student is humiliated or punished in class by a teacher.

Critical Evaluation

Classical conditioning emphasizes the importance of learning from the environment, and supports nurture over nature. However, it is limiting to describe behavior solely in terms of either nature or nurture, and attempts to do this underestimate the complexity of human behavior. It is more likely that behavior is due to an interaction between nature (biology) and nurture (environment).

A strength of classical conditioning theory is that it is scientific. This is because it's based on empirical evidence carried out by controlled experiments. For example, Pavlov (1902) showed how classical conditioning could be used to make a dog salivate to the sound of a bell.

Classical conditioning is also a reductionist explanation of behavior. This is because a complex behavior is broken down into smaller stimulus-response units of behavior.

Supporters of a reductionist approach say that it is scientific. Breaking complicated behaviors down to small parts means that they can be scientifically tested. However, some would argue that the reductionist view lacks validity. Thus, while reductionism is useful, it can lead to incomplete explanations.

A final criticism of classical conditioning theory is that it is deterministic. This means that it does not allow for any degree of free will in the individual. Accordingly, a person has no control over the reactions they have learned from classical conditioning, such as a phobia.

The deterministic approach also has important implications for psychology as a science. Scientists are interested in discovering laws which can then be used to predict events. However, by creating general laws of behavior, deterministic psychology underestimates the uniqueness of human beings and their freedom to choose their own destiny.

References

Pavlov, I. P. (1897/1902). The work of the digestive glands. London: Griffin.

Watson, J. B. (1913). Psychology as the behaviorist views it. Psychological Review, 20, 158-177.

Watson, J. B., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3(1), pp. 1-14.

Watson, J. B. (1924). Behaviorism. New York: People's Institute Publishing Company.

How to reference this article:

McLeod, S. A. (2014). Classical conditioning. Retrieved from www.simplypsychology.org/classical-conditioning.html

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Behaviorism as a movement in psychology appeared in 1913 when John Broadus Watson published the classic article psychology as the behaviorist views it. John Watson proposed that the process of classical conditioning (based on Pavlov's observations) was able to explain all aspects of human psychology.

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Series exploring the development of the science of psychology during the 20th century

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A blog for teachers of AS and A Level Psychology

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Freud audio book

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PSYCHOPATHOLOGY OF EVERYDAY LIFE by Sigmund Freud - complete unabridged audiobook - PSYCHOLOGY

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Psychopathology of Everyday Life by Sigmund Freud (1856-1939), translated by A. A. Brill (1874-1948). Professor Freud developed his system of psychoanalysis while studying the so-called borderline cases of mental diseases, such as hysteria and compulsion neurosis.

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Sound Phobia

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Imagine the sound of someone's nails scratching a blackboard.

Many people can't help but wince at the thought.

Now imagine hearing this sound again, but this time it entirely consumes you - rendering you unable to hear, think or see anything else.

It's distracting, distressing and quickly becomes unbearable. You're spurred into action: stop the sound or escape the noise.

Welcome to the world of misophonia.

Fight or flight response triggered

"Misophonia is a neuro-physiological disorder in which auditory stimuli - and sometimes visual stimuli - sets off a fight-flight reaction, which then has accompanying emotional negativity," Dr Jennifer Brout said.

Dr Brout is a psychologist from North Carolina in the United States, who is investigating misophonia with associate professor Zach Rosenthal from Duke University.

The newly-termed syndrome, which remains largely unstudied and not well understood, sees people set off by particular sounds, which are often bodily-related or repetitive in nature.

People with misophonia can be driven to outbursts of panic, fear, disgust or rage by simply hearing others go about their day - chewing, slurping, sniffling, throat-clearing, humming, tapping and so on.

"Across the board there isn't really one specific sound," Dr Rosenthal said.

"What we see though in our patients is that there seems to be a few themes."

And while not considered a psychiatric disorder, misophonia can have very real psychiatric consequences.

"This is not something where people are simply being dramatic or erratic," Dr Rosenthal said.

"This is actual brain responses in multiple different parts of the brain that are very real and are leading to very difficult downstream effects."

Sufferers not inherently violent, hateful people

According to researchers, misophonia appears to manifest itself both physically and psychologically.

"When you see it in a child, and especially in a toddler who has very little control over their physiologic and affect regulation, you can really see what a raw physiologically and neurologically-based response this is," Dr Brout said.

"It is a response that happens in your brain and body in a millisecond ... of which you have very little cognitive control."

Our brains, Dr Rosenthal explains, are "primed to look for signals" of danger in our environment.

And interactive "defensive motivational systems" within them help us survive, by activating our flight or fight response.

"People with misophonia are having automatic responses to stimuli in their environment," Dr Rosenthal said.

"But in the moment that the stimuli are there, they can't control their instant reaction in their brain.

"It gets called anger, it gets called rage, it gets called irritation or agitation ... but it's more than just simply an anger reaction."

For this reason, Dr Rosenthal says people who experience misophonia should not be characterised as violent, or full of hatred for others.

He says their response is actually not so different from the feeling of discomfort that many of us feel at the thought of nails scratching a blackboard.

"When that happens, you get the chills in your brain ... you have that experience, it doesn't feel good and it passes," he said.

"Of course in misophonia, they don't get the chills response and it's not the same sounds - but it's the same principle.

"It's an instant, immediate, uncontrollable brain-driven response.

"How the person makes sense of that and how others make sense of that becomes critically important in how people cope."

Effective treatments yet to be found

With no evidenced-based treatment for misophonia, Dr Brout says people with the condition must rely on their ability to use coping skills.

"As you grow older, how you're able to cope with it really mediates how your individual response to the stimuli is going to be," she said.

"And also contextual factors - are you with a partner who is accommodating? Do you have a lifestyle in which you can avoid certain stimuli?

"It's very different for each person. And it also varies ... some days are better than others."

Dr Rosenthal says in order to develop a treatment, researchers first need to figure out what the treatment is for.

"What is the 'it' that's been treated? We have to do a better job through research at understanding what that is, in order to develop evidenced-based approaches to treat it," he said.

It's hoped a multi-disciplinary approach to care, potentially including audiology, neurology, psychology, psychiatry, occupational therapy and music therapy, could yield effective treatments.

"There's a lot of ... contemporary cognitive behavioural therapies that have been shown to help people tolerate and accept automatic emotional responses, physiological responses, without having to try to change them, but instead changing the way in which they relate to them," Dr Rosenthal said.

"Those are called acceptance-based approaches. There's also, of course, changed-based approaches, that directly change how we think and how our body feels.

"We think the ideal coping skills approach really attempts to use all of those tools."

A 'spectrum' of misophonia?

Dr Rosenthal says for many people, misophonia is something that is very real and very difficult.

"Yet at the same time is not clearly understood ... so it's difficult to define with great specificity," he said.

As the director of Duke University's Sensory Processing and Emotion Regulation program, Dr Rosenthal says it helps to think about the syndrome on a spectrum.

"For some people, there might be no sounds in the world that lead to any irritation or annoyance," he said.

"For other people, there might be some sounds in some contexts that lead to slight irritation ... all the way across the spectrum to those people who are really suffering at the very tail end of the distribution - the very extreme cases."

Dr Rosenthal says it's "quite surprising" how many people in the general population struggle with having automatic, misphonic-like reactions to certain sounds.

But that doesn't mean all of them have misophonia,

"We don't have a line of demarcation at this point that has been defined," he said.

"What we have is a syndrome that can vary in severity."

The number of studies that have been conducted into the misophonia "could be counted on one hand", so the rate of prevalence and the exact cause of the condition remain unclear.

"What we see is that kids who demonstrate auditory sensory over-responsivity earlier in life ... a generally more over-responsive way of relating to sounds - those kids oftentimes are the ones who as adults we see having what sounds like misophonia," Dr Rosenthal said.

"General anxiety or general sensitivity to cues in the environment that one perceives as dangerous, that could certainly be a risk factor."

Both Dr Rosenthal and Dr Brout agree that a lot more research needs to be done to improve the understanding and treatment of misophonia.

"We simply don't know what we need to know in order to be helping our patients," Dr Rosenthal said.

"We need to look at how systems in the brain are interacting with each other in patients ... we need to be doing epidemiological studies that look at the prevalence and incidence of misophonia.

"We need to look at gender differences, at course, at prognosis, at some of the risk factors for better outcomes or worse outcomes.

"These are real people ... and they need help. There is a lot that needs to be done, and that's an understatement."
To hear more about misophonia, tune in to All In The Mind on RN in the coming weeks. The show airs each Sunday at 5:00pm and is repeated on Tuesday 7:30pm.

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Misophonia: When annoying sounds consume you

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Imagine the sound of someone's nails scratching a blackboard. Many people can't help but wince at the thought. Now imagine hearing this sound again, but this time it entirely consumes you - rendering you unable to hear, think or see anything else. It's distracting, distressing and quickly becomes unbearable.

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All In The Mind Podcast

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Lynne Malcolm: Hi, it's All in the Mind on RN, I'm Lynne Malcolm. Today:

Reading: Did you hear that? Help for children who hear voices.

Lynne Malcolm: Most parents would be familiar with their child talking to imaginary friends or their favourite cuddly toy in play. It's seen as a natural and important part of the development of children's imaginations. But, what happens when a child's world of make-believe seems to become a reality?

Reading: Turning nine years old two days ago was going to change my life. Things are going to be different, including my science grade...well, at least I hope so. I was sitting at my desk at school when my teacher, Mr Jones, handed me my science test sheet. I turned it over and barely finished reading the first question when that thing happened again. I couldn't believe it, that dreadful thing happened again! I thought to myself, I'm so weird. I was so scared to tell my counsellor that I heard a voice. It was so hard to talk about. The voice I heard belonged to a man, a one-legged pirate actually. He harassed me and I wanted him to stop. A lot of the time I felt like I was going to lose my mind.

Reading: Meet Carlos. For quite some time Carlos heard and saw two voices. One was a fire-blowing dragon that made hissing noises, and the other was a terrible which who had a menacing laugh.

Reading: Lala heard a voice too. Soon after her mother's passing, Lala started seeing her mum's figure and hearing her voice, especially at bedtime. From time to time Lala even talked back to the voice.

Reading: Chang heard a voice too, Mr Charley Charles. Mr Charley showed up whenever, wherever and however he wanted. Chang felt scared each time the noises and voice showed up. He felt like he was being harassed and bullied by Mr Charley.

Lynne Malcolm: Excerpts from the children's book Did You Hear That? by child psychologist from Singapore, Dr Seetha Subbiah.

Seetha Subbiah: The book is actually a very child friendly book, it's got lots and lots of illustrations. Although it covers a very heavy topic, it's simplified and it reads like a storybook. It's an interactive, dynamic book, where the main character is Susie, and she shares with her readers her experience and her frustrating experience with voices and how her parents and teacher helped her to realise that it's not bad, it's not wrong, it's not weird, it's not odd if you are hearing voices.

And they don't realise that she is hearing voices at first, but they do realise that she is struggling with something, and because they couldn't figure out what it was they encouraged her to see a counsellor and that there's no taboo to it and it's okay to go see one. And they finally take her there, and after some time the therapist is able to help her verbalise what's going on and normalise the fact that she may be hearing voices and helps her understand why the voices came about, when they came about and what was sustaining it, and helped her decide what she wanted to do with the voices and to set goals and help her achieve her own goals.

And then Susie goes on to introduce four other kids from different cultures and different countries, different backgrounds, but they all share something in common and it's the voices.

Lynne Malcolm: Dr Seetha Subbiah has 22 years of international experience in clinical psychology, treating children who've had trauma in their lives. In the course of her work she has found that some children hear voices that aren't there as a type of coping mechanism. One particular little girl inspired Seetha Subbiah to write a book for children who hear voices.

Seetha Subbiah: Having worked with kids that heard voices, I couldn't find anything in the market to use to help these kids normalise the experience, there were no clinical tools out there. But in 2003 I came across one child, the first child for whom I had to fight very hard to help her in the way that I thought she could be helped and needed to be helped, only because she had already been in treatment for six years and she had been passed on from one therapist to the next and one psychiatrist to the next. And by the time that I met her I was told that she is a lifer on medication because she was taking a concoction of medications. And they said it won't take too much of your time, just spend 10 minutes and just make sure she is taking her medication once a month and just send her out, there is nothing that can be done.

So I took on the case, and after I met her for the first time I said, no, there's something really going on with this child, I can't possibly just spent 10 minutes and shoo her out of my office, because right from the waiting area she wouldn't acknowledge me. She was there with her foster mother, there was no emotional reaction, no physical reaction, she just stared straight at the wall and sat military style with her arms right angled to her body and was very stiff. But she walked into the treatment room with me and she just had a very glazed look. No response for the whole hour, nothing, not a twitch of the eyebrow, I didn't even see her blink. She must have blinked but I didn't see her blink. And I said, no, something is not right, I've got to try and figure out...yes, I have a thick file with all sorts of notes in there and no one really knows what's going on with her, so they've tried different kinds of medication, but I'm going to pretend like there's nothing there and I'm going to start from scratch. So I worked with her for 2 ½ months before I got a reaction, and it was just a split second look, glance at me, and that was it.

Lynne Malcolm: When you say you worked with her, what did you do?

Seetha Subbiah: For the first 2 ½ months?

Lynne Malcolm: Yes.

Seetha Subbiah: I tried to rule out everything. Could she see? Vision? I walk right in front of her, she would not even track me with her eyes. Could she hear me? Can she understand my language? Can she understand my accent? Then I gave her options to leave the room if she didn't want to be there. But she didn't leave, she just sat there, and I said, okay, maybe she doesn't want to walk out right in front of me, so I'll go out for 10 minutes, I'll come back in 10 minutes and you can leave during that time. If not, when I come back then I'll just gather that you want to be here because I'm setting aside this whole hour, it's your hour, you get to choose and decide what you want to do and I will be here, and any time you're ready you just let me know.

So initially I would just sit there and try and engage her and I would just look at her, and I figured maybe that was just too overwhelming. So I said, well, I'm not going to be looking straight at you because that may be making you uncomfortable. What I'm going to do is I'm going to bring my work in, I'll bring my work in and I'll just sit here, I'll be looking at my books, and whenever you're ready you just give me a sign, show me a hand signal. I tried all of it, your eyes, blinking your eyes twice means this and once means this, hand signal, move something on the desk. And it took me 2 ½ months, and the first thing she did was give me a glance.

So then after that I said, okay, maybe it's because she is on so many different medications she is just very sedated and had a very blunted affect. So I tried to convince the psychiatrist that she was working with to see if she could titrate the medications, so lower the medication, because I needed something to work with, I needed some emotion, I needed anger, sadness, happiness, something to work with. There was just nothing, blank.

So I managed to convince them and they said, well, go knock yourself out, nothing is going to happen, I give you two weeks, I'll titrate it down just a little bit. If you don't see anything, then that's it, we will go back on. But thankfully she gave me some reactions within two weeks and she started engaging, not verbally but nonverbally, through drawing exercises, just showing that she wanted to connect. I would make a mark on the paper and she will make another mark on the paper. And so we went back and forth like this, and then she started manipulating toys in the room.

And so as treatment went on, it took about two years to complete treatment, and during that time we slowly titrated the medication back all the point where it was just almost nothing there. And I started to realise that she was hearing voices, had been hearing voices, and the reason why she was sitting military style right from the start was that she was trying with all her might, every single hair on her body, to try and control the voices so that she could engage with me and engage with school, engage with home, engage with other kids. She was like a zombie going to school, and everyone just accepted that that how she was and was going to be. She was failing her subjects, she didn't have any friends at school, didn't communicate with her foster family or her siblings. She was basically like a walking vegetable for those number of years.

And by the time she was done with treatment, teachers were saying that they didn't recognise this child, this is some other child, because she was getting As and Bs in school and she was laughing, playing, had friends and had sleepovers with friends, and friends would stay over the whole night, they didn't find her boring. And she was engaging with her foster family, and she seemed like a regular kid.

Lynne Malcolm: So what do you think had happened to the voices that made her non-communicative to start with? What happened in the process of the treatment with you?

Seetha Subbiah: It took quite a bit of work for her to figure out when the voices started. And before she entered the foster system in the US she had been subjected to quite a bit of abuse in her biological family, and that's why she was taken away from the family and placed in a foster family. So it was as a result of that abuse and the reaction to that abuse that she started hearing the voices. At first it was entertaining and enjoyable, they kept her company, she missed her family. And then it started becoming very intrusive and problematic and frustrating and overwhelming because she no longer had control over the voices. They decided when they showed up, how they showed up, why and how long they stuck around before they left.

Lynne Malcolm: And so how did you will help her manage those intrusive voices?

Seetha Subbiah: So she had to decide what she wanted to do with the voices, what role she wanted the voices to have in her life. And based on that we went forward. She wanted to get rid of them completely, so we proceeded along those lines and tried to figure out a whole bunch of different things that she could try to see what worked for her and what didn't. So she called them a bag of tricks and experimented with various things, like writing down what the various voices said and tore them up and threw them out, got babysitters in to keep an eye on the voices while she needed to do things. And talking to the voices and explaining to them that she will attend to them at a later time when she was available, et cetera.

Lynne Malcolm: So she took control of the voices, in a way.

Seetha Subbiah: Yes, she did.

Reading: After several weeks of talking to a counsellor, I realised that the voice I heard had something to do with a really bad experience I had when I was younger. I told my counsellor I still wanted the one-legged pirate to disappear completely. We brainstormed to see how I could deal with him. Some ideas we came up with didn't work and others did. I like to call the things that worked for me my tricks. Can you believe it? After four weeks I didn't feel so afraid and terrified. He finally stopped pestering me, I no longer felt so angry. I felt like I was in charge.

Reading: Carlos knew he was not crazy. He understood that his voices were trying to protect him from feeling uncomfortable and sometimes scary emotions like anger, sadness and fear. When Carlos felt that the dragon and the witch were too much to handle, he used several tricks. After some time, the witch and the dragon didn't bother him so much.

Reading: Lala is four years old. Six months ago her mother died quite suddenly. Soon after her mother's passing, Lala started hearing her voice, especially at bedtime. Her father became really worried after the third time he heard Lala talking to no one. Finally he took Lala to see a counsellor for help. After some time, Lala started explaining to her counsellor that mummy had to go because she was sick and the doctors could not do anything more to help her. Now I get to spend more time with my daddy. Just like my mummy, daddy loves me a lot.

Lynne Malcolm: You're with All in the Mind on RN. I'm Lynne Malcolm, and you've been hearing excerpts from the children's book Did You Hear That? Help for Children Who Hear Voices, by child psychologist, Seetha Subbiah.

She explains what's known about why children begin to hear voices.

Seetha Subbiah: There are lots of different reasons. Although hearing voices and seeing things that are not there, which are auditory and visual hallucinations, which are hallmark features of schizophrenia...schizophrenia is something that cannot be diagnosed until an older age...there are many other reasons why children may be hearing voices and seeing things that are not there. Trauma is usually a very large group of people. So trauma can come in the form of sexual abuse, physical abuse, emotional, psychological abuse, or it can just be a very jarring experience, not necessarily a tsunami or a reaction to an earthquake, but it can be just standing at the street corner and you see a car accident that was very alarming to a child. So that's one large group. Then another group of would be grieving children. Then sometimes as a result of depression or bipolar disorder you might hear voices. Substance abuse is another one, as a result of illicit drugs or sometimes even drugs that are given, like morphine in the hospital, you might end up seeing things are hearing things that are not there.

Lynne Malcolm: So your particular area of expertise is helping children who have been impacted by child abuse. What role does voice hearing play in that trauma?

Seetha Subbiah: There are no two children that I have seen that have presented the voice hearing exactly the same way or as a result of their early experiences will experience voices in the same way.

For some kids, the voice may take on the persona of the abuser. Sometimes it can be of the victim, so themselves. Sometimes it may have nothing to do with any character they might have come into contact with. And sometimes it is just a feeling that is so overwhelming and challenging for them to hold themselves and take responsibility for that, that is kind of packaged and parcelled out and projected out. And either immediately or at some point in the future it takes on a persona, it takes on a voice, a character. And for some kids it could be one voice or one noise, and for some others it may be three or four, and others it can be 10, 50 or 60. So when I say noises, it could be static noises, it could be phone ringing noises, it could be someone just calling out your name.

And it's so far off that only people who have experienced trauma will know what it feels like. All of us have that experience. Sometimes you think the phone rang and it didn't, or someone called you from the other office, you will go over and no one called for you. So like everything else, like depression, sadness et cetera, there is a continuum. And for voice hearing also there is a continuum. So many of us have had that kind of experience once in a while, or at least minimum once in a lifetime, but if you multiply that by 100 or 200 then you can kind of imagine what people who hear voices on a regular basis feel. So not only that they hear voices, but they are intrusive and challenging, overwhelming voices.

Lynne Malcolm: So what's your impression of how many children do experience voice hearing?

Seetha Subbiah: That's a great question. I don't know the exact numbers, and that's because this area has been a very neglected area for a long time, so there hasn't been much research done in the area. One of the numbers that I've come across is the Hearing Voices Network which is a large international organisation now, estimates that there are 280 million voice hearers throughout the world, and that includes adults as well.

My first version of the book was completed in 2006 and at that time my peers in the US asked to use this book, and it is Microsoft Word format with no pictures in them. And so first they started using it in a very targeted manner, introducing the book to only kids who heard voices. Then they decided to just leave this book lying around in the treatment room. And when that happens they noticed lots more kids who were gravitating toward the book, despite the fact it had no illustrations, and they started drawing pictures in there and started talking about voices that they had been hearing. Although the presenting symptoms, so the reasons why they came to the clinic in the first place had nothing to do with voices, there were other reasons, and they had been working with these kids for a year and never knew about the voices until they came across this book.

So then they started giving me feedback, that there are far more kids that hear voices than we ever thought. And we need to reach out to more of these kids because for some reason they think it's either not relevant or it's not appropriate to talk about the voices, and maybe culture has something to do with it, maybe what they are introduced to when they are really young, for example Mickey Mouse, Donald Duck, they will talk about someone being coocoo if they are hearing voices or talking to themselves, and so very early on they think it's something that is not socially acceptable and it's weird if you are hearing voices, and they hold back that information. And if that's what is going on then we really need to reach out to the kids and help normalise it. And so then after that is when I started getting more pressure to formalise the book and actually publish it.

So to answer your short question, I don't know exactly how many kids there are, and also culture plays a part in it and whether the community and society within which a child hears voices either celebrates the voice hearing or thinks it's problematic, and to what extent it's problematic.

Lynne Malcolm: So tell me a little bit more about the range of cultural responses to voices. I know your background, you're from Singapore. How, for example, is voice hearing seen and responded to in your background?

Seetha Subbiah: We are a multiracial and multireligious, multicultural community, so there are lots of perspectives and there are lots of subcultures within our communities. And so it depends on which community the child may come from. For example, Taoism which originated in China, there are Taoism mediums, they call them mediums. So a god or a goddess will come through that person and communicate to the people through that medium. And that is considered acceptable, and people actually will celebrate it and go and visit people who are mediums.

Then there are various religions, like Hinduism, that it's common for people to go into religious trances. It may be momentary but they are trances, and no one thinks anything of it. And if it's a Catholic family and if a child is hearing voices, then they get very concerned and they will consult with the priest, and typically an exorcism is what would be in order. So depending on which culture the child is from and how the family reacts to it, we may see them in the clinic or we may not see them in the clinic. And it's not actually the voice hearing that is the problem per se, it is the reaction to the voice and how one responds to the voice that becomes a problem.

What we've discovered is that there are lots more people out there who hear voices than actually we see in the clinic. So how do these people who hear voices and don't show up in the clinic survive and manage to go through their life, and then others find it challenging to get through daily life and doing what they need to be doing every day.

Lynne Malcolm: How would you like this book to impact the way people approach children who may be disturbed in some way, and perhaps the way they are treated?

Seetha Subbiah: I think the most important thing is to help find out why a child is hearing voices, and what may have been at the genesis of it, because that will help you understand as a clinician what the approach should be and the direction. And for families and just society in general to not mock the experience, not to label them very quickly as childhood schizophrenics, because thus far the first line of treatment for schizophrenia has been medication, and medication has side-effects. So I believe that we should try everything else first before we go to that. And by giving medication, not only could they suffer the effects of the medication, side-effects, but they may never end up getting the real treatment that they need, which is to try and understand where this came from. Because usually they are not born with it most of the time, so it shows up at some point. Why did it show up, when did it show up. And allow the child to gain control of it and decide what they want to do with it, as opposed to us deciding.

Lynne Malcolm: And one of the other things that you've included in the book are...you call it interactive because you've included little questions to the reader at the bottom of the page saying have you ever experienced this, do you think this is weird, questions like that to try and engage the child reader in thinking about it. Is that a particular strategy that you decided was going to be helpful?

Seetha Subbiah: Yes. Because there were no tools like this out there, I wanted to make sure that I made it really simple and engaging, that even a clinician who hasn't had training in knowing how to treat this sort of condition, the book will kind of guide you through it. And having worked with children in treatment, they can be very, very persistent. They so desperately want to be understood by adults that they will keep repeating and repeating and repeating until you get it. So even if the clinician were to miss it and not know which direction to go in, if it's right in front of the child, these questions are being asked, it's my belief that they will keep repeating it until the clinician will get it.

So I wanted the book to be as far reaching as possible, so hopefully any child that picks it up will find someone or something in there that they could relate to. The questions is one of them. Others may respond to the illustrations. So each child is completely different. Each family background that the child is from is completely different. There are kids with disability, there are kids who are chubby, there are kids who are skinny, there are kids who look like Barbie dolls. The stereotype is that if you look a certain way then you are protected from everything, but that is not necessarily true. So this is one of those things that I think will be good for kids to understand and accept that people are different and that we shouldn't marginalise them and we should normalise and accept them.

Lynne Malcolm: So what response have you had to the book so far?

Seetha Subbiah: Completely surprising. I had intended it as a clinical treatment tool, but I recognise and realise that kids who don't hear voices are finding it very interesting and they find that they can relate to it as well because there are so many emotions that are being talked about and challenging experiences, and every child has a challenging experience, not necessarily voice hearing, but they may feel marginalised or not accepted for something else, whether they are short or tall or curly hair or straight hair et cetera. And so lots more people are talking about it. An interesting request was for movie rights, which I had never thought this book would lend itself to, but there it is.

My hope and wish is that this book will reach every child that may be suffering in silence or alone somewhere in the corner and help them and help their families, and especially kids who are not able to verbalise what may be going on with them and they are struggling with it, that they can come out and get help for it, and it's not a bad thing, it's not a weird thing, it just is, and it's trying to tell you something. The voices are trying to tell you something. So don't ignore them, and just attend to them, and life can be good and happy with voices.

Reading: You know what? I'm not the only one. There are many other kids who hear voices. Would you like to understand and manage your voices like Carlos, Chang, Lala and me? If talking to someone and using tricks don't help with managing the voices immediately, don't give up, there are other things that can help you. Don't forget, it takes a lot of courage to talk about voices. It took each of us some time to learn about the role voices played in our lives and then how to cope with them. It was hard for all of us. You're not alone, just keep at it. We did it and so can you. Wishing you all the best in your journey.

Lynne Malcolm: Thanks to Mika Nielsen, Ada Saydam and Aparna Hari for the readings from the book Did You Hear That? Help for Children Who Hear Voices, by Dr Seetha Subbiah.

You'll find further details on the All in the Mind website.

Production today by Diane Dean and sound engineer Simon Branthwaite. I'm Lynne Malcolm. Thanks for your company, until next time, bye for now.

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Lynne Malcolm: Hi, it's All in the Mind on RN, I'm Lynne Malcolm. Today: Reading: Did you hear that? Help for children who hear voices. Lynne Malcolm: Most parents would be familiar with their child talking to imaginary friends or their favourite cuddly toy in play.

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All In The Mind Podcast

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Lynne Malcolm: Hi, it's All in the Mind on RN, I'm Lynne Malcolm. Today, the psychology of hoarding.

Journalist: Well, it's Sydney's most notorious house of hoarders, and it's on the market. The Bondi home of Mary Bobolas is being sold, even though it's full of rubbish and her family is refusing to leave.

Journalist: One of Sydney's longest running property disputes will continue, at least until today, after a family of notorious hoarders were granted a last minute stay against the forcible sale of their property. The sheriff's office is currently trying to sell the Bobolas family's Bondi home to recover about $160,000 in outstanding clean-up costs and legal fees.

Lynne Malcolm: News reports from a recent high profile case of hoarding in Sydney.

Catherine: It's not a happy thing, being a hoarder, because you can't share it with anybody. It's very sad. And sort of unnecessary. Why have I wasted my life? I could have been in relationships, I could have done things instead of this hoarding

Mercy Splitt: The act itself around hoarding is extremely secretive, unlike a lot of other things where we can actually see it, we can see people going for a drink at the clubs or gambling or whichever like that, but it's not uncommon for somebody to have two lives. You've got your 9-to-5, going to work, coming home, and then you've got that home life, that behind closed doors that no one sees.

Lynne Malcolm: Mercy Splitt, hoarding and squalor resource manager with Catholic Community Services in Sydney.

Some studies suggest that hoarding disorder affects somewhere between 2% and 5% of the population, which is double or triple the frequency of obsessive compulsive disorder for example.

Professor Randy Frost is a psychologist, at Smith College Massachusetts. He's researched and written about hoarding for over two decades.

Randy Frost: Well, hoarding is the acquisition of and failure to let go of a large number of possessions, even though those possessions may not have a great deal of instrumental value for the person. What makes hoarding a disorder is when those possessions begin to clutter the living areas of the home and prevent us from using them in the way in which they were designed, and when they create distress and impairment in the ability to function.

Of course the most extreme is the unfortunate case when people end up dying in a hoarded house because of a house fire, and this is unfortunately one of the real dangers of this problem. A study done in Australia, the Melbourne Fire Brigade covered a 10-year period of time and what they found was that hoarding occurred in less than one-quarter of 1% of all residential house fires. But those fires where hoarding was involved, they counted for nearly one-quarter of all the fire related deaths in residential house fires. So those are certainly the most extreme cases. In terms of clutter we've seen cases where rooms are so cluttered that they can't be entered, so the door is completely covered so that there's only a few inches between the top of the stuff and the ceiling. So these cases can be pretty severe.

Catherine: Hello?

Lynne Malcolm: Oh hello, it's Lynne Malcolm here from the ABC.

Catherine: Is the gate open?

Lynne Malcolm: I'll just try, hold on...

I'm visiting Catherine whose hoarding problem has developed over years, though recently she feels she's improved after getting help from a treatment program at Lifeline.

Good to meet you.

Catherine: Thank you.

Lynne Malcolm: Okay, so this is your home.

Catherine: Yes, this is me. Did you want to have a look through quickly?

Lynne Malcolm: Yes, so if we just walk through, this is the balcony...

Catherine: Yes, it had a lot of storage under it for a long time.

Lynne Malcolm: So we are surrounded by lots and lots of plants, and I can see plastic containers and bins and a fire brazier, and I can see a number of different plastic watering cans and pots. Do you often sit out here?

Catherine: Not a lot, no. I used to, but the clutter is a bit of a problem. In fact all these frames were under furniture on the balcony.

Lynne Malcolm: Okay, we are going into your bedroom now? So there's not a lot of room, is there, around your bed.

Catherine: No, there's not, but it was better than when there was a double bed and a tiny little track around, so it does look cluttered to you, but to me it's quite an improvement.

Lynne Malcolm: There are bookshelves up to the ceiling with all sorts of things stacked on them, there are lots and lots of books and drawers, and there's a couple of irons and some scarves...and what else can I see?

Catherine: More books around here.

Lynne Malcolm: More books behind me. And there's a clothing rack here. So do you use all these things?

Catherine: Well, that's the thing about hoarding, you don't get to use a lot of the items you think you need, you think will satisfy you. I've got scarves that I've never worn. I buy them at op shops though. You think you're getting a bargain, but no, I don't wear a lot of the things.

Lynne Malcolm: And what about the books? How many of the books will you have read?

Catherine: Well, very similar, I buy them because...particularly self-help books have been a really big feature of my acquisition, and I don't complete them.

Lynne Malcolm: And I can see here you've got some cassettes which are a thing of the past now, lots of cassettes.

Catherine: Yes, they are thing of the past, yes. It's the same with CDs, I don't tend to listen to them all that often, but I have quite a few, in case.

Lynne Malcolm: So we are going through the bathroom here, also again the walls are lined with cassettes and drawers and books and boxes of paper, lots of clothes hanging up on coat hangers on the door.

Catherine: Yes, summer clothing that should go downstairs to a storage cage but I haven't quite got there yet.

Lynne Malcolm: And what room would you call this?

Catherine: This would be the second bedroom.

Lynne Malcolm: There's no bed in it because there's not enough room for a bed.

Catherine: Well, it's only up against the wall.

Lynne Malcolm: Oh, it's standing up against the wall, with pillows stacked on top, and there's a clothing rack here with every manner of coat hanger you can imagine. You do have a little desk here with a computer, but it's pretty hard to get in to the desk.

Catherine: It is a little bit, and it's all about moving things, which is a pain in the neck.

Lynne Malcolm: This is another little toilet and laundry, and there is really no room here at all for anything, you could hardly get in here. In fact how do you get to the washing machine?

Catherine: Well, this is it, I have to move numerous items to get to the actual washing machine and then put them back.

Lynne Malcolm: And then you put them back?

Catherine: Yes.

Lynne Malcolm: Catherine.

Joanna also has a long-term hoarding problem. She lives in a three-bedroom house, with a large lounge room, two verandas and a car port. She says she can't use most of that space because of the extreme clutter.

So there is no space for you to move around? Where do you mainly spend your time?

Joanna: Well, I'm sitting in a corner opposite the TV, which takes up most of my day, and it's a bit dark and it's cold now. I wouldn't dare put a fire on. And if I do anything at all, it has to be outside.

Lynne Malcolm: And what sort of stuff do you accumulate?

Joanna: Well, there was a time when anything I'd use, a bottle top or a nail or little things that I saw. But basically it's down to a lot of clothes that I'll never wear, paper of every kind, and the newspaper collection and magazines, they are 35 years' worth. While it was liveable before for two people, I seem to have changed in some way and created a real untidy place, but I'm not a squalor person.

Lynne Malcolm: How do you feel about living in that space?

Joanna: Well, it's a bit scary. The Fire Brigade said if there was a fire I would never get out because of all the paper and plastic boxes, and I couldn't reach a window, so that's a bit scary. And I don't want to fall and have trouble with the ambulance not being able to get in, which was the case with my husband with the stretcher, but he didn't die until much later, from a cardiac arrest in the hospital.

Lynne Malcolm: Have you always lived like this?

Joanna: No. I lived in a room when I came here at 21, because I am a perfectionist, like most hoarders, and then I moved into a two-bedroom place in Bondi and never used the second room. But then due to the stress at work and various losses in my life or problems like cancer, miscarriages and so forth, which didn't worry me, but in my subconscious obviously something went wrong and I started to pick up newspapers. And things got out of hand, and I didn't realise I had all this stuff until my husband died and there it was staring me in the face.

Lynne Malcolm: So you talk about your husband, he died several years ago, I think you were overseas, for a period of time.

Joanna: Yes, I don't know what happened. He lay on the floor for a week I estimated, and three rooms were blocked by fallen stuff. However, nothing appeared to have struck him and I'll never know if he was startled or if somebody was in the house and sent things flying, because he couldn't talk and tell me, so I have to live with that mystery.

Lynne Malcolm: Do you feel that it's some way related to the state of the house?

Joanna: Well, I see that there was an avalanche, it must have had something to do with it, but I'm not sure what.

Lynne Malcolm: Psychologist Randy Frost has researched hoarding for many years and is the author of two books on the subject.

Randy Frost: People with hoarding problems, interestingly enough, tend to be more perfectionistic than other people. They are very concerned about making mistakes, and often that fear of making mistakes leads them to avoid things like discarding or passing up a possible purchase that they perhaps don't need.

Another feature that is characteristic of many people with hoarding problems is depression. I lot of comorbidity with depression, some comorbidity with other anxiety disorders like social phobia or generalised anxiety disorder.

A couple of other features that are common is an inability to make decisions easily, and here we get into some issues related to information processing and the way it's different. There's a great deal more complex thinking on the part of people with hoarding problems. These information processing deficits that we see in hoarding appear to be related to the amount of information that is being processed.

Let me give you an example. One of the cases in our book Stuff is a woman we called Irene, and Irene, when I got to her house one day her eyes lit up and she said, 'I've got to show you something,' and she went into the next room and she came back with a large clear plastic bag filled with bottle caps, and she said, 'Look at these bottle caps, aren't they beautiful, look at the shape and the colour and the texture.' When I see a bottle cap without a bottle, the information that goes through my head is very simple, it's that it is trash and how do I get rid of it. But for Irene the information flowing through her head was all about these unique details, these special features of the bottle cap and their meaning and what she could do to take advantage of those features.

So one of the things we think is going on is that information is being processed in a very different way in the brain, and that way makes it much more complex for people with hoarding problems to try to make a decision. There are some scanning studies that suggest a particular circuit is involved here, and the circuit is not unlike that circuit we find in obsessive compulsive disorder, and it's the anterior cingulate that's involved in this process.

Lynne Malcolm: Professor Randy Frost.

Joanna reflects on whether her hoarding has an emotional basis.

Joanna: Well, it's hard to say because I'm an only child, I never mix with people, I used to collect little things, and certainly since my husband died I would say so because, as I mentioned, things that were tidy but too much are now all over the place and I just don't care anymore. But now I can't use my kitchen. It was never like that before.

Lynne Malcolm: You've said that you remembered sometimes if you'd throw something out, you know, you wanted to throw out a bottle or something, and your mother would say, 'That bottle will cry if you throw it out.'

Joanna: I did break that habit because if I saw something on the ground, like something that had been dropped in a park, and then I saw another, if I left two of them on the ground, they'd have each other. Now, that sounds crazy but that's how I broke that addiction to the ground. If it was one thing I felt sorry for it, but if there were two I would turn my head and walk away and know that they had each other. It sounds crazy and I'm not crazy, but that's what happened with those sort of things.

Lynne Malcolm: How do you feel when you have to part with things?

Joanna: Well, I'd probably fight you if you tried to take one of my papers out of the house. I would never part with anything good. But I did put something in my mother's coffin. She died last year, 101, and I bitterly regretted it afterwards. I stopped eating, and it's taken a long time, and it wasn't even something that I cared about. And so I think if people made me take a lot of reasonable stuff away it would be terrible. I don't mind charity shops, I just don't know which ones to choose, I can't make decisions.

Lynne Malcolm: You're with All in the Mind on RN, I'm Lynne Malcolm, today with an insight into hoarding disorder.

Psychologist Randy Frost is a respected specialist in hoarding research.

Randy Frost: The attachments that form to possessions seemed to fall into two different categories. The first category is an emotional sort of attachment, where the object is sometimes given humanlike qualities, so there's a lot of anthropomorphism in hoarding. Also it's as though these possessions somehow come to be felt as a part of the person. By that I mean almost a part of their physical being. So people with hoarding problems, when other people have thrown away their things, it feels to them like they've been physically violated, it is like the feeling like someone cut off my arm somehow, the attachment is that strong.

A second way in which this attachment forms has to do with the beliefs about responsibility. That is, responsibility for making sure that possessions don't get wasted. So that's why we find lots of people with hoarding problems who fill their house with stuff that looks like trash to other people. But if you think about each individual item, each of those items might still have some utility for someone somewhere in the world. And it's almost as though ownership carries with it the responsibility for making sure that object doesn't get wasted. This is such a prominent feature, we've started calling it material scrupulosity because it looks something like scrupulosity concerns that we see in obsessive compulsive disorder.

Lynne Malcolm: So I wonder if you could further explain what the psychological mechanism that operates in hoarding between emotions and perhaps past trauma and the things that people collect.

Randy Frost: Well, we see trauma in about half of the hoarding cases, that is some kind of past trauma. The extent to which that trauma is associated with the development of hoarding is not so clear. And for many of the objects that people who have faced trauma save, these objects seem to give them a sense of comfort and safety. And it's almost as though the collecting of all these things and the gathering and the clutter that surrounds them seems to form some kind of buffer for them where they feel somehow protected and where there is at least some suggestion...we don't have data on this yet, but one of our hypotheses is that this collection of things that people surround themselves with buffer them against the development of post-traumatic stress disorder symptoms, especially for people who have had some kind of trauma.

Lynne Malcolm: One of the things that's very common for people to collect is newspapers, piles and piles of newspapers. Why is that?

Randy Frost: Well, information is one of the major things we see as valued in people with hoarding disorder, so newspapers, books, magazines. Even people who don't have hoarding problems often will collect and save lots of newspapers. Part of it is tied to this notion of perfectionism and needing to do things perfectly, because many people with hoarding problems will say that before they can get rid of a newspaper they need to read everything in a newspaper and remember it all. And that's a task that most of us don't even attempt. In part it's related to a phenomena that is kind of funny in hoarding and that is a special view of opportunities, that all information provides us with an opportunity for something. And it's almost as though people with hoarding problems can't let go of opportunities. All of us as we grow and mature learn that if we take advantage of one opportunity, we are letting go of other opportunities and we learn to tolerate that, but what if you couldn't let go of any opportunity? What if you wanted to experience everything in life and not let anything go? That is kind of what it's like for some people with hoarding problems, and especially with respect to information.

Lynne Malcolm: Randy Frost.

Catherine also has trouble dealing with paper.

And then we are going down a very cluttered corridor. This is the living area. And there's a desk over there that's got a whole lot of stuff on it that's covered up. Oh, that's the paperwork.

Catherine: That's the paperwork. I have trouble discarding paperwork at this point, but I'm working on it, I am working on it.

Lynne Malcolm: But you wouldn't be able to find anything that you wanted there, would you?

Catherine: Well, it can be difficult, it can be very time consuming.

Lynne Malcolm: So why do you think you've accumulated so much paperwork, for example?

Catherine: When I started nesting, so to speak, settled, I just accumulated a lot of paperwork. And because I didn't have a tin opener I got a lot of items from garage sales, but I went overboard, sort of making up for not being able to do it in earlier years...possibly, I'm not sure.

Lynne Malcolm: Tell me a little bit more about what you think has led to your hoarding?

Catherine: Well, I think a sense of deprivation as a young person. I grew up in a family of 11 children, one older sibling, and I left school very early, I didn't finish primary school, and I looked after my youngest siblings and did a lot of menial work, but I think that early deprivation of not having a lot of things, it comes back later. When you can, you go overboard with it. It's almost insatiable, you need more and more. But I feel very fortunate that I found the Lifeline hoarding course, that has really saved my life.

Lynne Malcolm: The Lifeline course Catherine is doing is based on Randy Frost's self-help program called Buried in Treasures.

Catherine: And in the course they have encouraged us to tolerate the distress that you can experience parting with things. It feels like you are powerless over it, like you have no self-control, and it's very depressing, and it's very hard to be positive and energetic when you are depressed. That's why the course has been so helpful. They walk you through a lot of these things, particularly those questions of do you need this, will this enhance my life, what is it about it that is so essential that I have it, how would you feel if you didn't have it. And the exercises they set to discard things are very, very challenging, and each week you are invited to take along something that you can discard.

I had great success. Then I got into this real flatness and they said that's fine, that's where you are meant to be. So the expectation that you will change overnight in my experience is really unrealistic. This wonderful psychologist came to my place and she said, well, 'You've got a lot of bowls.' Well, if she had seen the bowls before I had discarded...and she said, 'You've got 23 cane baskets.' Well yes, I have I suppose, but you see, I just put them there and they stay there and it becomes part of your life, and I don't need them, I don't use them.

Lynne Malcolm: And so how would that feel if I said, 'Look, I'm just taking away those baskets now, you don't need them,' how would that feel?

Catherine: Well, at this point if I could keep a few it would be tolerable, so that's a very gradual thing. And you start with the easiest things. I had 15 suitcases and I was able to put nine on the street. A lot of them came from the street, but now I've got six. So the progress can seem slow, but in fact to me it has given me this confidence that I can do this. And also what I particularly appreciate is the after-care under the auspices of Lifeline, we meet once a month with other people who've done the course. And we discard something there. And it's quite structured. So to me it's great progress, it's given me confidence and a level of self-control, despite all the cane baskets.

Lynne Malcolm: Catherine.

Randy Frost explains that his Buried in Treasures treatment program has been quite effective for many, and it includes a self-help book for hoarders.

Randy Frost: The research on the Buried in Treasures workshops looks pretty good, it produces change in behaviour, it produces a decrease in these hoarding behaviours and these excessive attachments to objects. It becomes pretty close to what we can achieve in therapy. One of the things we do in Buried in Treasures is try to get the person to start evaluating the true value these possessions hold in their lives. So each of the possessions that people have tell a story. And when people tell that story it's easier for them to let go, to think more flexibly about these objects. One of the things we know about hoarding is often times when the object is acquired and comes into the home, there is no processing of that possession and its importance, it just exists in the home and the person never really interacts with it until we start doing the exercises in Buried in Treasures and they get to look at and talk about that object and really experience what it's like for them and how important that object is for them once they consider, well, what would life be like without this object.

Lynne Malcolm: Mercy Splitt manages hoarding support programs with Catholic Community Services. This involves visiting people in their homes, and, as you can imagine, negotiations can be quite delicate.

Mercy Splitt: It is talking through the process with the person. So it's really important that all of the decisions are made by that person. So we can provide the supports and we can provide the tools, but at the end of the day if a person decides to hold onto something, they've got to make that decision to let it go, otherwise what happens is that we then replace these items with other things because they haven't dealt with the actual letting go of that item. So we look at why did you hold on to this piece of paper and what attachment did you have to it, what were the reasons, are you planning on using this piece of paper down the track? For what? When something is too difficult we tend to put it aside and focus on something else. So bringing it back on track, what are you going to do with it?

Lynne Malcolm: And how often are you successful with that, to actually bring somebody around? That's a very irrational expectation, isn't it, and it's not always a rational behaviour.

Mercy Splitt: It is, it's a slow process, it takes a lot of patience. You know, I've been in situations where I've sat there for two hours and we have managed to remove, say, three pieces of paper, as directed by the person, but they are three pieces of paper that don't come back and they don't get replaced because it was part of that letting go and saying goodbye to those pieces of paper. What it is as well is you are teaching a new practice and you are teaching a new behaviour. So over time it becomes a regular activity to look at something and go, okay, why am I holding onto this, what am I actually going to do with it?

Lynne Malcolm: Mercy Splitt.

Joanna has sought help for her hoarding problem a number of times. She now knows a lot about the disorder and she shares her knowledge with others, but she still struggles with it herself.

Joanna: If I could put everything in warehouse and sort it and then clean the house, everything perfect, and that would be the only way I can do it, because we want perfection and if we can't have it we have chaos. There is nowhere to sort things, it's dark, I can't open the curtains, so what do I do. It's frustrating, but I don't want to die and people come and throw good stuff away. There are things hidden somewhere that could be jewellery, or there could be valuables, I don't even know what I've got.

Lynne Malcolm: Do you ever have people over?

Joanna: One person came in, our best friend, he thought it was funny, made a video, which always causes a laugh. But when I saw that video again, I wish it could be that tidy. The other day I invited him through the house and he was speechless, he never said a word because of course it is way worse than when he made the video. So I know a lot about it but I'm not applying it to my life because I believe that you have to resolve the losses and the causes and clear your head before you can actually do anything.

Lynne Malcolm: And do you see a hope that you can resolve those things for yourself and therefore do something about your hoarding?

Joanna: I feel that I have no feeling, so it's a matter of action and time. I just want to find some place to lay it all out and do it systematically, like an assembly line and then I'd have no trouble, but how do you do that?

Lynne Malcolm: Joanna.

Does Randy Frost believe that full recovery from a hoarding disorder is possible?

Randy Frost: I don't know if I would talk about cure or recovery since we still don't have a full picture of what causes this. But there are people who can get control over it, and I think that's the way to think about this at this point, is gaining mastery over this urge, this urge to acquire and save things, and that is certainly possible.

Lynne Malcolm: Professor Randy Frost.

So, what do you most enjoy now about your life?

Catherine: I just love the idea that I'm capable and I'm confident that I can do this, and it's a very tangible thing. I took 238 books to Lifeline, and 138 another time, bags and bags and bags of them. To me that's practical evidence that it's working, that it has really been worth it.

Lynne Malcolm: Thanks to Catherine and Joanna for sharing their experiences with us today.

Head to the All in the Mind website for further information, including details of Professor Randy Frost's books on hoarding.

Production by Diane Dean and sound engineer Phil McKellar.

I'm Lynne Malcolm, catch you next time.

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Lynne Malcolm: Hi, it's All in the Mind on RN, I'm Lynne Malcolm. Today, the psychology of hoarding. Journalist: Well, it's Sydney's most notorious house of hoarders, and it's on the market. The Bondi home of Mary Bobolas is being sold, even though it's full of rubbish and her family is refusing to leave.

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Biomedical Treatments: Crash Course Psychology #36

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You can directly support Crash Course at http://www.subbable.com/crashcourse Subscribe for as little as $0 to keep up with everything we're doing. Also, if you can afford to pay a little every month, it really helps us to continue producing great content. *** Do you know how Prozac works? Or lithium?

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Getting Help - Psychotherapy: Crash Course Psychology #35

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mental illness (disease or medical condition)

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Psychological Disorders: Crash Course Psychology #28

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SUBBABLE MESSAGES*** To: Lola From: Daddy You are the best, I love you. *** To: Future Lia From: Mom and Dad Remember that learning isn't just useful, but also really fun! *** You can directly support Crash Course at http://www.subbable.com/crashcourse Subscribe for as little as $0 to keep up with everything we're doing.

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Depressive and Bipolar Disorders: Crash Course Psychology #30

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Emotion, Stress, and Health: Crash Course Psychology #26

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OCD and Anxiety Disorders: Crash Course Psychology #29

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Personality Disorders: Crash Course Psychology #34

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Schizophrenia and Dissociative Disorders: Crash Course Psychology #32