Why the Dodo Bird Argument is Important (and why it’s not)

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Are all forms of therapy effective? Saul Rosenzweig concluded in the 1930s, that yes, all modes are effective as long as the clinician is a skilled listener and the patient has a certain degree of readiness.

This argument, called the Dodo Bird Verdict — named after the famed dodo bird in Alice in Wonderland who determined that everyone who raced wins all the prizes — has experienced prevalence in the behavioral health community. Research labs across the world where modalities such as DBT, CBT, and psychoanalysis are measured for effectiveness, frequently find the Dodo Bird appearing in discussions.

Scott Miller’s work takes a different spin on the Dodo Bird Verdict, claiming that, yes, specific intervention techniques may be effective for a given presenting problem, but common factors such as therapist empathy, incorporating client feedback, and the nature of the therapist-patient relationship trump such theoretical constructs to a high degree.

In our co-authored book, Therapy in the Real World, we argue that joining and engagement comprises just one of six core meditational processes that are critical to effective, evidence-informed, real-world practice. The other five are motivational interviewing, cognitive behavioral strategies, acceptance and mindfulness strategies, multi-systemic collaboration, and relapse prevention.

This sets the stage to ponder a fascinating (and impressively executed) bulimia study conducted by Stig Poulsen and Susanne Lunn in Denmark that compared the effectiveness of CBT vs psychoanalysis. To quote this Guardian article:

Even though the participants in the Danish trial received vastly unequal amounts of treatment over an extended timespan – with those given psychoanalysis seeing their therapist far more than those allocated CBT – it was CBT that proved more effective. After five months, 42% of the CBT group had stopped binge eating and purging; for those receiving psychoanalysis the figure was just 6%. After two years, the proportion of the psychoanalysis group who were free from bulimia had risen to 15%. But this was still a long way short of the success of the CBT group after two years (44%), despite the fact that by then it was 19 months since the end of their course of treatment.

Impressive results, yes? Here’s the ringer: the primary researchers were psychoanalysts.

One of the main reasons that the Dodo Bird Verdict has experienced such lasting power is the understandable and important argument that bias toward the orientation of the particular lab conducting the study skews results. That’s why we here at Sound Behavioral Health think that studies like Poulsen and Lunn’s are hugely important, and that the researchers should be applauded for their commitment to science.

Medication, Families, Choice, and Empowerment

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We’ve been absorbing this article from the New York Times lately.

At Sound Behavioral Health, we believe that people with serious mental illness ought to have informed choice and family and institutional support in their care. We’ve worked too long in the system, seen too much punishment for “noncompliance,” and have seen too many people slip through the cracks to not wonder if there is another way.

The more coercive paradigm described in this article often leaves folks with serious mental illness with what feels like a double bind: either get with the program or go it alone. This paradigm is not just coercive to patients — it is coercive to psychiatrists and other providers, who bear some risk and liability in straying from established standards of care that are represented by medication and ‘swift discharges,’ even if those standards do not really work in the long term.

As Kelly Wilson points out: “Major organizations like the British Psychiatric Association are beginning to endorse real choice and real informed consent about the risks and benefits of medications. We are beginning to see clinical trials of no medication and minimal medication approaches to psychosis. And there are some very promising data out there showing that some, not all, but some, can thrive on alternatives to coerced high dose meds.”

What is deictic framing? And why is it important to good health?

file_101560_0_Baby_MirrorDeictic framing is framing events from different relational perspectives. For example, we can ask a client, “How can you-here-now reflect on the experiences of you-there-then?” When humans utilize this kind of perspective-taking, we can experience events, thoughts, feelings, and sensations differently than we usually do. This reinforces psychological flexibility.

We here at Sound Behavioral Health are digging on the new book “Mastering the Clinical Conversation: Language as Intervention” by Villatte, Villatte, and Hayes. Its breakdown of relational frame theory can get knotty at times, but our experience so far is that it’s worth the journey. (you can find the book here)

As part of the the book, the Villattes have created a very handy website with videos and blog posts. Here you’ll find three simple and immediately applicable methods to employ deictic framing in session with your clients.

What is epigenetics?

… and why might it matter to us?

The following article describes the current infancy stage of research into how environmental events affect sperm content.

Yup, you read that correctly.

In this study, the topic was obesity, asking the question: if we are overweight, how does that impact our sperm, and does it result in passing along vulnerabilities to weight gain in our children?

If environmental factors influence which genes traits are active in sperm, this could have pretty large implications regarding mental and behavioral health. Here at SBH, we are especially interested in trauma. Note the rats study and high stress mentioned in the article.

http://www.nytimes.com/2015/12/08/science/parents-may-pass-down-more-than-just-genes-study-suggests.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

New ACT meta-study

Recently, there have been quite a number of Acceptance Commitment Therapy meta-studies. This new one, published in the Journal of Affective Disorders and linked below, argues that we don’t need any more RCTs on seeing whether ACT helps vis a vis nothing or an inert condition.

In other words, ACT works for depression and anxiety, when compared to ‘treatment as usual.’ However, more understanding is needed when comparing ACT to other evidence-based practices such as CBT.

Link: http://www.jad-journal.com/article/S0165-0327(15)30365-7/abstract

 

 

de Blasio’s ThriveNYC Program

We at SBH are very curious to see what becomes of the NYC mayor’s new program to support folks who suffer from mental and behavioral health issues. The program includes 15,000 new units of supported housing, which is music to our ears, since we do consulting at dozens of homeless shelters across and are all too aware of the housing shortage, not to mention the prevalence of trauma and other health issues among those in transitional housing. Read the NYTimes article and stay tuned as we follow this closely.

http://www.nytimes.com/2015/11/26/opinion/treating-mental-illness-in-new-york-from-all-angles.html?_r=0