PSYCHIATRIC VIEWS ON THE NEWS
As we approach Halloween, news stories on mental health treatments are popping up much frequently than usual, and mainly from countries outside of the US. Perhaps that reflects the more stringent approval requirements in our country. The history of medicine and psychiatry is strewn with promising treatments, from bloodletting to primal screaming, but those failed to live up to their hype and hope.
Yet we need to continue to find better ways to help patients any way and anywhere we can. Will novel treatments from around the world be treats or tricks? Whatever they turn out to be, they are as fascinating and varied as Halloween costumes.
1. Behavioral activation
Who wouldn’t want a psychotherapy for clinical depression that would not only work faster than the current gold standard of cognitive behavioral therapy (CBT), but conducted by mental health workers with no formal training in psychotherapy? Wouldn’t primary care physicians who are inundated with psychological problems embrace the technique, given its relative simplicity and short timeframe? A trial in England suggests it is a possibility.1
Behavioral activation is a technique that tries to help patients identify the triggers of their depressed reactions and then encourages them to seek out unrelated positive experiences to develop alternative behavioral responses to rumination. After 12 months of the study, for those receiving at least 8 sessions of behavioral activation or CBT, both groups reported at least a 50% reduction in symptoms. Now, we must await further replication.
The successful treatment of PTSD continues to remain a challenge. There is no specific anti-trauma (eg, anti-depressant or anti-psychotic) medication. Various standard psychotherapies are tried, sometimes beneficially, sometimes not. One experimental treatment like eye movement desensitization and reprocessing (EMDR) has gained a small foothold, but we still need more and better strategies to treat PTSD.
In Israel, where war or terror trauma involves most families, a team of mental health professionals and filmmakers invented another possible treatment.2 They tried to see if a connection between filmmaking and psychotherapy—videotherapy—would have unique healing potential.
There are no videotherapy studies yet, but the participants of the experiment—middle-aged men who had lost children to disasters—apparently have reported that they are feeling and functioning better. In 24, 2-hour sessions that incorporated group support, participants learned how to make a short film with no words, but only music, that depicts how an ideal man may solve a problem that could be like, or unlike, their own.
The key was to empower participants to make a story that is not threatening and that is revised over the time of making a film, as if their own reactions to their own losses could be revised.
3. Family constellation
Germans have a historical habit of mind that mixes the mystical and scientific. This new therapy, often translated in English as family constellation, is a reflection of that tradition.3
The treatment helps Germans wrestle with the remaining guilt over World War II. To be German is still to be part Nazi in a psychologically inherited way. Even with Germany’s attempt, although belated, to talk about the role of the general population, as well as the more recent attempt to reverse their past by welcoming refugees and Jews once again, many have still not processed their relatives’ involvement with the Nazis.
Somewhat akin to psychodrama or family sculpting, participants are asked to intuitively play the parts of any participating family member. During a 2-day retreat, the therapist guides the process, which is described as part theatre, part therapy, and part séance. Each role player would attempt to channel the person or emotion they were asked to represent. Family secrets are often revealed and a sense of reconciliation obtained.
The theory behind this technique is that in addition to a Freudian individual unconscious and a Jungian collective unconscious, there is a family unconscious that can be tapped. Again, there is hope that such a treatment can work quickly. But could it produce something like false memories? Research has begun and seems promising so far.
Given that the pipeline of innovative new psychiatric medications has dried up for now, it is no surprise that some people turn to other countries for different medications. One of them is ibogaine, a substance derived from a rainforest shrub. It is touted to reduce drug cravings by resetting damaged neural pathways involving pleasure.4
1. Slomski A. Simple, less expensive psychotherapy effective for depression. JAMA. 2016;316:1250.
2. Horwitz S. How video can heal the bereaved in Israel. Forward. 2016;13:23-24.
3. Bilger B. Ghost stories: Making peace with the dead in Germany. The New Yorker. 2016;12:56-65. http://www.newyorker.com/magazine/2016/09/12/familienaufstellung-germanys-group-therapy. Accessed October 28, 2016.
4. 4. Nestor J. An Antiaddiction Drug Called Ibogaine Could Be a Wonder Cure—Or an Addict Killer. Scientific American. 2016;315(5):62-69. https://www.scientificamerican.com/article/an-antiaddiction-drug-called-ibogaine-could-be-a-wonder-cure-mdash-or-an-addict-killer. Accessed October 28, 2016.
5. Jodorowsky A. The Dance of Reality: A Psychomagical Autobiography. Rochester, Vermont: Pork Street Press; 2001.