Blogging about my mum's illness and my reactions to it led me to think again about self disclosure by health professionals.  Our job is to be helpful for our clients - it's what we're about.  Self disclosure by health professionals is a mixed bag.  It can sometimes be helpful and sometimes damaging.  Different schools of therapy and different styles of doctor have strong opinions about what's right and wrong in this area.  Strong opinions without research back-up tend to generate more heat than light.  As has been so delightfully stated "The plural of anecdote is not data".  This post is not at all intended to be exhaustive about research on health professional self disclosure.  It is intended to shine a light on some interesting facts and to raise some questions.

Here are a couple of studies on the prevalence of depression and anxiety, and four on risk factors for depression, bipolar disorder and suicide.  Strine et al report on a major survey of depression and anxiety in the United States.  They found "The overall prevalence of current depressive symptoms was 8.7% (range by state and territory, 5.3%-13.7%); of a lifetime diagnosis of depression, 15.7% (range, 6.8%-21.3%); and of a lifetime diagnosis of anxiety, 11.3% (range, 5.4%-17.2%)."  Smoking, lack of exercise, and excessive drinking were all associated with increased likelihood of mental disorders, as too was physical ill health.  Young et al, in a separate study, looked at the likelihood of depression and anxiety becoming persistent.  They estimated - at nearly 3 year follow-up - that the US prevalence of persistent depressive or anxiety disorder was 4.7%.  Only about a quarter of these sufferers were using appropriate medication and only about a fifth appropriate counselling.

Here are a series of information and assessment handouts on alcohol.  For additional information, note that the blog has a whole series of posts on the crucial importance of lifestyle choices, including how we use or abuse alcohol. 

Alcohol disorder assessment - two question screen - this is a useful two question screen for alcohol problems.  Other options include the well-known four question CAGE.

Alcohol disorder assessment - AUDIT and scoring - this is the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization to help identify people whose alcohol consumption has become hazardous or harmful to their health.

Damage caused by alcohol - this one page handout highlights some of the worrying and significant damage caused by excessive alcohol use.

Yesterday and today are a check-in time with my friend Larry.  I've written in a previous blog post how Larry and I have met every three or four months for many years specifically to review how our lives are going and to plan and prioritize our goals for the next few months.  "Taking charge" of our lives in this kind of way makes huge sense.  For example the self-determination literature (S-DT)  highlights the importance of making autonomous decisions about what we put our energy into.  This S-DT research and much other work (e.g. a recent study on goal-setting) also emphasises that this kind of approach is a core component of growing wellbeing in one's life.  Yeats wrote something like "A friend is someone who sees the potential in you and helps you to live it."  Meeting with an old friend in the way Larry and I have done, is certainly an example of what Yeats was talking about.

Here are two papers on mindfulness and four on sleep.  The Kuyken et al paper is important.  It compares mindfulness-based cognitive therapy (MBCT) with continuation antidepressants in the prevention of relapse in recurrent depression.  The results are great - "Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM (maintenance antidepressant) group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04).  MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains."  I have been cautious in my enthusiasm for MBCT (see previous post) but this is exactly the kind of research that we need to help clarify MBCT's potential further.  The second paper on mindfulness is lower key.  It is a mention of its potential in enhancing sexuality.  It makes sense - see last month's posts on the effects of meditation training on experiencing positive emotions - but the relevant research is still in its early stages. 

I posted half a dozen assessment questionnaires for PTSD and intrusive memories a week ago.  Here are further handouts and information about intrusive memories, trauma, imagery and PTSD.

Flowcharts 1 & 2 (Ehlers & Clark) - here are a couple of Powerpoint slides that - although in colour - print out well in black & white.  I particularly use the second of these slides as a handout when working to process traumatic memories.  I use it to explain the why, what and how of the therapeutic approach we'll use.  I think this orientation is especially important when working with traumatic memories, so that the client understands why they're being asked to re-connect to painful experiences they may well have been trying hard - and in Type I trauma, unsuccessfully - to forget.

This blog post on coping with difficult thoughts and feelings is downloadable as both Word and PDF handouts.

I wrote this entry first in April of last year, but with my mother's illness and my decision to write about it, I felt it made sense to post this again.

The aim of this blog is to be helpful - for clients who come to see me, for fellow health professionals, and for other website visitors. It's pretty obvious that I may be able to offer something useful from my knowledge and experience of being a doctor and therapist for several decades. What's less obvious is whether writing about my personal life might be helpful.

Here's a gutsy, nutritional, low sunlight kind of blog post to suit our post-holiday season.  First the gutsy bit.  Irritable bowel syndrome (IBS) - with its characteristic symptoms of abdominal pain, altered bowel habit, and possibly bloating - is very common, affecting about 15% of the population.  Ford et al systematically reviewed all research on treating IBS with fibre, antispasmodics, or peppermint oil.  Fibre was some use, but only in the form of ispaghula (UK Fybogel, Isogel).  The antispasmodics otilonium and hysocine (UK Buscopan) seemed also to be of help.  But what attracted me to the study was the finding that most helpful of the three treatments seemed to be the old-fashioned remedy of taking peppermint oil. 

Sadness.  I woke feeling sad ...