Brad Bowins

Dr Brad Bowins is a psychiatrist, researcher, and founder of The Centre For Theoretical Research In Psychiatry & Clinical Psychology. His research and writings challenge the status quo, fostering paradigm shifts so crucial to the advancement of science and knowledge. Several theoretical perspectives presented in peer-reviewed papers have advanced the way that key aspects of mental illness and other phenomena are understood. He is also an avid traveler, skier, scuba diver, underwater photographer, with several travel articles focusing on skiing, scuba diving, and adventure activities.

Mar 282022
 

A month into the disgusting attack by Putin and the Russian military against Ukraine, I write this post not in response to Putin, but in reaction to leaders of the west, NATO, and the United Nations. The bravery and resolve of the President of Ukraine, Volodymyr Zelenskyy, and the people of that country, in fighting a force ten times larger in terms of troops and weaponry is highly inspirational. Russian forces have been halted in some instances, stalled in most, and even pushed back, despite Ukraine forces being sadly deficient in weapons of offense. They need these weapons to survive and win, and without them are being pummeled by missile strikes, with citizens bearing much of the suffering. In stark contrast to the very inspirational performance of President Zelenskyy and Ukraine forces, is that of western leaders, NATO, and the United Nations, characterized by cowardice, self-interest, and stupidity, not necessarily in that order. They appear terrified of Putin, and what he might do despite the Russian leader being very calculating, and hence, extremely unlikely to apply long-range nuclear missiles, assuming Russia itself is not attacked. Self-interest is demonstrated by several European leaders wanting to ensure that the flow of Russian oil and natural gas continues, and how turning off the taps might impair their re-election hopes; they appear to be assuming that their citizens are as self-interested as they are, when support for Ukraine is extremely high in almost every country.

Then we come to stupidity, a nasty word but one that I strongly believe applies. It has been said that the only thing we learn from history is that we learn nothing from history, and to not learn the key lessons of World War II is frankly stupid, and certainly when applied to world leaders! When Hitler began his campaign of aggression the reaction of the west was generally appeasement, allowing Hitler to grow in confidence and capacity. An early aggressive intervention by the west would likely have ended his ambitions and prevented WWII in Europe. Much like Hitler, dictators like Putin undoubtedly interpret the stance of western leaders as weakness, and they are accurate in that perspective. Putin has expressed how Ukraine is an impediment to his ambitions for Eastern Europe. If Putin and the Russian forces succeed in taking Ukraine, incursions into eastern European countries are inevitable, at least once the Russian army has a chance to rebuild and learn from their mistakes. Then we will have WWIII in all likelihood! It is stupid not to learn from the lessons of history. The rhetoric of “not an inch of NATO soil is to be taken by Russia” is hollow, as if they failed to help Ukraine with weapons of offense, let alone do the ultimate right thing and send troops in to push the Russians into the Crimean Sea, then it is unlikely that they will not try and appease Putin when these incursions start. Giving up on the fight for freedom and democracy against control and autocracy once, means it will likely repeat. Perhaps these western leaders should consider the bravery of Franklin D. Roosevelt during WWII, who despite warnings from his advisors that England was expected to collapse in 6 months, and how Hitler will be upset about the United States delivering weapons, he ignored them and sent all the weapons available. The actions of Winston Churchill, and how his words and behavior guided and inspired the nation, likewise need to be pondered. Following in their footsteps, with his own flair, is Volodymyr Zelenskyy, who has acted as a true leader, standing strong and rallying his people and forces to fight the Russian aggressors. If I was a politician, I would want to be remembered as being like one of these three inspirational leaders, and not my performance being characterized by cowardice, self-interested, and stupidity!

Jan 302022
 

Delusions are false beliefs not at all consistent with reality. Although such thoughts might appear to comprise a separate category from normal thoughts, the content of thought consists of a spectrum from very tight and logical all the way to delusions. The content of thought is best viewed as cognitive distortions given that it is very difficult to perceive the exact nature of reality, an ongoing struggle for scientists. Minor cognitive distortions include positive and negative spins on experience, attribution biases, and fantasy. Positive cognitive distortions commonly provide a powerful psychological defense capacity, such as self-enhancing spins on events, and favorable attribution biases. For example: “Even though I did not complete university, I’m smarter than most people who have done so,” and, “The reason why I did not do well on that performance evaluation is that my boss is a difficult pain in the ass with unreasonable expectations.” Moderate level cognitive distortions consist of more extensive fantasy involvement, magical thinking, and over-valued ideas. There are many examples, including superstitions, belief in fortune telling and horoscopes, and reliance on unproven mystical modes of healing. Religious beliefs also constitute moderate level cognitive distortions with obvious defensive value, because first, there is no objective evidence for such beliefs and science if anything indicates that they are false, and second, such beliefs comfort as when answers to psychologically disturbing concerns are provided, as in, “It is God’s will that this happened,” and “I will go to a nice afterlife.” Extreme level cognitive distortions constitute delusions as the beliefs are not at all consistent with reality.

When under stress more extensive cognitive distortions frequently emerge, particularly in people vulnerable to this occurrence. The Covid-19 pandemic has generated enormous stress for the majority of the population, evident in multiple ways including illness, death of family members and friends, social isolation and loneliness, loss of jobs, rising prices, a sense of insecurity, delayed or cancelled medical interventions, the list almost endless. Consequently, more extreme cognitive distortions qualifying as delusions are seemingly rampant, and particularly expressed by vaccine and/or mask resistors. Many such delusional beliefs have been expressed such as:

The pandemic is not real:Covid-19 is clearly a new virus that has been repeatedly detected in infected humans.

Covid-19 is really just a cold virus:viruses that cause the common cold include rhinoviruses, adenovirus, and select coronaviruses, but the Covid-19 coronavirus is novel causing infections that are much more serious for many people than those involving common cold viruses.

RNA and DNA vaccines are designed to control our genetics:these vaccines have been in development for decades with testing, and fortunately this process was far enough along that Covid-19 came at the right time. The nature of these vaccines is that they utilize our natural capacity for manufacturing proteins to produce proteins present on Covid-19, enabling the immune system to launch an antibody attack against the virus. No other occurrence, and certainly not control, transpires.

Vaccines are designed to reduce the population of the world: it has been said that the only thing that we learn from history is that we learn nothing from history, and those advocating such beliefs might want to visit historical data. Many infections that brought disease and death, such as smallpox, pertussis, diphtheria, mumps, measles, rubella, tetanus, and polio have been virtually eliminated due to vaccinations. Interestingly, the only one that has been totally eliminated is smallpox because the sole reservoir was humans; it could not hide in other animals. Sadly, if vaccinations for smallpox were to transpire in this era the disease might not have been eliminated due to vaccine resistors.

Masks do not help:surgical type masks have been shown to reduce the spread of pathogens including Covid-19. Those who doubt this might request that operating room staff do not wear masks during their surgery.

As a psychiatrist and psychotherapist, I recognize delusions and treat them, both with antipsychotic medication and psychotherapy. The basis of psychotherapy for delusions is normalization, appreciating that cognitive distortions comprise a spectrum, with the goal of shifting extreme ones into the normal range. This involves a three-component process. First, have the person provide high quality evidence, such as will hold out in court, for their belief. Second, have the person generate alternative beliefs to their preferred one, these beliefs diluting the delusional one and fostering greater cognitive flexibility. As a therapist do not challenge their belief, but instead take it as one possibility. Third, have the person try to test the delusional belief. For Covid-19 beliefs qualifying as delusions, those holding such beliefs need to provide solid evidence. At this point, most or all will seek sources of information that confirm their belief with no due diligence of the credibility of the source—a self-confirming bias. No reputable information source provides any evidence in support of Covid-19 delusions. Based on this outcome accept that the preferred belief is only one option and generate alternative possibilities, the more the better. For example, “I have received many vaccinations prepared in different ways and am still alive, so maybe this one will be okay,” “Many people have died of this virus so it must be real,” “Physicians who care for patients cannot possibly benefit financially or otherwise, and some have died, so it might be worth really listening to what doctors have to say.” Next, try and test the preferred belief. For example, talk to and observe vaccinated individuals to determine whether or not they are still alive, and if they have mutated into a different person. As with delusional patients, some can and will work with this process, while others will require antipsychotic medication. Hence, an option might be to provide free antipsychotic medication to those suffering from Covid-19 delusions!

Accepting that the various distorted beliefs surrounding Covid-19 comprise delusional level cognitive distortions provides an accurate framing of the problem. Appreciate that as with milder and moderate level positive cognitive distortions, these beliefs provide psychological defense against fears associated with the virus, and also larger fears such as those derived from not understanding the nature of science. Recognize that when under intense stress as most people are with the Covid-19 pandemic, more extreme defensive cognitive distortions emerge in those most vulnerable to this process. Then approach the problem with a focus on normalizing the belief, and if this fails then antipsychotic medication might well be warranted.

Jun 182021
 

PANDEMIC COPING VIA STATES AND PROCESSES FOR MENTAL HEALTH

As with any major stressor the Covid-19 pandemic has challenged the coping capacity of people. Those with a solid capacity to cope with stress have fared better, whereas those with diminished ability have suffered to a greater extent often experiencing mental illness. My current research as a psychiatrist is timely because it identifies seven key states and processes for mental health crucial to coping with major stressors such as the pandemic:

ACTIVITY: Being active in general and specifically in regards to physical, social, nature, cognitive, art/hobby, and music activity advances mental health, and is effective in treating mental illness. Activity entails high behavioral activation and low behavior inhibition bolstering positive emotions and diminishing negative emotions, and absorbs a person in positivity countering negativity.

PSYCHOLOGICAL DEFENSE MECHANISMS: The nature of life is such that negative circumstances tend to outweigh positive scenarios, contributing to negative emotions such as sadness and fear over positive ones like happiness and interest. Psychological defense mechanisms counter negativity and favor positivity. Mature defenses such as humor, sublimation, positive anticipation, altruism, and suppression are powerful in this regard. Positive spins on events representing positive cognitive distortions and dissociating from negativity are two major ways we defend against negativity.

SOCIAL CONNECTEDNESS: Humans evolved in hunting-gathering groups, and consequently we require good quality social contact for mental health, with loneliness contributing to mental illness. Such is our need for positive social contact that any form including social media helps, and isolated individuals respond well to compensatory strategies such as pets.

REGULATION: Mental illnesses including depression, anxiety, mania, and psychosis entail compromised regulation over emotions and thought processes. Emotion regulation is potent for ensuring that positive emotions exceed negative emotions. Equally important is regulation of thought processes to ensure that they are compatible with reality.

HUMAN SPECIFIC COGNITION: Basic cognition, social cognition, and motivation comprise the fundamental aspects of human cognition. Basic cognition largely consists of executive functions such as attention, set shifting, and multitasking. Social cognition includes the capacity to interpret emotions in facial expression, understand the intent of others, and one’s own role in relationships. Motivation takes various forms that enhance the acquisition of important resources. Discussions of mental health and illness frequently omit human specific cognition, but deficits contribute to autism spectrum disorders, intellectual disability, attention deficit hyperactivity disorder, schizophrenia, bipolar disorder, and even depression.

SELF-ACCEPTANCE: Accepting oneself is an important component of mental health, and not liking who you are favors mental illness. Self-acceptance involves both evaluative and perspective components. Self-esteem is the evaluative aspect referring to a person’s global appraisal of their positive or negative value. Self-concept can be viewed as the sum of an individual’s self-efficacy beliefs regarding personal attributes and qualities. Self-acceptance transpires when both self-esteem and self-concept are robust.

ADAPTABILITY: Circumstances are ever changing and the capacity to flexibly adjust behavior to align with these changes is crucial for success and mental health. In contrast, lack of flexibility results in unfavorable outcomes contributing to mental illness. Indeed, repetitive maladaptive behavior is a key contributor to recurrent and persistent mental health problems.

These states and processes foster good mental health and resilience to stress and mental illness, in part by bolstering positive emotions and diminishing negative emotions. High behavioral activation and low behavioral inhibition generates positive feeling states. Psychological defense mechanisms routinely counter negative emotions shifting perceptions to favor positivity. Given our nature as a social species good quality social contact (social connectedness) produces positive feelings. Emotion regulation is essential for minimizing negative emotional states and blocking the amplification to depression and anxiety. Intact human specific cognition favors successful outcomes that yield emotions such as happiness and interest. Solid self-esteem and self-concept contributing to self-acceptance makes a person feel good about themselves. Adaptability enables a person to adjust behavior to fit with circumstances, ensuring optimal outcomes.

In regards to coping with major stressors such as the pandemic, the states and processes for mental health that really stand out are adaptability, activity, and social connectedness. So much has changed with the pandemic that applying the same behavior engaged in pre-pandemic greatly diminishes coping capacity. In some instances when a person has refused to wear a mask, social distance, or remain in their social bubble, infection with severe outcomes has transpired. In contrast, adapting to the new reality and engaging in safe behavior is life-saving. Those who have adjusted other behaviors relevant to the pandemic, as for example shifting from in-person to social media contact, typically fare better. Hence, adaptability has proven crucial to coping with the pandemic. Activity has also proven itself with Covid-19 coping, as those who have “frozen up” not getting out to walk or visit natural settings have experience greater declines in mental and physical health. In contrast, those who have remained active in as many safe ways as possible have not withered often faring well. Pandemics are socially isolating as contact with others can prove deadly, and it is difficult to know who to trust leading to increased suspicion. Obviously, this does not fare well with our nature as a social species. People who have maintained social contact via technology, even on the telephone or online have offset the social disconnect and feel connected to others.

When I started my research into the states and processes for mental health, my focus was on a trans-therapy approach to psychotherapy. States and Processes for Mental Health: Advancing Psychotherapy Effectiveness (Academic Press, 2021) reveals how major forms of psychotherapy and non-specific psychotherapy factors such as hope and the therapeutic alliance, actually work by enhancing these seven states and processes for mental health. From this I provide a trans-therapy approach drawing on general techniques and those derived from fifteen major forms of psychotherapy, to advance psychotherapy outcomes. As the pandemic emerged and progressed, the role of activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability in coping became increasingly apparent. Therefore, I encourage readers to consider these key states and processes for mental health and work on improving them to ensure successful coping with the pandemic, with particular attention to adaptability, activity, and social connectedness.

 

 

 

 

 

POST—STATES AND PROCESSES FOR MENTAL HEALTH: ADVANCING PSYCHOTHERAPY EFFECTIVENESS

Brad Bowins, M.D.

 

Identifying what mental health is characterized by is crucial if we are to fully understand the concept and advance psychotherapy effectiveness. Key states and processes for mental health consist of: activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability.

 

STATES AND PROCESSES FOR MENTAL HEALTH:

 

ACTIVITY: Being active in general and specifically in regards to physical, social, nature, cognitive, art/hobby, and music activity advances mental health, and is effective in treating mental illness. Activity entails high behavioral activation and low behavior inhibition bolstering positive emotions and diminishing negative emotions, and absorbs a person in positivity countering negativity.

 

PSYCHOLOGICAL DEFENSE MECHANISMS: The nature of life is such that negative circumstances tend to outweigh positive scenarios, contributing to negative emotions such as sadness and fear over positive ones like happiness and interest. Psychological defense mechanisms counter negativity and favor positivity. Mature defenses such as humor, sublimation, positive anticipation, altruism, and suppression are powerful in this regard. Positive spins on events representing positive cognitive distortions and dissociating from negativity are two major ways we defend against negativity.

 

SOCIAL CONNECTEDNESS: Humans evolved in hunting-gathering groups, and consequently we require good quality social contact for mental health, with loneliness contributing to mental illness. Such is our need for positive social contact that any form including social media helps, and isolated individuals respond well to compensatory strategies such as pets.

 

REGULATION: Mental illnesses including depression, anxiety, mania, and psychosis entail compromised regulation over emotions and thought processes. Emotion regulation is potent for ensuring that positive emotions exceed negative emotions. Equally important is regulation of thought processes to ensure that they are compatible with reality.

 

HUMAN SPECIFIC COGNITION: Basic cognition, social cognition, and motivation comprise the fundamental aspects of human cognition. Basic cognition largely consists of executive functions such as attention, set shifting, and multitasking. Social cognition includes the capacity to interpret emotions in facial expression, understand the intent of others, and one’s own role in relationships. Motivation takes various forms that enhance the acquisition of important resources. Discussions of mental health and illness frequently omit human specific cognition, but deficits contribute to autism spectrum disorders, intellectual disability, attention deficit hyperactivity disorder, schizophrenia, bipolar disorder, and even depression.

 

SELF-ACCEPTANCE: Accepting oneself is an important component of mental health, and not liking who you are favors mental illness. Self-acceptance involves both evaluative and perspective components. Self-esteem is the evaluative aspect referring to a person’s global appraisal of their positive or negative value. Self-concept can be viewed as the sum of an individual’s self-efficacy beliefs regarding personal attributes and qualities. Self-acceptance transpires when both self-esteem and self-concept are robust.

 

ADAPTABILITY: Circumstances are ever changing and the capacity to flexibly adjust behavior to align with these changes is crucial for success and mental health. In contrast, lack of flexibility results in unfavorable outcomes contributing to mental illness. Indeed, repetitive maladaptive behavior is a key contributor to recurrent and persistent mental health problems.

 

When these states and processes are intact, mental health including positive emotions is facilitated, and when compromised mental health suffers with negative emotions and mental illness ensuing. Given this occurrence a focus on activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability, provides an innovative trans-therapy and trans-diagnostic approach to treating mental illness and advancing mental wellbeing. Trans-therapy refers to strategies that apply across all forms of psychotherapy, and trans-diagnostic across various types of mental illness. Such an approach to psychotherapy is greatly needed due to major problems inherent in the current format characterized by numerous discrete forms of psychotherapy.

 

PROBLEMS WITH THE DISCRETE PSYCHOTHERAPY APPROACH:

 

SHEER NUMBERS: Numerous specific forms of psychotherapy exist with the number growing rapidly. The sheer number is overwhelming for consumers, providers, students, and funders.

 

RESEARCH BIAS: Competition for funding amongst the various forms of psychotherapy results in unintentionally biased research, with studies typically conducted by the originator or students of the particular type, and almost no negative result studies.

 

FADES AND FADES: Related to promotion of various forms of psychotherapy, those that succeed in marketing achieve fade status. However, history reveals that after the originator and a generation or two of students fades, so does the specific type of therapy.

 

FORMS OF PSYCHOTHERAPY FOR A GIVEN MENTAL ILLNESS: Virtually every version of psychotherapy treats conditions such as depression and anxiety, which is impossible if it is the special sauce of a form of therapy that is instrumental: the probability that so many diverse approaches could treat a specific problem is very unlikely.

 

EXTENSION TO MANY MENTAL HEALTH PROBLEMS: Most forms of psychotherapy are initially directed towards one mental illness but rapidly expand to treat many types of psychopathology. If most forms of psychotherapy work for many conditions, the real mechanism of action is almost certainly trans-therapy in nature.

 

NON-SPECIFIC PSYCHOTHERAPY FACTORS: Various non-specific factors such as hope and the therapeutic alliance are robust in psychotherapy outcomes, but do not align with specific forms of psychotherapy accounting for mental health gains. The impact of non-specific factors strongly suggests that trans-therapy influences account for the effectiveness of psychotherapy.

 

A TRANS-THERAPY APPROACH BASED ON STATES AND PROCESSES FOR MENTAL HEALTH:

 

In STATES AND PROCESSES FOR MENTAL HEALTH: ADVANCING PSYCHOTHERAPY EFFECTIVENESS (ACADEMIC PRESS, 2021), I examine 15 major forms of psychotherapy—Acceptance & Commitment Therapy, Behavioral Therapy, Cognitive Therapy, Compassion-Focused Therapy, Emotion-Focused Therapy, Existential Psychotherapy, Gestalt Therapy, Interpersonal Psychotherapy, Mindfulness-Based Therapy, Narrative Therapy, Person-Centered Therapy, Positive Psychotherapy, Problem-Solving Therapy, Psychoanalytic Therapy, Rational-Emotive Therapy—and Non-Specific Psychotherapy Factors, demonstrating how they actually work by enhancing activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability. Given this occurrence, a unified trans-therapy approach to advance these key states and processes for mental health is developed, drawing on both general strategies and robust techniques from existing forms of psychotherapy. To demonstrate how this works, the example of adaptability is provided:

 

ADAPTABILITY:

Flexibly adapting to ever changing circumstances is key to mental health. Generally, this can be advanced in psychotherapy by examining how a client perceives behavior in relation to circumstances. I have noted that many clients think in terms of good-bad, right-wrong, and the like, applying absolutes. Shifting their perspective to what is adaptive for the given circumstances can be quite enlightening, paving the way for more adaptive behavior. Encouraging the person to think of behavior relative to circumstances ongoing instills this approach as a pattern. The general way that non-specific factors appear to foster neural plasticity (see the Non-Specific Factors chapter) enables them to enhance adaptability.

 

            Adaptability is advanced by strategies drawn from different major forms of psychotherapy. Acceptance & Commitment Therapydoes so by having the client flexibly adjust behavior in the service of valued goals. Behavioral flexibility, labelled psychological flexibility, is encouraged to achieve these goals despite adversity. Cognitive flexibility itself is enhanced by producing broad and balanced perspectives to minimize avoidance responses. Cognitive Therapyalso advances psychological flexibility and so adaptability, largely by the reframing of negative perspectives including specific thoughts and underlying beliefs. Adhering to unreasonably negative thoughts typically results in maladaptive outcomes, whereas flexibly shifting perspectives to see the positive side fosters behavior that aligns with circumstances. When relationships are a focus, Interpersonal Psychotherapyproduces more adaptive behavior by resolving role disputes, fostering smoother role transitions, and improving social skills. Role issues often involve inflexible thoughts and actions, such as a man expecting his wife to do all the housework like his mother, and by adjusting expectations for this role transition, adaptive alterations in behavior ensues. If interpersonal skill deficits are a concern, improving these skills will provide for a more extensive range of social behaviors increasing the probability of adaptive outcomes.

 

            Mindfulness-Based Therapyimproves adaptability by instilling greater cognitive flexibility, likely due to improved control over attention, inhibiting negative thought streams, and shifting to a focus on the peaceful present. By altering negative and limiting self-stories to positive ones that are coherent and balanced, Narrative Therapyadvances adaptability: limited and negative self-narratives often occur with repetitive maladaptive behavior, such as “I can never win,” whereas positive and more comprehensive narratives favor actions adaptive to circumstances, with an example being, “I can win when the task matches my skill set.” Psychotherapists can readily assist a client in producing narratives that favor adaptive behavior. “Innovative moments” in story generation appear to shift rigid self-narratives into more flexible and adaptive stories.

 

Even the title, Problem-Solving Therapysuggests that it can promote adaptive behavior. Problems that bring people into psychotherapy commonly involve inflexible repetitive approaches that do not fit with circumstances. Solutions derived from the problem-solving steps—problem identification, clarification, generating realistic solutions, selecting the best option, developing an action plan, implementing it, and monitoring the outcome—will fit behavior to circumstances enhancing adaptability. Rationale-Emotive Therapyis ideally suited to improving adaptability given its focus on irrational negative beliefs that are not consistent with the demands of reality. Assertively addressing these irrational beliefs in therapy, and having the client develop rational beliefs fitting with reality greatly advances flexibility and adaptability.

 

            Psychotherapy generally can advance adaptability if the therapist looks at how the client perceives behavior in relation to circumstances. The common emphasis on absolutes such as good-bad and right-wrong favors inflexible and maladaptive actions. Encouraging, guiding, and supporting the client in processing behavior in relation to circumstances will produce much more adaptive behavior. Neural plasticity appears to increase as a non-specific psychotherapy influence, thereby fostering adaptive thoughts and actions. Several major forms of psychotherapy provide strategies to advance psychological flexibility, producing a shift from inflexible maladaptive perspectives and actions to flexible and adaptive behavior aligning with circumstances.

 

SUMMARY:

 

Applying general psychotherapy strategies and those derived from specific forms of psychotherapy to enhance the key states and processes for mental health, provides a unified approach to psychotherapy that resolves the practical and conceptual problems associated with the current discrete psychotherapy format. Change is a challenge, but in line with one of the states and processes for mental health—adaptability—the current discrete system of psychotherapy does need to shift to a trans-therapy orientation. The approach advocated based on key states and processes for mental health represents a comprehensive trans-therapy format, drawing on the strengths of existing forms of psychotherapy, to advance psychotherapy effectiveness.

 

 

Mar 142021
 

Announcing release of new academic book, States And Processes For Mental Health: Advancing Psychotherapy Effectiveness, Academic Press by Brad Bowins

Elsevier books

States and Processes for Mental Health: Advancing Psychotherapy Effectivenesspresents a novel mechanism of action for psychotherapy, revealing how psychotherapy actually works by advancing key states and processes characterizing mental health. This new understanding is presented in three sections. The first section identifies 7 states and processes for mental health. The second section examines 15 major forms of psychotherapy and non-specific factors with a comprehensive overview of each, followed by an empirical and theoretical proof of concept showing how they do indeed enhance the states and processes for mental health. In the third section, the author explores conceptual and practical problems in the current approach to psychotherapy, whereby discrete forms of psychotherapy are oriented to remedying psychopathology. Dr. Bowins then offers a new trans-therapy approach applying general strategies and those derived from existing forms of psychotherapy, to advance each of the states and processes characterizing mental health.

Key Features

Identifies states and processes for mental health—activity, psychological defense mechanisms, social connectedness, regulation, human specific cognition, self-acceptance, and adaptability

Reveals how current forms of psychotherapy and non-specific factors actually advance the states and processes characterizing mental health

Demonstrates problems with the current system of psychotherapy

Provides a novel unified approach to psychotherapy

Mar 292020
 

The coronavirus outbreak arose in late 2019 in China and spread in 2020. Spreading faster than the virus has been anxiety, panic, and fear-based responses. Consequently, every day sees a new rule or change in policy, even when such an immediate reaction is not warranted. Fear is an evolved emotional response occurring when threat or danger is perceived, motivating adaptive responses. Human intelligence has intensified threat and danger related thoughts, amplifying the emotional responses. Worsening the situation is contagion, and I am not referring to biological spread of the virus. If we see another person reacting with fear it triggers a feeling of fear: there must be a threat because that person is reacting with fear. Our social evolution has left us vulnerable to contagion.

To this point in time, fear and its amplification—anxiety—appears to have taken a greater toll on people overall than has the virus. As a psychiatrist, I have noted intense anxiety not only in patients but those I know and observe outside of my practice. Many people fully retreat avoiding walking in areas largely devoid of people, further enhancing the perception of threat and danger. Undoubtedly, lower mood and even depression is on the rise related to the extreme isolation and anxiety. Hence, the mental health impact due to the spread of fear and anxiety has outstripped the impact of the virus! Now some might respond that the virus is killing people. Yes, but what the early peer-reviewed evidence indicates is that most of these people are elderly with significant medical illness, a segment of the population that is highly vulnerable to severe outcomes from upper respiratory tract infections. My mother contracted such an illness while in a nursing home and passed away from it, although the underlying medical illnesses were really what took her. These unfortunate individuals are always vulnerable to upper respiratory illnesses such as from viruses and bacteria.

A horrible consequence of this excessive anxiety and even panic response, whipped up by traditional and social media, is that rational thought processes, planning, and responses are sacrificed. In crisis circumstances, it is prudent to take a look at the relevant pluses and minuses, and act accordingly. Covid 19 to date primarily takes the elderly and ill; it is not equivalent to the swine flu of 1918 that was killing young and healthy individuals, nor is it turning people into zombies. Given this apparent reality, a logical reasoned course would have been to protect those vulnerable from the outset, such as screening anyone who has contact with a physically vulnerable person, and ensuring that only screened individuals interact with them. Instead the response has generally been irrational and fear-based, such as focusing on extensive isolation of those not that vulnerable to serious outcomes, with day-to-day changes in policies and rules as opposed to a few days to a week to adapt. This reactionary process only serves to ramp up fear, and lacks sense. For example, blanket one size fits all approaches such as treating flights from all destinations, even those with no reported cases, as a major threat while ignoring train and bus travel. Also, discouraging people to get out and walk in areas that are not congested, although few areas are crowded nowadays. Walking and maintaining a reasonable distance from others has an extremely low chance of spreading the virus, and the vast majority of those able to walk are not that vulnerable to serious consequences. With the mental health benefits of walking, being active, and seeing others enjoying this experience anxiety is countered. In other words, the minuses are low and the pluses high.

My suggestion as a psychiatrist, and also someone who has engaged in adventure activities such as backcountry skiing and scuba diving, is to resist the temptation to react with anxiety and panic. Counter the negative threat and danger perceptions, and weigh in the pluses and minuses of different courses of action. Also, appreciate the contagion impact, and realize that just because someone is reacting with fear and/or panic it does not mean there is a threat. Maybe in our ancestral hunting-gathering group history a fear response indicated a predator, but not now. Applying humor which is a mature defense consisting of placing a lighter spin on things can be a major asset in these heavy times. A humorous anecdote comes from a person I know who works in a newsroom, where a sign indicates, “Report every story as if it’s World War III.” The newsroom staff are getting so sick and tired of having to report the WWIII coronavirus narrative that they are hoping for a murder, stabbing, or cat stuck in a tree, just for a break from the repetition! An additional and easy way to counter the escalating fear and even panic, is to absorb yourself in a positive focus as the absorption helps negativity recede. Who knows, when online video watching is exhausted maybe picking up a book and reading. Also, resist media exposure as it is designed to ramp up fear responses!

Feb 152020
 

Mental illness accounts for approximately half of all illnesses, but receives a fraction of the funding that physical illness does. In addition, treatment options are limited in their effectiveness and mental health in the general population is not ideal. Hence, there is a great need for beneficial and cost-effective interventions, with the situation dire in third world countries and even first world countries with unevenly spread mental health resources. But what might qualify as an option?

The answer is activity, particularly appealing given how natural and positive it is! In the realm of physical health physical activity is well established, but the notion of activity for mental health is still lacking. Interestingly, activity plays a much greater role in mental health than physical health, due to how for the latter it is really all about physical activity, while for mental health diverse types of activity play a role. As a psychiatrist treating a wide-range of conditions, I have seen first-hand the benefit of activity and routinely apply it to clients. Furthermore, I practice behavioral activation treatment (BAT), an intervention that is at least as effective as medication for severe depression. Furthermore, in my own life I have been highly active noting the benefits for mental health. This background and experience led me to research the spectrum of activity to reveal the evidence and uncover the reasons for why activity is so beneficial.

The resulting book, Activity For Mental Health(Academic Press) explores activity in general, and specific forms of activity—physical, social, nature, cognitive, art/hobby, and music. Two key reasons for why activity in general characterizes mental health are requirements derived from human evolution and the value of absorption in positivity. In contrast to our tree-dwelling higher primate relatives, humans had to be active walking about in search of food, water, safe resting sites, and other valuable resources. Consider our two-legged (bipedal) form of motion and how difficult this would be for chimpanzees, orangutans, and gorillas. These primates actually do quite fine in limited spaces, without the physical and mental costs that humans incur. In other words, we evolved to be active and this is expressed in the requirements for health. Regarding a positive focus, negative distractions are ever present and weigh us down psychologically. Absorbing oneself in a positive focus, such as that inherent in activity, removes a person from negativity fostering positive mental health. Absorption in positive foci represents a form of adaptive dissociation.

Beyond activity in general benefiting mental health, physical, social, nature, cognitive, art/hobby, and music activity each have an impact. In this day and age of “evidence-based” interventions, it is important to establish whether or not and to what extent the various forms of activity both treat mental illness and advance mental health in the general population. On a 1-5 scale with 1 the highest level, the evidence does not fall below 3 and is typically in the 1-2 range. The impact and reasons for why each form of activity is beneficial for mental health in brief consists of:

PHYSICAL HEALTH:

Various forms of research conclusively demonstrate that physical activity advances mental health. Improved physical self-perspectives and associated changes in self-concept appear to play a significant role in the psychological benefit. At a biological level, physical activity does appear to increase blood flow to the brain and neurogenesis meaning the growth and survival of neurons.

SOCIAL ACTIVITY:

Humans evolved in hunting-gathering groups instilling a social brain, in contrast to tigers for instance that are quite fine on their own. We require social contact and in a world that is becoming more and more socially fragmented, isolation and loneliness contribute to mental illness. It turns out that the impact is greater for loneliness than isolation per se. With social and emotional support, mental health is advanced.

NATURE ACTIVITY:

Given the beauty and serenity of natural settings it “naturally” follows that nature is beneficial for mental health, but certain safety related issues actually influence this outcome. The evidence is strong that nature activity can enhance mental health, even though the role of physical and social activity in nature has to be teased out. Regarding why nature activity seems to work, it induces relaxation responses thereby reducing stress responses. Several very interesting features of natural settings seem to align with how the brain is structured to achieve this outcome.

COGNITIVE ACTIVITY:

Although it would seem that mental activity enhances mental health in terms of mood and the like, very little research focuses on this, with the vast majority addressing the impact of cognitive activity on cognitive functioning, such as with dementia. The intriguing role of so-called negative symptoms is explored revealing the powerful impact on mental health and illness. One outcome that appears clear is cognitive activity predicting cognitive health and not the reverse. Pertaining to mental illness such as dementia the benefit is greatest in the early phases.

ART/HOBBY ACTIVITY:

I note that few people have a real hobby while many can benefit from acquiring one. Research backs up this perspective demonstrating how such activity both treats mental illness and advances mental health in the general population. This outcome arises from diverse studies conducted in many regions of the world. Several psychological benefits including empowerment and motivation flow from art/hobby activity.

MUSIC ACTIVITY:

This form of activity might seem to fit into the art/hobby category, but it is very distinct. The history of music and mental health is entertaining with the good, bad, and ugly all well represented. Ultimately, it appears all good based on how music activity resonates with emotions due to amazing similarities. In addition, music appears to activate and stimulate many brain regions. The evidence for music activity enhancing mental health is very strong, and it appears to have a profoundly positive impact on elderly people.

Consistent with my clinical work, I cover how behavioral activation treatment works to reveal the power of behavioral activation. However, the focus is on informal activity to treat mental illness and improve mental health in the general population. Activity including the specific forms of physical, social, nature, cognitive, art/hobby, and music, represents a robust, cost-effective, and easily accessible mental health intervention. Treat yourself to activity therapy in the ways discussed, and expand the degree of involvement and diversity of options to the benefit of your mental health.

See the Books section of this website for more information and links to sellers.

Nov 142019
 

Social and environmental justice, or more to the point, injustice, are often treated separately, but they are very interconnected. This intersection of social and environmental injustice might well be what eventually triggers widespread revolution, given that it is typically less affluent people who suffer the burden of the cost. In tropical countries, the poor often live right by the coast, while the wealthy reside in more exclusive hillside communities protected from flooding, for instance. Revolution was touched off in Syria by the intersection of social and environmental injustice, given that water scarcity linked to global warming created great suffering for poor farmers, while wealthier farmers could bribe officials to secure scarce water. This provides a country level example of what could happen on a global scale! Hence, it might be wise to consider the intersection of social and environmental justice when considering either.

Apr 252019
 

Some people have raised the issue of what defines mental illness, which is made clear in my book, Mental Illness Defined: Continuums, Regulation And Defense (https://bradbowinsbooks.com/mental-illness-defined/). Besides not aligning with the true nature of psychopathology, discrete diagnoses are less humanistic than a continuous characterization, whereby mental health problems range from normal to extreme levels. Take personality disorders, where in clinical practice there is an us versus them orientation. My continuous model of personality disorders views these problems as extreme and enduring expressions of common psychological defense patterns. For instance, avoidance is a normal survival defense when applied to dangerous agents, but when it occurs repeatedly in response to agents offering reward potential it is highly dysfunctional—avoidant personality disorder. We all engage in avoidance but it is the degree that counts, so the client and therapist are not all that different. The same applies to psychosis where based on a continuous model psychotic level cognitions represent the extreme range of thought content, thought form, and sensory perceptual experiences. We all experience psychotic level cognitions during sleep when dreaming, but with psychosis they occur repeatedly in the conscious and awake state, due (from my perspective) to impaired regulation over psychotic level cognitions. Hence, a value of my continuous model of mental illness (aside from aligning with scientific research and not pharmaceutical marketing needs plus our preference for discrete entities to simplify information process) is that it is much more humanistic!

Feb 202019
 

MENTAL ILLNESS DEFINED: CONTINUUMS, REGULATION AND DEFENSE presents a perspective on mental health and illness divorced from financial influence, and one that aligns with scientific evidence. The Diagnostic And Statistical Manual (DSM), which is essentially the diagnostic bible of mental illness, began emphasizing discrete conditions with the third edition (DSM-III). The starting point was Panic Disorder known to those in the pharmaceutical industry as the “Upjohn Illness.” Prior to this newly created discrete entity, panic was viewed as part of anxiety, a more intense expression. In DSM-II it was seen as “anxiety neurosis,”—“This neurosis is characterized by anxious over-concern extending to panic and frequently associated with somatic symptoms.” In 1964 Donald Klein published an article suggesting that panic was a distinct illness, and that these attacks could be forestalled by staying on medication. The study was partially funded by Geigy and Smith & Kline & French suggesting the possibility of bias in his concept. Klein being on the DSM-III task force, apparently persuaded the other members of the anxiety and dissociative disorders subcommittee that his view was correct, and panic disorder became an entity. The following year in 1981 Upjohn marketed alprazolam (Xanax) for this disorder when the market for benzodiazepines was declining. Research funded by Upjohn did not show much support for panic disorder as a distinct entity, but it was a good marketing story. Xanax became one of the hottest drugs in psychiatry by the early 1990’s being prescribed by psychiatrists for this new and widespread disorder.

Industry funded experts establish criteria for discrete disorders as laid out in the Diagnostic And Statistical Manual (DSM), and these experts are often funded by the pharmaceutical industry. Lisa Cosgrove and colleagues (Financial ties between DSM-IV panel members and the pharmaceutical industry) published in Psychotherapy and Psychosomatics in 2006 uncovered some relevant findings. They found that 100% of the “mood disorders” and “schizophrenia and other psychotic disorders” panel members had one or more financial associations with companies in the pharmaceutical industry. As David Healy has stated, “As often happens in medicine, the availability of a treatment leads to an increase in recognition of the disorder that might benefit from that treatment.” Panic disorder is such as example.

Natural entities tend to be continuous and mental illness is no exception. Separate continuums do occur, such as depression, anxiety, hypomania-mania, and psychosis as laid out in the book, but subtypes represent fictions as with discrete categories. Quantitative variation often yields qualitative variation as an emergent property. For example, intense levels of anxiety (quantitative) triggers the fight/flight/freeze response central to panic (qualitative). Likewise, melancholic depression with vegetative features emerges with intense depression. Beyond bias for profit considerations, we are all prone to seeing discreteness to simplify information processing: it is easier on the brain to see distinct items than follow a concept such as quantitative variation yielding qualitative variation as an emergent property. However, if psychiatry and clinical psychology are ever to become true sciences, then fictitious entities to simplify information processing and satisfy marketing needs of pharmaceutical companies must be discarded!

Dec 172018
 

Temperature values for global warming are reported in degrees above pre-industrial levels, with average values dominating. However, it seems far more sensible to report values for regions where global warming is having the most impact, namely the Arctic and Antarctic. On average, we are about 1 degree Celsius over pre-industrial levels, and this frankly does not seem to disturb most people, particularly if defensively downplaying the impacts of global warming. Considering that the Arctic and Antarctic regions are now about 2-4 degrees Celsius over pre-industrial levels, and 3-4 degrees is when runaway negative feedback cycles occur, I suggest that these regions need to be the focus. In researching global warming (see, At The Tipping Point: How To Save Us From Self-Destruction, bradbowinsbooks.com) and understanding how natural entities are highly interconnected, I came to appreciate that it is these negative feedback cycles that will be most telling. They include occurrences such as:

  • Open water absorbing more heat, driving more melting of sea ice, more heat absorption.
  • Carbon soot on ice absorbing light, melting ice raising temperatures with greater light absorption from open water.
  • Melting water from glaciers creating a lubricating surface causing the glacier to slide into the sea, where it melts, leaving less cooling ice.
  • Melting permafrost releasing methane, that ramps up temperatures, resulting in more permafrost melting.

 

Perhaps it is time that we move away from the focus on average temperature increases and emphasis temperature increases in the Arctic and Antarctic where it really counts. Those who spin things to not see an impact of these regions on the overall world and themselves personally, really need to appreciate that all things in nature are connected!