Nov 262023
 

Discrimination and persecution of homosexual and transgender people continues to be a major problem, and appears to be on the rise in many areas. A key reason for this distressing occurrence resides in how sexual orientation and gender are understood—discrete homosexual, heterosexual, male, female, identities. To simplify information processing we have a strong tendency to put things in discrete categories, such as gay, straight. The drawback of this psychological predilection is that it sets up in-group and out-group distinctions, a tendency derived from our 200,000 to 300,000-year evolution in hunting-gathering groups. Members of one’s group were usually genetically related and hence more likely to assist, whereas those from other hunting-gathering groups were unrelated and more likely to harm. Research has revealed that people automatically apply more positive evaluations to their in-group and negative to the out-group (Brewer & Miller, 1996; Sherif, 1961). The combination of our strong desire to place things in discrete categories and apply in-group/out-group distinctions, almost ensures bias against homosexuals and transgender people.

Attempts to manage discrimination and persecution related to sexual orientation and gender, take the form of encouraging leniency towards those impacted. While noble in its goal, such a strategy is almost certain to have limited results, because it has to overcome the powerful psychological tendencies to cluster things in discrete categories and make in-group/out-group distinctions. If sexual orientation and gender are truly comprised of discrete categories then this is all we have to work with, but what if our understanding of sexual orientation and gender is flawed?

While the human brain likes to cluster information in discrete categories, natural occurrences are almost always structured in a continuous fashion, such as from low to high on a given trait. For example, height and weight occur along a spectrum, as opposed to only short, tall, light, and heavy people. Behaviors also show this continuous progression as with aggression and nurturance varying in degree. As natural occurrences might sexual orientation and gender occur on spectrums? The answer is that they almost certainly do, as recognized by Alfred Kinsey for sexual orientation back in the 1940’s and 1950’s. The Kinsey Scale placed homosexuality at one pole and heterosexuality at the opposite pole. Although this continuous arrangement was revolutionary in import, it does not align with the realities of sexual orientation. Homosexuals and heterosexual must have a strong degree of the given sexual orientation, but varying levels occur within each type. Bisexuals must be placed in the middle, meaning less homosexual and heterosexual motivation than those with only one identity, however, many bisexuals have strong motivations of both forms. Then there are asexuals with little or no sexual motivation that cannot fit on the scale. Therefore, a bipolar continuous depiction of sexual orientation does not work.

What does work is separate homoerotic and heteroerotic dimensions of sexual attraction, motivation, and capacity. Each person has a level on both dimensions with “homosexuals” higher homoerotic than heteroerotic, “heterosexuals” higher heteroerotic than homoerotic, bisexuals equivalent levels on these dimensions, and asexuals very low homoerotic and heteroerotic motivation. Given its importance in reproduction the heteroerotic dimension is certain. A homoerotic dimension is equally likely based upon the presence of such behavior in numerous species of insects, invertebrates, reptiles, amphibians, fish, birds, mammals, and primates, serving diverse and important functions (Bagemihl, 1999).

Regarding gender, instead of discrete female and male categories, there are feminine and masculine dimensions of traits and behaviors. Those rating higher on feminine than masculine features tend to identify with female, while people rating higher on masculine than feminine features identify with male. Mostly this tendency aligns with biological sex and assigned sex at birth, but when it does not transgender feelings occur. This dimensional depiction of gender is consistent with how transgender people commonly describe themselves as non-binary or gender fluid, as opposed to just other sex.

From a perspective of discrimination and persecution, understanding sexual orientation and gender in dimensional terms will greatly reduce or even eliminate bias. This positive occurrence arises from how challenging it is to assign in-group and out-group designations when traits and behavior are shared. If we all have varying degrees of heteroerotic and homoerotic motivation, and male and female traits and behavior, then it is virtually impossible to make the in-group and out-group distinctions that underly discrimination and persecution. Bias is replaced by tolerance and compassion! Additionally, this revised understanding aligns with the apparent reality of sexual orientation and gender, and the truth often liberates us from bias.

In A New Perspective On Sexual Orientation: Theory Meets Reality (Cambridge Scholars, 2023), I present a perspective on sexual orientation based upon separate homoerotic and heteroerotic dimensions that we all have, essentially meaning that bisexuality is the norm. The dominant dimension in each person is preferentially active, but the non-dominant dimension can be activated by circumstances and internal states. Activation and deactivation of sexual orientation dimensions is consistent with how the brain largely works on the basis of activation and deactivation including to sexual stimuli, and how circumstances can trigger sexual orientation behavior. Erotic fantasy is a major activator of the homoerotic and heteroerotic dimensions, amplifying sexuality and sexual orientation behavior. The way that sexual orientation is understood—social construction—influences how it is expressed, with the current homosexual and heterosexual discrete categories tending to deactivate the non-dominant dimension, due to the psychological conflict that manifest with feelings and behavior conflicting with one’s sexual orientation identity. Of note, homosexuality and heterosexuality only arose in the nineteenth century, with sexual orientation understood in vastly different fashions prior to this.

The four-components consisting of homoerotic and heterotic dimensions, activation and deactivation of these dimensions, erotic fantasy, and social construction of sexual orientation, provides a comprehensive perspective on sexual orientation. The intersection of sexual orientation and transgender, understood as separate feminine and masculine dimensions, is also explored.

Jun 292023
 

Psychotherapy is the most common type of intervention for mental illness when the full spectrum of problems is considered. Unfortunately, progress is often limited with approximately one-third drop-out rates an indicator. For the two-thirds of clients that persist with psychotherapy, less than ideal outcomes are fairly common, generating frustration and disappointment for both the consumer and therapist. The combination of solid potential and real limitations necessitates an exploration of factors impeding the progress of psychotherapy, and application of robust strategies to reduce drop-out rates and enhance outcomes. Barriers to progress in psychotherapy span client, therapist, and interactive influences. Each category of influences includes unique contributions:

CLIENT INFLUENCES:

MOTIVATION: Progress in any endeavour relies on motivation and psychotherapy is no exception. Identifying benefits to psychotherapy and addressing perceived costs contributes to a robust benefit/cost ratio, and hence, motivation. Focusing on intrinsic motivation and appreciating that intrinsic and extrinsic motivation are additive or interactive, also assists. Motivation to change is impacted by: personality factors and most prominently open-closed to experience, fear of change, and rigid patterns of behavior, each manageable by specific interventions.

EXPECTATIONS: The relationship between expectations for psychotherapy and the reality encountered—the Expectation-Reality Match (or Mismatch)—is a very important consideration. If reality falls below expectations loss related emotions arise that demotivate, whereas when reality exceeds expectations gain related emotions occur that motivate. Expectation of linear change in psychotherapy, consistent with non-linear dynamical systems theory, is an interesting and highly workable aspect.

PERSONALITY DISORDERS: Disorders of personality comprise a common impediment to psychotherapy progress. Discrete characterizations and efforts to frame abnormal personality in terms of normal personality traits have severe limitations. However, normal psychological defensive processes expressed in an extreme and enduring fashion do produce personality disorders. Advantages of this model include a continuous organization, humanistic countering the us/them perspective, and effective strategies therapists and clients can utilize to improve psychotherapy outcomes.

REINFORCEMENT PARAMETERS: Reinforcement differs from punishment, always increasing the frequency of a behavior, positive reinforcement via reward and negative reinforcement by decreasing or eliminating an aversive state. Reinforcement parameters greatly impact on psychotherapy progress but are commonly overlooked. Structural, psychopathology, and codependence comprise three forms of reinforcement parameters impeding psychotherapy progress.

COMPLEXITY: Greater complexity usually translates into worse outcomes for any scenario. Comorbidity, severity, and practical issues provide potential barriers to progress in psychotherapy by adding complexity. Severity does seem to impede psychotherapy progress and this is clear for personality disorders.

RESISTANCE AND NONCOMPLIANCE: A distinction must be made between these concepts and nonresponse that can arise from many sources. Resistance and noncompliance comprise both a dispositional trait and an in-therapy state of oppositional, angry, irritable, and suspicious behaviors, that bodes poorly for treatment effectiveness. Emotional, dysfunctional patterns of behavior, and personality factor sources of resistance and noncompliance occur.

IMPAIRED STATES AND PROCESSES FOR MENTAL HEALTH: Activity, psychological defense mechanisms, social connectedness, psychological regulation, human specific cognition, self-acceptance, and adaptability characterize mental health, with deficits producing mental illness. From a perspective of psychotherapy progress, impairments to these states and processes for mental health limit outcomes. An understanding of this occurrence affords strategies that therapists can apply to overcome impediments to psychotherapy progress.

TRANSFERENCE: The notion of transference has a long history in psychotherapy originating with Sigmund Freud. Transference feelings are typically quite strong, consistent with the impact that they and transference interpretations have on psychotherapy outcomes. Negative transference can limit psychotherapy by blocking progress with mental health issues due to intensification of the condition, and it also contributes to resistance and noncompliance.

THERAPIST INFLUENCES:

COUNTERTRANSFERENCE: The therapist version of transference is countertransference, referring to how past relationships influence feelings and behavior towards the client. Early psychoanalytic notions of countertransference viewed it as unconscious interference and an obstacle to progress. This understanding has shifted to broader responses to the client, and how these reactions can be shaped by the client providing valuable information. Countertransference can inform about the client, impact therapy outcomes, and influence client resistance and the therapeutic alliance.

EMOTIONAL FACTORS: General categories of therapist emotional factors impacting on psychotherapy progress consist of emotional capacity and emotional stability. Emotional capacity involves several components pertaining to emotion information processing. The capacity to perceive, interpret, feel, and respond to emotions in others is crucial for empathy, which has a profound impact on psychotherapy progress. Therapist emotional instability arises from overuse of immature defense mechanisms, deficient emotion regulation, excessive reactivity, and lack of confidence.

PERSONALITY FACTORS: Both abnormal and normal personality traits of therapists can influence progress with psychotherapy. Although full-fledged personality disorders are unlikely, less intense expressions of avoidant, narcissistic, dependent, obsessive-compulsive, and borderline personality disorders can transpire and impede psychotherapy outcomes. Regarding normal personality, several traits subsumed under virtue, prosocial, and psychologically minded, enhance psychotherapy progress when robust and impede it when deficient.

SKILL FACTORS: Interpersonal skills consist of communication, collaboration, rapport building, alliance focus, boundary setting, cultural sensitivity, self-disclosure, and responsiveness. Collaboration, self-disclosure, boundary setting, and cultural sensitivity, each contribute to rapport building. Therapist interpersonal skills do influence psychotherapy progress, with deficits contributing to the general 35% dropout rate. Non-interpersonal skills include specific and general techniques, organization, and self-care.

INTERACTIVE INFLUENCES:

THERAPEUTIC ALLIANCE: The notion of a therapeutic alliance as a bond, connection, attachment between client and therapist has been around since the early days of psychotherapy, and has stood up very well as a non-specific factor. Key contributors include therapist empathy, client and therapist attachment patterns and communication, and therapist characteristics and skills with rapport building and appropriate responsiveness being very important.

INTERACTIONS BETWEEN CLIENT AND THERAPIST INFLUENCES: Numerous interactions impacting on the progress of psychotherapy transpire between client influences and the therapist influences. Transference and countertransference interactions amplify the effect of these influences. Personality interactions can really impede progress when both the client and therapist are disagreeable and/or reactive.

OVERCOMING BARRIERS TO PROGRESS IN PYSCHOTHERAPY: A CLINICIAN’S GUIDE (ROUTLEDGE, 2023), addresses the client, therapist, and interactive influences on psychotherapy progress. This comprehensive coverage reveals the spectrum of reasons accounting for why psychotherapy of diverse forms does not always progress as both the client and therapist would like it to. Effecting change can be difficult and elusive. However, by addressing the spectrum of reasons for this occurrence inclusive of client, therapist, and interactive influences, diverse impediments to psychotherapy progress can be managed with across therapy strategies, thereby reducing drop-out rates, and optimizing outcomes for the wellbeing of clients and success of psychotherapists.

 

 

Jan 302023
 

Acts of gun violence are a regular occurrence in the United States, prompting repeated calls for gun control of various forms. Unfortunately, these calls for legal reform fail, an occurrence as consistent as the gun violence that prompted the calls for reform. Perhaps it is time that the entire scenario be questioned, as there might be a better way to address this entrenched problem.

That better way is narratives! At an individual level we all have stories about our own life, some more central and others more minor. For instance, a person might view their athletic ability as a central self-narrative. In a similar fashion, nations have narratives that help to define them. In the United States arguably the most powerful narrative is, THE GUN. The west was won by the gun, and the cowboy-gun narrative is potent. Freedom and democracy represent another prominent narrative, although, maybe less robust than THE GUN, because democracy and freedom were largely won by the gun, as in World War II.

Of crucial significance, narratives are fiction and not reality, although they are treated like the real thing. For example, a cowboy and his gun—what could be more accurate? As it turns out, cowboys in the past and the few remaining in the present, can live just fine without a gun, but need a rope. For the true cowboy a rope is more important, but the storyline, “The west was won by the rope” does not really resonate well, even though it is more accurate. Given the power of prominent fictional narratives like THE GUN, trying to advance gun control is likely as effective as bringing a pellet gun to a tank battle. Might the power of narratives provide a way to make a real change in gun violence?

The key strategy that needs to be employed is to first change the prominent narrative to create fertile ground for legal changes. Take England where a prominent narrative is the monarchy and its role over centuries. If for some reason the monarchy was dangerous, trying to legislate its removal would be impossible given the power of the Royal Family narrative. Instead, this narrative would have to be diluted and weakened, such as by showing that the monarchy was not so important to England and maybe even detrimental. Then with the power of the Royal Family national narrative greatly diminished, legislating the abolition of it might be feasible. Likewise, if media, documentary and other filmmakers, writers, and leading figures, strongly questioned THE GUN narrative in the United States to dilute and weaken the power, then and only then, might legislative changes favoring gun control have a chance!

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
 

 

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.