Friday, December 26, 2008

Mindfulness Based Cognitive Behaviour Therapy (MB-CBT)

Meditation is easily, and correctly, regarded as a relaxation exercise, but it is also about increasing awareness of yourself and your surroundings. Both of these aspects can contribute to healthy living and overcoming psychological problems. Studies have shown meditation to decrease anxiety, fatigue, and suicidal ideation, as well as being beneficial to treating addictions, phobias, pain and to help prevent relapse into depressive states. Yoga has been found to increase spatial memory in adolescents and to also benefit adults suffering from depression (in conjunction with psychiatric medications).

There are many negative assumptions made against meditation categorising it as quiet time for new-age type people or as a spiritual or religious exercise. While this can be true, meditation is something that can be practised by everybody on their own terms. In fact, it is sometimes better to avoid using the term ‘mediation’ and instead refer to it as cognitive therapy, a relaxation method, or, depending on the patient, avoid labels altogether and simply try to guide them through homework exercises. Removing the stigmas associated with labels can increase patient participation in a potentially helpful augmentation to other therapies.

The word ‘mindful’ is commonly used on its own without associations to either meditation or CBT with the term being explained as experiencing the details of sensory information in discrete units without becoming overloaded, to enjoy each sensory experience, and to observe without having to immerse the self in the perceived chaos of environment, thoughts, and beliefs.

The point of that exercise is to respond to all the baggage people carry about what meditation is. We want to dispel those notions right away. So we say, "Look, the first exercise we'll do isn't breathing; it isn't sitting in the full lotus posture and pretending you're in a fine arts museum, or standing on your head. We're just going to eat a raisin—but eat it mindfully, with awareness."
You look at the raisin—feel it, smell it, and with awareness bring it to the mouth gradually, and see that saliva starts to get secreted just as you bring it up. Then you take the raisin into the mouth, and you begin to taste this thing that we usually eat automatically. From there it's a very short jump to realize that you may not actually be in touch with many of the moments of your life, because you're so busy rushing someplace else.
” (Kabat-Zinn)

New research is being done on the usefulness of MB-CBT in treating eating disorders (MB_EAT). Negative symptoms stem from the relationship between the self and food and distorted perceptions of that relationship including guilt and poor self-image. In persons suffering from eating disorders, the physiological mechanisms for appetite and the neurological pleasure response to eating are less active. It is therefore hypothesized that mindfulness based exercises, by increasing awareness of physical sensations particularly those accompanying eating, appetite, and digestion, can be helpful in treating unhealthy eating habits. However, this is still very new and much more research will need to be done in the area.

In spite of all the limitations, mindfulness is still an exercise that can prove to be very beneficial, at least on a patient-by-patient basis (as with most psychiatric treatments). It can also be modified for children by decreasing the length of exercises and using age appropriate topics/objects in the awareness exercises. Parents should also be encouraged to practise the techniques with their children. Whether adult or adolescent, it is important to practise the techniques regularly and consistently. For people who are interested, I suggest reading about the different approaches and follow the suggestions of practice.

Self-treatment exercises, though not sufficient alone to treat major psychiatric disorders, can help temper symptoms until next visit with physician thereby keeping people out of hospitals which can be distressing environments (but I do encourage people who are in crisis and need assistance to use the emergency services available to them, including the Emergency Department at hospitals) and give a person more sense of control over their symptoms.

References and Links:
-Bill Moyers interview with Dr. Jon Kabat-Zinn (developer of raisin meditation) who describes mindful meditation
-contains different mediation techniques for children in various age groups
- another site with meditation exercises for children
-mindful meditation instruction; also has instructions for different meditation styles

Sharma VK, Das S, Mondal S, Goswami U, Gandhi A. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression.

Manjunath NK, Telles S. Indian J Physiol Pharmacol. 2004 Jul;48(3):353-6. Spatial and verbal memory test scores following yoga and fine arts camps for school children.

Williams JM, Duggan DS, Crane C, Fennell MJ. J Clin Psychol. 2006 Feb;62(2):201-10. Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior.

R . Wall. Journal of Pediatric Health Care. 2005. Volume 19, Issue 4, Pages 230 – 237. Tai Chi and mindfulness-based stress reduction in a Boston Public Middle School.

Kristeller, Jean L. Mindfulness, Wisdom and Eating: Applying a Multi-Domain Model of Meditation Effects. Constructivism in the Human Sciences. 2003.

Thursday, December 18, 2008

Original Thought, Creativity, and Plagiarism

This research started with my belief that Newton and Leibniz could not have been the only two people documented as having simultaneously, and separately, conceiving of the same idea. This opinion of my mine, which is why it is always a good idea to research your opinions, was at the time based only on the discovery of calculus, a Google image of a child’s painting that looked remarkably like one of my own, and a vague recollection of the plot of The Secret Window.

As far as the calculus debate goes, Newton was first credited, and Leibniz publicly discredited, as having developed the new math. Later, after Leibniz’s death, both men were to receive credit for their contributions.

‘Credit’ is the re-occurring theme here; the proprietorship of an idea.

Personally, I do not believe in original thought or creativity, at least in the strictest sense of the definitions. Indeed, for someone who is a non-creationist, it would seem rather contradictory if I did. As a physicist, I believe the universe is infinite, and therefore everything from ideas to matter is already contained within it. Which warrants the question of scepticism, ‘Can ideas be scientifically measured?’

Plagiarism quite obviously does exist. All one has to do is copy another person’s work and put their name on it. But beyond blindly copying and pasting, the area of plagiarism also enters a grey area of the ownership of an idea. Certainly, if one author were to word-for-word publish another author’s work under their own name without giving credit, that would be plagiarism. But what if that author instead paraphrased the original work? What if the original work was used as a general base of inspiration for a story in which details varied greatly? Should the second author not be credited with their own interpretation of that which was presented to them, their interpretation being their idea of proprietorship? Should an artist who can reproduce Monet not be commended for their skill?

The legal definition of copyright infringement in Canada is primarily based on whether or not the person using a previous work will personally gain from such use. Also note the exceptions and limitations of ‘fair dealings.’

In times and societies where ideas carry an inherent dollar value, whether in the sale of a physical object of creation or in the remuneration for possible ideas as in research, the legalities of plagiarism are only natural.

However, there are other communities in which the creative process is what is acknowledged, and participants are encouraged to extrapolate on what has already been created. The point here being to encourage individual thought and creativity, not to attempt to create something brand new and then brand it.

Individual thought and creativity is something I absolutely do believe in and encourage. Active participation in thought is indeed the only thing with which to dispel ignorance. Furthermore, the joy of thought, discovery, insight, and work should not be measured in terms of how much, money or reputation, can be made off of it, but should instead be given value by that person engaging in the process. It is their thought after all. And if they choose to sell it for actual dollars, by all means. Anything that people will buy can be sold and bills do need to be paid and those who wish to devote their lives to the development of ideas should be compensated as much as any other entrepreneur.

Reputation is built within the confines of a particular social or professional circle. If what it is a person desires to acquire is something belonging to a particular person of a peer-reviewed standing, then they will pay for that name at least as much as for the work. So then, if someone else is selling renditions, why not let them? The reputable person will not lose anything by it, unless of course their group decides it’s time to initiate someone new into the circle. But, alas, such is the world of external validation.

Ultimately, and ideally, if ownership of ideas is redefined by what is different rather than what is similar, more people might be more willing to engage in producing ideas. If plagiarism is what leads to creativity, then plagiarism should be encouraged. The pitfall here of course is that thought itself can not be easily monitored, and so yes, there will continue to be people who lazily plagiarize. But this should not be a limitation for those who would work to take an idea, whether conceived individually or as an extension of some other conception, and to joyfully commit that idea to both the evolution of global thought and to the continual personal satisfaction derived from thought.

All of that said, any person who knowingly uses a previous work for inspiration/interpretation should always acknowledge their muse. It’s just polite.

Creativity and Psychiatry:

It has been long recognized and documented that persons with certain psychiatric disorders, particularly those with psychotic or psychotic-like symptoms such as schizophrenia and manic episode bipolar disorder, have been associated with greater creativity. It is because of this association that those afflicted (with bipolar disorder) are hesitant to assume any treatment for the illness believing it will decrease their creativity. However, there is little evidence to support this fear. In fact, when under treatment, a person is likely to be more productive and creative. There is some literature documenting that Lithium decreases certain brain functions associated with creativity. But the myriad of other pharmacological treatments for mood disorders offers many alternatives to this medication.

Creative treatments for emotional disturbances, including post-traumatic stress symptoms, include imagery centred CBT, narrative therapy, and art and play therapy.

Previous approaches to cognitive behavioural therapy were primarily based on verbal interactions. The more recent research looking into how stressful events, such as suicide, can be triggered and how anxious emotions from earlier trauma can be exaggerated by rumination in visual processes is helping to formulate new approaches to the psychotherapy regime. This new technique, termed ‘imagery rescripting,’ works under the basic principle of CBT in rewording a story, or opinions of an event, only it is an image that is restructured instead of a sentence.

Narrative therapy involves recounting one’s experiences in a story format. This can be done either with the assistance of a therapist who can help draw out a story if a person has a difficult time structuring their thoughts, or can be done as a self-help exercise by journaling. However, the benefits of this therapy require one to re-write their story by replacing negative words with positive ones, by looking at the experience from a different perspective as an author of their life story.

Art therapy also has some health benefits, although these are limited and not alone sufficient for treating psychiatric disorders. But, particularly for creative people, structured art therapy can help one better understand how their thoughts relate to their emotions. As with other creative therapies, the art being produced should be a new and positive reflection on previous negative distortions.

The benefits of the previous three therapies can be used in the treatment of many different psychiatric disorders beyond mood disorders. The purpose of cognitive therapies is to reconfigure distorted thought processes such as occur in personality disorders, eating disorders, and PTSD. Additionally, these therapies may be beneficial when treating adolescents and children as they are approaches that children may find easier to engage in and communicate with.

References, Suggested Readings, and Links:

Cashin, Andrew. Narrative Therapy: A Psychotherapeutic Approach in the Treatment of Adolescents With Asperger's Disorder. Journal of Child and Adolescent Psychiatric Nursing, Feb 2008.

Pennebaker, JW and Seagal, JD. Forming a story: the health benefits of narrative. J Clin Psychol. 1999 Oct;55(10):1243-54.

Holmes, Emily A., et al. Imagery about suicide in depression—‘‘Flash-forwards’’?. Journal of Behavior Therapy and Experimental Psychiatry. Volume 38, Issue 4, December 2007, Pages 423-434

Rothenberg, Albert. BIPOLAR ILLNESS, CREATIVITY, AND TREATMENT. Psychiatric Quarterly, Vol. 72, No. 2, 2001

Wright, Thomas E. CREATIVITY AND BIPOLAR DISORDER. Medical Problems of Performing Artists. September 1997.

O’Boyle, M., et al. Mathematically gifted male adolescents activate a unique brain network during mental rotation. Cognitive Brain Research 25 (2005) 583 – 587.

Carlsson, Ingegerd, et al. On the neurobiology of creativity. Differences in frontal activity between high and low creative subjects. Neuropsychologia 38 (2000) 873±885.

-copyright act

-a good overview of narrative therapy

-a good discussion about the grey areas of plagiarism and inspiration in art and design

-an inspirational motivation for developing thought with some exercises

-has some interesting excerpts from the Supreme Court regarding copyright laws