Wednesday, July 29, 2009

The Appetite Awareness Workbook – A Book Review

This well composed self-help book for disordered eating focuses on teaching the reader to adjust their eating habits based on physical cues instead of on external stimuli. At first I thought this approach might be problematic for more severe disordered eating habits as starvation and binge episodes can reset internal, physiological, metabolic signals. If a person starves themselves for an extended period, for instance, the body will grow tired of being constantly hungry and the person will cease to have an appetite drive. As well, when that person does eat, the body wants to take in as much food as it can and the person will also not have the feeling of being full, even if they are in pain. But this problem is addressed briefly in the book, arguing that the underlying signals for appetite are still there, they just need to be brought into awareness.

The book contained a fair amount of text, something I find to be a good quality in self-help books which might otherwise become overly redundant with their worksheets. The text gives the reader more insight into how and why they are working a particular issue. It offers support and encouragement during the recovery process as well.

The worksheets that were in the book, I found quite appealing; there was more of an inter-active, fill-in-the-blanks approach to record keeping (as opposed to circling a number or checking off symptoms from a list). Even the rating type worksheets kept the focus on mindful record keeping, using the scales more as visual aids. Also, the homework exercises begin challenging thinking patterns from the onset of the book, instead of introducing it as an exercise somewhere near the end of the book.

Mindfulness is the key concept in this book and they do a good job of reminding and guiding the reader through the process of becoming more aware.

Work is done on both a general and specific scale of mindful eating where appetite, instead of food amounts, is monitored. The book helps identify healthy and unhealthy external cues for eating and offers suggestions on how to maintain control of your eating in social situations where a number of pressures may occur. The author also spends a good amount of time near with an ending that encourages phasing out monitoring behaviours towards a sustained, mindful approach to eating and helps set out relapse plans.

One problem I had with this book (which I have with all self-help books) is that it requires the reader to be subjective about their thoughts and behaviours. As with any more severe disorder, readers should be encouraged to use these books as aid within a therapeutic framework.

A more specific problem was that the book was centered around binge eating. There were two appendices that briefly outlined AAT approaches to bulimia, purging, and restricting behaviours, but these chapters would have been better placed at the beginning of the book to help those people focus their work from the very start.

Final Rating: If I was a psychiatrist with an annual book allowance, this is a book I would add to my shelf and recommend to patients.

Sunday, July 19, 2009

Extraneous Humour II

Also, I'm a web-comic artist. This was originally posted at The Skeleton Show. Part one was posted last Saturday.

Saturday, July 11, 2009

Extraneous Humour

Also, I'm a web-comic artist. This was originally posted at The Skeleton Show. Part two will be out next Saturday.

Thursday, July 9, 2009

Music Therapy

There is a lot of research being done recently looking into the therapeutic benefits of music. Much of this research has examined pain and anxiety symptoms but less has been done in the specific context of mental illness(though many registered music therapists are out there).

A review done last year showed that while music therapy was well tolerated in depressed patients, had low drop-out rates, and improved symptoms, that the studies under review were of low methodological quality and few in number.

A recent study demonstrated improvements in people suffering from depression or psychosis with a dose related effect of music therapy sessions.

Another study showed an improvement in quality of life of people suffering from a mental illness, though there was no significant improvement in symptoms.

Evidence for the reduction of anxiety in children undergoing acupuncture who listen to their favourite song was found. A limitation of this study, and of interest to futures studies of the effects of music on mood, is there was no control for the type of song chosen by the child.

Another study (with subjects undergoing brain surgery) that shows patient chosen music can enhance quality of life and decrease anxiety when suffering from pain.

Future research in the area of the anxiolytic effects of music therapy with meal-times for eating disorders would be very interesting.

Choice of music can be an area of conflict in therapy. Obviously, what both patient and therapist want is music that will be comforting and supportive. Yet, the two parties may disagree on exactly what music this entails. Music is a very personal accessory, one as closely attributed to identity as hair. The therapist alone can not prescribe a particular music and expect it have results based on the content of the piece alone. As well, the patient may need to examine their choices in music for any negative influences resulting from their disorder (often a person who is depressed will seek comfort in depressing songs where it would be more advantageous to use happier songs to relieve discomfort).

For anyone who plays music, at any level, sharing music with your therapist can be quite beneficial as the therapeutic alliance and self-confidence may be strengthened. As well, practicing mindfulness techniques while practicing your instrument (or listening to your favourite music) can further improve symptoms. Examining favourite recordings in session can also be an insightful therapeutic exercise.

I do believe in encouraging the playing of music, where possible, as opposed to actively or passively listening to a recording. Playing an instrument is a full body experience, not just in how the player affects the instrument, but in how the instrument physically responds (tension, vibrations, texture…). The addition of the process of reading music, translating one symbolic language into another, may also help with cognitive deficits.

Furthermore, playing music with a group has the additional benefits of increasing interpersonal interactions in a healthy, supportive, and engaging environment. There are many groups which do not require an audition or any previous experience. Choirs (church or otherwise), amateur orchestras, karaoke, playing with friends, drum circles, and Rock Band (seriously) are just some ideas.

And if you’re looking to learn to play and are wondering which instrument is the best choice, the answer is cello. Anyone who says otherwise is obviously not a cello player. There is one lady in Vancouver who specialises in both cello playing and music therapy (I know nothing of her reputation).

The Music Therapy Association of BC has some interesting links.

Sunday, July 5, 2009

Vitamin D

Vitamin D! Yes, I am that excited. Also, ducks are funny. It’s all relevant.

Vitamin D is a steroid hormone synthesised from a cholesterol molecule into one of two forms, D2 (from plants) or D3 (via exposure to UV-B light or from fish oil). In order for either of these forms of Vitamin D to be useful to the body, they must be processed by the liver or kidney into its active form, 1,25-dihydroxycholecalciferol.

Vitamin D is responsible for mineral metabolism (including increasing calcium absorption) and bone growth.

Two major consequences of Vitamin D deficiency are rickets (softening and deformation of bone) in children and osteomalacia (same thing, different name) in adults.

Research has been looking into Vitamin D deficiencies, metabolic roles, and treatment outcomes in a wide variety of areas including cancer, Alzheimer’s, dementia, and depression (6, 7).

Toxicity of Vitamin D will not result from over-exposure to sunlight (though skin cancer may). Overdoses of dietary supplements can lead to serious liver and kidney side effects. Small overdoses over a long period of time accumulate in the body to produce toxic effects, whereas short-term or periodic large doses are safer (4).

It has been suggested, based on the fact that sunlight produces about 10,000 IU of Vitamin D, that the recommended daily dose of Vitamin D (200 – 400 IU) is too low and some doctors recommend increasing this dose up to a few thousand IU. Since D2 and D3 are different molecules and are metabolised differently, recommended dosing might be more complicated than simply saying Vitamin D. Some evidence exists that D2 is not as efficient as D3 (2), while other research indicates no differences in effectiveness (3).

Sources of Vitamin D include sunshine, fish oil or fat, eggs, and fortified dairy and cereals.

References: 1, 2, 3, 4, 5, 6, 7