Tuesday 6 December 2016

Be careful to whom you entrust your mental health

Just like medications, psychological therapies can come with potentially serious side-effects

Patricia Casey

Published 22/11/2016 | 02:30

There are many therapies available that promise more than they deliver
There are many therapies available that promise more than they deliver

Anxiety, stress and distress are universal emotions and their presence indicates that the person is a normal, functioning human being, dealing with the everyday challenges life throws up.

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These vary from grief at the loss of a loved one, to the stress of losing one's job or the anxiety of sitting for an examination. The support of others, along with their own innate strength, is enough to see one through. This is called resilience and, invariably, there is no need for any therapy. It is only when the person's day-to-day functioning is impaired that any therapy needs to be considered.

There are many therapies available that promise more than they can deliver. However, some are beneficial and have a scientific evidence base. The array is bewildering but none should be used for normal emotional reactions and some should be approached with caution.

Hypnotherapy has achieved a bad name over the years because of its association with performance and the belief that one loses control to another during the trance state. Yet there is scientific evidence to back up the benefits of hypnotherapy for anxiety states.

There are no hypnosis practitioners working within the public mental health system and most psychiatrists have never had any exposure to it. There is certainly a gap in our therapeutic armamentarium for anxiety with its demise. However, exaggerated claims regarding its use for other conditions, from low self-esteem or addictions, also tarnish its reputation.

Craniosacral therapy lacks any coherent explanation for its advertised benefits since they are described as subtle. There is no doubt that having one's head gently held by a therapist is likely to be pleasant, but the evidence that this in some way beneficially improves the circulation of the cerebrospinal fluid between the covers of the brain is simplistic and naive. One website claims "skilled practitioners can monitor this rhythm at key body points to pinpoint the source of an obstruction or stress. Once a source has been determined, they can assist the natural movement of the fluid and related soft tissue to help the body self-correct".

In 2006, Professor Steve Hartman from the College of Osteopathic Medicine, writing in Chiropractic & Manual Therapies, pointed to the continuing lack of evidence for this intervention.

Neurolinguistic Programming is not usually used in therapy and has found greater use in business and marketing. The evidence for its benefits in anxiety and stress-related conditions is lacking - that's not to say it may not be found to be useful in the future, but the number and quality of the studies available does not yet permit confidence in claiming benefits.

For acupuncture, there is no scientific evidence for the benefits of acupuncture for anxiety or stress-induced states, although there is a large body of research supporting its use in pain management.

Regression therapy is controversial and is not practised in mainstream psychiatry, although there are practitioners who make claims about its success. It is used to elicit traumatic memories that may be responsible for the person's present-day symptoms. In some cases, it is in this context that false memories of sexual abuse have been generated.

The management of sexual abuse and its impact on adults is treated with a mix of psychodynamic, narrative, behavioural and cognitive approaches that are now available through specific services established nationally several years ago and most general practitioners are aware of their whereabouts in your area.

Mindfulness has a very good evidence base for stress and anxiety and is also readily available in public mental health services, as are other psychotherapeutic approaches, such as cognitive therapy and psychodynamic therapy.

These therapies are not a one-size-fits-all approach and they will sometimes be used in combination to target the person's particular combination of symptoms and difficulties. Just like medications, psychological therapies are not inert interventions and they have side effects. Identified in various studies, these include: dependence on the therapist, making the completion of therapy particularly painful for the patient; loss of self-confidence with prolonged therapy; self-harm when painful issues are raised, such as abuse or childhood separations; and worsening of the symptoms for which they were referred.

Before commencing therapy, request information about the qualifications of the therapist, check the type of therapy they practise and the side effects. Then discuss it with your doctor before jumping headlong into a potentially-lifechanging experience.

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