TagCBT

Reading of the Week: Better Sleep, Less Psychosis? The Freeman et al. Study on Sleep & CBT

From the Editor

If students sleep better, are they less likely to have mental health problems like paranoia?

In this week’s Reading, we look at a new study from The Lancet Psychiatry. In this single-blind, randomized controlled trial, Oxford professor Daniel Freeman et al. consider students from 26 universities with insomnia, assigning them CBT (offered over the internet) or the usual care.

Spoiler alert: the students with CBT did better.

Sleep: good for babies, teddy bears, and students

In this Reading, we review that paper and consider the broader implications.

DG

Continue reading

Reading of the Week: “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA on Psychotherapy

From the Editor

Is CBT overrated? The authors of a new JAMA paper raise this question in a cutting Viewpoint.

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

Last week, we looked at conversational agents.

This week, we ask: is CBT really the gold standard for psychotherapy?

University of Giessen’s Falk Leichsenring and Medical School Berlin’s Christiane Steinert consider CBT and the research that has been done in the area. “CBT is usually considered the gold standard for the psychotherapeutic treatment of many or even most mental disorders.” But should it be? Leichsenring and Steinert argue no.

beck_aaron_t-_112798Aaron Beck: Great bowtie, but is his CBT really so great?

In this Reading, we review their paper, and consider their argument.

DG

Continue reading

Reading of the Week: Stressed & Expensive – the Chiu et al. Study on the Health-Care Costs of Distress and Depression

From the Editor

He isn’t able to work. He often can’t get out of bed. His partner is beside herself. And his diabetic management is poor.

He’s the sort of patient who we see often – in specialist offices (like mine) and in family medicine clinics, and also in emergency departments and on hospital wards. His depression is affecting his life, his family, his workplace – and, yes, his health. Here’s a quick question: how much higher are his health-care costs than those who don’t struggle with depression?

In this week’s selection, we look at a new paper by Maria Chiu et al., considering the costs of depression and distress.

business-comment_01_temp-1382010303-525fcdbf-620x348Distress and depression: Painful to patients – and costly to the system?

In this Reading, we review the paper, and consider the larger context.

DG

Continue reading

Public Coverage for Evidenced-based Therapies for Depression and Anxiety?

Should there be public coverage for evidenced-based psychotherapies for major depressive disorder and generalized anxiety disorder? The Ontario Health Technology Advisory Committee recommended yes in a new draft paper, and gave comment on ways of doing this.

1449525903619

The Committee asked for public feedback. In my submission, I noted: “The recommendations of the Ontario Health Technology Advisory Committee are reasonable and thoughtful.”

You can find my full submission here:

gratzer-ohtac-submission

Reading of the Week: Better Treatment, Safer Roads? The New JAMA Psychiatry Paper on ADHD & Driving

From the Editor

How can we reduce the number of car accidents?

We often speak about treating mental illness in terms of reducing personal suffering. Recent selections have looked at the economic cost of mental illness. But what are the implications to public health?

This week, we look at a new JAMA Psychiatry paper; this national cohort study involved more than 2.3 million people with ADHD, and considered motor vehicle crashes (as measured by emergency department visits) and whether or not they were taking medications.

Yes, he has a plaid shirt, but should he be taking his prescription meds?

Spoiler alert: The authors find “medication use for the disorder was associated with a significantly reduced risk” of vehicle accidents.

We also look at an editorial that finds “clinical pearls” in this paper.

DG Continue reading

Reading of the Week: The Future of Psychiatry – Part II of II

From the Editor

Is mental health becoming too technical (and forgetting patients as a result)?

The future of us clinicians?

This is the second Reading in a two-part series considering the future of mental health – not in terms of distant developments like biomarkers and genetically-tailored drugs – but rather by looking at measurement-based care and the evolution of the field.

Last week, measurement-based care.

This week, the end of the art of care?

This week, we look at an editorial The British Journal of Psychiatry that warns against physicians becoming “well treated skilled workers.”

And, continuing the consideration of ‘the future,’ we also consider a new paper that has received much attention. Can a web-based intervention help with insomnia? Spoiler alert – as The New York Times reported last week, “more than half of chronic insomniacs who used an automated online therapy program reported improvement within weeks and were sleeping normally a year later.”

DG Continue reading

Reading of the Week: Can We Prevent Psychosis? Part 2 of 2

From the Editor

Is an ounce of prevention worth a pound of cure? As noted last week, psychiatry tends to emphasize the treatment of illness, not its prevention. But preventing illness is our ultimate goal.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Last week. The psychosis risk calculator.

This week. Cost-effective prevention.

In this week’s Reading, we look at a paper that considers CBT to prevent psychosis in an ultra high-risk group; the paper also considers the cost-effectiveness of the intervention. So is Ben Franklin right in arguing that an ounce of prevention is worth a pound of cure? The paper doesn’t weigh in on Franklin, of course, but it does find that CBT is economically sound with an 83% likelihood of reducing the transition to psychosis and at a lower cost.

DG Continue reading

Reading of the Week: I Can’t Sleep – Insomnia, Part I of II

From the Editor

It’s one of the most common patient complaints: I can’t sleep.

What many of our patients aspire to…

Insomnia affects 6 to 10% of the population. It’s a common problem – and often chronic. But are we mishandling insomnia?

In a two-part, two-week series, we look at the latest in insomnia research.

This week. Fewer Pills, More Therapy. The new Clinical Practice Guideline.

Next week. Insomnia, Is There an App for That? The GoodNight Study.

This week, we look at the new American College of Physicians Clinical Practice Guideline on insomnia that suggests that CBT-Insomnia should be the first-line treatment.

DG Continue reading

Our New Paper: “Making Evidence-Based Psychotherapy More Accessible in Canada”

Happy to see that our paper has just been published (online first) in The Canadian Journal of Psychiatry. And what a great project. My co-author, Dr. David Goldbloom, is a former supervisor from my training, a mentor, and a friend. Back in residency, we talked about a joint project – so glad that, after a few years, it happened.

As usual, I learned much from working with him.

You can find the paper here:

http://cpa.sagepub.com/content/early/2016/04/05/0706743716642416.full.pdf+html

Reading of the Week: To Screen or Not to Screen – Pregnancy & Depression Screening

From the Editor

“Panel Calls for Depression Screenings During and After Pregnancy”

A government health-care panel making a revision to a past recommendation seems pretty ‘inside baseball’ – and hardly the stuff of international headlines. Last week, though, the decision of the U.S. Preventive Services Task Force to now recommend the screening of pregnant and post-partum women for depression was reported from New York to New Delhi.

For the record, The New York Times story (whose headline appears above) ran on the front page.

Why the change and what are the implications?

To screen or not to screen…

This week’s Reading looks at the big decision and we consider: is it a big bust?

DG Continue reading