emotional wellbeing: more than just a pill · 2019. 2. 10. · mental health - more than just a...

Mental Health - More Than Just a Pill - Dr Karan Sinha

Emotional Wellbeing:

More than just a pillDr Karan SinhaConsultant Psychiatrist

FRANZCP, MBBS, BMedSci, MPsych

Contents

About Me

Why is mental illness so prevalent?

Limitations of Psychiatric medications

Different types of Psychotherapies

Systematic review of Kindness Based therapies

Limitations of Psychotherapies

Loving Courage Therapy

15 min Meditation

Q & A

1

2


About me

Born in India, grew up in Australia with family.

Education: MBBS, BMedSci, MPsych (University of Melbourne)

Training: FRANZCP (Monash Health, General Psychiatry)

Psychotherapy:

Advanced Psychotherapies Core Program (RANZCP)

MBCT Certificate (Monash University)

Kindness Based Therapies Systematic Review (Masters Thesis)

Where I work: Nicholson Health and Wellness (Fitzroy North) and

Delmont Private Hospital (Glen Iris)

Spirituality: Follow Hinduism and Buddhism. Practiced daily

meditation and yoga for past 10 years, attended multiple

spiritual/yoga retreats.

Why is mental illness so prevalent?

Physical Needs: Addiction to Social Media/screen/drugs - sleep, exercise, diet, social interaction.

Safety: sexual abuse 1/3 females2 in developed countries, domestic violence 1/3 females2.

Love Self : social media comparing, body image, competition, divorce rates

Courage: concept of sensitivity to harm, bullying PTSD,

politically correct.

Love others: divorce rates 35-50%, forgiveness.

Self-Acutalisation:

Decline in Religion

“no religion, no stated”= 40%”

3

4


Psychiatric medications

Benefit:

Depression/Anxiety: antidepressants in severe disease

Psychotic illness- anti-psychotic treats positive symptoms

BPAD: mood stabilisers prevent manic episodes

Limitations:

Depression/Anxiety: mild- moderate disease ( 65%, only slightly above placebo rates, modest effect size1

Personality Disorders (Borderline)3, 5.9% prevalence4

Psychotic illness- negative symptoms

BPAD: depressive episodes weak evidence.

Side effects: weight gain, diabetes, sedation, agitation, insomnia, gastric side effects.

Psychodynamic Psychotherapy

Historically most prevalent psychotherapy, famous psychologists

Sigmund Freud (1900), Carl Jung, Klein, Winnicot

Long term, unstructured, 1 hr, average 1-10 years of weekly

therapy, 2-3/week.

Purpose: Reveal the unconscious content of a client’s mind to

alleviate psychic tension.

Components:

Early childhood experiences, Interpersonal relations, unconscious

conflicts, theories.

Unconscious Defences to avoid unpleasant conflict

Transference and counter-transference: dynamics re-emerge in

client-therapist relationship

Free association, Dream interpretation.

Poor evidence base: Meta-analyses 2012 and 2013, little

evidence for the efficacy of long term psychoanalytic therapy6

May be helpful for complex mental illness and personality

disorder.

5

6


Cognitive Behavior Therapy

History: 1960s emerged. Aaron Beck

Structured, time limited 6-18 session, 1 hour5

Present, here and now.

Behavioral: relaxation, activity schedule, exposure

therapy

Cognitive: core cognitions (catastrophic thinking),

cognitive distortion and restructuring.

Limitations: not deal with past, lack of

compassion/acceptance.

Mindfulness Based Cognitive

Therapy Mindfulness: “focusing one's awareness on the

present moment and accepting one's feelings, thoughts, and bodily sensations”

History: Mindfulness original use in Chronic Pain (Kabat-Zinn, 1982)2,

Based on Barnard and Teasdale's (1991) model7

Group therapy 10-15 participants, 8-12 weeks, weekly 1 hour session.

Guided meditations each session 30mins long with theory and group discussion.

Homework: recommended to meditate 30 mins daily (various meditation 3-30 mins long)

7

8


Mindfulness Based Cognitive

Therapy

MBCT Systematic review for Psychiatric Disorders (Chiesa, 2011)4

Significant reduction in Depression Relapses in Recurrent MDD (4

studies)

Risk reduction of 34%, 6 Studies (Piet, 2011)5

Similar relapse rate without AD compared to on ADs (1 study)

Reduction in Anxiety in BPAD (1 study)

Reduction in Anxiety in Anxiety Disorders (2 studies)

How does it work? Reduced worry, rumination and increased

mindfulness, self compassion and psychological flexibility (Gu, 2015)6

MBCT Program Example

1. Automatic Pilot (use of bells, raisin eating meditatiaon)

2. Dealing with Barriers (Body scan meditatiaon)

3. Mindfulness of the Breath (Breathing meditation)

4. Staying present (Stretching yoga meditation, Walking

meditations)

5. Allowing / Letting be (3 minute meditation, mindfulness of

thought)

6. Thoughts are not facts (Dysfunctional thoughts, Self

compassion)

7. How can I best take care of myself? (Opening to the difficult

people)

8. Using what has been learnt to deal with future moods (Warning

signs of relapse, lake and mountain meditation)

9

10


Kindness Based Therapies

Buddhism- “metta”- loving-kindness, “meditation focused on the

development of unconditional love for all beings”.

Kindness based meditations:

Loving-Kindness meditations (considerate, generous, supportive)

Compassion meditation (sympathetic and empathetic for your and

others suffering)

6-12 weekly 1 hour sessions

Compassion based therapies

Mindful Self-Compassion (Neff 2003)

alleviate suffering by generating non-judgemental kindness towards ones

suffering.

Compassion Focussed Therapy (Gilbert 2009)

Compassionate Mind Training (Gilbert 2009)

6-12 weekly 1 hour group session

Compassion Focused Therapy

Exercises:

Identify and counter self-criticism with kindness and

compassion

Recall memories of kindness (self and others)

Guided imagery meditations, safe place, kind wishes to

others

Compassionate to body parts and postures

Gestault Chair Compassion exercise- empty chair technique

Compassionate letter writing to self and forgiveness to

others

Gratitude journal

11

12


Forgiveness

Forgiveness therapies

Enright's Forgiveness Therapy2 (Enright, 1998),

lower negative emotions and higher positive

emotions.

Give up resentment and respond with kindness

toward the person responsible to relieve burden

of anger and a grudge

6-12 weekly 1 hour group sessions

Background

3 systematic reviews done previously

Compassion and psychopathology (MacBeth 2012), large

effect size

Kindness-based meditation on health and well-being (Galante

2014)- moderately effective in improving self-reported

depression, 22 studies.

Buddhist-derived LKM and CM interventions (Shonin 2015),

significant improvement in psychological distress.

Limitations

Healthy non-clinical samples, prevalence non-

intervention studies.

13

14


Systematic Review

Systematic Review of Effect of Kindness Based Therapies on Psychopathology in Psychiatric Clinical Samples (Dr Karan Sinha, 2015)

MEDLINE

(n =593)

Figure 1. Study selection flowchart

Web of

Science

(n =1,100)

EMBASE

(n = 1,053)

PsycINFO

(n =1,463)

CINAHL

(n =232 )

Scopus

(n =1,148)

Records after duplicates removed

(n = 3,705)

Records screened

(n = 3,705 )

Records excluded based on

inclusion/exclusion criteria

(n = 3,676 )

Full-text articles assessed

for eligibility

(n = 29 )

Full-text articles excluded, with reasons(n = 8)2= duplicate sample used3= majority of intervention not kindness based3= not a clinical psychiatric sample

Studies included in

qualitative synthesis

(n = 21 )

Studies included in

quantitative synthesis

(meta-analysis)

(n = 18 )

3 Studies excluded due to incomplete data for meta-analysis.

15

16


Figure 2. Effect of KBT on Depression Measures

-5 -4 -3 -2 -1 0 1

Standardized

Mean Difference

Gilbert et al (2006)

Lin et al. (2004)

Mendes et al. (2015).

Mendes et al. (2015).

Hofmann et al. (2015).

Lin (2010)

Kelly et al. (2015)

Kerr et al. (2014)

Laithwaite et al. (2009)

Laithwaite et al. (2009)

Bartels-Velthuis et al. (2015)

Kearney et al. (2013)

Hanna, (2013).

Total (fixed effects)

Total (random effects)

Figure 3. Effect of KBT on Anxiety Measures

-4 -3 -2 -1 0 1

StandardizedMean Difference

Gilbert et al (2006)

Boersma et al. (2015)

Boersma et al. (2015)

Lin et al. (2004)

Lin (2010)

Kerr et al. (2014)

Bartels-Velthuis et al. (2015)

Hanna, (2013).

Total (fixed effects)

Total (random effects)

17

18


Limitations of Psychotherapies

To many, hundreds: CBT, DBT, ACT, MBCT, MBT, IPT…

Focus on present or past?

Modest response rates comparable to medications.

Dependent on practitioner.

Difficult to apply structure- individualized to patient.

Mostly counselling: not changing old patterns thinking

Majority of effect is common “therapeutic alliance”

Lack of use of compassion and love until very recently:

Kindness Based therapies (systematic review)

Loving Courage Therapy

Combines Western Psychology and Eastern Spirituality

underpinned with the healing power of love.

Modern psychological concepts: Maslow's hierarchy of needs,

cognitive behavioural therapy, compassion focused therapy and

mindfulness, ‘New Age’ Self-Help, affirmations.

Ancient Hindu and Buddhist concepts are also used including

kundalini yoga, chakras, meditation, metta (loving/forgivness

self and others) and mantra.

19

20


Maslow’s Hierarchy of Needs

Kundalini Chakras Yoga Sutras of Patanjali (400 BC)

Crown Chakra- Pineal Gland

3rd Eye- Pituitary gland

Throat- Thyroid gland

Heart- Thymus gland

Solar – Pancreas gland

Sacral- Reproductive organs

Root- Adrenal glands

21

22


Physical Needs: Food, water, sleep hygeine, exercise, social, screen free time (1 session)

Safety: Environment, body, feelings, thoughts. (2 sessions)

Love Self : Environment, body, feelings, thoughts (2 sessions)

Courage: Exposure, Attention, Assertive Behaviour, Exercise,

Feelings, Thoughts. (2 sessions)

Love others: Behavior, feelings, thoughts.

Forgiveness of past and inner child. (2-3

sessions)

Knowledge: personality style,

core beliefs, excess desires (1

session)

Intuition: Mantra

universal

Love/consciousness (1)

Self-Realisation(Formless meditation, 1 session)

5th Chakra

Throat

4th Chakra

Heart

3rd Chakra

Solar Plexus

2nd Chakra

Sacral

1st Chakra

Root

6thChakra

Third Eye

7thChakra

Crown

Loving Courage TherapyTM

© Copyright Dr Karan Sinha

2018

Meditation

15 minute Safe Love Meditaion:

1 min: Aware of present

3 min: Safe place visualisation

3 min Self love of body

2 min Self love of breath

2 min Self love thoughts

2 min Courage

2 min Love others

23

24


Q&A

Thanks for your time :)

Contact and referral

Need a referral Via GP

Loving courage individual and group therapy:

Nicholson Health and Wellness:

PH: 03 9486 411, F: 9486 4122

[email protected]

https://nicholsonhealthandwellness.com.au/dr-karan-sinha/

Delmont Private Consulting Suites:

PH (03) 9834 3600, F: (03) 9834 3666

Email: [email protected]

Website: https://drkaransinha.business.site/,

https://www.facebook.com/drksinha.

Email: [email protected],

25

26

https://drkaransinha.business.site/

mailto:[email protected]


Bibliography

1. Christopher G Davey and Andrew M Chanen, The unfulfilled promise of the antidepressant medications, Med J Aust 2016; 204 (9): 348-350.

2. Australian Bureau of Statistics. (2012). Personal safety survey. Canberra: Australian Bureau of Statistics.

3. Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K (June 2010). "Pharmacological interventions for borderline personality disorder". The Cochrane Database of Systematic Reviews (6): CD005653.

4. Grant BF et Al (April 2008). "Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions". The Journal of Clinical Psychiatry. 69 (4): 533–45.

5. Beck JS (2011), Cognitive behavior therapy: Basics and beyond (2nd ed.), New York, NY: The Guilford Press, pp. 19–20

6. Maat S, de Jonghe F, de Kraker R, et al. (2013). "The current state of the empirical evidence for psychoanalysis: a meta-analytic approach". Harvard Review of Psychiatry. 21 (3): 107–37

7. Herbert, James D., and Evan M. Forman. Acceptance and Mindfulness in Cognitive Behavior Therapy: Understanding and Applying New Theories. Hoboken: John Wiley & Sons, 2011. Print.

Physical Needs: Food, water, sleep hygeine, exercise, social, screen free time (1 session)

Safety: Environment, people, behavior, speech, body, feeling, thoughts. (2 sessions)

Love Self : Environment, people, behavior, speech, body, feeling, thoughts (2

sessions)

Courage: Assertive Behaviour, Speech, Body language, Exercise,

Feeling, Thoughts. (2 sessions)

Love others: Behavior, people, speech, feelings,

thoughts. Forgiveness of past and inner child. (2-

3 sessions)

Knowledge: personality style,

greed, lust, anger, core beliefs

etc (1 session)

Intuition: Mantra

universal

Love/consciousness (1)

Self-Realisation(Formless meditation, 1 session)

Loving Courage TherapyTM

© Copyright Dr Karan Sinha

2018

27

28

emotional wellbeing: more than just a pill · 2019. 2. 10. · mental health - more than just a...

Documents