Skill Building for Psychosis

One of the very hard things about many psychiatric disorders, including bipolar disorder and schizophrenia, is that they often begin at a time that is critical to the development of many skills and abilities needed for successful adult life. Many years ago we visited a wonderful program in Atlanta developed for young people with schizophrenia called STARS. The program was …

Summer Vacation: Taking a Break from Therapy

Maybe because it’s summer, and everybody’s thinking about vacations, or maybe it’s just a coincidence, but we’ve been spending a lot of time talking with people these past two weeks about taking a break from treatment or drastically cutting back on treatment, etc. All of it has us wondering about how to think sensibly about these types of decisions. After …

Does Psychiatric Treatment Work?

How well do psychiatric treatments work? Aren’t psychiatric medications just placebos? Does psychotherapy really do anything? These are the kind of questions that mental health clinicians run into all the time. Dr. Maximilian Huhn and colleagues from the Munich Technical Institute (Huhn – reference 1) have conducted a major review of the data. They evaluated results from 852 clinical trials involving …

Internet Therapies Generate Interest

There is increasing interest in “apps” that can support mental health (one of our most enthusiastic readers recently posted a query on this topic on the forum). Apps are rarely intended to deliver “therapy” – they are usually not written by mental health professionals (although mental health professionals may be consulted along the way). Their goal is to be appealing …

Family Therapy Effective for Bipolar Teenagers

Family Therapy– Family-focused treatments have been shown to be effective adjunctive therapy to mood stabilizing medicine in adults with bipolar disorder (especially young, female adults), but whether this approach holds true in adolescents, has been unclear. Researchers from the University of California at Los Angeles (UCLA) assessed 145 adolescents with bipolar disorder to see if adding 9 months of family …

When the Grown-ups Disappear: On Self-Destructive Behavior

A brilliant young man I know has been stuck in a pattern of self-destructive behavior and constant and terrifying self-criticism. Nothing seems to be helping him get out of this cycle. We have thoughtful conversations about the problem and come up with various solutions but then, the next time we get together, the behavior remains unchanged. I often feel as …

Distress Tolerance

I have been doing some blog – surfing and happened upon a wonderful series, on the “disorderly chickadee” site that I have referred to in the past, about the skill of “Distress Tolerance.” In working with patients with depression, we often find ourselves encouraging them to learn about Dialectical Behavior Therapy (DBT). And of the many parts of DBT that …

Bay Area Bipolar Educational Group

Dr. Descartes Li (see interview in our “Conversations” section) is starting another Psycho-Educational Group for Bipolar Disorder this spring. We are happy to encourage all readers in the Bay Area to find out more information about these excellent groups. The group is an especially good option if you still suffer from mood swings, or have questions about managing your meds (and …

Sleep Therapy and Depression

What would you do if you could double the effectiveness of your antidepressants? Let’s say that this new treatment also had no known side effects, and was completely safe. That is what four studies have suggested could happen if people who were started on antidepressants received cognitive behavioral therapy for insomnia (CBTi). However, this treatment is not widely available. We …

PTSD Psychotherapy Affects Gene Activity

  Mind-body dualism seems alive and well in the land of mental health. I am still surprised how often someone will say, “well that’s not a biological depression.” Meaning that it is the kind of depression that can be understood as a result of events in that person’s life, or that it can be treated effectively with therapy, or that …

Therapy for Anxiety in Bipolar

Anxiety is very common in people with bipolar moods. In fact, anxiety is typically the first sign of mental health problems (often it is present in childhood) for people who later develop bipolar. As a psychiatrist, I am aware that we have fewer useful long term treatments for anxiety in bipolar than we do for the mood swings of the …

Treatment as Punishment

I have spent the last two days mulling over an interaction with a patient and with his therapist. The patient is a brilliant, young man who has somehow entered into a conflictual relationship with me. The nature of that relationship was encapsulated for me in a comment by his therapist. She called to let me know that he was escalating …

Acceptance versus Avoidance

Acceptance and Commitment Therapy (ACT) is based on the belief that five fundamental errors are responsible for much of human distress. One of these errors is the tendency to want to avoid painful feelings at all costs. Our addiction to our cell phones can serve as a distraction from the distress of loneliness. Or drinking. Or smoking. A colleague suggested …

Dual Treatment: Medications and Therapy Work Together to Treat Depression

A review in the prestigious journal JAMA Psychiatry suggests that there may be a clear biological explanation of how medications and psychotherapy work together to treat depression. The authors note that recent, unexpected, research findings suggest that antidepressant medications reactivate the brain’s ability to relearn old lessons. The medications allow the brain to modify old neuron connections in a way …

Therapy or Medications for Depression?

A new study published in the most prestigious psychiatric journal (JAMA Psychiatry – see reference below) strongly suggests that a brain scan might be able to help people decide whether therapy or medications are more likely to treat their depression. As background, although some people feel that for more severe depression medications are more effective, the fact is that most …

Recovery from Disability

Sometimes we are privileged to help someone who is disabled due to bipolar or depression to recover and resume a full and happy life. In the beginning we face many questions about the process. Family members may have become very skeptical about the value of treatment. Or they may wonder if the disabled person is exaggerating his or her symptoms …

Just Be Quiet

I just met with a smart, funny, attractive graduate student who had a severely traumatic childhood. She came in looking obviously frazzled and announced that she had been crying continuously since she got a terrible haircut the previous day.   I wouldn’t be human if I didn’t feel the urge to reassure her. Especially because, in addition to all her …

When Your Mirror Lies

When an individual spends massive amounts of time obsessing about minor defects or even normal elements of their appearance that it begins to impair daily life, then they are said to be plagued by Body Dysmorphic Disorder. Eve Fisher tells her personal story about BDD recovery. When Eve was 16 she began looking in the mirror for long periods of …

Know Your Body

Geneen Roth talks about how infatuated she was with her imperfections while growing up. She was constantly thinking of how much better looking she would be if she didn’t have certain features. If only she could cut out all the flaws, so just her best features would remain she could be happy.  Roth tried to reach self improvement through shaming …

Defuse Dangerous Thoughts

We want to spend a little bit of time talking about one powerful technique for dealing with dangerous thoughts. Dangerous thoughts are thoughts that make themselves true in powerful and self-destructive ways.  One example of a dangerous thought is from a very attractive young woman who had a terrible childhood of neglect.  She has a powerful, dangerous thought that pops …