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Psychotherapy Can Make Some People Feel Worse, Study Finds

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Psychotherapy can be a vital and even life-saving treatment for people experiencing mental health issues, but it’s not always a pleasant experience. A new study in the British Journal of Psychiatry quantifies the small part of the population who actively feel worse after therapy. About one in 20 people surveyed felt lasting negative effects from psychotherapy, the study found.

UK-based researchers led by Mike Crawford of the Royal College of Psychiatrists’ Centre for Quality Improvement surveyed adult patients from 220 English therapy clinics. Out of more than 14,000 respondents—most of whom received cognitive-behavioral therapy, group therapy, or some other kind of psychological treatment—more than 5 percent said that therapy resulted in lasting negative effects.

Minorities (both ethnic minorities and sexual minorities, including those who identify as LGBT) were more likely to report that therapy had been a negative influence. And younger people were more likely to have had a bad therapy experience that stuck with them than those over 65.

While the survey didn’t specifically ask what kind of negative effects therapy had, the researchers write that subsequent interviews of those respondents indicate that therapy can cause “exacerbations of existing symptoms and emergence of new ones including anxiety, anger and loss of self-esteem.”

It’s not terribly surprising that the mental health system doesn’t serve minorities as well as it should. Therapists have the same potential for bias as the rest of us, especially if they aren’t particularly well-educated on the issues facing minority patients. A prime example: As late as 2013, the American Psychiatric Association had to apologize for listing pedophilia as a sexual orientation [PDF]. The same organization has been criticized for its unwillingness to recognize that a lifetime of experiencing racism can contribute to PTSD.

The researchers behind the study suggest that the findings might encourage more consideration of "cultural competence" in the mental health field. 

[h/t BPS Research Digest]

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What Pop Culture Gets Wrong About Dissociative Identity Disorder
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From the characters in Fight Club to Dr. Jekyll and Mr. Hyde, popular culture is filled with "split" personalities. These dramatic figures might be entertaining, but they're rarely (if ever) scientifically accurate, SciShow Psych's Hank Green explains in the channel's latest video. Most representations contribute to a collective misunderstanding of dissociative identity disorder, or DID, which was once known as multiple personality disorder.

Experts often disagree about DID's diagnostic criteria, what causes it, and in some cases, whether it exists at all. Many, however, agree that people with DID don't have multiple figures living inside their heads, all clamoring to take over their body at a moment's notice. Those with DID do have fragmented personalities, which can cause lapses of memory, psychological distress, and impaired daily function, among other side effects.

Learn more about DID (and what the media gets wrong about mental illness) by watching the video below.

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New Patient Test Could Suggest Whether Therapy or Meds Will Work Better for Anxiety
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Like many psychological disorders, there's no one-size-fits-all treatment for patients with anxiety. Some might benefit from taking antidepressants, which boost mood-affecting brain chemicals called neurotransmitters. Others might respond better to therapy, and particularly a form called cognitive behavioral therapy, or CBT.

Figuring out which form of treatment works best often requires months of trial and error. But experts may have developed a quick clinical test to expedite this process, suggests a new study published in the journal Neuropsychopharmacology.

Researchers at the University of Illinois at Chicago have noted that patients with higher levels of anxiety exhibit more electrical activity in their brains when they make a mistake. They call this phenomenon error-related negativity, or ERN, and measure it using electroencephalography (EEG), a test that records the brain's electric signals.

“People with anxiety disorders tend to show an exaggerated neural response to their own mistakes,” the paper’s lead author, UIC psychiatrist Stephanie Gorka, said in a news release. “This is a biological internal alarm that tells you that you've made a mistake and that you should modify your behavior to prevent making the same mistake again. It is useful in helping people adapt, but for those with anxiety, this alarm is much, much louder.”

Gorka and her colleagues wanted to know whether individual differences in ERN could predict treatment outcomes, so they recruited 60 adult volunteers with various types of anxiety disorders. Also involved was a control group of 26 participants with no history of psychological disorders.

Psychiatrists gauged subjects’ baseline ERN levels by having them wear an EEG cap while performing tricky computer tasks. Ultimately, they all made mistakes thanks to the game's challenging nature. Then, randomized subjects with anxiety disorders were instructed to take an SSRI antidepressant every day for three months, or receive weekly cognitive behavioral therapy for the same duration. (Cognitive behavioral therapy is a type of evidence-based talk therapy that forces patients to challenge maladaptive thoughts and develop coping mechanisms to modify their emotions and behavior.)

After three months, the study's patients took the same computer test while wearing EEG caps. Researchers found that those who'd exhibited higher ERN levels at the study's beginning had reduced anxiety levels if they'd been treated with CBT compared to those treated with medication. This might be because the structured form of therapy is all about changing behavior: Those with enhanced ERN might be more receptive to CBT than other patients, as they're already preoccupied with the way they act.

EEG equipment sounds high-tech, but it's relatively cheap and easy to access. Thanks to its availability, UIC psychiatrists think their anxiety test could easily be used in doctors’ offices to measure ERN before determining a course of treatment.

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