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Who is the best counselor for your child?

1/30/2014

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Who is the best counselor for your child?

This week I have read a lot of blog posts that have to do with who and what kind of counseling would be best for those who are depressed and anxious. One writer allowed that someone skilled in Cognitive Behavior Therapy would be best for those who struggle. The writer also stated that a non-Christian CBT therapist might be better than many biblical counselors in dealing with anxiety and depression. Enough people have disagreed with that idea that I do no need to reply except to say that I disagree on all kinds of levels. CBT is not the secular equivalent of Biblical counseling.

This does bring me to a question that I do want to consider. Who would be the best counselor for your child if he or she were struggling with anxiety or worry? Children do have many things they can worry about today. I suppose some might say that experienced professional practitioners of CBT could be the best answer. But research that I read this week says something different.

In a study that looked at how well parents might be able to be counselors for their own children, it appears that parents may make the best counselors for lots of reasons.[i] The study done at the University of Reading in the U.K. looked at who counseled children with anxiety. Of the 194 children in the study, a third were placed on a waiting list and received no counseling during the study. A second group received counseling from their parents who were told how to do the counseling in face to face sessions and over the phone. The third group received counseling from their parents who were instructed with fewer face to face and phone sessions. The counseling to be used was a modified form of CBT that parents could learn.

The results should be an encouragement to parents! They won the contest. 50% of children who were counseled by their parents following instruction from the counselor were cured of their anxiety. Coming in second was the group who received less instruction but counseling the same way. 39% of those children were freed from their anxiety.  In the control group who received no counseling at all 25% had ceased to be anxious.

There are lots of lessons here. At least 1 in 4 anxious children will come to grip with their problem if nothing is done. But, if their parents counsel them twice as many or 50% will benefit.  The author of the article noted that parent directed therapy was much less expensive and appeared to be very effective. The important lesson is that parents can and do make a huge difference in the lives of their children and appear to be able to counsel their kids when equipped to do it.


I am not the least surprised by this. I have been involved in helping adults and children who struggle with anxiety for nearly thirty years now. It has been my observation that parents can and should be a child’s best counselor. Mothers and Fathers are the only people on earth who are given the primary task of raising, discipling, and yes, counseling children. We have the privilege of introducing them to the grace of our sovereign God who loves us and them. We are tasked by God with sharing the solutions of scripture to the struggles of worry and fear.

Once again science tells us something that common sense and our Bibles have told us. We get to show our children the same Jesus who said, “Come unto me…and I will give you rest.” Parents who are equipped with the scriptures can graciously help their children learn about a Savior who tells us that we do not need to worry when we trust Him.


[i] Parents as Co-therapists for Anxiety. Peter M Yellowlees, MBBS, MD. Medscape Psychiatry Jan 23,2014

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Blogging at 35000 Feet: Physician Heal Thyself!

1/24/2014

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Blogging at 35000 Feet: Physician Heal Thyself!

Well here I am again with extra time on my hands while sitting on the connecting flight back home. I spent the day with Dennis Rainey and Bob Lepine and had a great time talking about Good Mood Bad Mood, depression and bipolar disorder.
But, now that is done and it’s time to blog.

I generally go looking for a good medical article on a subject that interests me from a biblical counseling perspective. This time I was confronted with an article that asks an important question about doctors. Are we overweight? Do we, the guardians of all that is healthy, actually do the things that we tell our patients to do? Or, are like the Pharisees of Jesus’ day that placed huge burdens on the backs of men that they would not lift a finger to move themselves?

Well, in an article published on Medscape this week, it would appear that physicians are probably better at telling people what they ought to do, than doing it themselves. Of all physicians practicing in the United States, Family physicians come in second in the derby to be the most overweight only beaten out by general surgeons! And, when it comes to diet, guess what! Most of us eat just like you do; badly.

This has special meaning to me as I went to see the doctor myself a week ago. (Please none of the “did you see him in the mirror jokes" now!) And, I had my blood drawn. That of course was where the problem began. I am known as runningdoc on twitter and I have spent the last 44 years religiously running so that I could be less obsessed with what I eat. My labs were not terrible. I am not diabetic, but the results ended my long standing love affair with concentrated sweets.

I can hear the words to that well practiced lecture that I have given thousands of times to other folks. Yes, Mr. Soandso, your glucose is up just a bit and it isn't terrible but it is just like those rumble strips on the highway. You don't want to take this any farther. So, all the foods that I have lived on are mostly gone. The cookies, pie, candy, cake, ice cream, French fries are off the menu.

I suppose that means there is at least one doctor out here is suffering right along with his patients.  It will be good for me. At least that is what I keep telling myself while I miss the coconut cream pie. It will make me a lot more sympathetic when I hand that next patient an 1800 calorie no fun, no frills diet.

So while I sat in the Atlanta airport tonight waiting on my delayed flight and pondering the merits of all things sweet, I ate a granola bar and pretended it was coconut cream pie. And, I think about Hebrews 12:11. “All discipline for the moment seems not to be joyful, but sorrowful; yet to those who have been trained by it, afterwards it yields the peaceful fruit of righteousness.”


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Three thoughts on Suicide from an Observer

1/18/2014

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A good friend wrote this post and asked if I would want to use it. I read it this morning and decided that it was really good. And, that my readers would benefit from the insights contained. So, for the first time goodmoodbadmood.com is featuring a guest post. I hope that you find the same gracious hope in it that I did. –Charles Hodges MD

 

Three Thoughts on Suicide from an Observer
Anonymous guest post


News of a suicide always hits me a bit differently, I suppose, than it does someone who has never struggled with depression. Ten years into my own battle, news of a suicide—any suicide—hits as a blow beneath the belt. And a confusing one at that.

I remember like it was yesterday the first suicide news I heard after the depression had set in. It was a pastor. And my response was a tangle of emotions I didn’t know how to sort out.

I felt grief for him. (I know something of the inner pain that can drive someone to the brink.) But I also felt confused for me. If he—a godly leader—got to this point, might I eventually helplessly follow suit?

The Lord helped me through that season of confusion, but it’s never gotten easier to hear.

This past spring, for instance, when I heard of the death of Matthew Warren, I ached fresh again.

I grieved for his family, as I’m sure anyone who heard the news fresh did.

But on a personal front, it hit on a “bad day” for me. (If you’ve suffered from long-term depression, you know there are “good days” and “bad days.”) And it brought a level of confusion and pain that I felt I needed to distill into a logical sequence.

The three points I jotted down (in bold below) became anchor points for me through that season…and for the following suicide I learned of just a few weeks later.

If you struggle—or if you counsel those who do—perhaps these will be a help:

1. Medical doctors cannot effectively treat all depression.

My own journey through depression has included two prolonged periods of seeking relief through SSRIs. I remember a conversation preceding the most recent re-entry into the SSRI world when a well-meaning friend told me, “Depression is a treatable disease. Just take the medicine.” I think she thought I was holding out because I thought taking meds counters trusting God or something. I don’t. I was holding out because it didn’t help me in the past.

Her statement, however, gave me the renewed hope that helped to push me back to the doctor’s office—for another many appointments and many dosage adjustments.

I quit the SSRIs (with my doctor’s help, and with helpful perspective through Good Mood, Bad Mood) just one month before Matthew Warren’s death. His suicide—and the articles I read about how diligently and faithfully his family had sought help for him—was a solid reminder to not put trust in doctors.

I’m thankful for anyone who is helped with depression through medicine, but with or without medicine, our hope must be in the Lord—not in feeling good.

2. I will not bring such an intense grief to my family.

This point was actually a reconfirmation of a decision I made years ago. In the darkest times, I can’t always see how my life impacts or benefits others. But I can see (especially through reports of a suicide) the intense grief and confusion taking my life would have on others. Perhaps I don’t always feel I can be courageous for me—but I must be for them.

3. Even “untreatable” or “unresponsive” depression can be sustained by God’s grace. I choose to believe that God can and will sustain me as His servant for a lifetime.

When you’re hurting deeply and you hear that someone else was as well and the only way out they saw was to take their own life, it raises questions. “Will I get to that point as well?” “Will my resistance and courage weaken over time?” “Can I sustain this heaviness for a lifetime?”

The answer to all of those questions is two words: God’s grace.

His grace is sufficient (2 Corinthians 12:9). Is is a present tense verb—His grace is sufficient today, and it will be tomorrow. It will always be sufficient in the present tense. In the end, I must choose to believe that.

And so last April, as I distilled tumultuous feelings into these three anchors, I was reminded again of perhaps the most beautiful word in the world--hope.

Specifically, I was reminded of the “God of hope” (Romans 15:13) and His promise to undergird me with His grace.

In the end, suicide is a choice; so is resting in God’s grace.

“Because thy lovingkindness is better than life, my lips shall praise thee.”—Psalm 63:3

 

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Common Sense, Television, and Children's Brains!

1/15/2014

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It is a great time to be living as a doctor if you are interested in research that examines how the brain works. This week I came across an article that confirmed something that common sense should have told us. Watching television appears to lower the intelligence of children who watch it. And even more importantly, it appears to change their brains.

Researchers at the Tohoku University in Japan conducted a study that examined the effects of watching television on the brain structure as seen in brain scanning.[i]  They found that children who spent an average of 2 hours a day in screen time had increased gray matter in the frontal cortex. This was not a positive finding according to the researchers who correlated the increase gray matter with lower verbal intelligence. Children with superior intelligence quotients had thinning of gray matter in the same areas.

The researchers were careful to say that their study showed a correlative but not a causal relationship between watching television and the brain changes.  While learning a musical instrument would have a positive effect on brain development, watching television did not appear to have that kind of effect. The researchers noted that their study could not say if the changes were due to watching television or the absence of doing things like reading, playing a musical instrument, or playing sports that were displaced by television time.

So once again we are indebted to medical research for proving something that my mother knew in 1950. She would only let my brother and I watch 30 minutes of the “tube” a day and she would approve the program. Violently amusing programs like The Three Stooges were not on the playlist because my brother and I were good imitators.  We also did not suffer from childhood obesity. We read. We played outside.

As I travel and teach, I ask parents to tell me what they think would happen to their children if they lived to the age of 18 and never watched a minute of television or ever played a computer game? After a bit I tell them their child would just grow up and be normal! This week I spent a good bit of time reading about ADHD, and a recurring theme was that watching television and playing computer games more than 30 minutes a day has an adverse effect on the attention spans and concentration of children.  Now we know that the very structure of their brains may be affected by every minute they devote to screen time.

Reading books shapes the brain. Playing Monopoly with friends shapes intelligence and personality. Play outside on a sunny day determines the way we interpret the color of a blue sky. Playing the violin & the piano shapes our brains in ways that can be seen on the brain scans. Maybe it is time for parents to make choices for their children that they will appreciate when they reach their 18th year with a normal brain.  

[i] Hikaru Takeuchi, The Impact of Television Viewing on Brain Structures: Cross-Sectional and Longitudinal Analyses, the journal Cerebral Cortex bht315 first published online November 20, 2013 doi:10.1093/cercor/bht315
 
A summary of the article also appeared in the UK Daily Mail online at the following:

http://www.dailymail.co.uk/health/article-2537240/Children-watch-TV-damaged-brain-structures.html article  

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The Death of Chemical Imbalances

1/11/2014

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This past September Gary Greenburg published a blog that outlined the impending doom of the chemical imbalance theory.[i] For much of the last 30 years medical science has been enamored with the idea that all disorders of behavior and emotion could be explained by an imbalance of the chemicals inside our brains. In depression we lacked serotonin. In ADHD we need increased activity of norepinephrine and/or serotonin. In other disorders like schizophrenia, it has been thought that perhaps we had too much.

Well, it has become apparent that the theory which has ruled psychiatry and behavioral medicine is slowly being strangled at the end of an economic rope. Greenburg gives an interesting account of the history of psychiatric medicines. Like much of medicine they appeared in great measure because of chance observations that a medicine being used for other reasons also affected emotions and behavior. When medicines like Tofranil (depression), Thorazine (schizophrenia) and lithium were discovered, the doctors were actually looking for something else. At the time they had no idea why these medicines calmed the minds of those who took them.

Finding out how they worked would be kicked like a can further down the road. Eventually Joseph Schildkraut said that he believed that antidepressants worked by affecting serotonin, dopamine and norepinephrine in our brains. And, medical science was off to the race to discover similar compounds that had fewer side effects. And, Prozac was born.

The amusing secret in all of it was that actually no one really knew if these drugs raised serotonin in the brains of humans. Or, if they did, whether or not raising serotonin actually made any difference in how people acted or felt. Without any objective way to measure either serotonin or an understanding of the change in the human brain that was supposed to cause depression, they were making educated guesses. Studies were presented that showed that to some extent people said they felt better when they took the medicine. Unfortunately over time we found that people who took placebo pills (look like the real thing but do not contain medication) did just as well and often better than those who took the real medicine.

Why then at the pinnacle of success is the chemical imbalance theory dying? Well, it is not because researchers have been telling us that the theory cannot be proven. People have continued to believe it and doctors and manufacturers have continued to use the concept to prescribe medicine.

The cause of death is twofold. First, the patents on the major Psychiatric medications are running out. Cymbalta is running out this year. Soon it may be possible to buy it off the four dollar Wal-Mart drug list instead of paying 200 to 400 dollars a month.

Greenberg notes that several major drug companies have closed down their research departments that develop psychiatric drugs. In the absence of a real understanding of how the current drugs work, Greenberg says they really don’t know which direction to go for new psychiatric medicine. Forty years of research have not produced enough solid information to do any better on drug development than the chance discoveries that started psychiatric pharmacology in the first place.

With no new drugs in the pipeline and declining revenue from drugs headed off patent, there is no more money to continue “chasing down chemical imbalances that don’t exist.” “Without a new explanatory framework, drug company scientists don’t even know where to begin, so it makes no sense for the industry to stay in the psychiatric-drug business.”[ii] 

This may be a watershed time in medicine when an old theory will pass into history along with the humoral imbalances of Hippocrates. Most research today says that simply talking with depressed and anxious patients help them as much as the medicines that we have.

Maybe that is where a better answer will be found. And, that is where Biblical Counseling can offer hope from the scriptures to people who worry and are sad over loss.


[i]“The Psychiatric Drug Crisis, What Happened to Psychiatry’s Magic bullets? Gary Greenberg, 9/3/2013. Electronically retrieved at.

 http://www.newyorker.com/online/blogs/elements/2013/09/psychiatry-prozac-ssri-mental-health-theory-discredited.html

[ii] Ibid

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ADHD: Disease or Not?

1/6/2014

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ADHD: Disease or Not?

There is an interesting article out today that concerns the exploding diagnosis of ADHD. We have all kinds of reasons to be concerned about the diagnosis of Attention Deficit Hyperactivity Disorder. The ones that bother me most as a physician have to do with the lack of any clear and certain way to make the diagnosis. To this day there is no laboratory, x-ray, or physical finding that can be used to make the diagnosis of ADHD certain. All that we have are the personal testimonies of parents, teachers, children, and now adults who are looking for solutions to the problems they face in life. And, that is the difficulty. No one would say that the children or their adult counterparts do not have problems. The question is do they have a disease? And, should that disease be treated with medicines that are habit forming with significant side effects?

Dr Richard Saul is a neurologist who spent his career helping patients who carried the label of ADHD. In the New York Post today Dr. Saul discussed his new book “ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder” due out in February.[i] To say the least he was not trying to be subtle. The Doctor says several things in the article with which I agree. The first is that the diagnosis of ADHD is entirely subjective and often incorrect. The best insight that Saul offered was that these children and adults do have problems. And, I think that is the most important part of all of it.

Right now in the US 11% of children are being diagnosed with ADHD. (14% of teenage boys in another study) Dr. Saul says that most of his time was spent finding out what problem the child or adult had and helping them deal with that instead of labeling them with ADHD and providing a prescription.  He gave examples of children with vision problems, students who were bored with their subject, and adults who struggled with caffeine use and sleep deprivation as many of the things incorrectly labeled as ADHD. “One by one, nearly all of Saul’s patients turned out to have some disease other than ADHD such as Tourette’s, OCD, fragile X syndrome, autism, fetal alcohol syndrome, learning disabilities,…substance abuse, or even giftedness.” Saul described the diagnosis of ADHD as “an easy to reach for crutch.”[ii]

A disease always has pathology or a change in the body at the cell level that causes the malfunction. We may not be able to describe it. We may not be able to find it, but it must exist. And most of the time we can demonstrate the change which allows us to create medications or surgical corrections to fix the problem. In medicine understanding the pathology has always been the key to good treatment. Since we do not have the pathology for ADHD defined, we do not have tests that can make the diagnosis. The result is that people with real problems are mislabeled and treated with medicine that can cause them more harm than good.

Instead of being pushed along by our current “tolerant” agree with everyone about everything culture, maybe children and adults would be better off if we took the time to help them find other solutions to behavior and attention struggles. That is the message that Dr. Saul expressed in the article. I look forward to reading his book.


[i]“ ADHD does not exist,” Kyle Smith. New York Post, January 4th, 2014 @nypost.com.

Dr. Saul’s book “ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder,” is to be released in February, 2014 by HarperWave publishing.

[ii] Ibid.

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Happy New Year: Good News! Religion, Spirituality &Depression

1/1/2014

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It is always good when research confirms something you thought was true in medicine. And so it is this week. Research reported by doctors at Columbia University is telling us things that many of thought were true years ago. Religion and spirituality appear to have a positive effect on those who have a family history of depression.

In an article published this week in the Journal of the American Medical Association: Psychiatry[i] it was found that people who have a family history of depression are 90% less likely to have depression if they view religion and spirituality as an important part of their lives! My, is that ever different from the conclusions of Freud and those who would follow him when they said religion and particularly Christianity was the source of all guilt ridden neurosis. Even better, this difference can be seen in an objective manner.

MRI scanning that looks at the cerebral cortex of those who were in the study showed a difference in the thickness of this portion of the brain between those who for whom religion was important and those for whom it was not. This difference in the MRI was a difference that we could literally see in those who saw religion as important and were 90% less likely to be depressed.


It is important to keep in mind that this was a study that looked a correlation and not causation. The authors were not saying that considering religion to be important caused the cerebral cortex portion of the brain to be thicker. Nor, were they saying that religious belief caused the subjects to be less depressed. They were saying that both things could be found in those who viewed religion as important.


Studies like this should never be used to tell people who are depressed that if they have enough faith their depression will disappear. That is not what the research showed. It does tell us that something we believed has been supported in a way that can be measured. Spirituality/Religion affects the outcome of those thought to be at risk for depression, it does not cause it. It also appears to indicate that how one views religion is connected to and may change the very structure of our brains.

Another interesting part of the study showed that it was the importance the patient placed on religion not church attendance that made the difference. As tip of the hat to those trying to avoid legalism, going to church three times a week does not seem to insulate patients from depression. As one friend said, "we would have expected that. It is easy enough to attend church out of duty and get very little from it."

As a physician and a believer this makes me want to shout "as a man thinks in his heart so is he," along with lots of other encouraging passages of scripture. As a Biblical counselor it encourages me to want to help those who struggle or face problems that make them sad.  It gives me confidence that as Peter told us God has granted us everything pertaining to life and godliness including how to deal with sadness and depression.


 


[i] Miller L, Bansal R, Wickramaratne P, et al. Neuroanatomical Correlates of Religiosity and Spirituality: A Study in Adults at High and Low Familial Risk for Depression. JAMA Psychiatry. 2013;():1-8. doi:10.1001/jamapsychiatry.2013.3067.

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    Author

    Charles D Hodges Jr. MD
    I have been counseling people with mood problems and other family issues  for 25 years.  

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