Disease Management vs Biopsychosocial Health

The North American health care system's next evolution is from a disease management system to a biopsychosocial health care system that embraces the mind-body connection to bring it closer in-line with what we are learning about our own biology.

In 1977 psychiatrist George L. Engel at the University of Rochester, stated "the need for a new medical model" in an article he wrote for Science magazine.  He called for a biopsychosocial model for the investigation and treatment not only of mental disorders but also physical disease.  The biological-psychological-sociological model is based on the premise that human beings are biological beings who feel, think, imagine, act, and interact with others in sometimes complex relationships.  Our brains are not separate from our bodies or each other and each element affects the others, sometimes in profound ways.

In her 2005 book, “The Body Never Lies - The Lingering Effects of Cruel Parenting” Dr Alice Miller cites dozens of case histories of the famous and not so famous who developed physical disease as a direct result of abuse suffered as children.  Many of the cases were her own patients who were suffering from diseases as grim as cancer that was diagnosed terminal by physicians.  Yet these patients saw their disease go into remission or even vanish once the psychological problems caused by their childhood abuse was successfully treated.

Though many mental health practitioners like Miller have pursued the biopsychosocial model since Engel first proposed the idea, the medical community has been glacially slow to embrace it.

Dr Gabor Maté, a best selling author and world-renowned leader in mind-body wellness, recently delivered two seminars in Penticton, BC, hosted by the Penticton & District Community Resources Society.

Maté reported that he had recently been invited to speak by students at the University of British Columbia Faculty of Medicine.  When he described the biopsychosocial model - the mind-body connection - none of the students had heard of it. This model is not yet included as part of medical training despite decades of research producing compelling evidence to support it.

With the advent of Magnetic Resonance Imaging (MRI) in the early 1980s, we began to be able to see within the living human brain and in recent years actually witness it functioning.  What we found in the images generated startled the medical community and confirmed what many in the mental health field have suspected for decades; psychological and sociological events physically impact both the brain and body.

Post-Traumatic Stress Disorder (PTSD) can occur after a person experiences a shocking, sometimes life-threatening event.  Individuals affected develop a cluster of symptoms that include; anxiety, hypervigilance, avoidance of things that remind them of the event, nightmares, flashbacks, and panic attacks that combined we call PTSD.  As time goes on they also develop difficulties with concentration and memory.

MRI images of those suffering with Post-Traumatic Stress clearly show that in these individuals the cortex (executive function) has grown thinner and the hippocampus (memory storage and retrieval) has shrunk, indicating that their mental state is not due to a “disorder” but an actual physical injury caused by a horrific experience.  The shock of the traumatic event causes the brain to become “plastic” and change its structure in the form of an injury without direct physical contact.  The term for this is neuroplasticity and it is a double-edged sword.

More recent MRI studies on sufferers of PTSD indicated that Mindfulness practice also promotes neuroplasticity and saw the cortex of participating trauma patients thicken by 10% and their hippocampus grow by 25% after only 18 weeks of treatment.

We are learning that what can be done, can be undone by connecting the body to the mind and the mind to the body.

A research study just released in 2013, (see: The Deep Wounds of Early Childhood Trauma), has shown that trauma also affects the expression of our DNA itself; Early childhood trauma negatively impacts brain development and our immune system, while trauma later in life changes how our very cells grow or die.  In both instances, physical health is negatively impacted by psychological trauma, and in both, the successful treatment of the trauma improves physical health.

Seeing this growing body of evidence, some clinicians are coming to realize that the old mechanical model of the human brain as a separate independent organ is incorrect.  The body and brain are integral parts of the same interconnected system and we need to recognize that in order to work toward a holistic health system that promotes wellness both psychologically and physically.

The scientific evidence is there, all we need are some bold leaders in the medical community to embrace it.

Aaron D. McClelland, RPC - www.interiorcounselling.com/aaron

The Deep Wounds of Early Childhood Trauma

Recently published research indicates that early childhood trauma and trauma that occurs later in life changes the function of our DNA in different ways - more evidence that Post Traumatic Stress is not a “disorder” but is actually an “injury”.

We’ve known for years that early childhood trauma - such as child sexual abuse - causes deep emotional wounds that can last a lifetime if left untreated.  In the past few years, through the use of Functional Magnetic Resonance Imaging [fMRI], we have discovered that post traumatic stress not only changes the brain’s function, but its structure as well, such as causing the hippocampus to shrink, resulting in memory deficits.

But research by Dr. Divya Mehta and Dr Elizabeth Binder of the Max-Planck Institute of Psychiatry in Munich, Germany has discovered how early childhood trauma changes the way DNA is expressed in people who suffered abuse as children compared to those who experience trauma later in life.

“These are some of the most robust findings to date showing that different biological pathways may describe different subtypes of a psychiatric disorder which appear similar at the level of symptoms but may be very different at the level of underlying biology.” said Dr. Kerry Ressler, a researcher at the Emory University School of Medicine.

The study that was just published in the Proceedings of the National Academy of Sciences, is titled the Grady Trauma Project and examined blood samples of 169 individuals that were divided into three groups;

1. 108 who had experienced lifetime trauma but did not develop PTSD
2. 32 who developed PTSD after childhood abuse
3. 29 who developed PTSD without childhood abuse

Researchers analyzed the blood samples looking for patterns of genetic modification called DNA methylation - where stress-related genes were turned “on” or “off”

Though all participants with PTSD had similar symptoms - [nightmares; flashbacks; hypervigilance, etc] - those who had experienced early childhood abuse had alterations in their DNA expression that impacted immune regulation and brain development.

PTSD patients whose trauma occurred later in life had changes in DNA expression that impacted cell growth and promoted cell death.

“Traumatic events that happen in childhood are embedded in the cells for a long time.” said Binder in a press release, adding; “Not only the disease itself, but the individual’s life experience is important in the biology of PTSD, and this should be reflected in the way we treat these disorders.”

So, what does this mean for therapists who work with those suffering the symptoms of post traumatic stress?

It goes without saying that it is of utmost importance to find the source of the trauma before proceeding with any treatment plan. In addition, the therapist must be cognizant that the traumatic wounds may not only be psychological in nature, but include changes to the structure of the brain and DNA expression.  As therapists, the direct medical treatment of these wounds lay outside of our scope of practice, but that isn’t to say that we can’t help a client who is experiencing post traumatic stress symptoms.

Other research - [by way of fMRI scans] - have shown that combinations of traditional therapy along with having the trauma client learn and practice Mindfulness on a daily basis promotes Neuroplasticity that can reverse the brain injury PTSD has caused.  On the surface, this approach also sees a lessening or elimination of symptoms in these clients.

Dr. Bruce Perry’s Neurosequential Model of Therapy has produced significant results at his Child Trauma Academy in Houston, Texas, working with children who have been impacted by “developmental insults” including early childhood trauma.  This mode of therapy assesses where the “insult” took place in the developing brain and creates therapeutic interventions that stimulate the brain to resume development.

As for reversing the trauma impacts to DNA expression; Further research may very well lead to specific therapeutic interventions that will prove beneficial to our trauma clients.

Stay tuned.

Aaron D. McClelland, RPC - www.interiorcounselling.com/aaron

The Good Monsters

Tap and Mercy are members of the

Bikers Against Child Abuse motorcycle group.

Photograph by: Gord Waldner , The StarPhoenix

This is a very small blog entry with a link to a very big story ...

I want to bring attention to a group of individuals who at times live on the edge, who sometimes scare the rest of us as they thunder into our towns with their black leather kuttes and three piece patches.  They live in a world the rest of us don't understand - a world of brotherhood whose roots delve deeper than family, and for them, redefine family.

And sometimes they do amazing and inspiring things.

Here's a story about how they are helping to save a generation, one child at a time.

So next time you see a biker, flash him a wave - he just might be one of the "good monsters".

Aaron D. McClelland, RPC - www.interiorcounselling.com/aaron

"Can You Hear Me Now?"

Because bullying left them without hope ...

Sadly, this list is nowhere near complete.  What is heartbreaking is that each tragic death was preventable.

As a society we need to make bullying as unacceptable as we made drunk driving.  We need to help build resiliency in our children.  And most important of all; We need to start listening.

Aaron D. McClelland, RPC - www.interiorcounselling.com/aaron

Demystifying Neuroplasticity

The science of Neuroplasticity is finally entering the public consciousness through the media such as in the documentary “Changing Your Mind” on the Nature of Things.

We used to believe that once a person reached adulthood, their brain was set and unchangeable with the exception of damage through a stroke, brain injury, or other intracranial insult.  Medical science viewed the brain as a mechanical construct, not an organ that can heal or alter its function or structure.  But with the advent of Magnetic Resonance Imaging, science can now see the brain functioning as various areas become active.

One of the first things we learned was that Post Traumatic Stress actually changed not only the function of a person’s brain, but also its structure - in many PTS cases, the hippocampi [the brain organs responsible for memory storage and retrieval] shrink.  But as MRI technology was used to monitor treatment, we also discovered that this brain damage can be reversed.  A 2011 study conducted in Canada with people suffering from PTS showed that using targeted mindfulness therapies that enhance Neuroplasticity saw the patients’ hippocampi grow on average of 25%.  A result that startled the professionals conducting the study.

The analogy I often use to explain how mindfulness and other therapies enhance Neuroplasticity is to imagine a path through the forest; The more we use a specific path, the deeper and smoother that path becomes and being so, following it is easier that traveling through the forest any other way.  Our minds are the same - we develop neural pathways in our brain by repeated use and if those pathways lead us to depression, anxiety, or disordered thinking we feel stuck on those paths.

With targeted therapies such as mindfulness, Cognitive Behaviour Therapy and others, we can create new pathways.  And like paths through a forest, as we follow the new healthier paths and they become easier to walk down and the old troublesome ones will grow over and no longer be paths we choose to follow.

I integrated Neuroplasticity enhancement in my practice as a Multimodal therapist over a year ago, and my clients have experienced great success in overcoming mental health issues that have plagued them for years.  Because I employ a multimodal approach, I can utilize a vast array of therapeutic techniques that fit the strengths, needs, abilities, and preferences of each individual client.

Typically though, I begin with breathing and relaxation techniques to address their immediate symptoms, then move to mindfulness practice and Cognitive or Dialectic Behaviour Therapy as clients develop mastery over each progressive step.  Throughout the process, I provide psychoeducation for my clients so they are aware of the science behind each technique because I believe in taking a collaborative approach with my clients - to place their healing in their own hands.

With the growing knowledge of Neuroplasticity and techniques to enhance it, there is no better time for someone to embark on the road to mental health, no matter how long they have suffered from an anxiety, mood, or traumatic disorder.

Aaron D. McClelland, RPC - www.interiorcounselling.com/aaron

Why I Recommend Yoga to Clients

As a Multimodal Therapist, I not only look at the seven modalities that make us whole persons, but I employ therapeutic interventions that fall outside of standard “talk therapy” strategies.

One of the interventions I use is to encourage some clients to take up the practice of Yoga – specifically; Yoga styles that are gentle and incorporate measured diaphragmatic breathing as their core foundation.  The reason for this is that diaphragmatic or “belly” breathing enhances neuroplasticity, which is – after all – the key to effective psychological therapy.

 Yoga is also another form of mindfulness, which is emerging as one of the most effective therapies to help people overcome anxiety and mood disorders.  When combined with other traditional therapies, such as Cognitive Behaviour Therapy, mindfulness is extremely effective in reducing symptoms of anxiety and depression.  I’ve added Yoga to that list.

Yoga is a winning adjunct to therapy for a number of reasons;

• It helps us reconnect to our body
• It teaches us distress tolerance much in the same way mindful meditation does
• It helps us supply oxygen to, [and removes carbon dioxide from] our muscles – and being that excess carbon dioxide alone can trigger panic attacks, measured breathing can reduce symptoms of anxiety
• It lowers the stress hormone Cortisol in our body
• It lowers Dopamine levels – too much dopamine in the limbic system has been linked to paranoia and withdrawal from social situations
• It lowers Norepinephrine levels which can trigger a flight or fight response, raise the heart rate, raise the blood pressure, and trigger the release of excess sugar into the bloodstream
• It raises GABA [gamma-Aminobutyric acid] levels - a neurotransmitter that inhibits the fear and anxiety caused by overactive neurons
• It raises Serotonin levels - a neurotransmitter used both in our brain and our digestive system that keeps everything working properly 

All of these, and other physiological actions, reduce depression and anxiety, increases cognition and the ability to focus, and helps us sleep better.

A recent paper titled; “Yoga on our minds: a systematic review of yoga for neuropsychiatricdisorders”, by Meera Balasubramaniam, Shirley Telles, and P. Murali Doraiswamy explored 124 trials on the effectiveness of Yoga in treating symptoms of various mental and emotional disorders.  The study concluded that there is emerging evidence that Yoga has proven success in treating depression, sleep disorders, and anxiety when used as an augmentation therapy.

The styles of Yoga that have the highest efficacy for my clients are;

• Hatha Yoga – postures, regulated breathing, and meditation
• Viniyoga – gentle yoga with an emphasis on synchronizing postures and breathing
• Tibetan Yoga – fine, flowing movements, and controlled breathing

There is little doubt that Yoga is a physically healthy practice, but with emerging studies indicating its ability to bring about healthy changes in brain chemistry, any therapist should explore it as an augmentation to traditional mental health therapy.

Aaron D. McClelland, RPC – www.interiorcounselling.com/aaron

SIAD - March 1st, 2013

Friday, March 1st, 2013 is Self-Injury Awareness Day [SIAD].  To support those who struggle with non-suicidal self-injury, wear something orange.

Self-injury is a disorder shrouded by mythology, misunderstanding, and malice.  Many sufferers already feel shame and guilt because of their need to use self-injury to manage overwhelming emotional distress, and when facing the judgement and ignorance of others feel further isolated and hopeless.

If you've ever had a bad itch and scratched it until it "hurt-so-good", you've had a small taste of the relief those who use self-injury to cope with out of control emotions feel.

Many people who self-injure become addicted to it; During injury, the body releases endorphins into the bloodstream to mitigate pain.  Endorphins are the body's natural heroin.

The other thing to keep in mind is ... We just celebrated Pink Shirt Day as a means to bring a halt to bullying.  85% of those who self-injure disclose experiencing some form of trauma, including being bullied.  Many have also experienced physical abuse, child sexual abuse, and rape.

If you wish to learn more about self-injury, please read the series of articles I published on the subject last year.  They can be found here Self-Injury, Putting the Pieces Together.  There is a link at the bottom of each section that will take you to the next in the series.

Most of all, please wear something orange each March 1st.  Because most keep it secret, those who self-injure will not thank you for it, but seeing it may help some know we care.

Aaron D. McClelland, RPC - www.interiorcounselling.com/aaron