Dr Linden, Delta, Kelly discussed on The Carlat Psychiatry Podcast
I was excited to see that. The carl report shows psychotherapy this month. Focus but i have to say a found this interview on psychotherapy side effects rather challenging. Also one thing that patients struggle with in psychotherapy is that they avoid pain so when i practice psychotherapy. I'm often trying to get them to move towards that pain instead of away from it could be an exposure therapies like when i work with trauma phobias with depression. Depressed patients will often stay in bed and avoid doing anything because it makes them uncomfortable or anxious. So the way i see it. Psychotherapy is difficult and it ought to be difficult. Because that's what makes it work. So why is delta. Linden calling that a side effect. You're not alone in that kelly. Judging from the reader feedback a lot of people were challenged by dr linden's ideas. Here's what i think is going on. We have a bias in our field about psychotherapy and perhaps about life. And dr linden is coming at this work without that particular bias. Which is unsettling the biased. Goes something like what you just said. It's the idea that the only way to grow in life is through difficulty. And it's embedded in a lot of our idioms like no pain no gain every rose has its thorn. What doesn't kill you makes you stronger. And it even comes from our own empirical research like about years ago. There was a study finding that people can the most gains in psychotherapy when they went through difficulties in the therapeutic relationship and then worked it out in the therapy so delta linda leaves. You don't need to suffer to get better. Well he's a realist. And he sees side effects as somewhat inevitable third inevitable consequence of psychotherapy in fact of any medical treatment. Dr linden is just trying to call it what it is because for many years we've been glorifying them as the royal road to recovery in other fields of medicine. We don't do that when patients have memory loss on. Abc t. we don't say this is part of the cure. You need to forget the pain. That's been making you depressed. I have heard saidan. Psychopharmacology like with mood stabilisers. Some doctors warn patients that they may feel flood dull on the mood stabiliser but that this is an inevitable part of treating the extreme highs of mania or with sri's sometimes patients feel emotionally numb on them. Daughter will tell them. This is because the alternative is to fill anxious and overly reactive yet. I guess you're right. We do say that sometimes. And perhaps we shouldn't. I think what's happened here is that we've been so busy trying to get patients to stick with treatment whether it's psychotherapy or medication that we've created this mythology around the negative aspects of treatment. The side affects as though they were an inevitable. Sometimes necessary for the cure but really we can treat anxiety neurosis without causing apathy. Like the essa is to. There's beaupre lawn. Bruce sperone even m sam sam e. these don't tend to make people emotionally numb and sedation and affect of flattening are not inevitable. Consequences of mood stabiliser treatment. If they were then anything that made you feel tired out of it would treat bi polar disorder. These are side effect. They are not part of the cure. Pharmacotherapy the assessment of side effects has a long tradition. Meanwhile in the early days Think about konta gone. Didn't have a tradition also of them the learnt that especially regulators forced to have closer look on side effects and since then side effects from therapy are a maitre aspect of other accompanied villa marketed. Luck for example. I'm a trip to linda. Mold until the present is still available with nowadays never be marketed. So threats y you have a little bit tight on the topic from therapy widened. Psychotherapy up to now. There's no such tradition dissolve. Everybody who has thought grades new psychotherapy. And whether that's helpful not say interesting question okay so back to psychotherapy. Let's talk about exposure therapy. I understand out to lend. It is himself a cbt therapist and has done a lot of exposure work now. I thought it was necessary for phobic patients to experience anxiety. An order overcome their phobias exposure. Therapy does this and so did. The third wave behavior therapies like mindfulness and acceptance and commitment. Therapy these all encourage the patient to be with the anxious feeling instead of running away from it. You're right all of those psycho therapy's is causing anxiety and on the other side they all work to improve anxiety disorders so i can understand height. Come to believe that as you put it. We have to go if you have to go through the anxiety to get to the other side of it. We'll dr linden suggesting we stop calling this unnecessary step in therapy and call it what it is anxiety. It's a side effect. Well that makes it sound like there's something wrong like exposure is a pet therapy. No is another part of his work where it helps to put our biases aside to understand what he sang. Dr linden defines side effects as unwanted effects of good therapy. These aren't therapeutic. Mistakes like a violation and they aren't the result of bad therapy either again is just like with medications when search aline causes nausea or sweating. We don't say that it's a bad medicine or that. I'm a bad doctor for prescribing it. It's a side effect okay. Maybe i'm starting to understand it. Exposure therapy is a valid therapy. It's one of the best. We have slow became zaidi but it causes the side effect particularly in the beginning in that it makes the patient feel worse if they feel more anxiety the very thing they've come to us to overcome and if they get more anxious during the therapy there are several ways it could turn out one. They might get better if therapy works and come out with less anxiety than ever before but exposure. Therapy doesn't always work. It could cause flooding where it makes them anxious beyond the point that they can tolerate and they give up on therapy or there's a third possibility they might go through all the hard work of exposure therapy and not get any better or even worse they might go through exposure therapy with all the anxiety that entails and come out feeling worse in other words their condition could get worse during therapy now. It's hard to prove that any of those results are caused by therapy. Just like it's hard to prove that any given side effect is caused by a medication. But we at least need to think about these possibilities p treating scientists. They do exposure treatment. Want to have the patient confront anxiety in or the band to Out of culpas. In if it's really good treatment condemned be able for example to go up way without any anxiety anymore to get to that end. You have to expose the patient tool zip relations which are frightening for the patient if everything comes out fine baseman losing somebody but i've seen dozens of patients who asked the that.