Practical EQ

Paul Keedwell on the benefits of depression

An interesting article in the Guardian by psychiatrist Paul Keedwell argues that depression can have some benefits:

The truth is that short-term pain can lead to longer-term gain. A recently published follow-up study of depression in Holland - the Netherlands Mental Health Survey and Incidence Study (Nemesis) - used a sample of 165 people with a major depressive episode, and provides some preliminary scientific evidence to suggest that depression is indeed helpful in the longer term. Researchers who were looking for evidence to suggest that depression leaves people chronically disabled were surprised to discover the opposite.

His new book, How Sadness Survived: The Evolutionary Basis of Depression, looks fascinating - at the time of writing, the reviews that I've seen have all been five-star!

Depression: Prozac doesn't work (all that well)

From Ben Goldacre's essential Bad Science blog:

Yesterday the journal PLoS Medicine published a study which combined the results of 47 trials on some antidepressant drugs, including Prozac, and found only minimal benefits over placebo, except for the most depressed patients. It has been misreported as a definitive nail in the coffin: this is not true. It was a restricted analysis [see below] but, more importantly, on the question of antidepressants, it added very little. We already knew that SSRIs give only a modest benefit in mild and moderate depression and, indeed, for some time now, the NICE guidelines themselves have actively advised against using them in milder cases since 2004.

The full Bad Science posting is well worth reading - it makes some interesting points about how clinical trials could be regulated to stop drug companies burying studies that don't support their product and also includes a link to download the full text of the study, for free.

It's interesting, in news reports, to see the pharmaceutical industry protesting that the results of the study are "at odds with what has been seen in actual clinical practice" - e.g. the Eli Lilly and GlaxoSmithKline statements near the end of this report.

Meanwhile, psychoanalyst Darian Leader writes an interesting history of The Creation of the Prozac Myth, charting how the marketing of drugs has affected the diagnosis of depression over time to include the symptoms that the drugs have an effect on. As so often with articles written by psychoanalysts, he concludes with a swipe at cognitive therapies, likening them to drugs for offering a "quick fix" and not addressing underlying problems.

This rather leaves aside the effectiveness of psychoanalytic approaches, which haven't shown up well in trials (although a small study last year on psychodynamic psychotherapy for panic disorder is "among the first to prove clinical efficacy for a psychoanalytic therapy for any major psychiatric disorder").

I believe that the intelligent application of NLP modelling and second-order change interventions could actually achieve the holy grail of combining a quick fix with addressing underlying causes, because it works at the unconscious level (as opposed to trying to reach the underlying causes through conscious understanding, which takes a long time and probably makes you feel worse the more you talk about the problem).

Sorry about the rather impenetrable nature of the 'second-order change'  linked article. If anyone knows of an article on the web explaining the not all that difficult concept of first- and second-order change in understandable language, please let me know. Otherwise I'll write one soon!

Hilary Mantel on expanding our sympathies: thought for the day

"Much wickedness stems from our failure to imagine other people as fully human, and as our equals"

- Hilary Mantel in 'Expanding Our Sympathies', an interview published as an extra in the paperback edition of her brilliant novel 'Beyond Black'.

Confabulation: "Why did I do that? Hang on while I make something up"

It seems that we are not as much in control of our selves and our decisions as our subjective experience would suggest. In fact, most of our decisions are made unconsciously by the "elephant" of our unconscious processing (in Jonathan Haidt's useful metaphor from his brilliant book The Happiness Hypothesis) for while the main job of the "rider" of conscious awareness, who thinks and feels as if he is in control, is actually to make up justifications of the elephant's behaviour after the event. These explanations may bear no relation to the actual reasons driving the unconscious processing.

This process, called 'confabulation', was first noticed in the 1880s when Russian psychiatrist Sergei Korsakoff observed some of his patients making up often impossible stories to cover gaps in their memories caused by previous alcohol abuse. It has also been noticed in people with brain damage and some stroke patients as they concoct elaborate alternative explanations for the effects of their impaired brain function.

You might think that confabulation happens only when the functioning of the brain has been in some way disrupted. However, research suggests that confabulation is something we all do, a lot of the time, because we don't usually have access to the real (unconscious) reasons why we do things.

For example, Nisbett and Wilson's classic experiment in 1977 asked people which of four garments laid out from left to right they preferred. 40% of people preferred the rightmost garment - as expected, since people will tend to choose the rightmost item in a series, other things being equal. When asked why they chose that one, the subjects talked about the quality of the weave and the vividness of the colour. But the items were identical! (Nisbett, R.E. and Wilson, T.D. (1977). "Telling more than we can know: Verbal reports on mental processes". Psychological Review, Vol 84 pp 231-259.)

What's more, if we change our minds about something, we tend to forget that our original opinion is different - as in Goethals and Reckman's 1973  experiment (Psyblog: Our Secret Attitude Changes).

Helen Phillips' illuminating article Mind fiction: Why your brain tells tall tales (New Scientist 07 October 2006) quotes more confabulation studies.

So what are the implications of these findings? They add support to the NLP idea that "why?" is an unproductive question in therapy or coaching; not only are the responses likely to be excuses and justifications, but they probably won't even be an accurate representation of the person's real beliefs and  decision-making processes.

Also, they suggest that asking "why?" in usability tests will be a waste of time. The same might apply in other types of research like focus groups as well.

What can you do to increase your self-awareness by becoming more aware of when you are confabulating? Reflect, meditate, get other people to explore your reasons through pertinent questioning (as can happen in coaching or an action learning set), practise self-hypnosis (with the intention of listening to your unconscious mind as well as merely giving it suggestions) or keep a learning log or a journal - if the evidence of the beliefs you used to hold is there in black and white, it will be available to your conscious mind to learn from.

It's worth doing more to get to know yourself. The great hypnotherapist Milton Erickson used to say that the reason people had problems was because they were out of rapport with their unconscious minds.

Attending to the elephant

More elephant/rider related stuff - Maile McCarthy on her Breath by Breath blog (from where I've lifted her illustration) suggests attention as a way of bringing the conscious rider and the unconscious elephant into greater harmony:

noticing when your conscious and unconscious thoughts are pulling in opposite directions

As Fritz Perls said, "attention is itself curative".

Meanwhile, the Australian NLP trainer Chris Collingwood (in a separate conversation on nlpconnections.com) tells me that he prefers the description of 'conscious attention and unconscious processes' rather than conscious and unconscious minds - following John Grinder in this I think.

How to get Amazon reviews on your site...

I've just added a feed of Amazon reviews for my book to my web site at http://manchesternlp.com/achieveyourgoals.php You can specify how many reviews come through and limit the ones that show to a certain minimum star level (it's four stars or above on my page, but I've only had five star reviews so far :-) ). The code shows a random selection of reviews each time and also shows an average star rating. If you fancy one of these for your book, it's worth talking to Simon Jones (http://www.zakomedia.com/) who put it together for me. He can incorporate it into your site for a very reasonable fee! Or if you’re very techno-savvy with PHP you can probably work it out yourself....

Split brain experiments game

Here's an online animated game to help you get your head round Roger Sperry's split brain experiments, where he discovered what happens to mental processing if the corpus callosum linking the two hemispheres of the brain has been severed.

More fun than it sounds!

Split brain experiment game