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Treating AD/HD versus Managing AD/HD

About 5% of the adult population experience Attention-Deficit/Hyperactivity Disorder – AD/HD. AD/HD is a neuro-atypical condition. “Neuro-atypicality” means that a person who lives the experience of AD/HD has a different brain structure and functioning to the majority. People vary as to the degree of neuro-atypicality they experience. Some neuro-atypical people really struggle trying to live in the majority neurotypical world. Others seem to experience some degree of difficulty but have found ways to cope well enough. Almost always, however, getting through the day causes more stress, more anxiety and more fatigue than neurotypical people experience. Unrecognised; undiagnosed; and, untreated AD/HD certainly causes difficulties not only for those who experience it but for those in their life-space. It has been noted it causes or contributes towards increased risk-taking and what can follow – injury or even death. Research has shown it can lead to a reduced life-span.

When the presence of AD/HD is recognised and acknowledged there is naturally a desire to find a way to cope with the activities of daily living better. Understandably, there is the hope that AD/HD might be “cured”. But, unfortunately the term “cured” assumes disease or injury. Thinking in terms of “illness” and “cure” is misleading and frustrating. Instead, adopting the thinking that whilst AD/HD cannot be cured in favour of thinking that it can be managed will be optimal and lead to better outcomes.

How is AD/HD managed? There are several approaches that have backing from research and experience. I refer to my approach as being “E2”, i.e. empirical plus experience – empirically based practice with practice-based experience.

Ideally, E2, over the decades of my professional practice has demonstrated that managing AD/HD (ADHD) typically involves a combination of psycho-pharmacological medication and behavioural, and sometimes social, therapy. The two go hand in hand. The goal of management is to reduce behaviours that cause inattention, hyperactivity, and impulsivity and to increase functional behaviours in daily life. Some behaviours, that previously did not exist, may need to be established, others may need to be extinguished.

There are a minority who hold the view that AD/HD can be managed without medication. I am in the majority who believe that a neurological dysfunction logically requires a pharmacological intervention as an essential component in managing AD/HD. I have not yet encountered a case of successful management of AD/HD wherein a significant and sustained change of dysfunctional to functional behaviours was achieved without medication.

Medications do not simply remove the AD/HD behaviours. They reduce them so that alternative functional behaviours can be established and maintained. The prescribing professional will factor in the most suitable form of medication; dosage; and, ingestion regime (short acting or slow release, long acting). The most commonly prescribed medications for ADHD are stimulants. These include methylphenidate (Ritalin, Concerta, etc) and amphetamines (Adderall, etc). They help by increasing the levels of chemicals in the brain, e.g. dopamine and norepinephrine, that improve attention and reduce impulsivity. Medications generally produce an effect noticeable to the individual taking them but often also noticeable to others in their life-space. Usually, an effect can be evident within 15-20 minutes of ingestion. Medication can be taken daily as prescribed by the doctor. The effect is no longer evident in the longer term beyond the day the medication is taken. For people for whom stimulant medication may be contra-indicated, or in the doctor’s opinion, other non-stimulant medications, such as atomoxetine (Strattera) may also be prescribed.

Behavioural therapy, ranging from Applied Behaviour Analysis to CBT and its variants, is an effective adjunct to managing ADHD.  But, it needs to be employed in combination with medication to yield significant and sustained change. In the case of children and teenagers, behavioural therapies may include parent training and Applied Behaviour Analysis, in addition to social skills training to manage dysfunctional behaviours and improve social and academic functioning. It is a rare adult who needs social training. Some, however, will benefit from it.

With respect to children and adolescents especially, occupational therapists can help individuals manage AD/HD by teaching organisation and time management skills, as well as functional skills related to activities of daily living. Also, counselling or psychotherapy (e.g. CBT, ACT) can help those experiencing AD/HD learn coping strategies; better problem-solving skills; improve self-esteem; and foster relationships. In some cases, parenting training may be required to help manage the behaviour of children experiencing AD/HD and improve family interactions.

In conclusion, it is important to note that people can respond differently to different treatment approaches. Hence, working closely with a mental health professional to find the most effective treatment plan is advisable. It is also essential to note that AD/HD is a permanent (those seeing it within the medical model would say “chronic”) condition, so ongoing management and support is essential.

But It’s Cold Outside!

But It’s Cold Outside!

We know that getting out of bed in the morning can be harder on cold days.  It can feel so warm, and welcoming under those covers, but it is time to start your day!    

Did you know that having a wake up plan can help?  Using your senses can make it easier on those cold mornings:-  

  1. Start with some warming self massage before you get out of bed – rub your feet on the mattress, rub your hands together to warm you up.
  2. Temperature change – take the covers off and walk across the room
  3. Sound – you can set your alarm across the room/out of reach and get up to turn it off
  4. Light – open the blinds and see the day, or turn on the light.
  5. Movement – do some gentle yoga or Tai Chi, stretching, walking
  6. Breathe – stand or sit tall and focus on taking some deep breaths

Or you could use movement and sound by dancing/moving to your favourite music

Check your mindset and the story you are telling yourself about the day and the temperature.

Next step – have some lovely sensory inputs ready to get you through your morning routine and out the door.

Occupational therapy promotes well-being through doing meaningful occupations – and ways to do them with more ease and enjoyment. ????

Therapy Tips: Managing Insomnia

Therapy Tips: Managing Insomnia

Between 10 to 15 per cent of the population suffer from insomnia. Fortunately there are short-term, non-medication treatments that can improve the sleep of most people with insomnia. Cognitive behaviour therapy for insomnia (CBT-i) offers us some techniques.

When our sleep is disturbed night after night, we often attempt remedies that we think will help us. However, our efforts often actually prolong our insomnia.

We might try going to bed earlier to try to get more sleep. But, probably that will only give us more time to lie in bed awake. What we end up with is seeing bed as a place to be tired and anxious – maybe even distress.

We might try sleeping in after a bad night’s sleep. Maybe helpful in the moment but this is likely to interfere with sleep the next night.

We might try just staying in bed even we are not falling asleep. But, this can very easily end up with us training ourself to be awake and be stressed sleep in bed while not getting more sleep.

We might try taking a nap during the day. But, mostly this makes it harder to fall asleep at night. This is especially the case if we nap later in the day for a long time.

 We might try drinking alcohol. Alcohol tends to make us sleepy but, our sleep will be lighter and more broken. If we train ourselves to depend on alcohol to fall asleep, we are creating another problem.

All these strategies just maintain our insomnia.

This is where CBT-i comes in to change our sleep behaviours. CBT-I recommends the following:

Choose and maintain a standard bedtime and wake-up time. These times are based on careful records of your sleep using a sleep diary your CBT-I therapist can give you.  The aim is to match the time you spend in bed overall to the average amount of sleep you are actually getting. Going to bed and getting up at about the same time each day, our bodies and brains learn to expect sleep at the right time and for the right length of time.

Maintain your set sleep schedule regardless of how you sleep each night. This step is critical to interrupt our counterproductive efforts to sleep. If you have a broken night’s sleep and still get up on time, you actually increase the chance of sleeping well the next night.

Avoid naps during the day. Not napping makes it more likely that you will be tired enough to sleep at night.

Get out of bed if you are not falling asleep in a short time-span. As soon as sleep is not happening or you begin worrying about things or about not falling asleep, get out of bed. Go read a book I dim light and return to be only when you feel sleepy.

Avoid sleep medications or aids where possible. Many have the possibility of distressing side-effects that can harm us in the long run. External agents like alcohol or drugs make us unconscious without providing high quality sleep. CBT-I relies on our natural ability to have sound, refreshing sleep, without having to use chemicals.

This is just a sample of CBT-i strategies. There is more to CBT-I you might want to explore.

*Gregg holds a Practice Certificate in Sleep Psychology from the Australian Psychological Society.

This article is for general advice only and does not replace seeing your GP or Sleep Physician. You might wish to ask your GP to write a Mental Health Care Plan to refer you to a psychologist.

To refer to Chapman Marques Psychology & Relationship Counselling, contact Reception at Belconnen Specialist Centre on 6251 1880; fax: 6251 6887

Reviving a Relationship

Reviving a Relationship

It’s strange but it sometimes seems that the longer you walk with someone, the easier it is to fall out of step. 

You might be able to shuffle-step back into synch with your partner ………. or not.

If you’re finding yourself often (always?) out of step with your partner, if you’re trying to tango and they’re doing the polka – you might benefit from some help.

If this is your experience – book into Chapman Marques Psychology and Relationship Counselling where Gregg Chapman will employ Emotionally Focused Therapy and the Gottman Couples Therapy to assist you and your partner get back in step.

To book phone Reception on 6251 1880 or go online: reception@belconnenspecialistcentre.com. Note the conditions for booking couples therapy – they differ from booking for individual psychological therapy sessions.

Does online counselling work as well as face-to-face counselling?

Q: Does online counselling work as well as face-to-face counselling?

A: Quite simply – yes. Research suggests that it would seem so.  A recent comprehensive study investigated this question. It was conducted by Ashley Batastini, Peter Paprzycki, Ashley Jones, and Nina MacLean published in the Clinical Psychology Review, Volume 83, February 2021, entitled: Are video-conferenced mental and behavioural health services just as good as in-person? A meta-analysis of a fast-growing practice

https://doi.org/10.1016/j.cpr.2020.101944

The study conducted a series of meta-analyses of 57 empirical studies (43 examined intervention outcomes; 14 examined assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Online counselling consistently produced treatment effects that were largely equivalent to face-to-face delivered interventions across 281 individual outcomes and 4336 clients.

Two main points the study made were:

  1. The therapist being face-to-face physically with a client does not appear essential to generating therapeutic outcomes, and,
  2.  There are few meaningful differences in intervention or assessment outcomes between online and face-to-face delivery of counselling.

Lengthy wait lists to see a psychologist a problem? Attending therapy sessions a problem?

Lengthy wait lists to see a psychologist a problem? Attending therapy sessions a problem?

Here’s an option:
Chapman Marques Psychology is now offering Focused Acceptance and Commitment Therapy (FACT)1. This therapy developed from the “third wave of CBT” – Acceptance & Commitment Therapy (ACT). The FACT approach, within the brief therapy tradition, allows a psychologist to see more patients for a shorter time with outcomes comparable to lengthier therapy.

Debunking Five Myths Concerning Individual Psychological Therapy

Dr Kirk Strosahl, Dr Patricia Robinson and Thomas Gustavsson, in their 2012 text, Brief Interventions for Radical Change, debunked the assumption that therapy must take a lengthy period and demolish five commonly held myths concerning psychological therapy, offering an empirically validated rationale.

1. Patients want lots of therapy

Normally they don’t! Therapy is inconvenient for most patients. Not to mention too costly for many. The most common number of therapy sessions (the statistical mode), world-wide and across all therapies, for all categories of difficulty, that patients attend is … one! (cf. Brown & Jones, 2005; Talmon, 1990). A single session!

Most patients end their therapy quickly anyway – with or without the therapist’s agreement. Thirty to forty percent drop out of therapy without consulting their therapist (Olfson et al, 2009).
Only a small number of patients prefer long-term therapy (Strosahl et al, 2012). Most patients prefer brief therapy (Strosahl et al, 2012).

2. Degree of change is dependent on amount of time in therapy

It is a commonly held belief in the mental health community that the longer patients undertake therapy, the more benefits they gain. Howard et al. (1986) debunked this myth. They found that 15% of patients can have clinical improvements after booking an appointment even before the first session. Their study has been ignored. Baldwin et al. (2009) found that patients who engaged in brief treatments had relatively rapid rates of change compared to those in longer-term treatment.

3. The longer the therapy, the more powerful the effects

Not so! Molenaar et al (2011) showed that a long-term improvement in social functioning in depressed patients could be achieved in half the time. Similar results have been shown with anorexia (Lock et al, 2005); childhood conduct disorders (Smyrnios & Kirby, 1993); PTSD (Sijbrandij et al, 2007); panic disorder (Deacon a& Abramowitz, 2006); depression and a wide range of anxiety disorders (Cape et al, 2010). Strosahl et al, 2012) note that overall, research suggests brief treatments are just as effective for the same disorder as longer treatments. It could be said: the more effective the therapist, the shorter the therapy.

4. Brief Therapy is a superficial intervention with few long-term benefits

Research studies have demonstrated this is not correct (Baker et al, 2005; Bryan, Morrow & Appolonio, 2009). Strosahl, Robinson & Gustavsson (2012) comment that “the process of therapeutic change is not well understood and may in part be influenced by the subtle or not so subtle communications and expectations of the therapist”. If the patient hears a particular issue is going to take a long time to treat they may dutifully, if unconsciously, comply with that expectation.

5. Rapid, large clinical gains are rare in therapy

Again, research studies give the lie to this myth. Research by Doane, Feeney & Zoellner, (2010) and Tang, DeRubeis, Hollon, Amsterdam & Shelton (2007) estimated between 40% to 45% of patients can experience sudden, large gains in 2-4 treatment sessions. Similar gains have been noted in patients with PTSD (Doane et al, 2010, 52%); binge eating (Grilo, Masheb & Wilson, 2006, 62%); IBS (Lackner et al, 2010). Long term improvements in functioning as well as reductions in relapse rates were found in research by Crits-Christoph et al, 2001; Lutz, Stulz & Kock, 2009; Tang et al, (2007); and Renaud et, 1998). The evidence for rapid gains has also been established by a meta-analysis conducted by Aderka, Nickerson, Boe & Hoffman, (2012).

What can be concluded from this research?
Brief Focused Acceptance & Commitment Therapy can be:
o more accessible
o less time consuming
o less expensive
o just as effective as longer therapy
o more convenient for the patient
o less costly to the tax-paying public
o more effective for short attention focus teens
o less stressful for patients with focusing difficulties (e.g. ADHD).

FACT can be undertaken via telehealth where not contra-indicated.

Cost: $130 per 30-minute session. Medicare rebate on MHCP: $63.55. Out of pocket: $66.45 (Rates can change over time. Check current rates and rebates).

If you are interested, contact Chapman Marques Psychology at Belconnen Specialist Centre. 1 Some conditions may require longer single sessions or several sessions. FACT may be unsuitable for some patients and some presentations.

Are You Burnt Out?

Are you suffering burnout?

Take this quick quiz:

Do you drag yourself to work?

Are you disillusioned about your job?

Do you have trouble getting started?

Are you lacking the energy to be consistently productive?

Have you become irritable or impatient with co-workers or clients?

Are you now finding it hard to concentrate?

Are you dissatisfied with your achievements?

Have you become cynical or critical at work?

Are you comfort eating?

Are you “self-medicating” i.e. using drugs or alcohol to feel better or numb out?

Is your sleep disrupted?

Are you experiencing unexplained headaches, stomach or bowel problems, or other physical complaints?

Are you experiencing any of the following:

Lack of control

Role ambiguity or confusion

Unclear job expectations

Dysfunctional workplace interactions 

Workplace bullying

Being undermined by colleagues

Being micromanaged

Unpredictable extremes of activity

Lack of social support

Work dominating your time and effort leaving no energy to spend time with your family and friends.

If you answered yes to any of these questions, you might be experiencing job burnout.

Consider talking to a GP or psychologist as these symptoms could also be related to health conditions, such as depression. If you feel you would benefit from psychological therapy. book at appointment with Chapman Marques Psychology & Relationship Counselling at Belconnen Specialist Centre. To book phone Reception on 6251 1880 or go online: reception@belconnenspecialistcentre.com.

A guide to retaining information in your therapy sessions.

From 40% to 80% of medical information offered in treatment consultations is immediately forgotten by doctor’s patients (Kessels, 2003). The same is probably true of psychotherapy/counselling, so you will almost always benefit from having access to additional written information. Handouts given to you by Chapman Marques Psychology & Relationship Counselling provide clear, concise, and reliable information, which will empower you to take the essential active role in your management of your therapy. Learning about your mental health, having practical strategies and techniques, and other psychoeducation will help you better understand and overcome your difficulties. We believe that when you understand the process and content of therapy you are more likely to invest time and energy in the process and commit to making positive changes.

Two suggestions that ought to assist you gain maximum benefit from therapy:

1. Carefully read any handouts given to you. Put the actions you have committed to into consistent action.

2. During the therapy session take notes – either on your iphone or on a notepad.

Psychology Telehealth

What is “Telehealth”?

Telehealth is therapy delivered via video or telephone. Medicare rebates apply for psychology sessions held via telehealth meeting Medicare requirements.

Telehealth has also been approved as a method of service delivery for a number of private insurance companies accept telehealth as a treatment modality (depending on your level of cover).

Telehealth is now quite common – for example, GP, psychiatry, and psychology consultations are being delivered by telehealth.

Telehealth offers several advantages

Distance from the therapist is no problem – telehealth (consultation via telephone or video) improves access to psychological support by increasing convenience and removing geographical barriers.

Saves valuable time – telehealth does away with the time spent driving to appointments and clinic waiting room times.

No more parking problems

Safetyin these times of recurrent waves of pandemics you have no need for unnecessary possible exposure to the coronavirus travelling to and from your practice and possible waiting room exposure.

Being ill or quarantined is not a problem – telehealth puts your therapist into your own home. It keeps you and the community safe. You can engage in a telehealth consultation when you are ill – not putting others at risk of exposure.

Avoiding inclement weather – cold; wind; rain; hail or heat can be avoided with a telehealth session in your own home or workplace office.

Easier – some people find that telehealth is easier than meeting in-person.

Supported by national professional bodies The Australian Psychological Society and the Australian Association of Psychologists both approve and support telehealth.

Supported by research – according to recent research, there are no differences between outcomes of telehealth and therapy delivered in-person.

Results of a 2020 study of 4336 clients found that there were no differences between outcomes of mental health services delivered via videoconference and therapy delivered in-person. These results were obtained across a range of psychological problems and across a range of outcome measures.

This is consistent with previous research that has found no difference in outcome between Telehealth and in-person therapy for adults, adolescents and children treated for depression, anxietytraumaeating problems, and substance abuse.

Less dropping outTelehealth has been found to help you continue your therapy and not drop out from mental health care.

Medicare Rebates

You can see any psychologist in Australia via telehealth. All Medicare card holders are eligible to receive Medicare rebates for telehealth.  To receive rebates, Medicare’s requirements are:

  • You must hold a valid Medicare card.
  • You must have a Mental Health Treatment Plan (MHCP) and GP referral for 6 sessions (you can use this to see any psychologist you choose: in-person or via Telehealth)
  • After 6 sessions, you must return to your GP for a ‘Review of your Plan’. This Review gives you rebates for 4 more sessions (this is a total of 10 sessions).

To book your telehealth appointment contact Chapman Marques Psychology and Relationship Counselling – phone 6251 1880. Telehealth sessions must be pre-paid. You will also be required to complete the Intake Form; Confidentiality Statement; and, Telehealth Agreement Form prior to your session.

Please note: 

Telehealth for psychotherapy cannot be delivered if you are outside Australian territory as it requires clinicians to be registered in the country in which you are located.

However, Relationship Counselling can be delivered if you are located outside Australia.

Telehealth is not suitable for crisis situations such when life is at risk of imminent danger. For immediate mental health assistance: Please call the Mental Health Access Line – 1800 011 511 or Lifeline – 13 11 14 or Beyond Blue – 1300 224 636. If a life is in danger, please call 000 or present to your nearest hospital with an emergency department. All of these services operate in Australia 24 hours per day.