4 questions | Applied Sciences homework help

1. There is a wide range of types of practitioners. 2. Some types of practitioners lack standardization of training

and credentials. 3. Many different approaches may be used by practitioners within each professional group. 4. The person seeking help may have no idea which type of treatment approach is most appropriate. 5. Many practitioners use questionable practices, some of which may be difficult to recognize. The Well-Credentialed Cat A Philadelphia psychologist obtained certificates for his cat from five organizations: “certification” from the National Guild of Hypnotists and the International Medical & Dental Hypnotherapy Association; “regis- tration” from the American Board of Hypnotherapy; and “professional membership” in the American As- sociation of Professional Hypnotherapists. In each case, the only requirement was completion of a brief online questionnaire and payment of a fee—none checked any of the cat’s alleged credentials. The cat also obtained “board certification” from the American Psychotherapy Association (APA), an affiliate of the American College of Forensic Examiners. Although the APA asked for the cat’s curriculum vitae, it did not ask for documentation of credentials or check whether anything listed in the CV was genuine. Nor did it require any examination before issuing a certifi- cate attesting to the having met “rigid requirements” resulting in her “designation as a Diplomate.” The ac- ceptance letter that accompanied the certificate stated that diplomate status “is limited to a select group of professionals who, by virtue of their extensive training and expertise, have demonstrated their outstanding abilities in regard to their specialty.”7 Personal Glimpse Chapter Six Mental and Behavioral Help 93 pSYchologic MethodS Psychotherapy can be defined as any type of persuasive or conversational approach designed to help patients. Although there are hundreds of techniques and schools of thought, most have in common a wish to understand the patient and help the patient change emotional or behavioral patterns. Psychodynamic treatments are based on the premise that childhood experiences exert an unconscious influ- ence that actively shapes people’s current feelings and behavior. In analytically oriented psychotherapy, also called exploratory therapy, patients say what comes to mind (free association) and are helped to understand their feelings, mental mechanisms, and relationships with people. Insights are used to help patients develop healthier ways of dealing with feelings and life situ- ations. This type of therapy typically involves one or two 50-minute sessions per week for a few months (short-term therapy) or years (long-term therapy). It is especially appropriate for people who communicate well and are motivated to change. Psychoanalysis is a more intensive form of psychodynamic therapy in which free association is done while lying on a couch. It usually requires three to five sessions per week for several years. Few people can afford its high cost. Supportive therapy is a conversational approach in- tended to maintain or restore an individual’s highest level of functioning. Therapists give advice and reassurance, make suggestions, and discuss alternative behaviors and problem-solving techniques. Depending on the nature of the problem, treatment ranges from a single session, or a few sessions over a period of weeks or months, to long-term care over many years. Cognitive therapy, which typically involves 15 to 25 weekly sessions, is aimed at relieving symptoms rather than resolving underlying conflicts. It is used for the treatment of depression, anxiety disorders (mainly panic and phobias), anger management, personality disorders, and marital therapy. Therapeutic efforts center on decreasing faulty perceptions and negative attitudes. This is done by identifying how the patient reacts to life situations and helping the patient test the validity of these reactions. For example, someone who assumes that bad things never happen to good people might feel intensely unworthy in the face of an adverse event. The therapist attempts to modify this tendency by persuading the pa- tient that adverse events occur for many reasons, most of which have nothing to do with the person’s worth. Interpersonal therapy focuses on current relation- ships in order to help people deal with unrecognized needs and feelings and improve their interpersonal and communication skills. It typically involves three or four months of weekly 1-hour sessions in which the patient and therapist discuss the patient’s current relationships with family, friends, co-workers, neighbors, and others. The therapy also uses the patient-therapist relationship to help understand how the patient behaves in everyday life and is perceived by others.8 Behavioral therapy (also called behavior modi- fication) aims to replace maladaptive patterns with healthier ways of behaving. The therapist first analyzes the behaviors that cause stress, limit satisfaction, and affect important areas of the patient’s life. Treatment techniques can include (a) systematic desensitization (mastery of fears through gradual imagined exposure to circumstances that provoke anxiety), (b) relaxation train- ing, (c) exposure (gradual exposure to feared objects or situations), (d) flooding (maintaining exposure to feared situations until the anxiety dissipates), (e) reinforcement (rewarding behavior that is more mature), (f) modeling (copying a behavior demonstrated by the therapist), (g) social skills training, and (h) paradoxical intention (tem- porary encouragement of behavior the patient wishes to stop). Behavioral therapy usually involves fewer than 25 sessions. Biofeedback is a relaxation technique that can help people learn to control various autonomic functions. The patient is connected to a machine that continuously signals the heart rate, degree of muscle contraction, or other indicator. The patient is instructed to relax so that the signals decrease to a desirable level. The patient may ultimately learn to control the body function sub- consciously without the machine. Biofeedback was popularized before it had scientific support, and it is still abused by fringe practitioners. Nev- ertheless, it has gained a measure of respectability.9 It has been used to help patients control pain, anxiety, phobias, hypertension, sleep disorders, and some stomach and intestinal problems. Specialized techniques have been used to treat abnormal heart rhythms, epilepsy, Tourette syndrome (multiple tics), fecal incontinence, and Parkin- son’s disease. Most people who go through biofeedback training use it to acquire relaxation skills that could also be learned without electronics. Most qualified practitio- ners are psychologists, but some have backgrounds in other health disciplines. Untrained individuals with or without a professional degree can easily obtain a bio- feedback device and set up shop. Some promoters allege that “repatterning” a person’s brain waves can foster ef- fortless learning, health, creativity, and prosperity; others claim to achieve similar effects by causing the left and Part Two Health-Care Approaches94 right halves of the brain to function more synchronously. No scientific evidence supports such claims. In group therapy several people, usually eight to ten, meet with a therapist for discussion. Groups may be ho- mogeneous (composed of people with similar problems or backgrounds) or heterogeneous. The discussion may focus on specific topics or may deal with whatever comes up. Group discussions often help people feel less alone in their feelings and provide a “laboratory” for analysis of an individual’s behavior in a group situation. Reticent individuals may find group sessions, in which they can sit and listen, preferable to individual sessions in which they find it difficult to talk. In marriage counseling, husband and wife meet individually or together with a therapist to help them identify current marital conflicts. Acting as a referee, the therapist helps the couple communicate more effec- tively to negotiate solutions to their dispute. In family therapy the therapist meets with the family as a group to help resolve current family conflicts. Sex therapy is most appropriate for couples who basically get along well but have a problem with sex. Couples whose gen- eral relationship is poor will probably be better off with marital counseling or individual psychotherapy. Hypnosis is a temporary condition of intense con- centration or relaxation during which suggestibility is greatly enhanced. This state may be used to increase the patient’s control over a symptom or behavior. Hyp- nosis is not a treatment in itself but may accelerate the treatment process in properly selected cases. It has also been used for anesthesia during childbirth and dental procedures and for relief of headaches and other pain- ful conditions. Because not everyone is amenable to hypnosis, the therapist should have adequate training in both the procedure and the selection of patients. Expressive or creative activities, such as art, music, drama, poetry, or dance, are included in comprehensive treatment programs at hospitals and partial-hospital facilities. drug therapY Drugs are commonly prescribed for the treatment of anxiety states, depression, psychosomatic disorders, and psychoses. These drugs can affect both mental and physical functioning. Some take effect at once, some take several days to work, and some continue to work long after their use is discontinued. Antianxiety agents (sometimes referred to as minor tranquilizers) are used to treat anxiety states, psycho- somatic disorders, and alcohol addiction (during the detoxification process). Antipsychotic agents (sometimes referred to as major tranquilizers) are used mainly to treat psychotic reactions (thought disorders manifested by hallucina- tions, delusions, or loss of contact with reality). Since the early 1950s these drugs have revolutionized the field of psychiatry. Many patients who otherwise would have required lengthy (even lifelong) hospital stays are now able to improve or recover quickly. In addition, many previously institutionalized patients have been able to return to their communities. This has been a mixed bless- ing, however, because it has increased the number of homeless individuals in communities that lack adequate programs for helping the chronically mentally ill. Antidepressants are available to counteract severe depressions (those manifested by loss of appetite, weight loss, severe insomnia, feelings of hopelessness, or psy- chomotor retardation or agitation). These drugs usually require from a few days to several weeks to take effect. “Animal Magnetism” The concept of a dreamlike or hypnotic state dur- ing which cures of symptoms are attempted has existed since ancient times. During the eighteenth century a version was popularized by Austrian-born Franz Anton Mesmer (1733–1815), who acquired three doctoral degrees, including one in medicine. Mesmer derived his concept of “animal magnetism” from astrology and asserted that an invisible fluid permeated the universe, that blockages within the body could make people ill, and that removing the blockages would be curative. Although his theory was unfounded, his strong personality and suggestive approach helped some patients who had hysterical or psychosomatic symptoms. Mesmer treated individuals by touching them in various ways while staring into their eyes. He also treated groups who sat around a large vessel while he walked around to direct the flow of his alleged fluid. Most of his colleagues thought he was a charlatan. In 1784 the French government appointed a commission of experts (including Benjamin Franklin) to investi- gate. After conducting a brilliant series of controlled experiments, the commission attributed his cures to suggestibility, which they described as “imagination set in action.”10 Mesmer’s popularity waned after the report was issued. Today hypnosis plays a modest role in the treatment of emotional problems, and the word “mesmerize” means to hypnotize, spellbind, fascinate, or enthrall. Historical Perspective Chapter Six Mental and Behavioral Help 95 They are not appropriate for countering the minor upsets that are part of ordinary living. Some antidepressants and antipsychotic drugs can be prescribed as a single bedtime dose. This method reduces the cost of the medication, may aid sleep, and reduces the likelihood of annoying side effects. Antimanic agents, most notably lithium products, are used for bipolar illness (sometimes called manic- depressive psychosis). Anti-obsessive-compulsive agents are used to treat patients with uncontrolled repetitive thoughts or actions. Antianxiety agents and several other types of drugs are commonly prescribed for insomnia. Although oc- casional use of a “sleeping pill” may be appropriate, habitual use is not. People with frequent insomnia should seek professional help to correct the cause or to develop better sleep habits. Americans have been accused (with some justifica- tion) of being a “drugged society” because of their high use of alcohol and medications such as Valium (an anti- anxiety agent) and Prozac (an antidepressant). Although most people who receive antipsychotic medications probably need them, it is clear that physicians often prescribe antianxiety agents or antidepressants when it would be more appropriate to help patients identify and correct what is troubling them. Physicians are not entirely to blame for this, however; patients often press for instant and total relief. All psychoactive drugs have the potential for adverse reactions, some serious and some not. In each case the value to the patient must be weighed against the nuisance or danger involved. The most common side effects are drowsiness, agitation, dry mouth, tremor, and muscle stiffness. Some of these disappear with reduced dosage, continued use, or medication to counter them. Others are a reason to switch to another drug. One complication of particular concern is tardive dyskinesia, an involuntary movement disorder charac- terized by twitching and tongue-thrusting, which can occur with a prolonged high dosage of antipsychotic medications. Although uncommon, it is often irrevers- ible. Because the dangers of psychosis far outweigh the risk of tardive dyskinesia, there is no reason to withhold antipsychotic medication from individuals who are psy- chotic. However, it is poor medical practice to prescribe these drugs for nonpsychotic anxiety. The danger of withdrawal reactions to psychiatric drugs has been grossly exaggerated by the media. The problem sometimes develops with normally prescribed dosages of Valium and similar antianxiety drugs, but can be avoided by the common precaution of tapering off dosages rather than stopping suddenly. electroconvulSive therapY Electroconvulsive therapy (ECT), also referred to as EST (electroshock therapy) and shock treatment, involves producing a convulsion by giving a brief stimulus to the brain. To receive the treatment, the patient lies down and is rendered unconscious either by an electrical stimulus or by a short-acting barbiturate given intravenously. To protect against injury, a curare-like drug is also given so that the patient’s muscles do not contract during the convulsion. Electrodes are applied to one or both temples, and a small amount of current is transmitted to induce the convulsion. After the treatment the patient usually remains unconscious for about 15 to 30 minutes. A series of treatments may cause memory difficulty that clears up in a few weeks except for memories of some events during the months close to the period of treatment. However, the ability to remember other things or to retain new information is rarely impaired.12,13 ECT can be dramatically successful in certain types of severe depression and is sometimes helpful in severe psychotic reactions. However, it is seldom appropriate unless medication alone fails to produce results. An Attack from Within An acute anxiety attack is of sudden onset and may even begin without any apparent precipitating event. The patient is suddenly extremely apprehensive. He is aware of palpitations. Perspiration becomes profuse and breathing is difficult. . . . The patient often fears that a medical calamity is taking place within his body. Particularly during the first such attack, the patient is apt to feel that he will faint, or die, or lose control of himself or of his mind. In the severe anxiety attack, the patient literally reaches a panic state where he feels overwhelmed and completely helpless. He is aware of a tremendously strong impulse to run away from wherever he is. He knows not from what he runs, nor even clearly where safety lies. Even following the attack, the patient remains chronically fearful lest he suffer another such unpleasant attack. This, of course, creates . . . additional anxiety which only tends to aid in the precipitation of further attacks. O. Spurgeon English, M.D. Stuart M. Finch, M.D.11 Personal Glimpse Part Two Health-Care Approaches96 pSYchoSoMatic diSorderS From time to time everyone experiences symptoms that are physical reactions to tension. Common examples are headaches, diarrhea, constipation, nausea, dizziness, muscle cramps, dry mouth, cold hands, indigestion, excessive sweating, and palpitations of the heart (see Personal Glimpse box). Whether treatment is needed depends on the severity and frequency of the symptoms. They may require no treatment, self-medication with an over-the-counter product, medical care, or psychiatric treatment. These psychosomatic (psychophysiologic) reactions are mediated through the autonomic nervous system and are related to the action of adrenaline and related hor- mones on various parts of the body. Diarrhea before an examination, for example, is caused by increased intes- tinal motility. Tension headaches are caused by muscular tension in the back of the neck. Indigestion may result from excessive production of acid in the stomach. The symptoms of acute anxiety attacks—sweating, rapid heartbeat, palpitation, and a feeling of dread—are caused by release of adrenaline. Anxiety can also trig- ger hyperventilation syndrome, in which a feeling of shortness of breath is accompanied by lightheadedness and numbness of the hands and feet. On the more seri- ous side, asthma, high blood pressure, backache, and ulcerative colitis can have significant emotional com- ponents. Psychophysiologic reactions may be treated with (a) drugs that prevent the hormones from affecting the target organs, (b) antianxiety drugs or behavioral therapy to reduce tension, (c) psychotherapy to resolve the underlying causes of the tension, or (d) a combination of these. A large percentage of the ailments for which people seek medical attention are significantly related to tension. Excessive intake of caffeine is a common cause of symptoms that resemble those of chronic anxiety. The FDA requires food and drug labels to disclose the pres- ence of caffeine, but many people don’t realize that in addition to being present in coffee, caffeine is also found in tea, some soft drinks, and certain pain-relievers and cold remedies. Caffeine’s effect can last up to 18 hours in sensitive individuals. In people who become physically dependent on it, withdrawal during the night can cause headaches and grogginess in the morning. inpatient care Psychiatric inpatient care is needed in four basic situ- ations: (1) the patient is considered dangerous to self (either suicidal or not eating enough to sustain life), (2) the patient is considered dangerous to others, (3) the patient is so malfunctional that community care is not possible, or (4) specialized treatment available only on an inpatient basis is needed. Many communities have day-care or “partial-hospi- talization” programs where patients spend 6 to 8 hours per day in a therapeutic atmosphere. Some hospitals have night-care programs. Halfway houses can ease the transition from hospital to community living. Patients who are judged sufficiently dangerous to themselves or others can be committed involuntarily to either inpatient or outpatient treatment. Contrary to popular opinion, court decisions and state laws tend to define “dangerousness” rather narrowly. As a result, commitment against a person’s will can be difficult to initiate or sustain. A type of advance directive may be used to provide seriously mentally ill people who are in remission with a way to consent to treatment if they become too sick or upset to do so. These documents describe when and how treatment should be implemented if the patient becomes incompetent to make a rational voluntary decision. help for addictive Behavior Addictions are habitual patterns of chronic, excessive, sensation-seeking activities that persist even though they cause adverse social, family, occupational, or health problems. Potentially addictive behaviors include not only the use of alcohol, tobacco, and some other drugs, but also activities such as gambling, eating, exercising, shopping, playing video games, and sex.14 Although some people may recover from or mature out of some addictive behaviors on their own or with social support, others require assistance from professionals, self-help groups, or self-help materials. Professional assistance includes individual and group counseling, medications, and cognitive-behavioral therapy focusing on relapse prevention. Chapter 17 discusses help with smoking cessation. Drug Abuse Programs The treatment of drug abuse depends on the nature of the drug and the abuse pattern. Several types of treatment programs exist for people who use alcohol or other drugs excessively. Short-term methods include detoxification, residential therapy, medications to counteract or alter sensations produced by drugs, and drug-free outpatient therapy. Professional detoxification services enable people to withdraw safely and with reduced distress from Chapter Six Mental and Behavioral Help 97 drugs such as alcohol and heroin. Longer-term treatment may include methadone maintenance and residential therapeutic community treatment. Most inpatient programs for people with alcohol and other drug programs emphasize the use of self-help fellowships such as Alcoholics Anonymous or Narcotics Anonymous. These programs promote teachings about alcoholism or chemical dependency as an inevitably progressive disease of body, mind, and spirit that cannot be cured, but for which a “recovery” process is possible. Such teachings are not well supported by scientific evidence.15 For substance abuse treatment of adults, the Cali- fornia Evidence-Based Clearinghouse for Child Welfare (CEBC) has rated motivational interviewing—a direc- tive method to increase client motivation to change—as “well-supported by research evidence” and has rated various programs to support coping skills and com- mitment to recovery—including the community rein- forcement with vouchers approach—as “supported by research evidence.” For substance abuse treatment of adolescents, CEBC has rated multidimensional family therapy and multisystemic therapy as “well-supported by research evidence” and has rated adolescent com- munity reinforcement approach and several additional family therapy approaches as “supported by research evidence.”16 Selecting a therapiSt Four basic questions should be considered during the process of seeking mental health treatment: 1. What type of help is wanted? 2. Which practitioners can provide such help? 3. Are they available in the community? 4. How much can the patient afford to pay? If medication is desired, one should see a physi- cian. Most nonpsychiatric physicians can competently prescribe antianxiety agents and antidepressants for pa- tients who are not severely disturbed. For antipsychotic drugs, a high dosage of antidepressants, or any type of long-range treatment, it is best to consult a psychiatrist. Certification by the American Board of Psychiatry and Neurology is a good indication that a psychiatrist is qualified to administer medication, but this certification is not as useful a guideline in selecting a psychotherapist. If a conversational treatment is preferred, names may be obtained from a personal physician, cleric, school counselor, friend, local medical or psychiatric society, local or state psychologic association, or the local Yellow Pages. Psychoanalytic institutes located in some major cities and the departments of psychiatry at medical schools and hospitals can provide names of psychiatrists and psychologists who specialize in psy- chotherapy. Psychiatrists who have trained at university hospitals are more likely to be primarily interested in psychotherapy than those who have trained at state hos- pitals. However, psychotherapy has been relegated to a minor role in residency training programs, so the supply of psychiatrists who offer it has been dwindling. When seeking conversational treatment, “Do you primarily do psychotherapy?” is a good screening question. Many professional and certifying organizations publish a directory. Some public, hospital, and medical school libraries carry such directories, and many organi- zations have online referral mechanisms. Credentials can also be checked by contacting the national professional organizations listed in the Appendix. The current cost of psychotherapy with a private practitioner is usually $75 to $175 for a 50-minute ses- sion. Psychiatrists and psychologists tend to charge more than other therapists. In many communities, people who cannot afford private care can receive treatment at a mental health clinic where fees are based on the ability to pay. Most psychotherapy at community clinics is done by psychologists and social workers. A limited amount of counseling is available without charge to students through the student health service at most colleges and universities. Insurance coverage for psychotherapy is usually not generous. It typically covers 50% to 80% of the insurance company’s allowable cost per session, with a low dollar limit on total cost per year. Student assistance programs at some colleges and universities and employee assistance programs in some workplaces provide services to people dealing with per- sonal challenges including family or relationship issues, work-related problems, bereavement, addictions, stress, depression, or an array of other personal challenges. They provide services such as assessment, diagnosis, referral, crisis intervention, and brief treatment for free or at minimal cost. Psychiatrist Ronald Pies17 recommends consultation with a physician whenever mental problems are associ- ated with any of the following symptoms: blackouts; memory lapses (such as trouble recalling recent events); persistent headaches; significant unintentional weight loss; numbness; tingling or other strange sensations; generalized weakness; dizzy spells; significant pain of any sort; difficulty walking; shortness of breath; seizures of any type; inability to control urination; unduly rapid or forceful heartbeats; frequent, heavy sweating; tremor; or slurred speech. Part Two Health-Care Approaches98 Consumer Reports magazine has published the results of three large surveys of its readers’ experiences with mental health professionals. The first survey18 drew 4100 responses from readers who had sought profes- sional help for emotional problems between 1991 and 1994. Almost all felt they had been helped, with those who initially felt the worst reporting the most progress. Significantly more improvement was reported with long- term therapy than with short-term therapy. Overall, the respondents felt that psychiatrists, psychologists, and social workers were equally effective, and that marriage counselors were less so. Those who relied on their fam- ily doctors were more likely to receive medication and be less satisfied than those who sought specialized care. Consumer Reports’ second survey,19 which yielded about 3100 responses, found:

• A combination of talk therapy and drugs often worked best. But “mostly talk” therapy was almost as effective if it lasted for 13 or more visits.
• “Mostly drug” therapy was also effective for many people. Drugs had a quicker impact on symptoms than talk therapy, but it often took trial and error to find a drug that worked without unacceptable side effects.
• Forty percent of people who took antidepressants com- plained of adverse sexual side effects.
• Care from primary care doctors was effective for people with mild problems, but less so for people with severe ones.

The third survey, which drew 1544 responses, found most people were helped, but those who used both drugs and talk therapy for at least seven visits fared best.20 These results mirror other research findings that most people who seek treatment benefit from it and, for most problems, the most important factor in psychotherapy is the patient-therapist match rather than the type of treatment.21,22 How much therapy is “enough” depends largely on the patient’s personality and the nature of the problem. Obvious symptoms tend to diminish fairly quickly, but personality change usually takes longer. How can progress of therapy be measured? One sign is lessening of symptoms such as anxiety or depression. Another is mastery or better management of stressful situations that previously had caused difficulty. However, symptom relief can be temporary, and other types of improvement may not be obvious until many months have elapsed. Hales and Hales23 state that although there are no consistent indications that therapy is on course, there are “red flags” that suggest when it is not. These include a sense that the therapist doesn’t understand the problem, difficulty communicating or confiding, dreading each session, feeling “stuck,” and feeling that the therapist is behaving unethically. Negative feelings do not necessar- ily mean that the treatment is not working. People who feel they are not making progress should discuss their concern with the therapist. Ethical violations (some of which are discussed later in this chapter) are a reason to switch therapists. QueStionaBle “Self-help” productS Many recordings, books, and devices have been mar- keted with claims that they inspire people to function better mentally, improve relationships with others, re- lieve anxiety or depression, or achieve other desirable emotion-related goals. Gerald Rosen, Ph.D.,24 former chairman of the American Psychological Association’s Task Force on Self-Help Therapies, has noted:

• Although some of these materials may be helpful, most have not been tested for validity.
• Many self-help materials are promoted with extravagant and ethically questionable claims.
• The fact that a technique is useful as part of a therapy pro- gram does not mean it will work as a self-help measure. Self-help books are more likely to be helpful during periods of therapy than at other times.
• Few self-help books offer protection against failing to comply with instructions. Should failure occur, readers may inappropriately blame themselves, become skeptical that they can be helped, and fail to seek professional help.

Subliminal Recordings Thousands of videotapes, audiotapes, CDs, and DVDs purported to contain repeated messages are being mar- keted with claims that they can help people lose weight, stop smoking, enhance athletic performance, quit drink- ing, think creatively, raise IQ, make friends, reduce pain, improve vision, restore hearing, cure acne, conquer fears, read faster, speak effectively, handle criticism, relieve depression, enlarge breasts, and do many other things. At least one company has offered subliminal tapes for children, including a toilet-training tape for toddlers. Many products feature music said to promote relaxation. Most are claimed to contain messages that are inaudible or barely audible, but some are barely or fully audible. Videos may feature images, said to be relaxing, com- bined with repeated visual messages shown so briefly that they cannot be seen at normal playing speed. Many researchers have found that subliminal record- ings provide no benefit. One study of tapes from several companies concluded that they contained no embedded messages that could conceivably influence behavior.25 A research team tested tapes said to improve memory and self-esteem, but switched the tapes for half of the Chapter Six Mental and Behavioral Help 99 participants (to create a control group). Regardless of the tape used, about half of the subjects claimed to achieve the results they were told to expect—but objective tests of memory and self-esteem showed no change.26 A National Research Council committee concluded that although many people claimed that subliminal self-help tapes contribute to self-improvement, no scientific evi- dence supported such claims.27 Thus there is no reason to believe that music with subliminal messages can do anything more for physical or mental well-being than ordinary music. Recent research has shown that sub- liminal messages can be designed to alter what people think or want if they are unaware of receiving them, but this does not mean that such messages have therapeutic value.28 Biofeedback Gadgets Battery-operated skin-temperature monitors ($20 to $80) and devices that measure muscle or brain wave activity ($200 to $400) have been marketed through the mail for home use. The Harvard Health Letter has warned that such devices have not been systematically evaluated and are likely to “have a short working life before they wind up in a closet or attic, gathering dust.”9 Tests on home biofeedback devices claimed to help people manipulate their alpha waves have shown that the devices actually responded to the user’s eye movements or to interference from household electrical currents. Self-Help Instructional Programs Many entrepreneurs are using cable television infomer- cials to promise that their instructional materials can increase self-confidence, improve people’s performance, and bring success in various ways. Forbes magazine has noted that “inspirational” programs may serve a useful purpose if they enable someone to act more decisively.29 However, the programs have not been validated by sci- entific studies and probably will not help most people who buy them. “Brain Wave Synchronizers” Several companies have marketed gadgets that deliver flashing lights and sounds through modified eyeglasses and headphones. The devices are hazardous because flashing lights can trigger epileptic seizures in suscep- tible individuals, including some with no history of seizures. In 1992 the FDA was informed that a device of this type (the Relaxman Synchroenergizer) had caused a 21-year-old woman to have her first seizure. The device had been marketed with unsubstantiated claims that it could improve digestion and sexual function and con- trol pain, habits, and addictions. In 1993, at the FDA’s request, government agents seized the manufacturer’s entire supply, which a judge subsequently ordered destroyed.30 The FDA also stopped the marketing of InnerQuest Brain Wave Synchronizer, which had been claimed to provide diet control, stress relief, pain relief, and increased mental capacity.31 In 1995 the FTC and four state attorneys general settled complaints against Zygon International, Inc., which had claimed that users of The Learning Machine would learn foreign languages overnight, quadruple their reading speed, expand their psychic powers, build self-esteem, and replace bad habits with good ones.32 The device cost about $300. Beyerstein33 has debunked claims that various devices help people by synchronizing the two sides of the brain or increasing the frequency of alpha waves (a type of brain wave). Currently marketed devices are said to provide “brain wave entrainment.” Bach Remedies Bach remedies are made by soaking or boiling flowers in water to “transmit their energy” and diluting the re- sultant solutions with brandy. The products include an “emergency rescue formula” for “calming and stabiliz- ing emotions” and a line of 38 “flower remedies” said to alleviate negative emotions. In the United States, their leading marketer has been Ellon USA, Inc., of Lynbrook, New York. The products were developed during the 1930s by Edward Bach, a British bacteriolo- gist and homeopath, who—according to the company’s literature—“believed that the only way to cure illness was to address the underlying emotional causes of disease.” The flower remedies can be selected using Ellon’s 116-item “self-help questionnaire.” Someone who feels overwhelmed with work, for example, is advised to take Elm, whereas someone who has strong opinions and is easily incensed by injustices is advised to use Vervain. Another company describes its Rescue Remedy as “the one product you need to take care of all kinds of emergency emotional stress.” Its catalog has depicted the product as useful for (a) a woman under stress because her computer “froze,” (b) a mother cop- ing with a cranky toddler, (c) the partner of a doubles tennis player who missed a few shots, (d) participants in a minor auto accident, and (e) a man racing to board a plane who suddenly realizes he forgot to pack his suit and left his keys and ticket at home. Dietary Supplements and Herbs Many products marketed as “dietary supplements” are claimed to improve mental functioning. Kava and valerian are said to relieve anxiety; St. John’s wort and S-adenosyl-methionine (SAMe) are marketed for the Part Two Health-Care Approaches100 relief of depression; ginkgo biloba is claimed to improve memory; and many vitamin concoctions are recom- mended for treating Down syndrome, hyperactivity, autism, and other childhood conditions. Unlike prescription drugs, which require FDA ap- proval before they can be marketed, dietary supplements and herbs are not required by law to undergo rigorous testing for safety and effectiveness. Moreover, for those that show promise, there has not been enough research to determine whether they are safe or are as effective as FDA-approved drugs. In some cases, serious adverse effects have been documented. (For example, St. John’s wort interferes with the effectiveness of several prescrip- tion drugs, and kava, which the FDA has banned, can cause fatal liver disease.) In many cases, there is no credible evidence of benefit whatsoever. In addition, most herbal products sold in the United States are not standardized, which means that determining the exact amounts of their ingredients can be difficult or impos- sible. This subject is covered further in Chapter 11. QueStionaBle practiceS Many types of practitioners who profess to treat mental, emotional, and personal problems or to give advice are not qualified to do so. Because terms such as therapist, psychotherapist, and counselor are not defined by law, anyone may use these titles. The fields of sensitivity training, sexual counseling, marriage counseling, life coaching, hypnosis, and encounter groups contain many self-proclaimed therapists who have little or no training. Other types of unqualified practitioners ply their trade under titles such as astrolotherapist, autohypnotist, palm- ist, past-life therapist, reader-adviser, transformational counselor, metaphysician, graphologist (handwriting analyst), and character analyst. Some have certificates from diploma mills or correspondence courses. Some practitioners with reputable training and cre- dentials use methods that are unscientific or unethical. Some have personal problems that interfere with proper care of their patients, and some deliberately exploit their patients. The trouble with improper mental health treatment is not merely lack of efficacy. A disillusioning experience can cause the patient to stop seeking help or can trigger a personal

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