Yesterday NICE - the National Institute for Health and Clinical Excellence in England & Wales - published guidance on a diverse range of fifteen clinical, technology, interventional and public health subjects.  Their clinical guidance on Medicines Adherence  interested me, as too did their public health guidance on Promoting Physical Activity for Children and Young People.  The subject of this post is the clinical guidance on Antisocial Personality Disorder and in my next post, I'll talk about their guidance on Borderline Personality Disorder.  As Dr Tim Kendall, Joint Director, National Collaborating Centre for Mental Health, states: "Approximately 2 million people in the UK have personality disorders, with antisocial and borderline disorders being the most common.

Here are a set of diverse handouts and questionnaires on emotions, schema and personality.  The "triangle of emotions" is a model I put together to help guide work on the longer term dysfunctional personality patterns that we probably all experience to some extent.  The "big five" is a very widely used way of assessing personality, and this "ten aspects" version I find particularly interesting.  There are then a series of handouts from Arnoud Arntz's fine work on understanding and treatment of borderline personality disorder.  I have found that Arntz's ideas seem more broadly helpful than just with borderline (which anyway is a poor descriptor for this emotional regulation disorder).  There are also some sheets derived from Young's associated work on schema. 

In blog postings earlier this month, I've talked about supporting my Mum after her recent couple of strokes.  She's been shipped through three different hospitals and now is more peaceful in a nursing home.  It's sad - very sad at times - and it's great that she seems more comfortable, better looked after, and more content.  I definitely feel easier too.  Less weight on my shoulders, less emotional aching.

Here are half a dozen papers relevant to psychotherapy.   The first two throw some light on the question of whether it matters which form of established psychotherapy one uses to treat a particular depression sufferer - bearing in mind Cuijpers et al's recent meta-analysis suggesting that " ...

Here are a set of handouts and questionnaires about emotions.  It seems helpful to understand emotions through an evolutionary perspective - we have emotions, to a large extent, because they had (and have) survival value.  We are the descendants of people with adaptive emotional systems that helped them stay alive and function well.  Typically unwelcome feelings that seem maladapitve are due to emotions that are firing off inappropriately.  As a rule of thumb, if an emotion is an appropriate reaction to a situation it can help us respond successfully.  If the emotion is inappropriate then it's likely to be more useful to work to change the emotional response - through therapy or other approaches. 

Emotions are like a ‘radar system' - this pair of Powerpoint slides, that I print out as a two-slides-to-a-page handout, introduces the idea of emotions as an evolutionarily adaptive system.  I use the metaphor of emotions as a 'radar & rapid response system' - normalising emotions and conceptualising emotional problems as inappropriate levels of activation in a basically adaptive system.   

Blogging about my mum's illness and my reactions to it led me to think again about self disclosure by health professionals.  Our job is to be helpful for our clients - it's what we're about.  Self disclosure by health professionals is a mixed bag.  It can sometimes be helpful and sometimes damaging.  Different schools of therapy and different styles of doctor have strong opinions about what's right and wrong in this area.  Strong opinions without research back-up tend to generate more heat than light.  As has been so delightfully stated "The plural of anecdote is not data".  This post is not at all intended to be exhaustive about research on health professional self disclosure.  It is intended to shine a light on some interesting facts and to raise some questions.

Here are a couple of studies on the prevalence of depression and anxiety, and four on risk factors for depression, bipolar disorder and suicide.  Strine et al report on a major survey of depression and anxiety in the United States.  They found "The overall prevalence of current depressive symptoms was 8.7% (range by state and territory, 5.3%-13.7%); of a lifetime diagnosis of depression, 15.7% (range, 6.8%-21.3%); and of a lifetime diagnosis of anxiety, 11.3% (range, 5.4%-17.2%)."  Smoking, lack of exercise, and excessive drinking were all associated with increased likelihood of mental disorders, as too was physical ill health.  Young et al, in a separate study, looked at the likelihood of depression and anxiety becoming persistent.  They estimated - at nearly 3 year follow-up - that the US prevalence of persistent depressive or anxiety disorder was 4.7%.  Only about a quarter of these sufferers were using appropriate medication and only about a fifth appropriate counselling.

Here are a series of information and assessment handouts on alcohol.  For additional information, note that the blog has a whole series of posts on the crucial importance of lifestyle choices, including how we use or abuse alcohol. 

Alcohol disorder assessment - two question screen - this is a useful two question screen for alcohol problems.  Other options include the well-known four question CAGE.

Alcohol disorder assessment - AUDIT and scoring - this is the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization to help identify people whose alcohol consumption has become hazardous or harmful to their health.

Damage caused by alcohol - this one page handout highlights some of the worrying and significant damage caused by excessive alcohol use.

Yesterday and today are a check-in time with my friend Larry.  I've written in a previous blog post how Larry and I have met every three or four months for many years specifically to review how our lives are going and to plan and prioritize our goals for the next few months.  "Taking charge" of our lives in this kind of way makes huge sense.  For example the self-determination literature (S-DT)  highlights the importance of making autonomous decisions about what we put our energy into.  This S-DT research and much other work (e.g. a recent study on goal-setting) also emphasises that this kind of approach is a core component of growing wellbeing in one's life.  Yeats wrote something like "A friend is someone who sees the potential in you and helps you to live it."  Meeting with an old friend in the way Larry and I have done, is certainly an example of what Yeats was talking about.

Here are two papers on mindfulness and four on sleep.  The Kuyken et al paper is important.  It compares mindfulness-based cognitive therapy (MBCT) with continuation antidepressants in the prevention of relapse in recurrent depression.  The results are great - "Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM (maintenance antidepressant) group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04).  MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains."  I have been cautious in my enthusiasm for MBCT (see previous post) but this is exactly the kind of research that we need to help clarify MBCT's potential further.  The second paper on mindfulness is lower key.  It is a mention of its potential in enhancing sexuality.  It makes sense - see last month's posts on the effects of meditation training on experiencing positive emotions - but the relevant research is still in its early stages.