CLINICIAN'S DIGEST: New Science for Psychotherapy; Can We Predict How Therapy Will Progress?
Cooper, Garry, Family Therapy Networker
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We break one another's hearts, we're heartsick, our hearts take flight. The idea that the heart is the seat of our emotions predates written literature. In this technological age, people have taken to studying the heart to find the connection between emotions and disease.
Researchers have known for years that depression and heart disease are connected. Approximately one out of six people in the United States has had an episode of major depression, but among people with heart disease, it's almost one out of two. Anywhere from 11/2 to 3 percent of the population is afflicted with less severe, but still diagnosable, depression at any given time, but among patients with heart disease, says medical psychologist Robert Carney, it's closer to 18 percent.
The question has always been whether heart disease leads to depression or depression to heart disease. The January/February Archives of Family Medicine reports a study from the National Center for Health Statistics, a division of the Centers for Disease Control, in which 3,000 men and women were tracked for 7 to 16 years. None of them had high blood pressure at the beginning of the study, but 60 percent of those with intermediate levels of anxiety or depression later developed hypertension, which leads to heart disease or stroke. According to an article in January's New York Times by Gina Kolata, the latest thinking seems to align with the identification of depression as the precursor of heart disease.
The link between the two may be the stress hormone norepinephrine, which increases the blood pressure and heartbeat; depressed people have levels of norepinephrine that are up to 30 percent higher. Further, because of the vicious paradox of depression--while the overt symptoms are of listlessness, internally the stress level is elevated--signs of hypertension usually go undiagnosed and untreated until the condition becomes evident in heart disease.
The ancient poets were apparently right: people sometimes do die of broken hearts.
Knock, Knock . . .
Psychologists are knocking at the door of two of the previously exclusive mental health domains of psychiatrists. California recently became the first state to require that hospitals consider applications from clinical psychologists for medical staff membership. Psychologists will have admitting privileges for patients and will be able to participate in decisions concerning hospital practices and non-medical treatments. This is a significant step forward in both prestige and power. According to Russ Newman, the executive director of professional practice of the American Psychological Association (APA), similar measures are being considered in 16 other states, including Florida, Michigan and Nebraska.
Another development has even broader implications, not only for psychologists but for their clients. Approximately half of the state psychological associations have set up task forces on obtaining prescription-writing privileges for psychologists. Actual legislative pushes are planned within the year in California, Hawaii, Louisiana and Missouri. Elsewhere, state associations are actively working on establishing training programs for their members on prescribing medications.
The powerful managed care industry is supportive of the APA initiatives, since psychologists command lower fees than psychiatrists.
A Running Start
Clients who get the most out of family therapy are apparently the ones who begin with a good running start. …