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The Coalition of Behavioral Health Agencies, Inc. Coalition Briefs
An electronic newsletter of the Coalition's Center for Rehabilitation and Recovery

Elizabeth Saenger, PhD, Editor and Writer
No. 114-2, April 2015

The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.


A Next Big Idea in Psychiatry: An Interview with Susannah Tye, PhD

After hearing that inflammation might be a unifying concept and cornerstone in the psychiatry of the future, and even in health care tomorrow, RECOVERe-works editor Elizabeth Saenger, PhD, decided to scout for more information. Her journey brought her to Susannah Tye, PhD, Assistant Professor of Psychiatry & Psychology, and Director, Translational Neuroscience Laboratory, at the Mayo Clinic Depression Center. Dr. Tye researches the neurobiology underlying psychiatric conditions, so she was able to provide expert answers.

                                                  

What is inflammation?

Inflammation is part of the body's immune response and helps the body to protect and heal itself.  Inflammation can occur in response to an infection or may be a response to damage or irritation. During its early stages, inflammation facilitates healing and tissue repair. When this repair is completed, the inflammatory process typically ends.

However, under certain circumstances, inflammation can persist and become a chronic condition. This could be the result of long-term exposure to toxins, stress, or other factors that disrupt general well-being and interrupt normal daily rhythms (for example, getting enough sleep). In these cases, the cycle can become self-perpetuating, and a state of low-grade inflammation becomes the norm for the body.

Do you think psychiatric disorders can be explained in term of inflammation?

There is growing evidence that inflammation both contributes to, and results from, psychiatric illness. However, we do not fully understand the nuances or implications of this.

What we do know is that inflammation can affect mood and other psychiatric disorders. We also know that these disorders are negatively impacted, or even triggered, by stress. Stress can initiate changes in the way the immune system functions. Chronic stress, whether psychological (that is, work-related or family stress) or physiological (that is, poor diet or toxin exposure), can weaken the normal responses to acute stress, making an individual more prone to infection.  

Over the long-term, chronic stress can lead to chronic inflammation—which is becoming increasingly implicated in various psychiatric illnesses, including mood disorders, schizophrenia, and posttraumatic stress disorder. As well, this chronic inflammation has been linked to a variety of conditions that can co-occur in people with psychiatric illness, including diabetes, cardiovascular disease, and cerebrovascular disease.

As we better understand how inflammation contributes to the biological pathways underlying mental health, illness, and comorbidities, we will be far better able to help patients seeking treatment.

How could this understanding of inflammation affect the way we categorize, assess, and treat behavioral health problems?

Paradigms surrounding psychiatric illness are shifting. The interdependence of mind, brain, and body is becoming well-established. As our understanding of these interactions develops, we will be better able to look beyond the behavioral or psychiatric aspects of mental illness to treat the whole person. For example, we can no longer consider mood disorders solely disorders of the mind. Instead, there is mounting evidence that these are disorders of the mind, brain and body. Inflammation can be one contributing factor. The interplay of these factors, in turn, can impact an individual’s response to treatment in ways that we are only just beginning to understand.

Ideally, both general physiological health and mental health concerns would be assessed and the individual needs of each patient addressed through personalized treatment approaches. This could include assessment of biological features that often signal the presence or likelihood of inflammation, even though they do not cause inflammation (“markers”). Personalized treatment approaches could also include the assessment of reactivity to stress, and the strength of our inner clock (our circadian function).  In addition, personalized treatment could include controllable lifestyle factors known to impact both physical and mental health, such as exercise, diet, rest, and relaxation.

Do you think inflammation might it be one of the Next Big Ideas in psychiatry and mental health, or in health generally?

Yes. It already is. Psychiatric illness is a physical illness that arises from changes in the way the body (including the brain) either processes or responds to stimuli. This in turn affects the mind and one’s experience and interpretation of events. There is mounting evidence that alterations in immune responses, such as constant low grade inflammation, change the body, brain, and mind in interrelated ways.

Importantly, I think recognizing the role that physical processes play in mental illness will help destigmatize these disorders. The current stigma surrounding psychiatric illness often prevents those who are ill from seeking the treatment and support that they need. Sometimes, when they do seek help, this stigma can also limit the support they are offered from friends, family and coworkers who simply do not understand that they need appropriate treatment and time for healing.

While the causes can be many and varied, we now appreciate better than ever that mental illness results from disturbances in physiological systems that need to be stabilized – like all other illnesses. At the very least, our increased understanding for the role of inflammation (a classic sign that the body is attempting to heal itself) in psychiatric disorders helps to highlight the physiological basis of mental illness. In turn, I believe this is an important step towards validation of an individual’s state of ill health. I hope that validation will help pave the way towards better medical and cultural support for those with mental illness.

 

Jumpstart Your Individual Sessions to Improve Outcomes

Elizabeth Saenger, PhD

We all know our attitudes, such as the unconditional positive regard advocated by Carl Rogers, influence our clients.

Take this commonsense observation to the next level!  Reflect not just on your feelings about your clients, but specifically on their strengths before your next session. This perspective will help create an atmosphere where clients can access those strengths.

This idea is supported by anecdotal evidence from clinicians, and two cognitive behavioral therapy studies. The research found that strengths-focused treatment led clinicians and clients to focus on client competencies and goals during sessions. This had a positive impact on self-esteem, mastery, and other client traits.

In short, this focus on strengths before the session—called resource priming—can help you jumpstart your sessions, and improve outcomes.

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The opinions expressed in RECOVERe-works do not necessarily reflect the views of the Coalition of Behavioral Health Agencies.

To subscribe or unsubscribe to RECOVERe-works, a free publication of the Center for Rehabilitation and Recovery at the Coalition, please email esaenger@coalitionny.org.

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