Tuesday, August 18, 2009

Can We Teach People How To Avoid Mental Illness?

Prevention is an interesting word in psychiatry. It's hard to prevent mental illness-- we believe a lot of it is about genetics-- and when we think about prevention, we think about things like avoiding drugs and excess alcohol, getting enough sleep, growing up in a kind, safe, and loving environment with a reasonable amount of stability. Those are good things. When it comes to preventing Post-Traumatic Stress Disorder, we think about avoiding trauma, to the extent that we are able. Roy has written about the hypothetical idea of giving people medications to prevent the hard-wiring of traumatic memories and we talked about it in our My Three Shrinks Podcast #46 :Fugetaboutit!

But can you teach people not to get ill -- an insurance plan, if you will, or extra-protection-- before they get exposed to extreme trauma? Can you teach them not to get depressed? Not to get PTSD? It's a great idea, but as far as I know, people vary in their vulnerability and resilience, perhaps even tempermentally, and I'm not aware of research that shows you can teach people resilience in the fact of horror. It doesn't mean it can't be done, it just means I don't know of any research proving it. And if you can teach this, I want to be in the class, and I'd like to invite all the folks who live in the inner city to join me.

So Benedict Carey writes in today's New York Times about how the military intends to require emotional resiliency training for every soldier. Wow!

The new program is to be introduced at two bases in October and phased in gradually throughout the service, starting in basic training. It is modeled on techniques that have been tested mainly in middle schools.

Usually taught in weekly 90-minute classes, the methods seek to defuse or expose common habits of thinking and flawed beliefs that can lead to anger and frustration — for example, the tendency to assume the worst. (“My wife didn’t answer the phone; she must be with someone else.”)

Carey goes on to note:

“It’s important to be clear that there’s no evidence that any program makes soldiers more resilient,” said George A. Bonanno, a psychologist at Columbia University. But he and others said the program could settle one of the most important questions in psychology: whether mental toughness can be taught in the classroom.

So what's the downside? I'm not sure there is one-- except the price tag-- $117 million dollars for an unproven experiment? Couldn't we do some pilot studies first? Obviously I'm a bit of a skeptic-- perhaps we can teach people to be more adaptive in mildly stressful places, but I'm wondering if anything shields you from the extremes and the trauma our soldiers experience in combat. Funny to be spending so much for an unproven intervention in an arena where there aren't funds for treatment of those who give so much and come back so damaged.


HappyOrganist said...

I don't know. But my therapist is teaching me all about "resiliency" skills, which I guess can be learned Before traumatic stress as well as After.
We're all so different, though. I think maybe some things are unavoidable and kind of unpreventable. just in terms of - life is about learning, and so some things have to be learned and that happens sometimes after a catastrophe (instead of before). And that's just the way it goes.

Skills can be taught beforehand. And there are a lot of things we can do to help people grow up in safer environments in the first place. But inevitably we will all be pushed to our own limits (for our own learning).

That's my opinion, anyway.

mysadalterego said...

Oh, just the title of this post induces GUILT GUILT GUILT. I already torture myself on how I let this happen to me...what if they could prove something I could have done differently?

HappyOrganist said...


life is about learning! don't sweat the big stuff (or the small stuff). buy some antiperspirant and don't sweat it !

Unknown said...

People are different situations are different. For some people things apply but for others they don't. Its the way of life, lol. Still a great post, as always. I would love for an email back because I would like to feature you on my website it is www.therapycounseling.com. People can get free advice and consult from therapists and counselors. We don't have anybody to write blogs and I would for you to or atleast get your link on our page. my email is john.phone2phone@gmail.com get back to me as soon as you can.

Sunny CA said...

I laughed when I read the title of the article in the NY Times a few days ago. I think that the premise is false. How could a soldier "mentally prepare" to see his best friend blown to bits by a land mine, for example.

My psychiatrist does believe in reducing environmental stressers to improve a patient's mental health, but he advocates avoiding traumatic stress, not preparing for it!

In my opinion this is either an attempt at public relations or a plan created to deny future claims for PTSD (because these soldiers would have gone through a preventative program so therefore can't get PTSD).

Pleochroia said...

I doubt it would work for PTSD. But maybe for depression. To the extent that the examples given are representative of distorted thinking patterns among soldiers, it might be that developing more adaptive thinking patterns would help with interpersonal/family stress, help them maintain social support, etc. In other words, teach them how not to make a difficult situation (deployment) worse.

But I don't see it making a whit of difference for trauma.

Dr X said...

I'm very skeptical, but I don't oppose a well-designed experiment. I can't imagine why they need to spend $117 million dollars for the experiment. I'll set it up and run a good experiment for half that price with a few colleagues. Then we'll all retire.

Seriously, when I read the post I thought of Salvatore Maddi at the University of Chicago. Maddi has been conducting research on what he calls hardiness training for years. Hardiness refers to resilience in the face of stress.

Not surprising, Maddi has been interested in hardiness training for the military.


Anonymous said...

$117 million is probably not a very big program. I think it's worth trying.

My thoughts are that some people who might be inclined to mental distress would benefit from these sessions, particularly if they have friends and colleagues (what do you call a fellow soldier?) around to reinforce them.

A lot of soldiers are really young, and not very educated so it may or may not hit home with them.

If it were to give their commander or line leader a common lexicon to talk to them it may be helpful.

FooFoo5 said...

First, when gov't. is involved (regardless of level), the cost is boundlessly exorbitant. This is a pointless criticism. Just inquire of those on the receiving end (aye!).

Nevertheless, it strikes me logically (without any basis in the literature, which I shall explore later!) that "predictive" CBT," for example, might have some merit in the overall scope of negative statistical expectation. After all, for example, didn't such renowned clinicians as Minuchin "warn" us of the "traps" facing us? Is this not beyond "experiment," and a fundamental aspect of our training as therapists? Stash it away for later; it will (hopefully) come back when you need it.

Finally, Madame President, I could be MIA indefinitely, yet your observations never fail to pique my interest.

Anonymous said...

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The Girl said...

I agree with the others who suspect that it is a pre-emptive effort to be able to defend themselves against future PTSD claims.
It sounds nice in theory.