Upload
susan-ashlynn-sutton
View
218
Download
3
Tags:
Embed Size (px)
Citation preview
MacScotland presents
Focusing on Enhancing Well-Being:Depression and Health Beyond the Medical
Model
withMichael D. Yapko, Ph.D.
August 23, 2015Glasgow, Scotland
1copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Part 1:Reframing Depression and
The Power of Focus
2copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
What causes depression?
3copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
How you answer this question is the single most important
determinant of how you will deliver treatment… and how you will relate
to all I will discuss today
4copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Is Depression Caused By: Genetics? A biochemical imbalance in the brain? Systemic inflammation? Psychosocial stressors? Cognitive distortions ? A lack of environmental and social rewards? Social inequities? Cultural and/or familial influences? Mishandling key vulnerable situations? Dietary issues? A lack of physical exercise?
5copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Major Depression is a Heterogeneous Condition…
…and a variety of biological, psychological and social theories have been formulated to describe its development
6copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
The Biopsychosocial Model Of Depression
• Depression has a biological component (genes and biochemistry, diseases,drugs)
• Depression has a psychological component (cognitive distortions, history)
• Depression exists in a social context (social disturbances, distress, cultural influences)
7copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
One of the most powerful social forces operating today is the push to
comply with a biological interpretation of depression
8copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
In a triumph of marketing over science, the biology of depression
has been greatly overstated…
Depression is about much more than “it’s all in your genes” or “you have a biochemical
imbalance in your brain”
9copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
GENETIC EVIDENCEThe genetic variance for depression is
consistently placed at between .3 and .4
Genetic contributions are relatively mild and largely mediated by environmental
factors, including social ones
10copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
“The strongest predictor of major depression is still your life experience.
There aren’t genes that make you depressed. There are genes that make you
vulnerable to depression.”Kenneth Kendler, M.D.Professor of Psychiatry and Genetics
Medical College of Virginia
11copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
EPIGENETIC EVIDENCE• Epigenetics refers to the processes that lead from a
genotype to its final product…• In an excellent summary article published in September,
2009, the author wrote, “…how genes are expressed is invariably influenced by the milieu in which they function…recent research is beginning to identify environmental factors that lead to these changes…(for example) early parenting has been shown to change these epigenetic patterns, and thereby genetic expression.”
Masterpasqua, F. (September, 2009). “Psychology and Epigenetics.” Review of General Psychology, 13(3), 194-201.
12copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Psychotherapy and Epigenetics
• “Insofar as psychotherapy or counseling is effective and produces long-term changes in behavior, it presumably does so through learning, by producing changes in gene expression that alter the strength of synaptic connections and structural changes that alter the anatomical pattern of interconnections between nerve cells of the brain.”
Eric Kandel, M.D.Geneticist, Nobel prize winner in 2000
13copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Suggesting a drug will cure depression misses the
inescapable point…
…Depression is more a social than medical problem.
14copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
No Amount of Medication Can Teach Your Client:
• More effective coping skills• More realistic explanatory styles• Healthier relationship styles• More flexible and discriminative cognitive skills• Sophisticated problem-solving skills• More effective decision-making strategies• How to build and maintain a support network• How to transcend an adverse personal history• How to build a realistic and motivating future
15copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Drug treatment alone has many different problems associated with it (see the article “Treating
Depression with Antidepressants: Drug-Placebo Efficacy Debates Limit Broader
Considerations” posted on my website –www.yapko.com - for a detailed
summary of these)
Perhaps the biggest problem is in the unfortunate message, “You don’t have to change anything in
your life… you just have to take your drug and wait for it to work”
16copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Depression is a disorder that is built on a foundation of passivity
The last thing we want to do as clinicians is reinforce it
17copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
The more we learn about the biology of depression, the more we discover the power of human relationships to
either increase or decrease one’s vulnerability to depression
18copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
The Social Context of Depression
19copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Through the process of socialization, you evolve your individual patterns for responding to the challenges of life
20copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Depression Intensifies From One Generation to the Next
The first such study following 3 generations of high-risk families and has taken more than 2 decades to complete showed most of the prepubescent grandchildren with a 2 generation history of depression developed anxiety disorders that developed into depression as they aged into adolescence.
Weissman et. al, Archives of General Psychiatry, January, 2005
21copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
How often are other people at the heart of one’s depression?
Rejection, loss, betrayal, humiliation, abuse, and abandonment are all common points of
depression’s origin- and they are all social phenomena
22copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
And, how often is it our misperceptions about others that lie
at the base of depression?
Seeing rejection where there was none? Feeling left out despite invitations to join?
Missing social cues and misinterpreting others’ motives?
23copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
The quality of your relationships is a significant predictor of your risk for
depression
What about social skills training as a preventive opportunity?
24copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Stress Generation Patterns
• The presence of depression and/or anxiety seriously compromises these individuals’ stress coping resources. Minor aggravations become major problems.
• Poor problem solving skills lead to poor choices, which aggravate negative circumstances.
Hammen, Journal of Abnormal Psychology, 1991Harkness & Luther, Journal of Abnormal Psychology,2001
25copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Let’s Shift Our Focus to the Hypnotic Side of the Equation
26copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
The primary purpose of hypnosis and related approaches such as mindfulness is to absorb the person in a frame of mind that is consistent with the therapeutic
objectives
Using experiential approaches to teach empowering strategies is a core part of
that process
27copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Why Hypnosis for Depression?
• Helps people focus• Facilitates the acquisition of new skills• Encourages people to define themselves as
resourceful• Eases the transfer of information across contexts• Intensifies useful subjective associations• Provides experiential learning• Defines people as active managers of themselves
28copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Part 2:Group hypnosis; Expectancy
29copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
“Deeds are the offspring of hope and expectancy.”
Milton H. Erickson
30copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Stable Style Predicts Whether the Client Will be Prone to :
seek treatmentprogress quickly or slowlyactively participate in treatmentexperience a partial or complete
recovery relapse
copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com 31
The first task in treatment is to shift the person from a stable to unstable
attributional style
Co-create Vision of What is Possible:Realistic Hopefulness is Crucial!
copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com 32
Discovering and Creating Client Possibilities
• Identifying exceptions in the pattern• Identifying possible solutions• Identifying alternative framings• Identifying dissociated client resources• Encouraging experimentation• Avoiding labeling• Using presuppositions
copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com 33
Building Expectancy:Basic Structure
• Induction- focusing process• Response set re: future possibilities (e.g., what will change
in the future)• Defining steps toward the goal (e.g., linear sequence) and
acknowledging one’s salient resources (e.g., persistence, creativity)
• Dissociating feelings from action steps (e.g., follow the plan, not your feelings)
• Post-hypnotic suggestions for integration• Closure and disengagement
copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com 34
Part 3:The Case of Mike
35copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
The Inner Critic
Having an inner critic is normal. Believing it is negotiable.
36copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
All the things one would say to be helpful to someone can, of course,
be said without hypnosis…
But hypnosis makes for a focused experience of multi-dimensional
experiential learning
37copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Goals for My Session with Mike
1. Establish rapport and a therapeutic alliance2. Deframe his viewpoint (“It’s my past”) and reframe the
salient issue (“It’s the need for an effective strategy to deal with negativity”)
3. Encourage the development of a discrimination strategy (“What is worth listening to?”)
4. At times of uncertainty, help Mike shift his focus to future possibilities rather than past abuse to guide his choices.
38copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Goals for My Session with Mike (continued)
5. Re-associate Mike to his family, relating to them positively and with an absorption in them as a source of optimism and pride.
6. Introduce hypnosis/focusing techniques and encourage their development as skills for symptom management and empowerment
7. Reinforce critical thinking by addressing his global and dichotomous thinking and personalization of his parents’ limitations
39copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
• You can develop the skills to cope• The past doesn’t predict the future• You’re more than your history• You’re more than your symptoms• You have more resources than you
realize and you can learn how to use them effectively
copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com 40
Did You Notice?
• The change in Mike’s face and demeanor• Mike went from “I can’t” to “I can!”• Mike’s internal locus of control (“I have to be
the one to close the windows and doors”)• Mike’s revised association to his wife and
children
41copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Why Hypnosis for Depression?Because it Empowers People
• Helps people focus• Facilitates the acquisition of new skills• Encourages people to define themselves as
resourceful• Eases the transfer of information across contexts• Intensifies useful subjective associations• Provides experiential learning• Defines people as active managers of themselves
copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com 42
Part 4:Global thinking, ambiguity
43copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Global Cognitive Style as a Key Factor
When you can’t see the trees for the forest…
44copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Examples of Global Style in Client Self-Reports
• “I just want to be happy”
• “I just want to feel normal”• “I am my depression” (anxiety, history,or
diagnosis)• “I’m just so overwhelmed”
• “I get so bad I just can’t think”
• “The symptom just happens to me”
45copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
“I always wanted to be someone. Now I think I should have been
more specific.”
Comedian Lily Tomlin
46copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Examples of Global Therapeutic Truisms
• “Trust your guts” (inner sage, unconscious)• “Life is what happens to you when you had
other plans”• “Just let go…no need to try to control it”• “Be fully present in the moment”• “It’s a disease…it’s not your fault”• “Everyone is entitled to good self-esteem”
47copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Global Thinking in the Symptom Context Virtually Precludes the
Ability to:
• Compartmentalize (e.g., contain anxiety)
• Think linearly, sequentially• Maintain good boundaries• Make key discriminations
48copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
“Overgenerality Bias” and the Global Cognitive Style in Depression
Depressed individuals suffer from an overgenerality bias in retrieving personal memories of past emotional experiences as well as in imagining possible future experiences. For instance, when asked to recall experiences of anger, depressed individuals tend to report overgeneral events (e.g., “When I am with my girlfriend”) rather than a specific event (e.g., “last Sunday, I had an argument with my neighbor whose dog was endlessly barking”). (p. 560)
Philippot et al., Emotion, Nov., 2006, Vol. 6, No. 4, 560-571.
49copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
A discrimination strategy is an ability to skillfully distinguish between two
or more available options in a specific context
50copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Controllability as an ambiguous stimulus
51copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Extreme Perceptions Regarding Controllability
Learned Helplessness: Learned expectations that one’s efforts will have no effect on the outcome
Illusion of control: Learned expectations that one’s efforts are the sole determinant of the outcome
52copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Depressed and Anxious Individuals Tend to Underestimate Their Personal Power…
Thus, passivity seems like a reasonable response
53copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Exercise in Assessing Controllability
Task: Attach a specific numerical percentage of perceived controllability to the following vignettes, ranging from zero (no control) to
100 (total control).
54copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Ambiguity is a Risk Factor
• People strive to understand and make “meaning”
• Ambiguity raises, while certainty lowers, anxiety; projection as a coping device
• Cognitive distortions represent efforts to reduce, eliminate ambiguity
• A therapeutic goal is to learn to both RECOGNIZE and TOLERATE ambiguity
55copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Hypnotically Tolerating Ambiguity
Key messages:•It’s natural to make up stories to explain things… but
you don’t have to believe them!•It’s okay, sometimes even desirable, not to know
•Some questions simply aren’t answerable
56copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
• Orient client to hypnosis• Induction process• Build a response set regarding uncertainty (“You don’t
know what I’m going to say…”)• Introduce the process of inference (“We all make guesses
about the meanings of things we observe or experience”)• Suggestions/metaphors regarding inferences (“When you
were told the classic stories, did you wonder what they meant?”)
57copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
• Introduce the value of knowing (“It can inspire confidence to know you made a good decision based on the facts”)
• Suggestions/metaphors regarding “knowing” (“I wanted to buy a car with really good gas mileage so I read studies comparing models…”)
• Introduce the value of not knowing (“There are some questions we cannot answer, fortunately…”)
• Suggestions/metaphors regarding “not knowing” (“When I began college and I didn’t know what I wanted to do with my life, it allowed me an openness…”)
58copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
• Reframing and reinforcing “not knowing” as desirable in some contexts; the merits of saying “I don’t know”
-Cues for identifying when “not knowing’ is desirable (e.g., there is no way to know)
• Post-hypnotic suggestions for integration (“So when you find yourself making an interpretation about the meaning of some event, you can remind yourself…”)
• Closure• Disengagement
59copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
I want to advance an awareness for the value of experiential learning in general, the value of
hypnosis in particular, and how focusing--using methods like mindfulness and hypnosis-- makes a difference, especially when applied in a multi-
dimensional framework
60copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
The greatest potential for prevention is in teaching people how to step
outside their own thinking
61copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Prevention Opportunities
• Expanding diagnostic opportunities• Addressing sleep• Encouraging exercise• Working with couples and families• Screening for postpartum depression• Identifying children at risk• Teaching social and problem solving skills• Practicing foresight
62copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
An Excellent Review of the Current Depression Prevention Literature
• See “Major Depression Can be Prevented” by Ricardo Muñoz, William Beardslee, and Yan Leykin in the May-June, 2012, issue of American Psychologist (Vol. 67, No. 4, 285-295).
• Meta-analyses suggest that 22-38% of major depressive episodes could be prevented with currently available methods.
63copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
HIGHLY RECOMMENDED SELF-HELP RESOURCES
Depression is Contagious (Yapko)Breaking the Patterns of Depression(Yapko)Hand-Me-Down Blues (Yapko)Focusing on Feeling Good CD Program(Yapko)Calm Down! CD Program (Yapko)Learned Optimism (Seligman)Emotional Intelligence (Goleman)The Optimistic Child (Seligman)Feeling Good (Burns)
64copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
I’ll be providing a 3 day intermediate level hypnosis training (not for
beginners) in Nottingham in February
Please visit the ITC Consultancy website www.taking-control.co.uk
Or email [email protected] for details
I hope you’ll join me!
Please visit my website (www.yapko.com) to join my electronic mail list in order to
receive my newsletter
66copyright 2015 by Michael D. Yapko, Ph.D. www.yapko.com
Thank you for coming!
Michael D. Yapko, Ph.D.
E-mail: [email protected]: www.yapko.com
Address: P.O. Box 487 Fallbrook, CA.
92088-0487USA
67copyright 2015 by Michael D. Yapko, Ph.D.
www.yapko.com