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Behavioral Health: Fad Treatment Methods, Exposure Therapy, and the Importance of Data


Much like fashion trends which have a tendency to resurface every few decades, trends in mental health therapies and fads seem to be just as cyclical – and sometimes equally as out of the box.

More research has been devoted to exploring psychedelic substances such as LSD as a potential treatment for patients with certain psychological disorders such as depression and post-traumatic stress disorder (PTSD), and the approach has gotten traction in both the media and as a memoir about the experience of “microdosing” with these drugs. The same is true for “laughter therapy”—which some believe reduces anxiety and stress, boosts the immune system, and makes pain a little more tolerable—which has made headlines in The Guardian, Live Science, and NPR.

“While fad approaches to mental health definitely have a way of resurfacing, just as they do with diet and fashion,” said Thea Gallagher, PsyD, clinic director at the Center for the Treatment and Study of Anxiety at Penn Medicine, “these tactics, while research continues to be done to evaluate their effectiveness, are still a little lacking when compared to other methods.”

While Gallagher and her team aren’t jumping at the chance to recommend psychedelics to patients that come through the door, she does understand that there are some things that may just work for certain people.

“Very few approaches to therapy are 100 percent effective for 100 percent of our patients,” she said. “I think there will always be some outliers for whom these fringe approaches may be helpful, and even some who benefit from the placebo effect of it all.”

Another dubious “treatment” method cropped up in June 2018 in a story about to Kayne West. Yahoo! News reported that West’s wife Kim Kardashian staged an intervention and introduced him to a “controversial form of stress management known as ‘scream therapy’”—an approach that Gallagher plainly points out has “very little evidence-based information to support.”

As a clinician in an academic medical center, data is one of the first things Gallagher thinks about or points to if or when patients come to her with questions about certain behavioral health treatments.

“Of course, our practice is evidence-based and others in the field recognize them as effective methods, but the average person might think we’re a little nutty for some of these things we do,” Gallagher said. What Gallagher is referring to is exposure-based therapy, or simply the idea of facing ones fears by going out into the world and doing the things that make them the most uncomfortable, scared, or anxious. In fact, prolonged-exposure therapy (PE) was developed by Edna Foa, PhD, Director of the Center for the Treatment and Study of Anxiety, and through years of research is now incorporated more widely into practice.

For example, for someone with obsessive compulsive disorder (OCD), which is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over, the goal is to help them allow themselves to have these thoughts and eventually (in time) lessen these behaviors. OCD can also make people extremely meticulous, potentially germaphobic, and very doubtful or fearful of very basic tasks or interactions.

“These are behaviors that we will often treat both in the office, and out in the world, with what we call ‘in vivo’ exposures,’” Gallagher said. “For instance, we may take a patient with OCD who has a fear of germs down to the subway and have them touch the railing, turn-style or ticket machine. We may even ask them to eat a snack shortly thereafter without meticulously washing their hands. While this may seem like a menial task to some, these are interactions that can trigger someone’s OCD.”

By doing exposure therapy and showing the patient that there aren’t adverse effects and they can tolerate high distress when simply going through the subway, therapists are able to help patients work through their fears and feelings of panic during these high-stress events. Gallagher added, “typically over the course of 10 to 12 exposure-based sessions, we are able to help patients identify triggers and find ways to cope with them in the moment.”

Those with extreme fears of heights – the fear of being up high or for some, the fear of harming oneself if/when they are on a very high structure – may also benefit from exposure therapy.

“In these cases we may do sessions where we’ll just hang out in a tall building, or go out to the top of a parking garage a few stories off the ground, maybe even dangle our arms over the edge of the railing – safely of course,” Gallagher said. “Again, like in the subway, we’re trying to get our patients to identify triggers and realize they are actually safe and not at risk when doing simple everyday things. We also want to help them live with the uncertainly that we all deal with and accept that taking some level of risk is actually important. From there we can help them through these moments of panic, and come through with a better sense of how to manage their anxiety or symptoms when these feelings set in.”

Later this fall, Gallagher and her colleagues will publish a new study discussing the importance of evidence-based practices like exposure therapy. “We know from research findings that these are sound approaches that can help our patients work through their anxieties, triggers, or other stressors. Unlike recommending LSD or sitting in a room and screaming – which again, may work for some – our methods are always steeped in rigorous research and scientific data from many sources over many years,” Gallagher said. 

But since science evolves, Gallagher says she’s “not opposed to keeping an open mind” – the therapies and medications for mental illnesses that may be commonplace a decade from now may be only in nascent stages of development today.

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