Combatting the inner demons - proposed advance in treating schizophrenia

[stryder]

Confronting an avatar on a computer screen helped patients hearing voices to cope better with hallucinations, a UK trial has found. Patients who received this therapy became less distressed and heard voices less often compared with those who had counselling instead.

Experts said the therapy could add an important new approach to treating schizophrenia hallucinations.

The trial, on 150 people, is published in The Lancet Psychiatry journal. It follows a much smaller pilot study in 2013.

Hallucinations are common in people with schizophrenia and can be threatening and insulting. One in four patients continues to experience voices despite being treated with drugs and cognitive behavioural therapy.

In this study, run by King's College London and University College London, 75 patients who had continued to hear voices for more than a year, were given six sessions of avatar therapy while another 75 received the same amount of counselling.

http://www.bbc.co.uk/news/health-42097781

This might work for some, but I'd be sceptical. While this generates potentially a method of positive enforcement through self-affirmation it doesn't necessarily find or fix the root cause of the issue.

Psychiatrist's will still likely suggest the effects as being due to a genetic or damage relationship, and still will whole heartedly believe that such "hallucinations" are manifestations that people who they deem schizophrenia suffer.

In regards to the sciences, a number have advanced, psychiatry hasn't particular changed in years so this one small step for them is actually something big.... although I'd still say they are focusing way too much on treating a symptom rather than actually furthering an understanding into why such conditions exist. (especially since they already have a narrative they believe to be true, which means they can't evolve any further)

[C C]

Giving an irritating, disembodied voice a simulated face or body reminds me a tad of providing phantom pain with a visible limb extremity to unclench.

Jimmy [amputee], felt that his phantom hand was always agonisingly clenched, with his phantom fingernails digging into his missing hand. Ramachandran put a mirror between Jimmy's arms and asked him to move both his phantom and healthy limb simultaneously, while looking at the reflection of the healthy limb -- effectively fooling Jimmy's brain into thinking his phantom was moving in a normal way. Jimmy felt his clenched fist release almost immediately. "This is because you are creating intense sensory conflict -- the vision is telling you the limb is moving," Ramachandran explains. (What phantom limbs and mirrors teach us about the brain)

- - -

[Syne]

Yeah, since they said the benefits after 12 weeks became indistinguishable from counseling after 24 weeks, I would agree that it seems to only temporarily abate symptoms. But that's the business model of psychiatry, right? No solutions, just endless counseling/medication (with some actually exacerbating symptoms).

I would surmise that this only helps until the person realizes their voices aren't as amenable as their therapist-driven avatar. And I'd bet it is less effective with repetition, especially if symptoms are allowed to reassert themselves between attempts.

It is probably a good idea to find some way to get an exteriorized perspective on such voices, and I'd guess that the inclusion of the therapist only makes it dependent on said therapist (again, just as psychiatrists like it). I'd like to see the results of the patient using this technique alone, with them mimicking the voices and then watching the avatars act them out.

[Yazata]

The problem with schizophrenia (and other psychiatric illnesses) is that nobody knows what causes it. Apparently there's some underlying neurophysiological fault, but nobody knows what it is exactly.

So we are left with talking cures (that don't typically have much effect with the major psychoses) or trying to suppress symptoms with drugs. The latter is very imperfect and it has so many side-effects that many patients can't tolerate it.

It's really tragic for some patients who can't stand the side effects of their anti-psychotic medications but know that the voices and crazy ideation will overwhelm them if they go off the drugs. They are trapped in an intolerable place and start contemplating suicide. I'm thinking of one guy in particular who I vaguely knew and used to talk to in a local cafe, who disappeared years ago. (I wonder if he did kill himself.)

There's a philosophy-of-science point to be made about this. When psychiatric illness was swept into the physical disease model (correctly in my opinion), the idea appeared that physicians were the ones to treat it. So the medical specialty of psychiatry arose, despite it not having the kind of anatomical and physiological foundation that other medical specialties have. Psychiatry exists because people perceive a need for it, not because it has any fundamental understanding of its phenomena or is in any position to do much of anything with regards to treatment.

(It reminds me of the "social sciences" in that regard, or medicine back in the days when physicians used to bleed people.)

[Syne]

There's a philosophy-of-science point to be made about this. When psychiatric illness was swept into the physical disease model (correctly in my opinion), the idea appeared that physicians were the ones to treat it. So the medical specialty of psychiatry arose, despite it not having the kind of anatomical and physiological foundation that other medical specialties have. Psychiatry exists because people perceive a need for it, not because it has any fundamental understanding of its phenomena or is in any position to do much of anything with regards to treatment.

While I agree with you about the faults of psychiatry as a medical specialty, I would disagree that the physical disease model is correct, and for the exact same faults you describe. That seems to only aid its mass appeal as a placebo, since it largely absolves people of any serious work or responsibility on their part. Much like the genetic excuse for obesity myth. People just think "well, I can't do anything about it anyway". Evidence for things like neuroplasticity also lead to questions about the true direction of causation between physiology and behavior. We know that behavioral choices change brain physiology.