Evidence-Based Behavioral Health Epidemiology Clearly Defined

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Evidence-Based Behavioral Health Epidemiology Clearly Defined - Efficacy of empirical behavioral health data occurs when constants are measured and changed and legitimacy of the data occurs when it is generated by the client. The constant in behavioral health is the clients' emotional state. Measuring, monitoring and improving this constant is what brings about the efficacy of an intervention. What is measured, why it is measured and how the data is generated are questions which must be addressed when the term "Evidence-Based" is used in behavioral health. The Subconscious Restructuring® (SR®) paradigm clearly answers these questions. SR® InterventionThere is a consistent process the subconscious must go through to bring about an emotional state and behavior and the SR® paradigm is based on this constant. This subconscious constant occurs after an event and can be continually repeated by the subconscious until it is interrupted, restructured and reprogramed by the client. Interrupting and restructuring a subconscious process before it has the opportunity to manifest into an aberrant emotional state eliminates the need for background history, diagnosis or analysis of external variables and events. It takes four hours to complete the SR® Process and establish the foundational tools necessary to empower the client to intervene at will on their emotional state and behavior.SR® EpidemiologyDefining the epidemiology of an evidence-based behavioral health intervention begins with answering several important questions. Once these questions are clearly answered the formation of an evidence-based model can take place and moves the focus of behavioral health away from labeling and defining how a client or patient is responding to an aberrant emotional state to addressing how each person internally processes and stores their life events.An epidemiologic overview of the evidence-based SR® paradigm begins with 7 key questions (KQs):KQ1. What determines an emotional state and human behavior?What determines human emotion and behavior is information. The components of this information are words and pictures.KQ2. How does the subconscious work?The subconscious uses two key components to activate an emotional state, which in turn determines a behavior.1) You must talk to yourself, which usually begins with a questionAnd2) By asking a question, the subconscious will always generate an answer which in turn produces a correlating picture. It is from this subconscious picture the emotional state is determined and in turn determines a behavior. In its simplest form a subconscious process looks like this.Word - Picture - Emotion - BehaviorThe SR® paradigm interrupts and restructures this process which in turn reprograms the emotional state and behavior.Example: Keep in mind this is extreme slow motion. If I were to ask you where you went on vacation last the process occurs like this. You repeat the question to yourself and this evokes a picture of where you went on vacation. It is from this subconscious picture you are able to tell me where you went on vacation and how you felt about the vacation. This is how the subconscious works and one would not be able to function or communicate without the subconscious going through this process.KQ3. What do all behavior disorders have in common?The emotional state of the client is the constant among all behavior disorders.KQ4. What is the difference between brain, mind, conscious and subconscious?The brain is the portion of the vertebrate central nervous system that is enclosed within the cranium. The mind is in reference to conscious and subconscious. The way the brain processes and stores information is referred to as mind or subconscious.KQ5. What is the function of the conscious and subconscious mind?The single purpose of the conscious mind is to deliver information to the subconscious. The subconscious does everything else. KQ6. Is depression a disease or disorder?Does a behavior or emotion require a psychological process? If the answer to this question is yes one must ask if it makes sense to classify an aberrant emotional state as a disease? Disease from the days of Hippocrates has been in reference to pathological physiological processes which physicians faithfully adhere to. The patient or client perception of disease is something they did not bring on themselves and medical or pharmaceutical intervention is the only means of treating it effectively. This makes the initial issue much more complex, convoluted and confusing to the patient or client. The clear answer to this question is if a behavior requires a psychological process then it is a disorder. KQ7. Is depression caused by a chemical imbalance in the brain?The myth that depression is caused by a chemical imbalance is still endorsed even after Dr. Helen Mayberg has proven this hypothesis to be false with her research on area 2512. Dr. Maybergs' research confirmed it is the mind (subconscious) which affects the brain and not the other way around.Independent Evidence-Based SR® SupportOnce the above questions are clearly answered the formation of an evidence-based behavioral health model can take place and moves the focus away from evaluating external events to looking at how each person internally processes and stores life events.Dr. Helen Mayberg(1) inadvertently confirmed the answer of what brings about an emotional state with her research on area 25(2). Dr. Mayberg found using brain scans that the frontal cortex dimmed down and area 25 lit up in depressed patients. As a patient recovered from depression, area 25 dimmed down and the frontal cortex lit up. Through the course of experimentation Dr. Mayberg took a baseline brain scan of a group of healthy people and then asked them to think sad thoughts. When the follow-up MRI was taken area 25 showed greater activity and the frontal cortex had dimmed down. Dr. Maybergs' experiment concluded depression was a result of one's thought process which in turn effected the brain. While healthy patients recovered quickly, bringing MDD patients back by simply telling them to think positive thoughts was not effective.The ramifications of Dr. Maybergs' work are far reaching. Her research has discredited continued claims depression is caused by a chemical imbalance. It established a distinct difference between the effects and interaction of psychology and physiology. To more clearly understand Dr. Maybergs' work one needs to make a distinct difference between mind and brain. In computer terms the mind or subconscious would be referred to as the software and the brain as the hardware. In the case of Dr. Maybergs' work it is the software which is causing the hardware to malfunction. If depression is induced by one's thought processes then what would clearly be the best treatment.

If one simply understood what the subconscious did with incoming information the need for deep brain stimulation, ECT, pharmaceuticals or other high risk methods could be bypassed for the majority of patients.What SR® Measures•Emotional Checklist: The 12 point Emotional Checklist consists of a full range of human emotion and issues to collectively indicate a depressed state. The first three questions indicate anxiety, negative self-talk and anger levels. Question 4 addresses sleep, question 9 is in regard to eating behavior and question 12 is in regard to suicidal ideation.•Behavior Control Checklist: The 5 point Behavior Control Checklist enables the client to grade the counselor in regard to delivery of information and the clients' ability to fully comprehend the process. •Relationship Satisfaction Scale: The 5 point Relationship Satisfaction Scale addresses how the client relates to people they are closest to in their lives. Why it is MeasuredDepression: Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.(3) Antidepressants are the most commonly prescribed class of medications in the United States with over 27 million effected over the age of six.(4) Anxiety: Approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder.(5) Anxiety disorders frequently co-occur with depressive disorders or substance abuse.(5) Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.(6) Negative Self Talk: Depressed groups endorse significantly more negative self-talk and evidenced a significantly less-frequent occurrence of positive self-talk.(7) The first component the subconscious uses to bring about an emotional state and behavior is internal dialogue and this is the first process to be interrupted, restructured and reprogrammed with the SR® process. Anger: Anger and hostility are linked to coronary heart disease in both healthy and CHD populations.(8) Sleep: A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain.(9) Sleep deprivation adversely affects the brain and cognitive function.10 Eating Behavior: Physiological changes as a result of disordered eating can effect psychology(11) and in turn the psychology which brings about disordered eating effects the physiology.(12) Suicidal Ideation: Suicidal ideation has been linked to hopelessness(13) and anxiety14 both of which are measured in the Emotional Checklist and numbers which are monitored. Question 12 is a straight forward indicator of suicidal ideation and many times closely correlate with question 1 (anxiety) and question 5 (hopelessness). The risk of suicide attempts among the PTSD population is six times greater than in the general population.(15)How SR® Data is GeneratedSR® data is generated by the client with the SR® Institute EHR web app. This data cannot be changed by client or counselor after it is saved. ResultsThe efficacy of SR® has been consistent since its introduction into psychiatric care in 1990. Following are percent improvements of three recent case studies and one group study. Case Study 1: depression 78%, anxiety 71%, anger 83%, sleep 66%, suicidal ideation 83%, eating behavior 85%, relationship satisfaction, 55%. Case Study 2: depression 81%, anxiety 60%, anger 77%, sleep 80%, suicidal ideation 80% eating behavior 80%, relationship satisfaction, 21%. Case Study 3: depression 82%, anxiety 80%, anger 80%, and sleep 90% eating behavior 0%, relationship satisfaction, 44%. Group Study: depression 45%, anxiety 42%, anger 50%, sleep 37% eating behavior 36%, relationship satisfaction, 22%.You can find the raw data to the above studies here. www.SubconsciousRestructuring.com/pdf/SR-Institute-Case-Group-Studies.pdfResults for the two case studies and the group study are typical of the data generated over the twenty one years the subconscious restructuring paradigm has been in use. When the first three questions of the Emotional Checklist which represent anxiety, negative self-talk and anger are addressed through the initial 4 hours of the process the rest of the numbers typically come down. The three case studies met the desired result of < 5 on the Emotional Checklist and > 6 on the Behavior Control Checklist and Relationship Satisfaction Scale.Data AnalysisThe objective on the Emotional Checklist is to reach the lowest number possible with < 5 indicating a reasonable level of control by the client. A score > 4 indicates an issue to immediately address. A sustained score > 4 on question 12 at the first follow-up after completion of the process requires a recommendation to a psychiatrist. A score of > 6 on the Behavior Control Checklist indicates a reasonable understanding of the SR® process. A score of > 6 indicates reasonable relationship satisfaction on the Relationship Satisfaction Scale. SR® Training Certification & EHR ProtocolSR® Training is implemented and completed within two days with an EHR web app live or online as was Beau Chatham, MSRC and Paige Valdiserri, ME.d. Completion of certification can be accomplished in under two weeks. This represents a fast, cost effective, efficient behavioral health solution which can be implemented shortly after certification. The SR® Institute EHR software enables implementation of the SR® process, computation of data and data sharing worldwide from a central location. ConclusionsFrom what is measured, results produced to how data is tracked and monitored, SR® represents a comprehensive updated evidence-based paradigm for behavioral health. As demonstrated in the case and group studies interrupting a thought process before it has an opportunity to cause damage is effective, efficient and fast. References1. Am J Psychiatry. 2010 Dec;167(12):1437-44. Holtzheimer PE 3rd, Mayberg HS.2. DOI:10.1016/j.biopsych.2007.01.013. The World Health Organization. The World Health Report 2004: Changing History, Annex Table 3: Burden of disease in DALYs by cause, sex, and mortality stratum in WHO regions, estimates for 2002. Geneva: WHO, 2004.4. Arch Gen Psychiatry. 2009;66(8):848-856. doi:10.1001/archgenpsychiatry.2009.815. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.6. Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005 Jun;62(6):593-602.7. DOI: 10.1007/BF011760698. J Am Coll Cardiol, 2009; 53:936-946, doi:10.1016/j.jacc.2008.11.0449. Taheri S, Lin L, Austin D, Young T, Mignot E (December 2004)10. Neuropsychiatr Dis Treat. 2007 October; 3(5): 553-56711. J Eat Disord 21: 147-157, 1997.12. J Eat Disord 8:343-361, 1989.13. Am J Psychiatry 1985; 142:559-56314. Am J Psychiatry 1985; 142:559-56315. Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000;61 Suppl 5:4-12

Adi Hidayat

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Saturday, December 10, 2011