Positive Mental Training

1
(No Transcript)
2
Positive Mental Training

• A New Approach to Mental Health
• Building Mental Resilience
• Promoting Positive Mental Health
• Dr Alastair Dobbin
• Ms Sheila Ross, MSc

3
Top 10 GP annual contact rates1 per 1,000
population2 by condition3, standardised for age,
sex and deprivation 2004/05p
4
Figure 2 - Number of DDDs per 1000 population
(aged 15) per day 1992/93 to 2005/06
Source Information Services Division.
Healthcare Information Group
5

• Outline
• What is Positive Mental Training
• What is Hypnosis?
• Placebo
• New theories in depression
• Break
• Treating depression - groups
• Evaluation - GP survey
• More of Positive Mental Training
• Patient Video
• The Edinburgh Research and Roll Out
• Discussion

6

• Exercise

7
What is Positive Mental Training?

• A self help modular programme
• To listen to at home
• A DVD and 3 CDs
• Over 12 weeks one 18 min track a day
• Simple effective

8

• Based on the Swedish model of Integrated Mental
  Training
• Developed for Peak Performance in Sport
• Used over the last 30 years

9

• negative triggers /fear conditioning
• Poor self-image/limiting self belief
• Access to good self image/problem solving
• Accessing positive memories/conditioning

Depression Peak performance
10
What is Hypnosis?

• State of relaxation and absorption
• Induced by focused attention
• - Eye closure, relaxation, suggestion
• Decreases sympathetic autonomic arousal effects

11
Self Hypnosis

• Regular, systematic and long term self-hypnotic
  training was superior to hetero-hypnosis
  (hypnotist present) in a variety of measured
  dimensions.
• Audio taped hypnotic inductions were as effective
  as inductions given by a present hypnotiser
  measured on a standard scale of hypnotic
  susceptibility (Stanford Scale)

12
Triggers

• A trigger, conditioning -can be established
  after a single event
• (negative trauma, positive happy).
• Any stimulus for instance a word, movement,
  behaviour or situation, but also a thought can
  become a trigger
• In those situations where the subject is unaware
  of the presence of the trigger such a trigger can
  not be changed by voluntary effort

13
Self Hypnosis

• A positive emotion such as the ideal performing
  feeling can be borrowed from a previous event and
  then conditioned to a future event.
• Lars Eric Unestahl 1973 Hypnosis and post
  hypnotic suggestions (PhD thesis Uppsala
  University) VEJE international Orebro, Sweden.

14

• Derren Brown Video

15

• What drives this process?
• Survival
• Why is it unconscious?
• Emotion

16

• When a stimulus has become a trigger it works
  even in those situations where the subject is
  unaware of the presence of the trigger. Such a
  trigger can not be changed by voluntary effort.

17
Ventral Stream and Dorsal Stream
18
February 2008
19
The Power of Placebo

• Suggestion and Medication in the Treatment of
  Depression

20
PlaceboA Non-specific Treatment
21
PlaceboA Non-specific Treatment

• Pain
• Blood pressure
• Heart rate
• Anxiety
• Depression
• Parkinsons disease
• Angina
• Autoimmune diseases
• Alzheimers disease

• Rheumatoid arthritis
• Asthma
• Contact dermatitis
• Gastric function
• Sexual dysfunction
• Ulcers
• Warts
• Life expectancy
• etc

22
Placebo as a Specific Treatment

• Placebo morphine lowers pain
• Placebo diazepam lowers anxiety
• Placebo caffeine increases alertness
• Placebo antidepressants lower depression

23
Specific Factors Affecting the Magnitude of the
Placebo Effect

• Colour

• Sedative
• Blue
• Red
• Orange
• Stimulant
• Red
• Blue
• Analgesic
• Red
• White
• Blue
• Green

24
Factors Affecting the Placebo Effect

• Colour
• Dose

25
Factors Affecting the Placebo Effect

• Colour
• Dose
• Strength of drug
• Brand name
• Mode of administration

26
Placebo Surgery

• Angina
• Real surgery 73 improvement
• Sham surgery 83 improvement
• Osteoarthritis of the knee
• 2 Weeks Placebo gt real surgery
• 2 years No difference

27
Factors Affecting the Placebo Effect

• Colour
• Dose
• Strength of drug
• Brand name
• Mode of administration
• Adherence

28
Adherence
29
Adherence
30
Factors Affecting the Placebo Effect

• Colour
• Dose
• Strength of drug
• Brand name
• Mode of administration
• Adherence
• Condition being treated

31
Placebo Response as a Percent of Drug Response
32
A Meta-Analysis of Published Clinical Trials

• (Kirsch Sapirstein, 1998)

33
Pre-post Effect Sizes for Drug, Placebo, and
No-treatment Controls
34
Partitioning the Antidepressant Drug Response
35
Types of Medication
36
Percent of Drug Response Duplicated by Placebo
37
Other Medications

• Lithium
• Amylobarbitone
• Barbiturate
• Liothyronine
• Synthetic thyroid hormone
• Adinazolam
• Benzodiazepine

38
What do all of these active drugs have in common,
that they do not share with inert placebo?
39
Side Effects
40
Therapeutic Effects of Imipramine and Placebo
41
Side Effects of Imipramine and Placebo
42
Why are Side Effects Important?

• Informed consent
• May be given placebo
• Double blind
• Therapeutic effects may take weeks
• Side effects
• Most patients assigned to active drug break blind
  (Rabkin et al., 1986)

43
New Extra Strength Placebo
44
Active vs. Inert Placebo(Published Studies)
Outcome Significant drug placebo difference?
Percentage published studies
45
Listening to Prozacbut Hearing Placebo(Kirsch
Sapirstein, 1998)
46
Reaction to Listening to Prozac

• This cant be true

47
Analysis of the FDA Data(Kirsch et al.,
2002)(Kirsch et al 2008)

• Fluoxetine (Prozac)
• Paroxetine (Seroxat/Paxil)
• Sertraline (Lustral/Zoloft)
• Venlafaxine (Effexor)
• Nefazodone (Dutonin/Serzone)
• Citalopram (Cipramil/Celexa)

48
Advantages of the FDA data set

• Includes unpublished trials
• Same outcome measure (HAM-D)

49

• Duplication by Placebo 82
• Mean HAM-D difference 1.80 points
• NICE Clinical significance 3 points

50
Active placebos versus antidepressants for
depressionMoncrieff J, Wessely S, Hardy
RCochrane Collaboration on depression. April
2003

• Authors' conclusions
• The more conservative estimates from the present
  analysis found that differences between
  antidepressants and active placebos were small.
  This suggests that unblinding effects may inflate
  the efficacy of antidepressants in trials using
  inert placebos. Further research into unblinding
  is warranted.

51
Benedetti further reading

• Colloca L, Lopiano L, Lanotte M, Benedetti F
  (2004) Overt versus covert treatment for pain,
  anxiety and Parkinson's disease. Lancet Neurol 3
  679-684
• Benedetti F, Mayberg H, Weger T Stohler c,
  Zubieta H Neurobiological Mechanisms of the
  Placebo Effect The Journal of Neuroscience, Novemb
  er 9, 2005, 25(45)10390-10402

52
Theories in Depression

• Recent research into the nature of depression.

53
Theories of Depression

• By the end of this section you will understand
• What is CBT and why does it work
• What is over-generalisation
• What is the Hippocampus
• What is the Amygdala.
• What is an emotion. What is a feeling.
• Threat Perception and Dorsal and Ventral stream
  processing
• What is the Social Engagement system.
• How does Mindfulness reduce depression

54
Aaron Beck

• Dysfunctional thinking in depression caused by
  a schema - a set of fixed negative beliefs,
  activated during depression. Measured by
  Dysfunctional Attitudes Scale (DAS) one hundred
  statements with graded responses.1
• Low mood measured by the Becks Depression Index,
  (BDI) a snapshot of current mood.2

55

• From this was established
• Cognitive Behavioural Therapy
• Now the dominant therapy for the treatment of
  recurrent depression (and a host of other mental
  disorders).
• CBT says that by looking at the logical errors
  in our thinking, we can escape from recurrent
  self reinforcing negative beliefs and behaviours.

56

• Example a new friend says they will phone but
  doesnt
• We feel depressed. We assume friend doesnt like
  us.
• Cognitive change examine the possible causes
• Friend doesnt like me/ friend is too busy and
  stressed/friend is nervous of rejection/friend
  has lost phone number
• How do we know which applies? We dont
• Behavioural change phone friend
• Positive outcome reinforces the strategy.

57
CBT

• So, dysfunctional beliefs (nobody likes me) leads
  to negative behaviour (no point in phoning them).
  Question belief, change behaviour and
  reinforce functional belief.
• This leads to a permanent change it reduces
  relapse better than pharmacotherapy even though
  it is no more effective in the acute attack.

58
The Scientific Method

• A Good Theory makes the best fit with the
  observations, and if another theory comes along
  with a better fit, then the model needs to change
  to reflect this theory.
• Steven Hawking Today Programme 30/11/2006

59
Causal Factors in Depression

• Relapse is very common in depression
• Studies in relapse indicate causes-mediators
• Measure all the variables you can after first
  occurrence of depression
• Wait for relapse
• Find the most accurate predictor
• This represents the mediator the closest factor
  to vulnerability to depression

60
Predictors in depression

• Recovery is the same from CBT and
  anti-depressants but the former are less likely
  to relapse.1 2
• Dysfunctional thinking level does not predict
  relapse Dysfunctional thinking improves as
  depression lifts with CBT before the CBT
  challenges negative thinking rationally.3
• Q.V. Access to a set of dysfunctional beliefs is
  not the cause of depression.

61
Predictors in depression

• Overgeneral memory 1 predictor in most
  studies.1,2,5
• Unaffected by low mood, but modifiable.
• Measurable
• Applies to positive and negative memories, more
  to positive.
• A measure of categoric recall as opposed to
  specific recall.
• Negative What does the word anger make you
  think of? my aunt always (categoric) used to
  take me out if my father was angry
  (overgeneralised) , I remember once my aunt
  took me to the zoo when my father was angry
  (specific)
• Positive Word Happiness - a walk in the
  country last Sunday (specific) or walks in the
  countryside (over-G).
• Not improved in the recovered depressive by CBT,
  but improved by Mindfulness based Cognitive
  Therapy (MBCT) exercises.
• Measured using valenced word cues (categoric
  recall).

62

• QV Loss of access to specific (categoric)
  memories (overgeneralisation) predicts
  persistence in depression and depressive response
  to stress.
• Why might this be?
• What is the hippocampus?

63
Why is this important?1
64
Limbic System
65
(No Transcript)
66
Clusters of new cells that were produced in the
dentate gyrus of an adult rat. (a) New cells that
were observed 1, 7 and 21 d after birth.
Progression from clusters (day 1) to a dispersed
distribution along the length of the subgranular
zone (SGZ day 7) and into the granule cell layer
(GCL day 21) is evident.
67
New Neuron Formation 1
CA Cornu Ammonis Context and time storage DG
Dentate Gyrus Links current experiences (from
sensory cortex via entorhinal cortex) to form
contextual spatial and temporal mempories
68
(No Transcript)
69
Neuroanatomy in Depression

• All Studies on Neuroanatomy show
• Enlarged and overactive Amygdala (fear Centre
  overactive in depression and PTSD) close links to
  hypothalamus (HP-A axis) and sympathetic nervous
  system.
• This leads to exaggerated perception of threat.

70
Limbic System
71
Ventral Stream and Dorsal Stream
72
Theories of Emotion
James Lange now dominant theory better fit with
subsequent evidence
73
Overgeneralisation is reduced by thinking
styles
74
2 thinking styles

• Ruminative analytical or abstract, generalised,
  superordinate, decontextualised, verbally based
  and self evaluative usual thinking style
• Experiential Decentred or concrete, wide
  attentional field, contextual, process focussed,
  specific and subordinate for times of stress

75
Thinking Styles
76
Mindfulness has 2 effects

• Teasdale and Watkins postulated that this kind of
  meditative therapy had 2 separate mechanisms,
  thinking style and external visualisation so
  looked at the separate effects of these on mood
  and overgeneralisation.1 Improvement in mood
  was mediated by external visualisation. Decrease
  in overgeneralisation was mediated by thinking
  style (self focus).

77
Ruminative versus Experiential self-focus1

• To focus attention away from the self to
  inanimate objects whilst temporarily improving
  mood may not be helpful in the long run, it does
  not facilitate future processing of dysfunctional
  thoughts or memories.
• Instead of using external objects/ideas to reduce
  self focus, thinking style (ruminative Vs
  experiential) may alter the nature of self focus.

78
Ruminative versus Experiential self-focus

• Research Question can experiential versus
  ruminative thinking influence overgeneral memory
• Methods Series of statements with either
• Focus your attention on.. versus
• Use your imagination and concentration to think
  about
• Result administered to depressed patients 1

79
                                                  
       Table 1. Means and S.D. (in
parentheses) for proportions of memories recalled
that were categoric and mood ratings

• Note Despondency is the self-report of
  despondency on a 0100 visual analogue scale.
  Happiness is the self-report of happiness on a
  0100 visual analogue scale. Categoric is the
  proportion of memories recalled that were
  categoric.

80
Thinking Style

• most people by default in familiar situations
  use abstract construals (ruminative style)
  focused on meanings consequences and
  implications of actions, but when faced with
  difficult novel or complex situations often move
  towards more concrete (decentered) levels of
  processing

• Ref Watkins, E. (2008). Constructive and
  Unconstructive Repetitive Thought. Psychological
  Bulletin, 134, 163 206

81
Metacognitive Monitoring

• From work done in the early 1990s a group of
  researchers found that as well as traditional
  CBT, Mindfulness Based Cognitive Therapy (MBCT)
  also reduced relapse in depression.1 2 Instead
  of examining their negative thought processes and
  how this influenced outcomes, MBCT had
  participants doing exercises such as picturing
  the Grand canyon at sunset for 8 minutes.
• They developed a way of measuring resilience to
  depression. They called such resilience
  Metacognitive monitoring, and the scale for
  measuring it was based on autobiographical
  memory, called the MACAM (Measure of Awareness
  and Coping in Autobiographical Memory).
• They then conducted 3 studies which showed that
  the MACAM was the best predictor of relapse in
  depression studies. So a measure based on
  memory, not on a dysfunctional schema is the best
  predictor of relapse in depression, so the
  vulnerability in depression, the loss of
  resilience is based on poor memory recall.

82
Mindfulness Based CBT

• Teasdale 2004 an intervention designed to
  increase metacognitive awareness by changing
  patients relationship to negative thoughts and
  feelings without any attempt to change underlying
  beliefs in the content of negative thoughts can
  significantly reduce relapse or recurrence in
  depression
• For up to date review see Longmore Worrell
  (2007)

83
Summary Part 1

• To help depression we should
• Protect from overgeneralisation by changing
  thinking style (attentional manipulation) to
  experiential self focus (mental training)
• Protect from low mood by thinking of external
  objects and reappraisal.

84
Problem Solving ExtinctionThe Internal
Re-enforcement Hypothesis1
85
Pavlovian Conditioning
CS UCS UCR
Sound (Tone)
Electric Shock
86
Extinction
Avoidance Behaviour
1 2 3 4 5 6 No of
Trials minus Trauma
87

• INTERNAL REINFORCEMENT
• HYPOTHESIS
• Eisenhardt D, Menzel R (2007) Extinction
  Learning, reconsolidation and the internal
  reinforcement hypothesis Neurobiology of Learning
  and Memory 87, 2, p167-173

88
RECALL TRIALhas 2 effects simultaneously
Trauma Recall
1
CS2 - UCS CS1 CR2
(UCS)
Extinction
2
CS2 UCS CR3
89
Result of Recall(freezing behavioural outcome
of trauma)
Result
Result CR2 CR3
Freezing X - Y X -
Y
90
With Hypnosis removing effects of trauma
(amygdala/hypothalamic uncoupling)
Hypnosis
X 0
Freezing Extinguished
91
(No Transcript)
92
Reappraisal - Visualisation -Extinction common
pathway

• Mechanisms of reappraisal, visualisation, and
  many other techniques (including placebo
  response) may share the same pathway as
  extinction - evolution has piggybacked this
  technique
• ref Delgado, M.R., Nearing, K.I., Ledoux, J.,
  Phelps, E.A. (2008). Neural circuitry underlying
  the regulation of conditioned fear and its
  relation to extinction. Neuron, 59, 829-38

93
Break
94

• Depression Exercise Groups

95
An evaluation of Positive Mental Training in NE
Edinburgh

• July 2007

96
Survey outline

• An anonymous questionnaire sent to all doctors in
  NE Edinburgh of whom
• 22 had attended training
• 48 had not attended training
• Replies - 45
• 20 (91) had attended training
• 25 (52) had not attended training

97
For those who attended training
98
Benefits of training

• 68 those who replied who attended training felt
  that they had gained new insights into their
  patients mental processes.
• 84 of doctors feel better able to cope with
  their mental health patients.
• 33 of doctors feel better able to cope with
  other patients.
• 50 of doctors feel better able to cope with
  their working practice.

99
(No Transcript)
100
Use of Positive Mental Training by the GPs who
attended training

• 100 offer the programme to depressed patients
• newly depressed as an alternative to
  anti-depressants
• in addition to anti-depressants
• stopping anti-depressants
• 90 for anxiety and panic
• 30 for IBS, migraine, sleep, stress

101
1 trained GP reported always low prescribing rate
102
(No Transcript)
103
Reasons for using

• Self help treatment
• Immediately available
• Validated by research
• Remain actively involved with pts treatment
• Positive feedback from pts
• Specific focus during consultation
• Lack of stigmatisation

104
Comments by those using

• A very popular programme even people who just
  use CD1 have reported benefit
• Excellent addition to list of options available
  for depressed and anxious pts (staff!)
• Like the way it empowers pts to help themselves,
  esp when helped and then minor mood relapse
  self help easy to initiate again
• Helps mental wellbeing

105
What is Positive Mental Training?

• A self help modular programme
• To listen to at home
• A DVD and 3 CDs
• Over 12 weeks one 18 min track a day
• Simple effective

106
Its use in Primary Care

• Complies with NICE guidelines
• Fits with stepped care approach
• Library system
• Evidence for good patient preference compliance

107
Who for?

• Depressed anxious patients
• Exclusions?
• Easily Accessible by socially excluded groups
  done at clients convenience no therapist
  present - so
• Single mothers
• Low income
• Young men

108
Advantages

• Immediate psychotherapeutic intervention
• Simple (requires no reading skills)
• Good compliance effectiveness
• Free patient access library system
• Retains GP/patient relationship
• Can be used by other Health Professionals
• Fits in with existing systems

109

• Positive Mental Training
• The Programme
• DVD How Hypnosis Helps Depression
• Dr Alastair Dobbin 13 mins.
• CD1 The Foundations of Positive Mental Health
• CD2 Building Mental Skills for Success
• CD3 Building Personal Development for success
• Each CD has 4 tracks, each track 18 mins. long

110
CD 1

• Muscular Relaxation 1 2
• Jacobson relaxation with experiential self focus
• Notice the experience of relaxation and
  tension
• Encourages the observation of the body and
  breathing/Mindfulness
• Sets up a trigger
• Mental Relaxation 1 2
• Visualisation technique of a safe place
• Inner Mental Room
• Bolted onto physical relaxation

111
The Inner Mental Room

• Having created the mental room a self
  generated conflict free area
• There is now a safe place
• to base a number of Psychotherapeutic tools
  that the patient may explore and self-utilise.
• These come in CD2 CD3

112
Positive Mental TrainingCDs 2 3

• Each begins with Relaxation introduction and use
  of trigger and mental room to recall experiential
  mindset and remove negative affect (3 minutes)
• Music
• Fixing Positive affect to enable problem solving1
  
• Further psychotherapeutic tools -
• reframing, accessing positive memories/states,
  visualisation, desensitisation.

113
Positive Mental TrainingCD 2Building mental
skills for success

• 1. Self confidence.
• 2. Problem solving.
• 3. Ideomotor.
• 4. Trigger the future.

114
Positive Mental Training CD 3Building personal
development for success

• 1. Distance meaning
• 2. Love yourself
• 3. Creative thinking
• 4. Vision for the future

115
Patient Video
116
Intervention Design

• Starting 2/2006
• Funding
• Recruitment of Health Care Staff
• Access materials
• Educational aspects
• On-going support

117
A Benchmarked Feasibility Study of a
Self-hypnosis Treatment for Depression
118

METHODS Design Partially randomised patient
preference trial measuring the preference for and
response to either nurse led anti-depressants or
self-hypnosis. (Patients are offered their
choice after reading the information leaflet
those who do not have a preference are
randomised). Inclusion Criteria all patients
assessed as depressed by their GPs issued with a
new prescription for anti-depressants. Outcome
measures BDI-II, BSI and SF-36 measured before
and after treatment. DSM performed at entry
Location One Local Health Care Co-operative in
North East Edinburgh (85,000 patients, 80 GPs)
119

• Hypnosis Methods
• Self-hypnosis intervention devised
  specifically
• The programme consists of 12 CD tracks
• all with hypnotic induction and then
  suggestions for
• relaxation, creative visualisation, self
  confidence, self esteem, desensitisation,
  dissociation and association techniques, creative
  problem solving, distance from events and future
  visualisation.

120
Results

• 78/85 of referrals agreed to participate
• 58 fitted referral criteria
• High level of morbidity 90 reach criteria for
  DSM IV

121
RESULTS

• 54 in preference group, 4 in randomised group
• Preference group - 50 patients elected to receive
  self-hypnosis and 4 elected to receive
  anti-depressant drug treatment.
• Self-hypnosis preference group, 47 (94)
  completed the self-hypnosis 12 week course
• All the preference patients who opted for
  antidepressant drugs also completed their
  treatment, also confirmed by their GPs.
• Within the randomised group, 2 patients were
  randomised to anti-depressants and 2 to self
  hypnosis.

122
  BDI-II Paired sample statistics
a. The correlation and t cannot be computed
because the sum of caseweights is less than or
equal to 1.
123
  BSI 18 Paired sample statistics
a. The correlation and t cannot be computed
because the sum of caseweights is less than or
equal to 1.
124
Results

• Between group comparisons of outcome (based on
  the BSI and the BDI-II at 12 weeks) of those in
  the 2 groups in the preference arm suggest a
  significant positive difference of self-hypnosis
  over antidepressants. (Sig .012 and .004
  respectively)

125
Comparison of Dobbin et al preference arms and
benchmarked studies randomised data with
Confidence Intervals
126
Conclusions

• 1 - significantly more patients prefer
  self-hypnosis than medication for the treatment
  of depression
• 2 - there was a significantly greater change in
  the reduction of depression indices for those
  choosing self-hypnosis compared with those
  choosing medication
• 3 - High levels of completion of the 12 week
  course would indicate that the treatment was
  acceptable to patients.
• 4 - Benchmarking comparisons used to validate
  this study suggests this intervention has
  comparable effects to similar psychological
  interventions.

127
How to use it

• First Interview, establish diagnosis. Introduce
  the concept of mental training-problem solving
  and relaxation. Discuss pt being own therapist,
  unconscious mind knows where problems from and
  can sort.
• If patient seems keen give DVD and first CD
  take a note of name. ?Electronic tagging of
  record.(Read Code .8G8.)?
• Get patient back based on severity (1 week if
  very depressed 3 weeks if moderate) take back DVD
• Second interview, discuss progress, mental room,
  and prepare for self confidence (mention
  emotional literacy) and desensitisation.

128
Exclusions

• Alcohol problems, drug problems.
• Psychosis
• Bi-polar disorder

129
Final steps

• Final follow up.
• Emphasise permanent nature of change.
• Emphasise that patient may wish to use tracks
  again in future 1st CD if very distressed, others
  depending on preference.

130
The Edinburgh Roll Out

• Funding from Medicines Management Team
  Prescribing Development Initiative approved
  October 2005
• For North East Edinburgh 80 GPs 65,000 patients
  
• Familiarisation started 2/2/2006
• 2 x 2 ½ hour education sessions separated by 5
  weeks, run three times over 4 months. Locum
  payments 1 per 5000 pts
• 22 doctors attended 6 CPNs 4 Health visitors 6
  Psychologists plus sundry others

131
Edinburgh Roll Out

• Sessions included Research summary
• Theories of depression - new research in
  depression model of depression
• Neuroscience research basis
• 2 x live patients who had used the intervention
  discussing it
• Questions and Answer session
• Discussion group (2nd session)

132
Edinburgh Roll Out

• Evaluation ongoing e-mail contact with all
  practices supplies as necessary
• Follow up discussions face to face
• Evaluation of prescribing data per practice Vs
  use of intervention
• Evaluation of psychiatric referral patterns from
  practices Vs use of intervention
• Qualitative assessment of impact on GPs

133
Edinburgh Roll Out

• December 2006 roll out to South West Edinburgh
  funded by Edinburgh Community Health Partnership
  and the Pfizer foundation
• December 2006 first familiarisation sessions for
  South West Edinburgh 53 doctors 80,000 pts
• February 2007 roll out to South East and South
  Central Edinburgh
• April 2007 roll out to North West Edinburgh

134
Edinburgh Roll Out

• Current estimates based on returns from
  participating practices are that over 5000 people
  have been given Positive Mental Training CDs in
  Edinburgh.
• Anti-depressant figures show that the use of
  anti-depressants in North East Edinburgh has
  begun to drop, particularly in the early adopting
  practices (slide 4)
• By summer 2007 the initiative will be providing
  mental health services to a population of 750,000
  people.
• Formal studies will begin next April on the North
  West Edinburgh population with a possible further
  randomised trial.

135
(No Transcript)
136
Resource

• Dr Alastair Dobbin
• Brunton Place Surgery, 9 Brunton Place EH7 5EG
• alastair.dobbin_at_lothian.scot.nhs.uk
• Mobile [phone]
• This presentation on www.hypnodoc.co.uk
• Ms Sheila Ross
• sheila_at_positiverewards.co.uk
• www.positiverewards.co.uk
• 07799768879

137
The Scientific Method

• A Good Theory makes the best fit with the
  observations, and if another theory comes along
  with a better fit, then the model needs to change
  to reflect this theory.
• Steven Hawking Today Programme 30/11/2006