Psychotherapy is the dialectical treatment of mental disorders and psychological issues that consists of regular sessions with a trained Psychotherapist.
Specifically, Psychotherapy consists of planned application of techniques derived from psychological theories, by a therapist who is trained to understand these theories and apply psychotherapeutic techniques to help the patient modify non-functional personal characteristics such as emotions, values, attitudes and behaviors. A basic condition of psychotherapy is the creation of a relationship of trust between the therapist and the patient as well as the creation of a safe environment.
There are over 400 psychotherapeutic approaches, each with its own orientation. Each psychotherapeutic approach differs in terms of structure, content, duration and outcome. The most famous psychotherapeutic approaches are Cognitive Behavioral Therapy (CBT), Systemic Psychotherapy, Person-Centered Psychotherapy, Psychoanalysis and others.

Cognitive-Behavioral Therapy (CBT):
Cognitive-Behavioral Therapy (CBT) comes from the combination of Cognitive and Behavioral Psychotherapy. As its name suggests, the therapist focuses on replacing the patient’s negative thoughts/beliefs with alternative and more realistic thoughts/beliefs, as well as on modifying patient’s non-functional behaviors. CBT is a short-term treatment that focuses on the present and is successfully applied to a number of mental disorders and psychological issues.

Systemic Psychotherapy:
Systemic Psychotherapy considers the individual as part of a whole – “system”, and not as an isolated unit. Thus, it applies to individuals, couples, families and groups.

Person-Centered Psychotherapy:
Person-Centered Psychotherapy focuses on the relationship between the therapist and the patient as well as its ultimate goal is the patient to cover his/her emotional needs and reach the maximum of his/her abilities.

Psychoanalysis:
Psychoanalysis was developed by Sigmund Freud who focused on the importance of the unconscious and psychosexual development. Psychoanalysis explores how the unconscious influences the individual’s thoughts and behaviors as well as explores the patient’s childhood experiences, to identify whether and which past events contribute to the current challenges he/she faces. Some of the most famous psychoanalytic techniques are free association, therapeutic transference and dream interpretation.

The patient’s characteristics are usually considered as important prognostic factors of his/her experience during Psychotherapy. This refers to characteristics such as: age, gender, reported problems he/she deals with, the presence or absence of mental illness, patient’s resistance, difficulties he/she may face during his/her contact with other people, learning difficulties, as well as temperament and personality traits. However, one of the most important patient’s characteristics is his/her attitude towards Psychotherapy. Specifically, the patients’ attitudes towards Psychotherapy are described according to their expectations from it, such as:
the desire to eliminate the symptoms of the disease, the motivation to change – manage life’s difficulties, the motivation to get to know and understand themselves, the will to change some of their characteristics or behaviors as well as the desire to receive support.

Smart CNS Center provides Psychotherapy sessions by trained Psychiatrists and Psychologists for those who deal with mental disorders and psychological issues. Contact us at +30 210 440 1 440 for a more personalized approach.

Matilda Manaroli Clinical Psychologist, MSc
#smartcnscenter #psychotherapy #cbt #systemicpsychotherapy #personcenteredpsychotherapy #psychoanalysis

Social Anxiety Disorder (also known as Social Phobia) is a highly prevalent anxiety disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Social Anxiety Disorder is characterized by marked or intense fear of social or performance-based situations where scrutiny or evaluation by others may occur. Feared situations often include:

  • speaking in public 
  • meeting new people
  • talking with authority figures

Physical and motor symptoms associated with the disorder include blushing, trembling, sweating, and speech block, as well as many individuals with social anxiety fear that these symptoms might be observable to others. As a result, exposure to feared situations is typically accompanied by anxious anticipation, distress, and avoidance.

Social Anxiety Disorder affects a significant proportion of the general community, with a lifetime prevalence of approximately 8–13%. The disorder typically develops in childhood or adolescence, with a mean age of onset between 14 and 16 years. The development of social anxiety is influenced by a host of factors, including:

  • biological vulnerabilities
  • psychological vulnerabilities
  • genetics 
  • temperament/personality traits 
  • parental styles
  • peer influences

Social Anxiety Disorder impedes normal social development and is associated with significant functional impairment. Specifically, individuals with social anxiety typically avoid social, educational, and occupational situations that are perceived as threatening. This avoidance can severely hamper educational achievement, occupational performance, social interaction, relationships, and quality of life. Not surprisingly, social anxiety is associated with low self-esteem, suicidal ideation, lower education and socioeconomic status, unemployment, financial dependency, and being single. 

In addition, it is often observed that people suffering from Social Anxiety Disorder either ignore their condition or avoid dealing with it, attributing it to personality traits such as “shyness”. It needs to be pointed out that shyness is a personality trait that makes the individual feel bashfulness when he/she is in the middle of a crowded place. However, shyness and social anxiety are differentiated as follows:

  • greater intensity of stress in the case of social anxiety compared to shyness
  • severe physical symptoms (e.g. increased blood pressure, tendency to vomit, etc.) in the case of social anxiety as opposed to shyness
  • the most common coping strategy is “avoidance” in the case of social anxiety as opposed to shyness
  • people with social anxiety may not be characterized by bashfulness during personal moments but under certain circumstances when they feel they will be judged (e.g. speaking in public), as opposed to shyness

Both medication and psychotherapy are recommended for the treatment of Social Anxiety Disorder. In particular, patients with Social Anxiety Disorder often take medication such as antidepressants and anxiolytics. At the same time, psychotherapy is recommended to reduce their symptoms and in particular, Cognitive Behavioral Therapy (CBT) is considered as quite effective.

Source: https://www.sciencedirect.com/science/article/pii/S0094730X13000648

Matilda Manaroli Clinical Psychologist, MSc

Phototherapy is the use of bright white light (spectrum of visible light) for a specific period of time through a clinically certified phototherapy system according to the experts’ instructions. Phototherapy lamps/bulbs imitate sunlight at a high level of brightness which is tolerable and does not produce heat. Visible light passes through the eyes and acts as a signal for the epiphysis so that it stops producing melatonin – the sleep hormone – and thus resynchronizes the circadian rhythm, our biological clock. The exposure to light is the most important factor in regulating circadian rhythm.

Phototherapy & Seasonal Depression:
Also, Phototherapy is a first-line treatment for seasonal depression, which is characterized by fluctuations in emotion that occur not only during the winter months but also during the spring and summer. Even though, Phototherapy has been shown – with studies dating back to the 1980s – to be effective as a treatment for seasonal depression, its exact mechanism of action remains unknown. However, the hypotheses that have been made concern a) the correction of circadian rhythm through exposure to light b) the increase of synaptic serotonin in the midbrain area or a combination of both of the above mechanisms.
The success of Phototherapy in seasonal depression has aroused research interest in its use in other psychiatric conditions. Although the results for the use of Phototherapy in monopolar depression are contradictory in terms of its effectiveness, studies on monopolar depression in specific populations have shown a promising response. Specifically, studies have shown positive results in cases of postpartum depression but also in adolescents aged 14-17 years old with monopolar depression.

Phototherapy & Sleep Disorders:
Phototherapy is recommended to treat certain sleep disorders. Increased exposure to light in the morning can have positive effects in cases of insomnia through the effect of the light on the circadian rhythm. In cases of early awakening, the afternoon exposure to the light may be beneficial. In addition, phototherapy results in Delayed Sleep Phase Syndrome (DSPS), which has to do with the shift of circadian rhythm in the morning hours combined with the inability of awakening in the morning.

Phototherapy & Weight Loss:
Phototherapy has also been studied in obesity and eating disorders. If you are one of those people who wake up at night to eat with the inevitable effects on your weight, then it may be worth trying phototherapy since a number of studies show that it is effective in patients who experience overeating, especially nocturnal overeating. The mechanism behind this action has to do with the production of leptin and ghrelin which are responsible for the feeling of satiety of hunger. At the same time, phototherapy can indirectly offer an effect on emotional overeating, through antidepressant action and reduction of negative emotion.
Depending on the expected therapeutic effect, the patient follows a number of daily morning sessions, lasting 30 to 40 minutes, under the lamp of a certified phototherapy device, the light of which is painless and does not produce heat. The fact that Phototherapy is non-invasive with minimal side effects, makes it a good treatment choice in populations where pharmacotherapy presents limitations.

Phototherapy can be applied at the Smart CNS Center as a solution for all the above cases. Contact us at +30 210 440 1 440 for a more personalized approach.

The scientific team of the Smart CNS Center

#phototherapy #brainanatomy #depression #weightloss #sleepdisorder

Headache

Most people have experienced at least some headache episodes during their lifetime. Excessive stress, insomnia, alcohol consumption and menstruation, are typical causes of headache. Usually, most headaches are healed with the use of common painkillers and do not lead people to seeking medical help.

But in what cases should people consult a Neurologist?

Pain associated with another symptom should be evaluated by a doctor. For example, if visual disturbances (blurring, dark spots in the visual field, protoplasm and double vision of objects) coexist, a more extensive examination may be needed.

There are cases where the headache is accompanied by numbness in the limbs or muscle weakness, even with paralysis of one side of the body. In any case, the Neurologist will assess whether it is something innocent or something that needs further treatment.

A “red flag” for someone who has chronic headaches with specific symptoms is the change in the nature of the pain. In other words, this change might be the appearance of an unprecedented and persistent pain, perhaps localized at one specific area, which cannot be healed with the painkillers. Usually, in these cases the CT or MRI reveal the presence or not of a more serious problem.

When it comes to treating headaches, there are many treatments available for the acute phase of the pain as well as prophylactics with systematic use, which aim to reduce the intensity and frequency of the pain.

It should be noted that the frequent and reckless use of painkillers can be a cause of headaches, so it should never be abused.

The accurate diagnosis and the appropriate individualized treatment can offer a good quality of life to patients with headaches.

Verentzioti Anastasia Neurologist
#headache #neurologist #migraine

Unprecedented rate of depression-remission through an rTMS protocol.

New data on the treatment of depression was presented by researchers at Stanford University School of Medicine. In particular, according to an open study conducted by the University, a very short protocol of repeated transcranial magnetic stimulation (iTBS) was applied, which managed to quickly relieve the symptoms of severe depression in 90% of the participants. The treatment was named “Stanford Accelerated Intelligent Neuromodulation Therapy“, or “SAINT” and is approved by the Food and Drug Administration (FDA) for treatment of depression.

ITBS is a form of transcranial magnetic stimulation in which higher overall magnetic pulse dose of stimulation is applied in a shorter period of time. SAINT is an improved version of the accelerated iTBS protocol that uses MRI (fcMRI) guidance for greater accuracy in targeting the spots of interest (dorsolateral prefrontal cortex) in the brain.

The participants of the study underwent 10 sessions per day of 10-minute treatments, with 50-minute breaks in between. On average, 3 days of treatment were enough for participants to experience depression relief. More specifically, before treatment, the 21 participants experienced severe depression with suicidal ideation, resistant to medication. At the end of the sessions, 19 participants no longer reported depressive symptoms. Additionally, the only side effects of the new treatment were fatigue and some discomfort during the sessions.

According to the researchers, “no one expected these results as there has never been a therapy for treatment-resistant depression that’s broken 55% remission rates”. Even one month after treatment, 60% of the participants were still in remission as well as researchers perform follow-up studies to determine the duration of the antidepressant effect.

Source: https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2019.19070720?journalCode=ajp
#depression #fightdepression #rtms #ibms #transcranialmagneticstimulation

Prefrontal lobe and depression.

In recent years, a lot of researchers have increasingly linked the dysfunction of the prefrontal lobe to depression. The prefrontal lobe is the area that lies at the front of the brain, responsible for controlling high-level human functions. The following are indicative:

  • Behavior adjustment
  • Regulation of emotional expression
  • Attention & Concentration
  • Creativity
  • Design
  • Prioritization
  • Problem solving
  • Decision making
  • Judgement
  • Learning from experience
  • Social behavior
  • Inhibition

In a significant percentage of cases of depression, there is a dysfunction of the above functions. Specifically, studies that have been conducted using neuroimaging methods such as fMRI (Functional Magnetic Resonance Imaging), showed reduced or increased activation in specific areas of the prefrontal lobe.

For example, a relatively stable finding is the presence of reduced activation in the dorsolateral part of the prefrontal cortex (DLPFC) and correspondingly increased activation has been observed in the ventromedial part of the prefrontal cortex (VMPFC). And indeed, the ventromedial part which is linked with the depressed mood is the one that has a direct neural connection with the limbic system and especially areas related to emotion such as the amygdala. The dorsolateral part is the one that when dysfunctions, the person experiences loss of motivation and interests, apathy, thoughtlessness as well as inactivity.

An even more specific finding is the differentiation of the left from the right prefrontal cortex. Research data that also highlight the contribution of repetitive transcranial magnetic stimulation (rTMS) suggest that left frontal cortex dysfunctions and right frontal cortex hyperfunctions in depression. This finding also provides the theoretical background for the basic use of rTMS in the treatment of depression through intervention in the prefrontal cortex. The application of a high-frequency magnetic field to the left prefrontal cortex of the brain has a stimulating therapeutic effect, reversing its dysfunction. Similarly, the application of a lower frequency magnetic field to the right prefrontal cortex has an inhibitory therapeutic effect, reversing its hyperfunction. Both rTMS protocols have equally confirmed therapeutic potential.

In conclusion, the combined use of new knowledge of neurobiology, neurophysiology and neuroanatomy of the brain in parallel with the development of medical technology “opens a window” for the most effective treatment of depression and other disorders in the medium term.

Σπύρος Καλημέρης Ψυχίατρος Ψυχοθεραπευτής

Spiros Kalimeris Psychiatrist Psychotherapist
#rtms #depression #rtmstreatment

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