Abstract
These three Australian-made videos, each of 45–50 min duration, feature Dr Lisa Lampe, a consultant psychiatrist with an interest in anxiety disorders, and Dr Ron Raper, Professor of Psychology at Macquarie University, in the two videos on anxiety disorders, and Professor Philip Boyce, Professor of Psychiatry at Sydney University and Jillian Ball, a clinical psychologist and co-author of Beating the Blues in the video on depression, as well as patients who have these disorders.
Each video intercuts interviews with the presenters with interviews with patients to illustrate and describe the symptoms, disability and treatment of the three disorders. The editing is effective and the technical production is of a generally high standard.
Although the psychotherapeutic treatment approach is exclusively orientated to cognitive-behavioural therapy (CBT), the videos emphasise the necessity of tailoring this approach to the individual by a flexible use of CBT principles.
The videos illustrate the principles of CBT: the replacement of negative, unrealistic thinking with more rational, positive thoughts, the use of activity schedules and, in the case of the anxiety disorders, the use of relaxation strategies and exposure to feared situations. The use of CBT is presented from the perspective of the patient developing the skills to ‘become their own therapist’.
The videos illustrate nicely how simple strategies, such as monitoring through the use of a journal, assist the patient to distance themselves from their problems as a means to gaining mastery over their symptoms.
Although the videos are not comprehensive in scope, neither in relation to an understanding of the aetiology of these disorders, nor in regard to the use of other treatment modalities, they do offer patients the opportunity to see and hear others who suffer from these disorders and who are struggling, more or less successfully, to apply the recommended treatment. It is these personal testimonies which may be the most beneficial aspect of these videos for patients, offering hope and information about the sort of help which is available.
In the video on social phobia, patients are discouraged from using medications such as beta-blockers and benzodiazapines. However, the prevalence of comorbid disorders such as depression is acknowledged and qualified approval is given to the use of anti-depressants. The value of support groups is touched on.
The video on depression is almost worth purchasing just to hear Spike Milligan speaking briefly, but tellingly, of his father whom he perceived as loving him but never understanding his depressions. Interviews with Milligan and others serve to drive home the message that depression is an alienating and devastating experience, while at the same time providing hope and encouragement.
There is a brief discussion about bipolar disorder and the place of medication generally. There is acknowledgement that some depressive illnesses require both medication and therapy. This is the only video in which recommendations are made that advice be sought from clinical psychologists and psychiatrists about the type of illness and whether medication is needed.
The video on panic disorder follows a similar format, with additional comments by patients on a range of important issues related to having a mental illness: for example, the stigmatisation of mental illness, the sense of failure perceived by people with mental illness forced to confront their own vulnerability, and the tendency to seek a physical cause.
Treatment, based on a CBT model, is clearly explained and the value of interoceptive exposure as a part of the treatment program, is emphasised. The use of benzodiazapines is criticised, while there is qualified approval for the use of antidepressants.
Overall, I would recommend these videos as being potentially useful for patients and families of patients who are seeking some understanding of these disorders and of some of the treatments available. For clinicians who are using a CBT approach with their patients, these videos may provide some suggestions as to how to flexibly tailor the treatment, and how to present and explain the components of CBT to their patients. Clinicians may find it useful to loan these videos out to patients to motivate them and to reduce the stigma associated with mental illness. These videos may also be of use in the training of psychologists and psychiatrists.
The videos do not address the complexity of these illnesses. There is a failure to explain that some individuals cannot make use of CBT until their symptoms have been sufficiently alleviated by medication, and that the withholding of education, even anxiolytic medication is not always appropriate.
Dynamic issues, which are important in the genesis and maintenance of depression, or which may become obstacles to treatment, are never mentioned. The wish by many patients to develop an intrapersonal or interpersonal understanding of their illness that goes beyond the limitations of CBT, or the notion that clinicians, at least, could profitably have some familiarity with such an understanding, is not touched upon. The emphasis on ‘becoming their own therapist’ may be misunderstood by some patients, already demoralised by their illness, as a variation of the ‘pull your socks up’ approach. There is no reference to alcohol, substances or physical illness.
Surprisingly, and somewhat disturbingly, there is no mention of family doctors as a resource for initial assessment.
The price of these videos may be prohibitive to many patients. But these well produced, informative, and, at times, moving videos are worthy of a place in clinic and hospital libraries, in training programs, and in the rooms of the eclectic, general psychiatrist.