Background We report a randomised controlled clinical trial of neurofeedback therapy intervention for ADHD/ADD in adults. We focus on internal mechanics of neurofeedback learning, to elucidate the primary role of cortical self-regulation in neurofeedback. We report initial results; more extensive analysis will follow. Methods Trial has two phases: intervention and follow-up. The intervention consisted of neurofeedback treatment, including intake and outtake measurements, using a waiting-list control group. Treatment involved $\sim$40 hour-long sessions 2-5 times per week. Training involved either theta/beta (...) or sensorimotor-rhythm regimes, adapted by adding a novel 'inverse-training' condition to promote self-regulation. Follow-up (ongoing) will consist of self-report and executive function tests. Setting Intake and outtake measurements were conducted at University of Helsinki. Treatment was administered at partner clinic Mental Capital Care, Helsinki. Randomisation We randomly allocated half the sample then adaptively allocated the remainder to minimise baseline differences in prognostic variables. Blinding Waiting-list control design meant trial was not blinded. Participants 54 adult Finnish participants (mean age 36 years; 29 females) were recruited after screening by psychiatric review. 44 had ADHD diagnoses, 10 had ADD. Measurements Symptoms were assessed by computerised attention test (T.O.V.A.) and self-report scales, at intake and outtake. Performance during neurofeedback trials was recorded. Results Participants were recruited and completed intake measurements during summer 2012, before assignment to treatment and control, September 2012. Outtake measurements ran April-August 2013. After dropouts, 23 treatment and 21 waiting-list participants remained for analysis. Initial analysis showed that, compared to waiting-list control, neurofeedback promoted improvement of self-reported ADHD symptoms, but did not show transfer of learning to T.O.V.A. Comprehensive analysis will be reported elsewhere. Trial Registration "Computer Enabled Neuroplasticity Treatment (CENT)", ISRCTN13915109. Partly funded by Finnish science agency TEKES, project #440078. (shrink)

Mental health chatbots, along with computerised treatment in general, have gradually entered the realm of acceptability. This article looks at a chatbot called ReMind. It begins with an overview of the development of computerised mental health interventions, drawing links between the invention of cognitive behavioural therapy and automated therapy. The focus then moves to analysis of ReMind's conversational system. The bot acts as a sympathetic guide which directs the user to mental health activities, and as we (...) will see, a concept of mental health is produced through this system which is unique to the way that chatbot conversations are designed. The bot is tasked with interpreting the user's typed inputs in terms of keywords. Keywords are identified in terms of predetermined tags (‘sad’, ‘can’t sleep’, ‘relationship’, etc.). The bot then ‘predicts’ what the most appropriate response should be. ‘Prediction’ will be focused on to draw out how users interact with the bot in terms of conforming to the conversational logic imposed by the bot. This article illustrates a concept of mental health which is produced in the conversational dynamic between the users and the bot, and in how these conversations are directed on an abstract level by the ReMind company. The article concludes that the tautological cycle that the ReMind app facilitates represents a model of mental health which is correspondingly tautological in terms of users adopting an attitude of adaptation. This article addresses an urgent need to critically assess new forms of mental health interventions, and especially, technologically informed interventions. (shrink)

Mathematical models of tumour invasion appear as interesting tools for connecting the information extracted from medical imaging techniques and the large amount of data collected at the cellular and molecular levels. Most of the recent studies have used stochastic models of cell translocation for the comparison of computer simulations with histological solid tumour sections in order to discriminate and characterise expansive growth and active cell movements during host tissue invasion. This paper describes how a deterministic approach based on reaction-diffusion models (...) and their generalisation in the mechano-chemical framework developed in the study of biological morphogenesis can be an alternative for analysing tumour morphological patterns. We support these considerations by reviewing two studies. In the first example, successful comparison of simulated brain tumour growth with a time sequence of computerised tomography (CT) scans leads to a quantification of the clinical parameters describing the invasion process and the therapy. The second example considers minimal hypotheses relating cell motility and cell traction forces. Using this model, we can simulate the bifurcation from an homogeneous distribution of cells at the tumour surface toward a nonhomogeneous density pattern which could characterise a pre-invasive stage at the tumour-host tissue interface. (shrink)

Letheby’s naturalistic theory of psychedelic therapy argues that the therapeutic power of psychedelics lies in their ability to allow individuals “to discover the contingency, mutability and simulatory nature of their own sense of identity and habitual modes of attention.” The general shape of this project is persuasive; it is hard to see how the claim that successful therapy must involve changes to the self could be objected to, and Letheby sketches a consistent, if speculative, picture of psychedelic experience. (...) But the role of affect in psychedelic therapy is insufficiently explored by Letheby as a comparison to MDMA-assisted therapy indicates. This comparison further suggests that Letheby’s reliance on a particular conceptualization of ego dissolution experiences is in need of further explanation and justification. (shrink)

The classification of techniques used in mitochondrial donation, including their role as purported germ-line gene therapies, is far from clear. These techniques exhibit characteristics typical of a variety of classifications that have been used in both scientific and bioethics scholarship. This raises two connected questions, which we address in this paper: how should we classify mitochondrial donation techniques?; and what ethical implications surround such a classification? First, we outline how methods of genetic intervention, such as germ-line gene therapy, are (...) typically defined or classified. We then consider whether techniques of mitochondrial donation fit into these, whether they might do so with some refinement of these categories, or whether they require some other approach to classification. To answer the second question, we discuss the relationship between classification and several key ethical issues arising from mitochondrial donation. We conclude that the properties characteristic of mitochondrial inheritance mean that most mitochondrial donation techniques belong to a new sub-class of genetic modification, which we call ‘conditionally inheritable genomic modification’. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and (...) receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)

Long-standing psychiatric practice confirms the pervasive use of pharmacological therapies for treating severe mental disorders. In many circumstances, drugs constitute the best allies of psychotherapeutic interventions. A robust scientific literature is oriented on finding the best strategies to improve therapeutic efficacy through different modes and timing of combined interventions. Nevertheless, we are far from triumphal therapeutic success. Despite the advances made by neuropsychiatry, this medical discipline remains lacking in terms of diagnostic and prognostic capabilities when compared to other branches of (...) medicine. An ethical principle remains as the guidance of therapeutic interventions: improving the quality of life for patients. Unfortunately, psychotropic drugs and psychotherapies do not always result in an efficient remission of symptoms. In this paper I corroborate the idea that therapists should provide drug-resistant patients with every effective and available treatment, even if some of such interventions could be invasive, like Electroconvulsive Therapy (ECT). ECT carries upon its shoulders a long and dramatic history that should be better investigated to provide new insights. In fact, ECT has attracted renewed interest in recent years. This is due to the fact that antidepressant drugs in younger patients show often scarce effectiveness and unpleasant side-effects. Moreover, I show that, thanks to modern advances, ECT may work as a successful form of treatment for specific and rare cases, such as severe depression (with suicide attempts) and catatonia. (shrink)

What proper role should considerations of risk, particularly to research subjects, play when it comes to conducting research on human enhancement in the military context? We introduce the currently visible military enhancement techniques (1) and the standard discussion of risk for these (2), in particular what we refer to as the ‘Assumption’, which states that the demands for risk-avoidance are higher for enhancement than for therapy. We challenge the Assumption through the introduction of three categories of enhancements (3): therapeutic, (...) preventive, and pure enhancements. This demands a revision of the Assumption (4), alongside which we propose some further general principles bearing on how to balance risks and benefits in the context of military enhancement research. We identify a particular type of therapeutic enhancements as providing a more responsible path to human trials of the relevant interventions than pure enhancement applications. Finally, we discuss some possible objections to our line of thought (5). While acknowledging their potential insights, we ultimately find them to be unpersuasive, at least provided that our proposal is understood as fully non-coercive towards the candidates for such therapeutic enhancement trials. (shrink)

Sensory processing problems and related dysfunctions are among the most common conditions in children with autism spectrum disorder. This study examined the effect of sensory integration therapy on different aspects of occupational performance in children with ASD. The study was conducted on an intervention group receiving SIT and a control group with 3- to 8-year-old children with ASD. The Short Child Occupational Profile was used to compare the two groups in terms of the changes in their occupational performance and (...) the Sensory Profile was used to assess sensory problems. The intervention group showed significantly greater improvement in all the SCOPE domains, as well as in all the SP domains, except for the “emotional reactions” and “emotional/social responses” domains,. The effectiveness of SIT in improving occupational performance in children with ASD as a health-related factor is supported by our findings. (shrink)

This article describes some core elements of Logic-Based Therapy and Consultation and examines some of their epistemic properties.

This article examines discourse practices surrounding children’s participation, non-participation, and the ‘moral order’ of the family in the setting of family therapy consultations. The analysis focuses on two central issues. First, the relationship between therapists’ questions, the speaker selection techniques built into those questions, and the responses produced by family members. Second, the relationship between turn-taking and the linguistic features of person deixis in disputes that emerge around children’s orientation to implicit accusations in the talk of other participants about (...) them. The findings reveal how a familial ‘moral order’ is often at the root of how children’s competence as participants is managed by the parents, the therapist, and the children themselves. (shrink)

In this manuscript, we explore the potential therapeutic use of helminths. After analyzing helminths’ role in connection with human health from the perspective of their symbiotic and evolutionary relationship, we critically examine some studies on their therapeutic applications. In doing so, we focus on some prominent mechanisms of action and potential benefits, but also on the exaggerations and theoretical and methodological difficulties of such proposals. We conclude that further studies are needed to fully explore the potential benefits of this perspective, (...) and we encourage the scientific community in doing so. (shrink)

Current debate and policy surrounding the use of genetic editing in humans often relies on a binary distinction between therapy and human enhancement. In this paper, we argue that this dichotomy fails to take into account perhaps the most significant potential uses of CRISPR-Cas9 gene editing in humans. We argue that genetic treatment of sporadic Alzheimer’s disease, breast- and ovarian-cancer causing BRCA1/2 mutations and the introduction of HIV resistance in humans should be considered within a new category of genetic (...) protection treatments. We find that if this category is not introduced, life-altering research might be unnecessarily limited by current or future policy. Otherwise ad hoc decisions might be made, which introduce a risk of unforeseen moral costs, and might overlook or fail to address some important opportunities. (shrink)

This article discusses the potential of using interactive environments in autism therapy. We specifically address issues relevant to the Aurora project, which studies the possible role of autonomous, mobile robots as therapeutic tools for children with autism. Theories of mindreading, social cognition and imitation that informed the Aurora project are discussed and their relevance to the project is outlined. Our approach is put in the broader context of socially intelligent agents and interactive environments. We summarise results from trials with (...) a particular mobile robot. Finally, we draw some comparisons to research on interactive virtual environments in the context of autism therapy and education. We conclude by discussing future directions and open issues. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as friends and lovers. (...) There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

Recombinant DNA technology will soon allow physicians an opportunity to carry out both somatic cell- and Germ-Line gene therapy. While somatic cell gene therapy raises no new ethical problems, gene therapy of gametes, fertilized eggs or early embryos does raise several novel concerns. The first issue discussed here relates to making a distinction between negative and positive eugenics; the second issue deals with the evolutionary consequences of lost genetic diversity. In distinguishing between positive and negative eugenics, the (...) concept of malady is applied as a definitional criterion for identifying genetic disorders that could qualify for Germ-Line therapy. Because gene replacement techniques are currently unavailable for humans, and because even if they were possible the number of people involved would be quite small, the loss of diversity concern seems moot. Finally, we dissuss the issue of iatrogenic disorders associated with gene therapy and discuss several ‘real world considerations.’. (shrink)

Summary Giancarlo Trombini presents the continuation of his research on the question of which criteria can be used to assess the progress of therapy in an objectively verifiable way and to make the decision on the completion of therapy. In the first phase of his research, the phenomenological criterion of a qualitative change in the patient’s relations toward the positive and higher complexity was proposed for this purpose. In terms of the working method in analytic therapy, this (...) meant concretely: attention should be paid to what development is shown in the comparison of the relationships that occur in the dream narrative and in the subsequent associations. This criterion was therefore given the name manifest dream/association comparison (MDAC)—comparison between the manifest dream and the subsequent associations. The idea can easily be transferred to those therapy methods, which do not primarily work with reports of dream memories and subsequent associations—also, in other ways of working, it is possible to pay attention, in the way suggested by Trombini, to the qualitative development of the relationships which are thematized by the clients in the course of an hour. To this first criterion, another phenomenological criterion is now added in the present article: that of the “concluding therapeutic turn” (CTT). If the patient’s development reaches this turn in the course of the therapy in one session, this indicates, according to Trombini, that the therapy can soon be concluded. The fulfillment of this criterion can be recognized by the fact that in the sequence of dream narration and subsequent associations in a session, a relational dynamic toward the positive and higher complexity becomes recognizable and that is, at the same time, connected with a reconciliation of the three temporal reference systems (past, present, and future). The achievement of this CTT indicates that the patient is aware of the changes made in therapy and makes it evident to the therapist that the therapy is nearing completion. (shrink)

People who suffer from eating disorders often have to be treated against their will, perhaps by being detained, perhaps by being forced to eat. In this paper it is argued that whilst forcing compliance is generally acceptable, there may be circumstances under which a sufferer's refusal of consent to treatment should be respected. This argument will hinge upon whether someone in the grip of an eating disorder can actually make competent decisions about their quality of life. If so, then the (...) decision to refuse therapy may be on a par with other decisions to refuse life‐prolonging therapy made by sufferers of debilitating chronic, or acute onset terminal illness. In such cases, palliation might justifiably replace aggressive therapy. The argument will also draw heavily on the distinction between competent refusal of therapy and passive euthanasia, and the distinction between incompetent and irrational decisions. Both distinctions will then be applied to decisions to refuse food. The extent to which sufferers from anorexia nervosa can be categorised as either incompetent or irrational will be examined. It is against this background that it will be argued that at least some of those who suffer from eating disorders should have their refusals respected, even if they may die as a result. (shrink)

In this essay I argue that a comprehensive understanding of addiction and its treatment should include an existential perspective. I provide a brief overview of an existential perspective of addiction and recovery, which will contextualize the remainder of the essay. I then present a case study of how the six-step philosophical practice method of Logic-Based Therapy can assist with issues that often arise in addiction treatment framed through an existential perspective.

This article, addressed to Yoga Therapists, sorts out the historical roots of our idea of Yoga, elucidates the colonial interference and distortion of Yoga, and shows that trauma and therapy are the primary focus of Yoga. However, unlike most philosophies of therapy, Yoga's solution is primarily moral philosophical---Yoga itself being a basic ethical theory, in addition to Virtue Theory, Consequentialism and Deontology. This article goes some way to elucidating that it is quite ironic (and absurd) that many feel (...) the need to bring being “trauma-informed” into the title of Yoga education. That’s like the vacuous “chai tea” moniker (“chai” being the Hindi word for tea). Decolonizing our understanding of Yoga involves retrieving the original theory as the primary explanation of the topic, which allows us to understand how various activities, called "yoga," can be ways of practicing the moral philosophy of Yoga. The idea that "yoga" means many things and projects relies upon a contra logical methodology of interpretation which violates constraints of basic reasoning. Putting aside interpretation for explication is part of critical thinking but also our own self therapy. (Originally published in Yoga Therapy Today, a publication of the International Association of Yoga Therapists. Shared with permission.). (shrink)

This paper attempts to debunk the slippery-slope argument against human germ-line gene therapy by showing that the downside of the slope – genetic enhancement – need not be as unethical or unjust as some people have supposed. It argues that if genetic enhancement is governed by proper regulations and is accompanied by adequate education, then it need not violate recognized principles of morality or social justice. Keywords: germ-line therapy, slippery slope argument, future generations, social justice CiteULike Connotea Del.icio.us (...) What's this? (shrink)

As the potential for the first human trials of somatic cell gene therapy nears, two ethical issues are examined: (1) problems of moral choice for members of institutional review boards who consider the first protocols, for parents, and for the clinical researchers, and the special protections that may be required for the infants and children to be involved, and (2) ethical objections to somatic cell therapy made by those concerned about a putative inevitable progression of genetic knowledge from (...) therapy to mass genetic engineering in human reproduction. The author's viewpoint is that a consensus exists on the required moral approach to somatic cell therapy, but that no moral approach yet exists for experiments beyond this level, especially in the germline cells of human beings. Keywords: gene therapy, somatic cells, germ cells, institutional review boards, genetic engineering CiteULike Connotea Del.icio.us What's this? (shrink)

This chapter contains section titled: Introduction The Issue of Textual Difficulties and Style The PI Preface Baker's Contextualism Applying the Right Kind of Context Conclusions and Further Issues.

ObjectiveTo investigate the short-term effect of music therapy combined with binaural frequency difference therapy on patients with consciousness disorder.Materials and methodsNinety patients with definite diagnosis of disorders of consciousness were selected. These patients were randomly divided into control group, experiment 1 group and experiment 2 group, with 30 patients in each group. The control group was treated with routine clinical treatment and rehabilitation. In experiment 1 group, music therapy was added to the control group. In experimental group (...) 2, music therapy combined with binaural α frequency difference therapy was added to the control group. All patients were assessed before and after 30 treatments. The assessment items included Glasgow Coma Scale, Coma Recovery Scale revised, electroencephalogram, upper somatosensory evoked potential, and brainstem auditory evoked potential.ResultsBefore treatment, there were no significant differences in GCS score, CRS-R score, USEP, BAEP, and EEG scores among the three groups. After 30 times of treatment, GCS score, CRS-R score, USEP, BAEP, and EEG scores in 3 groups were significantly higher than those before treatment. And the consciousness rate of experimental group 2 was better than experimental group 1, experimental group 1 was better than the control group and the difference was statistically significant.ConclusionMusic therapy combined with binaural α frequency difference therapy is more effective in stimulating DOC patients. (shrink)

It has been known for long time that the cosmic sound wave was there since the early epoch of the Universe. Signatures of its existence are abound. However, such an acoustic model of cosmology is rarely developed fully into a complete framework from the notion of space, cancer therapy up to the sky. This paper may be the first attempt towards such a complete description of the Universe based on classical wave equation of sound. It is argued that one (...) can arrive at a consistent description of space, elementary particles, Sachs-Wolfe acoustic theorem, up to a novel approach for cancer therapy, starting from this simple classical wave equation of sound. We also discuss a plausible extension of Acoustic Sachs-Wolfe theorem based on its analogue with Klein-Gordon equation to become Acoustic Sachs-Wolfe-Christianto-Smarandache-Umniyati (ASWoCSU) equation. It is our hope that the new proposed equation can be verified with observation data. But we admit that our model is still in its infancy, more researches are needed to fill all the missing details. (shrink)

Biotechnology now makes it possible to enhance human traits as well as treat illnesses and disorders. What it has neglected to establish, however, is a clear line between these two functions, a distinction between what counts as treatment or therapy and what counts as enhancement. The bulk of the literature on enhancements focuses on the ethics of enhancements, not on the criteria that qualify a procedure as an enhancement . While the ethical questions regarding the desirability of enhancements are (...) certainly worthy of consideration, so is the issue of what constitutes an enhancement versus a form of treatment or therapy. Scholars have debated the issue of whether a distinction between therapy and enhancement exists, but the placement of that distinction has not yet been sufficiently addressed . Much like the field of bioethics itself, my study of this issue is a work in progress, so this paper will ask and explore questions relevant to this topic without providing answers to all of them. Nonetheless, they are important questions to ask with important implications for the future of bioethics. This paper will describe the line between enhancement and therapy, map the terrain and define the terms. It will also investigate where the line is at present, and where and how it has been set by legislation and private companies. It will then illustrate the issues, using two examples, to demonstrate the difficulties and complexities involved. Finally, it will explore the implications of the line for society’s financial as well as physical interests, and for healthcare access in the United States. It will conclude by considering the open question of how a company, a government, and a just society should go about setting the line. I hope that asking the questions and exploring their complexities will help draw attention to and prompt serious consideration of the placement of the line between therapy and enhancement. (shrink)

The concept of human gene therapy came on the heels of fundamental discoveries on the nature and working of the gene. However, realistic prospects to correct the underlying cause of recessive genetic disorders through the transfer of wild‐type alleles of defective genes had to wait for the arrival of recombinant DNA technology. These techniques permitted the isolation and insertion of genes into the first recombinant delivery systems. The realization that viruses are natural gene carriers provided inspiration for gene (...) class='Hi'>therapy and, as engineered vectors, viruses became prominent gene delivery vehicles. Nonetheless, when put in the context of human and non‐human primate studies, all vectors fell short of success regardless of their viral or non‐viral origin. Recognition of issues such as inefficient gene transfer and short‐lived or scant expression in the relevant cell type(s) prompted researchers to refine and develop several gene delivery systems, in particular those based on retroviruses, adeno‐associated viruses and adenoviruses. Concomitantly, available technology was deployed to tackle disorders that require few genetically corrected cells to attain therapy. BioEssays 27: 506–517, 2005. © 2005 Wiley periodicals, Inc. (shrink)

In 1937, John Dewey delivered a lecture to the College of Physicians in Saint Louis. His clear message was that in the practice of medicine it does not suffice for physicians to treat just the body, or to look to just the body for the mechanism of disease. Emphasizing the relational nature of organism-environment, he argued that the physician must treat the whole patient and must therefore consider the environment of the patient. It makes no sense, he suggested, to provide (...) medicine to address a problem with the patient's lungs and then to send him back into the coal mine. As he put it: "We must observe and understand internal processes and their interactions from the standpoint of their interactions with what is... (shrink)

The use of charged-particle radiation therapy is an increasingly important development in the treatment of cancer. One of the most pressing controversies about the use of this technology is whether randomised controlled trials are required before this form of treatment can be considered to be the treatment of choice for a wide range of indications. Equipoise is the key ethical concept in determining which research studies are justified. However, there is a good deal of disagreement about how this concept (...) is best understood and applied in the specific case of CPRT. This report is a position statement on these controversies that arises out of a workshop held at Wolfson College, Oxford in August 2011. The workshop brought together international leaders in the relevant fields , including proponents on both sides of the debate, in order to make significant progress on the ethical issues associated with CPRT research. This position statement provides an ethical platform for future research and should enable further work to be done in developing international coordinated programmes of research. (shrink)

Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of (...) sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosures of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions. (shrink)

Deepfakes are hyper-realistic but fabricated videos created with the use of artificial intelligence. In the context of psychotherapy, the first studies on using deepfake technology are emerging, with potential applications including grief counselling and treatment for sexual violence-related trauma. This paper explores these applications from the perspective of medical ethics and health law. First, we question whether deepfake therapy can truly constitute good care. Important risks are dangerous situations or ‘triggers’ to the patient during data collection for the creation (...) of a deepfake, and when deepfake therapy is started, there are risks of overattachment and blurring of reality, which can complicate the grieving process or alter perceptions of perpetrators. Therapists must mitigate these risks, but more research is needed to evaluate deepfake therapy’s efficacy before it can be used at all. Second, we address the implications for the person depicted in the deepfake. We describe how privacy and portrait law apply and argue that the legitimate interests of those receiving therapy should outweigh the interests of the depicted, as long as the therapy is an effective and ‘last resort’ treatment option, overseen by a therapist and the deepfakes are handled carefully. We suggest specific preventative measures that can be taken to protect the depicted person’s privacy. Finally, we call for qualitative research with patients and therapists to explore dependencies and other unintended consequences. In conclusion, while deepfake therapy holds promise, the competing interests and ethicolegal complexities demand careful consideration and further investigation alongside the development and implementation of this technology. (shrink)

It is estimated that one in ten U.S. adults suffers from chronic insomnia. If left untreated, chronic insomnia reduces quality of life and increases risk for psychiatric and medical disease, especially depression and anxiety. There are two forms of insomnia: secondary insomnia, in which it is comorbid with another condition such as psychiatric disorders, chronic pain conditions, or cardiopulmonary disorders, and primary insomnia, which does not coexist with any other disorder. This treatment program uses cognitive-behavioral therapy methods to correct (...) poor sleep habits. CBT has been proven in multiple studies to improve sleep hygiene by reducing time spent in bed before sleep onset, reducing time spent awake after first sleep onset, and increasing the quality and efficiency of sleep. Developed by the authors, this evidence based treatment can be used for both primary and secondary insomnia sufferers. Patients are first given information about healthy sleep and the reasons for improving sleep habits, then a behavioral program is developed to address that patient's specific sleep problems. Use of sleep logs, assessment forms, and other homework allows client and therapist to work together to develop an effective sleep regimen tailored specifically for each client. Finally, several sessions are dedicated to increasing compliance and problem-solving.TreatmentsThatWork represents the gold standard of behavioral healthcare interventions!BL All programs have been rigorously tested in clinical trials and are backed by years of researchBL A prestigious scientific advisory board, led by series Editor-In-Chief David H. Barlow, reviews and evaluates each intervention to ensure that it meets the highest standard of evidence so you can be confident that you are using the most effective treatment available to dateBL Our books are reliable and effective and make it easy for you to provide your clients with the best care availableBL Our corresponding workbooks contain psychoeducational information, forms and worksheets, and homework assignments to keep clients engaged and motivatedBL A companion website offers downloadable clinical tools and helpful resourcesBL Continuing Education Credits are now available on select titles in collaboration with PsychoEducational Resources, Inc. (shrink)

In this collection of papers and lecturers from the late Rainette Fantz, we witness firsthand the exhilarating possibilities inherent in the Gestalt therapy model. Frantz brings her background in theater to bear on her remarkable work as a therapy and teacher-work marked by delightful imagination, striking improvisation, and aesthetic beauty. The insights contained in these chapters illuminate everything from the intricacies of an opening session to the theoretical foundations of Gestalt dreamwork, and Frantz's candid style invites the reader (...) to explore with her the joys and sorrows of a career as a Gestalt therapist. (shrink)

In August 2011, a group of medical doctors, ethicists, academic and medical physicists were asked to debate and reach consensus on the potential need for randomised control trials to test charged particle radiation therapy for treating tumours. The outcome of the meeting was a paper recently published in the Journal of Medical Ethics entitled “Position statement on ethics, equipoise and research on charged particle therapy” by Sheehan et al. However 6 of the 30 meeting participants withdrew from authorship (...) of the ‘position statement’ because their views were not adequately represented. The ‘position statement’ did not state our reasons for withdrawing from the statement, which is a considerable omission. We had two principal objections: the case for the benefits to patients and society of randomized trials to test CPRT was not adequately represented, and the complexities and potential harms of CPRT were not clearly stated. In this response we explain and justify our objections. Patients, doctors and policymakers seeking to make independent judgments about whether equipoise exists for the relative benefits of CPRT should therefore read this document alongside the ‘position’ statement. (shrink)

The significant social and cultural transformations which took place in recent decades brought about significant changes in the way couples interact and deal with “the risk of bonding”. The vulnerability that characterizes the couple in post-modernity is the consequence of these changes. The application of a co-therapy model with couples in crisis is based on the premise of mutual gift, which has to be understood as both an exchange of expertise and professionalism to the benefit of the couple, and (...) as a bond of unity between co-therapists. The work that follows suggests some reflections which originate from the co-therapy model. The novelty of this model originates from the fact that the clinical work is based on two connected and complementary aspects: a deep attention towards the patient and a deep attention towards the relationship between the co-therapists. Both of these aspects are characterized by the dimension of gift. In this clinical model therapists transform any specific suffering lived by the couple in a positive relational experience between themselves which then becomes an example for the couple. Thus, for example, the inability to understand each other that the couple lives is contrasted by the capacity to listen to each other in a deep and authentic way by the therapists; the attitude of prevailing over each other in the couple, is counterbalanced by the therapists’ attention towards each other. And so on. This act of “overturning the limit” seems to reveal the therapeutic potential that a model of co-therapy, based on a new humanism, can offer to the clinical work with couples in crisis. (shrink)

How does law effect well-being? Can school rules influence the feel-good factor among children? If a self-perception of being ‘good’ improves well-being, people would prefer to be good—even children. But traditional school rules are often contrary to the principles of well-being, and create ‘good criminals’. Starting from the seemingly absurd truth—‘crime is caused by the law’— the paper proposes that children should learn to view law critically and creatively. Then, through a novel application of Occupational Therapy , and using (...) ‘law’ to focus social agency, a case study develops ‘The law of school dress’ as a public good. The result reflects Jeremy Bentham’s Principle of Utility. Philosophy of OT reminds us that the ultimate purpose of education is not just to learn: it is to improve well-being through learning as meaningful ‘occupation’. And ‘law’ has a part to play. (shrink)