Internet Mental Health

CANNABIS USE DISORDER





  • Cannabis use disorder is the continued use of cannabis despite clinically significant distress or impairment which usually includes:

    • a strong desire to take cannabis

    • difficulties in controlling its use

    • persisting in its use despite harmful consequences

    • a higher priority given to cannabis use than to other activities and obligations

    • increased tolerance

    • sometimes a physical withdrawal state

Prediction

    Episodic or continuous for years

Problems

Occupational-Economic Problems:

  • Causes significant impairment in academic or occupational functioning

Antagonistic (Antagonism):

  • Some develop suspiciousness, social withdrawal

Disinhibited (Disinhibition):

  • Intoxicated behavior, impaired driving

  • Impulsivity, dangerous risk taking, irresponsibility

  • Marital/child neglect in heavy users; legal problems

Cognitive Impairment (Impaired Intellect):

  • Cannabis intoxication causes:

    • Impaired motor coordination

    • Sensation of slowed time, impaired judgment

    • Decreased short term memory, impaired learning, apathy (even when not intoxicated)

  • Less commonly, cannabis intoxication can cause psychosis:

    • Paranoia or acute psychosis with delusions & hallucinations

    • Can trigger schizophrenia in 4% of regular users

  • Less commonly, cannabis intoxication can cause delirium:

    • Disturbance in attention (ie, reduced ability to direct focus, sustain, and shift attention) and awareness (reduced orientation to the environment)

    • Disturbance in cognition (ie, memory deficit, disorientation, language, visuospatial ability, or perception)

Emotional Distress (Negative Emotion):

  • Intoxication can cause anxiety and panic

Medical:

  • Intoxication causes relaxation, sleepiness, and mild euphoria (getting high)

  • Denial of addiction; respiratory illness; lung cancer

  • Marijuana is often cut with hallucinogens and other, more dangerous drugs that have more serious side effects than marijuana



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Click Here For Free Diagnosis

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Cannabis Use Disorder 304.30

This diagnosis is based on the following findings:
  • Abused cannabis in the past 5 years (still present)
  • Greater use of cannabis than intended (still present)
  • There is a persistent desire or unsuccessful efforts to cut down or control cannabis use (still present)
  • A great deal of time is spent in activities necessary to obtain cannabis, use it, or recover from its effects. (still present)
  • Craving, or a strong desire or urge to use cannabis (still present)
  • Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school or home (still present)
  • Continued cannabis use despite having persistent social problems that it made worse (still present)
  • Important social, occupational, or recreational activities are given up or reduced because of use of cannabis (still present)
  • Recurrent cannabis use in situations in which it is physically hazardous (still present)
  • Continued using cannabis despite knowing it caused significant problems (still present)
  • Developed tolerance to cannabis (still present)
  • Developed withdrawal symptoms to cannabis (still present)

Treatment Goals:

  • Goal: stop cannabis use because using more than intended.

  • Goal: stop cannabis use because it is getting out of control.

  • Goal: stop cannabis use in order to prevent wasting so much time using cannabis, or recovering from its use.

  • Goal: stop cannabis use in order to decrease craving for cannabis.

  • Goal: stop cannabis use so that she can better fulfill major role obligations at work, school or home.

  • Goal: stop cannabis use in order to improve the cannabis-related social problems.

  • Goal: stop cannabis use in order to increase time spent on important social, occupational, or recreational activities.

  • Goal: stop cannabis use in hazardous situations in order to prevent injury.

  • Goal: stop cannabis use in order to prevent further worsening of current cannabis-related physical or emotional problems.

  • Goal: stop cannabis use because tolerance to cannabis is developing.

  • Goal: stop cannabis use because cannabis withdrawal symptoms are developing.


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Diagnostic Features

Cannabis Use Disorder is a condition characterized by the harmful consequences of repeated cannabis use, a pattern of compulsive cannabis use, and (sometimes) physiological dependence on cannabis (i.e., tolerance and/or symptoms of withdrawal). This disorder is only diagnosed when cannabis use becomes persistent and causes significant academic, occupational or social impairment.

Cannabis users can develop tolerance to this drug so that it can be difficult to detect when they are intoxicated. Signs of cannabis use include red eyes, chronic cough, cannabis odor on clothing, yellowing of finger tips (from smoking joints), burning of incense (to hide odor), and exaggerated craving and impulse for specific foods.

Cannabis Intoxication causes significant psychological and social impairment. It begins with a "high" euphoric feeling followed by inappropriate laughter and grandiosity, sedation, lethargy, impairment in short-term memory, difficulty carrying out complex mental processes, impaired judgment, distorted sensory perceptions, impaired motor performance, and the sensation that time is passing slowly. Occasionally, anxiety, depression, or social withdrawal occurs. This intoxication has two or more of the following developing within 2 hours of cannabis use: red eyes (conjunctival injection), increased appetite, dry mouth, or rapid pulse.

Cannabis Withdrawal occurs after the cessation of (or reduction in) heavy and prolonged cannabis use. This withdrawal syndrome includes three or more of the following: irritability, anger or aggression; nervousness or anxiety; insomnia or disturbing dreams; decreased appetite or weight loss; restlessness; depressed mood; at least one of: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache. These withdrawal symptoms typically don't require medical attention; however, they make quitting cannabis difficult.

Complications

About 9% of cannabis (pot) users become addicted to it. Cannabis Use Disorder in school often causes a dramatic drop in grades, truancy, and reduced interest in sports and other school activities. In adults, this disorder often is associated with work impairment, unemployment, lower income, welfare dependence, and impaired social functioning.

Higher executive functioning is impaired in Cannabis Use Disorder which contributes to school and work impairment. This disorder also significantly decreases motivation at school or work (i.e., an "amotivational syndrome"). There is an increased risk of accidents while driving, at sports or at work.

Since cannabis smoke contains high levels of carcinogenic compounds; chronic cannabis users face the same cancer and respiratory illness risks as do chronic tobacco smokers. There is strong evidence that cannabis use can trigger the onset of Schizophrenia and other psychotic disorders.

Comorbidity

Individuals with Cannabis Use Disorder have higher rates of: Alcohol Use Disorder (50%), Tobacco Use Disorder (53%), Antisocial Personality Disorder (30%), Anxiety Disorder (24%), Obsessive-Compulsive Disorder (19%), Paranoid Personality Disorder (18%), Bipolar I Disorder (13%), and Major Depressive Disorder (11%). Adolescents have higher rates of Conduct Disorder and Attention Deficit - Hyperactivity Disorder.

Associated Laboratory Findings

Cannabis is detected on routine urine toxicology testing.

Prevalence

The 12-month American prevalence rate for Cannabis Use Disorder is 3.4% among 12- to 17-year-olds and 1.5% among adults age 18 years and older. The prevalence has increased during the past decade.

Course

Onset is usually during adolescence or young adulthood, but it can start in preteens and older adults. The onset is usually gradual. Cannabis use prior to age 15 is a strong predictor of later Cannabis Use Disorder, other Substance Use Disorders and Conduct Disorder

Outcome

The prevalence of Cannabis Use Disorder decreases with age, with rates highest among 18- to 29-year-olds (4.4%) and lowest among individuals age 65 years and older (0.01%).

Familial Pattern

In Cannabis Use Disorder it is estimated that 30%-80% of the variance of risk is explained by genetic influences. What seems to be inherited is impulsivity and novelty seeking which makes the individual more prone to Substance Use Disorders in general.

Effective Therapies

There is no FDA-approved pharmacological treatment for cannabis dependence. There are only two pharmacological, randomized, double-blind, placebo-controlled clinical trials which had a positive outcome (N-acetylcysteine, gabapentin) - but neither of these clinical trials has been replicated.

There are no randomized, placebo-controlled clinical trials of any psychosocial treatment. Thus the effectiveness of psychosocial treatment for Cannabis Use Disorder is unknown.



Top 20 Most Harmful Drugs In Britain In 2008

Professor David Nutt published in the Lancet the following rating of Britain's most dangerous drugs. They are listed in descending order from the most harmful.

1. Heroin

Class A drug. Originally used as a painkiller and derived from the opium poppy. There were 897 deaths recorded from heroin and morphine use in 2008 in England and Wales, according to the Office of National Statistics (ONS). There were around 13,000 seizures, amounting to 1.6m tonnes of heroin.

2. Cocaine

Class A. Stimulant produced from the South American coca leaf. Accounted for 235 deaths -- a sharp rise on the previous year's fatalities. Nearly 25,000 seizures were made, amounting to 2.9 tonnes of the drug.

3. Barbiturates

Class B. Synthetic sedatives used for anaesthetic purposes. Blamed for 13 deaths.

4. Street methadone

Class A. A synthetic opioid, commonly used as a substitute for treating heroin patients. Accounted for 378 deaths and there were more than 1,000 seizures of the drug.

5. Alcohol

Subject to increasing concern from the medical profession about its damage to health. According to the ONS, there were 8,724 alcohol deaths in the UK in 2007. Other sources claim the true figure is far higher.

6. Ketamine

Class C. A hallucinogenic dance drug for clubbers. There were 23 ketamine-related deaths in the UK between 1993 and 2006. Last year there were 1,266 seizures.

7. Benzodiazepines

Class C. A hypnotic relaxant used to treat anxiety and insomnia. Includes drugs such as diazepam, temazepam and nitrazepam. Caused 230 deaths and 1.8m doses were confiscated in more than 4,000 seizure operations.

8. Amphetamine

Class B. A psychostimulant that combats fatigue and suppresses hunger. Associated with 99 deaths, although this tally includes some ecstasy deaths. Nearly 8,000 seizures, adding up to almost three tonnes of confiscated amphetamines.

9. Tobacco

A stimulant that is highly addictive due to its nicotine content. More than 100,000 people a year die from smoking and tobacco-related diseases, including cancer, respiratory diseases and heart disease.

10. Buprenorphine

An opiate used for pain control, and sometimes as a substitute to wean addicts off heroin. Said to have caused 43 deaths in the UK between 1980 and 2002.

11. Cannabis

Class B. A psychoactive drug recently appearing in stronger forms such as "skunk". [Since this video was made; there is now conclusive proof that cannabis causes a 6.7 fold increase in the risk of developing schizophrenia.] Caused 19 deaths and there were 186,000 seizures, netting 65 tonnes of the drug and 640,000 cannabis plants.

12. Solvents

Fumes inhaled to produce a sense of intoxication. Usually abused by teenagers. Derived from commonly available products such as glue and aerosol sprays. Causes around 50 deaths a year.

13. 4-MTA

Class A. Originally designed for laboratory research. Releases serotonin in the body. Only four deaths reported in the UK between 1997 and 2004.

14. LSD

Class A. Hallucinogenic drug originally synthesised by a German chemist in 1938. Very few deaths recorded.

15. Methylphenidate

Class B drug. Brand name of Ritalin. A psychostimulant sometimes used in the treatment of attention deficit disorders.

16. Anabolic steroids

Class C. Used to develop muscles, notably in competitive sports. Also alleged to induce aggression. Have been blamed for causing deaths among bodybuilders. More than 800 seizures.

17. GHB

Class C drug. A clear liquid dance drug said to induce euphoria, also described as a date rape drug. Can trigger comas and suppress breathing. Caused 20 deaths and 47 seizures were recorded.

18. Ecstasy

Class A. Psychoactive dance drug. Caused 44 deaths, with around 5,000 seizures made.

19. Alykl nitrites

Known as "poppers". Inhaled for their role as a muscle relaxant and supposed sexual stimulant. Reduce blood pressure, which can cause fainting and in some cases death.

20. Khat

A psychoactive plant, the leaves of which are chewed in east Africa and Yemen. Also known as qat. Produces mild psychological dependence. Its derivatives, cathinone and cathine, are Class C drugs in the UK.

Ineffective therapies

Few individuals addicted to cannabis seek treatment. Even with treatment, fewer than 20% achieve long-term abstinence. Some argue that cannabis should be decriminalized, and that cannabis addiction should be treated "like any other medical disorder". They forget that there is no treatment for cannabis addiction that has been proven effective.

It is possible to stop using cannabis. To do this you must: (1) totally divorce yourself from drug-using or drug-supplying people, (2) not use alcohol or any other illegal drug, (3) be socially active and help others, (4) talk to other people who have successfully stayed off drugs, (5) devote yourself to important activities that give meaning and purpose to life (e.g., family, friends, sports, work, helping others, church etc.). Therapists know that these 5 steps work, but our therapies often are ineffective in motivating patients to complete these essential steps to recovery.

WARNING: Cannabis And Schizophrenia

Cannabis (pot) has been proven to nearly quadruple the risk of developing schizophrenia. In 1969-70, Swedish military conscripts (49,321 males representing >97% of the country's male population aged 18-20) were followed for 35 years. At the start of this study, none of the conscripts had schizophrenia. Over 35 years, those who had used cannabis more than 50 times at the beginning of the study had 3.7 times the normal rate of developing schizophrenia. This association was not explained by use of other psychoactive drugs or personality traits. Schizophrenia normally occurs in 1% of the population. 86% of individuals with schizophrenia are disabled and unemployed. Thus this research would suggest that legalizing cannabis could triple the incidence of schizophrenia in regular cannabis smokers. This would cause a massive increase in the national unemployment rate.

WARNING: Cannabis And Lung Cancer

Swedish scientists did a 40 year followup study of 97% of all Swedish males, aged 18-20, entering the Swedish army in 1969-70 (a total of 49,321 males). Participants were tracked until 2009 (i.e., age 58-60) for lung cancer using the computerized Swedish national health registry. For those males entering the army at age 18-20 that reported using cannabis more than 50 times; there was a twofold increase in the rate of lung cancer. It should be noted that most lung cancer occurs after age 60; thus this twofold increase probably underestimates the lifetime cancer risk from smoking cannabis. For males, lung cancer is the most common form of cancer. Thus this research would suggest that legalizing cannabis could double the incidence of lung cancer in regular cannabis smokers.

Legalizing Illicit Drugs

Some people argue that illicit drugs should be legalized to decrease the crime associated with these drugs. Historically, tobacco and alcohol were once illegal drugs. Tobacco smoking is now the leading cause of death in America, and alcoholism is the third leading cause of death. Thus legalizing illicit drugs does not make them any less medically and socially harmful. In fact the opposite is true; legalizing illicit drugs increases their use and the harm they cause. The Government of Finland is passing legislation that will gradually ban all tobacco use by 2040.



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Scientists Show Link Between Cannabis And Schizophrenia




Cannabis Found To Decrease Brain Connections




New, deadly form of cannabis




Pot is 4 times more potent than in 1970s, and more toxic





Stories

Rating Scales

Stages of Learned Behavior

Our survival involves learning what to avoid (i.e., fear) and what to approach (i.e., crave). Both fear and craving are essential for our survival, but both can spiral out of control.

For example, an individual can develop a phobia about snakes in which the fear becomes excessive. This phobia can develop into an obsession in which the individual spends much of the time thinking about snakes, and how to avoid them.

This obsession can develop into a compulsion in which the individual spends much of the time doing superstitious, compulsive, ritual behaviors aimed at avoiding snakes.

Likewise, an individual can develop an excessive craving for alcohol which causes significant distress or disability.

This excessive craving for alcohol can develop into an obsession in which the individual spends much of the time thinking about alcohol, and how to get it.

This obsession can develop into a compulsion in which the individual spends much of the time compulsively drinking, and feeling powerless to resist this craving.

Four Stages of Fear and Craving

4 STAGES OF FEAR 4 STAGES OF CRAVING
Normal Fear:
Is in proportion to the actual danger, and doesn't cause significant distress or disability.
Normal Craving:
Doesn't cause significant distress or disability.
Excessive Fear (Phobia):
Is out of proportion to the actual danger posed, and causes significant distress or disability.
Excessive Craving:
Is not socially acceptable, and causes significant distress or disability (e.g., "I'm using [cannabis] too much").
Obsessional Fear:
Persistent, unwanted or obsessional thoughts about the fear develop, which cause significant distress or disability.
Obsessional Craving:
Persistent, unwanted or obsessional thoughts about the craving develop, which cause significant distress or disability (e.g., "I spend much of my time thinking about [cannabis], and how to get it").
Compulsive Fear:
Compulsive behaviors develop (aimed at reducing the anxiety associated with the obsession), which the individual finds very hard to resist doing.
Compulsive Craving:
Compulsive behaviors develop (aimed at satisfying the craving), which the individual finds very hard to resist doing (e.g., "I can't stop myself from using [cannabis]").

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Dependence Syndrome Due To Use Of Cannabinoids F12 - ICD10 Description, World Health Organization

Repeated use of cannabinoids that typically includes a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.
Cannabis Use Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with cannabis use disorder needs to meet all of the following criteria:

  • A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

    • Cannabis is often taken in larger amounts or over a longer period than was intended.

    • There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.

    • A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.

    • Craving, or a strong desire or urge to use cannabis.

    • Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.

    • Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.

    • Important social, occupational, or recreational activities are given up or reduced because of cannabis use.

    • Recurrent cannabis use in situations in which it is physically hazardous.

    • Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.

    • Tolerance, as defined by either of the following:

      • A need for markedly increased amounts of cannabis to achieve intoxication or desired effect.

      • A markedly diminished effect with continued use of the same amount of cannabis.

    • Withdrawal, as manifested by either of the following:

      • The characteristic withdrawal syndrome for cannabis:

        • Cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily use over a period of a least a few months).

        • Three (or more) of the following signs and symptoms develop within approximately 1 week after the cessation of heavy cannabis use:

          • Irritability, anger, or aggression.

          • Nervousness or anxiety.

          • Sleep difficulty (e.g., insomnia, disturbing dreams).

          • Decreased appetite or weight loss.

          • Restlessness.

          • Depressed mood.

          • At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache.

        • The signs or symptoms of cannabis withdrawal cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

        • The signs or symptoms of withdrawal are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

      • Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

    • Specify if:

      • In early remission: After full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met for at least 3 months but for less than 12 months (with the exception that the criterion, "Craving, or a strong desire or urge to use cannabis," may be met).

      • In sustained remission: After full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met at any time during a period of 12 months or longer (with the exception that the criterion, "Craving, or a strong desire or urge to use cannabis," may be met).

    • Specify if:

      • In a controlled environment: This additional specifier is used if the individual is in an environment where access to cannabis is restricted.


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World Health Organization Drug Use Disorder Treatment Guidelines

Treatment Guidelines

Treatment Research

  • Does Teen Drug Rehab Cure Addiction or Create It?
  • State of the art treatments for cannabis dependence. (2012) Few people who might benefit from treatment actually receive it. Among those who undergo treatment in randomized trials, long-term abstinence is achieved by fewer than 20%. The efficacy of twelve-step programs in cannabis dependence has not been examined. Pharmacologic treatments are under development, but none have yet been firmly established. A recent meta-analysis of psychosocial interventions for illicit substance use disorders found that treatments for cannabis dependence had comparatively larger effect sizes than treatments for other substance use disorders. Combination therapies have proven most effective, particularly those that begin with a motivational intervention, utilize incentives to enhance the commitment to change, and teach behavioral and cognitive copings skills to prevent relapse. Among adolescents, family engagement and collaboration with community stakeholders adds substantial value. Although only 9% of cannabis users develop cannabis dependence, the volume of people who smoke cannabis ensures that the total number of people in need of help is larger than the capacity of substance abuse specialty services.
  • Substance use disorder among people with first-episode psychosis: a systematic review of course and treatment. (2011) Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of abstinence or reduction.
  • Antipsychotic agents for the treatment of substance use disorders in patients with and without comorbid psychosis. (2010) Although there is some preliminary evidence that atypical antipsychotic agents may be effective in treating substance dependence, results have been mixed, with some studies demonstrating positive and others negative or no effect. Studies in patients with comorbid psychosis suggest that atypical antipsychotic agents, especially clozapine, may decrease substance use in individuals with alcohol and drug (mostly cannabis) use disorders. Atypical antipsychotic agents are not effective at treating stimulant dependence and may aggravate the condition in some cases.
  • A meta-analytic review of school-based prevention for cannabis use. (2010) The results from the set of 15 studies indicated that these school-based programs had a positive impact on reducing students' cannabis use (d = 0.58, CI: 0.55, 0.62) compared to control conditions. Programs that were longer in duration (=15 sessions) and facilitated by individuals other than teachers in an interactive manner also yielded stronger effects. The results also suggested that programs targeting high school students were more effective than were those aimed at middle-school students.
  • Treatment of cannabis use disorders in people with schizophrenia spectrum disorders - a systematic review. (2009) Contingency management was only effective while active. Pharmacological interventions appeared effective, but lacked randomized controlled trials (RCTs). Psychosocial interventions, e.g. motivational interviewing and cognitive behavior therapy (CBT), were ineffective in most studies.

Treatment Evaluation

Crime


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Overcoming Drug Addiction


Self-Help Groups for Drug Addiction

Monitoring Your Progress

NOTE: When each of the following presentations finish; you must exit by manually closing its window in order to return to this webpage.

The Healthy Social Behavior Scale lists social behaviors that research has found to be associated with healthy social relationships. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Mental Health Scale lists behaviors and symptoms that research has found to be associated with mental health (or disorder). You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Life Satisfaction Scale lists the survey questions often used to measure overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



Life Satisfaction Scale (5-Minute Video)

The "Big 6" Dimensions of Mental Health

Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders.

This website uses these 5 major dimensions of human behavior (i.e., Agreeableness, Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional Stability) to describe all mental disorders. This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.

The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].



Desiderata (5-Minute Video)



The following "Morning Meditation" allows you to plan your day using these "Big 6" dimensions of mental health.



The following "Evening Meditation" allows you to review your progress on these "Big 6" dimensions of mental health.




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    "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

    Lord Kelvin (1824 – 1907)


  • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

  • Economist in grim battle against deceptive scholarship

  • List of Predatory Journals and Publishers

  • The power of asking "what if?"

  • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

  • Criteria For High Quality Research Studies

  • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

    • Randomized Controlled Trial:
      Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

    • Representative Sample:
      Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

    • Single Blind Trial:
      Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

    • Double Blind Trial (Better Than Single Blind Trial):
      Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

    • Baseline Comparability:
      Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

    • Confounding Factors:
      Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

    • Intervention Integrity:
      Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

    • Statistical analysis:
      Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

      Ask: Are the results both statistically significant and clinically significant? Many medical research findings are statistically significant (with a p-value <0.05), but they are not clinically significant because the difference between the experimental and control groups is too small to be clinically relevant.

      For example, the effect of a new drug may be found to be 2% better than placebo. Statistically (if the sample size was large enough) this 2% difference could be statistically significant (with a p-value <0.05). However, clinicians would say that this 2% difference is not clinically significant (i.e., that it was too small to really make any difference).

      Statistically, the best way to test for clinical significance is to test for effect size (i.e., the size of the difference between two groups rather than confounding this with statistical probability).

      When the outcome of interest is a dichotomous variable, the commonly used measures of effect size include the odds ratio (OR), the relative risk (RR), and the risk difference (RD).

      When the outcome is a continuous variable, then the effect size is commonly represented as either the mean difference (MD) or the standardised mean difference (SMD) .

      The MD is the difference in the means of the treatment group and the control group, while the SMD is the MD divided by the standard deviation (SD), derived from either or both of the groups. Depending on how this SD is calculated, the SMD has several versions such, as Cohen's d, Glass's Δ, and Hedges' g.

        Clinical Significance: With Standard Mean Difference, the general rule of thumb is that a score of 0 to 0.25 indicates small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate to large benefit, and above 1.0 a huge benefit. It is a convention that a SMD of 0.5 or larger is a standard threshold for clinically meaningful benefit.

      The statistical summary should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention).

      In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

        Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

        Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

        Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

      Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

    • Completeness of follow-up data:
      Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

    • Handling of missing data:
      Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

    • Replication of Findings:
      Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

    • Fraud:
      Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size ( n ), mean ( M ) and standard deviation ( SD ) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

      • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean ( M ) is defined as "the sum ( Sum ) of the values of each observation divided by the total number ( n ) of observations". So: M = Sum / n . Thus: ( Sum ) = ( M ) multiplied by ( n ). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate ( M ) multiplied by ( n ). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean ( M ) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value , and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

      • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible.

      • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

      • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

      • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

      • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

      • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

      • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

  • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

  • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

  • Not All Scientific Studies Are Created Equal - video

  • The efficacy of psychological, educational, and behavioral treatment

  • Estimating the reproducibility of psychological science

  • Psychologists grapple with validity of research

  • Industry sponsorship and research outcome (Review) - Cochrane Library

  • 'We've been deceived': Many clinical trial results are never published - (text and video)

  • Junk science misleading doctors and researchers

  • Junk science under spotlight after controversial firm buys Canadian journals

  • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

  • When Evidence Says No, But Doctors Say Yes


  • Cochrane Reviews (the best evidence-based, standardized reviews available)


Research Topics


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