January 27, 2013

The antidote to unicorns

For my own mental health, I find it important to spend more time learning from and sharing good information than rending my garments over bad. In that spirit, I share a truly wonderful video featuring Chris Thornton of Redleaf, making the case for neuroscience as a way to not just understand but support patients toward recovery.


  1. It is brilliant isn't it - so positive and sensible, and accessible to anyone, even perhaps those who feel affronted and threatened by talk of biology and neuroscience.

  2. He's so careful with his words..."may have,"could be..."
    No assumptions, up to date, accessible, and few of the larger stones are left unturned.

  3. Interesting talk by Chris Thornton. However, I think his observations about set-shifting difficulties might apply to adult AN patients who also suffer from clinical depression, but not generally to adolescents with AN. See, for example,
    Fitzpatrick, Set-Shifting Among Adolescents with Anorexia Nervosa, http://www.ncbi.nlm.nih.gov/pubmed/22692985
    Buhren, Cognitive Flexibility in Juvenile Anorexia Nervosa Patients Before and After Weight Recovery, http://www.ncbi.nlm.nih.gov/pubmed/22644538
    Shott, Cognitive Set-Shifting in Anorexia Nervosa,http://www.ncbi.nlm.nih.gov/pubmed/22492553
    Giel, Is Impaired Set-Shifting a Feature of 'Pure' Anorexia Nervosa? Investigating the Role of Depression in Set-Shifting Ability in Anorexia Nervosa and Unipolar Depression,
    The first three studies found that there were no siginificant differences in set-shifting abilities in adolescents with AN compared to non-anorexic adolescent controls. The fourth paper found that set-shifting weaknesses were strongly correlated with adult (not adolescent) AN patients who also suffered from unipolar depression, but not with patients who were not depressed.
    The lesson (and good news for parents) is that kids with anorexia nervosa tend to be relatively normal with respect to set shifting abilities. It is only if the illness persists into adulthood, and is accompanied by unipolar depression, that set-shifting deficits seem to become common.
    Furthermore, there is no evidence that mindfulness-based therapies are helpful for adolescents who have anorexia nervosa. Maybe bulimia and binge eating disorder, but not anorexia nervosa. Weight resoration seems to prevent set-shifting problems from developing over time.

  4. Interesting links CB-US and you are probably right, the majority of adolescents who have been sick for a relatively short period of time don't have set shifting difficulties and don't need some of the intense therapies being talked about here.

    However I'd like to see this question raised and answered from the first study you quoted "Future studies should explore set-shifting difficulties in a larger sample of adolescents with the AN to determine if there is sub-set of adolescents with these difficulties and determine any relationship of set-shifting to the development of a chronic from of AN" My hunch based on totally non-scientific method and a sample size of one is "yes" and "well it's certainly not going to make life easier", and I applaud the work being done by Thornton and others to work with those who suffer from these illnesses for a longer time and don't respond to or haven't had the good fortune to be offered evidence based treatments in adolescence.