[HN Gopher] Do no harm: can school mental health interventions c...
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Do no harm: can school mental health interventions cause iatrogenic
harm? [pdf]
Author : bumbledraven
Score : 16 points
Date : 2023-03-05 20:03 UTC (2 hours ago)
(HTM) web link (www.cambridge.org)
(TXT) w3m dump (www.cambridge.org)
| htag wrote:
| There's a body of evidence that some adults that practice
| mediation will have anxiety or depression worsen instead of
| improve (~10-25% depending on the study). Even this simple
| activity with thousands of years of history is not well
| understood and can do harm. Other interventions have even less
| history.
|
| One thing about being an adult is that if mindfulness increases
| your anxiety you can choose not to practice it. Children are
| often forced into mental health interventions by schools. Imagine
| being compelled into doing something that worsens your mental
| health by someone trying to improve your mental health. The
| authors are correct that we should be selective about which
| students get which treatments. Often these are applied more
| broadly than is appropriate. The authors make no claim about the
| size of the impact of this practice, or the number of students
| negatively impacted.
|
| Note: I'm from the US, the paper specifically comments on the UK
| education system.
| PaulHoule wrote:
| In my mind both CBT and 'mindfulness' can be pernicious. (Like
| that time I was suffering from asthma and anxiety at the same
| time and the last thing I wanted to do was pay attention to my
| breath.)
| renewedrebecca wrote:
| Just about any time I've tried to pay attention to my
| breathing, my heart rate goes up, so I totally get where you're
| coming from here.
| arrosenberg wrote:
| Are you rapidly mouth-breathing? The point of focusing on it
| is to make sure you are doing slow, steady nose-breathing.
| Slow nose-breathing causes your body to produce calming
| biochemical signals (for most people).
| PaulHoule wrote:
| I would point to this as a practice that works, it is about
| controlling the breath instead of observing it
|
| https://help.welltory.com/en/articles/3973614-long-exhale-
| fo...
|
| I was taught this method first at a Kempo Karate dojo in
| the late 1980s, it was also in Yoga books. It is associated
| with
|
| https://en.wikipedia.org/wiki/Vagal_tone#Respiratory_sinus_
| a...
|
| and well established scientifically today.
| MollyRealized wrote:
| For those who want to know what 'iatrogenic' means prior to
| dipping further into this thread: "Induced unintentionally in a
| patient by a physician. Used especially of an infection or other
| complication of treatment."
|
| Basically: is it causing the very thing the intervention is
| intended to help.
| woodruffw wrote:
| At the risk of nitpicking: iatrogensis isn't confined to the
| very thing the intervention intends to address; it can be any
| condition induced at the cost of treatment.
|
| Blinding a patient during eye surgery to remove a tumor is an
| iatrogenic outcome, for example.
| narwally wrote:
| * * *
| concinds wrote:
| Paper says that for some kids, CBT and mindfulness can increase
| negative symptoms, or have no effect.
|
| Not surprising, because they don't address the fundamental
| issues. Why would mindfulness help with depression, better than
| teaching these kids how to grieve in an effective, healthy way?
|
| CBT can be helpful, but it 'intellectualizes' problems too much.
| How about teaching these kids how to increase their self-
| confidence? How to identify their emotional needs? How to build
| their social skills, resolve conflicts in relationships, and
| assert their personal boundaries? Most sure aren't learning that
| from their parents.
|
| These interventions are far too superficial to obtain the
| intended results. I'll be pointlessly provocative now: they
| almost seem intended so that teachers/interveners can avoid
| having to deal head-on, one-on-one, with their students' "messy"
| emotions. No need for school adults to have empathic, difficult
| conversations with kids whose parents are undergoing a divorce.
| Instead, just teach the kids (as a group) how to intellectualize
| their emotions, or distance themselves from them. It minimizes
| the role of teachers and other trusted adults as a social support
| system, it places the onus on kids to "fix themselves", and it
| downplays the importance of emotions in causing these problems in
| the first place. It makes things very impersonal. Imagine if sex-
| ed classes were founded on Victorian notions of decency, would
| _they_ be of any help? It concerns me that so many intelligent,
| thoughtful scientists are barking up the wrong trees. If they
| refocused their efforts, they could be far more effective.
| narwally wrote:
| > CBT can be helpful, but it 'intellectualizes' problems too
| much. How about teaching these kids how to increase their self-
| confidence? How to identify their emotional needs? How to build
| their social skills, resolve conflicts in relationships, and
| assert their personal boundaries? Most sure aren't learning
| that from their parents.
|
| All the things you listed are already directly addressed within
| CBT.
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(page generated 2023-03-05 23:00 UTC)