Myndplan Blog Myndplan Blog Tue, 31 Oct 2017 14:42:20 +0000 en-US hourly 1 What is Myndplan? Wed, 20 Sep 2017 15:37:52 +0000 In this blog post, we go into detail on some of the features that we’re building for Myndplan. For a higher level overview – check out our website If you are a mental health care provider – learn more about Myndplan and how it can compliment your practice. The Myndscan We called the first version of […]

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In this blog post, we go into detail on some of the features that we’re building for Myndplan. For a higher level overview – check out our website

If you are a mental health care provider – learn more about Myndplan and how it can compliment your practice.

The Myndscan

We called the first version of our comprehensive mental health assessment tool the Multi-Axial Assessment Inventory, or MAI. We call the latest version the Matrix Assessment Inventory or Myndscan for short. It has a lot packed into it, all of it designed to help people in their efforts to get started on the path to understanding their symptoms and how to feel better, and to help therapists provide the best care as efficiently as possible. Here’s a sample of what’s in it:

Research domain symptoms

We are the first to break down users’ profiles using National Institute of Mental Health Research Domain Criteria Framework. We did this because Research Domain Criteria offers a system that can integrate information from just about any level of analysis. This means that we can easily add units of measurement that go beyond self-report as the scans develop, such as the kind of data people gather using a fitbit or heart monitor. It also makes it easy to translate scan results based on the findings of the latest cutting-edge research. To give just one example, we can directly translate our scan elements to neuroscience-based brain images.


Our own analysis of large datasets has been used to organize dozens of scan elements into several meaningful factors that explain a lot of the differences between individuals. These factors can be helpful in directing newer transdiagnostic approaches to treatment, such as David Barlow’s Unified Protocol for emotional disorders. Transdiagnostic approaches look at clusters of problems that all seem to share similar features and respond to the same treatment. For example, instead of treating panic, generalized anxiety, and phobias as different problems, a transdiagnostic approach groups these together and treats them using a common strategy.

Meaningful comparison groups

Most people are not psychiatric inpatients, aren’t attending college, and don’t just have a single diagnosis. Myndplan built its tools using real people with complex histories that typically can be found in primary care settings, like a doctor’s office, along with just plain healthy adults who work and occasionally surf the internet. Plus, men and women tend to score in very different ways on most measures. Myndplan allows users to choose the most relevant comparison group.


There has been an overwhelming amount of research conducted in mental health using census and other data that has been shown to predict things like the incidence of mental illness, risk of harm, and people’s response to treatment. Myndplan includes an intake that summarizes many of these findings and their potential relevance for each unique user.

Personalized feedback

Our feedback is automated to choose the most appropriate interpretations based on each user’s unique response set. Every profile is different, just like real people are.

Recommended guides

Getting personalized feedback about the elements and factors underlying mental health or illness is only the start. Each narrative report includes recommendations to help users select from a wide assortment of Guides outlining DSM5 diagnostic categories. It’s like a self-help book that reads the user, saving a lot of wasted time learning about irrelevant problems, while helping to ensure that nothing gets overlooked.


Functional assessments

Our guides look a lot like a friendly version of a diagnostic manual, but there are some important differences. For example, rather than simply listing off collections of symptoms, we explain how problems present and how symptoms tend to cluster. More importantly, we help users rank how accurately diagnostic criteria describe their own symptom patterns, and help them rate the impact this is having on their day to day functioning.

Explore and rate causes

Most experienced clinicians know that there are many different sorts of factors that contribute to mental health and illness. Our Guides describe a wide range of causes as well as evaluating the evidence underlying them. Users are encouraged to rank the extent to which each cause applies to their symptoms. This can help reveal both preferences and biases to guide treatment choices.

Rank treatments

Research has provided us with estimates of effect size, number needed to treat, and other tools to help in choosing the best interventions. Often, combination therapies give the best results. Yet relatively few people are presented with more than one option for treatment, and even fewer understand how multifaceted change efforts can improve outcomes.

Build a treatment map

Myndplan is developing tools to collate each client’s functional assessments, causal assumptions, and treatment preferences to create customized treatment maps. Decision trees are highlighted to reveal some of the potential strengths and weaknesses of each choice.

Neurodynamic feedback

We believe that neuroscience is a key tool for knowledge translation. By combining plain language explanations with vivid graphics, we bring the mind to life and help illustrate the psychology of just about everything that can be experienced. While no single model will ever account for each person or every diagnosis, neuroscience can help inform the learning experience and give therapists another useful tool for interpreting behavior.


The evidence is clear, tracking progress in therapy and session quality influences outcomes. We’ve automated the administration of some simple, quick monitors of common symptoms like anxiety and depression, along with a helpful measure of life satisfaction. Plus, we’ve done the research to uncover how to use the data. Did you know that some simple elements can predict treatment responders versus relapsers? Or that variability between sessions can be a useful indicator?

Provider Link

Myndplan puts clients in the driver’s seat when it comes to their personal information. Users build their own private record and control who has access. Clinicians can be invited to join using a unique access code. This gives people the ability to build a circle of care that can share in the change process regardless of where individual health practitioners work. The system works the other way as well – any health provider can invite their clients to join Myndplan. However, the client always retains control over their record and can withdraw access at any time.

Share data

Our secure chat feature allows for instant messaging within the Myndplan platform. This saves giving out personal emails and keeps the conversation within the secure client record. It makes it easier to keep communication lines open, particularly when providers are locked in behind firewalls in their own electronic record that limit client access.

Matrix Manual

Curious about learning more about the scans? Want to check out some of the research that went into constructing Myndplan? We’ve put together a detailed Manual that gives you the details.


Even the best efforts at knowledge translation can include baffling terms. Plus, on some occasions there simply isn’t a simple word to describe a more complex principle. Myndplan is building a comprehensive glossary to help users when they stumble over the meaning of a word or passage.


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Mental health myths Wed, 20 Sep 2017 14:52:18 +0000 Can you tell the difference between a mental health myth and fact? Learn the truth about the most common mental health myths. Myth: Mental health problems don’t affect me Actually, even if your mental health is strong, someone among your family and friends probably is working to overcome mental health problems. More than 1 in […]

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Can you tell the difference between a mental health myth and fact? Learn the truth about the most common mental health myths.

Myth: Mental health problems don’t affect me

Actually, even if your mental health is strong, someone among your family and friends probably is working to overcome mental health problems. More than 1 in every 5 people will experience symptoms of mental health problems in a given year. However, only a small proportion of those people will talk about it or seek help, so they often go unnoticed. Over a lifetime, almost 10% of men and 25% of women will experience a least one major depressive episode, and close to one-third of the population will experience panic-related anxiety.

Over a lifetime, almost 10% of men and 25% of women will experience a least one major depressive episode

When you look at all the possible mental health problems, it is easy to see how they influence everyone. Furthermore, if you are healthy, you are probably doing something to keep it that way, and getting support in those efforts. If either of those things were to change you would likely learn very quickly that mental health problems can happen to you.

Myth: Medications have terrible side effects and change your personality

To begin with, many of the best treatments don’t even involve taking medication. For most people, when medication is used in the right dosage, side effects are usually small or non-existent. In the case of many medications, there are a variety of choices to help people minimize any unwanted effects. Even more important, when medications work, people have fewer symptoms and feel better.

That’s a good change.

Myth: People with mental health problems are violent & dangerous

In fact, people with mental health problems are more likely to be victims of violence than they are to be perpetrators of it. While some people do become violent, the numbers are far fewer than in the general population. The real risk with mental illness is that out of desperation people will hurt or sometimes even kill themselves. It can be that serious.

Myth: People with mental health problems are weak, it is just an excuse for bad behavior

Many of the causes of mental health problems are outside of people’s control, and symptoms can be far more severe that you might imagine. Most people with mental health problems cope well enough that their symptoms are not noticed by others. When symptoms don’t improve, it’s usually because the wrong treatment is being used, or a treatment is not being administered properly. This usually requires a change in strategy, not just a change in attitude or more work.

Myth: Therapy and self-help are a waste of time

Thousands of studies have shown that specific psychotherapy techniques are effective in reducing or eliminating many of the symptoms that go with mental health problems. In many cases, they are even the first choice, gold standard treatment. Even many self-help methods have gained research support for their effectiveness. It turns out that there are lots of things a person can do to help with the right training and resources. Furthermore, when we look at brain connectivity, the same changes often occur with things like cognitive behavioral therapy that go with many drug therapies.

Myth: Mental health problems aren’t real illnesses

When most people think of the word illness, they think about things like physical injury, diseases or infections. These are thought to be “real” medical conditions that have clear causes and treatments. However, your brain is just as vulnerable to the effects of injury or illness, though the mechanisms may be different from that of other parts of the body. Just like other illnesses, mental health problems can be inherited, are influenced by a person’s experience and lifestyle, and can improve with the right treatment. And just like other illnesses, if there is no treatment things will often get worse, not better.

Some of the difficulty here is the use of the word illness. For many, it comes with a lot of assumptions about the way our biology can go wrong, or that diseases can invade our body. Newer research on brain connectivity is showing us that when it comes to the mind, how the parts work together is as important as whether the parts themselves are “healthy”. Dysfunctional patterns in thinking are reflected in very real and observable changes in brain connectivity, just as healthy functioning is underpinned by consistent networks and patterns of activity.

Myth: Everyone has problems, some people are just looking for excuses

The idea that mental health problems are somehow a reflection of people being dramatic or being complainers is a common one. Part of the reason this is so common is that many symptoms of mental health problems seem to simply be more extreme examples of common thoughts, feelings, and behaviors. As most people with mental health problems will tell you, the symptoms – and the stigma that goes with myths like this one – are something that most people would prefer to avoid at any cost. They are not something people choose to experience, and most people will do almost anything to get rid of them. Rather than being an excuse for bad behavior, this sort of stigmatizing belief is the kind of thing that keeps people from talking about their problems and getting help.

Myth: Mental Health is just another word for happiness.

Each and every day most people will experience episodes of happiness and unhappiness, not to mention lots of other positive and negative emotions. Unhappiness often motivates us to apply coping strategies and perhaps try to change things, which is a healthy thing to do even though it may be unpleasant or a hassle. So it is entirely possible to be unhappy yet have good mental health. However, if unhappiness persists despite your best efforts, it can contribute to mental health problems. Also, if you are unhappy even when conditions are good and stress levels are normal, this may be a sign of mental health problems.

Myth: People with mental health problems just lack smarts.

Being smart does not guarantee good mental health, though a lot of evidence does show that having more experience and education can reduce the amount and severity of mental health problems that occur in people’s lives. Most people with little or no education have very good mental health, and some very intelligent people have lots of mental health issues. What people with mental health problems really lack a lot of the time are things like an accurate and comprehensive diagnosis, a clear understanding of what that means and why it is happening, an achievable, research-based treatment plan, and access to qualified professional help. Without most or all these things, all the smarts in the world will be of little benefit.

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What is mental health? Wed, 20 Sep 2017 14:52:01 +0000 There is a lot more conversation happening about mental health, but most people are still a bit baffled when asked to define just what it means. Generally speaking, mental health refers to a person’s emotional, psychological and social well-being. Unlike most other aspects of bodily health that involve our limbs and organs, it involves the […]

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There is a lot more conversation happening about mental health, but most people are still a bit baffled when asked to define just what it means. Generally speaking, mental health refers to a person’s emotional, psychological and social well-being. Unlike most other aspects of bodily health that involve our limbs and organs, it involves the mind, whose main job is to help us think, feel, and carry out behaviors.

As with other aspects of your health, mental health can be influenced by attributes and features that are passed down in your family. It is also influenced by the resources available to you, such as those offered by education and wealth. It depends a lot on what you learn from your experience doing things and relating to other people. Good mental health usually requires understanding and knowledge about yourself and your abilities and limitations, not to mention insight into how the mind works. In addition to looking at how effectively you think, or how good you feel, it is measured by real-life functioning, such as how you cope with stress, work effectively and productively, relate and get along with other people.

What is Mental Illness?

While we all want to have good mental health, sometimes we fall short of this goal. Mental illness is a term that is often used to refer to conditions or disorders that go with unhealthy thinking, feeling, and behavior. This reflects the fact that mental illness is revealed by symptoms that undermine our ability to think effectively, that cause emotional suffering, or result in problems in our relationships. Often, the same symptoms tend to cluster together and are relatively common. This has given rise to diagnostic systems that name and describe disorders such as depression, anxiety, or schizophrenia.

Why label disorders at all?

A diagnosis is a group of symptoms that tend to occur together. Many systems have been developed to give these clusters a name. This is practical – it allows people to have conversations about shared experiences that give us difficulty, making it more convenient to look for possible causes, and helps us test out solutions, treatments, or fixes. If we didn’t have a common way of describing mental health problems or disorders, there would be no way to scientifically explore potential causes and cures. However, there is more than one way to label psychological problems. Here is a summary of three of the most prominent approaches:

DSM5 & ICD10

DSM stands for Diagnostic and Statistical Manual for Mental Disorders and has been referred to as the bible for listing and defining types of mental illness in North America. ICD10 is the 10th version of the International Classification for Diseases, and though it is very similar to DSM5, the categories and rules often differ. Both manuals tend to assume a disease model of mental illness, meaning that it is seen as caused by structural or biological changes in the brain. Myndplan Guides help you compare your results to DSM5 categories and points out some important differences from ICD10.


RDoC stands for Research Domain Criteria and is the system used by most researchers in North America. It was developed by the National Institute of Health to address problems with DSM5 – mainly that DSM5 tends to clump lots of symptoms into often arbitrary collections that are hard to objectively measure. RDoC breaks problems down into broad domains of interest. Within each domain are constructs, and these, in turn, contain very specific elements. The system taken together as a whole is called the Research Domain Matrix. The Myndscan is broken down into RDoC categories, which helps us relate your scores to most of the current research on mental illness, its causes, and its treatments. For this reason, we sometimes refer to the Myndscan as a Matrix Personality Inventory.

Transdiagnostic Models

Recent work such as David Barlow’s research into anxiety disorders suggests that many diagnostic categories are overly specific, and most problems fall into only a few very broad categories. For example, DSM5 diagnoses like panic, social phobia, and generalized anxiety appear to share a common set of symptoms and respond to many of the same treatments. Barlow suggests that transdiagnostic categories can be treated using a Unified Protocol – a common set of science-based methods that work for most people. Consistent with this idea, the Myndscan includes factor scores, which offer five broad groups of symptoms that describe most of the common problems people encounter.

Which approach is the best?

Most professionals tend to prefer using just one of these models. Psychiatrists and psychologists are often attracted to DSM5 and ICD10 because these sort of diagnoses are required by their work, and payment often hinges on using the appropriate “code”. Researchers prefer RDoC because the primary agency that grants funding require a matrix approach. Lots of other therapists like transdiagnostic approaches because they seem to reflect the reality on the street – that there is a lot of overlap among mental health problems and effective treatments work for a lot of apparently different problems. When it comes to consumers – the people who are treated by professionals or studied by researchers – the truth is that most haven’t heard of any of these approaches. What they need most is help understanding how to translate how each of these systems applies to their own experience. Only then can they decide which is the most helpful in explaining things.

What sort of things cause mental health problems?


Family history has been found to exert a strong influence on the expression of many mental health disorders through genes that are passed on from one generation to the next. Genes influence your brain chemistry and brain connectivity – the way your brain develops networks among its parts to help you think, feel and cope.

Life Experience

Positive experiences like having a safe, nurturing upbringing or a supportive social network can promote better mental health. Negative things like family violence, neglect, chronic stress or trauma can contribute to more symptoms of mental illness. Your life experiences mold who you are as a person, can turn on or shut down genes that influence how you cope, and alter the way your brain’s -networks determine how you think, feel and behave.

Individual Differences

Your unique psychological makeup can exert a strong influence on your mental health. Each person will develop preferences and traits that are distinct. Different people may rely on different coping methods, hold different assumptions about how much control they have over their lives, or have different values. People even differ to the extent that they are aware they have a problem! Your ability to think requires you to make assumptions about how life works and apply these assumptions to everything you do. If your assumptions are inaccurate or don’t mesh with those of society, you can end up with lots of unpleasant symptoms.

Which one is it?

People often behave as though only one of these three explanations accounts for most mental health problems. However, the fact of the matter is that biology, life experience, individual differences and a host of other things usually combine in determining how we think, feel and behave.

The future?

More recently, the field of neuroscience has helped bridge the gap between different causal explanations, since how the many different parts of your brain communicate within and between each other reflects some fundamental biological workings, is modified by life experience in very predictable ways, and can account for most individual differences. When used poorly, neuroscience-based explanations just confuse and befuddle people. But when it is used properly, neuroscience can make sense out of just about anything in the human experience. For this reason, Myndplan strives to translate neuroscience into plain language to help you understand your symptoms. As the saying goes, a picture is worth a thousand words. When people are shown some of the typical pathways that help explain what is happening in their personal experience, what needs to change, and how to make that change take place, understanding often follows. This sort of insight is often the key to making real change.

Learn about some of the common myths about mental health

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Getting facts right Tue, 19 Sep 2017 12:07:00 +0000 One of our goals with Myndplan is to support people’s effort to sift out the good stuff when they are trying to learn about psychological problems, their causes, and how to get effective treatment. At the same time we want to provide therapists with reliable information on how they can understand and help their clients. […]

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One of our goals with Myndplan is to support people’s effort to sift out the good stuff when they are trying to learn about psychological problems, their causes, and how to get effective treatment. At the same time we want to provide therapists with reliable information on how they can understand and help their clients. Like most people, I rely on the internet to get my facts, and the process of trying to find them has been informative. While it is very easy to get information about anything on the internet, it is not nearly as simple to find reliable guidance based on sound facts.

I’m lucky to have trained at a tech-savvy university. I also got to spend my career honing my research skills in the real world as the internet grew from a text only resource used almost exclusively by researchers to the enormous information portal that it has become today. Unfortunately, the rapid growth of the internet has meant that there is far more unreliable information than ever and makes it extremely challenging to separate the good from the bad, or in media terms, the fake from the real. Still, it is not as difficult as it may seem to cut to the chase and get at the good material if you know a few tricks. Here are a few things that I’ve learned that you might find helpful in your own searches:

1. Create an effective string of search terms

The first mistake most people make when starting to search for information is in their choice of keywords. These are the words you type into the search window when you get started, and everything else that happens will depend on which words you choose. Much of what you get back will hinge on how many and what type of words you use.

The whole is greater than the sum of its parts: Don’t just use a single word, particularly if it is the common label for a problem. While it may seem obvious to just type in the word “depression” if you are feeling blue to see what happens, the result will be very predictable – you’ll get a thousand pages of links, including a bunch of ads for things that probably won’t be too helpful. Creating a string of words that summarizes your query, such as “depression, treatment, effective” will narrow things down a bit. However, using strings of terms alone is not enough to get those pesky ads from the top of your page.

What you say is what you get: If possible, use clinical terminology rather than common terms or slang. Using depression as our example, typing in “major depressive disorder, treatment, effective” will get you very different results than when you use the simple term depression. For example, the words “scholarly articles” will appear, as well as more public and professional information sites and fewer ads.

Hint: Including the current or a recent year will limit your search to more up to date results. In psychology and psychiatry research things change quickly, so be sure you are looking at findings based on current, not outdated research.

Adding terms like scholarly, research, or study will help narrow things further to actual empirical research studies and the likes. But we’re not done yet. For most questions or problems, hundreds or even thousands of studies will have been conducted and published on the topic. To get at the good stuff, you’ll need to take some additional steps.

2. Read the Ingredients

Not all studies were created equally, but you don’t have to have a Ph.D. to spot the best research. To find the reliable papers you’ll need to understand a few key ingredients that go into a good research study, and also how you can use research about research to help your search.

Five terms you need to understand

Any good study should include a few important pieces. These include randomly sampling the population of interest, providing a placebo or other control group, and blinding the people involved in the study. You also want to know the actual size of the effect, and what the sources of bias were. If you understand what these terms mean it will help tremendously. Let’s take a quick look at each of them:

Random Sampling: Anything in mental health that’s worth reading will involve people. Who gets chosen to participate in a study matters as much as what they actually do. When researchers pick participants, it is important that this be as random as possible. Otherwise, it becomes more likely that the results can only be applied to a select group of people.

Control Group: No good study just looks at what happens when people are exposed to the experimental condition, whether this is some sort of exercise, drug, or therapy. To show real effects, it is necessary to include a group of people that don’t get the intervention – commonly called a control group. Otherwise, it is impossible to say whether the intervention caused the change or some other uncontrolled thing that wasn’t measured. Better yet, the best studies include placebo and/or sham control groups. An example of a placebo intervention is a pill that contains everything but the active ingredient. An example of a sham placebo is a pill that doesn’t contain the key active ingredient, but may have side effects from another active ingredient that are shared with the medication being studied, like dizziness or a metallic taste.

Blinding: The old saying in wartime was that loose lips sink ships. In research this saying also applies. The less the study participants know about what the expectations of the study are, the less likely they are to be influenced by these expectations. This goes for the researchers too. Good studies take pains to create double-blind conditions, where neither the people running the study nor the participants know what arm of the study they are in.

Effect Size: While you may find it surprising, just about anything can be shown to have a significant effect if you set up a study carefully. One simple rule of thumb is that the larger the group of people you look at, the more likely it is that you will find something that is statistically significant. In many cases, an effect can be highly significant from a statistical point of view, but almost meaningless from a clinical perspective. To help clarify the usefulness of findings, good studies will include something called the effect size. This is a value that estimates how strong the observed effect is, not just whether it exists.

Bias: Randomizing samples, blinding participants, and including placebo control groups are all ways of reducing bias in experimental results. These methods try to remove the effects of both the experimenters’ and the participants’ expectations so that the results reflect only the actual effects of the intervention itself. But there is another important source of bias that is frequently overlooked in science – the sort of bias that arises when researchers are in a conflict of interest. The most common example of a conflict of interest is when a researcher who is paid or supported by grants from a drug company studies the effect of one of the company’s new drugs. Bias can also occur when a scientist is testing out their own theory, rather than critically evaluating someone else’s ideas. Essentially, any time a researcher has a personal stake in the study, this introduces bias.

Hint: Typing in review or meta (short for meta-analysis) will limit your search to articles that summarize the existing research that has been done on the topic you are interested in. So if you type in major depressive disorder, treatment, effective and review or meta, you’ll get a list of articles that include mostly summaries of what all those individual studies on the topic have been showing. A fantastic source of information that scientists use for this purpose is the Cochrane Library . This is a priceless resource that more recently has built in tools to help people with little or no scientific experience to search and understand the extensive collection of information. The nice thing about Cochrane studies is that they go to great pains to evaluate the quality of research studies, including looking very closely at possible sources of bias.

3. Get the whole thing for free

If you have been trying to follow even a few of the above suggestions, you’ll probably have stumbled into a paywall. Every published research article contains an abstract – a short paragraph summarizing the purpose, method, and findings of the study. In virtually all cases, you can get abstracts without having to shell out any cash. However, when you try to look at the full text article, you’ll often encounter a paywall. To get at the content you’ll be asked to fork out an exorbitant fee. Thankfully, there are a couple of tricks that can help you get that good content for free:

Say the magic word: You can often get a free copy by typing in the name of the article you’ve found in your search bar, followed by the letters pdf. Almost every article will be available in pdf format, but pdf copies may be hidden in places like a researcher’s academic site in their biographic information, or in a post that they put up for students.

Search an open access journal: More and more journals are adopting an open access policy, which means they provide pdf downloads for free. This movement reflects a growing concern that research can only benefit society if we remove the barriers to accessing the results. Here are a few examples of how to tap into the open access world of research articles:


CORE stands for COnnecting REpositories, and is a massive search engine for finding open access articles put together in Britain. It is specifically designed to serve the general public and not just researchers. CORE is easy to use and includes some powerful filters to help narrow your search.


PLOS has quickly become one of the most popular and respected open access journals. Journals like PLOS have disrupted the traditional publication market by charging researchers for posting their work, instead of charging readers for accessing it.


The Directory Of Open Access Journals is based in Sweden and contains close to 10,000 open access journals. Like CORE it allows you to use a variety of filters in addition to your keywords.

As a final note, always remember that research articles will never be under headings that start with the google ad banner, nor will they be under a .com website, nor will they be in a newspaper or magazine.

So there you have it – with these tips you are more likely not just to find lots of relevant research on the topic that interests you, but also spot the good stuff and get a copy for free. Have a fun search!

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Eight Ways to Prevent Suicide Sun, 10 Sep 2017 22:56:48 +0000 One of the hardest things about being a therapist is knowing that someday one of your clients might act on the urge to kill themselves, yet being unable to accurately predict who and when it will strike. Roughly one in 10,000 people will die of suicide each year. Many more will try to kill themselves […]

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One of the hardest things about being a therapist is knowing that someday one of your clients might act on the urge to kill themselves, yet being unable to accurately predict who and when it will strike. Roughly one in 10,000 people will die of suicide each year. Many more will try to kill themselves and survive, and even more will contemplate the act. A lot of the factors that are known to increase the risk of suicide are also the sort of things that prompt people to see a therapist. So with each passing day, despite the best of intentions and every effort to practice vigilance and effective helping skills, the odds of something bad happening increase.
Despite over 50 years of intensive research no features have been identified that significantly improve our odds of accurately spotting who will attempt to die or succeed in the effort ”1”. We know of countless features in a person’s life that slightly increase the accuracy of predictions, but the change is on the level of buying two lottery tickets instead of one. To put it in practical terms, even with the best tools, the odds of correctly identifying someone who is going to kill themselves are impossibly small, whereas the odds of incorrectly identifying someone as mortally in danger from self harm are impossibly large ”2”.
I am telling you this to emphasize a very important point relevant to anyone who is motivated to help others: if all we did was try and predict suicide, therapists (and anyone else for that matter) would be next to useless, but when it comes to prevention, really significant changes become possible. In the case of suicide, it turns out that there are a lot of actions that can be done to prevent bad outcomes and insure that people have a chance to work out their problems ”3”. Recently, the World Health Organization released a groundbreaking public policy paper outlining many of the issues and their solutions ”4”.
Overall, the WHO report breaks suicide prevention strategies into two broad categories. The first involves changes that society on the whole can implement to make suicide more difficult to carry out. The second type of intervention involves health care interventions that can help reduce or eliminate the kind of thoughts and feelings that lead to suicide attempts. Here is a list of just a handful of the prevention strategies that the report describes:

1: Smaller Is better

One of the more common ways that people kill themselves is by taking an overdose of medication. Often, this happens when someone is in distress and turns to their medicine cabinet. Most people keep bottles of common pain remedies like tylenol or aspirin handy, and in most cases these bottles contain lethal amounts of the drug. Trying to guess who might employ this method is not an effective prevention strategy. However, doing something as simple as reducing the quantity of pills available in each bottle can work wonders. In England, legislation was introduced that did just that, and this simple change has been linked to a 50% reduction in poisoning death cases from such over the counter medications and a 60% reduction in transplants due to overdose liver damage.

2: Bridges, buildings & railroads

Jumping is a common method of suicide, whether it be from a high building, bridge, or in front of a train. Jumping sites are often easily accessible and the potential for acting impulsively is high. In many cases, places become known for their potential as jumping spots, yet year after year nothing happens save a gradually increasing death toll. Despite this, there are many simple structural changes such as gates, fences, and barriers that can restrict access to high risk areas. These have been shown to dramatically reduce deaths. For example, in Toronto the Bloor Street Viaduct became a renowned jumping spot. When a competition culminated in the installation of a dramatic – and beautiful – physical barrier the death rate dropped from close to 10 people each year to zero.

3: Make guns harder to access

There is a well established correspondence between the number of households owning guns and their use in suicides. While it is not reasonable to take everyone’s guns away, many simple measures related to the control of lethal weapons can help reduce suicide rates. For example, when the Brady Handgun Violence Prevention Act was put in place in 1994, people in many US states were required to observe a waiting period and undergo a background check before they could complete a handgun purchase. There was a corresponding 10% decline in suicides for people 55 and older. More stringent legislation restricting ownership has been put in place in several countries, with a corresponding reduction in firearm suicides.

4: Introduce guidelines for responsible media reporting

The media is important in society for providing people with information. Most of us rely on one or more news services or newsfeeds in order to keep up with events, whether they are in our immediate neighborhood or the world at large. However, just as the media can be helpful in providing information, the way the information is provided can influence our behavior. In the case of news about suicides, information is often presented using extensive and graphic stories because this catches and holds our attention. Unfortunately, the way media present news about suicides can also influence suicide rates.

A good example of this took place when Vienna opened its first subway line in 1978. Within a short time the news was awash with dramatic accounts of people throwing themselves in the path of trains, and this very coverage seemed to correspond with a rise in occurrences. When guidelines were introduced encouraging more responsible media reporting, suicide attempts in the Vienna subway dropped by 87%. This gets at what the media intellectual Marshall Mcluhan meant when he stated that “the medium is the message”. Applied to tales of suicide, sometimes what is most important is not the content of the news, but how it is presented.

5: Remove barriers to health care

When a behavior is difficult to predict, the odds of someone getting the help they need are diminished. Add to this the stigma associated with having suicidal thoughts, and you end up with a lot of people going it alone at a time when they really could benefit from a helping hand. Given what we know about the effectiveness of treatment in preventing suicide, this suggests that anything we can do to make healthcare more accessible to people should drive down the rates of suicide. In fact, this is the case. The availability of services like 24 hour crisis support lines show a strong correspondence with reductions in suicide attempts and suicide deaths. Training doctors to recognize and treat risk factors is another way of reducing barriers to effective care. In one telling example, the US air force initiated a program among its members geared to increasing help seeking behaviors, improving the availability of support and ensuring the delivery of effective treatment. The result? Not only were suicide rates cut by two-thirds, homicide rates and reports of family violence dropped by 50%.

6: Provide medic alerts for the elderly

Suicide rates tend to diminish with increasing age, but then rates climb again once people get beyond retirement. The elderly face many challenges that increase stress, physical discomfort, and mental health issues. All of these things increase suicide risk, yet trying to undo the effects of age is not going to be a winning method for preventing self harm. However, a recent study looking at attempts to improve access to emergency services by the elderly had some unexpected effects. The study, which provided medic alert devices to people living on their own so that they could easily access medical services in a crisis, resulted not only in improvements in overall health care, but cut the rate of suicides in the elderly participants by over 60%.

7: Use CBT or DBT Treatment for high risk clients

It’s not enough to simply insure that everyone has access to a health professional. When people present to their doctor, therapist, or other counselor with suicidal thoughts, it is important that they receive the proper treatment. Just as there are many factors that contribute to risk but offer little accuracy in predicting outcomes, there are countless therapies that are known to help people in general, but do little to reduce the incidence of suicide. One exception is cognitive behavioral therapy and similar techniques making up dialectical behavior therapy. These treatment methods teach people how to monitor their thinking, identify problem thoughts, learn skills to modify those thoughts, and reduce problem behaviors and feelings. Using CBT or DBT in suicide prevention with high risk groups cuts reattempt rates by 50%.

8: Use lithium to treat bipolar mood disorder

Along with many other things, mental illness is a potent risk factor for suicide. Among the types of mental illness known to put people at risk, bipolar mood disorder stands out as a particularly dangerous condition. This is because when bipolar disorder goes untreated, it can cause immense stress and suffering. Episodes of mania can result in impulsive behaviors that are self destructive if not outright lethal, and the suffering that goes with corresponding bouts of profound depression can be equally deadly. Unlike most other types of mental illness, cognitive behavioral therapies are not of much use to someone constantly cycling between profound mania and deep depression. However, when bipolar disorder is treated with lithium, a simple salt that is the gold standard for effective care, suicide rates drop by as much as 80%.

We can do better

Research suggests that when a person decides to kill themselves it is often a spur of the moment decision influenced by a complex web of factors 5. The sort of things that help prevent suicides from happening require relatively simple interventions, but involve a lot of planning and preparation. Communities need to be as safe as possible, and helping professionals need to be accessible and properly trained. Prevention strategies need public support and funding in order to be properly implemented. Making sure that society as a whole is taking the right steps to keep people safe and offer the most effective interventions needs to be a public health priority. That’s the sort of change we all should encourage. So don’t limit your interest in this topic to suicide prevention week, or those brief moments when a tragic death hits the news or impacts you personally. Be sure to do whatever you can to educate people you know about the issues and support prevention initiatives that can benefit everyone, every day.

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What lies beyond severe? Tue, 30 May 2017 20:57:10 +0000 The Myndplan prototype project is well underway. So far we have the Scans working seamlessly and are preparing to launch our innovative symptom monitoring component of the app. In addition to this systematic roll-out of features, we’ve been busy responding to requests from clients and clinicians using the app. Some of this feedback has concerned […]

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The Myndplan prototype project is well underway. So far we have the Scans working seamlessly and are preparing to launch our innovative symptom monitoring component of the app. In addition to this systematic roll-out of features, we’ve been busy responding to requests from clients and clinicians using the app. Some of this feedback has concerned the usual bugs and fixes that new software always requires. But in other cases the questions and suggestions we get revolve around new features that we may already be working on, but haven’t launched.  Recently we have completed preliminary work on an example of this sort of challenge, which relates to profiles with a pattern that includes an unusually high number of elevated scale scores.

The Symptom Checklist &  the “Ceiling Profile”

To understand the feature I’m about to describe, it will help to review some of the history of our scan development process. For many years as part of clinicians’ usual assessment and intake process, we provided clients with a well-known measure of acute distress, the Symptom Checklist-90-Revised 1, along with the Myndplan scans. Because the scans were under development, we needed additional tools like the SCL-90-R to help ensure that everything was working as intended. This meant that each time a clinician looked at scan scores for a client, they also had a Symptom Checklist profile for comparison. This kind of validity check is pretty common when questionnaires are being built, and was a critical part of the scan development.

Over the years, clinicians began to notice one particular pattern with the SCL-90-R that we knew was important, but could not decipher much further. It involved exceptionally high scores on all but a few of the scales making up the score profile, which for the SCL-90-R was charted on a single piece of paper in the form of a line graph connecting the various scale scores across the page. The shape of a typical SCL-90-R profile was of a jagged line, with a variety of peaks and troughs representing high and low scores. However, in some cases, scores would line up to form a distinctively flat line across the upper margin of the page – the ceiling of the profile form. At this level of distress no single score can be distinguished from another.

What did the SCL-90-R manual say about this “ceiling profile”? Only that the presence of extreme scores on several scales indicated a client’s overall level of psychological distress, or the extent to which they were “augmenting” their scores. The SCL-90-R manual describes the latter as either “dramatizing” or “faking bad”.

Many clinicians using the SCL-90-R had noticed that there seemed to be more than this going on with profiles that displayed a distinct “ceiling”. Furthermore, they were not seeing such a clear pattern on the profile of Myndplan scan scores. While it was true that the clients with these ceiling profiles on the SCL-90-R were frequently in some sort of crisis, there were often other features that suggested the solution was more complex, such as vague but disabling somatic complaints, overuse of opioid medications, and issues with employment.

Beyond the Ceiling

Recently, I brought this problem to Dr. Rod Martin, Myndplan’s research director and a crucial advisor on the prototype project. Dr. Martin has a career of academic teaching and research in clinical psychology under his belt, and along with all the accolades, articles, and books, he has accumulated a treasure trove of knowledge when it comes to data analysis. He was intrigued, and suggested that we have a closer look. First, he developed a small program to extract all the ceiling profiles we could find in our database. We then identified the strongest examples, and created a simple rule set that defined them.

In the next step, we performed some analytics using the Myndplan results for the clients who had classic versions of the SCL-90-R ceiling profile. It took a while to follow this process to its conclusion, but in the end we were able to confirm a solution using the Scans that predicts the “ceiling” effect with surprising accuracy. This means that we can use the scans to predict which clients will obtain a ceiling profile, without them having to actually complete the SCL-90-R. More importantly, the solution tells us a lot more about this group of people than the SCL-90-R ever did.

Into the Abyss

This is where our discussion gets to the crux of what a psychologist like myself – or any therapist for that matter – desires most from a good assessment tool: accurate predictions that help identify more clearly not just who the client is, but what some of their major issues might be, and how they will influence the therapeutic relationship and its goals over the course of therapy. In the case of the present investigation, we have discovered that some very important characteristics are associated with many ceiling effect clients:

  1. Co-morbid Problems
    In terms of the scales making up the various scans, several are involved, including suspicion, intrusive thoughts, drug use, depression, and what we call Factor I. Factor I is a combination of scales that describe people who are preoccupied with their health, struggling with their sleep, and extremely fatigued. It is frequently associated with chronic pain disorders and depression. We have tentatively labelled it “Somatic”, given that it contains symptoms that people with a lot of medical problems often complain about.

  2. No Work
    A close look at the problems that “ceiling profile” clients experience helps to fill out the picture. Most have symptoms that interfere with their ability to function – so much so that their job is at stake, if they are even able to work. The rest don’t have any work, and are desperate to secure some means of keeping food on the table and a roof over their head.
  3. Addictions are Common
    Two thirds have a history of drug problems, or current issues with drug use, most notably prescription opioids, but also benzodiazepines and alcohol.
  4. Soma, Soma, Soma
     Sixty percent would meet the criteria for somatic symptom disorder or illness anxiety disorder in the new DSM5, or the older somatization disorder that continues to exist in ICD10. This is a group of people with a long history of medical complaints, many of which have proven frustrating to treat. The distress caused by these problems has often been severe in comparison to other clients with the same symptoms and has resulted in frequent admissions to the local emergency department and visits to the doctor.
  5. Secondary Gain
    Close to 25% are probably malingering, though it is not difficult to understand why. For example, most do not have jobs and rely on very meagre disability benefit payments of one sort or another to survive. This segment of the group are desperately in need of money to survive and deathly fearful that their benefits will be cut off or reduced if they don’t take some sort of action.
  6. Lots of Legal Problems
    Another 20% are in trouble with the law, usually around domestic violence that erupted amongst all the stress.
  7. Elevated Suicide Risk
    Suicide is a prominent risk for more than 10% of this group, and the odds of someone actually dying are 150x greater than would be expected with non-clients. In other words, whether the distress is real or imagined, the consequences for people caught under circumstances that promote this pattern of responding can be dire, if not deadly. Essentially, this is a pattern that seems to signal a personality type that gets into frequent difficulties that have very real, negative consequences.


As a clinician, this is not a hard group to recognize. To say that it is made up of people who are struggling and in crisis is an understatement of epic proportions. For the most part, they present with an exceptionally difficult set of problems to work with. They experience frequent setbacks and their prognosis for recovery is exceptionally poor. For a sizeable minority, poverty is a significant barrier to progress in treatment. So is drug abuse. Unless these problems are addressed their symptoms will not improve. Personal crises and somatic complaints often dominate sessions and derail efforts to apply more helpful and effective treatment methods.

These are all things that a clinician wants to know before starting counselling. They suggest many issues that need to be explored early in therapy as the treatment relationship is established. They confirm that the client is feeling desperate, and as with all of us, desperate times often call for desperate measures. This is a problem set that genuinely puts a person at risk of harm, and may put others at risk too. After all, when someone is in crisis they are more likely to make bad decisions, and bad decisions often affect everyone.

In the end, we’ve identified some important characteristics that often go with a common pattern in extreme scores that may be helpful for both clinicians and clients to know. This provides a tool that flags a very specific set of problems indicating that a client may be stuck “between a rock and a hard place”. This often involves the kind of challenges that blur the line between psychology and sociology, or more precisely psychiatric illness and the desperation that goes with disadvantage and crisis. It turns out this is not so much a ceiling of distress as it is a sign of how circumstances have taken a person to “rock bottom”, and reflects a facet of some people’s desperate circumstances that cannot be labeled or fit neatly into a single diagnosis. Just the sort of situation any clinician wants to know before they embark on a course of therapy with a client, as it can have a huge impact on the options for change.

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Booking appointments Mon, 08 May 2017 00:32:31 +0000 We know that people with mental health issues can benefit from psychotherapy when the content of sessions draws from empirical research. However, recent evidence suggests that how frequently therapists and clients meet, and how long their sessions last may be just as important to outcomes as what happens during these encounters. New findings cast doubt […]

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We know that people with mental health issues can benefit from psychotherapy when the content of sessions draws from empirical research. However, recent evidence suggests that how frequently therapists and clients meet, and how long their sessions last may be just as important to outcomes as what happens during these encounters.

New findings cast doubt on long held traditions about session frequency and duration, and suggest that not all clients are the same when it comes to what works – and what doesn’t. It may be a good idea to consider new ways that therapy can be delivered not just because it can save money, but because it can be more effective.

Like most therapists across North America, I struggle with the fact that there is simply not enough time in the day to fit in all the sessions with clients that are required. No matter how I adjust my schedule, and despite repeated efforts with my colleagues to streamline our intake process and adhere to proven methods, we just can’t seem to get our wait lists down to reasonable levels. Early in my career, this was not a problem, since I was concerned with filling my schedule, not opening it up. But most good private practitioners and just about anyone in the public service will eventually reach a point where demand exceeds supply. Instead of talking about the methods we are using to treat people, team meetings gradually get consumed by concerns about how to deal with urgent referrals, how to fit more sessions into each week of work, what to do about pressure from benefit providers and employers to have us offer cost-effective solutions, and how to decide when treatment gains are good enough.

Part of the problem stems from some long held assumptions that therapists don’t even think about. For example, most of us adhere to the “50 minute hour” model that offers clients a solid chunk of time to talk about important issues and leaves several minutes for the therapist to document what occurred before the next session begins. Ideally, these sessions are held at regular intervals. A weekly or twice monthly frequency is most common. For clients who can afford the luxury, or perhaps in the event of a crisis, twice weekly sessions are not uncommon. At the other end of the spectrum, when therapists are busy and schedules get blocked in, the frequency of sessions can slow to once every three or four weeks, and sometimes even longer. Behind all of this lie a key set of beliefs that can be summarized as follows: In an ideal world, most therapists would have an hour for every session, meet with each client every week or two, and continue with sessions for as long as it took to get symptoms down to “normal” levels.

During my career as a consulting psychologist, I’ve worked in several different settings. These have included a busy private practice, several probation and parole offices, and a number of family health teams. I have also been active in a networking group where we take turns presenting on a variety of mental health topics. Not long ago I got into a discussion with some colleagues about how we all tended to follow the assumptions about session frequency and duration that I’ve mentioned above. Everyone seemed to be struggling with lengthy wait lists, busy schedules, and a growing sense that we needed to look more closely at our methods. Was it possible that the data in our client records might clarify what was going on?

To answer this question, we performed a quality assurance review of close to 120 treatment records divided among three clinicians. The available data included the mental health diagnosis, whether the client was taking any medication, how frequently they were being seen, and how long treatment lasted. Along with this information, we looked at session-by-session records of symptom severity for a total of over 800 treatment encounters.

Not Your Typical Drug Study

The results of this quality review proved to be surprising. For example, unlike the type of client in research studies that typically suffer from just one discrete problem, such as major depressive disorder, nearly all of the clients described a mixture of both anxiety and depression, and many had additional diagnoses, like opiate addiction or alcohol dependence. We also discovered that most were already taking some form of antidepressant medication to treat their symptoms when they were referred. This meant that the therapists were seeing clients with more complex issues than those who populate most treatment research studies, not to mention that they were trying to treat people who were probably not getting an ideal response from medication. In other words, the problems facing the typical client they see, and that probably thousands of other therapists work with across the nation, are much more complex than the ones that research studies base their findings on when looking at things like treatment effectiveness.

Initial Symptom Level Matters

Based on this quality review we were pleased to learn that despite how serious their problems were, on the whole, most of the clients were improving significantly with respect to their life satisfaction and key symptoms of depression and anxiety. Even when we controlled for the passage of time, which in itself can bring about healing, therapy proved to be having some beneficial effects. However, there were a number of surprises. For example, we discovered that the initial symptom levels that clients described at the start of therapy were very relevant to outcomes. People who started therapy with more severe symptoms and lower ratings of life satisfaction in comparison to other clients tended to end treatment with lower life satisfaction and higher symptom distress. But they also showed the same degree of improvement. In other words, people who start off worse finish worse, but improve just as much.

Different People Show Different Rates of Change

We also learned that regardless of how severe a person’s symptoms were at the start of therapy, different people experienced different rates of change. Some of the clients improved quite dramatically from one session to the next, whereas others seemed to improve more slowly. Furthermore, just as preliminary studies looking at the Myndplan assessment inventories had revealed, some very specific client characteristics predicted this rate of change. When taken together with our finding of symptom severity, this means that with the right tools it should be possible to identify not only how quickly a client is likely to respond to therapy, but also how many sessions they will require in order to achieve the same relative improvement.

Some Clients are More Variable Than Others

When we looked at clients’ mood monitor scores more closely, we also found some interesting things. Most importantly, while many clients demonstrated slower or faster rates of improvement over time, a subset of people showed unusual variability in their scores across sessions. It seems that some people are far more changeable with respect to their day-to-day mood states, perhaps because they are in more stressful or more desperate circumstances, or perhaps because they are more sensitive to the effects of everyday stress than the average person. Regardless, it seems that more of this variability, particularly in the case of anxiety, corresponds to both the severity of symptoms at the outset of treatment and the rate of response over time. It seems likely that this type of client will be far more likely to do better with more frequent sessions than if they are left with large blocks of time between sessions.

Fewer is Better

A final insight proved remarkably counter-intuitive. This involved the results when we looked more closely at the number of sessions clients were attending over the course of therapy. Contrary to our expectation that more is better, we were surprised to discover that clients who had more sessions showed less improvement, and in some cases, their condition even deteriorated! While you might be tempted to point out that this was probably a function of more severe symptoms or reflected a slower response to therapy, neither of these explanations seemed to account for the difference. For example, when we looked at first session symptom monitor scores they were unrelated to the duration of therapy. We also found no significant relationship between the passage of time and outcomes. Most of the difference in outcomes seems to be based on the actual number of sessions. This suggests that grouping fewer therapy sessions close together in time may be just as good, or even better, than more sessions spread out over time.

What Does Current Research Say About This?

These findings are consistent with some of the more recently published research on the topic of session frequency and duration. For example, Erekson et al 1 looked at the relationship between session frequency and psychotherapy outcomes in over 21,000 clients who were treated at university counseling centers and found clinically significant gains were achieved faster for weekly sessions than for twice monthly sessions. Cuijpers et al looked at 70 randomized treatment trials that included data on session frequency and duration and found that neither the total number of sessions nor the number of weeks in therapy had a significant impact on outcomes. Furthermore, the length of sessions was found to have no impact. What did make a difference? It turns out that the only significant effect that emerged in this study was for session frequency 2.

Another study by Storch et al 3 revealed that daily treatment sessions for 14 days were as effective as weekly treatment sessions for 14 weeks, with no difference observed on follow-up. These findings and the results of our own quality assurance work are consistent with Bohni et al’s proposal that exposure is an essential piece of any effective psychotherapy method 4. Whether we are trying to get someone with phobic anxiety or a panic disorder to face a feared situation or object, convince someone with depression to ignore negative thoughts or get out socially, or persuade someone with anger issues to keep calm and carry on, most of our work encourages people to practice behavior change every day that puts them in uncomfortable situations and encourages them to ride it out. As most undergraduates learn in their first introductory psychology course, more frequent exposure is almost always better than the exposure that is spread out over time when a client is trying to change their behavior, learn new behaviors, or maintain treatment gains.

Why is this important?

Psychotherapy is meant to help alleviate the suffering associated with mental health problems by reducing symptom severity, increasing adaptive behaviors, and improving quality of life. In addition to using the right methods, it appears that something as simple as the frequency and duration of treatment sessions can significantly impact these goals. Severity scores at the outset of treatment may be more useful for determining realistic goals than for estimating how long a person will be in therapy. Session length may be less important than most therapists – and clients – would like to believe. The results may seem counterintuitive, but in the end, the best outcomes may come from fewer sessions, shorter sessions, and more frequent sessions. This may defy tradition, but the evidence seems to be mounting that how we deliver treatment, not just what we deliver, may reduce suffering in addition to saving time and money.

Equally important here is the fact that if therapists and clients are not measuring symptom levels or keeping track of progress, it will be more difficult for them to judge how difficult the situation is in the first place, if progress is within normal limits, whether there are any characteristics that suggest a change in tactics is required, and when realistic goals have been achieved. As we start to phase in active symptom monitoring for clients using the Myndplan Beta prototype, we are hoping to address these issues and many more that are relevant to both providers and consumers. Stay tuned!


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The Arrowsmith program Fri, 14 Apr 2017 15:00:09 +0000 The Arrowsmith Program claims to help students with a wide range of learning disabilities. It is offered at schools in North America, Australia, New Zealand, and Asia. The method relies heavily on “cognitive exercises” that it claims have been drawn from neuroscientfic research by its founder, Barbara Arrowsmith Young. In this post, I describe how […]

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The Arrowsmith Program claims to help students with a wide range of learning disabilities. It is offered at schools in North America, Australia, New Zealand, and Asia. The method relies heavily on “cognitive exercises” that it claims have been drawn from neuroscientfic research by its founder, Barbara Arrowsmith Young.

In this post, I describe how Arrowsmith Young’s program can serve as an excellent case study illustrating several remarkably effective techniques for boosting the credibility of a product regardless of its merit.

In the enthusiastic response to my last post about Norman Doidge’s book “The Brain That Heals Itself”, I was asked to join in on the ongoing conversation around Barbara Arrowsmith Young, who has spent the past 30 years promoting a controversial program for treating learning disabilities. Dawn Brown is a Ph.D. psychologist in my network who is very familiar with the world of psycho-educational assessments. She pointed me to the controversy over the Arrowsmith Program’s use of intensive “cognitive exercises” with children and adolescents. Dawn was no doubt alluding to similarities between Arrowsmith Young’s emphasis on neuroplasticity in her program and Doidge’s enthusiasm for methods that “rewire” people’s brains. Like my investigations into the scientific underpinnings of Doidge’s book, my research into the Arrowsmith Program took me in a direction I didn’t expect. In the end, it taught me some important lessons about how to sell a product even if it may have no scientific basis, and why we all need to think very carefully about the implications of methods we use to sell our products and services, no matter how good our intentions.

Lesson 1: Boost your credentials

If you are an expert in your field you can skip this lesson. However, if you are like most people and are trying to hype something that is out of your league, the first thing you will have to fret about is how to massage your personal credentials. First, assuming you have a college diploma or university degree, be sure to describe it. Then write some inspiring stuff about some amazing books written by well-known brainiacs that inspired your great idea or product. The pairing of your basic educational qualifications and these genius level writers will encourage most people to assume you are an expert too.

Barbara Arrowsmith Young’s degrees are in child studies and school psychology.  In her bio, she also refers to being head teacher at the University of Guelph “Lab Preschool”. Most important of all, she makes a big deal about reading a textbook by A.R. Luria, an iconic neuropsychologist, and being inspired by research by “Rosenzweig”. Everything is true. None of it actually claims she’s a bona fide neuro psychologist or researcher. Yet somehow the teacher at a preschool comes off sounding like she’s a world authority on learning disabilities.

Lesson 2: Most of your staff don’t need strong credentials either

Most businesses are trying to save money. If you are providing a service that usually requires professionals who are credentialed, registered with a college, or regulated in some other way, this can get expensive. Sometimes you can simply argue that the professionals are not required to deliver the service because you are providing something different. Uber does this to justify not hiring taxi drivers. Many e-therapy sites do this by referring to their counselors as “coaches”. If you are trying to compete with services that are usually provided by expensive professionals, like teachers, there is yet another way to save money: just include a few in your staff. Then you can boast about the quality of your service, like the Arrowsmith School in Toronto does, by suggesting that “several of our staff are accredited, teachers…”. By the way, the Meriam-Webster dictionary definition of several is “more than two, but not very many”.

Lesson 3: Distract everyone with a good story

In the world of startups, this is known as the founder’s story. It can be part of a good pitch, and in the world of startups, the pitch is everything since early stage companies don’t usually have strong traction, good revenue, or other things that investors want. Most good stories include something about why you personally are closely tied to the product (i.e., the school of hard knocks). In Barbara’s case, she has a riveting tale of her own lifelong struggle to overcome multiple learning disabilities. In fact, she’s published a book titled “The Woman Who Changed Her Brain”. Better yet, her book has an introduction by none other than Norman Doidge, and Barbara’s story is the focus of the second chapter in his own bestseller “The Brain That Changes Itself”. If my child has ADHD the sad fact is that I will value these stories more than a dozen placebo controlled double blind research studies published in leading journals, since they are a lot more readable. Besides, isn’t a book as credible as a journal article?

Lesson 4: Make it sound like rocket science

Another version of this rule is “the best lie is the one that is closest to the truth”. You cannot read anything about the Arrowsmith Program without being inundated by difficult neuropsychological terms. Does this conceal lies? Probably not. Is it the truth and just the truth? It doesn’t really matter since you just have to mention the word neuropsychology and people’s eyes start to glaze over. It immediately conjures up images of lab coats, heavy framed glasses and pocket protectors laden with pens and pencils. Throw in some words like “neuroplasticity”, “connectivity”, and “cognitive exercises” and you’ll ensure that you are talking over everyone’s heads, even if the simple translation is that the brain is changeable, has an awful lot of connections, and can learn new stuff when we practice or rehearse things. Add some graphical images of neurons and they’ll conclude your method is revolutionary. Most important of all, when you use these terms a lot in your sentences, no one but a neuroscientist will be aware that what you are saying is nonsense.

Lesson 5: Pretend that research is in any document that contains charts and numbers.

You haven’t got a stitch of sound research to back up your claims? Don’t despair. Hire some academics to write policy papers, summarize your methods, or tabulate any basic statistics you have on user behavior. Better yet, get someone to present at an academic-sounding event. They probably won’t have the content required to get chosen as a speaker, but conferences will always offer them a poster spot so long as they pay the registration fee. Posters are just that – you get to put a poster on a partition wall in a vast room teeming with other poster presenters that summarize your information, and you spend a couple of hours answering the questions of anyone who feels compassionate enough to stop to have a look.

If you have some extra time in the evenings, you can also write up a case study. This is scientific terminology for a testimonial. Lots of journals publish case studies. Yup, researchers can’t resist the opportunity to plug themselves either, and case studies are rife in the research literature despite the fact that everyone knows they prove absolutely nothing.

How does the Arrowsmith Program perform on this measure? The “Arrowsmith Program Research Study Document” available on their website provides an impressive list of “studies” under headings such as “Independent Research in Progress”, “Completed Peer Reviewed Research”, and “Other Completed Studies”. Take a closer look, and you’ll find 3 poster presentations (there are 4 listed but two are the same poster presented at different events), 1 case study that made up a graduate student’s dissertation, and a handful of reports summarizing data collected on the same students that were presented to various school boards. There is not a single published, peer reviewed study in the entire collection. If I was a teacher, I’d give this a failing grade.

Lesson 6: Ignore negative results

You won’t do well trying to argue a point that you know you will lose. It is far better to avoid the argument entirely. After all, most people want to believe you. So when it comes to evidence that your product doesn’t work, simply pretend it doesn’t exist. Good research studies are expensive to fund, so anyone trying to prove you wrong is going to take it in the pocket. It’s safe to bet they have more important things to do. The only real threat will come from well-intentioned admirers who decide to try and prove your point but fail. The Arrowsmith Program has this problem. The only result you’ll get if you key in “scholarly research Arrowsmith” is this dissertation study by Rhonda Hawkins. She followed a class of students in a private prep school using the Arrowsmith method. Her results? Teachers and students found the process terribly stressful. Most performance indicators did not change significantly over the year. English scores actually declined. The only thing that improved was students’ self-esteem, which one would expect from a course that requires hours of 1:1 support every day 1. While the study easily matches anything cited by Arrowsmith schools in their lists of research as far as rigor, there is no sign of it in any of their literature. What?

Lesson 7: Blame the system

People need an outlet for their frustration. Parents of children with learning disabilities or ADHD are often frustrated and upset. They have to watch their children struggle in the current system, and fail. Year after year they are presented with IEPs that seem to fall flat. It’s a fight all the way and feelings get hurt, despite the fact that everyone’s doing their best. It is tempting to blame the system for a problem that is far deeper in its scope. Feeding mistrust and dislike of the system exploits what psychologists call cognitive dissonance. When we are frustrated and upset, and failing to meet our goals, we have two choices. Blame our selves, or blame the system. Dissonance theory suggests that most people will blame the system in order to reduce their inner discomfort. Barbara plays into this when she describes her master’s thesis work, which demonstrated how children educated using traditional methods seemed to show no real change or improvement after years of hard work in the system. According to Barbara, traditional methods offer only “workarounds” or ways to “compensate” for our weaknesses. The theme that plays constantly in all the information provided by Arrowsmith is that the traditional educational system consistently fails children with learning disabilities. In the startup world, this is called “defining the problem”. Every good pitch begins by giving the audience a heavily skewed account of how an existing product or process is failing everyone to an epic degree. People like it when you arouse their ire over how life can shortchange them, and as every psychologist or psychotherapist knows, anger can be very motivating.

Lesson 8: Be as inclusive as possible

Making slips of the tongue? Messy handwriting? Spelling mistakes? Distractible? Forgetful? Didn’t think through the consequences of your actions? Lose your train of thought? Shy or withdrawn when you meet new people? Trouble reading people’s emotions or body language? Get tongue tied? Struggle with math? Struggle with english?

Whew! Most people who read this list will relate to at least one or two of the items. When the full list includes 19 different deficits that are based on neuropsychological testing, as is the case with the Arrowsmith Method, you are covering most of the major cognitive skills that people possess. This is brilliant! By including something for everyone in your sales pitch, you will encourage people to mistakenly conclude that you are speaking directly to their issue when you are just being inclusive. This is also how many psychics succeed, and what makes a really good horoscope. The funny thing about life is that all the problems you’ve experienced that you’re likely to remember and count as important are pretty common and predictable, even if you don’t know it.

Lesson 9: Make your customers into advocates

As anyone who is a fan of Game of Thrones knows, little sparrows can be very, very powerful and disruptive agents of change. By rewarding your admirers and treating them like disciples, you can inspire them to fight your cause. Need to boost a shout out? Want an obvious sign of traction when your company is negotiating a new contract or sale? Or if you are with Arrowsmith, want someone to heckle the local school board as you try to sell them your curriculum? Advocates will lobby for you, protest for you and write reviews for you. Best of all, they’ll do this and more for free. If you confer a more salubrious title on some of your sales staff, such as “Program Representative”, you can even get your advocates to feed prospects directly into your revenue funnel. Proponents of the Arrowsmith Program do this very effectively by providing a detailed advocacy guide. It gives parents lists of resources including websites, videos, books, and pamphlets. It coaches parents on who to approach and how to present Arrowsmith’s material. Everyone knows that the best advocate for a child is that child’s parents. Just imagine if you could harness that sort of influence for your sales team!

Lesson 10: Don’t control for group differences

I should have put this one back with the other lessons that relate to research methodology, but I wanted to save the best for last. In scientific studies, it is well established that all sorts of subject characteristics can confound even the most carefully engineered experiment. This is not just about controlling for people’s expectations to rule out the influence of positive expectations (the famous “placebo effect). People also differ in predictable ways based on things like cultural background, gender, or age – to name just a few examples. Researchers who overlook these effects do so at their peril.

So how does the Arrowsmith Program perform in this department? It’s easy to find out. Just have a closer look at that “Research Document” I mentioned in Lesson 5 above. A quick scan of the studies they’ve included suggests that the vast majority had no control groups. But it gets better. Of the couple of studies that used comparison students, the largest and most recent one carried out for the Toronto Catholic School Board by William Lancee tells all. To begin with, Lancee used unequal samples, with 30 Arrowsmith students compared to only 10 regular students. Also, the samples weren’t randomized, nor were they matched for age or gender.

To the uninitiated, these may seem like minor issues that are quickly overshadowed by the apparently startling results. Basically, the students in the Arrowsmith Program appeared to vastly outperform those in the regular program on a wide variety of standardized educational tests. Yup, they improved their scores by an average of 30-50%, whereas the comparison students showed no improvement at all. But here is where things get interesting: if you look at the scores of the Arrowsmith Program students in Table 1 (which I have taken from the pdf copy of the paper), you’ll notice that they are lower at the start of the study than those for the regular students (that’s the column under the heading “30 AP Students” in the “Pre” group. In fact, they are significantly lower than the “Pre” scores of the “10 Comparison Students” on every single test. This suggests that we are not just talking about a random lack of correspondence in our comparison groups. Instead, this indicates pretty clearly that the groups were predictably different from the start.


Based on these numbers, it looks like the children in the Arrowsmith Program were as much as 2 grades behind the children in the regular group at the start of the study. On average, Arrowsmith Program Students started at the grade 2-3 level, whereas the Comparison Students started at the 4-5 level. Given that the age range for tests like the WRAT is 5-11 years, this means that the Comparison Students started at the upper limit of the test. In other words, there wasn’t a lot of room for improvement – a common problem in research that is aptly named the ceiling effect. On the other hand, the Arrowhead Program students started closer to the bottom of the age range for the tests, where there was much more room for improvement.

Where’s Alex?

I noted earlier that Barbara Arrowsmith Young claims to have been inspired by the legendary Russian neuropsychologist Alexander Romanovich Luria when she first developed her program. What would Luria think of the result? I suspect he would be rolling in his grave. Luria was not some technician who enjoyed administering learning assessments so much that he wrote a book on the topic. He was a brilliant thinker and theorist who understood that the kinds of tests that neuropsychologists conduct provide very limited signs of what is actually going on in the brain. His real passion went far beyond learning how discrete brain functions operate. Luria wanted to understand how our collective histories, intricate social forces, and diverse cultures exert an influence on – and are influenced by – the “adaptive flexibility” of the brain 2. His theories anticipated the kind of developments in neural network research that are current in today’s deep learning and AI movements. His discoveries in the field of neuropsychology were never meant to be used to justify a reductionist, oversimplified, and just plain inaccurate rendering of the brain as a collection of discrete parts that require focused exercise and practice to “fix” problems.

So there you have it – 10 lessons on how to blur the distinction between facts and fictions, or alternately, 10 ways that any person trying to sell a product or service can lose sight of the truth. In the end, this should remind all of us that science is a method, not a product, and neuroscience is simply one application of this noble pursuit.

When used properly, it promises to help us to understand, improve, and perhaps even heal our amazing brains. When used poorly, it’s just a quick and easy way to sell ideas, regardless of their truth or merit.

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Would you trust this man? Tue, 04 Apr 2017 18:42:04 +0000 Norman Doidge’s book “The Brain’s Way of Healing: Remarkable Discoveries and Recoveries From the Frontiers of Neuroplasticity” is a worldwide bestseller and has been widely praised for providing new hope for people who suffer from a wide variety of neurological ailments, chronic pain, and psychological problems. Unfortunately, it is also a fine example of how […]

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Norman Doidge’s book “The Brain’s Way of Healing: Remarkable Discoveries and Recoveries From the Frontiers of Neuroplasticity” is a worldwide bestseller and has been widely praised for providing new hope for people who suffer from a wide variety of neurological ailments, chronic pain, and psychological problems. Unfortunately, it is also a fine example of how a good writer can use bad science to promote treatments that simply don’t work.

As we have been building the platform for our consumer-centred Myndplan app, I have been immersed in neuroscience research. While this may not be most people’s idea of a fun time, it has actually proven to be a very exciting process that has me constantly learning new things. Recently, I built a comprehensive set of interactive Guides for mental health treatment based on current research and consistent with international clinical practice guidelines. This will be part of an AI treatment planning interface for use by consumers. So I guess you could say I was exactly the wrong guy to read Norman Doidge’s The Brain’s Way of Healing: Remarkable Discoveries and Recoveries From the Frontiers of Neuroplasticity (Whew!).

When I’m not working on Myndplan or seeing my therapy clients, I like to relax with a good book. To be honest, I usually pick a corny science fiction novel for my fun reading. I enjoy hard sci-fi, which is kind of like a literary form of Sudoku puzzle that teases you to try and figure out what is actually happening in the story. The science in hard sci-fi is usually pretty sound. But in the end the process of the story is all fantasy and speculation. As an added bonus for a psychologist like myself, today’s hard sci-fi is often all about the implications of modern neuroscience. But unlike my kind of sci-fi, Doidge’s book sounded like hard science without the fiction. Still, I was willing to give it a try. After all, this was a gift from my wife, who has listened to me talk endlessly of the miracle of neuroplasticity and brain function and thought that perhaps a bestseller on the topic might be suited to my tastes.

Norman Doidge is a psychiatrist and psychoanalyst, researcher, and author. He is on the faculty at the University of Toronto’s Department of Psychiatry, and research faculty at Columbia University’s Centre for Psychoanalysis. I had first read about him in an interview published in the Globe and Mail a while back on the “new neuroscience”. The article was in-depth and interesting. On reading it I was impressed with what it said about Doidge and his writing. Here was someone like me who could see the amazing implications of new research into brain function and its relevance to all sorts of human pathology. Based on my take from the Globe interview and other reviews, pretty well everyone seemed to be impressed. Plus the guy has sold millions of books. I’m a psychologist and a budding writer who hasn’t sold any books. Maybe I could learn about more than just neuroscience by giving it a read.

When I start reading The Brain’s Way of Healing it quickly became apparent that the critics might be correct in their estimation of his storytelling, but for all the wrong reasons. To be fair, Doidge’s book starts off with some interesting facts that I have been researching myself of late, such as how chronic pain can be unlearned, and the benefits of exercise on mental health.

However, before I know it I am being taken out of orbit into the realm of magical cures and snake oil remedies. Wait a second – I had thought this fellow was a psychiatrist!

Please don’t get me wrong. Doidge has some of his facts right. He has done his homework when it comes to the anatomy of the brain, and how the various parts relate to one another. He is pretty good at making the complex physiological and chemical properties understandable to the layperson. He seems to make neuroscience easy to understand. But by the time he has pulled me through chapter three, which introduces the idea of energy therapies and neuroplastic healing, I’m getting really uneasy. His account of the brain seems so clear and concise – yet my impression after combing through thousands of research articles is that on virtually every front there is controversy. Whether it concerns the exact boundaries of an anatomical piece of the brain, its precise function, the chemistry that makes it work, the things that can go wrong, or the treatments that can correct this, no one seems to agree on any but the most obvious things. And why haven’t I stumbled across these treatments that Doidge is praising as I’ve been conducting my own research? My suspicion has been aroused, but I’m still willing to give the guy a chance.

I read on with my enthusiasm fading, and my skepticism grows. I’ve spent years working on treatment guidelines, plowing through review articles and meta-analyses. So I’m primed for all the signs that an intervention is either well supported by research or on weak legs. All of my alarm bells are suddenly sounding at once. I had been suspicious when Doidge relied on a long case study in chapter 2 to illustrate how exercise could be used to cure symptoms of Parkinson’s disease. Wow. I am well aware of the value of exercise, and recent studies are looking very positive regarding its role in slowing the progression of many conditions. At the memory clinic where I work, we make a point of referring anyone with early stage dementia to a local exercise program for this reason. But the research is still pretty fresh, and by no means is exercise a cure for anything, never mind a chronic, deteriorating condition like Parkinson’s.

By the time Doidge starts into his case studies in Chapter 4 to illustrate the amazing benefits of Low Light Laser Stimulation, I’ve gone from doubter to atheist. Once again, he spends a lot of time getting very personal with a few case studies. He also goes out and talks to the people who invented the “LLLS” device, patented it, and have used it on “over a million” cases. I do my homework. A recent meta-analysis of 221 studies using this method for low back pain could only find five that met the criteria required to include them in the analysis. When these five were looked at, there was no significant effect of the treatment on disability or range of motion, though some weak evidence that pain levels improved. Looking at osteoarthritis pain the results are similar. LLLS studies were found to be of low quality, and while they may help with pain, there is no effect on physical function 1.

In yet another study, LLLS actually turns out to be harmful, with shoulder symptoms worse after treatment 2. I found this out in less than 20 minutes. Doidge doesn’t seem to have bothered to even look.

More important perhaps is what is missed entirely in this chapter – all of the studies to date looking at treatment of joint or osteoarthritic conditions show very clearly, using very sound study design, across thousands of individuals, and with large effect sizes, that exercise and weight loss are the best options for both reducing pain and improving mobility and function 3. Doidge seems to have left these solid facts back at the beginning of chapter two and instead is striking out into the no-man’s land of flaky science and gimmicky devices.

It’s like your doctor handing you a pamphlet about the benefits of polio vaccines for kids and then lecturing you for half an hour on how childhood vaccinations cause autism.

Chapters 5 and 6 moves on to something called the Feldenkrais Method, which involves a patented and trademarked technique for teaching a sort of judo-like treatment for stroke victims, kids with cerebral palsy, or just regular people with sore necks or stiff backs. Once again, the case studies are dramatic and the claims of miraculous change are bold. The science is also very effectively made to appear sound. And after all, there are hundreds of centers throughout the world providing this method of therapy, so how could it be wrong? However, when I look into the research literature I find lots of google ads, books and magazine articles, and… hardly any scientific studies. When I do burrow down and uncover a recent review of the research, I learn that the neurophysiological changes claimed by Doidge and Feldenkrais’ adherents don’t hold up. The treatment has some mild positive effects, but largely those you would expect from teaching relaxation methods 4.

This pattern is repeated for chapter 7, which introduces us to a device called the PoNS. The PoNS uses electrical stimulation to prompt all kinds of supposed neurological changes and neuroplastic improvements. Again, a dramatic case study. Again lots of impressive scientific arguments. But no actual science. I hunt through the literature again. Ads. More Ads. Some books on the topic. A website or two. One recent meta-analytical review. I’m curious and read it through from start to finish. I’ll admit I’m a bit intrigued now. The study reports that findings are positive. Then my brain turns back on. The review seems to lack rigor. There is no mention of Cochrane criteria – steps that should be taken to weed out the weak study design, or bias in the authors.

Perhaps that is because the authors of this particular study just happen to be the same fellows that Doidge interviews in his book, who are the same guys with the patent on the device (which they fail to mention in their research article).

There is another chapter on the use of “sound therapies” plus some appendices looking at matrix repatterning and neurofeedback techniques. I could go on, but all of this follows the same pattern. Doidge cites a few dramatic individual cases, he throws out loads of impressive sounding clinical arguments, he encourages us to share his enthusiasm. And always, none of the techniques are extensively researched, if they are researched at all. Those studies with any credibility fail to find the kind of strong effects that Doidge enthuses about throughout his book. When positive review articles exist, they are critically flawed and do not meet Cochrane criteria. Negative review articles are never mentioned.

The process is repeated with such precision that it is hard to conclude anything other than Doidge doesn’t actually want to know what the research world has to say about all these amazing techniques. Instead, his main purpose is to convince you to believe him.

This is not where I thought I would end up when I began reading Doidge’s book. I really, really wanted things to work out. I’ve had clients bring his book in and explain how it had inspired them to try one or another therapy that I’d never heard of. I had assumed that perhaps I was falling behind on my reading, not that the book was selling the equivalent of snake oil remedies. What makes it all the more tragic is the fact that Doidge uses the field of neuroscience as the foundation for his arguments, and in the process does a disservice. In The Brain’s Way of Healing, Norman Doidge tells a great story, but file this one under Fiction. Maybe even hard science fiction. Seems my wife got the book right after all.

For those of you who’d like to do some of your own research on just about any topic, keep an eye out for my upcoming handout summarizing tips and tricks based on what I’ve learned over a lifetime of searches.

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Myndplan update Sun, 19 Mar 2017 23:45:47 +0000 Since the launch of our Beta 1.0 product we’ve been hearing from many of you who don’t qualify for early access but would like to view the website and learn more about Myndplan. Earlier this week we installed our completed landing pages, which means that you can now get a taste of what things look like online and review […]

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Since the launch of our Beta 1.0 product we’ve been hearing from many of you who don’t qualify for early access but would like to view the website and learn more about Myndplan. Earlier this week we installed our completed landing pages, which means that you can now get a taste of what things look like online and review information about our services. This also gives clinicians and clients who are currently eligible to use the Beta release an easy way to get started. Now all that’s needed to join is a click of a button.

Included in the menu at the bottom of the landing page is a link to detailed answers to Frequently Asked Questions. These have been carefully selected to cover most inquiries that clinicians and clients who are new to Myndplan might have. Also available are links to our detailed Terms of Use, Privacy Policy, and information about how national privacy standards like the American Health Information Portability and Accessibility Act (HIPAA) and the Canadian Personal Health Information Protection Act (PHIPA) relate to our product.


What’s Next?

We’re keeping busy working on the next items in our priority-list of tasks so that we can continue to roll out the full suite of Myndplan Services. First up will be some additional clinical predictors and alerts, and we are nearly ready to kick off our comprehensive set of mood monitors. Dr. Shepherd will also be starting a series of articles for both consumers and providers on how to get the most out of the MyndScan MultiAx. Keep your eye on our Blog for more updates!

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