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What is 'Drugless Psychiatry' or Subjective Emotive Brief Therapy?

The procedure of therapy is simple.  A detailed  history is taken first.  A relaxation exercise is given for homework-to be done from three to thirty minutes daily.  In each session of therapy, relevant unresolved issues are addressed using imagery and associated emotions.  As the person becomes calmer with therapy and relaxation exercises, the mind is challenged more intensely with each successive session.  The previously unresolved issues become "irrelevant" as treatment proceeds.  A common word used by clients is -"Realization".  They tend to have more insight and "forgiveness" follows  spontaneously.  Traumatic memories become more vivid initially and then become hazy as therapy proceeds.  So everything traumatic in memory is capable of being neutralized.  Eventually lessons are left from the experiences that were previously distressing with emotions dissipated.

As an issue is addressed a client may experience restlessness, anger and sadness in succession.  A stage of numbness can sometimes precede sadness.  As the body releases tension, the client may go into a prolonged phase of extreme tiredness that may last for upto two weeks. By this time the mind has released most of the 'misery creating' issues and becomes alert, interested in daily living but lacking the energy to enjoy daily activities. This is the penultimate phase in recovery.  The end point in this work is always positive.  If someone has not experienced positivity while engaging in Subjective Emotive Brief Therapy, they have not reached the end point.

After a person has concluded treatment, they are advised to continue some form of relaxation or meditation for as long as possible.

How can psychiatry be drugless?

Psychiatry is a specialty of medicine in which a doctor makes a diagnosis after taking  relevant history and examination.  Treatment is done mainly with drugs with psychotherapy having a limited input.  In Chadha Model Subjective Emotive Brief Therapy, psychotherapy can become the major mode of treatment with medication playing a secondary role.

How can it be practised?

The sufferer in a psychiatric condition is an expert on their own distress state.  Anyone who is not in the place of the sufferer cannot imagine the depth of distress a person could be experiencing.A psychiatrist can be an expert in mental illnesses but they only have an objective view of the condition.In Subjective Emotive Therapy,the subjective distress is 'utilised' ( as Milton Erickson would put it) for treatment. The emotional distress related to each unresolved issue that the person can have access to, is neutralized or desensitized. It is an intense process.  A person not on medication who has good social support and does not have major personality problems can finish treatment quickly as compared to others. Since 1996, hundreds of people have benefited from this work.Confidentiality issues do not permit disclosure of such cases.

What is the theoretical basis of Chadha Model Subjective Emotive Brief Therapy?

Almost all psychiatric conditions can be understood on the basis of neurochemical imbalance in the body.  Trauma and stressful situations can trigger such conditions. Since these imbalances are caused naturally,then reversing the distress by relaxation, meditation, hypnosis and acupressure can recreate the balance in the neurochemicals in the body. This is possible by 'burning out ' the emotional impact of distressing memories and images. This is done by using relaxation as the foundation of therapy, which has to be done regularly combined with imagery exercises that are done under supervision. As the person becomes more relaxed they find it successively easier to dissipate the emotional distress with imagery. As the bottled up emotional distress is dissipated, the person becomes more relaxed. This is carried on till the person is comfortable with their emotional, physical and mental health.

What is the role of medication in this form of therapy?

Medication suppresses the emotional arousal state by interfering (not replacing) the neurotransmitters in the nervous system. This may become necessary when the person's condition is a threat to themselves or to others or when the quality of life is rapidly deteriorating.This happens when a person loses insight.In such conditions, medication is a support to the psycho-therapeutic process.Reducing medication can be considered by the prescribing physician only if the patient is stable.Any reduction in medication results in emotional arousal, which can be mostly, neutralized with therapy. This can be done successively till the person is off drugs.Medication suppresses emotions, relaxation releases them. If a patient can tolerate the current stresses in life without affecting others, they are most suitable for Subjective Emotive Brief Therapy.

Do emotions play a role in mental health conditions?

Most of the functional psychiatric conditions follow stressful life events. Emotions play an important role in the physiological experiences of these events.  We now know that neuropeptides are the chemical forms of memory in the body stored not only in brain cells. Counselling and psychotherapy reduce the impact of negative emotions -like anger or fear- on mental health.Chadha Model Subjective Emotive Brief Therapy works at a deeper level and is far more intense than counselling.

What  is the role of stress in health?

The role of stress in the causation of psychosomatic and mental health conditions is now well known.  Any organ in our body can be affected by stress.There are internal stressors locked up in the body's memory from past experiences that we are unaware of. These are in the form of neuropeptides.When adverse environmental situations present themselves,the internal stressors are activated and we experience stress in our awareness. It affects our immune system among others.  We get illnesses and infections that occur due to our body's healing processes being challenged.Now scientists are looking at stress as being one of the causes of cancer. Psychologically stress is experienced as anger, irritability, panic and phobias.Lethargy , sadness and depression may follow.  It has economic, family, social and personal consequences.It also affects our creativity and decision-making ability.

What kind of patients do not respond to this treatment?

People who depend on others to change them are unsuccessful in this kind of treatment. Those impatient to get results and those who hold everyone else but themselves responsible for their suffering. People who are fearful of change are initially less likely to do well.  People who have no family or social support are least likely to do well.Those who analyze everything and who think too much are slow in benefiting from this treatment.  Acutely psychotic patients, including those suffering with some forms of schizophrenia & organic disorders are also sometimes less likely to respond.

What is to be expected in this form of treatment?

A person undergoing treatment may go through the stages of agitation, anger , sadness and resolution successively,as each distressing issue is addressed.The final outcome is always positive.  The paradox is that the more acutely the results are expected, the slower is the process of change.People who benefit most are those who are patient with themselves.  The process brings positive results, when completed.Yet there are no guarantees that everyone who takes on therapy will complete the process.