Sunday, December 28, 2014

Can we use TV to prevent depression?

I was recently in Miami for the annual meeting for the International Society for Traumatic Stress Studies (www.istss.org) where the theme of the meeting was “Healing Lives and Communities: Addressing the Effects of Childhood Trauma Across the Lifespan.” There was an interdisciplinary panel at the meeting on “Using media to prevent trauma” between scientists and filmmakers. The goal of this panel was to open a dialogue within the scientific community about whether trauma is too prevalent to treat individually, and whether population based “interventions” are a more effective way to prevent the negative psychological consequences of trauma. Are we using a teaspoon to remove water from our punctured lifeboat? During this discussion, they brought up The San Francisco Mood Survey Project, which is uber-cool, so I was inclined to share it with you.

In the late 1970s, mental health awareness was increasing, and epidemiological surveys confirmed that almost 10% of people are depressed*, while 25% of people will be depressed at some point in their life. Even then, it is remarkable to note, there was an understanding among research-oriented clinical psychologists that cognitive-behavioral therapy (CBT) was the most effective way to treat depression. More about that in this past post.

Dr. Ricardo Muñoz of University of California- San Francisco is a psychologist specializing in effective interventions for the treatment of depression. Today, he focuses mostly on interventions using the internet, however in 1978, the best option for community intervention was television. Luckily, the host of a television news program in San Francisco approached him and a group of psychologists at UCSF and UC Berkeley to develop a mini-series on depression. So, the research group compiled active components of effective CBT for depression and compiled them into ten 4-minute segments that were aired during the noon, evening, and nightly news for two weeks. This is considered “primary prevention” because “rather than waiting for people to become depressed enough to seek therapy, preventive educational interventions can be made available to the general public.”

One week before airing the 10 segments, they conducted a phone survey by asking 216 individuals (~ 40 years) about their symptoms of depression and whether they engage in any of the behaviors that would (unbeknownst to them) be recommended on the television segments.

Some examples of the content of these segments are: making a list of 15 pleasant activities, writing out a contract to exercise and eat healthy, showing ways people can reward themselves for following the contract, listing positive thoughts, and showing how to relax.

One week after the 10th segment was aired, they conducted phone interviews with 220 individuals (58 were new). Participants reported on their depression symptoms, how often they engage in the behaviors recommended in the segments, and whether they watched any of the segments on the news in the past 2 weeks.

Unfortunately, only 47 of the participating individuals watched at least one of the segments of the intervention, however the results of the intervention were promising. Individuals whose pre- intervention depression scores were high (clinically significant) who also watched at least one segment, reported a decrease in depression symptoms one week after the intervention. This is an important finding because one of the biggest criticisms of community interventions like these, and more recently on the internet, is the worry that people who are depressed will stop seeking treatment and be at increased risk for persistent illness or suicide. See a past article about depression and suicide risk here. So not only did Muñoz and colleagues find that depression symptoms declined in people who watched the segments, but specifically in those with clinically significant symptoms.

Overall, I find it remarkable that this was done 30 years ago, but disappointing that more programs like this have not “taken off.” Clearly, there are benefits, but apparently the benefits don’t outweigh the costs. This study is no exception given how much time and money it must have taken to compose and produce the 10 segments, to only reach ~20% of a population. But perhaps we should be interested in long term gains, not 2 week gains. In graduate school, I learned about a concept called Gross National Happiness, was proposed by the King of Bhutan, as a way of dedicating national resources to promoting quality of life rather than productivity (GNP) per se.

What is also remarkable to me about this study was whether it was prevention or intervention. Keep in mind, the main finding was that people with clinically significant symptoms showed reductions. This implies that the segments were therapeutic, or served as an intervention. However, for some historical context, the first segment was aired the day after the Guyana mass suicide, not to mention the Mayor of San Francisco Moscone and Supervisor Harvey Milk were shot one week later. Thus, it is possible that the intervention somehow buffered the impact of these major socio-political traumas as evidenced by a lack of increasing symptoms.

This brings me back to my original topic, which is the question of whether we can prevent the negative impacts of trauma using media. And if we can, what might that look like? I often take my training as a clinical psychologist for granted, and forget that everyone is not trauma-informed. What clinical psychologists know about trauma is that telling your story with others is part of the healing process, as long as those others are “safe.” We know that when someone tells us about a personal experience, either rape or assault or a motor vehicle accident, that is privileged information that was very difficult to share. As receivers of that information, we are responsible for showing gratitude for that information, and validating them by recognizing the overwhelming emotions that must have accompanied their experience. The media does not routinely do that. Only the rarest journalists do that. As a result, we live in a world where emotions are stigmatized, shame is marketed, destitution is disgusting, and victims of trauma are never validated unless they can afford to pay for it. I wonder what the world would look like if instead everyone was “safe.”

*Depression is defined by two weeks of persisting low or negative mood and loss of pleasure in previously enjoyed activities which are then accompanied by several other unpleasant experiences (changes in sleep, appetite, worry, thoughts about death). If you are worried that you might be suffering from depression, you should take an online survey here, or contact your primary care physician for a referral to a therapist.

Muñoz, R. F., Glish, M., Soo-Hoo, T., & Robertson, J. (1982). The San Francisco mood survey project: Preliminary work toward the prevention of depression. American Journal of Community Psychology, 10(3), 317-329.

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