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31
Fun Stuff / Magic
« Last post by Pip on November 16, 2024, 02:58:16 PM »
"What's your father's occupation?" asked the school secretary on the first day of the new academic year.

"He's a magician, Ma'am" said Little Johnny.

"How interesting. What's his favorite trick?"

"He saws people in half."

"Wow! Now, next question. Any brothers or sisters?"

"One half brother and two half sisters."
32
Christian / Re: Devotions
« Last post by Pip on November 16, 2024, 02:30:19 PM »
https://proverbs31.org/read/devotions/full-post/2024/04/05/3-ways-to-walk-your-morning-blues-away-with-jesus?utm_campaign=Daily%20Devotions&utm_medium=email&_hsenc=p2ANqtz-9aQWM0gM9Y9o5amA5zVubJIZWCUSyVZq8nbY6Ja9MDRj1N_NbgkBioyQC80Zph6zQnHlis90hxQeUGIlsUuwHrQkcY7A&_hsmi=298904956&utm_content=298904956&utm_source=hs_email#disqus_thread

3 Ways To Walk Your Morning Blues Away With Jesus
April 5, 2024
by Bonnie Gray

“Are you tired? Worn out?  Come to me. Get away with me and you’ll recover your life. I’ll show you how to take a real rest. Walk with me and work with me watch how I do it. Learn the unforced rhythms of grace ...” Matthew 11:28-30 (MSG)

Early one morning, I woke up preoccupied. With a long to-do list and a stressful work deadline looming, I couldn’t figure out how I was going to get everything done. As I made coffee, I tried engineering my day like a game of Tetris optimizing every minute.  My heart sank. There wasn’t much space to breathe. Looking outside at the sunny, blue skies, I saw beauty but didn’t feel it. Instead, I felt weary. Have you ever had a morning like that?

The day is still young, but you already feel weighed down and tired, held captive by worry.  When I later returned to the coffeepot after getting dressed, can you imagine how bewildered I felt to find it full of clear water?

I had put in the filter and filled the tank, but I was so preoccupied I forgot the most important thing: coffee grounds!  As I made another pot, scriptures surfaced in my heart:  “Are you tired? Worn out?  Come to me. Get away with me and you’ll recover your life. I’ll show you how to take a real rest. Walk with me and work with me watch how I do it. Learn the unforced rhythms of grace ...” (Matthew 11:28-30).

Jesus’ words felt like a comforting hand on my shoulder. The phrase “walk with me” in the Message paraphrase captured my attention. Jesus invites us to spend time with Him and rest from the burdens we carry. The metaphor of taking a walk, hand in hand, implies an intimate, one-on-one reconnecting of hearts away from distractions.  How do you enjoy spending time with Jesus in your faith-walk?

Here are three of my favorite ways you can borrow today:

1. Listen to a worship song. Songs give us a simple way to practice the presence of God, calling us back to Him. Music can bring calm and comfort put on a favorite worship song, and let God whisper words of love to you.

2. Journal a prayer based on God’s Word. Just one loving word from God brings light into your day. As you slow down to read and reflect on Scripture, respond by journaling a prayer. Studies show 10 minutes of journaling can lower anxiety and improve mood.

3. Spend time outside reveling in God’s creation. When we hear birds sing, see trees bud, or take a walk in fresh air, we often feel refreshed with God’s loving presence. Studies show 10 minutes spent in nature can ease feelings of anxiety and sadness.

We can orchestrate the most optimized life and high-output schedule, but without time to rest, we don’t have peace or joy. We were created to walk in wellness with Jesus. So let's take the time to enjoy what helps reconnect our hearts to His.  Sometimes we can walk our morning blues away simply by spending time with our loving Savior and any day is a good day to start. Jesus will take care of us every day.
33
Depression Central / TMS for the Treatment of OCD
« Last post by Pip on November 14, 2024, 06:54:14 PM »
https://www.psychiatrictimes.com/view/tms-for-the-treatment-of-ocd?ekey=RUtJRDpFOTIxNUQyMy03MkY0LTREOEUtQjRBRi1GNEI1RjcyQ0M4ODM%3D&utm_campaign=emailname&utm_medium=email&_hsenc=p2ANqtz--nlF-8_Mfo6a_0UPAtQw-0GGboTGf2394JOKidOxAPBRJwiRz1l69g6Jc49QudlVLdI8XSyefqa9j4qdXdpV5r0d2VgA&_hsmi=331183538&utm_source=hs

October 25, 2024
TMS for the Treatment of OCD

Author(s):
Tommy Sung, MD,Coralie Eilers, MD

Key Takeaways

    rTMS demonstrated a moderate therapeutic effect on OCD severity, with a significant treatment response rate compared to sham conditions.
    Improvement in depression severity, longer TMS sessions, and fewer sessions were significant moderators of rTMS treatment effect.

A new study shows that rTMS has moderate therapeutic effects on OCD severity.

TRANSLATING RESEARCH INTO PRACTICE

Rajesh R. Tampi MD, MS, DFAPA, DFAAGP, Editor

While pharmacological and therapy-based treatments have shown therapeutic efficacy in obsessive-compulsive disorder (OCD), there are many patients who have inadequate responses to these treatment modalities. Repetitive transcranial magnetic stimulation (rTMS) has shown promise for treatment-refractory affective disorders. This meta-analysis included 25 randomized controlled trials (RCTs) with 860 participants. The aim was to assess the therapeutic benefit of rTMS in patients with OCD and explored the moderators of its treatment effect.

The Study

Steuber ER, McGuire JF. A meta-analysis of transcranial magnetic stimulation in obsessive-compulsive disorder. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023;8(11):1145-1155.

Study Funding

None listed.

Study Objectives

To examine the therapeutic benefit of rTMS in patients with OCD and to explore the moderators of its treatment effect.

Methodology

This meta-analysis adhered to PRISMA guidelines and included studies from 1997 to December 31, 2022. Pubmed, SCOPUS, and PsycINFO databases were searched using keywords: “obsessive-compulsive disorder,” “transcranial magnetic stimulation,” and “randomized controlled trial.” Inclusion criteria were that the study had to be an RCT that compares rTMS treatment with sham condition. In addition, the participants had to meet diagnostic criteria for OCD, and there had to be sufficient data to calculate treatment effects using psychometrically supported rating scales. The authors screened a total of 159 records for eligibility. After applying inclusion criteria, 25 studies were included with 3 trials having multiple rTMS conditions. This provided a total of 28 treatment comparisons for inclusion. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) was utilized to extract effect sizes for OCD severity. If multiple depression scales were reported in the RCT, the Montgomery-Asberg Depression Scale (MADRS) was favored over the Hamilton Depression Scale (HDS) and Beck Depression Inventory (BDI). To quantify treatment effects, Hedge’s g was selected. Effective sizes were calculated using change scores. Relative risk ratios were used to calculate the treatment response and effective size.

Study Results

The random effects model found that rTMS had a moderate therapeutic effect on OCD severity when compared with sham conditions. (g=0.65, P<0.001). Significant heterogeneity was identified (P<0.003) and Egger’s test indicated that publication bias was significant (P=0.04). Further testing using the Duval and Tweedie’s trim and fill method indicated that no studies needed to be trimmed and that a moderate therapeutic effect remained (g=0.65).

For treatment response, the average rate across trials was 39.5% for rTMS and 8.8% for sham conditions. A large treatment effect of rTMS when compared with sham conditions was found using the random effects model (Relative Risk [RR] =3.15, P<0.001). There was little heterogeneity across trials (P=0.61), but publication bias was present (P=0.03). When Duval and Tweedie’s trim-and-fill method was used, rTMS continued to show a moderate effect (RR=2.67), although 4 studies had to be trimmed. There were no significant differences between trials that used > 25% improvement on the YBOCS scale compared with >30%, >35%, or >40% improvement (P=0.86).

Three treatment moderators were found to be statistically significant when analyzing heterogeneity. First, when patients had a greater improvement in depression severity, this was found to produce a larger treatment effect of rTMS on OCD (P=0.02). Second, longer TMS sessions were associated with greater improvement in OCD (P=0.05). And lastly, a lower number of TMS sessions were associated with greater improvement in OCD severity (P=0.02).

It is important to note that patient average age, sex, duration of OCD illness, concurrent use of serotonin reuptake inhibitor pharmacotherapy or antipsychotic pharmacotherapy, baseline OCD symptom severity, and/or use of medication free status were not statistically significant regarding the treatment effect of rTMS on OCD severity. Other intervention characteristics that were not found to be statistically significant included rTMS motor thresholds, rTMS frequencies, coils used for rTMS, total number of pulses used, and the location of rTMS treatment including the dorsolateral prefrontal cortex, orbitofrontal cortex, and supplementary motor area.

When looking through trial design characteristics as moderators of rTMS treatment effects, sample size, trial attrition, and year of publications were not found to be statistically significant. There was no difference between studies that used full sham conditions vs those that did not (P=0.75). Finally, there was no statistical significance between trials that used treatment refractory patients, vs nontreatment refractory patients (P=0.81).

Study Strengths

1. This review included 25 studies and 860 participants.

2. Only RCTs were included.

3. Trials included different rTMS coils, frequencies, motor thresholds, and anatomical locations.

4. There were no conflicts of interest for the authors.

Study Limitations

1. The studies included only focused on acute treatment outcomes.

2. Statistical analysis did not correct for multiple comparisons.

3. Limited patient characteristics were available for extraction across trials, such as whether exposure and response therapy had been trialed.

4. Publication bias was present.

Conclusions

This meta-analysis found that rTMS had a moderate therapeutic effect for the treatment of OCD. In addition, greater improvement in depression severity, longer TMS sessions, and fewer number of TMS sessions were moderators associated with greater improvement in OCD severity.

Practical Applications

OCD is a heterogenous disorder that can be debilitating for patients. This study shows that rTMS has moderate therapeutic effects on OCD severity.

Bottom Line

Clinicians should consider rTMS as an intervention to alleviate OCD symptoms, especially in those who have failed other treatments or those with comorbid depression.

Dr Sung is a psychiatry second year resident at Creighton University in Omaha, Nebraska. Dr Eilers is a fourth-year psychiatry resident at Creighton University in Omaha, Nebraska. Dr Schuster is a fourth-year psychiatry resident at Creighton University in Omaha, Nebraska. Dr Mullen is an assistant professor of Psychiatry at Saint Louis University School of Medicine. Dr Tampi is professor and Chairman of the Department of Psychiatry at Creighton University School of Medicine and Catholic Health Initiatives (CHI) Health Behavioral Health Services. He is also an adjunct professor of psychiatry at Yale School of Medicine, and he is a member of the Psychiatric Times editorial board.

Reference

Steuber ER, McGuire JF. A meta-analysis of transcranial magnetic stimulation in obsessive-compulsive disorder. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023;8(11):1145-1155.
34
Christian / Re: Devotions
« Last post by Pip on November 14, 2024, 06:45:25 PM »
https://proverbs31.org/read/devotions/full-post/2024/04/04/handling-your-hard-emotions?utm_campaign=Daily%20Devotions&utm_medium=email&_hsenc=p2ANqtz-9AQWAt1QN99T5Yp14oqRmzKtkkP8SR5q8LXmb8CQyKwCd9dRn_d_3fO7MOmXMwU85e54vkJit98oofdrNThCLFjV2FzQ&_hsmi=298904719&utm_content=298904719&utm_source=hs_email#disqus_thread

Handling Your Hard Emotions
April 4, 2024
by Kendra LeGrand

"Then God said, 'Let us make mankind in our image …'" Genesis 1:26 (NIV)

“For this to work, you need to leave your mask at the door.”

These were words my counselor spoke to me in our second meeting. The first meeting was when she handed me a book on boundaries, which felt like a very blunt way to tell me I had a problem.  Now, when she told me to leave my mask at the door, it was all I could do not to fake a stomachache and never return.  She was saying I couldn’t keep my happy-go-lucky face on in counseling. It would get in the way of making progress. Instead, she challenged me to be honest in expressing my emotions honest with myself and God.  But I thought showing frustration, anger, disappointment and sadness as a Christian was wrong. I thought if I believed in God, then I shouldn’t express these bad emotions because they were just that: bad.  That’s when my counselor kindly stopped me again and said, “Those aren’t bad emotions. They’re hard emotions. They’re uncomfortable to sit with. But they are God-given. He isn’t afraid of our emotions. He wants us to be honest about our feelings.”

You see, we were created in God’s image: “Then God said, ‘Let us make mankind in our image …’” (Genesis 1:26).

Our purpose as image bearers is to glorify God, and He has given us so many emotions to feel as we walk out this calling. Our full range of emotions is a blessing. Even hard emotions have a purpose: For example, sadness can help us value joy. Anger and frustration can help us respond to injustice and value peace and stability. And our hard emotions drive us to depend on God.  Jesus experienced some hard emotions too:

    Frustration with merchants in the temple (Matthew 21:12-13).
    Sadness when His friend Lazarus died (John 11:35).
    Loneliness when He was on the cross (Matthew 27:46).

Though our emotions, if not dealt with and processed well, can lead us to sin, Jesus’ emotions stemmed from His righteous love for His people. In His anger, He did not sin. In His grief, He did not sin.  This “aha!” moment, realizing that all emotions are God-given, was freeing for me. And maybe you find yourself feeling a little freer too?

You may be:

    Upset with your child who hasn’t picked up their toys.
    Frustrated with a friend who keeps canceling plans.
    Angry at a spouse for the way they’re handling a work situation.

And those are OK feelings. We just don’t want to stay there all the time. We want to understand why we’re feeling how we’re feeling, repent if our emotions have led us to sin, and ask for the Holy Spirit’s help to handle our hard emotions with grace.  I’m becoming more comfortable not only leaving my mask outside the door of my counselor’s office but also when I meet with friends or in my church small group. I’m still not the best at expressing hard emotions but it’s not about perfection. It’s about progress.
35
The Lounge / Re: Members birthdays
« Last post by Pip on November 12, 2024, 06:14:32 PM »
:bday1: spud
36
One Step At A Time / Re: fighting depression and getting back in shape
« Last post by Amanda_George on November 12, 2024, 09:08:47 AM »
Another great one there, Jali!  Your time, patience and effort really shines through!
37
The Lounge / Re: Members birthdays
« Last post by Amanda_George on November 12, 2024, 08:56:31 AM »
Happy birthday, spud
38
The Lounge / Re: Members birthdays
« Last post by Pip on November 11, 2024, 05:00:08 PM »
Happy birthday, Beetzart anim_65
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The Lounge / Re: Members birthdays
« Last post by Amanda_George on November 11, 2024, 04:08:44 PM »
It's Beetzart's turn today!

:jumping0045:
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One Step At A Time / Re: fighting depression and getting back in shape
« Last post by Pip on November 10, 2024, 04:26:46 PM »
 :yes10:
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