You said I got something to say. Then you got that look in your eye.

You can hear Brad Arnold of the band 3 Doors Down singing “behind those eyes you hide.” The eyes tell a lot about our physical and emotional well-being. You may have heard that the eyes are the window to the soul. Now scientists believe that the eyes can also tell if someone has schizophrenia. Schizophrenia is a complicated disorder that affects the way a person thinks, acts, expresses emotions, and perceives reality. This disabling condition leaves its victim frightened and withdrawn. A recent research publication in Biological Psychiatry informs us that eye movements are associated with schizophrenia. Simple viewing patterns can detect abnormalities of eye movement that allow doctors to discriminate schizophrenia from control subjects with surprising precision.

Behind those eyes you lie and there’s nothing I can say.

Psychiatrists have been researching impaired eye movements as they related to schizophrenia for over a hundred years. Experts already knew that people with schizophrenia had established deficits in their ability to follow slow-moving objects with their eyes. When they attempted this, their eye movements did not match the trajectory of the moving object, and the result was a rapid eye movement. Now, lead researchers Drs. Benson and St. Clair report that by using a series of simple viewing tests, schizophrenics can be distinguished from other people. These doctors devised a model to test eye movement that has an impressive 98% accuracy rate for diagnosing schizophrenia.

As you turned to walk away I saw another look in your eye.

The study involved 88 people with schizophrenia and 88 control subjects. Benson, St. Clair, and colleagues assessed eye movements during smooth pursuit, fixation stability, and free-viewing tasks. The group differences regarding performance measures were evaluated by multivariate and univariate methods. The results showed that, as a group, the schizophrenia cases differed from the control subjects in many ways. The eye movement tests included the Lissajous pursuit, the horizontal pursuit, and the visual scanpath. The effects were found to be consistent over time and to have no correlation with medication, cigarette smoking, or gender.

Behind those eyes you lie, behind those eyes you hide…

Benson and St. Clair report that a predictive model with such accuracy could possibly be used in hospitals and mental health centers to assist physicians by enhancing and appending other symptom-based diagnostic criteria. Because the experts devised a model that has 98% precision, it can be a useful tool in the diagnosis of schizophrenia.  The authors reported that they also have unpublished information showing that eye movement pattern abnormalities are specific to other psychiatric subgroups. They plan to continue their research in hopes of using these findings for routine clinical practice.

References

Benson PJ, Beedie SA, Shephard E, Giegling I, Rujescu D, & St Clair D (2012). Simple viewing tests can detect eye movement abnormalities that distinguish schizophrenia cases from controls with exceptional accuracy. Biological psychiatry, 72 (9), 716-24 PMID: 22621999

Pedersen, T. (2012). Eye test identifies people with schizophrenia. PsychCentral.com.

Image via Inga Dudkina / Shutterstock.

Cognitive behavioral therapy (CBT) is based on the premise that inaccurate beliefs and maladaptive information processing have a casual role in depression and anxiety. It was developed by Aaron Beck in the 1960’s and in 1979 he and his colleagues had developed a detailed treatment manual for CBT. The aim of this treatment is to help patients acquire the abilities to identify the thought and images that accompany and precede the experience of upsetting emotions, distance themselves from the beliefs implied by these thoughts and images, question these beliefs for validity, and identify the themes in the content of these thoughts and images.

There are now over 100 computer-aided psychotherapy systems identified worldwide, many of them delivering CBT. One review found 97 different ones from nine countries when 175 studies were evaluated. The first one burst onto the therapy scene in the 1980’s, was developed by Dr. Selmi and associates, and was proven to be effective. This virtual therapy offers an alternative for depressed people who refuse therapy due to stigma, cost, or convenience issues. Most CCBT programs offer weekly sessions of around 40 – 50 minutes that involve cognitive restructuring without human contact. Minimal support by a mental healthcare professional is required. These programs focus on changing automatic thoughts and core beliefs to assist learning and retention. In addition, most computer-based therapy offers an introductory session involving psychoeducation, and then a final session on relapse prevention. Various types are available and can include email or phone contact with a therapist and direct feedback to the user as well. There are free online programs including Mood Gym by the Australian National University and myRay by Dr. Michael Benjamin.

Depression has been noted by the World Health Organization to be a significant public health problem with lifetime prevalence from 4.9% to 17%. Due to the shortage of licensed trained cognitive behavior therapists, this emerging intervention offers a cost-effective solution for those on waiting lists for therapy treatments. Cost analysis and economic research tells us that virtual therapy not only has proven clinical effectiveness, but cost effectiveness as well. The enormous burden that depression places on the healthcare delivery system and society can be lessened through CCBT utilization. Because of the accessibility of the treatment and its advantages of privacy and time conservation, CCBT is a promising solution to the under treatment of mild to moderate depression.

References

DeRubeis, R., Siegle, G., & Hollon, S. (2008). Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms Nature Reviews Neuroscience, 9 (10), 788-796 DOI: 10.1038/nrn2345

Gerhards, S. de Graaf, L., Jacobs, L., Severens, S., Huibers, M., Arntz, A., Riper, H., Widdershoven, G., Metsmakers, J., & Evers, S. (2010). Economic evaluation of online computerized cognitive behavioral therapy without support for depression in primary care: randomized trial. The British Journal of Psychiatry, 196, 310-318. PMID:20357309

Green, K., & Iverson, K. (2009). Computerized cognitive-behavioral therapy in a stepped care model of treatment. Professional Psychology: Research and Practice, 40 (1), 96-103 DOI: 10.1037/a0012847

Marks IM, Cavanagh K, & Gega L (2007). Computer-aided psychotherapy: revolution or bubble? The British journal of psychiatry : the journal of mental science, 191, 471-3 PMID: 18055948

Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys The Lancet, 370 (9590), 851-858 DOI: 10.1016/S0140-6736(07)61415-9

Bates B, Choi JY, Duncan PW, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D, Zorowitz R, US Department of Defense, & Department of Veterans Affairs (2005). Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: executive summary. Stroke; a journal of cerebral circulation, 36 (9), 2049-56 PMID: 16120847