5 June 2013

Dr. Robert McCarthy Interview - Part 1: Intro to Integrative Medicine | Building a Referral Network | ADHD

Dr. Robert McCarthy is the author of the new Integrative Medicine software suite published by the BFE. We recently had a chance to ask him a few questions about his approach to Integrative Medicine. Here is part one of a 3 part series.

How did you become interested in the field of Integrative Medicine?
I became interested in the concept of Integrative Medicine many years ago while completing postgraduate studies at the New York Center for Psychoanalytic Training in Manhattan. It became rather obvious to me that many psychotherapy patients over the course of their treatment reported an improved global health and physical well-being. For example, numerous medical conditions either improved or went into remission, and they were less susceptible to viruses and colds than was originally the case. In the early to mid-70s, this was certainly not something openly talked about or published by professionals, although the roots of biofeedback in operant conditioning date back to the 1930s with Thorndike and his cat experiments.

One of the Faculty members I took a course with was a psychiatrist, Dr. Clara Torda. Dr. Torda was the Chief Psychiatrist at Jacobi Hospital in Queens, New York if I remember accurately. Rumor was that in ten years as a practicing psychiatrist, she only wrote one script for a psychiatric bipolar patient requiring mood stabilization. Other than that, she remained a devoted psychoanalyst. I later learned that Dr. Torda specialized in the treatment of epilepsy, and found that weekly participation in group counselling was as or more effective in controlling seizures in patients than the standard medicines used at the time.

Dr. Torda tried to publish her research results, as she was also a staunch and devoted scientist, over the next ten years, but was unable to do so because all the medical journals she approached said that the majority of their advertisements were paid for by drug companies who would get upset about these results and might withdraw their ads. So, after almost a decade of attempting to publish the positive impact of group counseling experiences on reducing epileptic seizures, she gave up. So that piqued my interest and got me going in this direction.

How long have you been practicing Integrative Medicine?

I've been a full-time practicing mental health clinician for the last forty years. However, it’s the last twenty-five years that I have specialized in biofeedback and what we now call integrative medicine.

Is your practice in Myrtle Beach, SC predominantly comprised of mental health professionals?
The field of integrative medicine represents a diverse community of healthcare professionals that cuts across just about every specialty you could think of. Even though the only professionals working in my office (McCarthy Counselling Associates, PA) are mental health providers trained in biofeedback and integrative medicine, we routinely interact on a daily basis with other health care professionals in the community, particularly physicians and inpatient residential settings.

Tell us about building a referral network...
Originally, we had to do a lot of canvassing and reaching out to other health care professionals, resources and treatment programs in the community. Doing this can get very frustrating and stressful at times - with minimal responsiveness. However, after 20 years of persistence and "stick-to-itiveness", while continuing to educate health providers in the community, we now receive a large number of referrals from physicians, including specialists. For example, the Neurology group in town actually refers clients to us for quantitative electroencephalograms (qEEG) now to help clarify differential neuropsychiatric diagnoses. We view this as a major accomplishment, along with our ongoing affiliation with three of the most well-respected primary care practices in the area.

In addition, when I originally moved to this area twenty years ago the County school system said they did not accept outside opinions from anyone. Here we are after working with the school system for the past two decades, receiving an abundance of referrals for Attention-Deficit\Hyperactivity Disorder, learning disabled, asperger’s and autism spectrum disorders.

You bring up a topic that certainly receives a lot of media attention. What is your approach to diagnosis and treatment of ADHD?
The major problem today surrounding the controversial diagnosis of Attention-Deficit\Hyperactivity Disorder is simply the way many clinicians arrive at a diagnostic conclusion when assessing children, adolescents and adults. Recently, a study reviewed by Dr. Rabinowitz, Chief Scientist at Duke University, in his monthly newsletter, pointed out the questionable reliability and validity of pencil-and-paper questionnaires, and called for the greater use of quantitative electroencephalograms (qEEGs) whenever attempting to diagnose this disorder.

If you take a child to any clinician, whether it is a pediatrician, psychiatrist, family physician, neurologist, psychologist, social worker, licensed professional counselor, marital and family therapist, or psychiatric nurse practitioner, and we only talk to you about your family member’s symptoms and behavior, even if supplemented by checklists, and reach a diagnostic conclusion as to whether the individual has or doesn’t have Attention-Deficit\Hyperactivity Disorder, we'll be right about 60% of the time and wrong 40% of the time. From a research perspective, 50-50 represents coin flipping. Whether clinicians are willing to admit it or not, we're really not doing a whole lot better than coin-flipping with interviews and checklists. On the other hand, if we incorporate the results of quantitative electroencephalograms (qEEGs), the accuracy rates increase to well-above 90%, and are on a similar par with the results of MRIs and CT scans.

The other thing that hampers the medical community is not properly identifying co-existing or co-morbid psychiatric disorders. What traditional physicians often miss are learning disabilities, anxiety and mood disorders. In fact, several research studies have suggested it is actually more common to have Attention-Deficit\Hyperactivity Disorder and a learning disability, rather than either condition alone. Prescriptive medications can quickly aggravate and produce negative side effects by unknowingly aggravating these comorbid disorders. Approximately 5% of bipolar continuum patients have Attention-Deficit\Hyperactivity Disorder. What's nice about the qEEG is not only does it represent a state-of-the-art technique for diagnosing ADHD, but it also gives us the opportunity to thoroughly assess brain functioning in other ways.

Another thing the qEEG can show is configurational patterning associated with properly medicating children. While the DSM-IV talks about three subtypes of the disorder, Dr. Amen (one of the three leading brain researchers in the world) feels he has identified seven neurological subtypes. Only three of the seven subtypes defined by Dr. Amen respond well to the unilateral use of psychostimulant medication. Of greater concern, psychostimulants can make the other four subtypes as defined by Dr. Amen, worse. Commonly, we see children with ADHD and an anxiety disorder unilaterally prescribed a psychostimulant that causes them to become even more nervous, tense, restless, fearful, and unable to sleep. It’s like throwing gas on a fire to put it out. Patients and parents alike assume it’s a problem with the medicine, not a partial diagnosis and the prescribing doctor. Had this same child initially been given a qEEG and prescribed a psychostimulant along with an SSRI, the SSRI could have controlled the anxiety while the stimulant activated the frontal lobes. The patient would have progressed and family members would be happy. It's this interaction with co-morbid disorders that requires the kind of objective scrutiny that only neurofeedback and qEEGs

Although you are a proponent of the use of neurofeedback for ADHD, you seem to feel that pharmaceuticals have their place.
Absolutely! Our practice is not in any way anti-medicine. We provide scientifically-based treatment alternatives, and in some cases non-medicine treatment alternatives that eliminate the need for medicine. Approximately 50% of patients who do neurofeedback may no longer need medicine; while the other 50% of patients will likely need a combination of medication and neurofeedback to do as well as they are capable of.

In 2012, the American Academy of Pediatrics upgraded neurofeedback to a Level 1 treatment for ADHD. Click here to view chart. 

The INTEGRATIVE MEDICINE SOFTWARE SUITE is now available in the BFE Online Shop.
"Dr.  Robert McCarthy's Integrated Behavioral Medicine suite provides an extensive methodology for developing a very detailed  psychological profile for patients. The results will allow the clinician-practitioner to know which peripheral and EEG  based  modalities are most relevant for biofeedback training and  monitoring.  Although psychophysiological profiles have been in existence  since the 1940s this one is the most extensive developed so far."
Joel F. Lubar Ph.D.
Professor Emeritus
University of Tennessee
Director Southeastern Neurofeedback Institute Inc.
BCIA Senior Fellow-EEG, Board Certified in Neurofeedback QEEG Diplomate

In Part 2 of this series, we will discuss the benefits of Integrative Medicine and the need to educate both patients and doctors about this approach. Dr. McCarthy will share a case on how he used biofeedback to a client with headaches.




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