Matthew Gold

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Matthew Gold

Matthew Gold

@mdgld

formerly: neuroendocrine research, barista, animal and landscape photographer; future psychiatrist. @[email protected]

US-AZ Entrou em Ağustos 2009
264 Seguindo97 Seguidores
Matthew Gold
Matthew Gold@mdgld·
@SheerID @cursor_ai can you guys please help me get verified as a student? I’m having an issue and both support staffs are pointing me in the opposite direction.
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Matthew Gold
Matthew Gold@mdgld·
@psychunseen I’ve spent some time interacting with LLMs that I’ve purposefully modified with guardrails and grounding for discussion of mental health topics and even under those conditions the results are suboptimal, to say the least.
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no@bro_abra·
@DrGipps you expect insurance to reimburse patients based on "trust in therapy process"?
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Richard Gipps
Richard Gipps@DrGipps·
I'm a Clin Psychol in the UK, but struggle to 'identify as' one. For this there are several reasons, the main one being a use to which we're often encourage to put formulation... ie developing and sharing a formulation of the therapy patient's difficulties with them. This...
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Matthew Gold
Matthew Gold@mdgld·
@DrGipps @markrdavis Playing devil’s advocate, acting as a collaborator with patients may lead to more trust—making it easier for them to lower and confront those defense mechanisms. Could see this being relevant especially for disorders like ODD
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Richard Gipps
Richard Gipps@DrGipps·
@markrdavis But: being curious about what's psychologically going wrong for you can end up at best in only counter-productive 'intellectual insight' if you're not ready to repeal the defences in question.
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Matthew Gold
Matthew Gold@mdgld·
@lunettaporchett @Theholisticpsyc Or used, for that matter. There will probably always be clinicians misdiagnosing or writing patients off, and patients with a symptom constellation that current medical science can’t explain. What are you claiming? That any FND is just a misdiagnosis of something else?
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Ļųņęțțą Porchetta 🙅‍♀️🙅‍♀️
@mdgld @Theholisticpsyc Not true sadly. Even the so called research on FND uses patient searches for “conversion disorder” and conflates it with FND as one cohort. FND was created as patients realised conversion disorder was Dr code for ‘not real, all in the patients head, don’t investigate further’
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Dr. Nicole LePera
Dr. Nicole LePera@Theholisticpsyc·
The diagnosis of female hysteria never left. It just got rebranded to: borderline personality disorder.
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Matthew Gold
Matthew Gold@mdgld·
@lunettaporchett @Theholisticpsyc I’m not sure what you’re referring to. Whether or not you can point to a specific study that classified patients as having a FND because they searched for the term conversion disorder (which is incredibly unsound methodology), that is not how FND is supposed to be diagnosed.
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Matthew Gold
Matthew Gold@mdgld·
@jordanticus Psychodynamic therapy has its own brand. Hell, so does conversion “therapy”. The problem you’re describing relates to how our society (and most others) commodify knowledge, which isn’t specific to cognitive therapies, or therapy in general.
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jordan
jordan@jordanticus·
When psychotherapy is made into a commodity, CBT and other acronym therapies are the result. The acronym is not incidental. It's a brand that can now be mass produced for profit and extended to other commodities like books, trainings, etc. Academia played a role in its origination to be sure, but profit is what proliferated it and maintains it today.
GIF
CatBush@FeistyKittyPie

OK I used to appreciate some of David Burns' work but at his ripe old age he really should not be writing BS like this to grift. Fuck you David. You should be Feeling Bad.

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Matthew Gold
Matthew Gold@mdgld·
@jordanticus Which is what it’s designed to do. The first part is simply because ACT is not psychodynamic, but it never claims to be. I’m skeptical of psychodynamic therapies, I know research has borne out their efficacy—but has it showed that their epistemology is sound?
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jordan
jordan@jordanticus·
@mdgld No where in ACT are you instructed to understand intrusive thoughts as disavowed aggressive or sexual feelings being expressed symbolically. It does teach you to recognize that certain thoughts aren't literally true and that you don't have to engage with them.
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jordan
jordan@jordanticus·
Lots of ACT folks told me I'm mis-characterized it. And it had been awhile since I'd read through any ACT stuff. So I poked around on Stephen Hayes' site and found this defusion tool. Honestly, the more I research ACT, the less I respect it. Can anyone make a compelling case for it?
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jordan@jordanticus

Here I'm going to explain the problem with treatment approaches that in some form endorse the idea that thoughts are meaningless or should be ignored (CBT, ACT, ERP). Let's say a patient has a thought of stabbing their newborn baby. It terrifies or disgusts them. They fear that this thought means they're going to actually harm their child, or they're going crazy and need to be locked up, or just that they're in fact a very bad person. We call it an "intrusive" thought because that's how it's experienced. Something "not me" is attacking "me". But where else could this thought be coming from except from "me"? But the patient doesn't really want to hurt their baby, so this thought is nonsensical and therefore meaningless, right? Or at least just ignore it, right? This is what CBT, ACT, and ERP tell us. And at first glance, this seems like a good way to think about it. In fact, some people are able to take a degree of comfort from the idea their thoughts are meaningless and they sometimes find their symptoms do lessen a bit: "Oh good, I'm actually not a bad or dangerous person." So what's so bad about this? If it helps, it helps, right? The problem is that the patient does continue to suffer in some form. Maybe the symptoms persist at a mild or moderate level. Maybe they come back later. Maybe they have intrusive thoughts about other things. Maybe they become depressed. Etc etc etc. Why do they continue to suffer? Because the thoughts actually do have meaning. Just because a thought isn't literally true, doesn't mean it's not symbolically true. Or carrying meaning in some form. Intrusive thoughts are parts of ourselves that we can't integrate into our conscious understanding of ourself, but it's still us and it comes back to haunt us in symbolic form and will continue to do so until we integrate it. So what could thoughts of harming a newborn baby mean? Here's a patient who maybe can't tolerate their own aggressive feelings towards people they also love. So no matter how much we present evidence that they'll not physically harm their child, this completely misses the mark of the true source of their suffering. We can't just treat the fever and ignore the underlying infection.

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Matthew Gold
Matthew Gold@mdgld·
@liminaldoge @QualiaNerd I’m assuming you’re referring to a 2002 meta-analysis, at least that’s the one I can recall of the top my head. In 2018 there was a meta-analysis published in The Lancet that found SSRIs have a greater effect than placebo for acute treatment of MDD: thelancet.com/article/S0140-…
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QualiaNerd
QualiaNerd@QualiaNerd·
-Hey doc, why did you prescribe this anti-depressant which doesn’t work all that well and not that other one which works perfectly? -Because that other one would make you feel good. You aren’t provably depressed enough to warrant tolerating such a horrendous adverse effect.
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Matthew Gold
Matthew Gold@mdgld·
@lunettaporchett @Theholisticpsyc FND means we don’t understand the basis of the condition. Any competent neurologist knows that it’s still “real”, in the same way that depression is “real” even though we can’t point to a specific brain state that’s responsible. FND should be a diagnosis of exclusion
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Ļųņęțțą Porchetta 🙅‍♀️🙅‍♀️
@Theholisticpsyc Hysteria was also rebranded to conversion disorder, then to FND. Name changes to hide it is Dr code for ‘all in the patients head’. FND is an abusive diagnosis that ends all investigations into what is actually physically wrong. Thus denying medical care.
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Matthew Gold
Matthew Gold@mdgld·
@liminaldoge @QualiaNerd This is hilarious. TCAs have a crazy side-effect profile, have tons of serious interactions, and can literally be overdosed on. They do seem to work better than SSRIs but laziness is hardly the barrier to entry.
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Matthew Gold
Matthew Gold@mdgld·
@notaproviderMD Hi Dr. Johnson. As someone still training, my experience is that this is probably exacerbated by the process emphasizing and testing for rote memorization and pattern recognition.
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Nikki M. Johnson, MD
Nikki M. Johnson, MD@notaproviderMD·
Too many of you believe that practicing medicine is simple pattern recognition. Too many of you have been convinced that replacing doctors with AI is going to be a medical cost saver. Well, the perpetually growing list of new titles in hospital administration are the main people who believe this. Interestingly, they're also the real reason for the growing expenses in healthcare. Not the doctors reading your CT scans. AI can be very useful at making some systems and processes more efficient, which could save healthcare costs. It is far from being capable of considering everything that factors into making a diagnosis, including reading your radiograph, mammogram, or MR images. It isn't capable of reliably reading subtle abnormalities on a radiograph or complex images that don't match the patterns in datasets. x.com/i/status/20393… The price for getting your xray reading wrong is your life. You best believe the CEOs who want to replace your doctor with a non-physician and your xray reading with ChatGPT have already factored in the payout for your malpractice claim. They don't care about saving you money.
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Matthew Gold
Matthew Gold@mdgld·
@PhysInHistory Nothing says intelligence like…*checks notes* “A chronic pattern of behavior that disregards the rights and well-being of others”, amirite? You might want contextualize this, change the phrasing, anything really.
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Physics In History
Physics In History@PhysInHistory·
“Anti-social behavior is a trait of intelligence in a world full of conformists” ― Nikola Tesla
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Matthew Gold
Matthew Gold@mdgld·
@libsoftiktok Thanks for your wholesome post @libsoftiktok! That is indeed correct. Appreciate you giving a trans advocate some visibility on this holiday
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Libs of TikTok
Libs of TikTok@libsoftiktok·
This is the person who created “transgender day of visibility”
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