Cardano & Mental Health

INTRODUCTION

Depression is a public health global problem, particularly in high- and upper-middle income countries [1]. A systematic analysis emphasizes that depression is one of the five leading causes of years lived with disability (YLD) in 188 countries, contributing with 34.1 million years to the total YLD [2]. Prenatal maternal depression is one of the factors associated with the risk of offspring's depression [3]. Hence, there is a growing need for new public mental health interventions to mitigate this risk from its root, and reduce depression globally. In 2017, the global estimated prevalence of depression was 3.44%, but a recent meta-analysis estimated a prevalence of 25%, suggesting a significant impact of the COVID-19 on people's mental health [4]. Lost productivity as a result of anxiety and depression, costs the global economy US$ 1 trillion each year [5].

Our peer-reviewed articles demonstrate the effectiveness of a new classical psychotherapy – Family Constellations (FC) – on depression symptoms [6-7]. However, FC's founder – Bert Hellinger – was not interested in applied research on FC [8]. This stance seemed to cause an issue: on one hand, the individuals that study and/or work with FC as an emergent science (e.g., [9-12]), on the other hand, the individuals who advocates that FC needs more research to be used as a psychotherapeutic method (e.g., [12-14]).

Meanwhile, new psychotherapeutic methods are necessary to mitigate the escalation of depression (and other mental problems) globally. At our institute, service users (if they agree) are screened with psychometric tests before and after FC psychotherapeutic processes [6-7]. With a mean of 7 sessions, which implies a cost of around €320, the values of depression (on average) decrease, showing statistically and clinically significant changes.

Moreover, besides our service users, we are studying the effects (e.g., on depression) of FC on our students, and on volunteers of the supervised training of our students. Our databases are loaded with valuable information on the effectiveness of FC, but, as we are an independent organization, and our research work is totally funded by ourselves, we lack financial resources to produce more quality peer-reviewed papers on FC.

With Project Catalyst's funding, each of us dedicating four hours a day to research, we will be able to produce one scientific article at each twelve weeks' period. Thus, we plan to produce eight articles in two years (A1 to A8) as follows: Article number (A1 to A8). «Article's draft name». DS: Date of project's start (DD-MM-YYYY). DSP: Date of submission process start.

Note:

DS and DSP are contingent of Project Catalyst's funding schedule; hence, they are estimations.

EXTENDED PLAN FOR ARTICLES PRODUCTION

A1: «Process of change and effectiveness of family constellations: A mixed methods single case study on depression symptoms, and panic attacks, with a polytraumatized individual».

DS: 04-04-2022. DSP: 27-06-2022.

A2: «Systematic case series study (with 70 cases from our service users of FC) made with the DASS-21 (Depression, Anxiety and Stress Scale) and the PPDMQ».

DS: 28-06-2022. DSP: 20-09-2022.

A3: «Systematic case series study (with 70 cases from our service users of FC) made with the GHQ-28 (General Health Questionnaire, which has a depression subscale) and the PPDMQ».

DS: 21-09-2022. DSP: 14-12-2022.

A4: «Literature review on FC as a phenomenological instrument for psychosocial intervention, in several social contexts, e.g., psychotherapy, law, business management, social work, pedagogy».

DS: 15-12-2022. DSP: 09-03-2023.

A5: «FC methodology in the psychotherapeutic context: FC as classical psychotherapy; technical protocols, and psychotherapeutic interventions that show effectiveness on depression symptoms».

DS: 10-03-2023. DSP: 02-06-2023.

A6: «Quasi-experimental study on the effects of FC sessions on volunteers (with depression symptoms) of the supervised training of our students, made with EADS-21». (This research includes a control group).

DS: 03-06-2023. DSP: 26-08-2023.

A7: «Effects of 600 hours of a FC course on student's mental health, gauged with DASS-21 and WHOQOL-BREF (World Health Organization Quality of Life brief assessment)».

DS: 27-08-2023. DSP: 19-11-2023.

A8: «FC's efficacy on depression symptoms, a randomized controlled trial».

DS: 20-11-2023. DSP: 12-02-2024.

PLAN FOR EACH TWELVE WEEKS' PERIOD

We understand that for the writing of a scientific article, 12 weeks may seem unfeasible (and qualitatively dubious). However, we spent 5 years producing academic papers (https://bit.ly/papers_rg) as a team (with very short schedules), and we are used to complementing the best of our idiosyncrasies to produce high quality work. Moreover, we already have loaded databases for several studies, and we just need time (and funding) to produce one paper for each 12 weeks or W (i.e., approximately 3 months):

W1-2: Search of, at least, five pertinent scientific journals to submit the paper. Introduction's elaboration: framing the project theoretically, and emphasize its pertinence, literature review, concluding with the research question and the hypothesis (if applicable);

W3: Methods: participant's description, materials or instruments, design and procedures.

W4: Results: answering to the research question and relevant statistics.

W5-6: Discussion: summary of the research, theoretical and practical implications, limitations, and suggestions for future research.

W7: Conclusions: final remarks, thought-provoking and/or take-home message. First review: our own review, including a references list review. Final title and abstract's production.

W8-9: Second review: by two colleagues (meanwhile, review of the quantity of FC's peer-reviewed papers published, differentiating the ones on depression from all the others). Update changes derived from the second review.

W10-11: Proof-reading by a bilingual (English-Portuguese) scientist and psychotherapist (and, meanwhile, format the paper according to the chosen journal rules, prepare a cover letter to the journal's Editor, and continuing the review of the quantity of FC's peer-reviewed papers published). Update changes derived from this third review.

W12: Submission process: if the journal's Editor shows interest in the article, it will be sent for publication on the primary choice journal. For the meantime, preparation of Plan B (case the article is not accepted). If not accepted, a letter (about our paper) to the Editors of the other four chosen journals will be sent, and the article will be submitted to the first journal whose Editor demonstrate interest in the publication. This submission process transits to W1-12 of the next production (which is contingent on the timing of acceptance and receiving the peer-reviews). Changes and rebuttals after peer-review will also transit to W1-12 of the next production.

Thus, besides our work we will need the collaboration of a proofreader, and a networker (as we will explain later). At W8-9, we intend to offer 50 ADA to each of our two colleagues reviewers (of our own ADA, i.e., not included in the budget).

ASSURANCE OF PROJECT'S QUALITY

W8-9: Review by colleagues.

W10-11: Proofreading by a bilingual (English-Portuguese) scientist and psychotherapist.

W12 onward: Scientific journal's peer-review.

TEAM MEMBERS

TM1: Jorge Manuel Amaral Ramos (head of research), https://orcid.org/0000-0002-7735-0506

TM2: Sandra Maria Lapa Barroso Ramos (co-researcher), https://orcid.org/0000-0002-4169-1712

TM3: Proofreader: bilingual (English-Portuguese) scientist and psychotherapist (this member is not yet identified, for a matter of requested anonymity, but it is the person that made the proofreading of our two already published scientific papers).

TM4: Networker: advertising and promotions of the articles (as well as Project Catalyst and ADA) in social media, and with press releases (this member is not yet identified, as we have several hypotheses for this position, and we just want to initiate conversations after the decision on our project).

Notes:

• TM1 and TM2 will work in the project full-time (i.e., W1 to W12). TM3 will work only at W10-11. TM4 will work only at W10-12. Formal-legal receipts of the payments to TM3 and TM4 will be requested and presented to Project Catalyst. TM3 and TM4 are independent workers.
• TM1 and TM2 are the owners of a mental health & personal development business since 1998. In 2015 they trademarked the name of their institute to ICI – Instituto de Ciências Integradas™ (Institute of Integrated Sciences) at Instituto Nacional da Propriedade Industrial (National Institute of Industrial Property) where it is registered with number 552923. TM1 and TM2 are members of the American Psychological Association (member codes, C2002499083 and C2103204890 respectively).
• TM1 and TM2 work with FC since 2001, and developed four technical-scientific protocols for FC. The scientifically supported results of their twenty-years' work with FC, grant them legitimacy and confidence to make relevant contributions on FC's field. They already published (at SAGE, and at APA) two blind peer-reviewed articles [6-7], created the Psychotherapeutic Process Data Mining Questionnaire (PPDMQ) [6], and have four books published (three in Portuguese, and one in English). They have a large portfolio of service users, and have around 50.000 connections at several social networks (Appendix 1).
• TM1 and TM2 both have a master's degree in Clinical Psychology (TM1 is also a Linguistics' bachelor). TM2's clinical psychology's master thesis regarded self-perceptions of clinical psychologists and psychotherapists about the human qualities that contribute to the success of psychotherapy. TM1's clinical psychology's master thesis regarded contributions to improve the quality of clinical psychology and psychotherapy services. TM1's linguistics specialization regarded speech pathologies.
• TM1 and TM2 collaborated with the Portuguese judiciary system to work with FC on a family court case. After more than five years of litigation a couple solved their parental issue in about one month, with a total of ten FC sessions.

BUDGET

This requirement is only for the production of one article (A1: «Process of change and effectiveness of family constellations: A mixed methods single case study on depression symptoms, and panic attacks, with a polytraumatized individual»). Regarding articles 2 to 8 we intend to continue to apply to Project Catalyst's funds (i.e., F8 to F14).

Considering «Xe Currency Converter» website, at 13-11-2021: 1 Euro = 1.1442856 US Dollars (1 USD = 0,873908 EUR):

• TM1: $11,534.40 (€10,080.00): 20 hours per week X 12 weeks = 240 work hours X $48.06 per hour (i.e., €42 per hour).
• TM2: $10,435.88 (€9,120.00): 20 hours per week X 12 weeks = 240 work hours X $43.48 per hour (i.e., €38 per hour).
• TM3: $343.29 (€300.00).
• TM4: $411.94 (€360.00): 6 hours at W10, plus 6 hours at W11, plus 12 hours at W12 = 24 work hours X $17.16 per hour (i.e., €15.00 per hour).

HOW THIS PROJECT MAY IMPACT CARDANO

1. ADA's promotion by giving a 10% discount on FC consultations (including in session packages) to all our service users, if they pay with ADA.
2. ADA's promotion by giving a 5% discount on our FC classical psychotherapists course (in all the four modalities of payment) if it is paid with ADA.
3. Emphasize Cardano, Project Catalyst, and ADA in our website, several social networks (including at the coming metaverses) and in press releases (about our studies) as a positive, inclusive, secure, and innovative organization that is striving to decentralize applications, systems, and societies.
4. Emphasize Cardano's humanitarianism facet, as a catalyst of innovative and effective psychotherapies, that contribute to the improvement of global mental health.
5. Interest of other novel, and effective psychotherapies founders, therapists, teachers, and researchers, on the Project Catalyst, Cardano and ADA.
6. Emphasize Cardano's contribution to psychoemotionally healthier communities.
7. Despite our service users are mostly Portuguese speakers, and despite our information disclosures will be mostly made in Portuguese, it should be considered that Portuguese language is the sixth-most spoken language, by about 270 million speakers.

DEFINING SUCCESS

1. Conclusion of the project as planned (i.e., after 3 months).
2. Publication of the paper in a relevant scientific journal (after 6-9 months).
3. Wider acceptance, and use (by the general population) of FC as classical psychotherapy (measured in the number of peer-reviewed articles published at 3-month intervals) (after 2 years).
4. Decrease of depression symptoms in most of FC's service users (measured with psychometric, and possibly with biological tests, gauged by the articles mentioned at points 2 and 3) (after 2 years).
5. Increase of researchers' interest in FC, potentially contributing to the increase in the use of FC's by the general population (measured in the number of peer-reviewed articles published at 3-month intervals) (after 3-4 years).
6. Contribution of FC to the mitigation of worldwide escalating of depression, and to gains in work productivity (e.g., less absenteeism and presenteeism), and in the consequential reduction on global economy costs associated with depression (measured in meta-analysis, metasynthesis, and literature reviews) (after 4-5 years).
7. Implementation and continuing dissemination of the seven abovementioned points that may impact Cardano (after 6 months).

Success at points 3-6 are contingent of several factors (e.g., continuing receiving of funds, more research teams invested on FC, public interest on FC, official recognition of FC scientificity). Therefore, success at these points are highly subjective. Nevertheless, we will keep working hard to achieve success as we strongly believe that blockchain technology and cryptocurrency, can positively contribute to living in psychoemotionally healthier societies.

Additionally, and perhaps more importantly, children of mental healthier parents, will develop in more healthy environments, and, potentially, will become mentally healthier adults.

In an idealistic socialmacroscenario, psychotherapies will be just sporadically used (e.g., after a traumatic event). But, there is a long path to walk. And of course, FC alone will not solve the depression global escalation's problem. Yet, FC can be a part of a global developing effective innovative psychotherapies that, together, may contribute to a better quality of life. And Cardano can support this potential ubiquitous progress.

POTENTIAL HINDERING FACTORS ON THE PATH TO SUCCESS

We are aware that the path to success is not linear, without threats nor obstacles. Hence, we must also consider potential hindering factors on that trail. Especially because, in their beginning, many of the existent psychotherapies faced criticism and strong opposition. And of course, as FC's success increases, it must be ready to face threats and antagonism.

In our work, we built all the necessary components of a psychotherapy. We are also governed by a code of ethical conduct in scientific research and a code of ethics and deontology for classical FC psychotherapists (created by ourselves) and we are subject to the deliberations of the ICI's Ethics Committee, which has its own regulations.

Yet, more quality research is needed to strengthen the scientificity of FC. And, this is the domain where we want to engage more, because a strong body of a high quality scientific research is a robust argument against criticism. Nevertheless, we use (not spurious criticism, but) quality criticism as an opportunity to improve, and propel FC's practice and research to higher quality standards.

WHAT MAY HAPPEN AFTER THIS EFFORT

After this two-years project we have (at least) five more publications to publish:

1. Inferential inductive retrospective mixed-methods study on the womb's psychic life, and family psychodynamics, made with FC phenomenological approach.
2. FC effects on our service user's alexithymia, assessed with TAS-20 (Toronto Alexithymia Scale).
3. FC effects on students' volunteers' alexithymia, assessed with TAS-20 (Toronto Alexithymia Scale).
4. General Theory of Psychic Traits: a novel theory of personality that integrates several psychology theories.
5. Stages of the Psychotherapeutic Process: specific care and techniques for dealing with service users, according to the stage of the psychotherapeutic process they are in.

Notes:

• Points 4 and 5 are based, and inspired, on our phenomenological-inductive psychotherapeutic work with FC.
• About fifty percent of the work with these five potential publications is also already done.

Cardano & Mental Health: Two important securities, to live in a healthier and wealthier world.

REFERENCES

[1] Rehm, J., & Shield, K. D. (2019). Global burden of disease and the impact of mental and addictive disorders. Current Psychiatry Reports, 21(2), 1-7. https://doi.org/10.1007/s11920-019-0997-0

[2] Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., ... & Murray, C. J. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(9995), 743-800. https://doi.org/10.1016/S0140-6736(15)60692-4

[3] Su, Y., D'Arcy, C., & Meng, X. (2021). Research Review: Developmental origins of depression–a systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry, 62(9), 1050-1066. https://doi.org/10.1111/jcpp.13358

[4] Bueno-Notivol, J., Gracia-García, P., Olaya, B., Lasheras, I., López-Antón, R., & Santabárbara, J. (2021). Prevalence of depression during the COVID-19 outbreak: A meta-analysis of community-based studies. International journal of clinical and health psychology, 21(1), 100196. https://doi.org/10.1016/j.ijchp.2020.07.007

[5] The Lancet Global Health (2020). Mental health matters. The Lancet. Global Health, 8(11), e1352. https://doi.org/10.1016/S2214-109X(20)30432-0

[6] Ramos, S., & Ramos, J. A. (2019). Process of Change and Effectiveness of Family Constellations: A Mixed Methods Single Case Study on Depression. The Family Journal, 27(4), 418-428. https://doi.org/10.1177/1066480719868706.

[7] Ramos, J. A., & Ramos, S. (2021). Process of change and effectiveness of family constellations: "On the verge of divorce, I glimpse my finitude." A mixed methods single case study on suicidal ideation. The Humanistic Psychologist. Advance online publication. https://doi.org/10.1037/hum0000242

[8] Hellinger, B. (2003). Bert Hellinger on scientific research about Family Constellations. Training in Family Constellations as developed by Bert Hellinger. Penzberg, Germany.

[9] Hunger, C., Weinhold, J., Bornhäuser, A., Link, L., & Schweitzer, J. (2015). Mid‐and long‐term effects of family constellation seminars in a general population sample: 8‐and 12‐month follow‐up. Family Process, 54(2), 344-358. https://doi.org/10.1111/famp.12102

[10] Jafferany, M., Capec, S., Yaremkevych, R., Andrashko, Y., Capec, G., & Petrek, M. (2019). Effects of family constellation seminars on itch in patients with atopic dermatitis and psoriasis: A patient preference controlled trial. Dermatologic Therapy, 32(6), e13100. https://doi.org/10.1111/dth.13100

[11] Weinhold, J., Hunger, C., Bornhäuser, A., Link, L., Rochon, J., Wild, B., & Schweitzer, J. (2013). Family constellation seminars improve psychological functioning in a general population sample: Results of a randomized controlled trial. Journal of Counseling Psychology, 60(4), 601–609. https://doi.org/10.1037/a0033539

[12] Alonso, Y. (2005). Las constelaciones familiares de Bert Hellinguer: un procedimiento psicoterapéutico en busca de identidad. International Journal of Psychology and Psychological Therapy, 5(1), 85-96. https://dialnet.unirioja.es/servlet/articulo?codigo=1180953

[13] Talarczyk, M. (2011). Family Constellation Method of Bert Hellinger in the context of the Code of Ethics for Psychotherapists. Archives of Psychiatry and Psychotherapy, 13(3), 65-74.

[14] Thielbörger, R. (2014). Systemische Arbeit mit Familien. Ein kritischer Vergleich zwischen Bert Hellinger und Virginia Satir [Systemic work with families. A critical comparison between Bert Hellinger and Virginia Satir], München: GRIN Verlag.

APPENDIX 1

Facebook

https://www.facebook.com/san.jor.ramos/ («friends» page, 4.649 connections, plus 764 followers); https://www.facebook.com/sandraejorge (authors page, 1.600 followers), https://www.facebook.com/groups/namaste4ever (events group, 6.100 members), https://www.facebook.com/groups/cf.lisboa/ (FC Portuguese group, 2.066 members), https://www.facebook.com/groups/family.constellations.global (FC English group, 721 members) https://www.facebook.com/toppsic (page on psychology, 11.000 followers), https://www.facebook.com/constelacoes.f (page on FC, 18.248 followers), and https://www.facebook.com/ici.org.pt (ICI page with 1.933 followers).

Total Facebook connections: 47.081.

Twitter

https://twitter.com/ici_org_pt (73 followers).

Instagram

https://www.instagram.com/sanjorramos/ (authors page, 853 followers) and https://www.instagram.com/ici.org.pt/ (151 followers).

Total Instagram connections: 1.004.

Linkedin

https://www.linkedin.com/in/ankhsj/ (17.681 connections).

ResearchGate

https://www.researchgate.net/profile/Sandra-Ramos-Jorge-A-Ramos (106 followers).

Academia.edu

https://ispa.academia.edu/sej (956 followers).

Total social networks connections: 66.901. Of course, this number is lower, due to duplications or even triplications (i.e., the same person belongs to more than one of our social networks). Therefore, a more realistic number may be around 50.000.