Moving beyond medication: Suzanne So explores new treatment techniques

12 October 2016

Dr Suzanne Ho-Wai So focuses on the role of reasoning biases and their effects in the development of and recovery from delusions, with the hope of improving treatment efficacy for psychosis. She is also enthusiastic in promoting early intervention for psychosis.

So is an Assistant Professor at the Department of Psychology at the Chinese University of Hong Kong. Having graduated with a BA in Experimental Psychology at the University of Oxford and an MSSc in Clinical Psychology at the Chinese University of Hong Kong, So spent a number of years as a practising clinical psychologist in Hong Kong, and completed a PhD at the Institute of Psychiatry, King’s College London.

Medication and therapy

In the past, severe mental disorders (such as psychotic disorders and bipolar disorders) were treated purely with medication. However, people respond differently to medications and in the case of anti-psychotics, 25-50% of people do not respond well - and still experience delusions and/or hallucinations.

With this in mind, So’s particular focus is on how underlying psychological problems can affect the maintenance of psychotic symptoms and their treatment response. Specifically, the role of reasoning biases in the patient’s ability to cope with their condition.

Through research, first at Kwai Chung Hospital, then at Tai Po Hospital and Castle Peak Hospital, So found that patients with flexible thinking respond better to pharmaceutical and psychological treatment. Therefore, by helping patients to change the way they think and respond to experiences through methods such as Cognitive Behavioural Therapy (CBT) and reasoning training alongside medication, the likelihood of effective treatment is optimised. So and her team completed the first clinical trial on reasoning training in 2015, and the second is now being run.

CBT is a psychological technique that challenges the deeply rooted, emotion-filled thoughts that pepper our internal dialogue and can be a source of anxiety. These “automatic thoughts” are believed to often be the root cause of changes in behaviour and emotion, resulting in those afflicted withdrawing emotionally or lashing out. 

For example, in a conversation with a friend, someone with depression or anxiety may think to themselves, “She’s not talking much, I must be boring and unlikeable.” CBT trains the patient to counteract this automatic, unpleasant thought with something more reassuring and realistic, like telling themselves “She’s probably just had a long day at work or is worried about an upcoming meeting.” 

While originally developed for people suffering from depression, CBT has found usefulness in treating everything from substance abuse to bipolar disorder and obsessive compulseive disorder, often used in conjunction with medication.

Mental  health in Hong Kong

Although So’s primary focus is now research and teaching, she continues to see clients. This is demanding of her time, but as So says, it fuels her research interests as she can constantly feed everything that she learns from her clinical practice back into her research efforts.

Dr Suzanne So

This is particularly important in Hong Kong, where there is not yet enough local data to support practice, therefore it’s absolutely integral that clinical practice is evidence based and feeds back into research.

Another issue that Hong Kong faces is the relatively small number of practising clinical psychologists. So suggests that, apart from increasing the number of clinical psychologists, one longterm solution to this is to train more assistants to take ownership of certain aspects of treatment. This will enable more scope for service dissemination. Before this can happen, however, strict evidence-based protocols, a supervisory system, and continuous education need to be established so that treatment is always carried out correctly and effectively.

Clinical practice can be challenging. At times a patient may not realise that they have a disorder. However, often, after following a treatment plan for a period of time, they realise the difference that the treatment has had on their outlook and quality of life. Treatment, as far as So is concerned, is about empowering the patient.

So is particularly enthusiastic about the positive effects support in a group can play in a patient’s life. Shared experiences are a large part of any illness and by bringing groups together, a sense of communal support and mutual understanding develops, along with a sense of ownership, which is key to treatment. So has seen evidence of this in the treatment of patients with bipolar disorder, depression, and psychotic delusions.

Another challenge that So faces is common to many in the scientific and technology fields: the ever-quickening pace of development. This is, of course, a positive thing overall, but it’s important to ensure that clinical research continues to focus on the person as a whole. As So whole-heartedly believes, psychology is more than just behaviour - it is connected to the brain. Therefore research on a disorder must always be considered within the context of the whole person.

Dr Suzanne Ho-Wai So obtained her BA in Experimental Psychology and MSSc in Clinical Psychology at the University of Oxford and the Chinese University of Hong Kong respectively. She then served as a clinical psychologist at the Early Assessment Service for Young People with Psychosis (E.A.S.Y.) in Hong Kong, providing psychological assessment and interventions for hundreds of patients suffering from psychosis and their families. So has developed a strong interest in the psychological understanding of psychotic symptoms such as delusions, and completed a PhD on this topic at the Institute of Psychiatry, King’s College London. She is currently an Assistant Professor at the Department of Psychology, the Chinese University of Hong Kong. Dr So received a Croucher Scholarship in 2009.

To view So’s personal Croucher profile, please click here.

For more information on the E.A.S.Y. programme, please click here.