By Jen Laskey
While your doctor usually asks the questions during an exam, you can respectfully and proactively take charge, too. In fact, asking the right questions can make a big difference in the way you manage your bipolar disorder. Your health is important both to you and to your doctor, so don’t hesitate to inquire about any topic you feel is relevant to your condition, whether it’s a question about your bipolar diagnosis, something regarding your bipolar medication, curiosity about complementary or alternative therapies for bipolar disorder, or concern about your emotional health, your financial health, or any other lifestyle issue.
Engaging in a dialogue with your doctor will help educate you about bipolar disorder and the treatment options available to you, and it’ll give your doctor a better sense of who you are and how bipolar disorder is affecting your health and your life. With the lines of communication open, you and your doctor will be able to develop the best treatment plan for your individual needs.
But remember, your time with your doctor is limited, so be sure to arrive at your appointment prepared and ready to discuss bipolar disorder and the questions that are important to you. Start by:
Researching bipolar disorder. It’s a good idea to get a better understanding of bipolar disorder before your appointment. Through research, you may even be able to answer some of your own questions. Visit Everyday Health’s Bipolar Disorder Center, the Depression and Bipolar Support Alliance, the National Institute of Mental Health, and MedlinePlus.
Strategizing. Your family doctor may not be able to answer all your questions about bipolar disorder; some may be better addressed by a psychotherapist or psychiatrist who specializes in treating people with bipolar disorder. Discuss this with your doctor, set up a plan for addressing your concerns, and follow up with a specialist, as directed by your doctor. You can also do additional research of your own.
Keeping records. Consider keeping a journal about your bipolar disorder between visits to the doctor, and share any relevant information with your doctor, such as changes in mood or behavior and how well your medicine is working. Taking notes during your appointments will help you remember important details after your visit. Alternatively, you may consider bringing a recording device or inviting someone to accompany you and take notes.
General Bipolar Disorder Questions
If you haven’t yet been formally diagnosed with bipolar disorder, talk to your doctor about arranging an evaluation with a specialist, such as a physician, psychologist, or psychiatrist with experience in diagnosing and treating mood disorders.
Once you have a formal diagnosis, your doctor will give you information about the condition and recommend a course of treatment. You may have questions or concerns about your diagnosis and how bipolar disorder will affect your health and your life. Consider asking your doctor the following:
What type of bipolar disorder do I have? How severe is it? Can you explain the disorder to me?
What is the best method (or combination of methods) of treatment for bipolar disorder?
Does bipolar disorder change with age? Do people ever outgrow it?
How will bipolar disorder affect me over the long term?
What are the key components for successfully managing the challenges of bipolar disorder?
Are there other types of medical or mental health specialists who should be involved in my care?
When might hospitalization be beneficial or necessary?
Should I (or a member of my family) alert you if there are any changes in my behavior?
What kind of changes do you want to be informed about?
What should I do if I feel I’m in crisis or need emergency help?
Mood stabilizers, like lithium, or anticonvulsant drugs are commonly prescribed to help manage the symptoms of bipolar disorder. Your doctor may also recommend other types of medication, such as antidepressants and antianxiety and antipsychotic drugs. It is important to understand the medication your doctor is prescribing. Ask your doctor about it, read the insert the pharmacy includes with your prescription, and take the medication as directed by your physician. Knowing how your medication is supposed to work will help you evaluate its effectiveness and whether it’s the right medication for you. Here are some questions you may want to ask your doctor about bipolar disorder medications:
Do I need medication, or can I be treated effectively without it?
What types of medications are used to treat the manic and depressive mood swings of bipolar disorder?
How often and for how long will I need to take this medication?
Is there medication that I can take on an as-needed basis?
What type of drug are you prescribing for me, and how does it work?
Where can I get more information about this drug?
How will the medication make me feel, and how will I know if it’s working?
When can I expect to notice improvements in how I feel?
What are the risks if I don’t take my medication as directed, or if I forget to take it?
How has this medication been tested? Are there any recent clinical studies on it?
What should I do if I experience any side effects? Are there any that may require me to call a doctor? Are there any that may require me to stop taking the medication immediately?
Is this drug habit-forming?
Can I take this on an empty stomach, or should it be taken with food?
Could this medication interact with other medication I’m taking?
Are there any foods, drinks (such as alcohol), vitamins, herbal supplements, or over-the-counter drugs that I should avoid while taking this medication?
Can other conditions affect or be affected by my medication? What if I have a family history of heart disease?
What is electroconvulsive therapy (ECT)? Is it still used to treat bipolar disorder?
Complementary and Alternative Therapies
Doctors often recommend a combination of therapies to treat the symptoms of mania and depression. In addition to your medication, you may consider complementary or alternative therapies, such as practicing meditation, taking a yoga class, or trying a dietary supplement. Ask your doctor whether any of these options might be beneficial for you:
Are there any complementary or alternative therapies I should consider?
Do any clinical trials or research support these complementary or alternative therapies?
Do you recommend any herbs or other natural supplements, like omega-3 fatty acids or Saint John’s wort?
Bipolar disorder can take a toll on your emotional health and your relationships, but your doctor can help you find ways to cope with the emotional stress, manage your manic and depressive symptoms, and handle the impact bipolar disorder is having on your relationships. Psychotherapy, in particular, can help people with bipolar disorder recognize changes in their personality that may signal an oncoming mood swing. It can also help with other challenges, such as manic episodes, spending sprees, substance abuse, and withdrawal during depressed phases. Ask for a referral to a good therapist or support group and find out what else you can do to improve your emotional health while living with bipolar disorder.
Should I seek any emotional support from a support group or a therapist? Can you give me some referrals?
How will I know if my therapist is right for me?
Will I need to see both a psychologist and a psychiatrist? If so, why?
What is cognitive-behavioral therapy? Am I likely to benefit from this type of therapy?
Is social rhythm therapy effective at helping people with bipolar disorder improve their relationships and organize their daily routines?
How should I explain my condition to my spouse, family, and friends? What, if anything, should I say to my boss and co-workers?
How can my family and friends help me? Are there specific things I should ask of them?
What should I do if I feel I’m being discriminated against at work or school?
What should I do if I feel that I can’t keep up at work or school? What accommodations can I ask for? Where can I get more information about work- and school-related issues?
How is my condition likely to affect my relationships, and what can I do to improve my situation?
Health and Lifestyle Concerns
Maintaining a healthy lifestyle is one of the best ways to keep yourself in good shape. Participating in a physical fitness regimen, following a balanced diet, getting adequate rest and sleep, quitting smoking, moderating your alcohol consumption, and avoiding substance abuse of any kind can all contribute to your overall health. Check with your doctor to see whether you need to make any lifestyle changes or whether there’s anything he or she recommends that you do at home, work, or school to help you better manage your bipolar disorder:
Do I need to make any changes in diet, exercise, or how much I rest?
Can stress, drinking alcohol, smoking, or using drugs affect my condition?
Are there any activities I should avoid?
Should I make any special accommodations for school, home, or my work?
Can you recommend any good books, magazines, organizations, or online resources that focus on bipolar disorder?
The costs associated with your bipolar disorder treatment will have an effect on your finances. It’s crucial to find ways to balance your physical health with your financial health. Ask your doctor about ways in which you may be able to offset the cost of your treatment.
Will my medication be covered by my health insurance plan?
About how much will my medication cost?
Is there a generic version of the medication that would be more affordable? If not, are there other, equally effective medications that are available as generics?
Do you have any samples or discount coupons for my prescription?
If I need to be hospitalized, will the hospital accept my insurance? How much of my care can I expect to be covered? If my hospitalization is not covered by insurance, will I have any payment alternatives?
Are there separate fees or charges at the hospital for doctors, therapists, caretakers, or anything else? If so, what kind of charges can I expect?
If I choose a complementary or alternative therapy, is it likely to be covered by my insurance? If not, what kind of out-of-pocket costs can I expect?
Additionally, people with bipolar disorder sometimes get themselves into financial straits during manic phases in which they go on spending sprees or gamble. If this is a concern for you, consult your doctor or therapist and ask:
What can I do to control my spending during my manic highs?
How can I get help for a gambling problem?
By Dennis Thompson Jr.
Lots of people consider a pint of ice cream the perfect cure for the blues. Others indulge in sugary snacks as a way to get an energetic high. But for people with bipolar disorder, sugar and other simple carbohydrates may harm more than help.
Carbohydrate cravings in bipolar patients are legendary, so much so that increased intake of sugary treats is considered a clue to bipolar disorder during diagnosis. People who are depressed munch on sugary snacks to make themselves feel better and then, in the throes of a manic high, mindlessly devour high-carb junk food.
The question is, should those with bipolar disorder put the brakes on sugar intake?
Bipolar Disorder: Sugar and the Brain
Blood sugar and carbohydrate intake are very important to the brain. Your brain runs on glucose and depends on carbohydrates to supply the energy it needs. But for bipolar patients, carbohydrate intake also prompts the production and release of important neurotransmitters. The body produces tryptophan, an amino acid that the brain converts into the neurotransmitter serotonin. Serotonin creates a feeling of calm and well-being and reduces depression. So people with bipolar disorder are indulging in a form of self-medication when they eat sugary snacks during depressive lows or manic highs.
Doctors believe that people use this natural reaction to try to ease their bipolar symptoms when they have depression or mania. Eating large amounts of sugar can soothe a deep depression. It also can take the edge off a manic high.
But compulsive sugar intake is not an exact form of treatment, and people who eat too much sugar may find their mood swinging wildly — a terrible prospect for people with bipolar symptoms. They also face an inevitable “crash” following the intake of simple carbohydrates like sugar. Sugary foods burn hot and fast through the body, and their effects on brain chemistry and other bodily processes tend to be immediate, intense, and abrupt.
Bipolar Disorder: Getting the Right Carbs
Bipolar patients should not cut carbohydrates out of their diet. Because they are linked to the mood-controlling neurotransmitters, carbohydrates are important to managing bipolar symptoms. Instead, swap out simple sugars in the diet for more complex carbohydrates. Complex carbohydrates burn slow and long, ensuring a more controlled release of neurotransmitters to the brain. Complex carbohydrates are also healthier for you overall, keeping your blood glucose levels more stable and preventing the development of type 2 diabetes.
To help eliminate sugar cravings and maintain good blood sugar levels and healthy brain chemistry, you should:
Eat more fruits, vegetables, and whole grains, which are rich in complex carbohydrates.
Be sure to eat enough protein, which can improve alertness without the rush of a sugar high. Lean meats, poultry, fish, beans, and low-fat dairy products are good, healthy sources of protein. Poultry, oil-rich fish, baked potatoes, beans, oats, nuts, and seeds are protein sources that have the added benefit of being rich in tryptophan and can help the brain produce serotonin in a controlled, healthy fashion.
It might help to create a food and mood journal for keeping track of when you eat, what you eat, and any abrupt changes in mood you experience. These notes could hold the key to determining if certain foods are influencing your bipolar symptoms in a positive way.
By Rick Nauert PhD Senior News Editor
A new study suggests a dose-response relationship among playing violent video games and aggressive and hostile behavior, with negative effects accumulating over time.
Investigators discovered people who played a violent video game for three consecutive days showed increases in aggressive behavior and hostile expectations each day they played. They also found that those who played nonviolent games showed no meaningful changes in aggression or hostile expectations over that period.
Although other experimental studies have shown that a single session of playing a violent video game increased short-term aggression, this is the first study to show long-term effects from playing violent video games, said psychologist Dr. Brad Bushman, co-author of the study.
“It’s important to know the long-term causal effects of violent video games, because so many young people regularly play these games,” Bushman said.
“Playing video games could be compared to smoking cigarettes. A single cigarette won’t cause lung cancer, but smoking over weeks or months or years greatly increases the risk. In the same way, repeated exposure to violent video games may have a cumulative effect on aggression.”
Study results are published online in the Journal of Experimental Social Psychology and will appear in a future print edition.
In the study, researchers told 70 French university students that they would be participating in a three-day study of the effects of brightness of video games on visual perception.
They were then assigned to play a violent or nonviolent video game for 20 minutes on each of three consecutive days.
Investigators assigned the violent games “Condemned 2,” “Call of Duty 4″ and then “The Club” on consecutive days (in a random order). Those assigned the nonviolent games played “S3K Superbike,” “Dirt2″ and “Pure” (in a random order).
After playing the game each day, participants took part in an exercise that measured their hostile expectations. They were given the beginning of a story, and then asked to list 20 things that the main character will do or say as the story unfolds.
For example, in one story another driver crashes into the back of the main character’s car, causing significant damage. The researchers counted how many times the participants listed violent or aggressive actions and words that might occur.
Students in the study then participated in a competitive reaction time task, which is used to measure aggression. Each student was told that he or she would compete against an unseen opponent in a 25-trial computer game in which the object was to be the first to respond to a visual cue on the computer screen.
The loser of each trial would receive a blast of unpleasant noise through headphones, and the winner would decide how loud and long the blast would be. The noise blasts were a mixture of several sounds that most people find unpleasant (such as fingernails on a chalk board, dentist drills, and sirens).
In actuality, there was no opponent and the participants were told they won about half the trials.
Researchers discovered that, after each day, those who played the violent games had an increase in their hostile expectations. In other words, after reading the beginning of the stories, they were more likely to think that the characters would react with aggression or violence.
“People who have a steady diet of playing these violent games may come to see the world as a hostile and violent place,” Bushman said. “These results suggest there could be a cumulative effect.”
Investigators believe this may help explain why players of the violent games also grew more aggressive day by day, agreeing to give their opponents longer and louder noise blasts through the headphones.
“Hostile expectations are probably not the only reason that players of violent games are more aggressive, but our study suggests it is certainly one important factor,” Bushman said.
“After playing a violent video game, we found that people expect others to behave aggressively. That expectation may make them more defensive and more likely to respond with aggression themselves, as we saw in this study and in other studies we have conducted.”
Students who played the nonviolent games showed no changes in either their hostile expectations or their aggression, Bushman noted.
He said it is impossible to know for sure how much aggression may increase for those who play video games for months or years, as many people do.
“We would know more if we could test players for longer periods of time, but that isn’t practical or ethical,” he said. “I would expect that the increase in aggression would accumulate for more than three days. It may eventually level off.
“However, there is no theoretical reason to think that aggression would decrease over time, as long as players are still playing the violent games,” he said.
Source: Ohio State University
By Margarita Tartakovsky, M.S.
I love learning about the creative processes and daily habits of people who’ve given us great gifts, everything from powerful writing to awe-inspiring art to beautiful symphonies.
So I was excited to pick up a copy of Mason Currey’s book Daily Rituals: How Artists Work. In it, Currey shares the everyday routines of writers, composers, painters, playwrights, poets, philosophers, filmmakers, scientists and other artists — 161 in total.
In his introduction, he notes that Daily Rituals is “about the circumstances of creative activity, not the product; it deals with manufacturing rather than meaning.” His goal, he says, is “…to show how grand creative visions translate to small daily increments; how one’s working habits influence the work itself, and vice versa.”
Daily Rituals is a fascinating glimpse into some of the greatest minds, and the habits and practices that are integral to their creative process.
For instance, take exercise. For many of the individuals, it was (and is) indispensable. Spanish artist Joan Miró exercised vigorously. (He worried about suffering another severe depression, which he did as a young man.)
According to Currey, his routine included: “boxing in Paris; jumping rope and Swedish gymnastics at a Barcelona gym; and running on the beach and swimming at Mont-roig, a seaside village where his family owned a farmhouse, to which Miró returned nearly every summer to escape city life and recharge his creative energies.”
Novelist and writer Haruki Murakami has said that “physical strength is as necessary as artistic sensitivity.” In 1981, when he had just started working as a professional writer, Murakami led a sedentary life and smoked as many as 60 cigarettes a day. But he revised his unhealthy lifestyle. Currey writes:
He soon resolved to change his habits completely, moving with his wife to a rural area, quitting smoking, drinking less, and eating a diet of mostly vegetables and fish. He also started running daily, a habit he has kept up for more than a quarter century.
Oliver Sacks, a physician, professor and author of several bestselling books, including The Man Who Mistook His Wife for a Hat, prefers swimming, after he meets with his analyst at 6 a.m. “Swimming gets me going as nothing else can, and I need to do it at the start of the day, otherwise I will be deflected by busyness or laziness.”
For Tchaikovsky, long daily walks were essential to his creative process. The weather conditions didn’t matter. According to Tchaikovsky’s brother:
Somewhere at sometime he had discovered that a man needs a two-hour walk for his health, and his observance of this rule was pedantic and superstitious, as though if he returned five minutes early he would fall ill, and unbelievable misfortunes of some sort would ensue.
Others also followed superstitions. Truman Capote had to write in bed. In 1957 he told The Paris Review: “I am a completely horizontal author.” He’d write longhand using a pencil and then type up the final copy, balancing the typewriter on his knees. He had other superstitions.
He couldn’t allow three cigarette butts in the same ashtray at once, and if he was a guest at someone’s house, he would stuff the butts in his pocket rather than overfill the tray. He couldn’t begin or end anything on Friday. And he compulsively added numbers in his head, refusing to dial a telephone number or accept a hotel room if the digits made a sum he considered unlucky. “It’s endless, the things I can’t and won’t,” he said. “But I derive some curious comfort from obeying these primitive concepts.”
Ernest Hemingway had certain interesting idiosyncrasies, as well. Despite popular belief, he didn’t start his work by sharpening 22 number-two pencils. But he did write standing up, “facing a chest-high bookshelf with a typewriter on top, and on top of that a wooden reading board”; and “compose his first drafts “in pencil on onionskin typewriter paper laid slantwise across the board.”
When his work was progressing well, he’d move to the typewriter. When it wasn’t, he’d switch to answering letters.
Maya Angelou is particular about her work area. She’s said that she likes to keep her home pretty. “[A]nd I can’t work in a pretty surrounding. It throws me.” So she works in hotel or motel rooms. In a 1983 interview she shared her routine:
…I keep a hotel room in which I do my work – a tiny, mean room with just a bed, and sometimes, if I can find it, a face basin. I keep a dictionary, a Bible, a deck of cards and a bottle of sherry in the room. I try to get there around 7, and I work until 2 in the afternoon. If it’s going well, I’ll stay as long as it’s going well. It’s lonely, and it’s marvelous. I edit while I’m working. When I come home at 2, I read over what I’ve written that day, and then try to put it out of my mind. I shower, prepare dinner, so that when my husband comes home, I’m not totally absorbed in my work. We have a semblance of a normal life. We have a drink together and have dinner. Maybe after dinner I’ll read to him what I’ve written that day. He doesn’t comment. I don’t invite comments from anyone but my editor, but hearing it aloud is good. Sometimes I hear the dissonance; then I try to straighten it out in the morning.
B.F. Skinner, the founder of behavioral psychology, not surprisingly, treated his work as a lab experiment. (Would you expect anything less?) According to Currey, Skinner conditioned “himself to write every morning with a pair of self-reinforcing behaviors: he started and stopped by the buzz of a timer, and he carefully plotted the number of hours he wrote and the words he produced on a graph.”
So what’s the takeaway from these daily rituals?
They’re as varied and interesting as the great minds who followed them (and follow them today). And despite their great work, many still worried about their progress, struggled with creative blocks and experienced constant self-doubt (like William James and Franz Kafka).
So if you’re regularly second-guessing your work, take heart. You’re among an illustrious group. But I hope you don’t simmer in your self-doubt for too long. There’s work to be done.
by Dave Nussbaum
Jerry Seinfeld is not a fan of the check-at-the-end-of-the-meal-system. When you sit down to a meal, Seinfeld explains in the opening monologue of The Stock Tip, you’re hungry and money has no value to you. “You’re like the ruler of an empire,” ordering indiscriminately, “‘More drinks! Appetizers! Quickly, quickly! It will be the greatest meal of our lives!’” But at the end of the meal, the check comes. Now you’ve eaten, you’re anything but hungry, and you’re mystified by the total. “‘What is this?’” people ask, passing the check around the table, “‘Does this look right to you? We’re not hungry now – why are we buying all this food?’”
A new book, just out last month, by social psychologists Elizabeth Dunn and Michael Norton, tells us that there’s plenty of good research to back up Jerry’s complaint. The book, Happy Money, Dunn told me over the phone, aims to “get people to stop and ask, ‘is spending this money going to make me happier?’” Across five chapters, the book offers specific (but flexible) research-based strategies to help people maximize the happiness they get out of their money in their daily lives. Among their recommendations: spend money on others, invest in experiences instead of material goods, and when you do spend money on yourself, try to make it a treat.
But the advice that backs up Jerry’s dissatisfaction is summed up by the title of the book’s fourth chapter, Pay Now, Consume Later. The underlying idea is that because spending money can be painful, paying detracts from people’s enjoyment of an experience. Imagine you go out to a fancy sushi restaurant for your anniversary and every time you reach for a piece of a delicious dragon roll the waiter comes over and ask you to fork (or should it be chopstick?) over three dollars. So, rather than pay-as-you-go, Dunn and Norton suggest that people will be happier if they can separate the pleasure of an experience, like a meal or a vacation, from the pain of paying for it.
Beyond separating payment from an experience, Dunn and Norton also explain that people are better off paying for something first and consuming it later – and, if possible, much later. That’s why paying at the end of a meal will make people less happy than paying at the beginning, and they may be happiest if they can pay for their meal well in advance.
One reason paying at the end makes people less happy is based on what Nobel Prize-winning psychologist Daniel Kahneman calls the peak-end rule – when people think back on an experience, their memory is largely determined by its peak (the high or low point of the experience) and its end. So ending a meal with the check rather than, say, a delicious desert, can undermine people’s whole memory of the experience (Paul Rozin has done some research specific to meals and the peak-end rule that I discuss here).
A second reason not to end with the check, as Jerry’s rant implies, is that by the end of the meal, most of the joy of the experience is behind you. As he puts it, “you’ve got the pants open, you’ve got the napkins destroyed, cigarette butt in the mashed potatoes.” You’re paying for something that’s in the past when, according to Dunn and Norton, you’d be much better off if the pleasant experience you were paying for were still to come.
The third reason not to pay at the end is that you’re likely to end up paying for more food than you actually needed because ordering it was so painless. As Jerry says, “before you eat, money has no value.” Sure, people may occasionally recoil at an item that looks expensive on the menu, but because they don’t have to pay the bill until later, the price often fails to stop people from ordering way more than they need.
The obvious solution to Jerry’s problem seems to be moving the check to the beginning of the meal. That would be an improvement, Dunn told me, but there’s still on hurdle to clear: hunger. Even if people pay up front (which should improve their tendency to over-order) the problem is, in Jerry’s words, “you don’t care about money when you’re hungry.” As experience (and research) confirms, people buy more food when they’re hungry (a brand new study by Brian Wansink finds that people buy more high-calorie foods when hungry as well). So even in the pay-at-the-beginning system people will often end up overspending and have leftovers at the end of the meal. That might not be the worst thing in the world, but there is an even better solution: Pay in advance.
The idea might not be suited for trips to the drive-thru window at Burger King, but for a visit to a nice restaurant on a special occasion, it might be nice if you could pay in advance. That would help you get around all the problems with paying-at-the-end-system, and (as long as you aren’t hungry when you place the order) it would improve on the pay-at-the-beginning-system, too. But wait, there’s more! When you pay in advance, not only will the meal be more likely to feel free once it rolls around, you’ll also get the additional benefit of enjoying the anticipation of the meal. This is what Dunn and Norton call the “drool factor.” While you count down the days until your special meal, you’ll get the pleasure of imagining how wonderful it will be.
Some restaurants, like Grant Achatz’s Alinea in Chicago, have already adopted the pay-in-advance-system. Alinea sells “tickets” for meals as far as two or three months in advance. When you show up you’ve been dreaming about the meal for weeks and, when you’re done, there’s no bill to pay. Alinea, it seems, has infused their thinking with the wisdom of French novelist Gustave Flaubert who wrote that, “Pleasure is found first in anticipation, later in memory.” I’m not sure how Jerry would feel about waiting that long – he, George, and Elaine couldn’t even make it through a 22-minute episode before giving up in The Chinese Restaurant – but it would probably be better than getting the check at the end.
Anxiety Disorder Test: Do I Have An Anxiety Disorder?
Written by Natasha Tracy
Dr. Peggy Drexler
Author, research psychologist and gender scholar
When Heather began her career as a literary agent, she’d often greet her clients much as she would her friends: with a loose hug or a quick kiss on the cheek. She did not discriminate with her affections; it didn’t matter if the client was a much older gentleman or a woman around her age. And though she was a naturally affectionate person, she administered these greetings with actual professional purpose: “A hug or a cheek kiss always seemed to be a way to foster intimacy and connection, whereas a handshake was so formal and cold,” she said. “I thought a more familiar approach would help us establish closeness and trust” — vital, she thought, to the agent-writer relationship.
But over the years, Heather began to wonder if this hyper-familiarity might in some way undermine how these clients saw her. Did it make her seem childish? Too girly? Was she subconsciously using these greetings as flirtations? Her male colleagues certainly didn’t embrace their female clients nearly as freely, especially not the older ones, and they seemed to establish trusting relationships just fine.
Though it’s not entirely accurate to say that women are more affectionate than men, according to Gallup polls, that stereotype still prevails in the minds of most Americans. And indeed many women — and men — do embrace the professional embrace, hugging clients or colleagues in place of the traditional handshake. This is especially true as the American workplace has grown more casual. At the same time, working women are consistently coached in how to act “less girly,” and more “like men” in order to get ahead. Included among the advice: Handshake, not hug.
In Lean In, as Facebook COO Sheryl Sandberg encourages women to fight against unfair double standards, the message, in many places, appears to be that downplaying femininity is a good idea for those looking to be taken seriously. “Leaning in” includes being direct and voicing opinions. It also includes giving a firm handshake. This is, after all, how the men do it.
Still, there is proof that handshakes can be an effective way of forging a bond. A December 2012 study published in the Journal of Cognitive Neuroscience reported that a firm handshake increases the likelihood of a positive reaction, while diminishing the likelihood of a negative reaction. At the same time, there is also evidence, including from a 2010 study published in the journal Emotion that looked at the power of touch among teammates, that shows gentle or supportive touch can engender feelings of affection, help create a sensation of trust, and reduce levels of the stress hormone cortisol. The bottom line: Handshakes are effective, but hugs are, too.
When Lola began her new job as a department head at a custom publisher, she found that a quick hand on a staffer’s shoulder or elbow made delivering criticism more palatable. “Establishing a physical connection made difficult conversations easier for me and, I believe, them,” she told me. “I felt like I could see a difference in how information was received when I made it more personal, versus when I stood back, with folded arms, in a more ‘professional’ manner.” Though she would never do so in the office, whenever she ran into staffers outside of work, she was quick to give a hug or kiss. At the same time, she often wondered if such affection coming from a male boss might have come across as creepy or condescending. “I was aware that, as a woman, this was a tool I could use,” she said. “Did it make me any less serious, or effective, as a boss? I don’t think so. If being female made this method of interacting more acceptable, I welcomed it — with open arms, you could say!” Just because a hug wasn’t something a man would, or could, do didn’t mean Lola’s use of such affection diminished her effectiveness as a leader.
Which brings us to the real issue here: That is, challenging the idea that women need to behave more like men in order to get respect in the workplace, or make professional gains. Workplace style is entirely individual, and every female action needn’t be compared to its male counterpart. Women are women, men are men, and everyone’s different regardless of gender.
And just as the male workplace style shouldn’t be considered the superior one, the female-administered workplace hug or kiss isn’t right for everyone. Jenna, an investment banker, did not like to kiss, or be kissed by, clients, but found that avoiding doing so made her seem uptight and unfriendly. “I used to step backwards if I saw a hug or cheek kiss coming, trying to be subtle, but it was clear that this only offended people,” she said. “But I felt so awkward with the closeness.” Instead, she practiced being warmer with her handshakes, so that those clients who expected more familiarity received it, while Jenna was able to stay true to herself.
Striving for gender equality both in and out of the workplace doesn’t mean women should be striving to emulate, “overtake,” or actually be men. Whatever women choose to do — hug, kiss, handshake — it’s key to embrace the choice and approach the movement with confidence and ease. In the end, it’s less about the point of contact than about the attitude behind it.
By Carla Naumburg
At least once a week one of my friends or family members jokingly accuses me of mindless parenting. Chances are, they’re right. I first became interested in mindfulness and mindful parenting because I was unhappy with how often I was reacting to my daughters out of frustration, anger, or boredom. They’d whine or dawdle or throw tantrums or do something that is completely normal for a preschooler or toddler to do, and more often than not, I would snap or even yell at them.
I’m a year into my mindfulness practice, and I can honestly tell you that I still do snap and yell at my girls.
The difference is that now I have tools. Instead of constantly repeating a cycle of conflict and apologies, I know I can choose a more intentional way to engage with my kids. I am getting better at catching myself (sometimes before I lose my patience, sometimes right as it is happening, and sometimes well after the fact), taking a few deep breaths, and making a choice to respond differently. Sometimes I spend much of the day repeatedly reminding myself to breathe (and yes, I do feel like a bit of a crazy person on those days, probably because I am a bit of a crazy person on those days) because that’s what it takes to get me through each moment.
When I do lose it, I am less likely to berate myself for not being a better mother, which was my common reaction in the past. I used to convince myself that I was the only mother on the planet who yelled at her children, and I would sink into a place of deep shame and regret. Those negative feelings made it virtually impossible for me to come to a place of kindness towards myself and my kids.
Now, I try to forgive myself and remember that each moment is a new opportunity to make a different choice in how I want to respond to myself and my daughters. I try to remember that when I can create a little space in the middle of everything, I can choose which thoughts and behaviors I want to hang on to, and which I want to let go of.
I’m not sure how different it all looks from the outside (hence, my friends’ comments), but my internal experience is significantly improved. Most of the time.
Ask any mindfulness practitioner (even the experts, who will likely be the first to tell you that there’s no such thing as an expert in mindfulness) and they will tell you that none of us can be mindful all of the time. It’s not about being some super calm zen Mama as your little Tasmanian Devils are swirling around you. Mindfulness is a practice, a choice we make over and over again to keep coming back to the present moment, to the place in which we stop, breathe, and find space to make a different choice, no matter how far we have strayed.
By Dr. Jennifer Kromberg
Most of my patients are pushed into therapy by what they see as a problem – maybe it’s an eating disorder or a specific relationship issue like mistrust or infidelity. Many of these patients simply want the problem to go away. But a study recently published in the journal Advances in Life Course Research reinforces the idea that it’s rarely that easy. Many of your current problems aren’t the result of your current circumstances and instead require looking deeper into the transformative experiences of your childhood for anything that might resemble a long term fix.
Specifically, researchers Eva-Maria Merz and Suzanne Jak used results from the 3,980-person Netherlands Kinship Panel Study to show that the quality of your childhood relationships with your parents affects the quality of your romantic relationships as an adult. That might not be a newsflash, but the study also shows exactly what it is in your early patterns of attachment to your parents that predicts good and bad relationships now.
They started with a soup of factors that included a person’s childhood attachment to mother and father, childhood stressful relationship with mother and father, quality of the current romantic relationship, current family ties, and current loneliness. And, basically, they asked what was related to what, in other words, which – if any! – things in your past lead to which things in your present?
As you might expect, everything was related to loneliness. That is, everything except having a stressful relationship with your mother! It turns out that as long as you had the background of attachment to your mother – reliability, closeness, and supportiveness – you could also have fought with her, without these fights hurting your chances for healthy adult relationships or increasing your chance of loneliness. The same wasn’t true of fathers: fighting with dad was bad. In fact, it was this positive side of mom – how attached you were to her – that was the study’s best overall predictor of your current relationship quality, strength of family ties and loneliness. Really: kids who were attached to mom tend to experience good things as adults.
The aspects of attachment to mom that were most important in this study were “experiences and memories of the mother as a reliable resource in problem solving, as supportive, a close relationship partner, and understanding,” the authors write.
What’s especially interesting, if not especially surprising is that these early attachments matter at all. Your adult life including romantic relationships and feelings of loneliness may be the products of patterns created long ago. You do not ping and pong through life simply in the moment of your present experiences and instead interpret and react to these experiences as interpreted through the lens of your past.
As you look for current solutions, I suggest you first look to the problems of your past instead of simply focusing on the problems in front of you.
I’d love to add your voice to the conversation! Please get in touch via the comments on this page or at the social media links below.
By Lisa Helfend Meyer – Family Law Attorney
According to the latest U.S. Bureau of Labor Statistics, approximately 70.5 percent of mothers are now in the workforce. Not only are the number of working moms at near record levels, but also nearly 30 percent of working wives now outearn their working husbands, making them the primary breadwinners while dad is more frequently at home with the kids. These statistics have led to dramatic reversals in who gets primary custody and spousal support (aka alimony) when couples divorce.
Not so long ago, moms (working or not) almost always got the kids, while dads paid child support and alimony. It comes as a shock to many divorcing working moms that the tide is turning and dads whether or not they are the primary caretakers are being awarded at a minimum 50 percent because they don’t work.
While assuming the breadwinner role was a comfortable arrangement during the marriage, this situation can have consequences for a mother contemplating divorce. More often than not, the working mom is doing double duty in the family. In addition to her job outside the home, she is likely performing substantial childcare duties. She gets the kids up and ready for school, arranges playdates with friends, helps with homework, and organizes kids’ sports and other extra-curricular activities. This mom manages her kids’ schedule with the same precision that she brings to her professional life. Yet pursuing her professional dreams and financial success can put her at a distinct disadvantage in divorce if she has not physically been at home during the day. The hard reality is that while mom may be “doing it all” at home and in the workplace, it is dad who is being rewarded because he is physically at home during the day — even if he is not performing the majority of caretaking responsibilities.
Parental roles and responsibilities were once very traditional and the court’s decisions reflected those roles. Mom got the house and kids; dad got the business, paid support and spent Saturdays at Disneyland. In the 1980s, in recognition of the growing number of women in the workplace and fathers assuming more parental responsibility, a trend towards 50/50 custody became more the norm.
Today in some camps, the pendulum has swung with some psychologists and family law courts favoring children having one primary caregiver, especially when a child is very young. Judges want to know who is the hands-on parent and who spends more time with the kids. If the father is seen to have assumed this role during the marriage, it’s likely that the court will maintain the status quo when awarding custody, giving the father 50 percent of the time or in some instances the majority of the time. However other mental health professionals and courts believe that children are resilient and even if a father did not assume parenting duties during marriage, that a divorce can make better parents, and the court will award him 50 percent.
When the courts award primary or even 50 percent custody to the father, it’s often devastating for the mother. She feels like she is being penalized for working and having her children “taken away from her.” Even women who have reached the pinnacles of success in business get their identity through children and family, whereas men, for the most part, still get their identity from work. Unfortunately, society often stigmatizes the woman denied primary custody of her children. We wonder, what did a woman do “to lose” custody of her children.
While the courts can’t discriminate against a working parent and must be gender neutral, try telling that to the working mom who feels like the court has bent over backwards to favor the non-working father. In a practical sense courts do just that in an effort to appear “gender neutral.”
In my practice, I counsel many successful professional women on what they need to know and to do to achieve a custody arrangement that will be in the best interest of their children and be comfortable for them.
Avoid Going to Court
Nine times out of ten, it’s better to reach a custody agreement outside of the courtroom rather than having a judge decide your fate. Judges are pressed for time. Rather than examining subtle family dynamics, they may determine the best interests of the child by simply calculating work hours, school involvement and other factors that put the mom spending long hours at work at a disadvantage. If dad can devote more time to childcare and the present arrangement is working, the judge is unlikely to make a change in mom’s favor. Look for an attorney who has handled cases similar to yours and one with a track record in reaching successful custody settlements before going to trial.
Adjust Your Priorities
If you’re a working mom heading towards to divorce and want to pursue primary custody, I recommend adjusting your priorities to take on the role of custodial parent before the divorce. Instead of working 50 hours, consider cutting back on time in the office to devote more time to the kids. Strategies may include getting up a little earlier in the morning, bringing work home that can be done after hours, or investigating flex time arrangements with your employer. A word of caution, these changes have to be for real. Making them a month or two before filing for divorce will be seen as a ploy by the court.
Be Visible as a Caregiver
Are you a working mom who spends long hours in the office or on the road? Then it’s likely you aren’t as visible to teachers, the pediatrician and others who may end up testifying in court. It’s important to have your contributions recognized and documented. Using email and Skype to stay in touch with the school and teachers can help, but it’s also critical to have in-person face-time with the people involved with your child’s life. Again, you have to make it a priority to be present at parent/teacher conferences, doctor’s appointments, soccer practice, music lessons, etc. Document your lives by keeping a journal of important facts including the amount of time spent with children, activities you engage in, communications with teachers, concerns regarding the other parent, etc.
Don’t Be So Hard on Yourself
It’s impossible to give 100 percent to your career and 100 percent to your kids, so don’t beat yourself up if you aren’t able to give 100 percent to each facet of your life 100 percent of the time. You can still be a great mom. When you are traveling for work, communicate with your children daily by Skype or phone. If you are traveling during one week, try to spend more time with your children the following week or plan a special weekend outing or vacation.
See Your Ex as an Asset and not an Adversary
While your marriage may have ended in divorce, you and your ex can still be successful co-parents. As the other person who loves your kids as much as you do, your ex can be an asset and your best ally in raising your children. Divorce often makes dads better parents. Use the time your kids are with their dad to recharge your batteries and take care of yourself. This will enable you to be revitalized when your kids are with you and make the most of your time together.
As family law and the courts struggle to catch up with the changing needs of the American family, working mothers will have to rise to the custody challenges that working fathers have faced for decades.
By Janice Wood Associate News Editor
People who develop atrial fibrillation — a type of irregular heartbeat common in old age — may also be more likely to develop problems with memory and thinking, according to a new study.
“Problems with memory and thinking are common for people as they get older. Our study shows that, on average, problems with memory and thinking may start earlier or get worse more quickly in people who have atrial fibrillation,” said study author Evan L. Thacker, Ph.D., of the University of Alabama at Birmingham.
“This means that heart health is an important factor related to brain health.”
The study analyzed results from more than 5,100 people age 65 and older from four communities in the United States who were enrolled in the Cardiovascular Health Study.
Participants did not have a history of atrial fibrillation or stroke at the start of the study. They were followed for an average of seven years, taking a 100-point memory and thinking test every year.
Of the 5,150 participants, 552, or about 11 percent, developed atrial fibrillation during the study.
The researchers found that people with atrial fibrillation were more likely to experience lower memory and thinking scores at earlier ages than people with no history of atrial fibrillation.
For example, from age 80 to age 85 the average score on the 100-point test went down by about 6 points for people without atrial fibrillation. But the average dropped by about 10 points for people with atrial fibrillation, the researchers noted.
For participants ages 75 and older, the average rate of decline was about three to four points faster per five years of aging with atrial fibrillation compared to those without the condition, he added.
“This suggests that, on average, people with atrial fibrillation may be more likely to develop cognitive impairment or dementia at earlier ages than people with no history of atrial fibrillation,” he said.
Thacker noted that scores below 78 was suggestive of dementia. People without atrial fibrillation in the study were predicted to score below 78 points at age 87, while people with atrial fibrillation were predicted to score below 78 points at age 85, two years earlier.
“If there is indeed a link between atrial fibrillation and memory and thinking decline, the next steps are to learn why that decline happens and how we can prevent that decline,” said Thacker.
The study was published in the online issue of Neurology.
Source: American Academy of Neurology
In a study of the co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in early school-age children (four to eight years old), researchers at the Kennedy Krieger Institute found that nearly one-third of children with ASD also have clinically significant ADHD symptoms. Published in Autism: The International Journal and Practice (Epub ahead of print), the study also found that children with both ASD and ADHD are significantly more impaired on measures of cognitive, social and adaptive functioning compared to children with ASD only.
Distinct from existing research, the current study offers novel insights because most of the children entered the study as infants or toddlers, well before ADHD is typically diagnosed. Previous studies on the co-occurrence of ASD and ADHD are based on patients seeking care from clinics, making them biased towards having more multi-faceted or severe impairments. By recruiting patients as infants or toddlers, the likelihood of bias in the current study is significantly reduced.
“We are increasingly seeing that these two disorders co-occur and a greater understanding of how they relate to each other could ultimately improve outcomes and quality of life for this subset of children,” says Dr. Rebecca Landa, senior study author and director of the Center for Autism and Related Disorders at Kennedy Krieger. “The recent change to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to remove the prohibition of a dual diagnosis of autism and ADHD is an important step forward.”
Participants in this prospective, longitudinal child development study included 162 children. Researchers divided the children into ASD and Non-ASD groups. The groups were further categorized by ADHD classification according to parent-reported symptoms of ADHD on the Hyperactivity and Attention Problems subscales of the Behavioral Assessment System for Children-Second Edition, a standard assessment specifically designed to identify the core symptoms of ADHD.
Results revealed that, out of 63 children with ASD in the study, 18 (29%) were rated by their parents as having clinically significant symptoms of ADHD. Importantly, the age range for children in the study (four to eight) represented a younger and narrower sample than has been previously reported in published literature. “We focused on young school-aged children because the earlier we can identify this subset of children, the earlier we can design specialized interventions,” says Dr. Landa. “Tailored interventions may improve their outcomes, which tend to be significantly worse than those of peers with autism only.”
Researchers also found that early school-age children with co-occurrence of ASD and ADHD were significantly more impaired than children with only ASD on measures of cognitive and social functioning, as well as in the ability to function in everyday situations. They were also more likely to have significant cognitive delays (61 versus 25 percent) and display more severe autism mannerisms, like stereotypic and repetitive behaviors. The study findings suggest that children with the combined presence of ADHD and ASD may need different treatment methods or intensities than those with ASD only in order to achieve better outcomes.
Dr. Landa and her team recognize that this research supports the need for future prospective, longitudinal studies of attention, social, communication and cognitive functioning from the time that the first red flags of ASD are identified. Such research will lead to important insights about the relative timing of onset and stability of disruption to attention mechanisms and barriers to successful functioning in children with co-occurring ASD and ADHD.
By Therese J. Borchard Associate Editor
German psychoanalyst Eric Fromm said, “The task we must set for ourselves is not to feel secure, but to be able to tolerate insecurity.”
Everyone I have ever known — I take that back — every likable person I have ever known in this world has admitted to periods of sheer insecurity. They looked at themselves from the perspective of someone else — perhaps a person with no appreciation of their talents, personality traits, abilities—and judged themselves unfairly according to the perverted view.
I am terribly insecure much of the time. I grew up with bad acne, braces, and a twin sister who was in the popular group. The adolescent self-doubt had sticking power. At times I can pull off the image of a self-confident author and writer, but it usually lasts as long as the speaking event or lunch with my editor.
Lately the junior high inferiority complex has made a surprise visit, and I’m more insecure than usual. So here’s one of those lists that people are always writing — suggestions on what to do if you are feeling insecure, too.
1. Consider it beautiful.
Insecurity — vulnerability of spirit — is essentially humility, which is a divine quality. In fact, since pride is considered to be the origin of sin (Saint Augustine), then humility would be the greatest spiritual virtue. With insecurity, we admit that it’s not all about us, and that philosophy in this world of self-centeredness is quite lovely. Says Stephen Fry in “Moab Is My Washpot”:
“It’s not all bad. Heightened self-consciousness, apartness, an inability to join in, physical shame and self-loathing—they are not all bad. Those devils have been my angels. Without them I would never have disappeared into language, literature, the mind, laughter and all the mad intensities that made and unmade me.”
2. Read your self-esteem file.
A self-esteem file is a warm-fuzzy folder, but I really refuse to call it that because it sounds like I live in the land of the unicorns and fairies with retreats to the land of the rainbows and lollipops. It’s a collection of anything anyone has ever said, written, indicated that can be categorized as positive. Someone says something shallow like, “I like your shoes.” Sure, put it in there, with a note “I have good taste in shoes.” Another person mutters, “Dude, thanks for listening.” That goes in there as well: “I am a good listener.”
I suggest asking two or three of your best friends to list ten of your best qualities and put those in there to jumpstart the project. That’s what I did seven years ago. My therapist asked me to make a list of ten of my best qualities and I couldn’t do it. So she told me to ask my friends. I was embarrassed. Ashamed. Why should I need to do this? But my self-esteem file has saved me from weeks of self-loathing. Now it’s full of nice comments on my blog, emails, feedback from my books. I reach for it every time I feel a moment of insecurity coming over me.
3. Avoid people you feel insecure around.
I know this sounds like common sense, but it does require a bit of homework. Sometimes you have to rearrange your schedule, find a new route to work, take lunch at a different time, or compile a ton of excuses to have on hand. “I’m sorry I can’t go to happy hour with you guys. The truth is that your cliquish group does not make me happy. I have a better chance of getting happy by myself. Oh, and my dog needs to get groomed at 5 p.m. on a Tuesday night.”
You have to protect yourself. That should be your first priority for as long as you are feeling insecure, not convenience. Why torture yourself? If you think the popular group will notice, you’re wrong. Most likely they don’t care about you. But you won’t care that they don’t care if you are proactive about protecting yourself. Then, when you don’t feel as insecure, you can resume your old schedule or go to happy hour if you want and if your dog has been groomed.
4. Surround yourself with supportive people.
There are only a few people in my life who get me. Who really get me. When I’m insecure, I will drive 250 miles to see them, or squeeze a half hour into my hectic evening to talk to them on the phone. They remind me of what is good and unique about myself — maybe unorthodox and not at all appreciated by other folks — elements that contribute to my decent DNA. These people love that I have no filter, that I say whatever I am thinking out loud and therefore insult an average of two people every ten seconds. This character defect, they say, is refreshing!
Those trusted few are the voices of truth and we need as many voices of truth as we can get. “We’re going to have to let truth scream louder to our souls than the lies that have infected us,” writes Beth Moore in “So Long, Insecurity: You’ve Been a Bad Friend To Us.”
5. Know it’s invisible.
You figure everyone can see that you’re insecure. And that actually makes you feel more insecure. But here’s the wonderful truth. No one can see your insecurity. They are too worried about their own insecurity to notice your insecurity. Even when I think the world can see me shake – when I get really nervous or uncertain – few people can. Either that or they are lying to me when I call them on it. Do your friends look insecure when they are in a group of coworkers or with dysfunctional families? Nope? No one can see your insides but you.
5 Things To Do When You’re Feeling Insecure was originally published on Everyday Health in the Sanity Break blog.
So I was diagnosed with aspergers at the age of 7 and I had only a few of the symtoms. As I got older, the symtoms got milder and almsot all of them have dissapeered completly. Anywhay, heres why I think I don;t have aspergers
People with aspergers often lack social skills, wich often causes them to become shy, I was pretty shy as a child, but as I became a teenager, I came out of my shell more and more andnow, I’m still somewhat shy, but not notcabaly,[I will be turning 18 this year] Looking back on it, I thnik I was just natually shy, because I had somewhat average social skills, I was just to nervous to use them. About a year after my diagnosis, I started seeing a therapist, and I do not exzaggerage when I say this lady had NO CLUE what she was doing When I was in 5th grade, she put me in a social skills group to “help me read social cues”. I had NO PROBLEM reading social cues, wich also laeds me to bellieve I don;t have aspergers. I also have NO PROBLEM whith maintaining eye contact [something aspies struggle tremendously with] I do not take things literally[ another signs of aspergers] infact my friends say I understand jokes better than they do and they are NOT autistic.
Peopel with aspergers often exel in logical thinking, math, and science, but struggle with exepressing themselves emotionaly. I am the opposoite, I am AWFUL in math, I am more emiotional then logical and Im only average at science, but I am EXELLINT at expressing my emotions
When I was 12 I got a new therapist who was MUCH better than the old one. And seeing her lead me to be diagnosed with ADD which, I have to say, the diagnoses fits me like a glove, I would daydream in class, and I am very forgetful and disorganized. I am fairly inteligent for my age, but I am TERRIBLE at spelling, and reading is not my best subject eiter.
I have asked severeal peope lI know if they think I have aspergers and ADD. Pretty much everyone said I had ADD but I didn’t have aspergers. My friends were actually supprized I was ever diagonosed with aspergers. Alot of people in my class ask me If I have “dislexya” which I have NEVER heard of. So, do you think I have aspergers? Does dislexia cause similar symptoms to aspegrers? Am I only borderline aspergers? What do you think?
by Lisa Frederiksen
Coping with secondhand drinking | drugging is especially problematic for a young person because of the brain development that occurs from birth through one’s early 20s – especially if the parent or sibling’s drinking or drug use behaviors involved verbal, physical or emotional abuse. Why is this such a problem? Because it actually changes the way the brain works and in the case of substance abuse, those brain changes around childhood trauma become one of the five key risk factors for developing a substance abuse problem and/or an addiction.
For more on this concept, consider reading: “Secondhand Drinking, Secondhand Drugging,” “Childhood Trauma Leaves Lasting Marks on the Brain” and browsing through “The Adverse Childhood Experiences Study (ACEs)” website.
Affects of Coping with Secondhand Drinking | Drugging as a Young Person
In previous posts, such as: “How Teens Can Become Alcoholics Before Age 21,” I’ve written about how the brain’s developmental processes from ages 12 – 25 make a person’s brain especially vulnerable to developing a problem with alcohol abuse, even alcoholism.
The same is true of wiring coping skills for dealing with a family member’s substance abuse and/or substance addiction (alcohol or drugs); in other words, wiring skills to cope with secondhand drinking/drugging (SHDD) — coping skills such as those developed to “handle” a loved one’s verbal, physical or emotionally abusive drinking behaviors. Examples of these kinds of SHDD coping skills include retreating inside one’s mind or physically when confronted with abusive or scary drinking behaviors; carrying pent up, explosive rage that spills out in other situations because it cannot be expressed to the person abusively drinking/drugging for safety reasons; attempts to be especially “good” to make up for or “fix” the problem; or ….
When a person, especially a young person, does not understand drinking behaviors as a consequence of brain changes (and in the case of addiction, a brain disease) caused by the substance abuse, they think “it” (the behaviors) are their loved ones. Thus, they think their loved one’s behaviors are something they have to accommodate or thwart or believe, because, after all, it is their loved one! So they internalize — wire — coping skills to respond to the drinking behaviors.
As you’ve also likely read on this blog, the brain embeds brain maps (neurons talking to one another to produce a particular activity) for everything we think, feel, say and do — including how we cope with SHDD. The brain is especially vulnerable to how it wires these coping skills during the development that occurs from ages 12-25 — the time of brain maturity shown in the image below, a time-lapse of brain imaging studies reprinted with permission from Dr. Paul Thompson of UCLA’s Laboratory of Neuro Imaging.
Brain development occurring ages 12-25 makes a young person especially vulnerable to wiring unhealthy coping skills that they will carry throughout their life, unless and until, they understand that substance abuse / addiction causes brain changes and the resulting behaviors are not a reflection of them (the young person), they are the result of those brain changes that cause the drinking behaviors (further described in the “related posts” listed below).
The developmental brain changes occurring between ages 12-25 referenced above are related to:
1) Puberty. Puberty triggers new hormonal and physical changes, as well as new neural networks.
2) Continued development of the cerebral cortex (front area) — the “thinking” part of the brain. This involves neural networks wiring within the Cerebral Cortex — the idea of learning calculus vs. memorizing multiplication tables, for example. It also involves neural networks in the Cerebral Cortex writing to those in other areas of the brain — the idea of controlling emotions, which originate in the Limbic System, with logical thought, which originates in the Cerebral Cortex, for example.
3) “Pruning” and “strengthening” of neural networks. Pruning is when neural connections (i.e., brain cells talking to one another) that are not used or are redundant fall away (get “pruned”), and those that are used get strengthened, which makes the remaining neural connections more efficient (similar to the way an insulted cable wire works more efficiently than a non-insulated one). This concept is explained in more detail at The Partnership at Drug Free.org website, A Parent’s Guide to the Teen Brain.
Image: Thompson, Paul. Ph.D., Time-Lapse Imaging Tracks Brain Developing from ages 5 to 20, UCLA Lab of Neuro-Imaging and Brain Mapping Division, Dept. Neurology and Brain Research Institute, http://www.loni.ucla.edu/~thompson/DEVEL/PR.html Permission: Dr. Paul Thompson 5.7.09
By Traci Pedersen Associate News Editor
Mom’s Education Impacts Adult Kids’ Depression RiskA new study shows that children of women who didn’t graduate from high school have double the risk of experiencing major depression in early adulthood, compared to children of mothers who graduated.
“Our research indicates that a mother’s lack of high school education has a robust impact on her child’s risk of major depressive episode in early adulthood,” said senior author Amélie Quesnel-Vallée, Ph.D., of McGill University.
The higher risk of depression in children of mothers with less than a high school education could not be attributed to parental history of depression, early life adversity, or the children’s own education and income in early adulthood.
The study is the first in Canada to distinguish the impact of a mother and father’s education on depression in early adulthood.
For the study, researchers looked at a sample of 1,267 individuals from Statistics Canada’s National Population Health Survey.
Participants were first interviewed in 1994, when they were between 12 and 24 years old, and living with their parents. They were then followed for 12 years, and their risk of major depressive episode was assessed between the ages of 22 and 36.
“Depression in early adulthood strikes at a critical time,” said Quesnel-Vallée.
“An individual may be pursuing studies or apprenticeships, or starting a career or a family. A disruption caused by depression can potentially derail these events and have lifelong consequences.”
Interestingly, the father’s level of education has no impact.
“This, along with the fact that the effect of mother’s education was not explained by the children’s own education or income, suggests that mothers’ parenting skills may be at play here,” she said.
Alison Park, a researcher at the Institut National de Santé Publique du Québec who worked on the research for her master’s degree, said, “Education gives people practical skills, such as communication, analytical and problem-solving skills, as well as an increased sense of mastery.”
“A better-educated mother might be more confident in coping with difficulties arising from child-rearing. This increased confidence and feeling of self-mastery might serve as a model for her children.”
The research is published in the journal Social Psychiatry and Psychiatric Epidemiology.
Source: McGill University
By Traci Pedersen Associate News Editor
No Link Found Between ADHD Drugs and Future Substance AbuseChildren with attention-deficit hyperactivity disorder (ADHD) are far more likely than their peers to engage in serious substance abuse as teens and adults.
But do ADHD meds contribute to the risk?
In the most comprehensive research ever on this topic, UCLA psychologists found that children with ADHD who take medications such as Ritalin and Adderall are at no greater risk of using alcohol, marijuana, nicotine or cocaine later in life than kids with ADHD who don’t take these medications.
The researchers looked at 15 long-term studies, including data from three studies not yet published. The studies followed more than 2,500 children with ADHD from childhood into their teen and young adult years.
“We found the children were neither more likely nor less likely to develop alcohol and substance-use disorders as a result of being treated with stimulant medication,” said Kathryn Humphreys, a doctoral candidate in UCLA’s Department of Psychology and lead author of the study. “We found no association between the use of medication such as Ritalin and future abuse of alcohol, nicotine, marijuana and cocaine.”
The children had a mean age of 8 years old when the research began and 20 at the most recent follow-up assessments. They came from a broad geographical range, including California, New York, Michigan, Pennsylvania, Massachusetts, Germany and Canada.
“For parents whose major concern about Ritalin and Adderall is about the future risk for substance abuse, this study may be helpful to them,” Humphreys said.
“We found that on average, their child is at no more or less at risk for later substance dependence. This does not apply to every child but does apply on average. However, later substance use is usually not the only factor parents think about when they are choosing treatment for their child’s ADHD.”
The researchers report that children with ADHD are two to three times more likely than children without the disorder to develop serious substance-abuse problems in adolescence and adulthood, including the use of nicotine, alcohol, marijuana, cocaine and other drugs.
This new study does not oppose those results but finds that, on average, children who take stimulant medication for ADHD are not at additional risk for future substance abuse.
Ritalin is associated with certain side effects, such as suppressing appetite, disrupting sleep and changes in weight, said Steve S. Lee, a UCLA associate professor of psychology and senior author of the study.
“The majority of children with ADHD—at least two-thirds—show significant problems academically, in social relationships, and with anxiety and depression when you follow them into adolescence,” Lee said.
“For any particular child, parents should consult with the prescribing physician about potential side effects and long-term risks,” said Lee.
“Saying that all parents need not be concerned about the use of stimulant medication for their children is an overstatement; parents should have the conversation with the physician. As with other medications, there are potential side effects, and the patient should be carefully evaluated to, for example, determine the proper dosage.”
As the study participants get older, researchers will be able to study the rate at which they graduate from college, get married, have children and/or get divorced and to assess how well they function, Humphreys said.
As children with ADHD enter adolescence and adulthood, they typically fall into one of three groups of similar size, Lee said: one-third will have significant problems in school and socially; one-third will have moderate impairment; and one-third will exhibit only mild impairment.
The research is published in the journal JAMA Psychiatry, a psychiatry research journal published by the American Medical Association.
Source: JAMA Psychiatry
Seventy to 80 percent of children with ADHD respond to treatment with stimulants, so this is often the first line of defense. Doctors sometimes prescribe nonstimulants for the approximately 20 to 30 percent of children with ADHD who don’t respond to stimulant treatment.
There are over a dozen stimulant medications on the market, but here are the most common.
Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin, Focalin): The most widely-used drug therapy for ADHD and still the most common.
Lisdexamfetamine dimesylate (Vyvanse)
It seems strange that giving stimulants to an already hyper child could help, but researchers believe they may help adjust the levels of neurotransmitters in the brains of ADHD children. Stimulants can be prescribed in short-acting and long-acting forms, so your child may take medication as often as three times a day or perhaps only once a day. Medications come in pill, liquid, capsule and patch forms.
Most children experience some side effects, the most common being insomnia, decreased appetite, or weight loss. Occasionally, kids will experience irritability or a “rebound” effect when the medication wears off. Very rare side effects can include facial tics, which most often disappear with a lower dose or change in medication, and a reduced growth rate. Kids should be screened for any pre-existing heart conditions before starting stimulants.
There are two nonstimulants specifically for ADHD treatment in children.
Atomoxetine (Strattera): Strattera increases the levels of the neurotransmitter/hormone norepinephrine to the brain. Researchers think this chemical plays a key role in focus and attention. This drug may also reduce anxiety. Strattera can cause some rare but very serious side effects, including jaundice and other liver problems, and suicidal thinking.
Guanfacine (Intuniv): This newer form of Tenex, a drug for high blood pressure, was approved for ADHD treatment in fall 2009. Again, doctors are not really certain why it works, but it may help control behavior by affecting the prefrontal cortex, the area of the brain that serves as a check on our impulses. The most common side effects of Intuniv are tiredness and sleepiness. Other side effects may include low blood pressure and low heart rate, dizziness, fainting episodes and nausea.
There is no legitimate way to diagnose an infant with ADHD, but the American Academy of Child and Adolescent Psychiatry says that all of the following can be signs of a tendency to develop ADHD later.
Poor sucking/frequent feedings
Difficult to comfort/dislikes being held
Of course many babies exhibit these behaviors and do not go on to develop ADHD. They’re of more concern if the baby has other risk factors, such as a family history of ADHD or prenatal exposure to drugs, alcohol or cigarettes.
Diagnosing toddlers with ADHD is extremely controversial since developmentally, most lack impulse control and have short attention spans. However, children that will later be diagnosed with ADHD can exhibit these traits to the point where they are actually dangerous – hitting, taking toys, even dashing into the street – on an ongoing basis. Children with ADHD may have frequent and violent temper tantrums, and be poor sleepers and picky eaters as toddlers. (But please remember, none of these signs guarantees your child will have ADHD!)
Some parents do seek diagnosis and treatment for very young children with severe behavioral issues. But because the brain is still rapidly developing at this point and few psychiatric medications are approved for very young children since side effects can be severe and troubling, doctors are most likely to recommend only parental training and behavior modification.
In 2011, the AAP expanded its guidelines to diagnose children as young as age 4 in an attempt to provide evidence-based, specific recommendations for what some pediatricians were already doing unofficially: using Ritalin and other stimulants off-label to treat small kids with problems severe enough to get them expelled from preschool and wreak havoc on their families. Behavior modification therapy should be the first line of defense for preschoolers diagnosed with ADHD, with prescription medications like Ritalin to be tried at a low dose only if therapy is not effective on its own.
The vast majority of children are diagnosed with ADHD during the first few years of school when their inability to focus and lack of control make learning and social functioning difficult.
Children with ADHD may be rude, aggressive or inattentive in class. They are likely to forget assignments and lose materials. Many will fall behind because of ADHD behaviors or learning disabilities, which are common in children with ADHD. However, ADHD children can be extremely bright and may compensate, working feverishly to get good grades. Children with ADHD may have difficulty behaving appropriately on sports teams, at parties and on family outings. ADHD behaviors can cause family stress and strain parental relationships and marriages.
Once diagnosed with ADHD, children are most often treated with a combination of medication and therapy, however, some will only need one or the other. These therapies are effective in most children, but they’re not magic – many ADHD children will struggle more than their peers to succeed in school and social environments.
Early diagnosis and intervention is key to later success for ADHD children. Thanks to federal civil rights laws, public schools are required to provide accommodations or strategies and aids to enable children with ADHD to learn and compete with their non-ADHD classmates.
The Middle School Years
Many kids who have the inattentive type may be diagnosed for the first time around this age. Whether your middle schooler’s been recently diagnosed or not, an increasingly difficult curriculum and adolescent hormones can wreak havoc in the lives of ADHD kids (not to mention their parents!) Parents, teachers and doctors need to be ready to readjust treatment strategies, including changing medications and doses, and developing new methods for organizing more complex schedules.
Middle schoolers should also begin to take more responsibility for their decisions and therapy. Some experts recommend that kids take a “holiday” from medication if they want and see how it affects their lives and their school performance. Otherwise it can become an area of conflict with parents.
Behavioral therapy should also focus on strategies that kids, rather than parents, can employ to remember homework and materials. Color coded charts will give way to notebook or computer organizers.
Beyond Middle School
All teens are impulsive, but since ADHD kids can be even more so, the dangers that lurk for all teens — car accidents, drinking, drug abuse and irresponsible sex — are magnified for them. Experts used to think children outgrew ADHD in their teen years, but now research indicates that about 60% of children with ADHD will have the condition as adults, although symptoms become less severe over time. That’s why it is important for children to continue treatment and for parents to continue to advocate for their education. ADHD students may qualify for accommodations like extra time on standardized tests in high school and college.
Experts say teens who have learned how to schedule themselves and how to make appropriate decisions through therapy earlier in life will be less likely to struggle in school and with social relationships during the critical teen years. This will boost their self-esteem and lead to happier, healthier kids.
Eaing Disorders Information & Treatment Introduction
By John M. Grohol, Psy.D.
Table of Contents:
An Introduction to Eating Disorders
Symptoms of Anorexia Nervosa
Symptoms of Bulimia Nervosa
Symptoms of Binge Eating
Treatment of Eating Disorders
Tips for Friends & Family
Eating disorders are one of the unspoken secrets that affect many families. Millions of Americans are afflicted with this disorder every year, and most of them — up to 90 percent — are adolescent and young women. Rarely talked about, an eating disorder can affect up to 5 percent of the population of teenage girls.
Why are adolescent and young women so susceptible to getting an eating disorder? According to the National Institute of Mental Health, it is because during this period of time, women are more likely to diet to try and keep a slim figure and/or try stringent dieting. Certain sports (such as gymnastics) and careers (such as modeling) are especially prone to reinforcing the need to keep a fit figure, even if it means purging food or not eating at all.
There are three main types of eating disorders:
Anorexia (also known as anorexia nervosa) is the name for simply starving yourself because you are convinced you are overweight. If you are at least 15 percent under your normal body weight and you are losing weight through not eating, you may be suffering from this disorder.
Bulimia (also known as bulimia nervosa) is characterized by excessive eating, and then ridding yourself of the food by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. This behavior of ridding yourself of the calories from consumed food is often called “purging.”
A person who suffers from this disorder can have it go undetected for years, because the person’s body weight will often remain normal. “Binging” and “purging” behavior is often done in secret and with a great deal of shame attached to the behavior. It is also the more common eating disorder.
Eating disorders are serious problems and need to be diagnosed and treated like any medical disease. If they continue to go untreated, these behaviors can result in future severe medical complications that can be life-threatening.
Treatment of eating disorders nearly always includes cognitive-behavioral or group psychotherapy. Medications may also be appropriate and have been found effective in the treatment of these disorders, when combined with psychotherapy.
If you believe you may be suffering from an eating disorder or know someone who is, please get help. Once properly diagnosed by a mental health professional, such disorders are readily treatable and often cured within a few months’ time.
A person with an eating disorder should not be blamed for having it! The disorders are caused by a complex interaction of social, biological and psychological factors which bring about the harmful behaviors. The important thing is to stop as soon as you recognize these behaviors in yourself, or to get help to begin the road to recovery.
» Next in Series: Symptoms of Anorexia
Learn more about Eating Disorders…
Take one of our free online quizzes: Quick Eating Disorder Screening or the longer Eating Attitudes Test
Detailed diagnostic Anorexia, Bulimia, and Binge Eating Symptoms
Learn more about the Treatment Options available for Eating Disorders
Need more help or information? Check out our reviewed listing of Online Resources
Join Psych Central’s own Eating Disorder Online Support Group
Read the latest News & Research on Eating Disorders
Health Consequences of Eating Disorders
Back to the Eating Disorders Introduction
OCD Information & Treatment
By Wayne K. Goodman, M.D.
Washing handsObsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses. The majority of people with OCD have both obsessions and compulsions, but a minority (about 20 percent) have obsessions alone or compulsions alone (about 10 percent).
The person with OCD usually tries to actively dismiss the obsessions or neutralize them by engaging in compulsions or avoiding situations that trigger them. In most cases, compulsions serve to alleviate anxiety. However, it is not uncommon for the compulsions themselves to cause anxiety — especially when they become very demanding.
Examples of Obsessions and Compulsions
Common types of obsessions include concerns with contamination (e.g., fear of dirt, germs or illness), safety/harm (e.g., being responsible for a fire), unwanted acts of aggression (e.g., unwanted impulse to harm a loved one), unacceptable sexual or religious thoughts (e.g., sacrilegious images of Christ) and the need for symmetry or exactness.
Common compulsions include excessive cleaning (e.g., ritualized hand washing); checking, ordering and arranging rituals; counting; repeating routine activities (e.g., going in/out of a doorway) and hoarding (e.g., collecting useless items). While most compulsions are observable behaviors (e.g., hand washing), some are performed as unobservable mental rituals (e.g., silent recitation of nonsense words to vanquish a horrific image).
A hallmark of OCD is that the person recognizes that her thoughts or behaviors are senseless or excessive.
However, the drive can be so powerful that the person caves in to the compulsion even though she knows it makes no sense. One woman spent hours each evening sifting through the household trash to ensure that nothing valuable was being discarded. When asked what she was looking for, she nervously admitted, “I have no idea, I don’t own anything valuable.”
Some people who have had OCD for a long time may stop resisting their compulsive drives because they feel it’s just easier to give in to them.
Most OCD sufferers have multiple types of obsession and compulsion. Someone with OCD may complain primarily of obsessive-compulsive symptoms involving asbestos contamination, but a detailed interview may disclose that he /she silently counts floor tiles and hoards junk mail.
Learning More About OCD
How Do I Know if I Have Obsessive-Compulsive Disorder?
Specific Symptoms of OCD
The Course of Obsessive-Compulsive Disorder (OCD)
Distinguishing OCD From Other Conditions
Treatments for Obsessive-Compulsive Disorder (OCD)
Additional Treatment Options for OCD
Medications for Obsessive-Compulsive Disorder (OCD)
Online Resources for OCD
PTSD Information & Treatment
By Harold Cohen, Ph.D.
Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that follows experiencing or witnessing an extremely traumatic, tragic, or terrifying event. People with PTSD usually have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to.
PTSD, once referred to as “shell shock” or battle fatigue, was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. The event that triggers it may be something that threatened the person’s life or the life of someone close to him or her. Or it could be something witnessed, such as mass destruction after a plane crash.
Most people with posttraumatic stress disorder repeatedly re-live the trauma in the form of nightmares and disturbing recollections during the day. The nightmares or recollections may come and go, and a person may be free of them for weeks at a time, and then experience them daily for no particular reason. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Seeing things that remind them of the incident may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often very difficult.
PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. Symptoms may be mild or severe — people may become easily irritated or have violent outbursts. In severe cases, they may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was initiated by a person — such as a murder, as opposed to a flood.
Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A flashback may make the person lose touch with reality and reenact the event for a period of seconds or hours, or very rarely, days. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, usually believes that the traumatic event is happening all over again.
Posttraumatic stress disorder can be treated, usually with a combination of psychotherapy and medications (for specific symptom relief, such as for the common accompanying depressive feelings). People with PTSD should seek out a therapist or psychologists with specific experience and background in treatment posttraumatic stress disorder.
What Causes PTSD?
Symptoms and Diagnosis of PTSD
Differential Diagnosis of PTSD
Who is Typically Diagnosed with PTSD?
Treatment of PTSD
Myths and Facts about PTSD
Frequently Asked Questions about PTSD
Associated Conditions of PTSD
Two Stories of PTSD
PTSD: A Roller Coaster Life
This article is based upon a brochure published by the National Institute of Mental Health.
Overcome negative thinking and emotional barriers to life success
Published on May 1, 2013 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express
Have you spent a lot of time and money on psychotherapy or self-help books, yet you still feel stuck in unhealthy habits?. Unfortunately, verbal insight and understanding do not always lead to changing self-destructive behaviors (e.g. addictions, procrastination, angry outbursts) or removing distress. Knowing why you are depressed, anxious, or feeling pain doesn’t necessarily make you feel any better. However, if you get up and get active – walking, reaching out to friends, pursuing a hobby or creative activity, doing your yoga stretches, or even getting errands done, you will focus less on the negative feelings and they won’t last as long. Understanding what is most meaningful to you in life (such as your health, family, or work) and committing to taking specific, manageable actions to achieve your goals in these areas can put you back in the driver’s seat of your life.
Acceptance And Commitment Training
Acceptance and Commitment Therapy/Training (or ACT) is a short-term intervention used in psychotherapy or workplace settings. It combines principles of Mindfulness with techniques of motivation and behavior change. ACT can help you to break out of negative thought cycles, accept what you can’t control, stop running away from pain, and be more able to tolerate risk, failure, and uncertainty to reap the rewards of a meaningful, engaged life. It can help your career and health by teaching you how to handle negative emotions and overcome procrastination.
Some core principles of ACT are:
(1) Experiencing the Present Moment Directly
Similar to Mindfulness, ACT therapists use exercises to help you remain present and focused on the breath or your present thoughts and feelings, rather than trying to avoid them. Feelings are momentary, changing experiences in our bodies and minds. However, because of childhood learning experiences, we often develop judgments about them and what it means about us that we have them – such as “You’re depressed again – You’re such a loser!” When you focus on and describe the direct physical sensations of pain or anxiety (e.g., my chest feels tight), rather than feeling helpless or trying to distract yourself, you may realize that they are not going to kill you and that they will eventually pass. Watching feelings rise and fall in your body, gives you a sense of them as transient experiences, rather than as who you are in essence.
(2) Being Willing to Be Where You Are
Acceptance is often confused with passivity. In ACT terms, acceptance means “being willing to experience the present moment, even if it’s not what we would have chosen.” This also means accepting your life experiences and history, realizing you can never completely get rid of or make up for experiences of suffering. At the same time, you have a choice about what you do with your life now. You do not have to be so limited by old ways of thinking. Like any habit, change takes time and effort. Therefore, you will likely be uncomfortable for a while. It takes time to change your brain pathways and to have other people notice you are different and behave differently towards you. Like losing a lot of weight, you have to work hard for a long time before seeing noticeable results. Being willing means you no longer avoid uncomfortable thoughts, feelings, or situations by zoning out, not showing up, addictions, anger, or procrastinating. If you want to be healthier, you first need to be able to look at and experience how unhealthy you are right now. At the same time, you can commit to doing what you need to do in small bits, each day, to be a little bit healthier. Lifting the veil of self-deception can go a long way towards getting you focused on the right track.
(3) Separating Your Self From Your Thoughts
Your thoughts, feelings, and sensations are not who you are. ACT Training includes mindfulness, imagery, and language-based exercises to help you connect with your “observing ego” so you can observe your thoughts and experiences from a more objective vantage point.. Although your thoughts feel true, they are not necessarily the whole truth, because they are biased by your expectations from past experiences and self-definition. You do not need to let your thoughts and feelings determine your behavior. You can choose how to behave, based on your direct experience (what you see, hear, feel – independent of your judgments about these events) and your core values. You may think about a thought: “Is it kind? Is it truthful?,..” and so on. Based on the answer, you may choose to take the thought seriously or let it pass on by. Rather than changing the content of your thoughts, you can choose to change how you interact with them Thinking you are stupid or fat does not make you stupid or fat – it is just a passing thought in your head.
(4) Defining Your Core Values
Core values are the things in life that are most meaningful to us and that enrich our lives. They include such things as “Being healthy,” “Taking care of our families,” “Being honest and accountable,” or “Contributing to society.” When people come to therapy, they are often so overwhelmed with distress, feelings of self-pity or anger, or struggles with pain or addiction, that they have lost touch with what really makes them fulfilled. Even if they know “I want to be a good parent,” their day-to-day behavior may not reflect this because they are preoccupied with seeking escape from daily stress, thoughts about past, painful events, or trying to prevent an anticipated future threat. ACT therapists/trainers use imagery and writing exercises to help clients define their individual core values and gain motivation to reconnect with activities and people that enhance these values in our lives.
(5) Committing to Motivated Action
To live a meaningful, authentic life, you need to take risks, get out into the world, and tolerate uncertainty and anxiety. Exercises focus on setting manageable, attainable, meaningful goals – committing to taking specific, small steps that get you closer to your larger goals. The focus is on taking action, not expecting a particular result, since outcomes may be at least partially out of our control. To be successful is not necessarily to always feel happy or pain-free, but to live a full life despite the anxiety or pain. By facing what you fear, the fear will eventually lessen, and, even if it doesn’t, you will know you have done your best with what you have. This takes you out of the cycle of self-doubt, regret, and second-guessing yourself.
Who Can Benefit From ACT?
ACT, also known as Acceptance and Commitment Therapy/Training, when used in workplace settings, is a short-term intervention approach that has been used with substance abusers, people suffering from chronic pain and illness, patients with obsessive thoughts, anxiety, or depression. ACT works well with clients or employees who are tired of letting uncontrollable symptoms rule and want to take a more active role in defining and directing their own lives. I use ACT principles and interventions with almost every client to help them tolerate uncontrollable, stressful situations and focus on what they can change. ACT can create a basis for hope and help you tolerate the pain of changing.
According to SAMHSA’s Registry of Effective Programs,
“ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviors; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM-IV diagnoses, coping with chronic illness, and workplace stress).”
For more information about ACT, go to this link
Or watch this YouTube video by Dr Russ Harris:
About The Author
Melanie Greenberg, Ph.D. is a Clinical Psychologist, and expert on Mindfulness, Managing Anxiety, and Depression, Succeeding at Work,, and Mind-Body Health. Dr Greenberg provides workshops and speaking engagements for your organization and coaching and psychotherapy for individuals and couples
Visit her website:
Follow her on twitter @drmelanieg
Like her on Facebook www.fb.com/mindfulselfexpress
Read her Psychology Today blog & personal blog
By Lisa A. Miles
Families Could Help More in Treatment, If HIPAA Allowed ItWhy is it that families are kept so far out of the loop when it comes to a loved one’s health?
The quick, easy answer, of course, is the nation’s health insurance portability and accountability act (HIPAA). Physicians are able to share only certain information with the family unless the patient agrees to more. The problem is that the patient might be too elderly, addicted or mentally ill to cooperate or even understand what they are agreeing to (or simply stubborn).
Certainly individual civil liberties must be taken into consideration. This writer, in fact, is more than moderately liberal.
But there is a blurry but significant line that puts human wisdom to the test, as we evaluate true need for family assistance.
Beyond HIPAA’s ramifications, there are doctors who frankly don’t care to communicate with anyone other than the patient, no matter who they are allowed to talk to. As well, many estranged families may not be interested in the health of their kin.
But for those families of the mentally ill, alcoholic or addicted who want to help their loved one, they need to be able to communicate with clinicians, doctors, and therapists. Rather than just informing the treatment team of a loved one’s behaviors at home and not receiving a treatment team response, the family must be brought into the fold of treatment teams. In the wake of the school shooting in Newtown, Conn. in December 2012, nothing less is required.
HIPAA needs to be reworked. There needs to be an out clause granted to family members who obviously 1) are intelligently trying to work on their own coping strategies in a troubled family dynamic; 2) care about their ill family member; and 3) can offer the most significant information about the patient because of a shared living situation or close interaction.
Lloyd Sederer, MD, medical director of the New York State Office of Mental Health and adjunct professor at Columbia University Mailman School of Public Health, wrote a few weeks after the Newtown tragedy of families being the true first responders of psychiatric illness. How very true. And yet how shabbily they have been treated.
Anyone who has been around the block with a relative suffering from mental illness or related concerns — even those empowered with the great help of the National Alliance on Mental Illness and other advocacy organizations — knows how hard it still is dealing with treatment providers.
Who, after all, knows a patient’s symptoms better than the family who lives with someone exhibiting psychosis, neurosis, manipulative behaviors, or obsessive-compulsive mannerisms? Who directly witnesses what the patient may cleverly hide in a therapeutic session?
Should not symptoms drive treatment more than diagnosis? Symptoms, after all, are what delineate an individual as being functional, or not, in various scenarios. And should not families be given information on how to respond in ways that may actually help the patient?
Though there are so many more, these alone are perhaps the two most critical, simple means of understanding that families must demand to be brought into the fold, respected as harbingers of the most significant information about mentally ill and addicted loved ones who are suffering, for the most part, needlessly.
A simple questionnaire can help differentiate individuals experiencing normal age-related memory loss from those at risk for developing dementia, most notably by their orientation to time and patterns of repetitive speech, researchers found.
On the 21-item Alzheimer’s Questionnaire, patients having trouble remembering the day, month, year, and time of day were almost 18 times more likely to have amnestic mild cognitive impairment, a precursor to dementia, according to Michael Malek-Ahmadi, MSPH, and colleagues from the Banner Sun Health Research Institute in Sun City, Ariz.
Those who often repeated questions, statements, and stories on the same day also were at very high risk, the researchers reported online in BMC Geriatrics.
Distinguishing mild cognitive impairment, particularly when associated with memory loss rather than loss of other functional domains, can be clinically challenging and time consuming, and brief screening tools are sorely needed as the aging population expands, according to the researchers.
“Additionally, as new therapies for Alzheimer’s disease transition from being symptomatic to disease-modifying, identifying individuals who are at risk or in the earliest stages of the disease will be crucial in determining and improving disease outcome,” they wrote.
A pilot study by these researchers recently showed good sensitivity and specificity for the Alzheimer’s Questionnaire, with responses about various aspects of memory and related cognitive concerns being provided by caregivers or other informants.
To see if certain components of the questionnaire were particularly accurate in pinpointing these types of impairments, Malek-Ahmadi’s group compared responses among 47 patients who had been diagnosed with amnestic mild cognitive impairment and 51 controls who were participants in a program involving posthumous brain and body donation.
The diagnosis of cognitive impairment had been made clinically and with neuropsychological testing, with scores on verbal memory recall measures falling 1.5 standard deviations below normal ranges for age and educational attainment.
Cognitively normal participants all scored higher than 1.5 standard deviations on the neuropsychological tests.
The Alzheimer’s Questionnaire assesses memory, language, orientation, visuospatial competence, and functional capacity by a series of yes/no questions such as, “Does the patient have trouble remembering to take medications?”
On almost all questions, significantly more “yes” responses were seen for the cognitive impairment group.
Regression analysis determined that, along with repetitive speech and disorientation as to time, two other questions were highly predictive.
One was whether the patient has trouble dealing with financial matters such as paying bills, and the second was if the patient showed an impaired sense of direction, according to the researchers.
“These data indicate that problems with orientation to time, repeating statements and questions, difficulty managing finances, and trouble with visuospatial orientation may accompany memory deficits in amnestic mild cognitive impairment,” the researchers stated.
Empowering yourself to challenge your inner critic.
Published on April 18, 2012 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express
“You messed up again! “
“You should have known better!”
Of course it does! It’s that know-it-all, bullying, mean-spirited committee in your head. Don’t you wish they would just shut up already? I know I do!
The Committees in Our Heads
We all have voices inside our heads commenting on our moment-to-moment experiences, the quality of our past decisions, mistakes we could have avoided, and what we should have done differently. For some people, these voices are really mean and make a bad situation infinitely worse. Rather than empathize with our suffering, they criticize, disparage, and beat us down at every opportunity! The voices are often very salient, have a familiar ring to them and convey an emotional urgency that demands our attention. These voices are automatic, fear-based “rules for living” that act like inner bullies, keeping us stuck in the same old cycles and hampering our spontaneous enjoyment of life and our abilities to live and love freely.
Where Do the Voices Come From?
Psychologists believe these voices are residues of childhood experiences—automatic patterns of neural firing stored in our brains and dissociated from the memory of the events they are trying to protect us from. While having fear-based self-protective and self-disciplining rules probably made sense and helped us to survive when we were helpless kids, at the mercy of our parents’ moods, whims, and psychological conflicts, they may no longer be appropriate to our lives as adults. As adults, we have more ability to walk away from unhealthy situations and make conscious choices about our lives and relationships based on our own feelings, needs and interests. Yet, in many cases, we’re so used to living by these unwritten internal rules that we don’t even notice or question them. And we unconsciously distort our view of things so they seem to be necessary and true. Like prisoners with “Stockholm Syndrome,” we have bonded with our captors!
What Happens When the Committee Takes Charge of Our Lives?
If left unchecked, the committees in our heads will take charge of our lives and keep us stuck in mental and behavioral prisons of our own making. Like typical abusers, they scare us into believing that the outside world is dangerous, and that we need to obey their rules for living in order to survive and avoid pain. By following (or rigidly disobeying) these rules, we don’t allow ourselves to adapt our responses to experiences as they naturally unfold. Our behaviors and emotional responses become more a reflection of yesterday’s reality than what is happening today. And we never seem to escape our dysfunctional childhoods.
The Schema Therapy Approach
Psychologist Jeffrey Young and his colleagues call these rigid rules of living and views of the world “schemas.” Based on our earliest experiences with caregivers, schemas contain information about our own abilities to survive independently, how others will treat us, what outcomes we deserve in life, and how safe or dangerous the world is. They can also get in the way of our having healthy relationships in life, work, and love.
How Negative Schemas Affect Our Lives & Relationships
Young suggests that negative schemas limit our lives and relationships in several ways:
(1) We behave in ways that maintain them.
(2) We interpret our experiences in ways that make them seem true, even if they really aren’t.
(3) In efforts to avoid pain, we restrict our lives so we never get to test them out
(4) We sometimes overcompensate and act in just as rigid, oppositional ways that interfere with our relationships.
The Abandonment Schema – Diana’s Story
A woman who we will call Diana has a schema of “Abandonment.” When she was five years old, her father ran off with his secretary and disappeared from her life, not returning until she was a teenager. The pain of being abandoned was so devastating for young Diana that some part of her brain determined that she would never again allow herself to experience this amount of pain. Also, as many children do, she felt deep down that she was to blame; she wasn’t lovable enough, or else her father would have stuck around; a type of ‘Defectiveness” schema.
Once Diana developed this schema, she became very sensitive to rejection, seeing the normal ups and downs of children’s friendships and teenage dating as further proof that she was unlovable and destined to be abandoned. She also tried desperately to cover up for her perceived inadequacies by focusing on pleasing her romantic partners, and making them need her so much that they would never leave her. She felt a special chemistry for distant, commitment-phobic men. When she attracted a partner who was open and authentic, she became so controlling, insecure and needy that, tired of not being believed or trusted, he eventually gave up on the relationship.
Diana’s unspoken rule is that it is not safe to trust people and let relationships naturally unfold; if she relaxes her vigilance for even a moment, the other person may leave. In an effort to rebel against her schema, she also acted in ways that were opposite to how she felt; encouraging her partner to stay after work to hang out with his friends, in an attempt to convince herself (and him) that she was ultra-independent. This led to chronic anger and feelings of dissatisfaction with her partner’s lack of understanding of her needs; she neither understood nor acknowledged her own role in the cycle.
What Can We Do?
Schema Therapy can help Diana (and her partner) understand how their schemas result in ways of relating to self and others that are repetitive, automatic, rigid, and dysfunctional. By acknowledging and empathically connecting with her unresolved fears and unmet needs, Diana can become more flexible and free. These new theories and therapies can help to heal couples conflict and individual problems such as anxiety, depression, personality disorders, grief, and childhood trauma. The schema concept helps us understand how early childhood events continue to influence adult relationships and mental health issues. We need to recognize their influence, pay attention to what our automatic inner voices are saying, and (with professional help, if necessary), begin to free ourselves from their grip.
Schema Therapy Website: http://www.schematherapy.com/
About The Author
Melanie Greenberg, Ph.D. is a licensed Clinical Psychologist, and expert on Mindfulness, Positive Psychology, Emotion Regulation, and Relationships. Dr Greenberg provides workshops and speaking engagements for organizations, life, weight loss, or career coaching, and psychotherapy for individuals and couples.
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May 21, 2013 — Children who have suffered maltreatment are 36% more likely to be obese in adulthood compared to non-maltreated children, according to a new study by King’s College London. The authors estimate that the prevention or effective treatment of 7 cases of child maltreatment could avoid 1 case of adult obesity.
The findings come from the combined analysis of data from 190,285 individuals from 41 studies worldwide, published this week in Molecular Psychiatry.
Severe childhood maltreatment (physical, sexual or emotional abuse or neglect) affects approximately 1 in 5 children (under 18) in the UK. In addition to the long-term mental health consequences of maltreatment, there is increasing evidence that child maltreatment may affect physical health.
Dr Andrea Danese, child and adolescent psychiatrist from King’s College London’s Institute of Psychiatry and lead author of the study says: “We found that being maltreated as a child significantly increased the risk of obesity in adult life. Prevention of child maltreatment remains paramount and our findings highlight the serious long-term health effects of these experiences.”
Although experimental studies in animal models have previously suggested that early life stress is associated with an increased risk of obesity, evidence from population studies has been inconsistent. This new study comprehensively assessed the evidence from all existing population studies to explore the potential sources of inconsistency.
In their meta-analysis, the authors were able to rule out specific factors which might explain the link — they found that childhood maltreatment was associated with adult obesity independently of the measures or definitions used for maltreatment or obesity, childhood or adult socio-economic status, current smoking, alcohol intake, or physical activity. Additionally, childhood maltreatment was not linked to obesity in children and adolescents, making it unlikely that the link was explained by reverse causality (i.e. children are maltreated because they were obese).
However, the analysis showed that when current depression was taken into account, the link between childhood maltreatment and adult obesity was no longer significant, suggesting that depression might help explain why some maltreated individuals become obese.
Previous studies offer possible biological explanations for this link. Maltreated individuals may eat more because of the effects of early life stress on areas of the developing brain linked to inhibition of feeding, or on hormones regulating appetite. Alternatively, maltreated individuals may burn fewer calories because of the effects of early life stress on the immune system leading to fatigue and reduced activity. The authors add that these hypotheses will need to be directly tested in future studies.
Dr Danese adds: “If the association is causal as suggested by animal studies, childhood maltreatment could be seen as a potentially modifiable risk factor for obesity — a health concern affecting one third of the population and often resistant to interventions.
He concludes: “Additional research is needed to clarify if and how the effects of child maltreatment on obesity could be alleviated through interventions after maltreatment has occurred. Our next step will be to explore the mechanisms behind this link.”
By Therese Borchard
“There is no question that the most common destructive behavior affecting depressed patients, barring suicide, is alcoholic or any substance abuse,” writes J. Raymond De Paulo Jr., M.D., of the Johns Hopkins School of Medicine in his book “Understanding Depression.” He does not mince words on the seriousness of alcoholism and drug addiction to the recovery of depression:
Nothing makes the job of a psychiatrist treating depression and manic depression harder than alcohol and drugs. The most difficult treatment situations that I have ever seen patients and families confront, since I started my training in psychiatry twenty-seven years ago, occur when the patients’ illnesses are complicated by what we call addictive behaviors. While I have seen many successful outcomes, none were easy to achieve.
Here are some important facts you need to know about the relationship between depression and substance abuse: why addiction impedes recovery from depression and why depression sustains drug dependence.
1.Depressive illness makes people prone to destructive behaviors.
2.Destructive behaviors make depression and mood disorders worse.
3.Depressed people drink and use drugs to self-medicate.
4.There is a greater risk of abusing alcohol or drugs by people who have moderate depression than those who have depression that is severe.
5.There is a high relapse rate with drugs and alcohol when it occurs along with depression and mania. Depressed people who drink or abuse drugs are far more likely to suffer a relapse.
6.Approximately one-third of people with all mental illnesses and approximately one-half of people with severe mental illnesses also experience substance abuse.
7.More than one-third of all alcohol abusers and more than one-half of all drug abusers are also battling mental illness.
8.People with manic depression are particularly at risk. One study suggests that as many as 60 percent of people with Bipolar I have substance abuse problems at some point in their life.
9.The likelihood of developing alcoholism or substance is abuse is far greater in people with bipolar disorder than in those with unipolar depression or the general population.
A new study in the Archives of General Psychiatry found that alcohol abuse may actually cause major depression. The research results showed that alcohol use could trigger genetic markers that increase the risk of depression. In other words, the depressant effect of alcohol could lead to depression itself.
NEW YORK, May 20 (UPI) U.S. men who had attention-deficit/hyperactivity disorder as children weighed 19 pounds more at age 41 than those with no ADHD, researchers say.
Study co-author F. Xavier Castellanos, a psychiatrist at the Child Study Center at New York University Langone Medical Center in New York, and colleagues at Verona University in Italy; the Institute for Psychiatric Research in Orangeburg, N.Y.; and the Neuroingenia Clinical and Research Center in Mexico said ADHD might affect up to 11 percent of U.S. children, the majority boys.
The study involved 207 white boys with childhood ADHD — mean age of 8.3 — interviewed at ages 18-25 and age 41. At age 18, 178 boys without ADHD were recruited.
At 41, 111 men with childhood ADHD and 111 men without childhood ADHD self-reported their weight and height.
The study, published in the journal Pediatrics, found at age 41, the men who had ADHD weighed an average of 213 pounds, and 41 percent of them were obese, while the men who hadn’t had ADHD weighed 194 pounds on average, and 22 percent were obese.
The study didn’t figure out why boyhood ADHD might be causing weight problems in adulthood — the weight gain could be caused by psychological factors or neurobiology, Castellanos told NPR.
Differences in the pathways for dopamine, a neurotransmitter in the brain, have been found in both people who are obese and people with ADHD, Castellanos said.
“It makes sense, because they’re self-medicating with carbohydrates,” Dr. Edward Hallowell, a psychiatrist in Sudbury, Mass., who has ADHD and treats adults with ADHD but wasn’t involved with the study, told NPR. “Carbs do the same thing that stimulant medications do — promote dopamine.”
Read more: http://www.upi.com/Health_News/2013/05/20/ADHD-in-childhood-may-be-linked-to-obesity-in-adults/UPI-34151369093137/#ixzz2TwJL5KU5
By Margarita Tartakovsky, M.S.
How to Support an Anxious PartnerHaving a partner who struggles with anxiety or has an anxiety disorder can be difficult.
“Partners may find themselves in roles they do not want, such as the compromiser, the protector, or the comforter,” says Kate Thieda, MS, LPCA, NCC, a therapist and author of the excellent book Loving Someone with Anxiety.
They might have to bear the brunt of extra responsibilities and avoid certain places or activities that trigger their partner’s anxiety, she said. This can be very stressful for partners and their relationship.
“Partners of loved ones with anxiety may find themselves angry, frustrated, sad, or disappointed that their dreams for what the relationship was going to be have been limited by anxiety.”
Thieda’s book helps partners better understand anxiety and implement strategies that truly support their spouses, without feeding into or enabling their fears.
Below, she shared five ways to do just that, along with what to do when your partner refuses treatment.
1. Educate yourself about anxiety.
It’s important to learn as much as you can about anxiety, such as the different types of anxiety disorders and their treatment. This will help you better understand what your partner is going through.
Keep in mind that your partner might not fit any of these categories. As Thieda writes in Loving Someone with Anxiety, “The truth is, it doesn’t matter whether your partner’s anxiety is ‘diagnosable.’ If it’s impairing your relationship or diminishing your partner’s quality of life or your own quality of life, it will be worthwhile to make changes.”
2. Avoid accommodating your partner’s anxiety.
“Partners often end up making accommodations for their partner’s anxiety, whether it is intentional [such as] playing the part of the superhero, or because it just makes life easier, as in, doing all the errands because their partner is anxious about driving,” said Thieda, who also created the popular blog “Partners in Wellness” on Psych Central.
However, making accommodations actually exacerbates your partner’s anxiety. For one, she said, it gives your partner zero incentive to overcome their anxiety. And, secondly, it sends the message that there really is something to fear, which only fuels their anxiety.
3. Set boundaries.
Your partner might continue asking for accommodations, such as having you drive everywhere or regularly stay home with them, Thieda said. “You have the right to have a life, too, and this may mean telling your partner on occasion, and in a loving way, that you are going to do what you want and need to do.”
In her book Thieda devotes an entire chapter to effectively communicating this to your partner. Essentially, she suggests being empathetic, using “I” statements and giving specific requests.
For instance, she gives the following examples: Instead of saying, “You worry too much about what other people think of you,” you might say, “I’m concerned that your fears about what others think of you are holding you back at work.”
Instead of saying, “Don’t call me at work so much,” you might say, “It would be helpful if you would try some of the techniques you’ve learned for calming yourself down before calling me at the office.”
Also, “always consider whether a compromise is possible, but also recognize that you have the right to do things independently,” she said.
4. Relax together.
There are many techniques you can try together to alleviate anxiety. According to Thieda, “The body scan is a great couples mindfulness technique because one person can guide the other through the process.”
This promotes mindfulness for both partners. The partner giving instructions needs to pay attention to timing and the specific directions, she said. And the partner receiving the instructions needs to pay attention to each body part and releasing its tension, she said. (Here’s a sample body scan.)
5. Focus on your own care.
According to Thieda in her book, “When you live with an anxious partner, there can be a lot of tension in your relationship and in your home. Having self-care routines and plans in place can help you neutralize the static.”
Consider what you’re already “doing to promote physical, spiritual, mental, emotional, professional, and relationship health,” Thieda said. Assessing where you are helps you better understand where you need to go. For instance, you might want to set goals about improving your health or seek support from others, she said. You might want to work with a therapist or attend support groups.
What to Do When Your Partner Refuses Treatment
Anxiety is highly treatable. But your partner might not want to seek professional help. Thieda suggested considering the reasons behind their refusal.
For instance, they might’ve tried treatment before but it didn’t work. One reason treatment “fails” is because it’s not the right treatment for the person’s anxiety. According to Thieda, “It is best to work with a professional who uses cognitive-behavioral therapy techniques and is specifically trained in working with people who struggle with anxiety.”
They might’ve tried medication or psychotherapy alone, but they’d do better with a combination of treatments, she said. It’s also possible that your partner tried to take on too much, and ended up feeling even more anxious. “Maybe they need to approach their treatment in a different way, breaking down the challenges into smaller, more manageable pieces.”
Ultimately, the decision to seek treatment rests with your partner, Thieda said. “No amount of begging, pleading, or threatening is going to be effective, and will likely make things worse.”
The best thing you can do is to be supportive, encouraging and loving when they do decide to seek help, she said.
Having a spouse who’s struggling with anxiety can naturally become stressful for partners. But while this can be challenging, by educating yourself, setting healthy boundaries and practicing self-care, you can truly help your spouse and your relationship.