Individual, Family & Group Psychotherapy
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Apr 23

The 5 strangest cognitive disorders

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By Jenny Beres / VOXXI Health

They say that truth is stranger than fiction –  and the same rule applies in the world of brain disorders. In the delicate world of synapses, neurons and the human psyche, there’s always the chance for a bizarre combustion.  Here are some of the wildest and weirdest disorders that blur the lines of reality and great story telling – all while erring on the side of truth.

Cognitive disorders can range from dyslexia to very serious conditions such as not recognizing one side of all objects and believing oneself dead. (Shutterstock photo)

  • Synesthesia

How does a square taste? What color is the letter “O”?  Do those questions sound  illogical to you? Then you don’t have Synesthesia.

The University of Edinburgh Synaesthesia Research Group describes this disorder as the “joining together of sensations that are normally experienced separately.”

These “crossed wires” happen when one sense is triggered (say, touch for example), causing other senses and parts of the brain to become engaged (say smell and taste). So, in fact, for someone with Synesthesia, a letter could have a particular smell and a sound could be colorful as well.

This disorder isn’t considered harmful – in fact many people who have it feel that they are at an advantage. Research has also discovered a link between the condition and a heightened artistic talent, creativity and memory.

  • Foreign Accent Syndrome

Ever fake an accent at the bar, or while on vacation? For someone who has Foreign Accent Syndrome (FAS), faking is not an option. In fact, they can suddenly start speaking with another accent – different from their native language – involuntarily.

According to researchers at the University of Texas at Dallas Speech Production Lab, FAS is linked to brain damage caused by extensive trauma to the brain, such as a stroke, for example. This is not always the case though. There are rare cases of FAS that did not involved an illness or injury per se.

People who have FAS often mispronounce multi-syllabic words, tend to space and time words wrong and dismiss consonants – causing the word to sound “foreign” to other native speakers. Also noted is the way that vowels are softened and elongated, which can suddenly turn an American English speaker into a British English speaker. In Spanish speakers, this syndrome sounds Hungarian.

  • Body Identity Integrity Disorder

Those who suffer from Body Identity Integrity Disorder (BIID) have a strong belief that they would live “better” lives without their healthy, properly functioning limbs. This belief is also coupled with the desire to amputate those limbs.

According to some researchers, the disorder can manifest when “the brain is not able to provide an accurate plan of the body.”

When this happens the brain does not recognize the limb as part of the person. There is a serious risk for self-harm for people with the disorder.

  • Cotard’s Delusion

No, you haven’t been watching too much Walking Dead. Cotard’s Delusion is real, (though rare) and as close as you’ll get to the “undead” without Hollywood’s special effects.

Also known as the “Walking Corpse Syndrome” this neuropsychiatric condition causes a person to believe that they are indeed dead, non-existent, or that their soul is lost. In many cases, sufferers believe that they have lost all of their blood and organs, or that they are immortal (while being dead) and do not need to feed themselves.

Thought to be caused by a disconnection of the brain’s ability to pair emotions with recognition, a person with this syndrome is unable to form any sense, emotion, and above all –  connection to one’s self. Case studies have shown that this is primarily caused by damage to the natural “face recognition system.”

  • Neglect Syndrome

Neglect Syndrome often causes patients to only pay attention to one side of “space.” This means they only “see” half of a person, place, or object.

For example, a person with this syndrome will only shave one leg, or one side of their face, or eat just half of their plate and do not acknowledge food on the other half.  Paintings and drawings of people and objects only show up as “halves” when depicted by someone with Neglect Syndrome. This syndrome can be triggered by a stroke or damage to the contralateral hemisphere.

Apr 23

Stupid teen tricks: Beyond the cinnamon challenge

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Last month, we heard warnings about the “cinnamon challenge.” You may have warned your kids about it, but have you talked to them about the salt and ice challenge? How about the mustard challenge? Kids will find new, dumb “dares” no matter how many warnings we give them. So how do we challenge our kids not to jump on the latest idiotic YouTube stunt?

By Lela Davidson

When I noticed the dark brown wound on the back of my 13-year-old son’s hand, he explained that he had burnt himself with salt and ice. “I just wanted to see if it would work,” he said. “It didn’t even hurt.” When my shock turned to anger, he implicated his 11-year-old sister as an accomplice. I had apparently raised not one, but two, “gifted” children.

Why would honor students with no history of drug use or brain disorders maim themselves in the name of curiosity? They saw it on YouTube, naturally.

Hollye Grayson, M.A., MFT, works extensively with Los Angeles teens and she points out that our hyper-social society allows teens to emulate kids they would not associate with in person. These virtual peers can provide real validation.

“It’s a cool factor,” she says. “‘Look how cool that is. Look how many hits, how many people are looking at that cool thing he did.’” Even high achieving kids may crave this kind of attention. It’s different from the approval they receive from parents and teachers. “Before YouTube we didn’t have to worry about something like this. This is clearly a big problem now, with these kids copying these crazy things.”

After the salt and ice incident, I talked with my daughter and a friend  who had tried similar feats, like the cinnamon challenge, she saw on YouTube. The friend told me that kids copy the videos because they are funny, and because they want to prove for themselves that the results in the video really happen. This was the reason my own children had given for the idiotic stunt. I asked if she applied the same logic to trying drugs. “Oh, no way,” she assured me. “They teach us about drugs at school. They don’t teach about this stuff.”   As if teachers don’t have enough to do.

Dawn Spragg, a licensed counselor and founder of the Teen Action & Support Center in Rogers, Arkansas, says technology enables risky behavior and the quick dissemination creates momentum for a stupid idea. “It doesn’t have time to die down or be deemed dangerous. Everyone sees or hears about it at the same time.”

Grayson says it’s pointless for parents and teachers to try to warn kids against these behaviors anyway. “Their brains don’t even process that information. They need to visually see the results.” She suggests gathering teenagers together in an auditorium, showing them a bunch of funny stunt videos that end well, get them laughing and having a great time, and then hit them with the reality — images of what happens when the jackass moves go bad.

For days I watched my children’s skin peel and wondered what other stupid things they might try with common household items, or worse. I worried about the moment when that cool kid at the party passes my child a joint, or a square of paper, or a candy-colored pill. Spragg and Grayson say there is no set age when human brains become fully developed, and they agree that high-risk behavior can continue well into the early twenties — at least. Until then we need to expect some bad decisions.

Spragg goes back to the sage advice: know your child. “Do your best to understand their environment,” she says. “Watch YouTube’s top hits, talk to kids about their favorite clips, watch what they watch without comment.” She encourages listening in for clues. Kids talk about things with their friends when they think you aren’t paying attention.

As for my own intellectual giants, I half hope the ice salt burns leave nasty scars, visual cues that might prompt them to think again before relying on the first impulse of their undeveloped brains.

Apr 23

Children with bipolar disorder up 4000% !!

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WASHINGTON, April 23, 2012 – If the incidence of a childhood illness increased 4,000% in 9 years, you would think more people would be alarmed. The diagnosis of Pediatric Bipolar Disorder (PBD) did increase that much from 1994 to 2003, and is still on the rise. There is more buzz in the media about it the past few years, and research has been (and continues being) done.  PBD is not in the current version of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR ), which is the current guide to mental disorders; approved by the American Psychiatric Association in 2000. However, PBD is an accepted diagnosis by many psychiatrists and doctors who cite studies validating the need for it.

Symptoms

If a child or adolescent demonstrates “more than a few” of the behaviors below, and the parent or caregiver realizes there is definitely something wrong, it is possible the child could be diagnosed as bipolar.

  • Extreme, recurring depression, and sadness; disinterest in playing, talking about wanting to die or kill someone else.
  • Explosive anger (esp. after four); extreme hostility, irritability, and dangerous or risky behavior.
  • Intense separation anxiety, trouble sleeping, racing thoughts, and rapid, pressured speech; also unusual silliness.
  • Grandiosity, delusions or hallucinations, bossing authority figures, and age inappropriate sexual behaviors, hearing voices that speak of harming others.
  • Compulsive creativity, cravings for particular objects or food, excessive multi-tasking, and creative projects that depict graphic, over-the-top violence.

PBD can be confused with ADHD, borderline personality disorder, substance abuse, post traumatic stress disorder, or depression. In order for the symptoms to constitute PBD, experts look for distinct episodes of mania and depression with specified durations. Patterns of sleep, energy, and activity levels are considered, also family history.

Family History and Research

Children with PBD often have family histories that include mood disorders or substance abuse (or both). Should one parent have bipolar disorder, their children’s chance of onset increases 15% to 30%. When both parents are diagnosed the incidence rises 50% to 75%. However, to put this in perspective, most children with bipolar disorder nestled in their family tree do not develop PBD.

Research has shown that with onset of bipolar disorder in childhood or adolescence, symptoms are severer than with later onset. Children tend to have more intense symptoms and  to cycle between mania and depression more frequently. They are generally sicker than adults who are bipolar, and not as likely to recover.  Another studied revealed one-third of the PBD participants had made at least one suicide attempt.

The reluctance of physicians to diagnosis PBD prior to the mid 1990s is thought to be one reason why incidence used to be lower. The increased occurrence fits with a survey showing that two-thirds of adults with bipolar disorder believe their symptoms started in adolescence or childhood.

Troubling Treatment

Therapy is often recommended for PBD, and children are also prescribed mood stabilizing and psychotropic medications. Anyone who has worked with adults using these medications knows first-hand their insidious side effects. Most adults take them only when their symptoms become more of a hell than their reaction to the drug.

It is not within the scope of this article to say whether giving these drugs to kids is right or wrong, necessary, or not. It is, however, downright scary.  These heavy-duty medications present long-term health risks. Many facilitate substantial weight gain, and some are linked to later onset of diabetes, and metabolic problems. Another possible side-effect, tardive dyskinesia, is permanent. It involves involuntary, repetitive muscle movements that interfere with normal daily functioning.

PBD proponents highly recommend early treatment for best results, but no one knows the medication’s effect on children beyond the immediate reduction of symptoms.

The Opposition

The PBD diagnosis has its opponents. “The proponents of pediatric bipolar often rely on rhetorical sleights of hand to bolster their case by strategically framing the terms of the debate. They conflate facts with value judgments and wield these facts in an attempt to short-circuit and shut down all debate. They cite neurotransmitter activity, brain imaging, and heredity as proof that patients are “sick” when, at its best, this evidence signifies difference and diversity.” (Bossewitch)

Opponents also find it a stretch of the imagination that so many more children are thought to be mentally ill than ten or fifteen years ago. They point out that 80% of the world’s prescriptions for Ritalin are written in the United States, and over 200,000 of our children are now taking anti-psychotic medications (2010).

Environmental toxins and diets heavy in sugary and processed foods are cited as viable reasons for children’s mood swings or problematic behavior. One could argue that no child should be given any medication until they have been eating nutritious meals (and no junk food) for a few weeks.

State Your Case

There is more than one therapist in the U.S. that thinks the PBD diagnosis smells fishy. However, any parents who have children with this diagnosis, or professionals that see children with these symptoms and are convinced the diagnosis and treatment are valid; I invite you to share your story, experience, or thoughts about PBD.

Apr 23

Five Things That Can Ruin a Romance

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by Barbara Peters   The definitions of romance are varied and differ according to male and female interpretations. As a couple’s counselor, I often hear this cry from both men and women – “But I don’t know howto be romantic!”

Certainly there had to be romance early in these relationships. What happened?

Wikipedia has this to say . . .  “Romance is the pleasurable feeling of excitement and mystery associated with love.”  Focus on the words pleasurable, excitement, and mystery.  Who wouldn’t want to experience those heady emotions?

So how does relationship romance evaporate, allowing the blahs to take its place? Five culprits might be stealing your relationship’s pleasure, excitement and mystery.

1. Not expressing love and affection. Often partners get accustomed to thinking wonderful things about the other, but don’t share those thoughts. Remember when you were falling in love and romantic words flowed? Try them again and openly speak of your affection.

2. Not making time for each other. Mundane and simple tasks (grocery shopping) along with important and critical tasks (child rearing) fill our days. Often I suggest going out on a date with your partner. The most common excuse that comes back to me is, “We don’t have time to go out on a date!” Look at your time management, and then get creative to find ways to enjoy each other.

3. Not doing little things to please your partner. Remember when you sent cards, bought flowers, texted thoughts, paid compliments, hugged with passion, and blew kisses across a crowded room? Why did you stop? Did you fall into the trap of taking your relationship for granted, assuming it would last the test of time without any effort? Reframe that idea and realize romance needs your involvement.

4. Not having your own interests and actively pursuing them. Being needy, clingy and constantly following your partner’s lead can be unattractive and unhealthy for you relationship. When dating you had things to talk about and share. You brought a self-confident and interesting person into another’s life. You were a bit mysterious and exciting. Find that again and see how romance grows and strengths your relationships.

5. Not keeping an attractive physical appearance. Dress and groom each day to please your partner. Remember, girls, when you were going on a date how important it was to pick the right outfit and a neat hairstyle? And guys, didn’t you put on your best clothes also?  Be as concerned now about your looks and style as you did when you were dating. You’ll be happier inside, and your partner will be proud of you for looking so good!

The bottom line: romance takes work; it doesn’t float in on a billowy cloud. If you want to keep your lover’s heart on fire and enjoy a relationship that smolders, put forth the effort it takes to make it happen.

Apr 23

The First Few Years of Marriage

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By Margarita Tartakovsky, M.S.     Many couples assume that if you live together, getting married won’t really change your relationship, according to clinical psychologist Lisa Blum, PsyD, who specializes in Emotionally Focused Therapy. But things dochange – and with these changes come potential obstacles.   Even if you haven’t shared a home, you may not be prepared for the new challenges of matrimony. “These days, many couples wait a substantial amount of time before they actually get married, so the typical triggers of the redefinition of the relationship are simply there in the shadows, waiting to spring,” said psychotherapist and author Jeffrey Sumber, MA.

Why does marriage change a relationship? According to Blum, there are two reasons. For starters, being married feels different internally for couples. Secondly, people, including family and friends, treat you differently and perceive you as a unit.  According to Sumber, some partners might even panic the first year after realizing that “this is now our life together so we might as well get comfortable.” This “may even lead to a power struggle to make sure our own preferences and wants are met early on and thus create a trend into the future.”

Below, Blum and Sumber share their solutions for the most common challenges newlyweds face, along with general tips for a happy and healthy marriage.

Marriage Challenges & Solutions

Challenge: Becoming a unit. Once you’re married, you become a unit legally, socially and religiously, Blum said. As you navigate becoming a unit, differences are naturally magnified. Take the example of differing political affiliations. When you get married, you might wonder what your political commitment will be as a couple and where you’ll donate your money, Blum said.  The same questions surface surrounding finances – how do we spend our money? – and cultural and religious practices, she said. Even celebrating birthdays differently can become a big issue.

Families tend to be more tolerant of unmarried partners having separate plans – even if they live together, she said. But once you’re married, there’s more pressure to attend events jointly.

Solution: Unmarried couples also tend to have greater acceptance of doing things separately and differently, Blum said. But once the papers are signed, there’s the implicit expectation that you’ll do things one way, she said. “I don’t think that needs to be the case.”  Instead, when brainstorming solutions, step back and discuss whether you’re OK with doing activities separately, she said. Can you find a solution that lets each of you do what you love while letting the other in? As Blum said, “Rather than an ‘either or’ solution, could it be a ‘both and’?”  One couple Blum knows attends their own church twice a month and goes to the same services once a month. She’s also seen other couples alternate years for the holidays.

Again, the key is to avoid the assumption that there’s one right way – even if it looks very different from how your family of origin does things, Blum said.

Challenge: Decreased intimacy. Even within months of the honeymoon, some couples see their sex life change dramatically, Sumber said.

Solution: “It is essential that couples maintain an open dialogue about their sex life well before the wedding and then maintain this conversation long into the life of the marriage,” Sumber said. For some couples the solution is to schedule intimacy nights during the week, he said.

Challenge: Doing chores. Even if you’ve lived together for a while, who does what can still become an issue when you’re legally married, Blum said. That’s because longstanding attitudes and feelings about the role of wife and husband may creep up, she said.

Solution: Rather than fighting about taking out the trash, dig deeper. Talk to your partner about what doing certain chores means to you, Blum said. When you share the meaning and history of specific tasks, it makes negotiating chores much easier, she said. For instance, some people may feel disempowered not doing the bills or knowing their financial details.  Blum gave the example of a spouse who refused to sweep or vacuum the house. To her husband this came across as stubborn, sparking arguments. It turned out that as a child, the wife was overworked and nothing was ever good enough. Part of her rebellion as an adult was not doing the floors, Blum said.

What also helps is to make a list of household tasks and divide accordingly, Blum said. But don’t forget to include the invisible responsibilities, too. One of Blum’s professors used to call the tasks that required planning, organizing and monitoring the “executive functions of the house.” For instance, this might be keeping track of the dog’s medicine or knowing when to pay the bills.

General Marriage Tips

“The more you talk, the better”, Blum said. Couples often mistakenly assume that newlyweds don’t have any issues, so they avoid talking about the frustrating areas in their relationship, Sumber said. As a result, problems just snowball. “We compound our issues over time and feel resentful that nothing has changed even though we haven’t explained our needs,” Sumber said.  That’s why communication is key. In fact, “One of the greatest practices for having a happy, healthy relationship is open, honest, and kind communication,” Sumber said. “Many people forget to be kind in the transmission of uncomfortable information like sexual challenges, annoying quirks or troubling behaviors,” he added.

Blum agreed, and noted the importance of being willing to communicate about your differences without getting defensive or aggressive. It’s important for both you and your partner to be able to articulate how you feel about a certain tradition or issue and truly listen to each other, she said.

Create your own ways. Families can sometimes refuse to be flexible and become critical or judgmental if couples are trying new or different traditions, Blum said. If that’s the case (“and other options appear contentious”), she recommended creating your own traditions. For instance, you might spend Christmas Eve at home and then visit both families the next day.

Seek counseling. If you’re stuck on an issue, see a therapist who specializes in couples. This way, you hash out the tough stuff before problems worsen and multiply. Many of Blum’s clients confess to having had serious problems for years before seeking counseling.

Also helpful is finding a list of premarital counseling topics (like this one) to discuss together, she said.

Write down your agreements. Keep a record of your agreements on various issues, Blum said. This isn’t a contract or something written in stone, but a reference point, she said. The process of writing agreements down requires both partners to get specific about their solutions and helps them gain clarity, she said.

Have fun. It’s important for couples to keep having fun, Sumber said. This might include regular vacations or short weekend getaways, he said. He also suggested weekly date nights, such as nice dinners, couples massages, movie nights or game nights. “Take turns organizing and planning date nights to be sure that the relationship is a priority and that fun and play remain at the center long into the life of the marriage.”

Be grateful. Sumber reminded readers that all relationships are voluntary, and that partners are there by choice. “Someone, even someone I may not always like, is choosing to spend their days and nights with me. That’s pretty remarkable and we tend to take that for granted!”

Another key point to remember: “Relationships are work and just because we love one another doesn’t mean we are not here to challenge, trigger, grow and learn from each other,” Sumber said.

Apr 23

The Antidepressant Effects of Testosterone

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ScienceDaily (Apr. 2, 2012) — Testosterone, the primary male sex hormone, appears to have antidepressant properties, but the exact mechanisms underlying its effects have remained unclear. Nicole Carrier and Mohamed Kabbaj, scientists at Florida State University, are actively working to elucidate these mechanisms.  They’ve discovered that a specific pathway in the hippocampus, a brain region involved in memory formation and regulation of stress responses, plays a major role in mediating testosterone’s effects, according to their new report in Biological Psychiatry.

Compared to men, women are twice as likely to suffer from an affective disorder like depression. Men with hypogonadism, a condition where the body produces no or low testosterone, also suffer increased levels of depression and anxiety. Testosterone replacement therapy has been shown to effectively improve mood.

Apr 22

Can You Have Depression Without Sadness?

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Most of us consider sadness to be the hallmark sign of depression. In truth, some people experience depression without a whole lot of tearfulness and sorrow.  Depression without sadness sounds like a mental-health oxymoron, but it’s a very real condition that’s especially common in older adults. But because other symptoms of depression are present — trouble concentrating, fatigue, rumination— it too often gets dismissed as “just getting old.”

Overlooking the signs of depression in seniorscan be a dangerous mistake. The highest rates of suicide occur in men over the age of 85, and studies show that many of these men had visited their doctors in the month before their suicide — but their depression was not recognized.  “Older people don’t always say ‘I’m depressed.’ They tend to focus on physical symptoms instead of on sadness,” says Vineeth John, MD, associate professor of psychiatry at the University of Texas Health Science Center in Houston. “The diagnosis is frequently missed.”

10 Signs of Depression Sans Sadness

Depression is not a normal part of aging, even though the symptoms are often mistaken as so.  “Although elderly people with depression may have classic depression symptoms such as hopelessness, they may also express their sadness as headache or nonspecific aches and pains,”explains Dr. John. “This may result in them being given pain medications instead of being treated for their depression.”

Signs of depression without sadness include:

  • Personality changes
  • Isolation and loss of    motivation
  • Fatigue
  • Loss of appetite and loss    of weight
  • Agitation and    combativeness
  • Changes in sleep patterns
  • Poor concentration
  • Forgetfulness
  • Rumination
  • Deterioration in home and    self-care

Who’s at Risk for Depression in Old Age?

“Changes in the brain and illnesses that occur in aging may make it harder for the elderly to cope with stress and adapt to change, but depression is not a normal part of aging,” says John. Still, certain risk factors increase the risk of depression in the elderly — and knowing these risk factors may help doctors and loved ones spot depression (and start treatment).

Risk factors include:

  • Loss of a spouse
  • Loss of mobility and    independence
  • Change in living    arrangements
  • Chronic illness
  • Recent heart attack or    stroke
  • Use of alcohol or drugs

How Depression Is Diagnosed and Treated

“Sometimes the best person to recognize signs of depression in the elderly is a friend or family member who knows the elderly person’s level of functioning very well and notices a significant change,” explains John.  Mental health professionals may use a diagnostic tool called the Geriatric Depression Scale to help diagnose depression in the elderly. Some of the questions asked on the scale include:

  • Have you dropped many of    your interests and activities?
  • Would you rather stay at    home than go out and do new things?
  • Do you fear that    something bad is going to happen to you?
  • Do you feel you have more    difficulty with memory than most people?
  • Do you feel that you are full    of energy?

Doctors must also factor in the effects of all medications being taken and search for medical conditions such as Parkinson’s disease, thyroid disorders, or Alzheimer’s disease that increase the risk of depression.

“The good news is that depression in the elderly is very treatable, just as it is in younger adults,” notes John.“And treating depression may also improve the symptoms of other co-existing conditions.”  Depression and aging don’t always go hand in hand, but it is a common problem that often gets missed. Knowing the risk factors and signs of depression (even when sadness isn’t one of them), however, can help prevent a misdiagnosis.

Apr 22

What is Situational Depression?

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You’ve heard people complain that they’re depressed after a breakup, a layoff, or an overall terrible week. But are these people really experiencing depression? When a stressful situat ion is particularly hard to cope with, we react with symptoms of sadness, fear, or even hopelessness — a type of reaction that’s often referred to as situational depression. Unlike major depression, when you are overwhelmed by depression symptoms for a long time, situational depression usually goes away once you have adapted to your new situation.

Actually, situational depression is usually considered an adjustment disorder rather than true depression. But that doesn’t mean it should be ignored: If situational depression goes untreated, it could develop into major depression.  “Situational could lead to major depression or simply be a period of grief,” explains Kathleen Franco, MD, professor of medicine and psychiatry at Cleveland Clinic Lerner College of Medicine in Ohio. “If emotional and behavioral symptoms reduce normal functioning in social or occupational arenas, it should be treated.”

“Situational depression means that the symptoms are set off by some set of circumstances or event. It could lead to major depression or simply be a period of grief,” explains Kathleen Franco, MD, professor of medicine and psychiatry at Cleveland Clinic Lerner College of Medicine in Ohio. However, she adds that situational depression may need treatment “if emotional and behavioral symptoms reduce normal functioning in social or occupational arenas.”

Who Gets Situational Depression and Why?

Situational depression is common and can happen to anyone — about 10 percent of adults and up to 30 percent of adolescents experience this condition at some point. Men and women are affected equally.

The most common cause of situational depression is stress. Some typical events that lead to it include:

  • Loss of a relationship
  • Loss of a job
  • Loss of a loved one
  • Serious illness
  • Experiencing a traumatic event such as a disaster, crime, or accident

What Are the Symptoms of Situational Depression?

The most common symptoms of situational depression are depressed mood, tearfulness, and feelings of hopelessness. Children or teenagers are more likely to show behavioral symptoms such as fighting or skipping school. Some other symptoms include:

  • Feeling nervous
  • Having body symptoms such as headache, stomachache, or heart palpitations
  • Missing work, school, or social activities
  • Changes in sleeping or eating habits
  • Feeling tired
  • Abusing alcohol or drugs

How Is Situational Depression Diagnosed and Treated?

A diagnosis of situational depression, or adjustment disorder with depressed mood, is made when symptoms of depression occur within three months of a stress-causing event, are more severe than expected, or interfere with normal functioning. Your doctor may do tests to rule out other physical illnesses, and you may need a psychological evaluation to make sure you are not suffering from a more serious condition such as post-traumatic stress disorder or a more serious type of depression.

The best treatment for situational depression is counseling with a mental health professional. The goal of treatment is to help you cope with your stress and get back to normal. Support groups are often helpful. Family therapy may be especially important for children or teenagers. In some cases, you may need medication to help control anxiety or for trouble sleeping.

Situational depression and other types of depression are a common problem today, notes James C. Overholser, PhD, professor of psychology at Case Western Reserve University in Cleveland. “Many people are struggling with social isolation, financial limitations, or chronic health problems,” says Dr. Overholser. “A psychologist is much more likely to view depression as a reaction to negative life events. Many people can overcome their depression by making changes in their attitudes, their daily behaviors, and their interpersonal functioning.”

If you have situational depression, you should know that most people get completely better within about six months after the stressful event. However, it is important to get help, because situational depression can lead to a more severe type of depression or substance abuse if untreated. For many people with situational depression, the coping skills they learn in treatment can become valuable tools to help them face the future.

Apr 21

Is ADHD Linked to Thyroid Trouble?

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by Ed Zimney, MD 

Q:  I have ADHD, but I also have hypothyroidism. My medication does not seem to be working. What should I do? My thyroid med is 1.50 Levoxyl (levothyroxine), and my ADHD med is 30 mg generic Adderall (amphetamine-dextroamphetamine).

A:  Thyroid dysfunction has been suggested as a contributing cause of attention deficit hyperactivity disorder symptoms in a small minority of children. However, the relationship between ADHD and thyroid problems— in particular a genetic condition known as generalized resistance to thyroid hormone — is not well understood.

As far as I am aware, there is also very limited research to explain the potential interactions of your thyroid and ADHD medications. This is an issue that you should only discuss with your prescribing physician.

Apr 21

How To Change Negative Core Beliefs

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From: www.aliceboyes.com/  The most common core beliefs I help people change tend to fall into the following 3 categories. These core beliefs commonly underlie depression and anxiety.

Helpless Core Beliefs

such as:

“I’m incompetent” “I’m needy” “I’m weak” “I’m defective, I don’t measure up” “I’m a failure”

Unlovable Core Beliefs

such as:

“I’m unlovable” “I’m different” “I’m bound to be abandoned/rejected” “I’m defective, so others will not love me”

Worthless Core Beliefs

such as

“I’m worthless” “I’m bad” “I’m evil”

How to Begin Changing a Negative Core Belief

Step 1: Pick a new core belief that you would prefer.

For example, if your old belief is “I’m incompetent,” you would likely pick “I’m competent.” Don’t pick “I’m mostly competent” or “I’m sometimes competent.”

Step 2: Rate how much you currently believe the old negative core belief on a scale of 0% (= I don’t believe it at all) to 100% (I believe it completely) and do the same for the new positive core belief.

For example, you might say you believe “I’m incompetent” 95% and believe “I’m competent” 10% (the numbers don’t need to add up to 100%).

Step 3: There are two types of negative core belief. Which type do you have? (both can be changed)

One type is the very stable kind. For example, you believe you are incompetent and you have never believed anything else, not even when you are in a positive mood.  The other type is the type that goes up and down with your mood, anxiety, and stress. When your mood is low, you believe the negative core belief much more strongly than when you mood is positive. If your negative core belief changes due to transient things like your mood, anxiety, or stress, it can help you start to see that the belief is a product of these things rather than true.

Step 4: The most useful goal is usually to work on strengthening the new positive core belief rather than dismantling the old negative core belief.

Thoughts are funny things. The more you try to not think about something, the more you’ll think about it, so trying to eliminate negative thoughts completely doesn’t work. Instead, when you experience the negative core belief, you can learn to experience it as “just a thought” rather than as something that is true. Thanks, Mind!

Step 5: Positive Data Log.

For 2 weeks, commit to writing down evidence that supports the NEW core belief. For example, if you are trying to boost your belief in the thought “I’m competent” and you show up to an appointment on time, you can write that down as evidence.  Don’t fall into the cognitive bias trap of discounting some of the evidence. For example, if you make a mistake and then sort it out, this is evidence of competence, not incompetence, so you could put this in your positive data log.

Step 6: Re-rate how much you believe the old and the new core beliefs.

Hopefully there will have been a little bit of change.  For example, you might now believe “I’m incompetent” only 50% instead of 95%, and believe “I’m competent” 50% instead of 10%.  You’ve probably had the negative core belief for a long time, so change usually takes a period of a few months concerted work. You’re unlikely to be there yet.

Step 7. Tell Someone You Trust.

– Tell someone you trust what the old belief is and the new one you’re trying to increase. This helps decrease shame.  – If you have a partner, practice being able to let your partner know (in a self responsible way) that your negative core belief is activated. For example, “My negative core belief that I’m incompetent is activated right now, and that’s why I’m feeling embarrassed or why I’m avoiding. I just need a moment to figure out what action right now would be consistent with my new core belief.”

Step 8. An historical data test.

You can do this for either the old core belief, or the new core belief, or both.  I’m going to direct you to the example in this pdf rather than reinvent the wheel here. See column 2 of the page labelled page 275. The example is for the negative core belief “I’m abnormal.”

Step 9. Pick some other tools to try.

The pdf mentioned above has lots of other great examples of therapy techniques used to help clients change core beliefs. It’s designed for therapists but, if you’re a confident reader, you can read it too.  You might pay particular attention to the section on “Constructing Continua Criteria” that starts on Page 271 and continues onto Page 272. This will help you develop more flexible thinking.

Step 10. Where Did the Negative Core Belief Come From?

They usually come from childhood experiences. I might regret sharing this personal example but here goes anyway… Like I said anti-shame…  For example, I’m an introvert and as a kid I didn’t like to go to other kids’ houses after school. My Mum tried to explain that it might make it hard to have friends if I kept refusing to come over to play, but I accidentally interpreted this as no one was ever going to like me because I’m an introvert. (I get wiped out by too much social interaction, so I was completely over other people after a whole day at school.). My Mum is the best Mum in the world, but she’s not an introvert so she didn’t understand that I wasn’t capable of more social interaction after school. I chose to share this example because sometimes it’s not “bad parenting” that leads to negative core beliefs, rather it’s more related to the child’s temperament/sensitivity and parent-child temperament fit.  You can use imagery role plays in which you replay these painful incidents from childhood to help heal the wounds. Play both you and your parent, alternately. Set up 2 chairs and switch chairs when you’re in the different roles. When you are in the parent role, say what your parent might’ve said if they’d been able to completely understand LITTLE YOU and give you exactly what you needed (without providing any dishonest reassurance). Your parent should try to help LITTLE YOU understand and accept your emotions. When you’re in the child role, feel what it feels like to be responded to in a useful way, allow yourself to soak it up.  This tends to be quite a hard exercise so you might need to do “multiple takes” of your role play to figure out what would be a responsive but not dishonest thing for a parent to say, or you might need a therapist to help you.

Step 11: Self monitor when you are OVERCOMPENSATING for the negative core belief and choose more moderate behavior.

For example, keep a spreadsheet to record times when you observe that you are overworking to try to compensate for the belief “I’m incompetent.” Track how often this happens over time and try to reduce the amount.  When you notice it happening, step back from your activity, and choose a more moderate action. How would you be acting if you believed “I’m competent.”?  Do this for 4-6 months. Patterns that you’ve had for a long time take more than 5 mins to change.

Step 12: Self monitor when you are SURRENDERING to the negative core belief.”

In psychologist-speak, this means when you are acting as if the negative core belief were true. Related to the negative core belief “I’m incomptent,” surrendering might be not opening your VISA bill because you don’t trust yourself to keep track of your finances.  Behave how you want to feel. Behaving competent > feeling competent. Choose moderate, reasonable, doable behavior. What would be the single next action/step that a competent person would take? Try just thinking of the next step to help you not feel overwhelmed by the negative core belief.  Again, use some type of self monitoring to record when you observe yourself surrendering to the negative core belief, and try to reduce it over time. Think in terms of 4-6 months of effort.

Step 13: Self monitor when you are AVOIDING situations or behaviors that trigger the negative core belief.”

For example, you might avoid taking positions of leadership or not seek help from a professor on an essay, if doing so would trigger your “I’m incompetent” beliefs.  Again, behave consistent with your new core belief. What would you do if you believed “I’m as competent as other people.”?

Step 14: If you notice your mood is low or your anxiety is high, ask yourself “How much am I BUYING my negative core belief right now?” (0-100%)

“Buying/believing” a negative core belief is different from HAVING a negative core belief. You can have the experience of it, without believing it/buying it.  Asking yourself “How much am I BUYING my negative core belief right now?” (0-100%), when your mood is low or your anxiety is high, can help you see low mood/high anxiety as a product of believing your negative core beliefs.

Apr 21

By Janice Wood
Students who drink water during their school exams may improve their grades, according to new research.  Researchers from the University of East London and the University of Westminster theorize that the water boosts academic performance by keeping the students hydrated.

The researchers analyzed the behavior of 447 undergraduate students, looking at whether they brought drinks into exams. If a student did bring a drink into the exam, the researchers also looked at the type of drink it was.  Students who were in higher levels of the university were much more likely to bring drinks into the exam than those in their first year of undergraduate study, the researchers note.

The results showed that those who took water into the exam — and presumably consumed the water — did better in the exam than those who did not. The researchers did not check to see if the water was actually consumed, however.  “The results imply that the simple act of bringing water into an exam was linked to an improvement in students’ grades,” said Chris Pawson from the University of East London, who led the study.

“There are several physiological and psychological reasons that might explain this improvement with water consumption.”  He raises the possibility that water consumption may have a physiological effect on thinking functions that result in improved exam performance. He also theorizes that drinking water may alleviate anxiety, which is known to have a negative effect on exam performance.

“Future research is needed to tease apart these explanations, but whatever the explanation, it is clear that students should endeavor to stay hydrated with water during exams,” he said.  These findings could have implications on school policies for access to drinks during examinations at all levels of education, he added.  They also suggest that information about the importance of keeping hydrated should be targeted at first-year undergraduate students who are less likely to bring drinks into exams.

Apr 21

Early Signs of Dementia

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Dementia does more than rob people of their memory — research continues to show that this complicated condition is marked by a number of symptoms, especially at the onset. But they’re not always easy to recognize: From frequent falling to failing to recognize sarcasm, some of dementia’s early warning signs are subtle.

How can you know if you or a loved one is showing signs of Alzheimer’s disease or another form of dementia? Any change that is different from a person’s usual behavior or abilities could be a cause for concern, explains neuropsychologist Katherine Rankin, PhD, who conducts research at the UCSF Memory and Aging Center in San Francisco. Take a look at some of the earliest signs of dementia — you may be surprised.

Frequent Falling

Constantly tripping over your own two feet? Everyone falls now and again — but frequent falling could be an early signal of Alzheimer’s disease, according to new research. The researchers, who presented the study at the Alzheimer’s Association International Conference in Paris, looked at brain scans of 125 older adults and also asked them to keep track of how often they slipped and stumbled during an eight-month span. The results? Those participants who showed early signs of Alzheimer’s also happened to fall down more often. “People will come into our office concerned because they forgot what was on their grocery list last week, but when their spouse says they’ve fallen four times in the past year, that’s a sign of a problem,” says Rankin. People with this movement disorder, known as progressive supranuclear palsy, might not catch themselves on the way down either, making this dementia symptom even more dangerous.

Missing Sarcasm

You may or may not appreciate sarcastic senses of humor, but sarcasm is a part of our culture. “We see it as a nice way to be critical and so we use it constantly, even when we are trying to be nice,” says Rankin, who recently reported study results at the Annual Meeting of the American Academy of Neurology showing that people with both frontotemporal dementia (FTD) and Alzheimer’s disease tend to have a harder time picking up on sarcasm. Another unusual sign of dementia Rankin noticed? People with FTD couldn’t tell when someone was lying, although people with Alzheimer’s disease could tell. “FTD patients don’t have that sense anymore that things that people do could turn out badly,” she says.

A Disregard for the Law

Some younger people in the beginning stages of early-onset dementia lose their sense of social norms. Shoplifting, breaking into someone’s house, and inappropriate interpersonal behaviors, such as sexual comments or actions, all make the list of surprising dementia symptoms — and they can lead to legal trouble, too. Early-onset dementia can hit people as early as their thirties and forties, well before anyone around them would consider their out-of-character, law-breaking behaviors as signs of dementia.

Staring

“Reduced gaze” is the clinical term for the dementia symptom that alters people’s ability to move their eyes normally. “We all move our eyes and track with them frequently,” says Rankin. But people showing early signs of dementia look like they’re staring a lot. Rankin adds that, “they try to read and they skip lines.” This is one of the signs of dementia that the patient might not completely be aware of, although people around them probably will be.

Eating Objects

One surprising early sign of dementia is eating nonfood objects or foods that are rancid or spoiled. This is partly because the person forgets what to do with the things in front of them. For example, dementia patients might try to eat the flower in a vase on a restaurant table because they “know they are there to eat, but don’t know what the flower is doing there,” says Rankin. Unlike some other Alzheimer’s symptoms or dementia symptoms, this one has few other likely explanations.

Losing Knowledge

Now and again, most people find themselves desperately searching for the right word. In fact, failing to find the word you are thinking of is surprisingly common and not necessarily a sign of dementia, says Rankin. But losing knowledge of objects — not just what they are called, but also what they are used for — is an early dementia symptom. Oddly enough, people who are losing this knowledge can be very competent in other areas of their lives.

Losing Empathy

If someone who is usually sweet, considerate, and polite starts to say insulting or inappropriate things — and shows no awareness of their inappropriateness or concern or regret about what they’ve said — they could be exhibiting an early sign of dementia. In the early stages of some types of dementia, symptoms can include losing the ability to read social cues and, therefore, the ability to understand why it’s not acceptable to say hurtful things.

Ignoring Embarrassment

Being unable to recognize how others feel about a situation isn’t the only social cue dementia patients miss — people with dementia symptoms may also lose the ability to understand embarrassment. This is a multi-faceted sign of dementia: They themselves don’t feel embarrassed by the situations they find themselves in and they also don’t understand that situations other people are in (for example, on television sitcoms) are embarrassing or uncomfortable.

Compulsive, Ritualistic Behaviors

One sign of dementia that most people don’t expect is the need to complete extreme rituals or compulsive behaviors. “Plenty of people have odd habits and like things done a certain way,” says Rankin. But while these habits are within the realm of normal, extreme hoarding behaviors or detailed rituals or compulsions, such as buying a crossword puzzle book every time they go to the store even if they have hundreds of them, can be dementia symptoms.

Money Troubles

One of the classic early signs of Alzheimer’s disease is an increasing difficulty with money management. This might start off as having trouble balancing a checkbook or keeping up with expenses or bills, but as the disease progresses, poor financial decisions are often made across the board. Though many people brush this symptom off as just “a normal part of aging,” they shouldn’t. “We tend to associate aging with losing your mind. That’s not healthy aging — it’s a disease,” emphasizes Rankin.

Difficulty Speaking

“It’s a bad sign when people who used to be fluent and could speak smoothly stop being able to produce language that way,” says Rankin. Despite this dementia symptom, patients are often crystal clear in other areas. They can run a business, manage their family, or draw beautifully, but they have increased difficulty actually forming the words to speak.

Apr 20

Could Your Preschooler Have ADHD?

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SUNDAY, Oct. 16 —I n its new guidelines for diagnosing and treating ADHD, the American Academy of Pediatrics recommends that parents of preschoolers with behavioral issues get their kids evaluated. Could you spot the signs of ADHD in your young child?For the first time in 10 years, the American Academy of Pediatrics (AAP) has revised its recommendations for the diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD)in children. Among the biggest changes is the inclusion of preschoolers (4- to 5-year-olds) and adolescents (13- to 18-year-olds); previously, the guidelines focused only on kids between the ages of 6 and 12.

According to the U.S. Centers for Disease Control and Prevention, ADHD affects some 5.4 million children in the United States — more than half of whom are 11 or younger. Of those, as many as two-thirds exhibited symptoms at or before age 4, according to a study in the Journal of Developmental & Behavioral Pediatrics.  Diagnosing ADHD in children that young is complex and somewhat controversial. After all, most 4- and 5-year-olds are fidgety or have energy to burn — but how many of them actually need to be treated for it? The new AAP recommendations clear up some of that confusion for pediatricians and other health professionals, but parents of preschoolers should be aware of the signs and recommendations, too. Here’s what you need to know:

Is Your Preschooler’s Behavior Normal?

The AAP’s guidelines state that a diagnosis of ADHD should be based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which lists 18 symptoms for ADHD in children and adults: nine related to inattention, and nine related to hyperactivity and impulsivity. Only the latter — which include frequent fidgeting, excessive running around or climbing, excessive talking, difficulty playing quietly, and tendency to interrupt or blurt out answers before questions have been asked — apply to preschool-age kids.

“When we’re talking about ADHD in preschool children, we’re not talking about the inattentive form,” explains Andrew Adesman, MD, chief of developmental and behavioral pediatrics at Schneider Children’s Hospital in New Hyde Park, N.Y., and a member of the advisory board for CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). “We’re talking about children who are hyperactive and impulsive who may or may not have significant problems with distractibility.” Among the possible red flags, he says, are restlessness, difficulty sitting still, and trouble waiting for their turn.  But if that sounds like your preschooler, don’t panic. “You’ll see some of these behaviors in all youngsters from time to time,” says Everyday Health medical director Mallika Marshall, MD, a physician at the Massachusetts General Hospital Chelsea Urgent Care Clinic and a mother of three young children herself.  So how do you know if your kid is just being a kid — or if he needs to be evaluated for ADHD?

Diagnosing ADHD in Preschoolers

“The key, and this is true for all ages, is that the behavior has to impair function and occur in two or more settings,” says Dr. Adesman. “It’s not enough to just look for those nine symptoms — you have to also consider to what extent the behavior interferes with their abilities and exists outside the home.”

That second point is probably the most important when it comes to diagnosing preschoolers, Adesman adds. “The children really have to have difficulties not just in the home, but in the eyes of someone else such as a daycare worker, a preschool teacher, or even a grandparent,” he says. The problem with this, as the AAP notes in its report, is that not all preschoolers are actually in preschool.  “With older children, there are usually other grown-ups — like teachers, coaches, or counselors — who can provide information that can help in the diagnosis of ADHD,” says Dr. Marshall. “But many preschoolers aren’t in school yet, and even if they are, their teachers may not be equipped to make a thorough behavioral assessment.”

In those cases, Adesman says, it may be necessary for parents to get a referral to a preschool or other special-education program where staff can evaluate and work with the child as necessary. “Pediatricians really should not be rushing to make an ADHD diagnosis when a parent is the only one providing information about the child’s behavior,” he warns.  If ADHD is suspected, your child’s doctor will first need to do a physical and neurological exam to rule out other conditions, such as a learning disability, anxiety, or seizures. Then, using information gathered from parents and other adults about the child’s behavior, as well as from interviews with the child himself, the doctor will evaluate the severity and frequency of the symptoms against the criteria specified in the DSM.

Treating ADHD in Preschoolers

If it turns out that your child does have ADHD, getting proper and prompt treatment is important to manage symptoms. The AAP’s new guidelines spell out recommendations by age: For kids 6 to 18, the suggested plan is a combination of medication, such as methylphenidate (Ritalin), and behavioral therapy, with an increasing emphasis on the former as the child gets older. For preschool-age kids, however, the organization favors behavioral therapy alone as the first line of treatment.

According to the Preschool ADHD Treatment Study (PATS), a long-term, comprehensive review of more than 300 children between the ages of 3 and 5, behavioral therapy is a successful and safe option for many families. One-third of kids studied did not need additional drug therapy to manage their condition. Those who did require medication experienced significant improvements with methylphenidate — but were also prone to severe side effects such as appetite reduction, anxiety, and insomnia. The drugs may stunt preschoolers’ growth, too, though more research is needed to confirm this.  For these reasons, parents and doctors should attempt to manage symptoms without medications first, and then weigh the risks and benefits of drugs only if the child does not respond to behavioral therapy.

Such therapy generally involves parent-administered behavior modification techniques, such as offering consistent praise, ignoring negative behavior, and using time-outs. Dr. Marshall advises also giving your child some structure by setting routines for bedtime, bath time, mealtime, and before school or daycare.  If therapy is ineffective or unavailable, the AAP says medication may be prescribed, though in lower doses than are given to older kids. “Pediatricians should not be rushing in with medication casually,” says Adesman. “But at the same time, it should be considered, especially when there are concerns about the behavior impacting the safety of the child or a sibling, or when symptoms are interfering with the child’s developmental abilities.”

Apr 20

Tips to Increase Your Assertiveness

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By Margarita Tartakovsky, M.S.  “Assertiveness is all about being present in a relationship,” according to Randy Paterson, Ph.D, a clinical psychologist and author of The Assertiveness Workbook: How to Express Your Ideas and Stand Up for Yourself at Work and in Relationships. In other words, you’re able to articulate your wants and needs to the other person, and you welcome their wants and needs as well.

Being assertive is starkly different from being passive or aggressive. Paterson has a helpful analogy that distinguishes the differences. He explained:

In the passive style, all the world is allowed on stage but for you — your role is to be the audience and supporter for everyone else. In the aggressive style, you’re allowed on stage but you spend most of your time shoving the others off, like in a lifelong sumo match. With the assertive style, everyone is welcome onstage. You are entitled to be a full person, including your uniqueness, and so are others.

“Assertiveness involves advocating for yourself in a way that is positive and proactive,” said Joyce Marter, LCPC, psychotherapist and owner of Urban Balance, LLC. It also means being clear, direct and honest, she said.   For instance, if you’re upset with your boss over your performance review, you’re able to express your opinion in a diplomatic and professional way, she said. Again, this is very different from the other styles. If you’re passive, you might swallow your feelings and become resentful, which can chip away at your self-esteem and boost stress and anxiety, she said. If you’re aggressive, you might curse out your boss and quit. If you’re passive-aggressive, you might call in sick and give your boss the silent treatment, she said.

Why Some People Aren’t Assertive

Why are some people assertive while others aren’t? Many factors may contribute. Stress is one. “The fight-or-flight response is an evolutionary adaptation that pulls us toward aggression or avoidance, and away from calm, relaxed assertiveness,” Paterson said.

A person’s belief system also plays a role. According to Paterson, these assertive-sabotaging stances include: “Being nice means going along with others” or “It doesn’t matter if I’m assertive, no one will pay attention anyway” or “He’ll leave me!” That’s why it’s so important to become aware of these beliefs. “[This way you] can examine them clearly and rationally and decide what to do,” he said.  People with low self-esteem may feel inadequate and have a hard time finding their voice, Marter said. Others might fear conflict, losing a relationship, criticism or rejection, she said.  If you’re a woman, you might’ve been raised to set aside your needs and opinions and support and agree with others, Paterson said. If you’re a man, you might’ve been raised to react aggressively with a “my way or the highway” view, he said. Or just the opposite, you might want to be completely different. “[These individuals may be] fearful of provoking aggression when they are present in relationships, or of being ‘a jerk like my father was.’”

How to Be Assertive

Assertiveness is a skill that takes practice. It may always be easier for you to swallow your feelings, scream at someone or give them the silent treatment. But assertiveness is a better strategy. It works because it respects you and others.

As Paterson writes in The Assertiveness Workbook:

Through assertiveness we develop contact with ourselves and with others. We become real human beings with real ideas, real differences…and real flaws. And we admit all of these things. We don’t try to become someone else’s mirror. We don’t try to suppress someone else’s uniqueness. We don’t try to pretend that we’re perfect. We become ourselves. We allow ourselves to be there.

These are some ideas to get you started.

1. Start small. You wouldn’t try to scale a mountain before reading a manual, practicing on a rock wall and then moving on to bigger peaks. Going in unprepared just sets you up for failure. Paterson suggested trying to be assertive in mildly tense situations, such as requesting to be seated at a different spot at a restaurant. Then gently work up to tougher situations such as talking to your spouse about infidelity issues, he said.

2. Learn to say no. People worry that saying no is selfish. It’s not. Rather, setting healthy limits is important to having healthy relationships. Here are 10 ways to build and preserve better boundaries, along with 21 tips to squelch being a people-pleaser.

3. Let go of guilt. Being assertive can be tough — especially if you’ve been passive or a people pleaser most of your life. The first few times it can feel unnerving. But remember that being assertive is vital to your well-being. “Assertive behavior that involves advocating for oneself in a way that is respectful of others is not wrong — it is healthy self-care,” Marter said.  Sometimes, you might be unwittingly perpetuating your guilty feelings with negative thoughts or worries. “Replace negative thoughts — such as ‘I am a bad person for not loaning my friend money’ — with a positive mantra [such as] ‘I deserve to have financial stability and not put myself in jeopardy,’” she said.  Deep breathing also helps ease your worries and anxiety. “Breathe in what you need — peace, strength, serenity — and breathe out feelings of guilt, anxiety or shame.”  And if you still feel uncomfortable, put yourself in a compassionate parent or best friend’s shoes. “Sometimes it is easier to think about speaking up for somebody else who we love than it is for ourselves,” Marter said.

4. Express your needs and feelings. Don’t assume that someone will automatically know what you need. You have to tell them. Again, be specific, clear, honest and respectful, Marter said.

Take the example of ordering food at a restaurant, she said. You’d never just order a “sandwich.” Instead you’d request a “tuna on rye with slices of cheddar cheese and tomatoes.” If you’re worried of upsetting someone, use “I” statements, which usually make people less defensive.  According to Marter, instead of saying, “You have no clue what my life is like, and you are a selfish ass,” you might say, “I am exhausted and I need more help with the kids.” What also helps is tempering your anger and speaking from a place of hurt, she said, such as: “I feel so lonely and need you to spend time with me.”  “Focus on the real issue, not the minutiae,” she said. In other words, “are you really mad that the toilet seat was left up or that you were up with the baby five times the night before?” If it’s the baby — and it likely is — be clear and specific: “I am upset that I was up with the baby five times last night and need for you to get up at least twice a night.”

5. Check out resources on assertiveness. In addition to Paterson’s The Assertiveness Workbook, Marter recommended Your Perfect Right: Assertiveness and Equality in Your Life and Relationships (9th Edition) by Robert E. Alberti and Michael L. Emmons and Assertiveness: How to Stand Up for Yourself and Still Win the Respect of Others by Judy Murphy. Paterson also suggested taking a course on effective communication.

Apr 20

Theories About ADHD Causes

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Attention deficit hyperactivity disorder (ADHD) is now recognized as a common childhood disorder that can continue into adulthood. While diagnosing ADHD has become more common, understanding ADHD causes remains a work in progress. “There is no single test for diagnosing ADHD and there is no single ADHD cause,” notes Loren R. Dribinsky, MD, a psychiatrist at the Lahey Clinic in Burlington, Mass.

“We know that genes are one of the most important ADHD causes because ADHD runs strongly in families,” adds Scott J. Hunter, PhD, director of pediatric neuropsychology at the University of Chicago. “What we don’t know is how other possible factors influence those genes or make children’s brains more vulnerable to ADHD.”

Many theories about ADHD causes have been considered over the years, including:

  • Lack of good parenting
  • Stressful family situations
  • Excessive exposure to TV and video games
  • Lack of structure at school

Quite a few of these theories have been abandoned and new theories have replaced them. “One reason why we don’t know all the ADHD causes is that we can study genes and brain changes, but it is very hard to study environmental triggers,” explains Dr. Dribinsky.  Though we don’t completely understand why some children are more susceptible to ADHD than others, the brain changes that are seen in children with ADHD symptoms are not theoretical. Studies show that regions of the brain affected by ADHD are the same regions that control attention as well as impulse control in children without ADHD. Here are 10 theories — some more plausible than others — to explain the brain changes that cause ADHD symptoms:

  1. Genetics. ADHD symptoms tend to run in families. Studies show that one in four children with a diagnosis of ADHD will have a close family member with ADHD.
  2. Lead exposure. Studies have shown an association between lead exposure and ADHD symptoms in young children. Lead may enter a child’s drinking water from old plumbing fixtures. Children may also be exposed from lead paint. “These exposures are known to increase the risk of ADHD, but these exposures are becoming increasingly rare and most children with a diagnosis of ADHD have no evidence of significant lead exposure,” Hunter notes.
  3. Cigarettes and alcohol. Two toxins that have been shown to increase the risk of ADHD in children are cigarette smoke and alcohol. Smoking and drinking during pregnancy are associated with a number of serious health risks for both mother and fetus. Not surprisingly, several studies have specifically linked these substances to an increased risk of having a child with ADHD.
  4. Medications taken during pregnancy. A study done in the Netherlands found that children of women who were treated for high blood pressure during pregnancy with a medication called labetalol (Normodyne, Trandate) had a significantly higher risk of ADHD. “It may be that some medications given to a mother may interfere with fetal oxygen, but these are isolated findings and require more research,” cautions Hunter.
  5. Fluoride. The theory that fluoride could cause ADHD arose from a study done in rats. Although rats exposed to fluoride during the study did develop ADHD symptoms, this may not necessarily translate into increased risk among humans. “I know of no convincing evidence that fluoride is a significant ADHD risk factor for children,” says Dribinsky.
  6. Sugar and sugar substitutes. Both refined sugar and sugar substitutes have been studied as possible ADHD causes. Most studies show that neither sugar nor sugar substitutes affect children’s behavior or their learning ability. According to the National Institute of Mental Health (NIMH), there is actually more research to suggest that sugar is not linked to ADHD symptoms than there is research to support an association between the two.
  7. Celiac disease and food allergies. Some research supports the theory that food intolerance or food allergies, such as in the intolerance to the protein gluten seen in celiac disease, may be a trigger for ADHD symptoms. Studies have shown that a small percentage of children may get some relief from ADHD symptoms with diet restrictions. “Food sensitivities and nutritional deficiencies may play a role, but more research needs to be done,” says Dribinsky.
  8. Food additives. It has long been suspected that food additives such as food coloring or food preservatives might cause ADHD symptoms or make them worse. Recent research published in Britain supports a link between these additives and an increase in ADHD symptoms. Research is under way to see if these findings can be confirmed. “The effects of food additives are probably negligible for most children with ADHD, but some children may be more sensitive than others,” Hunter explains.
  9. Pesticides. “Recent studies done at Harvard suggest that pesticide exposure may increase the risk of ADHD in children,” notes Hunter. The researchers found that children who had high levels of pesticide in their urine had almost double the risk of ADHD as children who had undetectable levels.
  10. Complications during pregnancy. Many studies show that a difficult pregnancy can lead to ADHD. These may be complications that occur during fetal development in the womb, or complications that affect the baby’s brain during delivery. Complications that have been identified include high blood pressure during pregnancy, bleeding before the birth of the baby, babies who remain in the womb beyond their due date, long delivery time, and anything that impacts the baby’s oxygen supply during birth.

It remains unclear which of these theories play the biggest role in ADHD symptoms. It’s likely that a number of factors work together to determine whether a child develops ADHD. As Dribinsky points out, “We know that children with ADHD have brains that function differently … What we need to know more about is how the environment triggers ADHD symptoms.”

Adds Hunter: “Children who have a genetic predisposition for ADHD may be more vulnerable to pesticides, toxins, or other triggers. The areas of the brain that are responsible for attention and activity regulation are very sensitive.”  While exact ADHD causes are not yet known, this is an exciting and active time for research and discovery in ADHD. Some earlier theories seem less promising now, but new theories may hold the key to unraveling the mystery of ADHD in the future.

by Carl Sherman, Ph.D.          It’s common for children with attention deficit disorder (ADD ADHD) to have trouble making friends. How can parents help?

Amori Yee Mikami, Ph.D., assistant professor of psychology at University of Virginia, is studying this subject. In a series of study groups, she teaches parents of elementary school-age children how to be “friendship coaches” for their kids. The results are promising. Even teachers who don’t know about the program notice that kids who participate play better with their peers.  We asked Dr. Mikami to suggest social skills techniques that parents might find useful.

Helping a child make better friendships sounds like a tall order. Where do you start?

Start by listening. The more positive and trusting your relationship, the more likely it is that your child will accept your guidance. If he’s upset about a friendship problem, be empathetic. Give him a chance to express his feelings before saying what he should do differently next time.

Spend some time doing fun things together, just the two of you, without directing or criticizing his behavior. Building a relationship with your child pays off. Parents in my study groups have said that when they work on relationship-building at home, they see better behavior in their child’s peer relationships right away.

But you do have to direct and criticize bad behavior sometimes, don’t you?

Yes, but keep the ratio of positive to negative remarks as high as possible. Praise should exceed criticism — even constructive criticism—  by at least four to one. Look for the positive, even if it’s hard to find something to praise.

For example, you see your child with another child, and almost everything she does seems wrong. She goes up and says, “Hi,” introduces herself, and says she wants to play. Then she treats the other kid as a play-slave, and says, “We’re going to do this. I go first. You stand here.”

There’s a lot to criticize. But you can praise what she did well: walking up and introducing herself in a friendly way. As for the rest, there may be 20 behaviors that you’d like to change, but be selective. Pick the most important one or two—and be specific in what you say: “When you play a game, you get to move your pieces, but you have to let your friend move hers.”

Can parents take a more active role in promoting friendships?

They can and they should. ADHD kids may make poor choices when it comes to choosing friends. They pick someone they can boss around, often a younger child. Or they are attracted to “bad influences,” who are exciting because they’re always getting into trouble.

You can help your child make better choices — for instance, a friend with the same interests who’s also a good personality match.

A great way to find the right playmates is to volunteer at your child’s school and for extracurricular activities. You see other kids, and you get to know other parents. It’s an opportunity to network and to suggest playdates.


Apr 19

Sexual Side Effects & Young People: Should We Worry?

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By Kaitlin Bell Barnett

Pediatrician and author Claudia Gold recently published a column about my book, Dosed: The Medication Generation Grows Up, over at The Boston Globe in which she highlighted an issue I’ve been meaning to address here for some time: Young people and medications’ sexual side effects.

The drugs most famous for interfering in the sexual realm are the SSRI antidepressants, like Prozac and Zoloft, which can cause loss of libido and problems with sexual arousal and orgasm. But mood stabilizers, such as Tegretol and Depakote, which are commonly used to treat bipolar disorder, also cause sexual side effects for many people.  Both classes of drugs have been increasingly used in young people over the past couple of decades. But if these young people experience sexual side effects from the medications, what are the effects on their psychosexual development? Should we be worried?

Like so much on the topic of young people and long-term psychotropic use, there is a shocking lack of studies. A rare review of the literature from 2004, for example, found just one case report of erectile dysfunction in a teenager – even though SSRIs are widely known to cause this side effect in adults.  It seems that doctors simply aren’t bothering to ask their young patients about sexual side effects of psychiatric meds-or at least they’re not bothering to write them up as case studies. Or else, researchers simply don’t consider the side effects worth studying in this population.

Maybe this is because adults have a puritanical attitude toward teenage sexuality. If meds cause loss of libido and other sexual problems in young people, they may think it’s just as well – meds as natural protection against teen pregnancy and sexually transmitted diseases, so to speak.  If that’s the thinking, then adults are adopting a shortsighted-not to mention insensitive-approach. It doesn’t take a doctorate in developmental psychology to know that experiences in adolescence- including, of course, sexual experiences – can have lasting effects on one’s development and your psyche.

As I write in Dosed, “Despite the lack of formal studies involving young people, anecdotal evidence suggests that drugs causing decreased libido and sexual dysfunction do sometimes pose a real problem, psychologically and socially, both for teenagers who are in the process of developing a sexual identity and for young adults testing out long-term intimate relationships.”

After all, developmental psychologists consider forming a healthy sexuality a central task of adolescence. Anything that interferes with that-including drugs that take away sex drive or make sex painful, awkward or difficult-is not something to be taken lightly.  A number of young people I interviewed for the book did believe that taking medications with sexual side effects had, in fact, had long-term adverse effects.

They felt upset and disturbed at the idea of not having any sex drive compared to their peers, or having little or no libido when they were beginning to have romantic relationships. For young men, being unable to perform sexually could be particularly traumatic, especially at an age when they were supposed to be in their sexual prime.  On the other hand, others of my peers I interviewed considered sexual side effects a small price to pay for relief from depression, anxiety, obsessions, or other psychiatric symptoms.

More than one person pointed out that when you’re incredibly depressed or anxious, you have no sex drive, anyway, and little likelihood of entering into any kind of sexual situation. Taking a medication that increases your chances of any kind of romantic or sexual encounter, even if it hurts your libido or arousal a little, is vastly preferable to being alone and miserable.

Which camp do you fall into? How seriously should we take medications’ sexual side effects in teenagers and young adults? Are they likely to leave lasting psychological scars? Or are they just a nuisance, one more small sacrifice that comes with the territory when you make the decision to take meds?

Apr 19

Anxiety during Pregnancy

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By Margarita Tartakovsky, M.S.     It’s common to have some concerns and worries about being pregnant, having a healthy child, giving birth, and parenting your little one, according to Pamela S. Wiegartz, Ph.D, and Kevin L. Gyoerkoe, PsyD, in their book, The Pregnancy & Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions and Compulsions.

However, for some moms-to-be, anxiety becomes so severe and distressing that they’re unable to function day-to-day.

It’s only recently — over about the last decade — that researchers have begun exploring anxiety in pregnancy. Consequently, much more work is still needed.  But here’s what we do know.

1. Even though we don’t hear as much about anxiety disorders in pregnancy, they’re actually more common than depression. Estimates of anxiety disorders vary greatly. In their book Wiegartz and Gyoerkoe note that researchers have found that 5 to 16 percent of women struggle with an anxiety disorder during pregnancy or postpartum.

2. Untreated anxiety holds risks for both mom and baby. According to Wiegartz and Gyoerkoe, “severe, prolonged, or incapacitating anxiety can be harmful and needs to be addressed.” They cite several studies that suggested various risks for both mom and baby.

For instance, research has shown that moms-to-be with clinical anxiety are at increased risk for postpartum depression and postpartum anxiety. (You can learn more about postpartum depression here.)

They also noted that women with anxiety reported more physical aliments during pregnancy and may be at risk for post-traumatic stress symptoms after childbirth.

Some research has found that babies of anxious mothers may be susceptible to premature birth. (This study, however, didn’t find a link between anxiety in pregnancy and preterm birth.) There’s also evidence that mom’s anxiety may affect her infant’s temperament and lead to behavioral and emotional issues later on (see this study and this one on impulsivity).

While the above findings may stress you out even more, the good news is that anxiety during pregnancy is treatable. But obstetricians don’t regularly screen for anxiety. That’s why if you’re struggling with anxiety or anxious thoughts, it’s very important to talk to your obstetrician.

If your obstetrician doesn’t appear to be knowledgeable about anxiety disorders or dismisses your concerns, find another doctor for a proper diagnosis and treatment. For instance, you might make an appointment with a mental health professional or a psychiatrist. Below is a list on how to find help.

3. Cognitive-behavioral therapy helps to treat anxiety during pregnancy. Research has established that CBT is highly effective for anxiety disorders. But very little research has been done on CBT in pregnant women. One study found that CBT reduced anxiety in pregnancy and improvements lasted postpartum.

4. Taking medication during pregnancy may be OK — or not. Antidepressants – specifically selective serotonin reuptake inhibitors (SSRIs) — and benzodiazepines are commonly prescribed for anxiety disorders and have been shown to reduce symptoms.

Unfortunately, it’s unclear whether taking these medications during pregnancy harms the baby. This article in Psychiatric Times provides insight into pharmacological treatment.

Mental health blogger Anne-Marie Lindsey shares her experiences and what she’s learned about medication during pregnancy in this excellent piece, which also includes links to additional information and resources.

Essentially, some research has shown that medication may lead to adverse effects. But untreated anxiety also has risks. In some cases, moms-to-be do need to take medication. If there’s any consensus, it’s that taking medication is an individual decision that must be thoroughly discussed with your doctor.

Finding Professional Help

If you’d like to seek professional help, check out these resources from Wiegartz and Gyoerkoe’s The Pregnancy & Postpartum Anxiety Workbook:

Cognitive Behavioral Therapy

Medication Management

Pre- or Postnatal Care

Apr 19

Meditation Makes You More Creative

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ScienceDaily (Apr. 19, 2012) — Certain meditation techniques can promote creative thinking. This is the outcome of a study by cognitive psychologist Lorenza Colzato and her fellow researchers at Leiden University, published 19 April in Frontiers in Cognition.

This study is a clear indication that the advantages of particular types of meditation extend much further than simply relaxation. The findings support the belief that meditation can have a long-lasting influence on human cognition, including how we think and how we experience events.

Two ingredients of creativity

The study investigates the influences of different types of meditative techniques on the two main ingredients of creativity: divergent and convergent styles of thinking.

  • Divergent thinking Divergent thinking allows many new ideas to be generated. It is measured using the so-called Alternate Uses Task method where participants are required to think up as many uses as possible for a particular object, such as a pen.
  • Convergent thinking Convergent thinking, on the other hand, is a process whereby one possible solution for a particular probem is generated. This method is measured using the Remote Associates Task method, where three unrelated words are presented to the participants, words such as ‘time’, ‘hair’ and ‘stretch’. The particpants are then asked to identify the common link: in this case, ‘long’.

Analysis of meditation techniques

Colzato used creativity tasks that measure convergent and divergent thinking to assess which meditation techiques most influence creative activities. The meditation techniques analysed are Open Monitoring and Focused Attention meditation.

  • In Open Monitoring meditation the individual is receptive to all the thoughts and sensations experienced without focusing attention on any particular concept or object.
  • In Focused Attention meditation the individual focuses on a particular thought or object.

Different types of meditation have different effects

These findings demonstrate that not all forms of meditation have the same effect on creativity. After an Open Monitoring meditation the participants performed better in divergent thinking, and generated more new ideas than previously, but Focused Attention (FA) meditation produced a different result. FA meditation also had no significant effect on convergent thinking leading to resolving a problem.

Apr 19

A Buddhist Approach to Helping Low Self-Esteem

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By Tim Desmond

Teaching Self-Compassion in Therapy

Q: I’m working with a client who suffers from low self-esteem, and I feel like I’ve tried everything. Are there any Buddhist practices that might help?

A: While many therapists have begun to incorporate mindfulness into their work, additional Buddhist practices hold potential for helping clients, particularly those suffering from low self-esteem. One of the main goals of Buddhist meditation is cultivating compassion and love, and several techniques focus on developing these qualities toward oneself.

For example, Joseph, a young software engineer, came to see me to work on disarming his fierce inner critic. As he and I entered the resource-building phase of therapy, I taught him a form of metta (loving-kindness) meditation. This practice dates back more than 2,500 years, and, next to mindfulness, it’s one of the most commonly taught forms of Buddhist meditation.

When I use metta practice with clients, I generally begin by asking them to identify an image that easily inspires feelings of love, compassion, and warmth in them. Traditionally, this practice begins with using oneself as the first object of compassion, but for clients with low self-esteem, that can sometimes be too difficult. Many clients have an easier time picturing a baby, an animal, a religious figure, or a benefactor for this first step. The important thing is finding someone or something that naturally inspires uncomplicated and unambivalent feelings of compassion and love. With help, most clients can find an image that works, and can engage with the process.

Joseph chose his 1-year-old niece, and I asked him to picture her and allow feelings of love and compassion to arise naturally. I had him remain focused on this step for about three minutes, encouraging him to deepen into the experience by repeating the phrases “May you be happy. May you be healthy. May you be safe.” The purpose of these phrases, which are integral to the way metta practice is traditionally taught, is to help the client connect with an experience of a specific form of unselfish love. Love and compassion can mean many different things in our culture, but the type of love this exercise aims at is a deep feeling of acceptance and support.

After some practice, Joseph was able to get in touch with strong feelings of warmth and care toward his niece. Once we’d accomplished this, the next step was to help him direct some of those positive feelings inward. I sometimes think of this practice in terms of fighting a fire: at this point, the client knows how to open the faucet; now it’s time to learn how to aim the hose.

Helping clients with low self-esteem direct warmth and compassion inward is often a tricky process. I’ve found that different interventions work for different clients. For Joseph, we began by having him get in touch with strong feelings of love toward his niece and then turn that love toward himself while saying the phrases, “May I be happy,” and so forth. As soon as we started this, however, he was immediately overwhelmed by his inner critic. This is a common occurrence with clients who suffer from low self-esteem.

I asked him to tell me what his critic was saying. He said it was saying things like, “How could you ever deserve love? You’re despicable.” Rather than trying to argue with this voice or ignore it, we did exactly what this type of meditation traditionally recommends in cases like this: we made the inner critic the object of Joseph’s love and compassion. This tactic is a departure from how many therapists have been trained to deal with self-criticism, but I believe that it can be an incredibly useful tool.

In Buddhism, it’s said that true compassion and true love are impossible without understanding, so when I help a client shift the focus of compassion to an inner critic, I always start by asking the critic a few questions to create a foundation for the compassion. With Joseph, I said, “I want to understand that self-critical part of you more deeply, so I’ll be asking it some questions. I’d like for you to just listen to how it responds and tell me.”

In most styles of Buddhist meditation, connecting with the body is important for connecting with feelings. To transform a feeling, we start by bringing it up and sensing it in the body. Once it’s present in our awareness, we begin to inquire into its nature. There are many ways to do this, but with therapy clients, I’ve found that asking questions or offering sentence completions can be highly effective. The skill of asking the right question or offering the right sentence completion takes a great deal of practice, but from a Buddhist perspective, the most important thing about the exploration process is that you’re coming from a place of compassion toward that feeling.

I started with the question, “Is there anywhere in your body that you feel that inner critic?”

Joseph said he felt it in his chest.

Once he was present with his feeling, I said, “Now, I’d like you to ask that part of you, that critical voice in your chest, ‘How are you trying to help me?’”

Joseph was quiet for a moment, and then reported, “It says, ‘I’m protecting you from Mom.’”

I praised him and prompted him to ask it, “How do you protect me from Mom?” He answered, “If I feel good about myself, Mom will attack me. If I hate myself, I’ll be safe.”

Asking questions that assume the feeling has a positive purpose is part of inquiring with compassion. Before this, I’d learned that Joseph’s mother had been diagnosed bipolar and had been highly emotionally unstable; however, I didn’t fully understand exactly how that fit together with his self-criticism. I asked Joseph if there were any specific memories coming up for him, and he told me about a time when he was 5 or 6 years old, when he’d proudly showed his mother a good report card, and had been ridiculed by her. His mother said he thought he was better than everyone else. I empathized with Joseph, and we then spent some time just sitting with all of the feelings coming up in him.

Once he felt ready to move on, I asked him to get back in touch with the self-critical voice in his chest. When he said he could feel it, I asked him to try saying, “Thank you for trying to keep me safe from Mom. I know you’re trying to help me.” He immediately started crying, and said he felt a huge relief. He talked about feeling reunited with a part of himself that had been cut off. I suggested that, between sessions, every time he noticed the self-critical voice, he express this kind of gratitude for its desire to protect him.

As we continued therapy, we’d spend time each week with this practice. He’d begin sending love to his niece, and then shift to himself. When his inner critic flared up, he’d say, “Thank you for wanting to protect me from Mom,” and after just a few minutes of repeating this phrase and listening for any response, it would fade. Then he’d return to sending love to himself. Over time, he became adept at using compassion to disarm his inner critic, and had a much easier time loving himself.

Metta practice is an important and helpful part of the way I work with clients. Observing its potential to help clients move through problems that had appeared intractable has convinced me that the practice of offering love and compassion to problematic inner parts could be a significant contribution to the way we conduct therapy, both for our clients and ourselves.

Tim Desmond, L.M.F.T., is a Buddhist scholar, a therapist in private practice, and the director of a mental health day-treatment center for children. He was ordained into the Order of Interbeing by Zen Master Thich Nhat Hanh in 2005, and offers training and consultation to therapists around the world. Contact: tim@psychresources.net.

Apr 19

ADHD Stats and Figures

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1.     In the United States, Attention-Deficit/Hyperactivity Disorder (ADHD) affects an estimated 9.5%of children and 4% of Adults

2.     From 1996 to 2008, the number of children taking stimulants such as Ritalin rose from 2.4 to 3.5 percent. Over the last decade, a half million more children and many more adults have been prescribed stimulant medication.
3.     In 2012 the DEA (Drug Enforcement Administration) increased production quotas of Ritalin (methylphenidate) and amphetamine (Adderall) from 50,000 kg to 56,000 kg of methylphenidate and from 18,600 kg to 25,300 kg of amphetamine.
4.     ADHD symptoms first appear between 3-6 years of age.
5.     Two thirds or more of people with a diagnosis of ADHD will have the Combined type of this disorder meaning that they will be hyperactive, impulsive and inattentive.  One third will be predominantly inattentive.
6.     The number of people on stimulant medicine today is so large that the Federal Drug Administration (FDA) reports that increased demand for these medications have resulted in nationwide, ADHD medication, shortages.
7.     Thirty percent of ADHD patients do not get enough symptom relief from stimulant medication to warrant continuation of the medication.
8.     Two thirds of patients, despite debilitating ADHD symptoms, will no longer be taking their prescription medication a year after it is prescribed. Some will stop because of side effects, for some the medicine will simply not help their symptoms and others will stop for other reasons.
9.     Fifty to seventy percent of ADHD patients will still have some ADHD symptoms as adults.
10. Up to one-third of patients with a diagnosis of ADHD will never complete high school.
11. Twenty-five to forty percent of children with ADHD have a learning disorder.
12. Forty percent of patients diagnosed with ADHD also have a co-diagnosis of Major Depressive Disorder.
13. Twenty-five percent of patients diagnosed with ADHD have a co-diagnosis of anxiety disorder.
14. As many as fifty percent of patients with a diagnosis of ADHD have an additional diagnosis of Oppositional Defiance Disorder.
15. Ten to twenty-five percent of patients diagnosed with ADHD will develop substance abuse problems.
16. Studies have found that ADHD symptoms and related problems occur in 25 to 50% of both male and female prisoners.
17. ADHD is thought to be 80% inheritable which means that genetic factors account for 80% of the differences in symptoms seen in people with and without ADHD.
18. Fifty percent of patients with Tourette’s syndrome have accompanying ADHD.
19. No treatment for ADHD symptoms has been proven to help once the treatment is discontinued.
20. Two-thirds of children with ADHD will have improved symptoms after five weeks of a diet that restricts allergenic foods such as wheat, dairy, eggs and food preservatives.

These ADHD statistics are both impressive and staggering but stats and figures fail to tell the entire story in ADHD.  When I look at the 20 facts above I refuse to sink into a major funk.  Instead I focus on the fact that our future is brighter than these ADHD stats and figures indicate and that better medications and therapies are on the horizon.

Apr 19

Attention-deficit hyperactivity disorder (ADHD) has been linked to many negative outcomes. Usually first diagnosed in childhood, ADHD is characterized by impulsivity and inability to focus on tasks. Until recently, it was believed that ADHD did not widely persist into adulthood. However, new research has shown that many individuals still struggle with the symptoms of ADHD through their adult lives. The impulsive and immediate gratification traits that are common in ADHD have also been shown to increase the risk for substance usedisorders (SUDs). There has been much research dedicated to understanding this link. Additionally, people with ADHD are very likely to have other psychological issues, the most common of which are borderline personality disorder (BPD) and conduct disorder (CD). Both of these mental health problems also usually appear in childhood, and because of the similarity with ADHD, often go undiagnosed or misdiagnosed. Because of this, the majority of the research that has linked ADHD to SUD has failed to account for the influence of CD and BPD.

In order to get a clearer picture of how ADHD, CD, and BPD interact and affect the risk for SUD, Michelle Torok of the National Drug and Alcohol Research Centre at the University of New South Wales in Australia recently led a study involving 269 adult drug users. She assessed the participants and found that more than half of them had at least two of the mental health problems she screened for, and one-fourth of them had conduct disorder, BPD, and ADHD. Compared to the prevalence of these disorders co-occurring in the general population at rates of approximately 3%, these figures were startlingly higher.

After further examination, Torok discovered that contrary to previous research, ADHD was not the largest risk factor for SUD. Instead, when she controlled for both ADHD and BPD, Torok found that CD posed the biggest risk for future drug abuse in the participants. ADHD was actually found to be a minimal predictor of SUD. The study also revealed that the level of symptom severity of each mental health challenge was directly proportionate to level of illicit drug use. Even though her findings demonstrate that ADHD was not the most significant risk factor for drug use, she cautions clinicians and professionals to weigh these results carefully. She said, “Despite the weak predictive ability of ADHD, the significant comorbid associations between ADHD, CD, and BPD do attest to the fact that drug users with these disorders are an overall riskier subgroup of drug users.”

Reference:
Torok, M., Darke, S., Kaye, S. (2012). Attention deficit hyperactivity disorder and severity of substance use: The role of comorbid psychopathology. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0027846

Apr 19

Males Believe Discussing Problems Is a Waste of Time

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A new University of Missouri study finds that boys feel that discussing problems is a waste of time.

“For years, popular psychologists have insisted that boys and men would like to talk about their problems but are held back by fears of embarrassment or appearing weak,” said Amanda J. Rose, associate professor of psychological sciences in the MU College of Arts and Science. “However, when we asked young people how talking about their problems would make them feel, boys didn’t express angst or distress about discussing problems any more than girls. Instead, boys’ responses suggest that they just don’t see talking about problems to be a particularly useful activity.”

Rose and her colleagues conducted four different studies that included surveys and observations of nearly 2,000 children and adolescents. The researchers found that girls had positive expectations for how talking about problems would make them feel, such as expecting to feel cared for, understood and less alone. On the other hand, boys did not endorse some negative expectations more than girls, such as expecting to feel embarrassed, worried about being teased, or bad about not taking care of the problems themselves. Instead, boys reported that talking about problems would make them feel “weird” and like they were “wasting time.”

“An implication is that parents should encourage their children to adopt a middle ground when discussing problems. For boys, it would be helpful to explain that, at least for some problems, some of the time, talking about their problems is not a waste of time. Yet, parents also should realize that they may be ‘barking up the wrong tree’ if they think that making boys feel safer will make them confide. Instead, helping boys see some utility in talking about problems may be more effective,” Rose said. “On the other hand, many girls are at risk for excessive problem talk, which is linked with depression and anxiety, so girls should know that talking about problems isn’t the only way to cope.”

Rose believes that the findings may play into future romantic relationships, as many relationships involve a “pursuit-withdraw cycle” in which one partner (usually the woman) pursues talking about problems while the other (usually the man) withdraws.

“Women may really push their partners to share pent-up worries and concerns because they hold expectations that talking makes people feel better. But their partners may just not be interested and expect that other coping mechanisms will make them feel better. Men may be more likely to think talking about problems will make the problems feel bigger, and engaging in different activities will take their minds off of the problem. Men may just not be coming from the same place as their partners,” Rose said.

Apr 19

Middle School Worries

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by Kirk Martin

Anxiety stems from things you can’t control — and there are plenty of those in the life of a child diagnosed with ADHD. A middle-schooler may dread going to school because he feels lost in class and is afraid the teacher may call on him. He worries that he might blurt something out to a classmate and be sent to the principal’s office—again. Riding the school bus brings more anxiety. He walks to the back of the bus, never knowing whether someone is going to make fun of him.

Your child may be as tall as you now, but, inside, he is a scared kid. How can you help him overcome anxiety in school and with friends?

School

Make a list of your child’s talents and passions. Parents can tell me negative things off the top of their head: Their son is lazy, messy, unmotivated, and he talks back. But what does he love doing? What is he good at? Nothing eases anxiety in a child more than doing something he enjoys.

Have a teacher or mentor give your child a job that uses his talents. This gives your child’s brain something to focus on, instead of thinking about things he cannot control. Let’s say your daughter loves to doodle and draw. Have the art teacher ask her to design posters for the upcoming school play. Your budding scientist can help a science teacher with chemistry experiments. Instead of coming to school anxious, he will look forward to showing off his abilities.

Slow down your lifestyle. Navigating middle school is tough. Kids feel new emotions, deal with the opposite sex, and try to find their place. If you are rushing around at home, this will create even more anxiety. Plan downtime, and say no to extra activities.

Friends

Invite kids to your house. Teach your child to build friendships in the safety of his home. Invite three or four kids over to do something your child enjoys — having pizza or playing a video game. If your child has a social group of his own, he can walk the school halls knowing that someone has his back.

Arrive early for new activities. When going to that new tae kwon do class, it can be intimidating to walk in after other kids have already formed a social group. Arrive early, so your child can get acclimated and feel settled.

Apr 18

How to Handle Panic Attacks

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Panic attacks can be terrifying. These attacks stem from profound anxiety that can make your heart pound and your knees go weak. Panic attacks can make it difficult to catch your breath and can also cause chest pain and dizziness — you may even think you’re having a heart attack. A panic attack may only last a few minutes, but it can leave you feeling frightened and uneasy.

Understanding Panic Attacks

A panic attack and its symptoms of tremendous anxiety can strike suddenly, out of the blue. While a panic attack itself may be brief, it can lead to a lasting fear of having another episode. When panic attacks and the fear of having attacks occur repeatedly, people are said to have a panic disorder, a type of anxiety disorder.

“People have these panic attacks under various circumstances,” explains Martin N. Seif, PhD, a clinical psychologist in New York City and Greenwich, Conn. They constantly worry about having an attack and may avoid certain situations as a result. Eventually, people with panic disorder may realize that they aren’t actually afraid of the situation they’re avoiding, but rather of experiencing additional panic attacks, notes Seif.

Fortunately, you don’t have to live in fear of panic attacks. There are specific strategies you can use to help manage your anxiety and control your physical symptoms as well.

Panic Attacks: How to Take Control

The best way to stave off future panic attacks is by learning how to control your anxiety so that if you do start to notice symptoms of a panic attack, you can calm your mind and body until the symptoms fade.

“People who experience panic attacks have to learn how to cope with their feelings of panic,” says Seif. While medication can be effective, cognitive-behavioral therapy is one of the best techniques for managing panic and anxiety. “It involves recognizing that the panic-producing process is fueled by future-oriented, catastrophic thinking,” explains Seif. People with panic disorder have to become aware that their thoughts trigger a physical reaction, which results in a panic attack.

To gain control over panic disorder, it’s important to learn and practice anxiety management techniques, says Seif. Strategies that you can use to help you curb a panic attack include:

  • Breathing slowly and deeply. Anxiety can cause you to breathe very quickly, which makes both the mental and physical symptoms of a panic attack even worse. When you start to feel panicky, be sure to take slow, deep breaths to soothe your mind and body.
  • Stop and think. When your thoughts start spinning out of control, simply tell yourself to stop. Organize your thoughts and decide what you need to do to get yourself calm again.
  • Think positively. Push negative thoughts out of your mind, and remind yourself that you are in control. Think about times when you’ve been able to manage situations successfully and reduce anxiety.
  • Stand up for yourself. If you need to leave a situation, do so or tell someone you need to leave. Don’t be afraid to ask for help. Allowing yourself to become more upset will not help if what you really need is to take a walk and blow off some steam.
  • Relax your muscles. Anxiety causes your entire body to tense up, so make a conscious effort to relax each muscle from your toes all the way up to your neck and face.

Don’t wait for a panic attack to begin to try these techniques. Seif notes that it’s important to use these strategies regularly and learn to manage your anxiety in gradual stages. As you become more confident that you can rein in a panic attack, you can walk out the door each day breathing easier.

Apr 18

trichotillomania

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By Richard Zwolinski, LMHC,

Sara pulls the woven, green hat from her head to show her nearly bald scalp, with only a few tufts of long, thin hair surrounding her crown. Sara has trichotillomania. She pulls her own hair out.

“This is where I pull from, Dr. Deibler,” she explains.  I nod and say nothing, not because it’s unimportant, but because it’s important to react as if this discussion is like any other discussion, even though she has never before revealed her trichotillomania to anyone.

This is not the first time I met with Sara. In fact, we’d been working together for months, but this is the first time she felt comfortable enough to show me what she’s done to herself.

It hadn’t always been this way for Sara. She began pulling her eyelashes and eyebrows at age 7. Now, at age 14, she’s pulled nearly all of the hair from her head and wears a cap so that no one can see.  It’s not that she’s never sought help. She’d been to therapist after therapist, each one helping her cope with her parents’ divorce and family problems, but none of whom knew how to help Sara with her hair.

Now, she was working hard in her treatment to develop awareness, build coping skills, and develop new behavior patterns. She and her mother attended our trichotillomania support group to meet others who were struggling.  And, over time, Sara improved, not just her pulling, but her happiness, confidence and self-acceptance.

That was two years ago. She doesn’t come by much anymore because she doesn’t need to. She no longer struggles, but she remembers what it was like to struggle. Earlier this year, she spoke to our support group for those who struggle with hair pulling.  Many who attended wore head coverings, hairstyles, or makeup to hide their hair loss too, but not Sara.  She was able to tell them what trichotillomania was like for her, as she sat in front of them with her long, beautiful, blonde hair and showed them how this struggle can change. In Sara, they saw themselves and they saw hope.

I often tell my patients that aside from treatment itself, an important thing unfolds in recovery: When people stop hiding, they start getting better.  And this is what has happened for Sara; she stopped hiding and started living.

Dr. Marla Deibler, Sara’s therapist, will be with us on Therapy Soup for a few posts. Dr. Deibler is the founding director of The Center for Emotional Health of Greater Philadelphia. She specializes in the treatment of anxiety and the obsessive-compulsive disorders spectrum. She is also an expert on tricholtillomania, a hair-pulling disorder.

Welcome, Dr. Deibler. Let’s start with the basics. What is trichotillomania and who has this disorder?

I am very thankful for the opportunity to share information with your readers about this significant problem which is so rarely discussed.

Trichotillomania affects between 2% and 4 % of children and adults, with females affected more overall.  Every day in the Unites States, 200 to 400 children and adolescents begin pulling their hair, yet there is little awareness of this problem in mainstream culture. Very frequently, those afflicted with Trichotillomania suffer in shame and silence.

Trichotillomania (trick-o-till-o-MAY-nee-ah; also known as TTM or “trich”) is a disorder which causes individuals to pull out hair from the scalp, eyebrows, eyelashes, or other part(s) of the body, resulting in noticeable hair loss. Individuals who pull their hair typically wish to cease the behavior, but have difficulty doing so without assistance. This disorder is currently classified as an Impulse – Control Disorder; however, it is considered to belong to a family of Body – Focused Repetitive Behaviors (BFRBs), which include behaviors such as skin picking, nail biting, and lip or cheek biting.

The severity of trichotillomania can vary greatly from small areas of thinning hair to the complete absence of eyelashes, eyebrows, and/or scalp hair. Trichotillomania typically causes significant distress and may lead to shame, secrecy, and embarrassment as well as isolation and avoidance of activities due to fears that others will notice the hair loss. As a result, individuals often cover up or hide the behavior and are reluctant to seek treatment.

In addition to emotional distress and avoidance behaviors, trichotillomania has the potential to result in acute medical consequences. For example, those who bite and/or ingest pulled hairs may suffer from gastrointestinal distress or, moreover, intestinal blockage as the result of a trichobezoar (hair ball) which may require surgical intervention to remove the hair and restore digestive functions.

Apr 18

Medications to Treat ADHD – Which One?

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By Diana Rodriguez   ADHD is a behavioral disorder affecting millions of children and adults. However, ADHD can be successfully managed with a combination of therapy and ADHD drugs. There are several types of ADHD drugs that are useful, and several medications within each type. There are standards of treatment that often provide the greatest success, but they don’t work for everyone.

ADHD Drugs: Medication Classes Prescribed

The types of ADHD drugs used most often are stimulants, non-stimulant drugs including antidepressants, and high blood pressure medications.  The first line of treatment and the most commonly prescribed ADHD drugs are typically the stimulants, because they often work the best.  F. Allen Walker, MD, a psychiatrist who has ADHD and who runs his own practice specializing in ADHD in Louisville, Ky., feels the stimulant class of ADHD drugs is superior to other classes in treating ADHD.

“When treating patients, if you combine therapy and education with medication and you take the time to individualize the medication and dosage, that is the most effective way to treat ADHD,” says Dr. Walker.  Stimulants primarily focus on increasing the neurotransmitter dopamine in the brain, particularly in the prefrontal cortex.  “The theory is people with ADHD have a brain that’s a little bit thirsty for dopamine,” says Walker, and increasing dopamine levels allows an ADHD brain to function better.

Non-stimulant drugs can also be used to treat ADHD. Non-stimulant medications such as various antidepressants affect not only dopamine, but also other neurotransmitters such as norepinephrine and serotonin. Antidepressants are sometimes used in patients who are not able to tolerate stimulant medications.

High blood pressure medications can help manage associated ADHD symptoms like irritability, impulsivity, restlessness, and tics, though they aren’t very successful in managing inattention.

The Most Common ADHD Drugs

Here is a list of the most commonly prescribed ADHD drugs and information about each one:

  • Ritalin, Mehylin, Metadate, Concerta, Daytrana (methylphenidate). This stimulant can effectively manage all of the primary symptoms of ADHD — impulsivity, hyperactivity, and inattention. Studies show that methylphenidate offers the most significant and quick reduction of ADHD symptoms and doesn’t increase tics. Potential side effects include depression, dizziness, headaches, appetite loss, insomnia, and nausea. Studies have shown that Ritalin might have a negative impact on the healthy development of the brain in children and teenagers. Concerta is an extended-release form of methylphenidate. Daytrana contains the same medication in a patch that is applied to the skin daily.
  • Adderall (dextroamphetamine and amphetamine). This stimulant can effectively manage all of the primary symptoms of ADHD, with all the potential side effects of Ritalin. Studies have shown a rare side effect of heart attacks, which can be fatal, particularly if mixed with alcohol use.
  • Dexedrine (dextroamphetamine). This stimulant can effectively manage all of the primary symptoms of ADHD, with all the potential side effects of other stimulants. Studies show some evidence that dextroamphetamine may increase tics after long periods of time when given in greater-than-normal doses and should not be administered at such levels.
  • Vyvanse (lisdexamfetamine dimesylate).This stimulant is known as a prodrug, meaning it is inactive until metabolized in the body. Vyvanse may prevent the potential for drug abuse that has been reported with Adderall.
  • Focalin (dexmethylphenidate). This stimulant comes in a capsule, which can be opened and sprinkled on foods for those who have trouble swallowing pills. Though it is known to have fewer side effects than Ritalin, this medicine may stop working earlier than needed in some individuals.
  • Strattera (atomoxetine). This non-stimulant drug offers the benefit of 24-hour effects, which is longer than stimulants. It can also help battle depression and is a good choice for people dealing with ADHD and depression or anxiety, but it’s not as effective against symptoms of hyperactivity as stimulant drugs. Side effects can include fatigue, irritability, stomachache, headache, nausea, and vomiting. Studies show that atomoxetine is as effective as stimulants with some additional benefits and at a lower cost than some other drugs. Atomoxetine also doesn’t have the risk of abuse and dependence that stimulant drugs do. However, it’s been found to potentially increase the risk of suicide.
  • Aplezin, Wellbutrin, Zyban (buproprion). This antidepressant affects the chemicals dopamine and norepinephrine in the brain and can be a very effective treatment in people who have both ADHD and depression. Buproprion can effectively manage symptoms of hyperactivity and inattention in people who don’t find relief from stimulants or who can’t tolerate their side effects. However, antidepressants have not been found to be effective at managing impulsivity. Side effects can include blurry vision, drowsiness, dryness of the mouth, and constipation. Studies have shown that some antidepressants can increase the risk of suicide. Antidepressants are not approved by the U.S. Food and Drug Administration (FDA) for the treatment of ADHD.
  • Intuniv, Tenex (guanfacine). Intuniv, a long-acting form of the blood pressure medication Tenex, was approved for the treatment of ADHD by the FDA in September 2009. This once-a-day treatment for kids ages 6 to 17 is a non-stimulant medication thought to engage receptors in the area of the brain linked to ADHD. In 2011, the FDA said that Intuniv could be used along with a stimulant to help children who are not responding well to a stimulant alone. Guanfacine can strengthen memory, reduce distraction, and improve attention and impulse control. Side effects can include tiredness, abdominal pain, dizziness, a drop in blood pressure, dry mouth, and constipation.
  • Catapres (clonidine). This high blood pressure medication can manage ADHD symptoms of aggressive behavior, impulsions, hyperactivity, and tics, but it’s not very effective against inattention. Side effects can include drowsiness, dryness of the mouth, blurry vision, heart problems, and constipation. Studies have shown that this high blood pressure medication is becoming more popular and is a safe and successful treatment for ADHD in addition to or instead of stimulant medications, but it is not FDA-approved for this use.

With patience and a knowledgeable medical professional, you can find the right medication at the right dose to help manage ADHD symptoms.

In the 1970s, Herbert Benson’s book “The Relaxation Response” described a method for easing moments of great stress — the opposite of the “fight or flight” mechanism that causes panic when it kicks in at the wrong time.

Now, Benson says, new research by his team at Harvard-affiliated Massachusetts General Hospital (MGH) demonstrates that the relaxation response can create genetic changes in irritable bowel syndrome sufferers, and with further study might be applied to the treatment of other diseases — even cancer.  “It’s effective with virtually all diseases with a stress component,” Benson said.

Benson was speaking April 4 at the Dean’s Distinguished Lecture Book Presentation at the Harvard School of Public Health (HSPH). HSPH Dean Julio Frenk served as moderator.

Benson is a Harvard Medical School-trained cardiologist and founder of the Benson-Henry Institute for Mind Body Medicine at MGH. He was one of the first Western doctors to popularize the use of traditional meditation methods to reduce stress and illness. The technique he emphasizes consists of repeating a word, thought, or prayer while breathing deeply and simultaneously banishing negative thoughts as they pop into your mind. The process lasts between 10 and 20 minutes every day.

He said he was especially interested in speaking before future public health officials about the benefits of mind-body medicine because, almost 40 years after his book was published, there’s still resistance in the medical community.

“Between 60 to 90 percent of visits to physicians in the mind-body realm are poorly treated by drugs,” Benson said.  It wasn’t always so.  “People have been practicing yoga for thousands of years — people daven, count the rosary, do tai chi,” Benson said. “What they were doing was using techniques they believed sustained health and well being — and they were correct.”

Research detailed in Benson’s 2010 book, “Relaxation Revolution,” shows that centuries’-old mind-body treatment can have a profound effect on the treatment of diseases — right down to the human genome.

“To the extent that stress is a factor in a disorder, the relaxation response resilience program is effective,” Benson said. “There are some where it is 100 percent curative, such as tension headache. There others where it can influence a major component, such as hypertension.”

The relaxation response has made a big difference in the treatment of irritable bowel syndrome, a disorder that leads to abdominal pain and cramping, changes in bowel movements, and other symptoms. According to the National Institutes of Health, the condition afflicts one in six Americans.

Benson hopes genome researchers can determine how effective stress control is, and then integrate it with existing drug and surgical techniques.

“This can be done disease by disease by disease to better define what works,” Benson said.  Benson said the relaxation response is best done in the morning before work. He warned against cutting corners — less than 10 minutes a day.

“It can’t be quick and dirty,” Benson said. “The more you do it, the more changes will occur.”

Apr 18

ScienceDaily (Apr. 17, 2012) — At a time when obesity has become epidemic in American society, Dartmouth scientists have found that functional magnetic resonance imaging (fMRI) brain scans may be able to predict weight gain. In a study published April 18, 2012, in The Journal of Neuroscience, the researchers demonstrated a connection between fMRI brain responses to appetite-driven cues and future behavior.


“This is one of the first studies in brain imaging that uses the responses observed in the scanner to predict important, real-world outcomes over a long period of time,” says Todd Heatherton, the Lincoln Filene Professor in Human Relations in the department of psychological and brain sciences and a coauthor on the study. “Using brain activity to predict a consequential behavior outside the scanner is pretty novel.”

Using fMRI, the researchers targeted a region of the brain known as the nucleus accumbens, often referred to as the brain’s “reward center,” in a group of incoming first-year college students. While undergoing scans, the subjects viewed images of animals, environmental scenes, appetizing food items, and people. Six months later, their weight and responses to questionnaires regarding interim sexual behavior were compared with their previously recorded weight and brain scan data.

“The people whose brains responded more strongly to food cues were the people who went on to gain more weight six months later,” explains Kathryn Demos, first author on the paper. Demos, who conducted the research as part of her doctoral dissertation at Dartmouth, is currently on the research faculty at the Warren Alpert Medical School of Brown University.

The correlation between strong food image brain responses and weight gain was also present for sexual images and activity. “Just as cue reactivity to food images was investigated as potential predictors of weight gain, cue reactivity to sexual images was used to predict sexual desire,” the authors report.

The paper stresses “material specificity,” noting that the participants who responded to food images gained weight but did not engage in more sexual behavior, and vice versa. The authors go on to say that none of the non-food images predicted weight gain.

Heatherton and William Kelley, associate professor of psychological and brain science and a senior author on the paper, have a longstanding interest in psychological theories of self-regulation, also called self-control or willpower.

“We seek to understand situations in which people face temptations and try to not act on them,” says Kelley.  The researchers note that the first step toward controlling cravings may be an awareness of how much you are affected by specific triggers in the environment, such as the arrival of the dessert tray in a restaurant.

“You need to actively be thinking about the behavior you want to control in order to regulate it,” remarks Kelley. “Self-regulation requires a lot of conscious effort.”

Apr 18

Are You a Guilty Parent?

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by Ann Smith    I rarely meet a parent who denies having guilt about how they have raised their children. For most of us a moderate amount of guilt is actually a sign of love, our strong attachment and commitment to do the best we can to raise healthy children. Of course it is a matter of degrees.  As in all things, too much or too little can create a serious problem for both parent and child. The trick is to know we have it and why and more importantly, how it drives our choices and actions in our role as parent.

Guilt is an emotion, not a reality or a life sentence. Guilt arises when we become aware of failing to be the best we could have been for our children. It comes and goes and can be mild or debilitating. Guilt tries to tell us something is wrong and needs to be corrected. If it isn’t faced it will turn into shame, a feeling of worthlessness and a negative sense of self.

Guilt can heal and be resolved with compassion and time. It lessens when shared out in the open and with understanding. Shame is more difficult to resolve. It is not about making mistakes. It is about being a mistake. In time and with help it too can be lessened.

What do we feel guilty about?

These are the Top 20 comments I hear from parents about their guilt:

• I wasn’t there enough.
• I didn’t listen.
• I was too focused on the house and work.
• I wasn’t affectionate enough.
• I was critical.
• I yelled, hit, and blamed.
• I was a bad role model.
• I didn’t take the time to understand my children..
• I wasn’t consistent
• I pushed too hard.
• I didn’t push enough.
• I spanked.
• I drank.
• I was depressed.
• I fought with my children’s dad or mom.
• I got divorced.
• I said hurtful things.
• I was selfish.
• I ignored my child.
• I didn’t protect my children.

When Guilt Becomes Destructive

Guilt is a normal emotion that can be a warning sign or nudge in the right direction when it arises as a result of inappropriate behavior or stepping outside our own values. For some, guilt becomes a chronic, even obsessive thought process that is no longer connected to a specific mistake or regrettable action. When guilty parents become stuck in their pain they may be unwittingly creating more serious problems for themselves and even their children.  If a child becomes depressed, exhibits problem behavior, has ADHD, uses drugs or alcohol, gets poor grades, is lazy, is defiant of authority, overweight, anorexic etc. guilty parents react in a variety of ways to cope with their pain. They may not be aware of the guilt, shame or any of their emotions but will instead act out what is going on internally.

Self-blame can appear in many forms including enabling, dramatic pleas for change, threatening, blaming the child for your distress “How could you do this to me,” withdrawing, raging, anxiety, hovering or even quitting as a parent. Guilt can linger and follow us long after children are out of the nest.

Many parents do not realize that when they are visibly and dramatically upset about how their child is developing or performing, a normal child will internalize that as “I am not enough” or “I’m hurting my Dad and Mom.” Since children’s well-being depends on their attachment to us, they may work harder to be what they believe we want them to be even it is isn’t best for them. Some may run away emotionally, rejecting our help in order to cope. When a guilty parent pushes a child toward perfection, children may feel the need to appear okay while denying their struggles and feelings.

The Good News about Guilt

There is a silver lining here. If you’re stuck in this cycle of parenting – you can find a healthier way to manager your guilt and/or shame. Remember that parenting does not need to be perfect. Our children learn from every experience in their lives, even our mistakes.

If you had a very painful childhood you may be falling into the trap of viewing your children through the lens of your pain. You may be driven by your need to make it all better by giving your children a pain free childhood.

Do have compassion for yourself and your painful experiences. But try to separate your past experience from the new and improved approach you are providing for your children. The goal is “good enough” — not perfection. Children need some challenges and frustrations to become healthy functioning adults.  Remember to stand back and look at ourselves and our children as complex human beings. It is obvious that we are all imperfect, unpredictable, inconsistent, driven by heredity and environment, as well as resilient, and capable of change.

I remember myself as a young woman of 24, already divorced with a two-year-old son. I had no idea how young I was and how immature. I made many mistakes and I still have a twinge of guilt, mostly about being selfish and impulsive. However, I now have compassion for myself at that stage of my life. I know in my heart that I did the best I could with what I knew at the time and I had a lot of growing up to do.  The guilt I carried about being divorced was a heavy burden for me and my burden could have become a burden to my son. With help I discovered that my child did not have to be okay to convince me that I was a good mother.

A wise therapist once told me that children have a right to and a need for their own story in life. That includes making and learning from mistakes which my guilt could not allow. I learned that guilt could no longer play a part in my role as parent.  I went on to have a daughter and as my children grew I also had to learn that guilt did not need to be the spoiler in my memories of the joys and challenges of raising them.

The key is to focus on the process of parenting, which is basically loving, guiding and reassuring children instead of focusing on the outcome or how they turn out. Learning how to do this will ease the pressure of guilt and will help all of us to accept children as they are and to gradually let go of our role of parenting once they reach adulthood.

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