Individual, Family & Group Psychotherapy
Locations in New York & New Jersey

By Traci Pedersen Associate News Editor

No Link Found Between ADHD Drugs and Future Substance AbuseChildren with attention-deficit hyperactivity disorder (ADHD) are far more likely than their peers to engage in serious substance abuse as teens and adults.

But do ADHD meds contribute to the risk?

In the most comprehensive research ever on this topic, UCLA psychologists found that children with ADHD who take medications such as Ritalin and Adderall are at no greater risk of using alcohol, marijuana, nicotine or cocaine later in life than kids with ADHD who don’t take these medications.

The researchers looked at 15 long-term studies, including data from three studies not yet published. The studies followed more than 2,500 children with ADHD from childhood into their teen and young adult years.

“We found the children were neither more likely nor less likely to develop alcohol and substance-use disorders as a result of being treated with stimulant medication,” said Kathryn Humphreys, a doctoral candidate in UCLA’s Department of Psychology and lead author of the study. “We found no association between the use of medication such as Ritalin and future abuse of alcohol, nicotine, marijuana and cocaine.”

The children had a mean age of 8 years old when the research began and 20 at the most recent follow-up assessments. They came from a broad geographical range, including California, New York, Michigan, Pennsylvania, Massachusetts, Germany and Canada.

“For parents whose major concern about Ritalin and Adderall is about the future risk for substance abuse, this study may be helpful to them,” Humphreys said.

“We found that on average, their child is at no more or less at risk for later substance dependence. This does not apply to every child but does apply on average. However, later substance use is usually not the only factor parents think about when they are choosing treatment for their child’s ADHD.”

The researchers report that children with ADHD are two to three times more likely than children without the disorder to develop serious substance-abuse problems in adolescence and adulthood, including the use of nicotine, alcohol, marijuana, cocaine and other drugs.

This new study does not oppose those results but finds that, on average, children who take stimulant medication for ADHD are not at additional risk for future substance abuse.

Ritalin is associated with certain side effects, such as suppressing appetite, disrupting sleep and changes in weight, said Steve S. Lee, a UCLA associate professor of psychology and senior author of the study.

“The majority of children with ADHD—at least two-thirds—show significant problems academically, in social relationships, and with anxiety and depression when you follow them into adolescence,” Lee said.

“For any particular child, parents should consult with the prescribing physician about potential side effects and long-term risks,” said Lee.

“Saying that all parents need not be concerned about the use of stimulant medication for their children is an overstatement; parents should have the conversation with the physician. As with other medications, there are potential side effects, and the patient should be carefully evaluated to, for example, determine the proper dosage.”

As the study participants get older, researchers will be able to study the rate at which they graduate from college, get married, have children and/or get divorced and to assess how well they function, Humphreys said.

As children with ADHD enter adolescence and adulthood, they typically fall into one of three groups of similar size, Lee said: one-third will have significant problems in school and socially; one-third will have moderate impairment; and one-third will exhibit only mild impairment.

The research is published in the journal JAMA Psychiatry, a psychiatry research journal published by the American Medical Association.

Source: JAMA Psychiatry

May 30

Medication for ADHD


Seventy to 80 percent of children with ADHD respond to treatment with stimulants, so this is often the first line of defense. Doctors sometimes prescribe nonstimulants for the approximately 20 to 30 percent of children with ADHD who don’t respond to stimulant treatment.


There are over a dozen stimulant medications on the market, but here are the most common.

Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin, Focalin): The most widely-used drug therapy for ADHD and still the most common.

Dextroamphetamine-amphetamine (Adderall)

Dextroamphetamine (Dexedrine)

Lisdexamfetamine dimesylate (Vyvanse)

It seems strange that giving stimulants to an already hyper child could help, but researchers believe they may help adjust the levels of neurotransmitters in the brains of ADHD children. Stimulants can be prescribed in short-acting and long-acting forms, so your child may take medication as often as three times a day or perhaps only once a day. Medications come in pill, liquid, capsule and patch forms.

Most children experience some side effects, the most common being insomnia, decreased appetite, or weight loss. Occasionally, kids will experience irritability or a “rebound” effect when the medication wears off. Very rare side effects can include facial tics, which most often disappear with a lower dose or change in medication, and a reduced growth rate. Kids should be screened for any pre-existing heart conditions before starting stimulants.

Nonstimulant medication

There are two nonstimulants specifically for ADHD treatment in children.

Atomoxetine (Strattera): Strattera increases the levels of the neurotransmitter/hormone norepinephrine to the brain. Researchers think this chemical plays a key role in focus and attention. This drug may also reduce anxiety. Strattera can cause some rare but very serious side effects, including jaundice and other liver problems, and suicidal thinking.

Guanfacine (Intuniv): This newer form of Tenex, a drug for high blood pressure, was approved for ADHD treatment in fall 2009. Again, doctors are not really certain why it works, but it may help control behavior by affecting the prefrontal cortex, the area of the brain that serves as a check on our impulses. The most common side effects of Intuniv are tiredness and sleepiness. Other side effects may include low blood pressure and low heart rate, dizziness, fainting episodes and nausea.

May 28

Age by Age Stages of ADHD


There is no legitimate way to diagnose an infant with ADHD, but the American Academy of Child and Adolescent Psychiatry says that all of the following can be signs of a tendency to develop ADHD later.

Poor sucking/frequent feedings
Thumb sucking
Difficult to comfort/dislikes being held
Poor sleeper

Of course many babies exhibit these behaviors and do not go on to develop ADHD. They’re of more concern if the baby has other risk factors, such as a family history of ADHD or prenatal exposure to drugs, alcohol or cigarettes.

Diagnosing toddlers with ADHD is extremely controversial since developmentally, most lack impulse control and have short attention spans. However, children that will later be diagnosed with ADHD can exhibit these traits to the point where they are actually dangerous – hitting, taking toys, even dashing into the street – on an ongoing basis. Children with ADHD may have frequent and violent temper tantrums, and be poor sleepers and picky eaters as toddlers. (But please remember, none of these signs guarantees your child will have ADHD!)

Some parents do seek diagnosis and treatment for very young children with severe behavioral issues. But because the brain is still rapidly developing at this point and few psychiatric medications are approved for very young children since side effects can be severe and troubling, doctors are most likely to recommend only parental training and behavior modification.

In 2011, the AAP expanded its guidelines to diagnose children as young as age 4 in an attempt to provide evidence-based, specific recommendations for what some pediatricians were already doing unofficially: using Ritalin and other stimulants off-label to treat small kids with problems severe enough to get them expelled from preschool and wreak havoc on their families. Behavior modification therapy should be the first line of defense for preschoolers diagnosed with ADHD, with prescription medications like Ritalin to be tried at a low dose only if therapy is not effective on its own.

Grade-school Children
The vast majority of children are diagnosed with ADHD during the first few years of school when their inability to focus and lack of control make learning and social functioning difficult.

Children with ADHD may be rude, aggressive or inattentive in class. They are likely to forget assignments and lose materials. Many will fall behind because of ADHD behaviors or learning disabilities, which are common in children with ADHD. However, ADHD children can be extremely bright and may compensate, working feverishly to get good grades. Children with ADHD may have difficulty behaving appropriately on sports teams, at parties and on family outings. ADHD behaviors can cause family stress and strain parental relationships and marriages.

Once diagnosed with ADHD, children are most often treated with a combination of medication and therapy, however, some will only need one or the other. These therapies are effective in most children, but they’re not magic – many ADHD children will struggle more than their peers to succeed in school and social environments.

Early diagnosis and intervention is key to later success for ADHD children. Thanks to federal civil rights laws, public schools are required to provide accommodations or strategies and aids to enable children with ADHD to learn and compete with their non-ADHD classmates.

The Middle School Years
Many kids who have the inattentive type may be diagnosed for the first time around this age. Whether your middle schooler’s been recently diagnosed or not, an increasingly difficult curriculum and adolescent hormones can wreak havoc in the lives of ADHD kids (not to mention their parents!) Parents, teachers and doctors need to be ready to readjust treatment strategies, including changing medications and doses, and developing new methods for organizing more complex schedules.

Middle schoolers should also begin to take more responsibility for their decisions and therapy. Some experts recommend that kids take a “holiday” from medication if they want and see how it affects their lives and their school performance. Otherwise it can become an area of conflict with parents.

Behavioral therapy should also focus on strategies that kids, rather than parents, can employ to remember homework and materials. Color coded charts will give way to notebook or computer organizers.

Beyond Middle School
All teens are impulsive, but since ADHD kids can be even more so, the dangers that lurk for all teens — car accidents, drinking, drug abuse and irresponsible sex — are magnified for them. Experts used to think children outgrew ADHD in their teen years, but now research indicates that about 60% of children with ADHD will have the condition as adults, although symptoms become less severe over time. That’s why it is important for children to continue treatment and for parents to continue to advocate for their education. ADHD students may qualify for accommodations like extra time on standardized tests in high school and college.

Experts say teens who have learned how to schedule themselves and how to make appropriate decisions through therapy earlier in life will be less likely to struggle in school and with social relationships during the critical teen years. This will boost their self-esteem and lead to happier, healthier kids.

May 26

Eaing Disorders Information & Treatment


Eaing Disorders Information & Treatment Introduction
By John M. Grohol, Psy.D.

Table of Contents:

An Introduction to Eating Disorders
Symptoms of Anorexia Nervosa
Symptoms of Bulimia Nervosa
Symptoms of Binge Eating
Treatment of Eating Disorders
Tips for Friends & Family
Further Information

Eating disorders are one of the unspoken secrets that affect many families. Millions of Americans are afflicted with this disorder every year, and most of them — up to 90 percent — are adolescent and young women. Rarely talked about, an eating disorder can affect up to 5 percent of the population of teenage girls.

Why are adolescent and young women so susceptible to getting an eating disorder? According to the National Institute of Mental Health, it is because during this period of time, women are more likely to diet to try and keep a slim figure and/or try stringent dieting. Certain sports (such as gymnastics) and careers (such as modeling) are especially prone to reinforcing the need to keep a fit figure, even if it means purging food or not eating at all.

There are three main types of eating disorders:

Binge Eating

Anorexia (also known as anorexia nervosa) is the name for simply starving yourself because you are convinced you are overweight. If you are at least 15 percent under your normal body weight and you are losing weight through not eating, you may be suffering from this disorder.

Bulimia (also known as bulimia nervosa) is characterized by excessive eating, and then ridding yourself of the food by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. This behavior of ridding yourself of the calories from consumed food is often called “purging.”

A person who suffers from this disorder can have it go undetected for years, because the person’s body weight will often remain normal. “Binging” and “purging” behavior is often done in secret and with a great deal of shame attached to the behavior. It is also the more common eating disorder.

Eating disorders are serious problems and need to be diagnosed and treated like any medical disease. If they continue to go untreated, these behaviors can result in future severe medical complications that can be life-threatening.

Treatment of eating disorders nearly always includes cognitive-behavioral or group psychotherapy. Medications may also be appropriate and have been found effective in the treatment of these disorders, when combined with psychotherapy.

If you believe you may be suffering from an eating disorder or know someone who is, please get help. Once properly diagnosed by a mental health professional, such disorders are readily treatable and often cured within a few months’ time.

A person with an eating disorder should not be blamed for having it! The disorders are caused by a complex interaction of social, biological and psychological factors which bring about the harmful behaviors. The important thing is to stop as soon as you recognize these behaviors in yourself, or to get help to begin the road to recovery.
» Next in Series: Symptoms of Anorexia

Learn more about Eating Disorders…

Take one of our free online quizzes: Quick Eating Disorder Screening or the longer Eating Attitudes Test
Detailed diagnostic Anorexia, Bulimia, and Binge Eating Symptoms
Learn more about the Treatment Options available for Eating Disorders
Need more help or information? Check out our reviewed listing of Online Resources
Join Psych Central’s own Eating Disorder Online Support Group
Read the latest News & Research on Eating Disorders
Health Consequences of Eating Disorders
Back to the Eating Disorders Introduction

May 24

Obsessive-Compulsive Disorder


OCD Information & Treatment
By Wayne K. Goodman, M.D.

Washing handsObsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses. The majority of people with OCD have both obsessions and compulsions, but a minority (about 20 percent) have obsessions alone or compulsions alone (about 10 percent).

The person with OCD usually tries to actively dismiss the obsessions or neutralize them by engaging in compulsions or avoiding situations that trigger them. In most cases, compulsions serve to alleviate anxiety. However, it is not uncommon for the compulsions themselves to cause anxiety — especially when they become very demanding.

Examples of Obsessions and Compulsions

Common types of obsessions include concerns with contamination (e.g., fear of dirt, germs or illness), safety/harm (e.g., being responsible for a fire), unwanted acts of aggression (e.g., unwanted impulse to harm a loved one), unacceptable sexual or religious thoughts (e.g., sacrilegious images of Christ) and the need for symmetry or exactness.

Common compulsions include excessive cleaning (e.g., ritualized hand washing); checking, ordering and arranging rituals; counting; repeating routine activities (e.g., going in/out of a doorway) and hoarding (e.g., collecting useless items). While most compulsions are observable behaviors (e.g., hand washing), some are performed as unobservable mental rituals (e.g., silent recitation of nonsense words to vanquish a horrific image).

A hallmark of OCD is that the person recognizes that her thoughts or behaviors are senseless or excessive.

However, the drive can be so powerful that the person caves in to the compulsion even though she knows it makes no sense. One woman spent hours each evening sifting through the household trash to ensure that nothing valuable was being discarded. When asked what she was looking for, she nervously admitted, “I have no idea, I don’t own anything valuable.”

Some people who have had OCD for a long time may stop resisting their compulsive drives because they feel it’s just easier to give in to them.

Most OCD sufferers have multiple types of obsession and compulsion. Someone with OCD may complain primarily of obsessive-compulsive symptoms involving asbestos contamination, but a detailed interview may disclose that he /she silently counts floor tiles and hoards junk mail.

Learning More About OCD

How Do I Know if I Have Obsessive-Compulsive Disorder?
Specific Symptoms of OCD
The Course of Obsessive-Compulsive Disorder (OCD)
Distinguishing OCD From Other Conditions
Treatments for Obsessive-Compulsive Disorder (OCD)
Additional Treatment Options for OCD
Medications for Obsessive-Compulsive Disorder (OCD)
Online Resources for OCD

May 22

Posttraumatic Stress Disorder


PTSD Information & Treatment
By Harold Cohen, Ph.D.

Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that follows experiencing or witnessing an extremely traumatic, tragic, or terrifying event. People with PTSD usually have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to.

PTSD, once referred to as “shell shock” or battle fatigue, was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. The event that triggers it may be something that threatened the person’s life or the life of someone close to him or her. Or it could be something witnessed, such as mass destruction after a plane crash.

Most people with posttraumatic stress disorder repeatedly re-live the trauma in the form of nightmares and disturbing recollections during the day. The nightmares or recollections may come and go, and a person may be free of them for weeks at a time, and then experience them daily for no particular reason. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Seeing things that remind them of the incident may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often very difficult.

PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. Symptoms may be mild or severe — people may become easily irritated or have violent outbursts. In severe cases, they may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was initiated by a person — such as a murder, as opposed to a flood.

Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A flashback may make the person lose touch with reality and reenact the event for a period of seconds or hours, or very rarely, days. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, usually believes that the traumatic event is happening all over again.

Posttraumatic stress disorder can be treated, usually with a combination of psychotherapy and medications (for specific symptom relief, such as for the common accompanying depressive feelings). People with PTSD should seek out a therapist or psychologists with specific experience and background in treatment posttraumatic stress disorder.

What Causes PTSD?
Symptoms and Diagnosis of PTSD
Differential Diagnosis of PTSD
Who is Typically Diagnosed with PTSD?
Treatment of PTSD
Myths and Facts about PTSD
Frequently Asked Questions about PTSD
Associated Conditions of PTSD
Two Stories of PTSD
PTSD: A Roller Coaster Life

This article is based upon a brochure published by the National Institute of Mental Health.

May 21

Overcome negative thinking and emotional barriers to life success
Published on May 1, 2013 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express

Have you spent a lot of time and money on psychotherapy or self-help books, yet you still feel stuck in unhealthy habits?. Unfortunately, verbal insight and understanding do not always lead to changing self-destructive behaviors (e.g. addictions, procrastination, angry outbursts) or removing distress. Knowing why you are depressed, anxious, or feeling pain doesn’t necessarily make you feel any better. However, if you get up and get active – walking, reaching out to friends, pursuing a hobby or creative activity, doing your yoga stretches, or even getting errands done, you will focus less on the negative feelings and they won’t last as long. Understanding what is most meaningful to you in life (such as your health, family, or work) and committing to taking specific, manageable actions to achieve your goals in these areas can put you back in the driver’s seat of your life.

Acceptance And Commitment Training

Acceptance and Commitment Therapy/Training (or ACT) is a short-term intervention used in psychotherapy or workplace settings. It combines principles of Mindfulness with techniques of motivation and behavior change. ACT can help you to break out of negative thought cycles, accept what you can’t control, stop running away from pain, and be more able to tolerate risk, failure, and uncertainty to reap the rewards of a meaningful, engaged life. It can help your career and health by teaching you how to handle negative emotions and overcome procrastination.

Some core principles of ACT are:

(1) Experiencing the Present Moment Directly

Similar to Mindfulness, ACT therapists use exercises to help you remain present and focused on the breath or your present thoughts and feelings, rather than trying to avoid them. Feelings are momentary, changing experiences in our bodies and minds. However, because of childhood learning experiences, we often develop judgments about them and what it means about us that we have them – such as “You’re depressed again – You’re such a loser!” When you focus on and describe the direct physical sensations of pain or anxiety (e.g., my chest feels tight), rather than feeling helpless or trying to distract yourself, you may realize that they are not going to kill you and that they will eventually pass. Watching feelings rise and fall in your body, gives you a sense of them as transient experiences, rather than as who you are in essence.

(2) Being Willing to Be Where You Are

Acceptance is often confused with passivity. In ACT terms, acceptance means “being willing to experience the present moment, even if it’s not what we would have chosen.” This also means accepting your life experiences and history, realizing you can never completely get rid of or make up for experiences of suffering. At the same time, you have a choice about what you do with your life now. You do not have to be so limited by old ways of thinking. Like any habit, change takes time and effort. Therefore, you will likely be uncomfortable for a while. It takes time to change your brain pathways and to have other people notice you are different and behave differently towards you. Like losing a lot of weight, you have to work hard for a long time before seeing noticeable results. Being willing means you no longer avoid uncomfortable thoughts, feelings, or situations by zoning out, not showing up, addictions, anger, or procrastinating. If you want to be healthier, you first need to be able to look at and experience how unhealthy you are right now. At the same time, you can commit to doing what you need to do in small bits, each day, to be a little bit healthier. Lifting the veil of self-deception can go a long way towards getting you focused on the right track.

(3) Separating Your Self From Your Thoughts
Your thoughts, feelings, and sensations are not who you are. ACT Training includes mindfulness, imagery, and language-based exercises to help you connect with your “observing ego” so you can observe your thoughts and experiences from a more objective vantage point.. Although your thoughts feel true, they are not necessarily the whole truth, because they are biased by your expectations from past experiences and self-definition. You do not need to let your thoughts and feelings determine your behavior. You can choose how to behave, based on your direct experience (what you see, hear, feel – independent of your judgments about these events) and your core values. You may think about a thought: “Is it kind? Is it truthful?,..” and so on. Based on the answer, you may choose to take the thought seriously or let it pass on by. Rather than changing the content of your thoughts, you can choose to change how you interact with them Thinking you are stupid or fat does not make you stupid or fat – it is just a passing thought in your head.

(4) Defining Your Core Values

Core values are the things in life that are most meaningful to us and that enrich our lives. They include such things as “Being healthy,” “Taking care of our families,” “Being honest and accountable,” or “Contributing to society.” When people come to therapy, they are often so overwhelmed with distress, feelings of self-pity or anger, or struggles with pain or addiction, that they have lost touch with what really makes them fulfilled. Even if they know “I want to be a good parent,” their day-to-day behavior may not reflect this because they are preoccupied with seeking escape from daily stress, thoughts about past, painful events, or trying to prevent an anticipated future threat. ACT therapists/trainers use imagery and writing exercises to help clients define their individual core values and gain motivation to reconnect with activities and people that enhance these values in our lives.

(5) Committing to Motivated Action
To live a meaningful, authentic life, you need to take risks, get out into the world, and tolerate uncertainty and anxiety. Exercises focus on setting manageable, attainable, meaningful goals – committing to taking specific, small steps that get you closer to your larger goals. The focus is on taking action, not expecting a particular result, since outcomes may be at least partially out of our control. To be successful is not necessarily to always feel happy or pain-free, but to live a full life despite the anxiety or pain. By facing what you fear, the fear will eventually lessen, and, even if it doesn’t, you will know you have done your best with what you have. This takes you out of the cycle of self-doubt, regret, and second-guessing yourself.

Who Can Benefit From ACT?

ACT, also known as Acceptance and Commitment Therapy/Training, when used in workplace settings, is a short-term intervention approach that has been used with substance abusers, people suffering from chronic pain and illness, patients with obsessive thoughts, anxiety, or depression. ACT works well with clients or employees who are tired of letting uncontrollable symptoms rule and want to take a more active role in defining and directing their own lives. I use ACT principles and interventions with almost every client to help them tolerate uncontrollable, stressful situations and focus on what they can change. ACT can create a basis for hope and help you tolerate the pain of changing.

According to SAMHSA’s Registry of Effective Programs,

“ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviors; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM-IV diagnoses, coping with chronic illness, and workplace stress).”

For more information about ACT, go to this link

Or watch this YouTube video by Dr Russ Harris:

About The Author

Melanie Greenberg, Ph.D. is a Clinical Psychologist, and expert on Mindfulness, Managing Anxiety, and Depression, Succeeding at Work,, and Mind-Body Health. Dr Greenberg provides workshops and speaking engagements for your organization and coaching and psychotherapy for individuals and couples

Visit her website:
Follow her on twitter @drmelanieg
Like her on Facebook
Read her Psychology Today blog & personal blog

May 20

By Lisa A. Miles
Families Could Help More in Treatment, If HIPAA Allowed ItWhy is it that families are kept so far out of the loop when it comes to a loved one’s health?

The quick, easy answer, of course, is the nation’s health insurance portability and accountability act (HIPAA). Physicians are able to share only certain information with the family unless the patient agrees to more. The problem is that the patient might be too elderly, addicted or mentally ill to cooperate or even understand what they are agreeing to (or simply stubborn).

Certainly individual civil liberties must be taken into consideration. This writer, in fact, is more than moderately liberal.

But there is a blurry but significant line that puts human wisdom to the test, as we evaluate true need for family assistance.

Beyond HIPAA’s ramifications, there are doctors who frankly don’t care to communicate with anyone other than the patient, no matter who they are allowed to talk to. As well, many estranged families may not be interested in the health of their kin.

But for those families of the mentally ill, alcoholic or addicted who want to help their loved one, they need to be able to communicate with clinicians, doctors, and therapists. Rather than just informing the treatment team of a loved one’s behaviors at home and not receiving a treatment team response, the family must be brought into the fold of treatment teams. In the wake of the school shooting in Newtown, Conn. in December 2012, nothing less is required.

HIPAA needs to be reworked. There needs to be an out clause granted to family members who obviously 1) are intelligently trying to work on their own coping strategies in a troubled family dynamic; 2) care about their ill family member; and 3) can offer the most significant information about the patient because of a shared living situation or close interaction.

Lloyd Sederer, MD, medical director of the New York State Office of Mental Health and adjunct professor at Columbia University Mailman School of Public Health, wrote a few weeks after the Newtown tragedy of families being the true first responders of psychiatric illness. How very true. And yet how shabbily they have been treated.

Anyone who has been around the block with a relative suffering from mental illness or related concerns — even those empowered with the great help of the National Alliance on Mental Illness and other advocacy organizations — knows how hard it still is dealing with treatment providers.

Who, after all, knows a patient’s symptoms better than the family who lives with someone exhibiting psychosis, neurosis, manipulative behaviors, or obsessive-compulsive mannerisms? Who directly witnesses what the patient may cleverly hide in a therapeutic session?

Should not symptoms drive treatment more than diagnosis? Symptoms, after all, are what delineate an individual as being functional, or not, in various scenarios. And should not families be given information on how to respond in ways that may actually help the patient?

Though there are so many more, these alone are perhaps the two most critical, simple means of understanding that families must demand to be brought into the fold, respected as harbingers of the most significant information about mentally ill and addicted loved ones who are suffering, for the most part, needlessly.

May 18

Questions Help Tell Memory Loss from Dementia


A simple questionnaire can help differentiate individuals experiencing normal age-related memory loss from those at risk for developing dementia, most notably by their orientation to time and patterns of repetitive speech, researchers found.

On the 21-item Alzheimer’s Questionnaire, patients having trouble remembering the day, month, year, and time of day were almost 18 times more likely to have amnestic mild cognitive impairment, a precursor to dementia, according to Michael Malek-Ahmadi, MSPH, and colleagues from the Banner Sun Health Research Institute in Sun City, Ariz.

Those who often repeated questions, statements, and stories on the same day also were at very high risk, the researchers reported online in BMC Geriatrics.

Distinguishing mild cognitive impairment, particularly when associated with memory loss rather than loss of other functional domains, can be clinically challenging and time consuming, and brief screening tools are sorely needed as the aging population expands, according to the researchers.

“Additionally, as new therapies for Alzheimer’s disease transition from being symptomatic to disease-modifying, identifying individuals who are at risk or in the earliest stages of the disease will be crucial in determining and improving disease outcome,” they wrote.

A pilot study by these researchers recently showed good sensitivity and specificity for the Alzheimer’s Questionnaire, with responses about various aspects of memory and related cognitive concerns being provided by caregivers or other informants.

To see if certain components of the questionnaire were particularly accurate in pinpointing these types of impairments, Malek-Ahmadi’s group compared responses among 47 patients who had been diagnosed with amnestic mild cognitive impairment and 51 controls who were participants in a program involving posthumous brain and body donation.

The diagnosis of cognitive impairment had been made clinically and with neuropsychological testing, with scores on verbal memory recall measures falling 1.5 standard deviations below normal ranges for age and educational attainment.

Cognitively normal participants all scored higher than 1.5 standard deviations on the neuropsychological tests.

The Alzheimer’s Questionnaire assesses memory, language, orientation, visuospatial competence, and functional capacity by a series of yes/no questions such as, “Does the patient have trouble remembering to take medications?”

On almost all questions, significantly more “yes” responses were seen for the cognitive impairment group.

Regression analysis determined that, along with repetitive speech and disorientation as to time, two other questions were highly predictive.

One was whether the patient has trouble dealing with financial matters such as paying bills, and the second was if the patient showed an impaired sense of direction, according to the researchers.

“These data indicate that problems with orientation to time, repeating statements and questions, difficulty managing finances, and trouble with visuospatial orientation may accompany memory deficits in amnestic mild cognitive impairment,” the researchers stated.

May 16

When the Voice Inside Your Head Turns Bad…..


Empowering yourself to challenge your inner critic.
Published on April 18, 2012 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express

“You messed up again! “

“You should have known better!”

Sound familiar?

Of course it does! It’s that know-it-all, bullying, mean-spirited committee in your head. Don’t you wish they would just shut up already? I know I do!

The Committees in Our Heads

We all have voices inside our heads commenting on our moment-to-moment experiences, the quality of our past decisions, mistakes we could have avoided, and what we should have done differently. For some people, these voices are really mean and make a bad situation infinitely worse. Rather than empathize with our suffering, they criticize, disparage, and beat us down at every opportunity! The voices are often very salient, have a familiar ring to them and convey an emotional urgency that demands our attention. These voices are automatic, fear-based “rules for living” that act like inner bullies, keeping us stuck in the same old cycles and hampering our spontaneous enjoyment of life and our abilities to live and love freely.

Where Do the Voices Come From?

Psychologists believe these voices are residues of childhood experiences—automatic patterns of neural firing stored in our brains and dissociated from the memory of the events they are trying to protect us from. While having fear-based self-protective and self-disciplining rules probably made sense and helped us to survive when we were helpless kids, at the mercy of our parents’ moods, whims, and psychological conflicts, they may no longer be appropriate to our lives as adults. As adults, we have more ability to walk away from unhealthy situations and make conscious choices about our lives and relationships based on our own feelings, needs and interests. Yet, in many cases, we’re so used to living by these unwritten internal rules that we don’t even notice or question them. And we unconsciously distort our view of things so they seem to be necessary and true. Like prisoners with “Stockholm Syndrome,” we have bonded with our captors!

What Happens When the Committee Takes Charge of Our Lives?

If left unchecked, the committees in our heads will take charge of our lives and keep us stuck in mental and behavioral prisons of our own making. Like typical abusers, they scare us into believing that the outside world is dangerous, and that we need to obey their rules for living in order to survive and avoid pain. By following (or rigidly disobeying) these rules, we don’t allow ourselves to adapt our responses to experiences as they naturally unfold. Our behaviors and emotional responses become more a reflection of yesterday’s reality than what is happening today. And we never seem to escape our dysfunctional childhoods.

The Schema Therapy Approach
Psychologist Jeffrey Young and his colleagues call these rigid rules of living and views of the world “schemas.” Based on our earliest experiences with caregivers, schemas contain information about our own abilities to survive independently, how others will treat us, what outcomes we deserve in life, and how safe or dangerous the world is. They can also get in the way of our having healthy relationships in life, work, and love.

How Negative Schemas Affect Our Lives & Relationships

Young suggests that negative schemas limit our lives and relationships in several ways:

(1) We behave in ways that maintain them.

(2) We interpret our experiences in ways that make them seem true, even if they really aren’t.

(3) In efforts to avoid pain, we restrict our lives so we never get to test them out

(4) We sometimes overcompensate and act in just as rigid, oppositional ways that interfere with our relationships.

The Abandonment Schema – Diana’s Story

A woman who we will call Diana has a schema of “Abandonment.” When she was five years old, her father ran off with his secretary and disappeared from her life, not returning until she was a teenager. The pain of being abandoned was so devastating for young Diana that some part of her brain determined that she would never again allow herself to experience this amount of pain. Also, as many children do, she felt deep down that she was to blame; she wasn’t lovable enough, or else her father would have stuck around; a type of ‘Defectiveness” schema.

Once Diana developed this schema, she became very sensitive to rejection, seeing the normal ups and downs of children’s friendships and teenage dating as further proof that she was unlovable and destined to be abandoned. She also tried desperately to cover up for her perceived inadequacies by focusing on pleasing her romantic partners, and making them need her so much that they would never leave her. She felt a special chemistry for distant, commitment-phobic men. When she attracted a partner who was open and authentic, she became so controlling, insecure and needy that, tired of not being believed or trusted, he eventually gave up on the relationship.

Diana’s unspoken rule is that it is not safe to trust people and let relationships naturally unfold; if she relaxes her vigilance for even a moment, the other person may leave. In an effort to rebel against her schema, she also acted in ways that were opposite to how she felt; encouraging her partner to stay after work to hang out with his friends, in an attempt to convince herself (and him) that she was ultra-independent. This led to chronic anger and feelings of dissatisfaction with her partner’s lack of understanding of her needs; she neither understood nor acknowledged her own role in the cycle.

What Can We Do?

Schema Therapy can help Diana (and her partner) understand how their schemas result in ways of relating to self and others that are repetitive, automatic, rigid, and dysfunctional. By acknowledging and empathically connecting with her unresolved fears and unmet needs, Diana can become more flexible and free. These new theories and therapies can help to heal couples conflict and individual problems such as anxiety, depression, personality disorders, grief, and childhood trauma. The schema concept helps us understand how early childhood events continue to influence adult relationships and mental health issues. We need to recognize their influence, pay attention to what our automatic inner voices are saying, and (with professional help, if necessary), begin to free ourselves from their grip.

Schema Therapy Website:

About The Author

Melanie Greenberg, Ph.D. is a licensed Clinical Psychologist, and expert on Mindfulness, Positive Psychology, Emotion Regulation, and Relationships. Dr Greenberg provides workshops and speaking engagements for organizations, life, weight loss, or career coaching, and psychotherapy for individuals and couples.

Visit my website:
Follow me on twitter @drmelanieg
Like me on Facebook
Read my Psychology Today blog & personal blog

May 13

Child Maltreatment Increases Risk of Adult Obesity


May 21, 2013 — Children who have suffered maltreatment are 36% more likely to be obese in adulthood compared to non-maltreated children, according to a new study by King’s College London. The authors estimate that the prevention or effective treatment of 7 cases of child maltreatment could avoid 1 case of adult obesity.

The findings come from the combined analysis of data from 190,285 individuals from 41 studies worldwide, published this week in Molecular Psychiatry.

Severe childhood maltreatment (physical, sexual or emotional abuse or neglect) affects approximately 1 in 5 children (under 18) in the UK. In addition to the long-term mental health consequences of maltreatment, there is increasing evidence that child maltreatment may affect physical health.

Dr Andrea Danese, child and adolescent psychiatrist from King’s College London’s Institute of Psychiatry and lead author of the study says: “We found that being maltreated as a child significantly increased the risk of obesity in adult life. Prevention of child maltreatment remains paramount and our findings highlight the serious long-term health effects of these experiences.”

Although experimental studies in animal models have previously suggested that early life stress is associated with an increased risk of obesity, evidence from population studies has been inconsistent. This new study comprehensively assessed the evidence from all existing population studies to explore the potential sources of inconsistency.

In their meta-analysis, the authors were able to rule out specific factors which might explain the link — they found that childhood maltreatment was associated with adult obesity independently of the measures or definitions used for maltreatment or obesity, childhood or adult socio-economic status, current smoking, alcohol intake, or physical activity. Additionally, childhood maltreatment was not linked to obesity in children and adolescents, making it unlikely that the link was explained by reverse causality (i.e. children are maltreated because they were obese).

However, the analysis showed that when current depression was taken into account, the link between childhood maltreatment and adult obesity was no longer significant, suggesting that depression might help explain why some maltreated individuals become obese.

Previous studies offer possible biological explanations for this link. Maltreated individuals may eat more because of the effects of early life stress on areas of the developing brain linked to inhibition of feeding, or on hormones regulating appetite. Alternatively, maltreated individuals may burn fewer calories because of the effects of early life stress on the immune system leading to fatigue and reduced activity. The authors add that these hypotheses will need to be directly tested in future studies.

Dr Danese adds: “If the association is causal as suggested by animal studies, childhood maltreatment could be seen as a potentially modifiable risk factor for obesity — a health concern affecting one third of the population and often resistant to interventions.

He concludes: “Additional research is needed to clarify if and how the effects of child maltreatment on obesity could be alleviated through interventions after maltreatment has occurred. Our next step will be to explore the mechanisms behind this link.”

By Therese Borchard
“There is no question that the most common destructive behavior affecting depressed patients, barring suicide, is alcoholic or any substance abuse,” writes J. Raymond De Paulo Jr., M.D., of the Johns Hopkins School of Medicine in his book “Understanding Depression.” He does not mince words on the seriousness of alcoholism and drug addiction to the recovery of depression:

Nothing makes the job of a psychiatrist treating depression and manic depression harder than alcohol and drugs. The most difficult treatment situations that I have ever seen patients and families confront, since I started my training in psychiatry twenty-seven years ago, occur when the patients’ illnesses are complicated by what we call addictive behaviors. While I have seen many successful outcomes, none were easy to achieve.

Here are some important facts you need to know about the relationship between depression and substance abuse: why addiction impedes recovery from depression and why depression sustains drug dependence.
1.Depressive illness makes people prone to destructive behaviors.
2.Destructive behaviors make depression and mood disorders worse.
3.Depressed people drink and use drugs to self-medicate.
4.There is a greater risk of abusing alcohol or drugs by people who have moderate depression than those who have depression that is severe.
5.There is a high relapse rate with drugs and alcohol when it occurs along with depression and mania. Depressed people who drink or abuse drugs are far more likely to suffer a relapse.
6.Approximately one-third of people with all mental illnesses and approximately one-half of people with severe mental illnesses also experience substance abuse.
7.More than one-third of all alcohol abusers and more than one-half of all drug abusers are also battling mental illness.
8.People with manic depression are particularly at risk. One study suggests that as many as 60 percent of people with Bipolar I have substance abuse problems at some point in their life.
9.The likelihood of developing alcoholism or substance is abuse is far greater in people with bipolar disorder than in those with unipolar depression or the general population.

A new study in the Archives of General Psychiatry found that alcohol abuse may actually cause major depression. The research results showed that alcohol use could trigger genetic markers that increase the risk of depression. In other words, the depressant effect of alcohol could lead to depression itself.

NEW YORK, May 20 (UPI) U.S. men who had attention-deficit/hyperactivity disorder as children weighed 19 pounds more at age 41 than those with no ADHD, researchers say.

Study co-author F. Xavier Castellanos, a psychiatrist at the Child Study Center at New York University Langone Medical Center in New York, and colleagues at Verona University in Italy; the Institute for Psychiatric Research in Orangeburg, N.Y.; and the Neuroingenia Clinical and Research Center in Mexico said ADHD might affect up to 11 percent of U.S. children, the majority boys.

The study involved 207 white boys with childhood ADHD — mean age of 8.3 — interviewed at ages 18-25 and age 41. At age 18, 178 boys without ADHD were recruited.

At 41, 111 men with childhood ADHD and 111 men without childhood ADHD self-reported their weight and height.

The study, published in the journal Pediatrics, found at age 41, the men who had ADHD weighed an average of 213 pounds, and 41 percent of them were obese, while the men who hadn’t had ADHD weighed 194 pounds on average, and 22 percent were obese.

The study didn’t figure out why boyhood ADHD might be causing weight problems in adulthood — the weight gain could be caused by psychological factors or neurobiology, Castellanos told NPR.

Differences in the pathways for dopamine, a neurotransmitter in the brain, have been found in both people who are obese and people with ADHD, Castellanos said.

“It makes sense, because they’re self-medicating with carbohydrates,” Dr. Edward Hallowell, a psychiatrist in Sudbury, Mass., who has ADHD and treats adults with ADHD but wasn’t involved with the study, told NPR. “Carbs do the same thing that stimulant medications do — promote dopamine.”

Read more:

May 5

How to Support an Anxious Partner


By Margarita Tartakovsky, M.S.
Associate Editor

How to Support an Anxious PartnerHaving a partner who struggles with anxiety or has an anxiety disorder can be difficult.

“Partners may find themselves in roles they do not want, such as the compromiser, the protector, or the comforter,” says Kate Thieda, MS, LPCA, NCC, a therapist and author of the excellent book Loving Someone with Anxiety.

They might have to bear the brunt of extra responsibilities and avoid certain places or activities that trigger their partner’s anxiety, she said. This can be very stressful for partners and their relationship.

“Partners of loved ones with anxiety may find themselves angry, frustrated, sad, or disappointed that their dreams for what the relationship was going to be have been limited by anxiety.”

Thieda’s book helps partners better understand anxiety and implement strategies that truly support their spouses, without feeding into or enabling their fears.

Below, she shared five ways to do just that, along with what to do when your partner refuses treatment.

1. Educate yourself about anxiety.

It’s important to learn as much as you can about anxiety, such as the different types of anxiety disorders and their treatment. This will help you better understand what your partner is going through.

Keep in mind that your partner might not fit any of these categories. As Thieda writes in Loving Someone with Anxiety, “The truth is, it doesn’t matter whether your partner’s anxiety is ‘diagnosable.’ If it’s impairing your relationship or diminishing your partner’s quality of life or your own quality of life, it will be worthwhile to make changes.”

2. Avoid accommodating your partner’s anxiety.

“Partners often end up making accommodations for their partner’s anxiety, whether it is intentional [such as] playing the part of the superhero, or because it just makes life easier, as in, doing all the errands because their partner is anxious about driving,” said Thieda, who also created the popular blog “Partners in Wellness” on Psych Central.

However, making accommodations actually exacerbates your partner’s anxiety. For one, she said, it gives your partner zero incentive to overcome their anxiety. And, secondly, it sends the message that there really is something to fear, which only fuels their anxiety.

3. Set boundaries.

Your partner might continue asking for accommodations, such as having you drive everywhere or regularly stay home with them, Thieda said. “You have the right to have a life, too, and this may mean telling your partner on occasion, and in a loving way, that you are going to do what you want and need to do.”

In her book Thieda devotes an entire chapter to effectively communicating this to your partner. Essentially, she suggests being empathetic, using “I” statements and giving specific requests.

For instance, she gives the following examples: Instead of saying, “You worry too much about what other people think of you,” you might say, “I’m concerned that your fears about what others think of you are holding you back at work.”

Instead of saying, “Don’t call me at work so much,” you might say, “It would be helpful if you would try some of the techniques you’ve learned for calming yourself down before calling me at the office.”

Also, “always consider whether a compromise is possible, but also recognize that you have the right to do things independently,” she said.

4. Relax together.

There are many techniques you can try together to alleviate anxiety. According to Thieda, “The body scan is a great couples mindfulness technique because one person can guide the other through the process.”

This promotes mindfulness for both partners. The partner giving instructions needs to pay attention to timing and the specific directions, she said. And the partner receiving the instructions needs to pay attention to each body part and releasing its tension, she said. (Here’s a sample body scan.)

5. Focus on your own care.

According to Thieda in her book, “When you live with an anxious partner, there can be a lot of tension in your relationship and in your home. Having self-care routines and plans in place can help you neutralize the static.”

Consider what you’re already “doing to promote physical, spiritual, mental, emotional, professional, and relationship health,” Thieda said. Assessing where you are helps you better understand where you need to go. For instance, you might want to set goals about improving your health or seek support from others, she said. You might want to work with a therapist or attend support groups.

What to Do When Your Partner Refuses Treatment

Anxiety is highly treatable. But your partner might not want to seek professional help. Thieda suggested considering the reasons behind their refusal.

For instance, they might’ve tried treatment before but it didn’t work. One reason treatment “fails” is because it’s not the right treatment for the person’s anxiety. According to Thieda, “It is best to work with a professional who uses cognitive-behavioral therapy techniques and is specifically trained in working with people who struggle with anxiety.”

They might’ve tried medication or psychotherapy alone, but they’d do better with a combination of treatments, she said. It’s also possible that your partner tried to take on too much, and ended up feeling even more anxious. “Maybe they need to approach their treatment in a different way, breaking down the challenges into smaller, more manageable pieces.”

Ultimately, the decision to seek treatment rests with your partner, Thieda said. “No amount of begging, pleading, or threatening is going to be effective, and will likely make things worse.”

The best thing you can do is to be supportive, encouraging and loving when they do decide to seek help, she said.

Having a spouse who’s struggling with anxiety can naturally become stressful for partners. But while this can be challenging, by educating yourself, setting healthy boundaries and practicing self-care, you can truly help your spouse and your relationship.

May 1

The Blame Game


The art of blaming situations, people, and events for the quality of our own lives is a skill we acquire as a child. Children however, do not start out lying and blaming others. In fact, children generally begin by blaming themselves for the poor behavior of others. A child will eventually learn to lie because it eases the pain of what he or she has done, or what he or she is experiencing. (Lying is therefore a mood changing behavior and can become habit forming.)

For example, a child will break something and generally feel bad even though they might not look that way to others when the incident is first discovered. The broken object is now of less value. Even worse, the child may also feel like he or she are of less personal value as well, because he or she had failed to properly care for the object that is now broken.

This experience is painful enough for a child to endure without the hurtful consequences often imposed by adults. The toy is no longer the same and the child feels bad that they were unable to take care of it in the way that he or she had imagined they could. It can get even worse when others who have no knowledge of how the toy has broken discover the losses. If the child who broke the toy is emotionally shut down or fragmented, he or she will fail to take responsibility for the broken object and the blame game will begin. It is most likely that others will want to assign the responsibility to someone.

Assigning responsibility usually comes in form of blame and generally is accompanied by shame. You can see this for yourself in the following case example:

Mom: John, do not run when you are carrying that piggy bank!

John: Thinks to himself – what the heck, I can do it – I can do anything!

Sound: C R A S H

Mom: John!!!! How could you? Your grandmother just brought you that piggy bank. You should be ashamed of yourself. You are going to be the death of me!

John: It dropped. I did not do it. I don’t care about some dumb piggy bank anyway. Where is the candy? I am hungry! There is never any food in this house.

A child says, “It broke” and an adult, provided he or she has become an adult, says, “I broke it.” The child is failing to take responsibility. The adult is accepting responsibility. If however, we as adults continue to shirk responsibility for our own lives, our own feelings, and our own behaviors, we will inevitably need to assign the responsibility to someone. We look outside of ourselves. We blame.

If we are to grow in our romantic relationships we are going to need to avoid blaming, lying, and hurting. While the tendency to look outside ourselves for the cause of our own discomfort is a character defect that many of us acquired as children, unfortunately it has become as ineffective for us as adults as any other addictive behavior or drug of choice.

This is because we blame others when the perceived or real costs for appearing “wrong” are frighteningly high. During these high-stakes moments in childhood, and then in adulthood as well, many of us discovered that lying would ease the pain of what we have done. The “drug like” behavior of deceiving others, and eventually ourselves, became a “first addiction” for those of us who have perfected the art of self-justification. Yes, blaming and diverting responsibility away from ourselves sometimes appears to be an addiction in its own right.

Intimacy is about openness, honesty, and vulnerability. An inadequately treated addiction however, will erode each one of those features of true intimacy. If we are to create and maintain a true lasting relationship with our partner, we will need to be free of our dependence on blaming others – especially our partner – for our own thoughts, feelings, and behaviors. We need to break our habit of lying to ourselves and to others. We must take responsibility for our own lives and decisions so that we can bring our true selves to each other in open and vulnerable honesty.

This article was written by John & Elaine Leadem, senior supervisors of the Leadem Counseling & Consulting offices in Toms River, NJ and East Brunswick, NJ. The content of this article is based on the recently published book from Leadem Counseling: “Ounce of Prevention: A Course in Relapse Prevention.”

Site by EMTRER