Mental Health News Guide for Therapists

According to the U.S. surgeon general, mental health is the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and providing the ability to adapt to change and cope with adversity.

The term mental illness refers collectively to all diagnosable mental disorders—health conditions characterized by alterations in thinking, mood, or behavior associated with distress or impaired functioning.

A person struggling with his or her mental health may experience stress, depression, anxiety, relationship problems, grief, addiction, ADHD or learning disabilities, mood disorders, or other mental illnesses of varying degrees. Therapists, psychiatrists, psychologists, social workers, nurse practitioners or physicians can help manage mental illness with treatments such as therapy, counseling, or medication.

Mental illnesses are categorized as follows:

Neurosis: Also known as psychoneuroses, neuroses are minor mental illnesses like phobias, obsessive-compulsive disorders, and anxiety disorders, among others.

Psychosis: Psychoses are major mental illnesses in which the mental state impairs thoughts, perception and judgement. Delusions and hallucinations are marked symptoms. This may require the use of psychotic drugs as well as counselling techniques in order to treat them.

Articles

How to Survive Your Midlife Blues

Midlife malaise is common, but take heart: Happiness tends to rebound as we get older, and there are ways to cope in the meantime.

I’m in my 50s—a bit past midlife, but not exactly into old age. My kids have grown, I have a good career, my marriage is solid, and I’m still reasonably healthy. So, life satisfaction should be mine for the plucking.

But it’s not. I’m no happier than most people I know, and in many cases less so. Why am I in a slump when everything seems to be going, well, right?

That question is at the heart of Jonathan Rauch’s new book, The Happiness Curve. In his book, Rauch argues that a dip in happiness in midlife is a normal part of human development, and may even be a necessary precursor to later life satisfaction. He also suggests that if we can find ways to hang in there during this turbulent transition, our happiness will not just rebound, but will likely exceed our expectations.

The midlife slump

Though the idea of the “midlife crisis” has been around for decades—and mostly a subject of scorn and derision—Rauch says that “crisis” is really the wrong word for what happens to many of us in midlife. If you look at big patterns in global happiness data, and in longitudinal experiments where individuals are compared to themselves, a strong pattern emerges: Happiness dips gradually through early adult life until it’s at its lowest point, right around our mid 40s to early 50s (though “happier” countries tend to have earlier dips).

This happens regardless of life circumstances, like whether or not your income is high, you have kids at home, you’re caring for elderly parents, or you have a successful career. That’s not to say these things don’t matter for happiness—they do! As Carol Graham and other happiness researchers have found, a stable marriage, good health, enough money, and other factors are all good for happiness. It’s just that we appear to have a tendency toward malaise in midlife that can’t be explained by these factors alone.

“The happiness curve would not show up in as many data sets and places as it does, including among apes, if it were not to some extent hardwired,” writes Rauch.

Though the reasons for this dip in happiness are unclear, Rauch does a valiant job of looking through research to explain it. In one longitudinal study, for example, researchers found that, if you asked younger Germans how they thought their life would be five years down the road, and then compared it to how they actually felt five years later, their predictions were much higher than reality. In other words, they tended to be overly optimistic, and this mismatch seemed to mirror their declining happiness levels.

This makes sense—when expectations are not met, we are bound to feel disappointment. And, argues Rauch, when we don’t have any clear external markers in our lives to explain our disappointment, that can create negative feedback loops, where we feel bad and feel guilty for feeling bad.

“The feedback effect can and often does afflict people who do not experience any severe crisis or shock, people who, on the contrary, are doing fine,” says Rauch. “Sometimes the people who are, relatively speaking, least affected by objective circumstances will be most trapped in [negative] feedback loops.”

The old-age boost

Interestingly, this pattern completely reverses after midlife, so that older people tend to be much happier than they would have predicted five years earlier. This suggests that if we can hold on, things may just get better on their own as we become pleasantly surprised by our happiness levels, instead.

“Positive feedback replaces negative as disappointments become pleasant surprises, and as growing satisfaction and gratitude reinforce each other,” says Rauch.

In fact, there are many potential positives that come with aging, which Rauch recounts in the book. Here are some of the benefits of coming out of our midlife slump.

Stress tends to decline.

It seems intuitive—after all, we probably have fewer work or family stressors as we get older and our careers stabilize or our children leave home. But, in fact, researchers have found that even holding other things constant, stress still tends to go down as we age, and this downward curve in stress seems to be tied to our increased happiness.

Emotional regulation improves.

Not only do older adults tend to experience less intense emotions than younger adults, they also seem to handle emotions better in general. After listening to taped recordings of people making disparaging remarks about them, older adults responded with less negative feedback toward the critics and more detachment around the situation, suggesting greater emotional regulation.

Older people feel less regret.

Stephanie Brassen and her colleagues found that when people made the wrong choice and lost all of their winnings in a game, older participants experienced less regret than younger adults—a finding also reflected in their distinct brain activity patterns.
Older people are less depression-prone.

According to research, depression becomes less common as we get older. This may be because older adults seem to have a greater optimism bias—the feeling that things will work out—and more positivity—a focus on the positive rather than the negative in life—than younger people.

How to survive midlife

It’s good to know that, as you get older, things get better. But that doesn’t mean we can’t do anything to help ourselves deal with middle-age malaise. Luckily, Rauch has some ideas for getting through this time with more perspective.

Normalize it.

Just understanding that it’s a near-universal phenomenon can help us stop blaming ourselves for our feelings and learn to accept them more. It doesn’t mean you won’t still get disappointed, but at least you might stop berating yourself for how you feel, which otherwise only serves to make things worse.

Interrupt your internal critic.

We are basically wired to want more and to be optimistic about our future—at least when we’re young—because it’s to our evolutionary advantage. But, as disappointment sinks in, we may find ourselves comparing our achievements to others’ achievements and deciding we fall short. This is a recipe for additional suffering.

To counter that, Rauch suggests interrupting our internal critic using cognitive-behavioral therapy approaches to reframe a situation or stop incessant rumination. A short interjection of some internal mantra or reminder—like “I don’t have to be better than anyone else” or the shorter “Stop comparing”—may help you catch yourself and keep your mind from spinning out of control.

Stay present.

I know it’s ubiquitous these days, but mindfulness—or other present-minded disciplines, like tai chi, yoga, or even just physical exercise—can help you to turn off the self-judgment button, feel less anxious, and experience more positive emotions. In my own life, I’ve used mindfulness meditations, stretching, and taking a walk outside to help me become more present, and they never fail to point my mood in the right direction.

Share your pain with others.

Many people find it hard to reach out to others when they are feeling midlife discontent. They fear it implies that something is wrong with them, that they are deficient in some way, or that they’ll lose respect from others.

But sharing feelings with a good friend, who can listen with compassion and also support you through the experience, can help make you feel less alone. “In isolation, disappointment and discontent ferment and fester, which adds to shame, which feeds the urge for isolation. Breaking that cycle is job one,” writes Rauch.

A good friend may also help prevent you from doing something rash, like telling off your boss or cheating on your spouse—something that may seem like it’s going to rid you of your malaise, but will likely backfire.

Take small steps; don’t leap.

This may be hardest of all to do, but it’s so important. When you feel the midlife slump, don’t try to radically shake things up by throwing away your life’s work or your family and by starting over on some tropical island. Instead, consider making smaller changes that are aligned with your accumulated skills, experience, and connections.

Rauch points to the work of Jonathan Haidt, who has found that making progress toward our goals—rather than achieving our goals—and living a life of purpose are what lead to lasting happiness. So, instead of going for a full-tilt reorganization of your life, think about making incremental changes that will bring smaller boosts of positivity. Maybe you can consider a lateral move at work, re-energizing your marriage by trying new things together, or taking on a new hobby. That way, when your happiness curve goes up—as it likely will—you’ll not be left with a shattered life. Which brings us to his last suggestion…

Wait.

This seems like strange advice; but because midlife malaise is a developmental issue, it may be best just to wait out the happiness dip and accept that it’s likely to change. As long as you don’t sink into depression, holding steady may just be the best strategy.

That doesn’t mean you should ignore severe problems in your life; it simply means that if your emotions seem out of proportion to what’s going on, take heed and be patient with yourself. Of course, this would probably be a lot easier if people didn’t dismiss your feelings as some kind of narcissistic crisis. Rauch calls on all of us to stop disparaging people going through midlife difficulties and to show more compassion.

Additionally, his book suggests that stereotyping aging as a time of decline is wrong-headed. He points toward organizations—like Encore.org—that are working to change negative messages around aging and help older people feel supported rather than thwarted in their attempts to remain vital, contributing members of society.

On a personal note, I found his book to be quite uplifting and instructive. It definitely helped me to be more forgiving of myself for feeling midlife malaise…and look forward more to getting through it. Perhaps it will help other middle-aged readers realize that, just because you’re feeling discontent, it doesn’t mean that life is passing you by. Instead, it’s probably just getting ready to blossom.

Written by Jill Suttie

Kin Leung, Marriage & Family Therapist, MFT, Counseling Burlingame. I specialize in helping couples overcome struggles related to: infidelity, intimacy, miscommunication, mistrust, parenting and life transitions. I'm happy to say that it's POSSIBLE to regenerate the spark that brought you together in the first place. Although I have a special interest in working with Asians, many non-Asian clients benefit from my service due to my bicultural background and I believe I can offer you a unique perspective to reach your goals.


Look Up From Your Screen

Children learn best when their bodies are engaged in the living world. We must resist the ideology of screen-based learning

A rooster crows and awakens my family at the farm where we are staying for a long weekend. The air is crisp, and stars twinkle in the sky as the Sun rises over the hill. We walk to the barn, where horses, cows, chickens, pigs, dogs and cats vie for our attention. We wash and replenish water bowls, and carry hay to the cows and horses. The kids collect eggs for breakfast.

The wind carries the smells of winter turning to spring. The mud wraps around our boots as we step in puddles. When we enter a stall, the pigs bump into us; when we look at the sheep, they cower together in a corner. We are learning about the urban watershed, where eggs and beef come from, and how barns were built in the 19th century with wood cauls rather than metal nails. We experience the smells of the barn, the texture of the ladder, the feel of the shovels, the vibration when the pigs grunt, the taste of fresh eggs, and the camaraderie with the farmers.

As a parent, it is obvious that children learn more when they engage their entire body in a meaningful experience than when they sit at a computer. If you doubt this, just observe children watching an activity on a screen and then doing the same activity for themselves. They are much more engaged riding a horse than watching a video about it, playing a sport with their whole bodies rather than a simulated version of it in an online game.

Today, however, many powerful people are pushing for children to spend more time in front of computer screens, not less. Philanthropists such as Bill Gates and Mark Zuckerberg have contributed millions of dollars to ‘personal learning’, a term that describes children working by themselves on computers, and Laurene Powell Jobs has bankrolled the XQ Super School project to use technology to ‘transcend the confines of traditional teaching methodologies’. Policymakers such as the US Secretary of Education Betsy DeVos call personalised learning ‘one of the most promising developments in K-12 education’, and Rhode Island has announced a statewide personalised learning push for all public school students. Think tanks such as the Brookings Institution recommend that Latin-American countries build ‘massive e-learning hubs that reach millions’. School administrators tout the advantages of giving all students, including those at kindergarten, personal computers.

Many adults appreciate the power of computers and the internet, and think that children should have access to them as soon as possible. Yet screen learning displaces other, more tactile ways to discover the world. Human beings learn with their eyes, yes, but also their ears, nose, mouth, skin, heart, hands, feet. The more time kids spend on computers, the less time they have to go on field trips, build model airplanes, have recess, hold a book in their hands, or talk with teachers and friends. In the 21st century, schools should not get with the times, as it were, and place children on computers for even more of their days. Instead, schools should provide children with rich experiences that engage their entire bodies.

To better understand why so many people embrace screen learning, we can turn to a classic of 20th-century French philosophy: Maurice Merleau-Ponty’s Phenomenology of Perception (1945).

According to Merleau-Ponty, European philosophy has long prioritised ‘seeing’ over ‘doing’ as a path to understanding. Plato, René Descartes, John Locke, David Hume, Immanuel Kant: each, in different ways, posits a gap between the mind and the world, the subject and the object, the thinking self and physical things. Philosophers take for granted that the mind sees things from a distance. When Descartes announced ‘I think therefore I am’, he was positing a fundamental gulf between the thinking self and the physical body. Despite the novelty of digital media, Merleau-Ponty would contend that Western thought has long assumed that the mind, not the body, is the site of thinking and learning.

According to Merleau-Ponty, however, ‘consciousness is originally not an “I think that”, but rather an “I can”’. In other words, human thinking emerges out of lived experience, and what we can do with our bodies profoundly shapes what philosophers think or scientists discover. ‘The entire universe of science is constructed upon the lived world,’ he wrote. Phenomenology of Perception aimed to help readers better appreciate the connection between the lived world and consciousness.

Philosophers are in the habit of saying that we ‘have’ a body. But as Merleau-Ponty points out: ‘I am not in front of my body, I am in my body, or rather I am my body.’ This simple correction carries important implications about learning. What does it mean to say that I am my body?

The mind is not somehow outside of time and space. Instead, the body thinks, feels, desires, hurts, has a history, and looks ahead. Merleau-Ponty invented the term ‘intentional arc’ to describe how consciousness connects ‘our past, our future, our human milieu, our physical situation, our ideological situation, and our moral situation’. He makes readers attend to the countless aspects of the world that permeate our thinking.

Merleau-Ponty challenges us to stop believing that the human mind transcends the rest of nature. Humans are thinking animals whose thinking is always infused with our animality. As the cognitive scientist Alan Jasanoff explains in a recent Aeon essay, it is even misleading to idealise the brain independent of the rest of the viscera. The learning process happens when an embodied mind ‘gears’ into the world.

Take the example of dancing. From a Cartesian perspective, the mind moves the body like a puppeteer pulls strings to move a puppet. To learn to dance, in this paradigm, a person needs to memorise a sequence of steps. For Merleau-Ponty, on the contrary, the way to learn to dance is to move one’s physical body in space: ‘in order for the new dance to integrate particular elements of general motricity, it must first have received, so to speak, a motor consecration.’ The mind does not reflect and make a conscious decision before the body moves; the body ‘catches’ the movement.

Philosophers have long attributed a spectatorial stance to the mind, when in fact the body participates in the world. It is common sense that the head is the ‘seat of thought’, but ‘the principal regions of my body are consecrated to actions’, and the ‘parts of my body participate in their value’. People learn, think and value with every part of their bodies, and our bodies know things that we can never fully articulate in words.

Surely, one could reply, this might be true for physical activities such as dancing but does not apply to all intellectual pursuits. Merleau-Ponty would respond: ‘The body is our general means of having a world.’ Everything we learn, think or know emanates from our body. It is by walking through a meadow, hiking beside a river, and boating down a lake that we are able to appreciate the science of geography. It is by talking with other people and learning their stories that we can appreciate literature. Buying food for our family infuses us with a conviction that we need to learn mathematics. We cannot always trace the route from experience to knowledge, from a childhood activity to adult insight. But there is no way for us to learn that bypasses the body: ‘the body is our anchorage in a world’.

Merleau-Ponty would not be surprised if people showed him students learning on a screen. Students can project themselves into the world that they see on a screen, just as many people are capable of thinking abstractly. As long as children have had some exposure to the world and other people, they should be able to make some sense of what they see on screens.

Still, Merleau-Ponty gives us reasons to resist the trend towards computer-based education. Proponents of personalised learning point to the advantages of having kids on computers for much of the school day, including students working at their own pace to meet learning objectives. However, from a phenomenological perspective, it is not clear why students will want to do this for very long when the experience is so removed from their flesh-and-blood lives. Teachers and parents will have to use incentives, threats and medication to make children sit at computers for long stretches of time when children want to run, play, paint, eat, sing, compete and laugh. To put it bluntly: advocates of screen learning sometimes seem to forget that children are young animals that want to move in the world, not watch it from a distance.

At the farm, my children learned from being around the animals, trees, pastures, streams, stars and other physical objects. Things became more real, more immediate, than they would have been if a screen had mediated them. However, the experience was as deep as it was because of the relationships we formed with our hosts. The farmers would hold my children when placing them on horses or look them in the eye when explaining how to move sheep from one stall to the next. Our children had fun with their children while playing by the stream at dusk before dinner. When we drove away from the farm, my young son had tears in his eyes; he didn’t want to leave his new friends.

For proponents such as DeVos, computer-based education empowers students to work independently at their own pace, including at home rather than in brick-and-mortar public schools. Based on my experience at the farm, however, I would argue that this highlights one of the problems of screen learning: it does not easily enable children to form human relationships that are crucial to a satisfying educational experience.

In his important book Face-to-Face Diplomacy: Social Neuroscience and International Relations (2018), Marcus Holmes explains the science that justifies this intuition. Drawing upon research in philosophy of mind, cognitive science and social neuroscience, Holmes argues that physical copresence is essential to generate trust and empathy among human beings. Though his research addresses the puzzle of why diplomats insist on meeting face-to-face for important discussions, his work also explains the science of why people find it more satisfying to meet in person than to communicate by screens.

According to Holmes, diplomats insist on meeting in person with their colleagues. Good negotiators have a ‘feel for the game’ that works only when they share drinks, go on walks, shake hands, or have private conversations with their peers. Diplomats know that they need to embrace, breathe the same air, and look each other in the eye if they are going to arrive at optimal outcomes.

Holmes draws upon neuroscience to explain why face-to-face meetings, as a rule, achieve better results. Researchers such as the neuroscientist Marco Iacoboni at the University of California, Los Angeles have diagrammed the ‘mirroring system’ that enables human beings to understand each other’s intentions. Within the brain, there are mirror neurons that fire when we do an action or when we see another person doing the action. Folk psychology holds that when we see another person, we think for a moment before deciding how to react. According to the new ‘simulation theory’, we actually feel what the other person feels as mirror neurons fire in just the same manner as if the experience was happening to us. The mirroring system ‘enables advanced neural synchronisation between individuals’.

Communicating in person enables people to ‘pick up micro-changes in facial expressions’ and detect other people’s sincerity. Neuroscience shows that humans do a good job of reading other people’s minds. People often deceive one another, but meeting face-to-face aids the detection of deceit. In games, people are more likely to trust one another when they play in person rather than when they play online. Likewise, there is greater rapport and ‘coupling’ when people get together in the flesh: ‘Put simply, face-to-face interaction is an unrivalled mechanism for intention understanding.’

To what extent can new technology replicate face-to-face interactions? Holmes acknowledges that writing, calling or video-chatting often works fine for many forms of communication but insists that people must meet in the flesh to achieve a high degree of trust or social bonding. Citing the sociologist Randall Collins at the University of Pennsylvania, Holmes explains that people want to be in the physical presence of other people to generate emotional energy, ‘a feeling of confidence, elation, strength, enthusiasm, and initiative in taking action’. Communicating via email or the internet makes it harder to read another’s body language or perceive what is happening in the background as the other person talks into the computer’s camera. Communicating from a distance does ‘not provide the same physical and emotional connection’ as bodily coparticipation.

We can transfer insights about social neuroscience from international relations theory to education theory. Placing children in front of screens enables them to access information, meet people around the world, play games, read things, purchase things and so forth that would otherwise be inaccessible. But as an ‘interaction ritual’, screen learning generates less emotional energy than sharing a physical space with other teachers and students. Students looking at a screen will not trust, or care about, their teachers or students to the same degree. People might speak their mind more freely when there aren’t the same visual cues to hold their tongues, but this also means that people are more likely to be uninhibited and antagonistic. People will not have the same investment in an online education community.

A screen cannot provide the same emotional resonance as staying at a farm, participating in its rhythms, and forming bonds with the other people. Educators should be considering how to provide such opportunities to more students, including those whose parents do not have the time and resources to plan such trips themselves.

For many young people, digital media, even when used appropriately, can make education and community life worse. Digital media is a mixed blessing, at best, and many young people would prefer to spend less time on screens. At some level, most of us already know this. When private schools advertise, the images are often of kids doing physical activities or hanging out with a group of friends. People are fighting common sense, philosophy and science when they argue for children to spend more time on screens.

One could reasonably reply that many young people enjoy being on screens, and gain efficacy by being on the internet. This is the claim of the report ‘Children’s Rights in the Digital Age’ (2014), made by a team of Australian researchers partnering with the United Nations Children’s Fund (UNICEF). The researchers interviewed children around the world and used their words and examples to conclude: ‘Hearing the sentiments of children in eight different languages allows one truth to sound loud and clear: we need to take the necessary steps to ensure that all children can reap the opportunities of digital access.’

The report describes the real benefits that children accrue from spending time on digital media. Children can gain access to information, get faster service delivery, express themselves artistically and politically, have fun, and make and maintain friendships with others around the world. The report acknowledges the dangers of digital media, including exposure to violent and pornographic images, excessive use, and data-privacy concerns. But it argues that the ‘risk narrative’ is overstated. If children and their caregivers are responsible, it maintains, then they will likely reap the benefits of online access.

In a remarkable epilogue, however, the report quotes young people from around the world answering the question of what would happen if digital media disappeared. Here are a few of the responses from teenagers in different counties: ‘I’d spend more time doing things outside, not watching TV or my phone or anything, I’d find more productive things to do’ (Australia). ‘If I don’t have any digital media then I would read story books’ (Thailand). ‘It would not do any harm. In the end we are not hard-wired to digital media. We are not controlled by digital media’ (Turkey). ‘It would make other people more confident to be able to talk to other people face to face, not over the internet, actually be able to have conversations with them’ (Australia). ‘People would learn to live with other things, using other ways’ (Brazil). ‘At first it would be very hard just to get used to it, but since everyone would not have it, everyone would get over it. It’d be better as well ’cause everyone would be able to talk more, to work harder for friendship’ (Australia).

If the move to digital learning continues, children will spend much, if not most, of their waking hours in front of screens. They will use apps before they go to school, spend their days in front of computers, do their homework online, and then entertain themselves with digital media. Children are losing opportunities to experience the world in all its richness. The gestalt of a farm transcends what pixels and speakers can convey. Screens drain the vitality from many educational experiences that could be better done in the flesh. This drift toward screen learning is only inevitable if people do nothing to stop it. So let’s stop it.

Nicholas Tampio is associate professor of political science at Fordham University in New York. He is the author of Kantian Courage (2012) and Deleuze’s Political Vision (2015). His latest book is Common Core: National Education Standards and the Threat to Democracy (2018).

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can't pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.


The Psychology of Roller Coasters

Perhaps the draw of roller coasters is the enjoyment of the visceral sensation of fear itself, much like watching a horror movie.

Roller coasters may seem like a very modern type of entertainment—constantly getting bigger, faster and scarier thanks to advances in technology. But they actually date back to the mid-1800s. Gravity-propelled railways built to transport coal from up in the mountains down to the town in Pennsylvania, US, were hired out at weekends by fare-paying passengers riding purely for the fun of it.

Today theme parks are big business. But with queues occasionally as long as eight hours for an average ride of under two minutes—not to mention reports of riders suffering strokes, brain deformation and serious injury due to crashes—how come we put ourselves through it? What is it about roller coasters that some love so much, and is it an experience we tend to like less as we get older?

Enjoying roller coasters is linked to sensation seeking—the tendency to enjoy varied, novel and intense physical experiences such as rock climbing and parachute jumping. But what sensation do roller coasters provide that is so alluring? At first glance, it may seem to be down to the experience of speed. But the evidence for linking sensation seeking to speed is not compelling. For example, when it comes to driving at speeds above the legal limit, many people do it, not just sensation seekers.

Perhaps the draw of roller coasters is the enjoyment of the visceral sensation of fear itself, much like watching a horror movie. Physical signs of fear such as a pounding heart, faster breathing and an energy boost caused by the release of glucose are known collectively as the “fight or flight response”. We know that a roller coaster ride is likely to trigger this response thanks to researchers who measured the heart rates of riders on the double-corkscrew Coca Cola Roller in 1980s Glasgow. Heart beats per minute more than doubled from an average 70 beforehand to 153 shortly after the ride had begun. Some older riders got uncomfortably close to what would be deemed medically unsafe for their age.

In another adrenalin-boosting pastime, novice bungee jumpers not only reported increased feelings of well-being, wakefulness and euphoria just after completing a jump, they also had raised levels of endorphins in the blood, well known to produce feelings of intense pleasure. Interestingly, the higher the levels of endorphins that were present, the more euphoric the jumper reported feeling. Here, then, is clear evidence that people enjoy the sensations that accompany the fight or flight response within a non-threatening environment.

GOOD VS BAD STRESS

And yet, paradoxically, these bungee jumpers also showed increased levels of the hormone cortisol, known to increase when people experience stress. How, then, can a person simultaneously experience stress and pleasure? The answer is that not all stress is bad. Eustress—from the Greek “eu”, meaning good, as in euphoria—is a positive kind of stress that people actively seek out.

We know that a roller coaster ride can be experienced as a “eustressful” experience thanks to an intriguing study carried out by two Dutch psychologists. They were interested in asthma, and specifically its relationship with stress. Having noted previous research findings that stress leads asthma sufferers to perceive their asthma symptoms as more severe, they wondered whether an opposite effect might be possible by applying eustress.

And so, in the name of science, some asthmatic student volunteers were transported to a theme park and rode a roller coaster while their respiratory function was checked. The research findings were remarkable. While lung function predictably reduced from the screaming and general upheaval, so did the feeling of shortness of breath. This suggests that thrill seekers riding roller coasters perceive the experience as stressful in a positive way.

THE ROLE OF DOPAMINE

But roller coasters are not everybody’s cup of tea. Could differences in brain chemistry explain sensation seeking behaviours? The experiment with bungee jumpers suggest that people with higher levels of endorphins feel higher levels of euphoria. But there is no evidence that resting levels of endorphins might explain sensation seeking, they are more likely a response to the thrill than a predictor of whether we enjoy it.

A recent review instead looked at the role of dopamine, another chemical messenger substance in the brain that is important in the functioning of neurological reward pathways. The review found that individuals who happen to have higher levels of dopamine also score more highly on measures of sensation seeking behaviour. While this is a correlation rather than a causation, another study found that taking a substance called haloperidol, which disrupts dopamine’s effects within the brain, led to a measurable decrease in sensation seeking behaviour.

This line of research sets out the intriguing possibility that enjoyment of intense physical experiences such as riding on roller coasters may reflect individual differences in brain chemistry. People who have higher levels of dopamine may be more prone to a number of sensation seeking behaviours, ranging from harmless roller coaster rides to taking drugs or even shoplifting.

The question as to whether roller coaster riding still appeals as we get older has not been researched directly, but a recent survey looked at how keen people of different ages were on thrill-seeking holidays such as rock climbing trips. It showed that interest in these kinds of holidays peaks in early adulthood, declining with each passing decade. This indicates that older adults are less inclined to participate in activities similar to riding roller coasters. Perhaps experiencing one’s heart rate spiking dangerously close to medically accepted risk levels is not such a draw for the over 50s.

Though hard to pin down, people enjoy roller coasters thanks to a combination of speed, conquering fear and the positive effects associated with a massive rise in physiological arousal. A roller coaster ride is a legal, generally safe and relatively cheap means of experiencing a natural high. Understandably, people have been happy to pay money in exchange for doing it for centuries, and there is no sign of any waning in the appreciation of a bit of eustress.

By Richard Stephens, Senior Lecturer in Psychology, Keele University. Written for Scientific American

Kevin A Groves is a Clinical Psychologist Dallas, Texas. He graduated with honors in 1989 and has more than 29 years of diverse experiences. Kevin is also a family therapist and group counselor in Irving TX, formerly of Austin TX.


Psychology of Choice

Psychology of Choice

How psychology explains the everyday decisions that we make, and how we are unaware of the influences that guide the choices we make.

Each day, we make countless choices and decisions. We will consider some choices, such as when house-hunting, for weeks or even months. But the majority of decisions we make, such as which clothes to wear this morning or what to eat for lunch, are made routinely without substantial conscious consideration on our part.

An abundance of choice in our everyday lives is regarded as a luxury of modern living.

Fashion choices are an expression of our personality and even a person's preferences for particular brands when shopping may be considered as extensions of their persona.

The option to choose is something that we no longer just value but now expect - it is a prerequisite to all democratic institutions that people are given the option to choose between two or more candidates or ideas.

Yet, even when we are presented with a false choice (for example, when two candidates in an election offer practically identical policies) we still expect the ritual of making a decision. We demand and often take for granted the ability to make choices in our day-to-day lives, and free market competition feeds into that expectation by give consumers a degree of product choice whilst shopping.

Contrary to the demand for choice, however, psychologists have found that excessive choices can actually have a negative effect on us.

In this article, we take a look at the influences on decision making that most of us are unaware are even impacting us, and why we may not always be able to trust even the decisions that we thought we were making ourselves.

What unconscious influences affect the choices I make?
Unless you were being overtly coerced into making a forced decision, you will generally assume that you have the free will to make the choices in life that will provide the best outcome for you. However, underlying every decision we make are numerous influences affecting our choices.

Some of these influences we will not be conscious of constantly but will be able to point to them when asked our reasoning. For example, when eating dinner, you are fulfilling one of your instinctive needs to survive - eating.

Other influences (such as the presentation of choices, which we will look at in a moment) bypass our awareness and even after making a choice we will not recognise that they have manipulated our reasoning and affected the outcome of our decision.

First, let's take a look at the needs that influence our choices but that we are aware of.

How instinctive needs affect our choices

In 1943, U.S. psychologist Abraham Maslow proposed a Hierarchy of Needs - a set of innate needs organised in a pyramid, which every person aspires to fulfill. Each of these needs affects our behavior as we yearn to satisfy them.1

The most basic of that set of needs are our deficiency needs - essential physiological requisites for survival, such as nourishment, warmth and water. Whilst these survival instincts are no longer key to many of our decisions, they still influence our daily routine by way of mealtimes.

More significant are the growth or 'self-actualization' needs - desires for personal fulfillment which identified at the top of his needs hierarchy. Once our survival needs are met, we try to form relationships and undertake activities which will boost our self image.

These needs affect many of the choices we make when, for example, socializing, helping to determine the relationship choices we make with a view to increasing our self esteem.

Like Maslow, psychiatrist William Glasser distinguished between survival and psychological needs in his 1996 book Choice Theory.

Glasser (1996) postulated that unhappiness results from bad relationships with relatives and friends, which in turn suffer as a result of making misguided choices. He believed that by making better choices, we can maintain better relationships which will help us to lead a more fulfilled lives - reasoning which forms the basis of Glasser's Reality Therapy, which he had developed in the 1960s.2

Was Glasser's attribution of unhappiness to bad choices accurate?

Choice Theory seems to identify the root of all unhappiness - even mental disorders - as being self-determined decision making. As a result, his theories have been criticized as over-simplifying complex psychological issues, especially when psychologist have identified other factors that can influence mental health.

For example, psychologists have found that our genes and relationships in early life can pre-dispose us to some mental disorders.

Do we decide based on Marginal Utility?
Marginal utility is a theory which originates from the field of economics. It suggests that every decision we make is based on the getting the greatest potential benefit, known as marginal utility, from the choice (the optimal decision) that we make. Let's take an example:

At a fair, you pay to play a game where you are presented with 3 cups. Under each cup there is either nothing or a prize. You are given the potential prize and chances of the prize:

The 1st cup has a 50% chance of containing 2 coins
The 2nd cup has a 25% chance of containing 2 coins
The 3rd cup has a 20% chance of containing 2 coins
Which cup should you choose?

According to the theory, you will choose the first cup as it offers the highest potential reward. Philosopher Blaise Pascal employed marginal utility in reasoning known as Pascal's Wager3 - a calculation of whether or not to believe in God.

Pascal believed that the greatest marginal utility could be gained from believing. Doubters, he reasoned, should attempt to believe as this would gain God's favor, but there was no similar reward for not believing.

Of course, we are not always so rational as to make every decision based on a calculation of its reward. Let's take a look at some other influences over our choices.

Impact of choice presentation
Aside from cool-headed reasoning, how else do we make choices?

Ad men seek to manipulate the choices we make as consumers via the plethora of adverts that we see daily. But without explicit persuasion, how can they influence people without them even realising?

One method of manipulation is through the phrasing of questions, known as framing. This is particularly important in the development of questions presented to an electorate in a referendum.

The subtle phrasing of a closed question in a referendum has been found to affect people's choices.4

For example, an aversion to risk can lead people to Status Quo Bias - favouring a maintenance of the current situation even when the alternative could offer a greater marginal utility.

Samuelson and Zeckhauser (1988) demonstrated this with a study in which participants completed a questionnaire. Some question options were altered to be framed as maintaining the status quo. Where this occurred, participants were more likely to choose the option which maintained continuity, rather than risking change.5

The Status Quo Bias has also been noted in real world situations. Kempf and Ruenzi (2006) found that, when people were offered the opportunity to keep their financial plan or to change to a different plan, they were more likely to keep their existing plan even if an alternative offered a better reward.6

We can understand the Status Quo Bias in terms of loss aversion - people feel that they have more to lose than they have to gain by change.

Gächter (2009) identified this loss aversion in a group of PhD students who, when warned of a penalty fee for late enrolment to classes, were more likely to enrol than another group, who were incentivised with a reward for early enrolment.7

So if people tend to make conservative choices, can they be persuaded to choose options which will change their lives for the better?

'Nudging' towards better choices
This question is explored in the book Nudge (Thaler & Sunstein, 2008). Thaler and Sunstein developed the theory of Choice Architecture and more specifically, Nudge Theory.8

Nudge Theory postulates that people can be subtly 'nudged' towards making better choices and gained such traction with the UK government that it created a Behavioural Insights Team to look at how such a theory could be employed in the real world.

The team claims that 96,000 organ donors could be added to the donor's register by framing the opt-in question in a way that would draw on people's reciprocal altruism.9

Elsewhere, Nudge Theory has been employed at Amsterdam's Schipol airport, with adding a picture of a fly to the urinals in the men's toilets in order to improve their users' aim.

Social influences on decision making
Numerous other factors, or biases, can affect the choices we make without us even realizing their effect on us.

Social influences can lead us towards a herd mentality - making the same choice as our peers in order to 'fit into' a group. Solomon Asch identified this most acutely in a series of well-known conformity experiments, in which participants were asked to judge the length of a set of sticks.

Conspirators were asked to identify some identical sticks as being inches different in length to others. The genuine test subjects then copied this judgement when the sticks were obviously similar.10

Equally of note is the effect of social roles on the choices we make. Philip Zimbardo conducted the now infamous Stanford Prison Experiment (1971) in which participants were asked to take on the role of prison guards.

In doing so, they adopted the attitudes and choices that they perceived prison guards to have, and became increasingly sadistic towards participants playing the role of prisoners.11

Making better choices
The issue of how we make choices and decisions is far from a new one. The concept of free will - the ability to decide freely - is an important topic for theologians, who view it as key to being able to distinguish between 'good' and 'evil' - demonstrated literally in Adam and Eve's choice making in the Garden of Eden. This reinforces the idea that our ability to make choices defines us as individuals.

Yet, as we have learnt from numerous psychological studies, our choices may be free but they are not free from influence.

Many factors manipulate and restrain our decision making, whether intentionally or passively. Choice theory remains an active topic of research across numerous fields, with, for example, lawyer Kent Greenfield exploring the question of choice in depth in his 2011 book The Myth of Choice12.

How do we make better choices? It is almost impossible to claim to be free from influence of some type, but the least we can do is become more aware of those influences and understand how they affect our decision making without us being conscious of it.

By Psychologist World

References
Maslow, A.H. (1943). A Theory of Human Motivation. Psychology Review, 50(4), 370-396.
Glasser, W. (2007). Choice Theory: A New Psychology of Personal Freedom. New York: Harper Perennial.
Pascal, B. (1670). Pensees. Paris: Guillaume Desprez.
Watt, N and Syal, R. (2015). EU referendum: Cameron accepts advice to change wording of question. Retrieved January 6th, 2016, from http://www.theguardian.com/politics/2015/sep/01/eu-referendum-cameron-urged-to-change-wording-of-preferred-question.
Samuelson, W and Zeckhauser, R. (1988). Status Quo Bias in Decision Making. Journal of Risk and Uncertainty. 1(1). 7-59.
Kempf, A. and Ruenzi, S. (2006). Status Quo Bias and the Number of Alternatives. Journal of Behavioral Finance. 7(4). 204-213.
Gächter, S. Orzen, H., Renner, E. and Starmer, C. (2009). Retrieved from https://www.nottingham.ac.uk/cedex/documents/papers/2007-01.pdf.
Thaler, R.H. and Sunstein, C.R. (2008). Nudge. New Haven and London: Yale University Press.
Cabinet Office Behavioural Insights Team (2015). Applying Behavioural Insights to Organ Donation. Retrieved January 6th 2016, from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/267100/Applying_Behavioural_Insights_to_Organ_Donation.pdf.
Asch, S.E. (1951). Effects of group pressure on the modification and distortion of judgements. Groups, Leadership and Men. Pittsburgh: Carnegie Press.
Zimbardo, P.G. (1971). The power and pathology of imprisonment.Congressional Record. Serial No. 15, October 25th, 1971.
Greenfield, K. (2011). The Myth of Choice. New Haven and London: Yale University Press.

Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and couples therapy Fort Lauderdale. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders. My goal is to help you recognize, understand and have compassion for how you may have developed less-than-ideal ways of dealing with specific areas of your life.


On Revisiting PTSD

In an extract from his new book, John Marzillier meets people who have returned to the scene of their trauma.

On 27 August 1979, off the west coast of Ireland on a lovely sunny morning, a small boat, Shadow V, was blown to pieces by a 5lb gelignite bomb placed under the deck and activated by remote control by members of the IRA. Lord Mountbatten was at the helm. Also on board were his daughter and son-in-law, Patricia and John Brabourne, two of their children, 15-year-old twins Timothy and Nicholas, John’s mother Lady Brabourne, and Paul Maxwell, a 15-year-old Irish friend of the family. The bomb killed Lord Mountbatten, Lady Brabourne, Nicholas Knatchbull and Paul Maxwell, and seriously wounded Timothy and his parents. The IRA regarded it as a blow struck against English oppression in Ireland. To the bereaved families it was a devastating tragedy, the deliberate, cold-blooded murder of innocent people on a family outing to check on the lobster pots around the coast. This was no ordinary tragedy, if such a thing exists, for the Mountbattens were relatives of the Queen and the shock of the outrage reverberated around the world. Those of us who were living at that time can recall the event, even if, like mine, one’s recollection of it is hazy. I recalled that Lord Mountbatten had been killed but little else. I did not know anything about the personal consequences to the family, and had it not been for a meeting with Tim Knatchbull over thirty years later I doubt if I would ever have known anything more.

I first came across Tim at the 2010 Oxford Literary Festival when he talked with great candour about the trauma he had suffered. He had just published a book, From a Clear Blue Sky: Surviving the Mountbatten Bomb, in which he gave a detailed account of the events leading up to the murders, as well as recounting his experience, decades later, of returning to the west coast of Ireland, a journey that was as much psychological as it was geographical. I bought the book and asked Tim if he would grant me an interview, which he kindly did. I was interested to talk to him about several aspects of the trauma he had been through, the huge change it had made to his life at a young and impressionable age, the loss of his identical twin, Nick, and the long process of mental and emotional recovery that he went through. But most of all I was interested in his conscious decision to return to Ireland, and what that had meant to him.

In this chapter I will consider what may be gained from revisiting the site of a trauma and what the risks may be. As far as I can discover, there is no psychological research specifically on revisiting; that is, there are no studies evaluating whether or not returning to the trauma site is either beneficial or detrimental. In truth, it is difficult to do such research. There are so many confounding variables. Much depends on the nature of the person, the type of traumatic experience, the stage the person has reached in his or her recovery from the trauma, whether or not he or she is undergoing treatment, whether or not support is provided, what expectations the person has with regard to revisiting, and what actually happens during any revisiting. However, what we know clinically about the psychological recovery from trauma suggests that revisiting a trauma site could be an important part of the process of moving on, a way of putting the original trauma to bed – of achieving ‘closure’, to use an American term.

During 2003–4 Tim Knatchbull carried out a carefully planned series of visits. These proved enormously helpful to him, as I will describe. However, returning to where the trauma took place is not always beneficial. There is a misconception that the traumatized person should quickly ‘get back on the horse’, to use an old saying. In my work with the police, I saw a young WPC who had been in road accident in which the driver of the police car she was travelling in lost control at speed, going over a hump-backed bridge. The WPC injured her back and suffered considerable pain and anxiety. She told me that, a few days after the accident, on the advice of her GP, she returned to the accident site. But this had not helped her. The advice may have been well intentioned but it was psychologically inept. Revisiting the site of a trauma is not something that should be undertaken without careful preparation. Even more important is finding the right time to do it, if it is to be done at all. A few days after the trauma is often the wrong time, as the person is usually still suffering physical and/or psychological effects. There is a risk of making matters worse.

Revisiting is one component of certain trauma therapies (sometimes called ‘exposure’ or ‘reliving’ therapies) in which the trauma sufferer is exposed to trauma memories in order to aid the processing of those memories. At some point in the treatment the therapist and client may return to the trauma site together, often with beneficial results. Some trauma sufferers return of their own accord. This can be part of a self-help programme, as it was with Tim, or it may simply be a matter of necessity. George, who was in the 2005 London bombings, told me that he went back on the underground just five days after the explosion. He did not want to lose his job, which required travelling to properties all over London. The underground was the best way of getting around and so he forced himself to go back, getting through the initial fear. For a long while he found travelling on the tube difficult. He remained apprehensive, alert to possible terrorists amongst the passengers, sometimes leaving a carriage if someone looked suspicious.

Here, I will present the stories of two exceptional people who, for different reasons and at different points in their lives, made a deliberate return to a place where they had undergone harrowing traumatic experiences. Their stories illuminate the human desire for making sense of difficult and painful experiences and to mould those experiences into something new.

From a clear blue sky: Tim’s story

When Tim and his family left Ireland shortly after the bombing, it seemed unlikely that any of them would return. The family would be too much at risk of another attack. But Tim thought otherwise. In the car leaving Classiebawn Castle, his late grandfather’s holiday home, he announced that they would be back. His siblings told him that this would be impossible, but he stubbornly held on to the belief that he would one day return. It is not hard to understand why Tim should want to return. He had lost his beloved twin brother and because of his own injuries and those of his parents, there had been no opportunity properly to say goodbye to Nick. The west coast of Ireland had been a magical place for the brothers; it must have been difficult to imagine that all of that was gone forever. The effect of the atrocity was felt most directly by the people immediately involved, by those who had been killed, those injured and their relatives and friends. But the bomb also exploded a childhood, a happy way of life and, in Tim’s stubborn determination to return, there very probably lay a wish to recover that.

Tim revisited Ireland at two different times in his life. The first time was in 1987 when he was twenty-two and had finished his degree at Cambridge. In his book he described how he was feeling at the time.

I decided to make 1987 a gap year in which I would travel and work. I also wanted to return to Ireland for the first time since the bomb; I did not know what I would do there but I felt drawn to half-developed thoughts lingering at the back of my mind. I had an uneasy feeling about the hole in my life left by Nick’s death. I was aware that I needed to sort out my incomplete and confused emotions but I did not know how to proceed or how to explain my feelings to others.

He took an Aer Lingus flight to Shannon and had the impression of ‘landing behind some form of invisible barrier, a sort of emotional Iron Curtain’. On his own he drove around, visiting once- familiar places. Throughout he felt a cold, raw numbness. He was aware that painful feelings were somewhere beneath the surface, but he could not get in touch with them. Having just received his pilot’s licence, he hired a Cessna and flew out to the island of Inishmurray and back over Classiebawn. Later, he drove to the castle where he had stayed as a boy and viewed it from a distance, all the while feeling numb. In my interview I asked Tim about this first visit.

I just couldn’t make sense of the place. I didn’t have the support, didn’t know how to do it, didn’t have the courage of my convictions, didn’t have the wherewithal. Apart from anything, my life wasn’t set up for me to be there for a week at a time and I knew that I wasn’t making the progress that I needed to. And in 1987 people were still shooting and blowing people up.

Tim knew, emotionally, that he needed to revisit Ireland, but his return in 1987 did not lead to any catharsis or other emotional change. It is possible to see, with hindsight, that this revisiting came too soon in his life, when his feelings were still uncertain and confused, and when he had not established himself in a career or long-term relationship. He returned on impulse and alone. Though the return did not achieve what he had hoped, he wrote that it had ‘started something difficult but necessary’. It reinforced in him the conviction that he needed to return for something important – though, at that time, he had no idea what that might be.

The next time Tim returned to Ireland was in August 2003, sixteen years after his first visit. This was the start of a series of many short trips over a year in which he revisited places and people, allowing memories to resurface, and discovering ‘pieces of the jigsaw’ that had been lost. This experience was very different from his first visit. One reason was that he was different, an older man, more emotionally mature, with a wife and family and a firm sense of himself. He was also ready, a term that is difficult to define precisely, in this context. He had spent some time in psychotherapy and the neutrality of that relationship had allowed him the space to begin exploring his feelings. Tim told me about the importance of this in our interview.

My relationship with the therapist was very much, well, she was quite old school. So I didn’t form a deep bond and attachment with her. But there was a certain degree of healthy environment in her consulting room for me to know that I could experiment with what I was saying and feeling and thinking, articulating without risk to myself or others. I think there were some things I said to her that I would not have said to anybody else other than to a professional . . . and I think that there were probably half a dozen ingredients that I needed to get into my life before I was able to go through the process I describe in my book, the final process of saying goodbye to Nick, the feeling of taking off my rucksack.

Tim used the phrase ‘taking off my rucksack’ to describe the process of at last getting rid of the burden of unresolved grief for his twin’s death. The significant difference from the earlier visit lay, he believed, within himself.

On my first trip back in the 1980s . . . I found that I didn’t have what I needed to have inside me; the tool kit inside me was woefully lacking to make sense. It was like an operation that I needed to do and I didn’t have the scalpels for it. It took me years to find the tools and put them together and go back.

In his book Tim describes the various visits he undertook in 2003–4 and what he gained from them. He returned first of all to Classiebawn Castle, which had been leased to a local Irishman who made him welcome. Driving through the castle gates he noticed his grandparents’ initials and crest still on the gate pillars. As he walked into the castle, he saw the wooden-handled nets in which the family had caught prawns. ‘A rush of memories and emotions swept over me,’ he wrote. ‘I felt I had dived in at the deep end and I needed to go back outside to acclimatize.’ This was the start of rediscovering objects and places that immediately brought him back to his childhood. Walking around the castle he found many such evocations. ‘Each of these places – a room or a spot offering a familiar view – has something locked up in it, like a sweet fragrance. On opening it up for the first time, there is an evanescent and fragile sensation, soon scattered to the wind. From every corner the rooms whisper memories of sensations, noises and smells.’ This is one of the keys to revisiting, the sense of rediscovering the past through objects or places that were either long forgotten (from conscious memory at least) or were not remembered in any detail. Throughout his many visits, Tim found his memory jogged by these rediscoveries and that allowed the past back in – both the happy times and the painful ones.

A major purpose in revisiting a trauma site is to fill in the gaps in knowledge. Tim, like any other survivor of trauma, experienced the event only from his own perspective. He had been badly injured and so had lapsed in and out of consciousness. He had heard of certain events only later – the rescue of the wounded and the recovery of the dead, for example. And so he meticulously sought out people who had been there, so that he was finally able to piece together the sequence of events as described by witnesses. One benefit of doing this sort of reconstruction is to correct worrying misconceptions. For example, Tim had experienced flashback memories to when he was pulled out of the water by a couple in another boat. These included the vibration of the engine, the cold, the taste of saltwater and diesel, the smell of oil on his skin. But the flashbacks were never visual. He dreaded the moment that the visual memories might suddenly return. This anxiety was alleviated when his rescuers told him that he had been unable to see when he was pulled from the water, and that his sight returned only when they came ashore. There would be no visual flashbacks to that time.

Tim had never properly said goodbye to his brother, Nick. Because of his own injuries he had not been able to attend the funeral. He did not know in any detail what had happened other than that Nick’s body was eventually found in the water, several hours after the explosion. He talked to the people who had taken him from the water and heard exactly what they had done. He was shown a photograph taken at the time. ‘It was as terrible a photograph as I have ever seen,’ he wrote, ‘but it also gave me what I wanted: a sense of being there.’

The details were being filled in. In his book, Tim describes a highly charged moment when he is granted an interview with the pathologist who had examined Nick’s body. A ‘bulging red folder with “Mountbatten” written in large handwriting across its front’ is produced and together they go through it. I cannot do justice here to how Tim felt during this interview; it is beautifully and sensitively described in his book and I can only recommend that people read it. Revisiting the circumstances surrounding his brother’s death enabled him to say a proper and emotional goodbye, to lay aside the rucksack at last. Moreover, it released him from a feeling that he had scarcely been aware of. ‘I later realized that there had existed in my mind, even if subconsciously, a feeling that I had somehow abandoned Nick in this final duty. That trace of unreasoned and unreasonable emotion now disappeared.’ Tim encountered many places and many people on his frequent returns to Ireland. He kept a diary, which was to form the basis of his book. This project not only gave his visits a purpose beyond his personal need to revisit the site of the trauma, but it also allowed him to create something entirely new. In interviewing other trauma victims I have come across a few who have done something similar, making a film or setting up a website in memory of a loved one. Psychologically, I see this as an important part of the healing process. It enables people to take something positive from an awful loss and take control over events that, at the time, they had no control over. Tim described to me what it meant to him.

Some people find it unfathomable that I would want to talk about it and share it with others. But I have certainly come to the conclusion that it wasn’t just going back to the island; it was the ability to articulate it to myself and to be able to articulate it to others that were extra levels of healing. The ability to write it down, document it, share it with others is in itself a therapeutic thing to do.

A return to Colombia: Mark’s story

When people ask me what it’s like to be kidnapped, I always find it hard to put it into words, how to explain the not knowing, the sense of powerlessness, the very real proximity of death, the total lack of freedom and any sort of choice in the way your life progresses. It’s all these feelings but it’s all these feelings constantly. It never lets up. The shadow of your kidnap is always hanging over you. You go to bed with it, you wake up with it, and it’s only in those first few seconds of the morning that you forget where you are and for a few precious moments you are free.

These are the words of film director Mark Henderson, who was one of eight tourists kidnapped and held by Colombian guerrillas in 2003, in Mark’s case for 101 days. It was a gruelling, exhausting and at times terrifying experience. At first, the hostages believed that they were being held for money. Later, it became clear that the kidnappers had a political motive. They were part of the Ejército de Liberación Nacional (the ELN, or National Liberation Army), a Marxist guerrilla group that has been at war with the Colombian government for more than 40 years. Mark decided from the outset that the best strategy was to try and bond with the kidnappers.

Our captors didn’t actually beat us but they were cruel and would hold guns to our heads, threatening to shoot us. I’d do anything I could to ingratiate myself with them. You want them to like you – you don’t want to be the one who they shoot.

When two new guards arrived, Antonio and Camila, Mark found in Antonio someone he could more easily relate to. Unlike the other guards, these two were kind to the hostages. They were more educated and more politically aware.

Camila was the camp commander’s secretary and Antonio was effectively in charge of training new recruits, teaching them about the ELN’s Marxist doctrines. I got the impression that, out of all our guards, Antonio was the one who really believed in what he was fighting for.

Antonio and Mark talked about the situation in Colombia, the struggle of the poor and oppressed against a corrupt military regime. They shared the same taste in films and music. In this way, a bond was established which was to play a significant role in what happened to Mark when he was back in England. The hostages were eventually released following negotiations through a Catholic priest working for the Catholic Overseas Development Agency. Seven years later, Mark returned to Colombia for a reunion with Antonio, a journey which he made into a remarkable documentary film for Channel 4. I watched the film and decided to get in touch with him and ask him why he had returned to Colombia to make the film and what he had got out of it.

In April 2011 I met Mark in his flat near Clapham Common. We were surrounded by boxes and furniture as he and his partner were in the throes of moving. It was kind of him to spare me an hour at this busy time. As soon as the recording got underway, Mark settled easily into telling me the story of the making of the film. I was intrigued by the fact that he and Antonio had entered into an email exchange just under a year after Mark had been released, an exchange that went on for six years. The initial contact was brokered by the Catholic priest who had helped negotiate their release. When he was being held as a hostage, Mark had talked to Antonio about making a film about the ELN’s struggles. Mark told me how Antonio referred to that in his first email.

I think the words were, ‘I hear you are the star of the media over there now.’ And it was all quite weird wording because there was no apology, no specific reference to the kidnapping. He never used the word ‘kidnapping’, if you actually look at all the emails. He always talks about ‘your experience’, ‘your time in Colombia’, things like that.

In his second email, Antonio mentioned making the documentary about the ELN that they had talked about. Mark’s initial reaction was unequivocal; there was no way he would ever return to Colombia. Apart from anything else, it was not fair to his family to put himself at risk again. He had only been released just over a year ago. In 2010, when he eventually returned to make his film, the situation in Colombia was very different, and he too was different. This underlines the point I made when discussing Tim’s visits to Ireland, that timing is crucial. If a person is not ready (vague though this term is, it is important), the return might have adverse effects. From a psychological perspective, the key to revisiting is that it should be a success. But what does ‘success’ mean? What did Mark want from his return to Colombia? What did he actually gain? In our interview, I asked him how he had come to the decision to make the film after all.

I suddenly thought: ‘I want to go back and meet him. I want to find out what [actually happened].’ I spoke with everyone else about the kidnapping. It really is a cliché but you want to put all the pieces in place. I knew this bit and then my parents could give me this bit and the Met Police tell me this bit and the priest told me this bit and there was still a good quarter over here, which is their story. And because we had always been lied to during the whole process of the kidnapping, we could never actually tell when they were telling the truth. I wanted to sit down with him and say ‘Right, what was the truth?’

It helped that Mark was a television producer, familiar with the business of making documentaries.

I think once I got into the process – because making television is my profession – sometimes I would almost put on the director’s hat or my producer’s hat as opposed to the actual ex-hostage’s hat. [But] sometimes I had to step back from it and think about me, and this especially happened when I went back. When people say, ‘Why did you make the film?’ [I say] I just wanted to tell the story . . . I just wanted to have a testament of what happened to me. Now I understand why people write books. And actually having something physical I’ve realized means you can actually distance yourself from it. Even more, you can actually give it to someone and say, ‘That’s it’.

The film would be a tangible record of the kidnapping. Like Tim’s book, there would be something to show, something that others could see. Moreover, it would give Mark back the control he had lost when held hostage. Shortly after he was released, Mark began writing a book about his experiences. He had kept a diary from about day 8 or 9 of his kidnapping, but wanted to recapture what had happened, during the first few days in particular. He wrote about 80,000 words, a huge amount, but found the process of reliving the experience through writing made him feel anxious and weak. It affected his sleep so that he woke up screaming, or was jolted awake by disturbing dreams. He saw a psychologist, who advised him that these were symptoms of PTSD, and although he did not fit the complete diagnosis, the nature of his experience was essentially the same. That helped, Mark told me. It helped because Mark now knew he was not going mad and that he could get better. Writing the book almost certainly came too early in Mark’s recovery, and the very length of it suggests it had become a bit of an obsession. He abandoned the book and decided he needed to go back to the normality of work. Later, when he was stronger and had obtained some distance from the trauma of the kidnapping, he could revisit it in a form that he was more familiar with – film.

When Mark and another of the hostages, a German woman named Reini, finally met Antonio, they had prepared a series of questions to ask him. For security reasons Antonio was filmed in silhouette. In the film we see a short extract of this encounter, just a few minutes. But Mark told me that the meeting went on for seven hours, as Antonio was determined to answer all their questions.

‘[There were] four of us and one of him. And it really did feel like the tables had turned, like we were the ones in control. And then by him saying “No, I want to answer all your questions”, he was suppliant, what’s the word?’

‘Submissive?’

‘Submissive. He was almost being submissive. It really felt like a shift of power. He’d always been this kidnapper and now he wanted to give us whatever he could . . . and it wasn’t so much necessarily what he said, but it was the fact that he did it. That meant more to us.’

I asked Mark what he thought Antonio’s motive was in meeting them. Was he seeking to apologise, to make reparation?

I think so. I always wanted to believe in the humanity of all of our guards and yet with some of them I could never see it. With him I could. And that is why I never understood how he could do what he did and then live with himself . . . I think he met up with us because actually we did connect as people. He almost wanted to say ‘Look, I am not the person you think I am. I am a human being. I do care.’

In the film we see Antonio making an apology. At first he rationalizes the kidnapping in terms of the political struggle for human rights of oppressed people. But when Mark makes the point that he had violated their human rights, he admits the truth of this. He says what he did was wrong and asks for their forgiveness. In South Africa, the Truth and Reconciliation Commission enabled former enemies to meet and make atonement even for some of the most horrific crimes. The Forgiveness Project is a website that explicitly encourages and empowers people to explore the nature of forgiveness and alternatives to revenge by telling their stories. It is possible that, for Antonio, the act of meeting Mark and Reini began a process of making atonement for his part in the kidnapping. For Mark it was a very important part of regaining control through ‘filling in the pieces’ of the events, essentially providing different and better memories of that traumatic time. Mark put it very well in our interview.

By making the film and by being together we were almost overriding any memories we had of that place. And when we all came out, and even now when we speak to each other, we don’t talk about the kidnapping. We talk about when we made the film. It’s almost like we’ve replaced it.

Conclusion

Tim and Mark’s experiences show, in their respective ways, how it is possible to gain a great deal from going back to revisit the site of a trauma. Not all traumas lend themselves to this, of course; in some cases it is simply not possible to return. Both individuals had the same motive, to fill in the missing pieces of information that came from being physically back in the place where the trauma had happened, and interviewing people who had been there at the time. Mark told me that when he first met up with three of his fellow hostages again, the four of them were able to explain in detail what had happened or what they did at particular times. We know that memory is reconstructive and one consequence of the revisiting process is the realization that our memories do not always match the reality of the event itself. This is very much part of what happens in reliving therapy, when the client and therapist together return to the site and actively disconfirm irrational fantasies or beliefs. As Mark put it, new memories can now replace the old ones. These are more positive and, moreover, are in the control of the person: it is what they have deliberately set out to achieve. Another important feature of returning to the site of the trauma is emotional. Tim wanted to remember his brother Nick’s last moments, and in doing so say goodbye to him. Mark wanted to talk directly to Antonio and tell him how he felt. This is not just a matter of emotional catharsis, but something more active. Tim could finally lay down his rucksack and grieve for his lost brother. Mark could now see his Colombian experience in a different light. Finally, both achieved something memorable and creative, one a book, the other a film.

An extract from ‘To Hell and Back' by John Marzillier.

Diane Gaston utilizes an approach to therapy that emphasizes all aspects of the individual, including the psychological, emotional, spiritual, and physical. I specialize in PTSD trauma therapy long beach working with those who have affected and held back by past trauma and/or adverse life events. I also work individually and with couples who wish to improve their relationships.


The Sandwich Generation

Rising Financial Burdens for Middle-Aged Americans

With an aging population and a generation of young adults struggling to achieve financial independence, the burdens and responsibilities of middle-aged Americans are increasing. Nearly half (47%) of adults in their 40s and 50s have a parent age 65 or older and are either raising a young child or financially supporting a grown child (age 18 or older). And about one-in-seven middle-aged adults (15%) is providing financial support to both an aging parent and a child.

While the share of middle-aged adults living in the so-called sandwich generation has increased only marginally in recent years, the financial burdens associated with caring for multiple generations of family members are mounting. The increased pressure is coming primarily from grown children rather than aging parents.

According to a new nationwide Pew Research Center survey, roughly half (48%) of adults ages 40 to 59 have provided some financial support to at least one grown child in the past year, with 27% providing the primary support. These shares are up significantly from 2005. By contrast, about one-in-five middle-aged adults (21%) have provided financial support to a parent age 65 or older in the past year, basically unchanged from 2005. The new survey was conducted Nov. 28-Dec. 5, 2012 among 2,511 adults nationwide.

Looking just at adults in their 40s and 50s who have at least one child age 18 or older, fully 73% have provided at least some financial help in the past year to at least one such child. Many are supporting children who are still in school, but a significant share say they are doing so for other reasons. By contrast, among adults that age who have a parent age 65 or older, just 32% provided financial help to a parent in the past year.

While middle-aged adults are devoting more resources to their grown children these days, the survey finds that the public places more value on support for aging parents than on support for grown children. Among all adults, 75% say adults have a responsibility to provide financial assistance to an elderly parent who is in need; only 52% say parents have a similar responsibility to support a grown child.

One likely explanation for the increase in the prevalence of parents providing financial assistance to grown children is that the Great Recession and sluggish recovery have taken a disproportionate toll on young adults. In 2010, the share of young adults who were employed was the lowest it had been since the government started collecting these data in 1948. Moreover, from 2007 to 2011 those young adults who were employed full time experienced a greater drop in average weekly earnings than any other age group.1

A Profile of the Sandwich Generation

Adults who are part of the sandwich generation—that is, those who have a living parent age 65 or older and are either raising a child under age 18 or supporting a grown child—are pulled in many directions.2 Not only do many provide care and financial support to their parents and their children, but nearly four-in-ten (38%) say both their grown children and their parents rely on them for emotional support.

Who is the sandwich generation? Its members are mostly middle-aged: 71% of this group is ages 40 to 59. An additional 19% are younger than 40 and 10% are age 60 or older. Men and women are equally likely to be members of the sandwich generation. Hispanics are more likely than whites or blacks to be in this situation. Three-in-ten Hispanic adults (31%) have a parent age 65 or older and a dependent child. This compares with 24% of whites and 21% of blacks.

More affluent adults, those with annual household incomes of $100,000 or more, are more likely than less affluent adults to be in the sandwich generation. Among those with incomes of $100,000 or more, 43% have a living parent age 65 or older and a dependent child. This compares with 25% of those making between $30,000 and $100,000 a year and only 17% of those making less than $30,000.

Married adults are more likely than unmarried adults to be sandwiched between their parents and their children: 36% of those who are married fall into the sandwich generation, compared with 13% of those who are unmarried. Age is a factor here as well, since young adults are both less likely to be married and less likely to have a parent age 65 or older.

Presumably life in the sandwich generation could be a bit stressful. Having an aging parent while still raising or supporting one’s own children presents certain challenges not faced by other adults—caregiving and financial and emotional support to name just a few. However, the survey suggests that adults in the sandwich generation are just as happy with their lives overall as are other adults. Some 31% say they are very happy with their lives, and an additional 52% say they are pretty happy. Happiness rates are nearly the same among adults who are not part of the sandwich generation: 28% are very happy, and 51% are pretty happy.

Sandwich-generation adults are somewhat more likely than other adults to say they are often pressed for time. Among those with a parent age 65 or older and a dependent child, 31% say they always feel rushed even to do the things they have to do. Among other adults, the share saying they are always rushed is smaller (23%).

For members of the sandwich generation who not only have an aging parent but have also provided financial assistance to a parent, the strain of supporting multiple family members can have an impact on financial well-being.3 Survey respondents were asked to describe their household’s financial situation. Among those who are providing financial support to an aging parent and supporting a child of any age, 28% say they live comfortably, 30% say they have enough to meet their basic expenses with a little left over for extras, 30% say they are just able to meet their basic expenses and 11% say they don’t have enough to meet even basic expenses. By contrast, 41% of adults who are sandwiched between children and aging parents, but not providing financial support to an aging parent, say they live comfortably.

Family Responsibilities

When survey respondents were asked if adult children have a responsibility to provide financial assistance to an elderly parent in need, fully 75% say yes, they do. Only 23% say this is not an adult child’s responsibility. By contrast, only about half of all respondents (52%) say parents have a responsibility to provide financial assistance to a grown child if he or she needs it. Some 44% say parents do not have a responsibility to do this.

When it comes to providing financial support to an aging parent in need, there is strong support across most major demographic groups. However, there are significant differences across age groups. Adults under age 40 are the most likely to say an adult child has a responsibility to support an elderly parent in need. Eight-in-ten in this age group (81%) say this is a responsibility, compared with 75% of middle-aged adults and 68% of those ages 60 or older. Adults who are already providing financial support to an aging parent are no more likely than those who are not currently doing this to say this is responsibility.

On the question of whether parents have a responsibility to support their grown children, personal experience does seem to matter. Parents whose children are younger than 18 are less likely than those who have a child age 18 or older to say that it is a parent’s responsibility to provide financial support to a grown child who needs it (46% vs. 56%). And those parents who are providing primary financial support to a grown child are among the most likely to say this is a parent’s responsibility (64%).

Financial Support for Aging Parents and Grown Children

While most adults believe there is a responsibility to provide for an elderly parent in financial need, about one-in-four adults (23%) have actually done this in the past year. Among those who have at least one living parent age 65 or older, roughly one-third (32%) say they have given their parent or parents financial support in the past year. And for most, this is more than just a short-term commitment. About seven-in-ten (72%) of those who have given financial assistance to an aging parent say the money was for ongoing expenses.

Similar shares of middle-aged, younger and older adults say they have provided some financial support to their aging parents in the past year. It is worth noting that many parents age 65 or older may not be in need of financial assistance, so there is not necessarily a disconnect between the share saying adult children have a responsibility to provide for an aging parent who is in need and the share who have provided this type of support.

Overall, Americans are more likely to be providing financial support to a grown child than they are to an aging parent. Among all adults, 30% say they have given some type of financial support to a grown child in the past year. Among those who have a grown child, more than six-in-ten (63%) have done this.

Here the burden falls much more heavily on adults who are middle-aged than on their younger or older counterparts. Among adults ages 40 to 59 with at least one grown child, 73% say they have provided financial support in the past year. Among those ages 60 and older with a grown child, only about half (49%) say they have given that child financial support. Very few of those under age 40 have a grown child.

Of those middle-aged parents who are providing financial assistance to a grown child, more than half say they are providing the primary support, while about four-in-ten (43%) say they are not providing primary support but have given some financial support in the past 12 months. Some 62% of the parents providing primary support say they are doing so because their child is enrolled in school. However, more than one third (36%) say they are doing this for some other reason.

The focus in this report is on the financial flows from middle-aged adults to their aging parents and their grown children. Of course, money also flows from parents who are 65 or older to their middle-aged children. While the new Pew Research survey did not explore these financial transfers, previous surveys have found that a significant share of older adults provide financial help to their grown children. A Pew Research survey conducted in Sept. 2011 found that among adults 65 and older with at least one grown child age 25 or older, 44% said they had given financial support to a grown child in the past year.4

Beyond Finances: Providing Care and Emotional Support
While some aging parents need financial support, others may also need help with day-to-day living. Among all adults with at least one parent age 65 or older, 30% say their parent or parents need help to handle their affairs or care for themselves; 69% say their parents can handle this on their own.

Middle-aged adults are the most likely to have a parent age 65 or older (68% say they do). And of that group, 28% say their parent needs some help. Among those younger than 40, only 18% have a parent age 65 or older; 20% of those ages 60 and older have a parent in that age group. But for those in their 60s and beyond who do still have a living parent, the likelihood that the parent will need caregiving is relatively high. Fully half of adults age 60 or older with a living parent say the parent needs help with day-to-day living.

When aging adults need assistance handling their affairs or caring for themselves, family members often help out. Among those with a parent age 65 or older who needs this type of assistance, 31% say they provide most of this help, and an additional 48% say they provide at least some of the help.

In addition to helping their aging parents with day-to-day living, many adults report that their parents rely on them for emotional support. Among all adults with a living parent age 65 or older, 35% say that their parent or parents frequently rely on them for emotional support, and 33% say their parents sometimes rely on them for emotional support. One-in-five say their parents hardly ever rely on them in this way, and 10% say they never do.

Even among those who say their parents do not need help handling their affairs or caring for themselves, 61% say their parents rely on them for emotional support at least sometimes. For those whose parents do need help with daily living, fully 84% report that their parents rely on them for emotional support at least some of the time.

Not surprisingly, the older the parent, the more likely he or she is to require emotional support. Among adults with a parent age 80 or older, 75% say their parents turn to them for emotional support frequently or sometimes. This compares with 64% among those who have a parent ages 65 to 79.

Emotional support also flows from parents to grown children, even children who are financially independent. Overall, 33% of parents with at least one child age 18 or older say their grown child or children depend on them frequently for emotional support. An additional 42% say their grown children sometimes rely on them for emotional support.

When it comes to grown children, there is a link between financial and emotional support. Among parents who say they are providing primary financial support to their grown child or children, 43% say their children frequently rely on them for emotional support and 45% say they sometimes do. By comparison, only 24% of those who say they do not provide any financial support to their grown children say their children frequently rely on them for emotional support, and 39% say their children sometimes rely on them for this type of support.

Boomers Moving Out of the Sandwich Generation

Today members of the Baby Boomer generation and Generation X are represented in the “sandwich generation.” But the balance has shifted significantly. When the Pew Research Center explored this topic in 2005, Baby Boomers made up the majority of the sandwich generation. They were more than twice as likely as members of the next generation—Generation X—to have a parent age 65 or older and be supporting a child (45% vs. 20%). Since 2005, many Baby Boomers have aged out of the sandwich generation, and today adults who are part of Generation X are more likely than Baby Boomers to find themselves in this situation: 42% of Gen Xers have parent age 65 or older and a dependent child, compared with 33% of Boomers.5

This report will focus largely on adults ages 40 to 59, loosely defined as “middle aged.” While this group may not share a generational label, many of its members do have a shared set of experiences, challenges and responsibilities given the unique position they inhabit, sandwiched between their children and their aging parents.

Middle-aged adults who make up the core of the sandwich generation are living out these challenges and, in the process, perhaps ushering in a new set of family dynamics. Most middle-aged parents with grown children say their relationship with their children is different from the relationship they had with their own parents at a comparable age. Half say the relationship is closer, while 12% say it’s less close and 37% say the relationship is about the same. Older adults (those ages 60 and older) are less likely than middle-aged parents to say they have a closer relationship with their grown children than they had with their own parents (44%), and they are more likely to say the relationship is about the same (45%).

The remainder of this report will look at the basic building blocks of intergenerational relationships in more detail. The first section will look at attitudes about financial responsibilities and the reality of financial transfers. The second section will look at caregiving for older adults. How many older adults need assistance with day-to-day living, and who is providing that care? The third section will look at emotional ties across generations and explore the extent to which aging parents rely on their children and grown children rely on their parents for emotional support.

BY KIM PARKER AND EILEEN PATTEN

For the Sandwich Generation, Caregiver Support is becoming an increasingly prevalent mental health concern. Adults between the ages of 30-40 are juggling the responsibilities of children and aging parents. Erica Greenspan, LICSW of Kennedy Counseling Collective Counseling Metro DC, will work with you to navigate the burden that can come with balancing roles, while making time to care for yourself.


Under Too Much Stress? Some Tips On How to Cope

Stress affects us all from time to time, but how much stress is too much? If you're suffering from the warning signs below, follows these steps to start reducing stress now.

We live in a world where stress is almost unavoidable. Because technology creates the expectation that we make ourselves available to others 24 hours a day, balancing our commitments and coping with stress in healthy ways can seem impossible. Caught in a constant to-do list, we seldom make the time to evaluate the toll that fear, worry, and distress can take on our bodies and minds. How do you know when you’re under too much stress?

Everyone has their own unique stress response, so it’s vital to examine your physiological, behavioral, and psychological responses to the strain of life’s demands. Let’s take a look at a few common signs that you are under too much stress.
Signs You’re Under Too Much Stress
Physiological Signs

Chronic pain
Headaches
Muscle tension
Nausea
Clenching your jaw or fists
High blood pressure

Behavioral Signs

Increased use of substances (including nicotine, alcohol, caffeine, and illegal drugs)
Social withdrawal
Overeating and undereating
Angry outbursts
Exercising less often

Psychological signs

Sadness or depression
Anxiety
Restlessness
Lack of motivation or focus
Feeling overwhelmed
Irritability or anger

If you are experiencing any of these signs you may want to take action to reduce stress today. Here are some simple but revealing questions you can ask yourself to pinpoint areas for improvement or change. Asking the right questions can identify what improvements you can make to feel more relaxed and in control of your health.
Questions to Ask Yourself

Who’s in my support network?
Everyone should have people in their life who are positive influences, support providers, and role models for healthy living. They can be friends, family members, mentors, spiritual leaders, colleagues, and mental health professionals.

What activities do I enjoy?
Your work might be enjoyable, but everyone needs hobbies that aren’t about competition or personal accomplishment. What helps ease your worries and makes you more mindful about your body? These activities might include reading, dancing, gardening, board games, crafts, etc.

What are my sleep habits?
If you’re getting roughly 8 hours of uninterrupted sleep per night, you’ll be able to think more clearly, boost your immune system, and concentrate better on work and relationships. A simple step such as turning off screens an hour before bed can make a huge difference in your sleep quality.

Am I saying “no” to unnecessary tasks?
Ideally you should be able to pass on tasks that demand too much of you, aren’t your responsibility, or don’t fall in line with your personal values and objectives. If you’re not sure where to start, take a look at your schedule and to-do list, and see what can be delegated or removed completely.

Am I organized? Start to declutter your life. When you can manage tasks with an accurate schedule and prioritized to-do list, you reduce the unnecessary anxiety that can accompany a cluttered and confusing agenda.

When and how do I practice relaxation?
Taking time to relax can be as simple as reading a book, taking a walk, or listening to music. Maybe you need to spend a few minutes taking some deep breaths every day, or perhaps yoga or meditation can provide the needed time for tuning into your body.

Do I know professionals who can help?
A yearly physical can help you evaluate the impact of stress and generate solutions. Mental health professionals also can provide valuable insights about your behavioral and emotional health and help you create a plan for a well-balanced life. A therapist can teach you how to relieve stress through various techniques.

If you feel overwhelmed by a self-assessment and aren’t sure where to start, address your immediate physical concerns. Healthy eating, exercise, and professional consultation can have a significant impact. But don’t feel like you have to make all these major changes overnight. Starting small, perhaps by carving out space for relaxation and turning off technology earlier at night, can help you build momentum.

As you begin to make changes, be sure to pay attention to what reduces your stress, and don’t hesitate to take notes. Not every relaxation technique works for everyone. Consider using a journal or a phone app to track the effectiveness of your strategies and generate motivation. Finally, change can also be more exciting when you share the journey, so consider recruiting a friend as an accountability buddy. Together you can encourage each other to tackle stress and prioritize your physical and mental health.

Real change starts with asking good questions and playing detective with your mind and body. Start taking notes and begin conversations with people who can help. Stress may always play a role in your life, but it doesn’t have to be the villain in your story. With the right mindset, you can regain control over your mind and body.

By, Kathleen Smith, PhD

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can't pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.


Hypnotherapists – What are they and what do they do?

The idea of hypnosis or hypnotherapy has changed quite a bit in recent decades. Gone is the iconic image of a magician in a top hat and tails waving a gold watch in front a subject, telling them they’re “getting sleeeeepy, very, very sleepy.” Now, when many people think about a hypnotherapist, the image of a doctor in a professional setting is much more common. The practice of hypnotherapy is defined as guided hypnosis or a trance-like state of focus and concentration. This state is similar to being wholly absorbed in a book, movie, or even one's thoughts during meditation. The person responsible for facilitating or guiding this practice is a licensed hypnotherapist.

Hypnotherapists are alternative medical professionals trained in the art and science of hypnosis to help clients work through various issues. They’re different from doctors and psychologists but often work in tandem with these two professions. The Federal Dictionary of Occupational Titles describes the job of the hypnotherapist as one who "Induces hypnotic state in client to increase motivation or alter behavior patterns.” More specifically, the hypnotherapist “Consults with client to determine nature of the problem. Prepares client to enter hypnotic state by explaining how hypnosis works and what client will experience. Tests subject to determine the degree of physical and emotional suggestibility. Induces hypnotic state in client, using individualized methods and techniques of hypnosis based on interpretation of test results and analysis of client's problem. May train client in self-hypnosis conditioning.” Essentially, your hypnotherapist acts as a coach guiding your mind to create lasting change. In the trance-like state of hypnosis, your hypnotherapist can help you turn your attention inward to find the natural resources deep within yourself that can help you make changes or regain control in various areas of your life.

Hypnotherapists are certified by one of a number of professional organizations and colleges such as the American Institute of Health Care Professionals, The National Board for Certified Clinical Hypnotherapists, or the Hypnotherapy Academy. Training generally consists of in-class learning, training hours, a certification exam and varying education requirements. During instruction, students learn about the theory and history of hypnotherapy, proper technique, ethics, and how to help patients with specific issues such as addiction. Generally, certification programs require a minimum of 40-100 hours of hypnotherapy training, workshops, and related class time. They also include 20-30 hours of supervised individual training and at least two years of practical experience using hypnosis as part of a student’s practice. Students of this practice are either entirely dedicated hypnotherapy in their professional lives, or they use the method in tandem with another profession such as dentistry or psychology. Natural healing practitioners such as massage therapists, acupuncturists, and psychotherapists also use hypnotherapy to round out their offerings and provide multiple services to clients.

If you’re struggling with issues related to motivation, addiction, post-traumatic stress disorder or anxiety and you believe that the positive change lives within you, consider working with a hypnotherapist. They’re well trained, professional practitioners that are much evolved from the pocket-watch waving magicians of old.

By, Francis Killory, Hypnotherapist Seattle, offering Clinical Hypnotherapy, Hypnosis with Certified Medical Support. Hypnosis is a state of consciousness used by a licensed Hypnotherapist to perform Hypnotherapy and induce a hypnotic state.


Alternative Medicine

Tips for finding a balance

Do you want more from yourself? Ready to pay more attention to the interconnectedness of your body, mind, and emotions? Do you think that focusing on your health is a priority? If so, exploring alternative medicine may be for you.

Alternative medicine is defined as a range of medical therapies that aren’t regarded as orthodox by the medical profession.

Examples of alternative medicine include: Herbalism and diet
Yoga and Tai Chi
Massage
Chiropractic Care
Homeopathy
Acupuncture
Hypnosis
Meditation

In the past decade, the alternative medicine industry has become more widely accepted which has led these types of treatments to also be known as complementary medicine. Some medical professionals respect and understand the desire to add alternative medicine practices into a traditional care regime and encourage a patient to do so. If you choose to replace or compliment your care regime with alternative medicine, consider the following:

Try to treat the root cause of your discomfort before considering medication. Before embarking on any new medical treatments, take stock of your overall health.

Depending on your symptoms, there’s a chance that you can cut down on medications overall by fixing your ailments using alternative medicine rather than traditional medical interventions.

Perhaps, instead of taking prescription heartburn medicine you can reduce stress and cut down on foods that aggravate your stomach. Or, instead of using a daily anti-inflammatory to treat your chronic knee pain, you can lose weight or gain strength to support your aching joints.

Practices such as yoga, chiropractic care, proper diet, and meditation can all help with common health issues which may result in the reduced need for traditional medications.

Do your research. Did you know that St. John’s Wart can be a great way to help ward off depression but may also make birth control ineffective? Or that Kava, used to help lessen anxiety and insomnia can be bad for your liver? Before you begin taking alternative medicines makes sure that you do your research to understand the positives and negatives of each natural cure.

If you take multiple traditional medications, it’s also a good idea to speak to a pharmacist to make sure that any new natural remedies that you’re taking are compatible with the traditional ones. Focus on the way you feel and not the negative voices around you. Despite the fact that alternative medicine has been around longer than it’s “traditional” counterpart, friends, family, and even some medical professionals may push back on your decisions to pursue health via alternative medicine. Despite the potential pushback, it all comes down to your convictions, the way you feel and your quality of life. It’s always helpful to have positive voices around to lift you up so joining an alternative medicine online group or spending time with friends with the same convictions may help you stay on track. In the end, all that matters is that you feel well, reduce the need for traditional medications and have a healthy mind.

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and offers nutrition coaching in the New York City area.


9 Simple Ways to Deal With Stress at Work

According to research, the percentage of Americans who are stressed at work is high, and it’s only getting higher. According to the CDC’s National Institute of Occupational Safety and Health, studies have found the number of Americans who are “extremely stressed at work” range between 29 percent to 40 percent.

Unfortunately, work stress has significant health consequences that range from the relatively benign—more colds and flus—to the more serious, like heart disease and metabolic syndrome.

But, because stress at work is so common, finding a low-stress job may be difficult or impossible for many people. A more realistic choice would be to simply adopt more effective strategies to reduce stress at work. Here are some stress management techniques to try.

Start Your Day Off Right
After scrambling to get the kids fed and off to school, dodging traffic and combating road rage, and gulping down coffee in lieu of something healthy, many people come in already stressed, and more reactive to stress at work. In fact, you may be surprised by how much more reactive to stress you are when you have a stressful morning. If you start off the day with good nutrition, proper planning, and a positive attitude, you may find the stress of the workplace rolling off your back more easily.

Be Clear on Requirements
One of the factors that contributes to job burnout is unclear requirements. If you don’t know exactly what’s expected of you, or if the requirements keep changing with little notice, you may find yourself much more stressed than necessary.

If you find yourself falling into the trap of never knowing if what you’re doing is enough, it may help to have a talk with your supervisor and go over expectations, and strategies for meeting them. This can relieve stress for both of you!

Stay Away From Conflict
Because interpersonal conflict takes a toll on your physical and emotional health, and because conflict among co-workers is so difficult to escape, it’s a good idea to avoid conflict at work as much as possible.

That means don’t gossip, don’t share too many of your personal opinions about religion and politics, and try to steer clear of colorful office humor. Try to avoid those people at work who don’t work well with others. If conflict finds you anyway, try these conflict resolution strategies.

Stay Organized
Even if you’re a naturally disorganized person, planning ahead to stay organized can greatly decrease stress at work. Being organized with your time means less rushing in the morning to avoid being late and rushing to get out at the end of the day. Keeping yourself organized means avoiding the negative effects of clutter, and being more efficient with your work.

Be Comfortable
Another surprising stressor at work is physical discomfort. You may not notice the stress you experience when you’re in an uncomfortable chair for a few minutes. But if you practically live in that chair when you’re at work, you can have a sore back and be more reactive to stress because of it. Even small things like office noise can be distracting and cause low-grade frustration. Do what you can to ensure that you’re working from a quiet, comfortable and soothing workspace.

Forget Multitasking
Multitasking was once heralded as a fantastic way to maximize one’s time and get more done in a day.

Then people started realizing that when they had a phone in their ear and were making calculations at the same time, their speed and accuracy (not to mention sanity) suffered. There is a certain kind of frazzled feeling that comes from splitting one’s focus that doesn’t work well for most people. Rather than multitasking, try a new strategy known as chunking.

Walk at Lunch
Many people are feeling ill effects from leading a sedentary lifestyle. One way you can combat that, and manage stress at work at the same time, is to get some exercise during your lunch break and perhaps take short exercise breaks throughout the day.

This can help you blow off steam, lift your mood, and get into better shape.

Keep Perfectionism In Check
Being a high achiever can help you feel good about yourself and excel at work. Being a perfectionist, on the other hand, can drive you and the people around you a little nuts. Especially in busy, fast-paced jobs, you may not be able to do everything perfectly. But striving to just do your best and then congratulating yourself on the effort is a good strategy. Your results will actually be better and you’ll be much less stressed at work.

Listen to Music on the Drive Home
Listening to music brings many benefits and can offer an effective way to relieve stress after work. Combating the stress of a long day at work with your favorite music on the drive home can make you less stressed when you get home, and more prepared to interact with the people in your life.

By Elizabeth Scott, MS

Not sure why parts of your character hold you back in your work? For Work Stress Counseling Metro NYC, Kearns Group helps individuals study the gap between goals and their achievement. Through a contextual counseling we reveal the stress that gets in the way and design strategies to better reach their achievement. Conveniently located in Greenwich Village near Union Square.


Acceptance and Commitment Therapy

The Six Core Processes of ACT

The Psychological Flexibility Model
The general goal of ACT is to increase psychological flexibility – the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends. Psychological flexibility is established through six core ACT processes. Each of these areas are conceptualized as a positive psychological skill, not merely a method of avoiding psychopathology.

Acceptance
Acceptance is taught as an alternative to experiential avoidance. Acceptance involves the active and aware embrace of those private events occasioned by one’s history without unnecessary attempts to change their frequency or form, especially when doing so would cause psychological harm. For example, anxiety patients are taught to feel anxiety, as a feeling, fully and without defense; pain patients are given methods that encourage them to let go of a struggle with pain, and so on. Acceptance (and defusion) in ACT is not an end in itself. Rather acceptance is fostered as a method of increasing values-based action.

Cognitive Defusion
Cognitive defusion techniques attempt to alter the undesirable functions of thoughts and other private events, rather than trying to alter their form, frequency or situational sensitivity. Said another way, ACT attempts to change the way one interacts with or relates to thoughts by creating contexts in which their unhelpful functions are diminished. There are scores of such techniques that have been developed for a wide variety of clinical presentations. For example, a negative thought could be watched dispassionately, repeated out loud until only its sound remains, or treated as an externally observed event by giving it a shape, size, color, speed, or form. A person could thank their mind for such an interesting thought, label the process of thinking (“I am having the thought that I am no good”), or examine the historical thoughts, feelings, and memories that occur while they experience that thought. Such procedures attempt to reduce the literal quality of the thought, weakening the tendency to treat the thought as what it refers to (“I am no good”) rather than what it is directly experienced to be (e.g., the thought “I am no good”). The result of defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency.

Being Present
ACT promotes ongoing non-judgmental contact with psychological and environmental events as they occur. The goal is to have clients experience the world more directly so that their behavior is more flexible and thus their actions more consistent with the values that they hold. This is accomplished by allowing workability to exert more control over behavior; and by using language more as a tool to note and describe events, not simply to predict and judge them. A sense of self called “self as process” is actively encouraged: the defused, non-judgmental ongoing description of thoughts, feelings, and other private events.

Self as Context
As a result of relational frames such as I versus You, Now versus Then, and Here versus There, human language leads to a sense of self as a locus or perspective, and provides a transcendent, spiritual side to normal verbal humans. This idea was one of the seeds from which both ACT and RFT grew and there is now growing evidence of its importance to language functions such as empathy, theory of mind, sense of self, and the like. In brief the idea is that “I” emerges over large sets of exemplars of perspective-taking relations (what are termed in RFT “deictic relations”), but since this sense of self is a context for verbal knowing, not the content of that knowing, it’s limits cannot be consciously known. Self as context is important in part because from this standpoint, one can be aware of one’s own flow of experiences without attachment to them or an investment in which particular experiences occur: thus defusion and acceptance is fostered. Self as context is fostered in ACT by mindfulness exercises, metaphors, and experiential processes.

Values
Values are chosen qualities of purposive action that can never be obtained as an object but can be instantiated moment by moment. ACT uses a variety of exercises to help a client choose life directions in various domains (e.g. family, career, spirituality) while undermining verbal processes that might lead to choices based on avoidance, social compliance, or fusion (e.g. “I should value X” or “A good person would value Y” or “My mother wants me to value Z”). In ACT, acceptance, defusion, being present, and so on are not ends in themselves; rather they clear the path for a more vital, values consistent life.

Committed Action
Finally, ACT encourages the development of larger and larger patterns of effective action linked to chosen values. In this regard, ACT looks very much like traditional behavior therapy, and almost any behaviorally coherent behavior change method can be fitted into an ACT protocol, including exposure, skills acquisition, shaping methods, goal setting, and the like. Unlike values, which are constantly instantiated but never achieved as an object, concrete goals that are values consistent can be achieved and ACT protocols almost always involve therapy work and homework linked to short, medium, and long-term behavior change goals. Behavior change efforts in turn lead to contact with psychological barriers that are addressed through other ACT processes (acceptance, defusion, and so on).

Taken as a whole, each of these processes supports the other and all target psychological flexibility: the process of contacting the present moment fully as a conscious human being and persisting or changing behavior in the service of chosen values. The six processes can be chunked into two groupings. Mindfulness and acceptance processes involve acceptance, defusion, contact with the present moment, and self as context. Indeed, these four processes provide a workable behavioral definition of mindfulness (see the Fletcher & Hayes, in press in the publications section). Commitment and behavior change processes involve contact with the present moment, self as context, values, and committed action. Contact with the present moment and self as context occur in both groupings because all psychological activity of conscious human beings involves the now as known.

A Definition of ACT
ACT is an approach to psychological intervention defined in terms of certain theoretical processes, not a specific technology. In theoretical and process terms we can define ACT as a psychological intervention based on modern behavioral psychology, including Relational Frame Theory, that applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility.

by Steven Hayes

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can't pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.


Depression: the most common mental health issue

Adults with depression may have low self-esteem. They may display poor concentration, low motivation, and withdraw from social or recreational activities. They may respond intensely to criticism or feedback. Changes in appetite, weight, and sleep issues may occur. Depressed adults may display a decline in grades, and experience boredom and lethargy.

In terms of seeking treatment, adults who struggle with identity issues may be reluctant to identify themselves as someone who has a depressive disorder. Issues with authority and concerns about confidentiality may make seeking out help problematic. I am sensitive to these issues and make sure to validate and normalize my client’s experience. I also tailor my interventions to adapt to specific factors connected to the type of depression my client’s may exhibit. Anger, perfectionism, avoidance, and divorce are just some traits and stressors that can exacerbate depression.

Anger and Depression
Adults who have depression may present with typical symptoms such as a depressed mood and withdrawn behavior. Males who are depressed may display more anger rather than sadness. Males who feel pressure to live up to perceived gender norms may be less likely to show vulnerability. Their anger towards others may be a way to prop up their self-esteem and negative feelings about themselves. Unfortunately, their anger can serve to alienate them further. Therapy can provide a safe place to verbalize feelings and connect with deeper emotions. This can help my clients feel more connected and identify and modify cognitions contributing to their distress.

How I can help
I teach clients how to identify negative emotional states and understand the connection between thoughts and feelings. Through the therapy process they learn how to modify dysfunctional thoughts that lead to anger. They develop alternative perspectives that are more balanced and adaptive. I help my clients see underlying self-esteem issues that contribute to anger and depression. They learn how to observe difficult emotions without becoming flooded or acting on them and communicate more effectively. I strive to create a safe place where clients can increase self-understanding about who they are and what is important to them. This understanding often leads to more self-confidence and a stronger sense of self.

Perfectionism & Depression
In adolescence one of the major development tasks is developing one’s identity and independence. As teenagers experiment with discovering who they are they may place more emphasis and passion towards focusing on specific domains such as academics, athletics and peer relationships. They may develop lofty goals and ambitions as they pursue their goals. There striving and dreams of excellence is not always problematic. However, for some falling short of meeting their goals can lead them to become extremely self- punishing and punitive toward themselves. They may perceive failure or setbacks as intolerable. This can lead to depression, anxiety and irritability. Some people feel they will not live up to expectations and may avoid tasks all together, at times these expectations may be unrealistic.

How I can help
Having high personal goals and expectations is not unhealthy and can lead to success. However, problems arise if people react punitively if they fail to meet goals. Being extremely critical of oneself if goals are not met can lead to depression and anxiety. Harsh self-appraisals after not meeting goals can also decrease emotional resilience and lead to avoidance behaviors. To manage this type of perfectionism, I work with clients on skills to help develop compassion towards themselves. I utilize mindfulness and acceptance skills to help them learn to be able to define themselves in a holistic fashion rather than just by outcomes. I help them to confront issues rather than avoid them by helping them break down fears and tasks into manageable components.

Often people who have high expectations of themselves also have high expectations of others, which can leave them feeling disappointed and frustrated. I help my clients develop more realistic expectations regarding others. They learn how to see other perspectives, which can increase empathy and mitigate negative mood states.

Peer Relationships and Depression:
As teenagers transition into adolescence there is a shift away from caretakers to peers and friends as a source of social influence. For example, support, validation and encouragement, become roles that friends take on more significantly. Adolescent’s relationships with peers can greatly impact their self-esteem and mood. Teenagers who struggle with peer relationships may isolate and avoid others expecting rejection. This can further increase isolation and depression. Alternatively, a strong desire to fit in may lead teenagers to be over accommodating to their friend’s demands at the expense of their own interests. They may believe that if they don’t not accommodate, their friends will reject or abandon them. This can create resentment and hostility. The over accommodating teenager may feel that relationships are not reciprocal and that they are being taken advantage of.

How I Can Help
I employ CBT skills to help manage feelings or fears pertaining to rejection. Often my clients may view their relationships in a bias and negative fashion leading to distress. They may have inflated perceptions that others view them more poorly than is actually the case. Distress can be minimized by helping to perceive relationships more accurately. Mindfulness skills are used to help detach from others judgments or perceived judgments which can mitigate depression and anxiety. Helping identify negative patterns when selecting friends and helping to create boundaries can help establish stronger self-esteem. I explore with my clietns how their interpersonal style may impact relationships and get in the way of forming positive connections. I work with them on strategies for developing their interpersonal and communication style to improve relationships.

Divorce and Depression
Divorce can be an extremely painful process. There are different stages people experience as they go through the process. Initially, it may be hard to accept, leaving them feeling shocked and emotionally numb. They may also become withdrawn and minimize the separation. As times goes on they may blame themselves for the separation and believe if they just did better, were more easy going or more lovable the relationship would not have dissolved. Missing the family unit and adjusting to the stress of the dissolution of the marriage may lead people to feel unsafe and anxious. They may develop trust issues regarding relationships in the future.

How I can Help
I help my clients verbalize anger or depression regarding the divorce. Expressing feelings such a betrayal and disappointment can allow them to gain more clarity, insight and be less prone to internalizing negative feelings and blaming themselves. Giving them a place to process feelings can also help prevent rebellious or acting out behaviors. Mindfulness skills can be extremely helpful in navigating feelings of abandonment and rejection they may feel from one or both of their parents. Consulting with family members on setting proper boundaries and communication strategies can also be helpful.

Depression Treatment for Older Adolescents
College can be an extremely exciting time providing the opportunity for intellectual and emotional growth. However, personal freedom, self-exploration and challenging academics although invigorating, can be stressful. Being away from home, facing new demands and thinking about the future can be daunting and contribute to anxiety, depression or self-doubt. The symptoms may derive from the existential struggles that college students often face regarding who they are intellectually, emotionally, and sexually. Am I smart enough? Am I good enough? What is my purpose? are common questions college students ponder. Starting and leaving college are both significant life style shifts and may be particularly difficult for students. Fortunately, therapy can help.

How I can help
Psychodynamic therapy is a deeper dive into motivation and can create expanded awareness allowing college students to understand and resolve issues pertaining to identity, relationships and choices about meaningful careers. During the process of psychodynamic therapy college students can have the space to explore possibilities and find their authentic voice. CBT and Mindfulness skills can also help college students cope with depression, anxiety or volatile emotional states. Learning how to regulate emotions with mindfulness skills can also help with academic performance and time management.

Carolyn Ehrlich LCSW, CGP, Counseling Tribeca, specializes in Relationship Counseling NYC. In Couples Therapy Tribeca I help increase your self awareness and help you gain more insight into your inner life. We'll work together so you can get more out of every day and meet any challenge life throws at you.


Counseling in Tribeca New York City

Loneliness. Anyone can feel lonely. It doesn’t matter if you’re in a relationship or not, a social butterfly or someone who isn’t into crowds. To understand what’s making you feel alone, we’ll focus on your inner and outer experiences and work together to find useful things you can do to feel more connected to the world.

Depression. It affects the way you think and feel, it can even affect you physically. It can alter the way you think about yourself, your relationships and the people around you and the events you experience every day. We’ll work together to understand what’s going on and help you feel more positive.

Confusion. There are times when making a decision feels impossible. We’re not sure about who we are, how we live, who we love, or whether we’d be better off in a different career. But by spending some time together, we can help you find a sense of clarity and work out what’s really important to you.

I started Mindwork back in 2007 for people who want to get a better understanding of themselves and the world around them. I found InSession in 2017, InSession has been wonderful to work with, guiding my practice into a new area with their expert Marketing and SEO skills. I couldn't be happier with the results.

For Counseling Tribeca NYC, contact Therapist Carolyn Ehrlich with offices near TriBeCa in SoHo, specializing in Counseling TribecaCouples Therapy Tribeca.

Carolyn Ehrlich, LCSW,Relationship Counseling NYC


Fearing Death

How to cope with the inevitable end in a positive way.

As people age, go through life changes, or experience illness (either themselves or the illness of loved ones) the topic of death is often brought up. The idea of death is so different for so many people; it’s hard to agree on a universal definition of death. As far as we know, it can be as simple as no longer existing, or as complicated as moving from one plane of existence to the next. One thing about death can be universally agreed upon though and that is the fact that no one knows exactly what happens when you shuffle off this mortal coil. The knowledge of the unknown is scary to many people which leads to people fearing death. Some fear the act if dying: will it be painful? Others fear what happens after you die: do you move on, or just cease to be? Others fear what will happen to their loved ones once they’ve passed. Wherever your fear of dying originates from it can be lessened and controlled in many ways. Read through the list below to learn more about how to conquer your fear of death so you can get back to living your best life.

Plan what you can:
If you’re worried about how your family and friends will deal with your passing, planning the practical aspects of it while you’re able may put you at ease. Even if you have decades of healthy years ahead of you, the simple act of planning may be enough to help you cope with the reality of death. Create a will, purchase life insurance if you’re able and make your final wishes known to your loved ones. As a more emotional practice, tell your friends and family that you love and appreciate them whenever you get the chance, so you’re never worried about something being left unsaid.

Focus on living your best life:
Why fear death when you can be busy with life? Changing your focus from worrying about the end of your life to enjoying what’s happening in the present can be fulfilling and refreshing. Even if you’re close to the end of your life, having a positive outlook can be incredibly useful. Enjoy nature, make a bucket list, take up a new hobby. If you’re busy living, you won’t have time to worry about dying.

Talk to a professional:
Perhaps the above tips are far from useful. Maybe your fear of death is all-consuming, making it difficult to live your daily life. If the idea of death is overwhelming and makes it hard to enjoy your day to day life, talking to a therapist may be your best option. You may have underlying issues such as phobias, anxiety, depression or PSTD that make it hard to cope with the finality of death. If that’s the case, speaking to a professional will be an incredibly useful exercise that can help you work through these feelings to have a better, more positive outlook on life and death.

Mollie Busino, LCSW, Director of Mindful Power, counseling Hoboken. Mollie has had extensive training in Cognitive Behavioral Therapy, Rational Emotive Therapy, and Mindfulness. Her work focuses on Anxiety, Depression, Anger Management, Career Changes, OCD, Relationship, Dating Challenges, Insomnia, & Postpartum Depression and Anxiety.


Hypochondriasis Explained

Hypochondriasis is now more commonly known as Illness Anxiety Disorder (IAD). It is an official mental disorder that requires a diagnosis. When someone is diagnosed with hypochondriasis, it means they believe they have incredibly serious illnesses or diseases, when in fact nothing is physically wrong with them.

Someone with IAD may believe they have a life-threatening illness. They might even believe they have certain symptoms of different diseases, even if no one else sees those symptoms. Or, the symptoms they do have could be very mild to everyone else (including medical professionals) but seem incredibly severe to the person dealing with them.

It can be easy to brush off hypochondriasis as a disorder for someone who only wants attention or who might be paranoid. But, it goes much deeper than that, and can be a real problem for the people struggling with it every day.

What Are the Signs of Hypochondriasis?

The biggest tell-tale symptom of IAD is worrying excessively about having a particular illness or disease. Or, you may fear that you will eventually contract a life-threatening illness. Other common symptoms include:

Extended fear of an illness (more than six months)
Constant anxiety over health
Avoiding doctors
Obsessed with self-checking health status (checking blood pressure, etc.)
Concern for developing illness at some point is out of hand
The fear that can go along with hypochondriasis can be crippling for the individual dealing with it. Unfortunately, there isn't one concrete cause when it comes to what triggers some people to feel this way. However, certain risk factors have been identified, including:

A major life change
Stressful event
History of abuse, especially in childhood
History of physical illnesses
How Can IAD Be Treated?

IAD is diagnosed only based on what symptoms are described by the person going through it, as well as family members or friends who have noticed the symptoms as well. A mental health professional will want to know as many details as possible about what the individual is feeling, and when the symptoms started.

Management for hypochondriasis typically consists of regular office visits their primary care physician. That physician can help to ease their stress and offer peace of mind. Visits as frequently as every week may be needed. It's a good idea for the person with the disorder to stick with one doctor throughout the process.

If the fear becomes too severe for the person with IAD, they may need to seek out additional treatment and help from a mental health professional. A mental health doctor can help the individual figure out what might be causing hypochondriasis in the first place. Once that can be determined, it may become easier to treat and/or manage it.

The ultimate goal for someone dealing with IAD is to feel less mental stress and try to function and live as normal of a life as possible. Being able to understand that you don't have some serious condition can be difficult for the people who truly believe something is wrong with them. No matter what cause you to start feeling this way, it's important to find a management solution that works for you as soon as possible, so you can begin living your life freely again.

Written by, Janessa M Borges, Clinical Social Work, Therapist, LCSW, Couples Counseling Naples. My therapeutic approach is providing support to help clients effectively address personal life challenges, help them build on their strengths and attain the personal growth they are committed to accomplishing. When couples feel distressed & disconnected I integrate eclectic techniques offering a personalized approach tailored to each client.


Ketamine Infusion Therapy Benefits

Depression and anxiety affect millions of people in the United States each year. Even after an official diagnosis and treatment plan, many people don't find the relief they're looking for from traditional antidepressants or therapeutic treatments. Unfortunately, that often leads people with depression to seek different ways of self-medicating, which can lead to drinking, drug use, and more. People who can't find a treatment option that works can even begin to have suicidal thoughts and tendencies.

Ketamine is an anesthetic drug that has recently come into the medical world as a new potential type of therapy for treating depression. It has been used in the past as a powerful drug that blocks pain. In more recent years, Ketamine has become a popular 'club drug,' often known as 'Special K.' Club-users take it because it can cause people to experience a sort of 'out of body' sensation. So, why is it being tossed into the field of treatment for depression?

How Does It Work?

Unfortunately, one of the reasons this therapy is still used with such caution is because we're not 100% sure how or why it really works to treat depression. One theory, however, is that ketamine is supposed to change the way the cells in the brain talk to one another. It helps to block certain receptors that are associated with depression.

The administering of this drug is considered a type of 'therapy' because it is given through an IV directly into a vein. It's not a simple prescription pill, like most antidepressants. In most cases, you'll receive regular doses for a week or two, and follow it up with boosters every few weeks after that.

One of the biggest benefits to ketamine infusion therapy is how quickly it works. It's important to understand that there are no real 'quick fixes' when it comes to treating depression. But, most antidepressants can take weeks just to start kicking in. Ketamine only takes hours for its users to feel effects.

Is it Safe to Use?

For now, ketamine is not approved by the FDA as a treatment for depression. But, it's being used more frequently by people in the most dire of depressed states. Side effects can include feeling as though you're having an out of body experience, or it can cause a spike in your blood pressure. Unfortunately, doctors don't know much about what long-term side effects could be caused by the drug.

Do the benefits of this type of therapy outweigh the risks? That's something that should be answered by someone who has gone through the therapy, or continues to do it on a regular basis. For now, there isn't enough known about why ketamine helps with depression in order to consider it completely safe. It also isn't covered by insurance, and each treatment can cost hundreds of dollars.

But, the results for people with depression who have used this form of therapy don't lie: Ketamine is a fast and effective way to change the way your brain communicates in different areas. It provides a stronger solution than most antidepressants. If you're struggling with anxiety and depression and other treatments haven't worked, talk with your doctor about the possibility of ketamine infusion therapy. It could help to change the way you think immediately, and in the end, that could save your life.

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Ketamine Infusion Therapy is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.


Mindfulness-Based Stress Reduction (MBSR)

Everyone on the planet has felt a little out of control at times. You get angry or stressed out, tired or overwhelmed. After all, we’re all human. However, one thing as humans that we have on our side is the ability to breathe. Simply taking a deep breath and becoming aware of a moment when you feel your most stressed is profoundly helpful. The idea that breath and awareness help to cope with stress isn't all in your head either. Pausing during stressful times to become present is an incredibly powerful practice. It’s so powerful in fact that it’s been studied, organized into a program and taught around the world. This process is called Mindfulness-Based Stress Reduction (MBSR), and it can be used to help alleviate chronic pain, reduce stress, and improve your quality of life. MBSR incorporates meditation, body awareness and yoga to help people become more mindful. It was developed at the University of Massachusetts Medical Center in the 1970s by Professor Jon Kabat-Zinn and has been used since to provide calmness and stillness to those that practice it.

Despite having roots in Eastern spiritual practices such as Buddhism and Hinduism, MBSR itself is secular and can benefit anyone that chooses to learn and practice this useful skill.

MBSR teaches participants, through in-person or online courses to be present in any given moment. Noting a definitive joy, pain, anxiety or even a particular taste or smell can help you process it easier, providing you with more fulfillment or peace at any given moment.

The beauty of this practice is that it can be useful for both positive and negative experiences. MBSR can help make you more present at joyous events just as it can help you understand what’s exactly making you anxious during periods of negativity.

Try it for yourself:
Close your eyes, sit in a comfortable position, and focus on your breath for just 2 minutes. Become aware of the way your breath feels moving through your body or the way your body feels in your chair. If a passing thought comes into your mind, acknowledge it and then recenter your focus. After the 2 minutes are over, note the way you feel. Relaxed? More centered? Better poised to tackle the rest of the day? Try to do this once a day or at least when your anxiety gets the better of you. Awareness is an incredible thing, and once you learn to use it, it’s very powerful.

Who would have thought that simply being more aware of yourself can so strongly affect your well-being? Do you think that MBSR is for you? Both online and in-person trainings are available to help you learn and thrive from this technique.

Dr. Dimitra Takos is a Newport Beach Psychologist specializing in the treatment of adolescents and adults suffering from depression, anxiety, and trauma-and stressor-related disorders.


How to Get Along With Your Partner

There are a number of other skills for couples that help preserve a marriage, a friendship, and even a co-worker’s loyalty. These include:

Knowing the right time and place for everything, including arguments. For example, don’t bring up the dirty clothes strewn all over the bedroom floor this morning as soon as your significant other comes in the door after a grueling day at work. How would you know it was a grueling day?

Do not argue in the heat of battle. In fact, don’t battle, because you know you will likely say things that can never be forgiven, even if the other person never brings them up again.

Make sure you have the other person’s attention. This can be as simple as eye contact, and as firm as asking that person to sit down and look at you while you explain something.

Frame all complaints and comments using the word “I”. Don’t say “You always leave you dirty clothes on the floor!” Instead say “I work late, and it’s no fun to wake up to a mess in the bedroom.” This simple reversal changes blame to need – the exact location from which to negotiate change.

Don’t sweep relationship issues under the carpet. There will come a time when you reach the breaking point, and every angry, hurtful thing you ever thought spews out of your mouth. If you can’t talk to your life partner about issues, why are you even in a relationship?

Keep the message simple – no more than three items at a time. These can be promises or problems, but it’s always best to keep the message short.

Repetition is key. The more often we hear something, the deeper it penetrates into that grey matter between our ears.

Another way to reinforce any communication is to have the other person repeat the essence of what we have said back to us. This can take the form of a verbal summary or a written one, and neither one has to sound like a kindergartner’s lesson.

Be truthful about your own needs without purposely being hurtful. If the other person is talking, learn to listen without interrupting or getting upset every time he/she says something that you would rather not hear.

If you can master these rules of communication with your husband/wife, life partner, or significant partner, you will be well on the road to an ideal partnership, which includes: being able to talk honestly about each other’s faults; being able to make each other laugh; agreeing to disagree; taking time away from each other without guilt or fear; and always having each other’s backs.

Christy Weller, Psy.D., Couples Counseling Boulder. I bring a genuine curiosity, a kind appreciation of where you have been, and a non-judgmental stance so that you feel comfortable exploring your story and making sense of it. I tailor my work to each client and I'm trained in both short-term and long-term therapies.


My Irrational Moral Superiority

It's easy to judge someone for thinking they are 'better' than us in just about every aspect. But, looking in the mirror and saying the same thing can be a little more eye-opening. The reality is that most of us tend to think we are better than others, whether we say it out loud or not. We're smarter, we work harder, we have more to offer, etc.
The biggest area of self-superiority that we tend to hold against others, though, is that of our morals. The illusion of moral superiority affects more people than you might expect (and it probably affects you, too!). A study published in Social Psychological and Personality Science found that moral superiority is unique in just how prevalent of a positive illusion it is for so many people.

Why Do We Feel Our Morals are Better?

Through this particular study, researchers quickly found that most people are eager to give themselves high scores on the more positive areas of life. We all want to think we have better-than-average intelligence, for example. It's not hard to put that on a piece of paper when you're doing a study.

But, why was moral superiority so high for so many people? There is no concrete answer – at least, not yet. The researchers' theories suggest that we want to downplay the morals of others and boost up our own as a survival mechanism. We live in a world where we are so convinced that others are untrustworthy, that we give ourselves moral superiority over almost everyone else; even people close to us.

The next step is to research what aspects of these inflated beliefs about morals really mean the most to people. Morals can mean different things to different participants, and one person may be focusing on something like virtue, while another may be thinking about honesty.

Some of our superiority thoughts aren't so irrational. They give us an ego boost, make us feel better about our overall wellbeing, and for the most part are generally harmless. Even downplaying the strong traits of others isn't always a bad thing as long as it doesn't start to affect relationships.

But, moral superiority seems to be an unexplained phenomenon of sorts when it comes to how irrational it really is. Without more research to officially back up the reasoning behind it, we're left guessing as to why we're so concerned with feeling and looking morally better on paper than our neighbors.

Are There Dangers to Irrational Moral Superiority?

The idea of thinking we're somehow more righteous than others might seem harmless. But, if these ideas grow and gain momentum in all of us, it could lead to potential problems for the future. Conflict is bound to arise when we all think we have higher moral standards than those around us.

There are two sides to every debate, and if both side thinks they are more righteous than the other, it can make any argument turn even more heated. This could lead to a snowball effect for many different conflicts, and could even lead to more violent behavior in the future.

Carolyn Ehrlich LCSW, CGP specializes in Relationship Counseling NYC. I increase your self- awareness and help you gain more insight into your inner-life. We'll work together so you can get more out of every day and meet any challenge life throws at you.


Recognizing Your Stress – Where it Comes from and How to Manage It

A little bit of stress in everyday life is normal. It's nearly impossible to avoid. Sometimes, a little stress can even be a good thing! But, when you're overly-stressed, your life can feel like a battle field on a daily basis.
There are different types of stress to consider. The most common are 'acute stress,' which is an immediate reaction to a situation, or 'chronic stress,' which feels like a constant, longer-lasting problem. It is chronic stress that can take over your life, and even cause your health to suffer if it isn't managed correctly.

What Are Your Common Stressors?
Everyone has different 'triggers' that can cause stress in their lives. Some of the most common triggers include things like:

* Big life changes
* Sudden events
* Workplace environment
* Social situations
* Underlying fears
* Lack of control

Again, triggers are different for everyone and aren't limited to this list. But, it's important to know what makes you feel stressed. The more you can understand your personal stressors, the easier it can be to manage your stress levels, and reduce the chance of experiencing chronic stress. When you recognize what's causing you stress, you've already taken the first step toward getting it under control.

The good news? You don't have to figure it out on your own. We can help you sort out what might be triggering your stress, so together, we can figure out the best management solution.
How to Manage Your Stress

Stress can't be fully 'treated.' There will always be different stressors throughout life. But, knowing how to effectively manage it can make a big difference in how you're able to live your life. There are lifestyle changes and choices you can actively make that can help you get your stress under control. Just like there are different triggers for everyone, there are different management options for everyone, too. Some of the most popular solutions include:

* Changing your diet
* Getting more exercise
* Meditation/Breathing exercises
* Time management
* Talking to someone

Different relaxation techniques can make a big difference in how you're able to manage your stress levels. Finding a technique that works for you is the most important thing. Sometimes, just talking to someone or journaling your experiences can help to bring your stress to the forefront. Again, recognizing what triggers it is the first step in managing it.

It's not always easy to recognize our triggers, especially when stress becomes less acute and more chronic. But, if it isn't properly managed, it can do everything from ruin your relationships and career, to take hold of other aspects of your health.

Stress Management Help

Even though stress is a part of everyday life, it can become a problem for some people. Don't feel as though you have to deal with it alone. Even though it's common, it's not something that should be ignored when you find it affecting your life in negative ways.

Let us help you when it comes to recognizing what might be causing the most stress in your life. Sometimes, recognizing your triggers can be one of the biggest factors in reducing the amount of stress you experience on a regular basis. Stress itself might be normal, but it doesn't have to consume your life, your relationships, or your health. Together, we'll find ways to manage your stress levels, so you can take your common stressors and work through them in a healthy way.

Counselling Burnaby Vancouver, Via Counselling & Consulting. Burnaby Counsellor Shari Wood, M.Ed., R.C.C. dedicated to helping clients begin their personal therapeutic journey. A Clinical Counsellor, specializing in Individual and Relationship Counselling by helping people overcome self-doubt to build healthy relationships.


Anxiety Disorders

According to the Anxiety and Depression Association of America, Anxiety disorders are the most common mental illness in the in the United States, affecting 40 million adults, or 18.1% of the population each year. Despite the fact that it’s so common in the U.S and highly treatable, less than 40% of suffers get help for their condition.

Anxiety disorders develop from a complex set of risk factors. Genetics, brain chemistry, personality traits, and life events all contribute to the onset of anxiety disorders. In our world of constant stimulation, tight deadlines, hectic schedules and never-ending to-do lists, it’s easy to see why anxiety is so ubiquitous. Anxiety is a blanket term for a number of specific occurrences that can affect your daily life significantly. Anxiety can present itself in General Anxiety Disorder, Panic Disorder, Social Anxiety Disorder or Specific Phobias. Individuals can also suffer from conditions like Obsessive Compulsive Disorder, Major Depressive Disorder and Post Traumatic Stress Disorder. Generally, most of these conditions develop in adolescence and are more prevalent in women than men. Symptoms include an overall sense of dread, nervousness in social situations, rapid heartbeat and inability to control worry and negative thoughts. For some people, anxiety can be a small yet controllable issue throughout their day, but for others, it can take over their existence and cause extreme problems in all areas of their lives.

You often hear anxiety and depression being mentioned together and there is a good reason for this. Almost 50% of those diagnosed with depression are also diagnosed with anxiety. It’s a combination that can contribute to substance abuse issues and higher instances of divorce and even suicide.

So, what do you do if you believe that you have anxiety? As mentioned before, it’s a common problem but relatively under-treated. The best way to start treating your anxiety is to document times when you feel overwhelmed, nervous, full of dread or worried. Having documentation about your feelings and how often they happen is a great way to begin a dialogue with a medical professional. Your therapist will ask you about when you feel anxious and how it affects your daily life, so having a good record of it will help facilitate a smooth conversation. After you’ve been diagnosed with anxiety, you may be asked to employ various methods to reduce your anxiety like breathing exercises, visualization, journaling, physical exercise, or meditation. These exercises are a great way to help train yourself to better navigate anxious episodes so you can learn how to react to stress in a positive way. Various methods of talk therapy may also be used as a way to understand the underlying cause of your anxiety and work towards a resolution.

The most important thing to remember when you’re thinking about your anxiety is that it’s a treatable condition that can get better. Implementing therapy, journaling, meditation, breathing exercises and medication are all great ways to help combat this common condition. With consistency and a little work, your anxiety is an easily treatable condition that will get better.

Anna M. Hickey, Counseling Macomb, works with couples and families struggling with relationship issues


More On Cognitive Behavioral Therapy (CBT)

Your mind is an incredible thing. Every moment of your life is processed and analyzed almost instantaneously so you can react accordingly. Your brain is so reactive and sensitive to stimuli that the way you frame stressors and respond to issues can positively or negatively affect your well-being in incredible ways. Essentially, the way you react to your daily life can be either good or bad for your mental health.

If your thoughts lead to anxiety or depression or you suffer from conditions like PTSD, disordered eating, OCD, or borderline personality disorder, using a technique called Cognitive behavioral therapy may be the way to break from your negative thought patterns and forge ahead.

Cognitive behavioral therapy (CBT) is a psychosocial intervention technique used for improving mental health. It’s the most widely used evidence-based practice due to its ease of implication and general effectiveness. Guided by empirical research, CBT focuses on developing personal coping strategies that aim to change detrimental patterns in beliefs, behaviors, and emotions. It was originally designed to treat depression and is now used to help individuals with various other mental health conditions.

The primary distinguishing factor of CBT over other approaches to psychotherapy is that it is more problem focused and action oriented. CBT actively works to combat an individual's negative thoughts, feelings, and actions to help them achieve a stronger sense of self-worth and confidence. The beauty of CBT is that it looks at a person as a whole being and not just as a condition that needs to be fixed. It helps identify maladaptive thinking and changes it to help modify behaviors in ways that will positively influence all parts of a person’s life.

How it works:
When using the CBT technique, a therapist will first identify critical behaviors in a patient and then determine the frequency and intensity of these reactions to obtain a baseline. Once behaviors are determined, the positive ones are fostered to increase their rate, and the negative ones are discouraged to lessen or eliminate them. These behaviors are molded through various therapies including positive behaviors distraction, motivation, self-talk, and positive reframing.

Try it now: Change your mindset.
Some aspects of CBT can be done on your own as a way to help positively affect your mindset. By simply talking negative thoughts and turning them into positive statements, you can help alleviate stress and change your outlook for the better.

For example:
Instead of complaining about rush hour traffic, say “I’m grateful for being able to wake up each morning and be gainfully employed.”

Or, instead of stressing over a mess that your kids made, reframe it in a positive light: “I have healthy, happy kids that are capable of playing.”

Making small changes to your thoughts will help you to react better to difficult situations and find the value in every day.

However, despite your mind’s inherent power, it doesn’t change over night. It needs to be exercised just like a muscle in order to get stronger. The best outcomes from CBT take time and dedication. After all, you’re retraining your brain to work through negative stimulus more healthily. That’s hard work and when it comes to CBT, slow and steady wins the race.

Dr. Takos is a Newport Beach Psychologist specializing in the treatment of adolescents and adults suffering from depression, anxiety, and trauma-and stressor-related disorders.


What Are the Causes of ADHD?

The symptoms of Attention Deficit Hyperactivity Disorder (ADHD) often found in children lead many people to believe those particular kids aren't disciplined, or that they are given too much control at home. Those same symptoms in adulthood can lead others to believe that person is lazy or unmotivated, and even immature.

Unfortunately, there are many myths associated with ADHD in all ages. This is usually because most people don't take the time to learn the underlying causes of the disorder to begin with. ADHD is not about a lack of discipline in childhood or being lazy as an adult. It is a real disorder with real factors attached.

While most research suggests that ADHD is largely caused by genetics, there are more studies being done about possible external factors that could play a role in the disorder. Let's take a look at some of these potential causes.
Pesticides

While more research needs to be done, a 2010 study in Pediatrics discovered a possible link between certain pesticides and this disorder in children. If you are concerned about this link, there are two easy ways to fight back against the risk: Either choose organic produce for you and your children (even when you are pregnant), or gently scrub any non-organic produce that may have residue from pesticides.

Pregnancy Choices

It's common knowledge that the choices you make during pregnancy can have a lasting effect on your child. When it comes to ADHD, smoking and drinking have been linked to the disorder. In fact, children who have been prenatally exposed to tobacco or alcohol are nearly 2.5 times more likely to have ADHD than those who were not.

Genetics

The most important factor to consider when looking at ADHD is genetics. There are multiple other myths and factors associated with the disorder. This includes everything from too much sugar, to too much time in front of the television. While many of these 'myths' are continuing to be studied, there simply isn't enough evidence to showcase a strong correlation.

Genetics are the main cause of this disorder, as touched on earlier in this article. That means that it is passed on through the genes of parents, and not how they raise their child.

It has been shown that a child is more likely to have ADHD if a close relative has it, but more research needs to be done to determine which type of genes cause the disorder. As of now, it is believed that ADHD is caused by a missing gene or duplicated DNA segments.

Is It Possible to Prevent ADHD?

Because ADHD is mostly based on hereditary factors, it's very unlikely that you can prevent it from happening. Until more research is done on external factors, there aren't many ways in which to 'protect' your child from the disorder.

What is important is to recognize the symptoms for what they are. If someone in your family has the disorder and you notice your child showing similar symptoms, it's a good idea to get an official diagnosis.

No matter the official cause of a child or adult's disorder, getting it diagnosed quickly and recognizing that there is treatment available is the most important thing. Always be sure to stay up to date with the latest research being done on this disorder. The more studies and tests doctors and scientists are able to perform to determine a specific cause (or even a specific gene), the better treatment will become.

Marcy M. Caldwell, Psy.D. is a licensed clinical psychologist who specializes in the treatment and assessment of adult ADHD Psychologist Philadelphia.


The Good Ways to Argue

For most people, arguments are a way of settling disputes without anyone getting injured.

For some, however, arguing actually includes the getting hurt portion, and the winner is the one who can stay upright longest.

It doesn’t have to be that way, nor does anger have to be a “bad” thing. Counting to 10 while holding one’s tongue can lead to peace, but equally as often it leads to the kind of festering resentment and lingering bad feelings.

So let’s define some good and bad ways of arguing. Starting with the good ways:

First person please. “I feel hurt” is a lot less threatening than “You hurt me”, and – like a good wine – it also goes down more easily.

Own your anger. Don’t keep shoving it down and smiling as though everything was perfectly fine, until it seriously and irreparably isn’t.

Something else you need to own is the fact that you knew, before you said or did it, that your spouse/mate/life partner would be upset. And you knew this because you have said or done it before. Past the one-year mark, almost all arguments are repeat performances that haven’t been resolved yet.

You are not “in it to win it”. An argument with a loved one or friend is designed to find common ground, not a trophy. So put it all in perspective and try to see the bigger picture.

Stay focused on the issue at hand, and don’t bring a list of all the other things your significant other has done in the past 10 years to hurt you. If you must, write the problem down, with input from both sides. If it still seems too overwhelming, by all means give it some time, at least a short break. After which both of you might realize how silly the argument was, and how much you really like one another.

Different habits for different life partners. Some couples enjoy arguing and others are appalled by raised voices and harsh words. Whichever type your relationship is, factor temperament into your fight rules.

The good ways to argue? Well, there are never going to be any good ways, but there are fair ways – or should we say “non-righteous” ways. Dictionary.com defines righteous indignation as: retribution, retributive justice; anger and contempt combined with a feeling that it is one's right to feel that way (i.e., anger without guilt).

So, a few rules. A good argument follows a script. Couples who learn the script can avoid hurting each other too badly, but first they need to agree on their lines – and what type of behavior crosses that line. For many, these are specific words, like “always”, and “never”.

Going forward, imagine that these words have been redacted from your script, as have such trigger words as “chill”, “fine”, and “never mind. Also draw a marker through the words “seriously?”, and “whatever”. This latter, in the hands of your very angry significant other, comes out sounding extremely dismissive. Remember, being heard is the goal for both parties.

Carolyn Ehrlich LCSW, CGP specializes in Relationship Counseling NYC


Do I Have Postpartum Depression?

You came home from the hospital three weeks ago, a proud mom after eight grueling months of pregnancy.

You should feel on top of the world. Your baby is perfect: ten little fingers and toes, and the softest skin. The effects of labor – the tiny red spots all over your face and neck from pushing, the aching belly and back muscles, the sting of the stitches – are mostly gone. All the hormones that rushed into your blood during pregnancy have leveled off. Life is no longer an emotional roller coaster, just a rainy day.

You could probably get past – or at least get used to – the “new baby blues”: up every four hours to change and feed your little one as the laundry piles up, the floors need sweeping, the dishes threaten to overflow the sink, and dinner is pizza or whatever else can be delivered.

What you are having trouble getting used to is the fact that you are no longer the center of attention. Your friends – who used to call once a day to make sure you weren’t in labor on the basement floor – don’t call as often. Your husband or significant other jokes that you look like a zombie, albeit without the blood.

You know he (or she) is right, so you set aside a half-hour a day to shower, run a comb through your hair, and put on lipstick and blusher. Or at least you try to, but it seems baby has other ideas, and invariably starts crying the moment you step inside the shower. Your reaction is “oh, shit!”, and you wonder if maybe having a baby was a bad idea. A very bad idea.

Your mood plunges – to a place you have never been before. You feel excessive fatigue, decreased sex drive, loss of appetite (or the desire to gorge), and frequent changes in your response to others. Worse, you feel them far more often, and more intensely, than seems warranted. Even your gorgeous, extremely sexy husband or significant other is puzzled by your lack of interest, because you used to be the hottest thing since habanero chili peppers.

You may have postpartum depression, or PPD. Because the symptoms so readily mimic the feelings and behaviors of women who have recently given birth, it’s sometimes hard to tell. However, if the behaviors persist beyond the first two weeks, and get stronger rather than fading, you probably have PPD.

Other symptoms of PPD include:

Loss of pleasure in things you once loved
Feelings of worthlessness, hopelessness and helplessness
Persistent depression
Thoughts of death or suicide
Thoughts or hurting someone else, including those closest to you

A number of risk factors can influence whether you get PPD. These are:

A history of depression
A history of premenstrual dysphoric disorder, or PMDD
Your age at the time of pregnancy (the younger you are, the greater the likelihood)
A pregnancy that runs contradictory to your plans for life
The more children you already have, the greater the probability you will develop PPD
Having few friends or family, and no husband or SO to offer support and encouragement
Living alone
A conflicted relationship

The most important fact a woman undergoing PPD should take to heart is that the problem can be resolved. Between regular therapy sessions and antidepressant medicines – some of which can be taken while nursing – new moms stand a better-than-average chance of beating PPD.

Most therapists will also recommend joining a support group, because there is strength in numbers and problems seem smaller when you can talk them out with like-minded new moms!

Dwan Reed, PhD, LCSW, DTM, of Tallae Counseling & Wellness Center is a therapist specializing in Depression Counseling in Houston, TX.


How to Argue Effectively

Fighting is a part of almost every relationship. Even couples with the healthiest of relationships argue from time to time, whether it be about something simple and silly, or something more concrete and serious. For the most part, those in relationships get through fights eventually, and move on. But, if you've ever felt as though the arguments you have with your partner are unproductive, and they continue to linger in the air for days on end, you may not be arguing effectively.

Yes, there are several ways to 'fight a good fight,' and turn your disagreements into something that can actually be beneficial for your relationship. Let's take a look at a few simple tactics you can use during an argument to get through it successfully.

Don't Run Away From It

Far too often, arguments get swept under the rug. Or, maybe you brought up a subject once that was important to you, but it triggered a disagreement, so you have decided to avoid it ever since. Ignoring potential arguments is bound to build up frustration in one, or both of you. Ask the big questions, share your genuine opinions and feelings, and talk it out before it becomes an even bigger issue. The longer you sit on something that's bothering you, the larger it can become.

Take it Slow

Heated arguments rarely end well. In fact, they make it easy to say things we might later regret. To really argue effectively, you both need to agree to take things slowly, and start the conversation in a calm, collected tone. Think of it as an understanding, open conversation, instead of a disagreement.

If you're able to take things slowly, and respect each other's turn to speak, the disagreement is likely to have a better outcome for both people involved. Plus, feelings are less likely to get hurt.

Make Rules Beforehand

If each person goes into an argument not knowing what to expect, there are no boundaries. That's when things can easily get out of hand. Set ground rules for your disagreements during a more neutral time. Rules could be anything from trying to come to a 'big picture' solution, to agreeing not to name call or dig up certain subjects from the past. They will be different for every couple, so suit them to fit your needs together.

Don't Forget You're On the Same Side

It's so easy to consider your partner an enemy during an intense argument. Unfortunately, that usually doesn't end well. Instead, go into a fight mentally acknowledging the fact that you're on the same team. Ultimately, you both want what's best for your relationship, you may just have a different approach to getting there.

Arguments typically happen because one person is struggling with some aspect of the relationship. As partners, you should do what you can to come to a solution regarding that struggle. You may have different ideas as to how to do it, but using these tools and techniques, your disagreements don't have to feel so hostile. Instead, they can be productive and thought-provoking. You can actually accomplish your goals as a couple.

By remembering that you're in this relationship for the long haul, it's easier to look at your partner and want to figure out a solution, rather than lash out at them. Don't forget the commitments you've made to them, and yourself, and your arguments can be far more effective.

Written by Kin Leung, MFT, providing couples therapy Burlingame


How to Handle Depression After a Breakup

Break-ups are never easy, no matter how amicable they may be. Dealing with a broken heart isn't just some old tale. The fact is, going through a hurtful break-up can have real psychological effects, including depression. It can also be a trigger into deeper anxieties and depressive actions, if you're prone to the condition.

While curling up with your favorite movie and a pizza might be the stereotypical remedy for getting over a bad break-up, there are better coping mechanisms to help pull you from the depression it might cause. Follow the tips below to help you get through this rough time, and know that what you're feeling right now doesn't have to be permanent.

Give Yourself Time

Many people might tell you to jump right back into the dating scene after a break-up, to take your mind off things and find someone new. Unfortunately, that's likely to do more harm than good, and you won't be giving yourself the time needed to fully get over what happened. It's important to understand that you don't need to get over a relationship overnight. Work through things at your own pace, and don't expect to feel better right away.

Additionally, give yourself the chance to be emotional. It's okay to cry, or feel angry, or even feel sad for a week or two. Suppressing your real feelings will make it harder to truly get over the split. These feelings won't last forever, so don't be ashamed to give yourself a release.

Keep Up With Your Routine

Sometimes, a split from your significant other can throw a huge wrench into your life – including something as simple as your daily routine. Sometimes, even having meals regularly and getting enough sleep can become chores after a break-up.

Try as best as you can to follow your regular routine after your relationship ends. This will be harder to do at first, but if you keep putting in the effort, the familiarity of that routine can provide comfort and help to reduce stress.

Spend More Time With People You Love

After a relationship ends, It's easy to feel as though you're all alone, or that no one cares about you. In reality, that's likely very far from the truth. Don't be afraid to tell the people closest to you what happened, and how you're feeling. A strong support system is crucial after a break-up. Let them be there for you. They'll help to take your mind off of things, and give you reassurance that you have some incredible people in your life.

Accepting the Truth

Accepting any hard truth is never easy. But, it's important to think about what the end of this relationship means for you, and to realize that it wasn't a waste. Being bitter about the end is only going to make it easier for depression to creep in. Instead, try to focus on things you may have learned, and what you can take with you into future relationships throughout your life. Moving on and moving forward, after giving yourself enough time to do so, is the best way to get through a break-up and fight back against depression that may want to linger because of it.

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving Anxiety & Depression.


Happiness – Cause or Effect

Is happiness a joyful state of being? How about a pleasurable experience? Or possibly a positive emotion? Merriam Webster says it’s actually all three. Even with multiple definitions, words cannot really capture the idea of happiness. Psychologists refer to emotion as “procedural knowledge”; a skill such as riding a bike. Procedural knowledge cannot be learned or fully explained in words. Only experience can lead to a true understanding. And so it goes with happiness.

Psychologists tell us that happiness has three components:
1) an overall satisfaction with life
2) satisfaction with life domains (work, relationships, etc.)
3) for the most part, higher levels of positive emotions and lower levels of negative emotions

Even so, happiness as an experience changes throughout a person’s life span. Researchers studied twelve million blogs to extrapolate words that related to happiness. Younger writers, those in their teens and early twenties, used the words “ecstatic” or “giddy.” On the other hand, older writers in their forties and fifties conveyed happiness through words like “content, satisfied, relaxed.”

Happiness comes from three distinct sources:
1) 40% from intentional activity (self controlled)
2) 10% from circumstances (outside of self control)
3) 50% from “set point”

Set points appear to be genetically influenced and are a result of certain personality traits. People who rank high on the extraversion scale may find they experience more happiness. While people who rank high on the neuroticism scale may find they experience less happiness. A life event, whether triggered by an intentional activity or an outside circumstance, may create waves of happiness, but over time, the set point will take the person back to their innate level of happiness.

Returning to the relationship of age and happiness, people between the ages of thirteen and fifty or sixty, enjoy a rise in happiness throughout life. A fast descent occurs thereafter. Another important factor discovered in research is that attitudes and actions affect happiness; examples are:
1) having a positive attitude and seeing a silver lining in any dark cloud
2) prioritizing activity such as spending time with friends and family
3) completing an important life goal

Is too much happiness a bad thing? Psychologists say yes, in some cases. The risks of too much happiness are as follows:
1) being too happy may lead to not recognizing risky situations
2) being overly happy may be expressed at an inappropriate time
3) trying to be happy all the time in not authentic behavior. The risk of offending or confusing others with too much happiness is high.

Happiness is associated with many positive life outcomes: good problem solving skills, a creative, helpful image to the world, greater professional accomplishments and good decision making capabilities. There is an association between education, successful marital status and financial success; all three are associated with happiness. Some psychologists believe that these life outcomes are “effects” of happiness while other psychologists take another position. They believe that positive life outcomes are not “effects” of happiness, but that happiness is the “cause” of the positive life outcomes. Stop for a minute and think about this concept. It is very empowering to believe that choices, attitudes and actions are paramount to circumstances that “appear” to be out of our control. This concept in no way suggests that we should fake happiness in order to achieve a life goal. Instead we have the option to create coping skills. When life circumstances become obstacles, reframe those circumstances as opportunities, see the silver living and hold on to the positive outlook. You might find that happiness is a natural result regardless of outside circumstances.

Polly Sykes, Registered Psychotherapist, MEd, RP, is a Toronto Psychotherapist with extensive post-graduate training and experience in the treatment of Trauma, and the use of Emotion-Focused Therapy for both Individuals and Couples. The support of an experienced and highly-skilled Psychotherapist can be a powerful tool to help you face the challenges of life with more hope, more self-acceptance, and stronger relational bonds.


Depression in Seniors

Often we sense a sadness among the members of a senior care facility. We might also feel that same sadness around a widow or widower who is living alone. Sadness or an occasional “blue day” is about as normal as those same emotions experienced by a younger person. But when occasional sadness morphs into a longer term condition, the person may be experiencing geriatric depression, a mental and emotional disorder affecting senior citizens.

If a senior citizen is female, there is a higher risk of developing geriatric depression. Other risk factors include being single, divorced or widowed without the support of a social network. Stressful life events may also contribute. Many times seniors are forced into early retirement because of health reasons or even corporate downsizing. Ensuing financial insecurity creates a risk for geriatric depression. Further, as seniors advance in age and develop physical illnesses such as heart disease including invasive procedures for these illnesses, the door is open for geriatric depression.

Seniors who are prescribed powerful medications may find that mood alterations, including depression, are a side effect of the medication. Blood pressure medications, antibiotics, antiarrhythmics and steroids are only a few drugs that may influence mood and cause depression.

One might summarize from the information above that illnesses actually bring on bouts of depression; in other words illness is the cause and depression is the effect. However, that premise was challenged in research conducted by Lynanne McGuire, Ph.D. at the John Hopkins School of Medicine. McGuire and her colleagues findings supported the opposite premise; persistent mild depression in older adults may lower immunity and impair the ability to fight off disease. Depression is actually first cause. It is interesting to note that the length of the depression, not the severity, actually impairs a senior citizen’s immunity. Therefore depression can accelerate immunological declines.

What then are strategies to hold depression at bay, maintain immune strength and hold on to good health as one ages? One strategy involves activity, especially in retirement. Retirement need not be thought of as obsolescence and a rocking chair. Retirement is an opportunity for personal reinvention. Activity includes travel, joining a gym, thinking of all the things that one wanted to do while working but could not. Retirement is the time to do those things if resources are available. Volunteer work is always an option to create a reason to rise early and engage in the world. If, for example, a retiree is a pet lover, they could volunteer at a pet rescue organization. If a retiree is good at working with people who are in need, hospital work is an option.

Another strategy is to conduct a self assessment on lifestyle. Review all life habits such as diet, exercise, sleep patterns, even sociability. Most everyone can make improvements in some areas. As part of retirement reinvention, lifestyle changes can make a difference in attitude as well as mental and physical well being.

Probably the most important self assessment for senior citizen is personal attitude. How much time is spent during a day thinking sad thoughts instead of happy thoughts. Remember, thoughts are choices. How many times during a day are events or situations perceived through the “half-empty” glass perspective instead of the “half-full” glass perspective. Regardless of a person’s age, an occasional attitude adjustment may help ward off mild depression. Laughter is greatly underrated for its therapeutic benefits.

These strategies are suggested to manage mild bouts of occasional depression. If depression persists and is perceived as more severe, professional help should be sought. A trained certified therapist can make a diagnosis, develop a treatment plan and put the senior citizen on a more productive and fulfilling life path.

Copyright © 2015 Directory for Therapists


Teens & Smartphones, The Downside

It’s not an unfamiliar scene. Teens huddled in groups tenaciously clutching their smart phones while checking social media sites and appearing to be mesmerized by Instagram, Facebook and thousands of other apps. Teens have replaced conversation at family meals with smart phone use; some of them following the lead of their parents. The source of the compulsion to spend up to nine hours per day with smart phones or tablets is a psychological study unto itself. The effects are another. The purpose of this article is to examine proven and speculated effects.

Most people will not question the practical advantages of being connected via smart phones. Smart phones have become a body appendage feeding us with news, weather, driving directions, traffic reports, instant communication via text or email not to mention thousands of quite useful apps. Few would argue with these practical benefits. However, practical benefits aside, how do parents respond when cell phone abuse begins to negatively affect teens physical, emotional and mental health.

Sleep Deprivation: Many argue that cell phone use has become an addiction for many teens. They feel social pressure to remain constantly available to receive and reply to text messages and other communication. This pressure created by cell phone addiction increases stress, anxiety and sleep deprivation for many teens. Extended sleep deprivation may lead to drowsiness, irritability, fatigue and poor performance at school. One study showed that for each ten minutes later a teen went to sleep, there was a 6% chance they’d used drugs or alcohol in the past six months. If you notice your teen is sleeping with their cell phone on, try to instill a habit of turning off the phone before bed to allow for a full uninterrupted night’s sleep.

Brain Chemistry: Dopamine is an important chemical substance created by our bodies. Because of dopamine we are able to experience pleasure and reward. If dopamine production is interfered with due to addiction (even addiction to smart phones), the parts of our brains that impact executive control and emotion processing are impacted. Science has noted that teens (and adults) addicted to smart phones have a reduced amount of dopamine receptions in their brains. In order to experience continued pleasure, more cell phone use is required such as downloading new apps or receiving more notifications from various platforms.

Reduced Physical Activity and Mobility: If on average teens spend nine hours per day on their smart phone that means they are spending less time engaged in physical activity. Nine hours per day spent in a particular stationary position negatively affects physical development, back and spine pain and stiffness as well as soreness in wrists, fingers and elbows. There are now terms to described wrist, finger and elbow pain from habitual texting; “text claw” and “cell phone elbow”.

Cancer Risk: Cell phones do emit radio-frequency energy or electromagnetic radiation. This energy is absorbed by human tissues where the phone is held. However, there is no conclusive research or evidence that cell phones cause cancer. Speculation is a different matter. It is speculated (not proven) that if cell phone use causes cancer, it is likely to be more probable with people who begin cell phone use in their teens. Younger people are speculated to be at greater risk since their nervous systems and brains are still in a developmental stage. Making your child aware of this risk and encouraging cell phone use of no more than twenty minutes daily may help mitigate the risk. Further, using a land line for longer conversations could be helpful.

If parental intervention does not help curb the use of cell phones with your teen, and if you believe the use of cell phones has become abusive or addictive, the help and guidance from a professional certified psychologists trained in teen behavior may help.

Colin B. Denney, Ph.D., is the Director of the Pacific Psychology Services Center in Honolulu, Hawaii, he is a Child Psychologist Honolulu.


Post-Traumatic Stress Disorder

Post-traumatic stress disorder, more commonly referred to as PTSD, is a disorder that develops in individuals who go through horrifying, dangerous, scary experiences. It is natural for people to feel afraid after traumatic events and this fear triggers many split-second changes that help the body avoid or defend itself against danger. While most people recover from traumatic events fairly quickly, there are those who continue to experience problems and these are sometimes diagnosed with post-traumatic stress disorder. People with PTSD often experience fear even when they don’t face any danger.

Causes of PTSD
The range of events that can trigger PTSD include natural disasters, terrorist attacks, being held hostage, military combat, witnessing violent deaths, severe neglect, prolonged violence and sexual abuse, violent personal assaults as well as serious road accidents just to name a few. PTSD can manifest immediately after a scary event. It can also take a while i.e. days, weeks, months or even years, to develop. And while it’s not clear why it develops in some people and not everyone, at least one out of three people who have traumatic experiences develop PTSD.

Signs and symptoms of PTSD
Not everyone who goes through a traumatic experience develops acute or chronic PTSD. It’s also important to note that not everyone who suffers from PTSD has necessarily gone through a traumatic event. Some experiences like the death of a close family friend can trigger PTSD. Symptoms develop within a period of three months but may take several years to develop in some individuals. For symptoms to be considered PTSD-related, they have to persist for at least a month and so severe that work or relations are interfered with. The severity of these symptoms varies, with some people developing chronic PTSD. The following symptoms must be experienced for one month before an adult can be diagnosed with PTSD.

At least one re-experiencing symptom - frightening thoughts, flashbacks, and bad dreams.

At least two cognition and mood symptoms - disinterest in fun activities, negative thoughts about the world or oneself, distorted feelings like the guilt of blame.

At least two arousal and reactivity symptoms - trouble sleeping, angry outbursts, feeling on edge or tense, being easily startled.

At least one avoidance symptom - staying away from people, places, and events that remind one of the traumatic events, avoiding feelings or thoughts related to the event

Treatments and therapies
There are various types of psychotherapy that are utilized to help treat patients struggling with PTSD. Such include stress inoculation training, cognitive restructuring where people learn to make sense of bad memories, as well as exposure therapy patients, are safely exposed to their trauma events to help cope. Those experiencing PTSD due to on going trauma such as abusive relationships, feeling suicidal, drug abuse and depression are encouraged to seek treatment from experienced medical professionals. It is important to note that not every treatment works for every patient as PTSD manifests uniquely in each person.

Miriam Gold, LCSW, PLLC
Springboard Therapy
Therapy Services for Children, Adolescents, Adults, Families, and Groups

Miriam Gold specializes in trauma PTSD therapy in Raleigh, North Carolina. Her treatment specializations also include childhood and adult Trauma, adult survivors of trauma, both recent and past. Treating children and adolescents; Neglect/Sexual Abuse/Physical abuse, Community/War/Political Violence, Natural Disasters, Life Threatening Medical illness, Serious Accidents, School Violence, Traumatic Loss, Foster Care and Adoption, Attachment Concerns. Miriam is Rostered in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) through the North Carolina Child Treatment Program. TF-CBT is an evidence-based treatment for children, adolescents, and their parents or caretakers who have experienced trauma or loss. Extensive training in Cognitive Processing Therapy (CPT), an evidence-based therapy for adults.


Mental Health Bill, lawmakers tackle federal policies

Mr. Murphy, a clinical psychologist, had been tapped by House leaders to investigate mental health treatment in the U.S. in the wake of the Sandy Hook shooting in 2012. He and other advocates of changing the system have cited the obstacles family members faced in caring for people with serious mental illness, including privacy laws and provider shortages. These issues were also highlighted in a Wall Street Journal investigative series in 2013.

In the years since, Mr. Murphy and other backers of the law have agreed to soften some portions of the legislation in an effort stave off opposition. The bill has a Democratic lead co-sponsor, Eddie Bernice Johnson of Texas, and was unanimously approved by the House Energy and Commerce Committee.

Earlier iterations of the bill had sought to change the privacy rules in a law known as HIPAA so that providers could share details of a patient’s diagnosis, prescriptions and appointments with a known caregiver, require states to pass laws that compelled treatment for certain people as a condition of getting federal funding, and restrict advocacy groups that receive federal health funding from helping patients bring legal challenges to their treatment.

Read the article here.


The Denial Defense Mechanism

We all use different forms of defense when we need to. Whether we’ve been through a traumatic experience, we’re arguing with someone, or we simply don’t want to deal with something negative, our minds and bodies work to create defense mechanisms to help protect us. Unfortunately, there are instances where these mechanisms can get out of hand.

One of the most popular and widely-known defense mechanisms is denial. It’s considered to be a ‘stage of grief,’ and is apparent in many different defense mechanism research.

Believe it or not, denial is actually an unconscious defense mechanism, not a ‘lie’ or falsehood someone is doing on purpose. Quite simply, denial is the refusal to admit or acknowledge than a specific event has occurred. An example could be an alcoholic to refuses to believe they have a problem, or a wife hearing her husband was in a car accident, but refusing to believe it, etc.

Denial is used to avoid thinking about painful things, and is one of the most basic and primitive defense mechanisms we have, even from childhood. It also goes hand-in-hand with repression, or the idea of not letting certain thoughts into our heads.

Denial At Work

Denial can be both helpful and harmful, in different ways. Studies have suggested that small amounts of denial can actually be beneficial for the right situation. For example, if someone experiences a traumatic event, living in a state of denial for a short period of time can actually give their mind and body more time to process what actually happened, allowing it to come as less of a shock later. In these cases of denial, it’s almost as though reality is simply sinking in more slowly, and the person is willing to get past the denial naturally over time.

However, denial becomes harmful when someone is not able to overcome it. When they are not able to rationally talk about the issue and eventually get past ignoring it, it can simply snowball into something even bigger. A common example of consistent denial might be something like a couple facing a mountain of credit card debt, but refusing to believe it, so their bills keep adding up every month, and they don’t even look at them so they don’t have to face reality.

Finding Help

If you feel as though someone you know struggles with denial to the point where it is affecting their lives, and the lives of those around them, there can be help available from mental health professionals. The best thing you can do, however, is not to make the person struggling with denial feel forced into anything. If you can offer to see a professional with them, just to talk, it can be a great first stepping stone into beating denial. It’s never an easy journey when someone who has been using a defense mechanism finally has to face what they were hiding from, but it is the healthiest way to move past something like denial.

To read more on Denial and other mental health topics visit, InSession.io therapist website design & marketing


Dissociative Disorders - A Better Understanding

Dissociative Disorders - A Better Understanding

There are different stereotypes, opinions, and subconscious thoughts that go along with the term ‘Dissociative Disorders.’ Unfortunately, those stereotypes aren’t usually fair, and the assessments people make about these types of disorders can be dangerously false. Because dissociative disorders affect a relatively small number of people (roughly 200,000), we tend not to consider them to be as serious as we might with other mental or physical health issues, but that small number packs a big punch in terms of what these disorders can do, and how they can affect those dealing with them, and the people surrounding them.

Types of Dissociative Disorders

By definition, a dissociative disorder is characterized by an involuntary escape from reality. There is a ‘disconnection’ of thoughts, identity, memory, and consciousness. Many of these disorders arise because of a prior traumatic event, but no one is immune from it. They can happen at any age, to any race, or gender. However, a common candidate for dissociative disorder can oftentimes be children, who have suffered long-term emotional, physical, or sexual abuse. The disorder allows them to escape, become someone else, and forget about/cope with the pain and trauma they’ve had to deal with. Realistically, a dissociative disorder is nothing more than an extreme defense mechanism from our own thoughts.

Types Of Dissociative Disorders

Because dissociative disorders can be different things to different people, depending on their idea of ‘escape,’ there are different categories to make the disorders easier to understand, including:

Dissociative Amnesia - Difficulty remembering important information about yourself, such as abuse, or even identity.
Depersonalization - Lasting feelings of detachment from everything personal.
Dissociative Identity Disorder - Alternating between multiple personalities/identities.

What To Look For

Even though dissociative disorders can show up differently for different people, there are a few common traits to consider, including memory loss of specific events or people, out-of-body experiences, additional mental health issues (depression, anxiety, etc.), a lack of self-identity.

Dissociative disorders oftentimes go hand in hand with other, similar issues, including PTSD, so it’s not uncommon for them to be misdiagnosed, or mistaken for something else. Treatment can include anything from psychotherapies, to rapid eye movement conditioning, or even the introduction of similar medicines used to treat things like depression.

Dissociative disorders can be terrifying for the people having to go through them, and the families and friends surrounding those people. Yes, they are viewed as a way for an individual to escape, but there’s a good chance they are only harming themselves further in the process. If you think someone you know may be struggling with a dissociative disorder, it’s ultimately up to them to seek out the kind of help they need, but don’t be afraid to gently encourage it, if the disorder has become a real problem in their everyday life.

To read more on Dissociative Disorders and other mental health topics visit, Dr. Lynn Alexander, Palo Alto Therapy & Counseling


Social Drinking vs. Alcoholism - How To Know The Differences

We live in a society where going out for a drink or two is more often than not, the norm. And there is certainly nothing wrong with having a cocktail at a party, or sipping a beer over a ballgame, etc. Drinking has always been viewed as a social event, and many gatherings cater toward the alcohol itself, but that doesn’t necessarily mean there’s a problem.

However, because of today’s open acceptance of social drinking, it can sometimes be hard to tell when someone might be going too far, or past their limit - especially on a consistent basis. There’s a fine line between social drinking and alcoholism, and it can be more of a blurred line than many of us realize.

How To Know When It’s A Problem

Alcohol affects every single person differently, so it can be difficult to tell when a problem arises. One person might be able to have three or four drinks with no issues, while another might feel a ‘buzz’ after just one drink. Unfortunately, that’s why conditions like alcoholism stay personal for far too long, before other people begin to notice. Once other people do begin to step in, it’s often at a point where the illness has really grown, and become a huge problem.

So, there are a few things to consider for yourself before letting anything get out of hand:

Do you feel sometimes as though you should cut back on drinking?
Does drinking ever make you feel guilty?
Do you think about drinking or actually drink at ‘inappropriate’ times of the day? (ie; having a drink to cure a hangover in the morning, etc.)

Another thing to consider is the social aspect of drinking itself. Can you go to a party or restaurant/bar with friends and choose not to drink without any issues? If the answer is ‘no,’ and you feel as though you either have to have a drink to enjoy yourself, or to fit in with your friends, it may be time to take a step back and consider that to be a problem, before it escalates into an even larger one. Alcoholism results from a lack of control when it comes to drinking, which, in essence, is the very opposite of social drinking itself.

Ultimately, alcoholism is a battle, and an addiction, and the signs for it can be different for every individual. Some people can go months, or even years without showing any real signs of the illness while still struggling with it, while others will open up quickly and admit they have a problem. If you, personally, have felt as though you may have a problem with this addiction, don’t be afraid to seek out help before it snowballs - friends and family are a great way to start, but support groups, life coaching, and even therapy can be a big help when it comes to kicking the addiction.

To read more on alcoholism and other mental health topics visit, Kristy Hellum therapist Santa Rosa


Married Without Children - Choosing Not To Have Kids

Marriage and children have gone hand-in-hand since the beginning of time. As a culture, we’ve been trained to think that having children is simply what you do after you get married. In the not-so-distant past, many couples would have multiple children because it was a societal norm, and because those children were ‘needed,’ to help work, manage farms, etc. Having between 5-10 children or more was normal in the early-mid 1900s, and while forms of birth control were obviously less readily-available during those times, the idea of having that many kids wasn’t only accepted, but encouraged.

Even in more recent years, children have simply been expected as a result of being married. With women especially, the conversation of getting married and having kids always seemed to be a popular one. Today, though, that conversation is changing.

More and more couples are either choosing to have children later in life, or simply choosing not to have kids at all.

Why are couples choosing not to have kids?

There are hundreds, if not thousands of individual reasons people choose not to have children, and most of them are 100% personal to the couple making that choice, however, some common reasons include: Putting career first, trouble in the marriage, fear of a sluggish sex life, the cost of a child, etc.

Again, most reasons people give for not wanting kids is strictly personal, but as societal norms have changed, so has the pressure of having kids. Granted, it’s not accepted 100% - it’s still more often than not that married couples do have at least one child, but the focus on ourselves, our careers, and our relationships with our spouses and other people have greatly affected our overall desire to have kids.

This certainly isn’t to say we live in a selfish world. In the United States alone, over four million babies are born every year. However, many of those births are not the result of a marriage, and that stigma has begun to float away as well. Many people are seeing the choice to have a child or not to be something a woman has a right to decide for herself, whether she’s with her husband, or on her own.

In marriage, many people want to put their relationship first, especially if it’s a relationship that has had hardships or struggles. Where having a baby used to sometimes be a method of ‘strengthening’ a relationship, more and more couples now realize that bringing a child into a damaged situation can only make things worse for everyone, including the baby. Still, even the happiest of marriages choose not to have kids for personal reasons, and even though it may not be the ‘norm’ as of yet, the idea of not having kids in marriage is more widely accepted than ever before, and there’s no reason to believe those trends won’t continue.

To read more on Marriage and other mental health topics visit, Donna Shanahan, LMFT couples therapy Pasadena


Does Exercise Help Keep Our Brains Young?

For most of us, our bodies begin to lose flexibility and efficiency as we enter our 40s. Running and other movements slow down and become more awkward, and something similar seems to occur within our heads. As middle age encroaches, our thinking becomes less efficient. We don’t toggle between mental tasks as nimbly as we once did or process new information with the same aplomb and clarity. Click to read more from GRETCHEN REYNOLDS.