Wednesday 30 November 2016

It Shines: Living with Bipolar II Disorder

two-faced woman manic depression conceptI’m quick to reflect on high school glory days. It’s pretty silly, seeing as how I’ve not even reached the 10-year reunion mark. Flipping through my old yearbook, I noticed one of my favorite teachers wrote “Dear Beth, calling you a delicate flower would not give justice to your violently cheerful exuberance. It’s been amazing to watch your shifts from scarily giddy to sleepy to gloomy then back again.” I didn’t learn until later that this was a much abbreviated but also decent description of someone with type two Bipolar Disorder. Even with the intensity of my demeanor back then, no one would have pegged that onto a cheerleading prom queen.

I had a hodgepodge of symptoms that I never wanted to complain about but always knew were a problem. It took me a while before I confided in my doctor. Individually, the ailments were nothing to be alarmed about but experiencing them all at the same time (nearly all the time) became too much. The fatigue was easier to notice because of the way it affected my academic performance. I could sleep twelve hours at night and still feel the need for a three hour nap later that day. I began having nightmares every night and eventually experienced recurring sleep paralysis. I was always underweight, prone to infections with poor circulation and constant ice pick headaches, etc. And an even stranger development was a tick-chronic hiccups. These symptoms concerned my doctor and after exploring several possibilities to no avail, he eventually gave me an MRI to rule out cancer. Because he knew me as that charismatic girl from high school, he didn’t even consider that these were all physical manifestations of depression/anxiety.

Starting college, I knew I had been depressed on and off. My closest friends began to avoid me. They admitted that they ran out of ways to be there for me. I was exhausting the friends who poured so much love into me. I can’t place a finger on a watershed moment in time that broke me, but I vividly remember the signs. Having to cross a busy highway every day to get to class, I would dare myself to stand dangerously close to the road. I always entertained the thought of taking a swift step in front of the 18-wheelers that barreled by. Driving my car gave me ideas of swerving into oncoming traffic. I spent so much time fantasizing about dying. After sabotaging some of my strongest relationships, I was determined not to burden anyone else so I stayed quiet. Many nights I can swear my heart would break though and not in a way that typical teenage hearts do but in a way that was excruciating, and I would end up begging God to please take my life away. The sadness was palpable, but I wouldn’t impose on my friends.

I used to think if a person was medicated for their mental health their condition must be outrageous. I especially thought of bipolar disorder as a series of violent mood swings. In addition to this stigma, I also thought too many people are given medicine they don’t need. I figured the world was full of hypochondriacs and theatric people who manipulate doctors into prescribing pills. I dodged this avenue for the longest time. Then there was one night when my only reservation of jumping from the top floor window of my dorm was the possibility of a failed attempt. I couldn’t tell if the fall would be enough or if I would end up paralyzed. I even went outside to judge it from the ground up. By some stroke of horror I had at my own actions, I called NC State’s on-call counselor who stayed with me until 2 a.m. I could no longer ignore the need to seek help.

When I went to see someone, the suggestion that I might have bipolar disorder seemed nonsensical. That was ignorance on my part. The assessment was that I have severe bouts of depression, but I had never considered the other times, the euphoria and the mountain top experiences. Most people were only familiar with my contagious joy and perpetual need to spread it. My teacher’s words come back to mind.

After finding the courage to seek help, I’m now equipped with the right combination of medicine and therapy. I have help that doesn’t take away from who I am. I am still dynamic. I am still exuberant. It shines.



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OCD Triggers

Taking Wellbutrin for smoking cessation. Afraid it set off an ocd issue. Not sure. Can Wellbutrin cause a issue like this?

A: You didn’t give me much to go on. You should really talk to the prescriber about whether you are experiencing a side effect.

I do have one guess: Sometimes when a person gets serious about quitting smoking, the result is tremendous anxiety. You want to quit. But quitting makes you anxious. The anxiety makes you want to do go back to smoking for relief. That can feel like OCD.

If that’s what you think is happening, I strongly encourage you to add some talk therapy to your treatment for smoking cessation. Quitting smoking is hard! It is likely you need some more support while you do it.

I wish you well.
Dr. Marie



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The Type of Smile That Helps Start New Relationships

People feel emotionally close to others displaying this type of smile.

Dr Jeremy Dean's ebooks are:



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The Daily Activities That Promote An Upward Spiral Of Flourishing

People reported more positive emotions, including more enthusiasm and joy.

Dr Jeremy Dean's ebooks are:



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Suicide Is Our Modern Day Leprosy

Leper Rubber StampWhen I was preparing a talk about suicide prevention for a local church, there were moments when I become emotional just thinking about the subject matter. I felt confident when I started the presentation for a fantastic group of lay counselors, but did not plan for the water works to begin five minutes into the talk.  

It wasn’t just the heavy topic matter, it was looking at a room of people and realizing they took time from their busy schedules to learn more about what they can do to prevent suicide. I was overwhelmed by their compassion. Suicide prevention needs to be discussed everywhere and it’s a must-have discussion for our churches.

Church is a place for broken people, not perfect people, and should be the safest place for people struggling with thoughts of suicide. Unfortunately, some of the messages that have come from churches make the assumption that mental illness — depression especially — can be fixed if people would “pray more,” or “have more faith.” When this is the message congregants hear, of course they’re not going to seek mental health treatment. And they are certainly not going to consider medication regardless of how depressed they may feel.

During my talk, I referenced scriptures these lay counselors may want to use when they encourage people since this was a Christian ministry. However, I said that offering comfort to the hurting person needs to come first from the helper before the hurting person hears scripture. Although this may rub some people the wrong way, we can easily hide behind scripture. Now, I’m a big believer in the Bible and what it teaches us about life. But assurance needs to come first from the person sitting across the table.  

Before prayer or scriptures of comfort are offered, the hurting person needs to hear, “I’m with you”, “I’m sorry you feel so bad that suicide seems like the answer”, “I want you to live — let’s work through this together.” To hear these words from a fellow church member that their thoughts of suicide feelings won’t push people away — that their suicidal ideations do not make them a leper — is an incredible first step. Someone recognized their suicidal feelings are as big and real as cancer. Luke 10:33-34 says “But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, brought him to an inn and took care of him.” Our wounds are not only physical. They are also emotional and need equal care.

What I would love is to hear is that other churches in our communities want to learn how they can help in this fight for prevention. Their church members may have suicidal thoughts too, even the person who is there every Sunday, or who serves in children’s ministry, or who passes the offering plate. They’re human and not exempt from the chemical imbalances that happen in the brain.  

There’s a burden on my heart to reach more churches about this topic. I’m not going to beat anyone over the head with a Bible, but I will use scripture as a reason for those in ministry to get trained on this issue. Carry each other’s burdens, and in this way you will fulfill the law of Christ.” (Galatians 6:2) As a Christian, I absolutely believe there is a place for the Bible in helping other people.  Unfortunately too many people end up in my office when they reach out about their mental health issues — or suicidal thoughts in their church homes – and they’ve been made to feel they are struggling because they are not living the Christian life. And in some cases, that’s true. If we continually get fired from jobs because we have a habit of stealing from our employers, we may feel depressed because it brings financial problem, but clearly we brought that on ourselves! Most of the time, the cause is not that clear.

I believe that healing is possible and that suicide is preventable. But we can’t prevent what we don’t talk about. I also believe in the power of prayer — and medicine — to get people through these challenges. They are not mutually exclusive. There is a place for both of them. Suicide prevention is a big deal but unfortunately not enough people are discussing it. What if you knew you could save just one life? Would that be enough to address suicide prevention in your church? I believe we can reach the point where suicide is not our modern day leprosy.



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Playtime After Training Improves a Dog's Memory

Making time for play immediately after a dog training session improves the dog’s memory.


A Labrador Retriever playing fetch in the snow


New research by Nadja Affenzeller (University of Lincoln) et al investigates whether play following learning leads to better performance the next day. The scientists wanted to know whether this effect, previously found in humans, would also apply to dogs.

In people, it is thought that the hormonal response during positive arousal acts on parts of the brain called the hippocampus and amygdala and leads to better memory. The effect applies to a type of memory called declarative memory, which is our memory for facts and events (for example, the President of the United States, or the capital of Denmark).

Now we can’t expect dogs to tell us who is the President of the United States, but it is possible to get them to do a task very similar to one used in some of the human memory research: learning to tell the difference between two objects.

The results show that the dogs who got to play immediately after learning needed fewer trials in the task the next day, compared to the dogs who had rested instead.

First of all, each dog had a pre-training session, in which the dog was taught to approach an object. In the very early stages, food was placed on the object, and when the dog approached, s/he was allowed to eat it.

For those interested in the food canine scientists use as rewards, it was either a piece of pork or chicken sausage, depending on the dog’s dietary preferences.

In the training session, the dogs were taught to distinguish between two objects and choose the right one by putting their two front paws on a cardboard square on which the object was placed. If they went to the correct object, the researcher clicked and then gave them a reward. If they picked the wrong object, the researcher used a no-reward marker (“wrong” said in a neutral tone of voice).

The objects were not things the dogs were used to. There was a blue basket with white dots which contained a layer of woodchips, and a green box with black stripes on that had a layer of cat litter at the bottom.

The dogs were trained in sessions of 10 trials, until they had got 80% right in two sessions in a row.

Immediately after doing this, dogs either had a play session or a rest session, depending which group they were in.

The 8 dogs in the play session had a 10 minute walk to an enclosed area where they had a 10 minute play session, followed by the walk back. Dogs had a choice between fetching a ball or Frisbee, or playing tug.

The 8 dogs in the rest session were given a bed to lie on while the owner and researcher engaged in a 30 minute conversation. The researcher kept an eye on the dog and said their name or distracted them to prevent them from going to sleep.

The next day, the dogs came back to learn the same task again.

Dogs that had taken part in the play session re-learned the object discrimination much more quickly, taking 26 trials on average (plus or minus 6), compared to 43 trials (plus or minus 19) for the dogs who had rested.


A Labrador Retriever about to catch a tennis ball


The researchers took measures of heart rate, which differed between play/rest sessions as you would expect, but otherwise was the same for both groups of dogs. They also found that salivary cortisol was lower after the play sessions, which they found surprising (if you’re interested in salivary cortisol research, see this post by Julie Hecht).

19 Labrador Retrievers, aged between 1 and 9 years old, took part. The study focussed only on purebred Labrador Retrievers so that breed could not affect the results. Their prior training levels were also taken into account and evenly distributed across the two groups.

This turned out to be important, because the ‘experienced’ dogs who had previously taken part in cognitive tasks like this learned the task much more quickly. The gundogs need more trials, perhaps because they had previous experience of following human cues in the field, which didn’t happen in the lab. Some of the dogs were ‘naïve’ and had only basic obedience, did not work or participate in trials, and had never taken part in similar research before.

This shows it is important to take prior training experience into account when designing canine research studies.

Three of the dogs had to be excluded (two because of motivation issues, and one because of a preference for one of the objects), so only 16 took part in the full study.

The study does not show the mechanism by which memory is improved, but it is thought to relate to the hormones produced during the play session. However, the play also included exercise, and further research is needed to confirm whether it is play per se or exercise that caused the effect.

The scientists write,
“The results show that engaging in playful activity for 30 min after successfully learning the task improved re-training performance, evidenced by fewer trials needed to meet task criteria 24 h after initial acquisition. This significant difference between the two groups not only suggests that the intervention is affecting long-term memory rather than an improved short-term memory, but also that pleasant arousal post-learning has similar effects on enhancing memory in dogs as it does in humans.” 

This study asked dogs to discriminate between two objects that looked and smelled different. A similar real-life training task is scent detection. Further research to investigate the best ways to improve performance in the training of scent dogs for drug or explosives detection, or in medical testing, could be very exciting.

It’s nice to know another way in which dogs are like people. And next time someone says they’d like to end a dog training session on a positive note, perhaps a game of tug or fetch is in order.

If you're interested in the research on dog training, check out my dog training research resources page or my post about why canine science is better than common sense.

Reference: Affenzeller, N., Palme, R., & Zulch, H. (2017). Playful activity post-learning improves training performance in Labrador Retriever dogs (Canis lupus familiaris) Physiology & Behavior, 168, 62-73 DOI: 10.1016/j.physbeh.2016.10.014
Photos: dezi (top) and Dmussman (both Shutterstock.com)...




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Rubber Bands, Yoga Mats, and Trial Meeting Error

bigstock-128742473“Snap a rubber band,” a well-meaning counselor advises.

“Practice mindfulness. Don’t interfere with the intrusive thoughts when they strike,” a well-intentioned doctor counsels.

“If you expose yourself to the screaming thoughts, their intensity will slowly fade,” a seasoned practitioner recommends.

Feeling overwhelmed? That makes two of us.

As mental health consumers, we seek answers for the whirring madness in our minds. We limp to psychologists and psychiatrists, stockpile the latest self-help books, and embrace the latest diet fads. If I just follow the Atkins diet or Paleo diet or the Raw Food diet, the blaring thoughts will subside. Right?

But, I suspect, we are torturing ourselves–and our mental health. In our frenzied search for everlasting relief, we are muddling our already overtaxed minds. Our desperation is our biggest asset–and albatross.

A mental health consumer, my counselors have shepherded me through some of life’s biggest challenges. I am grateful for their friendships and wisdom. They have — and continue to be — mentors. But over my sixteen years of counseling, I have received divergent and, at times, contradictory advice.

My mind rattles; should I embrace mindfulness or challenge the pulverizing thoughts? Should I journal out the distressing thoughts, exposing them as bullying imposters? Maybe I should distract myself, burrowing into a favorite book? And the mind prattles on, brooding over counselors’ tips and tricks.

Information overload right?

As the latest self-help techniques whiplash through your mind, here is where I am supposed to provide sanguine advice for those spinnin’ heads. Yes, I may write a Psych Central column and, yes, I understand the paralyzing thoughts and feelings. But before dispensing any advice, I want to acknowledge your own wisdom and resilience against numbing depression and churning anxiety. You — yes you — are a skilled counselor, navigating your mind’s treacherous terrain with grace, vision, and perspicacity. But, in a cruel twist, that insatiable drive for more–treatment tips, counseling appointments, and medical diagnoses — results in less. As the thoughts flood your synapses, you cling to anything (Paleo diet? Oprah’s latest self-help book?) for mental tranquility. Your doggedness, though, reeks of desperation — not determination.

A serial overanalyzer and endless perfectionist, I understand your drive — and how it is driving you over the edge. Like you, I have questioned whether I am employing the “right strategy” or am really “getting” mindfulness. Second, or even, third-guessing your counselor, you feel besieged, even helpless, as the thoughts batter you into submission. “Mindfulness? But what about meditation? And my counselor keeps mentioning my diet. Well, maybe I will mindfully meditate about my diet,” you grumble — sarcasm dripping down your chin.

Here comes counsel, not another counselor. The advice: focus on what you do best–and sharpen that skill to a razor’s edge. If meditation foils the stomach-churning anxiety, embrace your inner yogi. Over and over again. After years of trial and more error, I now take an active role when the depressive thoughts plunge me into a blue abyss. I challenge their veracity, slowly unlocking the one-time stranglehold on me.

Yes, we all want a life raft when that inevitable blue wave threatens to topple us. But, first, we must build our own.



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When is it Neglect and When is it Something Else?

portrait of young man holds his hands over his ears not to hearLike most therapists, I regularly listen to clients who report what on the face of it seems like criminal assault, abuse or neglect of themselves or others in the family. As a mandated reporter, I am confronted with the dilemma: To report or not to report to protective services.

Ah, that indeed is a question. It is an important part of our job to protect the vulnerable. But we need to take exquisite care that in our effort to be responsive and responsible guardians of the innocent that we don’t inadvertently put a family through an investigation that is at best disruptive and at worst traumatic for all involved.

For the purpose of this article, I’m going to limit this discussion to instances of suspected neglect. The literature makes a distinction between two categories of neglect: active and passive.

Active neglect is when adult caregivers actively withhold care from their children or elderly or disabled people in their care.

Passive neglect is when caregivers are too overwhelmed, ill, burned out or impoverished to provide needed care. In both types of cases, a vulnerable person is being harmed. In both types of cases, reporting to protective services is mandatory and essential.

To those two categories, I add what I’m calling “counterfeit” neglect (with a bow to David Hingsberger who coined the term “counterfeit deviance”).

Like counterfeit money, counterfeit neglect looks like the real thing. But, on closer examination, “counterfeit” neglect is when something that at first looks like neglectful conduct on the part of caregivers is in fact behavior that is because of challenging family circumstances, family beliefs that are different from the norm, ignorance or is a self-protective response to negative experience with the “system” (a school, government agencies or government programs).

Note, please: Unlike counterfeit money, counterfeit neglect is not a result of an attempt by caregivers to deceive or manipulate others. It’s simply a look-alike.

In all cases of suspected neglect, it’s crucial that we not overreact to a situation we may not completely understand. Being too quick to report can permanently disrupt treatment, damage relationships within a family or negatively affect the willingness of the family to get the treatment or services they need.

Calm, respectful questioning can surface what is really going on in the family. If the problem isn’t neglect but the outcome of trying too hard to do too much with too little help, information or resources, we can be of enormous service to a family by supporting them in their efforts to do the best they can and to exercise their parental and/or legal rights. When appropriate, we can help them navigate the daunting service system.

Types of Counterfeit Neglect (the appearance, not the reality, of neglect): To protect privacy and confidentiality, these examples are fictionalized accounts.

Ø  Poverty: A teen at a program where we both volunteer liked to talk to me. She was always clean and neat but her clothing was tattered. She needed a haircut. She complained that her mother made them the same pasta dinners all the time. Other volunteers, well-intended middle class women, wondered if the teen’s mother should be reported to child protective services for neglect. Was the girl being neglected?

No. The family was struggling. They were doing the best they could with limited resources. They were barely able to provide the basics but they did do that. The mom was feeding her kids a diet that wasn’t creative but was adequate and she was clothing her kids from the local thrift stores. Basic is good enough – especially in a home that is a loving one.

Ø  Fear: The local senior center reported a family because their client was coming to the center with bad body odor. Although she lives with her daughter, the elderly woman is legally competent. When the center’s director asked why her mother wasn’t clean, her daughter explained that her mother didn’t like to bathe and would throw things at her if she tried to get her to do it anyway.

Her mother is a lot stronger than she looks! She was afraid her mother would hurt her if she insisted.

This is not reportable to protective services. Although the daughter is providing care, she is not a “caregiver” of a competent adult. Competent adults have the right to make poor choices – like not taking regular showers. (If the mother was not legally competent, it would be reportable).

In this case, the central issue is helping the daughter (who is otherwise providing fine care) manage her mother when she becomes aggressive.

Ø  Family Values: One family I know home-schools their kids and only lets them play with children who go to the same church. They believe it important to shelter their children from beliefs contrary to their own while they are young.

“I don’t want their heads filled with different ideas in school”, the father told me. “When they are older, they can make up their own minds.” Are they being neglectful by limiting their children’s social involvement to people like themselves? I don’t think so. Lack of diversity in kids’ playmates isn’t neglect (although it may be unfortunate). These parents are exercising their right to parent in a way that is true to their values.

Ø  Lack of information: One cold winter day, a neighbor of a rural family (single mom with disabled daughter) called the agency where I worked because she was concerned. When she had gone over for a visit that morning, the heat in the home was set to 50. The family was coping with the cold by wearing layers of clothing and huddling under blankets.

When a social worker went to see the family, she found that circumstances weren’t dire enough to report neglect of the disabled girl. The home was cold but not freezing. They did have a woodstove in one room and sufficient wood stacked out back to keep that room reasonably warm. Why was the heat set so low? The mom had become so discouraged in her attempts to navigate getting fuel assistance that she had given up. She hadn’t known who to call for help.

Ø  Negative experiences with the system: A family was reported to protective services sometime in the past. Although the case was unsubstantiated and social workers tried to be helpful, the family is now scared to death that the person in their care will be removed if they let anyone who represents the “system” in their door. They therefore continue to live more marginally than they would if they accepted more services. It is now up to the helpers (case workers, teachers, doctors, etc.) to work hard to reassure them and encourage them to accept the help available.

Exhaustion: An exhausted parent might fall asleep when he or she should be watching their kids. An overwhelmed parent might sit down and cry instead of making a hot meal for dinner. A frustrated caregiver of a disabled adult might yell something inappropriate. All the therapist hears (perhaps from an angry relative or a well intended neighbor) is that Mom or Dad didn’t supervise the kids or make dinner or that a caregiver is mean.

There is a fundamental difference between someone who is neglectful and someone who dropped the ball once or twice. Let’s remember that parents and caregivers are human, often doing superhuman work. A mistake where no appreciable harm was done can be the wake-up call an adult needs to do better self-care while taking care of others. Our job is to support those efforts.

Related article:  Neglect: The Quieter Abuse



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The Dilemna of Having Large Student Loans & Waiting to Start a Family

I am 26 years old. I am starting to worry about my financial future, as I have graduated with $85,000 in student loans. I am worried about retirement savings and I am worried about my short term future. I am worried that it would be irresponsible for me to get married and have children when I am in debt. The majority of my loans are private, so repayment plans are at a minimum. I have calculated that even with accelerated payments, that I can only be debt free within 10 years with my current salary. That’s 10 more years of living at home, no room for savings, and delaying the family that I know I want. I want to know if it is smart to think of these rewards when I have the burden of debt hanging over me? I know that my priority is to eliminate the debt as fast as possible, but I can only do so much and I am scared that 10 years is too long of a time to wait for a family.

A. You’re not alone in your concern about student loan debt. It is a top concern among American college students. The average student has approximately $30K in student loan debt, and many people have much more than that. This puts young people in the increasingly common predicament of having to live with their parents much longer than they had planned. These circumstances force many people to rethink their plans about their futures.

Obviously, you will have to pay back your student loans, but I’m not sure if it needs to come at the expense of delaying your plans for a family. You should explore your refinancing options. You might also consider extending your debt payoff time frame from 10 years to 15 or 20. There are likely other potential options to explore as well.

It would be helpful to consult a financial advisor and or thoroughly research your options. There are many good websites that can help. You might also discuss your concerns with a therapist. It’s always wise to consult a specialist when planning your future, financially or otherwise. Please take care.

Dr. Kristina Randle



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Marriage Mentors Are Everywhere

MentorWhen it comes to marriage, I cannot overstate the value of mentoring. If you were blessed to have grown up with happily married parents who communicated well, you probably learned, as though by osmosis, how to become happily hitched. Your live-in mentors paved the way.

But what if you grew up with parents who stayed together unhappily or divorced? Or if you were raised by a single parent? Typically, couples who see me for therapy grew up without viewing a healthy marriage. For them and for others desiring a happy, lasting union, good mentoring can fill the gaps.

Even if your parents were relatively happy together, their way might not be your way. Societal changes in recent decades include most women’s ability to support themselves financially. Consequently, many more of us require a more egalitarian, collaborative relationship than was the norm while we were growing up.

Adopting Realistic Expectations

A good marriage mentor helps you develop realistic expectations. My parents, of blessed memory, were divorced when I was thirteen. Before then, my father wasn’t home much. When he left for good, my mother felt abandoned. Her friends were unhappily married, divorced, or single.

So what I learned about marriage was not to expect a man to stick around. What I learned elsewhere came from fairy tales and romantic novels, which implied all you have to do is find a perfect specimen of a man to fall in love with, marry, and live happily ever after with, but with absolutely no effort on your part as he’ll do everything you desire to please you without your having to say a word about what you want because he is so good at reading your mind.

When an imperfection surfaced in a man I was dating, he was out of the picture. I pined after men I thought were perfect because I thought it was love when, actually, I was loving a fantasy. These men never let me get to know them well enough to see them as real people with vulnerabilities as well as strengths. For years this worked out okay. I got to complain to my friends about how sad it was that the men I liked didn’t want to become serious. I got to avoid getting married and having it not work out and becoming unhappy.

I’ve benefited from many mentors before and after I married. Most of them may have no idea of their impact on me, because mentoring can be subtle. It can happen through an overheard off-hand remark. Someone might toss advice your way and not find out whether you took it. Here are examples of two of my very helpful mentors.

You might be surprised to learn that my first mentors were my therapy clients. Despite my own struggle to get past my obstacles to marrying, or perhaps, unconsciously, because of it, I trained in and developed expertise in couple and family therapy.

Finding Good Role Models

A couple I saw early in my career as a therapist made a profound impact on me. They came in initially because the husband’s binge drinking was affecting their relationship. The wife, at first, had difficulty expressing her feelings. After some time, she told me privately that she learned that the best time to talk to her husband about something important was when they were in bed after having sex, because both of them felt comfortable and receptive.

I learned two important things from this couple: First, that it’s important it is to continue to have sex regularly with a spouse in order to stay connected emotionally as well as physically. And also to communicate positively about anything that might be preventing either spouse from wanting physical intimacy.

My second lesson from them occurred one time when I saw them together and my eyes welled up in tears because I was moved by their strong connection. They were learning to support themselves and each other. They continued with therapy to keep improving their relationship. I never saw this kind of caring and devotion in my parents. I’m grateful to them for showing me that is possible for spouses to remain loving and loyal while living through the ups and downs of marriage and life.

Developing Realistic Expectations

Another role model for me was a board member I’ll call Linda, with whom I developed a friendship when I was executive director of a family service agency. Linda, a physician, was happily married with two small children. She told me how she met her husband at a party, they dated, and became serious. I’m not ‘in love’ with him,” she said; “I’m very fond of him.”

Wow! Fond? Not madly in love? That was a new concept for me, which took a while to grasp. I suppose that “in love” means different things to different people, so it may be a matter of semantics. But I learned that really liking someone and being comfortable being myself with him was much more important than having the “crazy in love feeling,” with the emphasis on crazy because confusing that condition with true love is a big mistake.

Although I was quite high and in a somewhat dazed state after getting engaged, but truly the basis of it all was that I really enjoyed David’s company in a way that I felt grounded in myself rather than swept off into a fantasy.

Mentors are Plentiful

In case you’re wondering where to find mentors, here are some ideas:

  • at your synagogue, church or other place of worship;
  • in groups or organizations;
  • at work;
  • among friends and acquaintances;
  • in a therapist or other professional counselor.

By keeping your eyes and ears open, you can find mentors just about anywhere. Notice couples who laugh and speak kindly to each other. If you admire a trait or behavior in someone, you can try to emulate it. Maybe you’ll ask them questions; maybe not.

Here’s a simple example of how a therapist can also be a valued mentor who helps you replace marriage myths you might be holding onto with more realistic expectations:

A wife complains to me that her husband doesn’t talk about his feelings. When I tell her that while there are exceptions, men, in general, have a harder time doing this than women. I’m helping her to improve her outlook. She’s likely to start accepting him as a normal man, instead of judging him as “unfeeling.” This change in her can foster a better relationship in which her husband becomes more comfortable sharing more of himself with her than before.

Mentors Want What’s Best for You

Your mentors are on your team. They want you to succeed and be happy.

Still single when I left my job at the family service agency, I hadn’t seen Linda for many years, not until my husband and I attended the agency’s big seventy-fifth anniversary celebration. She was thrilled to meet my husband and learn that we’d become parents.

“I’m glad you found your prince,” she said.



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Restless leg syndrome in parents of children with autism

The findings reported by Maureen Russell and colleagues [1] provide some blogging fodder today and the observation that: "Biological caregivers of children with ASD [autism spectrum disorder] demonstrated a high prevalence of RLS [Restless Legs Syndrome] symptoms and poorer mental health."OK, I know some people might be asking 'just what is Restless Legs Syndrome'? It is a recognised condition complete with 'disease' title (Willis-Ekbom disease). Symptoms, as the name suggests, centre on 'an overwhelming, irresistible urge to move the legs'. But things might not just stop at 'jittery legs' when it comes to this condition, as various other parts of the body can also be involved and indeed, affect important functions such as sleep.Russell et al surveyed 50 biological caregivers (parents) of children diagnosed with an autism spectrum disorder (ASD) with regards to sleep habits "that included RLS as determined by four questions." They also "compared the sleep quality and daytime behaviors of children with ASD in caregivers with and without symptoms of RLS."They observed that just over a fifth of their caregiver cohort "fit the criteria for RLS symptomatology." They also reported that those 'biological caregivers' who reported RLS symptoms also reported "poorer mental health" based on responses to the "Medical Outcomes Survey (MOS) 12-Item Short Form (SF-12)." When it came to offspring parameters, authors reported that: "Caregivers with RLS described more night waking and greater internalized behavior problems in their children with ASD than the caregivers without RLS." They interpret this 'association' in the context that there is a degree of heritability attached to RLS and some of those sleeping issues noted in offspring could mean that the symptoms of RLS are also present in children diagnosed with ASD too.Noting the relatively small scale of the Russell study in participant number terms, the very preliminary method of reporting on mental health and the fact that there isn't a single test for RLS, these are interesting findings. I note the lead author has her PhD online (see here) showing how this research fits into a larger scheme of work on sleep and quality of life in caregivers of children with autism.Looking at the Russell findings in the context of 'hows and whys' there are some potentially important correlations that might be noteworthy. RLS has been linked with the presentation of attention-deficit hyperactivity disorder (ADHD), a not insignificant comorbidity noted in quite a bit of autism (see here). I don't want to make any connections where none might exist but it is reasonable to assume that an over-represented occurrence of ADHD in autism could be important. Insofar as the heritability of ADHD specifically across families, there is more to do in this area but it's not unheard of for ADHD symptoms to be present in other family members including parents. This could impact on the results reported by Russell et al.Although certain medicines have been associated with the symptoms of RLS, there is also a body of peer-reviewed science suggesting that a deficiency in iron might also be important [2]. There is still a degree of debate specifically as to how iron deficiency might 'cause' RLS but one of the primary lines of thinking revolves around how iron is an important co-factor for the biological reactions that turn the amino acid tyrosine [eventually] into the neurotransmitter dopamine. Again, minus any 'I know all the answers' sentiments, iron levels in relation to autism have been a source of some investigation down the years (see here). Some researchers have also talked about maternal iron intake potentially affecting the 'risk' of offspring autism too (see here) (with appropriate caveats).Whatever the reason(s) to account for the Russell findings, there is a requirement for further research in this area, for a start to assess just how prevalent RLS might be in both people diagnosed on the autism spectrum and their significant others. Knowing how much comorbidity seems to follow a diagnosis of autism (see here) I wouldn't be surprised to see yet another connection; this one however, might provide some rather important clues as to overlapping genetics and biology...Music, and Gotye still has an amazing song...----------[1] Russell M. et al. Symptoms of Restless Legs Syndrome in Biological Caregivers of Children with Autism Spectrum Disorders. J Clin Sleep Med. 2016 Oct 28. pii: jc-00043-16.[2] Li X. et al. Brain iron deficiency in idiopathic restless legs syndrome measured by quantitative magnetic susceptibility at 7 tesla. Sleep Med. 2016 Jun;22:75-82.----------Russell M, Baldwin C, McClain D, Matthews N, Smith C, & Quan SF (2016). Symptoms of Restless Legs Syndrome in Biological Caregivers of Children with Autism Spectrum Disorders. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine PMID: 27855729...

Russell M, Baldwin C, McClain D, Matthews N, Smith C, & Quan SF. (2016) Symptoms of Restless Legs Syndrome in Biological Caregivers of Children with Autism Spectrum Disorders. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. PMID: 27855729  




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From molecules to society.

From Hill et al.:

 Highlights
•Common SNPs (single nucleotide polymorphisms) explain 21% of social deprivation and 11% of household income 
•Two loci attained genome-wide significance for household income 
•Genes in these loci have been linked to synaptic plasticity 
•Genetic correlations were found between both measures of SES and many other traits
Summary
Individuals with lower socio-economic status (SES) are at increased risk of physical and mental illnesses and tend to die at an earlier age. Explanations for the association between SES and health typically focus on factors that are environmental in origin. However, common SNPs have been found collectively to explain around 18% of the phenotypic variance of an area-based social deprivation measure of SES. Molecular genetic studies have also shown that common physical and psychiatric diseases are partly heritable. It is possible that phenotypic associations between SES and health arise partly due to a shared genetic etiology. We conducted a genome-wide association study (GWAS) on social deprivation and on household income using 112,151 participants of UK Biobank. We find that common SNPs explain 21% of the variation in social deprivation and 11% of household income. Two independent loci attained genome-wide significance for household income, with the most significant SNP in each of these loci being rs187848990 on chromosome 2 and rs8100891 on chromosome 19. Genes in the regions of these SNPs have been associated with intellectual disabilities, schizophrenia, and synaptic plasticity. Extensive genetic correlations were found between both measures of SES and illnesses, anthropometric variables, psychiatric disorders, and cognitive ability. These findings suggest that some SNPs associated with SES are involved in the brain and central nervous system. The genetic associations with SES obviously do not reflect direct causal effects and are probably mediated via other partly heritable variables, including cognitive ability, personality, and health.


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Helping Clients Eliminate Cognitive Distortions

 

11In my 40 plus years of being in the field, the one thing that strikes me is how clients come to therapy lacking in some basic life skills. Even the most successful and accomplished client often needs some education on basic life skills such as to how to manage stress, how to deal with anger, and how to communicate assertively without lapsing into non-assertion or aggression, to name a few.

It became clear to me as my career progressed that as therapists we have an obligation not just to listen, not just to support – but to educate!

It is often thought that teaching clients is telling them what to do – but this is far from the case! Teaching does not mean telling! Rather, using learning tools such as handouts, worksheets, role playing, visualization, experiential activities and mini-lessons, mental health professionals are in a unique position to offer clients the “how tos” of making changes.

Teaching life skills offers strategies that are not generally learned in school or even in life – especially for clients who are not raised in emotionally validating environments. This proactive approach empowers clients with tools for life, and helps them experience change constructively. Beyond talking is “doing” and you can offer clients opportunities to experience and try out new behaviors, thoughts and skills.

With this premise of the importance of psycho-education, each week in this blog, I will offer a life skill and a handout, worksheet and/or activity that you can use with your individual or group clients.

One of the most important life skills I have taught clients over the years is the “how tos” of eliminating cognitive distortions. Based on the works of CBT notables such as Aaron Beck and David Burns, the ability to eliminate cognitive distortions has literally changed some clients’ lives. Limiting cognitive distortions help clients stick to the facts, not their interpretations. By identifying their types of cognitive errors, they are more able to replace unhealthy thinking with more helpful and rational thoughts.

In this link is a worksheet on Cognitive Distortions – This is by no means an all-inclusive list, but it offers clients a taste of common types of distortions and helps them be more objective about their ways of thinking.

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Often in my counseling session, when my clients say something that reflects distorted thinking, I stop them to ask them what type of distortion that statement reflected. As time goes on, they become better at identifying the type of distortion, and with this objectivity, are more easily able to replace their erroneous thinking with more constructive thinking.

For homework, I often have my clients use David Burn’s Triple Column Technique, which is to write their erroneous thought in the first column to an outside trigger, then in the second column identify the type of distortion, and then in the third column write the more rational response.

 

I also like to use acronyms to help clients remember important life skills. Using acronyms for breaking down cognitive distortions makes it “user-friendly” and employs humor. Elisha Goldstein writes in his book, Uncovering Happiness, of how to Crack the NUTS – Negative Unconscious Thoughts. Aaron Beck refers to identifying the ANTS – Automatic Negative Thoughts. I made up this worksheet to help clients use these acronyms.

http://ift.tt/2fBeOWA

Using worksheets such as these with your clients will offer your clients life sills learning to last a lifetime of thinking straight to feel great!

I welcome comments and suggestions on what you do to help clients improve their ability to eliminate cognitive distortions!

 



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A Hypothesis on Autism Spectrum Disorder and the Benefits of Solitary Life

Could autism spectrum disorder be related to the hunter-gatherer type of personality? Could natural evolution have purposely selected autistic characteristics to be part of the human gene pool as a necessary part of our society? This is a possibility. Read the article by Jared Edward Reser in the Evolutionary Psychology Journal. Here is a link to free access to the article.

A copy of the abstract is below:

Abstract:
This article reviews etiological and comparative evidence supporting the hypothesis that some genes associated with the autism spectrum were naturally selected and represent the adaptive benefits of being cognitively suited for solitary foraging. People on the autism spectrum are conceptualized here as ecologically competent individuals that
could have been adept at learning and implementing hunting and gathering skills in the ancestral environment. Upon independence from their mothers, individuals on the autism spectrum may have been psychologically predisposed toward a different life-history strategy, common among mammals and even some primates, to hunt and gather primarily on their own. Many of the behavioral and cognitive tendencies that autistic individuals exhibit are viewed here as adaptations that would have complemented a solitary lifestyle. For example, the obsessive, repetitive and systemizing tendencies in autism, which can be mistakenly applied toward activities such as block stacking today, may have been focused by hunger and thirst toward successful food procurement in the ancestral past. Both solitary mammals and autistic individuals are low on measures of gregariousness, socialization, direct gazing
, eye contact, facial expression, facial recognition, emotional engagement, affiliative need and other social behaviors. The evolution of the neurological tendencies in solitary species that predispose them toward being introverted and reclusive may hold important clues for the evolution of the autism spectrum and the natural selection of autism
genes. Solitary animals are thought to eschew unnecessary social contact as part of a foraging strategy often due to scarcity and wide dispersal of food in their native environments. It is thought that the human ancestral environment was often nutritionally sparse as well, and this may have driven human parties to periodically disband.
Inconsistencies in group size must have led to inconsistencies in the manner in which natural selection fashioned the social minds of humans, which in turn may well be responsible for the large variation in social abilities seen in human populations. This article emphasizes that individuals on the autism spectrum may have only been part
ially solitary, that natural selection may have only favored subclinical autistic traits and that the most
severe cases of autism may be due to assortative mating.
image credit: mizina via Fotalia


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5 Tips for Shopping with a Child with Autism Spectrum Disorder

The holidays can be a challenging time for all families and particularly families with a child with autism spectrum disorder. Autism brings a particular challenge to the family dynamics. Although autism has its beauty and each individual with autism (or without) has their own unique personality, strengths, and potential. However, during the holiday season, families are often likely to desire to go to the store to shop for food or for gifts or simply to get out of the house. The holidays also seems to increase the chaos in public settings unlike other times of the year.

The holidays are beautiful, but certain challenges can arise during this time of year.

Here are 7 tips for shopping with a child with a diagnosis of autism spectrum disorder.

  1. Plan ahead for basic needs. Make sure to address any basic needs such as if your child may be tired, hungry, or thirsty prior to going to the store. Behavior problems will be less likely to occur if you address these concerns prior to going into a store.
  2. Provide praise for positive behavior. Children with autism may walk away from you in the store if they get distracted by something and want to look at something they are interested in, they may complain or they may display a number of other undesired behaviors. When your child is NOT displaying these negative behaviors, provide praise by saying things like “I love you. Thank you for standing next to me.” or “I really appreciate you keeping your voice calm and kind.”
  3. Provide reinforcement for a positive shopping trip. Make sure that what happens right after the shopping trip is a positive experience for your child. What happens right after a behavior is what will influence whether it does or does not happen again. For example, let your child have some electronic time or a special treat.
  4. Ignore non-harmful inappropriate vocalizations. When your child complains or nags you about something, just simply ignore his statements, especially if you know you have already addressed the topic with him before. For example, if he wants to get into an argument with you about why you are saying you won’t buy him a toy, simply don’t respond to the statment or you can provide a very brief reminder, such as “I will not be buying toys today.” and keep your statement brief and very calm and do not engage in the argument. Repeat yourself if you prefer not to ignore him. But make sure you don’t give in. They need to learn that you mean what you say.
  5. Give your child opportunities for success. If you know it is very difficult for your child to go to the store, find ways that he can be successful, such as going to the dollar store (a smaller store compared to a large department store) or go during times when there will likely be less people. You can also take much shorter trips at first to help your child get used to going to stores. Kids need to experience success in order to practice their skills just like anyone else so they don’t give up on this everyday life skill.

image credit: : Alena Yakusheva via Fotalia



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Tuesday 29 November 2016

8 Surprisingly Simple Ways to Manage Anxiety at Work

*Head desk*

I have an anxiety disorder.

I have always had one. My mom says when I was a baby I would freak out for no reason and just start wailing. Not a lot has changed since then, to be honest, except now I am medicated, have a good therapist, and no longer require someone else to see to my peeing and pooping needs.

What It Feels Like To Have Anxiety And Depression At The Same Time

I still have my moments, but for the most part, I have learned how to manage my anxiety.

Let us pause here and do a little dance of celebration — Done!

There are still times when my anxiety gets the best of me. Usually it involves large groups of people or other high stress situations. And there’s nothing more high stress than work, even if you have a job that you love (hi boss!).

I’d like to share with you some tips and tricks I have found helpful for those moments anxiety at work threatens to overtake you.

Let’s DO THIS.

  1. Get Away from Your Computer.
    For most us, our workdays consist of sitting in front of our computers, barely blinking, let along getting up to move.

    I have found that it’s really helpful to set a timer for myself so that at least once an hour I get up and walk around. Go for a walk around the block, or, if your workspace doesn’t allow this, go for a walk around the building.

    Even just getting up and walking around your office can be the physical and mental outlet you need to let some of that stress and anxiety burn off without sending you into a spiral.

  2. Try Gentle Stretching.
    As awesome and getting up and moving is, sometimes we have days where this is almost impossible. We’ve got back-to-back conference calls or a deadline we have to meet. This is when doing stretching at your desk can be THE BEST for managing anxiety at work.

    My favorite exercise is this: look at the top left corner of your computer, look at the top right corner of your computer, look at the bottom right corner of your computer, look at the bottom left corner of your computer. Let your neck and head move slowly while you do this. It’s a gentle, easy stretch that immediately relieves that tension scowl we all get from staring at a screen for too long.

  3. Communicate with the People Around You.

    As a person with an anxiety, sometimes it feels like if I don’t express what’s going on inside me verbally like I am going to implode.

    If you feel this way at work it’s important that you have a work friend you can talk to. I’m not talking about someone you sit and bitch about work with (I think that’s negative and unhelpful for you both). Instead, what I mean, is don’t be afraid to communicate about whatever is giving you anxiety at work.

    Sometimes just saying “I’m scared I won’t get this done by five,” out loud can relief just the amount of pressure needed to help you get through your day.

  4. Drink All of the Water.

    This might sound hokey, but water and hydrating our bodies in general is so often the cure for what ails you. I’m not saying that water is going to magically heal you of your anxiety (because that is bullshit), but I do know that drinking a lot of water will keep you feeling centered, healthy, and make it easier for to concentrate on the task at hand without blowing your stack.

    If you’re an anxious person, taking care of yourself can so easily go by the wayside. Evaluate what your body needs.

    When did you drink water last? When did you eat last? Do you have a headache? Make sure you’re at your physical best and the mental best will follow suit.

    19 Quotes For When Anxiety Feels Completely Overwhelming

  5. Check in with Your Breathing.

    This one makes sense given number 4. Sometimes at work when I find myself on the verge of a total panic attack and I don’t know why, I realize that my mouth is pinched shut tight and that I’m taking rapid short breaths in and out like a furious little bull.

    If you are feeling anxious, check in with your breathing. Try circular breathing (in through the nose out through the mouth). Imagine your body as an empty bottle, and that each breath you are taking is like water pouring in from the bottom of your belly all the way up. Man, I got all chilled out just writing that.

  6. Make Yourself a List.

    This here is one of the oldest tricks in the book. If you are feeling overwhelmed and fearful, take the simple step of setting a list for yourself.

    When you have the physical list, you’ll find managing one task, and crossing it off gives you back the feeling of control that anxiety strips from you. Sure, anxiety is a bitch, but it’s also pretty stupid and easy to fool if you have the right tools.

  7. Take a Five-Minute Meditation Break.

    There’s taking a break to go to the bathroom, and taking a break to eat your lunch, why shouldn’t there be taking five minutes to reset yourself with meditation?

    You don’t need to be a professional guru, you can just do the circular breathing we mentioned above. Taking time out to pro-actively send a message to your brain that it’s time to relax and refocus can work absolute wonders.

    Of course it won’t always do the trick, but setting up the practice is another form of self-care that can be so beneficial in the long term.

  8. Remember That It’s a Cycle

    When I’m in the thick of my worst anxiety, it feels like it’s never going to end. Here’s a thing to remember: it will, it’s going to end. You aren’t going to feel like you are dying forever.

Anxiety isn’t all of who you are, it doesn’t have you, you have it. You’re going to be okay, even when it feels like you won’t be. You just have to keep fighting, and keep treating yourself with respect. I believe in you, and so do all of the people who love and admire you.

You got this!

This guest article originally appeared on YourTango.com: 8 Low-Key, Totally Do-Able Ways To Manage Anxiety At Work.



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Trouble with Father of My Child

From the U.S.: I am a single mother of a three year old having some trouble with my ex-fiance and the father of my child.

I left my ex-fiance two years ago after I came home from work to find my child starving and my ex passed out because he was drunk. My daughter hasn’t been fed all day long, and how I could tell is because all of the breast milk left for her was still in bottles in the same spots I left them in the refrigerator. My ex lied to me, saying he fed her an apple which we did not have in the house.

Needles to say he was gone the next day out of our house. I told him to get his life together and seek help for his alcoholism if he wanted his family back. Instead he got an apartment, a girlfriend, and drank even more, flaked out on his days to watch her (which were only a few hours at a time since I didn’t trust him), not to mention steal money from and claim he accidentally took it out of our conjoined bank account.

Fast forward two years he keeps trying to act like he is a father and demands my daughter to spend the night with him because he wants things fair. He pays no child support, does not do anything for our daughter or try to help support her in anyway. He claims he wasn’t ready to be a father before and that I should forget and move on.

I don’t know if I am doing the right thing by keeping her away from him or if it’s just me reflecting my resentment and anger at him for putting our daughter in danger multiple times. When my daughter requests him then I facetime him or set up a day to bring her to him but other than that I don’t want her to be in contact with him until she is old enough to decide if she wants a relationship with him or not.

He is a master manipulator and has a way of getting under my skin and guilting me into doing things for him.

I just don’t know what to do anymore.

A: Being a father is about more than biology. It is a responsibility! You were absolutely right to leave the relationship. He wasn’t taking responsibility then. He isn’t now.

If he wants things to be “fair”, he needs to man up and provide financial support. He needs to win your trust, not demand it.

If he pays a reasonable child support regularly and without whining for a year, then maybe you can consider whether to encourage a relationship with your daughter. I’d start with limited time with you there to see how he handles taking care of a toddler. And, no, it’s not okay for him to involve his girlfriend. He needs to show you he can take good care of a child without relying on someone else.

Don’t let this guy guilt-trip you. From what you wrote, it sounds to me that he is more interested in “winning” an argument with you than loving his child.

I wish you well
Dr. Marie



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Reason, Season, Lifetime: Accepting Impermanence in Relationships

Couple Standing Back To BackIt has been said that people enter our lives for a reason, a season or a lifetime.  

  • Reason (a project or one time activity, a “guardian angel” encounter when someone steps in and moves you out of a dangerous situation, a fleeting/swoop by lesson)
  • Season (a short term; perhaps a few months or years, interaction that teaches you lessons that you may not have learned otherwise.)
  • Lifetime (long term connections that may begin at birth or anywhere along the timeline, that endures, perhaps despite challenges, or may even strengthen thus)

The reality is that one day someone will die or leave you, or you will die or leave them. Sound morbid or maudlin? It need not. Instead, it calls for an awareness of the precious and often-times fleeting nature of relationship.

It begins with a desire for connection. According to scientist, Matthew Lieberman, the author of Social: Why Our Brains Are Wired to Connect, we are social creatures with an inherent need to engage with others.

Everyone you now know and love was once a stranger. When you gaze back over your timeline, can you recall a time when many of these people were not in your life? Some have been with you for so long, that it might be unimaginable.

Sara shares her experience, “Throughout his life my son would look at me puzzled when he would see me smile or greet ‘strangers.'” He would ask, “Do you know that person?” When I would respond, “Not yet,” he would continue, “Then why are you saying hi to them?” My answer was always, “Because they are in my world.”

Continuing, “How sad it would be to have missed the opportunity to connect with certain people who grace my life and how rich I am to now know and love them. It is hard to imagine what it was like before they stepped on stage. I have had fleeting encounters with folks whose smile or comment have made my day. I have lifelong relationships that I treasure. I anticipate connecting with anam cara (Gaelic for soul friend) as each day I set an intention for having extraordinary experiences and meeting amazing people.  And each day I do.”

“Walking through my door will be people I will love for decades and look forward to embracing as new links in those overlapping soul circles that so delight me,” she adds poetically. “I am grateful for my far-flung tribe, wherever it is that they are living and breathing now.”

Many of our interactions seem “meant to be,” or in Yiddish, “beshert.” Consider people who show up in unexpected ways as if scripted. You may have thought how wonderful it would be to have someone help you with a task and within short order, a person crosses your path who is ready, willing and able to be of assistance. A desire arises for a new friend who will engage in fun activities with you and later that day you hear about a meetup in your area that focuses on the very thing that peaks your interest.

Once a relationship is established, you may find yourself taking the person for granted; assuming they will fit into the “lifetime” category. Relationships need to be cultivated and tended to like a blossoming garden. With neglect, they will wither and with loving attention, they will flourish. This is so, whether we are speaking of platonic friendships, family relationships or romantic partnerships.

How to maintain the garden:

  • Keep the lines of communication open. People are not always mind-readers and can only respond to what they imagine you are thinking or feeling.
  • The same behaviors that drew you to each other can be maintained. Keep courting each other with kind and loving words and gestures.
  • Don’t let the fire get doused. Feed it with fun, attention and the fuel that lit it initially.
  • Speak to this person as if they are someone you love and would like them to remain in your life.
  • Start with the ending and imagine that the relationship is over, so that the pressure is off and you can speak the truth about who you are, rather than hiding your shortcomings to make a good impression.  
  • We can think about the concept of, “If I had a year to live, what would I do in that period?” An even more revealing question might be, “What if I knew my parent/child/partner/friend had a year to live, how would I treat them?” Would you be more patient and understanding? Would you spend more time together creating memories that will carry you through the loss?
  • Don’t sweat the small stuff and it is mostly all small stuff. Richard Carlson, the author of the beloved series by that name, had it all going for him. A wonderful marriage to Kristine, two thriving daughters, a solid career as a writer and speaker. On board a plane, headed to New York from California, he had a pulmonary embolism and died on December 13, 2006 at the age of 45. Would you be better able to accept what comes your way if you knew that each breath could be your last?

What happens when the show is over and the curtain comes down on the relationship?

Sometimes, despite your best efforts and that of the other person, the relationship dynamics shift and the person leaves your life either by your choice, theirs, or by agreement. Conscious uncoupling has become a more commonly spoken about concept, with the split between actress Gwyneth Paltrow and Chris Martin; lead singer of Coldplay. How do you maneuver those sometimes-treacherous waters?

It would be understandable to harbor emotions of sadness, anger and resentment in the wake of the loss. Allow yourself to feel it all, but be aware that permitting them to take up residence in your mind, might keep you trapped in a downward spiral. Find supportive people to be on your recovery team as you heal your heart.

Some relationships have toxic qualities (such as abuse, untreated addiction, lying, infidelity, criminal activity) that are better left, lest they pull you down into the abyss. Even if love remains between the two of you, there are times when it is safer to love from a distance.

Remind yourself that you had a life prior to meeting this person and will have one following the changing of the relationship dynamics. Once the relationship completes (as much as any relationship can be fully over), take a pro-active and self-loving stance as you decide who you truly are, outside its structure. Even as it can be a painful process, shedding the layers of who you were with this person, ask yourself who you are without them.

Thank the person, either aloud or in your mind, for the lessons that came as part and parcel of the relationship. There is always a gift in every interaction, even if it might not seem so at the time. Gratitude has a way of easing the pain and smoothing away the rough edges.

Regardless of the ways in which relationships change, be compassionate with yourself and the others involved, to help heal any residual wounds. Honor and appreciate it for what it was as you open the door for even more to enter and enrich your life.



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Depression Rates Highest In These 17 Jobs

There are four things about a job that are likely to make it have high depression rates.

Dr Jeremy Dean's ebooks are:



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The Personality Trait Linked To Doubling Of Heart Disease Risk

How pessimism and optimism independently influence the death rate from heart disease.

Dr Jeremy Dean's ebooks are:



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The Role of Make Believe Play in Adult Life

Funny family! Mother and her child daughter girl with a paper ac“You cannot change the past, but you can change how you feel about the past.”

We often hear how important it is for children to use their imaginations. But did you know you can strategically use imagination and make believe play to manage your emotions and feel better? In fact the use of fantasy is one way trauma therapists heal psychological wounds.

Amazing scientific fact: The brain cannot tell the difference between fantasy and reality. For example, when I imagine I am running, evidence shows my brain reacting in large part as if I am actually running. This helps explain why using imagination and fantasy is a powerful tool for feeling better.

Try this quick experiment:

Slow down by taking 4 or 5 deep breaths. Bring up a vivid image of someone or something you love that brings you joy and peace: church, the beach, your partner or best friend, great food, winning a sports game, your favorite song — anything that makes you smile. Stay with the image and keep sharpening it.

Notice changes in your physical state? Did your breathing or heart rate change? Do you feel warmer? More relaxed? If so, congratulations! You just used your imagination to make something physical happen. To feel better, physically.

While this technique is known to be incredibly helpful to emotional well being, our culture has a bias against adults using fantasy and imaginative play. Some consider fantasizing to be morally wrong – imagining doing something bad for example can be considered taboo — as egregious as actually doing something bad.

One example of the taboo around fantasizing is around sexual fantasies. Almost everyone I have spoken to about sex feels guilty about their sexual fantasies.

What if you could use fantasy without guilt or shame and were free to fantasize both to help yourself feel better and as a substitute for doing hurtful things to others? That’s part of what I (and many other therapists) teach.

Here are 4 ways you can use your imagination to feel better:

1. Imagine a peaceful place to calm down:

When you’re upset, imagine as vividly as possible a serene, comfortable place of your choosing, and breathe deeply. Feel yourself relax. Add sensations to make your fantasy more real. For example, if you’re imagining the beach, smell the salty air and feel the balmy breeze on your skin.

2. Discharge anger by imagining what you feel like doing to the person who angered you. (Parents, this is a great way to help a child who’s angry.)

Your core authentic Self is loving and compassionate. But when anger is triggered, you are overtaken by a specific biological agenda: you want to attack in order to defend and protect yourself! To safely discharge the intense emotional energy in your system, try imagining what your anger “wants to do.”

For example, when I was 4 years old I would sometimes try to hit my little sister when she was getting the attention I wanted. My mother taught me it was absolutely fine to be angry with my sister, but it was not ok for me to hit her. She taught, “we don’t hit people!” She bought me a blow up Bozo the Clown punching bag and told me I could pretend it was my sister and punch it all I wanted! I loved this idea.

I feel tickled even as I remember this 45 years later. My mother — ahead of her time in many ways — knew making me feel guilty would only fuel negative feelings between my sister and me. Providing me an outlet for my imagination turned something toxic into play. My sister remains my best friend.

3. Imagine your very own custom made perfect “parent” to love you exactly as you need.

When you are aware of being upset, try imagining your ideal nurturing figure comforting you in exactly the right way for you. You can choose a real person, a fictional character, God in some form that feels right to you, or even an animal.

The beautiful thing about fantasy is that we don’t need to be constrained by logic. Let this being comfort you. Imagine how their love feels as deeply as you can. If you like hugs (like I do), use your imagination to actually feel being hugged on your skin. Conjure everything you need.

4. Use sexual fantasies to spice up your long-term relationship.

One key to keeping sex exciting (especially monogamous sex) is the use of fantasy and make believe play. Try to put your guilt aside and approach fantasy as you would a blank canvas.

Imagine anything that excites you and bring that energy to your partner. This is far from a betrayal to your partner. It is a loving addition to your relationship that helps maintain your real life human connection.

To sum it up:
Give yourself radical permission to use your imagination in any way that serves you. Experiment! Do more of the imaginative play that feels best. If something doesn’t bring relief, don’t be hard on yourself — just keep testing and playing. Using imagination and fantasy keeps us creative, keeps our brains “in shape,” and — now you know — quite literally makes us feel better.



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5 Tips for Tackling your Spouse’s Narcissistic Family

dysfunctional familyThere are some days when the thought of knocking down a relative or in-law seems tempting. This is especially true following an unforeseen passive-aggressive personal attack. But if this person is a narcissist, they seem to have the resilience of a linebacker who takes the blow just to bounce back up again with even more determination to dominate the next time.

Winning in such an environment feels like a lost cause. Many happily settle for flying under the radar so as to avoid the attacks all together. Or they retaliate with similar passive-aggressive remarks in a game of tit-for-tat. Some even plow through the initial casual remarks with quick aggressive jabs designed to attack first.

Unfortunately all of these are usually met with heavy resistance from the other family members or worse yet a spouse. This can create an environment of isolation and turn the family gathering into them versus me atmosphere. Of course, this is the intent of the narcissist because it accomplished two things: allows the narcissist to remain the center of attention and allows them to play the victim when needed.

But, there is a better way. Here are five suggestions for surviving the next family event:

  1. Do pre-planning. Every winning team knows that one of the key ingredients to being successful is to understand your opponent. Families, both functional and dysfunctional, have a rhythm. Take a moment to step outside of a past gathering and make observations about how the family makes decisions, talks and treats each other and outsiders, has fun, negotiates, and determines who is in charge. What is important to the family: values, morality, religion, logic, feelings, or connection? This is not about finger pointing or trying to alienate one person or idea regardless of the dysfunction. Rather it is about information gathering.
  2. Form a strategy. Timing is everything. Just because a strategy did not work in the past, it does not mean that it won’t work in the future. Be open to all strategies and carefully select the best one depending on the nature of the event and the participants. For instance, in a large family gathering when the conversation gets dicey, ask the narcissist a question about themselves. This simple redirection will keep the person asking the question in good graces and redirect any unwanted negative attention. By doing so some reading on narcissism and understanding what makes them tick, several strategies can be formulated.
  3. Gather the team. The team might be a spouse, kids, or other safe relatives that see the narcissism for what it is. Don’t bother trying to enlighten the non-believers for now, family gatherings are not the place for indoctrination. Rather be intentional in the strategy phase to formulate a plan which gently exposes the narcissism. This is planting a seed for the future upon which more information will be layered for the non-believers. With the team, devise a boundary that can be easily agreed upon and reinforced when overstepped. Then logically share this boundary with the non-believer before the event. Everyone being on the same page in advance will increase chances of success.
  4. Work the plan. It might be necessary during the function to remind the team of the plan. In the case of a boundary being set, one person will have to courageously confront the narcissist when it is violated. Always do this in private first; embarrassing the narcissist in front of others will result in an immediate attack. Prior to the confrontation, inform the team that the boundary has been exceeded so they are ready to provide support after the altercation. This removes the narcissist’s ability to gather support afterwards. Be prepared for a bit of sulking from the narcissist when they realize that others are supporting the boundary and offer a compliment as an olive branch. This will endear the team towards the boundary setting mentality even more and reduce any level of discomfort.
  5. Evaluate the situation. Immediately following the event, review what worked and what didn’t before small bits of valuable information are lost. These nuggets include observations of body language, any eye rolling, withdrawing of a family member, negative self-talk, blatant lies, manipulative behavior, or multiple references to feeling guilty. It might be easier to select one family member at a time and review their spoken and unspoken behavior. This information can be used for recruiting more team members or placing them clearly in the narcissistic camp. Remember this is not about conversion; everyone must come into realization in their own time. Being patient with other’s timing demonstrates love.

While it may seem like this is a lot of work, and it is in the beginning, in the end it is worth the effort. Thinking long-term commitment rather than short-term alliance maintains a healthy perspective and a hopeful outcome.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Couselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.



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Child Psychiatry and Diagnoses in DSM-5

The Problem with Child Psychiatry in DSM-5CCPR: Dr. Frances, please tell us about your background with DSM.

Dr. Frances: I am a psychiatrist. I was chair of the DSM-IV task force. I have been quite critical of DSM-5 and concerned about the fact that too many people in the United States are already getting diagnoses and medicine they don’t need. I am worried that DSM-5 will make that worse.

CCPR: What makes you think that DSM-5 will make that worse?

Dr. Frances: There are a number of new diagnoses that will capture millions of people, and existing diagnoses like ADHD have been watered down, so it will be a lot easier for people to get the diagnosis. Twenty-five percent of the American public currently would quality for a mental disorder diagnosis (Reeves WC et al, Morbidity and Mortality Weekly Report 2011:60(03) ;1—32) and 20 percent are taking psychotropic medications (Medco Health Solutions, America’s State of Mind Report 2011: http://bit.ly/17VyHqK). An amazing Canadian study of a million kids showed that the best predictor of ADHD was whether a child was born in December or January, especially for boys. There is almost twice the rate of ADHD in the youngest kid in the class as opposed to the oldest kid in the class (Morrow RL et al, CMAJ 2012;184(7):755-762). Immature kids are being diagnosed with ADHD and often treated with medication. Twenty percent of high school boys in America get the diagnosis of ADHD and 10 percent of high school boys are on medication (Centers for Disease Control and Prevention, 2011-2012 National Survey on Children’s’ Health; http://1.usa.gov/Mb5D9L). This is ridiculous.

CCPR: One of your criticisms of DSM-5 is that the diagnoses don’t necessarily predict a clear prognosis or treatment approach.

Dr. Frances: My point regarding DSM-5 is that you don’t suddenly say that 10 million people have a mental disorder unless you know a lot more, unless you have evidence that that diagnosis is going to be useful. In DSM-5, diagnoses have been accepted on descriptive grounds. But this is not enough. We shouldn’t be adding diagnoses unless we know what the consequences are. The experience of the past is that every time we add a diagnosis it tends to be misused. And in this instance, the most likely misuse will be that people will begin treating it; the drug industry will be involved, and way before we know whether a medication is helpful, people are on medication. In 35 years of working with experts on diagnosis, I have never met one who said, “My area needs to be reduced.” Every expert wants to increase the purview; they always worry about missed patients; and they overvalue the research in their area, and their own research, so the system gets burdened with new diagnoses that are largely untested, just at the very beginning of understanding of whether they are useful or not, and then the unintended consequences come in.

CCPR: For example?

Dr. Frances: We have had a tripling in the last 20 years in ADHD (CDC op. cit) and a 40 times increase in autism since DSM-IV (CDC autism data, http://1.usa.gov/Gi1Nx). We have had a 40 times increase in childhood bipolar disorder (Moreno C et al, Arch Gen Psychiatry 2007;64(9):1032-1039)—even though we rejected the concept of childhood bipolar disorder in DSM-IV—because drug companies and thought leaders trumpet it and convince people that this is a phenomenon. A 40 times increase and a tremendous increase in the use of inappropriate antipsychotics in children. So the diagnostic system has to be protected. We shouldn’t be adding or changing diagnoses unless we know the consequences, and the one thing we have learned from past experience is that a likely consequence of any change is a lot of misdiagnosis and a lot of excessive treatment.

CCPR: You say in your book, Saving Normal, “Child psychiatrists often dare to go where no one has gone before and children wind up paying the price. They keep inventing new ways to wildly overdiagnose psychiatric illness in kids.”

Dr. Frances: Because insurance requires a diagnosis on the first visit, kids get a label that may last for life, and may be irrelevant to their long-term needs. But the labels don’t go away; they cause stigma and they haunt children and they lead to unnecessary treatment. We need to be careful. Diagnosis is a really serious thing and medication is a serious decision that needs to be made much more carefully with much more time and much more expertise. The thing we have to be aware of is that 80% of medications are given out in primary care.

CCPR: If your criticism is really about primary care doctors, why say that child psychiatrists wildly overdiagnose?

Dr. Frances: There are lots of things that are overdiagnosed in our field, but the three things that have come in the last 20 years—ADHD, autism, and bipolar disorder—have all been in child psychiatry and the primary specialties that deal with children. Children are the most vulnerable, there is the least research on how diagnosis and treatment affects them, and we shouldn’t be bathing them in so many drugs without much greater evidence than we have that they will be helpful.



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I Feel Frustrated, Depressed, Anxious, & Angry 7 Days a Week

It’s hard to sleep when I am anxious. & I feel anxious because I have been unemployed for roughly 8 years searching for a medication that will help with my anxiety and a sleep aid. But no pill can change the fact that I can never make up for loss time. I’m 30 y/o but I feel like a kid in an adult body & no matter what I do or how fast I do it, I can never seem to catch up with the rest getting left behind.

A. It’s common for depressed people to believe that everyone else is doing better than they are. They don’t see or feel the suffering of the masses. You are in tune with your suffering because you feel it intimately every day, but many other people are suffering, too. The erroneous idea that most others are not suffering can cause depressed people to feel even more depressed. They tend to believe that they are alone in their suffering. Generally speaking, that is not the case. You don’t see it and you may not hear about it, but life is exceptionally challenging for the vast majority of people.

It’s possible that your depression, anxiety and anger are directly tied to your being unemployed. That’s not an uncommon experience. Studies show that people without jobs are three times more likely to be depressed than people with jobs. Undoubtedly, being unemployed takes an emotional toll.

I don’t have enough information to know why you’ve been unemployed for eight years. It might be time to consider another line of work. Further education or retraining might be necessary. Having any job might be better than having no job.

People who are depressed have an increased risk of using drugs or alcohol or engaging in other negative behaviors. For that reason, it’s recommended that people with depression seek mental health treatment. It could prevent the development of the aforementioned problems which would ultimately create greater life stress.

Mental health treatment might potentially spark new ideas for employment. People with depression often have tunnel vision which severely limits their ability to perceive positive life options. They tend to only see negative options or no options at all. There may be other career opportunities of which you are unaware because of your depression. It is certainly worth your time and effort to do everything you can to feel better and to be happy. Therapy is one option that you don’t seem to have tried. It could be just what you need.

Finally, studies have shown that journaling for 20 minutes a day, for multiple days in a row, can significantly decrease your emotional stress. Research has shown that there’s a strong link between writing and emotional processing. One study of interest involves a Dallas computer company that laid off 100 senior engineers over the age of 50 who had worked there since college. A team of researchers had one group of engineers write about their feelings about being laid off. They wrote about feeling humiliated, rejected and thoroughly explored how their feelings affected their lives. The other two groups involved in the study wrote about either time management or did not engage in any writing. The researchers found that the individuals who engaged in writing about their emotional experiences were three times more likely to have found employment than those who had not written about their emotions. As one writer explained “In the process of writing, they were able to create the distance between the thinker and the thought, the feeler and the feeling, that allowed them to gain a new perspective, unhook and move forward.”

You can read more about the aforementioned study here.

Writing is not a substitute for mental health treatment when mental health treatment is necessary, but it could contribute to problem resolution by creating “… a new perspective, unhook[ing] and mov[ing] forward.” It’s worth a try and it’s free of cost. Please take care.

Dr. Kristina Randle



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