Wednesday 31 October 2018

The Vital Importance of Emotional Safety in Relationships

In a previous article I discussed how emotional safety is an essential foundation for intimate partnerships and close friendships. If we can deeply understand how intimacy gets disrupted, we can become more mindful about what it takes to create emotionally safe relationships. We’re wired with a human longing for secure, satisfying connections, but sadly, we may not be fully aware of how we create barriers to the intimacy we want.

Feeling emotionally safe means feeling internally relaxed and open. A nourishing intimacy can happen when barriers melt and hearts open, while also maintaining appropriate boundaries as necessary. When we’re intimate, we’re feeling connected. When we’re not connected, we feel distant, protective, or cautious.

Researcher John Gottman has identified criticism and contempt as intimacy-busters. In fact, contempt is the number one predictor of divorce, according to Gottman. Whenever we diminish a person through hurtful criticisms or sarcasm, we trigger their self-protective mechanisms. Just as a flower won’t bloom until conditions are supportive, our tender self won’t bloom unless we feel internally safe. Consistent respect, kindness, and appreciation, which are antidotes to criticism and contempt, are necessary conditions for a deepening intimacy.

In romantic relationships, love is a good start. But if we want to enjoy a healthy, secure attachment and the enduring connection of mature love, we need to feel safe. Such safety creates a foundation for emotional and sexual intimacy.

Early in a romantic relationship, our sexual attraction is often strong. We may wonder why it has faded over time. We might conclude that this isn’t the right partner or perhaps stray into an affair.

One reason that attraction may lessen is the loss of emotional safety. Trust is a fragile flower. If we’re feeling frequently blamed or shamed rather than respected and cherished, our tender heart may go into hiding as we feel unsafe to show our vulnerable self.

We might think we should be stronger and just let things roll off our back. And in fact it may help to explore whether we’re taking things too personally, losing perspective, or feeling overly offended by light-hearted teasing. But hurtful teasing or shaming that poke our partner’s tender spots are likely to push him or her away, thereby frustrating our desire to connect.

If you’re experiencing a loss of emotional, sexual, or spiritual intimacy, you might want to explore your possible contribution to the dilemma. Are you feeling angry, hurt, or fearful and acting-out these feelings indirectly rather than expressing your feelings and needs in a non-blaming, mature way? Do you tend to react defensively or not take your partners feelings and preferences seriously enough? Is your partner distancing from you because you insist on being right, or you’re not listening respectfully, or you’re using words, body language (eye-rolling, head-shaking), or a denigrating tone of voice that raises your partner’s shields?

Building emotional safety begins by becoming mindful about what not to do in relationships. The subtle or not-so-subtle ways we blame, criticize, and shame people is kryptonite to intimacy. We may not be fully aware of the slow, steady drip of harm we inflict on our relationships by lashing out or being snarky in our communication.

Feeling emotionally safe allows us to feel free to share our feelings, thoughts, and desires without undue fear. It takes courage and mindfulness to understand the shadow parts of our psyche that might unknowingly sabotage our longing for love and connection. When two people are committed to the process of creating a nurturing, supportive relationship and are willing to develop the skills necessary to create a safe climate to do so (perhaps with the help of couples counseling), relationships are more likely to thrive and endure.



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How to Have a Healthier Relationship with Your Phone

Our phones are the first things we see in the morning and the last things we see at night. They’re regularly by our sides (and bedsides). Any time we’re waiting anywhere for anything, we automatically pull them out. At the checkout line. At the doctor’s office. At the bank. At the bus stop. In the car line. In front of the microwave. In front of others.

Basically, any time there’s a pause, we pull out our devices. And often we don’t even realize we’re doing it. Because it’s become a reflex.

We also turn to our phones when we’re bored and when we’re feeling blue. We turn to them when we’re lonely and unsure. We turn to them to ease our discomfort. We turn to them because they’ve been designed to get us hooked. They’ve been designed to hijack our minds like slot machines.

On average Americans spend more than 4 hours a day on their phones. Another study found that we check our phones once every 12 minutes. One in 10 people checks their phone every 4 minutes. Half of Americans check their phones in the middle of the night—unless you’re between 25 and 34 years old, and then it’s over 75 percent.

And all of this is changing us. Maybe you can relate to Catherine Price’s words in her must-read book How to Break Up with Your Phone: The 30-Day Plan to Take Back Your Life: “My attention span is shorter. My memory seems weaker. My focus flickers. Sure, some of this might be due to natural age-related changes in my brain. The more I thought about it, however, the more I began to suspect that there was an external factor at play—and that the factor was my phone.”

But the empowering thing is that we can change this. In How to Break Up with Your Phone Price lays out a specific daily plan for an entire month. Below are some of my favorite tips, insights and examples from Price’s important, practical, wise book.

Explore your current and ideal relationship. Price suggests reflecting on these questions: What do I love about my phone? What don’t I love about my phone? What changes do I notice—positive or negative—when I spend a lot of time on my phone? What changes have I noticed since getting my first smartphone?

Now imagine the future: What would I like my new relationship with my phone to look like? What would I like to have done with my extra time? What would I like someone to say about how I’ve changed?

Price even suggests writing our future selves a letter or email addressing what success would look like and/or congratulating ourselves for cultivating a healthier relationship with our phones.

Create poignant reminders. There are many small, yet significant ways that we can use our own phones to inspire a healthier relationship. Price recommends writing this question on a piece of paper: “What do you want to pay attention to?” Then take a photo, and make that photo your lock screen.

Or ask a loved one to hold the piece of paper, which might make a more powerful image. Whatever image you choose, “whenever you reach for your phone, you’ll be reminded to check in with yourself first,” Price writes.

Focus on fun offline-activities. Using your phone less means you have more time for other activities. According to Price, “Unless you have some sense of how you want to be spending this reclaimed time, you’re likely to feel anxious and possibly a bit depressed—and you’ll be at risk of sliding right back into your old habits.”

Think about what you love to do, and what you’ve always wanted to do. Think about what fascinates you, and the people you’d like to spend more time with. Then make a list of specific, fun things you can do—without your phone, of course. This might be anything from doing a crossword puzzle at a cafĂ© to writing a short story to cooking a new dish to taking a hike.

Create new triggers. This helps you set yourself up for success, and makes it easier for you to do the things you aim to do. Price shares these examples in the book: If you’d like to read more, keep a book on your beside table or inside your bag. If you’re planning on meditating in the morning, decide beforehand how long you’ll meditate, what the focus of your meditation will be, and where you’ll meditate.

If you normally bring your phone into your room to soothe yourself to sleep, refocus on making your bedroom into a sanctuary in other ways (which really work): Buy a nice set of sheets, hang up calming pictures and use a lavender oil or spray.   

Exercise your attention span. “In order to undo the damage caused by the cumulative hours we spend on our phones, we need to restrengthen our attention spans—and engage in regular exercise (both mental and physical) to keep our brains in shape,” Price writes.

For instance, you might devote time to solely focusing on a single project or problem (while you’re walking somewhere, for instance). You might take a “music bath,” which is simply closing your eyes, listening to a favorite piece of music, and trying to pick out each instrument. You might write a letter to a loved one, or get lost in a book.

In fact, “over time, regular reading causes physical changes to the brain in areas responsible for reasoning, processing visual signals and even memory,” Price writes. It also encourages creativity and problem solving. 

Smartphones aren’t evil, of course. They help us do all sorts of cool, worthwhile things—everything from sending an important email while away from our desks to communicating with our families over FaceTime.

But many of us also turn to our phones way too much and for way too long—and our phones can stop us from paying attention to what really matters: our relationships (with others and with ourselves), our emotions, our creative ideas.

The key is to rethink your relationship with your phone: What does it currently look like? What meaningful changes do you want to make?

For Price, reducing screen time has sharpened her focus and it’s meant more time engaging in genuinely fulfilling activities.

“And I’ve learned that, just as light will fade a photograph, spending too much time on my phone was sapping color from my experience,” Price writes. “The more I pay attention to the actual world around me, the more vividness returns.” Maybe you will find the same.



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Sexual Issue with My Spouse

I am wondering if this is normal or something that I should be concerned about (To be clear, I’m not afraid for safety.), if it’s an issue that needs attention. My husband has ocd, ADHD, and a mild form of turrets. He doesn’t like wetness (no wet kisses, absolutely zero desire to have anything to do with a vagina). He’s a butt liking guy. He seems to be put off by sex itself as he wants to converse the entire time about my thong and sometimes even pretending to have one of us get shot or stabbed in the belly. Nothing can be mentioned about sex. It’s all about the thong, and scenarios of getting stabbed or shot. He can’t keep an erection without this. It’s so unfulfilling for me as I only have my imagination that he’s being normal, passionate and enjoying all of me in bed. For me to get anywhere myself, I need this imagination and certain maneuvers for stimulation. When he requires constant talking from me, I can’t even have that. (Though he gets upset if I don’t climax first. This gentleman way of letting the girl go first is sweet, but he doesn’t help in any way other than thrusting. I’ve tried to talk about it, it’s like asking a favor that he can’t stand doing, which kills it.) I don’t know why he is so put off by sex and my female parts. I know it’s not me. I know that I am fun, kinky, clean and full of passion. There has got to be something that is making him like this, either from a genetic reason or an experience in his life, or both. I need advice and someone to help me understand what it is that he has, a mental or sexual disorder? He’s also a high functioning alcoholic and mentally and psychologically controlling and abusive sometimes as well, if that information helps. I need to understand what I’m dealing with here as I don’t know what to do.

If the information that you have provided me is correct, then you are dealing with a very complex problem which is unlikely to offer an easy fix. From your description, he is an alcoholic, he is abusive and he is controlling. You say that you are not concerned with your safety, however when dealing with an alcoholic one should always be concerned for one’s safety. He also has Tourette’s, ADHD, and OCD. He is also sexually incompatible with you and your desires. If you were aroused to the type of sex that he desires the two of you would have a good sex life, but that would do nothing to diminish any of his diagnosable mental problems, his alcoholism or his tendency to be abusive and controlling.

You described him as being a functional alcoholic but he does not appear to be functioning well in life in general. Without extensive therapy it is very unlikely that he will improve in any aspect of his life. Many women would leave a man who was abusive. Many women would leave a man who was a long functioning alcoholic. Many women would leave a man who had fantasies of stabbing or being stabbed in the stomach.

Your happiness is as important as his happiness. I doubt sincerely, that you both can walk the same path to happiness. It is most likely that each of you will need to find separate paths to happiness.

It may be time for you to realize that he is not a common, normal, alcoholic guy with Tourette’s, ADHD, OCD, who is also abusive, controlling and repulsed by female genitalia. I wish you the very best of luck, in whatever decision you make.

Dr. Kristina Randle



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Why It’s Important to Explore Your Past in Therapy—Even When It Seems Unrelated

There’s a prevailing belief that exploring your past in therapy is pointless. A complete waste of time. After all, talking about past circumstances doesn’t change them. It’s also self-indulgent and narcissistic, right? And it takes too darn long. You can talk about your childhood for years and not get anywhere.

Plus, rehashing the past means blaming your parents for everything, and perpetuating the role of victim.

In actuality, these are all common myths and misconceptions.

Psychotherapist Katrina Taylor, LMFT, pointed out that there’s a difference between blaming and accountability. “If your parents have hurt you in the past, it’s important to take an honest look at how that’s affected you.” Doing so might spark a productive, healing conversation with your family and stop you from repeating similar patterns with your own kids, she said.

Exploring the past doesn’t mean perpetuating a victim stance either. Acknowledging our pain means acknowledging our vulnerability and humanity, Taylor said. “Being in touch with those feelings is what allows us to do something different in our lives.”

“By looking backward, one can better understand their present and make positive changes for the future,” said Emily Griffiths, LPC, a licensed psychotherapist in private practice who specializes in the treatment of anxiety, depression and trauma in Austin, Texas.

Exploring the past gives clients “corrective emotional experiences,” she said, which is “when a client experiences something that challenges a previously held belief.” For instance, maybe you grew up thinking that most people can’t be trusted or that you’re not good enough or capable.

“When people talk about their past they realize the distortions they had because of their age or position, they see how a reasonable thought then could be an unreasonable thought now, or they realize that they’ve blamed themselves for something they’d never blame another child for,” said Ryan Howes, Ph.D, a clinical psychologist in Pasadena, Calif.

After telling their story or answering a question, Howes’s clients have often said: “Wow, when I said that out loud, it seemed [‘not as scary’ or ‘totally irrational’ or ‘just what my mom would say’ or ‘not me at all’].”

Exploring their early environment helps clients understand who they are and why, said Taylor. They might explore everything from whether their parents encouraged independence or prolonged attachment to whether they invited emotional expression or wanted kids to be “seen and not heard,” she said.

Looking back also helps to uncover your relationship patterns, Taylor said. “[A] man who comes to therapy saying that his wife complains of his emotional coldness will understand himself on a different level when we explore the relationship with his stoic mother who encouraged him to ‘grin and bear it’ rather than cry.”

You might discover why you do all sorts of things today—why you say yes to things you don’t want to do, why you sabotage your performance when you can actually succeed, why you dwell on the negative. And then you can take action to challenge these patterns, Howes said.

In fact, mining the past for clues into your present behavior can be transformative. “When you realize you’ve sought out unavailable partners because you always wanted love from an unavailable parent, this can liberate you to seek love from people who really care about you,” Howes said.

Exploring the past is especially helpful when old messages persist and have contributed to a poor self-image, Howes said. You can learn where messages like “You’re a bad person,” “You’ll never make it” or “You’re just a phony” originated from and dismantle them, he said.

Howes also noted that delving into the past may be necessary when a client has experienced trauma. The key, he said, resides in retelling the story of the traumatic event, because the more you talk about it, the more you tend to lose the emotional impact. “By the tenth time [you tell] the story, it [feels] like [you’re] reading from a script, and you [don’t] feel the trauma at all.”

Griffiths agreed. “Reliving difficult experiences in the safety of the therapeutic relationship can help the client disconnect the memory from the physical aspects that are the source of extreme discomfort such as night sweats, panic attacks, and fixating on thoughts and past events.”

Griffiths underscored that if a client has discussed the traumatic event, doesn’t feel safe or doesn’t think it’ll be helpful to talk about in the moment, she doesn’t believe it’s essential to explore it. She focuses on creating a safe space for her clients to share their trauma when they’re ready.

Moreover, turning to the past is critical when there’s a longstanding problem the client has been unable to overcome. Taylor believes that a high percentage of people who start therapy struggle with problems that stem from their childhood experiences. The key is to zero in on the defenses—or adaptations, as Taylor calls them—that people have developed to deal with their family environment.

“At some point the symptom served an important purpose for the client and it continues to persist. Perhaps the client knows this is something they need to change but seem unable to do so.”

Taylor shared this example: A person keeps having relationships with emotionally abusive partners. They don’t want to keep doing this, and yet they regularly find themselves in these relationships. This client “consciously wants to change, but unconsciously feels pulled to repeat a familiar kind of relationship”—the early relationship with their caregivers. Maybe they internalized the message that they don’t deserve anything better than abuse, or maybe being criticized feels more loving than praise, she said.

“Exploring these questions is what allows the client to understand the motivations behind their choices and to begin to choose differently.”

You don’t always need to explore your past in therapy. As Howes said, if the problem is recent—you’ve been symptom-free your whole life, and a hit-and-run has made you feel uneasy on the road—he’s not going to ask about your grandmother. “Some problems aren’t rooted in the past, and digging would be a fruitless endeavor.”

Taylor shared these additional examples: a client needs space to grieve the loss of a loved one, they’re dealing with an empty nest, or they’ve lost their job. (However, if a client frequently loses their job, it’s time “to get historical and understand how the past is influencing the present and causing this person to sabotage themselves.”)

Some clients simply don’t care about the past. For instance, you have a strong dog phobia, and instead of learning how it developed, you just want it to stop, Howes said.

Not all therapists prioritize the past. Cognitive-behavioral therapists, for example, mainly focus on current thoughts and behaviors, Howes said.

“It’s the therapists who choose to look at relational patterns, early trauma, and the unconscious who find value in exploring the past.” Howes noted these therapists may use the following words to describe their work: “relational,” “attachment-based,” “Freudian,” “Jungian,” “depth-psychology,” “psychodynamic,” or “psychoanalytic.”

Howes believes that “we are shaped by data from our genetics as well as our past, with a strong emphasis on our earliest experiences. As the Alexander Pope quote from 1734 says: ‘Just as the twig is bent, the tree’s inclined.’ We can’t help but be influenced by our early life, especially the profoundly positive or negative experiences.”

“The therapists who dive into the past do so because they believe the origins of the problem, or the reasons the problem is intensified or remains stubborn, lies in the past,” Howes added.

Taylor believes that exploring our past goes beyond the individual; it benefits society.

“We all unconsciously repeat childhood patterns in our lives that we’re not aware of. We value certain emotions over others, we expect people around us to behave in certain ways, and we may struggle with empathy and compassion for those different from us.”

When we look into the past, we uncover these unconscious patterns, and when we better understand ourselves, we better understand others, too, she said. When we have compassion for all our parts—including the darker parts—we’re more respectful of others’ humanity.

“Overall, the work of therapy, and particularly with a focus on past relationships, contributes to a kinder world.”

If exploring the past is stopping you from seeking therapy, start your session by expressing this fear directly. According to Taylor, you might say: “I’m here because certain things in my life are not working but I’m hesitant to explore my history and I’m not sure why.”

As Howes added, “The beauty of therapy is [that you and your therapist are] united in a common cause—understanding you and helping you manage your life.”



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The Best Way To Overcome Loneliness

This works better than improving social skills, being around more people or even having more social support.

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A Tiny Dose Of This Can Unlock Creativity

It can enhance mental flexibility.

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Survey Skeleton



Karger Medical and Scientific Publishers has a lovely Survey Skeleton peeking out enticingly on some of their journal websites now.




It's to lure you to take their survey, where you can win attractive prizes....




...such as the unique Vesalius: The Fabric of the Human Body (value CHF 1,500).





Just thought you should know.




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The evolution of overconfidence

Johnson and Fowler on the crucial role of overconfidence in human success:
Confidence is an essential ingredient of success in a wide range of domains ranging from job performance and mental health to sports, business and combat. Some authors have suggested that not just confidence but overconfidence—believing you are better than you are in reality—is advantageous because it serves to increase ambition, morale, resolve, persistence or the credibility of bluffing, generating a self-fulfilling prophecy in which exaggerated confidence actually increases the probability of success. However, overconfidence also leads to faulty assessments, unrealistic expectations and hazardous decisions, so it remains a puzzle how such a false belief could evolve or remain stable in a population of competing strategies that include accurate, unbiased beliefs. Here we present an evolutionary model showing that, counterintuitively, overconfidence maximizes individual fitness and populations tend to become overconfident, as long as benefits from contested resources are sufficiently large compared with the cost of competition. In contrast, unbiased strategies are only stable under limited conditions. The fact that overconfident populations are evolutionarily stable in a wide range of environments may help to explain why overconfidence remains prevalent today, even if it contributes to hubris, market bubbles, financial collapses, policy failures, disasters and costly wars.


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The Positive Side of Fear

How often have you heard that “magic happens outside the comfort zone”? Well, maybe not that exact line, per se, but there seems to be various reiterations of that sentiment. They say to not let fear stand in our way. To rise above. To not let fear of falling bring us down (I think that was actually a song lyric from my college graduation montage.)

In any case, the self-help psychology market often urges us to transcend our fears and to conquer what’s in front of us.

For the most part, that’s not bad advice. (And I’ve read plenty of personal development blogs over the years, too.) If we have certain desires, and fears and anxieties interfere, then logically speaking, we absolutely can work to resolve these emotional issues.

However, it’s not always black-and-white.

Sometimes, there’s a line. A line between overcoming what we are afraid of and abstaining from what generates fear. That line is what brings me to writing this very blog post.

I tend to think that, at times, fear can be our body’s way of communicating a problem and it’s only natural for us to listen to our body and avoid said problem. Fear can easily be an emotional message that tells us to stay away from red-flagged situations, from situations outside our comfort zone that are not conducive to our emotional well-being, let alone feel “magical.”

And that’s okay.

I don’t think we lose points for not daring ourselves to be uncomfortable. Sometimes, being comfortable trumps the alternative, and it’s at these junctures that I want to listen to my body’s form of communication. It’s during these moments that I want to follow the instinct that says, “Hey Lauren, I know it’s cool that you’re leaving your comfort zone and trying something new and challenging yourself, but maybe you’re taking it too far here. Maybe it’s not really worth the fear and anxiety that you’re feeling due to the discomfort.”

In such circumstances, fear can be our friend. Fear is a warning signal that is instructing us to tread carefully, to avoid something that might be emotionally problematic. Fear is trying to help us navigate situations that can be overwhelming — and for good reason. Fear is not always a feeling that needs to be thwarted and transcended.

I’ve come across writing by Lissa Rankin, M.D., a NY Times bestselling author, wellness agent, and physician who talks about the beneficial aspects of fear.

She discusses how fear is certainly essential to our survival. Just how our ancestors needed to flee in dangerous situations, we too listen to fear when we come face-to-face with a deadly dilemma. Rankin labels this, “true fear.”

When true fear manifests, we don’t even contemplate how to take action, we just instinctively listen to the fear and make sure we are out of harm’s way. That being said, we don’t exactly find ourselves being chased by wild animals often, nor are we on the edge of a literal cliff frequently (At least I’d hope not.)

“True fear can also be subtle,” Rankin says. “True fear may show up as an intuitive knowing that says, ‘I’m not letting my child spend the night at that person’s house.’ It can show up as a dream, an inner voice, or a gut feeling that something bad is about to happen.”

In scenarios that do not reflect true fear, Rankin explains that this brand of fear, while not rooted in immediate danger, can still alert us to problems that we may want to pay attention to; in this kind of situation, fear can become our teacher.

This is what I hope this blog post can convey. Fear that arises in our lives is not always meant to be overcome. It’s not always the enemy, meant to be stopped in its tracks. It’s not alway meant to be associated with the self-help psychology that dares us to challenge ourselves. (Rise above!)

On the contrary, fear can teach us how to move forward and how to rein in distress. Fear can be an inner voice, an inner voice that is hoping to communicate an important message when the comfort zone line becomes rather blurry.

Fear can be an inner voice that can ultimately help us.



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How Do I Get Motivated to Do School Work?

From a teen in the U.S.: ever since I was young, in school i skimped on my school work. The main I way I would pass the grades is doing some homework and aceing the tests. i never study and don’t focus too much on the teacher when they are talking. due to this, my hand writing is awful and writing for too long hurts my hand since i’m not used to writing a lot for school.

this worked up until freshman year, where i started to tank. i’m now in 11th grade and way behind on credits. i have no motivation to do my work, my mind just blanks every I try to type.

another note is, I’ve lived on a livestock auctioning grounds my whole life and have been doing yard work since a young age. from this I’ve developed a hatred of work, and this is affecting my education. my teacher also thinks i have ADD I’ve wanted to get myself checked, but my family doesn’t think i have it and just thinks i’m lazy. is there something wrong with me? is there hope for me? what should i do? sorry for this all over the place post, but i’m out of ideas.

If your work in the yard is part of the family’s survival in hard economic times, you do need an attitude transplant. In that case, think about the importance of what you are doing and give yourself credit for your participation. Consider talking to your folks about whether there is a way for you to get a break from the home tasks or maybe to change the tasks you are doing.

As for your problems in school: This is not uncommon among very bright kids. They’ve been able to coast along on their brains during the time that other kids have had to work for their grades. Then they hit a wall. Native intelligence doesn’t work anymore when subjects get harder and the demand for managing multiple subjects gets challenging. Sometimes this happens in high school. Sometimes in college. But the lack of a work ethic always catches up with people eventually. So — you’re not alone.

That being said, it’s never too late to learn the discipline required to succeed academically. You don’t need me to tell you that doing so is necessary if you think you want a career that will require a college education. If you don’t know how to start, there may be a teacher or guidance counselor at school who can meet with you regularly for awhile to help you learn how organize, prioritize and manage your work.

To settle the ADD issue, talk to your school guidance counselor about what is required to get evaluated. If you do have ADD, you are not alone in that either. Kids with ADD do learn how to make it work for them so they can be successful.

Ultimately, how you position yourself for your future is up to you. Having “motivation” is a decision. It doesn’t descend from the skies. It isn’t genetic. It isn’t even something other people can make you have. It’s a choice. I’m not saying it’s easy to change a bad habit (like resistance to work) but, like all habits, it’s a matter of commitment to the project.You are clearly a smart guy. Put those smarts to good use.

I wish you well,
Dr. Marie



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Tuesday 30 October 2018

Trapped in Cycle of Mood Swings Because I’m Not “Bad Enough”

I have a history of mental health issues, and they run in my family. As a child, I couldn’t access care because my parents wouldn’t allow it. I self-harmed and suffered suicidal thoughts. While my brother had his own mental health struggles and developed drug/alcohol issues and delinquent record, so he got court ordered counseling.
As an adult, I’ve had unreliable food and shelter and been sexually assaulted. I can’t afford to attend college and pay for food/rent/bills even with financial aid, let alone doctors or therapy. While my brother’s criminal record has only grown, landing him in a fancy rehabilitation facility for 6 months to avoid jail.
Of course I love my brother and I’m happy to see him getting the support he needs, but it’s always hurt to watch his problems being acknowledged and healed because he was violent and criminally inclined, while I struggle to even support myself and can’t even get out of bed.
It seems like the only programs out there are designed for criminals or other people who have ruined their lives in some way. I don’t know how to get help. I don’t want to do the things my brother has done, I don’t want to hurt anyone, but it seems like that’s the only way to make people want to fix you.
If I don’t find some drastic way to prove I’m sick, I don’t think I’ll get help. How can I fix this?

Most communities have a local community mental health center (CMHC) or several. Their services are often free of charge. Do a google search for “psychiatric services and community mental health center.”

You can also contact local hospitals and ask if they offer low-cost or free services. Relatedly, local hospitals may offer psychological treatment via research studies.

Sometimes, universities offer affordable treatment for community members. Try searching Google for “low-cost or free psychological services and universities.”

Many religious institutions offer free or low-cost counseling services.

Other ideas include contacting mental health resource hotlines. Do a Google search for “mental health resources and the name of your town.” It’s common for local counties to offer those services for their residents.

If you served in the military, psychological treatment should be free. Contact your local Veterans Affairs (VA) hospital for more information.

The United Way has a helpline that is available round the clock for referrals for community services. Call 211 or visit their website at www.211.org

I understand your frustrations, but it is ill-advised to commit a crime or to engage in other drastic behaviors in order to receive treatment. Give the aforementioned suggestions a try. You might be surprised by what treatment is available in your own community.

I hope you’re able to find the help that you deserve. Thank you and please take care.

Dr. Kristina Randle



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Be Careful When Calling Those Addiction Treatment Hotlines

You have to love a guy dressed up in surgical scrubs with a stethoscope trying to sell you addiction treatment services. You know, those seedy inpatient rehab facilities that claim they can self-police their own horrible, terrible marketing practices.

But as this television commercial, that’s been airing for years on cable TV, clearly demonstrates, there remains very little that’s ethical about addition treatment marketing. That’s especially true if you get suckered into calling one of those addiction treatment hotlines you see on TV or on a website.

As we noted in August 2018, the rehab industry still needs federal oversight and regulation. That’s because it’s shown a curious detachment from the typical morals and ethics that govern most industries whose job it is to help people get well.

Enter The Addiction Network. Ostensibly some sort of referral network that treatment centers need to pay in order to be a part of, it runs laughable television commercials on cable TV, preying on people who don’t understand how the rehab industry’s aggressive treatment referral pipeline works.

Who Is the Addiction Network & Why Should You Trust Them?

The Addiction Network appears to be just a service of Pro Media Group, a “direct response marketing and advertising agency” in Miami, Florida. That’s right — you’re getting your addiction treatment referral from a marketing and advertising company.

The registered corporate manager of The Addiction Network LLC in Florida is one Jonathan Peress, an executive vice president at Pro Media Group.

The only web presence I could find of “The Addiction Network” is at makeamericasoberagain.com. That site says it was created by “Soap Creative Services.” Soap Creative Services’ CEO is Anthony Provenzano, according to Florida corporate records. And the owner of the website is registered to a company called “Winston Wolfe Media Group” and, yes, the same Anthony Provenzano. Tony also just happens to be a senior vice president at Pro Media Group.

Why are there so many shell companies involved in this effort, all seemingly owned or run by the same people at Pro Media Group? We reached out to the company for comment, and our call was returned by their attorney who wanted to understand the type of article we were writing before the company would respond to our questions. When asked about the multitude of companies, the attorney replied:

The Addiction Network offers an umbrella of products by being able to utilize the specific resources of multiple different companies. Soap Creative Services owns and maintains trademarks, intellectual property and copyright material and partners with the Addiction Network to license the use of this data. Promedia and Winston Wolfe are third party advertising and consulting agencies that assist in the management of media and technology for the Addiction Network.

Which doesn’t do much to explain why the principals of these other companies are all senior management at ProMedia.

What Happens When You Call?

I decided to call the number that flashed on my screen during a TV commercial break one weekday evening earlier this month. The number connected me to Treatment Management Behavioral Health. I called twice just to make sure I would get connected to the same referral service. (Your number may be different in your commercials, depending upon your geographical location, and you may be connected to a different company.)

The company is part of an enormous rehab empire called Treatment Management Company that is apparently owned by Bryan Deering, according to The Verge:1

But those aren’t the only businesses in Aid in Recovery’s network. Company filings and court records reveal a tangled web of holding companies within blandly named holding companies, adding up to a multimillion-dollar rehab business, all tied together by an LLC called Treatment Management Company. It spans four states, and includes phone rooms, urinalysis labs, detoxes, and rehabs. All of them are connected to one man, Bryan Deering, a millionaire who made his money in concrete.

The concerning thing wasn’t that I was connected to something that clearly wasn’t “The Addiction Network.” No, far more worrisome was that I after had hung up on them (twice), they called me back immediately. They also left a voicemail:

Hi, this is Chris with Treatment Management Behavioral Health. We actually had a missed call from this number, someone called us twice and nobody said anything. If you or a loved one are struggling with drugs or alcohol, please feel free to give us a call at this toll-free number, it’s open 24/7. It is 866-XXX-XXXX. Thank you very much and I hope you have a good night.

Polite, right? But oh so wrong.

The Ethics of Returning an Unknown Call for Treatment Services

As any first year graduate student in psychology can tell you, privacy and confidentiality are significant concerns of anyone seeking treatment services for a behavioral health or substance abuse issue. Many people don’t want their family — or even partner — knowing that they are getting or seeking out treatment. That is their right and is considered protected health information under the law.

A professional should never call back an individual and leave any identifying information about the service they’re calling from, because the person might be in an abusive situation. You just don’t know. The person may have called from a shared home telephone number. Leaving identifying information could open the victim up to further, additional abuse.

This is, in my opinion, a grievous violation of a person’s privacy in contacting one of these numbers. Yet the person whom I called back seemed entirely unaware or unconcerned about the issue. He just wanted his referral. Nowhere in the advertisement did it say that if you call that number and change your mind and hang up, they will automatically call you right back. (And trust me, I had to pause the TV commercial and get out a magnifying glass to read the tiny legal print that appears at the end of The Addiction Network’s ad.)

Now, had I been an abusive husband who is dealing with alcohol addiction and my wife had just tried calling this referral line, I’d have reason to believe my wife just betrayed me. And sadly what follows in this hypothetical situation isn’t all that difficult to imagine.

I received a second call-back from the same addiction treatment referral company, this time from a woman. After I began suggesting to this person that calling a person back twice to check on their referral, they handed the phone over to Chris, the same guy who left the voicemail. He got into a discussion with me about whether it’s a violation of a person’s confidentiality or privacy by calling someone back about “addiction services” to an anonymous number that contacted them and left absolutely no message.

To me, this is very simple. Therapists and addiction treatment referral people should not make any assumptions about the people who contact them. And there is no relationship established just because I call your number and hang up. Assuming it is perfectly okay to contact someone who hung up on you without saying a word — and leave a voicemail message — is wrong. Doing it twice is doubly wrong.

When I spoke with him, Chris did justify their behavior as the industry standard. “Hey, if you call any of the other referral services, they’ll do the same thing.”

That’s exactly the point. This isn’t a problem with just one company. While it’s easy to single out the service that put their telephone number on the TV commercial I viewed, this is symptomatic of an endemic problem throughout the treatment addiction industry.

What Can Be Done?

When I asked the company’s attorney about who a consumer could turn to in order to complain about the way they were treated by someone at The Addiction Network, she replied: “Consumers can always reach out to management at the Addiction Network to voice concerns about any third party, however, the Addiction Network does not own, operate, manage or is otherwise involved with the services offered by treatment facilities.” I’m not sure how a consumer is supposed to find “management” of this company, given that they have no website or contact information? The lawyer did note they only work with Joint Commission-accredited facility — demonstrating quite clearly how little such accreditation means in the real world. The Joint Commission does a horrible job of policing the addiction treatment industry.

Everyone deserves better from the rehab and addiction treatment industry. Especially the people most at risk, watching these kinds of low-budget ridiculous TV commercials featuring a fake surgeon encouraging someone to get addiction treatment.

I know the industry means well — but it can do better. I encourage them to re-evaluate these kinds of practices. I encourage them to take into account that they are dealing with real people’s lives here. In their relentless effort to get their next $200+ referral fee, they may unintentionally be putting someone at risk.

Footnotes:

  1. Treatment Management Behavioral Health is apparently accredited by the Joint Commission (another demonstration that credentials often mean little).


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Best of Our Blogs: October 30, 2018

It’s that time of year when I dedicate this blog to the things that terrify us. Normally it’s saved for those suffering from anxiety and mental illness. But fear over our state of the world is making everyone vulnerable.

As you gear up for Halloween, read how you can damper down or tame these fears by learning ways to address electronic use with your children, and how to stop our own anxiety from scaring our kids.

Yes there are legitimate reasons to be afraid these day. But there are also reasons to live with love and hope. We have more alternative treatments options available. And even as the news reports another tragedy, I’ve seen evidence in my own hometown of greater acceptance, support and unity.

Characteristics Commonly Found in “Alienated” Parents (or other Alienated Relationships)
(The Recovery Expert) – If you’re being rejected by your child, you probably exhibit one of these typical traits.

How a Traumatic Childhood Manifests in Social Anxiety
(Psychology of Self) – Did you know there are two types of people who suffer from social anxiety? This is your guide to understanding what it looks like and where it came from.

The Insidious Connection Between Electronics Use and Childhood Emotional Neglect
(Childhood Emotional Neglect) – It’s the one aspect of childhood emotional neglect you didn’t consider. Here’s how you can start using electronics in a more emotionally responsible way.

How Our Society Is Creating Anxious Kids: The Challenges For Parents
(Thoughts of a Therapist) – If you’re a parent, you need to read this.

10 Reasons a Person Divorces
(The Exhausted Woman) – Here’s how to know whether you should consider divorce.



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Trapped in Cycle of Mood Swings Because I’m Not “Bad Enough”

I have a history of mental health issues, and they run in my family. As a child, I couldn’t access care because my parents wouldn’t allow it. I self-harmed and suffered suicidal thoughts. While my brother had his own mental health struggles and developed drug/alcohol issues and delinquent record, so he got court ordered counseling.
As an adult, I’ve had unreliable food and shelter and been sexually assaulted. I can’t afford to attend college and pay for food/rent/bills even with financial aid, let alone doctors or therapy. While my brother’s criminal record has only grown, landing him in a fancy rehabilitation facility for 6 months to avoid jail.
Of course I love my brother and I’m happy to see him getting the support he needs, but it’s always hurt to watch his problems being acknowledged and healed because he was violent and criminally inclined, while I struggle to even support myself and can’t even get out of bed.
It seems like the only programs out there are designed for criminals or other people who have ruined their lives in some way. I don’t know how to get help. I don’t want to do the things my brother has done, I don’t want to hurt anyone, but it seems like that’s the only way to make people want to fix you.
If I don’t find some drastic way to prove I’m sick, I don’t think I’ll get help. How can I fix this?

Most communities have a local community mental health center (CMHC) or several. Their services are often free of charge. Do a google search for “psychiatric services and community mental health center.”

You can also contact local hospitals and ask if they offer low-cost or free services. Relatedly, local hospitals may offer psychological treatment via research studies.

Sometimes, universities offer affordable treatment for community members. Try searching Google for “low-cost or free psychological services and universities.”

Many religious institutions offer free or low-cost counseling services.

Other ideas include contacting mental health resource hotlines. Do a Google search for “mental health resources and the name of your town.” It’s common for local counties to offer those services for their residents.

If you served in the military, psychological treatment should be free. Contact your local Veterans Affairs (VA) hospital for more information.

The United Way has a helpline that is available round the clock for referrals for community services. Call 211 or visit their website at www.211.org

I understand your frustrations, but it is ill-advised to commit a crime or to engage in other drastic behaviors in order to receive treatment. Give the aforementioned suggestions a try. You might be surprised by what treatment is available in your own community.

I hope you’re able to find the help that you deserve. Thank you and please take care.

Dr. Kristina Randle



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Childhood Abuse, Complex Trauma and Epigenetics

Epigenetics refers to the study of a natural phenomenon and to the phenomenon itself. Epigenetics is the study of the mechanisms that turn on and off the expression of our genes without altering the DNA sequence. Epigenetics is also used to refer to the changes in expression of our genes.

Factors such as age, nutritional habits, psychological stress, physical activity, working habits and substance abuse can trigger changes in gene expression (AlegrĂ­a-Torres, 2011). These changes in gene expression, epigenetics, happen all the time in the natural world.

For example, two identical twins, born with the exact same DNA sequence may not express the same genes. One may develop an illness while the other does not. Even diseases that are highly heritable are not guaranteed to develop in both identical twins. If your identical twin has schizophrenia, you have a 53% chance of developing schizophrenia (Roth, Lubin, Sodhi, & Kleinman, 2009). But If you have the exact same DNA, and schizophrenia is genetically heritable, why do you not have 100% chance of developing the same disorder?

Our environment and lifestyle impacts our gene expression.

For better or for worse, the DNA we are born with does not predetermine our health. Life experiences and environmental factors play an important role in who we become.

For people facing mental health challenges, and for therapists providing treatment, understanding that DNA is not destiny can help shape treatment.

Epigenetics and inherited trauma; an experimental manipulation

In a recent study, researchers showed how interpersonal early life stress can impact second and third generation offspring. Researchers exposed mice offspring to early and unpredictable separation from their mother from day 1 to 14. The mother was subjected to stress and the offspring were physically restrained or placed in cold water. This kind of situation is classified as chronic and unpredictable stress.

The offspring displayed depressive symptoms, as was expected. However, the interesting result of this study was what occurred with the second and third generation offspring. The next generations were raised normally. However, the later generations also displayed abnormally high rates of depressive symptoms.

To factor out the effects of being cared for or being in a group with the first generation traumatized mice, the researchers inseminated the sperm of the past traumatized males into the eggs of non traumatized mice. The results were the same, offspring raised normally with non-traumatized mothers still displayed abnormally high rates of depressive symptoms.

While the mechanism of passing trauma through generations is unknown, it is thought that the the dysregulation of short RNA’s occurs as a result of an overexposure to stress hormones circulating in the body

The results are thought to be relevant for humans as well. Children exposed to early and ongoing trauma are more likely to develop a variety of physical, behavioral and emotional disorders. In addition to emotional and mental disorders, sufferers of childhood abuse are also at increased risk to develop physical health problems such as heart disease, obesity, and cancer (National Human Genome Research Institute).

Is fear heritable?

Puzzled by the problems in inner city communities where problems such as mental illness, drug addiction and other problems seemed to occur over generations, Kerry Ressler became interested in researching the intergenerational transference of risk. The Ressler lab investigates the genetic, epigenetic, molecular and neural circuit mechanisms that underlie fear. An experiment with mice revealed that memories of pain can be passed down to first and second generation offspring even though these offspring had never experienced the fearful stimuli.

In the study, small electric shocks were paired with a particular odor in male mice. After the situation occurred numerous times, the mice, when encountering the odor would tremble in fear even without the shocks. The first and second generation offspring of these mice displayed the same reactions to the odor, even though they had never experienced the electric shocks (Callaway, 2013).

So what does this mean? From these experiments we can see that the memory of significant trauma is passed down to the the next generation and even the generation after that. What happened to our grandparents and our parents seems to leave a memory in our physical beings.

The good news

Epigenetics is also affected by positive environmental influences. While we can see that trauma affects our offspring through the malleable process of gene expression, this new line of research is also showing that epigenetics can be reversed.

If male mice experience early trauma and then are placed in a nurturing environment they go on to develop normal behavior. Their offspring also develop normally. The conclusion of these studies, so far, indicates that early life stress can be reversed. At least some adults who seek out (and are able to attain) a nurturing and low stress environment can reverse the effects of past trauma. This is good news and should inform therapeutic approaches. It may not be necessary to rely as much on pharmaceuticals. Lifestyle changes and a supportive therapeutic relationship can go a long way to reversing trauma and preventing trauma from being passed down to the next generation.

References

AlegrĂ­a-Torres, J. A., Baccarelli, A., & Bollati, V. (2011). Epigenetics and lifestyle. Epigenomics, 3(3), 267-277.

Bell, J. T., & Spector, T. D. (2011). A twin approach to unraveling epigenetics. Trends in Genetics, 27(3), 116-125.

Callaway, E. (2013). Fearful memories haunt mouse descendants. Nature, 1, 1-6.

Roth, T. L., Lubin, F. D., Sodhi, M., & Kleinman, J. E. (2009). Epigenetic mechanisms in schizophrenia. Biochimica et Biophysica Acta (BBA)-General Subjects, 1790(9), 869-877.

Franklin, T. B., Russig, H., Weiss, I. C., Gräff, J., Linder, N., Michalon, A., … & Mansuy, I. M. (2010). Epigenetic transmission of the impact of early stress across generations. Biological psychiatry, 68(5), 408-415.

https://www.whatisepigenetics.com/a-fathers-stress-felt-for-generations/



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A Wonderful Sign Of High IQ

The study tracked 65,765 people born in Scotland in 1936 for 79 years.

→ Enjoying these psych studies? Support PsyBlog for just $4 per month (includes ad-free experience and more articles).

→ Explore PsyBlog's ebooks, all written by Dr Jeremy Dean:



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The Test That Detects Alzheimer’s Early

Current tests cannot spot the disease until it is too late.

→ Enjoying these psych studies? Support PsyBlog for just $4 per month (includes ad-free experience and more articles).

→ Explore PsyBlog's ebooks, all written by Dr Jeremy Dean:



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Self-care and finding personal peace in today's socio-political climate.

In Fort Lauderdale, FL, and now in Austin TX, I have organized discussion groups that meet regularly to discuss new topics and ideas. The Florida group named itself “The Roundtable” while the Austin group calls itself the “Austin Rainbow Forum.” The topic for the next Austin meeting, appropriate to the age of Trump, is “Self-care and finding personal peace in today's socio-political climate.”

The topic reminded me of a relevant talk I worked up some years ago titled “Are you holding your breath? - Structures of arousal and calm.” The talk describes downstairs and upstairs systems in our brain that regulate our arousal.

I thought I would show here a summary of part IV of that talk (parts of the summary, absent the context of the whole talk will seem a bit cryptic), and also show edited text that goes with part B. 1. dealing with the importance of our self construal in how we deal with stress. The link to the talk given above takes you to the whole package…


There are two broad categories of upstairs to downstairs, or top down regulators,  one emphasizing biased self construal (B. 1., middle list to the left) the other attempting more unbiased self observation (B2, right list) So, to start with the first:

It seems clear that most of us are completely unequipped to function without a vast array of positive delusions about our abilities, our futures, etc.  There is a large literature on this. Dan Dennett and McKay have just written a treatise in Brain and Behavioral Science that examines possible evolutionary rationales for mistaken beliefs, bizarre delusions, instances of self-deception, etc., they conclude that  only positive illusions meet their criteria for being adaptive.


Johnson and his colleagues have produced an evolutionary model suggesting that overconfidence maximizes individual fitness and that populations tend to become overconfident as long as benefits from contested resources are sufficiently large compared with the cost of competition. Unbiased strategies are only stable under limited conditions.  Maybe this is why overconfidence prevails, even as it contributes to market bubbles, financial collapses, policy failures, disasters and costly wars.


Most people report they are above average drivers and typically place themselves higher many scales than they really are. 70% of high schoolers rate, and, according to themselves,  a spectacular 94% of college professors possess teaching abilities that are above average.


In predicting the future we overestimate the likelihood of positive events, and underestimate the likelihood of negative one. Underestimate our chances getting divorced, being in a car accident, having cancer. We expect to live longer, be more successful, have more talented kids,  than objective measures would warrant. This is officially named the optimism bias, and it is one of the most consistent, prevalent, and robust biases documented in psychology and behavioral economics.


People update their beliefs more in response to information that is better than expected than to information that is worse,  and Dolan’s lab has actually found this reflected in activity in the prefrontal area that tracks estimation errors.  Highly optimistic individuals show reduced tracking of estimation errors that called for negative updates.   In other words, optimism is tied to a selective update failure and diminished neural coding of undesirable information regarding the future.


Our experience of the world is a mixture of stark reality and comforting illusion. We can't spare either. We might think of people as having a psychological immune system [on prezi list] that defends the mind against unhappiness like the physical immune system defends the body from illness.  Defense needs to be good, but not too good - somewhere between “I’m perfect and everyone is against me” and “I’m a loser and I ought to be dead.”


We engage in a wide array of mental gymnastics to salvage our self-esteem rather than owning up to our mistakes.    Recall the famous “mistakes were made” comment regarding the U.S. charging into the Iraq war.


One way to negotiate aging is to deny it, not spend give a lot of mental space to self fulling personal or societal expectations of decline. You can argue that psychological neoteny, retaining youthful attitudes and behaviors, is quite adaptive, especially in old folks, because it might help preserve plasticity of mind and personality that is very useful in ever-changing modern life.


Achievement is usually enhanced by having an inflated view of one’s abilities, which can also lead to working harder to live up to this enhanced self-image.  Students who exaggerate their current grade point averages are more motivated towards education and have higher calming parasympathetic activation when discussing academics.


If we generate a construal of ourselves as powerful, rested, and competent this can dial the blood pressure and sympathetics down and parasympathetics up.   A self construal of being powerless has the opposite effect.  Changes in immune status and inflammatory processes correlate with this transition.  Actually, our brain links to our immune system via the vagus nerve.


One's role in a hierarchy, or relative position in a gradient of personal helplessness to power, is a fundamental determinant of individual well being in both animal and human societies. Subordinate individuals show more chronic stress, anxiety-like behaviors, and susceptibility to disease.  This was most strikingly shown in a well known study on British civil servants.



So, as a summary: self deception can be useful and adaptive as long as it is not wildly inappropriate.  It can enhance vitality and motivate performance, yet enough realism should be retained to avoid straining to do what can not be done.



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Using Classical Conditioning to Fall Out of Love With Someone

Yes, it’s possible.

After a devastating breakup, it’s normal to still feel in love with your ex — you wouldn’t have been with them if you didn’t. And it takes a lot of time to get over that, move on, and learn how to fall out of love.

Founder of Relationship Psychology, John Alex Clark, shared some techniques in order to help the broken-hearted fall out of love with that someone. Yes, it’s possible to learn how to fall out of love with someone just by using a psychology concept called classical conditioning.

Writes Clark:

“Getting over a breakup can be a lot like quitting smoking. When a person chooses to give up a habit like smoking, the initial few days is always the hardest to overcome. Fortunately, it gets easier with time, patience, and practice.”

The Reason Human Beings Fall Out of Love Is Actually Really Sad

To start off, after a breakup, there is always something that will remind you of your ex. It can be a place, food, or even a certain time. The ex was a part of your life, so it’s normal to have these things remind you of them.

In order to fall out of love, Clark says that you must destroy these associations.

“People usually make mental bonds between two experiences, associating one with the other,” he says. “Certain situations or places can trigger an emotional response based on past incidents.”

In short, you must disassociate these places, food, or times from the memory of your ex. For example, if you and your ex always visited this one restaurant, going to that restaurant post-breakup is now painful because you see them everywhere. Instead of avoiding the restaurant like the plague, you could think about the good food and the friendly atmosphere.

“For each positive experience you connect to that once-painful place, the suffering declines,” explains Clark. “Your new, pleasant memories take its place and slowly you no longer make those identifications with your ex.”

Continue with this exercise each time, and soon enough, the painful feeling associated with the place will decline, replaced instead with the positive feelings.

The Oddly Effective Way to Get Over Someone & Fall More Deeply in Love With Yourself

Clark is also aware that this classical conditioning technique will not be easy for everyone, nor will it have the same positive results on everyone. So, you must embrace the pain of the heartbreak, but eventually, try to move on by disassociating these things from your ex.

“The more you brood over your suffering, the deeper you push it into your subconscious, making it harder to uproot when you’re finally ready to move on,” he says.

So embrace the pain and allow yourself to feel sad for now. But eventually, you have to start moving on again. Before you know it, the love you felt for your ex will be but a distant memory.

This guest article originally appeared on YourTango.com: How To Fall Out Of Love, Using A Psychological Technique.



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What Do You Call It When Someone Doesn’t React to Stress?

From a man in Hawaii: What is name of condition of someone who has extreme stressors in life (In last 7 months) my friend has quit drinking, quit thc, quit Jehovah Witness, getting divorced. but show no symptoms of stress. Is there a name for that condition. what are major potential problems?

Your friend is very fortunate to have a friend like yourself who is concerned about him. But do take one day at a time on this.

It’s possible that your friend isn’t stressed but, on the contrary, is relieving himself of the things that stressed him. If that’s the case, he is probably feeling good and enjoying life in new ways.

If, on the other hand, he is in denial about stress from all the life changes, it’s possible that he will at some point get very upset. Since i don’t know the person, I can’t speculate on what form that upset would take.

Or — it could be some combination.

Whatever the case, take the lead from him.

I wish you well,
Dr. Marie



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Monday 29 October 2018

The Complex Case for Inpatient Psychiatric Care

Amidst the cat pics and political memes, the images of my former elementary school classmates’ children, now elementary school students themselves, there will be a link to a mental health article smushed in there on my Facebook wall. Sometimes, usually against my better judgment, I click on it, because click-bait is just so deliciously clickable. Today, I made the mistake of clicking on an article written by Noam Shpancer, PhD, a psychologist and professor at Otterbein University. The article detailed the experience of a psychotic loved one who spent a brief time in an inpatient psychiatric hospital.

In his piece, originally published by Psychology Today, Dr. Shpancer finds fault with just about everything about the psychiatric facility in question, including, but not limited to: the aesthetics of the inpatient milieu (“Every wall and piece of furniture screamed, ‘institution!’”), the psychiatric technicians (“poorly-trained”), the restrictive policies related to contraband, (“Not only were phones and other electronic devices not allowed for patients, visitors weren’t allowed to bring them in either. Our bags were searched as we entered. The safety (or therapeutic) rationale for this procedure was not clear.”), the lighting, “dim”… I could go on, but you can, and should, read Dr. Shpancer’s article for yourself.

I worked at an inpatient, crisis psychiatric hospital for five years, and my eyes were open. They saw things not wholly dissimilar to the things Dr. Shpancer’s loved one saw, and that he saw during his visiting time with her (he complains about visiting hours, too). I would never claim that many of Dr. Shpancer’s observations about this particular psychiatric hospital do not also accurately describe my own experiences at the hospital where I worked. My building was drab and impersonal, too. Some psych techs did not orient their patients properly onto the inpatient unit when they were admitted. Some groups were absurd, poorly-run, and childish. Some staff members should not be allowed to work with people, let alone people with mental health challenges. There is good and bad everywhere.

And this is precisely the issue I take with Dr. Shpancer: nowhere in his diatribe does he write one single mitigating sentence, not one word to offer a different perspective other than an irate family member. Not once does he say that many psychiatric technicians, nurses, therapists, and other frontline staff workers are doing their best given insurmountable difficulties, daily heartbreak, insidious, recurrent disease, poor funding, apathetic politicians, staffing shortages, burnout, trauma exposure, and on and on and on. Nowhere does he write that psychiatric hospitals, despite their faults, and there are faults, save lives — that, without them, individuals with SPMI (serious and persistent mental illness) would be arrested and be sent to jail and, in many parts of the country without inpatient psych facilities, that is exactly what happens.

Why is the furniture institutional? Because it’s inside an institution — because psych hospital furniture gets peed on, and thrown, and because patients will try to use it to harm themselves.

Why are cellphones not permitted? Because psychiatric patients call the police, and the FBI, and the White House, and threaten their family members, and it’s much easier for the ward clerk to flip a switch and shut the phones off when that happens. Oh, and cellphones also have these things called cameras and they’re connected to the internet, so maybe giving patients in a psychiatric hospital a tool with which they could commit HIPAA violations and violate people’s right to privacy isn’t such a hot idea.

Why are visitors searched? So that they can’t bring in items of contraband; items that a patient could use to hurt him or herself, or someone else. Because it isn’t a secure environment if it isn’t secured.

Why do private, non-profit psychiatric hospitals look “drab, impersonal, and ill-lit”? I wrote grants and did fundraising for a private, non-profit psychiatric hospital for two years. It’s not exactly the easiest sell to donors and foundations. I encourage Dr. Shpancer to try his hand at that and see how much money comes rolling in to support the mission and pay for charming enhancements to the corridors and rooms. And if Dr. Shpancer thinks that insurance companies and patients are paying out tons of money to private psych facilities; that’s not happening. Most of the money comes from Medicaid reimbursements and county funding, and they aren’t exactly swimming in that.

Why are visiting hours so short? Visitors tie up everyone at the hospital, from the crisis worker who has to sign them in, identify them, search them, store their belongings, to the psych tech who has to escort them onto the unit and keep track of them, to the roundsperson who has to watch to make sure the visit is proceeding appropriately and that nobody is getting escalated or heated, to the psychologist who has to try to meet with family members when they are present, to the staff member who has to escort them off the unit. There is only so much that can be done in such a setting, in the most restrictive setting, and that is what inpatient hospitalization is: it is the most restrictive setting and, plain and simple, that’s not going to be a super nice experience for anybody involved. It isn’t super nice for staff either.

But for Dr. Shpancer to make sweeping generalizations about inpatient psychiatric hospitalization on the basis of one experience that wasn’t even his, and to not make any statements that mitigate his ire in any way is irresponsible. His essay will dissuade individuals who need help from seeking it, and it will convince family members and friends of people who need help not to involuntarily commit their loved one or friend, and that is dangerous.

I will say it for anybody to hear it: inpatient psychiatric hospitalization should be the option of last resort. Inpatient hospitalization can be traumatizing, and it can be ugly. There are myriad ways to intervene with an individual who is in a mental decline; therapy, warm lines, support groups, interventions, clergy, employee assistance programs, mobile crisis, etc. But when a person is an immediate danger to himself or another person, or is bereft of their ability to care for themselves, inpatient hospitalization is necessary. I heard time and time again from patients, “Yeah, it sucked, but this place saved my life.” And that’s the bottom line.



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Listen to This if You’ve Ever Played the Mental Illness Suffering Olympics

Gabe’s granny likes to say that the only thing you need to start a competition is two people. And while we all accept that people like to compete over their successes – who’s faster, prettier, or richer – it may come as a surprise to you that some folks compete over who is sicker.

Gabe dubs this contest “the suffering Olympics” and readily admits to having played this game, himself. “I wanted to prove I was sicker and it seemed important I was the sickest person in the room,” Gabe said after realizing what he was doing. “The reality is that we are all suffering, we are all afraid, and sharing those experiences doesn’t need to turn into a competition. In fact, it’s much, much healthier to not compete.”

In this episode of A Bipolar, a Schizophrenic, and a Podcast, Gabe and Michelle discuss who has it worse: Gabe for living with bipolar disorder or Michelle for battling schizophrenia. It shouldn’t surprise anyone how ridiculous such a discussion sounds. Listen in and learn from the two most competitive mentally ill people we know.

 

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“Would you date someone with schizophrenia or bipolar?”

 

Highlights From ‘Mental Illness Suffering Olympics’ Episode

[0:30] Gabe and Michelle play the suffering Olympics.

[3:00] Gabe tells a ridiculous conference story.

[6:10] Michelle makes the case that people with schizophrenia “have it worse.”

[7:00] Gabe counters that people living with bipolar have a harder time and suffer more.

[10:00] The debate rages on, with each side describing the negatives of each mental illness.

[15:00] Gabe & Michelle take a moment to consider the appropriateness of this conversation.

[17:00] Michelle tells the story of how she made a woman cry.

[19:30] Gabe & Michelle discuss what makes them different from each other and take a moment to reflect on what they have in common.

 

Meet Your Bipolar and Schizophrenic Hosts

GABE HOWARD was formally diagnosed with bipolar and anxiety disorders after being committed to a psychiatric hospital in 2003. Now in recovery, Gabe is a prominent mental health activist and host of the award-winning Psych Central Show podcast. He is also an award-winning writer and speaker, traveling nationally to share the humorous, yet educational, story of his bipolar life. To work with Gabe, visit gabehoward.com.

 

MICHELLE HAMMER was officially diagnosed with schizophrenia at age 22, but incorrectly diagnosed with bipolar disorder at 18. Michelle is an award-winning mental health advocate who has been featured in press all over the world. In May 2015, Michelle founded the company Schizophrenic.NYC, a mental health clothing line, with the mission of reducing stigma by starting conversations about mental health. She is a firm believer that confidence can get you anywhere. To work with Michelle, visit Schizophrenic.NYC.



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