Psychology Online

Autism and Music Therapy

2009-08-18T01:36:00.000+07:00

Written by Eisla Sebastian

When you have a child that has autism you desperately seek things that will allow you to connect with them. One thing that has been effective at reaching many kids with autism is music. The connection between music and autism has not really been explained, but it most likely has to do with the structure that is inherent in music, its sensory stimulation and perhaps the stimulation of the music processing portion of the brain. Whatever the reason is, music can be a great tool for helping kids with autism to express themselves and to manage their behavior.

Music Therapy
Music therapy can be used with kids that have autism. It involves the use of music in a therapeutic setting to help produce desired reactions or behaviors. For example, it can be used to connect with autistic children who are normally withdrawn or non-responsive to people trying to communicate with them. Music therapy can also be used to help downgrade behavioral outbursts or to encourage physical interactions with another person.

Music as a Soother
Music has the ability to elicit emotional responses from people. This characteristic can be used to help sooth kids with autism when they are having a melt down or having a difficult time adjusting to a new environment. The key to using music as a soothing device is to find the type of music that your child find soothing, interesting or enjoyable. This can take some time and it will take experimentation. However, when you find the music track that works you will notice its impact right away.

Music Equipment
If you want to use music as a soothing tool or as a stimulator you will need to pick up a few pieces of equipment. First you will need a audio player such as a CD player or a boombox. When you purchase electronics look for devices that are designed for young children. These items are more resistant to damage caused by drops and impacts. In addition to a music player you will also need to pick up a good pair of headphones. You don't want to get the kind that insert into your ears, but the kind that have cushioned ear-muffs. If you can afford it, the ones that can cancel out sound work great. Finally you will need a collection of CDs or MP3 downloads, depending on what type of music player you select. If you are low on cash you can also utilize Internet radio stations like Slacker for a great selection of free music from all sorts of genres.

Autism and Music Therapy: Ideas and Theories of a Parent

2009-08-18T01:32:00.002+07:00

There are many, many theories on the use of Music Therapy for children with Autism. And while my own son has never actually received Music Therapy officially, music has provided him with comfort and stability during his 12 years of life so far.

When he was just 18 months old, Matt could not walk, but he could bop to music. Incidentally, it was Janet Jackson's Design of a Decade that he started out with. After that, he expanded into Barney, Teletubbies, Sesame Street, Disney, 80's music, Classical Music, Motown, and eventually worked his way up to more current artists like Clay Aiken, Phil Collins, Elton John and Evanescence. He also enjoys Enya and Yanni. The key to using music as therapy for a child with Autism is the type of music. That is my theory anyways.

I have found, through experience, that the calmer the style of music, the calmer the child is. This is especially important with children on the Autism Spectrum. Oftentimes, children with Autism have problems with aggression and are prone to fits of violence. This is not the case with everyone, but to be on the safe side, it is best to ere on the side of caution and keep them away from the more "violent" types of music like Rap or Hip Hop. I have nothing against the genre in particular, but I don't feel it's appropriate for children with Autism to listen to music with questionable lyrics that talk about violence or other things of an inappropriate nature.

It is imperative that children with Autism be exposed to music early on if they are able to handle the stimulation. Some children with Autism can not tolerate music. For those that can however, starting early is the key. Often times, a soft Concerto or Meditation music is a good place to start, especially with toddlers. I used to help Matt go to sleep by playing music that was nothing more than the sounds of the Ocean. It worked. He couldn't go to sleep without it.

As he grew older, he did not need it, but even now, he is using a walkman with a CD of Evanescence in it, to keep himself calm when he needs help. He has told me as much. The school he attends also uses a sort of Music Therapy with him, allowing him to play a keyboard they have at the school. They also encourage him to go into the lower grade classrooms to sing to the younger children. It has worked wonders for both his self-esteem and his social skills, too. As a matter of fact, this year was the second year he sang in the school talent show.

The most interesting thing about this is that he was able to teach himself how to play the keyboard solely based on the music he's heard. He taught himself more than a dozen Christmas Carols and two Star Trek themes songs. All by just listening to the music. He had no sheet music at the beginning. And when I did buy him the Big Notes Sheet Music, the notes he was playing were identical to the sheet music. And I know that he's not the only Autistic Child to have this gift. It's very inspirational to see that, despite his Autism, he's got a definite gift. One that makes him very happy.

And it all started with music. So, if you have a toddler, or even an older child, see what music can do for them. It will be one of the best things you'll ever do to help make their Autism easier to deal with.

One last note. For most kids, Disney is a staple in every household. Try showing them Fantasia or Fantasia 2000..it will introduce them to classical music composers like George Gershwin and Beethoven. And that's not a bad place to start.

At least that's my theory. I hope that this provides assistance to other parents with children on the Autism Spectrum.

By : Elizabeth Tabian-Sosin

Music Therapy: Effective Treatment for Autism

2009-08-18T01:29:00.000+07:00

Implication and Use

In recent years, autism has gained widespread recognition as a significant complication among children, affecting growth and development. With far more children diagnosed today with autism, than in years past, measures have been taken to create therapy programs that are uniquely designed to address the needs of autistic children.

Music therapy is a service that is becoming increasingly more common for autistic children and their families. For children in the age group that is most interested in capturing their autonomy, usually around age three, the use of music therapy may have the greatest implications. As the period when children begin to express an interest in achieving tasks on their own, music therapy can assist the autistic child in doing so through the management of verbal expression.

For children with autism, the interest in gaining autonomy and performing tasks for themselves may not be enticing. As a result, many autistic children become extremely dependent on their parents for every aspect of their care. With the use of music therapy, autistic children can learn to not only perform self-care tasks, but also value the task for what it is; a chance to develop some form of independence.

Because autism may lead your child to become easily confused with tasks and instructions, self-care can often be a challenge for the autistic child to comprehend. Using music and lyrics, which incorporate these tasks, can assist a child in making that connection, cognitively, and learn to appreciate and perform the task. In the children's show, Barney and Friends, many children learn to incorporate independent tasks into their lives through the songs and lyrics provided. This same concept works for autistic children who have difficulty in performing these same tasks.

When struggling to teach your child the basis self-care tasks, such as brushing teeth, using the restroom and even taking a bath, it may be necessary to seek the guidance of a music therapist. With the intervention of a music therapist, you can obtain songs and music that is designed to teach your child these processes at home. In addition, a music therapist, with daily therapy, can guide your child through these tasks using music and lyrics. While it may seem odd to sing the steps of a simple self-care task, children with autism often process this form of learning best.

While there are many treatment options to consider for autistic children, music therapy is making great strides in improving the learning for all children, especially those with autism. By applying lyrics and music to daily activities, children learn to not only perform valuable independent tasks, but also learn to appreciate the task for what it is. When seeking treatment for your autistic child, ask your pediatrician about the services of a music therapist.

Music Therapy Helping Autistic Children

2009-08-18T01:25:00.002+07:00

It Creates Another Road to Communicate

People are beginning to use music therapy in dealing with autistic children. It has proved to be a form of communication that includes getting things done.

In The Miami Herald's "Health" section Jean Hwang of The Washington Post has written an article titled "Music gets backing for addressing autism." In the article she reports that Judy Simpson is working with her Jana. In order to get her to cooperate and enjoy her bath she sings to her. Jana is 15-years-old.

Judy is a music therapist. Jana is enrolled in music class with 37 other autistic children. She has never been able to develop normal speech patterns.

As the report goes on to tell us, a typical class would include a teacher sitting in a semi-circle and singling and play and instrument. The children may participate in some way such as shaking maracas and some rock back and forth.

Some children are agitated by sounds. Whether it is the sounds of ambulances or the music at school they react.

As with many medical conditions there are many different levels of affectation. There are kids that can for example, play music and even compose music.

With children who are more challenged it is a matter of trying to get them to do the basics. It is simply another way to communicate.

I am not surprised at the success of music when used this way.

When our sons were babies I would walk with them and I always sang a song I made up. It's called "A Little Old Man in a Boat" -- if you care. This song either put those boys to sleep or, it calmed them down or helped them focus.

It has done the same for our new granddaughter.

It is sad that people who sometimes mean well can cause hurt because of their ignorance of a condition.

I know a boy very well who has Autism. He is a great child and has a lot of friends.

His teacher thinking she was doing him a favor had him get up in front of the class and tell them how and why he was "different."

Of course he was upset and told his parents and there was a big problem but the point here is that people aren't educated about illness.

I have taken several music courses. Music's history, definitions and methods for use is a fascinating study.

Reference: http://www.miamiherald.com/living/health/story/963460.html

ADHD Linked To Sleep Problems In Adolescents

2009-08-04T16:52:00.001+07:00

ScienceDaily (May 6, 2009) — A new study shows that adolescents with a childhood diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) are more likely to have current and lifetime sleep problems and disorders, regardless of the severity of current ADHD symptoms. Authors suggest that findings indicate that mental health professionals should screen for sleep problems and psychiatric comorbidities among all adolescents with a childhood diagnosis of ADHD.

Results indicate that adolescents with a childhood diagnosis of ADHD, regardless of persistent ADHD were more likely to have current sleep problems and sleep disorders such as insomnia, sleep terrors, nightmares, bruxism and snoring. Of the total sample, 17 percent of children with ADHD were currently suffering from primary insomnia, versus 7 percent of controls; lifetime primary insomnia occurred in 20 percent of children with ADHD, compared to 10 percent of controls. Nightmare disorder affected 11 percent of children with ADHD and lifetime nightmare disorder affected 23 percent, versus 5 and 16 percent of controls. The presence of at least one psychiatric comorbid condition increases the risks for insomnia and nightmares.

According to principal investigator Susan Shur-Fen Gau, MD, PhD, associate professor at the College of Medicine and Public Health, National Taiwan University, symptoms and consequences of ADHD and sleep problems in children often overlap. Some primary sleep disorders are found to be associated with inattention, hyperactivity, behavioral problems and impaired academic performance, which are often mistaken for symptoms of ADHD.

"In some patients with ADHD, symptoms are caused or exaggerated by primary sleep disorders, and therefore treatment of the sleep disorder will improve ADHD symptoms," said Gau.

Data were collected from 281 consecutive patients (86.2 percent male) between the ages of 10 to 17 years who had been diagnosed with ADHD according to DSM-IV criteria at a mean age of 6.7 years, and 185 controls who did not have ADHD as a child or teen. Diagnosis of ADHD was made based on information obtained from parent and child interviews, observation of the child's behaviors, and rating scales reported by parents and teachers.

Findings of the study indicated that the rates of nightmare and lifetime nightmare disorder were more prevalent in girls and snoring was more prevalent in boys. Snoring may be more prevalent in boys due to an increased rate of sleep-disordered breathing in boys. Mothers were found to be more aware of symptoms related to ADHD in the presence of primary insomnia, sleep terror disorder or sleepwalking disorder, whereas teachers may be more sensitive to ADHD symptoms in the presence of primary hypersomnia and nightmare disorder.

According to the study, sleep problems in children with ADHD may be caused by a variety of factors, including internet addiction, hyperactivity, use of stimulants and the presence of other psychiatric disorders. Authors of the study state that the etiology of sleep problems and disorders need to be identified in children with ADHD, in order to create a modified treatment regime for sleep disorders and ADHD symptoms.

Journal reference:
Susan Shur-Fen Gau, Huey-Ling Chiang. Sleep Problems and Disorders among Adolescents with Persistent and Subthreshold Attention-deficit/Hyperactivity Disorders. Sleep, May 1, 2009 [link]

Extreme Personality Poses Risk Of ADHD, Conduct Disorder

2009-08-04T16:50:00.000+07:00

ScienceDaily (Mar. 26, 2006) — Children with personalities marked by aggressiveness, mood swings, a sense of alienation and a need for excitement may be at greater risk for attention deficit hyperactivity disorder or conduct disorder, according to a new Florida State University study.

FSU psychology professors Jeanette Taylor and Chris Schatschneider, FSU doctoral student Kelly Cukrowicz and University of Minnesota Professor William Iacono found that children with ADHD or conduct disorder had more negative emotions - aggressiveness, tension and feelings of being exploited, unlucky or poorly treated - and lower constraints - a tendency to break rules and engage in thrill-seeking behavior - than children with neither of the disorders. Not surprisingly, those children who have both ADHD and conduct disorder had the most extreme personality profiles.

"This helps us to understand that personality is part of the bigger picture of these disorders," Taylor said. "That could help with initial assessments or lead to unexpected discoveries or potential interventions. We're saying to researchers and clinicians, 'Think about personality when you look at these issues.' "

The study, published in the Journal of Child Psychology and Psychiatry, is the first to investigate personality trait patterns among children who have ADHD, conduct disorder or a combination of both. It is important to learn more about the co-occurrence of ADHD and conduct disorder because the consequences are so severe, Taylor said.

"It's more than the sum of its parts," she said, explaining that children and adolescents with a combination of the two disorders are at much higher risk of school failure, criminal activity, substance abuse and depression. Previous studies have indicated that between 15 to 35 percent of children with ADHD also have conduct disorder.

Between 3 percent and 5 percent of U.S. school age children are estimated to have ADHD, a disorder that encompasses symptoms of hyperactivity, inattention or impulsivity. Conduct disorder affects about 13 percent of children and adolescents and is characterized by severe misbehavior including chronic lying, setting fires, destroying property or hurting animals.

The researchers analyzed personality data from 1,438 sets of same-sex, reared-together 11-year-old and 17-year-old male and female twins who participated in the Minnesota Twin Family Study. The rate of ADHD, conduct disorder and the co-occurrence of both was about the same as is found in the general population, Taylor said. Those who did not have symptoms of the disorders served as the control group.

The connection between personality and the disorders is clear, but more research will have to be done to determine whether the personality traits are shaped by the psychological disorders or vice versa.

"Developmentally, it makes sense that the personality comes first," she said. "But to say that one causes the other is too simplistic. I think they become intertwined."

For ADHD Children, Mother's Depression & Early Parenting Predict Conduct Problems

2009-08-04T16:47:00.001+07:00

ScienceDaily (Apr. 12, 2007) — A mother's depression predicts whether children with ADHD (Attention Deficit Hyperactivity Disorder) will develop conduct problems such as lying, fighting, bullying and stealing, according to a new study from a University of Maryland researcher.

The study, published in the January 2007 issue of the American Psychological Association's journal, Developmental Psychology, also found that early positive parenting during the preschool years predicted fewer conduct problems as the children grew to early adolescence. The strength of the findings led the researchers to conclude that maternal depression may be a risk factor, whereas positive parenting may be a protective factor.

"This research gives us clear targets for early intervention to prevent conduct problems in children with ADHD," says Andrea Chronis, director of the University of Maryland ADHD Program and professor of psychology who served as lead author on the paper. "In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders."

The researchers say their study is the first to focus directly on the role of parent mental health and early parenting in the development of conduct problems among children with ADHD. Moreover, they point to previous research that shows the development of conduct problems to be quite common in children with ADHD. By one estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

"Parenting an ADHD child is very difficult for many families," Chronis says. "Often there's a growing cycle of negativity as parents' nerves fray and their children's behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle."

Findings and Method

Specifically, the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time, when other possible contributing factors were controlled. Also, children of previously depressed mothers had significantly higher levels of conduct problems over time compared to children whose mothers had never been depressed.

This research is part of an ongoing longitudinal study funded by the National Institutes of Health that follows ADHD children through their 18th birthday. Conducted by members of the research team at the Universities of Chicago and Pittsburgh, it consisted of a series of annual assessments of 108 children's behavior and development. Children ranged in age from four to seven at the start of the research. The parenting techniques were assessed using observational methodology during the first year of the study. Information on the mother's mental health was also collected annually.

The study focused on the mothers' health and parenting since they are most often the primary caretakers and are more likely to be depressed than men. Also, an earlier study by Chronis and the research team found that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids.

With a grant from the National Institute of Mental Health, Chronis and her research team at the University of Maryland are now developing and evaluating a 14-week behavioral intervention for depressed mothers of children with ADHD that targets effective parenting and reducing maternal depression.

Youth's Social Problems Contribute To Anxiety And Depression

2009-08-04T16:41:00.000+07:00

ScienceDaily (Mar. 25, 2008) — Socially successful children tend to have fewer symptoms of anxiety or depression, while children with problems such as anxiety and depression tend to have difficulties forming relationships and being accepted by friends. However, it is difficult to determine whether the anxiety and depression lead to the social problems, or vice versa. New research suggests that social problems are more likely to contribute to anxiety and depression than the reverse. The research also shows that this is particularly likely during the transition from adolescence into young adulthood.

Using data from Project Competence, which has followed a group of 205 individuals from middle childhood (ages 8 to 12) over 20 years into young adulthood, the researchers used detailed interviews with participants and reports from their parents, teachers, and classmates to create measures of so-called internalizing problems (anxiety, depressed mood, being withdrawn) and social competence (how well one functions in relation to other people, particularly with respect to getting along with others and forming close relationships). They then examined how these measures related to each other over time, taking into account the stability of each (in other words, that children who have social problems at the start of the study may continue to have them over time).

The researchers found that young people who had more internalizing problems (such as anxiety and depression) at the start of the study were more likely to have those problems in adolescence and young adulthood. Those who were socially competent at the start of the study were socially competent as they grew up. However, in addition to this evidence of continuity, the study found evidence of spillover effects, where social problems contributed to increasing internalizing symptoms over time.

Children who were less socially competent in childhood were more likely to have symptoms of anxious or depressed mood in adolescence. Similarly, young people who were less socially competent in adolescence were at greater risk for symptoms of anxiety and depression in young adulthood. The findings remained the same when the researchers took into account some other possible explanations, such as intellectual functioning, the quality of parenting, social class, and such problems as fighting, lying, and stealing. And the results were generally the same for both males and females.

"Overall, our research suggests that social competence, such as acceptance by peers and developing healthy relationships, is a key influence in the development of future internalizing problems such as anxiety and depressed mood, especially over the transition years from adolescence into young adulthood," explains Keith Burt, assistant professor of psychology at the University of Vermont and the study's lead author. "These results suggest that although internalizing problems have some stability across time, there is also room for intervention and change. More specifically, youth at risk for internalizing problems might benefit from interventions focused on building healthy relationships with peers."

Summarized from Child Development, Vol. 79, Issue 2, The Interplay of Social Competence and Psychopathology Over 20 Years: Testing Transactional and Cascade Models by Burt, KB (University of Vermont), Obradoviæ, J, Long, JD, and Masten, AS (University of Minnesota). The study was funded, in part, by the National Science Foundation and the National Institute of Mental Health.

Is Exposing the Rorschach Killing the Rorschach?

2009-08-04T16:38:00.000+07:00

The Rorschach has been exposed. Is it dying?

The New York Times recently staged the Wikipedia-Rorschach debate that's been going on at least since June, when emergency room doctor James Heilman posted all 10 ink blots on Wikipedia, along with the most frequent form responses. Heilman says that restricting this information from the public domain would be akin to "the Chinese government's attempt to control information about the Tiananmen massacre," according to The Times.

Technically, Heilman has a point. The Rorschach material is no longer protected under copyright law, because the copyright has expired. And, Heilman is not bound by the APA code of ethics, which requires that psychologists "make reasonable efforts to maintain the integrity and security of test materials." After all, he is not a psychologist (I don't think), just a person, like many of us, who can buy a set of the inkblots from one of its distributors for $100 to $200. (Some restrictions do apply. Western Psychological Services, for instance, requires that people who buy the test from them have a Masters degree in psychology or a related field, but not necessarily a license to practice.)

There are other reasons to cool the hysteria we might feel about the disclosure of a reliable psychological tool. On the scary side, of course, Wikipedia does give away a couple "clues" that might help test-takers skew or at least invalidate their scores. For instance, Wikipedia reports that psychologists monitor for an appropriate number of responses to each ink blot, for the organization of responses, for complexity, and for references to the human figure. But "organization" and "complexity" are technical words to people who score the test, and vague descriptions to people reading the Wikipedia entry. Indeed, it takes years of training to learn the nuance of scoring a Rorschach. If the "answers" to receiving a certain score were so simple that they could be listed in a Wikipedia entry, psychologists would not need years of testing classes before they earned their degrees.

To put it another way, there's a richness to every Rorschach response that's akin to the richness of any sentence someone speaks in a therapist's office. It's our job as clinicians to interpret and not just score the thing. As Alvin Burstein from the University of Tennessee says in the NYT article, "The process of making sense of one's experience is gratifying. To take Rorschach's test is to make sense of ambiguity in the context of someone who is interested in how you do that."

Also, there's the issue that projective responses are pretty hard to fake. It's hard, for instance, for an anxious woman to "act convincingly calm" during a test. (I use that example to obscure what I want to say, to give a more specific example of how one could or could not "cheat" the test. I feel bound by the code of ethics!) But it's certainly hard for a psychotic person to decide not to give psychotic answers.

That said, I am surprised the ink blots haven't been so widely exposed until now. And I do think it's very sad--that the thrill of exposure here threatens to render a helpful tool, which took years to build, less helpful. I feel like someone's spat graffiti on the Mona Lisa, or crapped on the Museum steps.

More on Emotional Intelligence and Bombs

2009-08-04T16:28:00.001+07:00

My latest post, a discussion and review of "The Hurt Locker" spotlighted emotional intelligence, specifically the psychological ability to mind-read others known as empathy and its deceivingly high importance in successful foxhole behavior. Coincidently, today's NY Times health section features an article that reiterates and expands upon much of what I wrote. As this article contains more in-depth information about a wider body of research on the human mind and bomb detection, I wanted to disseminate the link as well as some thoughts.

Here is the link: http://www.nytimes.com/2009/07/28/health/research/28brain.html

What is becoming increasingly clear with recent research findings is that some soldiers (like James in The Hurt Locker) are much better than most other individuals at detecting danger. Some confluence of cognitive and psychological abilities allows these super mind-readers of detection to constantly hone on an above-average, invisible mental radar. This radar comes in the form of a gut instinct or subtle physical sensation that hits the body a few seconds/minutes before it hits the conscious mind. Benedict Carey, author of the abovementioned article, likens this "moment" to when you pause as you are leaving your house but only well after the pause do you realize you've forgotten your wallet.

If you are a U.S. soldier patrolling an Iraqi marketplace, empathy can become a mildly prophetic power in identifying buried bombs. Empathy is so widely discussed in the literature that many fields have tweaked its definition to accommodate the purpose of study. Here, the purpose is things that are central to avoiding imminent threats, and empathy is discussed as the speed with which the brain reads and interprets sensations like the feelings in one's own body and emotions in the body language of others.

In my blog post, I discussed how the world of intelligence testing embraces rational processes like memory and all but discards emotional processes like empathy, despite the potentially high value this skill has in a military-specific context. This article notes the turning-of-the-tide. Yes, emotions are still viewed as the perpetrators of reckless, rebellious behavior (as James was accused of in "The Hurt Locker") but now emotions are also being seen as the key elements of the most sensitive detection equipment available, the human mind. "We understand emotions as practical action programs that work to solve problems, often before we're conscious of it. These processes are at work continually, in pilots, leaders of expeditions, parents, all of us," says Dr. Antonio Damasio, director of the Brain and Creativity Institute at the University of Southern California.

Another important point that the article notes but does not sufficiently analyze is the buffering effects that empathy and emotional intelligence exerts on PTSD. Without explicitly saying so, the article builds a persuasive case that bomb detection is a much too perfect occupation for developing PTSD. This is due to the genealizability of uncertainty.

The soldiers interviewed in the Times article describe the search for buried bombs as never routine, and never obvious. Bombs might be ticking away in an innocent looking divot in or a pile of discarded cans. In fact, one story tells of real bombs buried in fake rocks and fake bombs in plain view. Our brains are designed in such as to learn the association between life threatening danger and a pile of discarded cans in as quickly as one-trial. Walk past an explosion of this sort and when you return home taking out the garbage may feel like a life-or-death chore. Essentially, PTSD is learning in a new and dangerous environment that sticks even after a return to the old, safe environment. Due to such deceitful bomb burying tactics soldiers are unconsciously learning to fear that which is routine, mundane, and seemingly safe from all sides.

Empathy and emotional intelligence can become a bullet-proof vest against PTSD because it fights off one of its top predictors - peri-trauma dissociation. This occurs when you become so freaked out during a traumatic event that you curl up into the fetal position, psychologically, tune out and simply hope that danger will be averted. You fail to manage your emotions enough stay grounded and collected, accept the unfairness of it all and escape danger with speed and skill and, subsequently, self-efficacy (the knowledge that you can keep yourself alive). Walking around with a perpetually firm grasp on what you and others are feeling (empathy) and managing intense feelings and converting negative emotions to positive ones (all skills under the rubric of emotional intelligence), prevents this sort of mental fleeing.

Adult Animation: The New Image of "Old"

2009-07-25T13:28:00.002+07:00

Why old is the new young

The traditional or Old School view of the elderly is not a pretty picture. Free associate to the words, "Old" or "grandparent" and you are likely to activate the following images: trembling hands obliviously unwrapping hard candies with barely the motor skills to complete the task; a conversation that starts as a conversation but ends in bewildered silence, as names and dates are chronologically twisted beyond all hope and recognition. And then there are the cliched personality changes - an increasingly grumpy preoccupation with "how things used to be," or the serene, blanket dismissal of all things technological.

However stereotypical, this litany of "old person" symptoms - cemented anachronistic thinking, declining physical and mental abilities, sedated personality - are commonly perceived to constitute this phase of life long thought to be a meaningless wait for death. And although most stereotypes contain a nugget of truth, this Old School view may distort the truth to flagrant degrees. It is easy, for instance, to take note of the two million residents in nursing homes across America, but it is far easier to forget the 35 million senior citizens living and maybe even thriving outside of such assisted living settings.

In recent years an aggressive onslaught of academic research is presenting a New School view of aging that, oddly enough, resembles a rebirth of unexpected fulfillment and untapped creativity.

This attitudinal about-face is captured with striking accuracy and enthusiasm in the recently released, "Up," another blockbuster from Pixar, the leading film company in modern animation, according to Roger Ebert.

"Up" is the story of Carl and Ellie. They meet as 8 year-olds with shared adventurer spirits and dreams of traveling to Paradise Falls, a Lost Land in South America. They spend the next 70 years not doing this. Then, conflict arises. After Ellie passes away but before Carl's imperfect judgment can land him in a retirement home, Carl ties thousands of balloons to his home and takes off in pursuit of Paradise Falls. The film acknowledges Old School thinking, as we first meet a 78 year-old Carl who is in full cantankerous curmudgeon mode: He is a comedic recluse who actively resists the change coming to his neighborhood by shaking his cane at anyone who enters his line of sight, including Russell, the wide-eyed, optimistic Cub Scout who accidently comes along for the ride.

Despite this stereotypical start, the research supported New School thought soon dominates the plotline. Two main threads can be followed in this vein - the adventurer personality changes exhibited by Carl and the imaginative texture of the world in which Carl operates.

In recent years, the halls of academia have watched as the image of the elderly has experienced a counterclockwise effect - growing more youthful and energetic as far as achievement and creativity are concerned. In a recent Psychology Today blog post, Shelly Carson describes how this makes sense, as the aging brain increasingly resembles the distraction and disinhibition of the creative brain. Versus the young brain, the aging brain has proven triumphant in the following cognitive contests: production of novel associations, broadening knowledge base and focus of attention and diminished need to please or conform. If these are not the ingredients of a creative mind, I don't know what is.

Further, this epiphany of positivity about the elderly is reversing an assumption about genius long thought to be dead and buried. In a New Yorker article earlier this year Malcolm Gladwell challenges the premise that creative accomplishment is a young man's game played with exclusively youthful tools like exuberance and energy. He discusses "late bloomers," those geniuses who take a dramatically different approach to achievement compared with the more well-known and precocious prodigies of history. Unlike Mozart, a man whose achievements came full circle before his thirtieth birthday, painters like Cezenne, according to Gladwell, experienced greatest production in later life, because of age, not in spite of it. Cezenne benefited from an experimental, trial-and-error approach characterized by repetition, incremental gains and imprecise goals. This late bloomer path seems to accommodate an old man's game, best played with such tools as wisdom, patience and perseverance.

In "Up," Carl embodies both the creative brain and the late bloomer approach. After all, converting his house into a giant hot air balloon could not be more out of the box. Tethering that same house to his torso and stubbornly pulling it across treacherous underbrush could not be more tedious. In fact, by flying through the earlier stages of life in montage form, the last stage of life is presented as the most exciting and growth-inducing.

This New School of thought is not only counter-intuitive, it is paradoxical. As an individual ages and physically appears older, his/her mental state may be pulling a Benjamin Button. "Up" attempts to capture this notion by playing with our expectations and creating a fantastical, child-like physical landscape that speaks to the potentially re-born elderly audience members. A mature and sophisticated storyline is presented. but couched within a world that resembles a generic Disney movie for kids. After all, there are exotic creatures, goofy sidekicks and wild adventures. And in case we miss this point, the movie marks its animated narrative with the footprint of classic cartoon shows. The spontaneous adventure in a faraway land channels "Duck Tales," and the extended battle scenes high in the sky pays homage to "Tale Spin."

We know that this G-rated appearance is a head fake, however, because of the tongue in cheek humor. The subtext is rated at least PG-13, as the narrative reads like the kind of bedtime story that an adult tells his child to keep himself engaged. For instance, in a child's imagination, the exotic birds and talking dogs in "Up" would act as human as mommy or daddy. And yet the animals think and behave in exactly the ways an adult mind would have imagined them to - the dogs seem to have a genetic predisposition for tennis balls and they call sudden timeouts in order to chase imaginary squirrels. Inside the mind of an elderly individual may be a newlyformed youthful spirit; inside this youthful looking movie is a wise and elderly spirit.

As cinema starts to play catch-up to the literature that now exists on this hidden, positive side of aging, the take-home message is this: old age may always be a time of existential angst filled with fears and mourning. But with substantial effort and determination such negative experiences may be amenable so that the angst of death can be rerouted into an adaptive energy that catapults old age into a transformative experience. "Up" is a rich and vivid example of how "old" may be the new "young."

OCD Treatment: As Good As It Gets?

2009-07-25T13:26:00.000+07:00

For OCD, medication not necessarily "as good as it gets."

I got a call from a psychiatrist colleague of mine a while back. He was an old-school Freudian psychoanalyst who had his patients come in twice a week to lie on a couch, talk about their dreams, free-associate about childhood experiences, and so on. Although this type of treatment might be useful for some patients - especially those who wish to better understand and change troublesome personality patterns - it has not always been strongly supported by research.

As it turned out, the psychiatrist was calling to ask if I would take on one of his patients who suffered from obsessive-compulsive disorder (OCD) - a debilitating mental illness that afflicts about 2% of the population - wonderfully depicted by Jack Nicholson in the film, As Good As It Gets. The psychiatrist had already been treating this distraught young man for over 4 years, but his OCD symptoms actually worsened over that span of time. Since there's no good scientific evidence that Freudian psychoanalysis is an effective treatment for OCD, I wasn't terribly surprised.

Fortunately, during my grad school training at Duke, our instructors and supervisors emphasized the importance of asking, for each form of mental illness: which of the hundreds of possible treatments are most strongly supported by the research evidence?

For OCD, this is a no-brainer: a form of behavior therapy called exposure and response prevention (sometimes called exposure and ritual prevention) has outperformed other treatments (including meds) in the clear majority of relevant outcome trials.

To get some idea of the potency of behavior therapy for OCD, consider the results of the largest OCD comparative outcome study to date, sponsored by the National Institutes of Mental Health. The study pitted behavior therapy against a drug called Anafranil (clomiprimine), arguably the most effective OCD medication currently on the market. Here were the observed rates of favorable treatment response:

Behavior Therapy: 86%
Anafranil: 48%
Placebo: 10%

Notice that OCD is such a severe disorder that it has a minimal placebo response . . . it takes much more than placebo-induced positive expectancies to cure this particular illness. And even though Anafranil certainly outperformed the placebo in this study (48% to 10%), behavior therapy was considerably more effective (with a whopping 86% response rate). In fact, it wasn't even a close call.

There's a genuine tragedy, though, embedded in these numbers: many OCD patients will never even know that behavior therapy exists. While some will waste their time and money on ineffective forms of psychotherapy, most OCD patients will simply be told that they have a 'chemical imbalance', handed a prescription of Anafranil or a similar medication, and told in effect, "this is as good as it gets".

Sadly, it's hard to get the word out about behavior therapy for OCD. Few mental health reporters understand the field well enough to do the story. Drug companies have multimillion dollar budgets to promote their products - for better and for worse - whereas psychotherapists skilled in behavior therapy for OCD are small in both numbers and financial resources. (To find such a therapist near you, try contacting the Center for Anxiety and Related Disorders.)

In case you're wondering . . . within 4 months of my taking on the aforementioned OCD patient and treating him with standard behavior therapy, his symptoms were in remission. I've seen it repeatedly over the course of my career, and I'm not a particularly gifted psychotherapist (clinical research is my main gig), nor is OCD my area of specialty.

So lately, whenever I see an antidepressant commercial, I find myself thinking, "If only someone had the money for a series of slick commercials about behavior therapy! We've got to find a way to tell the 6 million OCD sufferers that there's a potentially more efficacious treatment out there - one (alas) that many have never even heard of."

Food Inc.: The Psychological Weapons of Protest

2009-07-25T13:24:00.000+07:00

Why we don't care about the things that kill us

Food Inc. is a case in point of powerful activism. Its mission is to crystallize two things about food in America: a. what we eat is disturbingly unsafe b. the system in charge of what we eat is disturbingly corrupt. There is anecdotal evidence and statistics. The presentation is accessible and thorough. This is as moving and well done a documentary as any since Al Gore's Inconvenient Truth. The weapons used in this intellectual war against Big Business of food are vast and effective. The problem, however, is that the villain this documentary wages war on is psychologically difficult to stay mad at for very long.

For instance, I left the theater a little too cognizant of the candy and soda I'd just ingested, I wondered just how many minutes it was going to take for the sense of outrage and disgust I currently felt to dissolve back into indifference?

One of the reasons I am not ashamed to admit this is because of research by Daniel Gilbert, a social psychologist from Harvard.

He has studied our psychological response to such large and abstract threats as global warming and concluded that the human brain is naturally designed to respond in a manner that is far from ideal. When it comes to certain evolutionarily relevant threats like snakes and darkness, Gilbert maintains that our alarm systems are sleek, smooth and dependable. And yet for certain other threats this same alarm system goes haywire, producing an emotional baseline of apathy and acceptance that is challenging to change.

So, where does Big Agriculture lie on the "response to threat" spectrum and does the documentary effectively battle these psychological barriers?

According to Gilbert there are four key elements of a threat without which we will not act instantaneously and decisively:

a. The threat must have a face. We are highly social beings and our wiring is triggered by the aggressive action of other people, as opposed to something invisible or unhuman. This is why the Big Business CEO's of the agricultural industry were so wise in refusing to interview. Consequently, Food Inc.'s list of villains is long and vague: the greedy private enterprises, the corrupt government, the apathetic consumers etc. Here, too little is done in establishing a face to put on the dartboard.

b. The threat must incite a moral sensibility. When we are confronted with something repugnant, our minds generate such powerful emotions as disgust, which compel us to action as much as anything. On this barometer Food Inc. lands not too far behind puppy killing. In providing extending home footage of little Kevin, a three year-old victim of E-coli, Food Inc. activates our moral centers. Additional images of pigs that are too fat to move, cows that are knee-deep in their own feces and chickens with heads bigger than Barry Bonds provide an exclamation point.

c. The threat must represent a clear and present danger. Gilbert says that global warming is not happening fast enough in that sense that our brains best respond in milliseconds to flying baseball bats, not incremental recessions in icebergs. The documentary highlights the what-have-you-done-for-me-lately elements of threat by highlighting the various outbreaks and recalls that have soiled America's clean bill of health.

d. The threat must cause absolute, not relative changes. We respond to threats that can be current and observed in real-time. The documentary does focus on such current crises as the obesity and diabetes II epidemics, but these disorders do not develop overnight.

Food Inc. tackles an issue that bats two-for-four leaving me to conclude that food impurity, as a villain that incites activism, ranks a little better than global warming but worse than terrorism. Incidentally, a terrorist is an extremely gratifying enemy, psychological speaking. Fuse Osama Ben Laden with the 9/11 attacks and bat a thousand on Gilbert's categorical system.

This documentary shows the industrial food industry to be a small group of greedy, clever business figures (probably old white and male, too) who abuse animals, workers and the welfare of just about everyone all so their respective pockets can be lined with yet another billion dollars. The veil has been lifted to reveal supermarkets that are barely a step removed from the grease and slime of McDonalds. Food Inc. convicts Big Agriculture of terrorizing a fair and healthy way of life. Indeed, this documentary will need to link the industrial food system with terrorism to incite the sort of feverish protest that is needed.

In Search of "The Dirty Old Woman."

2009-07-25T13:20:00.001+07:00

Where are all the "dirty old women" hanging out?

When a friend referred to "dirty old men" the other day, I wondered why we don't have a archetype for the "dirty old woman." Archetypes hold some truth. So I'm wondering if the "dirty old woman" exists in any big numbers--and if not, why not?

Men do generally lead more sexually aggressive lives than women do. Men account for the vast majority of our online predators, sex addicts, rapists, sociopaths, and pedophiliacs.

In turn, if we want to know why we haven't heard much about "dirty old women," we might assume that the male's sex drive is bigger or lasts longer into old age than a woman's sex drive does. While nearly all of us get bitter as we grow older and alone, a man's frustration might be just be more sexual. We might have "dirty old men" on the one hand and "bitter old ladies" (whose frustration is less sexualized) on the other. That said, the relative strength of our sex drives has never been clearly established.

There's also the fact that sexual predators are basically aggressors--and men and women have different relationships with aggression. Men tend to direct their aggression outwards, into external conquests. Women are more likely to take their anger out on themselves. That's one reason why women suffer higher rates of depression than men do. Depression is often described as anger turned in on yourself.

In that light, perhaps "dirty old men" are unsatisfied people who direct their frustration into the world, finding external targets for their appetite. Women, on the other hand, direct aggression inward. Here you can think of a parallel between the "dirty old man" and the "narcissistic diva." I'm thinking of the rise of divas like those on The Real Housewives of New Jersey (which I love to watch), who enter older age attacking their own bodies with manic sexual energy, in facelifts or dieting or shopping or hoarding. If some men sexually aggress through external conquests, perhaps some woman sexually aggresses through self-conquest.

That dichotomy (men entering the public realm; women keeping to the private) has been central to gender studies for ages. As early as 1869, John Stuart Mill wrote in The Subjection of Women that women have learned, through history alone, to not be the aggressor. They are taught that their realm of interest is in the home, in the body, or in appearance, rather than in political or public action. "All women are brought up," Mill wrote, "[being told] that their ideal of character is...submission. ...All the current sentimentalities [say] that it is their nature. [But] the greatest [mistake we make] is [our] unspeakable ignorance [about] the influences which form human character." He meant that women have been raised to be objects acted upon rather than aggressors. But they are not necessarily biologically more passive then men.

And one reason we might have more infamous male aggressors--more rapists, Napoleons, or Hitlers--is that women have been practically debarred from the public realm, so have either repressed their own aggressive impulses or enacted their conquests in the private realm (on their own faces, wardrobes, diets, or children).

But any search for the "dirty old woman" also needs to account for the taboo against female sexuality. Perhaps the women pedophiliacs, for instance, exist in higher numbers than we assume. But they're ashamed of telling anyone or getting caught. So we just don't hear about them. Hence: no public cliché of the "dirty old woman." And perhaps the modern rise of the "cougar" (an older woman who dates younger men) is a sign that women are feeling freer to express their sexuality and aggression in the public realm. But what's your take? Where are all the "dirty old women" hanging out?

What Does Hypnosis Really Feel Like?

2009-07-25T13:18:00.000+07:00

The experience of a hypnotic trance is not so unusual...

The experience of a hypnotic trance not so unusual or strange. To the contrary, it feels vaguely familiar to countless other moments in your life where you were absorbed in a zone, lost in thought, enthralled by bliss, or perhaps simply meditating. Meditation is actually the closest you can come to a state of trance without being guided there, as you would experience in hypnosis. I often refer to it as taking my clients on a journey, a metaphorical trip in your mind or imagination.

There are countless ways to enter a trance. It is similar to falling asleep just not losing conscious awareness. That means that you are able to hear and sense things around you but, typically your eyes are closed, you are not moving, just resting comfortably relaxed. Amazing things happen when you relax on purpose. You should notice that your breathing slows down and most of your muscles become relaxed. There is this sense of distance from where you are, the passage of time gets distorted and often you feel a pleasant, almost euphoric state of peace.

The depth of a hypnotic trance varies, it can be very light or extremely deep. When you feel comfortable with the hypnotherapist, you are willing to "let go" to and allow yourself to enter a trance, then you can experience the special power of the mind and imagination. The power of hypnosis does not depend on the depth of the trance, rather it is a matter of skills the hypnotist has to help you experience something special.

As you enter hypnosis, you actually disconnect your mind from the body and surroundings. That means that your awareness is withdrawn from the normal alert state you walk around in and goes inwardly. The power of hypnosis is your ability to harness the full potential of your imagination without the normal restrictions of the critical mind. This is when a skilled hypnotherapist can help you make dramatic changes in your life. The hidden power of trance is in the suggestions you listen to and how much you embrace these new ideas.

Hypnosis does feel very nice and relaxing, almost like taking a nap. The big difference is in what you are guided to experience during the trance. There are many unusual effects that hypnosis can have on a person. An example of a famous one is the arm levitation, where your arm rises up with a distinct sense that you are not doing it intentionally. There are many strange sensations a person can have during a trance which can only happen under hypnosis; none of these can cause you any harm or pain. Remember, that you cannot be hypnotized against your will, it works only if you agree to let it happen. So, perhaps you are now getting a bit more curious about taking a journey and exploring the hidden labyrinth of your mind.

Let me know if you have any questions. Regards JR

Helping Children Draw Out Their Traumas

2009-07-25T13:15:00.003+07:00

Drawing makes a difference in children's recovery from trauma.

It's well known that traumatic events have profound effects on cognitive, emotional, and physical functioning in children. Fortunately, many children recover from traumatic events in a matter of weeks, but others have serious reactions that may last months or years. For those children who do not bounce back, there is hope through structured intervention and one simple activity: drawing.

For almost twenty years, the National Institute for Trauma and Loss In Children [see earlier post, Resilience Matters in Traumatized Children's Lives] has been "ground zero" for the study and promotion of sensory-based interventions [art, play, and somatic therapies] in children's recovery from trauma. Dr. William Steele, founder of the Institute, has been a passionate, dedicated advocate and visionary for development and research on methods to support this approach. I first met Bill in 1994 after a decade of working as an art therapist and a mental health counselor with children exposed to violence, abuse, and neglect. I immediately knew that I had encountered a kindred spirit who understood how trauma is experienced by children -- that it is primarily an implicit experience that involves sensory memories involving sight, sound, touch, smell, and taste.

The idea that trauma is encoded in a sensory fashion by mind and body is now widely accepted by professionals who work with individuals with stress reactions, including posttraumatic stress disorder in children and adults. Well-known traumatologist Bessel van der Kolk observes that when terrifying events such as trauma are experienced, but do not fit into a contextual memory, new memories or dissociations inevitably are established. In other words, when a traumatic memory cannot be articulated with words, it remains at a symbolic level. So to retrieve it, it must be externalized in symbolic forms such as images. This iconic symbolization gives experiences a visual identity because the images created contain all the elements of that experience-in other words, what happened, our emotional reactions to what happened, and the horror and terror of the actual event.

What Bill Steele and I concluded more than a decade ago is that one of the best ways to begin to address the needs of children in trauma is to begin with drawing as a form of intervention. What we began to slowly find out over the next ten years was exactly why having children engage in drawing and similar creative activities made a difference. Here's a brief summary:

Drawing taps implicit memory. Trauma and drawing are largely sensory experiences; drawing pictures about aspects of "what happened" prompts sensory memories of traumatic events.
Drawing actively engages children in the process of repair and recovery. It provides the possibility to move from a passive to an active role in the treatment process.
Drawing provides a symbolic representation of the trauma experience in a concrete, external format.
Drawing makes us a witness to children's trauma experiences.
Drawing increases children's verbal reports about emotionally laden events. Research supports that drawing encourages children to provide more details and to organize their narratives in a more manageable way than children who are asked only to talk about traumatic experiences.
Drawing assists in reduction of reactivity (anxiety) to trauma memories through repeated visual re-exposure in a medium that is perceived and felt by the client to be safe.

This list is a very simplistic overview of why drawing helps children in trauma. Fortunately, we now have a growing body of research to support the reduction of posttraumatic stress in children and adolescents who participate in structured intervention using drawing as a core activity. As a researcher and helping professional, I continue to be intrigued by just how drawing "helps" bring about recovery, whether through decrease of worry or fear or reduction of more complex acute trauma and posttraumatic stress reactions. But of equal importance, giving traumatized children the opportunity to express through images what is often impossible to say with words underscores my responsibility to bear witness to their very human suffering, honoring those voices that might otherwise have remained silenced.

© 2009 Cathy Malchiodi

www.cathymalchiodi.com

Visit the growing community of art therapists from around the world at the International Art Therapy Organization [IATO], www.internationalarttherapy.org. One world, many visions...working together to create an inclusive and sustainable future for art therapy.

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Quirky Minds: Synesthesia, Taste the Rainbow

2009-07-25T13:09:00.001+07:00

Synesthesia, a condition in which the senses are cross-wired.
By Kirsten Weir, published on March 01, 2009 - last reviewed on May 11, 2009

Carol Steen was only seven when she discovered she was different, upon telling a classmate the letter A was the prettiest pink she'd ever seen. "She looked at me like I was crazy," she recalls. Steen has synesthesia, a condition in which the senses are cross-wired. She perceives colors when she views letters and numbers and when she processes certain audio, olfactory, or tactile input. The smell of gasoline appears as a brown fog in her mind's eye, while the letter C glows turquoise.

Until recently, most psychologists dismissed synesthesia as "too quirky" to warrant serious study, says Ferrinne Spector, a researcher at McMaster University in Ontario. That changed as scientists realized the phenomenon might hold clues to understanding normal perception. Now they're uncovering hints that synesthesia might not be so unusual after all.

Synesthesia takes many forms. Perceiving colors along with letters and numbers, as Steen does, is a relatively common variety. Other synesthetes commingle sounds with scents, or shapes with flavors. One study subject reportedly tasted Dutch cocoa when she encountered the word phonograph.

Along with McMaster psychologist Daphne Maurer, Spector studied synesthetic tendencies in people with ordinary perception. She asked volunteers to sniff various scents and describe the colors and textures they evoked. Many of the responses were unsurprising; the smell of lemons called to mind yellow. Other scents, though, triggered stranger associations. A significant number of volunteers said the odor of mushrooms evoked the color blue.

The aroma of lavender was repeatedly described as green and sticky. "There are consistencies in association you can't explain by your experience with the world," Spector says.

Meanwhile, at University College London, Roi Cohen Kadosh was inducing synesthesia in people with no history of the condition. Using post-hypnotic suggestion, he instructed four volunteers to associate certain colors with letters of the alphabet. After awakening, none of the volunteers consciously recalled the instructions. Yet when tested, all exhibited classic signs of color-grapheme synesthesia.

The findings suggest that all our brains are wired for sensory cross-talk. "I believe we all have some kind of synesthesia," Cohen Kadosh says. Normally, chitchat between distinct brain regions is mostly inhibited. In synesthetes, the gates of communication have been left open. "Connections that lie dormant in most of us are selectively active in synesthetes," Spector adds.

Suddenly, synesthesia is a hot research topic. For individuals such as Steen, it's nothing more than ordinary perception. "Some people who have it consider it a gift, but it's really just part of normal human experience," she says. "If I were to lose it, I'd be profoundly unhappy."

Case Study
Carol Steen, 65, an artist in New York

Artistic inspiration: Steen perceives flashes of color when listening to music or receiving acupuncture.
A family affair: Steen's father, cousin, and two second cousins have experienced various forms of synesthesia.
The upsides: When she noticed a tooth glowing orange, Steen knew she needed a root canal before feeling any pain.
The downsides: "I have to fight through the color of heavy speech accents, and it slows me down," she says.

Award Winning Journalism (?)

2009-07-15T08:44:00.000+07:00

Erroneous reporting wins prestigious award, starring Charles Nemeroff. Oy. Brought to you courtesy of Health Care Renewal. Read the full story and shake your head. Teaser:

Something about the simultaneously complex and sympathetic nature of mental health reporting is making reputable journalistic organizations and well-meaning reporters sloppy.

Dueling experts: Farcical spectacle that should be abolished?

2009-07-14T22:46:00.000+07:00

Dueling psychiatric experts are an appalling farce and "a travesty of the profession and the law," according to an op-ed in yesterday's Boston Globe.

The opinion piece comes in the wake of the high-profile sanity trial of Christian Karl Gerhartsreiter (GAYR'-hahrtz-ry-tur), a German con artist who used a string of fake identities (including "Clark Rockefeller") to establish himself in wealthy circles in New York, Boston and Los Angeles. Last month, a jury rejected the defense theory of insanity and convicted him in the kidnapping of his 7-year-old daughter. He was sentenced to four to five years in prison.

Psychiatrist Stephen Bergman (who writes fictional parodies of psychiatry under the pen name Samuel Shem) critiqued the various experts for, respectively:

charging too much money (one expert got $10,000, which ain't a whole lot these days)
giving opinions on TV ahead of the trial
spending only 2.5 hours with Gerhartsreiter
not having prior experience testifying in court

The prosecution's expert, psychiatrist James Chu, diagnosed narcissism and sociopathy. He testified that Gerhartsreiter exaggerated his symptoms and knew what he was doing was wrong.

Two defense experts, forensic psychologist Catherine T.J. Howe and forensic psychiatrist Keith Ablow, a Fox News commentator, both testified that Gerhartsreiter suffered from delusional disorder (grandiose type) and narcissistic personality disorder, and was insane when he fled to Baltimore with his daughter during a custody dispute.

Bergman saved most of his vitriol for the DSM diagnostic enterprise, which is so tainted by profiteering and bias that a "circus atmosphere" is almost inevitable when it is brought into court:

"The lucrative link between a diagnosis and a drug to treat it, when diagnosis itself is culture-bound and often subjective, pollutes the impartiality of the 'Diagnostic and Statistical Manual.' … If psychiatric diagnoses and treatments have an element of fuzziness, how could doctors paid by one side or the other not come up with a diagnosis wanted by their employer?"

His solution?

Do away with experts that are paid by either side. Instead, have a neutral panel whose opinions are binding.

Bergman makes some legitimate points, especially about how flaws in the system of psychiatric diagnosis impact forensic cases. (See my new article on this topic HERE.) And, some of his criticisms of these particular experts may be legitimate (although, ironically, he got their roles backwards*). Indeed, the defense appeal argues that the government's expert was unqualified and applied the wrong legal standard for criminal responsibility.

But, overall, Bergman misses the forest for the trees.

The adversarial system entitles each side to present its best case in court. To foreclose that option just because experts sometimes differ would be fundamentally unfair. After all, as a colleague of mine put it, disagreements are not unique to psychiatry: "Engineers routinely disagree in court over the cause of a collapsed bridge, just as chemists disagree in court over the nature of a substance."

And just because they disagree, that doesn't mean that the experts are dishonest or lack integrity, as Bergman implies.

Unfortunately, high-profile insanity trials like this one skew the perceptions of the public and pundits like Bergman. In reality, insanity (which varies by jurisdiction but generally requires that the defendant did not know the difference between right and wrong) is rarely invoked as a defense, and is even more rarely successful. One eight-state study found that the defense was used in less than 1% of cases, and was successful only about one-fourth of the time. In 90% of the successful cases, the offender had been psychiatrically diagnosed prior to the crime.

Even when the defense is invoked, the "dueling experts" phenomenon is rarer than people think. The vast majority of insanity cases are resolved behind the scenes because the experts for both sides are in substantial agreement. In such cases, a trial -- with its attendant publicity -- never takes place. (See Before and After Hinckley: Evaluating Insanity Defense Reform.)

Another public misconception is that successful use of the insanity defense allows people to "get off" for the crime. In reality, most insanity acquittees are sent to locked state hospitals that look very much like prisons. They often spend more time locked up than if they had been convicted of their crime.

Bottom line: A defendant's right to the best possible defense should not be foreclosed just because of errors or hype in the rare celebrity case.

----------
* Bergman wrote: “For the prosecution: one psychiatrist, famous from Fox TV and psychiatric thrillers, was paid $10,000 for his expertise as part of an 'insanity defense,' testimony that was challenged by his offering opinions about Rockefeller on TV in advance of the trial; a prosecution psychologist agreed with his diagnosis, basically of a narcissistic character who was 'delusional' -- that is, insane. For the defense: a psychiatrist who had seen the accused once for 2 1/2 hours and had never before testified in court came up with the diagnosis of narcissism and sociopathy -- that is, not insane." In reality, the two experts he said were prosecution witnesses were actually defense-retained, and the expert he labeled as "for the defense" was actually the prosecution's.

Diagnostic reification in court

2009-07-14T05:12:00.000+07:00

Good psychologists think in shades of gray. But the inside of a courtroom is painted black and white. One side wins, the other loses. Here, I discuss an ethical dilemma posed by this disjuncture between scientific uncertainty and the law's pull for absolutes. This dilemma concerns diagnostic labeling in court.

So begins my new "Ethics Corner" column in the July/August issue of the California Psychologist, available HERE.

Psychotherapy and Spirituality

2009-07-12T21:20:00.001+07:00

Psychotherapy and Spirituality
Rebecca L. Trautmann

Abstract

This article recognizes the spiritual dimension of each person as an important part of the therapeutic process, although many people experience difficulty talking about it. The process of finding words to express this dimension and exploring the meaning of that experience—with possible historical, introjected, and/or traumatic origins—are valued in the search for deeper meaning and mindfulness in life.

Emergence
“This may sound weird, but. . . .”

With words similar to this people often bring the spiritual dimension of their lives into their therapy. I would like to share here some of my own thoughts and experiences about the place of spirituality in psychotherapy, with the goal of expanding the therapy experience of the client who may be just beginning the process or deepening the experience of the client who is already in therapy but may have limited the scope of what he or she has brought into the process.

Much has already been written on this subject, with whole professional journals and associations specifically focused on this integration. Within transactional analysis, many wise and experienced practitioners have written books or articles in the Transactional Analysis Journal. To list just a few, Muriel James has written beautifully about the Inner Core of the self, also described as the Spiritual Self or the Universal Self (James, 1981; James & Savary, 1976, 1977). Morris (1972) and Edelman (1973) each wrote about spirituality in terms of ego states. Lawrence (1983) and Steere (1983) wrote companion articles on repentance as it compares to the transactional analysis process of redecision. In 1974 Isaacson wrote an article on religious scripts, and in 1999 Massey and Dunn wrote extensively on spirituality seen through the prism of family systems. Finally,George Kandathil and Candida Kandathil (1997) wrote eloquently about Berne’s concept of autonomy as the open door to spirituality.

At this point some may question, “What do you mean by spirituality?” Again, many good people have written about this subject. I like what George Kandathil and Candida Kandathil 1997, p. 28) wrote, so I will quote them at length:

Spirituality is the process by which human beings transcend themselves. For those who believe in God, spirituality is their experience of this relationship with God. For a humanist, spirituality is a self-transcending experience with another person. For some it may be the experience of harmony or oneness with the universe or nature in whatever way we describe it. It takes us beyond ourselves into a realm wherein “we can experience a union with something larger than ourselves, and in that union find our greatest peace” (James, 1902/1958, p. 395). . . . For believers of religion, spiritual experience takes place commonly within the framework of their religion. For others it takes place within the framework of their ideals and aspirations. But the experience itself is inexplicable and incommunicable in its entirety, what James (1902/1958) described as “the incommunicableness of the transport” (p. 311).

Some people may think that spirituality does not belong in psychotherapy, that therapists only deal with the emotional, behavioral, social, and cognitive aspects of our lives. While this may be true for some therapists, it certainly is not true for all. Many therapists know and value the spiritual dimension of life, but some will wait for it to emerge from the client and may not initiate the discussion directly themselves, leaving the impression that it is not part of the process. By the same token, some clients will not bring it up unless the therapist does, thus leaving the impression that it is not part of their lives. Other therapists will not deal with itat all, or will deal with it only insofar as it relates to the client’s overall psychological and social functioning. However, the therapeutic relationship works best when we can bring our whole selves to the relationship with the expectation and trust that at least here we can be known and understood, maybe even cared for, and thus know, understand, and care for ourselves, others, and the whole of creation.

The word “psyche” means “the soul, self, also the mind” (Mish & Morse, 1997, p. 592). The Chambers Dictionary (Kirkpatrick, 1983) defines psyche as “the soul, spirit, or the mind” (p. 1039). Therapy is the process of healing, of making whole. Thus, psychotherapy can be understood as healing of the soul/self or the mind, and therefore a place where our spiritual selves belong as much as every other aspect of who we are. For people disaffected with formal religious institutions or needing to heal from experiences related to their religious backgrounds, a psychotherapist may be the only (or at least the first) person able to hear and respond to their spiritual needs.

What often prevents people from initiating discussion of their spirituality is that it can be so difficult to talk about! Words can seem trite, inadequate, not quite right, or weird. This is why the subject may be introduced with words such as, “This may sound weird, but . . .” as I noted at the beginning of this article. Yet words are usually the primary vehicle we have to communicate our internal world or experience to another person (unless we are artists, musicians, dancers, etc). When words do not serve to communicate or bring us closer to others, we are inclined to keep that part of ourselves private and unshared—or to believe that it can only be shared in designated places or times, as in sacred meeting spaces, or only with specified people. Or we rely (gratefully!) on those people—poets especially—who have a gift for putting such experiences into words.

Each person’s experience of the Divine, of Spirit, is absolutely unique. It is easy to believe that no one else could possibly understand what that experience or “knowing” is like, especially if that experience is one of nothingness (no-thingness) or emptiness. For some it is a deeply personal relationship, and there may be somefear or hesitancy in sharing it with another person, almost as if in the sharing something will be lost, changed, or diminished. Some may even fear being shamed. Taking the risk of speaking about it with a trusted therapist can be very gratifying or releasing—sometimes even transformative. Here we can begin to find words—our own words—to feel more normal, more part of a whole, in these very private, personal, idiosyncratic experiences: these experiences of Spirit.

It is also important not to underestimate how potentially gratifying, releasing, even transformative your sharing might be for your therapist, too, in a reciprocal way. More than once I have had the experience of sudden clarity about my own spiritual quest through a client’s struggle. In that moment I also feel profound gratitude for the gift of my client’s sharing and for being able to do this work together.

For people who are aware of their soul’s stirrings, it is essential to find a therapist who is open and understanding and who perhaps shares a similar awareness. When I went in search of a psychotherapist for myself, many years ago, I specifically needed to know about the nature of our therapeutic relationship and whether the therapist would be available for “soul work.” Psychotherapy and the therapeutic relationship were so vitally important in my process of healing that I had to know that I could bring all aspects of myself to the relationship and that my soul yearnings would not only be accepted, but would be valued and care-fully explored.

There are therapists who specifically define themselves by their religious affiliation, such as “Christian counselors,” and thus let you know the context in which the therapy process will be understood. Other people have spiritual work as their particular focus in therapy. However, in the main, therapists do not specify this dimension in themselves or as a focus of their work. Therefore, it will be up to you as the client to inquire about it if it is important to you. You will also get a sense of your therapist’s orientation or availability if he or she asks about your spiritual life as part of getting to know you or from the way your questions are answered.

Convergence

In the process of meditating or finding the stillness of Spirit, many of us who live busy, crowded, overstimulated lives encounter obstacles that can be talked about and worked through in therapy. We may find ourselves distracted by unresolved encounters with others (e.g., an argument that was dropped but never resolved); regrets (e.g., “I wish I had taken the time to explore my child’s fears instead of just reassuring”); guilt (e.g., “How can I open myself to the experience of God when all I can think about is the terrible thing I said to my friend?”); fantasies (e.g., that trip to a faraway place that I would love to take); inner voices (e.g., “You should be cleaning the house, writing that article, or returning phone calls instead of just sitting here”); or feelings (e.g., anxiety, doubt, anger, even excitement). When we can note these distractions and honor them by bringing them into therapy, our meditations, prayers, worship, or even our constant mindfulness/awareness in each moment can be enormously enhanced. Working on unresolved guilt or finding new ways to resolve conflict, for example, can help free us from that thought-clutter in order to be more fully and wholly in the moment, whether we are meditating or going about our daily activities.
The other day I was with a client who said something in an offhanded way about “quickly praying” for certain people before falling asleep at night. I asked her why she prayed quickly. Her response was, “Because God used to be an important part of my life, but after [several losses] I don’t know where He is anymore, so I only pray out of habit.” After talking a little more she said, “Holding my mother while she died was the most terrifying and the most spiritual experience of my life. I have been haunted by the experience ever since and don’t know how to talk about it.” This led us into long, often emotional discussions about her relationship with her mother, her experience of God, and death—a huge part of her life that she had shoved into a closet and fearfully held shut (or open!) with her “quick prayers.”

In attempting to know God, some people discover that they have made God into their own image: God may be felt as a harsh,judgmental, frightening, remote figure who is actually a projection of their Parent ego state. Or God may be a nurturing, compassionate, creating mother figure. We try to learn who that figure represents, whether it is someone from their history or someone of their own creation, like some children create a frightening “bogeyman” to keep themselves from misbehaving. Others may be holding a secret that they believe to be unforgivable and expect God to be as unforgiving as they are of themselves. By directly encountering that figure or memory, working with it, and resolving these past relationships or experiences, real transformation can occur. Then they can be open to experiencing the Divine manifested and expressed in a multitude of different ways and with greater dimension than before. At the same time, they are able to be more loving, accepting, and expressive with themselves.

Some people find that they relate to God primarily from a Child ego state, looking to God as someone who will give them what they want or need, or deprive or punish them. Sometimes the concept of karma can be used in a similarly reductionistic way, seeing rewards for “being good” and negative experiences as the result of “being bad,” without realizing that this may be the Child’s view of parents or authority figures. When examined carefully and with sensitivity to what their relationship with parental figures was like, even the idea of karma can take on a much broader meaning and significance, one that allows people to be responsible for their lives and how they live in a much fuller, more authentic way. By addressing needs from the past and how they learned to get needs met, people not only resolve those experiences from the past, but also find themselves relating to others—including God—differently.

One man spent numerous therapy sessions in conversation with God—sometimes angrily, sometimes tearfully, but always with deep engagement—as he dealt with the experiences he had to cope with in his life. Ultimately, he began to face his own guilt for having betrayed his “bargain” with God, made at a time in his youth when he believed he was so bad (and deserving of his abuse) that he needed to devote his life to selfless service in order to “be good.”

This leads us to another area of exploration: the concept of “script.” As in the example just mentioned, people often decide on a life plan, usually based on decisions they made about themselves or others during difficult situations in childhood and often suggested or reinforced by family dynamics. This man so believed that his abusing mother was right and that he was an “evil, bad boy,” that the only way to stop being abused was to be “very good.” So he tried to be good in all the ways a little boy could, although he still believed (with his mother’s constant reminders) that God knew how truly bad he was. To be good for God, he committed himself to a career of service, for which he received a good deal of recognition and strokes. Underneath, however, he never embraced this reality because his firmly entrenched script belief was that he was bad and no amount of good works or self-punishment could change that. It was only when he came to therapy for help with his depression that he began to understand the basis for his conclusions about himself. When he talked to God in therapy he realized that it was this same script belief that formed not only his concept of God, but also his spiritual life.

Another client was talking about undergoing a surgical procedure and feeling quite distressed. I asked if she ever prayed. She burst into tears and said, “To whom?” This opened up the issue, yet unaddressed, of her having converted from one religious faith to another at the time of her marriage and her feelings of confusion, guilt, resentment, and, especially in this situation, separation from God.

Other kinds of experiences that might be brought to therapy include “unexplainable,” mystical experiences, like feelings of oneness; “peak experiences,” as described by Maslow (1964/1970); numinous experiences; or visions, to mention a few. Some people have profound yet disturbing experiences in the course of observing religious rituals or visiting sacred sites. These experiences are so often not talked about because of the failure of language to describe them adequately or the fear of not being understood or even thought of as crazy.

People—particularly, in my experience, children who have been traumatized—sometimesexperienced a presence, which they might refer to as “an angel,” during the trauma. One therapist who used art to work with a child finally inquired about the yellow spot in the corner of each picture depicting the accident. The child said, “That was the angel who was there with me the whole time.” A significant part of one client’s survival and healing was the awareness of these “presences” from an early age. They conveyed to her the existence of a loving energy, even though the environment in which she lived was anything but loving. Knowing this loving energy existed gave her the hope she needed to keep going and to believe that a loving relationship could be hers, somewhere, sometime. When people talk about an experience like this, they are sometimes condescendingly smiled at, which conveys the impression, “This is just your imagination” or “Isn’t that sweet?” (like in a fairy tale) or “We won’t give this any validity so you don’t get carried away with such fantasies.” What people really need is someone able and willing to talk open-mindedly about it and to find a way to understand the experience. What they do not need is the feeling that there is something wrong with them or that they cannot talk about it but must keep it to themselves.

Integration

As we become more comfortable talking about our spiritual selves or spiritual life, we begin to realize that there is no distinction between “my life” and “my spiritual life:” to be alive is to be spiritually alive. As with any other dimension of our being, we can be more or less aware, as we are more or less aware at any given moment of what we are feeling, or how fast our heart is beating, or the memory that is lingering on the edge of our consciousness. For both client and therapist, then, the goal is increasing awareness or mindfulness and integrating what may have been a split-off sense of a “spiritual self” with the whole of our being.

Nearing the end of several years of therapy, a client was reflecting on how he experiences a sense of quiet joy in his life. He recognized that he had actualized his dream of living simply, close to nature, and in the warmth of his family.“It feels almost spiritual,” he said after a moment of silence. And so it is. Transcending self through resolving script, being in full contact with ourselves and all of creation, living authentically and with integrity, and embracing the mystery of “beyond self” is what therapy can be about, whatever words we might use to describe it or however we might approach it.

Rebecca Trautmann, R.N., M.S.W., has a private psychotherapy practice in New York City. Please send reprint requests to her at RebeccaTrautmann@msn.com or at 349 E. 82nd Street, #5R, New York, New York 10028, U.S.A.

REFERENCES

Edelman, K. N. (1973). Is theology adult? Transactional Analysis Journal, 3(1), 50-51.

Isaacson, C. E. (1974). Religious scripts. Transactional Analysis Journal, 4(2), 38-40.

James, M. (1981). TA in the 80’s: The inner core and the human spirit. Transactional Analysis Journal, 11, 54-65.

James, M., & Savary, L. (1976). The heart of friendship.New York: Harper & Row.

James, M., & Savary, L. (1977). A new self: Self-therapy with transactional analysis. Reading, MA: Addison-Wesley.

Kandathil, G., & Kandathil, C. (1997). Autonomy: Open door to spirituality. Transactional Analysis Journal, 27, 24-29.

Kirkpatrick, E. M. (1983). Chambers dictionary. Edinburgh: Chambers.

Lawrence, C. (1983). Redecision and repentance: Reframing redecision work for the religious client. Transactional Analysis Journal, 13, 158-162.

Maslow, A. H. (1970). Religions, values, and peak experiences. New York: Viking. (Original work published 1964).

Massey, R. F., & Dunn, A. B. (1999). Viewing the transactional dimensions of spirituality through family prisms. Transactional Analysis Journal, 29, 115-129.

Mish, F. C., & Morse, J. M. (Eds.). (1997). The Merriam-Webster dictionary. Springfield, MA: Merriam-Webster.

Morris, F. R. (1972). Is theology adult? Transactional Analysis Journal, 2(2), 92-93.

Steere, D. (1983). Response to repentance article by Constance Lawrence. Transactional Analysis Journal, 13, 163.

This article was originally published in the Transactional Analysis Journal (Vol. 33, No. 1, pp. 32-36, January 2003). It is republished here with the permission of the author and the International Transactional Analysis Association.

AGGRESSION AND CANCER IN GROUP TREATMENT

2009-07-12T20:56:00.000+07:00

AGGRESSION AND CANCER IN GROUP TREATMENT
Louis R. Ormont, Ph.D.
Director, The Center for the Advancement of Group Studies, New York;
Clinical Professor, Gordon Derner Institute for Advanced Psychotherapy, Adelphi University
E-mail: ormont-mm@msn.com

This article was originally published in Psychotherapeutic Treatment of Cancer Patients, Goldberg J. (Ed.), 1981, New York: The Free Press, pp. 207-227

January, 2001

Every practitioner is familiar with examples of what J. B. Cannon called “wisdom of the body." The patient with a somatic problem knows without knowing. The unconscious holds vast stores of information which communicates hieroglyphically and indirectly. This information may remain meaningless if untranslated and yet manifest itself in bodily reactions.

The thesis that emotions and cancer are related is neither novel nor startling. For centuries, the role that grief, frustration and despair play in neoplasms has impressed many outstanding physicians. In 1870, Sir James Paget1, the great oncologist of his day, wrote that deferred hope, disappointment, and deep depression were followed by an increase in cancerous tissue. Others - Cutter2, Hughes3, Snow4 - went beyond a positive correlation; they were convinced that "mental depression" was the direct cause of a cancer.

These clinical observations lay fallow because there was little physicians could offer their patients beyond reassurance and a regimen of diet, rest, and relaxation.

The treatment challenge was taken up by the cellular specialists. With microscopes, x-ray machines, and chemicals, they attacked the malignancies. Great advances were made in the local destruction of neoplasms. The total organism within which the cell resided with its neural and hormonal systems received scant attention.

However, each time they identified a specific cause-effect relationship, specialists found they had to account for some annoying fact. For example, their research demonstrated that tobacco was directly implicated in lung cancer. Yet only a small fraction of the addicted smokers developed a malignancy.

The specialists attacked the problem anew. Every year they stumbled on additional precipitants of lung cancer. Why, with so many people exposed to so many different kinds of irritants, did so few develop lung cancer?

Early in the twentieth century, theoreticians began an energetic search for a framework that would account for the bewildering array of facts. The result was the hormonal-immunological theory.

This construct starts with the assumption that the body is always turning out defects due to faulty constitution, viruses, or pollutants. Fortunately, its defense system has a way of detecting maverick mutants and destroying them. But stress disrupts this detection and protection process; the body cannot correct the imbalanced physiology. The defective cells are free to reproduce themselves at random. This theory was supported by the observation that a cancer patient has weaker immunological defenses than the average person; his body cannot quickly and effectively destroy defective cells.

During the 1950's, Hans Selye5 and others mustered enough data to support the contention that emotional tensions may act as stressors. Such emotional states as depression and disappointment can exhaust the adrenal gland. It is no longer able to produce the hormones the body needs to prime the immunological response. If the exhausted gland does manage to send out signals, they are inadequate or misleading.

At this point, any of a number of carcinogenic precipitants can set off a toxic train of reactions. The over stressed system cannot monitor mutant ells or neutralize invading substances. Parasitic penetration, chemical and pollutant contamination, or ionizing radiation can do deadly damage to the vulnerable cellular tissues.

This finding was corroborated by experiments on healthy subjects. Cancer cells died when implanted under the skin of vital and vigorous subjects [Boyd, 1957]6. Even if these subjects did develop foci of neo plasia, they contained them and held them in check. It appeared, therefore that the nineteenth century surgeons were right. Emotions do influence the body's defenses.

However, long before the physiologists constructed their immunological theory, psychotherapists were observing and writing about the psychological implications of organic disease. Therapists had noted that the tendency to somatize develops early in life. Persistent stress during the developing years or a psychic trauma could lead to a life-long tendency toward organic expression of tension.

But psychoanalysts had hit-and-miss results with their efforts to reverse the tendency to channel tensions into the body. Investigating and analyzing the emotional states of despair, hopelessness, and their noxious cousins did not guarantee desirable results.

It emerged that an underlying drive was being neglected: aggression. But knowing this fact and doing something about it were two different things. Psychoanalysts had a method of treating the effects of disordered love but not the effects of primal rage. Even uncovering this hatred was often a formidable task. Patients tenaciously held on to their acceptable social feelings.

Should the rage well up, many therapists found it difficult and frightening to confront the patient, and with good reason. First of all, an angryspeaking patient could turn into an angry-acting one. Secondly, the patient's hatred induced unacceptable counter-hatred in his therapist. The prevailing opinion was that psychotherapy could do little with irrational anger. Psychiatrists resorted to palliative drugs to keep the obstreperous patient calm. Failing that, the patient was committed to an asylum.

A new set of constructs with new attitudes was needed. Sparked by the insights of Winnicott (1958)7, Searles (1967) 8, Alexander (1948) 9, Rado (1956)10, and Spotnitz (1976)11, investigators began to use their own feelings to investigate what patients were experiencing. They used these feelings to reconstruct the past, which their patients could not recall. With these feelings they penetrated deeply into the embalmed years from birth to age two. The early psychological stimulus and physiological responses were directly related to each other. Psychosomatic patterns could be pinpointed and studied. They illustrated that people's fantasy life, distorted self and body images, primitive defenses, and unmet maturational needs played a critical role in the development of schizophrenia and organic illness.

The developmental pieces began to fall into place. Either through inherited predisposition or defective mothering, certain children are especially vulnerable during their earliest years. They cannot convert drives and tensions into identifiable feelings. Their psyches can only express these tensions along the most primitive paths of communication - through body language, symbolic gesture, frozen attitudes, and the like.

The thwarting and frustration that these people experience eventually culminate in all shades of aggression. But it is a rage that cannot be expressed. In their minds, this aggression is capable of destroying the people they need for survival.

Finding no outlet for this aggression, they turn it against themselves. Such a redirection of energy raises further havoc with the way the body functions. Our physical being becomes the target of every unexpressed and unacknowledged negative feeling. Our denied drives become expressed as physical symptoms, which can range from a canker to cancer.

Research Evidence of the Somatic Effects of Aggression

The ravaging effects of unexpressed aggression have been observed by many researchers. Cobbs (1954)12 found that conflicts around the discharge of activity were high among those with cancer-susceptible personalities. Passivity inhibits the release of anger, even under dire conditions.

Bacon et al. (1952)13 found a facade of pleasantness in many women with carcinoma. This masked an inability to deal effectively with their aggressive impulses, as well as those of others. The victims felt resigned to an inverted expression of rage in the form of "passive suicide."

Kissen and Eysenck (1962)14 found that certain people who tended to "bottle-up" emotional difficulties also tended to contract cancer.

LeShan and Worthington (1955)15 observed that cancer-prone personalities tend to push down feelings of hostility rather than bring them to the surface and work them through. They suggested that this tendency lowers resistance to a malignancy.

LeShan (1966)16 noted again that one condition predisposing to cancer was the inability to use aggression as a self-protective tool. Envy, jealousy, competition, and resentment are squelched. The person, unable to find an interpersonal outlet for these emotions, comes to feel lonely and unloved.

Goldfarb et al. (1967)17 connected this inability to express hostility with the "hopeless-helpless syndrome." Because the victims think their condition unsalvageable, they allow themselves to sink into a bottomless despair. Electroshock therapy, aimed at clearing up the depression, often led to a remission of the neoplasm. They concluded that depression affects the immunological system. Depression is classically defined as aggression directed at oneself.

Simonton and Simonton (1975)18 confirmed that a predisposing condition for cancer was a marked tendency to hold back resentment. They also noted such correlates of stunted aggression as self-pity and a poor selfimage.

Mode of Attack

Such findings lead us to ask: How can psychosomatically entrenched aggression be approached, released, and resolved?

Modern psychoanalysts, especially Spotnitz (1969)19 offer an approach to the problem. First they deal with the way the person defends himself against the awareness and release of aggression. Then they help him redirect this raw energy away from his body, discharge it verbally, harness it at the service of his ego, and creatively sublimate it. This procedure can be applied in any of a variety of treatment modalities. In group therapy we make certain modifications. One is the use of the members as co-therapists.

There are several significant steps the therapist might take. To begin with, we mobilize the group's interest in a member's defense against aggression - the particular way a member wards off awareness of his unacceptable feelings. The aggression is not our initial concern: we are seeking out his protection against knowing he has it. This is no light task. As researchers discovered, cancer-prone people seem to be anything but hostile. They appear even-tempered, genuinely concerned about the comfort of others, friendly, and sometimes bordering on the heroic in their compassion.

Therefore, we spend our early contacts looking for, sensing out, or intuiting the ways a group member denies, represses, or avoids the feelings he senses are present. This may call for a free-floating, detached attention to his behavior or appearance. To the world he may seem no more than compliant, forbearing, or indifferent.

Having identified a member's particular survival mechanism, we do not jump in to change it. Instead, we silently study it. We observe, for example, when he uses his compliant response, how he repeats it, and the different forms it takes under different conditions.

Next we get confirmation concerning the mode of defense used. Other members are asked if they observed the pattern. When does it tend to be used? Can it be described?

After this, we mobilize the group interest in making the member aware of the defense. Members are encouraged not to hammer at the pattern but simply to apprise the person of this piece of his behavior.

We are now in position to separate the covert behavior from the underlying feeling. We encourage an investigation of all possible clues. Why did the member bite his lip and say "yes" when insulted outright? We pay detailed attention to subtly expressed attitudes, to intonation and to facial reactions. Sometimes the feeling emerges as soon as the defense is examined.

Often we have to show how the emotional state passes through the person's barriers. We watch for subliminal signs of leakage. Does the patient sense that his eyes are narrowing while the lower part of his face smiles? Is he aware that there is an edge of anger in his "helplessness?" Are there two messages being expressed at once?

With the softening effect of awareness, the inner world of the member comes to the fore. Now he may admit to inner torture. The despairer openly despairs; the griever grieves. Throughout this stage the member is encouraged to experience the unacceptable feeling.

All the while the members are training him to communicate his experience in words as fully as possible. Words are preferred, as an advance over "skin talk" and other, more primitive methods. Verbalizing establishes new neural pathways, outlets for inner stimuli, and opens up the way for fresh thoughts and ideas.

We want the member to direct his charged words toward a non-recriminating person in the group - one who will not punish or provoke guilt. The ideal target, of course, is the group analyst. His attitude and response can go a long way toward detoxifying devastating feelings.

While the member is struggling with these feelings, he may not acknowledge, or even know, that they are a cover for underlying aggression. Some members, especially prone to organic tension, need a form of communication that will reflect their own emotional state. These reflections help the member maintain his identity while permitting him to allow all his feelings their place. In reflecting, the analyst uses joining, mirroring, extending, role-reversal, devil-advocating, or out-crazying.

The analyst should use the group to do the work. In the following example, the analyst evoked the rage by mirroring it and used the group to mirror it further.

To a complaining woman, the analyst complained that she was taking up too much time with her woes. How could anyone get a word in edgewise? The woman took exception to this implied criticism. She contended that she was complaining only because she had a lot to complain about. What was wrong with the analyst? She proceeded to find fault with him. When he addressed her complaints, reflecting her attitude, she would let loose a stream of criticism. The other group members found the explosions a welcome change from her beseeching behavior. They caught the spirit of the analyst's reflection and began mirroring the member's behavior. Explosive confrontations went on for weeks. What Norman Mailer called "hatred that had never breathed the air of open rage" gave her a sense of personal elation and freedom.

With the aggression made manifest, the analyst encourages the group to investigate the feeling. Our purpose is to uncover erroneous ideas supportive of those emotional states and to plumb the foundations of negative feelings. Aggression can emanate from many sources - from frustration, rejection, abandonment, or counterphobic fear.

Members can help one another learn to tolerate all shades of aggression. They may encourage a new attitude toward it. Ideally, a patient learns to function effectively no matter how intense his irritability may be. Members never let him overlook his intolerance of it. So what if you are mad? Why can't you still speak in a civilized way? What makes you think you have to go into action or use four-letter words? We also have available other methods of intervention such as exploration, suggestion, education, and trial-and-error. Relying on them, we enable the patient to develop leniency toward his own aggression.

We can also relate present patterns to the climate of the patient's early life. The group itself may speculate about the relationship between a freed feeling and a physical symptom in a member. If the member himself cannot discover the crucial connections, the analyst can help him reconstruct the events of his formative years. The analyst can make use of the member's behavior in putting together a picture of his past. The group members, at this stage, become able to help the patient see his own aggression as valuable energy. Within the group setting, they can aid the patient to transform and refine it. For instance, they may show him how to convert anger that was previously destructive into socially acceptable wit, thus cultivating his new-found ability to put his aggression at the service of his best interest.

With the loosening and release of repressed feelings, made possible by the group's response and understanding, there occurs an enormous redirection of energy. The physical symptom loses much of its psychic charge. Then, as the feelings find verbal outlets and begin to abate in intensity and behavior changes, the malignancy seems to lose its virulence.

The Utilization of Group Therapy

Traditionally, the patient who seeks help has done so through individual analysis. This has certain obvious values. There is no better arrangement for searching deeply into the meaning of motives. However, this modality sometimes leaves the therapist with little leverage. His only ally is the patient, who oscillates between defying, drifting from, and denying all attempts to help him experience his emotions. The analyst is often rendered ineffective by the psychosomatically prone patient.

Group therapy has special advantages for working with the organically ill. Ulcer and colitis clubs have been notably successful in alleviating serious pathology. Though this writer has never conducted a group composed exclusively of cancer victims, it is conceivable that a shared setting could achieve the same results.

Group therapy offers a number of advantages so far as prevention is concerned, as it can exert pressure on the neglectful or self-destructive member.

In the following case, the group exercised its influence none too soon.

Some months after a hysterectomy, a woman in group mentioned in passing that she had abdominal discomfort and occasional bleeding. When questioned by certain members, she mentioned that she had not been back to see her gynecologist since the surgery. She brushed away their concern, construing her discomfort as a natural after-effect of her operation. She countered their every question with some seemingly plausible explanation for her torpidity.

However, one alarmed member would not be put off by her evasion and opened up each session with a prodding inquiry. She would promise to look into the matter but did not do so. The member observed, "You probably think something serious is going on. You are wishing it will go away by itself - counting on magic." The prodding member piped in, "I know what's wrong with us. We've been recommending that you go to a doctor. We should have pushed for a magician." A sharp exchange ensued. The next session she reported she had visited her gynecologist and a biopsy was scheduled. There was a malignancy, which, fortunately, was discovered in time.

The members had brought to her awareness the intense nature of her denial. Though she fought the group's reaction to her postponements, she had managed to glimpse the ludicrous nature of her own, endless rationalizations. It was not only this insight but also the release of her own anger that propelled her into taking care of herself. The value of the group was unmistakably evident in this case.

The sensitivity of a group enables it to provide early warnings and to repeat them. The patient with an incipient neoplastic growth is often reluctant to take the initiative in concern with his own health. There is a latent fear that the malignancy is already too advanced to be contained.

Even when the stress is not mentioned by the person, its vibrations can be felt by those who are attuned to the person's unconscious processes. Once these members are alerted to some smouldering crisis, they display uncanny skill in sifting out significant cues. Through their partial identification with the victim, they can often detect the faintest tremors of tension. One member may suspect the tension because of a particular side effect, another perceives it from a very different angle. For instance, the first discerns it in a dream, the second through its effect on an interpersonal exchange. If at times a member dashes off on a false lead, sooner or later another member is likely to call a halt and return the group to the basic track.

The following case illustrates the resilience of a group in its own pursuit.

A member presented the dream wherein termites were constructing a great hill on the plains of Africa. He kept tearing the hill down, but the insects persisted in rebuilding it. The group saw themselves as ants, constantly raising objections to his grandiose vocational schemes. They saw the dreamer as the undaunted builder of castles on the sand. Hearing this, the patient who had the dream lamented loudly that it was true: they were always fouling up his plans. There was a noisy interchange in which some of the interpretations went far afield.

Then a member, a woman with a borderline streak to her personality, expressed a more ominous view of the dream. She felt the hill was inside the dreamer. The termites were cells and were out of control.

At this, the dreamer blurted out that he did have a "funny sore" on his inner thigh that was not healing. A member asked if he had had it looked into. No, he had no physician. He would go to specialists with each body complaint. This was not specific enough. Members assailed him for holding such a negative attitude. By the end of the session he agreed to get a complete physical check-up from an internist. A lymphona was found, which could be contained.

By its understanding, empathy, and suggestion, a group can exert enormous effect. It provides an antidote to isolation. Perhaps its greatest asset for the organically ill is that it provides objects toward which the patient can direct strong feelings. The patient receives supportive acceptance within the group while he works through his conflicts. The consistency with which many members see that a person is doing is likely to provide him with a convincingly accurate picture.

On the other hand, the group's inherent weakness is its focus on the here-and-now at the expense of the highly pertinent there-and-then. This makes it difficult to relive a past experience intensely. Group does not provide the unlimited psychological space to a member which might enable him to explore his inner world. There is always a communal pressure, no matter how slight, to "get on with it" or reach some desired emotional response. The most restrictive aspect of group is its need to limit members to one part of the total talking time.

The ideal solution for the somatically vulnerable patient would be to reap the best of the two therapeutic worlds: that is, to enter conjoint therapy. While the patient is in individual treatment with one therapist, he attends a group with another therapist. In this approach his distortions, emotional communications, and behavioral manifestations are viewed from many angles and perspectives. The tendency to somatize tensions is carefully monitored under varied conditions.

No matter how organic the origin of the disease, the writer's assumption is that the process is inevitably accompanied by psychological and emotional stress. This position is holistic: it maintains that all functions, healthy or diseased, psychological and physiological, are intimately intertwined with one other. There is no point at which one ends and the other begins; rather, each affects the other.

A Note of Caution

The most evident limitation of the author's experience with cancer is his exposure to a population of only 38 cases, collected during a period of nearly 30 years. There were eight "cures," nine remissions, whose outcome is still in abeyance, 10 incomplete or prematurely terminated cases, and 11 failures. The types of carcinoma ranged from liver cancer to lymphoma.

The writer did not find a specific personality pattern that matched a specific type of malignancy. For example, cancer of the bowels was not a necessary correlate to an anal retentive character structure. Nor could a characteristic course of treatment be pinpointed. Every case followed a path different from the others. The only thing common to them all was the therapist's approach: an intensive study, analysis, working through, and resolution of the defenses against the verbal communication of buried aggression.

Also, since the writer's practice has been essentially with groups, the material is presented solely from what was revealed in the shared setting. The only way of corroborating what a group member reported was to see if his communications and actions in the group supported or confirmed it.

Despite enthusiastic endorsements and fervent testimonials from recovered patients, the writer cannot say there is any hard evidence that group psychotherapy, by itself, was the single curative agent; for in addition to chemotherapy, surgery, and radiation therapy, there were many other interventions being attempted at the same time.

A tightly controlled experiment would, of course, be impossible to conduct. When other therapeutic interventions were introduced, either by the group member or his medical specialists, the writer did not feel it his prerogative to interfere with them.

Two Case Histories

With these reservations in mind, let us consider several cases. We may learn most by comparing our successful outcomes with our unsuccessful ones. First, a case which had a successful outcome.

When her marriage fell apart, a woman, then thirty-five years old, began group treatment. Her self-effacing manner won ready acceptance from the others. She liked them. When she would present a problem that concerned her children or her job, she always found them helpful. They, in turn, appreciated her sensitivity and concern for them.

After about a year, she discovered a lump on her breast and went to a specialist. It turned out to be cancer. She was shattered by the news. So were the members, who rallied to her support. They seemed to suspend all other matters, in order to discuss the specialist she was seeing, the hospital she was to enter, her fear of mutilation, and the medications she was taking. They took seriously her doubts and left nothing untouched if it involved her anxiety over the cancer. In addition, they demanded that she mobilize her strength. They took instant exception when she spoke of "conserving energy" through passive acceptance of her condition or total dependence on some authority.

Her post-operative prognosis was only fair, and chemotherapy was instituted. It was physically debilitating and seemed to weaken her resolve. Once again, the members rallied to buoy up her spirits. For example, to help her bear her acute apprehension, a member taught her techniques for relaxation. She learned to utilize them well.

Before long she saw the group as the only stable force in her life. The members knew everything; she knew nothing. Life seemed composed of group meetings with breathless pauses in between. She became deeply dependent upon them and experienced a profound need to do the right thing for their approval. When they did approve, she felt loved and hopeful. She lived by their suggestions and according to their directions.

Still, the doctors indicated the malignancy might be spreading; further treatment was indicated. She fell into a state of desperation and became greedier than ever for the group's advice. However, the members were experiencing mounting frustration. Though she would follow their suggestions to the letter, she ignored the spirit behind what they said. They began to see her as doing everything to please, to feel good, to calm herself, but nothing to improve her lot.

Her response to their dissatisfaction caught them by surprise. Instead of contritely agreeing as usual, she became offended. She countered that the members were smug and unfair to her; none of them had a sense of what it was like to face death.

With the analyst's help, she began to fight for more attention. After each hostile encounter with a member, she could recall incidents from her past, and how she felt about them; most of these had previously eluded her.

She remembered that throughout her marriage she had been on the phone for hours with her mother, who played a dominant role in her life. Not surprisingly, her husband fretted about this and felt neglected. Finally, he insisted that she break with her mother. Somewhat relieved, she did. But she immediately replaced that relationship by commencing a telephone life with her nanny three thousand miles away. Her husband was furious and told her he would leave her if she did not stop her over-reliance on other people. In an effort to save the marriage, she stopped the calls. But she could not stop over-reaching and complying when anxious, and the marriage soon ended.

Recalling these incidents, she realized that being good had not given her much - a realization that appeared to deepen her despair. She had been living a charade. But another group member pointed out that she had been her own architect. She retorted, "What do you know about life? You've never even had a husband or children!" As this slipped out, she felt a pang of guilt. How could she have said such a thing? She apologized profusely.

However, the members were made of sturdier stuff than she expected. They confronted her in return. One person wanted to know "What's the big deal? Can't you say anything you want to say?" Their acceptance of her anger reduced her need to turn it on herself. She felt free to criticize them. And the offended members felt free to fight back. When the session ended, she was feeling exhilarated. Emboldened in the following sessions, she hurled stinging insults at the members, and being the object of their vehemence did not daunt her. One session after another was marked with acrimonious skirmishes. A member protested to the analyst, "The pussy cat's turned into a tiger!" Indeed, it did appear that all restraints had been broken. Her wild ideas and lack of verbal control bewildered everyone. member was especially

At one point, when her assault on another member was especially harsh, the analyst intervened. He told her that she was not there to attack people. This outraged her. Who was he to tell her what to say? He asked her to turn the question into a statement. She told him to drop dead. She would do what she wanted to do. He replied that he would do what he wanted to. And at the moment, he was thinking of asking her to leave. She stared at him in shocked silence. The rest of the session she sat sullenly.

Distressed, she opened the next session with a complaint. Didn't the analyst know that what she was doing in group was helpful to her? She was taking better care of her children than ever. She was cleaning her house. Indeed, her whole life seemed better in hand. If she could not be her rotten self, how could she continue to work in group or even live? He told her she could be anyone she wanted to be as long as she stuck to the contract: identify her feelings, put them into words, tell others why she had them.

This structure was too much for her. She ignored his words and regressed to petty complaining. She spent most of the next session on a mistake that had been made in her electric bill. She wanted the group's advice on how to handle it. Many gave their practical opinions and she seemed grateful. But then, a member questioned why she invested so much in a trivial matter. As she continued to talk about it, the group brought out that her thinking was burdened by concepts such as "must," "should," and "have to." As before, they found themselves up against her severe super-ego. But this time they knew there was more to her. They barraged her with questions. Who wanted her to do what? Suppose she refused? What would her preference be? Why wasn't she pursuing it? They refused to accept any self-demeaning rationale for her helplessness.

In this atmosphere, she soon recaptured her emerging freedom and confidence. Now, however, she was much more cooperative and less combative. For the first time, she showed some conflict-free curiosity about the physical details of her condition. She attended health conferences; she read copiously; she pursued a number of off-beat approaches in treating the carcinoma.

Soon she found a doctor who specialized in nutrition. Spreading her medical records in front of her, he explained in detail how cancer develops and progresses. He showed her actual pictures, slides and specimens of diseased tissue. When she came to him with techniques she had learned elsewhere, he was always interested. They talked about the seriousness of her condition. Several such conversations helped her discharge accumulated tension.

One technique she used effectively was visualization. It consisted of picturing healthy lungs. The physician helped by explaining how people breathe and what would interfere with it. This put her in intimate touch with the malignant process. She began to "think its death." Another exercise was to picture the cancer in her mind's eye as an octopus with a thousand tentacles. She visualized her "healthy cells" chopping away at them, gnawing at each tentacle. This exercise was followed by peaceful scenes of meadows through which she would go for a stroll with the group members. In her mind they told her that all was well and she could relax.

She described these healing exercises to the group. The members encouraged her to write them down in a journal. She began one, enlarging upon her fantasies and relating them to her malignancy. Occasionally, she read excerpts to the group, and members offered their impressions.

Though her real life appeared to be at a stalemate, her mind was a cauldron of activity. One session she came a half-hour early and eagerly waited for the group to arrive. She announced that she had a dream. In it, the world was as flat as a pancake in a frying pan. With a skillet she flipped it over. Some members seemed to know at once the dream's message. It was time for a change. They encouraged her to talk about the options open to her. Others helped her clarify what she wanted to do, and what could be done. An immediate decision was to quit her job, which had put constant pressure on her.

With this done, she phoned her estranged husband. He had moved to another city. She told him she wanted him to come back; she needed him. When he wavered, she decided to go off to see him. She spent three days persuading him that things were different. With misgivings, he returned on a trial basis. He made the provision that he himself visit her group to be sure the members knew the "true story." She might appear an independent person in public, but at home she played helpless and was excessively needy. He was reassured to discover that the group was already aware of these traits in her. And he appreciated their standing invitation to return when he wanted to.

That experience was crucial for their relationship. Until then, they had been on somewhat formal terms with each other; they had handled disagreements mainly by not dealing with them. Now there were spats, but there was also plenty of physical affection. The two of them gave up their concern over coming across to their neighbors as an "All American Couple."

To her it ceased seeming necessary that she do everything by herself. With the group's help, she overcame her fear of asking for her husband's co-operation with daily chores, such as helping with the Friday shopping; she dropped three friends who were "more of a drain then a gain". She joined a new church and took an active role in its art program, teaching a drawing class. Her husband supported her search for a part-time job and felt more comfortable about her resumed relationship with the nanny. He also helped her cultivate and maintain an independent attitude toward her mother.

She was no longer a victim of the desperate need for others. When the old passivity crept into her talk in group, the members were quick to point it out.

She developed a strong conviction that the total treatment was succeeding. Indeed, her enthusiasm took on a missionary drive. In hospitals, offices, wherever she met sick people, she urged them to assume a more optimistic attitude. Her vitality communicated itself to others.

Within this patient's mind, it would seem, lay the inherent power to inhibit the progress of her own malignancy. She rid herself of burdensome emotional baggage and established firm pathways for the future discharge of her energies, and thus freed her body to mobilize its weapons against the proliferating neoplastic material. Her revitalized system restored the natural order of physical functioning. It reestablished its capacity to cope with the malignancy through the immunological system. Medically, her prognosis went from guarded to excellent.

In this case, every step in combating the neoplasm was marked by a bout with her aggressive impulses. Whenever her anger, overt or covert, was overlooked her therapeutic movement ground to a halt. In various ways the group offered her a corrective opportunity to direct toward them the noxious attitudes that she formerly repressed, denied, contained, rationalized, or directed toward herself. She was permitted to be "bad" without being punished.

It may be that once they settle for a static state of existence, the bodies of certain people rebel against it. There is an inborn drive to move forward. If the body cannot break through the entrenched patterns, it redirects its basic drive into cellular tissue on a primitive level. The result is cancer.

Naturally, it is an open question as to how or why the neoplasm started. There may be a connection between the loss of needed objects - mother, nanny, husband - and the later onset of the carcinoma. What reversed the malignant process is an even more intriguing question. The patient's physicians attributed the improvement largely to chemotherapy; the group members saw their own understanding of the patient as curative. One even had the idea that it was a diet he had urged on her. The woman herself put a different construction on the cause. "Pain and death; these were my real motivators. And in a way my allies. They pushed me. It was the cancer or me."

Our failures are, of course, many and baffling. Yet some of our defeats would seem to illustrate the importance of getting in touch with one's own aggression. We seem to be hamstrung when the patient fails to develop an awareness of his hostility, is unable to release it, and thus cannot utilize it.

Sometimes we have the impression we are helpless spectators of a tragedy that plays itself out before our eyes. We experience our efforts as futile when the toxic effects of unexpressed aggression unfold before us.

A young actress held her father in awe. But his sudden death from cancer of the brain seemed hardly to affect her. She went off to attend his funeral and returned within the week. On the surface this seemed odd. He had encouraged her singing and acting career and given her money to further it, and she seemed very appreciative. But in another respect, her relief was understandable. She had to call him regularly. He wanted to know every detail of her professional career but would express great discontent with its progress. When he visited her, he was critical of her friends, her apartment, and her appearance. His carping was threatening to her. It implied that he might cut off his financial support. Of two areas he knew nothing: her group experience (which she paid for by teaching singing) and her uneven love life.

She entered group because of her penchant for turning chance attractions to men into compulsive involvements. These would last until the affair foundered on the rocks of distrust about six months later. She seemed sure the object of her love would sooner or later disappoint her, and indeed, at some point she would come across indications confirming her fears. At once, she would find the man wanting on a number of scores. In dissatisfaction, she herself would break up each relationship.

When members questioned her about the last of these, she replied that there had been nothing to the involvement in the first place. But she felt bitter and generally disillusioned, and these feelings manifested themselves elsewhere in her life. Within the next six months she suffered a number of professional reversals, one of which was mortifying. She almost landed and then lost a lead in a musical that opened to smash reviews. This epitomized a career in which she had repeatedly been the stand-by for some recognized star, never quite making it herself.

A few weeks later, she developed hoarseness. Being prone to hypochondriacal reactions in the face of reversals, she had remedies on hand and resorted to them. But this time the rasp worsened. Friends and group members urged her to see a physician. Always on some pretext, she kept postponing the visit. Finally, when she could no longer speak above a whisper, she consulted one doctor, and then several others.

Her vagueness and hesitancy confused the members. One insisted on knowing exactly what took place. Apparently, she had told each doctor that she did not want to know the "fancy name" of her ailment. All she wanted was a prescription. If she did not like the import of what the doctor said, she tuned him out and ignored his recommendations. She was discontent with all of them.

A member told her of a relative with a rare tropical disease, who could get no help from local doctors. He had finally cleared up the malady by going to a medical center for a "read-out and treatment." This tale sparked interest. The rest of the group prevailed on her to enter a well-known clinic, where a number of specialists would examine her and then consult among themselves. Reluctantly, at the tail end of a vacation to the Bahamas, she went.

The clinic made the differential diagnosis of malignancy of the throat, involving the thyroid, pharynx, and surrounding tissues. Because there was a familial history of neoplasms, and the growth had already metastasized, her prognosis was poor. The news of her condition devastated her. Upon returning to New York City, she closeted herself in her apartment and would see few people. She systematically restricted the arena of her life, pulling the social drawstrings so close together that she became virtually alone. She dropped out of acting classes, theatre going, and travel. Even her teaching, to which she was unswervingly committed, suffered. She missed appointments, rejected new students, and neglected to return phone calls.

Members were able to get her to attend group by picking her up on the way to the analyst's office, bombarding her with reminders, and alerting her answering service. During the sessions, she would question fate. Why her? What did she do to deserve it? It was not fair. There was no rhyme nor reason to life. There was little give-and-take with the members. But they kept confronting her with her self-pity and preoccupation. She began to make some contact with them and in the real world, as well.

Her reconstituted daily routine consisted of seeing doctors and talking to a few friends on the phone who were ever peppering her with novel medical nostrums. She studied pamphlets and literature she picked up at health food stores. There were missions to Bermuda, Mexico, and the Philippines, seeking healers. Just over the horizon there must be a new technological discovery or drug. She undertook a desperate search for anything that offered hope.

In a health food store she ran into a former member. He had left group a year before to go on the road with a show but had never returned to treatment. They had been attracted to each other, and she made it clear back then that she was quite fond of him. Naturally, he was distressed to see the disordered state she was in. He took her to dinner, had her apartment cleaned, demanded she take physical care of herself. He even set appointments at beauty parlors for her and brought her to the best clothing stores. He tossed her nostrums out of the window, insisted that she go to physicians he personally checked out, and forced her to attend group sessions regularly. He lectured to her about her self-neglecting habits, encouraged her in every way to live in the moment, and actively rejected her script of doom. He called the group analyst. After a consultation with him, he decided to see what he could do "to at least put the pieces together."

Initially this man had reminded her of her father, and now he actively behaved like him.

She began to mobilize an impressive amount of energy to deal with her problems. At each session she would arrive before the members, often with an agenda which she had rehearsed with her new lover. Her voice, though cracked and wavering, came across clearly. Members gave her space, sensing her courage and fragility. She made it clear that she did not want to hear what they thought would be helpful, only what she thought would be helpful. They sympathetically restricted their responses to telling her what she wanted to know.

Within a few sessions she revealed that she hated her voice. It had forced her life along restrictive lines. She felt her singing was instrumental in her father's death. He once had aspirations to be on stage and had hoped she would fulfill them, but she had let him down.

A member suggested another possibility. The reason she had never reached stardom in her singing was that her father would have taken credit for it. It would not be her achievement. Because she would not recognize her anger toward him for forcing her to live out his aspirations, all she could feel was guilt. After a long silence she broke into body-wracking sobs.

With this insightful experience, she became more accessible to group influence. For the first time she began to show a lively curiosity about her buried self. Everything became possible. It was possible that she had ambivalent feelings toward her father, that the growth might be the organic equivalent of mourning, that hating the cancer only paralyzed her, that dashing after folk remedies was just another avoidance of feelings - substituting hope for despair. She began to consider that her self-blame might be an evasion of her anger at the world, that her cancer was not a punishment for sexual liaisons or for her deceiving her father, and that if anything, her father might have muddled up her life (an idea she found freeing). Each time she discharged some anger, her guilt lessened.

With drugs, diet, and buoyed by the concern of the group and the insistence of her lover, she took a turn for the better. This development was aided by treatment with a hypnotherapist who helped calm her many paralyzing fears. Her vigor returned. Her voice regained part of its original timbre. She felt an awakened interest in the theater and returned to teaching.

Then a disguised calamity descended on her. Her father's will was read. Provision had been made for her to receive a half-million dollars. Instead of celebrating the news, she nosedived into grief again. With that descent went every sign of her emerging resentment to her father. Compounding calamity, her brother contested the will. Because he embodied aspects of her father, she could not bring herself to effectively counter his legal legerdemain. Group members were unable to activate any anger toward him.

Her boyfriend was equally frustrated by her passivity. An acting job on the road opened for him. He wanted her to come along. But she was too deeply immersed in self-recriminations to respond. They had a quarrel. He broke off the relationship and left the city.

With her staunchest ally gone, her shaky defenses fell apart. Though she did not deny she had a role in the rupture, she complained about her own state. She had been abandoned and felt vulnerable with her lover gone. But her primary cry had to do with her inability to do anything constructive.

Under group pressure she called a highly recommended lawyer. He was briefed by a member who told him about the extenuating circumstances under which he had to function. But she undermined the lawyer's efforts by not consulting him or keeping him abreast of developments. When her brother arrived in person, she capitulated to his demands.

The rasp returned to her voice. She reported a series of dreams to the group in which various kinds of snakes were throttling her. Their recurrence distressed her, and the group's interpretations had no effect on changing them.

Her dreams ended when she found a new figure to lean on. He was a young cancer specialist with definite ideas about the course of treatment. First, he instituted a radical form of radiation. Secondly, he prescribed a strict regimen of rest and sleep. He was firmly opposed to anything that might tax her reserves.

He had serious reservations about psychotherapy. In several phone conversations the analyst was careful to describe the group treatment as an adjunctive approach. The specialist still felt it was stressful. After all, she had been in treatment for some time and no remarkable changes had occurred. He ruled out the psychosomatic factor in her disorder. But he said he would not interfere with her therapy as long as she was "enthusiastic" about it.

She was definitely not enthusiastic about anything. Often she would fail to appear at the therapy sessions. When members managed to get her there, it was again difficult to stimulate any interest in the ongoing exchanges. No one could lift her out of her listless state. Several wondered why they expended themselves trying to get her to a meeting since they had so little effect on her.

The more helpless she felt, the more convinced she became that her specialist was omnipotent. He filled the role well. He was never at a loss for a new medication. He told her exactly what to do and how to do it. He was unconcerned with her secret yearnings or murmurred whims.

Her attendance in group became even more erratic. If a member's call happened to find her in, she would answer flatly. It seemed as if all her medical appointments were scheduled at exactly the hour the group met. Members felt they were combating a suicidal surrender. There was no fight left in her. It was as if the clock in her world had stopped ticking. She died soon afterwards.

We may speculate about the psychogenic causes of this failure, by contrasting it with successful cases. From the group dynamic point of view, there was minimal interaction between the patient and the rest of the members. Her interpersonal involvement with them tended to be shallow. She could cut off her own feelings as easily as she could cut off the other members.

Her behavior was explicable in transferential terms. She treated the group the same way her father treated her mother. She was fond of the members but they were not in any way central to her life. Initially, what kept bringing her back to the group was bewilderment over one unfortunate affair after the other. Later she returned to the group to deal with the malignancy. Never did she investigate in depth her relationships with the members. For the most part, she was aloof and artificially even-tempered.

The loss of her father had been overwhelming; the replacement was revitalizing. The former member who entered her life had afforded her a temporary spur toward health. He provided her with support, admiration, and he ministered to her narcissism. She was at her best when he was in her life. With him, she had learned to articulate her negative feelings. When he left, she lost touch with this important part of her emotional life.

There is no doubt that the mechanism of denial can be protective. It limits the input that can penetrate a person's insulation barrier. But there was so much denial in this patient that at times it was difficult to pinpoint what she was actually experiencing, particularly her negative feelings. Her uncommon social charm, when closely studied, appeared to have a plastic quality.

On the outside, she appeared poised and intact; on the inside there was chaos. The two sides seemed not to be in communication with each other. When her mechanisms of repression, displacement, and rationalization failed her, she retracted her ego boundaries, and withdrew into isolation.

If we assume the development of the cancer had something to do with her inability to deal with her aggression, the death of her father certainly set into motion a process that was as insidious as it was deadly. While her father lived, she at least had the tenuous possibility of surfacing her latent hatred and directing it toward him.

Once he died, the anger had nowhere to go. She could not mobilize it in the service of separation; her grief returned her to a state of helpless fusion with him. This dilemma forced her to turn her aggression against herself. The inwardly directed anger may have furthered complete collapse of the immunological system. Very possibly, it was not the pain of parental abandonment that set off the cancer, but rather her denial of enormous rage at being abandoned.

Identification with her father, followed by introjection of his image, may have been a precipitating factor in the malignancy. She had lost part of herself with his death, and had been unable to substitute another emotional object for him. Perhaps her body made a final heroic effort to regenerate this part of her lost self, sought to recover that part through the prolific growth of tissue. Some archaic pattern may have been set in motion, a tendency that existed before the central nervous system could organize, control and regulate the organism as a whole. From this point of view, we might view cancer as an expression of a deeply regressed urge as a drive to regenerate a psychologically amputated part of the self.

Naturally, de-differentiated cellular tissue cannot possibly replace a missing human being, an object of feeling. The effort was doomed to failure. Lower forms of life, such as the salamander, can, under stress, amputate a part of themselves and regenerate it later. The attempted reproduction by a human being under stress would, by analogy, be expressing itself through a neoplasm. However, as with any such speculation, this one leaves a number of questions unanswered. For instance, many people with cancer do not report the loss of a vital object, nor could such a loss be traced.

Another powerful factor would seem to be the patient's heredity. This is not to say that a person is marked for a malignancy. The majority of people so predisposed do not develop one. In fact, there seems a powerful potential in human beings to rise above their encoding, and this too invites the thesis that psychic factors are involved.

This patient's predisposition was doubtless stimulated by an expectation of the inevitability of cancer. It may have put her body into a state of prolonged resignation. This would be similar to the phenomenon known as the "anniversary syndrome," wherein a person gets the same illness or meets the same fate on the same day or date as a parent.

What does seem clear is that her malignancy coincided with the failure of her ego-coping dynamisms in the face of trauma. This coinciding of the onset of her disease and the deterioration of her defense mechanisms is at best an observation. If she had been able to keep in touch with her aggression and utilize it in life-preserving decisions and actions, would there have been a different ending to her case? Possibly. With further refining of our theory and technique, we may some day be able to answer this question.

Conclusion

It may prove valuable to regard cancer less as a disease than as a disorder in the body's biochemical signals. To alter these signals is to produce an impact on the body's immunological defenses. It would follow that any form of intervention designed to restore the body to physical health must use more than physical means.

Since emotions dramatically influence the biochemical system, one way of providing immunotherapy is by giving psychotherapy to patients. It should be flexible and interactional in content, constantly undergoing modification to satisfy the patient's needs.

It would seem that one effective way of meeting these needs is by group therapy. The primary aim of such treatment would be analysis and resolution of resistances to verbal communication. Its emphasis would be on the resolution of the patient's unwillingness to experience and to express negative feelings toward people important in his group life. With this accomplished, efforts can then be made to convert the freed energy so that it can be utilized in the self-assertiveness that defines our personalities and makes our lives productive and satisfying.

Notes

Paget, J., Surgical Pathology (2nd ed.), Longman's Green, London, 1870.
Cutter, E., "Diet on Cancer," Albany Medical Annals, July-Aug. 1887.
Hughes, C. H., "The Relations of Nervous Depression to the Development of Cancer," The St. Louis Medical and Surgical Journals, May, 1887.
Snow, H., The Reappearance of Cancer After Apparent Extirpation, I. and A. Churchill, London, 1870.
Selye, H., The Stress of Life, McGraw-Hill, N.Y. 1956.
Boyd W., "The Spontaneous Regression of Cancer," Journal of Canadian Association of Radiology, 8, 45, 1957, 63.
Winnicott, O., Hate in the countertransference. In Collected Papers, New York: Basic Books. 1958.
Searles, H., Concerning the development of an identity. Psychoanalytic Review, 53:507 - 520, 1967
Alexander, Frantz, Fundamentals of Psychoanalysis, New York, Norton, 1948
Rado, S. & Daniels, G.E., Changing Concepts of Psychoanalytic Medicine, Harcourt Health, St. Louis , MO, 1956
Spotnitz, H., Psychotherapy of Preoedipal Conditions, Jason Aronson, 1976.
Cobbs or Cobb, B., "A Social-Psychological Study of the Cancer Patient," Cancer, 1954, 1-14.
Bacon, C. L., Renneker, R. and Cutler, M. "A Psychosomatic Survey of Cancer of the Breast," Psychosomatic Medicine, 14, 1952, 453-460.
Kissen, D. M. and Eysenck, H. G., "Personality in Male Lung Cancer Patients," Journal of Psychosomatic Research, 6, 1962, 123.
LeShan, L. and Worthington, R. E., "Some Psychologic Correlatives of Neo-plastic Disease: Preliminary Report." Journal of Clinical and Experimental Psychopathology, 16, 1955, 281-288.
LeShan, L. "An Emotional Life History Pattern Associated with Neoplastic Disease," Annals of the New York Academy of Sciences, 125, 1966, 780-793.
Goldfarb, O., Driesen, J. and Cold, D., "Psychophysiologic Aspects of Malignancy," American Journal of Psychiatry, 123, June 1967, 1545-51.
Simonton, O. C. and Simonton, S. "Belief Systems and Management of the Emotional Aspects of Malignancy," Journal of Transpersonal Psychology, 7(1), 1975, 29-47.
Spotnitz, H., Modern Psychoanalysis of the Schizophrenic Patient. New York: Grune & Stratton, 1969.

Diagnosing Michael Jackson

2009-07-06T23:23:00.000+07:00

You have probably seen some of the postmortem efforts to pin psychiatric diagnoses on Michael Jackson, in the wake of his untimely demise. It's a pedantic enterprise, with no shortage of diagnostic contenders: Pedophilia, anorexia, body dysmorphic disorder, and a dual diagnosis (that's a psychiatric disorder plus a substance abuse disorder). Most recently, we've got J. Michael Bailey, the man transgender activists love to hate, wading into the fray with erotic identity disorde r and a paraphilia called autogynephilia.

"Whoa, folks! Not so fast!" say others.

Calling for a little reflection on this whole paraphilia-hebephilia-whateverphilia diagnostic craze is Scientific American columnist Jesse Bering, a research psychologist at Queen's University Belfast:

Would you really have wanted Oscar Wilde euthanized as though he were a sick animal? Should André Gide, whom the New York Times hailed in their obituary as a man 'judged the greatest French writer of this century by the literary cognoscenti,' have been deprived of his pen, torn to pieces by illiterate thugs? It's complicated. And although in principle we know that all men are equal in the eyes of the law, just as we did for Michael Jackson during his child molestation trials, I have a hunch that many people tend to feel (and uncomfortably so) a little sympathy for the Devil under such circumstances.

I highly recommend Bering's muse, "Pedophiles, Hebephiles, and Ephebophiles, Oh My: Erotic Age Orientation" (which, by way of full disclosure, cites yours truly).

Hypnosis for treatment of pain in children

2009-07-05T21:37:00.001+07:00

Alex L. Rogovik, MD PhD and Ran D. Goldman, MD
Pediatric Pearls is produced by the Pediatric Research in Emergency Therapeutics (PRETx) program at the Hospital for Sick Children in Toronto, Ont. Dr Rogovik is Assistant Director and Dr Goldman is Director of the PRETx program. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine

Hypnosis, known since the late 18th century, was recently accepted by the American Medical Association as a medical treatment when administered by an appropriately trained practitioner. A survey of 783 US primary care physicians found that 19.9% of them had used hypnosis, and 62.9% of pediatricians had used or would use hypnotherapy.1 Twenty percent of surveyed Canadian general practitioners had had training in complementary and alternative medicine, including hypnosis.2

The most important factor for determining the analgesic effect of hypnosis is the hypnotic susceptibility of patients. It is high in 10% to 15% of the population and moderate in 70% to 80%; women have substantially higher hypnotizability scores than men. Many studies have shown hypnosis and self-hypnosis to be effective in adults for treatment of acute pain caused by burn wound débridement and dressing changes, invasive medical procedures, surgery, and labour.3,4 Hypnotherapy is also beneficial for chronic pain conditions, such as chronic tension headache and migraine, irritable bowel syndrome dominated by pain, and pain caused by cancer therapy.4 Since the 1980s, hypnotic pain–management techniques have been systematically applied to pediatric patients. Surprisingly, children are easier to hypnotize than adults are and usually respond better to hypnotherapy given for both acute and chronic pain. Unlike adults, children are not burdened with cognitive stereotypes, and their boundaries between imagination and reality are less substantial. Hypnotic ability in children is limited in those younger than 3 years old, appears at 5 to 6 years old, and peaks at 7 to 14 years old.5

The hypnotic process usually includes the following steps:

assessment of hypnotic ability;
induction of analgesia, dissociation from the environment, and development of individual pain management strategies;
suggestion, imagery of a favourite safe place, and metaphors; and
termination of hypnosis, psychodynamic reprocessing of emotional factors, and posthypnotic suggestions.

Children behave differently from adults under hypnosis. While adults are usually cataleptic, children often fidget or appear restless during procedures. Highly hypnotizable children need no induction. Children’s vivid imaginations combined with stressful experiences elevate their receptivity to hypnosis.

Pediatric hypnosis has been used not only for pain control, but also in treatment of many disorders, including anxiety, phobias, posttraumatic stress, sleep walking, behavioural disorders, conversion reactions, anorexia nervosa, enuresis, soiling, intractable cough, speech and voice problems, tics, learning disabilities, drug abuse, dermatologic problems, diabetes, and juvenile rheumatoid arthritis.6

Hypnosis in painful medical procedures

Hypnosis has been used to alleviate pain during bone marrow aspirations and lumbar punctures, which are the most painful and distressing procedures in treatment of children with cancer. A randomized controlled trial involving 30 children aged 5 to 15 years undergoing bone marrow aspiration found that children under hypnosis reported reduced pain compared with their own baseline and compared with a control group.7 Children with leukemia undergoing bone marrow aspiration reported similar pain and fear with hypnosis and with undirected play, but both hypnosis and play groups reported less pain and fear compared with baseline.8 Although 3- to 6-year-old patients with leukemia undergoing bone marrow aspirations under hypnosis reported no less pain, external observers reported immediate decreases in pain, anxiety, and distress in the hypnotic imaging group compared with distraction and control groups.9

A study of the effects of direct and indirect hypnotic suggestions on lumbar puncture pain in 30 pediatric patients showed that levels of pain, anxiety, and distress were significantly lower after hypnotic analgesia (P < .001).10 Hypnotherapy alleviated pain, distress, and anxiety much more than distraction during venipuncture, bone marrow aspiration, and lumbar puncture in highly hypnotizable children in another study of 27 patients aged 3 to 8 years.11 Similarly, hypnosis substantially reduced pain and anxiety during painful medical procedures in children and adolescents with cancer.12

Hypnosis was also successfully used to diminish pain and anxiety from angulated forearm fracture reduction in 4 pediatric emergency patients who had no access to other analgesia.13 Similarly, postoperative pain and anxiety were substantially lower in the hypnosis and guided imagery group than in the control group of a randomized controlled trial of 52 children undergoing surgery.14

Hypnosis for chronic pain

Hypnotherapy and self-hypnosis can be effective for managing chronic pain in children as well. Among more than 300 patients who presented to a pediatric pulmonary centre and received hypnotherapy, 80% of children with persistent chest pain reported improvement. No symptoms became worse and no new symptoms appeared following the treatment.15 Four of 5 children who received hypnotherapy for chronic functional abdominal pain experienced resolution of pain within 3 weeks.16

Self-hypnosis, which most children can learn, can be effective in managing recurrent headaches. Twenty-eight self-hypnotized children aged 6 to 12 years recorded fewer migraine headaches in their diaries than children in placebo and propranolol treatment groups did.17

Hypnosis combined with other methods, such as acupuncture, is also acceptable for chronic pediatric pain. One trial conducted in 21 girls aged 6 to 18 years demonstrated that the treatment was not associated with adverse effects and resulted in substantial alleviation of both child- and parent-rated pain and anticipatory anxiety.18

Because of the lack of treatment specification, however, some authors suggest that hypnotizing children does not qualify as efficacious according to criteria for empirically supported therapies.19

Adverse effects and regulation

Most complications occur after hypnosis has been performed by a layperson, when a symptom was removed by a direct command, or following an inadvertent post-hypnotic suggestion. Adverse effects are mostly short-term (fatigue, anxiety, confusion, fainting, dizziness, nausea), but can include such serious reactions as stupor, chronic psychological problems, spontaneous dissociative episodes, resurrection of memories of previous trauma, and seizures.20 Therefore, screening for vulnerable individuals is recommended before beginning treatment.

Hypnosis regulation varies from province to province, and in many jurisdictions hypnotherapy is not regulated. Professional organizations, such as the Canadian Society of Clinical Hypnosis, offer training courses for health professionals and provide help with locating hypnotherapists.

Summary

Results of controlled studies demonstrated that clinical hypnosis and self-hypnosis can be beneficial for children in pain. Studies found pediatric hypnosis effective for painful medical procedures, such as bone marrow aspiration and lumbar puncture during cancer treatment, for alleviating postoperative pain and anxiety in children undergoing surgery, and for headaches and some other conditions involving chronic pain. Hypnosis might have serious adverse effects in vulnerable subjects and should be administered by appropriately trained and experienced health professionals.

References

Berman BM, Singh BB, Hartnoll SM, Singh BK, Reilly D. Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns. J Am Board Fam Pract 1998;11(4):272-81.[Medline]
Verhoef MJ, Sutherland LR. Alternative medicine and general practitioners. Opinions and behaviour. Can Fam Physician 1995;41:1005-11.[Medline]
Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg 2002;94(6):1639-45.[Abstract/Free Full Text]
Patterson DR, Jensen MP. Hypnosis and clinical pain. Psychol Bull 2003;129(4):495-521.[Medline]
Plotnick AB, O’Grady GJ. Hypnotic responsiveness in children. In: Wester WC, O’Grady DJ, editors. Clinical hypnosis with children. New York, NY: Brunner/Mazel; 1991. p. 19-33.
Olness K, Kohen D. Hypnosis and hypnotherapy with children. New York, NY: Guilford; 1996.
Liossi C, Hatira P. Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. Int J Clin Exp Hypn 1999;47(2):104-16.[Medline]
Katz ER, Kellerman J, Ellenberg L. Hypnosis in the reduction of acute pain and distress in children with cancer. J Pediatr Psychol 1987;12(3):379-94.[Abstract/Free Full Text]
Kuttner L. Favorite stories: a hypnotic pain-reduction technique for children in acute pain. Am J Clin Hypn 1988;30(4):289-95.[Medline]
Hawkins PJ, Liossi C, Ewart BW, Hatira P, Kosmidis VH. Hypnosis in the alleviation of procedure related pain and distress in pediatric oncology patients. Contemp Hypn 1998;15:199-207.
Smith JT, Barabasz A, Barabasz M. Comparison of hypnosis and distraction in severely ill children undergoing painful medical procedures. J Couns Psychol 1996;43:187-95.
Liossi C, Hatira P. Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients. Int J Clin Exp Hypn 2003;51(1):4-28.[Medline]
Iserson KV. Hypnosis for pediatric fracture reduction. J Emerg Med 1999;17(1):53-6.[Medline]
Lambert SA. The effects of hypnosis/guided imagery on the postoperative course of children. J Dev Behav Pediatr 1996;17(5):307-10.[Medline]
Anbar RD. Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatr 2002;2:11. Epub 2002 Dec 3.[Medline]
Anbar RD. Self-hypnosis for the treatment of functional abdominal pain in childhood. Clin Pediatr (Phila) 2001;40(8):447-51.[Abstract/Free Full Text]
Olness K, MacDonald JT, Uden DL. Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine. Pediatrics 1987;79(4):593-7.[Abstract/Free Full Text]
Zeltzer LK, Tsao JC, Stelling C, Powers M, Levy S, Waterhouse M. A phaseI study on the feasibilityand acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. J Pain Symptom Manage 2002;24(4):437-46.[Medline]
Milling LS, Costantino CA. Clinical hypnosis with children: first steps toward empirical support. Int J Clin Exp Hypn 2000;48(2):113-37.[Medline]
Gruzelier J. Unwanted effects of hypnosis: a review of the evidence and its implications. Contemp Hypn 2000;17:161-93.

Stress management: Understand your sources of stress

2009-07-05T21:26:00.002+07:00

Your response to the demands of the world determines your stress level. Take time to consider common stressors and how they may be affecting you.
By Mayo Clinic staff

The kids are screaming, the bills are due and there's a pile of work on your desk that's growing at an absurdly swift pace. It's undeniable — life often seems full of stress. But understanding the types and sources of stress — big and small, short-term and long-term, internal and external — is an important part of stress management. So where does your stress come from?

Two main types of stress

Stress is your body's reaction to the demands of the world, and stressors are events or conditions in your surroundings that may trigger stress. Two main types of stress you face are:

Acute stress. Also known as the fight-or-flight response, acute stress is your body's immediate reaction to a significant threat, challenge or scare. The acute-stress response is immediate, it's intense, and in certain circumstances, it can be thrilling. Examples of stressors that may cause an acute-stress response are a job interview, a fender bender or an exhilarating ski run.
Chronic stress. This results from long-term exposure to acute stress. The chronic-stress response is much more subtle than is the acute-stress response, but the effects may be longer lasting and more problematic. The stressors that may lead to chronic stress are the nagging, day-to-day life situations that often seem unrelenting. This includes relationship problems, work difficulties and financial woes.

Effective stress management involves identifying and managing both acute and chronic stress.

Symptoms of stress

While mild stress can actually be beneficial — it can spur you into action, motivate and energize you — it's often the buildup of the little things that can really "stress you out." Persistent stress can lead to many adverse health problems, including:

Physical symptoms, such as headache and fatigue
Mental symptoms, such as poor concentration
Emotional symptoms, such as irritability and depression
Social symptoms, such as isolation and resentment

Know your stressors

External exasperations
External stressors are events and situations that happen to you. While you may have control over some of these stressors and how much you let them affect you, there are times when they extend beyond your control. Some examples include:

Major life changes. These changes can be positive — a new marriage, a planned pregnancy, a promotion or a new house. Or they can be negative — the death of a loved one or going through a divorce.
Environment. These stressors could include a noise disturbance, such as a barking dog, or excessive light, as from a billboard across the street.
Unpredictable events. This category could include an increase in monthly bills, an uninvited houseguest or a pay cut.
Family. The occasional spousal spat, a teenager who refuses to cooperate or a nagging mother-in-law can all contribute to stress.
Workplace. Perhaps an overwhelming workload or an impossible boss.
Social. For example, a blind date or making a speech to a room full of co-workers.

Internal irritations

Not all stress stems from things that happen to you. Some of the stress response can be self-induced. Those feelings and thoughts that pop into your head and cause you unrest are known as internal stressors. Examples include:

Fears. These can be things, such as a fear of flying or heights, or more-subtle apprehensions such as participating in a discussion with a group of strangers at a meeting.
Uncertainty. Stemming perhaps from a looming restructuring at the office or waiting for medical test results.
Attitude. Having a negative view of the world can be stressful, since you create an unpleasant environment in which to live.
Unrealistic expectations. A perfectionist or controlling personality may lead to unnecessarily high stress levels. Overscheduling and not planning ahead can lead to worries.

Stress is here to stay

Not a day in your life goes by without encountering a situation or event that may trigger stress. And that's OK. By identifying and understanding the sources of your stress, you learn to better manage it. So what stresses you out?

Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

2009-07-05T20:59:00.002+07:00

Insomnia is a serious disorder and effective insomnia treatment can be crucial to getting the sleep you need. Until now, there were few safe, effective, non-drug insomnia treatments.
By Mayo Clinic staff

Insomnia is a widespread condition that's characterized by a difficulty in falling asleep, staying asleep or getting restful sleep. Like many people who experience insomnia, you may have turned to sleeping pills for relief.

However, new research and sleep studies show that your attitudes about sleep and certain behaviors are often the root cause of insomnia. Changing those attitudes and behaviors can lead to better sleep.

What's so good about a good night's sleep?

Sleep is essential for good physical and mental well-being. Natural sleep restores your body and mind and provides enough dreaming time (REM sleep) to sustain learning, memory and mood.

If you're sleep deprived, you're more likely to develop infections, and have high blood pressure, cardiovascular disease and diabetes. You may also be more prone to make mistakes on the job, take longer to recover from stress, have problems with learning and memory, and experience depression and irritability.

Problems with sleeping pills

There are times — such as during periods of pain or grief — when sleeping pills may help those who experience sleep deprivation. In addition, several hypnotics are now approved by the Food and Drug Administration for indefinite use.

However, many sleeping pills shouldn't be taken for more than a few days to a few weeks. Because they can be habit-forming, some people take these drugs far longer. Others may increase their dosage as the pills become less effective over time. Sleeping pills can also:

Mask the real causes of poor sleep, such as depression, heart trouble, asthma and Parkinson's disease, and delay treatment of these disorders
Interact with other medications or alcohol, often with serious, even deadly, results
Cause next-day grogginess or rebound insomnia — an inability to sleep that's worse than the original problem
Lead to high blood pressure, dizziness, weakness, nausea, confusion, short-term amnesia
Cause bizarre behavior that goes beyond traditional sleepwalking to include "sleep binge eating," "sleep shoplifting" and "sleep driving" — none of which the person remembers

Cognitive behavioral therapy: A tool for treating insomnia

Cognitive behavioral therapy (CBT) has emerged as a treatment for insomnia that's an effective alternative to sleeping pills, even for people with severe or chronic sleep problems.

CBT is a relatively simple, short-term treatment that has long been used to treat a range of conditions, including depression, panic attacks, anxiety, eating disorders and substance abuse. Studies have shown that psychological and behavioral factors play an important role in insomnia and that CBT can be effective in treating insomnia. A 2006 review of insomnia treatment studies conducted by the American Academy of Sleep Medicine found that CBT can help improve sleep and that benefits can be sustained over a long period of time.

CBT can benefit nearly everyone, including older adults who have been taking sleep medications for years, people with physical problems such as restless legs syndrome, and those with primary insomnia, a lifelong inability to get enough rest.

What's more, the effects seem to last — a year after CBT, most people still show benefits from the therapy and sleep more soundly than before. And there is no evidence that CBT has adverse effects.

How does cognitive behavioral therapy work?

Cognitive behavioral therapy helps you change the thoughts and actions that interfere with your ability to get restful sleep. The approach is based on the idea that how you think (cognition) and act (behavior) affects the way you feel.

The cognitive portion of CBT teaches you to recognize and change false beliefs that affect your ability to sleep. For example, you may believe that you must get eight hours of sleep every night to function. In fact, seven hours of sleep may be adequate for you. Cognitive therapy also deals with misperceptions about the amount of time you actually spend sleeping. People with insomnia often sleep more than they realize.

The behavioral portion of CBT helps reprogram the part of your brain that governs the sleep-wake cycle. It targets specific behaviors — what sleep experts call "sleep hygiene" — that negatively affect your sleep. Such behaviors include failing to exercise or drinking beverages that contain caffeine just before bedtime.

When used as an insomnia treatment, cognitive behavioral therapy usually requires four to eight 30-minute sessions with a trained sleep therapist. The approach works on multiple levels and contains one or more of the following elements:

Cognitive control and psychotherapy. This type of therapy helps you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.
Sleep restriction. This approach tries to match the time spent in bed with your actual sleep requirement. Reducing the amount of time you spend in bed without sleeping will actually increase your desire to sleep.
Remain passively awake. Called paradoxical intention, this involves avoiding any effort to fall asleep, with the goal of eliminating any anxiety you may feel about falling asleep easily.
Stimulus control. This method helps disassociate any negative cues you attach to the bedroom environment and condition a positive response with getting into bed. For example, you might be coached to use the bed only for sleep and sex.
Sleep hygiene. This method of therapy involves correcting basic lifestyle habits that influence sleep, such as smoking or drinking too much coffee or alcohol late in the day and failing to exercise regularly. It also includes tips that help you sleep better, such as winding down an hour or two before bedtime with a warm bath.
Relaxation training. This method helps you relax to reduce or eliminate the arousal that disturbs sleep. Approaches include meditation, hypnosis and muscle relaxation.
Biofeedback. This method measures certain physiological signs, such as muscle tension and brain wave frequency, with the intent of helping you control them.

The most effective treatment approach may combine a number of these methods. Realize that unlike sleep medications, CBT requires steady practice and that some approaches may cause you to lose sleep at first. Stick with it, and you should see results.

Insomnia as a symptom of another disorder

Because insomnia can be associated with many underlying disorders, such as depression, substance abuse or another sleep disorder, a thorough sleep evaluation is key in determining the appropriate treatment. In these cases, the root cause should be addressed simultaneously.

Finding help

The American Academy of Sleep Medicine has developed a standardized process and certification for behavioral sleep therapists, and you can locate a practitioner through its Web site.

However, there is currently a shortage of certified sleep therapists, and you may not live near a practitioner who can help. Further, the type of treatment — such as group versus individual — and frequency of sessions, may vary depending on the provider.

You may have to do some searching to find a trained practitioner and a treatment schedule and type that fits your needs. Start by obtaining a list of sleep centers from the National Sleep Foundation Web site. Many are associated with major hospitals. If you can't find one close to you, try locating a therapist who offers phone consultations. CBT books and CDs may be a good option until you find someone to help.

Comprehensive Treatment of Childhood ADHD

2009-07-01T01:48:00.000+07:00

By John M. Grohol, Psy.D.

While learning of the diagnosis of attention deficit disorder (ADHD) makes many parents feel relief, the real work begins in finding the right treatment approach for a child or teen diagnosed with ADHD.

If the diagnosis was made by a pediatrician or family physician, the first thing you should ask for is a referral to a mental health professional trained in the treatment of attention deficit disorder. This should happen before any treatment is prescribed, because, as you’ll learn, the order and focus of treatment is important. Although the inclination may be to start medication treatment immediately (with drugs such as Ritalin or Adderall), you should not give in to this feeling that you need “do something.”

Since the diagnosis of ADHD requires the child to have inattentive behavior in at least two settings — the home and school most often — the obvious interventions to change the child’s behavior involve those two settings. Comprehensive, effective treatment of childhood ADHD involves four different treatment strategies, used individually or combination:

Behavioral Parent Training
Behavioral School Intervention
Child Interventions
Medication

Parents shouldn’t expect instant changes in their child’s ADHD or behavior. Improvement and learning is a gradual process that takes time, especially with the behavioral interventions and training. However, research has shown that such interventions are longer-lasting, while the effects of medications will fade over time.

Behavioral Parent Training

Parental training benefits the child with attention deficit disorder because most parents simply don’t know what to do when dealing with an ADHD child. Even if a parent has raised other, non-ADHD children, learning how to best help a child or teenager with ADHD is a unique situation most simply have never had experience with.

Parents of ADHD children also usually have significant stress, and sometimes they may simply lack basic parenting skills. Some parents are often grappling with their own mental health issues, such as depression, anxiety, or bipolar disorder. ADHD children unintentionally contribute greatly to parental
stress and disturbed parent-child relationships. Learning good parenting skills can actually mediate most negative outcomes and therefore it makes sense to make it one of the main focuses of treatment.

Parent training usually takes on a focused, behavioral psychotherapy approach. The focus is on parenting skills, the child’s behavior, and family relationships. In parent training, parents learn skills and implement treatment with child, modifying interventions as necessary based upon how the child is doing. One of the key components of parent training is creating ADHD behavioral interventions for the home. These are easy to learn and implement and are a must for virtually any parent. Parents should also consider implementing the home daily report card (PDF).

Parent training is often done in a group-based, weekly session with therapist initially that lasts from 8 to 16 sessions. Most therapists will continue being in contact with the parents once the group sessions are done, as the parents need it (often for years). If a parent needs additional help throughout that time, most therapists will be glad to see the parents to help them through difficult childhood transitions (such as becoming a teenager).

Training can also involve discussion about maintenance of the program and relapse prevention, especially when the parent is under increased stress from relationship issues, work, etc.

Parent training is most often offered through a private psychotherapist trained in such interventions, but can also sometimes be found in schools, churches, primary care physicians and other common community outlets.

Behavioral School Intervention

Why are school interventions important in the treatment of a child or teen with ADHD? 33 percent of children with ADHD have academic problems every year and 48 percent have at least one year of special education. 12 percent of children with attention deficit disorder get held back a grade and nearly 10 percent of teens with ADHD will drop out of school if left untreated. Teenagers with ADHD will often score a full letter grade lower than other teens, even when controlling for academic skills.

School interventions are a behavioral approach where teachers are trained and implement treatment with the child, modifying interventions as necessary based upon the progress of the ADHD child. School interventions focus on classroom behavior, academic performance, and the relationships the child with his or her friends.

School interventions are typically available in most schools. Such intervention programs are administered most often by teachers, who’ve received specialized training in how to work with ADHD children. A core part of the school intervention is the school daily report card (PDF). The daily report card servers as a means of identifying, monitoring and changing the child’s classroom problems. It also acts as an avenue of regular communication between the parents and the teacher. It costs nothing, takes only a little bit of the teacher’s time, and is very motivating to the child (as long as the parent has selected the right rewards at the home for positive report card reports).

As with parental training, school intervention programs allow for maintenance and relapse prevention and will provide treatment for the child as long as necessary.

Child Interventions

Children can be their own best keepers, especially when it comes to how older children and teens learn most from — their peers (friends). The measure of the severity of a child’s ADHD can be seen in how impaired their relationships are with their friends. ADHD children with no close friends are a sign of severe ADHD that, if left untreated, predicts negative adult relationships. Friends can help an ADHD child immensely.

Child interventions take a behavioral and developmental treatment approach. They tend to focus on teaching academic, recreational, and social/behavioral competencies, decreasing aggression, increasing compliance, developing close friendships, improving relationships with adults, and building self-efficacy in the ADHD child.

Child ADHD interventions can include intensive treatments such as summer treatment programs (9
hours daily for 8 weeks), and/or school-year, after-school, and Saturday (6 hours) sessions. Such programs can also help with relapse prevention (e.g., through integration with school and parent treatments, which can all be linked together through a home/school report card system).

Medication for Childhood ADHD

Since not all children will respond to behavioral interventions, medications may also be considered in the treatment of childhood attention deficit disorder (ADHD). Behavioral interventions, like those listed previously, may not always be sufficient for some children. Parents and teachers can also sometimes not implement the program correctly, or keep it up over the long-term (after the therapist’s contact has ended).

At such times, the prescription of an appropriate psychostimulant medication may be appropriate as medications often offer more immediate short-term benefits (allowing the child to be able to better focus on the behavioral interventions). Such short-term benefits include decreased classroom disruptions, improvement in teacher ratings of the child’s ADHD behavior, improvement in compliance with adult requests, improvement in peer interactions, and increase in on-task behavior and academic productivity.

However, medications rarely should be used as the first treatment implemented. Twice as many parents will refuse any additional type of treatment for their ADHD child when a medication is prescribed first (and is ineffective), than when a parent first tries their child on a behavioral approach. Research has also shown that most parents prefer a behavioral approach (or a combined behavior and medication approach) over medications alone. A combined treatment approach also has shown that children can gain as much value from medications at significantly lower doses. Since ADHD medications have been linked to stunted childhood growth (height and weight), lower doses are generally preferred.

The need for a medication prescription should be determined following initiation of behavioral treatments, and its timing will generally depend on severity of the ADHD and responsiveness of the child to the behavioral interventions.

An individualized, school-based medication trial should be conducted with your child to determine need and minimal dose needed to complement the behavioral intervention. The physician or psychiatrist should cycle through methylphenidate and amphetamine-based medications (such as Adderall, Ritalin or Concerta) before trying other drug classes with your child. Your doctor should begin by prescribing the minimal dose needed, and only increase if symptoms don’t decrease over time (1 to 2 weeks). Consider the long-acting versions of a medication if dosing schedule doesn’t allow for multiple doses administered throughout the day.

Keep in mind that ADHD medications generally only work for as long as they are taken, hence the reason a combined approach that involves both behavioral interventions and medications is nearly always preferred. Medications are not effective for all children, and there is uniform lack of research evidence for their long-term use (more than 2 years). Medication compliance has generally been shown to be poor the longer a child is on a medication, and medication alone will likely have little effect on academic achievement, family problems or problems with relationships with their friends.

This article based upon a presentation by Dr. William E. Pelham Jr., October 2008.

Tips To Reduce Family Stress

2009-07-01T01:34:00.000+07:00

By Jane Collingwood

Stress caused by those close to you is hard to escape. As they say, “You can choose your friends, but you can’t choose your family.” Children, elderly parents, and visiting relatives all can be sources of stress.

Parenting Stress
Children bring happiness and fun, but also can be exhausting. Becoming a parent dramatically changes your daily routine and sleep pattern, bringing many new pressures.

Whether you stay at home or work, are single or married, have one child or six, the challenges are enormous. Staying calm and collected all the time is an impossible goal. Small hassles can add up until you are ready to burst.

This stress won’t just disappear, so look for ways in which you can reduce the strain:

Remember it’s not meant to be easy, but any problems you have will have been overcome by many parents before you. Search them out to use as a sounding board.
Adjust your priorities, including previous standards of order and neatness. Don’t take on unnecessary duties and responsibilities.
If you’re doing your best, don’t feel guilty. Every parent gets stressed and is sometimes overwhelmed.
Accept any help that’s offered. If you can afford it, consider paying someone to help with the cleaning, shopping or laundry, especially at busy times.
Take advice from people whose opinion you trust, and get specific advice when issues arise.
Set up a lockable, fireproof filing system for important documents, and use it.
Take care of yourself. Use stress management techniques and be alert to any symptoms. Take time for relaxation. You will be setting a great example for your children.
Plan ahead. Get as much as possible ready for the following day, and give yourself extra time to leave the house.
Anticipate and prepare for problems before they arise.
Write lists and use a calendar. You can’t be expected to remember everything.
Keep communicating with your children, and take the time to ease their worries.

Balancing Work and Family
Working and bringing up children often is challenging. During the tough times, remember and focus on why you made this choice. There will inevitably be conflicts between work and family responsibilities, so prepare as much as possible. Build up your support network, emergency funds, and your own energy. Use effective coping strategies and don’t put impossible pressure on yourself. Plan ahead, get help when you need it, and look for creative solutions.

Single Parenting
Everyone finds parenting hard at times, but single parenting has added pressures. One of the most difficult aspects of single parenting is not having another adult in the house to offer support and validation. But there’s nearly always something you can do to reduce the stress you feel and make life easier, and there are often people who are willing to help.

Ideas for single parents:

Develop and nurture several sources of support; perhaps team up with other parents. It’s always easier to cope if you have people to turn to.
Stay on top of your finances.
Always reassure your children and let them know how much you value them.
Fit in some time for yourself, and explore your feelings. Be kind to yourself and build up your confidence if it has been damaged.

Stress from Relatives
Many people feel guilty if they don’t enjoy spending time with their relatives, but it doesn’t make you a bad person, just an honest one. Look for the good in others and try to see things from their point of view, at least temporarily.

When visiting relatives:

Try to keep your expectations realistic. If you predict unpleasantness, don’t plan to stay for too long. Take a deep breath and remember it will be over soon.
If you anticipate criticism and stress-inducing questions, have your (reasonable) responses already prepared.
Strike a bargain with your children, perhaps a reward for behaving well.
If you do get upset, go for a walk, have a nap, or find somewhere private to call a friend and get it off your chest.
Pack a good book which lifts your spirits.

When relatives visit you:

Plan in advance where they will sleep, what you will feed them, and how can you budget to meet any extra costs.
Let them help with cooking and washing up, if they offer.
Don’t attempt an elaborate — stock up the fridge and freezer with food that’s quick to prepare.
If tensions are likely to arise, don’t provide too much alcohol.
When you go out, don’t feel you have to cover all the expenses.
Play games together to create a fun atmosphere.
Don’t feel you have to fill up every minute with activities.

10 Tips to Build Resilience in Teens and Young Adults

2009-07-01T01:29:00.000+07:00

By American Psychological Association

The ads make it look so easy to be a teen — everyone seems to be laughing, hanging out with friends, wearing exactly the right clothes. But if you’re a young adult, you know that life can be pretty tough sometimes. You may face problems ranging from being bullied to the death of a friend or parent. Why is it that sometimes people can go through really rough times and still bounce back? The difference is that those who bounce back are using the skills of resilience.

The good news is that resilience isn’t something you’re born with or not — the skills of resilience can be learned. Resilience — the ability to adapt well in the face of hard times; disasters like hurricanes, earthquakes or fires; tragedy; threats; or even high stress — is what makes some people seem like they’ve “got bounce” while others don’t.

What are some tips that can help you learn to be resilient? As you use these tips, keep in mind that each person’s journey along the road to resilience will be different — what works for you may not work for your friends.

1. Get Together

Talk with your friends and, yes, even with your parents. Understand that your parents may have more life experience than you do, even if it seems they never were your age. They may be afraid for you if you’re going through really tough times and it may be harder for them to talk about it than it is for you! Don’t be afraid to express your opinion, even if your parent or friend takes the opposite view. Ask questions and listen to the answers. Get connected to your community, whether it’s as part of a church group or a high school group.

2. Cut Yourself Some Slack

When something bad happens in your life, the stresses of whatever you’re going through may heighten daily stresses. Your emotions might already be all over the map because of hormones and physical changes; the uncertainty during a tragedy or trauma can make these shifts seem more extreme. Be prepared for this and go a little easy on yourself, and on your friends.

3. Create A Hassle-Free Zone

Make your room or apartment a “hassle-free zone” - not that you keep everyone out, but home should be a haven free from stress and anxieties. But understand that your parents and siblings may have their own stresses if something serious has just happened in your life and may want to spend a little more time than usual with you.

4. Stick To The Program

Spending time in high school or on a college campus means more choices; so let home be your constant. During a time of major stress, map out a routine and stick to it. You may be doing all kinds of new things, but don’t forget the routines that give you comfort, whether it’s the things you do before class, going out to lunch, or have a nightly phone call with a friend.

5. Take Care Of Yourself

Be sure to take of yourself - physically, mentally and spiritually. And get sleep. If you don’t, you may be more grouchy and nervous at a time when you have to stay sharp. There’s a lot going on, and it’s going to be tough to face if you’re falling asleep on your feet.

6. Take Control

Even in the midst of tragedy, you can move toward goals one small step at a time. During a really hard time, just getting out of bed and going to school may be all you can handle, but even accomplishing that can help. Bad times make us feel out of control - grab some of that control back by taking decisive action.

7. Express Yourself

Tragedy can bring up a bunch of conflicting emotions, but sometimes, it’s just too hard to talk to someone about what you’re feeling. If talking isn’t working, do something else to capture your emotions like start a journal, or create art.

8. Help Somebody

Nothing gets your mind off your own problems like solving someone else’s. Try volunteering in your community or at your school, cleaning-up around the house or apartment, or helping a friend with his or her homework.

9. Put Things In Perspective

The very thing that has you stressed out may be all anyone is talking about now. But eventually, things change and bad times end. If you’re worried about whether you’ve got what it takes to get through this, think back on a time when you faced up to your fears, whether it was asking someone on a date or applying for a job. Learn some relaxation techniques, whether it’s thinking of a particular song in times of stress, or just taking a deep breath to calm down. Think about the important things that have stayed the same, even while the outside world is changing. When you talk about bad times, make sure you talk about good times as well.

10. Turn It Off

You want to stay informed - you may even have homework that requires you to watch the news. But sometimes, the news, with its focus on the sensational, can add to the feeling that nothing is going right. Try to limit the amount of news you take in, whether it’s from television, newspapers or magazines, or the Internet. Watching a news report once informs you; watching it over and over again just adds to the stress and contributes no new knowledge.

You can learn resilience. But just because you learn resilience doesn’t mean you won’t feel stressed or anxious. You might have times when you aren’t happy - and that’s OK. Resilience is a journey, and each person will take his or her own time along the way. You may benefit from some of the resilience tips above, while some of your friends may benefit from others. The skills of resilience you learn during really bad times will be useful even after the bad times end, and they are good skills to have every day. Resilience can help you be one of the people who’ve “got bounce.”

Article courtesy of the American Psychological Association. Copyright © American Psychological Association. Reprinted here with permission.

DSM-V: Urgent warning and call to action

2009-07-01T00:53:00.000+07:00

Predicting a flawed manual that "will haunt psychiatry for many years to come," the chair of the DSM-IV Task Force has issued an urgent call to the American Psychiatric Association to change course on its revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) before it is too late.

Allen Frances' strongly worded appeal in the Psychiatric Times predicts the DSM-V -- scheduled for publication in May 2012 - will usher in a flood of new mental disorders that will medicalize normality, producing "a bonanza for the pharmaceutical industry but at a huge cost to the new false-positive patients caught in the excessively wide DSM-V net."

"In my experience, experts on any given diagnosis always worry a great deal about missed cases but rarely consider the risks of creating a large pool of false positives—especially in primary care settings. The experts' motives are pure, but their awareness of risks is often naive. Psychiatry should not be in the business of inadvertently manufacturing mental disorders."

Frances makes special note of the potential for "unpredictable and consequential" unintended consequences in forensic settings:

"Years after the DSM-IV was completed, we learned about the enormous unintended impact of a seemingly slight wording change we made only for technical reasons in the section on paraphilias. A misreading of our intentions in making the change had led to great confusion -- with forensic evaluators using the diagnosis of paraphilia not otherwise specified to justify the sometimes inappropriate lifetime psychiatric commitment of rapists who had no real mental disorder."

This prediction is prophetic in light of current lobbying efforts by the paraphilias subworkgroup to create a new "pedohebephilic disorder" category that could vastly expand sex offender diagnosis, proving a bonanza for the sexual offender civil commitment industry.

Frances is highly critical of the "inexplicable secrecy and the lack of openness to outside influence and criticism" surrounding the DSM-V revision process.

"Restricting the free flow of ideas creates enormous blind spots that greatly increase the risk of damaging unintended consequences…. The advisory group is far too small and select to reduce, rather than encourage, heated debate. In producing a new edition of the DSM, your harshest critics eventually turn out to be your best friends because they are most likely to help you avoid pitfalls."

He is urging the American Psychiatric Association to create an external committee to review what is going on with the DSM and make recommendations to avoid serious negative consequences in the future.

Frances' important article, A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences, is available HERE.

An accompanying Q&A, DSM-V Badly Off Track, is HERE.

Some of my related blog posts are HERE.

The Power of Music To Reduce Stress

2009-06-30T00:47:00.002+07:00

By Jane Collingwood

The soothing power of music is well-established. It has a unique link to our emotions, so can be an extremely effective stress management tool.

Listening to music can have a tremendously relaxing effect on our minds and bodies, especially slow, quiet classical music. This type of music can have a beneficial effect on our physiological functions, slowing the pulse and heart rate, lowering blood pressure, and decreasing the levels of stress hormones.

As music can absorb our attention, it acts as a distraction at the same time it helps to explore emotions. This means it can be a great aid to meditation, helping to prevent the mind wandering.

Musical preference varies widely between individuals, so only you can decide what you like and what is suitable for each mood. But even if you don’t usually listen to classical music it may be worth giving it a try when selecting the most calming music.

When people are very stressed, there is a tendency to avoid actively listening to music. Perhaps it feels like a waste of time, not helping to achieve anything. But as we know, productivity increases when stress is reduced, so this is another area where you can gain vast rewards. It just takes a small effort to begin with.

To incorporate music into a busy life, try playing CDs in the car, or put the radio on when in the bath or shower. Take portable music with you when walking the dog, or put the stereo on instead of the TV.

Singing (or shouting) along can also be a great release of tension, and karaoke is very enjoyable for some extroverts! Calming music before bedtime promotes peace and relaxation and helps to induce sleep.

Research on Music
Music has been used for hundreds of years to treat illnesses and restore harmony between mind and body. But recently, scientific studies have attempted to measure the potential benefits of music. They have found:

Music’s form and structure can bring order and security to disabled and distressed children. It encourages coordination and communication, so improves their quality of life.
Listening to music on headphones reduces stress and anxiety in hospital patients before and after surgery.
Music can help reduce both the sensation and distress of both chronic pain and postoperative pain.
Listening to music can relieve depression and increase self-esteem ratings in elderly people.
Making music can reduce burnout and improve mood among nursing students.
Music therapy significantly reduces emotional distress and boosts quality of life among adult cancer patients.

Meditation
Certain music is appropriate for meditation as it can help the mind slow down and initiate the relaxation response. However, not all peaceful or “New Age” music works for everyone. Music with no structure can be irritating or even unsettling. Gentle music with a familiar melody more often is comforting. But search around to find what produces a sense of calm, familiarity, and centeredness for you as an individual.

The sounds of nature often are incorporated into CDs made specifically for relaxation. For example, the sound of water can be soothing for some people. It can help conjure up calming images such as lying beside a mountain stream on a warm spring day. Birdsong may also be of use as an aid to help your mind slow down and release stressful thoughts.

Music Therapy
Because music has the potential to influence us both psychologically and physiologically, it is an important area of therapy for stress management. Music therapy can make use of biofeedback, guided imagery, and other established techniques to play an important role in the treatment of people with stress-related disorders. But due to the dramatic effects music can have, a trained and knowledgeable music therapist always is required.

When used in combination with biofeedback techniques, music can reduce tension and facilitate the relaxation response. It may be more compatible with relaxation than verbal stimuli, which may be distracting — music is processed mainly in nonverbal areas of the brain.

Music may help people to identify and express the feelings associated with their stress. In a music therapy session, the client can express these emotions, providing an important cathartic release.

Producing music in an improvisational way, and discussing pieces of music and lyrics in a group, can also help us become more aware of our emotional reactions and share them constructively with the group.

Thinking More Clearly
Finally, listening to music can help the brain by improving learning and memory skills, always useful when we’re under stress. This has come to be known as “The Mozart Effect.” Experiments carried out by scientists at the University of California at Irvine found that students’ test scores improved after listening to a recording of Mozart, compared with either a relaxation tape or silence. This may be because the processing of music shares some of the same pathways in the brain as memory.

References

Allen K. et al. Normalization of hypertensive responses during ambulatory surgical stress by perioperative music. Psychosomatic Medicine, Vol. 63, May/June 2001, pp. 487-92.
Aldridge D., Gustoff D. and Neugebauer L. A pilot study of music therapy in the treatment of children with developmental delay. Complementary Therapies in Medicine, Vol. 3, October 1995, pp. 197-205.
Hanser S. B. and Thompson L. W. Effects of a music therapy strategy on depressed older adults. Stanford University School of Medicine. Journal of Gerontology, Vol. 49, November 1994, pp. 265-69.
Good M. A comparison of the effects of jaw relaxation and music on postoperative
pain. Nursing Research, Vol. 44, Jan/Feb 1995, pp. 52-57.
Bittman B. B. Recreational music-making: an integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students: insights and economic impact. International Journal of Nursing Education Scholarship, published online July 9, 2004.
Waldon E. G. The effects of group music therapy on mood states and cohesiveness in adult oncology patients. Journal of Music Therapy, Vol. 38, Fall 2001, pp. 212-38.
Burns D. S. The effect of the bonny method of guided imagery and music on the mood and life quality of cancer patients. Journal of Music Therapy, Vol. 38, Spring 2001, pp. 51-65.
Rauscher F. H., Shaw G. L. and Ky K. N. Music and spatial task performance. Nature, Vol. 365, October 14, 1993, p. 611.

Music Therapy With Emotionally Disturbed Children

2009-06-30T00:39:00.001+07:00

David L. Hussey, Ph.D., and Deborah Layman, M.M., MT-BC
Dr. Hussey is assistant professor in the department of justice studies at Kent State University and faculty associate at the Institute for the Study and Prevention of Violence. Ms. Layman is a music therapist at Beech Brook Campus in Cleveland.

Music therapy is defined as "the prescribed use of music by a qualified person to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems" (American Music Therapy Association, 2003). While music therapy is closely aligned with the behavioral sciences, it is distinct in that it bridges art with science. Two publications by Elio Frattaroli, M.D., (2002, 2001) illustrate the dilemma faced by modern psychiatry in trying to understand mental illness, not only in the science of neurological processes but also in the art of skillful healing relationships.

Music therapists are skillful practitioners who orchestrate their talents to help soothe a wide variety of painful human conditions. While many psychiatrists are aware of the uses of music therapy for the treatment of autism, substance abuse, Alzheimer's disease and pain, far fewer are aware of the exciting work that's being done with children who have serious emotional disturbances.

Children with such disturbances have diagnosable mental health disorders and extreme functional impairment that limit or interfere with the ability to function in the family, school and/or community (Stroul and Friedman, 1994). Conservative estimates from epidemiological studies suggest that 8% to 12% of students ages 6 to 21 suffer from a significant disability, and approximately 8%, roughly 470,000 of this population, are identified through their schools as being emotionally disturbed (U.S. Department of Education, 2001).

A review of the music therapy literature delineates at least three broad domains of functioning where music therapy has been successfully utilized in the treatment of emotionally disturbed children: affect regulation, communication and social/behavioral dysfunction. Assessment and intervention in each of these domains requires strong grounding in developmental theory, a key component in the training of music therapists. Early on, music therapy was identified as an intervention to treat impairments in affective functioning, including reducing levels of anxiety (Cooke, 1969), and as a tool to improve emotional responsiveness (Wasserman, 1972). Music therapy has been well-suited to help improve communication deficits and stimulate nonverbal communication. Numerous positive outcomes in improving social functioning, social awareness and cooperation (Werbner, 1966), and decreasing disruptive behaviors (Hong et al., 1998) have been reported. One of the major contemporary applications for music therapy is working with children who have serious emotional disturbances and high degrees of impulsivity and limited ability to self-regulate (Layman et al., 2002).

Some of the modalities and techniques used in the treatment of emotionally disturbed children include live music production (e.g., playing instruments and/or singing), improvisation, guided imagery (e.g., pairing of visualization with music), creative songwriting and lyric analysis. After a careful assessment of the child's needs and capabilities, music therapists formulate individualized treatment plans that include goals and measurable objectives. Music therapists reinforce and shape targeted behaviors, while dynamically exploring underlying feelings and issues. Music therapists who work on multidisciplinary treatment teams often concentrate on a specific subset of treatment goals or objectives most appropriate for music therapy intervention. These techniques are applied in a variety of community treatment settings, as well as in hospitals, residential treatment centers and partial hospitalization programs. Therapy sessions with children typically last from 30 to 60 minutes and may be structured to include individual, family and group formats.

Rationale for Music Therapy

An advantage of music therapy is that it is an inherently nonthreatening and inviting medium. It offers a child a safe haven from which to explore feelings, behaviors and issues ranging from self-esteem to severe emotional dysregulation. Music therapy techniques can be designed to address more complex issues such as grief, abandonment or deeply conflicted emotions. As a medium, music therapy has enormous range and scope in targeting multiple clinical needs across the gamut of childhood developmental stages. It can set the occasion for a child to establish a meaningful relationship with an adult through musical play and interaction. Music therapy can also facilitate the development of prosocial skills, trust and feelings of positive attachment. Developmentally, almost all children respond to music. This greatly assists in laying a strong foundation for engaging in deeper therapeutic work. Children's natural interest in music is enhanced by the fact that they are occupied in stimulating motor and auditory activities more associated with play or fun than work or therapy. The careful and repetitious orchestration of such multisensory experiences, in the context of a skillful and nurturing relationship, has a remarkable range of clinical benefits.

Music Therapy Applications

The mental health care and child welfare fields are searching for effective therapies that can be utilized with victimized children, especially those who have comorbid disorders. The most heavily researched psychiatric sequelae of victimization is posttraumatic stress disorder, and its most frequently studied treatment is cognitive-behavioral therapy. A concerning gap in the treatment literature is that many emotionally disturbed children suffer from cognitive deficits and developmental disabilities. Research indicates that the average IQ of child welfare populations undergoing intensive mental health treatment is in the low- to mid-80s (Hussey and Guo, 2002). Such intellectual and information-processing deficits render cognitive and verbal therapies less effective for these children than for children with higher IQs.

Developing an Effective Treatment Protocol

2009-06-29T15:40:00.001+07:00

Andrea M. Victor, PhD and Gail A. Bernstein, MD
Dr Victor is assistant professor and Dr Bernstein is professor in the division of child and adolescent psychiatry at the University of Minnesota in Minneapolis. The authors report no conflicts of interest concerning the subject matter of this article.

Anxiety disorders are the most prevalent disorders among children and adolescents in both community and clinical settings. The high prevalence of anxiety disorders in children and adolescents leads to increased interest in the development and implementation of effective treatments. Anxiety disorders in children and adolescents are often associated with significant psychosocial impairments (eg, poor social relationships, decrease in academic performance, low self-esteem), and untreated anxiety tends to persist through adulthood.1,2

An effective treatment for anxiety disorders in children is cognitive-behavioral therapy (CBT).3 However, some children with anxiety disorders demonstrate minimal response to CBT alone. When children and adolescents show minimal response to a trial of CBT, psychotropic medications are often added for a multi- modal treatment approach.4 SSRIs are documented to be effective in the treatment of anxiety disorders in children.5 Most studies reviewed in this article include participants in whom generalized anxiety disorder, social phobia, or separation anxiety disorder was diagnosed.

Cognitive-behavioral therapy
CBT has been shown to be effective in the treatment of childhood anxiety disorders when used in individual, group, family, and school-based settings. Six essential components of CBT have been identified for the treatment of anxiety disorders in children: psychoeducation, somatic management, cognitive restructuring, problem solving, exposure, and relapse prevention.6
Psychoeducation provides families and children with information on anxiety disorders.
Somatic management techniques (eg, diaphragmatic breathing, progressive muscle relaxation) increase awareness and management of autonomic and physiological symptoms related to anxiety.
Cognitive restructuring strategies require that the child monitor his or her thought processes to recognize maladaptive, irrational thoughts and that these thoughts be replaced with more adaptive, rational thoughts.
Problem-solving methods are taught to the child so that he can identify coping strategies to manage anxiety-provoking situations.
Exposure exercises include hierarchical and systematic exposures to feared stimuli, which provide the child with practice in managing associated anxiety symptoms.
Relapse prevention (eg, decreasing session frequency while scheduling follow-up or booster sessions) is an important component of CBT because it encourages the child to take more control over his anxiety and to rely less on the therapist.

Individual and group CBT were shown to be consistently superior to a wait-list control condition (ie, no treatment) in children with anxiety disorders.7-9 Longitudinal research studies have shown that treatment gains with individual CBT were maintained and enhanced at 3- and 7.5-year follow-up.10,11 Flannery-Schroeder and Kendall9 compared individual CBT with group CBT and found that the interventions were equally effective and treatment gains were maintained after a 1-year period in children with anxiety.12

Furthermore, group CBT has been successfully used in school-based settings as a preventive and early intervention effort to target children with anxiety symptoms.8,13 Outcomes from these studies showed a decrease in anxiety symptoms or remission of anxiety in children who received school-based group CBT intervention compared with children who did not.

Studies have shown mixed results when a parent-training component is added to CBT. Some studies have shown no added benefits when parents were involved in their children's anxiety treatment14,15; however, other studies found some favorable outcomes when a parent component was added to the traditional child CBT model.13

In one study, children who participated in school-based group CBT or school-based group CBT with parent training were rated as having significantly less anxiety at posttreatment compared with children in the no-treatment control group.13 The parent component of the intervention included information on the following topics: the 6 components of CBT6 (described earlier), parental anxiety and stress management, the impact the child's anxiety had on family relationships, and implementation of behavioral contracting.

Further benefits were found in children whose parents participated in a parent-training component. On 2 outcome measures, the Clinical Global Impression (CGI)-Improvement Scale and the parent version of the Multidimensional Anxiety Scale for Children, significant benefits were found for children in the CBT with parent-training group compared with no-treatment controls but not for children in CBT alone compared with no-treatment controls. These results suggest that the inclusion of a parent-training component may provide added benefits to children with anxiety who receive group CBT.

Wood and colleagues16 developed a family component that specifically targets parental intrusiveness and lack of child autonomy, since these factors are shown to play a central role in the maintenance of childhood anxiety disorders.17,18 The parent-training sessions encouraged parents to provide choices for their anxious child when he is indecisive, allow their child to learn through mistakes rather than taking over to protect him, validate their child's emotional responses, and support their child's development of self-help skills.16

A family CBT program was compared with a child CBT program with limited parental involvement. The child CBT program was composed of individual sessions with the child, and the family CBT program was composed of sessions that consisted of time with the child alone, parents alone, and parents and child together. Children in the family CBT group demonstrated a greater decrease in anxiety severity at a faster rate compared with children in the child CBT group.16 Previous parent programs strove to train parents to support CBT skills at home and manage parental anxiety13; however, it may be important for parents to learn specific parenting strategies to aid in the reduction of the child's anxiety (eg, decrease parental intrusiveness, increase child autonomy seeking).

A recent study by Victor and colleagues19 examined the relationships among family functioning, parenting stress, parental psychopathology, and treatment outcome in anxious children. Results showed that a higher level of family cohesion before participating in group CBT was associated with a significantly greater decrease in child anxiety posttreatment. Parenting stress and parental psychopathology were not directly related to treatment outcome; however, parents from families with low cohesion endorsed significantly greater levels of parenting stress and parental psychopathology (ie, depression, anxiety, global severity) when compared with families high in cohesion. Thus, family cohesion may function as a mediator when there are high levels of parenting stress and parental psychopathology. Furthermore, these findings provide additional support for including a parent or family component in the treatment of children with anxiety.

Psychotropic medications
Psychopharmacological treatment is often considered for the treatment of anxiety disorders in children when symptoms are severe and significantly interfere with daily functioning (eg, school refusal, difficulty with participating in social activities) and children are exhibiting a minimal response to CBT. SSRIs are the first-choice medications for treating anxiety disorders in children and adolescents.4 Several randomized clinical trials (RCTs) support the efficacy of SSRIs in decreasing anxiety symptoms and in the short-term safety of SSRIs in youths.5,20-22

When examining pharmacological treatment effects in children who are anxious, RCTs often include children with generalized anxiety disorder, separation anxiety disorder, or social phobia. A multicenter study examined outcome following 8 weeks of treatment with fluvoxamine versus placebo and found that fluvoxamine had a significantly greater impact on reducing anxiety symptoms.5 Birmaher and colleagues20 completed a 12-week RCT comparing the effects of fluoxetine and placebo on children with anxiety. Results showed that children who received fluoxetine were more likely to be rated as much or very much improved on the CGI compared with children who received placebo. These studies provide support for the efficacy of SSRIs as treatment for anxiety disorders in children.

A literature review by Safer23 examined the efficacy of SSRIs in children and adolescents with depression or anxiety disorders using published RCT data. The review demonstrated that SSRIs when compared with placebo do not significantly reduce depressive symptoms in children; however, a modest degree of efficacy was found when using SSRIs with depressed adolescents.

In contrast, published data (such as presented earlier) provide evidence that children and adolescents with anxiety disorders demonstrate significant improvements when treated with SSRIs. The review by Safer23 indicated that SSRIs are probably more effective when treating children and adolescents with anxiety disorders rather than with depression.

Black box warning considerations
Although children and adolescents who participated in RCTs reported minimal adverse effects with medication, there continues to be concern regarding the use of medication to treat childhood anxiety and depressive disorders. The FDA now requires a black box warning on SSRI medications that states "antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder and other psychiatric disorders."24

In a meta-analysis of 24 controlled clinical trials of antidepressants with youths, Hammad25 demonstrated that the risk of adverse suicidal events was approximately 4% for youths receiving antidepressants versus approximately 2% for those receiving placebo.

Another meta-analysis of 21 studies of antidepressants in youths, including 14 treatment trials for major depression and 7for anxiety disorders, looked at the safety of SSRIs in children and adolescents.26 These studies included the original data provided by the drug manufacturers to the FDA in 2003.

The overall findings from this meta-analysis showed that the incidence ratio for serious suicidal events (eg, suicide attempt or suicidal ideation necessitating hospitalization) was 1.89, which represents a significant difference between drug and placebo for risk of suicidal events. Results were similar when the meta-analysis was repeated using only the 14 trials of youths with major depression. The incidence ratio was 1.95, which also showed a significant difference between drug and placebo on risk of suicidality. However, when only the 7 studies of youths with anxiety disorders were included, there was no significant difference between antidepressants and placebo with regard to suicidal events (incidence ratio = 1.31).26 Since fewer studies were included in the examination of the effects of antidepressants for treating anxiety, the latter result should be viewed as preliminary.

The black box warning on increased suicidality in children and adolescents who are being treated with SSRIs has led to substantial concern from parents and health care professionals. The use of antidepressant medications in persons aged 18 years or younger declined approximately 20% after the FDA released the first public health advisory warning in March 2004 about the increased risk of suicidality associated with antidepressants in children and adolescents.27 This suggests that parents may be less likely to seek antidepressant medication treatment in a clinical setting and some physicians may be overly cautious about prescribing this type of medication for children and adolescents, which results in some children not getting needed treatment.

Another concern is that the black box warning may impact parents' willingness to allow their children with anxiety to participate in research studies that include an SSRI component. Pretreatment attrition caused by medication concerns has been a substantial problem in previous studies and limits external validity of the research results. Young and colleagues28 reported a 67% pretreatment attrition rate in their study of social phobia in children and adolescents that included behavioral therapy, fluoxetine, and placebo. The most common reason given by parents who refused to allow their children to participate was fear of possible randomization to the medication group, which accounted for 45% of refusals.

In another study, parents answered a questionnaire about whether they would allow their children to participate in a hypothetical study that included an active medication group.28 A majority (64%) said they would not allow their children to participate, with the most common reasons being potential adverse effects and dependence on the medications. These data were collected between May 2001 and September 2004; therefore, resistance to medications was present before the black box warning. It is suspected that parental concern regarding antidepressants has increased since the inclusion of the black box warning.

Conclusion
Current research on the treatment of anxiety disorders in children is important for treatment in clinical settings. It is imperative that clinicians use data to develop and implement effective treatment protocols for children and adolescents with anxiety disorders.

When clinicians are developing a treatment protocol, it is vital that they assess the severity of anxiety, degree of interference, and the level of family functioning. The most effective treatment strategy will likely include a multimodal approach that comprises both psychosocial and psychopharmacological interventions.

Although knowledge about the treatment of childhood anxiety disorders has significantly progressed during the past 10 years, there are areas that need further exploration. It is crucial that future studies attempt to delineate specific treatment mechanisms of CBT and identify specific predictors of positive treatment outcome in childhood anxiety. In addition, research that examines the combined efficacy of CBT and medication versus CBT or medication alone in the treatment of anxiety disorders in children is needed to develop guidelines for combining and sequencing these effective treatments.

Currently, the Child and Adolescent Anxiety Multimodal Treatment Study is being conducted to compare several treatment modalities29: medication, CBT, medication and CBT, and pill placebo. The results from this study will provide important information regarding treatment of childhood anxiety disorders.

References

Essau CA, Conradt J, Petermann F. Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents. J Anxiety Disord. 2000;14:263-279.
Pine DS, Cohen P, Gurley D, et al. The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry. 1998;55:56-64.
Compton SN, March JS, Brent D, et al. Cognitive- behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J Am Acad Child Adolesc Psychiatry. 2004;43:930-959.
Connolly SD, Bernstein GA, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2007; 46:267-283.
The Research Unit on Pediatric Psychopharmacology Anxiety Study Group. Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med. 2001;344:1279-1285.
Velting ON, Setzer NJ, Albano AM. Update on and advances in assessment and cognitive-behavioral treatment of anxiety disorders in children and adolescents. Prof Psychol Res Pr. 2004;35:42-54.
Kendall PC. Treating anxiety disorders in children: results of a randomized clinical trial. J Consult Clin Psychol. 1994;62:100-110.
Dadds MR, Spence SH, Holland DE, et al. Prevention and early intervention for anxiety disorders: a controlled trial. J Consult Clin Psychol. 1997;65:627-635.
Flannery-Schroeder EC, Kendall PC. Group and individual cognitive-behavioral treatments for youth with anxiety disorders: a randomized clinical trial. Cognit Ther Res. 2000;24:251-278.
Kendall PC, Southam-Gerow MA. Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. J Consult Clin Psychol. 1996;64: 724-730.
Kendall PC, Safford S, Flannery-Schroeder E, Webb A. Child anxiety treatment: outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. J Consult Clin Psychol. 2004;72:276-287.
Flannery-Schroeder E, Choudhury MS, Kendall PC. Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1-year follow-up. Cognit Ther Res. 2005;29:253-259.
Bernstein GA, Layne AE, Egan EA, Tennison DM. School-based interventions for anxious children. J Am Acad Child Adolesc Psychiatry. 2005;44:1118-1127.
Nauta MH, Scholing A, Emmelkamp PM, Minderaa RB. Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: no additional effect of a cognitive parent training. J Am Acad Child Adolesc Psychiatry. 2003;42:1270-1278.
Spence SH, Donovan C, Brechman-Toussaint M. The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive- behavioural intervention, with and without parental involvement. J Child Psychol Psychiatry. 2000;41: 713-726.
Wood JJ, Piacentini JC, Southam-Gerow M, et al. Family cognitive behavioral therapy for child anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2006; 45:314-321.
Whaley SE, Pinto A, Sigman M. Characterizing interactions between anxious mothers and their children. J Consult Clin Psychol. 1999;67:826-836.
Wood JJ, McLeod BD, Sigman M, et al. Parenting behavior and childhood anxiety: theory, empirical findings, and future directions. J Child Psychol Psychiatry. 2003;44:134-151.
Victor AM, Bernat DH, Bernstein GA, Layne AE. Effects of parent and family characteristics on treatment outcome of anxious children. J Anxiety Disord. 2007; 21:835-848.
20. Birmaher B, Axelson DA, Monk K, et al. Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2003;42:415-423.
Rynn MA, Siqueland L, Rickels K. Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder. Am J Psychiatry. 2001; 158:2008-2014.
Wagner KD, Berard R, Stein MB, et al. A multicenter, randomized, double-blind, placebo-controlled trial of paroxetine in children and adolescents with social anxiety disorder. Arch Gen Psychiatry. 2004;61:1153-1162.
Safer DJ. Should selective serotonin reuptake inhibitors be prescribed for children with major depressive and anxiety disorders? Pediatrics. 2006; 118: 1248-1251.
Klein DF. The flawed basis for FDA post-marketing safety decisions: the example of anti-depressants and children. Neuropsychopharmacology. 2006;31:689-699.
Hammad TA. Results of the analysis of suicidality in pediatric trials of newer antidepressants. Psychopharmacology Drugs Advisory Committee and the Pediatric Advisory Committee. September 13-14, 2004. Available at: http://www.fda.gov/ohrms/dockets /ac/04/ slides/2004-4065S1_08_FDA-Hammad_files/ frame.htm. Accessed June 5, 2007.
Mosholder AD, Willy M. Suicidal adverse events in pediatric randomized, controlled clinical trials of antidepressant drugs are associated with active drug treatment: a meta-analysis. J Child Adolesc Psychopharmacol. 2006;16:25-32.
Rosack J. New data show declines in antidepressant prescribing. Psychiatr News. September 2005; 40:1-6.
Young BJ, Beidel DC, Turner SM, et al. Pretreatment attrition and childhood social phobia: parental concerns about medication. J Anxiety Disord. 2006;20:1133-1147.
National Institute of Mental Health. Child and adolescent anxiety disorders (CAMS). August 18, 2006. Available at: http://clinicaltrials.gov/ct/show/NCT00052078. Accessed on May 31, 2007.

Developing an Effective Treatment Protocol

2009-06-29T15:40:00.000+07:00

Aromatherapy History, Product and supply

2009-06-29T15:34:00.001+07:00

The origins of Aromatherapy can be traced through the religious , medical and social practices of all the major civilizations. The term 'Aromatherapie' was first used in 1928 by a French chemist- Rene Maurice Gattefosse to describe the therapeutic action of aromatic plant essences. He was fascinated by the benefits of lavender oil in healing his burned hand without leaving any scars. He started investigating the effect of other essential oils for healing and for their psychotherapeutic benefits.

Although the term 'Aromatherapy' has been coined only in the twenteeth century, this system of stress and depression and skin treatment has a long and distinguished tradition. even the Bible refers to the use of plants and their oils for the treatment of illness, and it is well known that the Egyptians used essential oils for embalming their dead, and as cosmetics.

Aromatherapy had been around for 6000 years or more. The Greeks, Romans, and ancient Egyptians all used aromatherapy oils. The Egyptian physician Imhotep recommended fragrant oils for bathing, massage, and for embalming their dead nearly 6000 years ago.

Today there is a world wide revival in the art of aromatherapy and contemporary research in beginning to understand the scientific foundations of oils properties and applications, discovered by trail and error over thousands of years.

What is aromatherapy?

Aromatherapy consists of the use of pure essential oils obtained from a wide assortment of plants, which have been steam distilled or cold-pressed from flowers, fruit, bark and roots. Aromatherapy is the use of pure essential and absolute oils. Aromatherapy is the science and art of using the volatile, non-oily essences of plants in healing. The appropriate oils can have powerful results, both on the body and the spirit.

What are the Uses and benefits of aromatherapy?

Aromatherapy is one of the fastest growing fields in alternative medicine.

Stress, pollution, unhealthy diet, hectic but sedentary life styles - all these factors have adverse effects on our bodies and spirits. The art of Aromatherapy harnesses the potent pure essences of aromatic plants, flowers and resins, to work on the most powerful of senses - smell and touch - to restore the harmony of body and mind. The value of natural plant and oil has been recognized for their healing, cleansing, preservative and mood enhancing properties, as well as for the sheer pleasure of their fragrances.

The healing power of essential oils is the main attraction in aromatherapy. It is also the main question for the skeptic. There is very little evidence for all the claims made by aromatherapists regarding the various healing properties of oils. The use of aromatherapy can be seen as part of a lifestyle choice -- a lifestyle that allows for pleasure because a moment of pleasure is healing.

It is widely used at home, clinics and hospitals for a variety of applications such as pain relief for women in labor pain, relieving pain caused by the side effects of the chemotherapy undergone by the cancer patients, and rehabilitation of cardiac patients.

Treating depression naturally -herbal treatment

2009-06-29T15:26:00.001+07:00

Herbal Remedy for curing Depression - Herbs for depression

For some people herbal remedies are useful in relieving the symptoms of depression. Many depression sufferers are able to significantly reduce or eliminate their depression symptoms through herbal and more cost effective means. Herbal and natural remedies offer more options for physiological treatment of depression symptoms.

There is a common perception that herbal remedies are safe because they do not require a prescription. Many of these substances, such as teas and dietary supplements, are sold as food. Because they are not sold as drugs, they are not subject to the stringent quality and standardization control of medications.

In addition, herbal remedies do not require the warnings of side effects or assurance of research proven therapeutic effect.

Herbs for depression

The herbs for depression include a wide variety of species for the treatment the same that there are varying degrees of depression, from mild to moderate or severe. The first step to prescribe either a natural remedy or a medicament is to determine if such depression is short terms or chronic studying carefully how often people are depressed and the circumstances around this situation.

St. John's Wort - Natural, wholesome, inexpensive and available over the counter, Hypericum perforatum seemed to be the dream remedy for depression. The herbal remedy had fewer side effects and as the researchers concluded, it showed promise for the long-term treatment of moderate depression.

SAMe - S-adenosylmethionine (SAM-E) is an amino acid that is used in the treatment of depression. SAMe is an essential amino acid required to maintain healthy neurotransmitter processes in the brain. People suffering from depression often have deficient quantities of certain brain chemicals. SAMe works fast to increase these levels and improve these deficient factors with little or no side effects.

5HTP - 5-Hydroxytryptophan (5-HTP) is an amino acid that is the intermediate step between tryptophan and the important brain chemical serotonin, a strong neurotransmitter in the brain. It specifically targets symptoms caused by low seratonin levels such as feeling down, changes in sleep patterns, etc. 5HTP has also been successful as a weight loss aid by suppressing the appetite.

Ginkgo Biloba - Ginkgo is found to be useful in relieving depression, especially in the elderly who suffer reduced blood flow to the brain, according to results form clinical trials. It is a powerful antidepressant and antioxidant that increases blood flow to the brain and other parts of the body. This improved blood circulation increases memory, promotes cardiovascular health and alleviates symptoms of Alzheimer's patients.

Siberian Ginseng -Siberian ginseng improves the balance of important neurotransmitters (including serotonin, dopamine, norepinephrine, and epinephrine) in the brain. Its various varieties are referred to as an adaptogen, a substance that assists body in adapting to external physical stresses. Ginseng is believed to stimulate the immune system, enhance abstract thinking and improve aerobic capacity. Ginseng may also benefit people with diabetes by regulating blood sugar levels.

When nutritional or hormonal imbalances are present with symptoms of anger, anxiety, frustration and/or guilt, the herbs for depression must be used with oils of Rosemay, Lemon, Bergamot or Clary Sage, good for fatigue, lack of concentration, despair and grief or Rose, Lavender and Sandalwood when the patient experiences mental hyperactivity and restlessness.

Along with herbs for depression, if you have any symptoms; walk, exercise, go to the movies or participate in activities that make you feel better but don't forget to consult a professional to get appropriate diagnosis and treatment.

Treating depression naturally -herbal treatment

2009-06-29T15:26:00.000+07:00

Depression

2009-06-29T15:24:00.000+07:00

Some people say that depression feels like a black curtain of despair coming down over their lives. Many believe that they are dull and does not deserve anything. Others feel irritable all the time for no apparent reason.

About 50% of all depressed patients experience a single episode and recover completely; the rest have at least one recurrence. Major depression can profoundly alter social, family, and occupational functioning. However, suicide is the most serious consequence of major depression; the patient's feelings of worthlessness, guilt,and hopelessness are so overwhelming that she no longer considers life worth living. Nearly twice as many women as men attempt suicide, but men are far more likely to succeed.

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Depression is a biological-based mental illness that can have lasting emotional and physical effects, such as feelings of worthlessness, guilt, or indecision; difficulty concentrating; change in appetite or sleep habits; loss of energy, interest, or pleasure; loud, violent, troubled, agitated, slowed, or anti-social behaviors; drug or alcohol abuse; and difficulty with interpersonal relationships.

A period of depressed mood which lasts for several days or a few weeks is a normal part of life and is not necessarily a cause for concern. Although these feelings are often referred to as "depression," they typically do not constitute a clinical depression because the depression symptoms are relatively mild and of short duration.

Most people with a depressive illness do not seek treatment, although the great majority-even those whose depression is extremely severe-can be helped. Thanks to years of fruitful research, there are now medications and psychosocial therapies such as cognitive/behavioral, "talk" or interpersonal that ease the pain of depression.

Unfortunately, many people do not recognize that depression is a treatable illness. If you feel that you or someone you care about is one of the many undiagnosed depressed people in this country, the information presented here may help you take the steps that may save your own or someone else's life.

Treating depression is especially important because it affects you, your family, and your work. Change won't come overnight - but with the right treatment, you can keep depression from overshadowing your life.

9 Steps to Using Self-Hypnosis

2009-06-29T02:14:00.000+07:00

By Adam Eason

No party is complete without balloons. Balloons are such fun aren’t they? Well, I associate them with having fun.

I have mentioned the idea lots of times before and quoted excerpts from my favourite self-help books such as ‘The Power Of Your Subconscious Mind’ by Joseph Murphy and ‘As A Man Thinketh’ by James Allen (which is available for free in the members area at my website by the way!) as they mention that rather wonderful idea of your mind being like a rich, fertile garden.

Of course, the garden needs tending – you need to plant good healthy seeds and if you do not take care of the garden, weeds can grow.

The thoughts you allow in your mind and especially the ones that you think of the most and focus on continually are the fruit that are going to grow and manifest in your life – it is as simple as that.

This week, I want to show you how to go into the garden of your mind and start letting go of fears of any kind. This is like primo-dynamite weeding!

Prior to actually starting this technique, just have a particular direction in mind as to how you are going to use this technique. By that, I mean that you should think of a specific area of your life that you may have some fears or apprehensions about. The more specific and detailed you can be with this technique, the more effective it is going to be for you.

When you have that in your mind, then proceed to the following simple steps while you are in a quiet place where you are not going to be disturbed.

Step One: So please do ensure that you are in a comfortable position so that you can relax, ideally learn how to take yourself into hypnosis by reading my self-hypnosis book. However, you can also use any other meditation technique or relaxation technique that is good for you.

Imagine breathing in to your stomach and then exhale nice and slowly, and as you exhale nice and slowly allow your eyes to be comfortably closed. Engage in the moment, notice your thoughts, feel your feelings and slow your breathing down naturally. Relax your body and get into a nice receptive state of body and mind.

This technique is going to be using your imagination a lot. You do not have to see these things in absolutely perfect detail. Just trust that you are doing them in the way that is right for you.

Step Two: In a nice relaxed state, using your imagination, imagine that you are in the garden of your mind.

Of course, make it a beautiful garden, and ideally, have an area that is a wide-open lawn. Take some time to engage in the wonderful natural, fresh smells, all the harmony of this beautiful place. Become aware of the colours, and the sounds that are present in this garden of your creation in your mind.

Ensure that you feel comfortable and safe and at ease with the tranquillity of your special garden and take all the time necessary to really connect with all those good feelings.

Step Three: Using your imagination further now, notice that in the middle of your beautiful lawn there is a large collection of helium-filled balloons.

There is something special about these balloons - You notice that they are not tied down. They are just peacefully, naturally floating there in that position. It is as if they have no weight or string holding them in place, they just float there in the centre of your lawn in the special garden of your mind.

Get this as vividly as you can in your mind. Again, spend all the time necessary to do so.

Step Four: Begin to move slowly closer to these balloons and as you draw nearer, imagine their colours. Notice that they are the most beautiful and vivid colours; real iridescent colours, almost as if these colours are unlike any you have seen before.

Imagine that these fascinating and enthrallinig colours have a hypnotic effect upon you. Imagine that they bring you a sense of peace, well-being and relaxation throughout your entire mind and body.

Imagine that as you move closer, those feelings of relaxation and comfrt increase. So that when you get right up close to them, it just feels nice and at ease to just stand beside the balloons and admire their beauty for a few moments.

Step Five: Now here comes the interesting bit….As you stand there you realise that these balloons hold all of your thoughts, all of your emotions, both positive and negative in relation to that specific thing that you thought of immediately prior to doing this exercise.

The rubbery material of each balloon allows you to see each thought or experience without any emotion or reaction, so that you can simply observe it in freedom.

Step Six: Lets have some fun with these balloons shall we? After all, I did say that balloons are for having fun, didn’t I?

So go ahead and reach out and pull one of the balloons from the group. As you look deeply into that balloon, allow your unconscious mind to reveal an image that symbolically identifies a fear or an experience or an event that is related to the issue you are focusing on.

Just notice what is inside of that balloon. That is, notice what your unconscious has chosen. Trust the wisdom of your unconscious mind to know what is right for you to know and that it selects the right thing without you trying to direct it consciously. Go with your intuition, instinct and gut feeling without too much conscious involvement.

Whatever it shows you, recognize it for what it is. Be aware of the thoughts that float within that balloon, feelings that are associated to that thing and see it all in that balloon.

At this stage, with that balloon at arms length, become aware of how that thing affected your thinking in the past and how it affected who and how you are.

Step Seven: Looking into that balloon, imagine that all of the colour is draining out of that image inside the balloon. Let it become vague and black and white and faint shades of grey only – even let it get fuzzy.

Now start to shrink it down in size, imagine that you are draining all the power out of this image and shrink it right down inside that balloon.

Imagine and see that the image is disappearing right into the helium that fills the balloon. So that all you can see is the beautiful texture of the clear balloon.

The helium inside absorbing all of the emotions surrounding that negative or sad image, kind of like a sponge, the helium is drawing away any remaining negativity that may have been there – dispelling all the last remnants of that image and that old fear.

When you are sure that all that remains is the beautiful coloured balloon, with a free, clear centre and that beautiful shell, then go ahead and let this balloon go. Release it into the sky and watch it float away. Watch it float higher and higher until it is completely gone and vanished and you feel that you have truly let go of it from your garden.

Trust your unconscious mind again. Trust that the old, unwanted, outmoded emotion and feeling is now gone, gone forever from the garden of your mind

Step Eight: Now if you need to, you can reach out and pull another single balloon from the bundle, allow your unconscious to show you any other negative emotion or memory or image that has to do with this issue and repeat the above steps until you have ensured that all fears and related memories, events or circumstances have been dissipated.

One by one, let all the balloons go into the beautiful sky.

Step Nine: When you have let go of all the balloons that you needed to, notice and imagine that you are left with a most powerful and purposeful sense of freedom and peace.

So that now you can look forward to aspects of your life with a freedom of mind and thought. Choose that this very day you are going to take some action that confirms to you that you have released that fear. Give your mind some true evidence – a real reference that you are free. The action is going to be what truly verifies the change in your life.

When you are ready to do so, just open your eyes, relax and come up and out of this experience, wiggle your fingers and toes, reacquaint yourself with your surroundings and go about your day ready to take that action and make a difference in your life.

Adam is a best selling author, consultant and speaker please visit his website for a vast range of personal development resources and to receive your free, instantly downloadable hypnosis session and amazing ebook: http://www.adam-eason.com. Thanks.

Hypnotherapy

2009-06-29T02:04:00.001+07:00

What is hypnotherapy?

The term "hypnosis" is derived from the Greek word hypnos, meaning "sleep." Hypnotherapists typically use exercises that bring about deep relaxation and an altered state of consciousness, also known as a trance. Many people routinely experience a trance-like state while they are watching television or sitting at a red light. A person in a trance or deeply focused state is unusually responsive to an idea or image, but this does not mean that a hypnotist can control the person's mind and free will. On the contrary, hypnosis can actually teach people how to master their own states of awareness. By doing so they can affect their own bodily functions and psychological responses.

What is the history of hypnosis?

Throughout history, trance states have been used by shamans and ancient peoples in ritualistic activities. But hypnosis as we know it today was first associated with the work of an Austrian physician named Franz Anton Mesmer. In the 1700s, Mesmer used magnets and other hypnotic techniques (hence the word, mesmerized) to treat people, and while he achieved a number of dramatic "cures" for blindness, paralysis, headache, and joint pain, the medical community was not convinced. Mesmer was accused of fraud, and his techniques were called unscientific.

Hypnotherapy regained popularity in the mid-1900s due to the notoriety and career of Milton H. Erickson (1901 - 1980), a successful psychiatrist who used hypnosis in his practice. In 1958, both the American Medical Association and the American Psychological Association recognized the therapy as a valid medical procedure. Since 1995, the National Institutes of Health (NIH) has recommended hypnotherapy as a treatment for chronic pain.

Other conditions for which hypnotherapy is frequently used include anxiety and addiction. (See "What illnesses or conditions respond well to hypnotherapy?")

How does hypnosis work?

When something new happens to us, we remember it and learn a particular behavior in response to that circumstance. Memories stored in our brains hold the original physical and emotional reactions that occurred when the given memory was first formed. Each time similar events occur again, the physical and emotional reactions attached to the memory are repeated. These reactions may be inappropriate or unhealthy. In some forms of hypnotherapy, the trained therapist guides you to remember the event that led to the first reaction, separate the memory from the learned behavior, and reconstruct the event with new, healthier associations.

During hypnosis, a person's body relaxes while their thoughts become more focused and attentive. Like other relaxation techniques, hypnosis decreases blood pressure and heart rate, and alters certain types of brain wave activity. In this relaxed state, a person will feel very at ease physically yet fully awake mentally. In this state of deep concentration people are highly responsive to suggestion. If you are trying to quit smoking, for example, a therapist's suggestion may successfully convince you that in the future you will have a strong dislike for the taste of cigarettes.

There are several stages of hypnosis. The process begins with reframing the problem; becoming relaxed, then absorbed (deeply engaged in the words or images presented by a hypnotherapist); dissociating (letting go of critical thoughts); responding (complying whole-heartedly to a hypnotherapist's suggestions); returning to usual awareness; and reflecting on the experience.

What happens during a visit to the hypnotherapist?

During your first visit to a hypnotherapist, you will be asked about your medical history and what brought you to see them -- in other words, what condition it is that you would like to clear up. The specialist will then, likely, explain to you what hypnosis is and how it works. You will then be directed through relaxation techniques with a series of mental images and suggestions intended to change behaviors and alleviate symptoms. For example, people who suffer from panic attacks may be given the suggestion that, in the future, they will be able to relax at will. The hypnotherapist will also teach you the basics of self-hypnosis and give you an audiotape for home use. This enables you to recreate the feelings you experienced during the session and reinforce the learning on your own.

How many treatments will I need?

Each session lasts about an hour, and most people begin to improve within 4 - 10 sessions. Together, you and your hypnotherapist will monitor and evaluate your progress over time. Children (aged 9 - 12), because they are easily hypnotized, tend to respond after only one or two visits.

What illnesses or conditions respond well to hypnosis?

Hypnosis is used in a variety of settings -- from emergency rooms to dental offices to outpatient clinics -- to relieve conditions with an emotional or psychological component. Clinical studies suggest that hypnosis may improve immune function, increase relaxation, decrease stress, and ease feelings of anxiety.

Hypnotherapy is effective in reducing the fear and anxiety that accompany pain and uncomfortable medical or dental procedures. For example, when used during an operation, hypnosis may improve recovery time and decrease anxiety as well as pain following the surgery. Clinical trials on burn patients suggest that hypnosis decreases pain (enough to replace pain medication) and speeds healing. Generally, clinical studies indicate that using hypnosis can lessen your need for medication, improve your mental and physical condition before an operation, and reduce the time it takes to recover. Dentists also use hypnotherapy to control gagging and bleeding.

A hypnotherapist can teach you self-regulation skills. For instance, someone with arthritis may be told that they can turn down pain like the volume on a radio. Hypnotherapy can also be an effective tool for managing chronic illness. Self-hypnosis can enhance a sense of control, which is often eroded by chronic illness. Children may benefit the most from hypnosis, probably because they are most easily hypnotized.

Clinical studies on children in emergency treatment centers show that hypnotherapy reduces fear, anxiety, and discomfort and improves self-control and cooperation with medical personnel.

Other problems or conditions that respond well to hypnotherapy include:

Inflammatory bowel diseases (namely, Crohn's disease and ulcerative colitis)
Sleep disorders, including insomnia
Addictions
Warts
Bedwetting
Fibromyalgia
Irritable bowel syndrome
Phobias
Labor and delivery
Fractures
Skin disorders [such as acne, psoriasis, and eczema (atopic dermatitis)]
Migraine headaches
Stress
Tinnitus (ringing in the ears)
Cancer-related pain
Weight loss
Eating disorders, namely anorexia and bulimia
Indigestion (dyspepsia)

Are there any risks associated with hypnotherapy?

Before considering hypnotherapy, you must obtain a proper diagnosis from a physician to understand what is being treated. This is especially true if your condition is psychological in nature (for example, a phobia or anxiety), in which case it is important to first be evaluated by a psychiatrist. Without an accurate diagnosis, it is possible that hypnotherapy may exacerbate your symptoms. Also, very rarely, hypnotherapy leads to the development of "false memories" fabricated by the unconscious mind; these are called confabulations.

How can I find a hypnotherapist?

Most hypnotherapists are licensed medical doctors, registered nurses, social workers, or family counselors who have received additional training in hypnotherapy. For example, members of the American Society of Clinical Hypnosis (ASCH) must hold a doctorate in medicine, dentistry, podiatry, or psychology, or a master's level degree in nursing, social work, psychology, or marital/family therapy with at least 20 hours of ASCH-approved training in hypnotherapy. Similarly, the American Psychotherapy and Medical Hypnosis Association provide certificates for licensed medical and mental health professionals who complete a 6 - 8 week course.

To receive a directory of professionals practicing hypnotherapy near you, contact:

The American Society of Clinical Hypnosis: www.asch.net
The Society for Clinical and Experimental Hypnosis: www.sceh.us/index.htm
The American Association of Professional Hypnotherapists: www.aaph.org
Reviewed last on: 8/10/2007
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

References

Alladin A, Alibhai A. Cognitive hypnotherapy for depression: an empirical investigation. IntJ Clin Exp Hypn. 2007;55(2):147-66.
Araoz D. Hypnosis in human sexuality problems. Am J Clin Hypn. 2005;47(4):229-42.
Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007;(3):CD003388.
Brown D. Evidence-based hypnotherapy for asthma: a critical review. Int J Clin Exp Hypn. 2007;55(2):220-49.
Brown DC, Hammond DC. Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labor. Int J Clin Exp Hypn. 2007;55(3):355-71.
Casiglia E, Schiavon L, Tikhonoff V, et al. Hypnosis prevents the cardiovascular response to cold pressor test. Am J Clin Hypn. 2007;49(4):255-66.
Flammer E, Alladin A. The efficacy of hypnotherapy in the treatment of psychosomatic disorders: meta-analytical evidence. Int J Clin Exp Hypn. 2007;55(3):251-74.
Graci GM, Hardie JC. Evidenced-based hypnotherapy for the management of sleep disorders. Int J Clin Exp Hypn. 2007;55(3):288-302.
Jensen M, Patterson DR. Hypnotic treatment of chronic pain. J Behav Med. 2006;29(1):95-124.
Kohen DP, Zajac R. Self-hypnosis training for headaches in children and adolescents. J Pediatr. 2007;150(6):635-9.
Lynn SJ, Cardena E. Hypnosis and the treatment of posttraumatic conditions: an evidence-based approach. Int J Clin Exp Hypn. 2007;55(2):167-88.
Nash MR. Salient findings: A potentially groundbreaking study on the neuroscience of hypnotizability, a critical review of hypnosis' efficacy, and the neurophysiology of conversion disorder. Int J Clin Exp Hypn. 2005;53(1):87-93.
Neron S, Stephenson R. Effectiveness of hypnotherapy with cancer patients' trajectory: emesis, acute pain, and analgesia and anxiolysis in procedures. Int J Clin Exp Hypn. 2007;55(3):336-54.
Page RA, Green JP. An update on age, hypnotic suggestibility, and gender: a brief report. Am J Clin Hypn. 2007;49(4):283-7.
Patterson DR, Wiechman SA, Jensen M, Sharar SR. Hypnosis delivered through immersive virtual reality for burn pain: A clinical case series. Int J Clin Exp Hypn. 2006;54(2):130-42.
Saadat H, Kain ZN. Hypnosis as a therapeutic tool in pediatrics. Pediatrics. 2007;120(1):179-81.
Stewart JH. Hypnosis in contemporary medicine. Mayo Clin Proc. 2005;80(4):511-24.
Thornberry T, Schaeffer J, Wright PD, Haley MC, Kirsh KL. An exploration of the utility of hypnosis in pain management among rural pain patients. Palliat Support Care. 2007;5(2):147-52.
Valente SM. Hypnosis for pain management. J PsychosocNurs Ment Health Serv. 2006;44(2):22-30.
Whitehead WE. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Int J Clin Exp Hypn. 2006;54(1):7-20.
Wobst AH. Hypnosis and surgery: past, present, and future. Anesth Analg. 2007;104(5):1199-208.

Women's Mental Health - Types of Therapy

2009-06-28T01:54:00.000+07:00

By Marlene C. Griffin

Hi Ladies,

Please don't feel offended or ashamed of the terms women's mental health, when being applied to you/us specifically. After age 40 so much is happening to us, so many changes and transitions. We don't understand what is going on in our bodies. This means the physical, mental, emotional and spiritual parts of our bodies.

A discussion of women's mental health will usually entail therapy of some sort. There is no way to avoid it. O.K.?

In this article, try to see the connections between women's mental health and her family. She is involved and a primary member. She may have her own personal mental health problems as well as those of her children and family. Women have a tremendous burden on their shoulders--and her mental health is strained and affected, to say the least.

What is therapy?

Women's mental health therapy is a way to help you understand yourself better and to cope better. Being in therapy does not mean you are crazy. Everyone has problems. Therapy is one way to help yourself with your problems.

Some of the problems that can be helped with therapy include:

depression
anxiety
drug or alcohol abuse
eating disorders
sleep problems
anger
grief

There are many different types of women's mental health therapies, which work well for other's also. One kind of therapy might work best for you, such as play therapy for small children, or family therapy for family conflicts. The kind of therapy that is best for you depends on what best meets your needs.

What types of women's mental health therapies are there?

The more common types of therapy are:
Art Therapy. Drawing, painting, or working with clay with an art therapist can help you express things that you may not be able to put into words. Art therapists work with children, teens, and adults, including people with disabilities.

Behavioral Therapy-works well for women's mental health issues. This type of therapy is very structured and goal oriented. It starts with what you are doing now, and then helps you change your behavior. Behavioral therapists may use techniques such as:

Exposure therapy or desensitization. First you learn ways to relax. Then you learn to face your fears while you practice these relaxation skills.
Aversive therapy. This pairs something unpleasant with a behavior to help you stop the behavior. For example, putting something that tastes bitter on a child's thumb to help stop thumb-sucking.
Role-playing. This may help you be more assertive or help resolve conflicts between family members.
Self-monitoring, or keeping a log of your daily activities. This may help identify which behaviors are causing you problems.

Biofeedback. This type of therapy can help you learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and physical symptoms such as headaches.

Cognitive Therapy. This type of therapy takes the approach that how you think affects how you feel and behave. This therapy helps you recognize unhealthy ways of thinking that keep you stuck. You learn to identify automatic negative thoughts such as:

"I never do anything right"
"The world is always against me"
"If I don't succeed all the time I am a failure."

You learn how to change your thoughts and this can lead to changed behaviors. It can also improve self-esteem and confidence. Cognitive-behavioral therapy combines behavior and cognitive therapy methods.

EMDR (eye movement desensitization reprocessing). In EMDR the therapist helps you cope with feelings and thoughts about distressing past events. You move your eyes back and forth, usually following the therapist's hand or pen, while you recall the event. This type of therapy is considered by many to be experimental.

Women's mental health/Family or Couples Therapy. Family therapists view the family as a system. They work with the whole family rather than just one person. The goal is for family members to openly their express feelings and to find ways to change negative family patterns.

Women's mental health related to Couples therapy helps partners improve their ability to communicate with each other. It may help you decide what changes are needed in the relationship and in the behavior of each partner. Both partners then work to learn new behaviors. There are different forms of couples therapy.

Women's mental health/Group Therapy. In group therapy a small number of people (6 to 10) meet regularly with a therapist. There are many types of therapy groups. Some focus on a specific problem such as anger management. Process groups do not focus on a single topic, but instead explore issues raised by members. Short-term groups are problem-focused and meet for a limited time, such as 6 to 12 weeks. Long-term groups deal with ongoing issues such as self-esteem.

Massage Therapy. Massage therapy may help to reduce anxiety and stress.

Women's mental health and Pharmacological Therapy (Medicines). Medicines can help improve your mental well-being. They may be prescribed by a psychiatrist or your healthcare provider. Your provider will work with you to carefully select the right medicine for you. There are many kinds of psychiatric medicines.

Antipsychotics may help with psychosis or other conditions.
Mood stabilizers may be used to treat mood problems such as bipolar disorder.
Antidepressants may help with depression or anxiety.
Antianxiety medicines may be prescribed to treat anxiety disorders.

The right medicine may improve symptoms so that other kinds of treatment are more effective. Medicines may also be used alone.

Play Therapy. Play therapy allows children to act out their problems with toys and games. Play therapists help a child feel more confident and less fearful.

Psychoanalytic Therapy. This type of therapy was developed by Sigmund Freud. In this type of therapy, you work to uncover things from your past that affect your thoughts, emotions, and behaviors. This kind of therapy can take years. It usually involves meeting several times a week. It can be quite costly.

Psychodynamic Therapy. This type of therapy helps you bring your true feelings to the surface. If you repress (purposely forget) or deny painful thoughts, feelings, and memories, they can still affect your life. Once you are aware of these repressed thoughts, feelings, and memories they become less painful.

Psychoeducational Therapy. This type of therapy involves the therapist teaching instead of the client talking. You may learn about disorders, treatment options, and how to cope with symptoms. Therapists may provide you with useful information or may help you learn different skills. They work with individuals and groups.

Relaxation Therapies. Learning ways to relax can help to reduce anxiety and stress. Yoga and meditation may also be helpful.

Your guide to empowerment and good health!

Marlene Griffin R.N.
Website URL--http://womenover40health.com
Email: marlenegriffin@womenover40health.com

I've been a registered nurse for 30 years and nearing retirement. However, I would like to continue helping my "patients" by way of my website. My focus is primarily on women over age 40 issues, but I receive emails from women younger and that's fine.

Child's Play - Child Play Therapy

2009-06-28T01:49:00.001+07:00

By Veronica Scott

Living with emotional stress and anxieties is not uncommon for adults.

But what if the person suffering from some sort of fear or apprehension is a child? Too often, children are experiencing a negative reaction to events taking place in their environment. Parents become separated or divorced, a child may experience some sort of traumatic abuse or perhaps a child lives in a place that exhibits excessive amounts of violence.

It is hard to deny the fact the world is changing on a daily basis, and our children have to cope with issues their parents and grandparents didn't even consider. Immediate satisfaction from television newscasts and newspapers constantly bombard children with negative images of death and destruction, and violence in television programs, movies or video games have created a cacophony of aggressive behavior in adolescents.

Whatever happened to the days when children played with the innocence of their youth?

Child therapists are infiltrating a kind of therapy that can help children recapture a sense of tranquility by exposing them to play therapy. Child play therapy exercises not only help children develop a sense of creativity and imagination, but they also help children communicate various fears and anxieties they have about the world around them.

Child therapy sessions use various games and toys so children will be able to express how they feel about events taking place in their lives at the time. Much like talk therapy for adults, play therapy allows a child to act out certain scenarios by using clinically proven tools to encourage expression. The end result demonstrates to therapists where they need to focus on to help a patient cope with their feelings.

Children can address parental conflicts associated with separation and divorces, or they can act out how they are treated at school by their peers. Child therapy is beneficial for children who have been traumatized by some sort of physical or sexual abuse. And child play therapy is helpful for kids who have issues with self-esteem or who have experienced some type of loss in their lifetime.

Play therapy sessions use a variety of tools and can last anywhere from thirty minutes to an hour for each session. Some of the more common methods used are storytelling, clay building, art and drawing. Other practices, such as music, doll houses, and puppets have also been used to help children express themselves.

Not every child will need to use play therapy during their adolescent years. But if you are concerned about your child's emotional stability, there are certain warning signs to look for:

Anger or fear
Aggressive behavior
Low self-esteem
Behavioral problems among other children
Change in sleeping and eating patterns
Separation anxiety
Interest in sexual behaviors
Difficulty adjusting to family changes

If you notice your child exhibiting any of these abnormal behaviors, it is important to take the next step and look into some type of therapy or help. Even if play therapy is not the answer your child needs, some other type of help could be beneficial.

Learn more about the fascinating world of miniatures. Visit TheMagicalDollhouse.com today for a great selection of dollhouses and dollhouse accessories from top miniature companies.

Are Your Children Safe With Their Toys?

2009-06-28T01:43:00.000+07:00

By Barry Chickini

You glance over at your young child and see her happily on the floor playing with her toys. Knowing she is safe, you go ahead and start preparing dinner. Between rinsing the vegetables and putting water on to boil, a tragedy could occur. Your child could be seriously or even fatally injured by her favorite toys.

This is something no parent should ever have to face, but it happens every day. Is your child safe with their toys?

In today’s toy and child care marketplace, product recalls happen all the time. Even with reputable companies and after what would appear to be exhaustive development and testing.

Unfortunately, sometimes a recall happens only after a child or multiple children have been hurt. Recently, the Thomas the Tank Engine toys were recalled. The recall included various Thomas and Friends toys because the paint finish on the trains contained lead. There were about 1.5 MILLION of these toys sold nationwide from January 2005 through 2007. The same reason prompted a recall of the Soldier Bear Action figures sold between August 2006 through 2007.

Central to the recall of the ‘Thomas’ Products and Fisher-Price was the danger of ‘Lead Poisoning’ which occurs predominantly in children who are well known to sample things by putting them in their mouths. Lead poisoning can damage internal organs including the kidneys, nervous system and brain. This is particularly dangerous because in children from age infant to seven years, their little bodies are still developing, and lead poisoning can leave PERMANENT IMPAIRMENT. Your child can suffer from a lower I.Q. and physical disabilities. All of this from her favorite toy that you thought was safe. With the knowledge of this today among manufacturers, this scenario should never have to happen.

Unfortunately, there is more. Children could become blinded, scarred, or disfigured if any of their toys have a rigid edge or surface. If your child picks up a toy like this and goes running around like children do all the time, this could be disastrous. Toys that contain loose attachments or cars that have wheels that move automatically could also be tragic. Your child's hair could become entangled in the moving parts, causing laceration, scalp injuries or even strangulation. Choking can occur with toys that have small parts or pieces, balls or removable parts.

So what do you do? Buy toys and really hope that nothing terrible happens? What if you're a child care provider or you're purchasing toys for a waiting room at a doctor's office? You absolutely cannot afford to take the chance of someone else's child being injured by one of the toys that you've provided for them to play with. It sure seems like most of the toys you buy could be dangerous. But not all of them are.

Primary Risks from Toys

Strangulation
Choking
Electric Shock or Burn
Lead Poisoning
Cuts and Scrapes

Some ideas for child toy safety at home

Buy only toys from reputable manufacturers
Use ‘Common Sense’ in toy selection
Buy toys appropriate for the child’s age
Inspect toys carefully for potential dangers
Expect the ‘Unexpected’: Look at toys with critical viewpoint
Do not leave small children unattended for any length of time
Packaging material is NOT a toy! Remove it from a child’s presence!
Use Safety Gear where available for the type of toy. (helmets, pads,etc)
Checkout toy reviews and recall notices. The internet makes this easy to do.

Nothing can take the place of 'common sense' here. You have to get 'outside yourself' as a adult and see the toy from the child's point of view. In other words, you can NEVER assume what a child will or won't do with a toy.

Let's be careful out there!

Barry Chickini is author and webmaster for http://www.ChildTherapyResources.com and writes and edits numerous articles on Child Therapy and Safety.

NPR: "High court rulings change legal landscape"

2009-06-27T21:53:00.000+07:00

NPR Morning Edition Report by Nina Totenberg

The Supreme Court has released three significant decisions:

The rights of criminal defendants to cross examine crime lab analysts

When federal courts may act to enforce federal mandates on the states

When, if ever, school officials may conduct strip searches of students for drugs

The rulings will have far-reaching consequences.

CLICK HERE for a written summary or to listen to a 5-minute NPR report.

Brits agog over U.S. sex offender practices

2009-06-27T06:00:00.000+07:00

A spate of media coverage of wacky U.S. sex offender policies is encouraging a sense of smug superiority among the British public. From sex offenders dumped under bridges on one side of the country to those locked in high-tech prevention detention facilities on the other, it isn't the most flattering portrait of the Land of the Free.

Most recently, BBC aired a special report on the ongoing disaster under the Julia Tuttle Causeway in Florida (which I’ve blogged about several times over the past two years). The community living in squalid conditions in makeshift huts and tents under the bridge, with no running water, electricity or toilets, has hit about 70 and just keeps growing.

"Welcome to American justice," Dr. Pedro Jose Greer of Florida International University told the visiting European journalist. "This is the stupidest damn law I have ever seen…. We have people living together with mental and physical illnesses in an environment where people can't possibly sleep because of the cars going by overhead -- where you can smell the urine and see the trash mounting all around us."

If that dirty laundry isn't bad enough, the other recent coverage of U.S. sex offender policies is no more flattering to us Yanks.

Filmmaker Louis Theroux, a quirky British-American best known for his television series Louis Theroux's Weird Weekends, was granted unprecedented access to the infamous Coalinga State Hospital in California, home to about 800 men serving "indefinite sentence for offences that they haven't yet committed and might never," in the words of the review in the (London) Independent.

The resultant documentary aired on BBC, "A Place for Paedophiles," depicts "a Kafkaesque place" where not just the sex offenders but also many members of the staff look pretty darned "creepy," says the Independent.

A Sun profile of Theroux and his film took the opportunity to paint an even kookier picture for the British public:

"They have karaoke nights, put on plays, and on their birthday are thrown a party with cake, ice-cream and gifts…. [They] spend their days at the £268 million centre playing ping-pong or watching DVDs, and they even stage Coalinga Idol contests based on Simon Cowell's talent show American Idol."

After experiencing Coalinga up close and personal, Louis expressed doubt that the Americans know what they are doing when it comes to sex offenders:

"The British system is that when an offender finishes his sentence, he is released on the sex offenders' register. If he then puts a foot wrong he is hauled back to prison. It's a lot cheaper than a system like Coalinga -- and a little bit more realistic."

"Coalinga is the weirdest place I've ever been to," Theroux says in the film. "I can't quite believe it exists. In America this is the latest way of getting a handle on sex offenders…. You assume the people who run this place know what they are doing, but you do question it."

Understanding Play Therapy

2009-06-27T01:37:00.001+07:00

By Sheri Fay

This past week there was another one of those awful stories in the news, the ones that make your eyes well with tears. This time it was a young boy who witnessed his mother's death. All he could say when questioned was Mommy's crying, Mommy's in the rug, his verbal abilities and understanding of the world still quite limited. I don't know all of the details of the case, what if anything he truly did see, but it is pretty clear that this young person has certainly had a traumatic experience.

Our culture, like so many others, values children a great deal. As adults we know very well the danger out there, we watch the 6 o’clock news and read the headlines. We go through our day attempting to meet the demands of the world, mostly stressed, maybe anxious, probably tired. Children have yet to enter this grown-up world, they want to play, have snacks, and watch Dora the Explorer. Us adults usually do every thing we can to shield them from it because we know the innocence of childhood will not last forever. So it comes as no surprise that much of the water cooler conversations these past few days have been about this little boy. I have heard things like “he needs some therapy”, “if he doesn’t address this it’s going to come back to haunt him years later” or “how will he ever get over this?”

As a child therapist who has worked with many children who have experienced trauma, I could confidently say that, thanks to play therapy, this too is manageable. Just like adults talk things out after going through something terrifying and traumatizing, children play through their feelings and reactions. This natural inclination of children to play out the things that are happening around them is their way of trying to make sense of their world. To them they are merely playing and because of this it feels safe and comfortable. Actually, over-talking about traumatizing events can cause more anxiety, putting children on the spot and making the event even bigger and scarier. It is through playing that children have a real chance to make sense of what is going on, and most importantly, resolve unconscious conflicts. Playing gives them a sense of detachment from which to explore and deal with their feelings.

During play therapy children use one of their best gifts, their imagination. A play therapists office is full of a variety of toys that children can choose at their will. The very choice of toys begins the play therapy experience. Children can act out different scenarios, try on several different solutions or outcomes, practice ways to resolve conflicts and cope with distressing material. They can put scary, hidden feelings and fears onto objects outside of themselves and watch and learn how these toys “handle them”. Whatever is on the child’s mind usually comes out naturally in their play. It is typical in the beginning of play therapy that the child’s toys are scared, unsure, usually defeated by some type of monster. But as the sessions progress, these same toys end up winning battles, overcoming adversity, and have a confidence they did not have previously.

Part of a play therapist’s training involves tracking play, watching for themes, and voicing toys in order to elicit a response from another toy. These techniques allow us to learn more about the meaning behind the play. If in a child’s play a giant dinosaur is walking through a Lego town and a doll is hiding behind a tree, a play therapist may ask, “What is the doll feeling?” The child, without even realizing it, is giving you clues to what he or she is experiencing. In addition, the therapist can ask, “what can the doll do to be less afraid?” stimulating the child to think of other ways to respond to their fears. The therapist can also play with the child while still allowing them to drive the process. For example, if the therapist is the dinosaur she may whisper to the child, “what is this dinosaur saying to everyone?” allowing the child to guide both the fearful doll and the scary monster. Through the course of the play therapy experience, the child may build and rebuild this Lego city. The difference being that each time the characters will act a little differently. The doll may slowly come out from behind the tree, speak to the dinosaur and ask him to go away, or realize that he is not so scary after all. The dinosaur may choose another path or make friends with the doll. This resolution and learning is then integrated into the child’s knowledge base.

The young boy in the news story mentioned above will obviously always remember this horrible tragedy and miss his mother terribly, but by engaging in play therapy he can process what has happened and learn the necessary coping skills to have a well-adjusted life.

If you feel your child may be suffering from a traumatic experience or causing you any concern you may want to consider a play therapist. Children can enter play therapy for a variety of reasons including depression, anxiety, behavior problems, school and peer concerns, social anxiety, and defiance among many others. If you are unsure if your child may have a mental health concern or you need help determining if therapy would be beneficial you can ask me a question on my website. I am a licensed Marriage and Family Therapist in Philadelphia, Pa in private practice and have been working with children, families and individuals for over 10 years.

I am a Licensed Marriage and Family Therapist in private practice in Philadelphia, Pa. I also have a website, http://www.askachildtherapist.com where you can ask a child therapist a question or schedule an online therapy session. I offer assistance with parenting advice, behavioral and emotional disorders in children and teenagers, and behavior management. I can also assist with determining if your child needs to seek counseling or if their behavior is developmentally appropriate. Please visit my website for more information

The ADHD Child Can Play - Toys for Children with ADHD

2009-06-27T01:28:00.003+07:00

By Sid Berger and Gwynn Torres

Childhood should be playful. Play is said to be the work of children. But, sometimes, the ability to play becomes strained when children have conditions such as Attention Deficit Disorder, with or without hyperactivity (ADD/ADHD).

Part of living with a child with ADHD is to understand the special needs of these children in order to maintain a happy and healthy balance. This includes the necessity of selecting the right playthings so playtime activities do not become more stressful by conflicting with what these children can comfortably manage and enjoy. One way we've heard ADHD described is that it's a performance disorder and not a deficiency of knowledge or skill. It is primarily manifested as a set of symptoms that interfere with the ability to focus on a task and get it completed.

Child psychologists and psychiatrists value the importance of play in therapy for children with ADHD. The right types of play allow children to express themselves in ways they can't do otherwise. Play within the right context and with the right supervision can also improve a child's focusing abilities and help him or her to learn the basics of getting along more cooperatively with other children. Medical attention for proper diagnosis and consideration of medication are certainly the core of treatment of ADHD. But in many situations, proper managing of a child's environment and activities can do a lot to keep the symptomatic behavior under control.

A toy doesn't have to be full of moving or electronic parts to stimulate a child's imagination. Children with ADHD often have difficulty with multi-step instructions and have an inability to stay focused on the task at hand. They frequently become frustrated with themselves in these situations. Toys can be very simple and still do a better job of keeping a child focused and entertained as well as giving them an outlet to express their feelings. Two such toy categories are pretend play and art supplies.

The flexibility of these traditional play activities can be as simple or involved as the opportunity permits. So, because these types of play are events of totally variable lengths, a child can complete the activity and feel a sense of accomplishment and build confidence.

Another advantage of pretend play and artistic activities for children with ADHD is that these categories of play allow parents and caregivers to provide positive feedback and reinforcement that is invaluable in keeping the child focused...and invaluable for the child's self esteem.

Pretend Play - Children of almost every age enjoy pretend play and benefit from the exploration of feelings that it affords. Dolls and action figures, puppets, costumes and even blocks are all toy categories that allow a child to fantasize and act out situations. Under the right supervision, children with ADHD can learn the value of considering the consequences of their actions. As they decide what happens next in their fantasy, they can get a better understanding of how others react to certain actions. In situations where you can encourage them to finish their story line, you
also can help them get used to following through on a task.

Drama - Dramatic activities such as skits, recitations, puppet shows and simple storytelling can let a child concentrate on being a different character for a short time. Put a costume on them and watch how quickly they start getting into character. However, it may take direction from you to keep them focused and enjoying the event.

Costumes need not be elaborate to let a child be another character. It need only be representational. A single feather in a headband, a necktie, a hat, sunglasses, scrubs or even just a sign or patch fastened to clothing is enough to let a child jump into another role. Let the child use his or her imagination to help find costume pieces as part of the dramatic play process. And don't restrict them to the costume box. Colanders make great space helmets.

When Sid's children were growing up, they had a "costume closet" with an assortment of coats, brightly colored shirts, hats and accessories such as scarves, belts, wigs and, of course, masks. If an article of clothing became outdated, before disposing of it, they'd consider its costume potential. Putting together a costume for Halloween was always a big event. On top of that, living in New Orleans offered them Mardi Gras as a second costuming event each year.

Playhouses and play tents - Giving a child a space of his or her own is a great way to encourage imaginative pretend play. Whether it's stretching a sheet over dining room chairs to make a house or a purchased indoor or outdoor playhouse or play tent with a theme, a child is free to role-play and make up scenarios that could happen in the space.

At The Creativity Institute, we carry several types of playhouses, play tents and tunnels in themes that include a teepee, theater tent, castle and military camouflage. We also carry puppet theaters that can double as play stores and other types of play spaces. Our big foam blocks are large enough to construct make- believe buildings and tunnels a child can climb over and under. We also have play panels that can be moved around to create an ever-changing mix of play environments. This type of pretend play is also conducive to playing with others, offering an opportunity for a child to develop those all-important socialization skills.

Puppet shows - Puppets allow a child to act out many different roles and have fun with character voices. There are many sources for skits that can be adapted to the puppet stage and even ready-to-perform scripts in your library and on the Web. At The Creativity Institute, we have a section devoted to puppetry with puppets and puppet theaters. You'll find links to script resources on the Internet, puppeteer tips and even a free sample scripts we adapted for the puppet stage. To make it easier to get started, we've bundled together puppets and puppet theater packages and even grouped puppet casts with accompanying scripts, ready to perform. There's an Aesop's Fables Puppet Starter Set with five puppets and four fables adapted to the puppet stage. There's also an Old MacDonald Puppet Starter Set with Farmer MacDonald and seven barnyard animal puppets and an accompanying script of the song. Again, your direction will be invaluable in providing enough structure for the event that will let the children have a greater sense of accomplishment and stay interested longer.

And because puppets offer a degree of separation from real issues, they can offer lots of opportunities for learning about inappropriate behaviors. For example, if a child with ADHD has been overly aggressive with other children, acting out the consequences with animal puppets can offer a more painless and effective lesson.

Record it - Getting the performances down on tape gives everyone more opportunities to laugh and enjoy it all over again. There's a difference between taping the children playing at creating the performance and "making a movie" of the show, and both are wonderful to watch again and again. Taping the children at play shows their performance, as well as the behind-the-scenes preparation. Making a movie is just a matter of trying to capture what the audience would see. All you have to do is prepare the children for the scene and start and stop the camera at the right
times - and move on. You can even start with a title card the children can make for the show - using their own artistic skills.

If the child acts out while taping is underway, continue shooting, but keep your reprimands to a minimum. Put your energy into trying to refocus the child's attention toward continuing the performance or easing into a hastier conclusion. Later, when viewing the tape, the child may be able to see problem behaviors more clearly, rather than focusing more on your anger.

Dollhouses and activity sets - Playing with dolls and action figures is another valuable opportunity for pretend play. Dollhouses, toy pirate ships, castles, firehouses, farms and other traditional activity sets have the magic to let children get lost in their imaginations. Even the more popular activity sets based on movies and TV shows allow the same opportunities. And don't forget what imaginations can do with boxes, blocks and anything that can become the setting for a creative play session.

Blocks - Toys for children with ADHD should be simple and encourage the use of their imaginations, and one of the most basic of toys is building blocks. Block play can be great for many ages. From simple stack-up and knock-over fun to imaginative building. Blocks teach problem-solving skills, because a child discovers how stacking and matching can produce different results. They can also become components of pretend play, because a child can fantasize what the structures are. There are also big foam blocks that are almost "life size" and let children create their own fantasy playhouses. These lightweight blocks are so versatile, they can be climbed on or tunneled under. Magnetic block and construction sets have pieces that connect in more ways than can conventional plastic snap-together blocks and allow even more imaginative opportunities. We also carry a selection of traditional and colorful wooden blocks that are full of fantasy building opportunities.

Blocks, like many traditional toys, have other educational advantages for a child with ADHD. The number of positive outcomes is limitless, so children can continue playing until they've reached a level of personal satisfaction. Whether the child is building with traditional blocks or shoeboxes, try to show interest in every structure. Encourage the child to name creations, even if it's simply Wobbly Land or Crazy Tower. Showing interest without criticism offers your child valuable, long-
lasting affirmation.

Art Activities - Any medium such as crayons, markers, chalk, paint and clay can give a child a wealth of expressive opportunities. Sometimes you may want to suggest a subject idea to get them started. Art supplies are some of the least expensive educational toys you can provide. Gwynn used to bring home old stationery and unused printed samples to give her children a virtually unlimited supply of art paper. She'd also purchase low-end copy paper, offering the kids free rein on a giant stack of blank paper.

And here's something you can try on a big scale. Sid used to get leftover paper billboards from the local outdoor company and tack them on his backyard fence, backside out, to give the children blank giant-size panels for murals. The change in scale of their artist's canvas gets them thinking of possibilities in a different perspective and keeps them intrigued for hours. Another way to give structure to art activities is with their own easel. We carry a selection of folding, double-sided and adjustable easels that provide a convenient supply of paper and drawing surfaces in a self-contained, accessible environment.

One rule of thumb to follow to help inspire your kids to express themselves is to encourage all efforts. Today's crooked stick figure could lead to tomorrow's Picasso. Most important, artistic expression is highly therapeutic to your child, even if it doesn't happen to please your eye.

Books - There are many books that can hold a child's attention. The public library is a great start and your librarian can help you. Garage sales and community book fairs are a great way to build a library of your own. Collections of rhymes, poems or short stories are a good way to start with a child who is easily distracted.

The Oppenheim Toy Portfolio listed the top toys for children with attention-deficit/ hyperactivity disorder (ADHD) and included, among other things, a magnetic construction set, a tree-house-theme dollhouse play set, a decorate-it-yourself birdfeeder, board games and a simple, basic rubber ball. Oppenheim also suggested the toy general categories of dramatic play and artistic activities.

*The National Institute of Mental Health recommends that if ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. This includes child psychiatrists, psychologists, developmental/behavioral pediatricians, behavioral neurologists and clinical social workers. After ruling out other possible reasons for the child's behavior, the specialist checks the child's school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A diagnosis is made only after all this information has been considered.

After a combined six decades of developing award-winning advertising, creative directors Gwynn Torres and Sid Berger decided to spread creativity beyond the world of marketing. They founded an online educational toy store specializing in toys that nurture creativity in children. They handpick each toy for its potential for developing vital creative resources in your child. The benefits of nurturing creativity can be profound, offering children tools for success in all endeavors athletic, artistic or academic. Gwynn and Sid are also accomplished musicians and songwriters, and between them they have managed to produce five wonderfully zany and significantly creative children.

Prison psychologist charged with aiding escape

2009-06-25T06:00:00.000+07:00

It's not terribly uncommon to hear of a woman succumbing to the allure of a ruggedly masculine prisoner.

Sometimes, the love bug bites an attorney. Other times, a female guard. Here in California, I regularly hear about female staff members from various professions caught trysting with civilly committed sex offenders at the state hospital.

Every so often, the passion overwhelms all reason, and the woman helps her boyfriend escape. Last year, we heard the odd saga of a deputy warden's wife in Oklahoma who had been living in a trailer with an escaped convict for more than a decade. (Bobbi Parker is back living with her husband while awaiting trial in that case.)

As with everything, psychologists and other professionals have tried to pigeonhole the women's motivations through labeling -- "the Bad Boy Syndrome," "the Florence Nightingale Syndrome," the abuse victim afraid of intimacy. Of course, as with most human conditions, the motivations are more complex and multidetermined than such labels can capture.

Whatever the reasons, the love bug just bit closer to home.

A 35-year-old prison psychologist has been arrested for allegedly helping in the escape of a 42-year-old killer from Frontenac Institution, a minimum-security prison in Canada where she worked.

Authorities believe Erin Danto, a U.S. citizen from Pennsylvania who had worked in the prison for about a year, had a romantic relationship with Andrew John Wood, serving time for the 1989 murder of a former friend. The two were caught together last Thursday.

In a comment to one of the news articles, someone who knows Dr. Danto called her a "true professional."

Dr. Danto's sad story is a reminder for all of us forensic and correctional psychologists. Be compassionate, but not too passionate. Don't forget the “B” word -- boundaries.

Today's (Kingston) Whig Standard has the story.

Further resources:

European women drawn to Texas death row inmates, by Scott Farwell, Dallas Morning News

Modern Love: Kept Together by the Bars Between Us, by Amy Friedman, New York Times (an essay by a newspaper columnist who fell in love with a prisoner)

Women Who Love Men Who Kill, by Sheila Isenberg (book)

Hat tip: Milan P.

The Top 10 Myths Behind Masturbation

2009-06-25T04:10:00.001+07:00

By John M. Grohol, Psy.D.

Masturbation still gets a bad rap in society, probably because it is a private behavior rarely shared or discussed in public with even the closest of friends. But masturbation is a normal part of sexuality in people, even if they are involved in a relationship with another person. In this article we answer the top ten myths regarding masturbation.

1. Does masturbation cause blindness?

2. Do spouses continue to masturbate after marriage?

3. Why are people so embarrassed about masturbation?

4. Why do women often have trouble reaching orgasm during intercourse?

5. How much masturbation is too much?

6. What do I tell my “touchy” toddler?

7. Will eating Kellogg’scornflakes make me stop doing it?

8. Is shower massager masturbation okay?

9. Can masturbation help me learn to have an orgasm?

10. Should I tell my partner that I masturbate?

An Overview of Sex Therapy

2009-06-25T04:02:00.002+07:00

By Amy Bellows, Ph.D.

These days, many couples find it hard to fit sex into their busy schedules. And it’s perfectly normal for people to go through periods when they’re just not in the mood for lovemaking.

But if you chronically lack desire for sex — for emotional or physical reasons — you may want to consider sex therapy. Seeking treatment for sex problems has become more socially acceptable today, but it’s still not easy for many people to talk to a professional about such an intimate area.

“There are probably a lot of people out there who could use therapy but don’t come because they’re embarrassed. They may go through years of needless pain or dissatisfaction,” says Alexandra Myles, MSW, a sex therapist at McLean Hospital in Belmont, Massachusetts, and in private practice.

Deciding whether sex therapy is for you

Before you decide to see a sex therapist, take the time to explore whether it is really what you need. Myles and other therapists recommend that you:

See a doctor, particularly if your problem is physical in nature. A gynecologist or urologist can detect difficulties due to illness, aging, or metabolic and hormonal imbalances. Prescription drugs, non-prescription drugs, alcohol, and smoking can all affect sexual functioning, according to Judy Seifer, Ph.D., a certified sex therapist and clinical professor at Wright State University in Dayton, Ohio.

Learn more about sexuality. In spite of the greater openness about sexuality today, many people have little understanding of their own bodies and sexual functioning. Informational and self-help books and educational sex videos, which are widely available, can be very helpful (see listing below) . Becoming better informed will help you decide whether you really need therapy; some people, in fact, are able to solve their own problems through self-help guides.

What happens in sex therapy

Many people come to sex therapy after individual psychotherapy fails to help them with their sexual problems. Masters & Johnson, the pioneers of sex therapy, discovered back in the 1950s that talking alone wasn’t enough to resolve sexual issues.

“The obvious thing is that you’re dealing with the human body so you can’t just talk about how you feel; you’ve got to work on the physical level as well,” says Myles. Sex therapy generally address the emotional issues underlying sexual problems and employs behavioral techniques to deal with the physical symptoms.

These behavioral techniques involve physical exercises that clients do on their own outside of the therapy setting. “Nothing should happen in the therapist’s office of a sexual or physical nature,” Myles emphasizes. (Sex therapists should not be confused with sexual surrogates, who do engage in sexual relations with clients. They are only licensed in certain states and are becoming less popular due to AIDS.)

One popular technique used in treating many sexual problems is called sensate focus, in which couples caress or massage each other without sexual contact. The goal is to help both partners learn to give and receive pleasure and feel safe together. As the partners become more comfortable, they can progress to genital stimulation.

As a result of performing this exercise, many couples discover new ways to experience pleasure other than sexual intercourse. “Some of my patients find that they become better lovers,” says Dennis Sugrue, Ph.D., a sex therapist at the Henry Ford Behavioral Services Program in West Bloomfield, Michigan.

Other exercises treat specific problems such as women’s inability to have orgasms and men’s erectile problems. Common complaints like these can usually be resolved in two months to a year of treatment, therapists report.

Performing these exercises often evokes strong feelings that are then explored through psychotherapy. People who have experienced sexual trauma or are confused about their sexual identity may need to spend more time working through their feelings. For couples, who make up the majority of clients, the focus is on improving communication and developing greater intimacy.

Finding a therapist

When looking for a sex therapist, it’s critical to find a practitioner with the proper credentials to deal with this sensitive subject area. A sex therapist should be an experienced psychotherapist (licensed social worker, psychologist, psychiatrist, or psychiatric nurse) with training in sex therapy from a reputable program, such as those offered by teaching hospitals or institutes.

These programs include instruction in sexual and reproductive anatomy and treatment methods. Other topics covered include sexual abuse, gender-related issues, and sociocultural factors in sexual values and behavior.

Sex therapists can become certified through the American Association of Sex Educators, Counselors, and Therapists (AASECT). Certified therapists must meet rigorous requirements and adhere to a strict code of ethics.

You can obtain referrals for sex therapists from AASECT and other professional organizations such as the National Association of Social Workers and the American Psychological Association. (See Organizations listing below for contact information.) or ask your primary care physician, gynecologist, urologist, or therapist.

The right therapist

In looking for a sex therapist, it’s particularly important to find someone whom you trust, respect, and with whom you share compatible values. Don’t be afraid to ask questions about the therapist’s background, philosophical orientation, and client-related experience with your problem.

A sex therapist can be very influential, says Gina Ogden, a certified sex therapist in Cambridge, Massachusetts and author of “Women Who Love Sex,” because “there are fewer people who you can talk with about your sexual issues.” She warns against therapists who have rigid ideas of what human sexual response should be. Myles agrees: “Sex is such a subjective experience. You can’t impose your own beliefs on a patient.”

If you see a therapist who says or does anything suggestive, or that involves nudity, terminate the relationship immediately. “Sex therapy is strictly talk therapy. There should be no ’show and tell’,” asserts Seifer, a former president of AASECT.

Most sex therapists today, according to Dennis Sugrue, “look at the whole person and try to help men and women redefine what it means to make love.” The effects of aging or physical problems “don’t mean that a couple can’t experience the pleasure and joy of being physically intimate with each other.”

Further Reading

Barbach L. For Yourself: The Fulfillment of Female Sexuality. Signet Books, 1975

Barbach L and Geisinger D. Going the Distance: Finding and Keeping Lifelong Love. Plume Books, 1993

Dodson B. Sex for One: The Joy of Self-Loving. Crown Trade Paperbacks, 1996.

Heiman J, LoPiccolo J. Becoming Orgasmic: A Sexual and Personal Growth Program for Women. Simon & Shuster, 1987.

Kaplan HS. How to Overcome Premature Ejaculation. Bruner/Mazel Publications, 1989.

Kaplan HS. The Illustrated Manual of Sex Therapy. Brunner/Mazel Publications, 1975.

Ogden G. Women Who Love Sex. Ogden Books, 1995

Walker R.The Family Guide to Sex and Relationships. Macmillan, 1996.

Zilbergeld B. The New Male Sexuality. Bantam Books, 1992.

Treatment of Alcoholism

2009-06-25T03:58:00.002+07:00

By Mark S. Gold, MD

To understand treatment and make the right treatment choices, it helps to have an overview. Treatment is often seen as having four general phases:

Getting started (assessment and evaluation of disease symptoms and accompanying life problems, making treatment choices and developing a plan)
Detoxification (stopping use)
Active treatment (residential treatment or therapeutic communities, intensive and regular outpatient treatment, medications to help with alcohol craving and discourage alcohol use, medications to treat concurrent psychiatric illnesses, 12-step programs, other self-help and mutual-help groups)
Maintaining sobriety and relapse prevention (outpatient treatment as needed, 12-step programs, other self-help and mutual-help groups)

Getting Started

First, the alcoholic must overcome denial and distorted thinking and develop the willingness to begin treatment—what Alcoholics Anonymous (AA) calls “the desire” to stop drinking. At this stage, it is important to obtain the help of someone knowledgeable about treatment and the options available.

When getting started, some people have lost control over alcohol to such an extent that they will only be able to make immediate decisions and set the most basic goal of quitting drinking. Development of a detailed treatment plan with goals and choices may have to wait until after detoxification.

On the other hand, “getting started” is exactly the place where some people with alcohol problems “get stuck.” In being stuck, denial is always a problem, but complete denial is not universal; people have various levels of awareness of their alcohol use problems, which means they are in different stages of readiness to change their drinking behavior. Professionals have taken advantage of this insight about alcoholism to develop treatment approaches that are matched to a person’s readiness to change.

Detoxification

The second phase of treatment is stopping use, which can be done on either an inpatient or outpatient basis. Medical evaluation and treatment are particularly important at this stage. A large proportion of alcoholics develop dangerous withdrawal symptoms that must be medically managed either in a hospital or on an outpatient basis.

Although detoxification is a critical step for many alcoholics, most treatment professionals are reluctant to call it treatment, and for good reason. Treatment is what helps a person develop a commitment to change, keep the motivation to change, create a realistic plan to change and put the plan in action. Successful treatment means a person begins to experience the rewards of seeing the plan work. Just taking away the alcohol does not automatically produce any of these outcomes.

Active Treatment

Relapse to alcohol addiction is most likely to occur in the first three to six months after a person stops drinking, a period characterized by physiological abnormalities, mood changes and complaints of anxiety, depression, insomnia and hormone and sleep problems. Getting active help and support during the early months of sobriety is critical for treatment to succeed.

In the third phase of treatment, a person typically gains the motivation necessary to maintain a commitment to sobriety, the knowledge and skills necessary to stay sober, and the support systems necessary to cope with the problems of daily life—the problems that everyone has to face—without resorting to the old “solution” of drinking. This is where the help of a treatment professional is important. A professional will help you better understand how alcohol has affected your health and your life, so that you can set goals and develop a plan to stay sober and choose the treatments that are right for you.

Some proven medications are available to help with alcohol craving and discourage alcohol use. A treatment professional will also help you choose medications and treatments for concurrent psychiatric illnesses, like depression or anxiety, if that is appropriate, or for a variety of health problems that often accompany alcoholism.

Research has shown that the longer people stay in treatment—that is, the longer they remain sober and actively committed to sobriety—the more likely it is that they will maintain sobriety. Some treatment professionals think of the phase of active treatment as lasting from six months to a year. During the first critical months of treatment, people often need a variety of supports, especially AA or other self-help groups, to achieve and maintain lasting sobriety.

Maintaining Sobriety and Relapse Prevention

It is often difficult to pinpoint when the active treatment phase ends and a person enters the maintenance phase of recovery. In the active stage of treatment, people learn what they need to do to stay sober and develop the many skills they will use to avoid relapse. A person could be said to enter the maintenance stage when he or she is comfortable with these skills and has had a chance to rely on them to stay sober when life throws them the inevitable curveballs, both in crisis situations and in everyday problem situations.

Many people in recovery attribute their ongoing sobriety to participation in a support group such as AA or Women for Sobriety.

An Introduction to Alcoholism

2009-06-25T03:53:00.002+07:00

By Cynthia Mascott, LMHC

What is alcoholism? According to the American Medical Association, “alcoholism is an illness characterized by significant impairment that is directly associated with persistent and excessive use of alcohol. Impairment may involve physiological, psychological or social dysfunction.” Psychologically speaking, alcoholism has less to do with “how much” someone is drinking, and more to do with what happens when they drink. If you have problems when you drink, you have a drinking problem.

The word alcohol comes from the Arabic “Al Kohl,” which means “the essence.” Alcohol has always been associated with rites of passages such as weddings and graduations, social occasions, sporting events and parties. The media has often glamorized drinking. Television viewers happily recount the Budweiser frog, the beach parties and general “good time” feeling of commercials selling beer. Magazine ads show beautiful couples sipping alcohol. Love, sex and romance are just around the corner as long as you drink the alcohol product being advertised.

The reality is that alcohol is often abused because it initially offers a very tantalizing promise. With mild intoxication, many people become more relaxed. They feel more carefree. Any preexisting problems tend to fade into the background. Alcohol can be used to enhance a good mood or change a bad mood. At first, alcohol allows the drinker to feel quite pleasant, with no emotional costs. As an individual’s drinking progresses, however, it takes more and more alcohol to achieve the same high. Eventually the high is hardly present.

How Common is Alcoholism?

Alcoholism is a complex disease, which has been misunderstood and stigmatized. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Alcohol Dependence and Alcohol Abuse are among the most common mental disorders in the general population, with about eight percent of the adult population suffering from Alcohol Dependence and five percent from Alcohol Abuse.

It is widely accepted that there is a genetic predisposition toward alcoholism. According to DSM-IV, the risk for Alcohol Dependence is three to four times higher in close relative of people with Alcohol Dependence.

The Progression of the Disease

Alcoholism is a progressive disease and follows several phases:

The Social Drinker: Social drinkers have few problems with alcohol. A social drinker can basically take or leave it. There is no preoccupation with drinking. A social drinker is able to control the amount of alcohol consumed and rarely drinks to the point of intoxication. For these individuals, drinking is a secondary activity. It is the party, the meal, the wedding that interests the social drinker, not the opportunity to drink.

The Early Stage: An individual who is experiencing the early stages of alcoholism will begin to have an assortment of problems associated with drinking. In early stage alcoholism, a person may start to sneak drinks, begin to feel guilty about his or her drinking, and become preoccupied with alcohol. Blackouts, drinking to the point of drunkenness, and increased tolerance (needing more alcohol to achieve the same effect) are all signs of early alcoholism.

An individual who is entering the early stage of alcoholism will seek out companions who are heavy drinkers and lose interest in activities not associated with drinking. Family and friends may begin to express concern about the person’s consumption of alcohol. Work problems, such as missing work or tardiness, may also take place.

Middle Stage: By the time someone has entered the middle stages of alcoholism, his or her life has become quite unmanageable, although the alcoholic still denies that he or she has a problem. At this point, the alcoholic will often drink more than intended. He or she will drink in an attempt to erase feelings such as anger, depression and social discomfort. Drinking in the morning to relieve a bad hangover may also take place. The alcoholic’s health care provider may begin to suggest that the alcoholic stop drinking. The individual may try to stop drinking, but without success. Job loss, medical problems, and serious family conflicts occur during this phase.

Late Stage: At this stage, the alcoholic’s life has become completely unmanageable. Medical complications are numerous and include liver diseases such as cirrhosis or hepatitis. Acute pancreatitis (inflammation of the pancreas), high blood pressure, and bleeding of the esophageal lining can result from prolonged use. The heart and brain are compromised so that an alcoholic is at a higher risk for a heart attack or stroke. Depression and insomnia and even suicide are more prevalent at this stage.

A condition known as Wernicke-Korsakoff Syndrome, which involves memory loss, indicates that the individual has sustained brain damage from drinking. A child born to a woman who drinks during her pregnancy may have a condition called fetal alcohol syndrome, causing a number of birth defects.

An alcoholic at this stage has become physically addicted to alcohol and will experience seizures or delirium tremens (DTs) if he or she stops drinking. It is extremely important to seek out medical care at this point in the disease process.

Treatment

If an individual is dependent on alcohol, he or she should be supervised medically during a detoxification process. Further treatment may include individual or group counseling.

Mental health professionals have been trained to treat substance abuse problems. You can seek out treatment with an individual counselor or by entering an inpatient or outpatient substance abuse treatment program.

Support groups such as Alcoholics Anonymous, Smart Recovery, and Rational Recovery have helped many alcoholics to stay sober, allowing them to live productive lives.

Couples Therapy

2009-06-25T03:51:00.000+07:00

First, it is important to realize that couples therapy, marriage counseling and marital therapy are all the same. These different names have been used to describe the same process, with the difference often based on which psychotherapy theory is favored by the psychologist using the term, or whether an insurance company requires a specific name for reimbursement.

Couples therapy is often seen as different from psychotherapy because a relationship is the focus of attention, instead of one individual diagnosed with a specific psychological problem. This difference only arises if you consider psychological problems to be similar to medical illnesses, and therefore confined to a "sick" individual who needs treatment. That medical model of psychological diagnosis and treatment is common, but is really inadequate to describe and resolve psychological problems. All psychological problems, and all psychological changes, involve both individual symptoms (behavior, emotions, conflicts, thought processes) and changes in interpersonal relationships.

Couples therapy focuses on the problems existing in the relationship between two people. But, these relationship problems always involve individual symptoms and problems, as well as the relationship conflicts. For example, if you are constantly arguing with your spouse, you will probably also be chronically anxious, angry or depressed (or all three). Or, if you have difficulty controlling your temper, you will have more arguments with your partner.

In couples therapy, the psychologist will help you and your partner identify the conflict issues within your relationship, and will help you decide what changes are needed, in the relationship and in the behavior of each partner, for both of you to feel satisfied with the relationship.

These changes may be different ways of interacting within the relationship, or they may be individual changes related to personal psychological problems. Couples therapy involves learning how to communicate more effectively, and how to listen more closely. Couples must learn how to avoid competing with each other, and need to identify common life goals and how to share responsibilities within their relationship. Sometimes the process is very similar to individual psychotherapy, sometimes it is more like mediation, and sometimes it is educational. The combination of the these three components is what makes it effective.

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Despondex: Is psych mania overreaching?

2009-06-23T04:24:00.000+07:00

First, click the image above to watch this ad for Despondex, the first-ever prescription depressant. It brilliantly captures how the pharmaceutical industry pathologizes human conditions, mints formal diagnoses to label them, and markets lucrative medications to treat them.

Take bipolar disorder in children.

It has gone from a rare condition to a common diagnosis. In an 8-year period (1994-2002), the number of children diagnosed as bipolar increased by 4,000 percent. Yes, that's right. Four thousand percent. As with the ADHD craze a few years ago, with the diagnostic labeling has come medications for about two-thirds of the newly bipolar. Medications that cause severe long-term health consequences, such as obesity and diabetes.

Now, show me a child who doesn't have radical mood swings. As Christopher Lane describes in Shyness: How Normal Behavior Became a Sickness, the steps to creating a disorder are straightforward:

Conduct a study.
Discover a previously overlooked problem.
Label it.
Create a formal diagnosis.
Promote a treatment.
Marginalize the critics.

Through this process, the prevalence of a disorder can be made to "rise and fall as erratically as the stock market" (to quote Kutchins & Kirk from Making Us Crazy) through adjustments to the wording, symptom duration, and the number of criteria required for diagnosis.

Indeed, we are witnessing this manufacturing process in the current effort to create a bizarre new diagnosis of "pedohebephilia" for the DSM-V, as I have blogged about more than once.

But has the psychiatric-pharmaceutical juggernaut gone too far? I am probably being overly optimistic, but I find this past week's developments mildly encouraging.

First came the research study published in the June 17 issue of the Journal of the American Medical Association, announcing flaws in the much-touted 'Depression Risk Gene' study upon which so much of our popular culture's notion of mental illness rests.

That followed exposes, such as one in the Miami Herald, of pharmaceutical drugmakers' use of ghostwriters to produce ''a huge body of medical literature that society can't trust.''

Just today came two more entries in the series of critical articles about psychiatric diagnosis and the pharmaceutical industry, in newspapers on separate continents -- the London Times and the San Francisco Chronicle.

The Chronicle's lead story focused on the diagnosis of bipolar disorder among children. The London Times article promotes a new book by the brilliant Richard Bentall (whose 1994 book, Madness Explained, deservedly won the British Psychological Book Of The Year award).

Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? pulls no punches: It "paints a stark picture of a mental health system riddled with corruption and incompetence, in which shrinks live it up on pharmaceutical company cash while patients are disrespected, dehumanised and drugged to the eyeballs."

Bentall isn't some foaming-at-the-mouth anti-psychiatry extremist. He offers rational argument and scientific evidence to back up his claims about the ineffectiveness of modern psychiatric "treatment" and the weaknesses in its underlying biomedical model.

Bentall is not optimistic about change, though, because psychiatry and drug companies "have a vested interest in keeping things are they are."

I am afraid he may be right. Even in the midst of critiques pointing out the long-term harm, more people than ever are popping pills and allowing their children to pop them too. The latest rage, bipolar disorder, has so inundated popular and youth culture that it's even become an aggressive verb on the playground, as in:

"You don't watch out, man, I'm gonna go bipolar on you!"

If we don't watch out, that will be the newest mental defense to violent crime.

Photo credit: Mike "Dakinewavamon" Kline (Creative Commons license)