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Children and Antidepressants: The Question of Harm 04 Jul 2016

The latest study intensifies concern that SSRIs are both ineffective and harmful

“For young people with major depression,” the Washington Post reported earlier this month, “antidepressants may help little if at all.” From ABC News in Australia, the focus extended to more than the drugs’ limited efficacy; it included their risk of harm, including from side effects and heightened suicidality: “Antidepressants for kids and teens ineffective, may even be harmful, study finds.”

The study in question, published earlier this month in The Lancet and led by Dr. Andrea Cipriani at Oxford University, examined the effectiveness and potential harm associated with 14 SSRI and Tricyclic antidepressants, prescribed in large numbers to adolescents and children worldwide: amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine. The Lancet meta-analysis examined data from 34 earlier studies involving more than five thousand youths, most of them aged 9 to 18, who had moderate to severe symptoms and had received a diagnosis of major depression. As Linda Searing at the Washington Post reported, “In an average year, an estimated 2.8 million Americans age 12 to 17, or roughly 11 percent of that age group, have at least one depressive episode.”

The Lancet study is significant not just in scale but also in explicitly correcting for bias, as it incorporated the results of unpublished clinical trials while offsetting for the fact that drug companies had funded 65 percent of them. Even taking into account that figure, 88 percent of the trials indicated additional risk of bias (29 percent of them were at high risk, while the remaining 59 percent indicated a moderate risk of bias).

But it was the study’s conclusion that drove health headlines around the world, though the finding itself wasn't exactly news: only one of the drugs, fluoxetine (Prozac), was found to be marginally more effective than placebo at relieving depression, an advantage offset by the drug's substantial number of side effects, including an increased risk of suicidal thoughts.

Weighing risks relative to benefits, the researchers concluded that antidepressants “do not seem to offer a clear advantage for children and adolescents” with major depression. Additionally, Dr. Cipriani explained, “the selective reporting of findings in the published trials and clinical study reports” made claims on behalf of such research dubious and of low value scientifically.

Jon Jureidini, a professor at the University of Adelaide, wrote in commentary about the research that the findings had “disturbing implications for clinical practice ... as the risk-benefit profile of antidepressants in the acute treatment of depression does not seem to offer a clear advantage for children and adolescents.”

That conclusion—disturbing though well-publicised elsewhere and thus far from surprising—acquired greater urgency as ABC News highlighted prescribing patterns for Australian children and adolescents between 2009 and 2012, noting that the number of children aged 10 to 14 who had been given antidepressants in those years had jumped by more than a third.

Iain McGregor, a professor at the University of Sydney and co-author of the study that generated that finding, asked pointedly at the time, “Why are we so reliant on meds for our mental wellbeing?”

It's a question doctors and parents of the many thousands of children and adolescents given antidepressants studied doubtless need to be asking, especially with the latest meta-analysis one of many signaling that the drugs are neither effective nor without a substantial risk of harm.

From quirky to serious, trends in psychology and psychiatry Christopher Lane, Ph.D. Christopher Lane, Ph.D., has won a Prescrire Prize for Medical Writing and teaches at Northwestern University. He is the author of Shyness: How Normal Behavior Became a Sickness.


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10 Common Signs Of Anxiety Disorders Everyone Should Know 29 Jun 2016

The common physical and psychological signs of an anxiety disorder

Anxiety comes in many forms, but all the different types often have certain core features.

Like many mental health problems, almost everyone experiences anxiety from time-to-time. Whether it is a problem all depends on the amount and nature of the anxiety. Everyday anxiety in response to stressful events is normal, but severe anxiety in response to relatively minor events can be seriously disabling. Bear that in mind when reading the signs of a ‘disorder’. For example, a lot of people have problems sleeping and muscle tension every now and then. This might happen before a job interview, when going into hospital or before a stressful event. But experiencing anxiety frequently and intensely over smaller matters can be a sign of something more serious.

Here are four typical psychological symptoms:

Feelings of panic, fear and uneasiness. Feeling constantly ‘on edge’ or restless. Having a frequent sense of dread. Problems concentrating. And here are six typical physical symptoms:

Muscle tension. Problems sleeping. Dry mouth. Shortness of breath. Heart palpitations. Dizziness. These ten do not cover the full extent of what people experience.

People often report a very wide range of different physical and psychological symptoms. I have seen lists with at least 50 items. Some people have many symptoms, others have fewer.

The real key to diagnosing an anxiety disorder is in the extent of the symptoms and how they affect everyday life. People experiencing severe or disabling anxiety most days should consider seeking some kind of help. Psychological therapies (including self-help) are particularly good at treating anxiety disorders. Apart from ‘generalised anxiety’, anxiety can also be triggered by all sorts of different things. Many of these are familiar terms nowadays: phobias, PTSD and social anxiety.


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The 5 Major Personality Traits... (and What They Mean for You) 27 Jun 2016

Your personality influences everything from the friends you choose to the candidates you vote for, yet many people never spend much time thinking about their personality traits. Understanding your personality can give you insight into your strengths and weaknesses. It can also help you gain insight into how others see you.

Most modern-day psychologists agree there are five major personality types, referred to as the "five-factor model," and everyone possesses some degree of each.

1. Conscientiousness

People who rank highest in conscientiousness are efficient, well-organized, dependable, and self-sufficient. They prefer to plan things in advance and aim for high achievement. People who rank lower in conscientiousness may view those with this personality trait as stubborn and obsessive.

Fun fact: Studies show that marrying someone high in conscientiousness increases your own chance of workplace success, as a conscientious spouse can boost your productivity and help you achieve the most.

2. Extroversion

People who rank high in extroversion gain energy from social activity. They're talkative, outgoing, and comfortable in the spotlight—but others may view them as domineering or attention-seeking.

Fun fact: Be on the lookout for a strong handshake. Studies show that men with the strongest handgrips are most likely to rank high in extroversion and least likely to be neurotic (see below). However, the same doesn't hold true for women.

3. Agreeableness

Those who rank high in agreeableness are trustworthy, kind, and affectionate toward others. They're known for pro-social behavior and are often committed to volunteer work and altruistic activities. Other people, however, may view them as naïve and overly passive.

Fun fact: Seek a financial investor who is high in agreeableness. Studies show that agreeable investors are least likely to lose money from risky trading. But you may want to avoid an investor who's high in openness—that personality trait is associated with overconfidence, which can lead an investor to take excessive risks.

4. Openness to Experience

People who rate high in openness are known for having a broad range of interests and vivid imaginations. They're curious and creative, and tend to prefer variety to rigid routines. They're known for their pursuits of self-actualization through intense, euphoric experiences, like meditative retreats or living abroad. Others may view them as unpredictable and unfocused.

Fun fact: Openness is the only personality trait that consistently predicts political orientation. Studies show that people high in openness are more likely to endorse liberalism and more likely to express their political beliefs in general.

5. Neuroticism

Neurotic people experience a high degree of emotional instability. They're more likely to be reactive and excitable, and they report higher degrees of unpleasant emotions like anxiety and irritability. Other people may view them as unstable and insecure.

Fun fact: Neurotic people seek acceptance by publishing a lot of pictures on Facebook. Studies find they're less likely to post comments or updates that could be seen as controversial, and much more likely to post lots of pictures. (They also have the most photos per album.)

Understanding the Basics of Personality

An individual's personality remains relatively stable over time. The traits you exhibited at age seven are likely to predict much of your behavior as an adult. You can, of course, change some of your traits—it takes hard work and effort to make big changes, but most researchers agree that it is possible.


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Evidence base of Psychoanalytic Psychotherapy 22 Jun 2016

There is a growing body of research into the effectiveness of psychoanalytic psychotherapy.

Researchers have demonstrated good evidence for the positive effects of psychodynamic therapies for various psychological disorders, including depression, anxiety, post-traumatic stress disorder (PTSD) and eating disorders. The studies referred to here have evaluated either the general effectiveness of long- and short-term psychodynamic psychotherapy, or the impact of psychodynamic psychotherapy on specific illnesses. These studies are among an ever-increasing number being published and cited in eminent psychological, psychiatric and medical journals.

Examining the effectiveness of long-term psychodynamic psychotherapy (here meaning at least a year or 50 sessions) in complex mental disorders, a paper from 2011 found that long-term psychodynamic psychotherapy (LTPP) appears to be more effective than less intensive forms of psychotherapy in treating complex mental disorders. [1] Another paper[2] reviewing LTPP on a larger scale compared 23 studies, involving a total of 1053 patients. It concluded that LTPP had a significantly higher rate of effectiveness in targeting problems and general personality functioning than shorter forms of psychotherapy.

A widely cited paper from 2010 summarized the evidence for the general effectiveness of psychodynamic psychotherapy.[3] It concluded that psychodynamic therapy has as positive an impact on patients as other therapies, such as cognitive-behavioural therapy (CBT), that have been more readily promoted in modern healthcare What is more, patients who had psychodynamic therapy not only saw an improvement in their psychological difficulties during treatment, but this improvement continued after treatment had ended.

In a 2008 paper focusing on depression, researchers produced an overview of the effectiveness of psychoanalytic and psychodynamic therapies.[4] The paper examined available evidence, and concluded that the benefits for patients of short-term psychodynamic therapies are equivalent to those produced by antidepressants and CBT.

Research has also been conducted into the impact of psychodynamic psychotherapy in specific psychological disorders. A 2007 study investigated the effects of psychodynamic psychotherapy in panic disorder.[5] The researchers compared the effect on patients of panic-focused psychodynamic therapy versus relaxation training. There were 49 adults in the study, and they were all diagnosed with panic disorder. Many were also suffering from agoraphobia and/or depression. The participants who received psychodynamic treatment showed a significantly greater reduction of panic symptoms than those receiving relaxation training, as well as greater improvement in psychosocial functioning (the term ‘psychosocial’ refers to an individual’s psychological state in relation to social factors).

In 2011 researchers conducted a review of trials into the effect of short-term psychodynamic psychotherapy in patients with personality disorder.[6] Looking at the results of eight studies, the researchers concluded that psychodynamic psychotherapy may be considered an effective treatment option for a range of personality disorders, producing significant and medium- to long-term improvements for a large percentage of patients.

Research has also been done into the cost-effectiveness of psychodynamic psychotherapy, which has often been regarded as too expensive to be funded in the public sector.[7] In fact, a study of more than 100 patients who had received at least six months’ worth of NHS psychiatric treatment without improvement, found that psychodynamic psychotherapy resulted in both significant improvements in the patients’ symptoms and value for money. Not only did the patients’ mental health improve with psychodynamic psychotherapy, but they also spent fewer days as in-patients, had fewer GP consultations, required less contact with practice nurses, needed less medication and sought less informal care from relatives. Consequently the extra cost incurred through using psychodynamic treatment was recouped within only six months.

(Based on a research summary by Jessica Yakeley and Peter Hobson) [1] Leichsenring, F., Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. The British Journal of Psychiatry, 199(1): 15-22. [2] Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy. Journal of the American Medical Association, 300, 1151-1565. [3] Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist 65(2): 98-109. [4] Taylor, D. (2008). Psychoanalytic and psychodynamic therapies for depression: the evidence base. Advances in Psychiatric Treatment, 14, 401-413. [5] Milrod, B., et al (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry, 164, 265-272. [6] Town, J.M., Abbass, A., Hardy, G. (2011). Short-term psychodynamic psychotherapy for personality disorder: A critical review of randomized controlled trials. Journal of Personality Disorders, 25(6): 723-740. [7] Guthrie, Moorey, Margison et al (1999). Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Archives of General Psychiatry, 56, 519-526. Read Peter Fonagy's talk: "Grasping the Nettle – or why Psychoanalytic Research is Such an Irritant" Read Ron Britton's response to "Grasping the Nettle" Read Phil Richardson's response to "Grasping the Nettle"


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Create a Calm and Positive Mindset With These 7 Simple Cues!! 20 Jun 2016

Create a Calm and Positive Mindset With These 7 Simple Cues Happiness, gratitude, kindness—here's how to add these feelings to your day.

The other day I was bounding up the stairs to get something I’d forgotten when I had this realization: Although getting older, I am still healthy enough to climb stairs with ease—in fact, I enjoy it! Suddenly I felt deep gratitude for my good health.

“Gratitude” is a mental attitude I want to cultivate. So it occurred to me…Why not use every instance of stair-climbing as a cue to evoke and savor that wonderful inner feeling of gratitude?

It worked. As I continued to link “gratitude” with “stair-climbing,” I found that the “gratitude attitude” would pop up automatically in other situations, especially those involving physical activity like walking or gardening.

Deliberating setting up a cue—like stair-climbing—to trigger a desired emotional state—like gratitude—l was a new idea for me. True, I had often used cues to trigger a behavioral habit or action, like blocking the stairs with the laundry basket so I couldn't possibly forget to carry it down to the laundry room. This time, though, I began to think about how I could use cues as signals to a more positive mental outlook. I came up with seven great ideas that work for me. Adopt them for yourself or use them to imagine how you could create your own cues for positive mental states.

But first…what IS a cue?

Clues to Cues: First Steps

A cue is a signal that reminds your brain to activate a particular emotion, action, or thought.

Without thinking about it, you probably use cues all the time to activate the mental states you need. For example, if you know you are going to meet up with a manipulative person, you will probably activate a mental state of wariness. Or, if you are about to visit a sick friend, you might naturally feel a caring concern as you enter his home.

But you can also deliberately choose cues to create helpful and happier mental attitudes. To do this, you could identify one positive mental state you would like to cultivate or strengthen. Some possibilities:

Calmness Kindness Self-compassion Patience Self-confidence Motivation Happiness Other Advertisement

Got it? Then you’ve done two important things:

You’ve made the decision to change, and… You’ve defined your goal. Now you just need to do this:

  • Choose your cue.
  • Cues to Use

    Almost anything can serve as a cue, as long as it triggers the thoughts or emotions you are trying to evoke. My 7 ideas are below. Notice that even unpleasant mental states or sensations can sometimes be used to activate pleasant ones.

  • Use a pleasant sound as a cue for a positive mental state. We live next to a church. I find that I can link the sound of the church bells to one of my goals—a calmer mind. So when I hear those bells, I take a few deep breaths, relax my body, and clear my mind. Ah, much better!

  • Use an unpleasant sound as a cue for a positive mental state. BLLLT! That’s the unpleasant sound announcing that my partner has a message on his phone. At first I felt startled and then annoyed when I heard this grating noise. But my partner is hard of hearing and needs a loud sound that will get his attention. So I decided to make lemonade out of lemons and use the harsh jangle as another cue for a calmer mind. Deep breath, calming self-talk…Ah, much better!

  • Use an object as a reminder. Fellow PT blogger Toni Bernhard shares an unlikely cue to the mental habit of “kindness” in her wonderful book, How to Wake Up. When she leaves the house, she uses the cue of her hand on the doorknob to remind her to approach other people in a friendly and open-hearted way. What a beautiful way to cultivate a positive mental attitude and a worthwhile value!

  • A piece of art, a gift from a loved one, a photo of loved ones—any or all of these could become cues to the positive mental state of loving. I cherish a mug with hearts on it that my partner gave me 20 years ago for Valentine’s Day. While others might see it as just a cheesy mug, I feel the love every time I use it!

  • Use a time of day as a reminder. To build feelings of happiness, take one minute in the evening for the classic “Three Good Things” exercise. Just think or write about three things that went reasonably well that day. In one research study, participants who wrote down three good things each night for just one week boosted their happiness levels and reduced feelings of depression for 6 months!
  • I adapted this exercise to promote self-confidence and a spirit of learning, re-labeling it “The 3 Growth Things.” For each “good thing” that occurred during my day, I figure out if I just got lucky or if I did something that helped create that positive experience. Recognizing my own role in my happiness is empowering. If there was a significant event that I did not handle well, I thought about what I might do differently next time, thereby changing a mistake into a learning experience.

  • Use a negative state of mind as a reminder to activate the positive state of mind that you seek. This sounds impossible and, yes, it can be a challenge! But with a little practice, you can do it. For example, you are probably all-too-familiar with your critical inner voice. When you hear it making harsh judgments about you (again!), deliberately counter that voice with self-compassion. Possible self-talk: “It was a difficult situation. Maybe I didn’t handle it the way I wanted to. But anyone can make a mistake. And now I know what to do.”

  • Use your body as a cue. Sitting up straight is not only good for your spine; it could be a wonderful cue for the mental states of “assertiveness,” “motivation,” or “determination.” In fact, one study showed that practicing good posture could increase your willpower. Likewise, standing up could be a cue to become more alert. Deliberately smiling could be a cue to put your troubles in perspective; the act of smiling in itself will trigger a happier mood.

  • Use an activity to create a positive mental state. I mentioned stair-climbing. Two more popular activities, both well-researched, are singing and—wait for it!—dish-washing. And of course many people use meditation or prayer to evoke a more hopeful or calmer mental state. (For more stress-reducing activities, click here.)

  • Re-Mind Yourself

    The practice of setting up cues and using them regularly may seem like a small contribution to your mental health. Yet you will discover that these small actions lead to many benefits. Paying attention to your personal cues may help you "wake up" to the present moment. Positive mental states can lift your mood, give you energy, and provide you with much-needed infusions of happiness or calm on a daily basis. Used enough, you may even be able to create a new mental habit. Eventually you may find that you've built up reserves of positive emotions in your mind and brain, reserves on which you could draw during tough times.

    After a while, you may habituate to your chosen cues. If your cues lose their power to trigger positive emotions, try new cues or focus on different mental attitudes. Cues have their limits, but they are good ways to add gratitude, contentment, and calm to your daily routine.


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    12 Tips to REduce Your Child's Stress and Anxiety 13 Jun 2016

    Anxiety symptoms are common in children and adolescents, with 10-20% of school-aged children experiencing anxiety symptoms. An even larger number of children experience stress that does not qualify as an anxiety disorder. So how can you help to reduce your child's anxiety and stress?

    1) Encourage your child to face his/her fears, not run away from them.

    When we are afraid of situations we avoid them. However, avoidance of anxiety-provoking situations maintains the anxiety. Instead, if a child faces his or her fears, the child will learn that the anxiety reduces naturally on its own over time. The body cannot remain anxious for a very long period of time so there is a system in the body that calms the body down. Usually your anxiety will reduce within 20-45 minutes if you stay in the anxiety-provoking situation.

    2) Tell your child that it is okay to be imperfect.

    Often we feel that it is necessary for our children to succeed in sports, school, and performance situations. But sometimes we forget that kids need to be kids. School becomes driven by grades, not by enjoyment of learning if an 85 is good, but not good enough.This is not to say that striving is not important.It is important to encourage your child to work hard but equally important to accept and embrace your child's mistakes and imperfections. (Click here to read more about this in another blog post, The Eyes of the Tornado).

    3) Focus on the positives.

    Many times anxious and stressed children can get lost in negative thoughts and self-criticism. They may focus on how the glass is half empty instead of half-full and worry about future events. The more that you are able to focus on your child's positive attributes and the good aspects of a situation, the more that it will remind your child to focus on the positives. (Click here to read more about focusing on the positives in Embracing the Worst).

    4) Schedule relaxing activities.

    Children need time to relax and be kids. Unfortunately, sometimes even fun activities, like sports, can become more about success than they are about fun. Instead, it is important to ensure that your child engages in play purely for the sake of fun. This may include scheduling time each day for your child to play with toys, play a game, play a sport (without it being competitive), doing yoga, paint, have a tea party, put on a play, or just be silly.

    5) Model approach behaviour, self-care, and positive thinking.

    Your child will do what you do. So if you avoid anxiety-provoking situations, so will your child. If you face your fears, so will your child. If you take care of yourself and schedule time for your own needs, your child will learn that self-care is an important part of life. If you look for the positive in situations, so will your child. Children learn behaviours from watching their parents. So when you think about your child's psychological well-being think about your own as well.

    6) Reward your child's brave behaviours.

    If your child faces his or her fears, reward this with praise, a hug, or even something tangible like a sticker or a small treat. This is not bribery if you establish this as a motivator prior to your child being in the situation. If you reward behaviours your child will engage in them more often.

    7) Encourage good sleep hygiene.

    Set a bed time for your child and stick to that bed time even on weekends. Also have a 30-45 minute bed time routine that is done every night. This helps your child to transition from the activities of the day to the relaxed state necessary to fall asleep.

    8) Encourage your child to express his/her anxiety.

    If your child says that he or she is worried or scared, don't say "No you're not!" or "You're fine." That doesn't help your child. Instead, it is likely to make your child believe that you do not listen or do not understand him/her. Instead, validate your child's experience by saying things like "Yes, you seem scared. What are you worried about?" Then have a discussion about your child's emotions and fears.

    9) Help your child to problem solve.

    Once you have validated your child's emotions and demonstrated that you understand your child's experience and are listening to what your child has to say, help your child to problem solve. This does not mean solving the problem for your child. It means helping your child to identify possible solutions. If your child can generate solutions, that is great. If not, generate some potential solutions for your child and ask your child to pick the solution that he or she thinks would work best.

    10) Stay calm.

    Children look to their parents to determine how to react in situations. We've all seen a young child trip and fall and then look to their parent to see how to react. If the parent seems concerned, the child cries. This is because the child is looking to their parent for a signal of how to react to the situation. Children of all ages pick up on their parent's emotions and resonate with them. If you are anxious, your child will pick up on that anxiety and experience an increase in his/her own anxiety. So when you want to reduce your child's anxiety, you must manage your own anxiety. This may mean deliberately slowing down your own speech, taking a few deep breaths to relax, and working to ensure that your facial expression conveys that you are calm.

    11) Practice relaxation exercises with your child.

    Sometimes really basic relaxation exercises are necessary to help your child to reduce their stress and anxiety. This might mean telling your child to take a few slow, deep breaths (and you taking a few slow breaths with your child so your child can match your pace). Or it might mean asking your child to image him or herself somewhere relaxing, like the beach or relaxing in a backyard hammock. Ask your child to close his/her eyes and imagine the sounds, smells, and sensations associated with the image. For example, close your eyes and picture yourself on a beach. Listen to the sound of the surf as the waves come in and go out. In and out. Listen to the sound of the seagulls flying off in the distance. Now focus on the feel of the warm sand beneath your fingers and the sun warming your skin.Your child can do these techniques on his or her own during anxiety-provoking times.

    12) Never give up!

    Anxiety and stress can be a chronic struggle and often the source of a child's anxiety changes over time so it can feel as though you are always putting out fires. With repetition of the anxiety and stress management techniques, your child will learn how to lower his/her anxiety level and how to cope with anxiety-provoking situations.The key is repetition so keep it up!

    Resources If you think that your child is suffering from an anxiety disorder or experiencing a high level of stress or you need the help of a therapist please see the following resources:


    My website: http://psychology.case.edu/research/fear_lab/index.html

    Child Anxiety Network: http://www.childanxiety.net/

    Anxiety Social Net: http://www.anxietysocialnet.com/


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    Making the Most of Psychotherapy, Counseling, or Coaching 06 Jun 2016

    A reader wrote to me: "I am currently in therapy. What do you think is the best way to get the most out of it? Perhaps, you could write an article about it?"


    Getting counseling, coaching, or psychotherapy are major commitments of money and time, not just the sessions but the work you must do between sessions to get the most from them.

    We tend to think that the coach/therapist/counselor is the key to making all that worthwhile but what the client does may be at least as important. Here are things you might want to do:

    Choose wisely

    Which treatment modality works best (e.g., cognitive-behavioral vs childhood-rooted therapy) depends heavily on the individual client. It's been said, only half joking, that the most successful modality is the one you believe in. So trust your gut feeling---but that feeling should be based on a careful selection process:

    Speak with two or three practitioners recommended highly on Yelp or by your friends. Google them and visit their site to see if they specialize in your kind of problem. Just as you wouldn't use a general practitioner for a serious physical problem, you shouldn't use a generalist counselor for your serious psychological or career problem. So, see an appropriate specialist: depression, helping unhappy lawyers, whatever.

    Try a session with one or more good prospects. Don't be too swayed by the practitioner's niceness. Sometimes, a practitioner is nice but ineffectual. The key question is, "Do you sense the practitioner is quite competent in the art and science of helping someone with your problem and whose personality and intellectual style is compatible with yours. A spiritual, intuitively oriented client might not do so well with a practitioner who stresses logical reasoning.

    Before sessions. Except perhaps for the first session, email a suggested agenda to the practitioner. Writing it concretizes your thinking and helps the practitioner prepare for your session. Of course, if s/he suggests an alternative, consider it, although you generally should have the final say.

    In sessions

    Be appreciative. It's easy to forget that practitioners are people too, and while we try to be our best with all our clients, we're more likely to go the extra mile for clients we like. So, express your appreciation for their efforts on your behalf.

    Be honest and ask for honesty.

    Practitioners aren't mind readers. If you withhold what's really going on, it could take even a skilled, intuitive practitioner a long time to get to the foundational issue(s.) Be as honest as you can. Conversely, ask the practitioner to be honest with you: If s/he perceives an important negative about you, even if it might be tough for you to hear, say that you'd rather hear it. Of course, the practitioner isn't always right, so if s/he says something that feels wrong, tactfully, say so. If the practitioner is doing something you feel isn't helpful--for example, being too tough or not tough enough, too intellectual or too touchy-feely, too practical or not practical enough, tactfully give the feedback. Most practitioners are eager to flex to meet client needs or at least be given an opportunity to explain why s/he's doing what s/he's doing. Take notes and/or record the session. People forget so much of what goes on in sessions. I record all sessions and urge my clients to, within a day, listen to the mp3 and take notes. That way they derive the session's full benefit right away. Procrastinating clients who wait to listen until the day before our next session miss out on a lot.

    Ask questions. There really are no dumb questions. If a question pops into your mind, getting the answer usually should take precedence over what's going on the in the session.

    Ask for homework. If the practitioner doesn't assign homework, ask for it or propose an assignment. You're only in sessions a tiny fraction of your week. You must try out ideas generated in the session, do research on possible directions, keep a log, etc.

    Between sessions

    Love yourself enough to fully commit to doing that homework, not perfunctorily but with zest. This may be the key to getting the most of your counseling, coaching, or therapy.


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    6 Ways to make Couples Therapy work for you!! 02 Jun 2016

    Have you ever wondered if couples therapy could help you and your partner resolve an ongoing conflict, learn to communicate better, or reach new levels of intimacy? Couples therapy can do each of these things, but only if you avoid common traps and pitfalls. Here are six ways to make couples therapy work for you.

    1. Don't wait too long. When I worked as a couples therapist, it was not uncommon for one member of a couple to let slip that they'd already consulted an attorney about a divorce. Sometimes both members of the couple had "lawyered up." It seemed they wanted to be able to say they had tried everything, but really they had already made up their minds and wanted out. Couples therapy in such a situation is likely doomed to fail. Couples have a much better chance at repairing the relationship if they catch the problems early on.

    2. Find the right therapist. Make sure you do your homework and go to a therapist trained in some type of evidence-based couples therapy. Couples therapy requires many specific skills; a therapist trained in John Gottman's approach would be my first choice.

    3. Be honest with the therapist. It's frustrating working with couples when one or both parties don't tell the truth. As I mentioned above, sometimes people have already consulted an attorney about a divorce and are not upfront about this. Other times ongoing affairs are involved and kept a secret. Another area frequently kept hidden from me is that of substance abuse. A good therapist will not judge you, but needs to know everything in order to help you.

    4. Show up for the session. I mean this literally and figuratively. First of all, be there on time and ready to participate. Turn off your phone and put it away. This may seem obvious, but I've actually had to tell people to put away their phones during the middle of a session. Actively engage in the session. Do your best to listen, share, and have an open mind.

    5. Do your homework. Some couples therapy will require work between sessions. You may be asked to fill out relationship questionnaires. You may be asked to practice communication skills. There may be materials to read. If it sounds like school, it is: you're learning new relationship skills. It sounds cliché, but you'll get out of couples therapy what you put into it.

    6. Give it time. Couples often want quick fixes to problems that have built up over years, perhaps even decades. Gottman notes that, on average, couples spend six years being unhappy before getting help. That results in a lot of resentment! Don't expect couples therapy to work magic overnight. Similarly, don't expect the therapist to "fix" your problems—a good therapist will act more as a relationship coach. In time, if you do your part, there's hope that you and your partner can remember the good things that brought you together in the first place.


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    Tools to Overcoming Bad Moods 30 May 2016

    Depression: 7 Powerful Tips to Help You Overcome Bad Moods

    Jared Erondu/unsplash.com Source: Jared Erondu/unsplash.com There is no health without mental health.

    In the past decade, depression rates have escalated, and one in four Americans will suffer from major depression at one time in their lives.

    While there is no quick fix or one-size-fits-all for overcoming depression, the following tips can help you manage depression so it does not manage you.

    1. Beware of rumination. The word "ruminate" derives from the Latin meaning for chewing cud, a less than appetizing process in which cattle grind up, swallow, then regurgitate and rechew their feed. In the human realm, ruminators analyze an issue at length (think “emotional vomiting.”). Studies show that depressive rumination most often occurs in women as a reaction to sadness, while men tend to focus on their emotions when they're angry, rather than sad. Many ruminators remain in a depressive rut because their negative outlook hinders their problem-solving ability.


    Remind yourself that rumination does not increase psychological insight. Take small actions toward problem-solving. Reframe negative perceptions of events and high expectations of others. Let go of unhealthy or unattainable goals and develop multiple sources of social supports.

    2. Focus on what you’re doing right. As rough as your life is right now, you haven’t fallen off the edge, and this is not just by chance. Key is to remember that humans are remarkably resilient and capable. Because depression can cloud your judgement, it can be tempting to overemphasize the negative aspects of situations, while discounting the positives.

    Action-plan: At the end of the day, write down three things you did well. No need to overthink this, and no act of taking the high road is too small. For example, “When my coworker emailed the budget proposal, he forgot to cite a source. Rather than get upset, I spent two minutes researching the answer and added the information myself.”

    3. Resist the urge to live in the past. Time spent reliving, rewriting and recreating the past is like purchasing a one-way ticket to the dark depths of despair. This insidious mental habit is as much a threat to emotional wellbeing as any. Self-loathing or blaming others will not get you on the right side of feeling better, any more than believing the answer is found at the bottom of a bottle of Jack Daniels. You cannot do life differently if you don’t change your thought process.

    Action-plan: Commit to a new way of thinking and you will commit to a new way of being. If living in the past takes up a lot of your mental real estate, this article will help you rewire your thought process. Past regrets serve one purpose and that is to rob you of your resolve to do things differently in the present.

    4. Leave the future where it belongs. Just as the living in the past leads to depression, fearing or worrying about the future contributes to anxiety. Daily stress and frustration are primarily caused by persistent feelings of overwhelm caused by uncertainty. Chronic worriers tend to catastrophize and before you know it, every headache is a brain tumor, and every romantic rejection is proof that you’re fated for a life of solitude.

    Action-plan: Have faith in uncertainty, and in life. A good way to practice is by cultivating a state of mindfulness each and every day. When you learn to intentionally redirect your mind to what is happening in the here and now, you’ll increase your mental energy reserves so you can spend more time on enjoyable tasks. Click here for a beginner’s video about mindfulness basics.

    5. Incorporate structure into every day. A lack of scheduled activities and inconsistent routines can increase feelings of helplessness and a loss of control over the direction of your life. Adding a plan to your day can help you regain that sense of control and decrease the feeling that you’re just a passive participant in life.

    Action-plan: The following guide may help you develop structure and assess whether your time is well-spent based upon your productivity and moods. On a paper or word document, make five columns:

    1. Time of day: - Early morning (waking time until 10am) - Late morning (10am—12pm) - Early afternoon (12pm—3pm) - Late afternoon (3pm—5pm) - Evening (5pm—8 pm) - Night (8pm until bedtime)

  • What you plan to do (complete the night before)
  • What you actually did (if different from your plans)
  • How you felt about what you did (rate your mood on a scale of 1-10)
  • Situations and thoughts which may have negatively affected your mood. Fill out at end of day. Adjust and revise accordingly.
  • Remember there are very few victims in this world. Despite your childhood and life experiences, you are responsible for your choices as an adult. While trauma and tragedy may have informed your world view and your ability to trust others, nothing good comes out of seeing yourself as a victim (even if you were).
  • Action-plan: Take responsibility for your life. Switch the dial from victim to survivor and revel in feelings of strength and empowerment. Rather than seek retribution over those who have wronged you, seek redemption. Refuse to wallow in self-pity and focus on comforting others. After all, there is always someone out there fighting a battle greater than yours. The victim gives up at the first sign of struggle, while the survivor puts one foot in front of the other and keeps moving.

    7. Find your social support network. Humans are wired to connect. Chicago psychologist John Cacioppo, author of the book, Loneliness, writes about how "the need for social connection is so fundamental that without it we fall apart, down to the cellular level. Over time blood pressure climbs and gene expression falters. Cognition dulls; immune systems deteriorate. Aging accelerates under the constant, corrosive presence of stress hormones. Loneliness, Cacioppo argued, isn’t some personality defect or sign of weakness—it’s a survival impulse like hunger or thirst, a trigger pushing us toward the nourishment of human companionship."

    Action-plan: In short, reach out: Call a friend or family member and get together for coffee, or go for a hike, or meet up at a park. Even small steps like volunteering and smiling at strangers makes a difference. In long, open up your life.

    Get more self-care tips + free relaxation Mp3 audio recordings when you subscribe to wiredforhappy.com

    Follow Linda Esposito on Facebook, Twitter, and Instagram.

    Copyright 2016 Linda Esposito, LCSW


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    Does the Full Moon Make Your Kids Less Sleepy? 23 May 2016

    Do you ever attribute your child’s wild or wound-up behavior to the presence of a full moon? If so, you’re far from the only parent to feel as though your child might open his mouth and howl at the dark sky. Our connection to the moon and to lunar cycles has been the subject of legend, speculation, and mythology for much of human history as we know it.

    The relationship of human behavior—and sleep—to the shifting phases of the moon has also been the subject of scientific inquiry. While still scientifically underexplored relative to the influence of solar, seasonal, and circadian rhythms and clocks, the effects of lunar rhythms are being investigated by scientists across disciplines. There is mounting evidence that the lunar cycle influences physiological function and behavior in animals, including birds, fish, and other marine life.

    With regard to its effect on human physiology, behavior, and sleep, the scientific findings of the impact of lunar rhythms has been mixed, with some findings pointing to associations between phases of the moon and changes to sleep patterns and activity levels, while other studies failing to show a link.

    Full moon, less sleep

    A new, large-scale international study examines the effects of lunar phases on the sleep and waking activity levels of children. Researchers from around the globe collaborated on this investigation, which included more than 5,000 children from 12 different countries. They discovered a change in children’s sleep patterns associated with the changing phases of the moon.

    Researchers used data from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), an ongoing research project with study sites in Australia, Brazil, Canada, China, Columbia, Finland, India, Kenya, Portugal, South Africa, United Kingdom, and the United States. The countries that participate in ISCOLE reflect a diversity of geographic location as well as a range of economic development and other sociocultural factors. (These participating nations represent five major geographic regions of the world: Europe, Africa, the Americas, Southeast Asia, and the Western Pacific.)

    The children in the study were between the ages 9-11. A total of 5,812 children participated in the study, spread roughly evenly among the 12 participating nations. Sleep and waking activity levels were measured using waist-worn accelerometers. Researchers collected data on nighttime sleep duration, and sleep efficiency—the amount of time spent sleeping compared to the total amount of time spent in bed. They also assessed waking activity levels from light to moderate and vigorous, and overall sedentary time. The data collected was analyzed in relation to three different lunar phases:

    Full moon (plus or minus 4 days) Half moon (plus or minus 5-9 days from the nearest full moon) New moon (plus or minus 10-14 days from the nearest full moon)

    The scientists’ analysis revealed a small, but statistically significant, change to children’s sleep duration in connection with the full moon. The children slept an average of 4.9 minutes less during the time of the full moon, compared to the time of a new moon, for an average 1 percent reduction in total sleep time.

    This was the only sleep and activity measurement that was associated with changing moon phases. Researchers found no links between the different lunar phases and children’s waking activity levels, sedentary time, or sleep efficiency.

    Other evidence of the moon-sleep connection

    While scientists didn’t find broad or dramatic shifts in children’s sleep patterns linked to the moon, their study—the first to examine the lunar influence of sleep in children across five major regions of the world—did establish a modest but meaningful link between sleep duration and lunar phases. This research aligns with other, previous studies that have demonstrated an association between human sleep patterns and the lunar cycle.

    Swiss researchers in 2013 shared results of an in-laboratory study of sleep and lunar cycles. They found several significant changes to sleep patterns associated with the full moon:

    Decreased sleep duration: participants slept 20 minutes less, on average, during the full moon phase Delayed sleep: participants took an average of 5 minutes longer to fall asleep at or around the full moon Reduced melatonin: participants showed lower levels of the “sleep hormone” at the full moon Diminished sleep quality: Participants reported sleeping less soundly during the full moon phase Changes to sleep architecture: Participants spent less time in slow wave sleep, and took longer to reach REM sleep, near to the full moon

    This study garnered a lot of attention, as it strongly suggested links between human physiology and sleep and the phases of the moon. Additional studies subsequently reported similar changes to sleep patterns linked to the lunar cycle. One investigation—also conducted by scientists in Sweden—found reduction in sleep time of an average of 25 minutes near the full moon. Researchers also found changes to sleep architecture, particularly a change in the time it took participants to enter REM sleep around the time of a new moon. Participants, who slept in laboratory during the study, also demonstrated greater reactivity to environmental stimuli while asleep, during periods of a full moon.

    A team of scientists from Europe, Canada, and the U.S. also found links between the lunar cycle and sleep duration, sleep efficiency and quality, and changes to slow-wave sleep and REM sleep.

    Moon-sleep findings mixed

    But not all evidence points clearly to an association between sleep and the lunar cycle, or demonstrates uniformly what that association may be. A recent study of more than 2,000 men and women in Switzerland found no link between the phases of the moon and sleep duration or sleep quality.

    Another recent investigation—one of the few other studies to look specifically at children’s sleep in relation to lunar phases—found changes to sleep and activity levels that were distinctly different from the current study. In this study, Danish researchers studying 795 children ages 8-11 found that children slept slightly more—an average of 3 minutes—around the time of the full moon, not less. In addition, they found that children’s activity levels also changed in relation to the moon, and that children were slightly less active during the full moon phase, by an average of about 4 minutes of moderate or vigorous activity.

    The folkloric link between sleep and waking behavior and the moon has been with us for a very long time. We’re only at the beginning of a scientific exploration of this possible connection, and how it may affect our sleep patterns—and our children’s. We know that other forms of animal life possess physiological and behavioral connections to the moon. More research—sure to come—may eventually show us whether we do as well.

    Sweet Dreams,

    Michael J. Breus, PhD

    The Sleep Doctor™


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    Mental Health - never too late to start and so important! 20 May 2016

    In a fast paced, technology driven, highly pressured work and family enviroment, one of the most important aspects of one's wellbeing is your Mental Health. Read about some important Lifestyle changes that can assist in promoting and boosting better mental health.

    When we seek help for a mental health condition, we can expect to hear about various medications and treatment options, but what’s often missing from the conversation is any talk of lifestyle changes. In a recent University of Illinois study, about half of those with symptoms of mental illness reported that they receive no wellness advice from their health care provider.

    That’s a lamentable oversight because lifestyle changes—things as simple as nutrition and exercise—can have a significant impact on quality of life, for any of us, but especially for those dealing with issues such as depression, anxiety, bipolar disorder and schizophrenia. They can also help minimize the development of risk factors that can lead to conditions like diabetes, cardiovascular disease, and hypertension, all of which are seen at higher rates in those with mental illness, the study noted.

    If you are dealing with a mental health challenge, take the initiative when speaking to your clinician. Ask for specifics on what changes you can safely make in your daily life to improve your mental health; there’s no single answer. But research has shown that lifestyle changes in several key categories can pay healthy dividends for most. Among the most powerful:

    1. Enhance Your Diet

    Research shows that our diet can influence our mental health, for both good and bad. Fruits and vegetable are associated with better mental well-being, according to recent research from the University of Warwick. That’s important because mental well-being—feelings of optimism, happiness, self-esteem and resilience—can help protect not only against mental health problems but physical ones as well.

    Fatty foods, on the other hand, may increase the risk for psychiatric symptoms by changing the bacteria that live in our gut, according to new research. A study done with mice showed increased anxiety, impaired memory, repetitive behavior, and brain inflammation as a result of a high-fat diet. Some fats, however, fall into the “good” category. Omega-3 fatty acids such as are found in salmon, for example, may help with some forms of depression.

    Sugar, of course, should have only a minimal place in your diet. Not only can it spark rapid weight gain and an addictive response in some, it has been linked to higher rates of depression and can make mental health symptoms worse, according to the National Alliance on Mental Illness (NAMI).

    2. Make Exercise a Priority

    You’ll want to check with your doctor before you start any exercise regime, but physical activity has been shown to have significant benefits for those dealing with mental health issues. A Southern Methodist University study labeled exercise a magic drug for those with anxiety and depression disorders and called on doctors to more widely prescribe it. Research shows even low levels of activity—things such as walking or gardening for half an hour a day—can help ward off depression now and even later in life. Exercise has also been shown to improve the mental and physical health of those with schizophrenia. (One note: If you have bipolar disorder, be aware that exercise can trigger mania in some. Get your doctor’s OK before adding new forms of physical activity to your life.)

    As a bonus, exercise helps not only with mental health and fitness but also with weight control. This is especially important because weight gain is a side effect of many medications for mental illness. Extra pounds may not only make you less healthy and more prone to developing illnesses such as diabetes, they can also add to your mental distress.

    3. Practice Techniques to Reduce Stress

    Stress feeds mental illness, and mental illness feeds stress. Taking steps to minimize the stress in your life can help slow this vicious cycle. Consider adopting techniques such as mindfulness meditation; a Carnegie Mellon University study found that even 25 minutes a day for three days in a row can reduce stress and build resilience. And a Johns Hopkins research analysis determined that meditation can improve symptoms of anxiety and depression.

    Yoga is another powerful choice for stress reduction, as well as being good exercise. A Queen’s University study found it can even help us view the world in a less negative, less threatening way, which can be a huge benefit for those with mental health disorders. (Again, a note for those with bipolar disorder: A recent study found risks as well as benefits in yoga. According to a recent study, some with bipolar disorder found it a “life-changing” positive, while a minority reported it can intensify both high and low moods.)

    4. Get Enough Sleep

    We all crave a refreshing night’s sleep, but don’t always get it. We can boost our odds by committing ourselves to good sleep hygiene. That means going to bed and getting up at a consistent time, getting sufficient exercise (earlier in the day rather than late at night), avoiding heavy evening meals and caffeine, practicing relaxation techniques, and forgoing activities that get in the way of our shuteye, such as those Netflix marathons. If you’re still having trouble, don’t turn automatically to sleep aids, which research shows may actually shorten your lifespan. See your doctor or a sleep specialist for help.

    Making lifestyle changes in support of your sleep is well worth the effort. Poor sleep has multiple negatives: Studies show fatigue makes it harder to choose healthy foods, it’s been linked to obesity and cell damage, and it can make mental illness symptoms worse. Sleep deprivation has been shown, for example, to trigger schizophrenia symptoms. Consistently good sleep, on the other hand, can help keep stress at bay, as well as boost mood, protect the brain and give us the energy we need to deal with all that life throws at us.


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    On Marrying the Wrong Person 08 Mar 2016

    A great article talking about relationships and modern marriage. It's well worth a read.


    Most People With Addiction Simply Grow Out of It: Why Is This Widely Denied? 02 Oct 2014

    When I stopped shooting coke and heroin, I was 23. I had no life outside of my addiction. I was facing serious drug charges and I weighed 85 pounds, after months of injecting, often dozens of times a day.

    But although I got treatment, I quit at around the age when, according to large epidemiological studies, most people who have diagnosable addiction problems do so—without treatment. The early to mid-20s is also the period when the prefrontal cortex—the part of the brain responsible for good judgment and self-restraint—finally reaches maturity.

    According to the American Society of Addiction Medicine, addiction is “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” However, that’s not what the epidemiology of the disorder suggests. By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do, according to a study of over 42,000 Americans in a sample designed to represent the adult population.

    The average cocaine addiction lasts four years, the average marijuana addiction lasts six years, and the average alcohol addiction is resolved within 15 years. Heroin addictions tend to last as long as alcoholism, but prescription opioid problems, on average, last five years. In these large samples, which are drawn from the general population, only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.

    While some addictions clearly do take a chronic course, this data, which replicates earlier research, suggests that many do not. And this remains true even for people like me, who have used drugs in such high, frequent doses and in such a compulsive fashion that it is hard to argue that we “weren’t really addicted.” I don’t know many non-addicts who shoot up 40 times a day, get suspended from college for dealing and spend several months in a methadone program.

    Only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery. Moreover, if addiction were truly a progressive disease, the data should show that the odds of quitting get worse over time. In fact, they remain the same on an annual basis, which means that as people get older, a higher and higher percentage wind up in recovery. If your addiction really is “doing push-ups” while you sit in AA meetings, it should get harder, not easier, to quit over time. (This is not an argument in favor of relapsing; it simply means that your odds of recovery actually get better with age!)

    So why do so many people still see addiction as hopeless? One reason is a phenomenon known as “the clinician’s error,” which could also be known as the “journalist’s error” because it is so frequently replicated in reporting on drugs. That is, journalists and rehabs tend to see the extremes: Given the expensive and often harsh nature of treatment, if you can quit on your own you probably will. And it will be hard for journalists or treatment providers to find you.

    Similarly, if your only knowledge of alcohol came from working in an ER on Saturday nights, you might start thinking that prohibition is a good idea. All you would see are overdoses, DTs, or car crash, rape or assault victims. You wouldn’t be aware of the patients whose alcohol use wasn’t causing problems. And so, although the overwhelming majority of alcohol users drink responsibly, your “clinical” picture of what the drug does would be distorted by the source of your sample of drinkers.

    Treatment providers get a similarly skewed view of addicts: The people who keep coming back aren’t typical—they’re simply the ones who need the most help. Basing your concept of addiction only on people who chronically relapse creates an overly pessimistic picture.

    This is one of many reasons why I prefer to see addiction as a learning or developmental disorder, rather than taking the classical disease view. If addiction really were a primary, chronic, progressive disease, natural recovery rates would not be so high and addiction wouldn’t have such a pronounced peak prevalence in young people.

    But if addiction is seen as a disorder of development, its association with age makes a great deal more sense. The most common years for full onset of addiction are 19 and 20, which coincides with late adolescence, before cortical development is complete. In early adolescence, when the drug taking that leads to addiction by the 20s typically begins, the emotional systems involved in love and sex are coming online, before the cognitive systems that rein in risk-taking are fully active.

    Taking drugs excessively at this time probably interferes with both biological and psychological development. The biological part is due to the impact of the drugs on the developing circuitry itself—but the psychological part is probably at least as important. If as a teen you don’t learn non-drug ways of soothing yourself through the inevitable ups and downs of relationships, you miss out on a critical period for doing so. Alternatively, if you do hone these skills in adolescence, even heavy use later may not be as hard to kick because you already know how to use other options for coping.

    The data supports this idea: If you start drinking or taking drugs with peers before age 18, you have a 25% chance of becoming addicted, but if your use starts later, the odds drop to 4%. Very few people without a prior history of addiction get hooked later in life, even if they are exposed to drugs like opioid painkillers.

    So why do so many people see addiction as hopeless? One reason is “the clinician’s error,” which could also be known as the “journalist’s error” because it is so frequently replicated in reporting on drugs. If we see addiction as a developmental disorder, all of this makes much more sense. Many kids “age out” of classical developmental disorders like attention deficit/hyperactivity disorder (ADHD) as their brains catch up to those of their peers or they develop workarounds for coping with their different wiring. One study, for example, which followed 367 children with ADHD into adulthood found that 70% no longer had significant symptoms.

    That didn’t mean, however, that a significant minority didn’t still need help, of course, or that ADHD isn’t “real.” Like addiction (and actually strongly linked with risk for it), ADHD is a wiring difference and a key period for brain-circuit-building is adolescence. In both cases, maturity can help correct the problem, but doesn’t always do so automatically.

    To better understand recovery and how to teach it, then, we need to look to the strengths and tactics of people who quit without treatment—and not merely focus on clinical samples. Common threads in stories of recovery without treatment include finding a new passion (whether in work, hobbies, religion or a person), moving from a less structured environment like college into a more constraining one like 9 to 5 employment, and realizing that heavy use stands in the way of achieving important life goals. People who recover without treatment also tend not to see themselves as addicts, according to the research in this area.

    While treatment can often support the principles of natural recovery, too often it does the opposite. For example, many programs interfere with healthy family and romantic relationships by isolating patients. Some threaten employment and education, suggesting or even requiring that people quit jobs or school to “focus on recovery,” when doing so might do more harm than good. Others pay too much attention to getting people to take on an addict identity—rather than on harm related to drug use—when, in fact, looking at other facets of the self may be more helpful.

    There are many paths to recovery—and if we want to help people get there, we need to explore all of them. That means recognizing that natural recovery exists—and not dismissing data we don’t like.

    Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She has contributed to Time, the New York Times, Scientific American Mind, the Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her last column for Substance.com was about which parts of the 12 Steps she would keep, which she would throw away and why.


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    The Role of Psychotherapy in Society 31 May 2013

    Considering the expansion of state sponsored psychotherapy services in the UK, a recent article explores the political role of psychotherapy in society and examines some of the philosophical roots of the "talking cure."

    As a liberal, I support the state’s provision of CBT for two reasons: first, it leaves open the question of the meaning of life, and second, it’s effective and people ask for it. (As an aside, I do think there should be a more diverse range of evidence-based therapy available.) It’s quite another matter for the state to impose a comprehensive theory of the good life on their citizens without their consent. I am wary of governments using pseudoscience to smuggle moral paternalism in through the back door. A society in which we are all quantified according to our adherence to Positive Psychology would be a regression into the Middle Ages.

    (Image credit: Fox Valley Institute)


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    Do we need to change the way we are thinking about mental illness? 13 May 2013

    NO Simon Wessely, member of the Royal College of Psychiatrists

    Next week the American Psychiatric Association is publishing its fifth take on the classification of psychiatric disorders, the DSM-5. Judging by the sound and fury, you might be forgiven for thinking that this is something radical – a great breakthrough in our struggle to better understand mental disorders, or alternatively a dastardly plot to extend the boundaries of psychiatry into everyday life and emotions at the behest of greedy drug companies. Or, if the position statement from the Division of Clinical Psychology (DCP) is to be believed, an attempt to emphasise the biological causes of mental disorders over the social and psychological.

    In fact, it is none of the above. A classification system is like a map. And just as any map is provisional, ready to be changed as the landscape changes, so is classification. Our knowledge of the changing landscape can come from many sources. This week's Lancet, for example, highlights new research showing the genetic overlaps between several serious psychiatric disorders, which call into question the current boundaries between schizophrenia and bipolar disorders (genes matter, even if we don't yet fully understand how). I expect that the map of severe mental illness in DSM-6, when it appears, will have been redrawn and that it will be on the basis of a better biological understanding of those disorders.

    But does that mean that, as the DCP is saying, psychiatry is gradually being taken over by the biologists, attempting to reduce human experience to the level of molecules and cells? The answer is an unequivocal no. Psychiatry is the study of the brain and the mind. Psychiatrists look at the whole person, and indeed beyond the person to their family, and to society. That is why even as a medical student I knew that psychiatry was for me – it was about biology, but it was also about psychology, and sociology, ethics, politics and much else. Psychiatrists react to the tired arguments about biology versus psychology in the same way as geneticists react to sterile debates about nature versus nurture – it's both. Mindless psychiatry is as unhelpful as brainless psychiatry, and the psychiatrist who ignores the social environment is, well, not a psychiatrist. Political decisions about the economy in, for example, Greece or Russia have had serious consequences on some, but not all, mental disorders.

    So why the fuss about DSM-5? After all, it's hardly a good read – not the kind of book anyone will take on holiday – and it isn't the system of classification that we use over here in any case. In practice, most UK mental health professionals will barely notice much difference. Some diagnostic criteria will have improved, others less so, and no doubt there will be some "only in America" stories about the inevitable daft new category. But most of those in the business of helping those with mental disorders will be less concerned with what is in and what is out than with the reality of underfunded and overstretched services. The idea that we are part of a conspiracy to medicalise normality will seem frankly laughable as we struggle to protect services for those whose disorders are all too evident under any classification system.

    Simon Wessely is a member of the Royal College of Psychiatrists and chair of psychological medicine at King's College London

    YES Oliver James, author and clinical psychologist

    A student friend of mine once started claiming that she was being controlled by electrical impulses beamed across the city by "authoritarian capitalists". She spent hours in the bath, cleaning herself.

    Following her removal to an asylum, her parents arrived to collect her possessions. Nearly all of her (mostly clean) clothes were deemed so "soiled" they would need to be burnt. The room was obsessively cleaned. Her father was a health inspector.

    Within the medical model of mental illness, she had inherited genes predisposing her to obsessive rituals and to psychosis. The model does not entertain the possibility that the health inspector's intrusiveness distressed her or, as it turned out, that he had sexually abused her.

    Yet 13 studies find that more than half of schizophrenics suffered childhood abuse. Another review of 23 studies shows that schizophrenics are at least three times more likely to have been abused than non-schizophrenics. It is becoming apparent that abuse is the major cause of psychoses. It is also all too clear that the medical model is bust.

    In the press release accompanying publication of DSM-5, David Kupfer, who oversaw its creation, states: "We've been telling patients for several decades that we are waiting for biomarkers. We're still waiting." This is an astonishing admission that there are no reliable genetic or neurological measurements that distinguish a person with mental illness.

    While there is some evidence that the electro-chemistry of distressed people can be different from the undistressed, the Human Genome Project seems to be proving that genes play almost no part in causing this. Eleven years of careful study of our DNA shows that differences in it do not explain mental illness, hardly at all. If one sibling is anxious or depressed and another is not, at most, differences in DNA can only explain 1-5% of why it is one and not the other.

    Of course, some researchers maintain that, given more time (and money), they will still come up with significant results. But off the record, nearly all molecular geneticists admit that it now really does look as if differences in DNA will explain very little.

    By contrast, there is a huge body of evidence that our early childhood experiences combined with subsequent exposure to adversity explain a very great deal. This is dose dependent: the more maltreatment, the earlier you suffer it and the worse it is, the greater your risk of adult emotional distress. These experiences set our electro-chemical thermostats.

    So does subsequent adult adversity. For instance, a person with six or more personal debts is six times more likely to be mentally ill than someone with none, regardless of their social class: the more debts, the greater the risk.

    We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity.

    Oliver James trained and practised as a clinical psychologist. He is the author of Love Bombing – Reset your Child's Emotional Thermostat


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    Upcoming International Conference 05 Apr 2013

    The International Neuropsychoanalysis Society is hosting its 14th conference in Cape Town from the 22nd to the 25th of August. The conference is entitled The Clinical Applications of Neuropsychoanalysis and will feature internationally renowned experts such as Jaak Panksepp, Mark Solms, Oliver Turnbull and Katerina Fotopoulou.

    The congress is aimed at professionals working with all aspects of mind/brain disorders and development. Neuropsychoanalysis contributes to understanding the mind/brain interface. But what are the practical implications of this understanding for our clinical work, as psychoanalysts and therapists or as neuropsychologists and psychiatrists? Set in the beautiful grounds of the University of Cape Town, this congress will address that question. Come learn about the implications of neuropsychoanalytic research for such diverse clinical topics as conversion disorders, depression, addiction, epilepsy, dementia and focal neuropsychological syndromes (e.g., confabulation). Find out also about the clinical implications of neuropsychoanalysis for conventional psychoanalytic therapy.

    CPD points will be provided for both the conference and the education day. Please click on the link below to go to the conference webpage.


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    Transcranial Magnetic Stimulation Used to Treat Chronic Pain 17 Mar 2013

    Using a new treatment that has shown promising results in alleviating major depression, researchers at Stanford now claimed some success using transcranial magnetic stimulation (rTMS) to treat sufferers of chronic pain.

    Until now, pain seemed out of reach for rTMS because the regions involved in pain perception lie very deep within the brain. The other disorders helped by rTMS all involve brain areas close to the skull. To treat depression, for example, a single magnetic coil directs a magnetic field at the dorsolateral prefrontal cortex, a region of the brain's outer folds. When aimed at different areas of these outer folds, rTMS improves the motor symptoms of Parkinson's disease, staves off the damage of stroke, lessens the discomfort that follows nerve injury and treats obsessive-compulsive disorder. The magnetic field affects the electrical signaling used by neurons to communicate, but how exactly it improves symptoms is unclear—scientists suspect rTMS may redirect the activity of select cells or even entire brain circuits.


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    Daniel Kahneman On the Experiencing and Remembering Self 12 Feb 2013

    Using examples from vacations to colonoscopies, Nobel laureate and founder of behavioral economics Daniel Kahneman reveals how our "experiencing selves" and our "remembering selves" perceive happiness differently. This new insight has profound implications for economics, public policy -- and our own self-awareness. Widely regarded as the world's most influential living psychologist, Daniel Kahneman won the Nobel in Economics for his pioneering work in behavioral economics -- exploring the irrational ways we make decisions about risk.


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    Who Will You Be in Ten Years TIme? 18 Jan 2013

    Harvard psychologist Dan Gilbert and his team created an online study involving 19 000 people to better understand how well they were able to predict the extent to which they would change in the future. Since many of the major decisions we make will have long lasting consequences, this study seeks to better understand how people make predictions about their future selves.

    Although teenagers are notoriously bad at envisioning their future selves ("Of course I'll always want this butterfly tattoo!"), Gilbert says he was surprised that even older people seem to underestimate how much they'll change. For example, 68-year-olds reported modest personality changes in the previous decade, but 58-year-olds predicted very little, if any, change in the coming decade, even though their survey answers indicated that they had changed considerably since they were 48. Several follow-up experiments suggested that these differences reflect errors in predicting the future rather than errors in remembering the past. Gilbert and colleagues call this effect "the end of history illusion," because it suggests that people believe, consciously or not, that the present marks the point at which they've finally stopped changing.

    In additional surveys, the researchers found that people similarly underestimate changes in their personal values (things like success and security) and preferences (like their favorite band and best friend). "What these data suggest, and what scads of other data from our lab and others suggest, is that people really aren't very good at knowing who they're going to be and hence what they're going to want a decade from now," Gilbert says.


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    New Edition of the DSM Finalised 13 Dec 2012

    The DSM-5 has been finalised and is due to go on sale from May next year. Here are some of the responses and commentary in the last week to the changes:

    • Thinking Clearly About Personality Disorders.

      The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.

    • A critical take by Allan Frances who was the chair of the DSM-IV Task Force, DSM 5 Is Guide Not Bible—Ignore Its Ten Worst Changes.

      New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs- often by primary care doctors after brief visits. Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs. APA is not competent to do this.

    • Science blogger Vaughan Bell adds his take on the changes: The DSM-5 has been finalised.

    • A detailed monitoring the revisions of both the DSM and ICD can be found at Dx Revision Watch.

      This site has been monitoring the revision processes towards DSM-5 and ICD-11, generally, since the beginning of 2010 and endeavours to provide timely updates and content of interest to consumer groups and professionals who are stakeholders in these classification systems.

    • A concise breakdown to the updated manual here: Final DSM 5 Approved by American Psychiatric Association.

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    The Impact of Infant Stress on the Teen Brain 11 Nov 2012

    A study published today in Nature Neuroscience contributes to understanding the specific ways in which exposure to early stress affects the connectivity of the maturing brain.

    “This is one of the first demonstrations that early stress seems to have an impact on the the way this regulatory circuitry is set up in late adolescence,” says Richard Davidson, a neuroscientist at the University of Wisconsin-Madison and one of the leaders of the study.

    The study showed that 18-year-old girls who had had high cortisol levels at age 4 have weak connectivity between the amygdala, a deep nub of the brain known for processing fear and emotions, and the ventromedial prefrontal cortex, an outer region involved in curbing the amygdala’s stress response.

    (Image credit: editinghelpsite - http://www.flickr.com/photos/lem22/)


    New South African Fact Checking Organisation 02 Nov 2012

    South Africans now have their first fact checking organisation, in the mold of similar initiatives in the US and Europe.

    From their website:

    Africa Check is an independent, non-partisan organisation which assesses claims made in the public arena using journalistic skills and evidence drawn from the latest online tools, readers, public sources and experts, sorting fact from fiction and publishing the results.

    Their team includes the science writer and physician, Ben Goldacre, who we have featured in a previous post.

    You can read more about the initiative here.


    The Marshmallow Test Revisited 02 Nov 2012

    A recent study summarised here, offers an interesting update on the classic Marshmallow Test.

    "Coauthor Richard Aslin said that their findings remind us about how complex human behavior is. "This study is an example of both nature and nurture playing a role," he says. "We know that to some extent, temperament is clearly inherited, because infants differ in their behaviors from birth. But this experiment provides robust evidence that young children's actions are also based on rational decisions about their environment."

    The Marshmallow Study Revisited from University of Rochester on YouTube.

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    On the DSM-5 25 Oct 2012

    Often referred to as the bible of psychiatry, the Diagnostic and Statistical Manual of Psychiatry (DSM) will be published in its fifth edition in May next year, once again transforming the way in which mental illness is defined. In this series of five short essays Paul Fitzgerald takes a closer look into the DSM providing a basic introduction to some of the issues.

    Psychiatric research indicates that things are more complicated than the manual leads us to believe. In reality, many diagnostic categories overlap. Over the years, many new diagnostic categories have been proposed. As a consequence, many individuals now fit several diagnostic labels. Should their different disorders all be treated separately, or at the same time?

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    Debating Free Will 25 Oct 2012

    Earlier this year Harvard's Mind, Brain, and Behavior Initiative hosted a fascinating discussion/freewill/) between Dan Dennett, Josh Greene and Steven Pinker on the topic of free will . Be sure to check out some of the other talks on the website.

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    Why do children hide by covering their eyes? 25 Oct 2012

    Children often think they're hiding when covering their eyes. Researchers at the University of Cambridge attempt to find out why. Be sure to read the rest - it's really interesting.

    Now things get a little complicated. In both studies so far, when the children thought they were invisible by virtue of their eyes being covered, they nonetheless agreed that their head and their body were visible. They seemed to be making a distinction between their "self" that was hidden, and their body, which was still visible. Taken together with the fact that it was the concealment of the eyes that seemed to be the crucial factor for feeling hidden, the researchers wondered if their invisibility beliefs were based around the idea that there must be eye contact between two people - a meeting of gazes - for them to see each other (or at least, to see their "selves").


    An Autodidact's Dream 08 Oct 2012

    Here is a list of courses run by Coursera which may be of interest to some of you. For those of you who don't know, Coursera is a new elearning initiative involving a number of American Universities offering high quality introductory courses in a number of fascinating subjects.

    The Marshmallow Test 07 Oct 2012

    In this popular test, several kids wrestle with waiting to eat a marshmallow in hopes of a bigger prize. This video is a good illustration of temptation and the hope in future rewards. This experiment is based on many previous and similar scientific tests.

    The Marshmallow Test from Igniter Media on Vimeo.