“Kids can impulsively run into the street. They can hit another student in line at school. They can climb up on the roof and jump off, hoping to fly like Superman,” said Terry Matlen, ACSW, a psychotherapist and author of Survival Tips for Women with AD/HD.

And they can have tantrums. There are many reasons why kids with ADHD have meltdowns. For instance, “for many children with ADHD there is no internal understanding of ‘later.’ It’s now or now,” Matlen said. They have a hard time putting their wants and needs on hold. Because they’re kids, they’ve also yet to learn how to calm themselves or express their needs and emotions appropriately, she said.

“A little disappointment becomes the end of the world and nothing seems to stop the child from, what looks like, obsessing over their intense needs of that moment.”

They also might feel overwhelmed by external events, such as “too much noise or excitement at a party… Combined, these symptoms make it very hard to stay calm when under stress or when they feel fearful or anxious.”

When your child has a tantrum, especially in public, it can be tough to know how to respond. Some parents vacillate from one extreme to another, from placating their child and giving in to punishing them and getting angry, according to Matlen.

But while it might seem impossible, you can navigate the rocky road of tantrums. Here are expert strategies to prevent tantrums or tame them when they start.

1. Pinpoint the source.

Psychotherapist Stephanie Sarkis, Ph.D, suggested looking “at what might be triggering your child’s behaviors.” When you can find the source of the behavior, she said, you can make strides toward changing it.

Knowing what triggers your child, Matlen said, can help you defuse their tantrum as early as possible. For instance, is your child hungry? Are they sleep-deprived? Are they experiencing strong emotions? Once you pinpoint the underlying problem try to solve it, she said.

This also is a good tool for preventing tantrums. For instance, if your child can’t handle the overstimulating environment of a local fair, just don’t take them, Matlen said.

2. Explain consequences in advance.

Before a tantrum ever starts, Matlen suggested talking to your child about the negative consequences of bad behaviors. She gave this example: “If you scream and cry when I turn off the TV, you won’t be able to watch it later today.”

Matlen took this approach when her daughter was 5 years old. She tended to have tantrums when she didn’t get a new toy at the store. “Before our next outing, I told her that if she had a tantrum, I would simply pick her up and take her home. No toys and no more visits to the store for a very long time.”

Her daughter still had a meltdown. But instead of getting furious or frustrated, Matlen picked up her daughter and took her to the car. She drove home without saying a word. And it never happened again.

“This, of course, may not work for all children, but it’s an example of planning ahead and having an outcome that everyone understands.”

3. Talk to your child, and encourage them to talk back.

Talk calmly and quietly to your child, and acknowledge their feelings, Matlen said. Doing so helps your child feel heard, Sarkis said.

For instance, according to Matlen, you might say, “I know you’re angry that I won’t buy you that toy today. It feels frustrating and it makes you feel like exploding inside, doesn’t it?”

Then, encourage your child to express their emotions, as well: “I’d be awfully upset too if I couldn’t get what I wanted right now — let’s talk about why this is so important to you so you can help me to understand.”

4. Distract your child.

For younger kids, distraction may work, Matlen said. “Talk about something completely different, like how excited you are to watch the TV show you planned, when you all get home.”

5. Give them a time-out.

“Sometimes, nothing seems to work, though, and a child will not stop no matter what you try,” Matlen said. When that happens, calmly explain that they’ll need to go to their room. They can come out after they’ve calmed down. This is a powerful way to learn self-soothing behaviors, she said. Because of that, it’s important to keep objects that promote healthy coping, such as a teddy bear or fidget toys, she added.

6. Ignore the tantrum.

“Sometimes the best reaction to a tantrum is no reaction,” said Sarkis, author of several books on ADHD, including Making the Grade with ADD: A Student’s Guide to Succeeding in College with Attention Deficit Disorder. That’s because “even negative attention is attention, and it gives a ‘payoff’ for the behavior.” So not giving your child an “audience” might help to lessen the length of the tantrum.

If your child has a tantrum in the middle of the store – and it’s not crowded – let them have the tantrum, Sarkis said. “You may get looks from others. It’s OK. Just remember that not paying attention to the behavior helps extinguish it.”

7. Give them reminders.

According to both experts, kids with ADHD have a hard time with transitions. They can have a meltdown when it’s time to leave the playground or stop playing their videogame to have dinner, Matlen said. “Things that are pleasurable are hard to stop, especially when the transition is into an activity they might not enjoy.”

This is when reminders are key. For instance, remind your child at 30, 15, 10 and 5-minute intervals that dinner is ready, Matlen said. Also, establish appropriate consequences if they don’t comply, such as not playing videogames after dinner, or playing them for 15 minutes instead of 30 next time, she said. (Or just ban videogames before dinner altogether, she said.)

Matlen gave this example of what to say to your child: “I know it’s hard for you to stop playing your PlayStation when it’s time for dinner. I will give you reminders so that you can wind down. However, having a tantrum is not acceptable, so if that happens, you will (fill in the blank).”

8. Praise your child when they do show self-control.

“Parents need to catch their kids being good much more than they catch them being ‘bad,’” Sarkis said. “Children with ADHD respond well to positive reinforcement.” Plus, “whatever you focus on grows,” she added.

According to Matlen, instead of saying, “You are such a good boy for not having a meltdown when I said no to ice cream,” a better response would be, “You must have really felt proud of yourself that you didn’t have a tantrum when you saw that we were out of cookies – good job!”

9. Avoid corporal punishment.

“It’s a normal reaction to get angry when a parent sees his or her child flat out on the floor lashing out, kicking and screaming,” Matlen said. You might grab your child or even spank them. But this only fuels the negative situation and everyone’s emotions, she said. “Corporal punishment may defuse the behavior temporarily – though usually, it only escalates the negative behavior – but it also sets the tone that it’s OK to hit people when you’re angry.” Also, a child needs to “get himself in control.”

Dealing with tantrums is difficult. But by planning ahead, staying calm and applying specific strategies, you can defuse them. And if the tantrum doesn’t quiet, try to ride it out.

I communicated with Dr. Hudak recently, to clarify some questions, get his take on some extrapolations of anxiety and even to inquire about an interesting diagnostic title he proposed in his presentation.

Conference breakout workshops, be they NAMI or just about any organization, can never do justice to a topic in the short time allotted, but it is always good to get a small group together to at least begin a dialogue.

In his session, Dr. Hudak defined anxiety, reviewed the disorders as classified by the old and up-and-coming Diagnostic and Statistical Manual (DSM), discussed when and how to treat anxiety, and addressed referral concerns. Most of the content described herein is directly from his slide presentation, combined with quotes from my interview with him.

Interestingly, anxiety is “the only psychiatric symptom that is also experienced by individuals with no psychopathology.” Think about what that means. It can be found in normal emotion, or in psychiatric illness. But it can show up as “secondary to a medical or psychiatric illness, or as a primary symptom of a medical illness.” There are two states– not just psychological but also physiological — and four components — somatic, emotional, cognitive, and behavioral.

It is hardly a secret that even mild anxiety can show up in our bodies. The onset of hives for me during teen years, personally, was definitely emotionally-based, no matter how physically those deep red welts marred my arms. And as the emotional and behavioral components of anxiety are “givens,” in a sense, I asked Dr. Hudak to elaborate a bit on some of the cognitive components that might surface.

“The main one is an inability to concentrate or an inability to focus or pay attention,” he replied. “People sometimes complain to me that they feel like they have ADHD because their concentration is so bad.”

Due to internal family conversations that I have witnessed and been a part of at NAMI groups, though, I was thinking along the lines of more severe cognitive impairment even if acutely, as in stress-induced psychotic symptoms, disorganized thinking in how one presents to others, disassociation, or any manipulative behavior.

Given a chance to respond further, Dr. Hudak explained that “diistorted thoughts absolutely occur secondary to anxiety.” He gave the example of a mother who may not let ever her kids leave the house due to fear that they might get into a car accident and die.

“If they do leave, they may be required to check in every few minutes to ensure her they have not died, which most people would consider very extreme.” He goes on to say that “cognitive restructuring (in order to get her to realize that the chances of this happening are extremely unlikely and her reactions are extreme) is a part of the treatment, but only part. Simply doing that alone won’t work. Other behavioral methods are needed as well.”

As for stress induced psychotic-like symptoms, Dr. Hudak felt them “extremely rare” (but I know many family members through NAMI who might disagree!) Most important, as stressed in his workshop, “anxiety is expressed in a wide variety of ways by different individuals.”

The outgoing DSM has obsessive-compulsive disorder (OCD) as an anxiety disorder, but it will apparently be given its own weighted place elsewhere in the new one. Anxiety Disorder NOS (Not Otherwise Specified) will still be there, though, and Dr. Hudak curiously had it labeled “Hudak’s Syndrome.”

“This is a joke I tell to drive home a point. Every major psychiatric category has a NOS category which is generally used as a wastebasket term, for symptoms that don’t appear to be a diagnosable psychiatric condition…. I don’t feel it is a wastebasket term but is an actual separate illness that people can have, and to emphasize that it is different from generalized anxiety disorder.”

He goes on to say that he has certainly heard others comment, as well, that anxiety NOS is an actual illness and not just an NOS category.

His presentation gives an integrated approach for the treatment of all anxiety disorders, with consideration of medications and behavioral therapy, yet he definitely feels, as most, that “cognitive-behavioral therapies are the only ones shown to be effective for anxiety disorders.” These include specific physical techniques to help people cope with anxiety, as well as cognitive ones, such as self-record keeping and progress-tracking. “Thinking skills” also help individuals face situations that cause anxiety.

In his presentation, Dr. Hudak covered panic attacks in depth. I found it interesting to note that he included explaining the harmlessness of panic attacks as a specific, disarming therapeutic technique to be included in treatment.

A thorough look at the latest medications, and the symptoms they best treat, was given via his slide lecture. Some interesting points definitely stood out. He mentions FLAMS (Frontal Lobe Amotivational Syndrome) as a potential severe side effect of SSRI meds. Individuals being treated with these may “feel apathetic and emotionless…. very difficult to treat.”

“Exposure with Response Prevention” was one of Dr. Hudak’s slides and topics. This “teaches people that the physical symptoms of anxiety are normal and OK.” In treatment, a careful attempt to try to raise the heart rate will take place (by doing triggering behaviors and mechanisms).

Dual diagnosis — mental illness and co-occurring substance abuse — is a problem for many. Whether attending AA or NA, or on a treatment with an agonist like suboxone, it has been documented that acute anxiety is one of the most common co-occurring conditions with these patients.

Dr. Hudak feels that the the best way to determine the cause of the anxiety in these circumstances is to get patients sober. Nevertheless, anxiety can and will present in myriad forms, for myriad people, as is clearly pointed by his research and effective presentation.

An effective workbook is referenced in Dr. Hudak’s material — Mastery of Your Anxiety and Worry, by Zinbarg, Craske and Barlow, as well as some local resources for OCD, one of Dr. Hudak’s specialties.

Couples commonly talk about feeling unsupported by their partners in the things that are important to them – longing to feel that their spouse is their friend. Lack of support often is seen by the hurt spouse as caused by the other’s selfishness, or lack of caring or empathy.

Though this may be what is going on with some couples, selfish behavior or lack of empathy frequently is caused by hidden hurt and resentment tied to longstanding unresolved marital issues. When hurt and resentment masquerade as selfishness, the prognosis can be hopeful for some couples. Addressing and repairing past conflicts directly in the context of therapy often allows the flow of love in the marriage to be restored.

Nancy had left her career to become a full-time mom. Years later, as she re-entered the work force, she felt liberated and excited, reclaiming a part of herself that had been dormant for years. Joseph had trouble sharing in Nancy’s excitement over her job prospects. In spite of their financial stability, he seemed curiously hung up on how much money she’d be earning and whether he thought the job was a worthwhile use of time. When Joseph couldn’t be happy for her and let her be free, it compounded Nancy’s ongoing feeling that he didn’t really care about her, and she became increasingly hopeless about their marriage.

Impasse Despite Improved Communication and Relational Skills

Joseph was a caring person and loved Nancy but even when he felt supportive of her, or others, he had difficulty expressing feelings and empathy – finding it unnatural, awkward and risky. In therapy, Joseph worked on developing better empathic skills and communication. He focused on improving his ability to tune in to his wife’s feelings and respond to them, for example, noticing her feelings instead of reacting from his own point of view as if the job opportunity was his.

Joseph learned how to express empathy, which dramatically improved his relationship with his children, but this work in therapy did not resolve the impasse in his marriage. Though his behavior and communication was better, Nancy still did not feel he was truly connected with her. It was as if he were going through the motions, but it didn’t reach her and didn’t feel real. Feeling unsupported, empty and alone, she began to conclude that maybe he was incapable of authentic connection.

Unconscious Emotional Barriers at Play

When lack of support and empathy are symptoms of an underlying conflict, improving communication skills and “emotional intelligence” is not the solution alone. In these cases, an unconscious emotional barrier will continue to reveal itself and defeat practical solutions until it is tackled. The roadblock and its cause must be confronted directly and understood, releasing the couple from its hold and allowing tenderness and connection to be restored. Healing occurs as rigid assumptions are relinquished, and replaced by empathic understanding of one another in real time.

Focusing on the here and now helps individuals become aware of their negative thoughts, acknowledge them without judgment and realize they’re not accurate reflections of reality, writes author William Marchand, M.D., in his comprehensive book Depression and Bipolar Disorder: Your Guide to Recovery. In it, Dr. Marchand recounts the benefits of mindfulness interventions and provides in-depth information about other psychotherapeutic and pharmacological treatments.

Through mindfulness, individuals start to see their thoughts as less powerful. These distorted thoughts – such as “I always make mistakes” or “I’m a horrible person” – start to hold less weight. In his book Marchand describes it as “watching ourselves think. We ‘experience’ thoughts and other sensations, but we aren’t carried away by them. We just watch them come and go.”

Mindfulness-based cognitive therapy (MBCT) is a group therapy that combines mindfulness principles with cognitive therapy to help prevent relapse in depression. It’s based on mindfulness-based stress reduction (MBSR), a program developed by Dr. Jon Kabat-Zinn. MBSR includes mindfulness tools, such as meditation, a body scan and hatha yoga, along with education about stress and assertiveness, according to Marchand. (Learn more here.)

MBCT teaches individuals to detach from distorted and negative thinking patterns, which can trigger the return of depression. (Learn more here.)

Studies have suggested that MBCT is a valuable intervention for depression. This recent meta-analysis found that MBCT was highly effective in reducing relapse for major depression. This study found that it was beneficial for individuals currently struggling with depression.

Getting professional treatment for depression is vital. But there are complementary mindfulness practices readers can try on their own. Marchand shared his suggestions below.

Mindfulness Meditation

“Mindfulness meditation is essentially training one’s attention to maintain focus and avoid mind wandering,” said Marchand, also a mindfulness-based cognitive therapy provider who practices meditation in the Soto Zen tradition. “Strengthening one’s ability to focus attention can help with concentration and memory.”

If you’re new to meditation, Marchand suggested carving out 10 to 15 minutes to meditate on most days. Specifically, “sit in a comfortable position and focus attention on the physical sensations of the breath.” Your mind will probably wander. That’s completely normal, he said. Simply refocus your attention back to your breath.

Psychotherapist and meditation teacher Tara Brach, Ph.D, has a number of guided meditations on her website.

Mindfulness in Daily Activities

Whether you’re eating, showering or getting dressed, you can practice mindfulness while doing any activity, according to Marchand, also a clinical associate professor of psychiatry at the University of Utah School of Medicine. The key is to focus on your physical sensations, such as “sight, taste, touch and smell.” Focus on the moment, instead of the past or future, he said.

Marchand suggested applying mindfulness to one activity every day. Again, you can be mindful with any task or action, such as brushing your teeth, having dessert or washing the dishes.

For instance, if you’re eating mindfully, minimize your distractions – such as watching TV or working on your computer – slow down your pace and pay attention to the taste, texture and aroma of your food.

Another option is to take a mindful walk, which also is helpful because it includes exercise, “an important component of healing.”

Mindfulness is a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.

Additional Resources

In his book, Marchand suggests additional self-help resources on mindfulness. These are:

• Books by Jon Kabat-Zinn: Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress; Coming to Our Senses: Healing Ourselves Through Mindfulness; and Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life.
• The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness by Mark Williams, John Teasdale and Zindel Segal.

This month we’re pleased to present our interview with Linda Hatch, Ph.D, a clinical psychologist who pens the popular blog “The Impact of Sex Addiction” on Psych Central. Hatch is a certified sex addiction therapist in private practice in Santa Barbara, Calif. There, she specializes in treating sex addicts and sex offenders, along with their partners and families.

Throughout her career, Hatch has worked with both adult and juvenile sex offenders, mentally disordered offenders and sexually violent predators in and outside of the courts and prison system. She also has consulted with the Superior Court, the Probation Department, the Board of Prison Terms, and the State Department of Mental Health, providing forensic assessment and expert testimony.

Hatch is the author of the book Living with a Sex Addict: The Basics from Crisis to Recovery. You can learn more about Linda Hatch at www.sexaddictionscounseling.com, where she also blogs about sex addiction.

1. What’s surprised you the most about being a therapist?

I guess it’s that after the 40 or so years I’ve been a clinical psychologist I continue to find it endlessly interesting. It is as though the work and I have gone through many changes over time and I have evolved along with those changes. I have done so many different things: teaching, research, student counseling, child psychology, crisis intervention and forensic psychology.

In the last five years I have gained a whole new specialty in sex addiction, which has revitalized my professional life yet again. I had wanted to be a therapist from a young age but I did not know how much my work as a therapist, and lately as a writer, would be continuously intertwined with my own emotional growth.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy?

I recently read Chemical Dependency and Intimacy Dysfunction edited by Eli Coleman PhD. It’s a superb collection of articles about every aspect of the relationship between chemical dependency and human sexuality. What interests me so much about it is that it is, in part, a foundational attempt to look at common roots of chemical dependency and sex as a drug of abuse in terms of family dysfunction.

The book is truly comprehensive and holds up extremely well, dealing with every possible aspect of addiction and relationships including attachment issues, addiction interaction, codependency, boundaries, communication, shame and so on.

3. What’s the biggest myth about therapy?

I think people are sometimes too trusting of clinicians simply because the clinician has the right credentials. Therapy is a craft and not everyone is equally good at it because they had the same training. Also, not every therapist is right for every patient.

Patients need to be empowered to judge for themselves whether a therapist is someone they have confidence in. This is hard because therapy clients are usually grappling with some emotionally difficult problems and often tend to be less critical and more trusting than they would otherwise be.

4. What seems to be the biggest obstacle for clients in therapy?

For addicts it is fear—fear of the therapy relationship itself, of being open and vulnerable with another person. Addicts often have early attachment problems, which make them mistrustful of letting anyone know them. It can be an extremely uncomfortable situation for many clients.

5. What’s the most challenging part about being a therapist?

In treating sex addicts it is the fact that it is often very hard for the client to establish and/or maintain abstinence from their particular addictive acting out behavior. As a sex addiction therapist, I am torn between imposing a task oriented treatment protocol that we know works, while still allowing for the fact that everyone does recovery in their own way and in their own time.

Clients need a lot of support and structure to do what they need to do but also permission to do things in the way that they are capable of doing them given their unique set of strengths and obstacles.

6. What do you love about being a therapist?

I love that therapy has a lot in common with mindfulness practice. It involves being present, being authentic and using all parts of my mind and intuition. I love that therapy is a process that can never be completely duplicated by having the client read a book. In psychology the problems are relational in origin and ultimately relational in the recovery process.

7. What’s the best advice you can offer to readers on leading a meaningful life?

For me meaning comes out of the struggle to overcome suffering and liberate ourselves from obstacles to fulfillment. Meaning comes as we successfully navigate the challenges of each life passage. And ultimately meaning comes from bringing our knowledge and ideas to others. We cannot do everything we dream of doing but we can do the things that we can do; we can use our gifts.

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?

I feel like I was destined to be a clinical psychologist. I have always been fascinated by the human mind—I think I inherited this from my parents. I was raised on Jung, Freud, Perls and other early therapists. I majored in philosophy as an undergraduate and found out later that I have an uncle who is a philosophy professor.

Much later after becoming a psychologist, I connected with another uncle whom I had never met only to find out he was a clinical psychologist! If I were starting out today I think I would be drawn to neuropsychology to a greater extent, as that seems to be the new frontier at this point in history.

9. If there’s one thing you wished your clients or patients knew about treatment or mental illness, what would it be?

I think clients don’t realize how much change is possible from even the smallest shifts in awareness. Therapy is often in the very subtle changes in perception, which allow for big changes in functioning and self-concept. A little change makes a big difference.

10. What personally do you do to cope with stress in your life?

I am fortunate to have a very low stress life right now. I believe that being in recovery myself has made all the difference, but also luck. I do what I enjoy, I am happily married, live in abundance and have meaningful relationships. Being very mildly cyclothymic myself (it runs in my family), I need to keep my everyday life balanced and grounded. Spiritual reading and meditation helps in this.

It is widely believed that the Beats led to the hippies of the 60s and contributed to changing societal views towards drugs, sex, the arts, and more. When people debate about legalizing marijuana or same-sex marriage today, they can trace such ideas back to the Beats. In their book Mania, authors Ronald K.L. Collins and David M. Skover examine the lives of those men referred to as the Beats and how these fascinating individuals left an indelible mark on our culture.

Collins and Skover explicitly state that in this work they “seek neither to demonize nor apologize for Ginsberg and his cohorts.” That is, the authors aim to present the Beats in an honest way, without necessarily glorifying some of the more contentious aspects of the group members’ lives. In certain ways, the book emulates the writing of the Beats themselves; the stories are raw, without any sugarcoating of the alcohol, drugs, or sex that permeated the scene of these counter-cultural icons.

By the end, the reader feels that they have journeyed across the country with Kerouac, Ginsberg, and the entire cast of “angelheaded hipsters.”

While the Beat Generation was undoubtedly an influential movement in our history, one might wonder why a book about this group is being featured on a mental health website. In fact, the field of psychiatry and mental health were prominent themes in the lives and writing of many members of the Beats.

Allen Ginsberg was once a patient at the Columbia Presbyterian Psychiatric Institute and much is told in Mania about the relationship he formed with writer Carl Solomon while they were both there receiving psychiatric care. Jack Kerouac as well was sent to a psychiatric ward while he served in the Navy. One of Kerouac’s more famous quotes is the line from On the Road that begins “The only people for me are the mad ones…”

In these stories of what authorities in the 40s and 50s deemed “madness,” we can catch a glimpse of the history of psychiatric treatment. While it is hard and perhaps inappropriate to speculate as to whether or not these famous men suffered from mental illnesses, it seems that their nonconformity to society’s norms certainly played a role in their hospitalization. For instance, Ginsberg’s homosexual behavior was cited as one of the reasons for his need of care, whereas nowadays this would not be the case. Much of what may have seemed shocking in their day would seem to be to be normal or commonplace to most people today.

The authors utilize Ginsberg’s famous poem “Howl” as a focal point of the book. Perhaps the most well-known work of the Beats (it shares its title with a 2010 film about Ginsberg starring James Franco), its opening lines echo its writer’s experience with emotional distress: I saw the best minds of my generation destroyed by madness.

With graphic imagery and stark language, the poem typifies the Beat ethos of presenting life exactly as one sees it, with no holding back. As Collins and Skover put it, this poem represents when Ginsberg “turned his inner madness outward.” The book also goes into detail regarding the famous obscenity trial over the poem. Through this legal battle, the reader sees how the Beats influenced the very definition of art in modern times.

Whatever one thinks of the Beats and their writing, there is no denying that they had a major influence on our society: Artists from Bob Dylan to the Beatles have commented on the inspiration they drew from this group. Mania offers an intriguing look at the Beat Generation, even for readers who may be unfamiliar with these compelling icons. Meanwhile, for those who may be well versed in the history of the counter-cultural movement, the book provides a great deal of new insight. And although the book is not meant as a history of mental health care, it serves as a fascinating look at what was considered psychologically “abnormal” just half a century ago.

Mania
Top Five Books, March, 2013
Hardcover, 464 pages
$26.00 

Fortunately, key strategies can reduce and improve these symptoms. “The most important strategy is definitive treatment for the depression with psychotherapy and medication,” said William Marchand, M.D., a clinical associate professor of psychiatry at the University of Utah School of Medicine and author of the book Depression and Bipolar Disorder: Your Guide to Recovery.

For instance, psychotherapy helps individuals become more aware of their cognitive symptoms, which can be subtle, Dr. Marchand said. It also teaches individuals specific techniques to improve their symptoms. And it helps clients gain a more accurate perspective on their illness.

“Because of the negative thinking associated with depression, there is a tendency to interpret symptoms as personal failings rather than as symptoms of an illness. A therapist can help one see things as they are – rather than through the distorting lens of depression,” Marchand said.

In addition to professional treatment, there are many strategies you can practice on your own to improve cognitive symptoms. Below are several techniques you can try.

Revise Distorted Thoughts

“I think it’s vital to teach any depressed individual how to ‘think happy,’” Serani said. Revising problematic thought patterns is key because they only fuel the fog and despair of depression.

“This approach definitely takes some time, patience and elbow grease, but once [it’s] learned, [it] enhances well-being.”

The first step is to monitor your negative thoughts, which you can record in a journal. A negative thought is anything such as “I’m a total loser” or “I can’t do anything right,” she said.

It’s also important to focus on how a negative thought affects your mood. By and large, it derails it. “Generally, [negative thoughts] will worsen mood, decrease hope and lower self-esteem.”

Next, challenge the reality of your thought, and replace it with a healthier one. Serani gave the following example: “Am I really a loser? Do I really do everything wrong? Actually, I get a lot of things right in life. So I’m not really a loser.”

Finally, review how each realistic thought affects your mood. According to Serani, it “leads to a healthier frame of mind. Now this new, healthy thought replaces the negative one and shifts mood into a less depressive place.”

Use Your Senses

“For helping with executive functioning skills for memory, focus and decision-making, I always recommend using your sense of sight, hearing and touch,” Serani said.

Technology can be especially helpful. For instance, you can set reminders for taking medication, attending therapy and running errands on your smart phone, computer or tablet.

If you don’t have access to technology or prefer pen and paper, Serani suggested placing brightly colored notes with reminders around your home and office. “Using touch to write will track the task more deeply into your memory and the visual cue to ‘see’ the reminder will help you keep your focus.”

Your sense of touch also can help when making a decision, said Serani, who uses this technique herself, “especially if I’m struggling with a significant melancholic mood.” She suggested a grounding practice, which “helps you be in the moment”: Place your hand on your heart, take a deep, slow breath and ask yourself the question you need to know. “Slowing things down and focusing on your sense of self can better help you make decisions.”

Take Small Steps

“Depression has a way of taxing you physical[ly], emotional[ly] and intellectual[ly], so taking smaller steps will help keep your energy reserve from burning out,” Serani said. Break down longer, more complicated tasks into bite-sized steps. This helps you “rest, refuel and re-attend [to your task].”

Have A Cushion

Therese Borchard, a mental health blogger and author of the book Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes, also struggles with cognitive symptoms from time to time. Whenever possible, she reduces her workload. “I’ve always prepared for days like that by working a little harder on the days I feel good, so I have a little cushion.”

Take Breaks

Because depression is so taxing on your brain and body, taking breaks can help. When she’s working, Borchard takes breaks every two hours, or “every hour if I’m really struggling.” Your breaks might include stretching your body or taking a walk around the block.

Be Kind To Yourself

“One of the most important things to do is remember not to be too hard on yourself if you still find you’re forgetful, have trouble focusing or making decisions,” Serani said. “Remember that you are experiencing a real illness.” Blaming yourself and losing patience only adds “to your already full plate.”

As Borchard noted in this piece on working from home with a mental illness, “When I was in the midst of my most severe depression, I couldn’t write at all. For almost a year…I try to remember that when I have a bad day where my brain feels like silly putty and I am not able to string two words together. I try to remember that courage isn’t doing a heroic thing, but getting up day after day and trying again.”

Goldstein describes mindfulness as “paying attention to something on purpose and with fresh eyes.” This is why mindfulness is so helpful. Instead of focusing on how badly we want the pain to stop, we pay attention to our pain with curiosity and without judgment.

This approach is very different from what our brains naturally do when we experience the physiological sensation of pain. Our minds typically launch into a litany of judgments and negative thoughts. According to Goldstein, we start ruminating about how much we hate the pain and want to wish it away. “We judge the pain, and that only makes it worse.” In fact, our negative thoughts and judgments not only exacerbate the pain, they also fuel anxiety and depression, he said.

What also makes matters worse is that our minds start brainstorming ways to soothe the pain. Goldstein likens this to the Roomba, a robot vacuum. If you trap the Roomba, it just keeps bouncing off the edges. Our brains do the same with scouring for solutions. This “creates a lot of frustration, stress and feeling trapped.”

Mindfulness teaches people with chronic pain to be curious about the intensity of their pain, instead of letting their minds jump into thoughts like “This is awful,” said Goldstein, also author of The Now Effect: How This Moment Can Change The Rest of Your Life and co-author of A Mindfulness-Based Stress Reduction Workbook.

It also teaches individuals to let go of goals and expectations. When you expect something will ease your pain, and it doesn’t or not as much as you’d like, your mind goes into alarm- or solution-mode, he said. You start thinking thoughts like “nothing ever works.”

“What we want to do as best as we can is to engage with the pain just as it is.” It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently, he said.

Goldstein called it a learning mindset, as opposed to an achievement-oriented mindset. In other words, as you’re applying mindfulness to your pain, you might consider your experience, and ask yourself: “What can I learn about this pain? What do I notice?”

As Jon Kabat-Zinn, Ph.D, writes in the introduction of The Mindfulness Solution to Pain, “From the perspective of mindfulness, nothing needs fixing. Nothing needs to be forced to stop, or change, or go away.”

Kabat-Zinn actually founded an effective program called mindfulness-based stress reduction (MBSR) in 1979. While today it helps individuals with all sorts of concerns, such as stress, sleep problems, anxiety and high blood pressure, it was originally created to help chronic pain patients.

“In MBSR, we emphasize that awareness and thinking are very different capacities. Both, of course, are extremely potent and valuable, but from the perspective of mindfulness, it is awareness that is healing, rather than mere thinking…Also, it is only awareness itself that can balance out all of our various inflammations of thought and the emotional agitations and distortions that accompany the frequent storms that blow through the mind, especially in the face of a chronic pain condition,” Kabat-Zinn writes in the book.

Mindfulness provides a more accurate perception of pain, according to Goldstein. For instance, you might think that you’re in pain all day. But bringing awareness to your pain might reveal that it actually peaks, valleys and completely subsides. One of Goldstein’s clients believed that his pain was constant throughout the day. But when he examined his pain, he realized it hits him about six times a day. This helped to lift his frustration and anxiety.

If you’re struggling with chronic pain, Goldstein suggested these mindfulness-based strategies. He also stressed the importance of paying attention to what works for you and what doesn’t.

Body Scan

A body scan, which also is included in MBSR, involves bringing awareness to each body part. “You’re bringing attention to what the brain wants to move away from,” Goldstein said. However, instead of immediately reacting to your pain, the body scan teaches “your brain the experience that it can actually be with what’s there.”

You’ll find helpful videos with a three-, five- and 10-minute body scan on Goldstein’s website.

Breathing

When “pain arises, the brain reacts automatically,” with thoughts, such as “I hate this, what am I going to do?” Goldstein said. Though you can’t stop these first few negative thoughts, you can calm your mind and “ground your breath.”

Goldstein suggested simply breathing in slowly and saying to yourself “In,” and breathing out slowly and saying “Out.” Then you also might ask yourself, “What’s most important for me to pay attention to now?”

Distractions

A distraction can be a helpful tool when your pain is high (such as anything above an 8 on a 10-point scale), Goldstein said. The key is to pick a healthy distraction. For instance, it could be anything from playing a game on your iPad to focusing on a conversation with a friend to getting lost in a book, he said.

Mindfulness is an effective practice for approaching chronic pain. It teaches individuals to observe their pain, and be curious about it. And, while counterintuitive, it’s this very act of paying attention that can help your pain.

Both parents need to nurture children. Healthy parenting helps the grown child be his or her own best mother and father. A child must not only feel loved, but also that he or she is understood and valued by both parents as a separate, unique individual and that both parents want a relationship with him or her. Although we have many needs, I’m focusing on nurturing emotional needs.

Emotional Needs

In addition to physical nourishment, including gentle touch, care, and food, emotional nurturing consists of meeting a child’s emotional needs. These include:

• Love
• Play
• Respect
• Encouragement
• Understanding
• Acceptance
• Empathy
• Comfort
• Reliability
• Guidance
• The importance of empathy

A child’s thoughts and feelings need to be taken seriously and listened to with respect and understanding. One way of communicating this is by mirroring or reflecting back what he or she is saying. “You’re angry that it’s time to stop playing now.” Instead of judgment (“you shouldn’t be jealous of Cindy’s new friend”), a child needs acceptance and empathic understanding, such as: “I know you’re hurt and feel left out by Cindy and her friend.”

Empathy is deeper than intellectual understanding. It’s identification at an emotional level with what the child feels and needs. Of course, it’s equally important that a parent appropriately meets those needs, including giving comfort in moments of distress.

Accurate empathy is important for children to feel understood and accepted. Otherwise, they may feel alone, abandoned, and not loved for who they are, but only for what their parents want to see. Many parents unwittingly harm their children by denying, ignoring, or shaming their child’s needs, actions, and expressions of thoughts or feelings. Simply saying, “How could you do that?” may be felt as shaming or humiliating. Responding to a child’s tears with laughter, or “That’s nothing to cry about,” or “You shouldn’t be (or ‘Don’t be’) sad,” are forms of denying and shaming a child’s natural feelings.

Even parents who have sympathetic intentions may be preoccupied or misunderstand and misattuned to their child. With enough repetitions, a child learns to deny and dishonor natural feelings and needs and to believe that he or she is unloved or inadequate.

Good parents are also reliable and protective. They keep promises and commitments, provide nourishing food and medical and dental care. They protect their child from anyone who threatens or harms him or her.

Tips for Self-Love & Self-Nurturing

Once grown, you still have these emotional needs. Self-love means meeting them. If fact, it’s each person’s responsibility to be his or her own parent and meet these emotional needs, irrespective of whether you’re in a relationship. Of course, there are times you need support, touch, understanding, and encouragement from others. However, the more you practice self-nurturing, the better your relationships will be.

All of the things a good mother does, you have the superior capacity to do, for who knows your deepest feelings and needs better than you?

Here are some steps you can take:

• When you have uncomfortable feelings, put your hand on your chest, and say aloud, “You’re (or I’m) ____.” (e.g., angry, sad, afraid, lonely). This accepts and honors your feelings.
• If you have difficulty identifying your feelings, pay attention to your inner dialogue. Notice your thoughts. Do they express worry, judgment, despair, resentment, envy, hurt, or wishing? Notice your moods. Are you irritable, anxious, or blue? Try to name your specific feelings. (“Upset” isn’t a specific feeling.) Do this several times a day to increase your feeling recognition. You can find lists of hundreds of feelings online.
• Think or write about the cause or trigger for your feeling and what you need that will make you feel better. Meeting needs is good parenting.
• If you’re angry or anxious, practice yoga or martial arts, meditation, or simple breathing exercises. Slowing your breath slows your brain and calms your nervous system. Exhale 10 times making a hissing (“sss”) sound with your tongue behind your teeth. Doing something active is also ideal for releasing anger.
• Practice giving yourself comfort: Write a supportive letter to yourself, expressing what an ideal parent would say. Have a warm drink. Studies show this actually elevates your mood. Swaddle your body in a blanket or sheet like a baby. This is soothing and comforting to your body.
• Do something pleasurable, e.g., read or watch comedy, look at beauty, walk in nature, sing or dance, create something, or stroke your skin. Pleasure releases chemicals in the brain that counterbalance pain, stress, and negative emotions. Discover what pleasures you. (To read more about the neuroscience of pleasure, read my article, “The Healing Power of Pleasure”.)
• Adults also need to play. This means doing something purposeless that fully engages you and is enjoyable for its own sake. The more active the better, i.e., play with your dog vs. walking him, sing or collect seashells vs. watching television. Play brings you into the pleasure of the moment. Doing something creative is a great way to play, but be cautious not to judge yourself. Remember the goal is enjoyment – not the finished product.
• Practice complimenting and encouraging yourself – especially when you don’t think you’re doing enough. Notice this self-judgment for what it is, and be a positive coach. Remind yourself of what you have done and allow yourself time to rest and rejuvenate.
• Forgive yourself. Good parents don’t punish children for mistakes or constantly remind them, and they don’t punish willful wrongs repeatedly. Instead, learn from mistakes and make amends when necessary.
• Keep commitments to yourself as you would anyone else. When you don’t, you’re in effect abandoning yourself. How would you feel if your parent repeatedly broke promises to you? Love yourself by demonstrating that you’re important enough to keep commitments to yourself.

A Word of Caution

Beware of self-judgment. Remember that feelings aren’t rational. Whatever you feel is okay and it’s okay if you don’t know why you feel the way you do. What is important is acceptance of your feelings and the positive actions you take to nurture yourself. Many people think, “I shouldn’t be angry (sad, afraid, depressed, etc.). This may reflect judgment they received as a child. Often it’s this unconscious self-judgment that is the cause of irritability and depression. Learn how to combat self-criticism in my ebook, “10 Steps to Self-Esteem,” available in online bookstores.

It follows a mom through her day with a little boy who appears to have some kind of developmental delay. The voice-over tells us he was in the neonatal intensive care unit for over 100 days. Now he looks somewhere between 3 and 4 years old. She makes him a peanut butter sandwich and laughs when he spills the milk. She plays with him and keeps a watchful eye while she goes about daily chores. She washes his hair as he kicks and squirms. She struggles to brush his teeth. Then there’s story time and a kiss good night. All the while, she is the epitome of patience and all smiles.

Then the ad gets real. Having tucked her little boy in, having said she wouldn’t trade him for any other kid, she has a moment alone on the front porch. In that moment we see “the look.”

Anyone who has been there knows what it means. To see it cross another’s face is to feel it in the gut. It’s the shadow that passes through in a moment of exhaustion. It’s the small piece inside that does wish, if only for a moment, that she did have another kid; one who didn’t need her every single minute of every single day.

Then she does what loving parents do: She takes a breath, remembers the blessings of being a mom to this special child, and goes in to get ready for another day and another round of constant care.

Moms, and dads with kids who are disabled or chronically ill know that look and the feelings that create it. They also know the moment that comes next: the moment of renewed commitment that is born of love and hope and determination. Raising a disabled or chronically ill child is not for sissies. If parents weren’t strong before this special child became theirs, they’ve developed strength they never knew they had in them.

Mother’s Day is almost here. Let’s all take a moment to appreciate the mothers who do everything every other mom does plus a whole lot more.

They are the moms for whom the first months of sleeplessness extend into years. They are the moms who become experts on their child’s diagnosis and therapies and education plans. They have learned to manage endless appointments with medical specialists and endless meetings with educational experts. They have learned an awesome vocabulary of medical terminology, education jargon and insurance codes.

Complicated schedules and routines and star charts have become second nature. Those who have kids with special diets know how to spot dangerous ingredients in a cupcake from a hundred yards away. Those with behaviorally challenging kids can handle a tantrum while folding laundry and planning dinner. Many even find the energy to organize support groups, get involved with agencies that offer activities for their kids, and advocate for other families as well as their own.

Contrary to conventional wisdom, most of their marriages are strong. Sure, the demands on these couples are many and constant. But most do better than just cope. They succeed as partners and as parents and develop positive feelings and values about raising a child who is challenged and challenging. The birth or adoption of a child with special needs has taken their lives in unexpected directions that aren’t always pleasant but are nonetheless meaningful and important. When asked, most will say that parenting their child has made them better people.

That strength and love and commitment extends to their nondisabled kids as well. If they thought about it, they could take enormous pride in their success in raising compassionate, competent kids whose experience with their brother or sister with a difference has made them sensitive to the needs of others. Most moms don’t think about it. They are just doing what feels right and good for their families.

For mothers of children with special needs, Mother’s Day rarely means a dinner out or diamonds. A qualified babysitter is hard to find. Money is more likely to go to bills than jewelry. Often the child who made her a mother can’t understand a holiday, can’t carry a tray to give her breakfast in bed and won’t be bringing her a bunch of violets or a card made all by himself. These moms celebrate their day with their different child in a different way.

And celebrate they do. They find joy in the knowledge that they are nurturing a child’s spirit as well as her health. They take satisfaction in knowing that each accomplishment, however small it may look to others, is a major victory. Each of her child’s achievements is at least partly her own. She knows the value of her efforts and the importance of keeping a positive attitude and counting the blessings of every day.

Still, it never hurts to hear all this acknowledged. Loving words of appreciation from a partner, spouse, friend or extended family members do mean a lot. If you know such a mom, reach out this Mother’s Day and let her know that you see her for the amazing person she is. A phone call or visit or card may seem like a small thing but for a mom in the special needs trenches, it can really make her day. The support of others added to her own commitment is what makes it possible for her to take that breath and get ready for another day.

I did not read the foreword or the praise-filled blurbs in the front of the book before reading it myself, as I did not want to be swayed one way or another. Instead, I tried to dive in with a somewhat skeptical yet mostly open mind, with the knowledge of my own many failed attempts to adhere to or complete a 12-step program successfully. But when I laid the book down, after soaking up every word and working through every exercise, I thought, Finally! Someone gets it.

Sacco, an adjunct professor of psychology, pulls back all of the recovery/12-step jargon and red tape, and gets down to the bare bones of what is a “must” in order to experience freedom from addictions and habits that control one’s life. He details the core issues that have to be addressed and gives practical, real-life applications that can be implemented immediately. His plan does require an attitude of desire for a better life and a belief in a higher power, whatever or whoever that may be for you. Most important, he gives a real sense of hope, instead of a long list of tasks to complete. He suggests that choosing which aspects of recovery programs work for you, rather than making oneself abide by every single instructed step, can lead to greater success. 

This is crucial when speaking to people who have tried and failed before and want only to be successful in kicking the monster called addiction. Hope is rare in the addict’s world. And sometimes a to-do list of meetings (30 meetings in 30 days for the first month) filled with people one doesn’t know or trust can be overwhelming. It may even be the first step towards another failure if an addict isn’t ready socially or emotionally to jump into a public forum.

I am a recovering addict myself. I spent numerous years living with an overwhelming feeling of failure in regard to my attempts to get substance free. I spun my wheels, so to speak, trying to do what I was told and trying to complete the steps I was advised to complete. Unfortunately, I had neither the maturity nor the appropriate knowledge of a higher power required to make a full recovery. And the failure that occurred time and time again prevented me from realizing that I was capable to succeed in this area.

The author begins his book by explaining the foundation of his plan—the one that can supposedly help one overcome addiction and bad habits in 30 days or less. Sacco posits that three things will need to be addressed in order for true health and recovery to be attained. Together, they form the psycho-social-spiritual. Respectively, they are mental health and well-being (psycho), social well-being (social), and belief in God, a higher power, or the universe (spiritual). He shows how all three work independently, as well as how they become dependent on one another.

He breaks the book into three sections as well. The first contains the components of what an addiction is and why it continues to exist and fester. In the second, he discusses how we, individually, may contribute to the manifestation of an addiction. And third, he presents 30 days of “intentions” to work into one’s daily life. He purposely chooses the word “intentions,” as opposed to “affirmations,” he tells us. His careful choice here is to encourage “active choosing” and “powerfully expecting” outcomes. This is based on his belief that “active choosing” engages the mind to learn on one’s own terms and not be at the whim of whatever garbage flows in. And the act of “powerfully expecting” is believing something will come to pass. It demonstrates our confidence in our own beliefs and abilities, he says.

Sacco, a former private practitioner in the areas of relationships, criminal psychology, addictions and mental health, writes in a no-nonsense, straightforward manner that is easy to understand, even if one is not very fluent in psychology terminology. He acknowledges that everyone is different and that not all types of therapies or treatments work for everyone. Some of the more popular therapies for addiction  are biased, however, requiring a commitment to the so-called full process. For some, this can be a recipe for failure. The message conveyed in this book is that you can take it all or take just the parts you need, depending on where you are psychologically, socially, and spiritually.  It is a buffet of options—and, ultimately, your rate of success begins and ends with you.

After reading the book, I am no longer a skeptic. I believe this is a process that can and does work. Reading it, you will begin to understand how your past and the negatives associated with it can be what keep you stuck in the mud of misery. You will also come to understand and learn about sweet acceptance. And in the middle of all of this, you will find what you have been looking for: peace of mind.

Right Now Enough is Enough!: Overcoming Addictions and Bad Habits for Good in 30 Days or Less!
Booklocker.com, January, 2013
Paperback, 254 pages
$18.95 

The aptly-titled Things I Wish I’d Known: Cancer Caregivers Speak Out, by Deborah J. Cornwall, is a welcome resource for those struggling to help the people they love who have cancer.

My grandmother, mother, father, and wife all had cancer. My mother was a caregiver for both her mother and my dad; I helped with all four. My parents and wife recovered, though my dad was housebound and disabled for the remaining nine years of his life. 

Cornwall, meanwhile, has had her own experiences with cancer. Her mother-in-law died of breast cancer at a young age, and the author herself was diagnosed with breast cancer 33 years to the day after her mother-in-law’s death. Cornwall recovered. Her experience, she says, including extensive volunteer and consulting work with the American Cancer Society, led her to write this book. She contacted and interviewed many caregivers of persons with cancer, and created this guide to help them.

Cornwall does a good job describing what caregivers, as well as patients, go through, and what one can do to stay afloat during the grueling process. The caregivers in her book mention a void after death — but there is also a void after a successful outcome. You spend all your time and energy in the fight to overcome cancer and it becomes your center. When that fight is done, you are left seeking a new center. The people in this book share ways to do that, and to commit to living life to the fullest. Hearing it in the voices of the caregivers themselves is particularly powerful.

After old age and dementia, cancer is the third leading reason for caregiving. To that end, Cornwall quotes Rosalyn Carter: “There are only four kinds of people in this world: Those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”  No two experiences are the same, either—I know this from my own caregiving, and Cornwall knows it, too. “There are over 100 different types of cancer that can arise in nearly any part of the body,” she writes. Even people with the same type of cancer getting the same treatment may react very differently.

What can make things especially hard for both the patient and the caregiver is that many of those with cancer had no history of the illness in their family, Cornwall reports. Being diagnosed with the disease seems to be some kind of random event that hits out of nowhere. The caregivers she interviews include children, spouses/domestic partners, relatives, siblings, and friends. Those with cancer range in age from two to 90, with 40 different types of cancer, and the different caregiving paths Cornwall writes about last from a short four days to a long 23 years. About half of the patients of the caregivers she interviews had a successful remission and went on to live a cancer-free life.

The book approaches the daunting, unpredictable task of caregiving in a step-by-step way, with each step clearly explained and most often in the words of caregivers themselves. It covers all aspects of the journey, beginning with getting a clear diagnosis, which may not be easy. Problems can occur because of symptoms, such as fatigue, being attributed to other causes. This can be especially true when the person has no family history of cancer and also does not have any behaviors associated with increased risk. Many of the patients in this book never smoked and had been athletic. Cancer was just not something anyone would suspect.

Cornwall also writes about the person who may have a rare cancer that local physicians have not seen before. At times, she tells us, caregivers had to work hard and really push to get a correct diagnosis. “Working through the diagnostic tests and waiting for results was the hardest part for many caregivers,” she writes.

The book also provides testimony from caregivers on how they gathered information to help make informed decisions about treatment. This is crucial. There may be times when the patient is so distraught that they have difficulty making those decisions and need someone they love and trust to help. Choosing your treatment team is crucial, and Cornwall goes into detail. There are many factors to consider: experience with the type of cancer and outcomes, the chemistry you have with the medical staff, whether to go with a local hospital or a major cancer center, whether to get second opinions, and whether it is time to change physicians. Every decision potentially has life or death consequences. As Cornwall writes, caregivers learn the ins and outs of the medical system including privacy issues, legal issues in decision making, and especially how to advocate in a way that will be heard among medical staff.

For those who need resources, Cornwall lists them extensively. She cites patient navigators in hospitals, as well as many websites that give information on such things as free lodging when a treatment center is far away from home. Financial issues are covered as well, including insurance, prescription drugs, employment, and important record keeping. Cornwall also talks about creating a healing environment. A person does not need to be defined by their cancer. She provides guidance about what to say and how to be when you are with people with cancer and those who care for them. Since cancer can strike at any age, there is an extensive section on children and cancer—both when children are the patient and when they are in the family of a person with cancer.

A very important and sometimes overlooked aspect of caregiving is taking care of oneself. Caregiving stress can potentially take as many as ten years off the life of a caregiver, according to a study at the University of California. The people Cornwall interviews speak of many ways to self care. They also share how they dealt with the aftermath of the cancer, regardless of the outcome. If your loved one dies, there is the void, the grief, and sometimes visions of the one lost. But, again, there is a void even if the outcome is that the patient is cancer-free.

No matter what, being a caregiver means going on a very rocky journey — and Cornwall’s book is a thoughtful and excellent travel guide. It will give you ideas of how to cope and how, even in the darkest most frightening moments, to find your way to grace and resilience.

Things I Wish I’d Known: Cancer Caregivers Speak Out
Bardolf & Company, October, 2012
Paperback, 258 pages
$19.95

Ego is the bad guy here, a brimming pool of selfishness, spite, defensiveness, emptiness, and whatever negative term you want to add. We have to transcend ego to get to Spirit, which is pure happiness, Mutchler tells us. This is essentially his book’s thesis, with some explanation of the mechanisms he encourages the reader to use to get from ego to Spirit. We live in “uncertain times,” he says, and this makes us feel isolated and competitive. We look for answers outside of ourselves when we should look within and go back to where we come from — which, apparently, is Spirit.

Spirit, as defined in the book, is equivalent to pure consciousness and comes from a single source of divine energy. Ego, on the other hand, is limited consciousness, because it’s not who we are. In the author’s words, “Consequently, and over time, an ever-widening gap has developed between who we are—ego—and who we really are—Spirit. The result is a growing state of tension for humankind that makes life stressful, disconcerting, and oftentimes miserable.”

The explanation of Mutchler’s perspective begins with the Big Bang, and tries to connect quantum physics to human consciousness. There are also brief descriptions of  different types of subhuman consciousness, including material, plant, and animal, presumably meant to set the stage for human consciousness, the main topic of the book. Consciousness, however, is not something the author wants to break down. He tells us: “But remember, consciousness is purposely not defined in this discussion. To define anything is to limit and confine, and we want to do neither. We want simply to stay open to what consciousness is and let our understanding of it unfold as we work our way through its various levels of expression.”

Considering that science started with classification and definition, the above statement is a little startling.

The word ego, meanwhile, is derived from the Latin for I, and in Freudian theory was the arbiter between Id and Superego. In popular usage it refers to a heightened sense of self importance. But according to Mutchler, these are all mistaken concepts. Instead, he defined ego as a “state of consciousness.” Yet since he won’t define consciousness, we’re left without all the information we need. Is he saying that ego is consciousness, and consciousness, ego?

Whatever this ego-consciousness is, it isn’t a positive thing, he tells us in subsequent chapters. It makes us claim superiority to quell our unconscious sense of inferiority. It makes us project blame on others, and thrives on suffering and bad news. It’s judgmental, acquisitive, and entitled. It’s a jealous, envious drama queen that will do anything to survive.

In the next section, the combat between ego and Spirit takes on Manichean dimensions; it’s clearly evil versus good. Ego consciousness is likened to hell with almost unlimited destructive powers. “Collectively ego consciousness threatens to destroy mother earth and her ability to sustain us,” Mutchler writes. Love is Spirit’s weapon in dealing with the ego. In the author’s words, “ ‘Talk’ to your ego, assure it that dying isn’t necessary. It needs only to transition to another state of being….”

Being aware of ego is, Mutchler writes, the way to transition. How to do this? Look for situations where you feel upset, the author says, as ego thrives on suffering. “Each time you notice ego intruding into your thoughts, behaviors, or emotions,” he posits, “you are stepping directly into the world of Spirit.” As ego recedes, you become more open, friendly, moral, and ethical. If you spot ego in others, he says, you’re less judgmental.

The most useful part of the confused book, therapeutically speaking, focuses on how we describe our ongoing lives to ourselves. This section is very much in tune with contemporary cognitive therapy. The author states that there is a language of the ego and a language of the Spirit. Ego language is deeply ingrained and has been with us all our lives, though it is not the original cause of our suffering. This so-called ego language, Mutchler writes, “plays a large role in sustaining ego consciousness and perpetuating human suffering.” A few examples from a long list of words is “Disgrace, Regret, Shame, Worry.” Spirit language on the other hand is positive, life affirming. It includes “Peace, Joy, Happiness, Harmony.”

Awareness of our ego language and changing it is, according to the book, a major means of moving from ego to Spirit. To this end the author provides pages of judgmental adjectives and their less judgmental alternatives.

After all of this, the final section of the book, called “The Choice Is Yours,” talks about death in the style of a Hallmark condolence card.

The essential message of Beyond the Ego can be reduced to one line: Be less selfish and you’ll have a happier life. The book’s most salient aspect is the focus on language as a means of perpetuating unhappiness. But it is not a real behavioral science book, and leaves too much out.

Beyond the Ego: Where Love, Joy, and Peace of Mind Await You
Balboa Press, 2012
Paperback, 208 pages
$14.99 

Yet cognitive symptoms are quite common. “[They] are actually significantly prominent in depression,” said Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression.

And these symptoms are incredibly debilitating. “In my opinion, when cognitive symptoms of depression hit, they are more of a pressing concern than physical symptoms.”

Cognitive symptoms can interfere with all areas of a person’s life, including work, school and their relationships. Problem-solving and higher thinking, according to Serani, are greatly diminished. “This can leave a person feeling helpless and without a plan of action to defeat depression.”

Poor concentration can cause problems with communication, and indecisiveness may strain relationships, according to William Marchand, M.D., a clinical associate professor of psychiatry at the University of Utah School of Medicine and author of the book Depression and Bipolar Disorder: Your Guide to Recovery.

The cognitive symptoms of depression also may get confused with other conditions, complicating diagnosis. Here’s a specific list of symptoms along with similar disorders.

Cognitive Symptoms of Depression

“Cognitive symptoms can be subtle and often go unrecognized,” according to Dr. Marchand. Fortunately, psychotherapy can help individuals become more aware of these symptoms, such as distorted thinking, he said.

Marchand and Serani shared these cognitive symptoms of depression:

• Negative or distorted thinking
• Difficulty concentrating
• Distractibility
• Forgetfulness
• Reduced reaction time
• Memory loss
• Indecisiveness

Disorders That Mimic Depression

“The cognitive aspects of depression usually involve a person’s thinking being sluggish, negative or distorted in quality,” Serani said. However, there are many other disorders that share these similar symptoms, because they, too, inhibit cognitive function. Unfortunately, this means that the “risk for misdiagnosis is high,” she said.

For instance, Serani mentioned attention deficit hyperactivity disorder (the inattentive type), post-traumatic stress disorder and substance abuse.

Co-occurring disorders can add to the confusion. “In many cases there are comorbid conditions such as dementia (in elderly individuals), adult ADHD and generalized anxiety disorder, and it can be difficult to sort out which condition is causing the cognitive symptoms,” Marchand said.

It’s critical to receive a proper and comprehensive evaluation to make sure that you have depression or another condition. Again, psychotherapy and medication can improve cognitive symptoms along with other symptoms of depression. Also, there are many strategies you can try on your own to reduce symptoms and feel better (which are explored in another article).

1. Everyone has challenges.

Clinical psychologist Christina G. Hibbert, PsyD, wants readers to know that they’re not alone in their struggles. “We all have challenges. Even as I sit in my chair helping [a client], I have challenges too. It hurts me to see clients feeling like they’re the only ones on earth who ‘need therapy.’”

Therapist Joyce Marter, LCPC, agreed. She believes that our struggles are simply “part of the human condition…[E]verybody struggles with issues related to self-esteem, identity, navigating relationships, coping with various life traumas, managing stress or challenges in creating the life we want, personally and professionally.”

2. Everyone can benefit from therapy.

Therapy is a healthy and proactive approach to dealing with challenges, Marter said. “A therapist is like a personal trainer for your mind. I believe we can all benefit from therapy at various points in our lives and see it as a preventive and routine form of health care.”

3. Seeking therapy is courageous.

It’s a common myth that therapy is for weak people who can’t fix problems on their own. “I think of therapy as making use of all the tools at one’s disposal to manage negative emotional symptoms and maximize strengths and fulfillment,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. “People willing to delve into their own psyches are … actually quite courageous.”

4. Therapy helps you navigate life.

You can apply the skills you learn in therapy to any area of your life, according to Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression. “It really doesn’t matter if you go to therapy for anxiety, depression, to lessen obsessions, to quit smoking or to learn how to parent – whatever the reason – the techniques of self-reflection and thought-changing are involved in all.” In fact, she said, many people consider therapy to be the most meaningful and valuable experience of their lives.

5. Therapy is a process of self-discovery.

“To my thinking, therapy does not need to be an excruciating experience. Sometimes I think we do therapy itself a disservice when we call it ‘work.’ For my clients, I like to think of their therapy as a process of self-discovery, more joyous in the end than painful,” Duffy said.

6. Therapy isn’t about blaming others.

“Some people think therapy is about blaming their parents or their life histories for all of their woes,” said Marter, also owner of the counseling practice Urban Balance. Therapy is actually “about honoring those experiences and then taking full responsibility for your life from here forward.” She shared Wayne Dyer’s quote: “Everything you do is based on the choices you make. It’s not your parents, your past relationships, your job, the economy, the weather, an argument or your age that is to blame. You and only you are responsible for every decision and choice you make.”

7. Therapy is a place to say and ask anything.

“Therapy isn’t the place to put your best foot forward and try to convince the therapist that you have it all together,” according to Ryan Howes, Ph.D, a clinical psychologist and author of the blog “In Therapy.” Instead therapy is a space to be fully and authentically yourself. Bring everything from your daydreams and fantasies to your harsh opinions and random thoughts, he said. “A skilled therapist will work to understand these impulses and beliefs without judgment and help you make sense of them. Save the pleasantries for the outside world, and let your raw, real thoughts and feelings out here.”

The same is true for asking your therapist questions: If there’s a question you’d really like to ask about your treatment or therapy in general, ask away, Howes said. “If the therapist doesn’t want to answer, let them explain why and how not answering benefits you in the long run. If you’re not satisfied with the answer, let them know.” He noted that therapy is a relationship. “Therapists should be experts at setting boundaries and working through relational issues in a constructive way.”

8. Therapy doesn’t end as soon as you feel better.

Jeffrey Sumber, M.A., a psychotherapist, author and teacher, wishes that people knew that improvement doesn’t signal the end of therapy. “So often, folks begin to feel the shift within themselves, their patterns change, their mood improves, and they terminate treatment only to find themselves in a similar situation down the road.” That’s because those shifts are a mark of progress, not proof of a cure.

“The counseling process is multi-layered and the feelings of renewed purpose and lifeforce that accompany the internal shifts we make are actually there to help propel us forward so that we feel this way every day on our own. I wish people took the signs of improvement as a confirmation that treatment is helping, not over.”

9. Don’t compare your insides to others’ outsides.

“I often hear clients pathologize themselves and suggest that most other people are functioning at a higher level in various aspects of their lives,” Marter said. In reality, however, “we are all dealt a different hand of hardships and blessings. Therapy is a place to help you think through how you want to play your hand.” In fact, she’s seen “people overcome great adversity and others squander great blessings.”

10. Your thoughts dictate your feelings and behavior.

Marter cited Gandhi: “A man is but the product of his thoughts.” This is why it’s so helpful to pay attention to the things you say to yourself and shift your perspective to more realistic, empowering thoughts. “Through therapy, we can let go of negative or irrational thinking and promote positive thinking and a practice of gratitude that will attract more positivity into our lives,” Marter said.

11. Acceptance isn’t limiting; it’s liberating.

“Don’t get me wrong, there are times when we need to keep striving, pushing, and holding out hope for better health, better careers, or healthier relationships,” Howes said. However, many individuals end up wasting their time and energy wrestling limitations they can’t change, instead of focusing on the things they can alter. According to Howes:

We need to accept our age. We need to accept many physical and mental illnesses and addictions. We need to accept the past. We need to accept others as they are. This isn’t to say we need to like it, or that we can’t work to make the best of each of these entities, but we need to relinquish the idea that we have any power or responsibility to change them. Once people realize they can accept instead of fighting things beyond their control, they realize they have much more time and energy for things they can impact.

12. You are worthy. Whether her clients come in with depression, anxiety, relationship problems or parenting concerns, Hibbert believes that, at the core, they’re all struggling with the same thing: “an inability to comprehend and feel their worth.” She’s also seen this with friends and family and experienced it herself. “I’ve had to work very hard to discover my own self-worth.”

She wishes people truly understood that “they’re more than how they feel, what they do or say, and what they think. Deep down, we are each of infinite worth.” Connecting to our self-worth is “the key to living a life of meaning, abundance and joy,” said Hibbert, also a women’s mental health, postpartum and parenting expert. (She talks more about self-worth in this piece.)

13. Life requires balance.

Howes noted that while the idea of balance is cliché, he’s also seen the damage of living in extremes. “People who work too much, party too much, spend too much time online, exercise too much or let themselves become consumed by their relationships will face the consequences of a life out of balance.” The skills for achieving moderation are challenging yet critical to learn, he said.

14. Growth and progress are not linear.

“We all go through setbacks, relapses or regressions in life as a normal part of being human,” Marter said. Experiencing a setback doesn’t mean you’re back to square one. Instead, this is an “opportunity to learn, get back on the saddle, grow and move forward. Life is a process of ebbs and flows.”

15. Work on the inside.

According to Marter, “Some people are waiting for external factors such as a relationship, a job, a perfect body or a fat bank account to make them happy.” Instead, the key is to work from the inside out. She cited Eckhart Tolle: “If you get the inside right, the outside will fall into place.” Marter added: “Therapy is a place to explore your greatest gifts and align your life with those so that you will achieve all you desire personally and professionally.”