Psych Central Original articles in mental health, psychology, relationships and more, published weekly. 2016-07-24T14:36:30Z Bethany Duarte <![CDATA[Book Review: Mindful Relationships]]> 2016-07-21T18:14:57Z 2016-07-23T17:35:25Z Shelved among a number of other books on relationships, I found Mindful Relationships: Creating Genuine Connection With Ourselves and Others, by Dr. Richard Chambers and Margie Ulbrick. The authors write […]]]>

Shelved among a number of other books on relationships, I found Mindful Relationships: Creating Genuine Connection With Ourselves and Others, by Dr. Richard Chambers and Margie Ulbrick. The authors write using a straightforward, technical tone fitting of their combined backgrounds in clinical psychology, mindfulness-based therapies, physiotherapy and family law.

Mindful Relationships tackles relationship dynamics: with oneself, within a couple, within a family, and in the workplace. Each of these segments is framed using an understanding of the value of mindfulness and meditation. With a healthy balance of neurology, psychology, and the classic message of self-love and self-compassion, the book makes a clear case for how mindfulness and relationships begin with self-love. The universal use of “we” throughout the book draws the reader in to what the authors are experiencing, establishing a collective consciousness that is both comforting and disarming.

The informative, case-study enriched approach appeals to the academic in me, but loses me as a potential “client” of the practice. While the authors’ arguments are technically supported, I found the book to be lacking anything profound about either mindfulness or relationships, much less combined; it struck me more as a repackaging of well-known concepts into a different product that functions as well as the original.

Because of my vocation, I spend the bulk of my time working on and developing relationships while identifying the need for and applying the tenets of self-care and compassion. As a result, I read a large number of self-help, self-care, and relationship-building material, all of which take on another variation of the same theme: be aware, be mindful, be intentional. Due to the increase in popularity of mindfulness through meditation, this book fits into that slot on my bookshelf, and as such, is measured against works of similar caliber and content. On that shelf, it would not be something I would re-read, but something I would share with someone who was new to the concept or struggling specifically with being real and open with themselves.

As mentioned, the authors introduce the concept of mindfulness through meditation for the benefit of the self first and then for the benefit of others. They emphasize that meditation simply enhances the benefits that come from being mindful, and that mindfulness is “tuning in, not tuning out.” Once the practice is established, the authors move onto how to apply mindfulness in everyday life, starting with self-compassion. While this is a valuable concept in every way, I struggled with the overly self-focused nature of the book. I was grateful to move on to the section on how to apply mindfulness in relationships and in the workplace.

In what I considered to be the core part of the text, the authors next showed how a mindful approach can transform your relationships by increasing intimacy with self and others and by developing clear expectations and an empathetic heart. These are standard assertions and are beneficial to a reader new to the concept of mindfulness, but do not add to the fundamental understanding of relationship building. The same tenets are then applied to the family unit, and the authors stress the importance of passing on the mindfulness lifestyle to children in order to create a society that is, as a whole, more mindful. One particularly valuable addition to note was the emphasis made by the authors on technology and the importance of limiting TV and internet time. I found that bit of information to be useful due in large part to the suggestions made and exercises recommended to increase your children’s ability to be present without stimulation.

Perhaps the most valuable application of mindfulness, in my opinion, was in the area of work and leadership. Mindfulness plays a key role in defining expectations in the workplace, being sensitive to the needs of your clients, customers and employees, and in helping to shape an organizational vision. The authors’ emphasis on being an emotionally intelligent leader really resonated with me and I was immediately engaged with the material at a deeper level.

While Mindful Relationships would not make it to the top of my list for the topic, the content was fundamental, sound, and clearly written, so I presume it would appeal to a wide and diverse audience. Perhaps the most engaging material was found in the exercises scattered throughout the text, which prompt readers to put mindfulness practice into action, for instance, savoring memories made with your family instead of rushing on to the next thing. As a reader, the exercises gave the concepts a practical context.

For a foundational understanding of how mindfulness works in relationships – with yourself and with others around you, Dr. Chambers and Ms. Ulbrick achieved a solid, case-study enriched primer that is accessible to a wide audience. The notations on mindfulness in the workplace are stellar and user-friendly, and would stand on their own as a follow-up work. Lastly, the exercises provide a tangible means to grow to a new level of connectedness with oneself, spouse or partner, family and work environment.

Mindful Relationships: Creating Genuine Connection with Ourselves and Others
Exisle Publishing, March 2016
Paperback, 263 pages

Bella DePaulo <![CDATA[Book Review: Splitopia]]> 2016-07-21T18:17:22Z 2016-07-22T17:45:04Z Wendy Paris knows what you think of her divorce. It’s what her friends thought when she told them she and her husband were splitting: “Neither my husband nor I like […]]]>

Wendy Paris knows what you think of her divorce. It’s what her friends thought when she told them she and her husband were splitting:

“Neither my husband nor I like to fight, but once we entered the twilight zone of divorce, they assumed we’d lose our personalities and values and transform into raging lunatics of hate. Our son would be irrevocably damaged. I’d be destitute, too miserable to work.”

This litany of doom is the prevailing divorce narrative, perpetuated by pundits, popular culture, and moralizers. Sometimes social science research is marshaled in supposed support of this tragic tale.

Paris is having none of it. In Splitopia, she does not tiptoe over the heartache or the pain of ending a marriage, but she does gift us with a compassionate, compelling, carefully-researched account of a new and more humane story of divorce — one in which the main characters can become better people in the end.

Whatever you think you might experience in the early years of divorce, you will find a frank account of just about all of it. The cascade of emotions; the ways in which divorce affects not just the couple and their children, but friends and family and colleagues, too; the implications of the split for your financial, mental, and physical well-being, as well as your work — it is all there, with all the immediacy of the best memoirs.

Also significant is what is not there: sections on how to find the most brutal attorneys and take your ex for all he or she is worth. Instead, Paris shows us today’s more constructive options of mediation and collaboration, and even takes us on a tour of the Resource Center for Separating and Divorcing Families, “the utopia of divorce in Denver.”

Perhaps because I have written about the many ways we make a home now that so few of us live in nuclear family households (in How We Live Now: Redefining Home and Family in the 21st Century), I especially appreciated Paris’s chapter on creating a home on her own. In How We Live Now, I also wrote about committed couples who choose to live in places of their own — a phenomenon known as “living apart together.” I was intrigued by Paris’s version of it; after she and her husband divorced, they moved together across the country, into places of their own, while they continued to cooperate in raising their son.

I never have and never will experience divorce because I will never marry. I have chosen single life, and live it fully, joyfully, and unapologetically. Nonetheless, I enjoyed just about every page of Splitopia. Paris is an engaging storyteller and gifted teacher. Her careful instruction begins with the table of contents, which offers not just chapter titles, but a preview of what’s in each chapter. For example, we learn that the chapter “Laying the Groundwork for a Good Divorce” will tell us “What we can do to help ourselves get through: commit to self-compassion; take ownership; don’t confuse filing with closure; build a toolkit; combat anger with empathy; resist the urge to compare; create positive moments.” The same commitment to making it all very clear continues throughout the book.

Stylistically, Splitopia is an excellent version of a popular template for writing contemporary nonfiction. Wendy Paris has a strong central theme about the good divorce and how to achieve it. She makes her case by interweaving her own divorce experiences with those of many other people she interviewed, as well as featuring relevant social science research and insights from experts. Paris also provides useful material in the back of the book, including annotated lists of resources for readers and professionals, and a wise set of suggestions for policy reforms.

When journalists write about research from the social sciences, one risk is that they will focus only on the most directly relevant studies — for example, the ones with “divorce” in the title, and miss out on all of the psychological insights other research has to offer. That didn’t happen to Wendy Paris. I was delighted, over and over again, to discover that she found some of the most telling nuggets, wherever they were hiding.

Even when reporting on the most relevant studies, journalists sometimes describe the results in ways that fit the accepted wisdom of the times. Paris, fortunately, does not fall for that one, either. As have too few others before her, she explains what’s wrong with the claims that the children of divorced parents are headed toward troubled lives.

So many people will find their own experiences captured in Splitopia. But one group is entirely missing. They are the people I have been hearing from for nearly two decades, people who are among those accounting for the slipping rate of remarriage nationwide. I’m talking about the people who discover, after divorcing, that single life suits them. They are not single because they dread dating, and they are not running away as fast as they can from an ex that they loathe. (Some even have quite kind things to say about their former spouse.) Instead, they are embracing their new single life. They don’t fear loneliness; they savor solitude. They don’t ascribe to the narrow view of relationships, in which only romantic ones count; their friends aren’t “just” friends. To them, single life is a meaningful and authentic life, and they are so delighted to finally get to live that life.

Splitopia: Dispatches from Today’s Good Divorce and How to Part Well
Atria, March 2016
Hardcover, 325 pages

Janet Singer <![CDATA[OCD and Depression]]> 2016-07-19T00:39:46Z 2016-07-22T17:15:03Z ]]> OCD and depressionWhen my son Dan’s obsessive-compulsive disorder was severe, he was barely functioning. He isolated himself from his friends, and could barely move from point A to point B. He’d spend hours at a time either sitting in his “safe” chair or just lying on the floor. Eating a morsel was a struggle.

Not surprisingly, he was diagnosed with depression. Even on a “good” day, when he was somewhat able to go through all the motions of normal living, he was tormented nonstop by obsessions. Who wouldn’t be depressed living like this?

Thankfully, even though he was battling depression, he was still totally invested in beating OCD, and was able to commit himself fully to exposure and response prevention (ERP) therapy, the evidence-based psychological treatment for obsessive-compulsive disorder. As his OCD improved, his depression lessened, and eventually dissipated. This is not an uncommon sequence of events for those suffering from both depression and OCD.

But what if you are dealing with OCD and depression, and your depression overtakes you so much that it hinders your ability to participate in ERP therapy? While the depression might still be a byproduct of living with obsessive-compulsive disorder, treating the OCD before the depression is just not feasible and will likely set you up for failure. In this case, the depression needs to be treated first so that engaging in therapy can be possible.

A good health-care provider can work with you to discuss the best ways to treat your depression, whether it involves psychotherapy, medication, or lifestyle changes (which of course might be difficult for those dealing with the restrictions of severe OCD).

The frequent co-occurrence of OCD and other brain disorders such as generalized anxiety disorder (GAD) or social anxiety disorder underscores the importance of having a health care provider who is knowledgeable about OCD and experienced in treating it and co-occurring conditions. While in some cases the treatment process might seem straightforward enough, comorbid illnesses can potentially impede a correct diagnosis and treatment. In other words, it gets complicated.

If depression isn’t recognized as the reason for ineffective therapy, those with obsessive-compulsive disorder might believe their illness is treatment-resistant, and become convinced that ERP therapy just won’t work for them. They give up and are left with no hope at all, which might possibly lead to an even deeper depression. It becomes a vicious cycle where OCD is likely to garner even more strength.

The bottom line is OCD is treatable, as is depression. A competent therapist will be able to formulate the best plan for the successful treatment of both disorders. Of course if you are working on fighting your OCD and feel your depression is getting in the way of your ERP therapy, make sure to let your health care provider know. Beating OCD and depression can be tricky, but it is possible, and those suffering from both can go on to lead happy, productive lives. My son is living proof of this.


Bethany Duarte <![CDATA[Book Review: What Men Should Know About Women]]> 2016-07-21T18:11:14Z 2016-07-22T03:07:43Z From William Shakespeare to John Dunn, poetry has a unique ability to tug on the heart strings, stir emotions, convey deeper meanings, and even transport the reader to another time […]]]>

From William Shakespeare to John Dunn, poetry has a unique ability to tug on the heart strings, stir emotions, convey deeper meanings, and even transport the reader to another time and place. In the case of Erica M. Loberg’s work What Men Should Know About Women, I experienced each of the above; however, the experience was not a positive one and I found myself in a place I never wanted to be as a reader.

Loberg’s take on “what men should know about women” is divided into three loose chapters, covering the topics of self, the body, women, and the city. Her foray into examining the concept of self includes estimations of self-worth based on physical appearance, the struggle of the woman to reconcile reality with the image of perfection often presented, as well as the general struggles of overcoming, fighting adversity, encountering depression, and submitting to discouragement.

The body chapter paints a picture of a woman’s insecurity over thinning hair and weight gain, with an oh-so-subtle side order of eating disorder. The portion entitled “women” is a discussion of what the reader would assume are Loberg’s own emotional feelings and thoughts, of which 90 percent discuss sex in some way. The 10 percent that mentions love and genuine connection is written in such a way that the reader is left to assume that the poet has never experienced a satisfying or deep connection. Finally, the city portion takes on the tone of an observer walking through the streets of a busy metropolis, taking the time to note the sounds, smells, thoughts and feelings of all around, including the asphalt.

Poetry is highly subjective; poetry is highly emotional and incredibly personal. Loberg’s attempt strikes me as an honest and vulnerable cry from an equally emotional heart. Loberg communicates from a background of manic depression, thus tinging the poems with swings of desperation, drops of depression and spurts of mania. In this sense, it exhibits the honest perspective of those fighting through this disease, and would likely be relatable to such an individual. Its tone is highly provocative and Loberg speaks of sex with an unusual candor that elevates the poetry from beyond sensual to openly erotic. Considering the ratio of erotic verse to non, it also demonstrates the high importance of sexuality to the poet.

Despite its subjective and “open-to-interpretation” nature, poetry is still an art form, and a review of such a body must base its suppositions on the nature of that art itself. In its simplicity, lack of clear rhythm, ability to incite an emotional response, and to paint a strong picture for the reader, this is a successful work of verse.

Conversely, the content, while true to the poet’s experience, is derogatory, degrading, diminutive of human nature, and insulting. The content degrades a woman’s experience of her self to that of a piece of human flesh that is dominated by negative self-image, what seem to be abusive relationships, and loveless sexual encounters. An off-hand introspective about only waxing for the right man and what he would do in response implies the woman’s role as sex toy and object, thus further promoting all that feminism has fought for years to eradicate.

The verses approaching talks of love and depth of feeling were correlated to the quality of sexual encounters, promoting the ideology that the two are not mutually exclusive. Reading the verse did not inspire or enthrall me as a reader; instead, it saddened me to see a woman who thought so little of herself publicly degrading herself even further. As a reader who has walked through depression, some of these poems would have been triggering to me. For that reason, I don’t recommend it to those fighting feelings of low self-worth and battling sex addiction because this verse will only fuel both of those thoughts.

While it is an honest expose of the poet’s experience, it does not strike me as poetry, but as a verbal regurgitation of the poet’s own swirling emotions. If this was Loberg’s aim, then I say a job well done; however, I would not crack open the work again.

What Men Should Know About Women
Chipmunkapublishing, June 2015
Paperback, 144 pages

Bethany Duarte <![CDATA[Book Review: Mastering Your Mean Girl]]> 2016-07-21T18:13:01Z 2016-07-21T18:13:01Z “But I don’t have an inner mean girl!” That’s what I was inwardly yelling upon picking up Mastering Your Mean Girl. Of course, the voice in my head that responded […]]]>

“But I don’t have an inner mean girl!” That’s what I was inwardly yelling upon picking up Mastering Your Mean Girl. Of course, the voice in my head that responded (i.e., the Mean Girl) was telling me that I had been the victim of mean girls, that I was mousy, too quiet, too loud (at the same time), too fat, and too quirky to really benefit from from author and coach Melissa Ambrosini was writing about. Self, meet “Mean Girl.”

As defined by Ambrosini, a former dancer, entertainer and luxury-liver extraordinaire, the Mean Girl on the inside is simply the ego. The Mean Girl is the never-ending source of negativity, self-deprecating talk and fear-based ponderings. Ambrosini rooted out her Mean Girl at proverbial rock bottom while I found mine as I endeavored to start my own business while attending school full time and trying to get out of debt. Regardless of the point of contact, the author purports that everyone has their own Mean Girl telling them they can’t, they won’t, and they’re not good enough to do whatever they are dreaming of.

Mastering Your Mean Girl doesn’t attempt to eradicate every life experience or negative thought you’ve ever had, as many self-help books attempt. Instead, it focuses on how one key component — love — changes your perspective from one who lives with a negative-Nancy mentality to one with love for yourself, others and for life. At first glance, the concept seems campy and overdone, but Ambrosini focuses on the value of loving yourself first from the honest perspective of someone who knows the dangers of not doing so.

In the first part of the book, she tackles the force that so often keeps us limited by our Mean Girl: fear. She challenges the reader to look at the genuine motivation behind each decision and whether it is fear or love.

One that hit me particularly hard was taking every job or gig I was offered (even if I hated it) out of fear that there wouldn’t be another and I would run out of money. Love says that you deserve to hold out for the right opportunity, so stop taking the wrong ones, while fear says grab all that you can because there is only so much. She throws down another gauntlet by challenging readers to unconditionally love themselves, instead of only showing self-love when they accomplish a goal or handle something just so. The primer on love rounds out with a comment on self-worth. Someone who loves herself and understands the value of doing so believes that she is worth things; she is worthy of success, joy, and most of all, reciprocated love.

From this foundation, Ambrosini challenges her readers to live from the position of being loved, asserting that only once they love themselves and believe themselves to be worthy of love can they live from love and send it onward. What does that look like? Taking care of your body and having a healthy relationship with food, pursuing only what makes your heart come alive (because you’re worth something that you’re passionate about!), having a positive relationship with money, and nurturing healthy connections with others. Ambrosini says it’s living from these “love yourself” points that starves your Mean Girl and shuts her up for good, and it’s from that happy place that the self-confident and “love-centered” girl that can give back to the world.

Do these tenets work, or are they another self-help ploy meant to inspire and pump up the reader without producing tangible results? The real kicker is the fact that Ambrosini writes with conviction based in a wealth of negative and positive personal experiences. As I read her book, I found myself nodding along because it’s not only believable, I can hear her heart and soul in the pages. She has lived these moments and has seen the impact loving herself had. As a reader, I appreciated her message and the candid way it was delievered, and I will likely return to these pages for inspiration as I battle my own Mean Girl with loads of self-love.

One thing that I feel is important to note is that Mastering Your Mean Girl doesn’t read like a traditional self-help book, but as a companion journal to a life that once was marred by self-destruction and is now a testament of victory over fear, self-hatred and self-abuse. Some testaments should be taken seriously and honored as they are; love yourself, take time to cultivate positive, healthy relationships with your world and those in it, and watch that Mean Girl take a hike.

Mastering Your Mean Girl: The No-BS Guide to Silencing Your Inner Critic and Becoming Wildly Wealthy, Fabulously Healthy, and Bursting with Love
TarcherPerigee, March 2016
Paperback, 288 pages

Joseph Cirigliano, MA, MS <![CDATA[Suicide: Helping Survivors Cope]]> 2016-07-19T00:40:28Z 2016-07-21T17:20:50Z ]]> Suicide: helping survivors copeWhy do individuals commit suicide?

Despite its prevalence, suicide remains highly stigmatized and survivors of suicide often suffer in silence in fear of being judged and criticized. This paper will first examine the prevalence of suicide, focusing on gender, culture, method, and mental illness. Further, this paper aims to explore the impact suicide has on parents, siblings, children, peers, spouses, attempters, and therapist survivors. A thorough examination of the areas of greatest difficulty each survivor group experiences will be done. Finally, a thorough review of treatment guidelines and efficacy will be explored. With these goals, the hope is to shape the therapist’s understanding of the suicide based upon the relationship to the victim of suicide, and guide treatment based upon the available evidence of treatment efficacy.


Based upon 2004 statistical data (Laughinrichsen-Rohling, Friend, & Powell, 2009) suicide was identified as the third leading cause of death among youth and young adults. Much research in the prevalence of suicide has been aimed at identifying gender, age, and socioeconomic status differences. Research consistently finds men demonstrate higher rates of suicide, while females are consistently more likely to make a suicide attempt (Spicer and Miller, 2000; Grucza, Pryzbeck, & Cloninger, 2005), which is sometimes identified as the gender paradox (Langhinrichsen-Rohling, Friend, and Powell, 2009). In addition, elderly individuals were found to attempt suicide at a lower rate, but due to significant use of lethal means, completed suicide at a high rate. Furthermore, attempters are more likely to be teenagers, young adults, women, and African American (Spicer and Miller, 2000).

Impact on survivors


Parents have been widely studied as suicide survivors. Many studies compare parents who are suicide-bereaved to those who are bereaved from homicides or accidents. Several studies found there was not a significant difference in emotional distress for type of bereavement, but shame seems to be a unique experience of suicide-bereaved parents. This unique factor may account for the difference in the way suicide survivors interact with the public (Murphy et al., 2003; Seguin, Lesage, Kiely, 1995; Demi 1988).

Further research has examined the interaction of suicide-bereaved parents and the social world. In qualitative analyses, parents stated they rarely felt permitted to talk about the deceased, and expressed a desire to share experiences but felt unable to do so publicly. In addition, parents reported regularly monitoring their conversations based upon the comfort of others, leading to isolation which is present more in the suicide-bereaved parents than other forms of loss (Maple, Edwards, & Plummer, 2010).

Parental suicide survivors also are more apt to blame themselves for actions either taken or overlooked and often felt powerless over the situation. Blaming was found to be endemic in the families of suicide, where the child was viewed as an innocent victim in the incident. Furthermore, the parents of suicide victims expressed a need to reconstruct their lives through an extensive period of self-examination and self-exculpation (Tornblom, Werbat, & Ryedelius, 2013; Owens et al., 2008).

For therapists, encouragement to share their experiences may be a way to alleviate the shame and guilt expressed throughout the research. The acknowledgment of significant emotions of guilt, blame, anger, and shame needs to be at the forefront and addressed in the therapeutic relationship. In addition, existential processes aimed at allowing exploration of blame and the self may prove to be a significant factor in a parent’s ability to move on and live a meaningful life after a child’s suicide.


While shame and guilt colored parents’ experiences, the siblings of suicide victims present a different challenge for therapists. It is first important to note there was found to be a seven-time increase in depression in siblings of suicide victims and 43 percent of the depressed siblings showed significant suicidal ideation (Brent et al., 1993). Dyregrov and Dyregrov (2003) and Dyregrov et al. (2015) took a deeper look into the impact of sibling suicide. They found that younger siblings living at home experienced the most difficulties in the aftermath of the suicide. This was hypothesized to be the result of a closer relationship to the then bereaved parents.

In addition, siblings have a great difficulty expressing grief, and may have challenges in communicating knowledge for fear of breaking the confidentiality of the deceased sibling. Furthermore, siblings were found to be overlooked often because of a greater focus on parents, and because parents cut off communication to protect the surviving child from information. However, this severing of communication was found to result in an experience of isolation, and did not protect the siblings from developing psychological symptoms (Dyregrov & Dyregrov, 2005; Dyregrov et al., 2015).

The challenge for therapists in addressing siblings of suicide victims is uncovered in the work of Powell and Matthews (2013) and Dyregrov et al. (2015); they found most siblings reported needing professional help to overcome the grief experienced. However, their perception of health care providers may have been negatively colored by their sibling’s negative experiences.

In addition, siblings often view therapists as incompetent if they do not directly address the suicide, instead focusing on the resulting emotions. Therapists should create an empathetic dialogue allowing venting, grief, and hostility, and should assess for fears for personal risk or for more suicides in the family. In addition, siblings often need immediate and repeated contact despite hesitation to openly seek treatment (Powell & Matthews, 2013).


Transmission of suicidal behavior is noted in the literature as one of the greatest threats to children of suicide victims. In fact, Hung and Rabin (2009) found children of suicide victims were two and a half times more likely to report suicidal ideation, and six and one half times more likely to attempt suicide than control groups.

In addition to increased suicidal behavior, a significant increase in psychological disturbance was found across research including higher levels of depression, increased social maladjustment, and post-traumatic stress disorder (Pfeffer et al., 2000; Ratnarajah & Schofield, 2007; Sethi & Bhargava, 2003). A correlation was identified between mania and parental suicide. In addition, children who found the bodies of the deceased parent were significantly more like to develop post-traumatic stress disorder and major depressive disorder (Hung & Rabin, 2009; Sethi & Bhargava, 2003).

For therapists, these findings can guide treatment and direction by providing knowledge of what the child is likely to be experiencing, as children often have difficulty in identifying their current emotional experiences. In addition, based upon the research demonstrating the impact of the surviving parent on future adjustment, gauging the family interaction and functioning pre-suicide, and the parental involvement following the suicide becomes an important part of treatment. The potential for family sessions focusing on parent interaction skills and emphasizing the need for emotional support and being available to reduce secondary loss may be a significant factor in minimizing future maladjustment.


Buus, N., Caspersen, J., Hansen, R., Stenager, E., & Fleischer, E. (2014). Experiences of parents whose sons or daughters have (had) attempted suicide. Journal of Advanced Nursing, 70(4), 823–832..

Dane, B. O. (1991). Counselling bereaved middle aged children: Parental suicide survivors. Clinical Social Work Journal, 19(1), 35–48.

Dyregrov, K., & Dyregrov, A. (2005). Siblings after suicide — “the forgotten bereaved.” Suicide & Life-Threatening Behavior, 35(6), 714–724.

Grucza, R. A., Przybeck, T. R., & Cloninger, C. R. (2005). Personality as a mediator of demographic risk factors for suicide attempts in a community sample. Comprehensive Psychiatry, 46(3), 214–222.

Hung, N. C., & Rabin, L. A. (2009). Comprehending childhood bereavement by parental suicide: a critical review of research on outcomes, grief processes, and interventions. Death Studies (Vol. 33).

Langhinrichsen-Rohling, J., Friend, J., & Powell, A. (2009). Adolescent suicide, gender, and culture: A rate and risk factor analysis. Aggression and Violent Behavior, 14(5), 402–414.

Maple, M., Edwards, H., Plummer, D., & Minichiello, V. (2010). Silenced voices: Hearing the stories of parents bereaved through the suicide death of a young adult child. Health and Social Care in the Community, 18(3), 241–248.

Murphy, S. A., Clark Johnson, L., Wu, L., Fan, J. J., & Lohan, J. (2003). Bereaved Parents’ Outcomes 4 To 60 Months After Their Children’s Deaths By Accident, Suicide, or Homicide: a Comparative Study Demonstrating Differences. Death Studies, 27(1), 39–61.

Owens, C., Lambert, H., Lloyd, K., & Donovan, J. (2008). Tales of biographical disintegration: How parents make sense of their sons’ suicides. Sociology of Health and Illness, 30(2), 237–254.

Pfeffer, C. R., Karus, D., Siegel, K., & Jiang, H. (2000). Child survivors of parental death from cancer or suicide: Depressive and behavioral outcomes. Psycho-Oncology, 9(1), 1–10.<1::AID-PON430>3.0.CO;2-5

Powell, K. A., & Matthys, A. (2013). Effects of Suicide on Siblings: Uncertainty and the Grief Process. Journal of Family Communication, 13(4), 321–339.

Ratnarajah, D., & Schofield, M. J. (2008). Survivors’ Narratives of the Impact of Parental Suicide. Suicide & Life – Threatening Behavior, 38(5), 618–630. Retrieved from
Ratnarajah, D., & Schofield, M. J. (2007). Parental suicide and its aftermath: A review. Journal of Family Studies, 13(1), 78–93.

Séguin, M., Lesage, A., & Kiely, M. C. (1995). Parental Bereavement After Suicide and Accident: A Comparative Study. Suicide and Life-Threatening Behavior, 25(4), 489–498.

Sethi, S., & Bhargava, S. C. (2003). Child and adolescent survivors of suicide. Crisis, 24(1), 4–6.

Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: Incidence and case fatality rates by demographics and method. American Journal of Public Health, 90(12), 1885–1891.

Törnblom, A. W., Werbart, A., & Rydelius, P.-A. (2013). Shame behind the masks: the parents’ perspective on their sons’ suicide. Archives of Suicide Research : Official Journal of the International Academy for Suicide Research, 17(3), 242–61.


Ross Rosenberg, MEd, LCPC, CACD, CSAT <![CDATA[Codependency No More: How to Recover from Self-Love Deficit Disorder]]> 2016-07-19T00:39:41Z 2016-07-20T17:15:35Z When a therapist colleague and friend recently asked me to explain what Self-Love Deficit Disorder is and how to treat it, I panicked — although I love talking about my […]]]>

codependent no moreWhen a therapist colleague and friend recently asked me to explain what Self-Love Deficit Disorder is and how to treat it, I panicked — although I love talking about my latest discoveries, especially my renaming of codependency to Self-Love Deficit Disorder. I paused to think of the best response.

Being fatigued from seeing six psychotherapy clients that day, I considered using the therapist’s conversation maneuver of avoiding the subject by asking a similarly difficult question about a topic on which the client loves to talk. My second impulse was to skirt the question by explaining that the answers are best explained in my latest seminar video, the six-hour “Codependency Cure.” These discoveries organically materialized in my life as a direct result of my need to heal emotional wounds and to tear down the emotional, personal, and relational barriers keeping me from experiencing self-love.

My third impulse, the best one, was to proudly and enthusiastically share my “children” with yet another person. Those who know me well understand how my Human Magnet Syndrome, Codependency Cure, and Self-Love Deficit theories and explanations are byproducts of my own family of origin issues (trauma), my rollercoaster journey to recover from it, and the joy of learning to live free from codependency. This is not just a set of theories I like to talk about, but a personal mission that I plan to be on for the rest of my life.

Although I wasn’t excited about the prospect of talking shop at that moment, I tapped into a well of energy and enthusiasm that gave me the much-needed boost to give a condensed rendering of my latest work. But this time, I set a boundary: it would only be a 15-minute explanation! I figured since I had already given many radio interviews, written many articles, created training courses, and, of course, been a psychotherapist for 29 years, it would be a piece of cake.

18 Guiding Principles of Self-Love Deficit Disorder & The Human Magnet Syndrome

I did it with time to spare. Knowing that others might ask me the same question again or would benefit from a similarly condensed rendition of my conceptual and theoretical work, I decided to create a written version of this discussion. The following are my 18 guiding principles of Self-Love Deficit Disorder and The Human Magnet Syndrome.

  1. “Codependency” is an outdated term that connotes weakness and emotional fragility, both of which are far from the truth. The replacement term, “Self-Love Deficit Disorder” or SLDD takes the stigma and misunderstanding out of codependency and places the focus on the core shame that perpetuates it. Inherent in the term itself is the recognition of the core problem of codependency, as well as the solution to it.

    Self-Love Deficit Disorder
  2. The absence of self-love results in deeply embedded insecurities that render a person powerless to set boundaries or control their narcissistic loved ones. The person with Self-Love Deficit Disorder, the SLD, is often oblivious or in denial about their dysfunctional relationships patterns with narcissists, as to admit to it would require them to face their core shame and pathological loneliness.
  3. Pathological Narcissists (Pnarc) have one of three personality disorders or have an addiction: Borderline Personality Disorder, Antisocial Personality Disorder, or Narcissistic Personality Disorder. The Pnarc addict will cease their narcissistic ways if they do not have one of the above personality disorders and they remain sober (abstinent of their drug of choice) and active in their recovery program.
  4. The SLD once was a child who was raised by a Pnarc parent who flew into fits of rage, anxiety, sadness, or depression if and when their immediate needs were not catered to or immediately met. This child emotionally survived by avoiding their narcissistic parent’s anger (narcissistic injuries) by morphing into the “trophy,” “pleasing,” or “favorite” child that the Pnarc parent needed them to be. This child grew up learning that safety and conditional love were available to them if they buried their own needs for love, respect and caring while becoming invisible.
  5. Similar to the child who would become a SLD adult, the Pnarc suffered the same fate of being raised by an abusive, neglectful, or depriving Pnarc parent. Unlike the future SLD child, this child would not or could not find a way to please his narcissistic parent or provide them with pseudo self-esteem, pride or vanity. Even worst, another sibling could have beat them to “trophy status,” which would have rendered them useless to their narcissistic parent. Ultimately, this child was deprived from any form of conditional love, respect and caring from his Pnarc parent. He mostly likely grew up experiencing that the only love he would experience is that which came from him, at the expense of others.
  6. The inherently dysfunctional SLDD/Pnarc “dance” requires two opposite but distinctly balanced partners: the pleaser/fixer (SLD) and the taker/controller (Pnarc). When the two come together in their relationship, their dance unfolds flawlessly: The narcissistic maintains the lead and the SLD follows. Their roles seem natural to them because they have actually been practicing them their whole lives; the SLD reflexively gives up their power and since the narcissist thrives on control and power, the dance is perfectly coordinated. No one gets their toes stepped on. SLD’s dare not leave their dance partner, because their lack of self-esteem and self-respect makes them feel like they can do no better. Being alone is the equivalent of feeling lonely, and loneliness is too painful to bear.
  7. Men and women always have been drawn into romantic relationships instinctively, not so much by what they see, feel or think, but more by an invisible and irresistible relationship force. “Chemistry,” or the intuitive knowingness of perfect compatibility, is synonymous with the Human Magnet Syndrome. This is the attraction force that brings compatibly opposite, but exquisitely matched, lovers together: SLDs and Pnarcs. Like two sides of a magnet, the care-taking and sacrificing SLD and the selfish and entitled Pnarcs are powerfully drawn together, sometimes permanently.
  8. SLDs repeatedly are attracted to or find themselves intractably in a relationship with a narcissist despite the lessons they keep willing themselves to learn. It is like they are addicted to riding rollercoasters, for which they remember the thrill and elation, but conveniently forget the terror and their subsequent promise to never do it again. Yet they keep getting back in line for another ride.
    Roller Coaster Amnesia
  9. SLDs feel trapped in their relationships because they confuse sacrifice and selfless caring with commitment, loyalty and love. The SLD’s distorted thinking and value system is fueled by an irrational fear of abandonment, loneliness and core shame.
    ]]> Janet Singer <![CDATA[OCD and Healthy vs. Unhealthy Doubt]]> 2016-07-19T00:24:26Z 2016-07-19T17:15:49Z ]]> OCD and healthy vs. unhealthy doubtWhen my son Dan was dealing with severe obsessive-compulsive disorder, I would often watch over him like a hawk, taking note of all of his behaviors. Was this OCD? Was that OCD? Wait, maybe that’s normal behavior? I spent a lot of time trying to analyze all his actions. I finally realized my intense involvement in his life was doing us both more harm than good, and with some effort I was able to let go and just trust my son, who was working hard on fighting his OCD.

    What I wasn’t aware of at the time is that sometimes those who suffer from obsessive-compulsive disorder aren’t sure themselves if their thoughts and behaviors are related to their disorder. Because sufferers often have such insight into their OCD, I just assumed they knew when what they were thinking or how they were acting was OCD-based. However, from reading blogs and connecting with people, I realize this isn’t always the case. So how do we know if certain feelings or actions are related to OCD?

    In his book When in Doubt, Make Belief, author Jeff Bell discusses healthy (intellect-based) doubt vs. unhealthy (fear-based) doubt. While theoretically it might be easy to distinguish between the two, Bell, by using an example of a man deciding whether to cross a busy New York street, shows us how complicated it can be. As he says, “…the same fear-based doubt that can distort our thinking is also quite adept at masquerading as intellect-based doubt.” (Bell, page 9).

    In his book, Bell talks about the five questions he asks himself to help determine the source of his doubt:

    1. Does this doubt evoke far more anxiety than either curiosity or prudent caution?
    2. Does this doubt pose a series of increasingly distressing “what if” questions?
    3. Does this doubt rely on logic-defying or black-and-white assumptions?
    4. Does this doubt prompt a strong urge to act — or avoid acting — in a fashion others might perceive as excessive, in order to reduce the anxiety it creates?
    5. Would you be embarrassed or frightened to explain your “what if” questions to a police officer or work supervisor?

    I think these questions are spot-on, and even though I don’t have OCD, I often refer to them when I go into one of my “what-if” modes. I especially like numbers four and five, as I believe that most of the time, deep down, those with OCD do know when their worries are irrational. They might just need to stop for a minute, step outside of their minds, and evaluate the situation. A little perspective can do wonders.

    If you have OCD, and even if you don’t, why not give these questions a try when you find that your doubts are leading to intense worrying? If you find you answer “yes” to these questions, there’s a strong chance you are dealing with unhealthy doubt fueled by fear.

    As the saying goes, knowledge is power, and the more those with OCD are aware of how their disorder operates, the better position they’ll be in to fight it. Of course, a competent therapist can go a long way toward helping us sort out healthy doubt from unhealthy doubt. Once the difference is obvious to those who are struggling with this sneaky disorder, OCD doesn’t stand a chance.


    Marie Hartwell-Walker, Ed.D. <![CDATA[Staying Involved as a Non-Custodial Parent]]> 2016-07-04T19:13:49Z 2016-07-10T17:45:07Z ]]> staying involved as a non-custodial parentIt is often difficult for non-custodial parents to have regular, meaningful contact with their kids following the divorce. It is so difficult that there are many non-custodial parents who gradually slip out of their children’s lives. Studies verify the problem. In the U.S., 83 percent of children report not seeing their non-custodial parent on a weekly basis and 33 to 50 percent report not seeing them in the previous year. Although almost 85 percent of non-custodial parents are fathers, it’s important not to ignore the 15 percent who are mothers. The reasons many of these fathers and mothers gradually fade out of their children’s lives are much the same.

    It doesn’t have to happen. If you are a non-custodial parent, you can and should stay in your children’s lives. Your children need you. Kids who have regular access to and positive relationships with both parents following a divorce or separation do better educationally, behaviorally and psychologically. You need them as well. Parents who lose touch with their children often experience chronic shame and depression.

    If you are a non-custodial parent, you can ensure that you and your children have regular, positive contact. It isn’t up to the other parent. It isn’t up to the children. It’s up to you to maintain the connection.

    The following are the most common reasons clients have given me over the years for why they became discouraged about having regular contact with their children. Sessions were dedicated to empowering them to do something about it.

    • The divorce may be legal but it isn’t over.

      You and the other parent are still so angry, hurt or defeated that you can’t deal with seeing each other. Contact with each other during dropoffs and pickups for the kids results in continuation of the fights that led to the divorce. One or the other of you can’t stand going through yet another go-around of hostilities.

      If a fight about some issue has never solved the problem, what makes you think another round of the same fight will yield different results? It’s exhausting for the two adults. It isn’t healthy for the kids to witness yet another fight between their parents. If the issues are important enough to fight about, they are important enough to address through some mediation or counseling. Get some help so you can both have an emotional as well as legal divorce.

    • Being a visitor in your children’s lives is too painful.

      Being relegated to the role of visitor makes you feel like the world thinks your time with your kids is optional. Because you see the kids only intermittently, you have become less and less aware of their interests and activities. Visits have become more and more awkward. The kids are less willing to visit with you. You may have salvaged your self-esteem by convincing yourself that the kids are better off without you.

      Reject the notion that you are visiting. Parents who are spending time with their children are parenting, not visiting. The division of time should reflect respect for the children’s need to have regular, ordinary contact with both parents. Work with your ex to see to it that you share responsibility for your kids’ daily lives. Make decisions about where you work and live that enable you to be actively involved. Spend relaxed time with them during the week. Go to parent-teacher conferences, doctor appointments and other important meetings. Attend your children’s practices, performances and games, just as you would as a full-time parent. Make sure you stay in touch with your children through texts and calls and social media (for older kids) when you are not physically with them.

    • Unrealistic child support requirements.

      Most divorced parents who are court-ordered to pay child support do so. Of those who don’t make their payments, two-thirds say they don’t have the financial resources to pay. Perhaps you are one of them. It’s not that you don’t want to pay. It’s not that you don’t want to provide for your kids. But you can’t figure out how to meet your entire obligation. Nonpayment has led to frustration and anger at the system. You stay away because you don’t want to deal with reminders from your ex about what you owe or your shame and anger about your inability to pay.

      Negotiate child support that honors the children’s need for both parents to have some stability. Ideally, you and your ex should work on an approach to your collective finances that lets both of you have a home that includes space for kids and the ability to care for them while they are in your care. Consider the employability and resources of both of you. If you and your ex are too angry with each other to do this on your own, see a mediator for some help before you go to court.

    • Your anger is renewed by your support system.

      Your friends and extended family are so angry with your ex that every conversation with them includes reminders about all the ways you have been wronged. You feel that you have to stay angry with the ex in order to get continued support from your own parents or siblings. This is especially difficult if they help you with finances or childcare.

      Draw some boundaries. Your friends and relatives probably mean well, but their anger isn’t helpful. It gets in your way of making a working relationship with your ex for the children’s sake. It isn’t healthy for the children to feel torn between their other parent and their relatives. Thank these people for their concern and support. Insist that they back off so you can provide a healthy environment for the children.

    • Your new partner doesn’t want to have to deal with the kids.

      You’ve fallen in love again. The new person in your life is wonderful in every way except one: She or he doesn’t want to have to be involved with your children.

      This relationship may not be for you. Your children are not going to go away. You can’t erase your past with your ex or pretend you are not a parent. You don’t want to be always caught between responding to the needs of your children or attending to your partner. Your children deserve to have love and care from all the adults in their life. If the person you are seeing can’t accept those realities, move on.


    Margarita Tartakovsky, M.S. <![CDATA[Clinicians on the Couch: 10 Questions with Alyssa Mairanz]]> 2016-07-04T19:12:19Z 2016-07-09T17:45:45Z ]]> Alyssa Mairanz

    In our monthly interview series, we take a behind-the-scenes look at how therapists work and live — something we rarely get to see otherwise. We ask them about everything from what it’s like to conduct therapy to how they cope with stress. We also explore the biggest myths about therapy, what they wish their clients knew, their best advice for leading a meaningful life — and lots more.

    This month we’re pleased to feature Alyssa Mairanz, a licensed mental health counselor (LMHC) and certified dialectical behavior therapist (DBTC). Mairanz has a psychotherapy practice in New York City, where she works with individuals, couples and groups.

    She specializes in helping adults and teens struggling with various life transitions, self-esteem, managing emotions, relationships and identity issues. She helps clients explore the experiences that have impacted their current situation and learn concrete strategies to make the changes in their lives that they’ve been searching for.

    For more information, check out her website, Facebook page, Alyssa Mairanz Therapy, or follow her on Twitter @AlyssaLMHC.

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

    What has surprised me most is how similar people are. Everyone comes from such different backgrounds, cultures, races and experiences. Yet at the core, underlying issues are the same. Self-esteem, relationships and career are common themes.

    The specific details and situation will differ, but the bottom line is that we are all just people who are trying to lead a meaningful and satisfying life. I think that’s an important realization because often people think they are alone in their experience and no one can understand. It can be helpful to know that there are others who can relate to you.
    2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy? 

    I recently read The 5 Languages of Love, written by Gary Chapman. The book is about how each person has a primary love language. A love language is what someone needs to feel loved and safe in any relationship. The five languages are words of affirmation, gifts, acts of service, quality time and physical touch. By learning your primary love language, you can more effectively give and receive love. The book lays out the five languages and talks about how to figure out what yours is. Chapman also discusses how to learn to speak each language when you don’t know how.

    I found this book very relatable because many times my work with my clients is around relationships; familial, romantic, platonic and professional. Relationships are such a huge part of people’s lives. But they can often come along with conflicts because all relationships take work. When it comes to relationships, the word communication is often brought up.

    What was interesting about this book is that it focused specifically on communication expressing love. Many of my single clients talk about dating being hard because in a new (or sometimes even long-term) relationship, it is hard to gauge how the other person feels. People want to know that those in their life care for them, and often are preoccupied wondering what others actually think. Knowing your love language and that of people in your life can really help with this. When you know what you need to feel loved, you can express and ask for it. Knowing what your friends, family members, boyfriend/girlfriend, etc., need will allow you to provide that.

    3. What’s the biggest myth about therapy?

    Unfortunately, there are too many and they get in the way of people even entering therapy in the first place. Something I hear often is that therapy is just about rehashing the past and will blame everything on your mother, so what’s the point?

    There are two misconceptions with this thought process. First is that therapy is only about the past, and second that it is pointless to do that. In regards to the former, in reality therapy is not about the past; it’s about making changes in your life. Yes, sometimes to do that you look to the past, but you also focus on the here and now and what you can do to reach your goals.

    That being said, our experiences do have an impact and what we go through early on in life will shape us. Our parents/caregivers often have the biggest impact; that’s where this stereotype of it’s all on the mother comes from. However, it’s not a blame game; it’s just about understanding the effect our experiences have had on us so that we can move forward.

    Each therapist puts different amounts of focus on the past and will have different techniques to help their clients. Therefore, the key is to find the right therapist for you.
    4. What seems to be the biggest obstacle for clients in therapy?

    Obstacles for clients in therapy can be very individual based, but something many people struggle with is enduring the therapy process when it’s hard. Entering therapy is a big step and often people do so because they had enough and do not want to continue operating the same way they have been.

    However, change is hard. Therapy can become intense, opening old wounds and digging deep into one’s emotions. It can be difficult to sit through the process and not run from it or shut down. Trusting in your own resilience and talking about this with your therapist can ease the stress and help one push though.

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

    For me, the most challenging part is when I am dealing with a lot of personal stress or I am not feeling well. I feel that I am in a profession where I always need to be on my game. When I am not feeling at my best, it can be difficult to go into a session. It is never easy to do any job when you are managing personal issues or illness. I have had other jobs, and for me personally, this is harder to manage as a therapist. I have tools to help navigate through this but it can be a struggle sometimes.
    6. What do you love about being a therapist?

    I love hearing people’s life stories. Everyone has their own experience and getting to be a part of that is very rewarding. Getting to see the progress people make and be with them on their journey is extremely interesting.

    I feel that being a therapist is the closest one can get to reading minds. Being inside people’s heads is fascinating. People often wear masks and don’t let the world see the real self. I love getting to see each person as the masks fall and helping them feel more comfortable showing the world that side of them.
    7. What’s the best advice you can offer to readers on leading a meaningful life?

    Be kind to yourself! There is that saying “treat others how you want to be treated.” I find people have an easier time being kind to others and don’t give themselves the same courtesy they do to other people. I like to say “treat yourself how you treat others.”

    There is a negative connotation to the word selfish, but people should look after themselves. Yes, it’s important to think of others and be compassionate, but you can’t help others if you don’t first help yourself.

    Remind yourself that you are a worthy person who deserves happiness. Take care of your needs, and make sure your inner voice is speaking nicely. We are often our own worst critics. Change that and become your best cheerleader.
    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?

    There are times when I am stressed and having a difficult time and I ask myself “would I be better off having chosen a different career?” The answer is always no! I can’t think of another job that would give me the same satisfaction as being a therapist.

    This career path has played such a positive role in my own journey towards personal growth that I would not change a thing. There were times when this was tested and I questioned the choices I made relating to my career. But at the end of the day, I have landed in the exact place that I want to be.
    9. If there’s one thing you wished your clients knew about treatment or mental illness, what would it be?

    I want people to know how brave they are to enter therapy. It is not an easy step to take or process to go through. I also think it’s important for people to know that therapy is not magic, and therapists do not always have the answers. Both of these things are important so that people recognize their own strength.

    I have heard many people talk about therapists and how amazing they are. Many clients have expressed to me “Alyssa, I don’t know what I would do without you.” People are a lot more resilient than they think they are. Therapy can be a necessary catalyst to make changes in your life, but you are ultimately doing the work.

    Just taking that first step towards making change is huge! Just recognizing one’s inner strength is a huge part of the therapy process, and people need to give themselves more credit.
    10. What personally do you do to cope with stress in your life?

    I often ask myself “what would I tell my clients?” This is helpful in a few ways. First, it helps me gain some objectivity and not be so caught up in the experience. Many times the best way to deal with stress is to take a step back. This will allow you to think clearer, thereby, being able to know how to proceed most effectively. This helps me to do so.

    Asking myself this question also reminds me of the skills I have at my fingertips. I work with my clients on skills and strategies to help manage emotions and cope with stress. I sometimes need a reminder myself that this is available for me to utilize.

    Some specific things I generally do are: meditation; turning to friends and family for support; and making sure I am taking proper care of myself in terms of sleep, eating habits, exercise, etc. Sometimes it can be hard to remember these things, which is why taking a step back can be helpful.

    John M. Grohol, Psy.D. <![CDATA[Depression & Vitamin D Deficiency]]> 2016-07-09T13:26:39Z 2016-07-09T13:26:39Z Vitamin D is an important vitamin your body needs to stay healthy. Most people don’t get enough vitamin D, because our primary way of making it is through exposure to […]]]>

    Vitamin D is an important vitamin your body needs to stay healthy. Most people don’t get enough vitamin D, because our primary way of making it is through exposure to sunshine (without sunscreen). Lack of of vitamin D — vitamin D deficiency — has been implicated in numerous health problems, including mood disorders like depression.

    What is the relationship between vitamin D and depression? Can a simple vitamin D deficiency be the cause of my depressed mood? It’s more complicated than it looks.

    The Mixed Evidence on Vitamin D & Mood

    There have been more than a few research studies that have examined the impact of vitamin D on depression and other mood disorders. Observational studies have generally found a correlation, but could not determine which way the relationship went (e.g., does depression contribute to low vitamin D levels in the body, or does low vitamin D levels contribute to depression?).

    For instance, one set of researchers conducted a systematic review and meta-analysis in 2013 (Anglin et al.). They looked at one case-control study, ten cross-sectional studies and three cohort studies. (Notice the lack of randomized-controlled trials (RCTs) versus observational studies?) “Our analyses are consistent with the hypothesis that low vitamin D concentration is associated with depression,” but acknowledged their findings weren’t based on any RCTs.

    Randomized-controlled trials (RCTs) are the gold standard in drug and supplements research. They compare the effectiveness of the drug or supplement with a sugar pill, what researchers call a placebo.

    Earlier this year, a study was published that did look at the findings of RCTs in connection with depression and vitamin D. This study examined 10 randomized trials (nine were randomized placebo-controlled trials [RCTs]; one was a randomized blinded comparison trial) and 20 observational (cross-sectional and prospective) studies (Okereke & Singh, 2016). What did the researchers find?

    In 13 of the observational studies, they found a correlation between vitamin D deficiency and mood (e.g., depression). But in the placebo-controlled, randomized trials — the gold standard of drug and supplemental research — they found something very different.

    “Results from all but one of the RCTs showed no statistically significant differences in depression outcomes between vitamin D and placebo groups.” In other words, the group of people who received vitamin D supplements didn’t differ significantly from the group of people who received a sugar pill (placebo) on their depression scores. This suggests that vitamin D supplements don’t really help much, if at all.

    Another big study published in 2014 — the Pro V.A. Study — also examined vitamin D concentration levels in 1,039 women and 636 men aged 65 and older (Toffanello et al., 2014). Their findings were also not good. “Although an independent inverse association between 25OHD levels and GDS scores emerged for women on cross-sectional analysis, vitamin D deficiency showed no direct effect on the onset of late-life depressive symptoms in our prospectively studied population.” In other words, while they found a small effect in women (a one point difference in depression scores), the differences overall were not significant.

    What This Means for Depression & Vitamin D

    Contrary to conventional wisdom, it appears that the association between depression and vitamin D is a small, tenuous one at best. The most recent studies seem to suggest that the believed connection between vitamin D deficiency and depressive mood either doesn’t exist, or is simply a small correlation.

    Regardless, vitamin D is important to your overall health. There are other studies demonstrating its impact on reducing blood pressure, hypertension, risk of MS, and even Type 1 diabetes (Webb, 2015). It also appears important for bone health in general, and long-term deficiency in vitamin D has been linked to osteoporosis (Webb, 2015).

    You can get a lot of your vitamin D by just spending a little time each day outdoors in most places. However, in colder seasons or climates, that may not always be possible. Vitamin D supplements can be obtained over-the-counter and are a safe way to increase your vitamin D serum levels.

    However, according to the latest research, taking vitamin D supplements alone aren’t likely to change your mood. If you expect it to work like an antidepressant drug, you may be in for a surprise.



    Anglin RE, Samaan Z, Walter SD, McDonald SD. (2013). Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry, 202, 100-7. doi: 10.1192/bjp.bp.111.106666.

    Okereke, O. & Singh, A. (2016). The role of vitamin D in the prevention of late-life depression. Journal of Affective Disorders, 198, 1-14.

    Toffanello, Elena D.; Sergi, Giuseppe; Veronese, Nicola; Perissinotto, Egle; Zambon, Sabina; Coin, Alessandra; Sartori, Leonardo; Musacchio, Estella; Corti, Maria-Chiara; Baggio, Giovannella; Crepaldi, Gaetano; Manzato, Enzo. (2014). Serum 25-hydroxyvitamin D and the onset of late-life depressive mood in older men and women: The Pro.V.A. Study. The Journals of Gerontology: Series A: Biological Sciences and Medical Sciences, 69A, 1554-1561.

    Webb. GP. (2015). Vitamins/minerals as dietary supplements: a review of clinical studies. Dietary Supplements, 139-169.

    Nicole Trach & Dr. Austin Mardon <![CDATA[Cognitive-Behavioral Therapy for Schizophrenia]]> 2016-06-30T00:39:32Z 2016-07-08T17:45:42Z ]]> brain-1294854_960_720Search Google for cognitive-behavioral therapy (CBT) and you’ll find this: “A type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression.”

    On the surface, it seems unlikely that this type of therapy would be associated with people suffering from schizophrenia, a serious mental disorder affecting approximately one percent of the world’s population. But it may be an effective supplementary therapy to pharmacological treatment for those with the disorder.

    Post-hospital care often begins while patients are still in the hospital, and applies the principles of treatment engagement, goal-setting, positive actions and removing roadblocks to recovery (Moran, 2014). It is believed that utilizing these ideas will allow patients to assume more control in their daily lives and allow for a return of functionality where they may previously have lost some.

    CBT is considered an effective way to apply these principles and teach the patient how to practice them on their own. It is the most universal treatment in addition to medication in the UK, as well as recommended to become a second frontline treatment by the UK National Health Service (, 2014).

    According to the Beck Institute website (2016), “the goal of CBT is to help people get better and stay better.” The website also explains that the therapy is a platform for the therapist and client to work together to change the clients’ thinking, behavior and emotional responses. This ties in with the ideas of treatment engagement and setting goals. Through practicing this, schizophrenia patients feel that they can take more control in their daily lives. Once the barriers of feeling helpless and being defined by their illness are removed, it is easier to move forward. It is an important step in the life of anyone suffering from mental illness to feel hope for the future and be able to achieve some forms of independence.

    CBT targeted toward schizophrenia was researched only after it had been proven effective for anxiety and depression, to provide a treatment for the residual symptoms (Kingdon & Turkington, 2006) that remained once the patient was on medication. It is common knowledge that even with compliant pharmacologic therapy, patients still experience both positive and negative symptoms, such as delusions, hallucinations or symptoms similar to depression. Additional symptoms include a reduction in motivation, emotional expression and feeling, and a lack of pleasure and interest in life, among other cognitive impairments affecting memory, thought organization and task priority (, 2016). Medication side effects such as uncontrollable movements, weight gain, seizures and sexual dysfunction also can be debilitating (Konkel, 2015).

    Mental health professionals have reiterated over the years that CBT and medication have been demonstrated to be effective treatments for schizophrenia. According to the UK’s National Institute for Health and Care Excellence (NICE), “almost half of all practitioners, people using mental health services and their families say that CBT is the most important intervention alongside the use of medication” (NICE, 2012).

    One study comparing CBT to other forms of psychosocial interventions found that CBT and routine care together were more effective than any of the other therapies examined (Rector & Beck, 2012). The authors acknowledged that there are many flaws in the studies they combined and compared, but it holds promising results that may be tested in more rigorous and controlled studies in the future.

    There also have been studies showing that there is little to no effect from cognitive behavioral therapy in reducing symptoms of schizophrenia. Jauhar et al. (2014) concluded that CBT has a small, if any, therapeutic effect on the symptoms of schizophrenia when they conducted a systematic review and analysis, including accounting for potential bias, of previous studies that showed positive results.

    There is an argument to be made that acutely psychotic patients would be unable to participate in psychological interventions, which would make it difficult to provide them CBT. Through encouragement to take up small activities that are possible for psychotic patients, they can move toward being in a well enough state to be able to take up formal CBT (NICE, 2012). Attending the sessions and doing the homework associated with therapy could also become a problem. The rates of medication noncompliance alone would suggest that it would become an issue.

    Logically speaking, if CBT works to alleviate depression, it would apply to the negative symptoms associated with schizophrenia, since they are essentially the same. Once negative symptoms are less of an issue for the patient, it may help them handle positive symptoms as well. Even if the positive symptoms couldn’t be helped, at least the individual wouldn’t have to deal with the full range of symptoms that contributes to reduced social and occupational functions.

    CBT might not work as well as some studies claim, but it may. It is clear that more research needs to be done with better control methods, but in the meantime, as there are answers still being sought, it is worth a try.


    Beck Institute. (2016). What is cognitive behavior therapy (cbt)?. Retrieved from

    Jauhar, S., McKenna, P., Radua, J., Fung, E., Salvador, R., & Laws, K. (2014). Cognitive―behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal Of Psychiatry, 204(1), 20-29.

    Kingdon, D., & Turkington, D. (2006). The abcs of cognitive-behavioral therapy for schizophrenia. Psychiatric Times. Retrieved from

    Konkel, L. (2015). Schizophrenia treatment. Retrieved from

    Moran, M. (2014). CBT addresses most-debilitating symptoms in chronic schizophrenia. Psychiatric News. Retrieved from

    NICE. (2012). Patients with psychosis should be offered therapy. Retrieved from

    Rector, N., & Beck, A. (2012). Cognitive Behavioral Therapy for Schizophrenia: An Empirical Review. The Journal Of Nervous And Mental Disease, 200(10), 832-839. (2016). Learn more about schizophrenia. Retrieved from (2014). Cognitive behavioral therapy (cbt) for schizophrenia. Retrieved from

    Barry Quigley <![CDATA[A Letter to My Future Suicidal Self]]> 2016-06-29T21:52:38Z 2016-07-07T17:45:27Z ]]> suicide prevention campaign to help suicidal peopleBarry,

    You have opened your sealed envelope because suicide is now an option. Through no fault of your own, you were drawn here by your illness and circumstances. As your past rational, cogent and lucid self, I don’t know exactly what led you to this point. To fall this far, something has happened to all you have learned in therapy and by practicing various skills. Your confidence that you are strong enough to survive this is shaken, if not completely absent. Know this, Barry: you have survived the fearsome specter of suicide before. You cannot control the events that brought you here; with courage and support you can alter your responses to the events. You can choose to survive.

    Many times you have stood alone on the banks of your black river called depression with its dead and gnarled trees along the banks with green meadows in the distance. You chose not to enter the river then. Something made this time different. Perhaps it is not beneficial to focus on the path taken but to focus on the path forward.

    Where are you now? Are you ankle-deep in the slow-moving waters near the safety of the riverbank? Or, have you loaded your pockets with stones, turned your back on the safe haven of the bank and moved into the swiftly moving neck-deep water in the center? Have you been carried downstream by events and emotions, past the safety of the accessible riverbanks to where the river’s edge now meets the vertical canyon walls, making an exit seemingly impossible? Even so, it is not too late. You can choose. You can cast the stones from your pockets and float down to where the terrain is more amenable to an exit from your river. You cannot choose to be rich, handsome, or loved; however, you can choose to be alive.

    I cannot dispute, that at this future moment, your feelings, emotions, pain and suffering are palpable with an almost physical presence with you. You may have concluded them to be beyond the hope of real or palliative relief. Several times in your life, you have been in the river at various depths with your back to the bank. At those times, you chose to come back to the safety of the bank. What makes this time different? Is it a matter of degree; is the trauma beyond your ken?

    Before the monster can be tamed, its powers and effects must be known. In May 2016, a phrase in a psychology book struck a deep emotional chord with you: “Suicide is a death like no other.” That same day you wrote the following:

    Suicide is a death like no other; I cannot let this statement simply stand alone, it begs and demands that I expound upon, define and make it my own.

    Suicide denies the survivors the rationality of a loved one’s slow death by a terminal illness and time to say goodbye. It denies them the righteous anger of sudden death at the malicious hands of another. It denies them the “bad things happen to good people” comfort of an accidental death. The survivors are left with questions that can only be asked but never answered and an intractable guilt due to actions not taken or clues not seen.

    The grief of surviving a suicide is only comparable to the loss of one’s child. Time does not heal these special wounds. They are festering scabs, persistently and forever reopened by memories, the empty chair and thoughts of what could have been. The survivors may even lose the solace of their religion; their loved one is now and forever a sinner.

    The person completing the suicide harbored no viruses, germs or bacteria. Unbidden by the breath, not conveyed by innocent contact, nonetheless others will be infected and tainted by the act itself. Perversely, those most intensely affected by the suicide may well become the most severely infected. It may lay dormant for decades, but once having lost a loved one to suicide, the survivors are now more at risk of the same sad and lonely fate. The heirs are now doubly damned; they carry the potential genetic curse and have been infected by the act.

    A terminally ill person. A mother whose car has skidded off an ice-covered road into a lake; the car is filling rapidly with frigid and numbing water; her seat belt is jammed. A father trapped in the upper floors of the World Trade Center on 9/11. The person contemplating suicide has a power these others do not possess although they desperately desire it: he can choose not to die.

    The person contemplating suicide is alone in a manner which brings me to tears because I so ache and desire to express it but lack the poetry and emotive skills to do so; I have experienced that desperate isolation once. The person contemplating suicide is in so many ways more alone than the physical isolation of a shipwreck survivor far from shore or a compass-less solitary hiker lost in a blinding mountain snowstorm. He is so maddeningly mentally alone because his rational self has abandoned him or been driven away. The irrational self is left in an impenetrable dark solitude with a faint light over the only door; the door is labeled ‘suicide.’

    The person contemplating suicide has knowledge no others possess about themselves, even the classically terminally ill (neglecting that depression is too often a terminal illness). He knows the moment, manner and method of his passing.

    Only atheists complete a suicide. Even the most devout and pious person completing a suicide, in his final moments becomes an atheist. How can he not be when his God has forsaken him?

    You are now in a better position having explicitly defined suicide as a death like no other. You know what suicide is and what it does; it is no longer some ephemeral construct as it once was. You know the impact on the survivors. You retain at least the vestiges of your coping skills. Moreover, you know that suicide is a permanent solution to a temporary, albeit devastating, problem. You survived August 2015. You can choose to alter your deadly path; with help and hope you can alter your potentially lethal response to events.

    At 7:30 p.m. on August 22, 2015, you made a noose from your belt in a period of utter hopelessness and loneliness. You may very well be as scared now as you were then and rightly so. As you knew then and know now it would have been/will be no tepid halfhearted attempt; you would have/will die. Know this, Barry: in that indescribable fear and loneliness, staring at your improvised noose, you still retained enough wits to call your therapist and the suicide hotline. You have progressed so far since then; you have more options, skills and support. You can make a rational choice.

    Note that tragic events may precede a suicide but do not cause it. Your response to the events is what will put your head into the noose. There is no ironclad and formal if/then logical construct that binds you to death by your own hand. True, something horrible has happened, perhaps you cannot even express it. Know this, Barry: there is a vast range of choices, pathways and actions between a traumatic event and suicide; it is by no means foregone. Do not go down the single path that immediately and forever excludes life. You can do some of the things in this letter but more powerfully you can decide to survive.

    A helpful phrase stays with you: “Just because you are struggling doesn’t mean you are failing.” A physical battle would be so much easier! Instead you are fighting a two front psychic war. You are trying to deal with, cope and understand the trauma that caused you to open this sealed envelope. The fact that a “death like no other” is being considered means that a potentially fatal internal battle is being waged between your rational and irrational self. Do not judge yourself too harshly as failing, driving yourself farther from the safe haven of the riverbanks. You have an illness, no failing on your part brings you here. You can choose to alter your emotional response.

    When you were well, you clearly understood the distinction between pain and suffering. In fact, you were proud of yourself that you were able to grasp the distinction. Recall that pain is inevitable but suffering has some element of choice. It may seem hard to grasp right now but pain and suffering are different. If you are truly suffering right now, can I ask you to back up a step? Did you somehow choose to suffer as you sometimes do to punish yourself or simply to feel some kind, any kind, of emotion? If the former, you have had success with holding those thoughts at bay. With courage and knowledge of past successes, you can alter your suffering. The pain will still exist but the suffering can be minimized by your choice and actions. If the latter, and you are reading this, you have simply gone too far.

    Read the “Suicide, a death like no other” section again, particularly the survivor impacts. You are not a mean or vindictive person. Is it possible for such a caring person to possess such suffering as to damn your progeny with your final act? What pain do you feel right now? You are considering ending that pain; indeed you might only have one hour left of the pain. When will it end for those you leave behind; after decades, when they follow you in the same desperate act? Although not the most self-caring act, you must survive with the pain, to prevent hurting others. With help, you can come to understand and deal with the pain and the associated suffering to improve your lot.

    When you were young, you watched the TV show MASH every week. You were also drawn to the seemingly innocent melody of the theme song. A few years later you found out its title: “Suicide is painless.” This was a troubling and conflicting discovery for a teen like you.

    Know this, Barry: For the person completing the suicide, it is not painless. The body’s violent and wracking attempts to expel a poison. The crushing pressure of a hanging. The terror of the onrushing ground. The brief but intense panic of self-suffocation or drowning. Can even a bullet outrun the synapses of pain? In addition to the physical pain, there is also emotional trauma; recall that you have been near death three times. When you were 8 you almost drowned; you know it is true that your life flashes, backwards, before your eyes. You will never know how you survived your almost-fatal accidental asphyxiation when you were 20; you regained consciousness, alone, in fresh air with no idea how you got there. Although these are no doubt traumatic, they are almost mundane when compared to 2005.

    There is a stark terror associated with impending death. In 2005, you had a medication reaction; headaches beyond what you had ever experienced. The ER staff dismissed it as a mere migraine. Although you had no history of migraines, they sent you back to the waiting room. As you waited, each heartbeat caused wracking spasms of pain which continually added to the overall pain, seemingly bringing death closer. Soon, you were on your hands and knees in the ER bathroom vomiting due to the pain; the passage of time slowing greatly. In this time-dilated space, as one particular heartbeat ended, you somehow knew that the next would end your life. In that prolonged time between heartbeats, you huddled in your pain, knowing you would die within seconds.

    Some have dismissed your suffering because the next heartbeat did not kill you. No one can understand that you knew you were going to die and the trauma it caused. The physical pain was intense, the terror of impending death indescribable. Eleven years later, I choke up as I write about the terror. The hopelessness you felt last August and the knowledge of impending death in 2005 are of decidedly different natures but are comparable in intensity. Are you ready to face it again, perhaps within the hour?

    There is no romanticism associated with the physical pain and emotional impact of suicide. The distorted reality for the person abruptly ending his life leads him to believe he is making a decision. He thinks that he has made a rational weighing of the short-term pain of the act against the interminable future psychic suffering. However, his suffering has cruelly deprived him of the keystone of the argument: hope. He sees only ‘pain now, no pain later.’ With hope, interminable future psychic suffering need not occur. With hope, there are alternate, healthy paths. With hope, an alternate future exists. Hope means things can be different. Can you now acknowledge the possibility of hope? Also, the act of suicide does not eliminate future suffering, it is simply transferred, albeit in a different manifestation, to the survivors.

    Decisions and choices, Barry; that is what it comes down to. Right now, a purist would say that you are “cognitively impaired.” I wrote this while I was well because I don’t want to die; I want to cuddle and coddle my grandchildren’s grandchildren. I am trying to connect with whatever rational part remains; suicide is a permanent solution to a temporary problem. You can get better, you have before. You just need to be alive to do so.

    At a high level, suicide becomes an option when suffering exceeds the ability to cope. The trite answer is to decrease suffering or increase coping. At this point, I’m not sure these abstract concepts will serve you. Focus on what can you do this instant to increase your survival odds. In no particular order:

    • Contact your therapist; text first, immediately followed by voice mail. Don’t use soft words like you did before (“am in crisis, please call”). Be disturbingly clear and share your fear with her: “suicidal, alone, scared beyond words; I have a noose.” Truthfully, what you want is kind, palliative words; a verbal hug if you will; but her kind and caring words will not stay your hand. She cares about you and is concerned for your welfare but her effective options are limited. More than likely she will insist on the emergency room. If you simply dump on her that you are suicidal but are unwilling to do anything, she will, to ensure your safety, call the police for a welfare check.
    • If alone, get with people. This may be as simple as watching TV with your wife or getting out of the house to the bookstore or coffee shop. Note that this is a safety tip, not a coping one; you may very well come back to the house in a state of mind not much better than when you left.
    • Hold a puppy or a baby to refocus on life.
    • Get a hug from someone who loves you.
    • Tell your wife. I cannot imagine any circumstances where you would say “I am suicidal, please help me.” She loves you and is perceptive. Something as simple as “I feel like I did in August 2015” should do the trick.
    • Do not drink alcohol. Through no fault of your own, your thinking is impaired by the severe state of your illness. You might not survive the loosening of inhibitions that alcohol provides.
    • Do not even start a suicide note. Although you did not consider writing one in August 2015, completing one could be seen as accomplishing an expected task on the path to suicide.
    • Do journal but be careful. Journaling in an impaired state can be risky; the words may give shape, substance and motive to the ugly thing. Stick to facts and descriptions of emotions for now, leave out judgments.
    • Call the national suicide hotline at 1-800-273-8255. Expect care and concern and direction to the ER.
    • Get to the emergency room.

    Barry, it is vital to know that at this moment you are impaired by your illness. Life or death decisions made now are a sham. You must and can choose alternate responses. If not immediately for yourself, then to prevent harm to those you love and who return your love.

    Lastly, I love you.

    Suzanne Kane <![CDATA[Overcoming Turmoil from Self-Destructive Emotions]]> 2016-06-29T22:01:25Z 2016-07-06T17:45:02Z ]]> Black TornadoWhen emotions tie you in knots, there are bound to be negative effects. It can be tough to know how to overcome these powerful emotions and get balance back.

    Here are some tips for managing difficult emotions and regaining equilibrium.


    Anger is one of the most powerful emotions and potentially the most self-destructive one. Whether you have mismanaged your feelings of anger or simply don’t recognize the signs that anger is taking over, you can learn how to be more proactive in dealing with anger and its aftermath.

    It’s important to learn how to recognize when you are angry. For example, when you feel like throwing something against the wall or you blurt out angry words to others, you’re angry. Another sign of anger is when you feel choked and something is about to erupt inside.

    You might have dealt with anger in the past by denying it, rationalizing that what’s going on is something other than anger. The problem with denying and rationalizing this powerful emotion is that it tends to drive those angry feelings deeper. There’s a strong likelihood they’ll resurface later, probably at the most inopportune moment or when least expected.

    What do you do when you find yourself getting angry or suddenly realize that you are filled with anger? Are you able to own that anger? Do you have successful coping methods to deal with it? Or do you just try to ride it out until the anger subsides?

    Common signs that you are becoming angry or are, in fact, already angry include:

    • Rattling off words rapid-fire
    • Making sarcastic or biting comments
    • Experiencing a growing list of various pains: stomach, back, neck and head
    • Thinking violent thoughts
    • Feeling the need to physically leave a room or get away from others so that anger doesn’t erupt in a physical altercation

    Ask yourself how you currently deal with angry feelings. Do you isolate yourself so that anger doesn’t jeopardize relationships, your job, or other situations? Do you engage in other types of compulsive behavior to help mitigate anger, such as drinking too much or using drugs?

    Next, think about what precipitates the anger. Who were you with when you became angry? What else was going on with you at the time? Were you exhausted, overstressed, just got some bad news, jealous, lonely, feeling ill, hungry or scared? By pinpointing those situations, you will be better able to deal with the emotion of anger.

    Remember that you decide how you will behave. By weighing and balancing one behavior choice over another, you should be able to make the right decision. Use reason and be calm. Try anger management techniques. If there is another person that you can talk to about your feelings, do so, including a professional counselor if needed.


    Many people confuse being alone with loneliness. They are not the same. You can be alone by choice and perfectly content to be that way and you can feel lonely even in the presence of others. Being alone is a fact. Being lonely is an emotion you feel.

    What are the dangers of loneliness? Beyond the obvious negative effect of keeping you away from interacting with others, loneliness tends to keep you focused on all the negatives in your life. All the bad things that have happened or may yet happen diverts your attention from taking steps toward any goals you may have.

    When you experience loneliness, being with other people is probably the last thing you want to do. But that is exactly what you should do. Visit close friends or spend some time with loved ones and family members.

    Recognize that it may take time to erase feelings of loneliness. By being active and surrounding yourself with others, you’ll be taking constructive steps to deal with loneliness so that it doesn’t derail your life.


    Fear is another powerful and potentially paralyzing emotion. Being afraid to take action is no way to live. Not only does fear prevent you from going ahead with action plans in pursuit of particular goals, it has a negative cumulative effect. Fear will overcome you if you let it. But most fear involves things that have not happened yet or may never happen.

    As with anger, the key steps to overcoming fear are to recognize it, identify the signs, and figure out what causes it. Then decide how you will act when you are afraid. Determine the best strategies to use. Vary and modify them as circumstances and situations demand. A technique you used in the past may work well, or it may need revision if it doesn’t work now. Be flexible so that you can adapt and create new coping strategies.

    Tina Arnoldi <![CDATA[Book Review: Why Can’t I Stop?]]> 2016-06-24T17:19:13Z 2016-07-05T17:18:02Z What if you had a pint of ice cream for dinner last night and spent three hours on social media? You probably wouldn’t hear any judgment at work the next […]]]>

    What if you had a pint of ice cream for dinner last night and spent three hours on social media? You probably wouldn’t hear any judgment at work the next day. In fact, your colleagues might nod and smile because they’ve been there. But what if you drank a fifth of vodka and gambled away your mortgage? No one’s laughing now. Instead they’re judging you. “How could you do such a thing?” they would ask. “Why didn’t you control yourself?”

    Any number of behaviors, whether socially acceptable — like eating and being on the internet — or not quite as acceptable, can turn into an addiction. In Why Can’t I Stop? Reclaiming Your Life from a Behavioral Addiction, Grant, Odlaug, and Chamberlain review commonly known addictions in an easy-to-understand guide.

    The book is a great introduction for the layperson who wonders, “Why don’t they just stop?” It’s an equally good overview for clinicians like myself who are not actively working in the addictions field. After providing some basic information about addictions, the authors focused on gambling, stealing, sex, the internet, food, shopping, hair pulling and skin picking, before wrapping up with some general helpful advice for family members. Although some of the information in Why Can’t I Stop? was repetitive, the repetition did make it a good reference for people who may only want to read the most personally relevant chapter.

    Each chapter is laid out in the same way — sharing why we need to care about the addiction and whether it really is a disorder. The ability to identify what makes something a disorder is clearly an important distinction because of the acceptable addictive behaviors in our culture. Take eating, for example. It’s rare for me to attend a church, work, or networking event where food isn’t involved. At times, it almost seems as though none of us are allowed to eat at home! Since it is “normal” to have food constantly in our faces, it’s understandable that food addiction can become a problem for some people.

    I appreciate that the authors didn’t dwell too much on whether the behavior needs to be formally included it’s in own DSM-V category to be considered a problem. Bravo! Just because something is not categorized in the diagnostic manual does not mean it’s not something of concern. Material on which characteristics distinguish behaviors from a different type of disorder was valuable. A good example is online shopping. Rather than focusing strictly on general distress from the amount of time spent online, the authors suggest that it might be shopping and spending that is the problem, which could mean a compulsive buying disorder rather than an internet addiction.

    Some of the consequences presented in the book do seem to be expected outcomes. For example, if you gamble, you’ll probably have financial problems. However, other consequences are things people may not immediately consider. Internet addiction can result in “minor physical problems such as dry eyes or blurred vision.” That’s perhaps not the first concern people would think of.

    In my opinion, the medication section had the most repetitive information. There does not seem to be a clear cut answer in regards to proper medication for addictions; however naltrexone, used in substance addictions, was often cited as a potential option for other addictions. It seems the medication section could have been a chapter of its own, perhaps with a reference chart noting differences. As clinicians and family members, we probably would not be heavily involved in deciding which medication one should use, but I suppose it’s good to know what is out there.

    The end of each chapter lists key points for family members, such as modeling healthy behavior, helping the struggling family member stay away from triggers, and encouraging formal treatment for their loved ones. Although some of this advice may come across as very obvious, in times of stress, we all probably forget the things that “should” be obvious to us normally. It’s great to have a section devoted to family members so they know that any small action they take does matter.

    The resources section at the end could be expanded. It lists some treatment centers as well as books relevant to the addictions discussed. It would be helpful to see more options in here, especially since some of the books were published more than 20 years ago.

    Overall, I would recommend this book to most people. For those already in the addictions field, this is not a comprehensive or advanced book on these addictions, so there’s no new information for people specializing in this type of work. For students, family members, clinicians focused on other areas, and people struggling with addictions, it does offer some insight and affirmation that these are real problems and, more important, they can be treated.

    Why Can’t I Stop? Reclaiming Your Life From a Behavioral Addiction
    Johns Hopkins University Press, June 2016
    Paperback, 232 pages