World of Psychology Dr. John Grohol's daily update on all things in psychology and mental health. Since 1999. 2017-08-21T15:45:43Z https://psychcentral.com/blog/feed/atom/ Jessica Wright, LCSW <![CDATA[Therapist Grief]]> https://psychcentral.com/blog/?p=108877 2017-08-11T20:27:22Z 2017-08-21T15:45:43Z Jessica Wright and her dog IvoryAs a therapist, many people come in with issues with grief. For years I have tried to help clients figure out the well know Elisabeth Kubler Ross Stages of Grief and what stage in their grief they are in: denial, anger, bargaining, depression and acceptance. It has been sad to watch clients suffer and deal with grief. I have wished many times that I could help take their pain away. Until one month ago, I had never lost anyone or any pets that were close to me.  

One month ago, my husband and I decided to go for a light walk/jog with our two kids and our 14-year-old dog Ivory. It was a normal 75-80-degree summer midwestern night. We had finally started to get fully adjusted to our new lives here, as we moved here from the city about 1 ½ ago. As we ran than night, Ivory no longer kept up. She kept her beautiful smiling dog grin but almost like a stubborn mule didn’t want to go faster than a brisk walk, so we did not push her. This dog, was the kind of laboratory/husky mix that for the last 13 years had pulled me on our normal runs down the street. She had so much energy I wondered if I’d ever catch up to her. I never wondered if she would die, she was literally the smartest and strongest dog in the world and my first dog and most beloved animal. After that slow jog, she barely made it back inside the house and by the next morning she could no longer get up to go potty or eat. She was diagnosed with cancer all over her belly that had spread to her brain. Two days later we were forced to put her down. I am still confused until this day with how we did not know about her cancer and worry that our job pushed her over the edge.

My whole world was shaken up after losing our dog Ivory. Her and I conquered the world together, she was there for me when I had felt so alone, so confused and so lost. She was that companion that when everyone was busy she was excited to be by my side, day in and day out. We have been busy with our two young children both under 3 years old, did she get cancer because of her broken heart and because she thought she was being replaced? Does she watch us from heaven? Does she feel lost without us, just like we have without her? Was it okay that I was not strong enough to be there to put her down, and that my amazing husband was the only one who could stand next to her in her possibly most scary time in her life?

I am writing this to cherish Ivory’s life and her spirit. She was there with me during my 11-year process of becoming a Licensed Clinical Therapist. She puts the hours in next to me, and even put up with me when I was tired and just did not feel like taking her on a walk, when I should have.

Her life will never be in vain. I just pray when I work with clients that I can relate more to their loss. A loss, is a loss whether it be a parent, child, friend or pet. It changes us, it makes us question everything and reevaluate our choices, our time and even our distractions and values. Losing Ivory gave me two specific pathways of how to channel the pain and emptiness. I could get stuck in the sadness of losing her and become angry with the world, myself and maybe even God? Or I could find ways to work through the pain, and lift up Ivory’s spirit by remembering all the unconditional gifts she gave to myself and so many others.  

 

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Linda Sapadin, Ph.D <![CDATA[When Procrastination is Persistent, Pervasive and Pointless]]> https://psychcentral.com/blog/?p=108741 2017-08-08T22:55:38Z 2017-08-21T10:30:21Z Sure we all procrastinate sometimes. Why not? Let’s see, shall I spend the evening doing mind-numbing clean-up chores or enjoy a good time with my friends? Shall I do tedious paperwork or plop down on the couch and watch my favorite show? It’s never been easy to control our urges, especially when what we “should” be doing goes against our grain.

In the digital world, however, procrastination is even harder to conquer. Accessible, appealing, addictive distractions are everywhere. Beepers beckon. Entertainment entices. Digital devices ding. Social networks seduce. Gaming, blogging, chat rooms, You-Tube, video streaming — and more — easily lead us astray. Digital temptations are just so much more seductive. Exciting, fast-paced entertainment actually changes the way our brains operate. If a task doesn’t immediately hold our interest, our minds gravitate to other matters.

So, what’s a person to do? Can’t we just enjoy ourselves? We all procrastinate about something; so what’s the big deal? Yes, agreed. I don’t know anyone who doesn’t ever put a task off to another day. You tell yourself, you’ll clean out the garage; yet, it doesn’t get done. You say you’ll organize your paperwork, but it’s still a mess. Oh, well. You can live with your disorganization. It’s not that bad, as it’s not affecting your personal, family or career goals.

But, what if, it is that bad? Or worse? What if your procrastination is not something to chuckle about as people tend to do? What if your procrastination is persistent, pervasive and pointless? Let’s look closer at those three descriptive terms.

Persistent Procrastination is when your procrastination is never ending. You don’t do what needs to be done. Or, you start doing a task but never finish. Or, you only lurch into action at the last minute, prodded on by an impending deadline or a ticked-off third party. Or, you put a lot of effort into a project but never complete it because you conclude that it’s “not good enough.” You’ve always got “a reason,” but, after a while, that reason rings hollow.

Pervasive Procrastination is when your procrastination is widespread, permeating many areas of your life. It’s not just the tough tasks you put off; it’s even the simple things. Procrastination has become a tenacious trait. It’s your modus operandi. Though you may say you have every intention of doing what needs to be done, your energy remained dammed, damning you to staying just as stuck as ever.

Pointless Procrastination is when your procrastination is meaningless, senseless, even a bit inane. You put off doing tasks, not because you would rather watch TV. No, you just put it off. And spend the time doing nothing, unless staring into space or vegging out on the couch count as something significant.

So, as you can see, persistent, pervasive, pointless procrastination is nothing to chuckle about. Just the opposite. It’s a dysfunction that needs to be addressed. It may be a sign of depression, dependency, anxiety, apathy, attention deficit or brain impairment.

A caveat: Now that you know that procrastination can be a sign of a serious dysfunction, don’t go overboard diagnosing yourself or a loved one.  Seek out professional help before you conclude that procrastination is a sign of a mental or physical disorder.

Despite its seriousness, it may simply be a bad habit that has taken hold. And, as I’m sure you know from experience, changing ingrained habits is tough, but not impossible. Though the digital age makes it harder to stay on track, still, you can learn how to modify, alter and tweak your ways to reduce your procrastination habit. And when you do, you will develop a more enhanced, enriched, empowered version of yourself. Anyone against that?

©2017

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Psych Central Staff http:// <![CDATA[Here’s How to Stop Being a Prisoner of Regret]]> https://psychcentral.com/blog/?p=108611 2017-08-08T22:47:10Z 2017-08-20T20:30:15Z

“We are products of our past, but we don’t have to be prisoners of it.” — Rick Warren

Regret — whether for things that you have done or things that you had no control over — can keep you frozen in the past, unable to move forward. Sadly, there are no magic wands that can turn back the hands of time and change what has happened, but despite this I believe we’re not entirely powerless to affect the past, after all.

I first began thinking of this subject when my daughter was young and having serious ongoing problems with fear. She wasn’t able to go to school or to be separated from me for any length of time at all.

I really could sympathize with her. As an adoptee from Korea, I knew that she had been relinquished by her mother at birth, placed in an orphanage, then with a foster mother, and ultimately taken from that woman to make the long journey to America and her “forever” family — but not without a whole lot of emotional baggage onboard.

I wished with all my heart that I could have been with her through those first months so that she would have known that she was safe and loved. I was sure that was the root of her troubles now, but no amount of safety in the present seemed to make up for the lack of it in her past. It seemed there was nothing I could do about her rocky start in life. Or was there?

Being a meditator, and someone who is comfortable with visualizations, one day I had the brilliant idea to try simply “re-writing” her past.

I visualized myself in the birthing room with Lia, taking her tiny body into my arms and telling her how much I loved her, that she was safe, and that I was waiting for her. I also whispered in her birth mother’s ear that I would take good care of her daughter, and that everything was going to be all right.

The visualization felt wonderful, and I repeated it many times, going on to visualize myself at my daughter’s side through all of the other changes she went through in those scary first months of her life.

Whether or not I was actually impacting my daughter, I certainly found these visualizations helpful to me! I felt I was somehow able to make up for what she had missed out on and, over time, I really think it did help Lia to overcome her fear (although I’d never be able to prove it).

Perhaps it was only because my energy had changed, which affected her in turn. At any rate, she gradually seemed to relax and gain the confidence that had eluded us through so many years and so many other attempts to help her feel safe.

Since then, I’ve used my “time travel” meditation in many other circumstances. For instance, I think every parent has had lapses of control that we deeply regret in hindsight. I vividly remember once losing my temper with Lia as a toddler, for breaking an item that was precious to me. As she grew older and seemed so intent on always being perfect, I wondered sadly how much I had contributed to her fear of “messing up.”

So again, I went back to that remembered situation in a visualization. Obviously, I couldn’t change the fact that I had yelled at her, but I visualized surrounding her in love and whispering that everything was okay — she hadn’t done anything wrong.

In my imagination, we watched my earlier self yelling, and I told her, “She’s just tired, poor thing. She’s not really mad at you, she’s mad at herself. Let’s just send her some love.” And we did.

As before, I have no idea whether my visualization actually had an impact on Lia’s perfectionism (I hope it did), but it certainly helped me feel more compassion and less shame regarding my past actions.

On yet another occasion, I mentally placed a retroactive bubble of love and protection around Lia when she was facing a scary situation that I hadn’t known about at the time. There are literally endless scenarios for tweaking things in the past, so don’t go too crazy with this! Save it for the situations that really weigh on your heart.

These techniques work equally well even if you aren’t a parent. You can mentally send the adult version of yourself back into your childhood to provide love and support to your earlier self.

Children are especially vulnerable, since they have so little understanding of the true context of what is happening. We all remember times when we felt alone and frightened — how wonderful to take that scared child in your arms and let her know it will all be okay, that she isn’t truly alone.

Although it’s tempting to imagine different outcomes for those painful times, I try to always stay true to what actually happened and simply provide whatever energetic support seems best. For better or worse, we are the product of these experiences; they are a part of who we are. But it may be possible to heal some of the wounds they left behind, even many years down the road.

Does it really work? We know so little about time, but quantum physics gives us some understanding of how slippery a concept it is. At the very minimum, these techniques bring present comfort and a sense of being able to help what previously seemed beyond help.

The feeling of powerlessness to change the past is one of the most corrosive aspects of regret. Even if it is only “imaginary,” the sense of efficacy we get from taking some retroactive action is priceless.

For very traumatic situations, especially ones that you have not already explored in therapy, I would definitely recommend first trying these techniques with a therapist. However, most of us have a long list of more garden-variety regrets we could safely use “time travel” meditation to address.

To begin, simply relax and breathe deeply, gently allowing the situation to come into your awareness. Let your intuition be the guide, and use any words, color, light or other visualizations that occur to you. (As a general rule, you can never go wrong by simply blanketing the experience with love and compassion.)

Don’t force yourself to feel forgiveness if that isn’t what you feel — if there is some antagonist involved, you can safely just ignore them and concentrate on providing comfort to the one who needs it. Remember that you are the “wise adult” in this scene, there to provide perspective and support, not justice or retribution.

Continue to breathe deeply and notice whatever emotions come up. Close the meditation when it feels complete, and return as often as you like! Sometimes once will be enough; sometimes (as with Lia’s birth) it will take many sessions to feel complete. Again, let your intuition be your guide.

Be respectful if you use the technique on other people or situations that you didn’t personally experience. I felt close enough to Lia to insert myself into that scene, but I would hesitate to do so in most other situations. I also shared with her what I was doing and, even though she was still fairly young at the time, I think she loved the idea that her mommy was there, at least in spirit, at her birth.

Although it’s true that “what’s past is past,” it may be possible that we don’t need to leave it at that. I believe we can send our love and our energy through time and, in the process, perhaps heal ourselves of painful regret.

This post is courtesy of Tiny Buddha.

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Dr. Andrés Fonseca https://thrive.uk.com/ <![CDATA[Internet Therapy for Children with OCD]]> https://psychcentral.com/blog/?p=108881 2017-08-08T22:44:44Z 2017-08-20T15:45:22Z Obsessive compulsive disorder (OCD) is condition that affects about 2.2 million Americans and 750,000 people in the UK. It has two key features: thoughts that repeat themselves over and over again (called obsessive thoughts) and feeling that the person must do certain actions repeatedly (compulsions). The person thinks the thoughts are silly, but they cannot stop them. Sometimes only carrying out the actions stops the thoughts for a while. The typical example is thinking that your hands are dirty, even though you know they are not, and having to wash them repeatedly. The person can spend a huge chunk of the day carrying out these compulsions. This often makes it very difficult to function at all. This can be even more tragic when it affects a child.

I vividly remember a patient of mine I will call Leo for the purposes of telling his story. Leo’s mother brought him to my clinic when he was 8 years old. He was small for his age and quite slender, but, somehow, he had quite a presence. He would look at you in the eye and speak in precise well-crafted sentences. I remember having the impression that he was always mildly disappointed that adults — me included — did not quite live up to his expectations. He never came across as peevish or snooty; just seemed to take in the fact that you were flawed, but forgive you for it. His mother told me that he had been having some horrible thoughts for a while. He started avoiding his friends, spending increasingly more time in his room, and, most recently, refusing to go to school and to be with his mother for any period of time. She did not really know what those thoughts were, but she said that he had only told her he was worried about spending time with other people, as he thought he might hurt them.

When I interviewed him on his own with his mother waiting by the consulting room door, he told me that he was worried he was going to kill his friends, people at school, his mother, and other relatives. He did not want to do it, but every time he was with anybody — particularly anybody he cared about — he would have these horrible thoughts of him attacking them viciously. Sometimes he could see the whole horrible attack in his mind and it frightened him very much. That’s why he felt he couldn’t go to school or be with his mother or his friends; he was worried he would ‘lose control’ and attack them. I asked him if he had ever attacked anybody and he was horrified with the question. ‘Of course not, doctor,’ he replied in his precise tones. In fact, his mother later told me that he was a very peaceful and quiet child who had never started a fight in his life. The diagnosis was clear: OCD. The treatment presented a problem. At the time there was a very long waiting list for therapy in the clinic where I worked and I did not want to prescribe medication for a child when the obvious first choice was cognitive behavioral therapy. This lack of available and affordable therapy continues to be a serious problem for many children like Leo.

Internet-based CBT (ICBT) is a possible solution. The patient follows the same techniques as visiting a therapist, but does so more independently following a structured program. It is more successful when supported by a clinician, but it enables the clinician to only focus on problems and makes the intervention much more efficient. There is very good evidence of this approach being useful in adults, but would it work with someone like Leo.

Fabian Lenhard and colleagues have recently done a study on the cost-effectiveness of ICBT in comparison to untreated patients on a waiting list. The study was carried out in Sweden, on 67 adolescents (aged 12-17) each with a diagnosis of OCD. The interventions were either a 12-week ICBT course or waiting for treatment. The researchers carried out assessments before and after the treatment in both groups. Two types of costs were estimated: ICBT and any costs for the young people waiting for treatment. This included educational (being away from school) and medical costs. ICBT costs included clinician’s time and software costs.

After ICBT, 27% of the participants showed at least 35% decrease in symptoms, whilst not one person in the waitlist group showed an improvement. Also young people in the waiting group had greater healthcare costs. These findings suggest that ICBT is not only clinically beneficial for treatment, but also results in cost savings in comparison to leaving those with OCD untreated. For Leo this would have been ideal as he could still be on the waiting list, but already improving. As it turns out he did recover, but he had to wait longer than the 12 weeks that this study lasted. This is a great loss of opportunity at an age when education is so important. Given the type of child he was I think he would have been less disappointed with me if I had been able to offer something like this to him.

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Sandra Kiume http://blogs.psychcentral.com/channeln/ <![CDATA[IMAlive: A Global Crisis Chat Service]]> https://psychcentral.com/blog/?p=108814 2017-08-08T15:57:31Z 2017-08-20T10:30:09Z IMAlive.org is an online crisis counseling service that uses an instant message (IM) chat interface instead of phone or SMS texting.

Out of Sight is not Out of MindI maintain Online Suicide Help, a global directory of services which are usually restricted to one country or even one small town. This has meant that most countries in the world could not access any services. Recently I learned that IMAlive changed its service area from US and Canada to be the first crisis chat service available worldwide, and I emailed to find out more about this change. John Plonski, IMAlive’s Director of Training and Developer of its Helping Empathically As Responders Training (HEART) program, kindly wrote back to share more.

Q. Why was IMAlive created as a web-based crisis counselling service?

A. The advent of IMAlive marked a logical next step in the evolution of providing helping services to those in crisis or at risk of suicide. As internet use became ubiquitous (it took 70 years for 90% of American homes to have electricity it took only 26 years for the Internet to reach a similar saturation level) those of us in the helping field made a move that paralleled the shift from face-to face assisting to telephone helping that happened in the early 1960’s. The internet represented barrier free portal to help paralleled the use of the telephone.

Q. Why do people prefer it to a phone helpline or texting service?

A. Allowing that the IMAlive platform handles text and chat (IM) in the same manner and those who come to us use either method this answer will address the user preference over telephone access. Additionally, I feel I need to make the clarification that the advent “digital interactions” (DI) has not created a paradigm shift from telephone services. Rather (citing the experiences of agencies that have both telephone and DI access) the numbers of telephone interactions have continue to follow statistical norms and DI has augmented the total number people reaching out. But back to the question:

• The person reaching out “digitally” is most likely using the most accessible means of communication available to them.
• The perception of confidentiality – When I say this I am not speaking in terms of the “agency” standards of confidentiality and anonymity but the fact the person reaching out does not have to worry about someone overhearing their conversation. Think in terms of privacy rather than confidentiality.
• The DI provides a sense of protection to those who feel they are judged, ridiculed or viewed as being “different” by those around them.
• Some people have more confidence in expressing their thoughts and feelings using the written as opposed to the spoken word. This can be attributed to the asynchronous nature of DI which allows the person to “say” something then review their thoughts before passing them on to the other person in the interaction (although spell-check does make for some interesting thoughts). A corollary to this is sometimes just easier to write something than speak something.
• Telephonophobia – There is a population that is uncomfortable talking on the telephone. The reasons for this dynamic are varied but chat provides the option to get real-time help without doing something that makes the person uncomfortable.
• DI alleviates situations where the person’s dialect, accent or physiological condition makes understanding the spoken word difficult.
• The Multitasking Myth – The public’s attachment to tech devices has deluded them into thinking they have become expert multitaskers. It’s not uncommon to see someone watching TV while working on their laptop, texting a friend, following a Twitter feed about the show and listening to their fave music mix. The reality is they are not multitasking. They are effectively “taskswitching” – though probably doing it poorly. Chat enables the individual to continue doing what they are doing while receiving assistance – even while at school or work.
• In some cases people feel that they receive better assistance in a chat session than they would on the phone. The dynamic working here is – “These guys are smart enough to have chat so they are probably a good resource for me!”
• The DI allows some to feel they are in more control via the written word. This coupled with other dynamics listed above helps them feel they are in control of the conversation and can be more explicit in what they want to communicate facilitating a more productive exchange of ideas.
• The ability to scroll back through the chat session to recall information that was mentioned previously without having to ask the other person to repeat what was said. Also helpful in those times when we say to ourselves, “Gee, What did I say when…?”

Q. Do you think having the support of the PostSecret community and its founder Frank Warren has made you more web-savvy? How about the influence of your other major supporters?

A. We at IMAlive are very appreciative of the support afforded us by PostSecret and the many others who have recognized the need to remove the stigma and taboo surrounding crisis, mental health and suicide. Granted I am perhaps more of a luddite having learned my skills in a world of rotary telephones and databases that lived in shoeboxes full of hundreds of 3×5 cards. However, as a presenter at the 1997 Alliance of Information and Referral Systems National Conference, I did present a well attended workshop titled “Everybody’s Gone Surfin’ ” which addressed providing help through the internet. At that time the internet was a “Golly gee whiz!” thing. Dial-up connections and “You got mail” were the reigning technologies. How times have changed? I think, if nothing else, Frank helped the founders of IMAlive have the foresight and power of conviction to be the first virtual crisis intervention network. It is that foresight and conviction that has nurtured IMAlive into a service with approximately 200 volunteers on 5 continents. IMAlive’s 10-hour online video, Helping Empathically As Responders Training (HEART), coupled with hours of individualized observation sessions of potential volunteers ensures a consistency of service based on accepted crisis intervention standards that is reinforced and supported by our global network of volunteer supervisors. For this – “Thank you all!”

Q. Why did you make the decision to begin offering services globally?

A. While it may be considered laudable the decision to offer services globally was not made by the principles of IMAlive. That decision was made by the platform we use for our chats which does not have the capability to differentiate the location of incoming chats and filter out those coming from other places. With that in mind a decision was made to accept all incoming chats regardless of country of origin. It just seemed that turning someone away because of location would violate the basic mission of IMAlive.

Q. How are you able to overcome obstacles that some other services talk about: regional funding and professional liability within borders?

A. To answer the first part of this question I will simply say that in today’s fiscal environment all non-profits are faced with a daily battle to secure funds in an effort to maintain viability and sustainability. By regional funding I will assume you are referring to government funding. At present IMAlive receives no funding from any government and relies on private donations and the support of our organizational benefactors. As for professional liability – My total lack of knowledge of things legal means I will not be able to provide an adequate answer beyond my understanding from 30+ years of experience in the field that tells me Good Samaritan laws offer legal protection to those who give reasonable assistance to those who are in need or at risk.

Q. Do you offer translations, service in any language other than English?

A. IMAlive does not offer translation of languages other than English. Having said that it is interesting that people whose language is not English have been able to reach out to us and receive help using the various translation apps available on the internet.

Q. Have you adapted your volunteer training to make it more culturally sensitive?

A. At the risk of sounding culturally insensitive about cultural sensitivity I will reply in this manner:

As the developer of HEART this is an issue I have given much thought to over the years. When I consider the topic I find myself going back to the core of HEART. One of HEART’s core tenets maintains the Responder and the person experiencing crisis are equals. This tenet discounts the concept of the omnipotent Responder and empowers the individual who may be feeling powerless as the result of their crisis permitting the Responder and the person to collaborate regarding a solution best suited to the needs of the individual

The tenet of equality is closely coupled to two of HEART’s core fundamentals which are Acceptance and Respect. Acceptance is the “non-judgmental” piece of Crisis Intervention. Acceptance maintains that regardless of what we think or feel about a person we will not judge them, their situation, their actions, or their ability. Basically people, situations, actions, and abilities are things to be acknowledged, not judged.

Once we accept the need to be accepting and non-judgmental we can then embrace the concept of Respect. This means Responders will respect each person’s unique individuality and ability even in those times when a person’s ability may not be immediately evident to the Responder or the person in crisis.
Basically the Responder will respect the individual enough to accept that they can learn new skills or adapt to resolve the crisis at hand.

Does this mean we teach our Responders to ignore cultural differences? Not at all. Ignoring the cultural differences that exist all around us represents a judgment. Some of them have a positive impact on individuals. Others are potentially, if not inherently, negative or dangerous. The strength of HEART lies in the fact the cultural differences would be acknowledged and the person would be engaged in a discussion that would address their own inherent strengths and abilities to empower them to effect personal change which will help them to survive, thrive and regain control of their situation.

So does this mean IMAlive ignores the existence of cultural insensitivity? No. In fact, our selection process and training of new Responders has a structure to screen for those views people may have which would impact their effectiveness as Responders. Of course this begs the question, “Why not train cultural sensitivity?” Generally the issues we would address with sensitivity training are fairly well ingrained in the individual embracing certain beliefs and mores – and that is okay as we would not judge the person based on thier belief system. However, Crisis Intervention work can be stressful enough without adding the stressor of “Abandon your core beliefs!” So rather than create additional stress for the individual we offer them volunteer options that may be more suited to them and therefore more satisfying for them.

Q. For crisis services there’s something known as “Active Rescue,” which means if someone needs emergency medical care, police will be dispatched to the person and they’ll be taken to a hospital. Does IMAlive practice Active Rescue, and if so, how do you manage it in countries where emergency services may not be available?

A. The simple, and accepted answer is, “Where immediate risk of harm or death to the person or others is exists and where it is possible to ascertain the location of the person IMAlive will do all it can to intervene actively.” The appropriate answer in more involved. To appropriately address the question we need to talk about several issues.

First we need to understand there is a distinction between “Suicide Prevention” and “Suicide Intervention”. If we think of a persons “journey”, a continuum, from no thoughts of suicide – to a precipitating event that evokes thoughts of suicide – to a point where the thoughts placing the person at risk are addressed and suicide risk is ameliorated OR the person acts on their thoughts.

Suicide Prevention is a concept that applies to both ends of the continuum of suicide risk. Ideally Suicide Prevention is a combination of efforts by government, helping organizations as well as mental health and related professionals to reduce the incidence of suicide attempts and death. These efforts include, but are not limited to:
• Restricting or controlling access to lethal means (weapons and drugs)
• Reduction of conditions that constitute risk factors for suicide (poverty, bullying, abuse)
• Community awareness of the indicators a person maybe at risk and a corresponding care network those at risk can be readily referred to
• Programs to lessen the stigma and taboo surrounding mental health and suicide
• Accessible treatment for those experiencing depression and its psycho-social symptoms
• Responsible media reporting regarding suicide and deaths from suicide
• Providing social supports to address issues that lead to suicide risk (education, living wages, abuse prevention initiatives)

In short suicide prevention is not a top down solution (government, clinical professionals, society) but a combination of top down and bottom up initiatives. Think of it this way – Government and the mental health community can develop the best programs to help those at risk but unless we, the people that comprise society, take an active role in identifying those at risk all the efforts and money spent are for naught. This is the one side of Suicide Prevention.

This brings us to the other side of the suicide continuum – Suicide Prevention involving Active Intervention. The news tabloids and Hollywood have created an image that thoughts of suicide are unstoppable and portray the graphic image of a person who has a reflective moment before they leap to their deaths or the camera fades to black and we hear the fatal gunshot. This widely held, though erroneous, view rejects the reality that the person at risk wants to live and the majority of the time will do so. Estimates indicate that 3% – 5% of a population has thoughts of suicide at any given time. Yet the number of deaths from suicide, though tragic, is incredibly small if you accept the prevalence of suicidal thoughts. This tells us the vast majority of persons at risk are able to somehow shift from the danger of suicide to relative safety. Part of this dynamic is IMAlive and the many, many crisis intervention/suicide intervention services available to those at risk globally.

However there are those rare times when an individual has traversed the continuum of suicide and they are in immediate risk of harm or death to themselves or others. What may have been an opportunity for intervention has now become an emergency and IMAlive will attempt to take whatever steps are necessary and possible to protect and preserve life. Yes, there is “Caller ID” and that was helpful in providing Active Rescue until the advent of mobile devices and internet intervention services as identifying information is more device dependent than location dependent – despite what Hollywood would have us believe. What needs to be mentioned here is that the only resource generally available to those, like IMAlive Responders, looking to provide Active Rescue is their training and their supervisory support staff – the majority of the time that teamwork results in a person in need of Active Rescue achieving safety.

Thanks for the wealth of information!

IMAlive.org is always seeking volunteers, who can contribute online from anywhere in the world. Please visit the web site to learn how.

If you are in crisis, please reach out anytime from anywhere to this helpful service.

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Psych Central Staff http:// <![CDATA[Learn How to Stop Being Your Own Worst Critic]]> https://psychcentral.com/blog/?p=108604 2017-08-08T15:53:36Z 2017-08-19T20:30:00Z how to judge yourself less

How to tune out self-doubt.

When we summon the courage to take a risk or make a change, we often encounter fear and a little voice that talks trash.

“You won’t be good at it. Don’t try it. You’ll fail anyway. It’s not worth the humiliation. Try again later. It won’t be good enough. Everyone will laugh at you.”

That is your inner critic talking. Does it sound familiar?

How To Not Give A Damn About What Other People Think Of You

We all experience vulnerability and we all have an inner critic. It’s just part of the human psyche. When they clash, whose team wins?

Let’s start by explaining each side.

Vulnerability

Most people grow up believing that vulnerability is weakness. Over 13,000 pieces of data in the research of Dr. Brené Brown show that vulnerability is actually courage.

The definition of vulnerability is the following: risk, uncertainty, and emotional exposure.

We fear the unknown, what will happen if we go to the interview for the job we don’t feel qualified for. What will happen if you tell your partner how you really feel? The uncertainty and the risk mixed with fear are a recipe for anxiety and just fodder for your inner critic, right?

Well…Brown’s research also shows that vulnerability is the birthplace of love, belonging, and joy — what we all really want. That risk can lead to reward and not just pain.

Vulnerability requires courage.

The Inner Critic

The inner critic’s purpose is to keep us safe. When something went wrong in your childhood, it planted seeds in your inner critic’s mind that doing that wasn’t safe. It created conditions where you learned what was safe and what was too risky.

This can be as simple as touching the stove when it’s hot, so you get burned. You can see then, that in a good way, your inner critic wants to keep you safe. It doesn’t want to see you get hurt. So the next time you go near something hot, you’ll hear an internal warning to be careful or to steer clear.

However, the inner critic doesn’t grow up and mature in the same way. It’s rooted in absolutes and believes every danger is 100 percent true and will happen.

The first time you got your heart broken because you told someone how you felt? Your inner critic will tell you never to talk about your feelings with your partner that openly again. It wants to share the worst case scenario with you, as it believes it is guaranteed to happen in order to stop you in your tracks.

So what’s one to do to know how to stop being so critical of oneself?

1. Call Out Your Inner Critic.

Say: “Inner Critic, I hear you. What are you trying to protect me from? What are you so worried will happen? How do you know that’s true?”

2. Thank It for Trying to Protect You From Harm.

Acknowledge that there’s a part of you that exists for self-protection, but sometimes, to your own detriment.

3. Ask Yourself: “What If That Wasn’t True?”

A million other things could happen. Something amazing could happen. You’ll never know if you don’t take steps forward. What else could be true if you do this?

4. Create a Safety Net for Yourself.

First, get present and recognize where you are. Are you safe — physically safe — where you are? Are you in danger now? If things don’t go as planned, what can you do or what will you do?

5. Write Down Some Motivation, If You Have To.

“If things don’t go as planned (good, bad, or indifferent), I’ll call my best friend. Or get a massage. Maybe watch a movie that makes me cry so I can just cry it out. Or go to the gym and hit the punching bag. I’ll have a celebratory dinner with my partner. Or a solo dance party to feel the joy of being rewarded for trying and taking the risk. I’ll express gratitude towards myself for trying.”

5 Reasons Why It Feels So Darn Hard To Love Yourself Sometimes

When we are vulnerable and show up in our lives, great things can happen. Does that mean we never get hurt? No. Brené also says that the bravest among us are also the most broken hearted.

We cannot go through life unscathed. If we allow our inner critic to control our lives, we will likely never take risks, step into uncertainty, and expose our emotions. While you may stay safe, you will also not experience the fruits of courage: love, belonging, and joy.

You are the mediator between your own sense of vulnerability and your inner critic. You can experiment with how much risk, uncertainty, and emotional exposure you can tolerate.

Understand your limits and recognize your own growth. It’s amazing how much you’ll surprise yourself when you give yourself permission to go for it.

This guest article originally appeared on YourTango.com: 5 Ways To Shush Your Inner Critic That Keeps You From Doing YOU.

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Suzanne Kane <![CDATA[How to Be Honest with Yourself]]> https://psychcentral.com/blog/?p=108772 2017-08-08T15:50:37Z 2017-08-19T15:45:27Z

“When compassion awakens in your heart, you’re able to be more honest with yourself.” – Mingyur Rinpoche

Do you lie to yourself? Maybe just a little? Maybe a lot? Whatever the answer, you’re not alone. Most people tell lies, rationalize at times, trying to reassure themselves with a self-talk that’s more wishful thinking or revisionist in nature than actual truth.

Sometimes, that’s not all bad. If you need to embroider what happened with a brighter colored thread to get past it, maybe that’s healthy.

For the most part, however, learning to be honest with yourself is the more proactive approach. How do you get there? Does it take a long time to be comfortable with honesty? What steps can you take today? Here are some thoughts.

Try to see things from the other person’s point of view.

What might look black and white on the surface to you is probably quite different from the way the other person looks at the same set of facts or circumstances. After all, how we view a situation is always colored by our prior experiences, our upbringing, values and other factors. Therefore, each of us has a world view that is somewhat unique. You may see as failure not being able to accomplish an objective, while I may regard it as a learning experience and be less put off by it or feel the need to justify it with lies. By putting yourself in the other person’s shoes, so to speak, you may help increase your sense of understanding and compassion. In so doing, you’ll increase the likelihood that you’ll be a bit more honest with yourself. It’s certainly worth a try.

Accent the positive.

Find one good thing you did today and be grateful for the chance you had to make a difference. It doesn’t need to be a life-changing act to qualify. Just highlight some positive effort you made today and this will help frame your outlook to do more of the same. For example, if you went out of your way to brighten the day of a co-worker who’s experiencing family difficulties, that’s a positive act on your part, one that you did with no requirement for reciprocity. You can and should feel good about what you did. In fact, the more good that you can do, the more honest you’ll tend to be about yourself and your capabilities. After all, this is a habit that pays handsome dividends in the long run.

Forgive yourself.

One of the reasons people lie to themselves and others is to escape the consequences of wrongdoing — or failing to live up to their responsibilities. To be able to move forward from past misdeeds or lack of appropriate action, however, you must first forgive yourself. It may feel strange to do so, yet self-forgiveness has a powerful aftereffect. Once you take ownership of what you did in an honest and forthright way (to yourself), and forgive yourself, you’re ready to move forward in life. This will help make self-honesty a little easier to incorporate into daily living.

If you feel that you want to help others, that’s compassion awakening in your heart.

Instead of always thinking of excuses or trying to gain an edge, if you begin to feel like you want to do something to help another, that’s often a good sign that you’re beginning to feel compassion. And that’s a very positive development. Make it a point to nurture compassion, rather than trying to squelch it as uncomfortable or requiring you to actually make good on the feeling. Honestly, who doesn’t need compassion? It helps both the person who feels it and the recipient of the powerful emotion.

Remind yourself that honesty is important.

Research studies at UCLA and MIT have found that a simple reminder to be honest works most of the time, with or without religious context. If you want to train yourself to be honest, you can do so with self-reminders. If you value the truth, insist on telling the truth — or say nothing at all to avoid lying. This is also applicable to how you employ self-talk.

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Alicia Sparks <![CDATA[Psychology Around the Net: August 19, 2017]]> https://psychcentral.com/blog/?p=109174 2017-08-18T18:23:11Z 2017-08-19T10:30:30Z

Happy Saturday, sweet readers!

Guess what? I’m going “off the grid” this weekend. Well, maybe not in the strictest of senses (I’ll still have my computer and phone) but in the sense that…well, let’s just say I’ve been neglecting my own personal interests — things I enjoy and feel help my personal growth — and it’s hurting my mental health. I feel unfulfilled. I have to figure out a way to stop that.

Starting today.

But first, the latest in this week’s mental health and wellness news! Learn how to be more supportive of your child’s teacher, why some researchers believe we need many more in depth studies on medical marijuana, that a new app is helping people who deal with mental illness connect with one another, and more.

Psychology of Hate: What Motivates White Supremacists? While white supremacists are nothing new, research shows the numbers are growing and it could be because these people tend to have more aggression and the “dark triad” personality traits (i.e. narcissism, psychopathy, and Machiavellianism — which is the tenancy to manipulate others for your own gain) than others.

How to Be Supportive of Your Kid’s Teacher: School’s in session for many — and right around the corner for others — so if you don’t already know, it’s time to learn these ways you can better support your child’s teachers that focus not only on just the teachers, but also on your kid and you.

The Psychology of Brand Loyalty: 5 Key Takeaways: Some research says brand loyalty is dying — that consumers are look more for item quality than item brand — while other research says that’s just not true. For businesses and consumers alike, here are five ways to better understand the psychological factors that contribute to brand loyalty.

A Psychiatry Researcher Explains the ‘Real and Urgent Need’ for More Research Into Medical Marijuana: Researchers at the Veterans Health Administration conducted and published in the Annals of Internal Medicine two studies that found there isn’t enough high-quality research that provides evidence of both the benefits and harms or using medical marijuana for conditions such as pain and post-traumatic stress disorder (PTSD).

First US Transgender Surgery, Psychiatry Fellowships: Mount Sinai Health Systems in New York City has launched two new transgender-related medical fellowships. One fellowship focuses on transgender surgery (given to Bella Avanessian, MD, who completed a plastic surgery residency) and the other on transgender psychiatry (given to Matthew Dominguez, MD, who completed a general adult psychiatry residency), and both are the first of their kind in the United States.

Huddle Is a Mental Health App That Aims to be a Safe Space to Share With Peers: When Dan Blackman learned his deceased father was a functioning alcoholic who never got the help he needed, he created Huddle, “an online video platform where people could share their issues with one another,” to help the millions of adults with mental health problems who don’t seek help due to stigma connect with other people suffering the same issues.

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Marcia Naomi Berger, MSW, LCSW <![CDATA[What if You Suspect Emotional Infidelity?]]> https://psychcentral.com/blog/?p=109259 2017-08-21T13:26:59Z 2017-08-19T03:01:49Z Emotional infidelity can be as heartbreaking for the betrayed partner as a physical affair. Sometimes it’s hard to know what’s going on when your spouse assures you that a relationship with a friend, coworker, or social media acquaintance is innocent. But if you are concerned that that emotional intimacy is developing, you can look out for the signs listed below and then decide how to deal with the issue.  

Signs of Emotional Infidelity

  • Your spouse is texting the suspected emotional affair partner more often than you and turning off his phone or computer when you show up.  
  • Your partner is dressing differently, spiffed up as in courtship mode.
  • Your credit card statement shows payments at bars and restaurants different from the ones you frequent, and other unexplained expenses show up.
  • Your partner detaches from you emotionally by becoming withdrawn or unusually critical toward you. Physical detachment can easily follow a lack of emotional intimacy. The “cheating” partner may sense that having sex with his or her spouse would be disloyal to the emotional affair partner.  

Expressing Your Concern

If you suspect your partner of having an emotional affair, first process your feelings (fear, betrayal, anger, hurt, helplessness, or confusion) enough to have a calm manner when initiating the conversation. If you come across as angry and accusing, your partner is likely to become defensive, dismiss your concern, or counterattack, like by calling you paranoid or irrational.

Say kindly and respectfully that you want to discuss something that concerns you. Ask if this is a good time to talk before proceeding, or agree on a different time. Then say:

  • which signs of an emotional affair you’ve noticed;
  • how you’re feeling about the apparent emotional affair  insecure, uncomfortable or , anxious, something else;
  • what you would like your partner to do. Examples of what you might want your partner  to do:  
  1. Discontinue contact with suspected or actual emotional affair partner;
  2. include you in all interactions with that person;
  3. agree to transparency regarding emails and texts sent and received;
  4. get a job elsewhere if the person is a coworker;
  5. see a therapist with you to talk about both of your concerns in a safe setting;
  6. tell you what might be missing in his relationship with you makes him look for intimacy elsewhere.
  • what you are prepared to do if your partner is not willing to do what it takes to end a developing or current emotional affair. You might decide to separate, divorce, get therapy for yourself to help you make a wise decision, or do something else.

Prevention Is the Best Strategy

We can control only our own behavior, not our partner’s. The best way to prevent the prospect an emotional affair from happening is to keep our marriage fulfilling  ⎯ with romance, intimacy, teamwork and kind, respectful resolution of issues. By holding a weekly marriage meeting that uses the simple agenda and positive communication skills explained in detail in Marriage Meetings for Lasting Love: 30 Minutes a Week to the Relationship You’ve Always Wanted, most couples can create this kind of emotionally intimate relationship. Partners who keep their bond strong are more likely to stay emotionally and physically faithful.

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Linda Sapadin, Ph.D <![CDATA[Feeling Scattered]]> https://psychcentral.com/blog/?p=108739 2017-08-08T15:50:29Z 2017-08-18T20:30:18Z healing a broken heartWhen I sat down to write this article, I was completely focused on what I wanted to accomplish. Now, here it is, just 20 minutes later, and I’m feeling scattered and unfocused.

What happened?

  • An “urgent” text pinged, saddling me with another task I must accomplish by the end of the day.
  • My cleaning crew arrived, late again, and the noise from the vacuum cleaner is making it impossible for me to concentrate.
  • Then, my next client called. She was close by; could we possibly start the session earlier?

So, now the calm I was feeling is gone, replaced by the stress of wondering how to fit everything into my day.  

Do you experience days, perhaps weeks, like this? I wouldn’t be surprised if you do as we live in a culture of busyness. Too much to do, too much on your mind, too many distractions. Is it any wonder that you feel like you’re being pulled in too many directions?  Thoughts are swirling in your brain. How will you ever get it all done?

So, what do you do when you are feeling scattered and agitated? Here are some answers:

  1. Most importantly, don’t panic. It may feel as if you’ll never get it all done, but you will. Maybe not in the time frame that you had hoped for.  But, if you’ve made a commitment and you’re a responsible person, trust that you will get it done.
  2. Practice mindfulness. Be in touch with your thoughts and feelings, without judging yourself. I know, this is not easy to do. Still, aim to become fully aware of what’s happening now rather than ruminating about the past or worrying about the future
  3. Decide what’s most important for you to do RIGHT NOW. You can’t do everything at once so be mindful of your present energy level. Maybe what you need to do right now is to have lunch.  Maybe it’s tackling the tough task; maybe the easy task. You be the judge.
  4. Minimize distractions by turning off your phone and other electronic devices. This means no e-mail, no texts, no social media, no TV, no Internet. Wow! Without all those potential distractions, you may find that you have plenty of time to do what needs to be done. Diversions are so much a part of our lives that we don’t appreciate how much time they gobble up.
  5. Turn big intimidating tasks into smaller, less threatening ones. Instead of overwhelming yourself by looking at the whole panorama of tasks in front of you, divide the tasks into smaller, doable bits. That way, they’ll be easier to tackle.
  6. Encourage and support yourself.  Tell yourself, “I can do this.” I made this phone call; only two more to go. I wrote two paragraphs; I’m on a roll. Good for me; I am focused. I will meet my goals. I feel pride in my progress; joy in my accomplishments.

 

 

 

 

 

 

So, have I taken my own advice? You betcha! To begin to feel less scattered, I took a deep breath. I told myself not to panic; it will all get done. I became mindful about what I was thinking and feeling. I decided to tell my client to come on over; we could start early. Then I instructed my cleaning crew to move to another area, away from my office and to save the vacuuming for later. After I finished the session with my client, I had a relaxing cup of tea. I briefly scrolled through my messages and e-mails, realizing that nothing required my immediate attention; not even that “urgent” text.

Then I turned off my phone; I did not want to be distracted under any circumstances. I took another deep breath and returned to writing this article. As I became aware that my advice was not only for you, but also for myself, I rewrote the first few paragraphs. As I continued writing, I realized that I was no longer feeling scattered; my mind was on the task at hand. And now I am finished. I feel good. I did it! And I still have time to watch my favorite TV program. Good for me!

©2017

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Rebecca Lee <![CDATA[The Ties Between Crime and Malignant Narcissism]]> https://psychcentral.com/blog/?p=108823 2017-08-08T15:20:27Z 2017-08-18T15:45:45Z What do Jim Jones, OJ Simpson, and Ted Bundy all have in common? They were charismatic, charming, and had the ability to influence almost anyone. They also demonstrated specific characteristics associated with malignant narcissism.

Malignant narcissism is known as a mixture of narcissism and antisocial personality disorder. They lack empathy and often live in grandiose fantasies that compete with reality. If the fantasies are revealed as such, the afflicted person may become hostile with high levels of rage.

Malignant narcissism is not an individual diagnosis in the DSM, rather it is a subset of Narcissistic Personality Disorder. As well as having symptoms of a Narcissistic Personality Disorder, a person with malignant narcissism also displays paranoia.

Jim Jones suffered from paranoid delusions especially during the last days of his cult. When he first became obsessed with the CIA, Jim Jones began his search for “The Promised Land.” By instilling his fear into the minds of his followers, he was able to control large groups of people, ultimately leading to their death.   

Since the personality of a malignant narcissist cannot tolerate any criticism, paranoia is usually stemmed from being mocked. Often times they will inflict paranoia in others by preaching highly controlled ideologies. Usually these are at least some-what fabricated to tailor the needs of the narcissist.  Religion and philosophy are two categories they often gravitate toward.

Pathological lying is another obvious trait of malignant narcissism. Ted Bundy lied about his killings to various professionals, but not to be considered innocent. For example, he told one psychologist that he started killing women in 1974, but later he said the killing started in 1969. At one point, Bundy said there were 35 victims in all, but in another setting he claimed over 100. The criminal investigation reports that Ted Bundy seemed to be lying to impress people rather than avoid jail.  Many times he said the deaths of the women he killed were higher than the victims reported.

Pathological lying can be much more subtle than in Ted Bundy’s case. The term “gas lighting” is often used when someone denies another person’s reality to purposely manipulate them into feeling insane. This is another tactic frequently used in both malignant narcissists and general narcissists with NPD.

Perhaps the most terrifying symptom of malignant narcissism is the lack of empathy that is required to carry out behavior. OJ Simpson frequently called his wife fat while she was pregnant. This was explained with the charisma of someone who was just “joking around.” Looking closer, this was not an isolated incident. He frequently beat his wife as well as publicly humiliated her by having affairs. When his wife was murdered, he seemed uninterested in his children, focusing more on himself.  It is hard to prove that someone does not have empathy especially if that person is highly charismatic.  

Someone with a lack of empathy may demonstrate kind facial or body language while simultaneously hurting another person. Because of the contrast in what is being said vs. what is being done, many people can feel as if they are losing their mind.

The warning signs of involvement with someone who may be afflicted are as follows:

  1. Success At Any Cost. A close inspection of past relationships may show a failure to treat people kindly for the promise of a grandiose, yet superficial success. Beware of flaunted expenses, especially if there are a lack of people to share in the enjoyment.
  2. Narcissists may be hypersexual, often in relation to power and control. Incest is frequently reported as well as a lack of regard for partner and boundaries.
  3. Incessant Blaming. Lack of personal responsibility is a key sign.  Often a narcissist will play ‘the victim’ even when he/she has hurt someone else.
  4. Violence. Since their ego is so fragile to begin with, any criticism received feels like an attack.  They fight back much harder than what is doled out.  Someone who uses violence frequently, demonstrates lack of impulse control and may also have multiple addictions.
  5. Manipulation. Pitting people against one another for the ultimate goal of loyalty is often used by narcissists. In this case, loyalty often means isolation.

If you are involved with someone who has these traits, most professionals advise leaving. There is no treatment for narcissism and statistically the outcome for change is low.  The longer someone stays in a relationship with a narcissist, the worse they feel.  

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Brandi-Ann Uyemura, M.A. <![CDATA[Best of Our Blogs: August 18, 2017]]> https://psychcentral.com/blog/?p=109205 2017-08-18T00:20:11Z 2017-08-18T10:30:28Z Many of us are living our hell. We feel trapped, imprisoned, and unhappy by circumstances we have no control over.

Maybe we’re unemployed or stuck in a relationship, job or state that we can’t stand. When I feel this way, I think of Holocaust survivor Viktor E. Frankl and his life changing book, Man’s Search for Meaning. 

While we sometimes can’t move, we have a choice to change our thinking. We can find ways even in an intolerable state to find meaning, power and even joy.

This week, we learn that an inspiring quote, changing our thoughts and understanding our partners can make a difference in how free we feel in our lives.

Nine Thoughts For The Thinking Person
(Therapy Soup) – If you are a thinker looking for inspiration, these nine quotes will change you in a positive and meaningful way.

25 Spot-On Quotations About Narcissism
(Narcissism Decoded) – This is for those who deal with a narcissist almost every day. These people feel your grief, annoyance and pain.

Can Narcissists, Sociopaths, and Psychopaths Feel Empathy, Sadness, or Remorse?
(Psychology of Self) – Emotions like sadness, compassion and empathy look surprisingly different in those who exhibit narcissistic, sociopathic, and psychopathic tendencies.

5 Ways Pathologically Envious Narcissists Undermine Your Success
(Recovering from a Narcissist) – It’s the one thing that could ruin your relationship and also a sign of narcissistic personality disorder. Here are five behaviors that indicate a pathologically envious narcissist.

4 Ways To Stop Fighting
(Healthy Romantic Relationships) – Here are the reasons why you fight with your partner and how you can stop for good.

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Therese J. Borchard http://www.thereseborchard.com <![CDATA[How New Generation Drugs Are Targeting Depression]]> http://psychcentral.com/blog/?p=100447 2017-08-17T12:56:56Z 2017-08-17T22:30:53Z Two years ago, I talked with a prominent psychiatrist about what could be done for all the people who have treatment-resistant depression who do not respond — or only partially respond — to the drugs on the market today.

“We wait for better drugs to come out,” he said.

I wanted a better answer, because my experience with the newer drugs like Zyprexa (olanzapine) — atypical neuroleptics (a type of antipsychotic) that were supposed to treat bipolar disorder with fewer side effects than typical mood stabilizers like lithium and Depakote (divalproex sodium) — proved to be a disaster.

But I am coming around to agree with the psychiatrist.

With better research comes new ways of tackling the beast of depression. As we learn about different systems that may contribute to the illness and the complicated mechanisms of the brain, scientists are thinking differently about drugs to treat depression and bipolar disorder.

A fascinating article published October 15 in The Economist, “Novel Drugs for Depression,” discusses where we’ve been in terms of drug treatment for depression, and the wide road ahead of us. The article is hopeful and exciting.

Depression: More Than a Chemical Imbalance

Drug companies like Pfizer sold the public the simple “chemical imbalance” theory for depression in the late 1980s and 1990s because it’s easy to understand: A shortage of neurotransmitters like serotonin could be replenished with a class of drugs called selective serotonin reuptake inhibitors (SSRIs).

But it’s really not that simple.

In an April 2015 editorial in The BMJ, “Serotonin and Depression: The Marketing of a Myth,” professor of psychiatry David Healy, MD, explained that there was no correlation between serotonin reuptake-inhibiting potency and antidepressant effectiveness, and that the low-serotonin story is a myth to make people feel better that depression is not a weakness.

“There is little question that the role of serotonin in depression was over-emphasized and over-marketed in the 1990s,” explains Ron Pies, MD, professor of psychiatry and behavioral sciences at SUNY Upstate Medical University in Syracuse and author of Psychiatry on the Edge, “though most psychopharmacologists understood that the neurobiology of depression was much more complicated. Indeed, the term ‘SSRI’ is itself a misnomer, since some of these agents also affect other brain chemicals — for example, sertraline has mild effects on dopamine. None of this, however, should be used in service of the equally mythological claim that ‘antidepressants don’t work’ or are ‘no better than a sugar pill.’ This is demonstrably false, at least with respect to moderate-to-severe depression.”

How Effective Are Current Antidepressants?

As it turns out, at standard doses of the most commonly used SSRIs, only one-third of people achieve remission with the first medication prescribed.

According to the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, a project funded by the National Institute of Mental Health, if the first choice of medication does not provide adequate symptom relief, switching to a new drug is effective about 25 percent of the time. Switching from one SSRI to another is almost as effective as switching to a drug from another class.

If the first choice of medication doesn’t provide adequate symptom relief, adding a new drug while continuing to take the first medication is effective in about one in three people. Unfortunately, one-third of people cannot achieve full recovery even after trying multiple options.

Here’s Where Ketamine-Type Treatments Come In

In another post, I discussed ketamine (Ketalar), which some people are hailing as a miracle drug for depression.

Often referred to as “Special K,” it has been around since the 1960s and is a staple anesthetic in emergency rooms. Ketamine is also an illicit, psychedelic club drug.

In the last 10 years, studies have shown that it can reverse the kind of severe suicidal depression that traditional antidepressants can’t treat — and sometimes in the matter of a few hours.

Ketamine isn’t quite ready for prime time yet because of concerns about safety and long-term effects. One study published in January 2014 in the British Journal of Clinical Pharmacology included among possible side effects psychedelic symptoms (hallucinations and panic attacks), nausea, cardiovascular stimulation, memory defects, and bladder and renal complications.

But given its tremendous success (75 percent) in treating patients who have been resistant to other depression medications, new ketamine-related treatments are emerging.

Esketamine is one such drug. In a study published in September 2016 in Biological Psychiatry, esketamine delivered rapid and significant improvement of depressive symptoms in people who had not responded to current available drugs.

In a double-blind study, the researchers randomly assigned 30 patients to get a placebo, or a lower (0.2 mg/kg) or higher (0.4 mg/kg) dose of esketamine. The patients got two IV doses during the double-blind phase, which was followed by a two-week follow-up phase in which they could receive up to four additional, optional open-label doses.

The earliest antidepressant effect occurred just two hours after the first infusion. Within three days, more than 60 percent of patients receiving either dose of esketamine saw improvement in depressive symptoms. The authors compare this response rate to only 37 to 56 percent of patients after 6 to 12 weeks on conventional antidepressants.

Fast-Acting Drugs Aimed at a New Target

As The Economist article explains, drug companies are studying ketamine in hopes of imitating the way it works. According to the article:

Many people think ketamine affects the action of a common neurotransmitter called glutamate by blocking the activity of receptors for this molecule. One hypothesis is that it interacts with a glutamate receptor called NMDA that had never previously been thought to be involved in depression. Several firms are therefore seeking to mimic the effect of ketamine by aiming at the NMDA receptor.

Rapastinel (formerly known as GLYX-13) is an NMDA-blocking drug that is being developed by Allergan, an Irish company. A recent clinical trial showed that a single intravenous dose produced statistically significant reductions in depression scores in people who had failed treatment with other antidepressants.

The results occurred within 24 hours and lasted for an average of seven days. The effect of a single dose was nearly twice as great as the effect seen in clinical trials of most conventional antidepressants after four to six weeks of treatment.

The Economist article makes the point that we are far from a neat conclusion about how depression acts in the brain, and that lots of drugs work well even though we don’t know precisely how.

But with ketamine comes a new way of approaching depression that should offer hope to persons not helped by standard antidepressants. Even if the drugs aren’t ready now, we can believe that there may be substantial relief of symptoms at some point in the near future.

Join Project Hope & Beyond, a depression community.

Originally posted on Sanity Break at Everyday Health.

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Kurt Smith, Psy.D., LMFT, LPCC, AFC <![CDATA[What to Do When Your Friends Divorce]]> https://psychcentral.com/blog/?p=108829 2017-08-17T23:44:12Z 2017-08-17T18:15:22Z marriage in troubleYou have been best buddies for years. As couples you were at each other’s weddings, baby showers, and housewarmings.

You spend more weekends together than not. And, almost as much as growing old with your spouse, you picture growing old with them. Until — divorce.

When the couples you are closest to start to fall apart it can hurt almost as much as if your own marriage were ending. Family trips and weekend barbecues will never be the same. Friends becoming the family you chose is true for many, and when a family splits up everyone suffers. So, what do you do when your best friends decide to call it quits?

Support

They are your friends for a reason. You probably love them like family. Try to remember that the problems they have with one another are theirs and not yours.

They have decided to leave each other, not leave your friendship. And, although it will be a difficult process to redefine the boundaries of your relationship, you should still be there to listen and support as they each need it. Your pain at their split is not their focus right now. But your friendship is likely to be needed more than ever.

Try not to take sides. Whatever the reasons they have decided to end their marriage, getting drawn into the drama will not help them, or the future of your friendship. Remaining neutral but caring is your best course. And taking sides can affect your own relationship and family in a negative way, too.  

Adjust

The landscape of your relationships with each of your newly single friends will change bit by bit. With effort and caring it will maintain, but many things are likely to be different. How different will depend a lot on how friendly their split is, but accept that going forward you are still not likely to be doing group vacations.

Spending time with each of them in different ways may take a bit of juggling. It may also require a conversation with each of them about your intentions to stay friends with them both and how that will look. He comes to one event and she comes to another? Or, will they be okay under the same roof?

Protect Your Relationship and Family

This is new territory for you and your family. What does it mean that the people your children may have referred to as “aunt” and “uncle” are no longer together?

This can create a need to explain marriage separation and divorce to your kids. It may also scare them. If this can happen to another family, could it happen to yours? Reassuring your children that each family faces unique circumstances, and that they are safe should be a priority.

Children, both yours and theirs, are another reason not to take sides. Your children probably love them each like family and do not need to hear bad things about either one of them. Their children may love you like family and need all the positive adult support and love they can get.

A close friend’s divorce can also rattle your own relationship. Much like your children wondering if this could happen to their own family, you may be wondering the same thing. Don’t let the pain of others color the way you feel about your spouse. Every relationship is different and faces different problems. No matter how similar you felt you were as couples in the past, their problems are not yours. However, this may be a good time to talk with your spouse about what you value in your relationship and how to keep things strong between the two of you.

Nothing about divorce is easy. Unfortunately, because of the high divorce rate it is likely that divorce will affect you and your family in some way. When it affects close friends (or family) it is a sad situation for all. Just try to remember that they are divorcing each other, not you.

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John M. Grohol, Psy.D. http://psychcentral.com/ <![CDATA[Psychology Today Promotes Its Own Trump Fake News]]> https://psychcentral.com/blog/?p=109191 2017-08-18T00:10:50Z 2017-08-17T14:15:33Z No matter what your political view, it is disconcerting when we run across news online that is not factually correct. President Trump refers to such news stories as “fake news” — but also includes in this category any news story he simply doesn’t agree with.

Earlier this month, Psychology Today ran an article titled, “60,000 Psychologists Say Trump Has ‘Serious Mental Illness’.”

The problem with this headline? It wasn’t true. But that didn’t stop the editors at Psychology Today from publishing it on their web site for four consecutive days, before they were called out on the issue on Twitter for its inaccuracy.

Headline writing is as much an art as it is a science. I understand how difficult it can be for headline editors to read a story and ensure that the headline accurately reflects not only the article’s main topic, but also the facts.

The article in question was authored by Suzanne Lachmann, Psy.D., a clinical psychologist in New York. In it, she apparently did not make a claim that “60,000 psychologists say Trump has ‘serious mental illness.’ Instead, she wrote:

The group “Duty to Warn,” founded by influential psychotherapist Dr. John Gartner, has gathered nearly 60,000 signatures on a petition calling for the removal of Donald Trump from office due to “serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States.”

When informed that the headline didn’t reflect the content of the article — or the petition itself — the author blocked the person, Jeffrey Guterman, Ph.D., a mental health counselor from Florida:

Sometime after this notice, the Psychology Today editors decided the original headline actually was untrue. So they changed the headline to, “Petition Declaring Trump Mentally Ill Pushes for Signers,” and added a little editorial note at the bottom of the article noting the change.

What the editors failed to tell their readers is that the content of the article also changed. The author or the editors removed “from mental health professionals” in the first paragraph.

A Fake Petition?

In addition to the factually incorrect headline promoted by Psychology Today, the petition itself leaves a lot to be desired. Unfortunately, like too many articles that don’t critically examine their subject, the article didn’t actually note any issues or concerns with such a petition. Instead it delved into the history of whether it’s okay to diagnose celebrities and other public figures from afar. (The answer has always been, sure, if you want to.)

The petition reads simply enough:

We, the undersigned mental health professionals (please state your degree), believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States.

The problem? Not every one of the people signing the petition is a mental health professional, much less a psychologist. In fact, since Change.org – where the petition was hosted – has no way of knowing who’s a mental health professional and who’s not, the petition features thousands of non-professional’s “signatures.”

John Gartner, Ph.D. (another Psychology Today contributor) is not exactly neutral on this issue. Especially given his May 4, 2017 article in USA Today entitled, “Donald Trump’s malignant narcissism is toxic: Psychologist,” that begins: “If you take President Trump’s words literally, you have no choice but to conclude that he is psychotic.”

Obviously this is a professional with an axe to grind, who passionately believes in his remote diagnostic abilities.1

I get that there are many people angry at the current political situation in the United States. But promoting questionable petitions through fake news headlines that don’t critically examine the legitimacy (or purpose) of the petition doesn’t help anyone. In fact, such articles simply serve as confirmation that the media is biased against the president.

We can do better than this. We must do better than this in order to retain the trust and respect of our fellow citizens.

For more information

Psychology Today’s article: https://www.psychologytoday.com/blog/me-we/201708/petition-declaring-trump-mentally-ill-pushes-signers

Footnotes:

  1. If you think remotely diagnosing a person with only publicly-available information results in accurate and reliable diagnosis of a mental disorder, I have a bridge to sell you in Brooklyn. That’s not to say there is no value in remote diagnoses from time to time, but that at least in this particular case, we’ve beaten this horse to death.
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