depression

6 Surprising Symptoms of Postpartum Depression and Anxiety

6 Surprising Symptoms of Postpartum Depression and Anxiety

Are you pregnant or recently had a child? Are you feeling angry/irritated, numb, have brain fog, insomnia, and/or physical discomfort? These are all signs of postpartum depression. Read more here.

Using the Mnemonic “Three Cs” with Children and Adolescents

Using the Mnemonic “Three Cs” with Children and Adolescents

Managing stress, anxiety and depression starts with managing your thoughts. 

The 12 Worst Habits for Your Mental Health

The 12 Worst Habits for Your Mental Health

Do you practice any of these unproductive mental health habits? This article discusses the most common pitfalls that people engage in that hurt our mental health and why they are so damaging.

Health.com / Carey Rossi@goodhealth  /  Nov. 3, 2014

Change these simple, everyday routines to live a happier life

Depression is usually brought on by factors beyond our control—the death of a loved one, a job loss, or financial troubles. But the small choices you make every day may also affect your mood more than you may realize. Your social media habits, exercise routine, and even the way you walk may be sucking the happiness out of your day, and you may not even know it. Luckily, these behaviors can be changed. Read on for 12 ways you’re sabotaging your good moods, and what you can do to turn it around.

How we feel can affect the way we walk, but the inverse is also true, finds a study published in the Journal of Behavior Therapy and Experimental Psychiatry. Researchers found that when subjects were asked to walk with shoulders slouched, hunched over, and with minimum arm movements, they experienced worse moods than those who had more pep in their steps. What’s more, participants who walked in the slouchy style remembered more negative things rather than positive things. Talk about depressing.

Get happy now: Lift your chin up and roll your shoulders back to keep your outlook on the positive side.

Seasonal Affective Disorder Sufferers Have More Than Just Winter Blues

What are the winter blues? Can you just power through until the Spring? Should you seek treatment or are there things you can do to improve your mood? Dr. Rohan answers these questions in this article. SAD expert Kelly Rohan, PhD, explains the difference

Reporters/editors/producers note: The following feature was produced by the American Psychological Association. You may reprint it in its entirety or in part. We only request that you credit APA as the source.

Depression, the secret we share

Andrew Solomon shares his experience of depression and poses many challenging questions within this Ted Talk.  Is the opposite of depression not happiness but vitality? What role does our shame about mental illness play in maintaining our silence and avoiding treatment? Is access to treatment prejudiced by our expectations? Link to Ted talk

Friends Wanted

The new year seems to trigger discussions about connections, loneliness and friendships. Perhaps a time for reflection or a reaction to all the expectations of gathering with others around the holidays. This article explores and explains the importance of social connections to our emotional and physical health. New research by psychologists uncovers the health risks of loneliness and the benefits of strong social connections.

By Anna Miller

Monitor Staff

January 2014, Vol 45, No. 1

Print version: page 54

New research by psychologists uncovers the health risks of loneliness and the benefits of strong social connections.

It took a trip to the hospital for Cathryn Jakobson Ramin, 56, to confront a nagging concern she'd had for years: She had no friends. "I didn't have one person who could pick me up," says the journalist in Mill Valley, Calif., who went to the hospital for a small medical procedure.

Ramin does have many friends — those she first met in childhood and in the four cities she's lived in as an adult — but they don't live nearby anymore. She also has a strong marriage, two grown sons and a successful career. But she has few local friends she can call on in a time of need — or for simple companionship.

"I like the sense of sitting in someone's kitchen with a cup of tea and cookies and just shooting the [breeze]," she says, admitting she feels a void. "That to me is a very important part of life."

Psychologists agree. While research on relationships has skirted adult friendships — tending to focus on adolescent friendships and adult romances — the importance of strong social connections throughout life is gaining scientific clout, having been linked with such benefits as a greater pain tolerance, a stronger immune system, and a lower risk of depression and early death.

"For years and years … people speculated that if you felt alone or you lived alone or you were alone a lot, you wouldn't eat good meals, you wouldn't exercise as much, nobody would take you to the doctor," says Laura Carstensen, PhD, who directs Stanford University's Center on Longevity. "But I think what we're learning is that emotions cause physiological processes to activate that are directly bad for your health."

Yet forging platonic relationships isn't always easy. Ramin's situation appears to be increasingly common: According to a meta-analysis with more than 177,000 participants, people's personal and friendship networks have shrunk over the last 35 years (Psychological Bulletin, 2013).

Combine that trend with the United States's rising age of first marriage, a divorce rate nearing 50 percent and a life expectancy that's at an all-time high, and you get "a demographic shift such that there are now [more] people who don't have a marital partner to supply the intimacy they need," says Beverley Fehr, PhD, a social psychologist at the University of Winnipeg and author of the 1996 book "Friendship Processes." "In light of those shifts, I think that friendships are more important today than ever before."

I'm so lonesome I could die

A lack of friends isn't simply an inconvenience when you want a movie partner or a ride to the hospital. A sparse social circle is a significant health risk, research suggests. In one meta-analysis of 148 studies comprising more than 308,000 people, for example, Brigham Young University psychologists found that participants with stronger social relationships were 50 percent more likely to survive over the studies' given periods than those with weaker connections — a risk comparable to smoking up to 15 cigarettes a day and one double that of obesity. And the risks of poor relationships are likely greater, the researchers say, since the studies didn't look at the quality of participants' social connections (PLOS Medicine, 2010).

There's some evidence that more really is merrier. In one recent study tracking 6,500 British men and women ages 52 and older, psychologist Andrew Steptoe, PhD, of the University College London and colleagues found that both feeling lonely and being socially isolated raised the risk of death. However, only social isolation — measured in terms of frequency of contact with family and friends, and participation in organizations outside of work — appeared to be related to increased mortality when the researchers adjusted for demographic factors and baseline health (PNAS, 2013).

But contrary to Steptoe's findings, most research indicates that feeling isolated is more dangerous than being isolated, says psychologist John Cacioppo, PhD, co-author of the 2008 book "Loneliness: Human Nature and the Need for Social Connection." In one 2012 study, he and colleagues looked at data from more than 2,100 adults ages 50 and older and found that feelings of loneliness were associated with increased mortality over a six-year period. The finding was unrelated to marital status and number of relatives and friends nearby, as well as to health behaviors such as smoking and exercise (Social Science and Medicine, 2012).

"It's not being alone or not" that affects your health, Cacioppo says. "You can feel terribly isolated when you're around other people."

In his ongoing Chicago Health Aging and Social Relations Study, funded by the National Institute on Aging, Cacioppo and colleagues have also linked loneliness with depressive symptoms and an increase in blood pressure over time.

Other research indicates positive social connections might accelerate disease recovery. In a study of 200 breast cancer survivors, psychologist Lisa Jaremka, PhD, and colleagues at the Ohio State University found that lonelier women experienced more pain, depression and fatigue than those who had stronger connections to friends and family. The more disconnected women also had elevated levels of a particular antibody associated with the herpes virus — a sign of a weakened immune system (Psychoneuroendocrinology, 2013).

Particular genes may play a role in explaining why our bodies are so attuned to our social lives, says psychologist Steve Cole, PhD, at the University of California, Los Angeles. In one study, he and colleagues including Cacioppo analyzed the gene expression profiles of chronically lonely people and found that genes expressed within two subtypes of white blood cells are uniquely responsive to feelings of loneliness. The cells — plasmacytoid dendritic cells and monocytes — are associated with diseases such as atherosclerosis and cancer, as well as "first line of defense" immune responses (PNAS, 2011).

Cole says the most "biologically toxic" aspect of loneliness is that it can make you feel chronically threatened, an emotion that can wear on the immune system. "It's really that sense of unsafe threat, that vague worry, that's probably what's actually kicking off the fight-or-flight stress responses that affect the immune system most directly," he says.

Friends in adulthood

As researchers work to better understand the link between friendships and health, they're also helping to answer a question familiar to anyone who's ever moved to a new city, lost a spouse or otherwise found themselves feeling alone: How do you make friends as an adult? Here's what the research suggests might work:

  • Be a familiar face. The idea that familiarity breeds attraction is long-established by research, and was again supported in a 2011 study led by psychologist Harry Reis, PhD, at the University of Rochester. In the first experiment, same-sex strangers rated how much they liked one another after having several structured conversations. In the other, strangers chatted freely online. In both cases, the amount participants liked their partners increased with each exchange (Journal of Personality and Social Psychology, 2011).

Rachel Bertsche, a writer in Chicago, witnessed this phenomenon outside of the lab when she joined a weekly comedy class a few years ago. At first, she thought her classmates were strange. But she gradually changed her mind — and soon wound up joining the group for drinks after class. "Consistency is so important," she says.

Fehr agrees. She says sticking to a simple routine — whether it's going to the same coffee shop at the same time every day, joining a class like Bertsche or even just going to the office mailroom when it's most crowded — can help turn strangers into friends.

  • Divulge a secret. There are ways to make fast friends, too, psychologists say. Research by Stony Brook University professor Arthur Aron, PhD, showed that gradually increasing the depth of questions and answers between strangers can spawn friendships in just 45 minutes (Personality and Social Psychology Bulletin, 1997). Fehr and her team are building on this model by directing a couple of college buddies first to ask each other neutral questions, such as, "When did you last go to the zoo?" and slowly build up to more intimate questions such as, "If you knew someone close to you was going to die tomorrow, what would you tell them today — and why haven't you told them yet?"

So far, she's seeing men's friendships getting stronger. "When they do open up to each other, they feel closer to each other and they feel more satisfaction with the relationship," she says.

  • Realize it's in your head. Loneliness is a subjective experience that can often be a self-fulfilling prophecy, says Cacioppo. "When people feel isolated, the brain goes into self-preservation mode," he says, meaning that they become preoccupied with their own — not others' — welfare. While the response is an innate one meant to protect us from threats, over time, it harms physical and mental health and well-being, and makes us more likely to see everything in a negative light. It can also make us seem cold, unfriendly and socially awkward. But recognizing what's in your head can help you get out of it, Cacioppo says.

In a review of interventions to reduce loneliness, he and colleagues found that those that encouraged participants to challenge their own negative thought processes — for example, by sharing a positive part of their day with someone else — were more effective than interventions seeking to improve social skills, enhance social support or increase opportunities for social contact. "It has a surprising effect," Cacioppo says. (Personality and Social Psychology Review, 2010).

  • Log on, with caution. Liz Scherer, a copywriter in Silver Spring, Md., used social media to forge friendships when she moved from New York City to Annapolis, Md., about 10 years ago at age 42. Through Twitter, she connected online with others in her business and met many of them in person at social media conferences. "I've made some really good friends who I talk to … every single day," she says. "They're good social supports and business supports."

Research suggests Scherer's positive experience with social media is most common among people who are already well connected. A review of four studies by psychologist Kennon Sheldon, PhD, of the University of Missouri, and colleagues, for example, found that more time on Facebook was linked to both high and low levels of connectedness. Psychologists posit this may be the case because Facebook supports relationships among those who are already highly socially connected, but might make those who are isolated feel even more so (Journal of Personality and Social Psychology, 2011).

"If you rely on virtual relationships entirely, that's probably bad for you," Carstensen says. "But when you're using email and face time to supplement real relationships, that's a good thing."

  • Don't force it. If the pressure to forge new relationships is more external than internal, put away the "friend wanted" ad and focus on what and who does make you happy, says Carstensen. "If people are not very socially active and they aren't necessarily interested in expanding their social networks, and they seem OK emotionally, then you shouldn't feel alarmed," she says.

After all, being highly connected has its downsides, too, says University of Sheffield psychologist Peter Totterdell, PhD, who studies social networks in organizations. He's found that people with large work-based networks tend to be more anxious than those with fewer connections. "Possibly what's going on there is that you get more possibilities, more resources, but at the same time you've got more responsibility as well," he says.

And trying to change who you are can backfire, since people's likelihood to forge connections seems to be relatively constant throughout life, Totterdell says. "People may have a natural inclination, and to try to change that [may] make them uncomfortable with the results," he says.

The bottom line? Whether you're content with two close friends or prefer to surround yourself with 20 loose acquaintances, what matters is that you feel a part of something greater than yourself, Carstensen says.

"We shouldn't judge people who say, ‘I'm not a party goer, I don't want to make friends, I don't want to hang out in the bars or the clubs' — that's fine," she says. "There's a whole bunch of people who feel the same way."

Link to article

Treating Depression Helps Some Smokers Quit

Does depression make quitting smoking more difficult? This study seems to find that treating depression does help people quit smoking. Read more to find out.

Sep. 19, 2013 — Studies have shown that people with depression are about twice as likely to smoke cigarettes as people without depression and they are less likely to successfully quit than smokers without depression. A new evidence review in The Cochrane Library finds that depressed smokers may stop smoking longer and benefit overall from mood management interventions after they quit smoking.

“Health professionals should encourage their smoking patients with depression to use a smoking cessation intervention that includes a psychosocial mood management component,” said the study’s lead author Regina van der Meer, MPH, a researcher at the Dutch Expert Centre on Tobacco Control.

The researchers studied 49 randomized controlled trials, including 33 trials that focused on smoking cessation with a mood management element for those with current or past depression. The analysis compared both smoking cessation programs using psychosocial interventions, like counseling or exercise, and those using bupropion, an antidepressant to standard non-smoking programs.

When psychosocial components were added, smokers were able to stop smoking for longer periods. While bupropion was effective for those with a history of depression, it was not found to be effective for smokers with current depression.

Gregory L. Kirk, M.D., director of Rocky Mountain Psychiatry Consultants, LLC in Denver, who agreed with the review’s findings, emphasized that smokers with depression, past or present, have more medical problems from smoking and higher death rates from smoking-related illnesses.

“In a standard smoking cessation program, people with depression are more likely to have negative mood changes from nicotine withdrawal, but the non-depressed group can experience mood states as well. But when depressed smokers quit, depression symptoms may actually improve. This makes it all the more critical to understand this high-risk group of smokers and what helps them quit tobacco,” he said.

Story Source:

The above story is based on materials provided by Health Behavior News Service.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Link to article

Diabetes + Depression = Increased Risk of Death, Review Finds

Can depression lead to death in people with diabetes? According to new research depression causes people with diabetes to follow a cycle of hopelessness, poor self care and increased risk of other health conditions. This in turn leads to increased mortality. This study urges integrative care to address the depression in individuals with diabetes.

Feb. 21, 2013 — People living with diabetes who also have untreated depression are at increased risk of death, according to a new evidence review in General Hospital Psychiatry.

 More than 42,000 patients with type 1 or type 2 diabetes and depression were analyzed in the review. The reviewers discovered that depression was associated with a 1.5 fold increase in the risk of dying. In four of the studies reviewed, co-morbid depression was linked to about a 20 percent higher risk of cardiovascular death for people with diabetes.

Diabetes affects 25.8 million people in the U.S., according to the 2011 National Diabetes Fact Sheet, and about 30 percent of these people also experience symptoms of depression.

"Depression consistently increased the risk of mortality across virtually all studies," said Mijung Park, Ph.D., lead author and assistant professor at the University of Pittsburgh School of Nursing. "We can now postulate that the harmful effect of depression is universal to individuals with diabetes."

Todd Brown, M.D., associate professor of medicine and epidemiology at Johns Hopkins University in Baltimore, said it is very common to see a patient go into a downward spiral when obesity-related co-morbidities, such as diabetes, high blood pressure, obesity and depression converge.

"Obesity can lead to worsening metabolic status that can lead to hopelessness and decreased physical activity, which in turns worsens obesity, and the cycle continues," he explained.

The encouraging news is that depression is a highly treatable condition, said Park. Because depression can make diabetes self-care more difficult and lessen quality of life, she suggested that depression treatment should be included in overall diabetes care strategies.

Story Source:

The above story is based on materials provided by Health Behavior News Service, part of the Center for Advancing Health.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Link to article

Toxic Teachers: Are teachers the new mean girls? QL Investigates the bullies in front of your blackboard.

When you think about being bullied as a teenager, would you include your teachers as the culprits? I was recently quoted in an article exploring the negative impact of teacher bullying and how to cope. Publication: Girls' Life Author: Abbondanza, Katie Date published: August 1, 2013

"She said a 6-year-old could do better work."

"He criticized every little mistake I made."

"She called me stupid in front of the whole class."

As tough as it is to report, each of those statements came straight from GL readers discussing their very real experiences with bullies. But these bullies aren't fellow classmates - they're teachers.

We grow up thinking that teachers are kind, trustworthy and fair. And most are. But that's why the reports of educators singling out and berating students are troubling. This isn't girls being sensitive or overreacting to one-off comments. Teacher bullying is happening in classrooms across the nation. In fact, a 2012 study found that 45 percent of the 116 teachers surveyed copped to bullying a student. And the effects can be devastating to girls' self-esteem.

Bad Teacher

While it may seem harsh when your teacher doles out a detention after you flaked on the homework for the third time, if that's her rule for everyone, it's not bullying. Rather, teacher bullying is typically defined as using a position of authority to either manipulate or belittle a student past what's accepted as normal discipline, according to Dr. Stuart Twemlow, who has researched this topic.

It's important to remember that teachers are human, so they may lose their cool on a stressful day. But repeatedly lashing out or acting controlling is different. Name-calling, singling someone out, overreacting to the point that a student is afraid or physically intimidating or hitting a student all count as bullying or abusive behaviors.

Miranda H., 17, knows firsthand what it's like to be bullied by a person in power. During her sophomore year, she was harassed by her band instructor after a scheduling conflict didn't allow her to sign up for two periods of music.

Due to her other classes, Miranda, a talented saxophone player, had to take a seat in a less prestigious ensemble.

"I was one of his favorite students freshman year, but he made my sophomore year terrible," she says. "He would yell and be cruel, saying I was a 'disgrace to the band.'"

Just as scary, Miranda's teacher blamed her for his outbursts, a classic trait exhibited by abusers. He told her if she had just done what he wanted, he wouldn't have to call her out all the time.

"It was terrible," she says, adding that she'd go home in tears nearly every day. "I was constantly on edge, and I couldn't concentrate in my other classes."

Miranda's father talked with the band teacher at one point, but he denied any abusive behavior. And though she took all the right steps, his reaction made her feel like she was wrong, which is typical among bullying victims.

"If a teacher is calling you inappropriate names or repeatedly singling you out for minor mistakes [which are different from behavioral issues], know that you did nothing wrong," says Jennifer Musselman, a therapist who works with teens.

Speaking Up

It's easy for students to feel powerless in these situations, but all the experts we spoke with stressed the importance of talking to your teacher before things escalate. In some cases, he or she might simply have high standards for you and be inadvertently treating you differently than the rest of the class. Regardless of the reason, you have to say something.

Where to start? Be direct. You should bring up exactly what's bothering you, whether it's the way your teacher ignores your hand when you raise it or how it hurts your feelings when she teases you, even if she's joking.

Mention that you've noticed it more than once. Maybe your teacher isn't aware her behavior is bothering you, and all it will take is a quick after-class conversation to get her to back off.

Of course, confronting your teacher doesn't always guarantee success. Maggie L., 17, had an eighth-grade art teacher who constantly singled out her work. She loved to draw, but her teacher always criticized her. One day, Maggie spoke up and asked what she could do to improve her piece.

"Well, if I were you, I'd throw it out and start over," the teacher told her, even though she was almost done with the entire assignment.

"Sometimes, her comments hurt my feelings." Maggie confessed. "Teachers are in such a powerful position. No matter if you like them or not, their opinion of you really matters. It's very different from classmates being judgmental or not liking you."

Maggie's thoughts get to the heart of why teacher bullying is so troublingand why girls have to continue to defend themselves even after that initial chat with their teacher.

"[If a teacher's behavior is] starting to affect your self-esteem or your grade, it's time to take your concerns to a trusted adult like your mom, dad, school counselor or another teacher," says Jennifer. She recommends documenting the day, time and what the teacher said so you can have a record of what happened.

"Be very clear on what the teacher is saying or doing that is causing you to feel this way," she says. "If possible, list any classmates who can vouch for you."

Ask your parents to talk to the teacher with you, and give them your written list of concerns and incidents. They might decide it's time to talk with the principal or the vice principal, who will hopefully remedy the situation. In the meantime, focus on your work and, if necessary, ask for extra help from a friend or school counselor.

Damage Control

Truth is, just one semester with a toxic teacher can negatively influence your life for years to come, which is why it's extra important to deal with the damage before it's too late.

Miranda, the one-time band star who was bullied, ended up quitting her instrument altogether by the time junior year rolled around.

After having her teacher read her English paper out loud and then call her stupid, Nina J., 14, is now afraid to make her presence known in class. "I never raise my hand in class anymore, because I'm afraid she will make me feel dumb," she admits.

Nina's case may be extreme, but the psychological effects of dealing with a toxic teacher can linger long after class is dismissed. Dr. Nerina GarciaArcement, a clinical psychologist, says to put your feelings down on paper - either by journaling or writing a letter to your teacher that you don't send. Talking with a school counselor also can help sort through the issue.

A Fresh Start

If all else fails, know you can remove yourself from the situation if you and your parents talk with the school's administration. "If the teacher doesn't change, it may be time to transfer out of that class," says Jennifer.

Take Emily M., 15, who eventually decided to take it one step further. She switched schools after her former school's only drama teacher picked on her endlessly.

"He'd say I'm obnoxious and ugly and annoying and stupid. That there was no way I'd ever be an actress," Emily says.

In the end, Emily made the tough decision to transfer, opting for a fresh start. "As hard as it was to leave, it would have been even harder to continue to deal with that teacher," she says. "I'm finally back to my old cheerful self. I'm a lot happier as a person now."

But even if the cruel comments cease or you remove yourself from dealing with critical remarks by changing classes or schools, check yourself for any persistent habits you may have picked up during that time period - like not speaking up in class or thinking you're not good at a certain subject - just because a bully teacher told you so.

"Try to figure out, 'How did this impact me?'" says Dr. GarciaArcement. And then, if you realize you're scared or are avoiding something you used to love, figure out a plan to get involved again - away from the watchful eye of your toxic teacher.

Miranda, who quit playing saxophone because of her experience, could form a jazz band with some friends outside of school. Maggie, who stopped believing in her artsy abilities, could take a lowpressure drawing class at a ree center.

And remember, while it's unfair that you have to deal with a bullying teacher, know that most educators are supportive, professional people who want to see you go far. So for every toxic teacher in this world, there are hundreds of others out there ready to guide you in the right direction. Keep an eye out for the ones who will truly help you shine.

Read more: http://www.readperiodicals.com/201308/3030678731.html#b#ixzz2eQjJuSRa

Link to article

Yoga Helps Ease Stress Related Medical and Psychological Conditions, Study Suggests

Yoga might increase GABA activity, low GABA (neurotransmitter) is linked to anxiety disorders, post-traumatic stress disorder, depression, epilepsy, and chronic pain. So practicing yoga might reduce distress from these disorders. Mar. 6, 2012 — An article by researchers from Boston University School of Medicine (BUSM), New York Medical College (NYMC), and the Columbia College of Physicians and Surgeons (CCPS) reviews evidence that yoga may be effective in treating patients with stress-related psychological and medical conditions such as depression, anxiety, high blood pressure and cardiac disease. Their theory, which currently appears online in Medical Hypotheses, could be used to develop specific mind-body practices for the prevention and treatment of these conditions in conjunction with standard treatments.

It is hypothesized that stress causes an imbalance in the autonomic nervous system (parasympathetic under-activity and sympathetic over-activity) as well as under-activity of the inhibitory neurotransmitter, gamma amino-butyric acid (GABA). Low GABA activity occurs in anxiety disorders, post-traumatic stress disorder, depression, epilepsy, and chronic pain. According to the researchers, the hypothesis advanced in this paper could explain why vagal nerve stimulation (VNS) works to decrease both seizure frequency and the symptoms of depression.

"Western and Eastern medicine complement one another. Yoga is known to improve stress-related nervous system imbalances," said Chris Streeter, MD, associate professor of psychiatry at BUSM and Boston Medical Center, who is the study's lead author. Streeter believes that "This paper provides a theory, based on neurophysiology and neuroanatomy, to understand how yoga helps patients feel better by relieving symptoms in many common disorders."

An earlier study by BUSM researchers comparing a walking group and a yoga group over a 12-week period found no increase in GABA levels in the walking group, whereas the yoga group showed increased GABA levels and decreased anxiety. In another 12-week BUSM study, patients with chronic low back pain responded to a yoga intervention with increased GABA levels and significant reduction in pain compared to a group receiving standard care alone.

In crafting this neurophysiological theory of how yoga affects the nervous system, Streeter collaborated with Patricia Gerbarg, MD, assistant clinical professor of psychiatry at NYMC, Domenic A. Ciraulo, MD, chairman of psychiatry at BUSM, Robert Saper, MD MPH, associate professor of family medicine at BUSM, and Richard P. Brown, MD, associate clinical professor of psychiatry at CCPS. They are beginning test these theories by incorporating mind-body therapies such as yoga in their clinical studies of a wide range of stress-related medical and psychological conditions.

Link to article

Mental Illness and Marriage

I was interviewed on how mental illness affects marriage and how to cope. Listen to the podcast.

What kind of impact does mental illness have on a marriage?

In today’s society, it’s becoming more and more common for individuals to be living with some sort of mental health condition or illness like anxiety or depression. And while there are many issues and conditions that present themselves in different, unique ways, oftentimes the effects on a marriage are very similar.

In addition to anxiety and depression, some people suffer from more extreme conditions like post-traumatic stress disorder and substance abuse problems. When these issues creep in without the proper treatment, their impact on a marriage and the individual can be fundamentally problematic. In some situations, the partner without the condition will have to pick up the slack for the other. And in many cases, couples will begin to suffer from tension and exhaustion within their marriage.

Our guest today is Dr. Nerina Garcia, a clinical psychologist with Williamsburg Therapy and Wellness in Brooklyn, NY. Nerina is here to give us some advice about how couples and individuals can learn to cope with mental illnesses within marriages while building a network of support.

To find out more about Nerina and her practice, visit her website or call (917) 816-4449.

Podcast: Play in new window | Download

Link to podcast

Childhood Trauma Leaves Mark On DNA of Some Victims: Gene-Environment Interaction Causes Lifelong Dysregulation of Stress Hormones

How we live and what happens to us changes our genes. Trauma in early childhood can change DNA and lead to PTSD, anxiety and depression.

Dec. 2, 2012 from Sciencedaily.com— Abused children are at high risk of anxiety and mood disorders, as traumatic experience induces lasting changes to their gene regulation. Scientists from the Max Planck Institute of Psychiatry in Munich have now documented for the first time that genetic variants of the FKBP5 gene can influence epigenetic alterations in this gene induced by early trauma.

In individuals with a genetic predisposition, trauma causes long-term changes in DNA methylation leading to a lasting dysregulation of the stress hormone system. As a result, those affected find themselves less able to cope with stressful situations throughout their lives, frequently leading to depression, post-traumatic stress disorder or anxiety disorders in adulthood. Doctors and scientists hope these discoveries will yield new treatment strategies tailored to individual patients, as well as increased public awareness of the importance of protecting children from trauma and its consequences.

Many human illnesses arise from the interaction of individual genes and environmental influences. Traumatic events, especially in childhood, constitute high risk factors for the emergence of psychiatric illnesses in later life. However, whether early stress actually leads to a psychiatric disorder depends largely on his or her genetic predisposition.

Research Group Leader Elisabeth Binder of the Max Planck Institute of Psychiatry examined the DNA of almost 2000 Afro-Americans who had been repeatedly and severely traumatised as adults or in childhood. One-third of trauma victims had become ill and was now suffering from post-traumatic stress disorder. The risk of developing post-traumatic stress disorder rose with increasing severity of abuse only in the carriers of a specific genetic variant in the FKBP5 gene. FKPB5 determines how effectively the organism can react to stress, and by this regulates the entire stress hormone system. The scientists hoped to cast light on the mechanisms of this gene-environment interaction by comparing modifications of the DNA sequence of victims who had not become ill with that of those who had.

The Munich-based Max Planck scientists were then able to demonstrate that the genetic FKBP5 variant does make a physiological difference to those affected, also in nerve cells. Extreme stress and the associated high concentrations of stress hormones bring about what is called an epigenetic change. A methyl group is broken off the DNA at this point, causing a marked increase in FKBP5 activity. This lasting epigenetic change is generated primarily through childhood traumatisation. Consequently, no disease-related demethylation of the FKBP5 gene was detected in participants who were traumatised in adulthood only.

Torsten Klengel, a scientist at the Max Planck Institute of Psychiatry, explains the findings of the study as follows: "Depending on genetic predisposition, childhood trauma can leave permanent epigenetic marks on the DNA, further de-repressing FKBP5 transcription. The consequence is a permanent dysregulation of the victim's stress hormone system, which can ultimately lead to psychiatric illness. Decisive for victims of childhood abuse, however, is that the stress-induced epigenetic changes can only occur if their DNA has a specific sequence."

This recent study improves our understanding of psychiatric illnesses which arise from the interaction of environmental and genetic factors. The results will help tailor treatment particularly for patients who were exposed to trauma in early childhood, thereby greatly increasing their risk of illness.

Story Source:

The above story is reprinted from materials provided by Max-Planck-Gesellschaft (2012, December 2). Childhood trauma leaves mark on DNA of some victims: Gene-environment interaction causes lifelong dysregulation of stress hormones. ScienceDaily. Retrieved December 10, 2012, from http://www.sciencedaily.com­ /releases/2012/12/121202164057.htm

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Managing and supporting grieving employees

I was quoted in this article discussing the benefits of supporting employees through their grief. By www.hrmonline

Losing a close friend or family member, a child or spouse, is a nightmare for all of us and when it happens to a co-worker or employer then we can struggle to know how to support. While there are policies in place for grievance leave, what do you do when the affect is felt for weeks or months

Licensed therapist Steve Havertz knows from experience the difference between having a supportive manager, and management that seems to view your struggle as a cost to them.

Havertz lost his wife in 2003, but leave constraints meant he had to return to work after just 10 days. Despite the quick turnaround the positive relationship he had with his manager made it easier to manage a return to work.

“I had a great relationship with my boss and she was always asking how I was doing. That made a huge difference. I felt supported and she was understanding and supportive,” he said. “I thought I was an expert on grief and loss until I actually experienced it two times. Now I really am an expert personally and professionally.”

A few years later Havertz’ young daughter was diagnosed with cancer. He worked hard to balance full-time work with her cancer treatments, but while his direct supervisor was supportive he received emails from the “uppers” querying why he needed the leave.

“It left a very bad taste in my mouth,” he said. “Then when Emmalee died [in 2009], my boss has changed and the ‘uppers’ were the same and both not supportive. I was did not dare talk about any of my feelings and even let them know I was struggling.”

With further conflict over the next six to 12 months, Havertz ended up leaving the company. The difference wasn’t in how much leave he got, but in how caring his company was.

“It make all the difference if the EE feels support and is asked how they are doing for months after the loss. Talk to them weekly to see how they are carrying to load of work, emotions, family and personal health. I don't think the amount of time off is the issue, it is the amount of concern felt and support given.”

It’s a sentiment echoed by New York clinical psychologist Nerina Garcia-Arcement, who said supporting employees is economically, as well as morally responsible. Grieving employees often feel emotionally and cognitively impaired and are less productive.

“They will likely not be as productive, as their attention, memory and concentration will be impacted by their emotional response to their loss,” Garcia-Arcement said. “This is a time when employers can show sensitivity and as a by-product gain increased loyalty and appreciation from an employee.

That employee is likely to return to work feeling grateful for the support they received from their employer and "give" back to their employers through increase productivity, Garcia-Arcement added.

link to article

Hurricane Sandy: Coping with the Emotional Aftermath

By Nerina Garcia-Arcement, Ph.D. Natural disasters, such as Hurricane Sandy, remind us of our vulnerability. The closer the impact of the hurricane to you the more intense your reaction can be. Surviving a natural disaster such as Hurricane Sandy can bring about stress, anxiety, depression and post traumatic stress symptoms. If you have experienced emotional distress in the past, then a major stressor such as Hurricane Sandy is likely to exacerbate a pre-existing condition.

Typical emotional reactions include disbelief, feeling confused or helpless, irritability, sadness, fear, difficulty focusing and making decisions, feeling preoccupied and ruminating about what happened during/after the storm, worrying about what future negative things could occur, and re-experiencing events from the disaster. Common physical reactions are sleep problems, nightmares, feeling jumpy and being easily startled, racing heart, trouble breathing, headaches and trembling.

If you notice you are experiencing these problems there are actions you can take to feel better:

  1. Do not isolate yourself: Seek out support from loved ones, friends and neighbors that know what you are going through.  This will help you realize you are not alone in your pain.
  2. Talk to friends and loved ones about how you are feeling: Expressing your worries, fears, anxieties, sadness, disbelief and confusion can be healing and cathartic.
  3. Limit your news watching: Seeing the images of destruction simply reminds you of your traumatic experience and reinforces your feelings of fear and vulnerability.
  4. Donate or volunteer your time through relief efforts: This will help you feel more in control and that you can make a difference. Aiding others through their pain helps reduce your own.
  5. Engage in hobbies or life affirming activities: Doing things you enjoy will help distract you from your distress and remind you that there is beauty and creativity in the world, not just destruction.
  6. Stay Active: Exercise or go outside for walks. These activities will get your mind off of your problems.  Getting your body moving will help release hormones that relieve stress.

If you find you are still distressed after trying these suggestions, consider talking to a mental health professional or a faith based adviser. Surviving a natural disaster can have a lasting negative impact on how you see the world and how you feel. Addressing your emotional pain now can reduce the chances of your stress, anxiety, depression or PTSD symptoms lasting for years into the future.

 

Naming the Shame that Can Cripple

I was quoted on the causes of shame, how to cope and treatment options. By Marcia G. Yerman

When Amy Ferris asked me to contribute an essay to Dancing at the Shame Prom: Sharing the Stories That Kept Us Small, I wasn't sure that I had any shame. Then, when I thought about it, I realized that I did. I just hadn't framed it that way. I agreed to participate. After I handed in my essay, I heard back from co-editor Hollye Dexter. "I think you are holding back," she said. "Can you go a little deeper?" So I did. Along with twenty-six other women, I wrote openly about issues that had impacted my life.

Now that the book is out, I have taken off my memoirist hat and am writing as health journalist. Reading the stories that encompassed familial alcoholism, sexual abuse, parental suicide, distorted body images, hoarding, alienation, and racial identity anxiety - I wanted to get to the psychological root of how shame shapes who we are and how we live our lives.

I interviewed four practitioners who shared insights that were both clinical and revelatory. We focused on how shame specifically impacts girls and women. Many of their observations and verbiage overlapped. To a person, they all began the conversation by drawing a distinction between shame and guilt.

Shame is a feeling or belief that screams, "I am bad." Guilt is evidenced as, "I did something bad." Shame is feeling worthless. Guilt is external; you can fix it. Specifically, shame is, "I am damaged."

Amber Lewter, EdS., LAPC, whose background includes working as a survivor advocate at a rape crisis center, told me, "When women define themselves as being bad, it creates low self-esteem and a poor sense of self-worth." Treating those who have experienced childhood sexual trauma, Lewter sees women coming in for counseling with a lot of "shoulds" ("I should have told someone.").

She conducts an exploration of shame through expanding awareness of external factors, pointing out that what happened "was beyond the control" of the patient. She believes that shame is more of an issue for women because they are "relationship-centric" and therefore bring childhood shame and a "less than" mindset into their adult relationships.

Ph.D. and Licensed Clinical Psychologist, Nerina Garcia-Arcement, qualifies shame as "an insidious emotion, often at the root of mental health problems like depression and anxiety." She sees shame as creating "a sense of isolation which poisons an individual's self-esteem."

She told me, "My patients feel silenced due to their shame. Often, they can't even speak out loud what they feel ashamed about." Garcia-Arcement defines shame as a reflection of a "core value." Therefore, what results is a need to cover up what we feel ashamed about.

She related, "The power of shame is that it silences us and creates internal negative dialogue, such as, 'I wasn't good enough. I deserved it.' So we want to stay invisible. We don't want to feel vulnerable. This stunts our ability to grow." Garcia-Arcement explained how the fallout of shame translates into a "fear of takings risks."

"A silent killer," is how Lori Freson, Licensed Marriage and Family Therapist, describes shame. Her practice specializes in women's issues and self-esteem.

"Women don't always acknowledge shame as a presenting problem," she said. "Women can have body image problems and not realize it is shame."

She spelled out, "Shame about our bodies can lead to isolation, depression, and eating disorders." Shame about sexual abuse can lead to "avoidance of intimacy, relationships, sexual problems, and self-harm." Shame about an addiction "can delay or sabotage" efforts to recover.

Finally, she added the key observation, "Shame is connected to self-perception and how you think people perceive you."

Founder of the Critical Therapy Center, Silvia M. Dutchevici, spoke at length about how our culture "plays into our perceptions." Her philosophy embraces a holistic approach. "Psychology is not in a vacuum," she emphasized. She referenced the issue of race, class, gender, ideology, and economic status. Her point of view is that "society has issues as well," forcing people to "adapt to a false criteria rather than challenging that criteria."

Dutchevici was crystal clear in her assessment. "For women in particular, depending on the trauma, feelings of shame may arise from our culture's imposition of gender roles and the way women have been socially conditioned regarding their view of themselves. The more a society demands perfectionism," Dutchevici continued, "the more we have shame."

Both Freson and Garcia-Arcement addressed this element as well.

"A lot of shame comes from external societal factors," Freson said. "People want to be accepted. People are afraid of being different. Shame among women and girls is more prevalent because of cultural standards."

Freson pointed to celebrity media and fashion magazines. "People shut shame down because they want to have the perfect image." Her message about shame to young girls is, "You don't have to be perfect. Be your best self."

"The core expectation for women," said Garcia-Arcement, "is that we can do it all. Be beautiful and be everything to everybody." When girls and women buy into cultural norms they "learn to hate their bodies and themselves." It all comes back to not being "good enough." Garcia-Arcement illustrated shame from the ground level of family dynamics, up and outward toward group identification.

"Our family is a reflection of who we are," she said. "So if there is a family behavior [alcoholism, suicide, sexual abuse, domestic violence], it's still a part of us." Treatment by Garcia-Arcement entails the challenges faced by people of color. She identified that if a person from a minority community does something that the rest of the group is not proud of - it is seen as a "personal reflection on who they are."

In tandem, Dutchevici - a political refugee from Romania - touched on the use of shame as a tool of control in promoting a specific ideology. Shame also operates by keeping group memberships and affiliations intact.

So what can be done? All four women I spoke with communicated the need to explore an individual's experience through expanding consciousness.

Lewter articulated about introducing an awareness of "external factors." Freson, who maintains that if "shame is not exposed and dealt with it can destroy your relationships and your life," believes the more exposure the topic gets the more taboos are broken down.

Applauding the premise of the book, Freson sees it functioning as a tool for dialogue while enabling readers to discover, "Oh. It's not just me. I'm not the only one."

Dutchevici agreed. "The more people come out and talk about shame, the less power it has." She reiterated that it was important to "name the emotion."

"The first step is to realize that you are not alone," Garcia-Arcement reiterated. She uses a combination of talk therapy, cognitive behavior therapy, and insight-oriented work. She suggested mindfulness exercises, trying to connect the mind and body, sitting with your feelings, and being in the moment. Garcia-Arcement stressed the power of stories, advising the importance of sharing one's story.

"Empathy is essential to healing. If you can't say it out loud yet, write it down. Excise it from yourself. Writing is a useful tool, as there is no witness to the shame." An important element of eventually sharing the narrative is that it helps individuals "normalize their experience," through a realization that they are not alone and not to blame.

(The Shame Prom has a Tumblr blog where anyone can post a shame narrative, either with her name or anonymously).

Garcia-Arcement said definitively, "Everyone has shame. We just don't want to look at it."

In her essay, Elizabeth Geitz wrote, "I've learned letting go of shame is one of the most freeing things I've ever done. I've learned that I don't have to dance at the Shame Prom forever. The dress, the shoes, the long-wilted corsage are now gone.

"The music has finally stopped."

Link to article

Maternal Depression Can Impact Children's Health

Maternal depression is a topic that is difficult to discuss out loud. Mothers often feel shame as they struggle to cope with the demands of motherhood.  In this article I am quoted on the impact depression has on mothers and their children. I share helpful coping strategies and treatment options.
By Rheyanne Weaver HERWriter September 20, 2012 - 7:25am

Maternal depression is not only an ongoing struggle for mothers, but research suggests children of depressed mothers can be impacted in multiple ways.

For example, a recent study published in the Journal of Affective Disorders noted that mothers who are depressed have a reduced responsiveness toward infant distress, which can lead to harmful effects on the child.

However, the small pilot study stated that women who received cognitive behavioral therapy treatment had a reduction in their depression and as a result, were also more responsive toward infant distress.

Another study published in the journal Pediatrics found that children ages 4 and 5 were more likely to be short for their age if their mothers were depressed starting around nine months after the child was born.

An article about the study on Medpage Today stated that children of depressed mothers could have an “increased stress response,” which could lead to higher cortisol levels and lower levels of growth hormones. This could lead to a shorter height.

Mothers with depression might practice “poor parenting behaviors and feeding practices” as well, and children might form an insecure attachment with depressed mothers.

The article added that stunted growth at a young age is associated with various negative outcomes, such as poor development, reduced scholastic performance, smaller body size as an adult, and higher levels of death.

Nerina Garcia-Arcement, a licensed clinical psychologist, said in an email that there are many negative health outcomes for children of depressed mothers. For example, children of depressed mothers tend to visit the emergency room more often, and they might even develop depression in their teens.

“A depressed mother often is less responsive to their child's needs (i.e., when distressed, hungry) and does not have the emotional and physical energy to play and cuddle with their child,” Garcia-Arcement said.

“This can be disruptive to forming a secure and healthy emotional bond with each other. When a child does not feel safe and secure they can go on to become isolated, have difficulties making friends and develop anxiety and depression.”

Mothers suffering from depression need to make treatment a priority for their own health as well as their children’s.

“A parent is modeling for a child how to cope with challenges,” Garcia-Arcement said.

“The best example a mother could set for her child is that when you don't feel well, you don't ignore it. Instead you prioritize your well-being and you seek out help. Things they can do includes speaking to a mental health professional, reaching out to friends and family for social support, attending mom groups in person or participating online.”

She suggested that mothers make a point of getting out of the house every day for 15 minutes minimum. It is best to exercise, but mothers can even take their children for a walk or saunter in the neighborhood or at the mall with their babies in a stroller.

“Mothers should ask for child care assistance from their partner, family or friends in order to have time to do things alone,” Garcia-Arcement said.

“Moms need time [to] rest and catch up on sleep (sleep deprivation makes depression worse). They must do something kind for themselves, such as taking a hot bath, reading a book, getting a massage, engaging in a neglected hobby, and watching a comedy that will make them laugh. Reach out and meet up with a supportive friend.”

She also suggested spending bonding time with children for at least 10 minutes a day, which can lead to a greater connection, and children can also feel more safe and secure.

Ramani Durvasula, a psychology professor at California State University, said in an email that since mothers tend to be primary caregivers, children can suffer in many aspects of life if their mothers are depressed.

For example, children might not receive the nutrition they need and might have reduced sleep. They could also develop anxiety, depression and social withdrawal.

Mothers need to eat healthy, sleep and exercise consistently. Especially for women who have a history of depression, it’s important to make a plan for increased support once the baby comes.

“Many mothers try to be superwoman/supermom - and maternal depression is not part of that plan,” Durvasula said.

“Lots of times people write it off to fatigue and stress, and untreated depression can get worse and worse. Depression is a treatable disorder, and when there are children involved it is critical that it be managed to ensure the health of mother and children.”

Link to article

Organizing Your Life

I was recently on the Colin Lively Show, discussing how to declutter your mind.  The entire show was filled with helpful tips on how to better organize your home, office and mind. The description for the show is below:

Oh lord, if this show wasn’t sent from on-high, than it was Hildamae’s dying wish coming true: get Colin to clean his room! So, there it is, the cat is out of my Birkin bag: I can be rather messy. But aren’t we all? Whether it be in mind, life, schedule, desk, purse, closet, or your inbox, somewhere you are a little messy; and a little messy can lead to a great deal of stress. It is, as Dawn Falcone put it, “stuck energy.” For me, Consuelo un-sticks my stuck energy four times a week, but that doesn’t cover all my bases: I still need to go to Dr. Feldheim, my therapist, and Dr. Koplowitz, my psychiatrist, to get my mind in order.

I was stunned to learn that our outer world is very much a reflection of our inner world. For instance, a messy desk can be a sign of a stressful work environment or chronic work overload. It is important to create systems that keep our lives orderly and neat. We do not need to be neat freaks, but organization is one of the keys to happiness. Growing up, we polished the silver under the iron fist of Hildamae, she said the harder we scrubbed the more we would feel her love. Boy was she right! Three hours of polishing spoons made my wrist feel so loved that they were practically stuck in an arthritic state until my mid-40s. “Sheets tight enough on which to bounce a quarter,” she would demand. By the time I went to college, I had had enough Old Dutch Cleanser, Clorox and Bon-Ami running through my blood that I vowed never to clean again. And I have not touched a mop since!

This week I will be speaking with three personal organizers and a psychologist, and we are going see how we can change our state of mind with a Swiffer, or two, or forty-seven.

This week I will be speaking with three personal organizers and a psychologist, and we are going see how we can change our state of mind with a Swiffer, or two, or forty-seven.

Dawn Falcone is not only passionate about organization, she knows it has a HUGE impact on personal sanity, success, and overall stress level. She emphasizes the point that reducing clutter and chaos will ultimately bring reward in the form of clarity, serenity, and time. She works closely with her clients to design spaces that reflect their personality and spirit. Dawn is a proud member of the (National Association of Professional Organizers) and is a certified interior environmental coach. Her work has appeared in many publications including: Real Simple, Woman’s World, Home And Garden Television, and Apartment Therapy.

Bonnie Joy Dewkett is the founder of The Joyful Organizer and is an organizing expert, author, motivational speaker, and radio personality – oh and she is an expert in time management! Boy oh boy does she know how to block-out a day!

Andrea Brundage of Simple Organized Solutions (S.O.S.) offers personalized hands-on organizational solutions to help small-to-medium sized business owners and homeowners function in efficient and organized environments. In partnership with its clients, S.O.S. creates “sensible solutions for your organizational needs.”

Dr. Nerina Garcia-Arcement is a licensed Clinical Psychologist and a Clinical Assistant Professor, in the Dept. of Psychiatry, at NYU School of Medicine. She specializes in challenges associated with life transitions, stress, anxiety, and depression.She provides a holistic therapeutic session by using a combination of Cognitive Behavioral Therapy and insight oriented/psychodynamic techniques to identify current problems, develop individualized strategies to ease stress, and gain insight into understanding one’s patterns in behavior. Dr. Garcia strongly advocates the act of self exploration, which helps us understand the way we think and act, it will also help shed light on our behaviors that worked in the past but are not effective any longer.

Link to podcast/show

Organizing Your Life

How Are You Coping With the Recent Mass Shootings?

I was quoted on the important topic of PTSD and typical reactions to mass shootings and trauma. In this I share tips on how to cope after a trauma.

By Rheyanne Weaver  |

The two mass shootings in the last couple of months have been on the minds of many Americans, especially because they took place in seemingly safe places -- a movie theater and a temple. Experts have suggestions for how the general public and victims can cope with such saddening and scary events.

Nerina Garcia-Arcement, a licensed clinical psychologist, said in an email that she previously worked with 9/11 survivors. “Unfortunately many people do not seek help for mental health problems following a trauma and most people wait an average of 10 years to seek mental help,” Garcia-Arcement said.

“A majority of my 9/11 clients sought help six to 10 years after 9/11. By this point many were isolated from all social support, had difficulties working as they avoided public transportation and public spaces, and suffered from chronic stress due to fear of the ‘next terrorist attack.’"

She hopes that victims of recent shootings get help from mental health professionals sooner in order to cope with trauma. There are a plethora of mental health issues that could result from being a victim of a shooting.

“The closer the person was to the event, the more emotionally impacted they are likely to be,” Garcia-Arcement said.

“For people directly affected by the recent shootings, it is common to experience Post Traumatic Stress Disorder (PTSD), anxiety (including panic attacks, generalized anxiety and phobias related to the attack, such as social phobias or fear of the dark) and depression symptoms.”

“It is a normal reaction for people to re-experience or remember the event, have nightmares, feel sad and scared, be hypervigilant, avoid reminders of their trauma and isolate from people,” she added. “This is the mind trying to process and make sense of what happened.”

“Survivors of the [Colorado] shooting will find that things like the smell of popcorn, popping sounds, the dark, being in crowded spaces or watching a movies might trigger reminders of their experience,” Garcia-Arcement said.

“These are normal reactions that can be managed with deep breathing, relaxation exercises and positive self talk (i.e., ‘this is just a reminder, it is not happening again. I am okay. I am safe.’). For many survivors, those in the theaters and injured, survivor's guilt is common.”

People who were not directly involved in the shooting can still suffer from slight mental health issues as well, such as “sadness, horror and anxiety,” and avoidance of reminders of the shootings.

Here are some tips from Garcia-Arcement to help people cope with the recent shootings:

1) “Offer each other social support, as individuals and as a community.”

2) “Remind yourselves that this was an isolated horrible event that happened to good people. It was not their fault.”

3) “My strongest recommendation is that survivors and the general public do not avoid reminders of the trauma and do not isolate. It is instinctive for people to avoid things that remind them of their trauma. Unfortunately once they begin avoiding going to movies or spending time in crowded spaces, it often escalates to avoiding more and more things. They begin to misinterpret the fact that they are safe simply because they avoided going to the movies, instead of forcing themselves to go to the movie and realizing they are safe.”

4) “A person should seek mental health support if they are feeling overwhelmed by their reactions to the shooting. If after a few months they find they are still experiencing PTSD, anxiety or depression symptoms, they ought to seek a therapist that could help them process their normal reactions.”

Robin Zagurski, a licensed clinical social worker, works with adults and teens who have gone though traumatic experiences. She said in an email that a major indicator that professional mental health is needed after a mass shooting is if people are unable to function in their daily lives.

She suggested keeping the same daily routine in order to distract from thinking about the recent shooting, and taking care of one’s overall health and well being.

She said that it’s difficult to plan for rare shooting situations, but to be aware of any “leakage” statements, where a future shooter may tell someone or post on the Internet what their plans are.

Don’t assume these statements are merely threats. Reporting this to authorities could potentially save lives.

“Think ... of maintaining your safety in all environments, especially for hazards that have a higher likelihood,” Zagurski said.

“For example, always know where the exits are in any building in case of fire. Practice evacuations so that you know how to get out safely. If someone talks to you about hurting themselves or others, report it to authorities immediately.”

 

Link to article

Mental Health Issues to Be Aware of in Your 20s

I was quoted in this article regarding typical mental health issues for people in their 20s. I discuss the impact of stressful transitions and how to cope. by Rheyanne Weaver |

People in their 20s seem to have it all: youth, energy, health, and looks. But they are also still figuring themselves out, and this time of change can bring certain mental health concerns as well. Experts have information on these issues that tend to impact people in their 20s, and provide some solutions for addressing and coping with these problems.

Clinical psychologist Dean Haddock, a marriage, family, and child counselor and the executive director and founder of Community Counseling and Psychological Services, points to a fairly common activity of 20-somethings that can lead to mental health issues if it’s not checked: alcohol and drug use.

“The first problem that leads to many others is alcohol and chemical abuse, which often leads to dependency,” Haddock said in an email. “The mental disorders that follow are often depression, anxiety, and brain injury. Of course, self-esteem and body-image problems often lead to eating disorders.”

Haddock gives three tips to help people in their 20s prevent and get through some common mental health concerns:

  1. Know your genetic history of mental disorders. Knowing is half the battle to avoid those disorders in yourself.
  2. Be choosey about your friends, as they will influence your decisions. Healthy friends lead to healthier decisions.
  3. Self-esteem is often the result of the people who matter to you. If they do not esteem you, then you will not esteem yourself.

Nerina Garcia-Arcement, a clinical psychologist and clinical assistant professor at NYU School of Medicine, suggests that the many life changes people experience in their 20s can cause mental health issues at times.

“Your 20s are filled with life transitions that can be stressful,” Garcia-Arcement said. “This is a time when young adults are solidifying their personalities, developing their independence from family, starting or finishing college, beginning new jobs, developing a career, forming romantic relationships, and learning to manage their existing family relationships and friendships within these context.”

“Individuals in their 20s don’t have a lifetime of experience to draw on when managing multiple life transitions at once,” she added. “When someone experiences these transitions, anxiety and depressive disorders can occur.”

Here are six of Garcia-Arcement’s tips to help people in their 20s cope with mental health issues more common to that age group:

  1. Seek out and form strong support networks.
  2. Seek out others who are going through similar experiences and share your feelings, whether you are feeling worried, nervous, scared, sad, confused, or excited.
  3. Know that you are not alone in your confusion about your career and relationships.
  4. Seek out mentors who have achieved their goals, and ask for advice.
  5. If you are feeling stress, sadness, or anxiety, engage in activities that will help you manage those feelings such as yoga, meditation, exercise, hobbies, social activities, relaxation exercises, and deep breathing.
  6. If you feel you are not getting the necessary support and feel overwhelmed or depressed, seek out mental health professionals who can help you manage the feelings related to your life transitions.

Stephanie Sarkis, a licensed mental health counselor, said in an email that anxiety and depression are some of the main mental health issues 20-somethings face.

“We have seen an increase in these issues due to the lagging economy and difficulties finding employment,” Sarkis said. “Many people in their 20s have moved back in with their parents, which can trigger feelings of failure and frustration.”

Dr. Maiysha Clairborne, a family physician and wellness and stress management coach, added in an email that eating disorders associated with body dysmorphic disorder and body-image issues are also common for people in their 20s. She has three overall tips for people in this age group:

  1. Talk to someone. The worst thing that a person can do when they are feeling depressed, anxious, or alone is to isolate more. Many times when we talk with someone we trust about what’s going on, we come to realize that we are not the only ones experiencing it and then we can get support.
  2. Get active. Staying physically active not only helps to keep the body fit but also helps release endorphins and serotonin in the brain, which help keep the mood elevated. Physical activity is also a good release for stress and anxiety.
  3. Minimize sugar and junk food. Sugar and processed junk foods can worsen the emotions of stress, anxiety, and depression because they cause erratic changes in your body’s blood sugars. This can disrupt the normal release of hormones in the brain that keep your moods stable.

Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said there are many issues specific to people in their 20s, including problems associated with medication use.

“Many people were on stimulants/meds for their ADHD when they were younger, but they thought it was okay to stop their meds when they were done with school,” Carroll said. “Now they are struggling at work and don’t know why. I’ve also seen young adults stop all kinds of meds like their thyroid meds because they didn’t know why they were even on it, and then they have all kinds of problems.”

Bad habits involving drug and alcohol use can start to become a major substance abuse issue when people are in their 20s, and other mental health issues start coming to the forefront at this time in peoples’ lives. Examples include bipolar disorder and schizophrenia. Also, panic attacks can start for people who have a genetic predisposition and who have higher amounts of stress associated with newfound adulthood.

“The 20s are an important time of social/emotional development,” Carroll said. “Unlike previous generations, identity formation often takes the entire 20s due to the complexity of modern society. It could be said that adolescence lasts until the early 30s in today’s society due to [prolonged] periods of education (grad school, law school, med school, etc.), lack of stable job options, and delays in getting married and starting families.”

Carroll, who is also an assistant professor at the University of New Mexico School of Medicine, suggests that when it comes to serious relationships and marriage, people in their 20s should consider how their choices could eventually affect their mental health and how their brain plays a part in their decision.

“Many 20-somethings are tempted to get married, but it is generally a bad idea because the brain in not done developing until about 25 [years old] … which leaves young adults vulnerable to having their rational mind be overwhelmed by their feelings or stress,” Carroll said. “Relationship choices often dramatically change from the early 20s to the late 20s, so many people find that the person that was perfect at 22 is a disaster at 27.  This can be an incredibly hard transition, to have to break up with your former soul mate that you thought you’d love for life because you’ve changed so much over the last several years.”

Link to article

Domestic violence and mental health: How are they intertwined?

Domestic violence leads to complicated emotional reactions. In this article I share information that sheds light on typical reactions to trauma and why it is difficult for the abused to leave.

By Rheyanne Weaver |

The United States still has a lot of work to do in regard to addressing the prevalence of domestic violence.

In fact, an in-depth story from the Arizona Republic has pointed to the fact that in the last several years, the number of deaths from domestic violence has stayed fairly consistent in Arizona.

While this means there hasn’t really been an increase in deaths, there certainly hasn’t been a decrease either.

Fortunately, researchers are seeking more information about domestic violence and specifically about domestic violence that ends in death. Not surprisingly, much of the research has a mental health aspect.

For example, the article mentioned how substance abuse, depression and estrangement are just some of many risk factors that could increase a battered woman’s chance of eventually being killed by her partner.

Later, the article explained that generally before a battered woman’s life ends at the hands of her partner, there are warning signs. For example, the partner usually engages in a specific kind of abusive behavior called “intimate partner terrorism” or “coercive control.”

“Coercive control is almost exclusively the domain of men,” according to the article. “It is long-term and tyrannical abuse that includes, often in addition to physical violence, attacks on a woman's self-worth, degrading remarks and obsessive monitoring of her whereabouts and her contact with other people.”

The abuser often has mental health issues like depression or substance abuse, and struggles with obsessive and possessive behavior. In some cases, abusers cope with massive self-shame by severely abusing or killing their partners.

Mental health experts have more insight into how domestic violence can impact mental health, and what issues sometimes predispose people to being in relationships that involve domestic violence.

Nerina Garcia-Arcement, a licensed clinical psychology and a clinical assistant professor at the NYU School of Medicine, said in an email that there is a gradual process that leads from “normal” relationships to relationships involving domestic violence.

“Women don't enter violent relationships where they are being hit from day one,” Garcia-Arcement said. “They date men that pay attention to them, are possessive and slowly begin to limit their behavior and social interactions (i.e., the woman can't talk to friends or family as much or at all, or she can't wear certain things). Often this controlling behavior is couched as ‘loving them.’"

Then comes the act of lowering the victim's self-esteem.

“Once they are socially isolated, they (abusers) begin to erode their self-esteem by insulting them or calling them names, telling them that no one else would want them, etc.,” Garcia-Arcement said. “Once the (victim’s) self esteem is fragile, they often begin the physical abuse.”

“This is why women don't just leave,” she added. “By the time they are being hit, they are socially isolated, feel stupid and undesirable, doubt their self-worth and fear the consequences of leaving. If they are not staying out of fear, they are staying because they have come to believe they deserve this treatment, that they are at fault for being hit, for ‘being stupid/saying the wrong thing,’ etc."

Women in abusive relationships tend to suffer from mental health issues like anxiety, depression and post-traumatic stress disorder as a result, she said.

“Many women who are in abusive relationships grew up in households where they witnessed abuse,” Garcia-Arcement said. “This normalizes it. Confuses love and violence. This is a pattern that is familiar. For other women (who) don't grow up in abusive households, the typical cycle of abuse prepares them. Their self-esteem gets eroded until the abuse makes sense.”

David M. Reiss, a psychiatrist and previous interim medical director for Providence Behavioral Health Hospital, just spoke at the 35th annual convention of the International Psychohistorical Association about child abuse and trauma, and their impact on individuals, communities and society. He said in an email that relationships with domestic violence are characterized by dysfunction and pathology.

“No relationship can maintain appropriate intimacy and trust if there is violence occurring,” Reiss said.

Some women also try to rationalize that it’s better for the children if they stay with their abusive partner.

“Staying ‘for the children’ is misguided, as children need role models who do not let themselves be abused,” Reiss added.

Freda Emmons, the author of “Flame of Healing: A Daily Journey of Healing From Abuse and Trauma,” said in an email that she grew up with abuse throughout her childhood.

Her mother was a victim of abuse by her father, and the mother also contributed to some child abuse along with the father.

“I asked her once why she stayed and she said it was because of us kids; she didn't believe that she could provide for us,” Emmons said. “I told her it would have been better to get assistance or whatever she could do to spare us the horrible years of pain.”

However, Emmons’ mother couldn’t take care of herself and was suffering from issues that are associated with abuse victims, so she was unable to protect her children from their father or herself.

“I think some women have been so battered, physically and emotionally, that they have lost their sense of personal value,” Emmons said. “They think that they are the cause of the problem, that if they would just be a better wife, mother, spouse, cook, cleaner, etc. that the abuse would stop. It never does.”

She hopes her book can help others find a way out of the despair she experienced.