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

8 Ways Kids Can Give Thanks

Appreciating our blessings and taking time to notice what we are grateful for helps us feel happier and reduces depression. This is a great article about how to instill gratitude in children. These helpful tips are appropriate for all ages, whether children or adults. By nurturing a sense of gratitude from an early age, your children will learn to appreciate big and small blessings.

By Ansley Roan

Teaching kids to be thankful doesn't involve guilt trips or lectures on the less fortunate, and the benefits will last longer than the turkey sandwiches. Grateful children may grow into happier adults, according to Christine Carter, Ph.D., author of Raising Happiness and director of the Greater Good Parents program at the University of California at Berkeley. "Pioneering social scientists think that 40 percent of our happiness comes from intentional, chosen activities throughout the day. Thankfulness is not a fixed trait. It's a skill that can be cultivated, like kicking a soccer ball or speaking French," Dr. Carter says. Because Thanksgiving is high season for gratitude, it's an ideal time to talk to your children about remembering the blessings. Try these easy and interesting tips to teach your children to develop a habit of thankfulness.

Shop, Buy, and Share

Trips to the grocery store, drugstore, or toy store can be opportunities to think of others. Next time you're stocking up, encourage your children to pick one or two canned goods to donate to a Thanksgiving food drive or a food bank. Shelters also need donations of personal care items (soap, toothpaste, diapers) or new clothing (warm socks, jackets). Check with local shelters to see what they need, and have kids choose the supplies. They'll learn to think of others and start to appreciate the necessities they ordinarily take for granted. National toy drives, like Toys for Tots, provide new gifts for children. Ask your kids to imagine what children their age might want, and then help them buy it. The item could be something on their wish list or even something they already have and love, like a cherished teddy bear.

De-clutter and Donate

Encourage your children to donate toys they no longer use or clothes they've outgrown. Let them know that some things they don't need might be useful for another child. Suggest that they consider a short list of items to donate, and then bring them to a drop-off place such as the Salvation Army. Involve them in considering what they don't want anymore so they will have new appreciation for their toys and clothes. Just remember not to force it: If they're not ready to give something away, that's okay. Avoid warning the kids that they won't get something new to replace what they give away; they may associate sacrifice with loss or punishment. Instead, find other ways to cultivate a sense of gratitude and helping others.

Volunteer Your Time

Look for opportunities to volunteer as a family. Friends and neighbors may know of a group that can use the help. Serve food at nearby shelters or put together care packages for senior citizens or soldiers oversees. Show how giving time, not just money or objects, is another way of helping others and acknowledging gratitude for what you already have. Or devote time to neighbors or other family members by scheduling a group project to rake leaves for an elderly relative or cook a meal for someone who's under the weather.

Showcase History

Even young kids draw turkeys or learn about the Pilgrims in classrooms. Ask your child (or the teacher) about the lesson plans and build on those at home. Have little ones imagine what the Pilgrims might have been grateful for that first Thanksgiving in Plymouth. They may have been grateful to be with each other or to be living in a new country. The more advanced the lesson, the more possibilities. Kids can also imagine what the Pilgrims might appreciate in your house today. They might enjoy good food and the time with family, as well as modern conveniences like heat and hot water.

Write Notes of Appreciation

Ask your kids to write a handwritten note to someone they're thankful for; if kids are too young to write, have them a draw picture instead. Ask them to consider who makes their lives better or brighter. Is it the babysitter? A favorite aunt? A family friend who always remembers birthdays? When children reflect on who they want to write to, they learn to value people in their lives who have touched them. No doubt the recipient will appreciate a note from the heart, too. Plus, you can spread the blessings by composing more than one note!

Don't Forget Family

Many parents teach their children to say thank you when they receive a gift, but family members often forget to thank each other for everyday favors. "I think we lack ways to talk about gratitude," Dr. Carter says. "My kids have picked up notions of what romantic love is from Disney movies, but they probably couldn't say a word about how Cinderella feels thankful for all that her fairy godmother has given her. We don't talk much about good things that come from other people's efforts." Set an example by thanking your children and your spouse. Saying "Thank you for cleaning your room" or "Thank you for sharing with your brother," not only lets children know that their efforts (like folding laundry or running errands) are appreciated, it also instills the idea that "thank you" is not reserved for the birthday bonanza. Children see gratitude in action, and it's good for household harmony too.

Appreciate Small Moments

Take time to appreciate the good things with your kids. Use travel time in the car as an opportunity to share something positive, perhaps by saying, "Look at the pretty leaves on that tree" or "Wasn't it fun to make that drawing in class today?" These simple conversation starters encourage children to contemplate and appreciate the blessings around them. When you tuck them into bed, ask what they're grateful for that particular day. Gradually weave these observations and questions into your time together to cultivate thankfulness.

Keep Gratitude Going

Long after the turkey is eaten and football season ends, continue to practice thankfulness throughout the year. In the summer, donate your time when charities and food banks need extra help because regular volunteers are on vacation. One of the most practical ways to inspire gratitude is also the simplest. You don't have to be involved in big projects all the time. Set aside time to name one or two things every person in the family is grateful for each day. "Researchers have found that people who practice gratitude feel considerably happier (25 percent) than those in a control group," Dr. Carter says. "They are more joyful, enthusiastic, interested, and determined. Grateful people are more likely to be both kind and helpful." Raising children with those traits would be enough to make any parent thankful.

Copyright © 2011 Meredith Corporation.

Ansley Roan is a freelance writer and editor in New York City. She writes about faith and spirituality, health, and parenting. Her work has appeared in The Washington Post, Chicago Tribune, Glamour, and Teen People.

link to article

Trauma and Disaster: Helping Teens Manage the Impact of Hurricane Sandy

Listen to my interview on The Mary Waldon Show on the emotional impact and how to cope with Hurricane Sandy. Hurricane Sandy has had a tremendous impact on countless families up and down the east coast of the United States. Such an event can leave even the most well-informed parent with questions and concerns.What is the potential impact of natural disasters and other traumas on teenagers? What can parents do to help mitigate the impact of Hurricane Sandy? What is an expected reaction to such extreme events, and what kinds of reactions indicate a need for professional intervention? For answers to these and other related questions, please tune in to The Mary Waldon Show to hear the insight and expertise of Dr. Nerina Garcia-Arcement, an expert in the treatment of Post Traumatic Stress Disorder.

Link to radio show

Bite, chew, savor

Mindfulness can help reduce anxiety and new research shows it can help with overeating. This article discusses the importance of mindfulness to gaining awareness of our eating habits and the role food plays in our emotions. 

Jean Kristeller reconnects people with their hunger and other inner experiences to curb overeating.

By Amy Novotney

November 2012, Vol 43, No. 10

Print version: page 42

Eat when you're hungry, stop when you're full. It sounds simple, yet for many Americans, it's anything but, says clinical psychologist Jean Kristeller, PhD. Barraged by advertisements for high-fat, high-salt and high-sugar foods, and confronted with restaurant portions fit for two or three people, it's all too easy these days to forget what the experiences of hunger and satiety feel like, she says.

"We eat when it's time to eat, when food is put in front of us or because we need to handle feelings of anger, anxiety, depression or simple boredom," says Kristeller, a psychology professor at Indiana State University and president and co-founder of The Center for Mindful Eating.

Kristeller has developed an intervention called Mindfulness-Based Eating Awareness Training (MB-EAT) that blends "mindful eating" exercises, such as being aware of hunger, chewing food slowly, tuning in to taste and noticing fullness, with mindfulness meditation practice to cultivate more general moment-to-moment awareness of self. Psychologists around the country are using it to help binge and compulsive eaters, diabetics, and people who are mildly and moderately obese to regulate their eating and avoid weight gain.

"Traditional techniques for tackling the obesity epidemic often don't take into account the strong drivers of eating: negative emotions, cravings and impulsivity, particularly in the face of highly palatable food," says University of California, San Francisco, psychology professor Elissa Epel, PhD, who has collaborated with Kristeller on several research studies using MB-EAT. "Mindfulness training gives us more control over these strong drives and makes us more aware of the triggers of overeating that come from outside of us."

Kristeller advocates no particular diet — and no foods are off-limits. She teaches students to savor their food while eating, rather than mindlessly eating while watching television, surfing the Internet or reading the paper.

It's this everyday applicability that makes Kristeller's approach so valuable, says social psychologist Ronna Kabatznick, PhD, a former consultant to Weight Watchers International. "It's one thing to have these strategies in textbooks, but she's embodied them by teaching people very specific skills such as how to enjoy a buffet or restaurant meal," Kabatznick says. "She's simplified mindful eating for everyday living."

Saying goodbye to super-size

Kristeller's MB-EAT 10-week course teaches people that, once they pay attention to their body's signals, brownies and chocolate cake are best experienced and savored in just a few bites.

"Our taste buds are chemical sensors that tire quickly," she says. "The first few bites of a food taste better than the next few bites, and after a large amount, we may have very little taste experience left at all."

Mindfulness-Based Eating Awareness TrainingParticipants in her training programs — those who struggle with food and weight issues and health-care professionals interested in helping them — focus on three mindfulness practices: awareness of hunger and what it feels like in the body, awareness of what it feels like to be full, and the practice of savoring — slowing down to truly taste food and be mindful of the various flavors and sensory experiences associated with each bite. A variety of foods — including chocolate — are used in the program, and Kristeller even assigns participants increasingly challenging homework assignments, such as going to a buffet. She teaches them that by attending to how much they are enjoying the food and recognizing the point at which it stops being as enjoyable, they can eat much smaller amounts, leave food on their plates and return for seconds if they still want more.

"It's about finding satisfaction in quality, not quantity," Kristeller says. She also teaches people not to beat themselves up if they overeat, but to see this as a learning experience.

With funding from the National Center for Complementary and Alternative Medicine at the National Institutes of Health, Kristeller has proven the program's effectiveness. She's completed two studies — one at Indiana State University, another with Ruth Wolever, PhD, at Duke University — with more than 100 binge eaters and obese non-bingers. She's found that binge eaters who take her MB-EAT program reduce their bingeing from four times per week, on average, to about once a week. When they do binge, she says, they report that the binges are much smaller and feel less out of control. Participants also report that their depression decreased (Journal of Health Psychology, 1999Eating Disorders: The Journal of Treatment & Prevention, 2011). Both bingers and non-bingers also improve significantly on other indicators of more balanced eating and emotional regulation. Furthermore, these effects are proportional to the amount of mindfulness meditation practice that is reported.

Other researchers are testing her program as a treatment for obesity. Gayle Timmerman, PhD, RN, at the University of Texas at Austin, has successfully adapted it for use with eating restaurant meals, showing a significant impact on weight and dietary intake. Epel and her associate, Jennifer Daubenmier, PhD, recently paired MB-EAT with stress reduction exercises in an intervention with obese women. They found that the more mindfulness the women practiced, the more their anxiety, chronic stress and deep belly fat decreased. Obese participants in the mindfulness program also maintained their body weight while those in the control group increased their weight over the same period of time (Journal of Obesity, 2011). And in an ongoing study with overweight pregnant women, Kristeller, Epel, Daubenmier and Cassandra Vieten, PhD, director of research at the Institute of Noetic Sciences, are teaching participants similar mindful-eating techniques in an effort to help these mothers-to-be avoid excessive weight gain.

"One lesson we've learned is that with the effort and attention to eating taught in the MB-EAT program, people can change their relationship with food very quickly, and within a few sessions, they're often starting to eat differently," Epel says.

The three-minute raisin

Kristeller's interest in meditation began as an undergraduate at Swarthmore College, where she read about research on how meditation can help lower blood pressure and heart rate and reduce ruminative thinking. Kristeller began meditating to reduce the stress of college and immediately found that it calmed her "chattering mind," she says. Later, as a doctoral student at Yale studying food intake regulation with Judith Rodin, PhD, and self-regulation theory with Gary Schwartz, PhD, Kristeller began using meditation to treat eating disorders.

"Judy was identifying how a lot of the disregulation in eating behavior was from people's lack of tuning in to their hunger signals," Kristeller says. "I thought you could help people tune back into those experiences."

After graduating from Yale in 1983, she joined the faculty at the University of Massachusetts Medical School, where she met Jon Kabat-Zinn, PhD, and took part in his eight-week Mindfulness-Based Stress Reduction (MBSR) program. Kabat-Zinn introduced her to an exercise where participants slowly eat three raisins as a way to begin to cultivate mindful awareness.

"A light bulb, so to speak, went off for me during this exercise," Kristeller says. "I saw it as another way to help ground people in their experience of eating, and began thinking about how to do this more systematically, particularly around the kinds of foods that people eat that get them in trouble — the high-sweet, high-fat foods. I wondered what would happen if people started engaging with those foods this way." Now, thanks to her research and her clients' enthusiastic feedback, she knows.

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.

 

Money matters

This article touches on the stressor of money and its impact on marriages.  Money is a leading cause for separation, this article addresses the importance of dealing with it in therapy.

Psychologists are helping young couples stay afloat financially in increasingly turbulent economic waters.

By Rebecca Voelker

October 2012, Vol 43, No. 9

Print version: page 48

Psychologists are helping young couples stay afloat financially in increasingly turbulent economic waters

Troubled young couples who see Brad Klontz, PsyD, in his Kapaa, Hawaii, psychology practice often end up talking about more than their relationship with each other: They find themselves discussing their relationship with money, too.

"Some of the symptoms bringing them in—feeling depressed, feeling anxious, having panic attacks—they may not know how much the role of money is playing in those symptoms," says Klontz, a clinical psychologist and certified financial planner.

Unprecedented levels of student debt, high credit card debt and a dismal job outlook have presented some young couples with financial challenges their parents and grandparents didn't have to face. These days, more psychologists are stepping in to help couples tackle their financial burdens. Money stresses are nothing new for couples just starting out, but trying to resolve them in therapy is.

"There is a much greater awareness now among general psychologists that this is a very important issue to explore," says Philadelphia psychologist Maggie Baker, PhD, also an expert in financial issues.

To respond to the growing need for psychologists to talk to their clients about money management, Atlanta financial psychologist Mary Gresham, PhD, is spearheading an effort to launch an APA division of financial psychology. She's circulating a petition supporting its creation, and financial planners welcome her efforts.

"A trained, educated psychologist is a necessary component in certain financial planning relationships," says Paul Auslander, president of the Financial Planning Association. Some couples can benefit from behavior modification techniques to curb runaway spending or make spending compromises, he says. "But I suspect that there aren't enough financially trained psychologists to help couples coping with recession repercussions."

Combining households, combining money

A common scenario that brings on financial turmoil for newlyweds is that although they may have lived together before marriage, they failed to discuss their financial union before they said "I do," says Gresham. "They had operated under the roommate plan, where each one pays half of the expenses or one pays one set of bills and the other pays another set," she explains. But as they settled into married life, neither spouse knew what was going on with their partners' money. "Then they can't figure out how to collaborate, how to mix the money together."

Gresham looks at four issues with every couple: "math," values, emotions and process. To begin helping couples work through these issues, Gresham asks the couple to take an objective look at how they spend their money, using tracking software so they can see how their income is distributed among rent or a mortgage and other commitments. Baker takes a similar approach in beginning her work with couples. "It's important to get facts into the room," she says.

Seeing how much cash disappears in a $4 latte or a meal out can be a sobering experience. "The emotions start to come in all through this process," says Gresham. That's when she probes more deeply, asking couples about how their perceptions of money growing up affects them as adults. For example, children of cash-careful families may hoard their money as adults, while free-spending families may have kids who later on can't hang on to a paycheck. The reverse can happen, too.

"If a spender marries a hoarder, over time there's bound to be conflict," says Baker. "The spender loves the immediate gratification of spending, but for a hoarder it's almost painful to spend money."

A generational change

In Hawaii, Klontz is conducting research to understand couples and their finances, surveying 422 adults ages 18 to 80, with varying levels of income, education and net worth. His research, published last year in the Journal of the Financial Therapy Association, shows that younger adults are more likely than their parents or grandparents to have potentially damaging "money scripts"—subconscious beliefs that drive their financial behaviors. He found that adults 30 years old and younger were most likely to be "money avoiders" who become anxious, fearful or even disgusted when the conversation turns to money. Younger adults also were more likely to equate net worth with self-worth and to believe that the more money they have, the happier they will be.

These beliefs, Klontz says, are linked with lower income and net worth. People with these views may set themselves up for financial failure by simply ignoring money issues, giving assets away, gambling excessively or compulsively buying things they want but can't afford. "Very often in my work with couples, conflicts over money are really the result of conflicting money scripts," he says.

He uses a psychodynamic approach to examine clients' experiences with money in childhood. Living with a workaholic parent who pursued an ever-bigger paycheck but never was at home or being in a family that neglected life's necessities because parents hoarded cash could trigger present-day money troubles. "The more emotional the experience, the more rigidly these beliefs become locked in place," Klontz says.

Healing begins, he says, when a couple can open up to each other and be empathetic. "They may have very different attitudes about money, but if they can hear each other and respect each other, then they can come to a compromise" about sound money management.

"They become a money team instead of money adversaries," Gresham adds.

Link to article

Parenting that works

This is a wonderful and short article that outlines 7 proven parenting techniques. Seven research-backed ways to improve parenting.

By Amy Novotney

October 2012, Vol 43, No. 9

Print version: page 44

Parenting that works

Search for parenting books on Amazon.com, and you get tens of thousands of titles, leaving new parents awash in a sea of often conflicting information. But thanks to the accumulated results of decades of empirical research, psychologists know more than ever before about what successful parenting really is.

The Monitor asked leaders in child psychology for their best empirically tested insights for managing children's behavior. Here's what they said.

1. Embrace praise

Simply put, giving attention to undesired behaviors increases undesired behaviors, while giving attention to good behaviors increases good behaviors, says Alan E. Kazdin, PhD, a Yale University psychology professor and director of the Yale Parenting Center and Child Conduct Clinic.

"When it comes to nagging, reprimand and other forms of punishment, the more you do it, the more likely you are not going to get the behavior you want," says Kazdin, APA's 2008 president. "A better way to get children to clean their room or do their homework, for example, is to model the behavior yourself, encourage it and praise it when you see it."

But parents shouldn't offer that praise indiscriminately, says Sheila Eyberg, PhD, a psychology professor at the University of Florida who conducts research on parent-child relationships. Eyberg recommends parents provide their children with a lot of "labeled praise"—specific feedback that tells the child exactly what he or she did that the parent liked. By giving labeled praise to the child, such as, "I really like how quietly you're sitting in your chair," when a child is having trouble calming down. The parent is focusing on what's relevant to the behavior problem, Eyberg says. Several studies back her up: Psychologist Karen Budd, PhD, found that training preschool teachers to use labeled praise improves the teacher-child relationship and helps teachers better manage behavior in the classroom (Education and Treatment of Children, 2010).

Kazdin also recommends reinforcing the praise with a smile or a friendly touch. And feedback should be honest, says David J. Palmiter Jr., PhD, a practitioner in Clarks Summit, Pa., and author of the 2011 book, "Working Parents, Thriving Families."

"I was at a girls' softball game recently and I started to get a headache from all the praising going on for poor performance," he says. "This can often deprive a child of the wonderful learning that comes from failure."

2. Look the other way

Research also suggests that parents should learn to ignore minor misbehaviors that aren't dangerous, such as whining about a sibling not sharing or a toddler throwing food on the floor.

In several studies, Kazdin and his team found that when parents changed their responses to behaviors—for example, they ignored screams but gave a lot of attention to their children when they asked nicely for something—the child learned that asking nicely is the better, more reliable way to get attention ("The Kazdin Method for Parenting the Defiant Child," 2008).

3. Learn about child development

Parents are also more effective when they read up on child development to understand the misbehaviors that are common for each developmental stage, says Eyberg. Often, when a child displays a behavior that a parent doesn't like, such as making a mess while eating, it's because the child is simply learning a new skill, she says.

"If parents understand that the child isn't making a mess on purpose, but instead learning how to use their developing motor skills in a new way, they're more likely to think about praising every step the child takes toward the ultimate goal," she says. Parents who know what a child is capable of understanding, feeling and doing at different ages and stages of development can be more realistic about what behaviors to expect, leading to less frustration and aggression.

4. Do time-out right

Three decades of research on time-outs show that they work best when they are brief and immediate, Kazdin says. "A way to get time-out to work depends on ‘time-in'—that is, what the parents are praising and modeling when the child is not being punished," Kazdin says.

Research also suggests that parents need to remain calm when administering time-outs—often a difficult feat in the heat of the misbehavior—and praise compliance once the child completes it. In addition, he says, parents shouldn't have to restrain a child to get him or her to take a time-out because the point of this disciplinary strategy is to give the child time away from all reinforcement. "If what is happening seems more like a fight in a bar, the parent is reinforcing inappropriate behaviors," Kazdin says.

5. Prevent misbehavior

John Lutzker, PhD, who directs the Center for Healthy Development at Georgia State University, has even stopped advising parents to use time-outs. Instead, he teaches parents to plan and structure activities to prevent a child's challenging behaviors, based on previous research:

  • Plan ahead to prevent problems from arising.
  • Teach children how to cope effectively with the demands of the situation.
  • Find ways to help children stay engaged, busy and active when they might otherwise become bored or disruptive."We've found in our work over the past 20 years that if you do a good job teaching parents planned activities training, there's no need for time-outs," Lutzker says.

6. Take care of yourself first

Parents receive some of the best parenting advice every time they take off on an airplane, says Palmiter: If the cabin loses pressure and you must put on an oxygen mask, put one on yourself first before you help your child.

"I see households all across America where the oxygen masks have long since dropped and all of the oxygen is going to the children," says Palmiter.

Yet the research makes it clear that children are negatively affected by their parents' stress. According to APA's 2010 Stress in America survey, 69 percent of respondents recognized that their personal stress affects their children, and only 14 percent of children said their parents' stress didn't bother them. In addition, 25 percent to 47 percent of tweens reported feeling sad, worried or frustrated about their parents' stress. Another study published last year in Child Development found that parents' stress imprints on children's genes—and the effects last a very long time.

That's why modeling good stress management can make a very positive difference in children's behavior, as well as how they themselves cope with stress, psychologists say.

Palmiter recommends that parents make time for exercise, hobbies, maintaining their friendships and connecting with their partners. That may mean committing to spending regular time at the gym or making date night a priority.

"Investing in the relationship with their partner is one of the most giving things a parent can do," Palmiter says. Single parents should establish and nurture meaningful connections in other contexts. A satisfying relationship with a colleague, neighbor, family member or friend can help to replenish one's energy for parenting challenges.

7. Make time

Too often, Palmiter says, the one-on-one time parents offer their children each week is the time that's left over after life's obligations, such as housework and bill-paying, have been met.

"We often treat our relationships—which are like orchids—like a cactus, and then when inevitably the orchid wilts or has problems, we tend to think that there's something wrong with the orchid," he says.

To combat this issue, Palmiter recommends that each parent spend at least one hour a week—all at once or in segments—of one-on-one time with each child, spent doing nothing but paying attention to and expressing positive thoughts and feelings toward him or her.

"It literally works out to about .5 percent of the time in a week," he says. The most effective time for a parent to create those special moments is when the child is doing something that she or he can be praised for, such as building with Legos or shooting baskets. During that time, parents should avoid teaching, inquiring, sharing alternative perspectives or offering corrections.

Palmiter says many families he's recommended the strategy to over the years have told him that adding an hour of special time in addition to the quality time they spend with their children—such as attending a baseball game together—has significantly improved the parent-child relationship. In addition, a study published in January in the Proceedings of the National Academy of Sciences shows that, particularly among younger children, a parent's demonstration of love, shown through nurturing behavior and expressions of support, can improve a child's brain development and lead to a significantly larger hippocampus, a brain component that plays a key role in cognition.

"The metaphor I use is, what an apple is to the physician—'an apple a day keeps the doctor away'—special time is to the child psychologist," Palmiter says.

 Link to article

What Can I Do to Help? 5 Things You Can Do for Someone With Cancer

I was quoted regarding how to help and offer support to a loved one with a cancer diagnosis.

2 0 1 2Aug13

What Can I Do to Help? 5 Things You Can Do for Someone With Cancer

Posted by Staff

When it comes to a loved one being diagnosed with cancer, it can be hard to know the right things to do for them. Everyone has different preferences and ways of dealing with hard times, but there is always something you can do! Here are the best tips and pieces of advice from those who should know best!

1. Send letters, care packages or gift cards that offer a little extra support and help.

My coworkers went together and got me a very generous Visa Giftcard that we could use anywhere to help offset some of our gas, medication and other miscellaneous costs. This was incredibly nice and generous of them and really came in handy at a time when we needed some relief. -- Laura Ybarra, currently undergoing chemo for Hodgkin’s Lymphoma.

Choose gifts that are personal and useful that they will appreciate. My favorites are an e-reader that can be downloaded with books by that person's favorite author or an iPod shuffle that can be loaded with their favorite music. These are great welcome distractions during the long hours of chemo or waiting in a doctor's office. -- Lisa Lurie, cancer survivor and co-founder of Cancer Be Glammed.

Visits may be too much for someone who is severely ill or weak from treatment. If that's the case, get some greeting cards and mail one each day to the patient. Yes, snail mail -- it brightens someone's spirits to know they're thought of. Include jokes, affirmations, inspirational sayings and cartoons. -- Tina Tessina, psychotherapist and author.

2. Think of the other family members and caregivers. They need support, too!

If the person has children, schedule a few outings or daytrips with them. The parent can rest and recover at home, knowing that the kids are safe and having fun. -- Stacey Vitiello, breast cancer physician and radiologist.

Reach out to the spouse, parent or significant other to ask them what you can do to help. They will know best. Offer to bring a meal, do grocery shopping or any other errand with which they may need assistance. -- Helen Szablya, Peritoneal Carcinomatosis survivor.

If you’re not the main caretaker, ask that person how they’re doing. Offer them support. Give them a break. Bring over a dvd movie, a piece of fruit, some cookies—something for the caretaker alone, or that they can share. Give the caretaker has a few hours of “me time” while you stay with the patient. -- Claudia Mulcahy, breast cancer surivivor.

3. Keep things as normal as possible by being yourself and doing activities together!

I needed to live everyday as though my cancer was not there. Even if it is just doing one activity that the person loves and can handle. Let them decide to a degree to what they can handle as well.-- Laura Ann Tull, breast cancer survivor.

Be yourself and be present. Don’t shy away and disappear and don’t try to be another person. They want the person you were BEFORE the cancer diagnosis. -- Susan Bratton, Chief Executive Officer of Meals To Heal.

Encourage them to get out of their home. Come over and take a walk with them, drive them around the block or simply sit outside with them. -- Nerina Garcia-Arcement, Ph.D Licensed Clinical Psychologist.

4. Ask, don’t assume.

Instead of assuming what they need, simply ask. Many friends and family of patients think that they should already know what they need, and what they should be doing for them. They will appreciate your straightforwardness. -- Molly Tyler, Director of e+CancerHome.

Ask if the patient wants to get phone calls, and then call within the acceptable hours to give news, or to listen, but don't make the patient do the talking unless he or she wants to. -- Tina Tessina, psychotherapist and author.

5. Suggest support programs and websites.

Encourage the cancer patient or their support team to create a website so they can post the progress and not receive a million calls each day. -- Helen Szablya, Peritoneal Carcinomatosis survivor.

When someone is going through treatment for an illness, it’s hard for them to answer the phone and stay in touch with all the people who want to talk to them. Caring Bridge is a great service that they can use to keep everyone informed about how they are and in addition people can send them good wishes. -- Lisa Lurie, cancer survivor, co-founder of Cancer Be Glammed.

Encourage your friend or family member to join a cancer support group, this form of social support can extend their life. -- Nina Garcia-Arcement, Ph.D. Licensed Psychologist.

Link to article

 

 

 

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

When Your Kid's Sick at School How to help (and calm your own anxiety) when a college kid gets ill

Life transitions are difficult for all involved. This article addresses the struggle of letting your child grow and become independent, while still being a concerned parent.  I am quoted on common illnesses college students experience and how to help while letting your child gain independence. By Vanessa McGrady

So your baby’s grown up and gone away to college. You’ve packed her full of good advice and loaded her up with enough technology so that you could find her at the bottom of the sea, if it came to that. But no matter how independent college students become, nearly every parent gets that call home at some point: “Mom, I’m so sick.”

It’s a helpless feeling, and you might wrestle with a decision to go visit or bring your child back. Typical ailments for college students include viruses, gastrointestinal infections or "stomach flu,” mononucleosis and food poisoning. A university health service also fields cases of sexually transmitted diseases and injuries from accidents—some which involve alcohol. (These of course, happen only to other people’s children.)

You can’t drop everything to tend to each new boo-boo, but there are things you can do to help prevent trips to the clinic.

“It is very common for college students to get colds and the flu. This happens most often around midterms and finals season. Stress lowers the immune system and makes it easier to ‘catch bugs,’” says Nerina Garcia-Arcement, a licensed clinical psychologist at New York University School of Medicine.

RELATED: College Prep: Communication

You can’t drop everything to tend to each new boo-boo, but there are things you can do to help prevent trips to the clinic and, in the worst-case-scenario, the emergency room.

“Parents can help by offering support, reminding their kids to practice stress management, socialize to reduce isolation and increase social support, eat well and exercise. Care packages that encourage this are encouraged,” says Arcement.

A big part of preparation for college is to make sure your kids have the basics of self-care down, says Dr. Claudia Borzutzky, Lead Physician at University Park Health Center for University of Southern California’s Keck School of Medicine. That includes:

  • Regular exercise, healthy diet, adequate sleep (at least six to seven hours a night for most people)
  • Frequent hand washing during cold and flu season
  • Responsible use of alcohol and avoidance of binge drinking
  • Safe sexual practices
  • Use of bicycle helmets and respect for traffic and safety regulations on college campuses.
  • A primer on over-the-counter medications, most of which will suffice for the following: regular coughs, colds and flus that last less than a week or do not cause fevers over 100.5 degrees, shortness of breath or dizziness.

RELATED: Coping With College—as a Parent

Borzutzky says it’s also important to make sure kids understand their new campus's student health center hours and what kind of care they can access there. They should have a copy of their health insurance card and know what to do in an urgent medical situation.

You’ll also want to ensure that your kids' vaccinations are all up to date, including meningococcal vaccination, HPV vaccination (now recommended for both women and men), and annual influenza vaccination or the “flu shot,” especially for those with asthma or other chronic medical conditions.

One thing that may frustrate you, as your college student grows into adulthood, is that while you can always provide information about your child’s health to his doctor, you no longer can request information without your child’s written permission. If your child is under 18, privacy laws for issues such as mental health, drug use and reproductive health vary depending on the state.

“Learning to deal with minor illnesses without a parent close by is part of the separation and maturation process older adolescents need to go through as they approach young adulthood,” Borzutzky says, “However, in the case of more significant or prolonged injuries or illnesses, students will need to use their own best judgment about their ability to cope on their own without extra support, and parents and family are, of course, an essential part of their care and recovery when that is not the case.”

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

Why a cancer diagnosis can turn a loved one into a fair-weather friend

This article discusses the unexpected reactions of loved ones to a cancer diagnosis.  I share insights into why people might not react as expected.
2 0 1 2Aug20

Why a Cancer Diagnosis Can Turn a Loved One into a Fair-Weather Friend

Posted by Staff

Cancer and PsychologyIn difficult times, people tend to lean on their family and friends for support, care, and love. Receiving a cancer diagnosis is certainly a time when the support of loved ones is especially important. However, what if, instead of support, a patient received a narcissistic attitude from a loved one? Instead of care, a loved one retreated from the patient’s life? How should someone in a situation like this react to their loved one’s attention-seeking and negative attitudes and what explains the behavior?

Stress, Sickness and Relationships

“I have very little contact with [my mother],” says Rebecca Cagel, whose cancer diagnosis caused an extremely negative attitude from her mother and, ultimately, the end of their relationship. “Since my diagnosis my mother continuously insults me and tells me I am going to be a "bag lady" because I am unable to work a forty hour week.”

Extreme negativity, especially from parents, can be hardest to deal with and can only be partially explained by stress.

“When stress levels are lower, people can cover up their fears, think more rationally,” says Elizabeth Lombardo, Ph.D., Physical Therapist, Psychiatrist, and author of ‘A Happy You: Your Ultimate Prescription for Happiness’. “But when the imminent death of a loved one is thrown at them, calling to mind their own mortality and helplessness regarding death, stress levels can skyrocket.”

According to Lombardo, extreme stress can lead to feelings of anger, fear, and anxiety, all of which can manifest into negative behaviors and feelings towards the patient. In the case of Rebecca Cagel, her mother’s fear for her daughter’s life may have led to this negative behavior. This negativity is not healthy for a cancer patient, however, and can be cause for the severing of the relationship.

“It is sad but I have to distance myself from her because it would be too frustrating and depressing to be around her,” says Cagel. “I have to take care of myself and get her negativity out of my life.”

Can a Relationship be Salvaged?

There is a way, however, to potentially save a relationship that has been hurt by extreme negativity-- empathy might be the key.

“You might say something like, I know my cancer is tough on all of us, and it is not uncommon to feel scared, sad or even angry about it,” says Lombardo. “When you empathize, then the person will be more likely to be able to hear the rest of what you have to say.”

Expressing your concerns in an understanding, non-threatening way will help alleviate tension and could play a big part in maintaining relationships through tragedy.

Negativity By Any Other Name

Negativity can appear in a less obvious way than outright insult and rude commentary. Some people begin to seek attention or behave selfishly in response to a loved one’s diagnosis. In these instances, ego is most likely to blame.

“Those who utilize narcissistic traits...are usually those with poor egos,” says John Lops, an adult, child, and adolescent psychiatrist from Brooklyn, NY. “Events such as tragedies can be a platform to display how important they can be, as well as a wonderful opportunity to fulfill their narcissistic urges.”

Many times these people will go over the top in their attempts to support and care for the patient, defining their doing as how special they are and showing others how appreciative they should be of him or her. But according to Lops, a poor ego is injured further when the acknowledgment of these “nice gestures” from other family and friends moves to the past. Then these narcissistic traits reveal themselves as selfish and attention-seeking.

Carla Ulbrich, who suffered from a severe and chronic, but not terminal, illness was faced with these behaviors when a close relative made a comment about needing to get sick in order to get any attention from the family. Ulbrich remembers her next thought: “You can think that, and I suppose you can even whisper it to somebody, but do you really have to shout it to the person who is already suffering kidney failure?”

There is a way to deal with this type of behavior while still keeping this person’s fragile ego in mind.

“Due to the fragility of folks who displays these behaviors, confronting, for the most part, will not be helpful,” says Lops. “I would probably thank them and make them aware to what extent I appreciate their efforts.”

It is important for a patient to, in some cases, completely remove this person and their negative behavior for some time, and Lops suggests expressing appreciation, but also telling him or her that they need not take further responsibility of aiding in getting through whatever tragedy occurred.

Radical Reactions

Other radical behavior, such as denial or withdrawal, can also be caused by stress. Loved ones may gradually withdraw from a recently diagnosed friend out of discomfort or fear. Avoidance is the only way they can deal with such serious news.

“They can't let in or accept that their loved one is sick or dying. Instead they focus on themselves and deny that extreme changes such as a difficult treatment or even death is in their friend and family's future,” says Nerina Garcia-Arcement, Ph.D. Licensed Clinical Psychologist, Clinical Assistant Professor, Dept. of Psychiatry, NYU School of Medicine.

Avoiding the patient and denial of the situation can increase as the patient’s health deteriorates. Walter Meyers of San Diego, CA remembers how a friendship ended before a terminal diagnosis took a close friend’s life.

“Suzy, Scott and I all...worked together for years. When Suzy was diagnosed with cancer, I tried to be there for her, visiting her often in the hospital, even donating blood platelets for an [experimental treatment],” recalls Meyers. “As Suzy got sicker, Scott drifted further away...and when things got to the point that it was apparent nothing more could be done, Suzy called Scott to tell him goodbye. He said: “You think you’ve got problems? I went bowling last night and couldn’t break 100!”

Scott never made it to see Suzy and did not attend the memorial service. Meyers says he has not spoken to him since.

In all cases and at all levels of severity, negative behavior and attitudes in light of a loved one’s tragedy is serious and personal. However, it is important for both the patient and his or her loved ones to remember that a severe illness can affect everyone involved, both negatively and positively. By remembering this, it is easier to react empathetically and rationally in the face of such a life-changing event.

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

Priming for a new role

This is a great article for pregnant women that are experiencing "mommy brain" and are trying to understand why they are having trouble remembering things or paying attention.  It is not all in your mind, there is a biological reason for this.

Priming for a new role

Pregnant women and animals experience slight decreases in learning and memory—changes that appear to pave the way for cognitive benefits in motherhood and may even advantage mothers as they age.

By Tori DeAngelis

September 2008, Vol 39, No. 8

Print version: page 28

Kyra DeBlaker-Gebhard is normally an ace at keeping track of special occasions. But since she's been pregnant, "I can't remember a birthday, a graduation or an anniversary," laments the 30-year-old Washington, D.C., writer.

Her communication skills have also taken a plunge: "Especially in my first trimester, I had a very difficult time speaking coherently and writing clearly," she says.

DeBlaker-Gebhard is far from alone: Between 50 percent and 80 percent of pregnant women report memory and thinking problems during this time.

"Until I finally talked to a friend about it, I thought it was just me," DeBlaker-Gebhard says.

Recently, researchers have been examining whether this phenomenon--dubbed "baby brain"--has an objective basis. It's part of a recent wave of research looking at how pregnancy and motherhood affect women cognitively, a different slant from previous research that has focused on brain areas and processes that more directly influence females' propensity to nurture their young.

The findings suggest an intriguing picture that is good news for anyone embarking on the adventure of motherhood, notes University of Richmond neuroscientist Craig Kinsley, PhD, a main researcher in the area. Pregnant women do in fact experience a physiologically based baby brain, the likely result of a hormone flood that peaks in the third trimester as well as possible external factors, such as a more chaotic life during pregnancy, studies are showing. But related research finds that once the women give birth, other brain mechanisms kick in that help them protect their young by bolstering their cognitive abilities, and these benefits may last into old age.

"There is a tendency to see pregnancy and lactation as somewhat debilitating conditions," says Kinsley. "However, when it comes to motherhood, we're looking at changes that are beneficial to the female, and for the majority of her life."

Support for 'baby brain'

In the most stark evidence that the baby brain phenomenon is real, research has found that the brain actually shrinks a little during pregnancy. In a study reported in the January 2002 American Journal of Neuroradiology, Angela Oatridge, PhD, of Hammersmith Hospital in London, and colleagues found that women's brain volume diminished by about 4 percent during pregnancy, then returned to normal after delivery. Similarly, a study reported in the February 2000 Hormones and Behavior (Vol. 37, No. 1) by neuroscientist Liisa Galea, PhD, of the University of British Columbia, found that the volume of the hippocampus-a key center for memory and spatial learning--was smaller in pregnant rats than in nonpregnant rats.

In other studies, Galea showed that rats in their third week of pregnancy-the equivalent of the first human trimester, when levels of progesterone, estradiol, prolactin and related hormones are at their peak-showed decreased spatial learning ability compared with nonpregnant rats, an effect others have found during the early postpartum period as well.

Galea also has been studying new nerve growth in the hippocampus, both in pregnant rats and in rat mothers, known as dams. It's an intriguing area of study, she says, because the hippocampus is noted for its ability to generate new nerve cells throughout adulthood. Interestingly, she found no differences in nerve-cell growth in pregnant rats compared with virgin rats, and much lower levels in rat dams during the early postpartum period.

The findings suggest that on the biological level, pregnancy and the early postpartum period "are almost like a down time," Galea says. "Given that hormone levels rise to at least 1,000 times their normal levels during the third trimester, then plunge around birth, it's not surprising that some things get muddled in that hormonal soup."

In humans, it is difficult to study such brain and nerve-cell changes. As a result, researchers who study pregnant women generally focus on the women's performance on cognitive and memory tasks-important, they say because people are often notoriously inaccurate when it comes to assessing their memory abilities. So far, they've found that just as in rats, pregnant women perform worse on some learning and memory tasks than nonpregnant controls.

For example, in a meta-analysis of studies on pregnant women and memory functioning reported in the November 2007 Journal of Clinical and Experimental Neuropsychology (Vol. 29, No. 8), psychologists Julie Henry, PhD, of the University of New South Wales, and Peter G. Rendell, PhD, of Australian Catholic University, found a pattern: Pregnant women across all trimesters performed slightly worse than matched nonpregnant controls on memory tasks that impose particular demands on executive functioning, which encompasses higher-level thinking processes for creating and actualizing goals. Those effects lasted up to a year postpartum, they found.

In another study, the team examined how pregnancy affects prospective memory-our ability to remember to perform intended future actions, such as taking medicine at a particular time-known to be highly sensitive to failures in executive control. Pregnancy researchers are particularly interested in studying prospective memory because it is susceptible to real-life distractions, to which pregnant women and new mothers are especially vulnerable to, the researchers note.

In the study, published online March 14 and now in press at the Journal of Clinical and Experimental Neuropsychology, Rendell and Henry compared women in their third trimesters with controls on two types of prospective memory tasks, one in the lab and one in the field. The tasks were similar in that each combined aspects of real-life functioning and a lab-test paradigm. The lab test was a board game called "Virtual Life," which required participants to make choices about daily activities and remember to carry out lifelike tasks, while the field task required women to remember from home to push a button and log in the time at prescribed times over seven days.

Although the two groups performed equally well on the lab tests, pregnant women did significantly worse than controls on remembering to follow through on the field task.

In a related, as-yet-unpublished study, University of British Columbia doctoral student Carrie Cuttler, UBC Psychology Professor Peter Graf, Galea and UBC postdoctoral fellow Jodi Pawluski, PhD, compared 61 women in all three trimesters of pregnancy and 24 nonpregnant controls on lab and field measures of prospective memory. Again, the women did equally well on the lab tests, but women in the first trimester did significantly worse than others on the field-based prospective memory task.

Though it's unclear why the two studies found differences in the stage at which women were most affected, both suggest that lifestyle factors may be exacerbating a subtle underlying deficit, the researchers agree.

"We have a hard time finding these problems when pregnant women are in a distraction-free, sterile lab environment," says Cuttler. "But when women are in their everyday lives and they're dealing with all of these competing demands--their husbands and children pulling them this way, their work pulling them another way--that's when you see these deficits."

Findings on older adults underscore the point, notes Rendell. In other studies, he has found that older adults-who often have more structured, familiar routines compared to younger adults-tend to perform well on real-life prospective-memory tasks, but worse on lab tests.

"These differences suggest that lifestyle is working to support older adults and challenge the pregnant women," he says.

Motherhood as the fix?

After delivery, though, these deficits appear to reverse, at least in animals. In a paper in the February Archives of Sexual Behavior, (Vol. 37, No. 1), the University of Richmond's Kinsley summarizes a decade of work that he, his students and others have done showing that mother rats, monkeys and even beetles perform better on learning, memory and cognition tasks than nonmothers. His lab also has found brain and nerve-growth correlates for some of these phenomena. (Kinsley was the first to show that motherhood enhances spatial learning and memory in rat dams.)

Over time, Kinsley and others have tested two evolution-based hypotheses on why mothers may develop new cognitive and memory skills. One is that their brains and hormones change to enhance their abilities to fend off predators, leave the nest to find food and return quickly so their young aren't attacked. The other theory is that these changes reduce the mothers' fear and anxiety so they can better face such challenges.

"We and other labs have found a lot of support for both," Kinsley says. As a recent example bolstering the first hypothesis, an unpublished study by Kinsley's students Naomi Hester, Nathalie Karp and Angela Orthmeyer found that over three trials, mother rats were five times faster than virgin rats at catching crickets. Meanwhile, researchers including Inga Neumann, PhD, of the University of Regensburg in Germany have shown that pregnant and lactating rats are less prone to fear and anxiety in the face of stress than virgin rats, as measured by fewer stress hormones in the blood.

Kinsley's team is now looking into other ways animals' physiology may change to accommodate motherhood, such as improved blood flow and motor skills. Like Galea, Kinsley has also looked at nerve growth in the hippocampus of pregnant, mother and virgin rats. He found an increase in dendritic spines on neurons in an area that regulates some types of learning in pregnant and mother rats compared with virgin rats, he says.

Pawluski and Galea are seeing a more mixed picture. They find decreased dendritic branching in the hippocampus in first-time dams at the time of weaning and more dendritic spines in second-time moms. But on behavioral measures, rat moms perform significantly better on spatial working memory tests than nonpregnant rats, with first-time moms performing the best of all.

One potential explanation for those contradictory findings is that the enhanced learning in first-time dams may be partially caused by stress hormones, which tend to be higher in pregnancy and especially in first-time mothers. In addition, the team has not yet looked at nerve-cell growth in dams that have had more than one pup, Galea says. It is also possible that the "nerve pruning" that takes place during motherhood actually benefits spatial learning, she speculates.

Later rewards

Meanwhile, Kinsley's lab is also looking at the brains of rat moms that are past bearing age to see if earlier benefits accrue into older age. In a study headed by Kinsley's student Jessica D. Gatewood, reported in the July 2005 Brain Research Bulletin (Vol. 66, No. 2), the team found that at 24 months-the equivalent of a person's mid-80s-mother rats were better at learning spatial tasks and showed less memory decline than age-matched rats that were never pregnant.

In examining the older dams' brains on autopsy, the team also found significantly reduced levels of immunoreactive amyloid precursor protein, a marker of neurodegeneration and age-related cognitive decline, including Alzheimer's disease, Kinsley says.

For him, such changes suggest a place for motherhood alongside other natural developmental periods such as sexual differentiation, puberty and menopause.

"This is another epoch in a female's life," he says. "The brain changes are as dramatic as what you see during the other phases."

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Can Social Anxiety Be Caused by a Nutritional Deficiency?

I was quoted on the topic of social anxiety and its causes. by Rheyanne Weaver |

If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria: http://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books: The Mood Cure by Julia Ross Depression-Free Naturally by Joan Mathews-Larson Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

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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.”

 

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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.”

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Social Anxiety Can Be a Hidden Problem in College

I was quoted on the topic of social anxiety, its causes and how to cope or treat the symptoms. by Rheyanne Weaver |

Public speaking is generally not a favorite activity of most people—in fact many people seem to fear public speaking or at least avoid it when they can. But most people are also not crippled with embarrassment or anxiety when they have to present in front of a class or when they are called on to answer a question. For students with social anxiety, being put into the spotlight occasionally during class presentations or participation is enough to make them avoid those classes altogether.

New research from the University of Plymouth and University of the West of England (UWE) Bristol looked at the impact of social anxiety in higher education, and psychologist Phil Topham estimates that “10 percent of university students experience significant social anxiety,” according to a news release from UWE Bristol.

Social anxiety disorder or social phobia is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as “a marked and persistent fear of social or performance situations in which embarrassment may occur.” There are several other diagnostic criteria, including that “the social or performance situation is avoided, although it is sometimes endured with dread.” People are only diagnosed with the disorder if their life is significantly negatively impacted.

Out of over 1,500 students who were surveyed, some students experienced “frequent anxiety in learning situations that involved interacting with students and staff.” To cope with this anxiety, students would not participate in lectures and presentations or would even skip class. Other students wouldn’t take any classes that involved presenting at some point, according to the news release.

The researchers conclude that students who experience social anxiety “could be missing out on learning opportunities and may be distracted from attending to academic information by excessively focusing on their anxieties.”

Although the researchers don’t believe students should be treated as potentially fragile and coddled, there needs to be more support available for students with social anxiety without further stigmatizing these students or making them feel like their “flaws” are exposed. The researchers even give some suggestions for support in the university, including “not singling out students for questioning in lectures or setting assessed presentations in their first term,” and “sensitive appreciation of the shame and conflict caused in students by the desire to succeed and the fear of failure.”

Basically, college professors need to take into consideration the styles of all college students—some love the spotlight, others have social anxiety, so it’s best to ease students into participating and presenting during class.

Mental health experts have some tips on how to succeed in high school and college despite having social anxiety.

Nerina Garcia-Arcement, a clinical assistant professor at NYU School of Medicine and a licensed clinical psychologist, gave one major suggestion in an email to help students who are experiencing social anxiety.

“Do not avoid what you fear,” Garcia-Arcement said. “The more you avoid, you are creating evidence that it is more comfortable to not do something. Instead, if you face what you fear you can slowly prove that your worst fears will not be realized.”

She also suggests that students follow these four steps to take control of their anxiety:

  1. Stop and evaluate what you are feeling (i.e., butterflies in your stomach, sweating, trouble breathing, heart racing).
  2. Stop and evaluate what are you thinking (i.e., “people will laugh at me,” “I will fail,” “I will look ridiculous.”)
  3. Practice activities that will reduce the physical symptoms, such as deep breathing, muscle relaxation exercises and imagining yourself in a safe place.
  4. Challenge your negative thoughts by stopping the critical belief and instead replace it with a positive thought such as “people have never laughed before,” “I can do this,” “looking silly is the point of this activity, and if I do look silly so what.”

There are effective treatment options for students who have access to a mental health professional.

“Talk therapy is extremely effective for social anxiety, especially cognitive behavioral therapy. Medication can be taken in severe cases, Garcia-Arcement said. “Learning to manage the physical anxiety symptoms and stopping and controlling the negative thoughts is essential to controlling social anxiety. Sometimes people can do it on their own, sometimes they need help with monitoring thoughts and feelings and figuring out what gets in the way of using these new skills.”

She has three other tips for students who are trying to decrease their social anxiety:

  1. Practice deep breathing, meditation, yoga, and exercise. These help manage and control anxiety.
  2. Ease into social activities, first with smaller groups and eventually, as you feel comfortable, with larger groups.
  3. Practice what you fear in a controlled environment. First practice the presentation or talking to a stranger in front of a mirror, later practice in front of someone you trust such as a friend or parent, then go into the real situation.

Scott Carroll, a child psychiatrist who works at the University of New Mexico, said that part of the problem can be that some students don’t realize they have an issue that needs to be worked on.

“Many people with social phobia … often just think they are shy and don’t realize they may have a treatable condition,” Carroll said. “Also, if someone has been anxious their whole life, they may not realize they are significantly more anxious than other people.”

Once students do realize they have a disorder, they have a variety of treatment options available to them, including individual psychotherapy (such as cognitive behavioral therapy), social skills therapy groups, and multiple types of medications.

Carroll has two other coping methods for college students who have social anxiety disorder: positive self-talk, in which you reassure yourself that it’s okay to talk or say hello, can be helpful with milder forms; and repeated exposure, which leads to decreased anxiety, like joining Toastmasters to get comfortable with public speaking.

Jeffrey Gardere, a contributing psychologist at Healthguru.com, said in an email that it’s beneficial for students with social anxiety to have friends they can rely on to come along with them in situations that could cause more anxiety.  Sometimes self-help books can be useful as well.

“The young person with social anxiety may also want to stay away from stimulants such as energy drinks and caffeine in order to avoid becoming even more nervous,” Gardere said. “And certainly [try] to avoid liquor, marijuana or any other chemical that is a self medication in order to feel relaxed, simply because they may be more at risk for possible addiction.”

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How to Quell the Fears of Childbirth

Anxiety can influence a woman's experience during labor. I was quoted in this article regarding how stress and worry can impact a woman's delivery and how to manage their anxiety. by Rheyanne Weaver |

It’s common to fear to some extent painful experiences we aren’t familiar with yet, such as childbirth for soon-to-be mothers. However, a new study found in BJOG: An International Journal of Obstetrics and Gynaecologysuggests that women who fear childbirth tend to actually be in labor for longer than women who aren’t fearful of giving birth.

A news release on www.ScienceDaily.com stated that 2,206 women were included in the study. These women were only giving birth to one child vaginally, and 7.5% of these women were determined to be fearful of childbirth at 32 weeks into their pregnancy. The report estimated that between 5% and 20% of pregnant women generally fear childbirth.

For women who feared childbirth, the average labor time was about 1 hour and 32 minutes longer than in women without as much fear. When other factors were considered, the women with fear of childbirth still took 47 minutes longer for labor than women without the same amount of fear. Women who feared childbirth were also more likely to need intervention during labor, such as instrumental vaginal delivery and emergency Caesarean section. However, most women who feared childbirth were still able to have a successful vaginal delivery.

The study added that there are different factors that cause women to fear childbirth, such as having a baby for the first time, being a young mother, having little social support, having a history of abuse, and suffering from psychological issues.  Other experts share their professional opinions on the causes of fear of childbirth and what women can do to decrease that fear.

Julie Hanks, a licensed clinical social worker, the owner and executive director of Wasatch Family Therapy, LLC, and a mother of four children, said in an email that she believes fear of childbirth is actually quite common in our society. “I think it is common for women to fear childbirth because it has become so medicalized in our society,” Hanks said. “Instead of viewing childbirth as a natural process that women’s bodies were created to do, it is viewed as a scary, painful, ‘out of control’ experience that needs medical intervention.”

She said that some women who have gone through specific painful experiences before might be more likely to have a fear of childbirth. “In my clinical practice I have seen a link between childhood sexual trauma and fear of childbirth,” Hanks said. “Since childbirth and sexual abuse involve the same organs, it is often emotionally tied together. Additionally, feelings of helplessness and of being controlled by a man may emerge during the childbirth process (often a male OB).”

General anxiety could also lead to fear of childbirth. “Certain mental illnesses, like anxiety disorders, may predispose certain women to anxiety about the childbirth process, especially with first-time moms,” she said.

The stories of other women who have had bad experiences with childbirth could also add to the fear for first-time moms. “Women may fear childbirth because of family stories surrounding their mother or sister’s childbirth experiences,” Hanks said. “Additionally, women tend to share their birth ‘horror stories’ more frequently than they share uncomplicated birth stories, playing into a cultural fear of childbirth. I think this can impact mental health in general.”

The whole concept of becoming a mother can bring up a lot of issues, not just childbirth itself. “Taking on the new role of becoming a mother is also emotionally loaded and may bring up a woman’s own fear of inadequacy and self-doubt about whether or not she will be able to provide the nurturing that this helpless baby requires,” Hanks said. “If a woman has emotional neglect, abuse, or other unresolved issues with her own mother, those ‘left over’ emotions may surface as a woman now faces becoming her mother.”

There are even more mental health issues that can be associated with pregnancy and childbirth. “Hormonal fluctuations may impact emotional health relating to childbirth,” Hanks said. “Also, family pressures, relatives coming into town to celebrate the birth of a new baby may add to the overall stress of childbirth experiences.”

If physical health is impacted, then mental health is also not far behind. “Eating disorders or distorted body image may play into mental health issues, anxiety, and obsessions around childbirth,” Hanks said. “The physical changes that often accompany pregnancy and childbirth are often frightening to women who have built their self-worth around their appearance.” Hanks shared her thoughts on helping women overcome any fear they may feel in relation to childbirth. She said, “I believe that a cultural shift in viewing childbirth as a normal, natural process that generally doesn’t require intervention would really help women embrace the process without fear. Also, sharing positive childbirth stories openly may help shift women’s views.”

Dr. Ingrid Rodia, an OB-GYN and associate professor of obstetrics and gynecology at Geffen School of Medicine at UCLA, said in an email that some women are more anxious in general, and others do have a higher risk in regard to childbirth, so these can both lead to issues with fear.  She added that the most common fears women have in relation to childbirth are pain, concerns about the baby coming out “normal,” and concerns about surviving childbirth. “Women might fear childbirth because they are already overwhelmed and wonder how they are going to deal with the additional demands,” Rodi said. “Women who did not plan the pregnancy, and especially those who did not want to be pregnant, are particularly at risk for anxiety and depression. Those women with a pre-existing mood or anxiety disorder are at increased risk of anxiety and depression, not only during the pregnancy, but also post partum … Psychological issues before the pregnancy can lead to more fear of childbirth.”

Financial issues, a poor relationship with the father, and psychological issues can add to fear of childbirth as well. “Basically, in order to decrease the fear of childbirth, the pregnancy should be desired, the woman should feel financially and personally supported, and she should have medical and psychiatric problems identified and treated prior to pregnancy,” Rodi said.

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at NYU School of Medicine, said in an email that pain and negativity associated with childbirth tends to be exaggerated in the media and among family and friends, adding to a fear of childbirth. “The media’s portrayal of childbirth with women screaming in agony makes it understandable why women might fear childbirth,” Garcia-Arcement said. “Rarely are stories of childbirth portrayed as calm and peaceful, where women are in control of the experience and the pain. Some women have heard negative stories of long and difficult labor from family and friends. If this is their first child, fear of the unknown is common. Women worry about what might happen, what might go wrong and how they will react to the pain of childbirth. This is an experience perceived as out of their control, which can be scary.”

Women who have mental disorders and have certain personality types might fear childbirth more than others. “Women that are already experiencing anxiety and depression symptoms prior to pregnancy are likely to have those symptoms exacerbated by things like a difficult pregnancy or worry about what to expect during childbirth,” Garcia-Arcement said. “Individuals that like to be in control of their experiences will likely worry about childbirth, an experience that cannot be dictated by a mother but can be managed.”

Women do have real concerns in regard to pregnancy, because each pregnancy and childbirth experience is different, and some women do require C-sections, endure more pain, and have complications with delivery, adding to that fear. However, Garcia-Arcement does have several tips for women who may fear an upcoming childbirth experience.

  1. Become informed about what will happen during labor and childbirth. She said, “Childbirth itself might not be within a woman’s control, but how she reacts to it is. Being informed can be empowering. Avoidance of what is feared will only make it worse.  Becoming an informed consumer will help women feel they can make better choices during childbirth. Women ought to learn about what typical labor medical procedures and medications are used.”
  2. Choose the doctor or midwife who is right for you, and plan to use the hospital or birthing center that matches your beliefs about childbirth.
  3. Create a birth plan and discuss concerns and wishes with your medical provider. This is your baby and your body, so don’t be afraid to ask questions before and during labor.
  4. Learn how to use deep breathing techniques, muscle relaxation exercises, and imagery of a safe peaceful place to reduce anxiety.
  5. Plan to use distraction with positive self-care activities.
  6. Seek support from other women, whether in a group setting or online.

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Experts Share Tips on Getting the Life You Want Right Now

I was quoted on how to problem solve and set goals. By Rheyanne Weaver |

Remember those 10 pounds you were supposed to lose last year? Or what about that fantasy novel you were supposed to start writing during that recent vacation?

Many people have goals and a basic outline of what their ideal life would be, but they don’t necessarily do what it takes to get the life they want. Luckily there are experts who can help you find that inner power to start living your true life right now.

Stever Robbins, the host of the “Get-it-Done Guy” business podcast, an executive coach and adjunct lecturer at Babson College, has four tips for people who know what they want to do in life, they just haven’t managed to get there yet.

1) “Stay connected to them on a regular basis. Draw out a life map that connects your daily projects to your highest goals and review it daily, so you can see how the little items are connected to your big motivators.”

2) “Plan for change. Any big change of goals will change who you hang out with, what you talk about, and how you go about your daily life. Think that through ahead of time, anticipate the changes, and set up structures to make them happen.”

3) “Get a friend. It's easier when you have someone else and can hold each other mutually accountable.”

4) “Start with action and controlled experiments. Don't quit your day job to write your novel. Find ways to write small pieces at no risk, and then increase your writing only if it's really giving you the joy/happiness/progress you want.”

Mark Wiggins, a motivational speaker, trainer, co-creator of the Journey to Success program, and author of the book “Permission to Succeed: The Only Person Who Needs To Give It Is You,” gave six straightforward steps of his suggested process toward achieving goals:

1. “Determine your destination.”

2. “Identify your purpose.”

3. “Set your goals.”

4. “Develop your strategy.”

5. “Take action.”

6. “Evaluate your progress.”

Michelle King, a personal and motivational life and relationship coach, has five motivational tips for people who need a jumpstart toward their goals:

1) “Get clear on exactly what it is you want to achieve and accomplish in life. Brainstorm the idea and strain out the maybe's and the no's pertaining to the goal. When you have reached a complete and utter ‘Yes, this is exactly what I want,’ then the ability to move forward becomes so much more smoother.”

2) “Set a time frame as to when this goal needs to be accomplished. A time frame creates an urgency and establishes the motivation that is needed to accomplish your affirmation.”

3) “Realistically, list exactly what it is that is slowing you down and standing in your way of achieving what you set out to do. Once you acknowledge the obstacles, consider how these obstacles are impacting your ability to move forward. One by one, work through the obstacles that are holding you back. You will discover that many of these obstacles are much more minimal than you thought, and can be overcome just by addressing that specific issue or eliminating it from your life. For example, if you are on a mission to lose 30 pounds but have a pantry filled with junk food, how else are you going to resist the temptation of eating the food if you don't get rid of it? Be bold and be brave about eliminating these obstacles -- it's only for your benefit.”

4) “Make sure you tell someone what you are trying to achieve so that you can receive the support you will need at obtaining your ultimate goal. Seek out a friend or professional that will ensure you are holding yourself accountable for what you desire to accomplish.”

5) “Once you've accomplished one major goal through this process, the ability to achieve the next goal or goals will be obtained with ease and confidence. Take it one step at a time.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at NYU School of Medicine, said in an email that it’s important to not just have major goals, but to have small goals along the way that are realistic. This helps build confidence and self-esteem enough to achieve even larger goals in the future.

She also suggested listing benefits of a certain goal, as well as the obstacles, and putting that list in a place that stands out the most at home or work. This list will be a reminder for achieving that major goal, and also help work on removing the obstacles.

Lauren Whitt, a motivational counselor and corporate wellness practitioner, has three additional unique tips to help you on your path to success:

1) "Track your goals daily by using a ‘mirror tracker.’ Using a dry erase marker, list out your goals on a mirror you look at daily. Make a note or tally of progress each day. This will help as both a reminder and a motivator as you see what you've accomplished."

2) "As you achieve both smaller and larger goals, reward yourself. For example, if your ultimate goal is to get fit and one of your initial goals is to go to the gym X amount of times per week and you meet that goal, reward yourself with a new workout accessory, like a shirt."

3) "Creating an inspiration wall is another way to remind yourself of the goals and dreams you are working towards. You can do this on the inside of a closet door, bulletin board or social media page. If your goal is to lose weight, hang pictures of your dream vacation spot or beach view. Then go there when you've achieved that goal."

Christine Cashen, a certified speaking professional, has three tips for accomplishing goals and getting the life you yearn for:

1) "Do three things every day to move you towards your goal. This way you don't get overwhelmed and keep moving forward.”

2) “Become an investigative reporter. Find people who have your dream job and speak with them about their path and what suggestions they may have. You may find a great mentor.”

3) “Take a risk. When you think you can't do something, use this risk chant (you must say it in chant voice): ‘Oh what the heck ... go for it anywayyyyy!’”

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