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Mental Health

Mental Health (2117)

Wednesday, 19 September 2012 00:00

Self-Talk & Self-Esteem

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One of the most important tools in developing and maintaining healthy self-esteem involves monitoring the messages we tell ourselves.  All day long, you have messages, called self-talk, going through your head.

For many people, these messages tend to be very negative.  Messages may include distorted thinking and irrational beliefs,  or they may include comments about our inadequacies and failures.

Stop and think about it.  How many times this week have you thought something like, “Ugh. You’re so stupid,” “I’m not capable,” or even something like, “I’m a fat slob?”  And how many times have you told yourself something positive?  

Our thoughts typically include blatantly negative messages, but, often, they are so subtle that we do not even realize we are thinking so poorly about ourselves.  Over time, these negative thoughts chip away at our self-esteem, putting us at risk for depression.

Our thoughts, not actual events, create our moods, determine the way we feel about ourselves, and contribute to how we perform in various endeavors.  In other words, the bad things that happen do not really cause us to become upset.  We get upset because of the way we think about these events.  Similarly, disappointing things sometimes happen because we’ve made ourselves believe they will.

If you find yourself feeling upset about a poor grade, it is not the letter at the top of the paper that is creating your mood, ultimately subconscious thoughts, such as, “I should have done better,” that bring you down.  

I caught myself engaging in negative self-talk a few months ago when I backed into another car.  My immediate thoughts were, “You are so dumb!  You should have looked in the mirror!”  I felt terrible.  Recognizing the negative self-talk, I was able to change the message and tell myself, “Everybody makes mistakes.”  Doing so helped me to feel better and protected my self-esteem from being damaged by personal attacks.  

The good news is that negative self-talk can be reversed.  It takes effort, much like breaking any bad habit.  But when you learn to recognize and change the way you think on a daily basis, you can improve the overall way you feel.  To learn more or to receive help in recognizing and shifting your negative self-talk, find a therapist who works from a cognitive-behavioral perspective.  

With practice, you can shift your entire way of thinking, improve your self-esteem, and have a more positive outlook.

Psychological testing can offer very valuable clues to getting your son or daughter on the right track this next school year, especially if suspect a disparity of high level of intellectual functioning with academic underperformance or social conflict. While this combination can result in frustration for children and parents in the short-term, if prolonged, long-term consequences may result. Severe academic resistance and/or unrelenting social rejection may be very hard to overcome once the damage is incurred. So--the key is to ACT FAST.

Psychological testing has the ability to identify any underlying roadblocks to efficient cognitive and behavioral functioning. It also helps parents and teachers unlock the natural abilities of a seemingly underperforming or uncooperative child.

Many schools offer some form of testing but generally a child is already experiencing severe academic or social distress before being referred. Also, these tests may not be as detailed or comprehensive as those offered by licensed clinical psychologists.  

When getting your child tested, it is most important to undergo a battery of tests, for when their results are combined, a very detailed, comprehensive picture of the individual’s strengths and areas for improvement emerges. One popular psychometric test, the WAIS-IV, quantifies several areas of cognitive functioning and can be very informative--but it is only one piece to the puzzle.

Psycho-Educational Testing

Testing can be broken down into two categories: psycho-educational and neuropsychological. Psycho-educational tests such as the Wechsler Intelligence Scale for children and adolescents (e.g. WISC) measure cognitive functioning such as processing speed, working memory, and problem solving skills. Detecting the presence of a learning disorder or other academic difficulties helps students develop a lesson plan to allow for optimal performance.

Neuropsychological Testing

Neuropsychological testing is more comprehensive and uncovers how an individual’s specific brain functions (e.g. memory, attention, language) and how it impacts a child’s cognitive and behavioral functioning.

Results of neuropsychological evaluations reveal strengths and weaknesses of the individual’s cognitive or psychological difficulties. Additionally, neuropsychological testing can also evaluate the deleterious effects head trauma such as concussion injury may have on brain functioning. Such testing can unveil causes of cognitive deficiencies and tailor a treatment plan to promote healthy brain functioning and rehabilitation.

Pursuing psychological testing is very important especially for individuals experiencing distress in academic or social settings. It is especially important to have this information prior to the start of the school year so parents and teachers can work with the individual and foster environment allowing for the child to meet their potential.

Parent should interview and find an independent, licensed and experienced psychologist with a good rapport with the child’s age group to enhance obtaining valid, appropriate test results. Not all test providers will resonate with each child.

Hotwiring A Successful School Year

By taking matters into their own hands—and supported by independent, professional reports and recommendations--parents can quickly partner with teachers and others to create a tailored plan for school success. Together with your school age child or teen, you can jump start success and promote confidence this academic year—and beyond.

According to the American Academy of Child and Adolescent Psychiatry, Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and into adulthood. The National Institute of Mental Health reports that 3 to 5 percent of school-age children have ADHD. It is not clear what causes ADHD, although there is substantial research indicating genes play a large role. There is also considerable evidence that environmental factors may contribute to the disorder.

There are numerous symptoms indicating possible ADHD but the symptoms fall into three categories; hyperactivity, impulsivity, or inattentiveness.

• Hyperactive children appear to be in constant motion and reach out and touch everything. They talk nonstop, fidget, squirm, and have a need to engage in continuous activities.

•    Impulsive children speak at inappropriate times, have emotional melt downs, don’t consider consequences, have difficulty waiting their turn, and make choices that have immediate satisfaction, without regard to long-term negative consequences.

• Inattentive children bore easily, have difficulty organizing and completing tasks, forget things, make careless mistakes, become distracted easily, and can’t follow multiple instructions.

ADHD impacts a child’s ability to filter impulses, problem solve, and execute goals. Symptoms are typically apparent early in a child’s life; before the age of seven. However, many times the symptoms are there but are not noticed until later on, particularly with children who are predominantly inattentive. There are numerous conditions that may appear to be ADHD. Sometimes, difficult children are incorrectly labeled with ADHD. On the other hand, there are children who legitimately have ADHD who go undiagnosed. To ensure a correct diagnosis, a child suspected of having ADHD should be carefully examined by a medical doctor and tested by a psychologist to rule out conditions other than ADHD.

A psychiatrist can help determine if medication would be beneficial and a qualified psychotherapist can help a child with ADHD change behavior, develop coping skills and build on his or her strengths.

• Behavior therapy helps children to manage and develop controlling, relaxing, and goal motivated behavior.

• Talk therapy can help children to develop coping skills, and validate and manage thoughts, feelings, and emotions.

• Social skills training provides a method for children to learn social cues about other people’s feelings, sharing with others, when to seek help, and to ask questions before acting out.

• Note-taking and lists helps children to improve comprehension, eliminate distractions, and stay on track.

• Family-based interventions are beneficial in providing wrap around support and processing for the family.

ADHD is not just a problem for children, it is a long-term chronic condition. Research indicates that adults with untreated ADHD have to higher rates of failure to complete school, job loss, alcohol, cigarette and drug addiction, divorce, and driving accidents and tickets. Fortunately, with the right combination of medication, therapy, and educational support, the symptoms of ADHD can be effectively managed.

Monday, 11 February 2013 11:55

Improving Communication and Conflict Resolution

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Nobody gets married with the idea that they will one day be getting a divorce. Divorce isn’t something that anyone looks forward to and it is never an enjoyable step to take. However, the fact is that divorce is one of the hallmarks of modern American society. There is research that indicates half of all marriages in this country eventually end in divorce.

Some common reasons that contribute to the high divorce rate in America are:

• Poor communication

• Lack of conflict resolution skills

• Financial problems

• Failed expectations or unmet needs

• Addictions and substance abuse

• Physical, sexual, or emotional abuse

• Infidelity

While there are many reasons that may contribute to a couple deciding to divorce, poor communication and an inability to resolve conflict are inevitably a large part of the picture. Research has shown that using a structured communication format can be very helpful for couples to communicate in a more healthy and constructive way.  

In a structured communication format, one person is the designated talker, and the other the designated listener. Only one person speaks at a time, and the other person’s job is purely to listen; not just listen, but to listen with the intent to understand the other person’s perspective. Only when the first person is completely done talking does the other one begin to express what they have to say. The roles are then reversed. This is empathic communication.

Setting the stage for good communication to occur is important. It must be the right time and place for both you and your partner. The discussion will be blocked if either you or your partner are upset or distracted. Pick a time to talk when both of you are physically and emotionally available.

Take responsibility for what you are thinking and feeling by using “I” statements when expressing yourself. “I feel unheard” will be far better received and understood by your partner than “you never listen to me.”

When listening to your partner, listen without interruption and use active listening. Reflect back to him or her what you are hearing. Check to see if you have heard and understood correctly. Even if you don’t agree with what your partner is saying, pay attention and listen.

If you find that you have difficulty putting into practice this type of structured format, you may need help from a professional. Seeking the help of a qualified relationship therapist may be very helpful and facilitate you and your partner developing the communication skills that are necessary to keep your relationship flourishing.

Wednesday, 01 August 2012 00:00

ADD: What’s The Real Problem?

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ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder) is becoming more common. Thousands of children and adults are diagnosed and treated every year. In 1970, 150,000 children were treated with stimulant drugs for this disorder; now, there are over 2.7 million. There was a 22 percent increase in this diagnosis between 2003 and 2007.  Many are starting to ask whether there is another option for these children and adults besides drugs.

Diagnosis: Getting It Right

The first step is to be sure of the diagnosis. Often, people with learning disabilities are assumed to have ADD, when what they really need is treatment for their learning disabilities.  Some parents have found it necessary to try independent testing by psychologists who specialize in learning disabilities to get to the root of the problem. Some children suspected of having an attention deficit may in fact be gifted and bored with school. Children with sleep apnea may be too tired to focus in school.  

Some doctors are starting to take a more integrative approach to this problem by looking at the whole picture of what is happening in the family, school, and community.  Sometimes, something as simple as a change in school will change the behavior. TV watching and sleep habits can greatly affect attention.

Start With the Basics: Diet

Food sensitivities are a trigger for some children, so a diet of whole foods with no corn, soy, dairy, or gluten may be effective. Avoid all artificial colors, flavors, and preservatives. Foods should be low on the glycemic scale, which increases blood sugar gradually. This is especially important for breakfast. Too many children eat foods that increase their blood sugar quickly, such as many breakfast cereals marketed to children.  A better breakfast includes some protein, healthy fats, and fiber, like an egg sandwich on a whole wheat English muffin.

Supplementation

Some studies show good effects from fish oil (essential fatty acids – EPA and DHA), zinc, and iron. There are special tests for iron deficiency beyond checking a blood count.  Studies show that supplementing with zinc can actually help to lower the dose of stimulant medications.  Magnesium can also be helpful.

Other Approaches

Parents can often learn parenting skills to deal with frustrating home situations.  A great book is Howard Glasser’s Transforming the Difficult Child: A Nurtured Heart Approach. It is also important to work closely with the school for positive interventions.

Other approaches, including neurobiofeedback, herbs, neurotransmitter testing, and amino acid supplementation, are controversial but can be effective in specific circumstances. Lifestyle changes, including less TV and computer use and more yoga, meditation, exercise, martial arts, and time in nature have significant benefits.

So yes, there are many options besides medication.  Given that we have no studies  on  long-term side effects of medications, it may be a good idea to step back and ask ourselves how so many children can need medication and what the real root problem causing this epidemic might be.

Anxiety is a natural reaction associated with the “fight or flight” response, and a general feeling of nervousness. Anxiety symptoms can arise during inappropriate situations or unwarranted times and present themselves in a variety of ways, such as shortness of breath, increased heart rate, restlessness and feelings of apprehension.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), there are twelve anxiety disorder diagnoses ranging from Post Traumatic Stress Disorder (PTSD) to Specific Phobia. Usually, there is an underlying fear or catalyst that is directly correlated with the individual’s excessive reaction or response. For some, this may be a fear of social situations, while for others the fear may be associated with a previously distressing experience.  Either way, the cognitive processing of specific situations has been skewed and must be modified with the intent of preventing avoidant behaviors and an isolating lifestyle.

When identifying an appropriate treatment approach for anxiety, it is imperative to accurately diagnose the specific type of anxiety that the individual is experiencing. For parents, it is important to identify the signs and symptoms that categorize anxiety disorders as primary diagnoses rather than secondary diagnoses while differentiating the symptoms from normal child development.

An experienced therapist will be careful to make sure that anxiety is the primary disorder before treating because anxiety can be a secondary symptom of another disorder.

A common example, the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) can be confused with the symptoms of Generalized Anxiety Disorder (GAD). Anxiety can also be identified as a secondary symptom of substance abuse. In these instances, it is imperative to identify all possible factors through a thorough evaluation and assessment.      

Within psychotherapy, the most common approach to behavior modification for anxiety disorders is called Cognitive Behavioral Therapy (CBT). The cognitive portion of CBT helps people identify the maladaptive thinking patterns while the behavioral portion of CBT addresses the actual responses to these maladaptive thought processes. A common approach to CBT is “exposure therapy.” This practice allows the therapist to slowly “expose” the client to the fear with the intent of gradually building appropriate responses and behaviors. This can be achieved through actual exposure to a particular fear or recalling events in a safe environment. Over time, it has been proven that CBT and exposure therapy decrease the maladaptive responses while increasing the individual’s ability to appropriately cope with fearful thoughts and feelings.  

Continued psychotherapy in combination with medication management usually yields a positive outcome for the management of anxiety. However, all child and adolescent psychotherapists as well as parents must factor in the characteristics of natural child development when considering the diagnosis of an anxiety disorder.

Sunday, 01 July 2012 00:00

Recognizing Verbal Abuse

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A home should be a happy and safe place.  A home should be the place where we feel loved and accepted for being ourselves.  In truth, a home is also the place where our personal conflicts are worked out, sometimes in destructive ways.  Our internal conflicts may involve issues of anger, power, and control - all of which can lead to verbal abuse.  

Verbal abuse leaves no physical scars, but the emotional wounds can be deep.  It is important to recognize verbal abuse when it occurs and then do something about it.  A verbally abusive household is usually not a happy place.  On the surface, others may see both the verbal abuser and the victim of the abuse as a happy couple, the nicest of people.  But behind the scenes, there exists a pattern of manipulation and intimidation, unreasonable demands, sarcasm, and angry outbursts.

At the onset of these relationships, everything may seem wonderful.  The person who later becomes verbally abusive may shower the eventual victim with gifts and compliments and make that person feel like the most important person in the world.  Gradually, however, the relationship deteriorates.  The abuser’s anger and need for control are projected onto the victim.  The victim is blamed for not being “good enough,” and the relationship gradually turns into an emotional roller coaster.

The person on the receiving end of the abuse may adjust to the situation over time, so that he or she is unaware of the extent of the abuse.  The abuser usually fails to take responsibility for creating the problem, and it is the partner who takes the blame.  These relationships are characterized by denial, poor interpersonal boundaries, control and power issues, trust issues, and unresolved anger.

Verbal abuse can almost always be seen as a control issue. Ironically, it is the abuser who sees him or herself as the victim.  Therefore, the abuser feels the need to control the partner in order to allay his or her own insecurities.  The person receiving the verbal abuse, hoping for closeness and approval, goes along with the control and may accept blame for causing the problems.  Roles become confused.  The abuser is the victim, and the victim is the abuser.  The situation becomes murky and perpetuates the conditions that breed verbal abuse.

Because the partners in a verbally abusive relationship have usually adapted to their situations, as painful as this may be, it might require the intervention of a trained therapist to interpret the communication patterns objectively and empathically.  New and healthier ways of communicating can be learned, along with the issues of control, the need for equality in a relationship, and how to trust and respect one’s partner.

Summer break from middle school, high school or college is a very exciting time, but can be very detrimental to adolescents and young adults with ADD/ADHD.

Of course most kids would prefer “hanging out” with their friends all day long rather than attend structured, supervised activities. But research indicates that children and adolescents who are not involved in a structured activity such as sports, summer camps, volunteering, or work are more likely to engage in negative behavior and substance use.

The relationship between substance abuse and ADHD is well-documented. On a recent drug use survey completed by Fairfax County Public School students, close to 40% of respondents admitted to frequent drug and alcohol use (more than 2x per week) and cited ‘boredom’ and ‘lack of activities’ to participate in as primary triggers.

Working parents have an uphill battle to ensure enough summer oversight but reducing free time needs to be a priority, especially for older teens even though they can technically care for themselves.

A well structured summer break offers many benefits: a chance to meet new people, explore new things, participate in new activities, increase mastery of an existing interest, travel and enhance experiential learning. The goal(s): increased skills, enhanced self-confidence and self-awareness.

Align Interests and Activities

Summer activities must be aligned with a child’s interests so that it can be predictable, stimulating, and long-lasting. If a child pursues their interests daily, they are more likely to engage in positive behaviors such as socialization, problem solving, and physical activities. Researching and deciding upon suitable summer activities together is the key to reducing resistance and increasing the odds of a positive experience.

Notably, ADD/ADHD college students should be using their summer break constructively by getting jobs or internships aligned with their majors, increasing work or life skills or volunteering.

Summer camp is a popular option for tweens and teens. If finances are an issue, scholarships to county camps may be available. If summer camps are not an option, community centers, sports teams, volunteer opportunities and summer jobs are great alternatives.

Connect With Other Parents

If none of these resources work for your family, parents need to connect with other parents in the community. Plan days for your child to spend time at a friend’s house with proper supervision during work hours.

So sit down with your kids, determine their interests, and what they would like to accomplish this summer. Be prepared to face some opposition, but don’t back down. When given some freedom of choice, your child will be more likely than not to take an active role in planning their summer. And, they will hopefully make memories, grow and learn—a “win-win” for everyone.

Monday, 03 December 2012 11:42

Five Tips For Relationship Success

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1. Ask. Generally speaking, partners feel that asking about thoughts, feelings, wants, and needs demonstrates caring. If you ask with a genuine wish to know, your partner is likely to experience the inquiry as loving.

2. Tell. If you want your partner to know what you’re thinking or feeling, tell your partner. We sometimes believe that if our partner cared, s/he would already know. What defines caring partners is not magical telepathic abilities but wanting to know. Trust that your partner cares enough to want to know – tell.

3. Listen, attentively. Listening attentively means making your partner’s answer the most important thing in the world to you at that moment. It is important to sustain this attentiveness until your partner has fully and completely told whatever s/he is willing to share at this time. It is a very affirming experience to be listened to in this way.

4. Understand. Understanding requires a commitment of energy and caring. If you commit yourself to understanding, you commit yourself to a process that will result in a successful match between intended transmission and actual reception. It can be exhilarating to feel a partner’s commitment to understanding you this fully.

5. Be responsive. Being responsive means demonstrating to your partner that you are influenced in some way by what you now know. If I do something because of what you told me, that I listened to and understood, I’m being responsive. If you tell me that you want me to quit my job and run away to the circus with you, I don’t have to be responsive by running away to the circus. But I need to demonstrate that I care about what you’re saying, perhaps by inviting you to tell me about your need to make such a radical change and ask if you’ve always wanted to be a lion tamer.

These five tips won’t guarantee a successful relationship. But without these five things no relationship has much chance of success. By implementing these five things you make a fine start toward a healthy and satisfying relationship. If you’re already in a not-so-successful place in a relationship, try using these five tips to get yourself to solid ground. They can’t hurt and they may be the lifeline that you need.

Wednesday, 28 November 2012 15:29

Communicating Assertively

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Have you ever had difficulty speaking up for yourself?  How you define yourself, positively or negatively, depends a great deal upon the messages you’ve heard from others throughout your life.  We internalize the things we’ve heard about ourselves from other people and this becomes the basis of our self-esteem, which can be either mostly positive or mostly negative.  If we see ourselves in a negative light, we may feel that we are not worthy of speaking up for what we want and this can lead to passive behavior as a lifestyle.

People who experience difficulty with their assertiveness skills have to look deeply within to assess their self-esteem and see what they can do to create a more positive definition of themselves.  They can find things about themselves that they like.  They might practice using positive self talk such as, “I am an interesting person and have interesting things to say” until this message replaces any old negative messages they may have heard throughout their lives.

Turning a legacy of negativity into a present sense of positive feelings takes some work, persistence, and motivation but the rewards are enormous. One day you realize that you really do like yourself, like who you are and have something to say that is of value to other people.  This does not imply that you are working toward conceit or a superior, condescending attitude.  You are simply working to repair old negative messages that have held you back in the past.  You are working on balance.

Being able to assert yourself in life requires positive self-esteem.  Once you feel good about yourself, you can then go out into the world with a healthy sense of pride and assertively deal with the many experiences and people who come your way.  

Communicating with others assertively involves the ability to express your ideas clearly and effectively.  It does not involve blaming the other person or putting them down.  There is no room for sarcasm when communicating assertively.  

Assertive speaking often involves the use of “I” statements.  That is, you talk about how you feel about something without attacking the other person.  For example, you might say, “I feel uncomfortable when you talk about our boss that way,” but you would not say, “You make me feel uncomfortable when you gossip about our boss”.  Assertiveness does not aim to put the other person into a defensive stance, but rather aims to open communication between people.  

Learning to become assertive is not just an exercise in discovering appropriate responses to uncomfortable social or personal situations.  Rather, it mirrors a personal process of self-discovery that is often aided by working with a therapist.  The goal is to reach your authentic genuine self.

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