Category: Anxiety

Lena Dunham's Representations of Mental Illness

00Anxiety, Asperger's Syndrome, Featured news, Health, Media, Obessive-Compulsive Disorder, OCD, Self-Esteem March, 17
Karolina Reis on Flickr

Source: Karolina Reis on Flickr

Media portrayals of mental illness are often controversial and have been criticized for inaccurate stereotypical depiction.

But more recently viewers have seen a notable shift towards more accurate representations. Writers, producers, and actors are using their own experiences to create more authentic characters and situations.

The controversial television series Girls on HBO leads the way.

Lena Dunham –actress, writer, director, and executive producer of Girls– stars as the show’s protagonist Hannah Horvath, who struggles with obsessive compulsive disorder (OCD). Through her character, Dunham conveys her own personal journey, enabling viewers to observe genuine symptoms of the illness.

Dunham was diagnosed with OCD around age 9. In an excerpt from her new book, she discusses the experience of intrusive thoughts:

“I am afraid of everything. The list of things that keep me up at night includes but is not limited to: appendicitis, typhoid, leprosy, unclean meat, foods I haven’t seen emerge from their packaging, foods my mother hasn’t tasted first so that if we die we die together, homeless people, headaches, rape, kidnapping, milk, the subway, sleep.”

As a public figure, Dunham feels a responsibility to discuss her disorder openly. She believes this approach helps people better relate to those who live with mental illness.

Researchers Joachim Kimmerle and Ulrike Cress explored this in an article published in the Journal of Community Psychology. Their study demonstrated that we can learn about mental illness from fictional shows when the information is accurately presented, highlighting how there can be many useful and creative ways to disseminate knowledge in mental health.

However, research by Nicole Mossing Caputo, a marketing and public relation specialist, and Donna Rouner, who has her PhD in mass communication, at Colorado State University found that when viewers don’t relate to the storyline or don’t form an emotional bond with a character, social stigmas tend to persist.

When a link to a storyline is successful or an emotional bond is formed, viewers become less critical and adopt the protagonists’ perspective and understand their struggle. Connections to narratives and characters like Hannah Horvath help battle misconceptions.

Another show, Parenthood, candidly explores the struggle of living with Asperger’s Syndrome (Autism Spectrum). Like Dunham, the show’s creator Jason Katims uses his own experience of raising a son with Asperger’s to connect with viewers on issues surrounding mental illness.

Dunham’s representation of OCD on television has increased public discussionaround mental health. It has increased the visibility of various mental-health communities and has helped pave the way for other shows to do the same.

In a Psychology Today article, Jeff Szymanski, Executive Director of the International OCD Foundation, speaks to this progress:

“Lena did a service not only to herself by letting the world ‘see’ what the struggle looks like, but to the entire OCD community at large by showing some of the pain, stigma, and struggle any person with mental health issues has to endure.”

And many are taking notice.

Shortly after Girls first aired, Allison Dotson—an OCD sufferer herself—wrote an articlefor the Huffington Post explaining how the depiction of Hannah on Girls has helped fight stereotypical portrayals of her disorder:

“As someone with OCD, I find it refreshing to see this often misunderstood illness portrayed in a realistic way on an acclaimed television show. Just as Hannah herself resists typical far-fetched sitcom stereotypes — she’s not model thin, she struggles with her finances and her career choices, and she often finds herself in believable awkward situations — her OCD symptoms are presented in a way that resists the low-hanging fruit of a kooky character most of us never encounter in our day-to-day routine.”

– Alyssa Carvajal, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Mental Healthcare Lacking for Small Business Owners

00Anxiety, Burnout, Depression, Featured news, Health, Stress, Work July, 16

Source: Gary Suaer-Thompson on Flickr

Being your own boss, doing something you love, having control over your own schedule. These are only a few reasons why people choose to start their own business.

But the reality many small business owners face is far less appealing. Financial stress, professional isolation, long hours, and blurred boundaries between work and family life can take a toll on mental health.

Although there is a growing focus on mental health in the workplace, programs often target large companies with thousands of employees, providing fewer options for those running small businesses.

Jeffrey Markus, entrepreneur and founder of Daddyo’s Pasta and Salads restaurant in Toronto, knows firsthand the psychological impact of running a small business. When his restaurant was struggling, he took it personally:

“I was a go-getter and an entrepreneur. But as business slowed I was more and more affected. I couldn’t separate myself from my business. It was the worst experience of my life. It put a strain on my marriage and I missed out on seeing my daughter grow up, which was very difficult for me.”

In Markus’ opinion, small business owners are overlooked when it comes to providing support for people in the workplace.

And he may well be right. While employees in larger organizations often have access to human resource support or programs, business owners and entrepreneurs are left to deal with stress on their own.

Associate professor Angela Martin of the Tasmanian School of Business and Economics in Australia, conducts research on the mental health of small business owners. She believes that while there is some evidence of a growing awareness for providing mentally healthy workplaces among larger businesses, it may not be helping entrepreneurs:

“Small business owners need access to support, but the current workplace mental health programs are missing all of these people. These models don’t work in small business as they do in a larger organization. They don’t translate to a single person.”

Martin’s research has been used to develop a set of preventative guidelines that help small and medium business owners recognize the signs and symptoms of mental health issues in themselves and their employees. But she is working in an under-investigated field:

“There is no big systematically collected data, so we don’t know how many people are affected and what impact it is having on small and medium business.”

Another issue is that while small businesses are often seen as one type of industry, they are actually quite diverse—ranging from building contractors and health professionals to artists and online retailers. These differences mean that the time and cost constraints faced by individual business owners are also different.

In Jeffrey Markus’ experience, the number of small business owners in distress is alarmingly high. But after facing his own share of crises, he has learned to care for himself as well as his business:

“People are borrowing against their homes which can cause marital issues. Many marriages break down when husbands and wives clash within a family business. But I had to reframe my thinking and approach to things. I had to get the entrepreneur life to work for me, not against me.”

Markus has learned a few simple things that go a long way, such as saying no to the prospect of expanding his restaurant to multiple locations, remembering to leave time for relaxation and self-care, and being more present within the lives of his family and close friends.

In considering his experience, he notes that community and peer support were key in helping him get through tough times.

Rebekah Lambert, a good friend of Markus, is an entrepreneur working to help other small business owners connect with each other and find support. Her company, The Freelance Jungle, is an Australian initiative providing community support and helping people manage the stress of running a business:

“I found a lot of people are having a hard time. I saw a lot of them spending money on being a businessperson, but not on getting proper support.”

Markus agrees that small business owners need to support each other due to the absence of government programs. This is particularly important since business owners’ poor mental health will affect not only their lives but also the mental health of their employees.

Potential solutions being examined by Lambert and other entrepreneurs are online associations and support networks, local meetup groups, and mentorship programs. With a current lack of formal mental health programs, it is important that business owners learn to look after themselves in the meantime.

– Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Sexual Freedom: Only Part of the Equation for LGBTQ Refugees

00Anxiety, Embarrassment, Featured news, Loneliness, Resilience, Sexual Orientation, Stress July, 16

Source: Eric Constantineau on Flickr

Montgomry Danton is a gay man from the Caribbean island of Saint Lucia. In June 2014, he fled persecution in his home country to claim asylum in Canada because of his sexual orientation. By September 2014, he had been granted refugee status under the Immigration and Refugee Protection Act of 2002.

Leading up to his official hearing at the Immigration and Refugee Board, Danton experienced the fear and anxiety common to many LGBTQ asylum seekers. He reported feeling isolated and depressed, being unable to sleep or eat, and experiencing thoughts of suicide. At one point, Danton wanted to give up and return home to Saint Lucia, despite the danger this would have posed to his life.

One might imagine that after a successful refugee hearing, the difficult part would be over. It would be time to start building a new life in Canada. But for Danton, and others like him, the struggle to become established in a new country can be as stressful as the claims process itself. In an interview with the Trauma and Mental Health Report, Danton said:

“It was a relief to know I can actually stay in Canada to be who I really am and be comfortable with myself and also my sexuality. People think coming to Canada is a good thing, you know? But you have to prepare for challenges.”

Some challenges are broad, ranging from finding affordable housing, to gaining employment, to securing basic necessities like food and clothing. But others are more specific to individual circumstances, including language barriers and cultural unfamiliarity.

LGBTQ refugees, in particular, may continue to experience social isolation, perpetuating a sense of danger and persecution. Individuals who have undergone physical and emotional trauma may not be able to move past their experience and attain a sense of personal safety until they establish a support system in Canada.

For Danton, building a new life has been stressful, edging him back towards the depression he experienced during the refugee claims process, and before that, in Saint Lucia:

“There are certain times I just wish I was back home because if I was back home I would be comfortable living my life.”

He, like many others, has been struggling with the concept of ‘home.’

In Saint Lucia, Danton did personally meaningful work as an outreach officer for the LGBTQ organization, United and Strong, and lived with his partner. In Canada, he is unemployed, has moved four times since his arrival, and has been dependent on the assistance of acquaintances and friends.

“In Saint Lucia, if it was safe for me to be who I am, to show that I’m gay, I wouldn’t think about coming to Canada. I would have stayed.”

For Danton, and for other LGBTQ asylum seekers, safety, security, and freedom of expression are only a few aspects of a meaningful existence. As a refugee, he has had to sacrifice many other significant parts of his former life, which is a common tradeoff for many in his position.

And the choice between freedom of sexual expression and stable housing and employment is an unimaginably difficult one to make, as is the choice between safety from persecution and the comforting presence of friends and family back home.

Still, Danton emphasizes his gratitude and appreciation at being granted asylum. He is happy to feel safe, to be far from the persecution he experienced on a daily basis in Saint Lucia, to be accepted into a country like Canada where he hopes to reclaim his life.

“At the end of the day, I’m still grateful and I’m trying my best to not let the challenges get the best of me. I’m thinking about moving forward.”

– Sarah Hall, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Is Casual Sex Really So Bad?

Is Casual Sex Really So Bad?

10Anxiety, Depression, Featured news, Health, Relationships, Self-Esteem, Sex December, 15

Source: John Perivolaris on Flickr

Smartphone apps like Tinder, Grindr, Down, Tingle and Snapchat have opened up a new chapter in the complicated world of dating and casual sex.  Dubbed “hookup culture,” smartphone users 18-30 years of age are said to be navigating a very different sexual landscape than their parents did.

Early research on the topic found that undergraduates who engaged in casual sex reported lower self-esteem than those who did not.  Yet, other studies reported no evidence of higher risk for depressive symptoms, suicidal ideation, or body dissatisfaction.

According to adjunct professor Zhana Vrangalova of New York University, the phenomenon of casual sex is layered with individual, interpersonal, emotional, and social factors.  Reasons for engaging in hookups are different.

Her recently published study demonstrates that casual sex is not harmful in and of itself, rather one’s motivations for engaging in casual sex is what affects psychological well-being.

Vrangalova draws upon self-determination theory:  Behaviours arise from autonomous or non-autonomous motivations.  When we do something for autonomous reasons, we are engaging in behaviours that reflect our values – the ‘right’ reasons.  When we do something for non-autonomous reasons, we are seeking reward and avoiding punishment – the ‘wrong’ reasons.

In the context of casual sex, Vrangalova and her team of researchers were able to show that those who hooked up for non-autonomous reasons (i.e. wanting to feel better about themselves, wanting to please someone else, hoping it would lead to a romantic relationship, and wanting favours or revenge) had lower self-esteem and higher levels of depression and anxiety.

But those who engaged in casual sex for autonomous reasons – fun and enjoyment, sexual exploration, learning about oneself – reported higher than normal levels of self-esteem and satisfaction, with lower levels of anxiety.

If hooking up for the right reasons, casual sex does not appear to have a negative impact.  Still it’s not so simple.  A number of issues need to be addressed.

Many studies examine “hookup culture” on college campuses, particularly the sex life of middle to upper class young adults.  Since college years are often a tumultuous time of self-discovery and changing opinions, longitudinal research on the long-term benefits (or drawbacks) of casual sex need to be carried out.  Few studies have explored how casual sex affects the mental health of individuals above age 30.

Outside the college domain, information on how different casual sex arrangements (one night stands vs. friends with benefits vs. non-monogamy) affect mental health is scarce, as is research exploring how casual sex behaviours vary between people of different ethnicities.  Preliminary research shows that non-white women report lower desire for casual sex.  How or why this is the case has not been examined.

There is little doubt that the sexual landscape has changed in the past few decades. Technologies, and more specifically social media, have altered the way we approach and engage in interpersonal relationships. But the idea that younger generations are ditching the traditional dating scene in favour of hooking up has not been supported by recent research.

Hang-outs, group dates, friends with benefits, no-strings-attached… For those emerging adults who are engaging in these behaviours with a psychologically healthy frame of mind, is it really so bad?

– Magdelena Belanger, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Book Review: “Drop the Worry Ball”

Book Review: “Drop the Worry Ball”

00Anxiety, Attachment, Featured news, Parenting, Perfectionism, Resilience July, 15

Source: Stephan Hochhaus/Flickr

Parents are inundated with conflicting advice on how to raise their children. Pediatrician William Sears’ attachment parenting couldn’t be more different from the approach taken by “tiger mother” Amy Chua.  The range of “how-to” styles can leave parents scratching their heads about what’s best.

Research tends to support an authoritative parenting style, a balance of clear guidelines and expectations paired with warmth and attentiveness.  But in this age of perfected parenting, we are seeingan increase in anxiety and depression in children. Some think that caregivers are overparenting, and that this over-attentiveness may be causing problems.

In his latest book Drop the Worry Ball (2012, Wiley),clinical psychologist Alex Russell says that children no longer grow up; nowadays we raise them, placing all responsibility on the parents.  This results in caretaking that is too protective, too involved.  At the extreme, this becomes helicopter parenting.  Parents “hover” nearby, hyper-aware of the risks and needs of their child before the child is able to evaluate a situation or make decisions on their own.

Russell’s observation of the two outcomes of over-parenting:  too little or too much anxiety in children, parallel research of Ellen Sandester, professor at Queen Maud University College of Early Childhood Education in Norway.  Sandester argues that it is through risk that children expose themselves to fearful situations, and the thrill experienced from coping with anxiety helps develop the child’s evaluation of their ability to cope with future challenges.  When children are prevented from engaging in these non-catastrophic risks, they become either hypo-anxious or hyper-anxious.  With the first, there is too little realistic perception of consequences, so the child seeks greater thrill or tries out more dangerous situations.  With hyper-anxiety, the lack of experience leads the child to become phobic of novel situations.

Similar, but not identical to Sandester, Russell argues that we are seeing two kinds of children develop as a result of over-parenting.  First, there are those who become disengaged or avoidant of stress and anxiety and don’t want to take on the adult world. And second, there is the hyper-anxious child, the pleaser and perfectionist.  The imbalance of anxiety is created by anxious parents who hold the worry for their children –essentially shielding them from normal developmental experiences.  Similar to Sandester’s analysis, these children are deprived of the opportunity to cope with healthy, necessary levels of stress and anxiety.

That anxious parents could produce anxious children is not surprising, but that over-attentive parenting leads to hypo-anxious, disengaged children seems counterintuitive.  A lot of media attention has been given to the increasing numbers of children who are disengaged.  Russell argues however, that the same parenting style can create this avoidance of anxiety.  The parents make the adult world appear stressful and unmanageable, so why grow up?

Russell acknowledges that there is no quick fix, and that all parents make mistakes.  He recommends a mindful approach to parenting.  That is, a shift back to listening and reflecting on what the child says and does, instead of giving advice or actively taking over.

Parents need to appreciate that the child has the ability to cope with everyday risks, and need to give the child the space he or she needs to solve problems.

This book is a worthwhile read for parents.  Sometimes we need to remind ourselves that raising kids is about being “good-enough,” not perfect.

After all, children do grow up, and seem to do this best with a little space to explore and learn from mistakes.

– By Heather Carter-Simmons, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Abusing Your Body Through Exercise

Abusing Your Body Through Exercise

00Anxiety, Body Image, Diet, Featured news, Obessive-Compulsive Disorder, Sport and Competition June, 15

Source: Flickr/Mario Lazaro Delgado Marquez

Last year, a good friend of mine became obsessed with the gym. Preoccupied by the “small” size of his muscles, he would spend hours staring at himself in the mirror. Others commented on how great his body looked, yet he didn’t believe them. Sticking to a rigid exercise and eating schedule, he stopped socializing with friends, became secretive, and dropped out of school.

A sense of hatred toward a particular body part, hiding it, or using extreme measures to change it is commonly seen in people with Muscle Dysmorphic Disorder (MDD).

MDD is most common in men, especially professional body builders or frequent gym-goers, and individuals who work or live in an environment where weight and appearance are considered important. My friend was a kinesiology student and was surrounded by an MDD-conducive environment.

MDD is listed in the DSM-5 under the spectrum of obsessive-compulsive disorders(OCD) to reflect its similarities to both process and treatment of OCD. MDD is also a subcategory of body dysmorphic disorder (BDD), a pathological preoccupation with features that are perceived as defective or grotesque, which leads to persistent stress and obsession. In MDD, the emphasis is specifically on muscularity. My friend’s particular body part was his biceps; even though he had stretch marks from over-working them, he still complained they were too small.

MDD is also distinct from eating disorders. The concern is not with striving to be thin, but rather with their perceived underdeveloped muscle mass. At times I would see my friend eat three cans of tuna and four eggs in one sitting – he felt his body needed the protein to build mass.

Statistics on MDD are limited since it is categorized under BDD. The prevalence of BDD is approximately 2.4% of the general population which makes it more prevalent than schizophrenia or bipolar disorder.

Symptoms of MDD are deceptive. The trouble with diagnosing MDD is that patients often do not consider themselves ill or in need of help. The more my friend became involved in the gym, the more I would try and talk to him about my suspicion that he was suffering from MDD, but the conversations never ended well. To add to the complexity of the disorder, some individuals with MDD tend to wear baggy clothes to hide their bodies, while others wear tight clothes to show off their muscular stature.

But getting help is important, as potential long term effects include damaged muscles, joints, cartilage and ligaments due to inadequate rest from strenuous weightlifting. They are also more likely to have a poorer quality of life, show a higher frequency of anabolic steroid abuse, and even suicide attempts.

Criteria for diagnosis include repetitive behaviours caused by preoccupations with perceived body defect(s), excessive training, following a rigid diet, avoidance of social events to maintain diet and exercise schedules, and avoiding situations that include body exposure, which may lead to extreme anxiety. The individual’s body perception causes considerable impairment in daily functioning. The diagnosis requires two of these criteria to be met.

There are analytical tools to help diagnose MDD. Most common is the Muscle Appearance Satisfaction Scale developed in 2002 by Psychologist Stephen B. Mayville, which rates levels of muscle satisfaction, substance use, and injury. Or the Muscle Dysmorphia Inventory which is a six factor scale that determines body size, exercise dependence, supplement use, dietary behaviour, physique protection, and pharmacological use.

And there are psychological treatments as well. The most common of which is Cognitive Behavioural Therapy (CBT), which teaches an individual to identify and modify distorted thoughts (e.g., I am not muscular enough), and to replace unhealthy behaviours (e.g., exercising four hours a day) with healthier ones. Treatment with selective serotonin reuptake inhibitors (SSRIs) has also been used with MDD, but the most effective treatment is a combination of CBT and medication.

Despite recent awareness and treatments, with rising interest in fitness clubs and health supplements, as well as pressure on males to be unrealistically muscular and lean, a further rise in MDD wouldn’t be surprising.

– Jenna Ulrich, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Family Storytelling: Good for Children (and Parents)

00Anxiety, Family Dynamics, Featured news, Parenting, Resilience, Self-Esteem March, 15

Source: Heather Carter-Simmons

I recently received an envelope of photos from my mother; each image came with a story.  My daughters’ favourite turned out to be one about their Uncle David.  Living on a farm in Arkansas, David was four when he got new, slightly too-large, cowboy boots. The clomping noise drove my mother nuts, so she told him to take the boots off or go outside. Hearing the clomp-clomp yet again, she yelled at David; but there was no reply.  She marched into the kitchen only to find it wasn’t David at all but their horse in the kitchen…eating the chocolate chip cookies my mother had laid out to cool.

My daughters like the story because it’s funny.  And embedded within is the message that parents are not always right—a popular theme with children.

But in the context of so much else we have going on, how important is it to share a story about an uncle my daughters have never met?

Quite important, it turns out.  Research shows that writing about family events and expressing emotions around them can be healing. And Marshall Duke and Robyn Fivush, on faculty at the Emory Center for Myth and Ritual in American Life, found that telling and listening to family stories has value as well.  Key factors in sharing family stories are the life lessons and traditions that are passed on, but there are other benefits too.

Duke and Fivush found that sharing family stories creates resilience in children.  Their “Do You Know?” questionnaire assesses how much children know about their family, knowledge they couldn’t have acquired unless they had been told, like “Do you know where some of your grandparents met?”  Children who knew a lot about their family history also scored high for levels of self-esteem and feelings of control and capability.

Duke and Fivush also found lower levels of anxiety and depression and fewer displays of aggressive behaviour in children whose families shared family stories.  The same relationship was not found for families who just talked about daily events.

Stories pass on life lessons, instilling a sense of capability.  And the shared history and time taken to tell stories also fills the need to connect, providing, in Fivush’s view, a sense of belonging in our families, becoming a part of something larger than ourselves.

Telling stories in an interactive way, where the child or parent asks for assistance in conveying the story is important to building storytelling skills.  Elinor Ochs, professor of anthropology at UCLA, discusses storytelling as “theory building”.  The act of creating a story and having family members challenge your “theory” of events being related helps children develop the skills needed to create and test explanations.

It also highlights something my mother pointed out—there are many versions of the same event. When she and her sisters get together, they argue over each other’s renderings:  “That’s not what I remember…”  Yet each may be accurate for the teller.

And some stories just need embellishment. My great-grandmother would correct her son about stories he’d be telling, often prompting him to say, “Another good story ruined by a durned eyewitness.”

Factually accurate or not, the act of engaging in family storytelling brings richness to one’s sense of family, and with that, a connection to a shared past.  I tried to give my daughters a strong foundation from which to create their own stories, and I hope to be there to challenge another tall tale.

– Contributing Writer: Heather Carter-Simmons, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Heather Carter-Simmons

This article was originally published on Psychology Today

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Coping With Traumatic Brain Injury

10Anxiety, Child Development, Cognition, Depression, Empathy, Environment, Featured news, Health, Memory, Neuroscience, Productivity, Sleep, Sport and Competition, Trauma February, 15

Source: Shine In Your Crazy Diamond//Flicker

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Control has reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object,) and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

  • Take additional time on activities as needed
  • Manage fatigue (with exercise/relaxation, sleep)
  • Ask for repetition of key information and written outlines of key terminology
  • Repeat back what people tell you to ensure you are understanding
  • Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
  • Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
  • Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
  • Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
  • Exercise can help relieve tension, improve sleep and attention
  • Seek out a quiet room to complete work or practice techniques as needed
  • Social support is extremely helpful

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Controlhas reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object), and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr 

This article was originally published on Psychology Today

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Why Does Anyone Love Men Who Won’t Love Back?

10Anxiety, Attachment, Bias, Featured news, Health, Media, Relationships, Sex February, 15

Source: conrado/Shutterstock

You’ve seen the character a thousand times—the mysteriously sexy male protagonist. The lone wolf.

He saunters into women’s lives, gives them a wink, and they trip over themselves to gain his affections. Little do they know, he is incapable of such basic inclinations as love, having in fact buried his emotions years ago in the corners of his cold heart. Naturally, he becomes even more desirable, and the women who were tripping over themselves before, are now desperately crawling after him. This cannot last forever, and the lone wolf must leave. And so he does, leaving a trail of broken hearts in his wake.

The plot has appeared in many Hollywood movies, from classic westerns to gangster films to the James Bond series. Even romantic comedies have jumped on the bandwagon, with jaded, rejecting players who finally meet “the one” and struggle to learn how to love.

50 Shades of Grey, the film based on the novel about a fictional BDSM relationship, just hit theaters. Anastasia, the female protagonist, is portrayed as a normal, healthy young woman, while Christian Grey is the king of lone wolves—though presumably all lone wolves are the de facto kings of their prides.

Christian Grey has all the typical trappings of the tall, dark, and mysterious stranger. He refuses any type of romantic relationship, claiming to not be a “flowers and romance kind of guy.” He forbids Anastasia from touching him or even making eye contact during sex. Though we may shake our heads and claim we would never endorse such a relationship, the book series has sold over 100 million copies worldwide.

A quick perusal of most fan-generated lists of the sexiest fictional male characters reveals our obsession with solitary, rejecting men—James Bond, Indiana Jones, George Clooney in pretty much anything, Batman, Edward Cullen (whose heart is literally dead)—and the list goes on.

We love characters who can’t love us back. Though there are slight differences, the Christian Greys and James Bonds of the world are strikingly reminiscent of the dismissive-avoidant attachment style.

Briefly: The dismissive-avoidant style is characterized by discomfort with intimacy or feelings of vulnerability. Being emotional or dependent, for such people, is equated with weakness. Hollywood has ensured that we find this type of character irresistible. It’s hard to find a movie that doesn’t frame the solitary male as desirable. By the same token, it’s rare to find a “clingy” (or anxiously-attached) character portrayed in a positive light.

Of course fiction is fiction, but pop culture permeates our norms. It’s hard to ignore the influence on our vocabulary and perceptions of self and other. Who doesn’t secretly want to be as cool as James Bond? As nonchalant as Don Draper? Or, for that matter, as flippant as the avoidant Mary Crawley of “Downton Abbey”? Nobody wants to be the clingy ex-girlfriend or the nagging mother-in-law.

So why do dismissive-avoidant types get all the screen time, portrayed as the coolest-of-the-cool while the anxiously attached are stereotyped as clingy and annoying? Is being stoic and rejecting really better than seeking too much affection?

It’s important to draw a distinction between what actual dismissive-avoidant individuals are like and Hollywood’s portrayal of them. It’s not that being dismissing-avoidance gives you physical agility, a six-figure salary, or an arsenal of quippy pick-up lines. More likely, you would have frustrating intimate relationships, a higher likelihood of mental health difficulties, and an underlying anxiety kept at bay by defensiveness. Films often portray such individuals without the negative aspects we would more clearly see in real life.

So why continue to portray dismissive-avoidance in such glowing terms?

It sells.

Imagine if, in the first James Bond film, Agent 007 had settled down with Honey Ryder in a gated community with two kids and a dog. There would hardly be a chance for a 25-film franchise. To keep milking the character, he must never be tied down. The character rarely changes. And the producers hit “reset” when they start creating the next film.

Although 50 Shades of Grey is far from the main culprit, it is symptomatic of our masochistic submission to dismissive-avoidant characters.

But I suppose there are worse ways to spend an evening out.

Guest Writer: Aviva Philipp-Muller, The Trauma and Mental Health Report

Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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The Heart is a Drum Machine: Drumming as Therapy

00Anxiety, Creativity, Depression, Featured news, Neuroscience, Resilience, Therapy January, 15

We moderns are the last people on the planet to uncover what older cultures have known for thousands of years: The act of drumming contains a therapeutic potential to relax the tense, energize the tired, and soothe the emotionally wounded.

So says Gary Diggins, an Ontario sound therapist.

When I met him, I entered his studio with some trepidation, overwhelmed by the hundreds of instruments I did not know how to play. Drums from around the world. Didgeridoos, rain sticks, and other indigenous instruments decorated the walls. I had come with the intention of exploring the sound therapy community to find out why so many people are choosing music as a form of healing as opposed to other, more traditional approaches to mental health treatment.

Since that first drumming experience, I began attending monthly sound therapy sessions: People coming together to create sound with the intention of restoring physical and mental well-being.

Diggins’ particular practice of sound therapy has been shaped by his studies with a Columbian Shaman, a Jungian therapist, an African Griot, an Australian Aborigine, and a few professors from the University of Toronto. The challenge, Diggins says, is to frame this ancient practice in a way that makes it accessible to wider cultural circles.

In Diggins’ group settings, clients connect with other drummers and create a supportive and collaborative musical community. For some, the positive impact comes from the feeling of belonging to a community. For others, it comes from the physical act of drumming and simultaneously connecting with one’s own emotional experience.

Neurologist Barry Bittman, who co-developed a program for REMO called Health Rhythms with music therapist Christine Stevens, found that group drumming and recreational music making increases the body’s production of cancer killing t-cells, decreases stress, and can change the genomic stress marker. Bittman says drumming “tunes our biology, orchestrates our immunity, and enables healing to begin.”

Psychologist Shari Geller, who teaches at York University, says her own early experiences with drumming sparked her interest in the practice’s healing benefits.

After working with Bittman at his Living Beyond Cancer Retreat at his Mind-Body Wellness Center in Pennsylvania, Geller combined her work as a clinical psychologist, her training in emotion focused therapy, and mindfulness with group drumming in a program called Therapeutic Rhythm and Mindfulness (TRMTM).

In studying the technique and combining it with her clinical knowledge, she discovered that healing can occur when emotions are enhanced through music making. She says it allows people to process trauma with greater ease and that through the facilitation of mindful drumming, people can express difficult emotions.

For individuals coping with depression, anxiety, or trauma, there is something more intuitive and liberating about communicating through music. Some find the combination of group therapy and drumming effective as it brings more contemporary approaches to mental health together with creative and non-judgemental expression of emotions.

Alongside the plethora of research on the effects of music on the brain, studies have found that drumming offers numerous health benefits. For women dealing with eating disorders, children with autism, cancer patients, war veterans living with PTSD, individuals with anger management issues, people with addictions, and even Alzheimer’s patients, drumming offers physical and emotional benefits.

Music therapies are now available in many hospitals and in a variety of counselling settings. More informal drumming circles are becoming increasingly popular within corporate team building and stress management workshops.

In Diggins’ view, our modern and secular world needs meaningful rituals and ceremonial practices to support major transitions and to challenge individuals.

For many seeking the benefits of therapy, an hour spent creating music and an hour spent in therapeutic drumming is an hour well spent.

– Contributing Writer: Jana Vigor, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: <a href=”https://www.flickr.com/photos/hundreds/2831410776/“>max_thinks_sees</a>

This article was originally published on Psychology Today