Category: Anxiety

Brain Trauma, feature2

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

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Book Review: Becoming Trauma Informed

00Addiction, Anxiety, Child Development, Cognition, Empathy, Environment, Featured news, Health, Leadership, Parenting, Psychopharmacology, Race and Ethnicity, Stress, Therapy, Trauma, Treatment December, 14

Red, and your heart starts to race. Red, and your palms sweat. Red, and the sounds around you blur together. Imagine becoming emotionally aroused or distressed at the sight of simple stimuli, like the colour red, without knowing why.

Because triggers like this can take the form of harmless, everyday stimuli, trauma survivors are often unaware of them and the distress they cause in their lives. And clinicians who practice without the benefit of a trauma-informed lens are less able to help clients make the connection.

To address this and other concerns, researchers Nancy Poole and Lorraine Greaves in conjunction with the Centre for Addiction and Mental Health (CAMH) in Toronto recently published Becoming Trauma Informed, a book focused on the need for service providers working in the substance abuse and mental health fields to practice using a trauma informed lens.

Becoming Trauma Informed provides insight into the experiences, effects, and complexity of treating individuals who have a history of trauma. Without a clear understanding of the effect traumatic experiences have on development, it is challenging for practitioners to make important connections in diagnosis and treatment.

The authors describe how someone who self-harms may be diagnosed with bipolar disorder, possibly insufficiently treated with only medication and behaviour management. But using a trauma informed lens, the practitioner would more likely identify the self-harming patient as using a coping mechanism common to trauma survivors, giving rise to trauma informed care.

Such care involves helping survivors recognize their emotions as reactions to trauma. And helping clients discover the connection between their traumatic experiences and their emotional reactions can reduce feelings of distress. 

Throughout the text, the authors describe an array of treatment options, pointing to ways they can be put into practice; for example, motivational interviewing to provide guidance during sensitive conversations, cognitive behavioural therapy for trauma and psychosis, and body centred interventions to allow clients to make connections between the mind and body, an approach that has become increasingly popular in recent years. 

Importantly, the authors emphasize that a single approach to trauma-informed care is unrealistic and insufficient. While all treatments should include sensitivity, compassion, and a trusting relationship between therapist and client, specific groups require unique approaches. 

The authors devote chapters to specific groups, including men, women, parents and children involved with child welfare, those with developmental disabilities, and refugees. They outline different approaches necessary for trauma informed care in various contexts, such as when working in outpatient treatment settings, in the treatment of families, and when working with women on inpatient units, where treatment requires sensitivity to both the individual’s lived experiences and environment

A unique and compelling feature of this book is the focus on reducing risk of re-traumatization, an often neglected topic. Responding to the need for trauma survivors to feel safe, the authors outline how trauma informed care minimizes the use of restraints and seclusion (practices that can be re-traumatizing), and they offer ways to reduce the risk of re-traumatization by placing trauma survivors in less threatening situations, where they are less likely to feel dominated. This may involve matching female clients to female therapists or support groups comprised of only females. 

The numerous case studies help illustrate specific scenarios, challenges, and outcomes of trauma informed care and highlight the growing recognition of the link between substance abuse, mental illness and traumatic experiences.

While the text is theoretically grounded, the authors convey information in a way that is accessible to wider audiences. It provides critical information for those working in the field by underscoring the relationship between past experiences and current functioning.

Becoming Trauma Informed delivers a deeply informative look into the field of trauma therapy.

– 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: https://www.flickr.com/photos/auntiep/4450279893/

This article was originally published on Psychology Today

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U.S. Government Fails to Support Families of Hostage Victims

00Anger, Anxiety, Appetite, Ethics and Morality, Featured news, Parenting, Politics, Post-Traumatic Stress Disorder, Resilience, Sleep, Stress, Teamwork, Trauma November, 14

On August 19, 2014, a YouTube video of American journalist James Foley’s beheading was released by the terrorist organization ISIS (Islamic State in Iraq and Syria). Weeks later, two more videos were released, showing the execution of American journalist Steven Sotloff and British aid worker David Haines. Each victim was taken hostage years ago and ransom demands for their release were directed at their families in the months prior to their deaths.

But their families faced more than the pain of watching their loved ones die. The US government pressured relatives of hostages to do nothing to help.

According to Sotloff’s parents, a member of President Obama’s National Security Council threatened the family with criminal prosecution if they attempted to pay a ransom to ISIS for Sotloff’s release. A similar conversation was held with Foley’s family.

The US government emphasizes that they do not negotiate with terrorist organizations. But is threatening the families of hostages justifiable?

Families in hostage situations feel powerless, especially when information about their loved one is scarce. Government officials exacerbate this sense of powerlessness. Along with initial anxiety, feelings of isolation, loss of appetite, and trouble sleeping, families of hostage victims who are denied the ability to intervene are more likely to develop long-term conditions like Post-Traumatic Stress Disorder and Generalized Anxiety Disorder.

Furthermore, the US government may actually be stepping outside of its own legislation by forcing victims’ families into inaction.

According to an FBI report from April 2014 that discusses the protocol for helping families in overseas hostage situations, the ideal scenario is very different from what took place. The report states that a highly experienced operational psychologist should be put on the case to help the victim’s families by providing them with a sense of hope. 

“We [should] let them know there are people actively working to recover their family member and that we aren’t giving up”, says Carl Dickens, an operational psychologist with the FBI. In addition to emotional support, families should also be provided with temporary living accommodations and emergency expenses. 

When asked if they felt the US government gave them adequate support, the Sotloffs responded, “Not at all. We never really believed that the administration was doing anything to help us.”

The British government has also stood strong on their position to not pay ransom money to terrorist organizations. But the Haines family was never threatened. Despite their anger toward the law, friends and family of Haines did not experience the same pressure their American counterparts faced. “The government and foreign office did their best,” said Mike Haines, brother of the fallen aid worker, “we have complete satisfaction with what they did. We felt very much part of the team.”

The White House has denied all accounts of threatening the Sotloff and Foley families. Yet the Obama administration has become more attentive to families of the latest overseas hostages and the latest victim, Peter Kassig. The famiy of an unidentified female aid worker who is presently being held hostage by ISIS recently had personal meetings with Obama to discuss the situation.

This is an important step towards finding a balance between respecting victims of terrorists and protecting the public good. But in the meantime, where the government has failed, the families of victims are trying to help others like them. Foley’s parents are establishing an organization to aid families of overseas hostage victims through counselling and support. The James W. Foley Legacy Fund will help build a resource center for families of American hostages and foster a global dialogue on government policies in hostage crises.

– Contributing Writer: Alessandro Perri, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: https://www.flickr.com/photos/babasteve/4705515039/

This article was originally published on Psychology Today

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Fear of Ebola Leaves Orphaned Children Abandoned

00Anxiety, Child Development, Cognition, Deception, Diet, Fear, Featured news, Grief, Health, Parenting, Politics, Post-Traumatic Stress Disorder, Sleep, Stress, Teamwork, Trauma October, 14

13-year-old Jennette’s (name changed by UNICEF) grandmother died from Ebola. Shortly after attending the funeral, Jennette began to feel sick. When fever developed, she was taken to a local treatment center along with her mother and sister. All three family members tested positive for Ebola. Against all odds, they were successfully treated and released.

Jennette broke down in tears as she spoke about her experience as a victim of Ebola to Timothy La Rose, a Communication Specialist with UNICEF Guinea. Despite being healthy again, Jennette could not feel good about her recovery, now facing the stigma of being an ‘Ebola contact’.

“I cannot return home [to] my aunt who threatened me a lot when I was sick. So far she has never asked about my fate.”

The WHO (World Health Organization) estimates Ebola fatality rates between 25 and 90 percent. Passed on through contact with the bodily fluids of an infected person, symptoms are gruesome and can include internal and external bleeding. Currently, there are no approved vaccines, and the 2014 outbreaks in Guinea, Liberia, and Sierra Leone have created immense fear among those living in affected regions. Even in the United States, by October 2014 a handful of cases have quickly led to panic in some regions.

Jennette is only one of the many children facing the consequences of neglect due to the distrust surrounding Ebola survivors. UNICEF estimates that about 3,700 children have lost one or both parents to the current outbreak.

UNICEF’s regional director for West and Central Africa, Manuel Fontaine, said, “these children urgently need special attention and support; yet many of them feel unwanted and even abandoned.”

After surviving Ebola or losing a family member to the virus, these children are being shunned by surviving relatives due to fear of reinfection. “Orphans are usually taken in by a member of the extended family, but in some communities, the fear surrounding Ebola is becoming stronger than family ties,” Fontaine told CNN.

Orphans—some as young as two years old—are in the streets alone, lacking proper shelter, healthcare, and nutrition. Many of these children have undergone extreme trauma. Some have spent weeks in isolation wards without caregivers or proper mental healthcare. The New York Times reported a gut-wrenching scene:

In the next ward, a 4-year-old girl lay on the floor in urine, motionless, bleeding from her mouth, her eyes open. A corpse lay in the corner — a young woman, legs akimbo, who had died overnight. A small child stood on a cot watching as the team took the body away, stepping around a little boy lying immobile next to black buckets of vomit. They sprayed the body and the little girl on the floor with chlorine as they left.

Surviving children must also struggle with the grief of losing parents and siblings. “The hardest part of the job is telling parents their children have died or separating children from their parents,” Malcolm Hugo, a psychologist working in Sierra Leone, told the Guardian.

Many children are displaying symptoms of Post-Traumatic Stress Disorder, a condition that may develop after exposure to trauma. Intense grief, changes in eating and sleeping patterns, and extreme cognitive impairment are being reported in children who are most affected. Symptoms of depression and anxiety are also common.

The WHO reports that the most severely affected countries, Guinea, Sierra Leone, and Liberia lack resources to help those affected by the outbreak.

Many humanitarian aid agencies like Doctors Without Borders have sent physicians and healthcare workers to help in the treatment and containment of the disease. However, very little psychological or medical help is available for orphaned survivors. UNICEF has appealed for $200 million to provide emergency assistance to affected families but has only received a quarter of the amount so far.

Currently, the organization is looking at unique ways to provide emotional support. In Liberia, they are working with the government to train mental health and social workers. UNICEF will also be working with Ebola survivors who are now immune to the disease to provide support to children quarantined in health centres.

In a statement to Al Jazeera, Fontaine explained, “Ebola is turning a basic human reaction like comforting a sick child into a potential death sentence.” Further work needs to be done to abolish the harmful distrust surrounding Ebola survivors, and strengthen family and community support. Without this support, orphaned children face a harsh and unwarranted emotional toll, alone.

– Contributing Writer: Khadija Bint Misbah, 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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No Place to Be a Child

00Anxiety, Child Development, Cognition, Depression, Education, Empathy, Environment, Featured news, Grief, Health, Meditation, Resilience, Social Life, Stress, Therapy, Trauma, Treatment October, 14

“If we are to teach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children” – Mahatma Gandhi

Over 18 million children are currently living in regions affected by war. While most humanitarian aid groups focus on meeting the basic physical needs of these children, in the midst of armed conflict, cognitive, social and emotional development is often inhibited and overshadowed by regional chaos.

Exposed to violent, traumatic and stressful situations that threaten their sense of stability and well-being, children have few places to simply be children, where they can play, learn and socialize safely. And few resources are in place to help them heal from the psychological burdens of war.

As the need for rehabilitative and restorative measures gains greater recognition by the international community, a growing number of child rights advocates, organizations and researchers are stepping forward to understand the implementation of psychologically therapeutic programs for war-affected children. The challenge is in figuring out what is needed, what is available and what will work across a variety of cultures, contexts and settings.

Seeking to bring psychological care on a tight budget, academics and policy advisors have emphasized evidence-based programs. Theresa Betancourt, professor and director of the research program on children and global adversity at Harvard’s school of public health, and her colleagues are evaluating the effectiveness of child trauma programs based in countries such as Uganda, Sierra Leone, Chechnya, Gaza, Sudan, Kosovo, Bosnia and Croatia.

Individual therapeutic interventions such as trauma focused therapy and narrative exposure therapy have shown promise among children affected by war and are approved by UNICEF as preferred techniques.

Group interventions have been used to accommodate the psycho-social needs of a greater number of children. These include Interpersonal group therapy for depression, creative play, mother-child psycho-education and support, and torture group psychotherapy with cognitive behavioural techniques.

Some other psycho-social initiatives have focused on the creation of Child Friendly Spaces (CFS’s) and Temporary Learning Centers (TLC’s) within refugee camp settings or local communities. These provide a child-centered environment for play, basic education and socialization; and they identify children in psychological distress.

But some concerns have been noted. The focus on trauma can lead to community stigmatization. In addition, these therapies are hard to carry out on a large scale due to the high costs of employing highly-trained professionals. Individualized services are rare and reserved for severely distressed children, usually demobilized child soldiers.

Problems arise when trying to apply western definitions and measures of distress that are not necessarily applicable to other cultures and contexts. And in understanding any given child’s psychological functioning, it is important to factor in ongoing stressful events and the social dynamics that a war-affected child must deal with on a daily basis.

There has been a movement away from a traditional western “clinical treatment” model toward a more inclusive, holistic framework of “psycho-social intervention,” termed to reflect the complex interplay between a child’s psychological and social development.

More effective group interventions for children have tended to be those that involve a school setting, address everyday stressors, utilize a form of trauma/grief-focused psychotherapy or use mind-body relaxation and coping techniques such as meditation, biofeedback and guided imagery.

Benefits include decreases in posttraumatic stress disorder, improved coping skills, and greater psychological relief and psycho-social adjustment.

Still, universal, comprehensive, culturally-sensitive psychological services for war-affected children remain a long way off. For more information on mobile psycho-social and education programs for war-affected children, please check out The Freedom to Thrive Foundation. Email FreedomToThriveFoundation@gmail.com to find out how you can get involved.

– Contributing Writer: Adriana Wilson, 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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To Share or Not to Share (the Family Bed)

00Alcohol, Anxiety, Appetite, Attachment, Child Development, Empathy, Featured news, Health, Parenting, Sleep, Smoking October, 14

Some of the most common questions posed to parents of newborns, particularly by other parents, relate to sleeping patterns. Choices around sleep can be personal and sometimes controversial.

In western cultures, it is normal to put infants in different rooms. But in much of the rest of the world, the baby either sleeps with parents (bed-sharing) or in close proximity to the parent (co-sleeping).

These differing traditions often present a dilemma to parents in western societies who hear opposing points of view when seeking advice.

James McKenna, professor of anthropology at the University of Notre Dame considers that despite the dominant view (no bed-sharing), parents increasingly are opting for co-sleeping or bed-sharing. In fact, half of U.S. parents with infants bed-share with their children during at least part of the night.

This is especially true for breastfeeding mothers as co-sleeping can make night-time feeding easier to manage. It is thought by many that co-sleeping while breastfeeding results in the mother being more in-tune with the infant’s immediate hunger needs and as a result, the infant quickly learns that their needs can be satisfied. This contributes to the development of secure attachment

According to the American Academy of Pediatrics and Academy of Breastfeeding Medicine, mothers should sleep in close proximity to their baby not only to help facilitate breastfeeding but also to improve the survival rate of the developing infant. 

McKenna also indicates that from an anthropological viewpoint the proximity and sensory touch associated with bed-sharing induces positive behavioural and physiological changes in the infant. Studies have found long-term benefits of bed-sharing or co-sleeping. For example, children who bed-shared were found to have less anxiety and a higher level of comfort in social situations later on.

Traditional western medical views on bed-sharing tend to be rather negative. Based on the Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada, the main reason cited is the threat of sudden infant death syndrome (SIDS).

The Joint statement defines SIDS as, “the sudden death of an infant less than one year of age, which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, an examination of the death scene, and a review of the clinical history.”

Because it is difficult to distinguish specific causes of death that occurred during sleep, in many SIDS cases the cause may be cited as “unintentional suffocation due to overlaying,” which may be used to discourage bed-sharing.

Yet in many of the studies where infant deaths are discussed, parental smoking, alcohol consumption and unsafe sleeping practices are often major factors, as opposed to bed-sharing per se. Understanding preventative measures and safe sleeping practices can help reduce the incidence of SIDS.

Further, some research has found a strong link between breastfeeding and lowered risk of SIDS. Fern Hauck of the University of Virginia reviewed 18 studies that looked at the relationship between these two variables and found that babies exclusively breastfed had a 70% lower risk of SIDS, and the risk is lowered further the longer breastfeeding continues. Researchers attribute this lowered risk to infants being able to awaken more easily, reducing the risk of sudden death.

Daniel Flanders, pediatrician at North York General Hospital in Toronto, states that as a physician he follows the guidelines for the prevention of SIDS, but feels that strong recommendations against bed-sharing undermine parental choice on how to raise one’s child. He notes that in non-westernized communities bed-sharing is often a major part of the cultural practice of child rearing, and therefore his approach is to present the most relevant and up-to-date information available so the parent can make an informed decision.

There are several measures one can take to reduce the risks associated with bed-sharing. One of the most important things for the baby’s safe sleep is ensuring that the surface the infant sleeps on is firm, smooth and flat. Sheets should be tucked and never loose, whether the child sleeps with the parents, in a sidecar or in the crib.

If parents choose to bed-share there should be ample space for all, with both parents agreeing to the arrangement. The bed should not be shared with multiple children, especially if one or more are slightly older. Also, if the bed is raised off the floor there should be a mesh guardrail around the bed to prevent the baby from falling over. If the bed is against the wall, parents should ensure that there is no gap between the bed and the wall at all times.

Although bed-sharing is often discouraged by many in the medical community due to its association with an increased risk of SIDS, this does not mean that the practice is without benefit. Done safely, bed-sharing and co-sleeping offer unique opportunities for the development of closeness between parent and child.

Parents must choose the arrangement that works best for them and their families. For more information: Safe Sleeping Practices for Infants

– Contributing Writer: Saqina Abedi, 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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Dr. Mom and Dad

00ADHD, Anxiety, Attention, Child Development, Depression, Environment, Featured news, Health, Intelligence, Leadership, Motivation, Parenting, Psychiatry, Psychopharmacology, Self-Control, Sleep September, 14

We live in a world of self-diagnosis. With access to online medical databases like WebMD and kidshealth.org, it is easy to type symptoms into Google, find a diagnosis and present findings to the family physician.

Self-diagnosis may seem harmless, but it can become problematic when we diagnose ourselves or our children with more complicated conditions, behavioral disorders like Attention Deficit Hyperactivity Disorder (ADHD).

The over-diagnosis of ADHD and the over-prescription of medications like Ritalin, Adderall, and Vyvanse (to name a few) have been longstanding problems in the health care community. Clinical psychologists Silvia Schneider, Jurgen Margraf, and Katrin Bruchmuller, on faculty at the University of Bochum and the University of Basel found that mental health workers such as psychiatrists tend to diagnose based on “a rule of thumb.” That is, children and adolescents -often males- are diagnosed with ADHD based on criteria such as “motoric restlessness, lack of concentration and impulsiveness,” rather than adhering to more comprehensive diagnostic criteria.

Parentsmotivation to get help for their child’s problems along with free access to online information may play a role in the over-diagnosis of ADHD.

A study by Anne Walsh, a professor of Nursing at Queensland University of Technology found that close to 43% of parents diagnosed and 33% treated their children’s health using online information. Of concern, 18% of parents actually altered their child’s professional health management to correspond with online information. Considering the questionable quality of some online health information, these numbers are worrisome.

Furthermore, as primary caregivers can sometimes be persuaded, it is possible that parental conviction of the child’s diagnosis may play a role in physician decisions to treat. With basic diagnostic criteria for ADHD readily available online, some parents may be quick to self-diagnose their “restless and impulsive child.”

“It sometimes happens that parents come to me convinced that their child has ADHD [based on their own research] and in many circumstances they are correct,” says Dan Flanders, a pediatrician practicing in Toronto, Canada.

 According to Flanders, there are certain traits that make a child more likely to be misdiagnosed with ADHD. “Children who have learning disabilities, hearing impairment, or visual impairment may be mistaken as having ADHD because it is harder for them to focus if they can’t see the blackboard, hear their teacher or if they simply cannot read their homework.”

Flanders adds that gifted children, children with anxiety or depression, and children with sleep disorders are commonly misdiagnosed with attention disorders. “Gifted children learn the class objectives after the first 10 minutes of a class whereas their classmates need the whole hour. For the remaining 50 minutes of class these children get bored, fidgety, distracted, and disruptive. The treatment for these children is to enrich their learning environment so that they are kept engaged by the additional school materials.”

Children with anxiety and depression can be misdiagnosed with ADHD because there may be an interference with a child’s ability to learn, focus, eat, sleep, and interact with others. For children with sleep disorders, “one of the most common presentations of sleep disorders is hyperactivity and an inability to focus during the day. Fix the sleep problem and the ADHD symptoms go away.”

It is, however, important to note that these disorders are not mutually exclusive of each other. “A child can have a learning disability, anxiety, and independent ADHD all at the same time.” 

While it is often beneficial for parents to consult online databases for background information, Flanders warns against relying solely on information found online because the information may not be up-to-date and cannot replace a thorough psychological assessment.

Why, then, do parents resort to this quick fix of information?

Walsh reported that parents use online health information for a range of reasons including feeling rushed and receiving limited general lifestyle guidance from their doctors.

Flanders points out that the doctor’s approach should always be to review the data honestly and objectively with parents and then openly present the treatment options available to them.

“The most important part of ADHD treatment is making sure of the diagnosis. There are so many children who are started on medication inappropriately. Throwing medication at the problem is not the answer unless the diagnosis is well established and the differential diagnoses have been exhausted.”

– Contributing Writer: Jana Vigour, 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