Category: Depression

Is Online Treatment the Next Frontier for CBT?

Is Online Treatment the Next Frontier for CBT?

10Cognitive Behavioral Therapy, Depression, Featured news, Psychiatry, Therapy, Trauma December, 15

Source: Mark Anderson on Flickr

Social media have dramatically changed the way many of us connect with family and friends. Some are now proposing that online relationships, particularly online therapeutic relationships may revolutionize mental health services by giving people with limited access a viable alternative to traditional treatment approaches.

One of these online alternatives, iCBT (internet-based Cognitive Behavioural Therapy) was derived from the tenets of traditional CBT pioneered by psychiatrist Aaron Beck.

Both target automatic negative thoughts that people have about themselves, the world, and their future, thoughts considered to be central to disorders like depression and anxiety.

But unlike traditional CBT where clients and therapists regularly meet in person, iCBT requires individuals to keep a journal recording their state of mind on an ongoing basis. Clients are given cognitive exercises, and their progress is tracked remotely by a therapist who reads the self-reflective journals, with feedback provided by e-mail.

The approach is currently being tested for its effectiveness in treating Generalized Anxiety Disorder (GAD). Psychologist and online therapist Marlos Postel conceptualizes iCBT as an approach that combines the advantages of structured self-help materials with the expertise of a therapist who directs activities and encourages clients.

Research from the University of New South Wales in Australia reports promising results, including improvements in patients with GAD, even compared to face-to-face treatments, with therapeutic gains maintained over three years.

Notably, many argue that online treatments eliminate an important ingredient, the therapeutic relationship between clinician and client. Research on the importance of this clinical relationship, the working alliance, has consistently shown it to be the single largest factor in predicting outcome. A central element of psychotherapy, it fosters trust, collaborativeness, and therapeutic change.

And some argue that underlying a strong alliance is the ability to detect non-verbal cues and subtle shifts in emotion that a client may demonstrate during therapy. Psychologist Madalina Sucala and colleagues from Mount Sinai School of Medicine in New York found that these cues account for a greater proportion of psychotherapy outcome than does treatment modality.

Notably, a different study conducted by Sucala found e-therapy and face-to-face approaches equivalent in outcome, despite the absence of non-verbal cues in e-therapy.

These discrepancies led researchers Gerhard Anderssona and Erik Hedman to suspect that some aspects of e-therapy may foster a different type of alliance between therapist and client. In a recent study, they found that iCBT creates a strong emotional connection between client and therapist because the therapist has more time to critically reflect on clients’ cases. Similarly, the online interactions did not affect client perceptions of how much their therapist cared for them or how much they trusted the therapist.

And co-director of the eCentreClinic and psychologist Nickolai Titov, an advocate for e-therapy, lists a number of advantages of the approach in a recent report. He found that iCBT is less-expensive—often 20-40% the cost of traditional therapy—and presents a viable alternative for rural locations where therapists are less accessible. Titov also found that many people can benefit from the relative anonymity of iCBT, as a common barrier to seeking therapy is embarrassment and fear of disclosure.

Therapists using modalities other than CBT have also started to come online. Clinicians using behavioural, interpersonal, and emotion-focused approaches have also begun offering online treatments. Even psychodynamic psychotherapy, which is traditionally a long-term, relational form of counselling, has been adapted into online formats.

Still, face-to-face mental health treatments are far from being replaced. Just as older styles of therapy are used alongside newer ones, online therapy may represent a promising treatment option for those comfortable with the format.

– Sumeet Farwaha, 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

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

Avatar Therapy Shows Promise For Voice Hearers

Avatar Therapy Shows Promise For Voice Hearers

00Depression, Featured news, Happiness, Health, Identity, Therapy October, 15

Source: Surian Soosay/Flickr

Auditory hallucinations are difficult to treat.  People show a wide range of response to antipsychotics.  And, the medications are associated with negative side effects. Psychological treatments like cognitive behavioral therapy (CBT) may help one cope with hearing voices, but they are usually not effective in quieting them or reducing their frequency.

An alternative method for voice hearers is a new computer–based approach called Avatar Therapy, developed at the University College London (UCL) by Emeritus Professor Julian Leff and his research team.

Avatar Therapy works as a collaborative process.  With the therapist, the patient constructs a digital representation of the face and voice that best suits one of their heard voices.  The therapist speaks as if they are one of the patient’s persecutors, and this speech is synced with the movement of the avatar’s lips, allowing for the patient to confront a simulation of their auditory hallucination in real time.

Patients have the opportunity to enter into a dialogue with their voices and learn how to gradually take control of the hallucinations.  By giving invisible and often menacing entities a face, these experiences can become easier to confront.  The therapeutic process allows for a safe space where the patient may practice  standing up to their voices in preparation for when they occur.

While research into Avatar therapy’s efficacy is limited to one pilot study, the results show promise.  After engaging 17 patients (who had not responded to medications) in up to seven 30 minute sessions of the therapy, patients experienced a significant reduction in the frequency and intensity of auditory hallucinations.

Also noteworthy is the abrupt cessation of voices in three of the patients who reported having experienced auditory hallucinations for 16, 13, and 3.5 years.  A follow up with these patients confirmed this cessation had continued three months after the pilot study. Patients also experienced a decrease in depression and suicidal thinking; encouraging results, since depression is often seen in cases of schizophrenia, and 1 in 10 of those diagnosed attempt suicide.

Patients were also given an MP3 recording of the conversations with their avatar from all the therapy sessions.  They were encouraged to listen to the recordings whenever they were feeling harassed by the voices.  This may have also contributed to their continued improvement.

Despite these preliminary results, Leff and his team caution that this approach may not be for everyone.  The study began with 26 patients, 9 of which dropped out.  The researchers attribute this drop out rate to the fear instilled in the patients by their voices and the threats uttered by them.

If this treatment is to have any effect, the patient must first be able to exercise a certain degree of tolerance over the voices, and be willing to manage the distress they produce. That said, another obstacle Leff and his colleagues face is working on ways to help patients develop stress management skills, so that more individuals may benefit from this approach.

The method may even open doors for further innovations in treatments for voice hearers, approaches that venture towards listening, understanding, and confronting one’s voices rather than suppressing them.

– Pavan Brar, 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

After a Stillbirth, Interpersonal Support Facilitates Coping

After a Stillbirth, Interpersonal Support Facilitates Coping

00Caregiving, Depression, Featured news, Grief, Health, Parenting, Resilience October, 15

Source: Judit Klein on Flickr

Over 2 million babies are stillborn every year worldwide, resulting from a genetic or physical defect, an illness suffered by the mother, or problems with the umbilical cord. In more than one quarter of cases, no cause can be determined.

In a recent interview with The Trauma & Mental Health Report, Heather, a mother and mature student shared her experiences surrounding stillbirth and commented on the services provided for families.

I chose to name my baby Benjamin.  I didn’t return to work after I got the ultrasound results and eventually I resigned.  I didn’t want to face the office, or their sympathy.

Immediately after a stillbirth, parents are offered various services to help manage their grief.

I was given a private room for the induction – an artificially stimulated labour – and received options for grief counselling and the services of priests and rabbis at the hospital.  We had him cremated, and the tiny basket of ashes was buried on my grandmother’s grave.  My husband and I also received genetic counselling to try to find the cause of the loss.

Parents of stillborn children have the option to see, touch, or hold their baby.  Memories that validate their experiences as parents can be created through handprints or footprints, pictures, or keeping locks of hair.  It can be overwhelming to make these decisions while coping with the reality that your child is gone, but these options may help parents make sense of their grief.

I was 21 weeks pregnant, so I was already making plans, thinking of names, and my daughter was looking forward to having a sibling.  I also looked physically pregnant… I was ready to have a baby, and in a fleeting moment he was gone.  It was so hard to move forward after that, and it was hard to reach out for help.

Interactions with hospital staff following the death of the child may influence how parents cope.  A 2013 study by Soo Downe, an associate professor at the University of Central Lancashire, found that parents believed there was only one chance to create an environment conducive to coping.  This means that positive memories and outcomes following a stillbirth depend as much on caring attitudes and behaviors of staff as on high-quality clinical procedures.

When interactions with hospital staff did not create a supportive environment, parents became distressed, which added to their grief and affected their ability to manage their jobs, family life, and mental health.  This additional stress can ultimately impact couples’ willingness to seek help.  When these interactions were more compassionate, parents were more likely to have positive, healing memories that aided their psychosocial recovery.

It is also common for parents to develop poor coping strategies, and to adjust differently after the loss of a child. Those who do not seek out services because of shame, fear, or anger tend to suffer in silence. A study by social worker Joanne Cacciatore, Faculty Associate at Arizona State University, shows that women who attend a support group develop fewer post-traumatic stress symptoms than those who do not.

Opening up to other bereaved mothers is helpful for reducing grief and other mental health difficulties.  Partners may also find reaching out to religious or spiritual leaders, funeral homes, and support groups helpful.  Online resources like blogging can also be useful for parents looking to connect in an anonymous way.

Heather was lucky to have the support and experience of the women in her family, which played a critical role in how she managed her grief.

I was grateful that my mother came out to stay with me during the termination.  Talking with her helped.  Other family members also began opening up for the first time about their experiences with miscarriage and stillbirth.  I didn’t feel so alone.

Some organizations are working to educate marital partners on coping styles and seeking out support.  The International Stillbirth Alliance works to improve stillbirth prevention and bereavement care for those who have lost a child.  Although they do not provide individual services, they work with other organizations to connect locally and globally to improve standards of care.

Women who have had a stillbirth can benefit from bereavement services and support of their loved ones.  Those who suffer in silence will likely do so much longer than they have to.

– Danielle Tremblay, 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

Rehabilitation Benefits Young Offenders

Rehabilitation Benefits Young Offenders

00Anger, Depression, Featured news, Health, Law and Crime, Punishment, Trauma September, 15

Source: Kim Silerio/Flickr

“We are seeing far too many young offenders entering the adult system who should be dealt with in the juvenile system,” says public defender, Gordon Weekes, in a short documentary published in April 2014, by Human Rights Watch.

With little support and a lack of rehabilitation resources available in adult facilities, young offenders prosecuted as adults are often faced with harsh protective and disciplinary measures like solitary confinement.

But, solitary confinement is just as common in juvenile correctional facilities. In 2013, an Ohio juvenile correctional facility placed a young boy in solitary confinement where he spent 1,964 hours in isolation. Referred to as K.R. in court documents, his longest period of seclusion was 19 consecutive days.

Although declining, in the 1980s through the mid-1990s, serious and violent juvenile crimes were on the rise, raising concerns about whether to subject young offenders to longer prison sentences and the same legal proceedings as adults. In 2011, Human Rights Watch (HRW) and the American Civil Liberties Union estimated that more than 95,000 youth were held in prisons, most of these facilities using solitary confinement.

A 2012 HRW report states that solitary confinement is often used to punish young people for misbehavior, to isolate children if dangerous, to separate children vulnerable to abuse from others, and for medical reasons (including suicidal ideation).

Yet, research shows that solitary confinement can cause serious psychological and developmental harm to children, and can have a detrimental effect on one’s ability to rehabilitate.

In the HRW report, adolescents indicated a range of mental health difficulties during their time in solitary confinement. Thoughts of suicide and self-harm were common. Several participants even described that their requests for mental health care were not taken seriously.

Kyle B., a participant of the HRW study recalled:

“The loneliness made me depressed and the depression caused me to be angry, leading to a desire to displace the agony by hurting others. I felt an inner pain not of this world… I allowed the pain that was inflicted upon [me] from my isolation placement to build up. And at the first opportunity of release (whether I was being released from isolation or receiving a cell-mate) I erupted like a volcano.”

According to researchers at the 2014 Advancing Science Serving Society annual meeting, prisoners kept in isolation lose touch with reality, and can develop identity disorders after spending long hours without social interaction. It can also be damaging to individuals with pre-existing mental illnesses or past childhood trauma.

Incarcerated adolescents who have been accused or found guilty of crimes can be extremely difficult to work with.  UN Special Rapporteur on torture, Juan E. Méndez, advises that “solitary confinement should be used only in very exceptional circumstances, for as short a time as possible.”

The US Supreme Court has consistently emphasized the importance of treating young people in the criminal justice system with special constitutional protections regarding punishment. Since solitary confinement is physically and mentally harmful to adolescents, many are calling for reform.

The HRW report suggests alternatives to solitary confinement to foster rehabilitation. They suggest increasing the number of trained supervised staff in facilities, like social workers and other mental health professionals. Providing adolescents with programs and activities in groups may help with development and rehabilitation. The HRW also emphasizes rewarding positive behaviours instead of punishing bad ones.

Research has also linked the role of education to improved behaviour and lower rates of delinquency among incarcerated youth.

Along with appropriate mental health care, education may improve rehabilitation efforts and assist youth in productive re-entry into their communities.

– Khadija Bint Misbah, 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

Taboo of Male Rape Keeps Victims Silent

Taboo of Male Rape Keeps Victims Silent

00Depression, Featured news, Friends, Gender, Post-Traumatic Stress Disorder, Sex, Stress June, 15

Source: Mitchell Joyce/Flickr

“My name is Will, and I think rape is hilarious…when it happens to a dude,” begins the monologue in a recently posted video written and performed by actor, Andrew Bailey. In this powerful mostly-satirical piece, Bailey opens discussion about how male sexual assaults are brushed off. “A male can’t be raped because he must have wanted it.”

Rape can and does happen to men. Approximately 1 in 6 men have experienced some form of sexual abuse as children, and 1 in 33 American men are reportedly survivors of attempted or completed rape.

And these statistics are likely an under-representation. According toRAINN, an anti-sexual violence organization, about 60% of all sexual assaults are not reported to police.

Although women are more likely to be sexually assaulted, Western notion of masculinity and gender have made it difficult to view men as victims of abuse. Men are often expected to welcome sexual advances, not view them as unwanted, rendering them less able to identify a sexual assault when it occurs to them.

“Male survivors may be less likely to identify what happened to them as abuse or assault because of the general idea that men always want sex,” Jennifer Marsh, the vice president for Victim Services at RAINN told CNN.

A further challenge is the widely-held view that physical strength makes men incapable of being overpowered or assaulted. James Landrith, a sexual assault survivor, spoke to CNN: “We [men] are conditioned to believe that we cannot be victimized.”

But, a research study led by Janice Du Mont from the University of Toronto, reported that male victims are often drugged prior to assault. While the assailant is usually male, female aggressors who violently sexually abuse male victims are not uncommon.

After an assault, the victim often feels troubled by his inability to protect himself, questioning his masculinity, feeling that a sense of control has been taken from him. They may also feel ashamed about the incident, making them reluctant to speak out. In fact, 71% of adult sexual assault survivors hold the view that “nobody would believe me” as a reason for not reporting the incident.

Many report receiving little to no support from family and friends, as they often fear disclosing the abuse. In an interview with theDepartment of Justice Canada, a male sexual assault victim recounts, “no one knew about it, so I just felt very alone, and I didn’t communicate any of that.”

“All the guys would laugh at me about it,” Bailey says in his monologue. Uncomfortable disclosing the reality of the experience, Bailey’s character gives in to rape humour, to fit in with friends. “I was like ‘psych’, I totally did enjoy it; then they high-fived me and told me I was cool.” Indeed, it is not unusual for male victims to fear rejection and harassment from others. Many keep silent.

Victims also report a complex range of emotional difficulties: isolation, anger, sadness, shame, guilt, and fear. Post-traumatic stress disorder (PTSD), major depression and anxiety disorders are also common among victims.

Raising awareness and encouraging male survivors to reach out for support may be challenging, but education regarding sexual abuse and demystifying misconceptions surrounding rape is essential to help male survivors heal.

In research by the Department of Justice Canada, survivors suggested raising awareness through campaigns to better inform male survivors about available resources.

A recent UK initiative created a £500,000 fund for male victims of sexual abuse, bringing considerable public attention to the issue. The UK Ministry of Justice began an international social media campaign using the hash-tag #breakthesilence to end stigma and raise awareness.

Duncan Craig of Survivors Manchester, a survivor-led/survivor-run organization states, “In the future I would like to see both the government and society begin talking more openly about boys and men as victims and see us trying to make a positive change to pulling down those barriers that stop boys and men from speaking up.”

– Khadija Bint Misbah, 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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Treatments Available to Long Term Abduction Victims

10Animal Behavior, Cognition, Depression, Dreaming, Family Dynamics, Featured news, Health, Parenting, Psychiatry, Psychoanalysis, Sleep, Stress, Therapy, Trauma April, 15

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Between 2002 and 2004, 16-year-old Amanda Berry, 21-year-old Michelle Knight, and 14-year-old Georgina DeJesus were abducted from the streets of Cleveland, Ohio. They were lured into the home of Ariel Castro where they spent the next 11 years in captivity.

Often kept in restraints and locked rooms, the women regularly had their lives threatened to deter any plans of escape.  They were given little food or the opportunity to bathe. Sexual abuse led to Knight being impregnated several times, only to be beaten and starved in order to force miscarriage.  It wasn’t until May 2013 that the women were finally rescued and Castro arrested.

Other cases popularized by the media include that of Elizabeth Smart, held captive for 9 months, and Jaycee Dugard who was held captive for 18 years. These victims are now free, but living with the emotional aftermath.

In a 2000 study by the Department of Neurological and Psychiatric Sciences at the University of Padova, interviews with kidnap victims showed common after-effects of abduction including vivid flashbacks of the events, nightmares, and feelings of depression, all common symptoms of Post-Traumatic Stress Disorder.  Hypervigilance was also reported, where individuals anticipated danger and frequently felt guarded, leading to trouble sleeping, eating, and social withdrawal due to difficulty trusting others.

Mental health professors David A. Alexander and Susan Klein, from the Aberdeen Centre for Trauma Research in the UK also add that some victims end up “shutting off’ their emotions or denying that they even experienced a traumatic event, which may stem from a desire to avoid anything that reminds them of their trauma.

How does someone this traumatized even begin to recover?  Clinicians who work with these victims help them find opportunities to make their own decisions, to slowly understand that they are no longer powerless.

Clinical psychologist Rebecca Bailey, therapist to Jaycee Dugard, is the author of, “Safe Kids, Smart Parents: What Parents Need to Know to Keep Their Children Safe.” In an interview with the Trauma and Mental Health Report, Bailey explained: “Number one is helping victims find their voice.  When you’ve been kidnapped, so much of your world is about having choices made for you…From day one you have to give them choices for everything, Do you want a glass of milk, or do you want a glass of water? Things like that.”

Another important aspect to recovery is the role of the family.  It is through a strong connection with the family that the victim can feel safe, comforted, and empowered.  Bailey mentions “tribal meetings” with families soon after rescue to reunify both parties and create a support system. Through these family systems, further recovery is possible.

Specific therapeutic approaches for victim recovery really depend on the individual.  In some cases Cognitive Behavioural Therapy can be used, in other cases experiential therapy or a more psychodynamic approach can be implemented.  Common techniques used in therapy with kidnapping victims are role-playing, therapeutic pets, music, or even walking through the wilderness in an attempt to trigger underlying feelings that must be dealt with.

Often, different therapies are combined to see which works best for the individual. Bailey reminds, however, that client interaction with the therapist also has a large impact on recovery.

Bailey: The most important thing is for the therapist to be mindful, authentic, and purposeful. Counterproductive would be having a therapist who says very little.  This could almost reinjure [the victim] because they need a certain amount of modelling as well.

Modelling how to have an authentic healthy relationship—after the abusive one they had with their abductor—is crucial to helping the victim integrate aspects of normal everyday life.

Still, even with proper therapy and a strong support system, the trauma of being abducted and held captive for years is unlikely to be erased.  In the case of the young women in Cleveland, along with many others, the journey to recovery has been a challenging one, but one that has been described as worth taking:

“I may have been through hell and back, but I am strong enough to walk through hell with a smile on my face and my head held high,” says Michelle Knight in a YouTube video addressed to the public.  “I will not let the situation define who I am.  I will define the situation.”

– Contributing Writer: Anjali Wisnarama, 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

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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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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State of Emergency: Suicide in First Nations Communities

00Addiction, Anger, Depression, Education, Featured news, Grief, Health, Identity, Politics, Post-Traumatic Stress Disorder, Spirituality, Suicide, Trauma December, 14

On April 17th 2013, Chief Peter Moonias declared a state of emergency in the community of Neskantaga. Two suicides within days of each other are only the most recent in a string of sudden deaths that have ravaged the group. 

In the four months prior, seven people died, four of them from suicide, and twenty more made suicide attempts. In a community as small and remote as Neskantaga (the reserve is home to 300 people and is only accessible by plane), the residents are tight-knit. And the losses of their family members, friends and neighbours have left many struggling to cope.

Suicide is disturbingly common among some Inuit and First Nations groups, with the rate in some communities eleven times higher than the Canadian average. Overall, First Nations peoples have a suicide rate twice the norm in Canada, a statistic that has been stable for at least three decades.

Colonization of the Americas has had a profound effect on Indigenous populations. In the centuries since first contact, 90% of the American Indigenous population has been wiped out due to plagues, warfare, and forced relocations. The legacy of land seizures and residential schools still haunts these groups.

The immediate survivors of these incidents would undoubtedly be traumatized, but many of the people who have committed suicide in recent years were not personally exposed. How can trauma inflicted centuries ago have an impact on current suicide rates?

The answer lies in the concept of historical or collective trauma, which Maria Yellow Horse Brave Heart, Associate Professor at the University of New Mexico, defines as “cumulative emotional and psychological wounding over the lifespan, and across generations, emanating from massive group trauma experiences.”

Also known as generational grief, the trauma results from suffering profound losses in areas such as culture and identity, without resolution. Unresolved, deep seated emotions like sadness, anger and grief are passed on from generation to generation through parental practices, relations with others and culture-wide belief systems.

In everyday life, the trauma manifests itself through social problems like drug use, familial abuse and violence. These events can cause traumas of their own and result in depression and PTSD, both of which increase suicide attempts.

Young people are especially at risk. In the cohort of 15-24, the rate of completed suicides is five to seven times the national (Canadian) average, and suicide attempts are even more frequent 

Chris Moonias (no relation to Chief Peter Moonias), an emergency response worker in Neskantaga, told the CBC that since the end of 2012, “We average about ten suicide attempts per month, and at one time we surpassed thirty attempts in one month.”

In addition to unresolved grief, Cynthia Howard of Laurentian University identifies several factors that contribute to suicides in Aboriginal communities. These include: attendance at residential schools and abuse experiences there, forced assimilation, displacement, and adoptions. These experiences have left legitimate feelings of distrust towards dominant American and Canadian cultures and feelings of loss of culture.

Some people also feel strung between two cultures (dominant culture and their own band’s culture) while essentially belonging to neither. Feeling alienated and lacking a sense of belonging can leave many people depressed and feeling that their lives lack a sense of purpose.

Other issues such as low socioeconomic status and extreme poverty, along with low levels of education and lack of opportunity have lead to feelings of hopelessness and helplessness.

“Learned helplessness” occurs when a group or individual, usually after a series of disastrous events, believes they have no control over the outcome of any situation, and that perceived failures in the present will likely continue into the future. Without hope, people sometimes feel that living is worse than not living. This feeling is only exacerbated by a shared history of trauma and its consequences, and can culminate in suicide.

Unfortunately, many people suffering do not receive adequate help. Their families and friends are also left without professional support, continuing the cycle of unresolved grief.

Perhaps it is fitting that Chief Moonias of Neskantaga called a state of emergency. His community has reached a tipping point and must be healed in order to move forward. 

As of now, the federal Canadian government has offered some monetary and human aid, but unless we go beyond band-aid solutions, frequent suicides and their consequences will continue to haunt Neskantaga.

– Contributing Writer: Jennifer Parlee, 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/kittysfotos/6235090832/”>Kitty Terwolbeck</a

This article was originally published on Psychology Today