Category: Health

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In Long-Term Care, Patient-on-Patient Violence on the Rise

00Aging, Anger, Cognition, Dementia, Featured news, Health, Trauma November, 17

A January 2016 Vancouver Sun article reported on 16 seniors in British Columbia (BC) killed in the last 4 years from violence in long-term care facilities.

While the mention of violence in nursing homes conjures images of support workers abusing patients, these altercations actually took place between patients. In each case, either one or both of the people involved suffered from a severe cognitive disability.

In one case, Karl Otessen, who suffered from dementia, had experienced multiple outbursts in which he would attack staff or rip off his clothes. He was on medication, and behavioral strategies had been implemented by the nurses, yet Otessen’s final attack resulted in a fractured hip, and he later died from related complications.

This sort of violence by a patient is rarely premeditated, making it difficult to prevent. The Alzheimer’s Society describes dementia patients as having difficulty describing their needs, leading to frustration and aggression. And dementia often causes decreased inhibition, resulting in violent and unpredictable outbursts.

In an interview with Global News, Sara Kaur, a support worker at a long-term care center in Mississauga, said that “Conflict can be prevented by understanding dementia and a senior’s inability to communicate simple needs.” By understanding the causes and symptoms of a mental-health disorder, a long-term care facility employee has a better chance of resolving potentially violent situations in a productive manner.

Many facilities have reported that they are under-staffed and under-equipped. But an article from Healthy Debate Canada, a publication focusing on the Canadian health care system, notes that:

“While we need more staff in long term care, just establishing an arbitrary number for staffing ratio isn’t the solution; it’s equally important to look at how much time staff are able to spend directly with residents, and whether they have the training they need to provide quality care.”

In Otessen’s case, although nurses tried to use a number of behavioural techniques to calm him, if a specific mental-health treatment plan had been in place, it’s possible that his violent behavior would have been reduced or eliminated entirely.

The Ontario Long Term Care Association, which examines progressive practices for long-term care homes, has suggested the use of specialized teams of nurses and support workers who are trained in identifying the triggers that lead to aggression in dementia patients. After identifying those triggers, the goal is to then create a solution to address the issue and protect other patients.

Using specialized teams may reduce the burden on regular support workers while also addressing the mental health needs of patients in an individualized manner. It is not enough to issue facility-wide policy changes to address behavioural issues when their causes vary from case to case.

The issue of patient-on-patient violence won’t be resolved without further attention. In Canada alone, there are currently over 750,000 individuals living with dementia, a number projected to double in 15 years. The growing elderly population must be considered when implementing budgetary and training changes to long-term care facilities.

–Andrei Nistor, 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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Expressing the Inner Voice May Bring Benefits

00Cognition, Featured news, Health, Optimism, Self-Help, Self-Talk November, 17

Source: geralt at Pixabay, Public Domain

An app called Dragon Anywhere allows people to talk to their smart phone with no word or time limits. Talking out loud with a piece of technology is socially acceptable these days, but what about when no one or no thing is listening?

Many associate hearing voices or talking to oneself with mental illnesses like schizophrenia. And because these behaviours deviate from the norm, they make people uncomfortable.

But might there be benefits to expressing inner voices out loud?

James McConnell, an American biologist and animal psychologist, has said that talking to oneself is psychologically healthy. And neuroscientist Jill Bolte Taylor, in her book My Stroke of Insight, argues that speaking out loud makes the mind more focused, and even calls it “a powerful instrument”.

In an article in The Quarterly Journal of Experimental Psychology, Gary Lupyan and Daniel Swingley discuss the functions of talking to oneself, also known as self-directed speech. Compared to thinking about a word (e.g., chair), hearing a word out loud can make us better visual detectors of that word in our surroundings. Speaking facilitates the search. This phenomenon is called the label feedback hypothesis.

It is unclear, however, whether the label feedback hypothesis can be applied to broader concepts like happiness. Can happiness literally be spoken into existence?

Proponents of positive affirmations think so, noting the benefits of repeating positive statements directed toward oneself. A study at the University of California, Los Angeles, showed that students who repeated positive affirmations produced fewer stress hormones. And another study published in the Personality and Social Psychology Bulletin by a team of researchers from Columbia, Berkeley, and Google found positive self-affirmations help those in low-power positions perform better.

Self-talk has other benefits as well. In a PsychCentral piece, Talking to Yourself: A Sign of Sanity, psychologist Linda Sapadin notes that giving voice to our goals focuses attention, controls emotions, and keeps distractions away.

In fact, this may be the best way for some individuals to get organized. While a number of people are visual learners, using calendars and to-do lists, it may be that others do better by simply speaking out loud.

Matt Duczeminski explains in his book 6 Benefits of Talking to Yourself (No, You’re Not Crazy) that talking through your thoughts helps distinguish big tasks from smaller ones, for example, getting organized by talking through a to-do list.

But not all self-talk is useful. In fact, talking about our failures and putting ourselves down can be quite harmful. As Sapadin puts it, “That kind of self-talk is worse than no talk at all.” And it can lead to a self-fulfilling prophecy, where we view ourselves negatively and act accordingly, attracting others who reinforce those beliefs.

The link between negative self-talk and depression is also quite strong. In fact, those who engage in more negative self-talk experience more stress and inferior health, both psychologically and physically. Language and cognition expert, Steven Hayes, says negative thoughts are like passengers in the backseat of the car you’re driving. You hear them, but your focus should be on the task ahead.

Another way of coping with negative self-talk is by giving your negative voice a name. Brené Brown, author of the New York Times Bestsellers The Gifts of Imperfection and Daring Greatly, calls her inner critic ‘The Gremlin’, making light of the little voice inside her head.

So… if you’ll listen to yourself, keep talking.

But be kind to you.

–Marjan Khanjani, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Social Media Societies Pose Risks to Mental Health

00Anorexia Nervosa, Featured news, Health, Media, Self-Harm, Self-Help, Social Life, Social Networking November, 17

Source: IraEm at Pixabay, Creative Commons

The internet is rife with social media societies on many popular sites, including Twitter, Instagram, and Tumblr. #Ana, #Sue, #Cat—translated, they mean anorexia, suicidal, and self-harm.

By searching these tags, online users are exposed to a slew of posts from people experiencing the mental illnesses or issues tagged. On Instagram you can find pictures of users with fresh cuts on their arms accompanied by the hashtag #Cat, indicating self-harm.

A study by Janis Whitlock, Jane Powers, and John Eckenrode at Cornell University found that the self-injury-related message boards studied were mostly frequented by females between the ages of 14 and 20.

With so many young people accessing social media, membership to these online communities can be concerning. In an interview with Vice, Frank Köhnlein, a youth psychiatrist at the University Clinic in Basel, discussed how young members are particularly vulnerable:

“Young people who are already fragile and perhaps already have experience with self-harm could be massively stimulated by this sort of thing and encouraged to self-harm again. When self-harm is glorified or—as in this case—put into an almost religious context, so that it is evaluated positively, the risk is particularly high.”

The Whitlock study showed that online interactions can reduce social isolation in adolescents since the exchanges allow teenagers to connect with others easily. In essence, social media can serve as a virtual support group where users gain instant help.

But negative implications may outweigh the positive. Whitlock also found that participating in self-harm message boards online can normalize and encourage self-harm, and teach vulnerable individuals tactics to conceal self-injurious behaviors. Users within these virtual sub-communities often exchange techniques for self-harming as well.

A study by Carla Zdanow and Bianca Wright at the Department of Journalism, Media, and Philosophy at the Nelson Mandela Metropolitan University looked at user statements in two Emo Facebook groups. They found that cutting was discussed often, with teenagers openly expressing affirmative opinions of these behaviors.

Sites like Instagram are aware of the precarious environment their users have created. When searching for tags like #Sue, a “Content Advisory” warning comes up reading, “Please be advised: These posts may contain graphic content. For information and support with suicide or self-harm please tap on Learn More.” The notice displays a link to Befrienders Worldwide, a site that provides emotional support to prevent suicide. Users can then choose to view posts or navigate away from their original search.

Instagram outlines the types of photos and videos that are “appropriate” for posting in their Community Guidelines, specifically singling out eating disorders, and self-injury as not welcome in the community.

Megan Moreno at the Seattle Children’s Research Institute and colleagues conducted a study where they found 10 hashtags on Instagram related to non-suicidal self-injury (NSSI). A popular image outlining the code words for mental illnesses titled #MySecretFamily had over 1.5 million search results. Only one-third of the NSSI related hashtags generated content advisory warnings, which means that the majority of this NSSI content is easily accessible to all Instagram users, regardless of age or mental stability.

In an interview with A Stark Reality, a 15-year-old girl from Denmark, whose name was changed to protect her identity, described her relationship with this online community:

“The community means that I can express myself, and talk to people all over the world that feel the same way. Sometimes we cheer each other up, other times we drag each other down in that big, black hole called sadness.”

For better or worse, people reach out to online communities. But sites like Instagram and Twitter can play a greater role in providing their users with mental health resources and accurate information.

Abbiramy Sharvendiran, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Medicating women’s sexual desire still highly controversial

00Featured news, Health, Integrative Medicine, Low Sexual Desire, Meditation, Psychopharmacology, Sex November, 17

Source: Minjung Gang at flickr, Creative Commons

On August 18, 2015, the U.S. Food and Drug Administration (FDA) approved Flibanserin, a drug that treats low sexual desire in women.

With the medication’s presence on the market, you’d think that low sexual desire in women would be well understood. In fact, there is still widespread debate on the issue. Marta Meana, a psychologist at the University of Nevada, writes:

“Desire is the most subjective and acutely amorphous component of sexuality.”

And Lori A. Brotto, a Professor of Gynecology at the University of British Columbia, offers a similar view, explaining:

“There is no clear consensus on the causes of sexual dysfunction in women.”

While women experience obstacles to fulfillment, the causes are complex. According to Brotto:

“An abundance of data indicates that low sexual desire is strongly influenced by a woman’s relationship satisfaction, mood, self-esteem, and body image.”

Medication is, at best, a partial treatment for problems with desire.

There are also differing perspectives on proper terminology around the issue. In an interview with the Trauma and Mental Health Report, Kristen Mark, Director of the Sexual Health Promotion Lab at the University of Kentucky, said:

“Sexual dysfunction may not be the most accurate way to describe low sexual desire. Women may experience sexual problems, but sexual desire ebbs and flows, so people should expect that it will fluctuate.”

Deciding between the word “dysfunction” or “problem” may seem trivial. But language creates meaning, and shapes how health professionals treat clients and conduct research.

Other clinicians agree. Leonore Tiefer, Associate Professor at the New York University School of Medicine, offers two metaphors for sex. The first is digestion. In this metaphor, sex is “just there”. Like digestion, it does not require learning, but is a natural or innate action that the body is equipped for at birth.

The other metaphor is dance. There are many ways to dance. Some people are better at dancing, and some people like dancing more than others. Tiefer argues that sex, like dance, is a learned skill.

Tiefer has advocated extensively against pharmaceutical interventions for female sexual problems. In 2000, she convened The New View Campaign, a collective of clinicians and social scientists dedicated to reframing the conversation around sexuality.

In a 2006 article on disease mongering, Tiefer explains why a purely biological approach to sexual health is inadequate:

“A long history of social and political control of sexual expression created reservoirs of shame and ignorance that make it difficult for many people to understand sexual satisfaction or cope with sexual problems.”

To emphasize that sex has a social context, the New View wrote an alternative system of classification for sexual problems. The first category is “sexual problems due to socio-cultural, political, or economic factors”, and the second is, “problems relating to partner and relationship”.

These categories includes specific causative factors, such as “ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints.”

According to Tiefer:

“Popular culture has greatly inflated public expectations about sexual function. People are fed a myth that sex is “natural”—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, they are likely to look for simple solutions.”

The drug Flibanserin is one of these ‘simple solutions’. Its approval has been met with controversy.

According to Loes Jaspers and colleagues at Erasmus University Medical Center, the effectiveness of Flibanserin is very low. In a meta-analysis examining the effect of the medication in about 6000 women, Jaspers found that those receiving the drug experienced, on average, only 0.5 more “sexually satisfying” events per month compared to those receiving a placebo.

At the same time, it carries a black label, which the FDA assigns to drugs that include serious side effects. For Flibanserin, these include sedation and fatigue. When combined with alcohol and other common drugs, it can cause dangerously low blood pressure and fainting.

And non-medical treatments, such as mindfulness-based sex therapy, can be effective for treating low sexual desire. According to Brotto, mindfulness shifts attention away from negative, self-defeating thoughts, and towards sensation and pleasure.

Mark, however, thinks that hope should not be abandoned for a medical solution. She says:

“At this point, I would not recommend Flibanserin for most women coping with desire problems. There may be a medication in the future that meets women’s needs when used in conjunction with other approaches, but this just isn’t it.”

Whether women’s sexual problems should be medically treated is still debatable. But what is clear is that social and cultural factors shaping women’s sexual experiences should not be bypassed for a quick solution.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Police Need Training to Deal With Mentally Ill Offenders

00Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Psychiatry, Psychopathy, Stress October, 17

Source: Free Images at Pixabay

On March 4, 2016, Devon LaFleur, a 30-year-old struggling with bipolar disorder, went missing. His father contacted law enforcement to notify police of his son’s mental illness and tendency towards violence. After learning that LaFleur had allegedly robbed a bank and was on the run, Toronto police tracked down and fatally shot the young man during a confrontation.

In many instances where mental illness is concerned, police officers respond too quickly with force. In an analysis conducted by The Washington Post, American officers shot 124 people who showed some sign of mental or emotional distress in 2015.

The Post explains that, for the majority of these crimes, the police were not called for reports of criminal activity. As in LaFleur’s case, police were contacted by “relatives, neighbors or other bystanders worried that a mentally fragile person was behaving erratically.”

An article by psychiatry professor Richard Lamb and colleagues at the University of Southern California reports that police officers are authorized to transport individuals with mental illness for psychiatric evaluation when there is reason to believe that they pose a danger or threat. But the researchers also state that this responsibility turns officers into ‘street-corner psychiatrists’ without giving them the training they need to make on-the-spot decisions about mentally ill offenders.

An article published in Criminal Justice Review by Teresa LaGrange shows that “higher educated police officers recognize a broader range of disorders” and they are more likely to “view the situation as requiring a professional intervention.”

However, LaGrange also recognizes that instead of teaching practical skills like learning how to identify individuals with mental-health conditions, many educational workshops only consist of general descriptions about psychological terms and concepts.

Police officers need to know how to handle individuals who display different types of mental illnesses. The Washington Post analysis states that the most extreme cases of mentally ill people causing a disturbance were schizophrenic individuals and those who displayed suicidal tendencies or had some form of post-traumatic stress disorder (PTSD).

In some states, crisis intervention team training (CIT) is being implemented to help officers identify mental illness and determine the best course of action.

CIT consists of a 40-hour training program for police forces that educates officers on mental-health issues and medications and teaches about mental-health services in the local community. CIT also teaches methods that help de-escalate heated situations by encouraging officers to allow vulnerable individuals to vent their frustrations—methods that could have been useful in LaFleur’s case to reduce the risk of violence from both the police and offender.

So far, this program has been considered effective by the police departments using it.

Major Sam Cochran of the Memphis police department, a retired officer and a coordinator of the CIT program, emphasizes that law enforcement should partner with local mental-health agencies: “If communities give attention only to law enforcement, you will fail as a training program. You cannot separate the two.”

Although the task of identifying mentally ill individuals can be daunting, these training programs are a step toward preventing injustices for individuals like LaFleur. Providing officers with appropriate training not only improves the ability to handle job stress but may also provide mentally ill offenders with a chance to receive treatment.

–Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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When a Sibling Dies by Suicide

00Depression, Family Dynamics, Featured news, Grief, Health, Suicide October, 17

Source: Clair Graubner and Clair Graubner at flicker, Creative Commons

“As far back as I can remember, Michael was always good at being silly. He could make me laugh harder than anyone. He was very creative, and always had a good ear for music.”

In an interview with the Trauma and Mental Health Report, Samantha (names changed for anonymity) shared her experiences living through the suicide of her older brother, Michael, when she was sixteen years old.

Michael’s battle with mental illness began as a teen. He struggled with low self-esteem and clinical depression, and consequently self-medicated.

“After my parentsdivorce, his mental health took a turn for the worse. He was always getting stoned and was generally depressed… After he took LSD with his friend, he was never the same. He was in a psychotic, suicidal state from the drug, so my parents took him to a mental hospital one night… He stayed in the hospital for a week, and was moved to a rehab facility to learn coping skills to become less dependent on marijuana. He was in an extremely dark place during his stay there, and came home in September to start school. He committed suicide on October 15, 2007.”

Samantha’s experience is not uncommon. Suicide is the second leading cause of death for young people aged 15 to 34. And according to a report published by the National Institute of Mental Health, depression and substance abuse (often in combination with other mental disorders) are common risk factors for suicide.

“Words could never express how I felt when I found out. I fell to the ground in absolute hysterics. It’s such an out-of-body memory for me… to go from having an older brother and having visions of our future together, to then in a second having all of that taken away from you.”

Samantha also experienced dissociative thoughts after her brother’s suicide.

“I remember thinking that maybe we were being ‘punk’d’, and that this was all part of a twisted social experiment to show the devastating effects suicide has on a family. That probably lasted a year or so in order to protect my brain from feeling too deeply and to help me focus on other things, like getting into college.”

Samantha began using marijuana and alcohol regularly to numb feelings of anger and loss. Her transition to college was challenging—she had difficulty balancing school work with partying, and often felt isolated.

“I felt like I couldn’t relate to most of my peers, and was extremely lonely. I was always getting high by myself, and reflecting on the past. While all of this was going on, my dad got remarried and had a baby during my freshman year of college. It was really hard for me to watch him start a new family while I was still grieving the loss of our old family.”

Samantha’s decision to self-medicate to deal with her unresolved grief is common among adolescents who lack strong social support.

“I think about Michael every day… but finally I have the relationships and living environment to really dig deep and process what I’ve been through. Yoga and meditation have also played a huge part in my healing process, as well as hula hoop dancing.”

In fact, yoga and meditation can help the healing process. Research by psychology professor Stefan Hofmann and colleagues at Boston University describes the benefits of mindfulness meditation for anxiety and mood symptoms. In their meta-analysis of 39 research studies, individuals who practiced mindfulness meditation experienced reduced anxiety, grief, and depressive symptoms.

Everyone grieves in their own way, and moving on doesn’t have to mean leaving the loved one’s memory behind. As for Samantha: “Michael continues to live on with all of those who knew him.”

–Lauren Goldberg, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Wearing Cancer Survival Like a Badge of Honor

00Featured news, Grief, Health, Positive Psychology, Relationships, Resilience October, 17

Source: eKBS at DeviantArt, Creative Commons

“I have stage 3 cancer; my friend has stage 1—which is like a pimple.”

On her personal blog, Debbie Woodbury, a woman diagnosed with Stage 0 cancer, references this comment by a fellow cancer patient. While she considers the comment hurtful, she is not particularly surprised.

Cancer prognoses vary, and there is large variation in survival between types and degrees of illness. Some are fortunate to survive without the sickening effects of chemotherapy, the fear of losing hair, or surgeries that leave patients bedridden for weeks. But people may also minimize their cancer journey, or be made to view their experiences as ‘lesser’.

Woodbury explains:

“Without a tumor and with a Stage 0 cancer diagnosis, I started this journey not even sure I was qualified to call myself a cancer patient.”

Similarly, Lesley Miller writes of her husband:

“I bought him a bold yellow shirt that said ‘survivor’ across the front. ‘Survivor,’ in his mind, is nothing to tell the world about. He didn’t do anything to claim survivor status; his body just had a treatable cancer that happened to respond to drugs.”

Just like that, degrees of illness become a competition, belittle personal struggles, and create segregation among patients and those in remission.

In January 2015, cancer survivor Cindy Finch posted an article in the Huffington Post entitled “The 6 Injustices of Cancer.” The article received a great deal of backlash for suggesting that certain cancer patients “get off really easy”. She claimed:

“I’ve heard it a hundred times, ‘I’m a cancer survivor, too.’ ‘Oh, really? What type of cancer did you have and what was your treatment?’ ‘Oh, I had thyroid cancer and had to take a radioactive pill for 30 days. Then I was all better.’”

Finch talks about individuals with ‘worse’ diagnoses:

“These folks represent the worst among us. If you’re not one of these folks, perhaps you should be quiet and sit down, and let someone else tell their war story.”

As if some cancer patients just aren’t macho enough. Attitudes like these have negative consequences on patient mental health.

Cancer patients often report feelings of guilt for surviving the illness. Survivor guilt is common among people who have gone through traumatic experiences, such as war, accidents, natural disasters, and interpersonal abuse. For Woodbury, not suffering enough throughout her cancer experience elicited guilt feelings.

Some individuals also consider themselves less deserving. Ann Silberman, a breast cancer survivor, writes in her personal blog:

“It was my belief that others deserved to live more than I did. Better people than me are now gone; people who were funnier, who were kinder, who had more to give.”

And then, of course, there are expectations people have of cancer patients: The image of the strong, inspirational individual, filled with gratitude for a second chance at life.

Silberman continues:

“I am still trudging along, bitching about how cold I am and slamming pain meds for my aches and pains.”

According to Crystal Park and colleagues at the University of Connecticut at Storrs, living through cancer results in the development of new identities that can define people for the rest of their lives. For those still in active treatment, the identity of patient or victim can develop, carrying the connotation of severe suffering inflicted on them. But for those who have survived such adversity, the most common identity was survivor, which carries the connotation of cure.

As cancer becomes an engrained aspect of an individual’s identity, it may be natural for those who suffered greatly to take pride in how much they overcame, indeed to try to silence others who have not experienced the same level of adversity.

But Woodbury takes umbrage at this view, noting:

“The truth is that cancer is not a competition and, just as I am enough, so is my cancer. I certainly did go through less than someone else might have gone through. Thank God for that. For that I should be grateful, not made to feel, by myself or anyone else, that I am guilty of not suffering enough to qualify in the cancer games.”

– Eleenor Abraham, 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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Trauma Exposure Linked to PTSD in 911 Dispatchers

00Featured news, Health, Post-Traumatic Stress Disorder, Therapy, Trauma, Work September, 17

Source: Public Domain at flickr

In February 2016, Gail—a 911 dispatcher with Toronto Paramedic Services—found herself in tears at work. She had just received a call about Wallace Passos, a three-year-old boy from Toronto, who fell from a 17-story apartment building to his death.

At age 57, Gail has been working as an Emergency Medical Dispatcher for 15 years. Taking calls from around the city, she dispatches the closest ambulance. All dispatchers are expected to work 12-hour shifts, at times with only one colleague on duty.

This past year, Gail’s job became especially difficult for her when she was diagnosed with Post Traumatic Stress Disorder (PTSD). Gail recently spoke with the Trauma and Mental Health Report to discuss the experience that led to the diagnosis:

“I’m still haunted by the sounds of the family crying on the phone after the three-year-old fell off the building. I imagine the boy in pain, and it’s just awful.”

Gail is not the first emergency dispatcher to experience PTSD symptoms. A study conducted by researchers at Northern Illinois University described how 911 dispatchers are exposed to duty-related trauma, which is defined as an indirect exposure to someone else’s traumatic experience. Duty-related trauma puts dispatchers at risk for developing PTSD. Participants in the study reported experiencing fear, helplessness, and horror in reaction to various calls they received.

Along with the stress of being on the receiving end of difficult calls, emergency dispatchers also deal with the pressure and demand of following protocol, despite variability in situations.

Toronto Paramedic Services follows specific protocols set by The National Academy of Dispatch. The system was developed at Salt Lake City, Utah in 1988 and incorporates a set of 33 protocols for those answering 911 emergency phone calls. On a call, everyone is treated equally and is asked the same basic investigative questions. These questions are then used to give priority to life-threatening situations and provide guidance to first responders like firefighters, paramedics, and police officers on the scene.

While the protocols can be useful for guiding dispatchers through stressful situations, in other circumstances, they can cause pain and discomfort when a dispatcher can tell that a situation is hopeless. Dispatchers are not trained to deal with each unique case differently; they are expected to follow through with the routine questions regardless of circumstances.

In the case of Wallace Passos, Gail had to give instructions for CPR despite knowing that the child was already dead.

“It’s not just that the little boy died, but I feel that I traumatized the people that were trying to help him because I was required, in my position as a dispatcher, to tell them what to do to try and save him. And I knew from their description that he was dead. But we have to follow the procedure; we have to try.”

This predicament is further compounded by the blame placed on dispatchers for negative outcomes. Gail explains:

“People curse us and call us names just because we’re doing our jobs.”

Before her diagnosis, Gail often found herself crying at work without reason; she would take a call regarding a minor injury and become emotional. Her supervisor eventually gave her permission to take a leave of absence.

Over the past few months she has had disruptive sleep, nightmares, headaches, and unexplainable muscle spasms:

“I am hyper-vigilant, especially when I hear sirens. And it doesn’t have to be an ambulance; it could be a police car or fire truck. I hear the sirens and I start tensing up and looking all around me.”

Gail has been on a year-long search for proper psychological support for her PTSD. Unfortunately, there are few mental health benefits offered to dispatchers. Gail sought help from doctors, counselors, and social workers, most of whom referred her to other mental healthcare workers without providing much support.

But there is reason to be optimistic. The Ontario government passed legislation in February 2016 for better mental health support and benefits for first responders with PTSD, including 911 dispatchers.

“It made me sad that no one was stepping up and taking care of us. I want my peers to understand what it’s like to have PTSD after doing this job because I felt so alone when it happened to me. But this new legislation is huge. I think it’s very important because it’s raising awareness around this concern.”

–Afifa Mahboob, Contributing Writer

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Using Mindfulness with Opioid Addicted Chronic Pain Patients

00Addiction, Chronic Pain, Featured news, Health, Mindfulness, Therapy, Therapy News August, 17

Source: frankieleon at flickr, Creative Commons

In March 2016, legislative bodies in Maine put a bill forward to combat the state’s rising opioid addiction problem. New restrictions on opioids for chronic pain require doctors to limit prescriptions to just 15 days, and to encourage doctors to consider non-medicinal forms of treatment.

Treatment of chronic pain involves a delicate balance between managing pain relief and risk of drug addiction or abuse. Opiates have been used for centuries to treat acute and chronic pain. There is little debate over the short-term benefits of medication, but their use for chronic, non-malignant pain is controversial.

Chronic pain is a debilitating lifelong illness, affecting more than six million Canadians. The National Institute of Health defines chronic pain as lasting for at least six months, and creating both physical and mental strain on the victim’s quality of life. Patients may experience fear, depression, hopelessness, and anxiety in coping with their pain.

At the annual 2013 American Psychiatric Association meeting, pain specialists debated how to properly treat chronic pain and explored new forms of non-medicinal treatment.

Jennifer Potter from the Department of Psychiatry at the University of Texas advocates continued use of opioid prescriptions, but cautions doctors to examine potential risk factors for substance abuse.

“The vast majority of people with chronic pain do not go on to develop an opioid addiction, so it’s important for patients to understand that if this medication benefits you, it’s not necessarily a concern. We can’t let our response to the rise in prescription drug abuse to be denying access to all people in pain who can benefit from opioids.”

But a 2015 study by Kevin Vowles and colleagues from the University of New Mexico found that, on average, 25% of chronic pain patients experience opioid misuse and 10% have an opioid addiction. So, we also need non-medicinal treatment options to care for lifelong pain.

“Patients with substance abuse issues can be treated for pain in a variety of ways that don’t involve opioids,” says Sean Mackey, Chief of the Pain Management Division at Stanford University and Associate Professor of Anaesthesia and Pain Management.

One alternative way to approach chronic pain is through mindfulness, described as the process of paying active, open attention to the present moment. When a person is mindful, they observe their own thoughts and feelings from a distance, without judging them as good or bad.

Mindfulness is based on acceptance of one’s current state, and is becoming increasingly popular among patients as a way to help with pain symptoms.

Jon Kabat-Zinn, founding Executive Director of the Center for Mindfulness at the University of Massachusetts, advocates for mindfulness-based strategies to be incorporated into chronic pain treatment programs.

Kabat-Zinn created the popular Mindfulness Based Stress Reduction approach designed to treat chronically ill patients responding poorly to medication. The eight-week stress reduction program involves both mindfulness practice and yoga, and is effective in alleviating pain and in decreasing mood disturbance and stress.

A study by Natalia Morone and colleagues at the VA Pittsburgh Healthcare System showed the benefits of mindfulness in older adults with chronic low back pain by looking at diary entries of participants throughout an eight-week mindfulness treatment program. They found that treatment improved attention, sleep, pain coping, and pain reduction through meditation.

Some participants gained better awareness of their body throughout treatment:

“It felt good to realize [through mindfulness] that I can co-exist with my pain. Being mindful helped me realize that in my angry reaction to my back pain, I was neglecting my whole body. I saw my body only through my pain, which caused me to hate my body over time. I can now see myself outside of my body, and am working day by day with my meditation to become a happier person living with chronic pain.”

The authors also found that practicing mindfulness helped participants create vivid imagery to enhance their mood and decrease pain. One patient noted:

“I hear a sound in the distance and felt it was bearing my pain away, replacing it with a joyful ‘lifting’ of my spirits.”

While no miracle treatment exists, mindfulness can help improve patient quality of life.

–Lauren Goldberg, 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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Barriers Prevent Soldiers From Seeking Psychological Help

00Featured news, Health, Post-Traumatic Stress Disorder, Psychopathy, Therapy, Trauma August, 17

After two tours of duty in Iraq, Sergeant Eric James of the United States Army returned home to Colorado where he began experiencing symptoms of Post-Traumatic Stress Disorder (PTSD).

James sought out a military psychiatrist for his declining mental health. In over 20 hours of recorded audio, therapists and officers at Fort Carson in Colorado can be heard berating James for suggesting he may be suffering from serious mental illness and ignoring his repeated requests for help. James was told that he was not emotionally crippled because he was “not in a corner rocking back and forth and drooling.”

James’ experience in seeking mental-health treatment may be indicative of a wider, systemic issue within the military. As pleas for help go unanswered, soldiers have begun to actively avoid mental health treatment, fearing consequences like forced retirement or reduced pay.

An article in the The Globe and Mail addressed one of these issues directly:

“Because Canadian Forces members do not earn a pension until they have served 10 years, this encourages some to wait until they’ve reached that milestone before asking the military for mental health counseling and other aid.”

Mental-health programs become inaccessible as soldiers are caught between a desire to seek out support and a fear of losing financial security, potentially losing their livelihood or living with declining mental health.

Worse, a 2012 Harvard Gazette report on the US Military stated that:

“Estimates of PTSD are higher when surveys are anonymous than when they are not anonymous.”

There may be consequences for soldiers who speak up about their mental health issues, and these consequences act as a barrier to seeking help.

It’s also possible that James’ case may be an example of the old “patch ’em up and send ’em back” approach to treating members of the military, whereby doctors and therapists devise a quick fix for physical and mental problems in an effort to get soldiers back into active duty.

Donald (name changed for anonymity), a current member of the Canadian Armed Forces, told the Trauma and Mental Health Report in an interview that painkillers and antidepressants are often prescribed in place of a more comprehensive approach to health concerns. These treatments address symptoms, but not the underlying causes.

Using medications to help sufferers of PTSD manage symptoms is an important aspect of treatment. But if supportive psychotherapy is provided either on its own or alongside drug therapy, the need for medications can be significantly decreased.

A study published with the American Psychiatric Association noted that:

“While treating PTSD with drug therapy has accumulated some empirical support, the Institute of Medicine rates trauma-focused cognitive behavioral therapy as the only first-level treatment for PTSD.”

And while proper treatment for PTSD is necessary, it can be expensive. An article from the LA Times reported a military estimate of treating PTSD to be $1.5 million over a soldier’s lifetime.

For James, after an internal investigation, he was ultimately sent for treatment and received a medical retirement with benefits. Many of our military personnel receive no treatment at all, leaving them to struggle with PTSD on their own.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.
–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller

This article was originally published on Psychology Today