Category: Health

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

Cosmetic Vaginal Surgery Ignores Women’s Mental Health

Cosmetic Vaginal Surgery Ignores Women’s Mental Health

00Body Image, Ethics and Morality, Featured news, Gender, Health, Media, Self-Esteem October, 15

Source: summerbl4ck/Flickr

“I just thought I was so different from everyone else that I wanted my vagina to be changed,” said 21-year-old, Rosie, during her interview for The Perfect Vagina, a 2008 documentary on vaginal reconstructive surgery.

Rosie received a labiaplasty to remove the skin of her labia minora (internal genitalia). While the operation is relatively simple, the risks include bleeding, infection, permanent scarring, nerve damage, and a painful three-month recovery.

David Matlock, a cosmetic surgeon and director of the Los Angeles Laser Vaginal Rejuvenation Institute pioneered the vaginal surgery market in Los Angeles. He claims he can create “the perfect vagina,” a promise that brings in about 12 million (USD) a year.

But researchers at the UCLA Center for the Study of Women believe the concept of a “perfect vagina” arises from consistent exposure to homogenous images of women’s genitalia.  Pornography, medical textbooks, and sex shops show a similar vagina that is pink, hairless, with only the labia majora (external genitalia) visible.  Even the popular women’s health and sexuality book Our Bodies Ourselves shows only one image of the vagina.  Yet, the appearance of the healthy vagina is highly variable.

Why are more women opting for vaginal reconstructive surgery?  John R. Miklos, director of Urogynecology and Reconstructive Vaginal Surgery at the Atlanta Medical Center, found that most of his patients (on average 35 years of age) pursue the labiaplasty to improve sexual function, or to reduce pain during intercourse.

Other reasons for labiaplasty include alleviating discomfort from clothing or exercise, pressure from male or female sexual partners, reducing shame from having large labia minora, and boosting self-esteem.  And many labiaplasty patients are dissatisfied with the appearance of their genitalia and have lower sexual satisfaction.

Cosmetic surgeons state that women have the right to make decisions about their bodies. The American Academy of Facial Plastic and Reconstructive Surgery reported that women are the highest consumers of cosmetic surgery. In 2013, they accounted for 80% of all surgical (rhinoplasty, chin implants) and non-surgical procedures (BOTOX).

But many researchers take issue with that idea, arguing that vaginal cosmetic surgery patients often struggle with mental health.

Labiaplasty becomes problematic when young girls and women are looking for a self-esteem boost, as the surgery does not necessarily result in a positive outcome.  And for women struggling with low self-esteem, when one body part gets “fixed,” the dissatisfaction may shift rapidly to another.  This ongoing pursuit may be reflected in depression, anxiety, and even plastic surgery addiction.

However, Bruce Allan, an obstetrician-gynecologist from Calgary, Alberta, considers his patients to be very “well-adjusted people,” stating that a woman getting a labiaplasty is the same as a bald man getting a hair transplant.

Scientists at the Centre for Appearance Research at the University of the West of England have developed a psychological screening tool for all cosmetic surgery patients.  And specifically for labiaplasty candidates, there is the genital appearance satisfaction scale.

According to The American Society for Aesthetic Plastic Surgeons, psychological evaluations are not a mandatory procedure. Yet, most cosmetic surgeons are aware of body dysmorphic disorder, a chronic psychological illness characterized by obsessive, negative thoughts about one’s body and real or imagined flaws in physical appearance.  If patients opting for this surgery are doing so because they are suffering from a mental illness, one may ask whether it is indeed ethical to proceed?

Cosmetic surgeons would do well to consider the patient’s age when it comes to vaginal reconstructive surgery.  Young girls may prioritize a “quick fix” without understanding the surgery’s invasiveness.

And with adequate training to administer psychological screening tools, cosmetic surgeons could identify which patients should speak to a mental health professional before signing up for a labiaplasty.

Perhaps labiaplasty candidates can be given the opportunity to consider taking another route to address underlying body image dissatisfaction.  Patients might be better off if their doctors started tackling the problem from the top-down.

– Shira Yufe, 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

LGBTQ Refugees Lack Mental Healthcare

LGBTQ Refugees Lack Mental Healthcare

00Featured news, Health, Law and Crime, Loneliness, Sexual Orientation, Stress, Trauma September, 15

Source: William Murphy/Flickr

In 2012, the Canadian government introduced cuts to the Interim Federal Health Program (IFHP), which provides health coverage for immigrants seeking refuge in Canada. Coverage was scaled back for vision and dental care, as well as prescription medication. At the same time, the introduction of Bill C-31, the Protecting Canada’s Immigration System Act, left refugees with zero coverage for counselling and mental health services.

The bill affects all refugees and immigrants, but individuals seeking asylum based on persecution for sexual orientation or gender identity have been hit especially hard by these cuts.

LGBTQ refugees are affected by psychological trauma stemming from sexual torture and violence aimed at ‘curing’ their sexual identity. Often alienated from family, they are more likely to be fleeing their country of origin alone, at risk for depression, substance abuse, and suicide.

On arrival in Canada, refugees struggle with the claim process itself, which has been cited by asylum seekers and mental health workers as a major source of stress for newcomers. For LGBTQ individuals, the process is even harder, having to come out and defend their orientation after a lifetime spent hiding and denying their identity.

In 2013, six Canadian provinces introduced individual programs to supplement coverage. The Ontario Temporary Health Program (OTHP) came into effect on January 1, 2014, and provides refugees and immigrants short-term and urgent health coverage. But it still lacks provisions for mental health services.

Envisioning Global LGBT Human Rights, an organization and research project out of York University in Toronto, has been collecting data from focus groups with LGBTQ refugee claimants both pre- and post-hearing. A recent report by lawyer and project member Rohan Sanjnani explains how the refugee healthcare system has failed. LGBTQ asylum seekers are human beings deserving respect, dignity, and right to life under the Canadian Charter of Rights and Freedoms. Sanjnani argues that IFHP cuts are unconstitutional and that refugees have been relegated to a healthcare standard well below that of the average Canadian.

Arguments like these have brought legal challenges, encouraging courts and policy makers to consider LGBTQ rights within the framework of global human rights.

In July of this year, Bill C-31 was struck down in a federal court as unconstitutional, but the government filed an appeal on September 22. Only if the appeal fails could immigrant healthcare be reinstated to include many of the benefits removed in 2012.

Reversing the cuts to IFHP funding would not solve the problem entirely. LGBTQ asylum seekers face the challenge of finding service providers who can deal with their specific needs. The personal accounts collected by Envisioning tell a story of missed opportunity, limited access to essential services, and ultimate disappointment.

In the last two years, programs have sprung up to address these special needs. In Toronto -one of the preferred havens for LGBTQ refugees- some health providers now offer free mental health services to refugees who lack coverage. Centers like Rainbow Health Ontario and Supporting Our Youth have programs to help refugees come out, and to assist with isolation from friends and family back home, and with adjusting to a new life in Canada.

Still, the need for services greatly outnumbers providers; and accessibility issues persist.

Organizations like Envisioning try to create change through legal channels, but public opinion on LGBTQ healthcare access needs to be onside for real change to occur. Recent World Pride events held in Toronto were a step in the right direction. But specialized training of healthcare professionals and public education would go a long way in providing the LGBTQ community with the care they need.

– Sarah Hall, 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

Probiotics May Help Alleviate Autism Symptoms

Probiotics May Help Alleviate Autism Symptoms

00Autism, Diet, Featured news, Genetics, Health, Therapy August, 15

Source: David Robert Bliwas/Flickr

Probiotics can be found in many foods, like yogurt, soups, and even pizza, and are often viewed as a “cure-all” –from improving digestive health and immune function, to lowering cholesterol levels.

Probiotics are live organisms that, when taken in adequate amounts, have the ability to quickly colonize the gastrointestinal track and increase the amount of beneficial microbes, creating a balance in the gut microbiota that is considered health enhancing.

Autism Spectrum Disorder (ASD) is a neurobiological condition that impairs children’s social and communicative functioning, and often presents in the first three years of life.  Many children with autism experience severe gastrointestinal problems, and the associated discomfort often worsens behavior.

Currently, there is no cure for autism, nor have any drugs been developed to treat symptoms.  And no screening test can determine if a child is at risk for autism.  The disorder can sometimes be detected in 18 month olds, but the majority are not diagnosed until much older.

Recently, California Institute of Technology researcher, Elaine Hsiao found that treating mice who exhibit autistic symptoms with probiotics can restore both gut barrier function and behavioural abnormalities.

In Hsiao’s study, researchers injected pregnant mice with a virus that enhanced anxiety, decreased ultrasonic vocalizations, increased gut barrier permeability, and shifted the gut micro flora in the offspring.  When the offspring were given a human strain of Bacteroides fragilis as a probiotic, the bacterial balance was restored, and autism-like behavioural symptoms were alleviated.

A serum metabolite called 4-ethylphenylsulfate, produced by some mice gut bacteria, was found to be elevated in the offspring of the autism model.  After the probiotic injection, this metabolite decreased to normal levels.  Furthermore, injecting 4-ethylphenylsulfate into normal mice produced symptoms of anxiety, suggesting that this metabolite, in combination with others, affects neural circuits linked to autism.

Neurologist  Natasha Campbell-McBride, formerly at Bashkir Medical University in Russia, reported that almost all mothers of autistic children have irregular gut flora. This is noteworthy since at the time of birth, newborns inherit gut flora from mothers. An analysis of the gut micro floras of healthy and autistic children revealed that gut micro flora in autistic children is of lower quantity and diversity.

Studies have shown that infants born by C-section develop dissimilar and less diverse micro flora than naturally born babies.  It seems passage through the birth canal has a positive effect on the infant’s gut bacteria and may play a preventative role in autism.

The percentage of women having C-sections in the U.S. has increased from 5-10% in 1965 to 32.8% today.  According to the Centers of Disease Control and Prevention (CDC), autism rates are also on the rise.  Fifteen years ago, 1 in 10,000 children were diagnosed with autism.  Ten years ago, 1 in 1,000.  Current statistics from the CDC report the figure as 1 in 50.

Taken orally, probiotics have been deemed safe and are well tolerated for use during pregnancy. The most common adverse side effects reported are bloating and flatulence, which typically subside with continued use.  It is still unclear which strain of probiotic may be most beneficial.

To date, the Food and Drug Administration (FDA) has not approved any specific probiotic health claims and the quantity of probiotics needed to be beneficial is still unclear.

Celebrities like Jenny McCarthy believe that symptoms of autism can be relieved by dietary changes.  McCarthy claims a strict wheat and dairy-free diet cured her son.  But anecdotal reports are of limited value, often reflecting the idiosyncratic opinions of influential individuals.

Large-scale clinical trials that study the effects of diet on those with autism are needed. In the meantime, anecdotal evidence is compelling and may eventually lead to definitive findings.

Shifting micro flora in the gut may make a potentially useful treatment for autism available.  The method may even make assessing a genetic predisposition to autism possible.

Research is still in its early phases.  Probiotics may improve digestive health, but the jury is still out on whether they can definitively reduce autism symptoms.

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

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

Copyright Robert T Muller

This article was originally published on Psychology Today

Trauma Workers At Risk for Compassion Fatigue

Trauma Workers At Risk for Compassion Fatigue

00Burnout, Empathy, Featured news, Health, Resilience, Self-Help, Trauma, Work July, 15

Source: Brian Walker/Flickr

The expectation of unending compassion for others is unrealistic. For trauma workers, hearing devastating stories can take its toll. This can be seen in detrimental effects to physical and emotional health; that is, a specific type of burnout called compassion fatigue.

The Trauma & Mental Health Report recently spoke with compassion fatigue specialist and director of Compassion Fatigue Solutions in Kingston, Ontario, Françoise Mathieu, to discuss the symptoms of the condition and how trauma workers can protect themselves from it.

Q: What is compassion fatigue?

A: It is a gradual shift and decline in an individual’s ability to feel empathy and compassion towards others. It is not an illness or disorder. Often, the term compassion fatigue is used interchangeably with vicarious trauma or secondary traumatic stress (STS), but there is a distinction.

STS refers to a traumatic, stressful experience without direct exposure to the trauma. STS results from hearing traumatic stories, like hearing witness testimonies or stories of torture. Over time, those stories can shift your view of the world to a tainted and jaded one, to the point where you lose the ability to experience joy. For example, people who work with victims of sexual trauma may have a hard time trusting babysitters or coaches. Vicarious trauma is the result of the accumulation of several STS experiences.

Q: Who is susceptible to compassion fatigue, vicarious trauma, and STS?

A: Helping professionals are the most susceptible. This typically includes physicians, nurses, mental health care workers, allied health professionals, therapists, clergy, law enforcement, teachers, long term care workers, and personal support workers.

The public can also start internalizing trauma from continuous exposure to graphic images portrayed by the media. Overexposure of the September 11th, 2001 terrorist attacks created a heightened sense of danger and paranoia. The difference is that the relationship helping professionals form with their clients is very unique: You become deeply vulnerable. When you’re opening your heart and listening to someone’s pain, it can be very intense.

Q: Are there any signs and symptoms of compassion fatigue?

A: A major warning sign is workaholism. Many helping professionals are so dedicated to their jobs that they don’t have a balance between their work and home lives. The more caring you are, the more vulnerable you are. We call it a “normal consequence” of doing a good job. Helping professionals may experience a decline in empathy, reduced collegiality, dreading client appointments, and belittling their stories.

Or, someone might be doing a great job at work, but they have nothing left to give at home. Warning signs are irritability, social isolation, emotional and physical exhaustion, or self-medicating with drugs, alcohol, or even excessive shopping.

Q: What can protect trauma workers?

A: With increased budget cuts, many trauma workers do not have adequate training, so Trauma Informed Training can be highly protective. Richard Harrison and Marvin Westwood, researchers from the University of British Columbia (UBC), studied experienced trauma therapists and found that those who connected spiritually or creatively with something outside their work and felt supported by their families and communities managed well with the stress of their jobs.

Establishing a deep therapeutic alliance characterized by a meaningful relationship with clients, based on presence and heartfelt concern, also provided professional satisfaction.

Q: What can a person with compassion fatigue do to alleviate symptoms?

A: We can’t prevent compassion fatigue, but there are strategies and tools for professionals to be able to feel grounded, present in the moment, and well trained. Ask yourself these questions:

–Do I work somewhere where I have control? Control over your schedule can reduce compassion fatigue. Small changes can make a big difference.

–Do I have a debriefing process that might relieve some of the emotional strain?

–Do I have access to supportive people whom I can consult with, when I hear difficult stories?

–Am I trained in trauma-related concepts, so that I have a better understanding of the side effects?

–Do I have a transition ritual, a way to leave work behind and transition into my home life? (e.g., yoga, exercise)

Last, research shows that the most effective strategy is Mindfulness-Based Stress Reduction, which recommends relaxation techniques to reduce stress and improve self-compassion.

Mathieu adds that even if you have your own past history of trauma, it doesn’t mean that you shouldn’t be a helping professional. In this case, it’s important to identify your triggers, ensure you have a support system, and that your caseload doesn’t remind you of your personal trauma.

Mathieu cautions the trauma worker to “pay equal attention to the needs of your client, and yourself.”

– By Shira Yufe, 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

Dysregulation: A New DSM Label for Childhood Rages

Dysregulation: A New DSM Label for Childhood Rages

00Anger, Child Development, Cognition, Featured news, Health, Parenting, Self-Control, Stress July, 15

Source: Mary Anne Enriquez/Flickr

With the many changes in the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), among the most significant has been the inclusion of Disruptive Mood Dysregulation Disorder (DMDD)—a direct response to the dramatic increase in the diagnosis of bipolar disorder in children and adolescents during the 1990s.

Diagnosing bipolar illness in children is considered elusive at best.  Characterized by extreme and distinct changes in mood, bipolar illness ranges from depressive symptoms to manic “highs.”  In younger populations, the shift between manic and depressive episodes is not so clear.

Children often experience abrupt mood swings, explosive and lengthy rages, impairment in judgment, impulsivity, and defiant behavior.  Such parent-reported symptoms became a popular basis for childhood bipolar disorder diagnoses.

In recent years, Ellen Leibenluft, a senior investigator at the National Institute of Mental Health and an associate professor at Georgetown University, developed the concept of “severe mood dysregulation” as distinct from bipolar disorder.  Her research highlights the difference between unusual intense rages, and the distinct mood swings in bipolar disorder.

Anchored in her research, the DSM-5 task force attempted to develop a new classification for a disorder that shared some characteristics with bipolar disorder but did not include the abrupt shifts in mood.  By doing so, the task force hopes the rate of diagnoses for bipolar disorder in children will decline.

The DSM-5 characterizes DMDD as severe recurrent temper outbursts that are “grossly out of proportion in intensity or duration” to the situation.  Temper outbursts occur at least 3 times per week and the mood between outbursts remains negative.  To separate DMDD from bipolar disorder, children must not experience manic symptoms such as feelings of grandiosity, and reduced need for sleep.

Differentiating between bipolar disorder symptoms and rages unrelated to mood swings may very well be a step in the right direction.

But some studies suggest that DMDD may not be all that distinct or useful as a diagnostic entity different from those already in use, such as oppositional defiant disorder or conduct disorder.  It may be that DMDD is not a condition of its own, but rather a primary symptom of a larger issue.  Irritability and rages may be an indication of a disorder already established in previous versions of the DSM.

Aside from diagnostic labels, taking social situations into account may lead to a sharper understanding of rages in children.

While the role of biology cannot be discounted in the development of mental disorders, childhood behavioral problems may be affected by social and economic circumstances. Financial hardships and other parental stresses have an effect on children’s mental well-being, and stress may be detrimental to the communication between the parent and child.

Along with biological conditions, the DSM task force should consider the impact of the child’s social experience.  Helena Hansen, assistant professor of psychiatry at the New York University School of Medicine, argues that the recent revisions in the DSM-5 have missed key social factors that trigger certain biological responses.  Her article, published in the journal Health Affair, emphasizes the importance of understanding how social and institutional circumstances influence the epidemiological distribution of disorders.

For example, differing temperaments can explain why some children appear to cope well with life stresses while others develop problem behaviors.  Lashing out in the form of rages and tantrums may be a natural response to intolerable anxiety and stress for some children.

As new terms for disorders are coined, such as DMDD, we need to ask if the development of another category is the best alternative.  Is substituting one label of childhood behavioral problems for another really our best option?

Due to the many possible causes for temper outbursts, giving the child a single label may not be all that helpful.  Instead, determining the core issues surrounding the rages may be more useful in providing the patient with an effective treatment plan.

Also, let’s keep in mind that mental disordersare simply constructs, not unique disease states.  They are developed to allow better understanding of a group of behavioral, emotional, and cognitive symptoms, and are regularly revised based on new research and changing cultural values.  While the DSM is useful for the purpose of understanding the challenges faced by patients, it should not be given “bible” status.

Along with mental health care providers, it is important for parents to get informed about DMDD, to ask questions, and to get involved in discussions when considering treatment options for their child.

– 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

The Changing Face of the Heroin Addict

The Changing Face of the Heroin Addict

00Addiction, Featured news, Health, Law and Crime May, 15

Source: Jonathan Silverberg / Flickr

Hollywood and much of the Western world was shocked by the sudden passing of actor Philip Seymour Hoffman in February of 2014.  Reports rapidly circulated that Hoffman, 46, was found dead from an overdose, with a needle in his arm and multiple bags of heroin nearby.  Described by the New York Times as “one of the most ambitious and widely admired stars of his generation,” Hoffman did not fit the stereotypical profile of a heroin user.

His death has brought an alarming pattern to light.  New heroin users are not necessarily troubled or poverty stricken persons from inner city environments.  Many are younger, “middle class,” and from rural or suburban areas.

Governor of Vermont, Peter Shumlin, gave an unprecedented “State of the State” address that focused exclusively on the massive surge of heroin abuse in his state.  Calling it a “full-blown heroin crisis,” Shumlin explained that heroin use in Vermont has increased over 770% in the past decade, with 4300 new addicts in 2012 alone.

Vermont is a small state known for its idyllic cottage country and rural areas.  Unlike neighbouring states New York and Massachusetts, it lacks the large urban sprawl usually associated with drug addiction.  Its unemployment rate is the seventh lowest in the country, and nearly everyone has some form of health insurance.

Fifteen years ago, Vermont saw a massive jump in the amount of OxyContin addictions across the state.  OxyContin is a powerful and highly addictive narcotic painkiller.  Its opiate effects quickly build a tolerance and produce a powerful, euphoria-inducing high.

Many of those who became addicted were middle and working class individuals who sought pain relief for a variety of injuries –some legitimate, others not.  Many now claim that doctors were over-prescribing and setting patients up for destructive drug addictions.

In 2010, North American pharmaceutical companies, in reaction to a strong push from anti-drug groups and legislators, replaced OxyContin with a new version that was supposed todeter drug abuse.  The newer drug, OxyNeo, is much harder to break up and becomes a gel-like substance in water, making it difficult for users to crush and snort or “cook” and inject.

Around the same time, new legislation was drafted to make access to OxyContin more difficult to obtain.  In Canada, the Narcotics Safety Act requires patients to show photo ID to both their prescribing doctors and pharmacists before they can have prescriptions written and filled.  This new legislation combined with OxyContin’s reformulation has made it increasingly difficult to get enough of the drug to feed an addiction.

OxyContin addicts are now turning to its cheaper and more easily accessible cousin, heroin.

Heroin is similar to OxyContin in that it’s part of the “opioid” family of drugs.  Both narcotics produce euphoria-like highs and many users seek its effects to temporarily numb both physical and emotional pain.  But the effects of heroin are much stronger and more destructive.

The initial “rush” felt by new heroin users is a more powerful high than that produced by OxyContin.  The user is often propelled to consume increasingly larger quantities of the drug in an attempt to replicate that high, placing them at risk of overdose.  It’s this pursuit that makes heroin so dangerous.  And when the drug is not available, the accompanying withdrawal symptoms are intense and can drastically alter mood and behaviour.

Street value and availability of heroin has also changed considerably.  Ten years ago, heroin was a very different product.  It was more expensive ($50-$150 a bag), less pure and difficult to find.  Now we are seeing a steady supply being sold, at a fraction of the cost, that is 3-4 times more pure –the current street price for a bag is $10-$30.

Not only has the drastic drop in street value made it more accessible, but its purity has made it more attractive.  Ten years ago, a bag of 2-3% heroin had to be cooked and injected to attain a powerful high.  New supplies with 7-10% purity can be smoked or snorted – similar to cocaine. This opens up a much wider group of users who shy away from using a needle.

While well intentioned, the steps taken by Canadian and American drug companies and legislators likely played a part in creating a potential heroin crisis affecting populations in ways and numbers like never before.

The new user is often young, educated, and for many readers of this article, more like you than you think.

– 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

A Contrast to Psychiatry: The ‘Hearing Voices’ Movement

A Contrast to Psychiatry: The ‘Hearing Voices’ Movement

00Conformity, Education, Featured news, Health, Identity, Psychiatry, Therapy May, 15

Source: Oiluj Samall Zeid / Flickr

The 1961 classic, The Myth of Mental Illness by Thomas Szasz, revolutionized the way we think about atypical mental phenomena.

And over the years, the diagnosis of schizophrenia has been criticized fervently, with some characterizing it as an umbrella term for separate psychological phenomena that vary in combination and severity from person to person.

Critics of the term have described the way experiences such as hearing voices are conceptualized and defined.  The International Hearing Voices Network (Intervoice) views hearing voices as a normal variation in human experience—albeit one of an unusual nature.

Representing a lesser known view within the field of mental health, the group encourages voice hearers to “accept that the voices are real, and to accept that the voices may have meaning (metaphoric or literal) based on one’s life experiences.”

In the interest of communicating different (and sometimes controversial) ideas in mental health, The Trauma & Mental Health Report recently spoke with a mental health nurse (who requested anonymity), whose current research examines voice-hearers’ narratives about their emotional experiences.  While not a member of Intervoice, the interviewee’s research represents an alternate approach to traditional psychiatry.

 Q:  Can you explain the structure and method of the narrative approach you are working on?

A:  Put at its most basic, I am following the method called ‘Dialogical Narrative Analysis’, outlined by Sociologist, Arthur Frank.  In my work, Dialogical Narrative Analysis examines the stories that voice-hearers have about their emotions and what those stories do for them.

Q:  How best do you think these experiences should be conceptualized if not as psychopathological?

A:  It would be best to ask those with the experience.  At the moment it seems as though they are greatly helped when they don’t dismiss their experiences as ‘illness’, but engage with them as meaningful.  Having seen the prolonged effects of both approaches over a number of years, I can say that it’s the voice-hearers and those with unshared beliefs [what we usually refer to as delusions] who clearly have the most to teach us.

Q:  Supporters of drug interventions often explain the use of pharmaceuticals for treatment as diminishing the occurrences of delusions or hallucination.  Can you comment on this way of thinking?

A:  It’s a normalizing practice; it seeks to return outliers to a normal.  I’m hardly the first to point out that what is considered normal is subject to extreme change.  This is how we get situations where persons and behaviours are rated as mad in one generation and acceptable in the next— like having a baby outside of marriage, or homosexuality.  This leads some in the Hearing Voices Movement to hope that what happened to the identity of being homosexual can happen to the identity of being a voice-hearer.

Q:  Does this point out a flaw in our cultural and scientific understanding of the meaning of ‘delusion’ and ‘hallucination’?

A:  The word ‘delusion’ is a judgment, and in the Hearing Voices Movement they tend to prefer the term ‘unshared belief’.  Many would agree that the problem with a ‘delusion’ is not so much in thinking, but in the interaction with humanity.  ‘Hallucination’ also implies a shared version of ‘real’ experiences which would be difficult to justify, a concept of normal which is utopian.

Many within the Hearing Voices Movement reject both terms.

Q:  Should therapeutic efforts end with the attempt to remove the occurrences of hallucinations or delusions?

A:  I think you can see now that I am not altogether in favour of ‘therapeutic efforts’.  Too often there is a lot of therapeutic effort, a lot of money, a lot of well-meaning people, and not very much thinking.  I am quite certain I would not like to be on the receiving end of ‘therapeutic efforts’.  I would like there to be justice and healing in communities.

Even if we were to know the complete neurological makeup of a voice-hearer’s brain, we would still lack true insight into the actual experience of hearing voices.  Understanding and accepting the lived experiences of these individuals is an indispensable tool for promoting coping and recovery.

It allows us to see the distressed individual not as some ‘gene-machine’ gone wrong, but a human who bears a certain relationship to himself and the world.

– 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