Category: Sleep

5477101794_6258493273_b copy

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

Source: artmajor24//Flickr

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

love is war, feature2

Love Is War: Post Infidelity Stress Disorder

00Anger, Attention, Cognition, Dreaming, Empathy, Featured news, Health, Hormones, Infidelity, Memory, Post-Traumatic Stress Disorder, Relationships, Self-Esteem, Sex, Sleep, Stress, Trauma March, 15

Source: Daquella manera/Flickr

Blind-sided by the one you love, the one you married.

Learning about your spouse’s infidelity can be emotionally and physically devastating. The emotional damage is reflected in what some mental health professionals call Post-Infidelity Stress Disorder (PISD), for the stress and emotional turmoil experienced afterward.

Psychologist Dennis Ortman, author of Transcending Post-Infidelity Stress Disorder, describes the term as “not to suggest a new diagnostic category but to suggest a parallel with post-traumatic stress disorder, which has been well documented and researched.”

In Post-Traumatic Stress Disorder (PTSD), re-experiencing the trauma repeatedly is the first of three categories of symptoms described. The disorder is marked by flashbacks of war for veterans, nightmares of the accident for car wreck survivors, and painful memories of abuse for survivors of intra-familial trauma.

So too, in PISD husbands and wives will replay the painful realization of betrayal.  Even after the initial fall-out, people will have recurring thoughts of their partner with another.

Psychologist and certified sex therapist, Barry Bass, adds, “Like trauma victims, it is not unusual for betrayed spouses to replay in their minds previously assumed benign events,” those times when their spouse became defensive when asked a simple question, or the late nights at work, or the text messages from unnamed friends, all of these become viewed as possible deceitful acts.

The second category of symptoms for PTSD, avoidance and emotional numbing, is seen in PISD as well.  Rage or despair that comes after the initial shock of discovering the infidelity can be followed by a state of emotional hollowness.  Formerly pleasurable activities lose their appeal.  Those who were cheated on sometimes withdraw from friends and family and describe feelings of emptiness.

The last category of PTSD symptoms, hyper-vigilance and insomnia, can also arise for those dealing with infidelity.  Sleep patterns become erratic; and concentration becomes a challenge, affecting work performance and family life.

PISD can have physical consequences as well as emotional ones.  The stress of discovering infidelity can lead to what has been dubbed broken heart syndrome, also termed stress cardiomyopathy.  The American Heart Association describes symptoms such as sudden chest pain, leading to the sense that one is having a heart attack.  Physical or emotional stressors, such as a loved one passing or major surgery trigger a surge of stress hormones that temporarily affect the heart.  The condition typically reverses within a week.

Despite the stress, there is life after an affair.  Due to the symptomatic similarities, therapists are now beginning to use PTSD counseling techniques to help couples either stay together or move on.

Exposure and cognitive restructuring are techniques used when dealing with traumatic memories.  In exposure, spouses are asked to gradually imagine those heart-wrenching moments and to cope with them gradually, whereas cognitive restructuring substitutes irrational thoughts, feelings, and behaviours induced by the trauma, with adaptive ones.

Counselors use these “trauma focused” explorations with clients, sifting through the distressing memories and aversive feelings, to help build the client’s self-esteem and confidence in dealing with the betrayal or loss of the relationship.

Therapists are also working with their clients to help them understand the unique reasons that led to the infidelity.  Understanding why the affair occurred can help both people.

Along with help from family and friends, wounds can be bandaged and trust restored.  Infidelity trauma and the time and strength involved in recovery remind us that love, like war, can have its casualties.

– Contributing Writer: Justin Garzon, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: Daquella Manera/Flickr

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

YN5H0VTR6O

Ritual Abuse, Cults and Captivity

00Child Development, Diet, Environment, Fear, Featured news, Gratitude, Identity, Post-Traumatic Stress Disorder, Sleep, Therapy, Trauma February, 15

It is almost impossible to imagine the realities endured by victims of ritual abuse:  multiple abusers with systematic motives coordinated with the sole purpose of perpetrating and maintaining a cycle of abuse.  Cults and organizations such as David Koresh’s Branch Davidians use torture and sexual abuse to control their members and force them into compliance.

Behind The Abuse

The Ritual Abuse Task Force of the L.A. County Commission for Women defined ritual abuse as involving:

“…repeated abuse over an extended period of time.  The physical abuse is severe, sometimes including torture and killing.  The sexual abuse is usually painful, humiliating, intended as a means of gaining dominance over the victim.  The psychological abuse is devastating and involves the use of ritual indoctrination.  It includes mind control techniques which convey to the victim a profound terror of the cult members…most victims are in a state of terror, mind control and dissociation.”

According to psychologist Louis Cozolino of Pepperdine University, ritual abuse is characterized by a number of perpetrators of both sexes and the presence of many victims.  The abuse is often carried out in contexts where children are in groups, and within families or groups of families.

Often seen are mind-control techniques that involve combinations of extreme abuse and “brainwashing.”  For example, “psychic driving” is defined by psychologist Ellen Lacter (who runs www.endritualabuse.org) as taped messages that are played for hours non-stop, while the victim is in a state of consciousness altered by sleep deprivation, electro-shock, sensory deprivation, and inadequate nutrition.

Researcher Patricia Precin of the New York Institute of Technology, alongside Cozolino, report that many ritual abuse survivors suffer from PTSD.  Clinicians also see a high frequency of Dissociative Identity Disorder (DID) among such adolescent and adult patients.

And in an Australian study of workers at the Center against Sexual Assault (CASA) including psychiatrists, psychologists, and other clinicians, 70 percent of all counselors agreed with a single definition of ritual abuse and 85 percent agreed that ritual abuse was an indication of genuine trauma.  CASA workers were much more likely to believe their client’s ritual abuse and marginally more likely to identify ritual abuse cases than other therapists.

Cozolino references a vast amount of corroborating evidence for the existence of ritual abuse, such as police reports and therapeutic case studies.  In one of his papers he describes one such case:

“A five-year-old victim in the Country Walk case related that one of his abusers at his day-care setting had been killing birds.  This young boy spontaneously repeated the following well-rehearsed prayer to his startled father:

‘Devil, I love you.

Please take this bird with you

and take all the children up to hell with you.

You gave me grateful gifts.

God of Ghosts, please hate Jesus and kill Jesus because

He is the baddest, damnedest person in the whole world.

Amen.

We don’t love children because they are a gift of God.

We want the children to be hurt.’ ”

Although such accounts are well documented, not everyone believes ritual abuse exists. Bernard Gallagher from the Centre for Applied Childhood Studies at the University of Huddersfield considers ritual abuse a result of erroneous diagnosis made by agency workers:

“This includes pressuring children into making disclosures, the misinterpretation of children’s statements and an over-reliance upon preconceived ideas concerning the existence of ritual abuse.  This results in what psychologists and statisticians might refer to as ‘false positives, ” writes Gallagher.

After The Cult

Escaping the torment of a cult is perhaps the most difficult part for a survivor, but recovery and rehabilitation can be just as challenging.  Cozolino and colleague Ruth Shaffer interviewed survivors, focusing questions on recovery.  They reported that the majority considered participation in support groups a necessary adjunct to psychotherapy.

It may seem counterintuitive to treat ex-cult members as a group because their abuse took place in a group setting.  However certain precautions may be taken to make treatment effective.

For example, British researcher Nicole Durocher notes that organizers must take care not to construct a group that resembles a cult gathering in any way.  The support group has to be sensitive to the special needs of each ex-cult member and to the particular context of the cult from which they exited.

The professional in the group must differ from those in other support groups, acting as an advocate-mediator to observe the group, identifying conflicts, clarifying alternatives for resolution, and negotiating compromises.  These support groups occasionally have the professional co-lead the group with an ex-member acting as an observer, guide, and consultant.

One survivor of multi-generational ritual abuse who wishes to remain anonymous, has written a public letter to the Stop Mind Control and Ritual Abuse Today (S.M.A.R.T) organization, reflecting on his own struggle with PTSD.

“My PTSD often reminds me of what it is to be a soldier.  On the battlefield when every moment is life and death, a soldier will do many things and anything to survive.  When the soldier returns to a normal, non-war society he can’t understand why he did the things he did.”

He goes on to say that with the help of therapy, his shattered life and sense of self can be pieced together again:

“I cry, I sing, play guitar, listen to music, sleep normal hours instead of being awake all night, and more than anything else, I try to change who I was… into who I am.”

– Contributing Writer: Justin Garzon, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: https://stocksnap.io/photo/YN5H0VTR6O/

This article was originally published on Psychology Today

168194-173344

Methadone Treatment May Prolong Addiction

00Addiction, Diet, Environment, Fear, Featured news, Health, Motivation, Psychopharmacology, Resilience, Sleep, Spirituality, Stress, Trauma January, 15

The conventional treatment for opioid dependence is to prescribe methadone.

Similar to morphine, methadone is a synthetic opioid sometimes referred to as a narcotic. It is useful at preventing opioid withdrawal, minimizing drug cravings, and is said to reduce the risk of HIV, Hepatitis C and other diseases associated with intravenous drug usage. Methadone is also cheap, and best of all legal.

Despite the advantages, methadone is highly addictive, and has many side effects such as dry mouth, fatigue, and weight gain.

Treatment involving methadone requires a weekly medical visit to renew the prescription, sometimes leading those who are addicted back to the very environment and people that they need to avoid to stay clean.

The Trauma & Mental Health Report recently spoke with Leslie (name changed for anonymity), a patient who has been receiving methadone maintenance treatment (MMT), who says, “Sometimes I wait all day to see the doctor. During that time, you can’t help but associate with other users, hear “drug talk”, or even see drugs being passed around. The methadone doctor doesn’t push counseling and is not there for support. I’m only going to get my prescription.”

Toward the end of treatment, methadone dose is slowly tapered to prevent withdrawal. But most users don’t wean off completely. Leslie says she didn’t have the motivation or tools to do so until she started seeing her drug addictions counselor:

“I’ve been trying to get off of methadone for 18 months now. It has helped with the withdrawal symptoms, and life is easier to manage since I’m not running the street 24/7 looking for my next fix. And I have more time to get my life on track. But, In order to ‘knock’ the addiction you need to figure out what your personal triggers are. My counselor has helped me with this. She also provides a safe place for me to go and discuss my problems and any issues I have with MMT.”

The greatest fear is relapse. Although part of the recovery process, relapse can have physical and emotional consequences. But it helps to identify personal triggers: cues that provoke drug-seeking behavior, the most common of which are stress, environmental factors such as certain people or places, and re-exposure to drugs.

The most important missing link in MMT is drug counseling. Meeting with a counselor is not mandated and patients seldom see one. Those who seek counseling benefit from help determining personal triggers, and preparing for potential relapse. A counselor may help create a healthy living plan that focuses on improving mental health with nutrition, exercise, sleep, building healthy relationships, and spiritual development.

Better family relationships also help with recovery. Including family members in treatment increases commitment to counseling and also helps family members understand what the person is going though.

Opioid addiction is more than physical dependence. Initial detox is a start. Methadone helps with the physical aspects of withdrawal, and helps users lead a more normal life. But without the help of a drug counselor, MMT isn’t enough.

Without counseling, social support, a drug free environment, and the desire to change, we lead the patient only part way there. And part way isn’t enough.

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

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

Copyright Robert T. Muller

Photo Credit: www.123rf.com/stock-photo/lonely_man.html

This article was originally published on Psychology Today

165992-170730

Video Games Rated A for Addictive

00Addiction, Depression, Diet, Featured news, Health, Neuroscience, Optimism, Psychopharmacology, Self-Control, Sex, Sleep, Stress, Treatment December, 14

Picture if you will, flashing screens, loud noises, focused faces and a crowd gathered to watch high stakes games; games that end only when you run out of money.

This is not a casino. Those faces are staring at flashing computer screens in an arcade and the high stakes match is actually a video game.

Scenes like this make it possible to view video gaming as an addiction. Like a gambler endlessly playing slots, the video gamer can spend hours on the vice of choice.

Those who consider gaming as addictive highlight similarities between models of addiction and the behaviour of those who can’t seem to stop playing video games, despite the consequences 

What does it mean to be addicted to a video game? Addiction used to be a term reserved for drug use defined by physical dependency, uncontrollable craving, and increased consumption due to tolerance. Advances in neuroscience show that these drugs tap into the reward system of the brain resulting in a large release of the neurotransmitter dopamine. This is a system normally activated when basic reinforcers are applied, like food or sex. Drugs just do it better.

Gaetano Di Chiara and Assunta Imperato, researchers at the Institute of Experimental Pharmacology and Toxicology at the University of Cagliani, Italy, found that drugs can cause a release of up to ten times the amount of dopamine normally found in the brain’s reward system. This has led to a shift in how addictions are viewed. Any physical substance or behaviour that can “hijack” this dopamine reward system may be viewed as addictive.

When can you be sure that the system has been hijacked? Steve Grant, chief clinical neuroscientist at the National Institute of Drug Abuse, says it happens when there “is continued engagement in self-destructive behaviour despite adverse consequences.”

Video games seem to hijack this reward system very efficiently. Certainly Nick Yee, author of the Daedelus Project, thinks so. He explains, “[Video Games] employ well-known behavioral conditioning principles from psychology that reinforce repetitive actions through an elaborate system of scheduled rewards. In effect, the game rewards players to perform increasingly tedious tasks and seduces the player to ‘play’ industriously.” Researchers in the UK found biological evidence that playing video games and achieving these rewards results in the release of dopamine.

This same release of the neurotransmitter occurs during activities considered healthy, such as exercise or work. Since dopamine release is not bad per se, it is not necessarily a problem that video games do the same thing.

In her book, Reality is Broken: Why Games Make Us Better and How They Can Change the World, Jane McGonigal writes, “A game is an opportunity to focus our energy, with relentless optimism, at something we’re good at (or getting better at) and enjoy. In other words, game-play is the direct emotional opposite of depression.” Playing games can be an easy way to relieve stress and get that satisfaction that comes with dopamine release.

But it is concerning when this search for the dopamine kick becomes preferable to real life, when playing video games replaces activities like socializing with friends and family, exercising, or sleep. Nutrition may begin to suffer as the gamer picks fast-food over proper meals. School-work and job performance suffer as gaming turns into an escape from life. It becomes troubling when video games are used as the main way of coping.

Psychologist Richard Wood says just that in his article Problems with the Concept of Video Game “Addiction”: Some Case Study Examples. “It seems that video games can be used as a means of escape…If people cannot deal with their problems, and choose instead to immerse themselves in a game, then surely their gaming behaviour is actually a symptom rather than the specific cause of their problem.”

Regardless, there are some unable to stop despite the consequences. In rare cases it has actually caused death, through neglect of a child or physical exhaustion. Excessive video game playing may represent a way of coping with underlying issues. But it becomes its own problem when the impulse to play just can’t be denied.

Psychiatrist Kimberly Young, Director of the Center for Internet Addiction Recovery argues that “[gaming addiction is] a clinical impulse control disorder, an addiction in the same sense as compulsive gambling.” Her centre is one of many that are now found in the United States, Canada, the United Kingdom, and China.

These clinics treat those with gaming problems using an addiction model. They use detox, 12-step programs, abstinence training, and other methods common to addiction centres.

Notably, many people play well within healthy limits, and engage in the activity for diverse reasons. Stress relief, a way to spend time online with friends, or the enjoyment of an interactive storyline are all common reasons for playing. Whatever the reason for starting, when you can’t stop you have a problem. 

We are often critical of labels in mental health, for good reason; they can be misused. On the other hand, a label can sometimes be helpful. If we call it an addiction, then we recognize it as a problem worth solving.

– Contributing Writer: Bradley Kushner, The Trauma and Mental Health Report 

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

Copyright Robert T. Muller

Photo Credit: Ben Andreas Harding

This article was originally published on Psychology Today

164882-169627

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

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

This article was originally published on Psychology Today

163216-167891

Fear of Ebola Leaves Orphaned Children Abandoned

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– Contributing Writer: Khadija Bint Misbah, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

161190-165652

To Share or Not to Share (the Family Bed)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– Contributing Writer: Saqina Abedi, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

159993-164389

New EEG Technology Makes for Better Brain Reading

00Cognition, Featured news, Health, Intelligence, Mind Reading, Neuroscience, Optimism, Personality, Post-Traumatic Stress Disorder, Sleep, Sport and Competition, Therapy, Trauma September, 14

Clinical psychologists have a long tradition of attempting to understand what is “on the mind” of their clients by use of psychological tests. The Wechsler Adult Intelligence Scales, for example, have been used for decades to assess intelligence levels. And other empirically valid psychometric measures are commonly used to understand patient mood or personality functioning.

To this point, direct examination of brain activity as a window into the client’s mind has remained elusive. But advances in the field of brain examination using electroencephalographs (EEGs) may be changing all that.

The first EEG was developed in the 1920’s by the German psychiatrist Hans Berger. He developed it to test the biological electricity produced in the brain, and first used it during brain surgery performed in 1924 on a 17-year-old boy.

If the EEG has been around for almost a century, why is it so important now? Recent technological advancements may soon have a profound impact on how mental health practitioners diagnose mental illness.

Currently, we know that the EEG records activity in the brain through electrodes attached to the scalp. When neurons (electrical pulses the brain uses to send messages) fire, they produce a small current. The EEG reads and records this current between 250 and 2000 times a second. The graphs it makes of these readings are what we know as ‘brain waves.’

The EEG is primarily used to diagnose epilepsy. As of 2005, 70% of EEG referrals were for epilepsy. During an epileptic seizure there is a large spike in brain activity that the EEG has little difficulty detecting. Even then, it is used in conjunction with a clinical examination by a physician, not as the sole means of diagnosis.

The second most common use is to diagnose sleep disorders such as narcolepsy and sleep apnea. The EEG is effective at reading the brain waves produced during sleep, which show special patterns in those with sleep disorders.

Biomedical engineering professor Hans Hallez of Flanders’ University writes, “during the last two decades, increasing computational power has given researchers the tools to go a step further and try to find the underlying sources which generate [brain waves]. This activity is called EEG source localization.”

Source localization is the technique that tells us which part of the brain is communicating. With advances in neuroscience and imaging techniques, we know what activities are represented by different parts of the brain. For example, activity in the primary visual cortex in the occipital lobe is related to vision and activity in special areas of the temporal lobe is associated with speech.

If you know what part of the brain is communicating and what it is responsible for, then you can start to build a picture of what brain waves from different parts of the brain mean. In theory, this is what some experts consider akin to mindreading

But the game-changer is this: recent developments in the field have led to a portable EEG that is relatively cheap, effective, and requires no human scoring.

Philip Low, who is the founder, CEO, and chief scientific officer of NeuroVigil Inc., developed a complex algorithm in 2007 that allows one electrode to do the work of many. His company has developed what they have named the iBrain. It uses one wireless electrode sensor the size of a quarter to record brain activity with an app that works on a smartphone.

Low says, “our vision is that one day people will have access to their brain as routinely and as easily as they currently have to their blood pressure.” He hopes to code brain wave profiles of those suffering from mental illnesses into a database at NeuroVigil that receives information from iBrain users’ cell phones. The iBrain 3 is expected to cost around $100 and be available to the public in the next few years.

Low isn’t the only one pushing the boundaries of EEG technology using single electrode devices. Hashem Ashrafiuon, a mechanical engineering professor at Villanova University’s College of Engineering has developed similar technology. His work is being used in sports helmets that can instantly diagnose concussions by detecting large changes in brain waves that occur immediately after impact.

Ashrafiuon sees many applications for his work. “It can basically be used to diagnose any health problem that affects brain activity. We hope to monitor brain health in patients with mild traumatic brain injury, post-traumatic stress disorder, Alzheimer’s disease, mild cognitive impairment, and sleep and circadian disorders.”

It is the belief of technology developers Low and Ashrafiuon that we will one day have brainwave profiles of all mental illnesses stored. Diagnosing a mental illness would be assisted by comparing brain wave profiles of a patient to a database of stored sample profiles, allowing for rapid diagnosis.

Does it sound too simple? Perhaps. Diagnosis of mental illness involves a substantial behavioral component. What the brain looks like may be a far cry from the choices a given individual makes, and how those choices affect later functioning. 

Still, there is reason for guarded optimism about the developments in EEG technology. The portability and improved accuracy will help with the diagnosis of epilepsy and sleep disorders, allowing patients to be comfortable at home and still be monitored. The more physically and economically accessible it is the better.

In a few years you may be the proud owner of Low’s iBrain 3. But in all likelihood, it won’t replace mental health practitioners any more than a good toothbrush replaces a dentist.

– Contributing Writer: Bradley Kushnier, 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