Category: Attention

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Universities Can Do Better To Help with Mental Illness

00Anxiety, Attention, Emotion Regulation, Featured news, Social Life, Stress August, 19

Source: Filip Bunkens at Unsplash

A good friend of mine, Jessica (name changed), was diagnosed with social anxiety disorder in September of 2017, the same year she enrolled in university. And, as is the case with many other mental illnesses, her anxiety took over her life.  

Post-secondary students all over the world face mental illnesses that affect their schooling.  Research done at the University of Alberta suggests that half of the student population felt “overwhelming anxiety” within the past 12 months of attending university. In an interview with the Trauma and Mental Health Report, Jessica shares her experience dealing with anxiety at school as a “feeling of constant worrying that goes away only when she leaves class”.  

After taking some time to review her current situation, Jessica dropped out of school. Psychologist Martin Antony, professor at Ryerson University in Toronto, and author of the Shyness and Social Anxiety Workbook discussed the impairment those with anxiety-related disorders can experience:  

  “It is not uncommon for people with especially high levels of anxiety to drop out of school completely or take a leave of absence from school.”

Despite this fact, there has been little research on the relationship between anxiety and quitting school. One study found that out of 201 individuals with anxiety disorders, 49% dropped out of school, with 24% of dropouts attributing their decision to their anxiety. These students often struggle with going back to school and completing their degrees. The main hindrance Jessica faces is the delay in receiving her degree:

“The art program has specialized studio classes where they teach pottery, photography, sculpting, painting, stone carving, things like that. I don’t know how long it’s going to delay my schooling.”

Without being physically present in these classes, Jessica fails to complete her degree requirements.  Inevitably, this puts her behind in finishing her typical four-year degree.

The Anxiety and Depression Association of America suggests that accommodations can help alleviate anxiety experience at school. In the U.S., students have the right under the Individuals with Disabilities Education Act (IDEA) to request accommodations such as writing in alternative exam rooms, or receiving longer time for exams.  

However, these accommodations are quite general, and may do more harm than good. Clinical psychologist, Anu Asnaani, at the Center for the Treatment and Study of Anxiety and assistant professor at the University of Pennsylvania explains the importance of meeting the needs of each student. As anxiety and depression based disorders require specialty interventions, Asnaani believes that school administered accommodations will not treat them.

Similarly, Martin Antony agrees that accommodations recommended by schools may help maintain anxiety rather than help students overcome it:

“One of the most powerful ways of overcoming a fear of being around others is to practice being around others. However, accommodations may run counter to this idea by isolating students. Accommodations such as these may help people to feel more comfortable in the short term, but they may also interfere with overcoming fear in the long term.”

Jessica recalls her experience with the counselling and disability service at her university as unhelpful. She received accommodations of lecture notes, a seat with an empty chair on each side of her, the ability to sit close to the back of the room, and alternative exam testing. Yet, none of these accommodations helped reduce her anxiety.

Regarding counselling, disability, and student wellness centers across all post-secondary institutions, Asnaani recommends: 

“If the techniques and therapy that the counselling centers at school administer are not working for the students, then being able to make a referral to community partners is important.  Other resources that students can look at for help or finding a suitable therapist are the Association for Behavioral and Cognitive Therapies and Anxiety and Depression Association of America.” 

Inevitably, Jessica enrolled in online classes to slowly continue working towards the completion of her degree. However, this isn’t always a solution, especially for individuals in hands-on programs, such as art. For Jessica, the online classes helped eliminate her anxiety.  She is now able to work on her course work in the comfort of her own home. 

Anxiety therapies often teach their patients how to be their own therapist. When asked about mechanisms students learn in therapy, Asnaani and Antony agree that exposing yourself to the feared situation over time and cognitive-behavioural therapies can help reduce anxiety in students.  

For Jessica, the experience has been life changing.  She often wishes that she had received more support from her school and offers this piece of advice to others in similar situations:

“Take things step by step, you and your well-being are the most important. It’s okay to take time for yourself and there is no rush to finish school. There are other routes to take if you are unable to attend classes, such as taking online classes like I’ve been doing. You are not alone in this situation and there are always people to talk to and resources available to you, whether at the school or even online.”

Fortunately, for Jessica, online classes enabled her to complete some of her first-year elective courses. Unfortunately, there is still a lack of adequate tailored accommodations for post-secondary students experiencing mental disorders preventing them from gaining the education they need for their future careers.

– Lucia Chiara Limanni, Contributing Writer , The Trauma and Mental Health Report

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

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Coping Through the Lens of a Camera

00Attention, Career, Ethics and Morality, Featured news, Media, Trauma, Work May, 19

Source: American Documentary, Inc at Flickr, Creative Commons

Documentaries tell compelling stories. But while we become captivated by moments on screen, we forget there is someone behind the camera, watching events unfold in real-time. Cameraperson, a recently released documentary by Kirsten Johnson, portrays her experiences filming documentaries, and it includes footage captured while traveling and filming.

Johnson has travelled the world – from the United States, to South America, to Europe – filming documentaries on topics such as America’s hunger problem or a notorious FBI burglary. She worked on Citizen Four, a documentary about a former CIA agent leaking government information. Sometimes, the stories are about traumatic historical events such as the Rwandan Genocide and the Bosnian War. She has visited the sites of mass killings and heard the stories of people who have survived tragedies. 

I had the opportunity to speak with Johnson, and learn about her experiences. Born in Seattle, she was always curious about the world and wanted to travel. She describes herself as a “visual person.” And as the daughter of a psychiatrist, she always wondered about the unique experiences of others. Her personal background, along with an interest in political inequalities, led her to pursue a career in documentary filmmaking.

In an interview with the Trauma and Mental Health Report, Johnson explains why she followed this path:

“As a doc filmmaker you’re trying to help reveal a human rights injustice, or a problem that people haven’t looked at or paid attention to, and you know people don’t want to hear it. People don’t want to watch a film about rape in Bosnia. Then the question is, how do you find a way for people to look at things they don’t want to look at?”

I asked Johnson about one of her first jobs filming documentaries:

“I filmed over 200 interviews with holocaust survivors, it was one of the first experiences I had in filmmaking and being deeply interested in how people tell the stories of their trauma. I got interested in the stories themselves, and how people remember them because some people remember different aspects. What I found surprising was that over half the people I interviewed had never talked to anyone about it before—this was the first time they had ever talked about it. There was just a curiosity in me, how could it be that somebody experienced something so devastating and never spoke of it?”

Many filmmakers have likely had similar experiences, so I was curious if Johnson had ever shared her experiences with other people in the industry:

“As camera people, we work so much we rarely get the chance to talk together. I have always talked a great deal with the people who I film with as they’re listening and I’m watching. We process our experience together. Or the translators, those are the kinds of people I’ve had deep conversations about things we were witnessing together.”

Johnson described some of the unspeakable events she had witnessed, and how she copes with the trauma while still doing her work:

“There’s often an aesthetic pleasure even though you may be filming a terrible moment—somehow, the light, the fabric, their skin, what they are wearing, helps you as the camera person cope with the things you are taking in. That’s what I realized when I was looking back at my own footage. It’s this active creative process you’re involved with when you’re trying to organize it and see it differently and search for the beauty in it.”

She described one such experience with a Bosnian family:

“We were filming about how rape was a weapon during the Bosnian war and listening to horrible stories about people who had to leave their homes. Being with one of the few families who had returned to their home—it was beautiful to witness that.”

When asked about the particularly overwhelming and painful moments she is confronted with during film shoots, Johnson incorporates practical and simple strategies to maintain “psychological equilibrium”. 

“ I try to sleep enough, eat with relish, laugh a lot and move in all kinds of ways. I read what others have written, talk to friends, see a therapist who has known me for years, watch movies and play with my kids. If I have been traveling too much, I stay home and if I have stayed somewhere too long, I go somewhere new and the world surprises me one more time.” 

The importance of telling stories is integral to documentaries. Filmmaking is about more than just reporting on tragedies, it’s about giving people a voice. Yet, more often than not, we don’t think about the person behind the camera, who witnesses trauma in order to share stories with the world.

-Amanda Piccirelli, Contributing Writer, The Trauma and Mental Health Report

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

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When the Expectation is for Parents to Hover

20Attachment, Attention, Child Development, Featured news, Identity, Parenting December, 16

Source: Dennis Skley on Flickr, Creative Commons

In September 2015, the Supreme Court of British Columbia, Canada, ruled that a mother, known only as ‘B.R.’, could no longer leave her eight-year old son home alone for two hours after school. As reported in a Vancouver Sun article by Brian Morton, this court decision implies that children under the age of ten cannot be left unsupervised under any circumstance.

The implications of this case reach far beyond B.R.’s personal story, and may have serious consequences, raising questions around babysitting, and even whether parents can leave children alone in the house to fetch something from the backyard or to have a conversation with the neighbours.

The ruling is seen by some as reflecting a shift toward helicopter parenting, where parents “hover”, rarely leaving children alone or allowing them to make their own decisions. This consistent interference may in fact hinder a child’s development.

Kathleen Vinson, a professor at Suffolk University, views parental hovering as preventing children from gaining a sense of independence and privacy, which in turn can impede a child’s ability to mature into a healthy, responsible adult later in life. In her research, Vinson found that:

“…the impact of having helicopter parents may have resulted in children’s under-involvement in decision-making; reduced ability to cope; and lack of experience with self-advocacy, self-reliance, or managing personal time.”

Vinson’s research highlights a helplessness and lack of control that many of these children feel. As they move through adolescence to enter university and an increasingly competitive job market, these young adults may find it difficult to juggle the stress brought on by sudden autonomy.

Similar views are expressed by Lenore Skenazy, author of the blog Free Range Kids.With tongue-in-cheek, this self-proclaimed “world’s worst mom” speaks out against tactics such as GPS-tracking one’s children. She supports the idea that it is normal for both parents and children to make mistakes. According to Skenazy, these experiences are an opportunity for a child to develop and mature:

Childhood is not a crime. Down time is not dangerous. In fact, it’s the fertile soil where creativity takes root. Do you wish you’d grown up with your mom tracking your every move? If not, don’t do it to your own kid.” 

But parents often believe they are doing the right thing. Over-attentiveness may come from a place of genuine concern, and the consequences of leaving one’s children unattended.

A Parents Magazine article explains that for many, even the smallest failure or accident can seem disastrous, especially if parental involvement could have prevented it.

And parental involvement is a crucial aspect of a child’s mental health and development. In their textbook, Home and School Relations, University of North Dakota professors Glenn Olsen and Mary Lou Fuller examine the impact of parental participation in children’s education. The authors found that children whose parents showed more interest and involvement in their growth tended to excel academically across multiple domains, including classroom performance and standardized testing—a trend that continued well into higher education.

Still, problems arise when parent involvement extends too far, leaving young adults helpless in trying to find their footing, impeding normal development and failing to foster independence.

For such competencies are necessary to cope with the trials and tribulations of adult life.

–Andrei Nestor, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Killing the American Hero, Killing the Fair Trial

00Attention, Featured news, Health, Law and Crime, Media, Post-Traumatic Stress Disorder, Psychiatry, Psychopathy April, 16

Source: Quadraro on DeviantArt

Was he “insane” or not? That is the question jury members in Erath County, Texas addressed, on February 25th, 2015, during three hours of deliberation in the Eddie Ray Routh case.

Routh, a veteran of the Iraq war, was convicted of murder after he shot two fellow veterans, Chad Littlefield and Chris Kyle, who was famously known as the most prolific sniper in American history and whose memoir inspired the blockbuster film, American Sniper. Kyle, who worked to help veterans cope with post-traumatic stress disorder (PTSD), was asked by Routh’s mother to see if there was anything he could do for her son. When Routh, Littlefield, and Kyle went to a shooting range—a routine practice used by Kyle to help veterans ‘blow off steam’—Routh opened fire, killing both men.

Routh’s defence lawyers pursued an insanity plea, citing a diagnosis of paranoid schizophrenia as the reason for his actions.

According to section 8.01a of the Penal Code of Texas, an individual may successfully plea not guilty by reason of insanity if evidence proves that at the time of the incident, the accused, as a result of “severe mental disease, did not know that his conduct was wrong.” Citing a police interrogation that took place after the incident—not before, as outlined by law—where Routh answered that he knew what he did was wrong, prosecutors argued that the defense was invalid. The jury agreed, and Eddie Ray Routh was sentenced to life in prison with no chance of parole.

Decisions in so-called insanity cases are often controversial. Routh’s case calls into question the legal system’s impartiality and treatment of mental health issues, in particular.

The case was widely publicized for its duration, which coincided with the release of American Sniper. The film was highly acclaimed and portrayed Chris Kyle as a hero, especially for the townspeople in Erath County. Typically, when a jury from a particular area is likely to be biased, it is common practice for defense lawyers to move the trial outside the district in which the crime was committed. In Routh’s case, this motion was denied, despite some jurors even admitting to having seen American Sniper before making their decision.

In addition to lacking impartiality, the Texas court also failed to properly account for Routh’s mental health.

Routh was diagnosed with paranoid schizophrenia by a psychiatrist prior to the incident at the shooting range. His medication was found when police raided his home. According to Routh’s family and friends, he had also experienced episodes of aggression, irritability, suicidal thoughts and attempts, and psychotic episodes. These episodes consisted of extremely erratic delusions ranging from vampires and werewolves, to him believing he was God and Satan.

But the insanity exclusion in Texas does not take a holistic view of an individual, instead using narrow and limiting language to define insanity. While Routh may have agreed that his actions were wrong after the event, there is no way to know what he was experiencing throughout. And if his previous psychotic episodes are representative, he may have been psychologically removed from reality at the time of his actions, possibly believing he was acting to save his own life.

Some argue that Routh and others like him should still be held responsible for their actions, despite their mental health problems. But, what many do not understand, is that being found not guilty by reason of insanity does not mean the individual walks free. In many cases, such a verdict could lead to extremely long detention in a psychiatric institution, where individuals are kept under close watch as they undergo treatment for their disorder.

In refusing to accept Eddie Ray Routh’s insanity plea, the Texas legal system is doing more than just punishing an individual who may not have been aware of his own actions, they are also denying treatment to a seriously ill person. At this rate, many mentally ill individuals will continue to be punished for actions they did not intend or understand, never receiving treatment and never having a chance to recover.

For more details about the Not Criminally Responsible Defense (as it is known in Canada), see our article entitled Myth Busting the Not Criminally Responsible Defence.

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Love Is War: Post Infidelity Stress Disorder

60Anger, Attention, Cognition, Dreaming, Empathy, Featured news, Health, Hormones, Infidelity, Memory, Post-Traumatic Stress Disorder, Relationships, Self-Esteem, Sex, Sleep, Stress, Trauma March, 15

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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

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Dr. Mom and Dad

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– Contributing Writer: Jana Vigour, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today