Category: Cognition

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A Brain Stimulation Device May Power Healing

00Cognition, Cognitive Stimulation Therapy, Environment, Featured news, Health, Neuroscience February, 18

Source: UCI Research at flickr, Creative Commons

Promising new treatments for neurological disorders are aimed at transforming disease management through neuroplasticity—the brain’s ability to alter its structure and function to adapt to changes in the environment. Leading-edge research is investigating how technological solutions can enhance neuroplasticity, boosting recovery from neurological damage.

In September 2016, Helius Medical Technologies announced positive results for its pilot study using a brain stimulation device to treat pediatric Cerebral Palsy (CP). CP affects muscle control due to injury or malformation of the brain. For the study, some participants received standard physiotherapy, while others received standard physiotherapy along with 20 minutes of brain stimulation with Helius’s experimental device.

Those who received brain stimulation showed improvements in muscle spasms and gross lower limb motor function, over those who did not. And, there were improvements in quality of life, social status, and cognitive function. One explanation is that the brain stimulation device heightens the brain’s natural ability to heal, producing enhanced benefits from physiotherapy.

This new method of brain stimulation is termed cranial nerve non-invasive neuromodulation (CN-NINM). A successful feasibility study was done for the treatment of Multiple Sclerosis (MS), and studies are underway for Parkinson’s disease, brain injury, and stroke. Participants are reporting improvements in mental health and wellbeing, such as greater mental clarity and increased energy. And benefits may extend to other neurological conditions as well.

The brain stimulation device used in these studies comes from decades of work by researchers at the University of Wisconsin-Madison, in the Tactile Communication and Neurorehabilitation Laboratory (TCN Lab). The team named the device the Portable Neuromodulation Stimulator (PoNS). The PoNS consists of a small array of electrodes that transfer an electrical current to the patient’s tongue, activating areas of the brainstem and cerebellum. Researchers theorize that this activation induces a sequence of activity that spreads through the brain.

In his book, The Brain’s Way of Healing, researcher and psychiatrist Norman Doidge explains how brain stimulation enhances neuroplastic healing. Doidge says an underlying cause of symptoms in neurological disorders is a dysregulation of electrical activity in the brain. He explains the sequence of activity caused by the PoNS may help the brain balance the electrical activity in its networks of brain cells. Balancing promotes rest and relaxation of these cells, allowing further stimulation alongside appropriate rehabilitative therapy. Stimulation reactivates dormant or dysregulated brain cells, and reintegrates them into functioning networks. Taken together, these changes make an ideal state for neuroplastic healing to take place.

Doidge shares a story about Broadway singer Ron Husmann’s remarkable recovery, which Doidge attributes to neuroplastic healing. Multiple Sclerosis led Ron to lose control of his bladder, mobility, and singing voice. Devastated by the loss of his voice and feeling he had nothing to lose, Ron travelled to the TCN Lab. He spent two weeks in intensive speech therapy, accompanied by brain stimulation with the PoNS device. By the end of his stay, Ron was singing and dancing again.

Brain stimulation and modulation are not new. They are central to established, FDA-approved treatments, such as deep brain stimulation (DBS), for neurological disorders. But, an important difference between the PoNS device and deep brain stimulation is that DBS is a highly invasive treatment. It involves the insertion of an electrode into the patient’s brain, and introduces several possible risks, including infections and strokes. And so, DBS is only used as a last resort. But the PoNS is non-invasive and presents few risks. Plus, the effects of the PoNS appear to continue even after the stimulation ends, whereas the benefits of DBS tend to end when stimulation is turned off.

Reported side effects for treatment by the PoNS, though, include increased salivation, mild headaches, and jaw pain. To reduce side effects, researchers teach participants swallowing and relaxation techniques that manage saliva and tension in the jaw.

Although early evidence for the PoNS device is impressive, skeptics point out that the number of participants used in the studies is small, which reduces confidence in reported outcomes. And although the team at the TCN Lab has shown that the PoNS increases activity in key brain areas, theories on how, precisely, it contributes to healing are still unclear.

Still, the PoNS shows promise as an addition to rehabilitation programs, and as a way of promoting physical and mental health. This technology is one to watch.

–Stefano Costa, 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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In Long-Term Care, Patient-on-Patient Violence on the Rise

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

Source: SpaceShoe at flickr, Creative Commons

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

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

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

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

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

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

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

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

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

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

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

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.
 

This article was originally published on Psychology Today

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

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

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

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

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

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

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

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

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

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

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

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

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

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Expressing the Inner Voice May Bring Benefits

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

Source: geralt at Pixabay, Public Domain

An app called Dragon Anywhere allows people to talk to their smart phone with no word or time limits. Talking out loud with a piece of technology is socially acceptable these days, but what about when nobody else is listening?

Many associate hearing voices or talking to oneself with mental illnesses like schizophrenia. And because these behaviours deviate from the norm, they make people uncomfortable. But might there be benefits to expressing inner thoughts out loud in this way?

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Expressing the Inner Voice May Bring Benefits

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

Source: geralt at Pixabay, Public Domain

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But be kind to you.

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

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Staffing Shortage Underserves Long Term Care Residents

10Aging, Cognition, Dementia, Featured news, Health, Loneliness, Social Life February, 17

Source: Chris Marchant on flickr, Creative Commons

In the summer of 2014, I volunteered at a long-term care facility (LTC) in the Peel Region of Southern Ontario. Most of the residents who lived there were diagnosed with some form of cognitive impairment, primarily dementia. I saw first-hand the unfortunate reality of understaffing, and how it leads to deficits in patient care.

As the elderly population has grown, Ontario has seen a 22% increase in admission rates of LTC residents as of 2014. And the number of residents with cognitive impairments is especially high. According to the Ontario Long Term Care Association’s 2014 annual report, 62% of residents have Alzheimer’s disease or another form of dementia resulting from stroke, developmental disability, or traumatic brain injury.

Patients with cognitive impairments may have other mental health disorders as well. The Canadian Institute for Health Information (CIHI) indicates that 25.9% of residents in Ontario long-term care homes have shown symptoms of depression through 2013 and 2014.

In my time volunteering at the LTC, I noticed that residents often refrained from socializing because they were unable to take part in events due to memory deterioration, speech issues, and physical ailments such as paralysis or arthritis. Most residents required staff to transport them from one place to another and though they worked hard to support residents, there were simply not enough staff to supervise these daily activities.

Jane (name changed for anonymity), the Supervisor of Activation at an LTC in the Peel Region, spoke to the Trauma and Mental Health Report about this issue. Jane is responsible for organizing activities that motivate elderly residents to engage in social interaction and improve cognitive well-being.

Jane agreed that one of the biggest challenges for LTCs is staffing:

“Year by year, the case load of different residents is increasing, but with such little funding we do not have enough staff to support their needs. If residents aren’t participating in daily events and activities, their cognitive functioning is negatively impacted.”

A University of Ottawa study found that between the years 2000 and 2010, over 60% of residents with multiple cognitive deficits lacked stimulating therapeutic activities and social support. It showed that while residents received sufficient assistance with physical needs, such as feeding and changing, cognitive functioning continued to worsen in areas like memory and attention.

Jane also explained that despite research emphasizing the importance of activities that are engaging, staffing shortages make it difficult for these activities to be held in LTC homes:

“We need more activation staff for art therapy, music therapy and physiotherapy as these activities are beneficial to residents’ cognitive functioning. However, many activities are cancelled or postponed because of a lack of staff to facilitate the activities and monitor the residents. A few years ago, residents only needed one staff member or nurse for assistance, now they need two or more people. Sometimes, they’re left waiting for support.”

But perhaps the real issue here is funding. Adequate funds are necessary to increase the amount of staff within LTCs, so that residents can develop social relationships, participate in interactive activities, and improve their cognitive functioning and capabilities. Jane agrees:

“Funding hasn’t increased yet the resident conditions are changing and they require more care. The caseload is increasing, with little funding.”

Funding should also be allotted for appropriate staff training. LTC residents with cognitive impairments have a unique set of needs. According to the University of Ottawa study, residents require assistance in areas such as memory retention and engaging in regular social activities to help them interact and feel like recognized members of their community.

Making use of mental health first aid programs, such as the workshops offered atConestoga College and the Baycrest Health Sciences’ Geriatric Mental Health Serviceconference, can go a long way in improving the services staff provide.

As a past volunteer for an LTC home, I have seen the impact of limited support on residents’ lives. Greater funding and more staff to facilitate therapeutic activities are crucial to optimizing the care residents receive and to ensuring better cognitive functioning.

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Book Review: The Marshmallow Test

20Behaviorism, Career, Child Development, Cognition, Emotion Regulation, Featured news, Self-Control June, 16

Source: Jørgen Schyberg on flickr

Walter Mischel, a psychologist best known for the Marshmallow Test, produced his first book at the age of 84.

The Marshmallow Test: Mastering Self-Control hit bookshelves in the fall of 2014, and became an instant media sensation. Part memoir and part scientific analysis of Mischel’s work on self-control, the book reviews research on the Marshmallow Test, which he first carried out at Stanford University, and which has since been replicated around the world.

The Marshmallow Test is a way of assessing children’s capacity for delaying gratification and resisting temptation. Children are placed in a room by themselves and given one marshmallow. An experimenter explains that if the child waits 15 minutes, they will receive a total of two marshmallows to eat. If they don’t wait, they’ll receive only one. After the experimenter leaves the room, the child is observed through a one-way mirror or recorded. The longer a child is able to wait, the greater the ability to delay gratification.

Many videos of children taking the Marshmallow Test have been posted to YouTube, often showing amusing coping strategies children use to maintain restraint. The Marshmallow Test has been so widely popularized that even the Wall Street Journal referred to it in assessing a proposed budget by U.S. president Barack Obama.

In his book, Mischel looks at the correlation between outcome on the test at age 5 or 6 with social skills and academic performance later in life. Results show that children who are able to wait longer for two marshmallows have better social skills and higher academic test scores. The book provides several explanations for this phenomenon, including the possibility that the Marshmallow Test accesses characteristics, such as delay of gratification, that are related to developing positive social skills and performing well academically later on.

For those seeking a step-by-step guide to improve self-control and achieve higher grades, this is not the right book. Mischel discusses theoretical concepts and summarizes research. Although he integrates many personal narratives to add a human touch, the book is not meant as a guide to self-improvement.

With critical and thorough analysis, Mischel instead explains how genetic, environmental, and social factors can impact self-control. He emphasizes that self-control is not predetermined or universal across all areas of an individual’s life. Someone who shows a great deal of control in academia may struggle to show that same level of control when overcoming problem drinking.

Making the content more personal, Mischel often incorporates his own challenges with overcoming a nicotine addiction and how his research was often affected by observations of his own children.

Empowerment is another important issue discussed throughout the book. In one section, Mischel refers to his time as a trainee in a clinical psychology doctoral program, recalling how he watched his mentor, George Kelly, work with an extremely anxious woman. The woman had asked Dr. Kelly, “Am I falling apart?” to which he replied, “Would you like to?”

Using this case, Mischel shifts the focus from the Marshmallow Test and how it might predict future action to how perceived self-control can impact demonstrated self-control. This is an idea that Mischel calls the ‘The Engine of Success.’

The idea is that there are essential resources nurturing and cultivating self-control. Mischel explains this theory through the case of George, a student completing his bachelor degree on a full scholarship at Yale University.

At the age of nine, George was enrolled in a KIPP school, which is an American charter school. Mischel explains how such schools attempt to integrate self-control, self-discipline, brain development, and delay of self-gratification into their curriculum. He emphasizes the need for more schools like this.

Although the original Marshmallow Test predicts a specific type of self-control in later life, Mischel stresses that self-control is fluid. Taking control of any area of your life, he suggests, starts with asking the very question George Kelly asked his client: Would you like to?

– Genevieve Hayden, 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

Listening to voices

Can Some Lead A Better Life Listening to their Voices?

10Cognition, Cognitive Behavioral Therapy, Featured news, Psychopathy, Therapy, Trauma February, 16

Source: rumeysa babadostu on Flickr

Hearing voices is usually considered a sure sign of mental illness, but recent studies suggest that hearing voices is more common in the general population than previously thought. Though inconclusive, research estimates are that between 2 and 10% of people hear voices, with only 45% actually qualifying for a psychiatric diagnosis.

The notion that hearing voices can be non-pathological is still controversial.  Contemporary psychiatry views hallucinations (auditory or otherwise) as the result of abnormal brain function, representative of a more pervasive psychotic disorder.  Coming from a disordered brain, the content of voices are said to have no inherent meaning.  Treatments minimize or eliminate symptoms (usually through the use of medication) and provide coping strategies through cognitive behavioural therapy (CBT).

The ‘Hearing Voices Movement’ challenges the medical model.  Started in the early 1990s, the movement provides an alternative, non-pathological framework, claiming that hearing voices is fairly common in the general population and can exist outside of psychotic disorders.  They view voices as resulting from life events, (e.g., traumatic experiences), and that better coping comes from gaining insight into how the voices relate to unresolved trauma.

In a Dutch study published in 1989, Marius Romme, at the University of Limburg in Maastricht, and science journalist Sandra Escher found that out of 450 participants, about one third reported being able to cope well with their voices.  Of this group, people were more likely to have a positive interpretation of the voices, accepting them as part of their life instead of trying to fight or ignore them.   Although many of these participants still found some voices distressing, they were able to draw firmer boundaries and felt less powerless than the group that did not cope as well.

Building on the fundamentals revealed by their research, Romme and Escher were able to translate their findings into a therapeutic approach.  Known as the Maastricht approach, the aim is to foster curiosity about the content of the voices in order to gain insight, resolve underlying emotional problems due to past traumas, and eventually accept the voices as a part of the client’s life and self.

Voices can be positive, negative or banal –many voice hearers have some combination of the three.   In treatment, the client is asked to set aside a time to listen to the voices nonjudgmentally, as if they were talking to an actual person.  Along with the therapist, they try to unravel when the voices began and why.

In contrast, treatments like cognitive behavioural therapy (CBT) and similar methods aim to reduce the frequency, intensity and believability of hallucinations.  People receiving this type of therapy are encouraged to directly challenge the content of the voices, and cope by focusing on other things in their environment and use distraction to redirect their attention.

But when techniques like distraction and redirecting attention are used incorrectly, they result in people suppressing and fighting their symptoms, rather than learning to live with them.

Several studies show that individuals who try to suppress thoughts and hallucinations may increase their frequency and intensity, and exacerbate distress   (described in the work of Social Psychologist, Daniel Wegner of Trinity College).  Alternatively, the Maastricht approach encourages the client to eventually accept their voices without challenging their content or trying to fight them.

Some claim success for this kind of acceptance-based treatment, even in cases of psychosis.  In a study by clinical psychologists, Patricia Bach and Steven Hayes at the University of Nevada, Reno, 80 inpatients with schizophrenia were assigned to either continue their treatment as usual or engage in four sessions of acceptance and commitment therapy (ACT) in addition to usual treatment.

At the end, patients who attended the ACT sessions were three times less likely to be hospitalized again, and were more likely to question the voices’ control over them and evaluate the reality of the voices’ claims.  Bach and Hayes think the acceptance component allows people to be less distressed overall and view the voices as ‘just thoughts’ that don’t necessarily have meaning or power over them.

While ACT is a widely validated therapy, the Maastricht approach has less research to back up its claims.

The Maastricht approach is still considered peripheral in many circles, especially the idea of voices as an extension of human experience.   And critics of the treatment take issue with the implication that almost all auditory hallucinations are caused by traumatic experiences, overlooking or down-playing evidence regarding genetic and biological influences.  While it is true that many people who hear voices have experienced traumas in their lifetime, there is little evidence that trauma alone can directly cause auditory hallucinations.

And, some claim the Hearing Voices Movement ignores the needs of people with severe mental illnesses such as schizophrenia, which involves a host of other symptoms in addition to hearing voices.  Using the ‘hearing voices therapy’ only addresses one aspect of a multifaceted syndrome and may be harmful if the other symptoms worsen.

Still, when we look at the idea of hearing voices in a way that is not exclusively pathology-based, we open new possibilities, and we engage in what psychologist Andrew Moskowitz (University of Aarhus, Denmark) claims to be a necessary paradigm shift.  Indeed, it may be time for one.

– Jennifer Parlee, 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

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Treatments Available to Long Term Abduction Victims

60Animal Behavior, Cognition, Depression, Dreaming, Family Dynamics, Featured news, Health, Parenting, Psychiatry, Psychoanalysis, Sleep, Stress, Therapy, Trauma April, 15

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– Contributing Writer: Anjali Wisnarama, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today