Category: Emotion Regulation

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When Doctors Are At-Risk for Suicide

00Burnout, Depression, Embarrassment, Emotion Regulation, Featured news, Health, Suicide May, 19

Source: Feature: skeeze at Pixabay, Creative Commons

They had known each other well enough in the early days of medical school, when they were students studying well into the night. After graduation, they went their separate ways, each assuming the other was doing well.

“I wanted you to hear it from me,” a colleague sadly said on the phone. Dr. Ranjana Srivastava nearly fell to the pavement when she was told that her long-time friend and colleague—a clinician, wife, and devoted mother—had died by suicide.

Unfortunately, this is not the first that time Dr. Srivastava had to face the suicide of a colleague. In a piece she wrote for The Guardian, Srivastava explains:

“Forced smiles and tough hides abound in the workplace, where always being ‘fine’ is a badge of honour. This is why it can be so difficult to distinguish doctors who will indeed be fine from those who need help.”

Research shows a higher rate of mental health problems among physicians. A 2013 report estimates over 25% of doctors in Australia having at least a minor psychiatric disorder, with 10% reporting suicidal thoughts in the past year. A survey of 2000 U.S. physicians showed that roughly half believed they met criteria for a mental illness in the past, but had not sought treatment. And in Canada, recent research estimates over 26% of Canadian doctors suffer professionally due to poor mental health, with 20% of them reporting they had been depressed in the last 12 months. Overall, roughly 30% of physicians worldwide have depression or symptoms of it, according to an extensive review published in the Journal of the American Medical Association (JAMA).

Why is this the case? The answer isn’t all that clear, but according to physician and social worker Katharine Gold and colleagues, stigma is to blame. Their research looked at survey responses of over 2000 female physicians, and it showed that stigma attached to mental illness is greater among medical trainees and physicians than in the general population. According to one respondent:

“I have been discriminated against in a department after disclosing my history of well-treated depression to my department chief.”

And this is not an isolated incident. Studies show that 50% of doctors are less likely to work with a colleague who has a history of depression or anxiety disorder, with four in ten admitting to thinking less of such a colleague. And throughout the years, healthcare organizations have favoured a punitive approach when addressing the issue of physician mental illness, rather than a supportive one. So disclosing mental health issues by a medical doctor can pose a real threat to licensing, career, and reputation, leading to reluctance to seek help.

In an interview with the Trauma & Mental Health Report, medical student Jamie Katuna explains the predicament physicians face:

“Getting care could mean problems for doctors. If they seek help for mental health issues and if someone decides they are ‘unstable’ and shouldn’t be seeing patients, that physician is out of a job and would have a really hard time finding another one. So instead, doctors suffer in silence.”

When deteriorating mental health makes it difficult to work, many physicians ignore their symptoms and continue to work anyway, often self-medicating with drugs or alcohol to avoid the perceived embarrassment of having a psychological disorder.

Steps are being taken to bring awareness. Many universities and medical organizations are starting conversations about physician wellness and stigma reduction. Physicians and medical students who have lived through suicide attempts, depression, and other mental health issues are standing up for themselves and each other. Likewise, organizations such as the American Foundation for Suicide Prevention and the American Medical Association have recommended reforming medical licensing questions to make it clear that physicians may get help without fear of negative consequences. Despite the growing support, Thomas Schwenk of the University of Nevada School of Medicine noted that change isn’t happening fast enough:

“A lot of [conversations about mental health stigma are] very difficult and very slow to happen, and unfortunately tragic incidents like the two suicides in Quebec and other suicides across the country are still occurring because it’s taking time to change that culture.”

There are some resources available. In Canada, organizations like Physician Health Program and the Canadian Medical Association provide a range of direct services for physicians and medical students at risk of, or suffering from, substance use, psychiatric disorders, or occupational stress. The interventions offered can include awareness workshops, referral to treatment, and monitoring, all while maintaining confidentiality. Also, online resources such as ePhysicianHealth and Combating Stigma are available.

Most solutions exist at a personal or program level, but the problems are pervasive and affect the entire structure of healthcare education. According to Katuna:

“The culture of medicine should undergo amazing and radical transformations. We need to redesign how we implement medical education.”

Systematic problems require systematic solutions and until then, medical professionals remain at risk.

— Ilia Azari, 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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Mental Illness in Youth Often Goes Undetected

00Adolescence, Anxiety, Child Development, Decision-Making, Depression, Emotion Regulation, Featured news, Health December, 18

Source: Zarina Situmorang at DeviantArt, Creative Commons

When university student Kinga (name changed) was young, she struggled with symptoms she couldn’t identify. She had shortness of breath and would suddenly get anxious. Her mother took her to a doctor, and Kinga was diagnosed with asthma. Despite asthma treatment, her inability to catch her breath persisted, and she had feelings of panic.

In retrospect, Kinga isn’t so sure she had asthma at all, believing she was misdiagnosed. In an interview with the Trauma and Mental Health Report, she explains:

“The doctors never knew what was wrong with me, probably because I didn’t have the right words to explain what was happening, and maybe because I wasn’t failing in school.”

Some mental illnesses, even those that are familiar, such as anxiety and depression, can be hard to identify. For youth with subtle to moderate symptoms, diagnosis can be especially difficult. Psychiatrist Peter Jenson and colleagues emphasize that diagnoses tend to rely on adults noticing symptoms. Children and teenagers often don’t have the knowledge to recognize their own mental-health difficulties.

As Kinga entered her pre-adolescent years, she always felt tired. Everything she did took a little more effort. While she continued her day-to-day activities, her symptoms followed her around. She says:

“I always performed well in school. I went out with friends, attended dance and language classes, but the fatigue was almost too much to bear. I had to fight the fogginess in my head to concentrate in school, and push myself through the exhaustion in dance class.”

Struggling pre-teens may not even realise that their mental health is at risk. They might only feel a little more tired or pessimistic. But these symptoms can hinder their ability to perform to their full potential.

Kinga also experienced other symptoms, like irritability:

“Sometimes, I would scream at my parents or siblings over the smallest things. My mom called it ‘being a teenager’, she didn’t realise, none of us realised, that it was more than that.”

Despondent and unable to get help, Kinga took matters into her own hands and researched her symptoms on the Internet. She recalls:

“I was so fed up with feeling like this. So I turned to Google. I searched ‘what is tiredness a symptom of?’ In my 16-year-old mind, that was all it was. I was just tired. I clicked on a link— ‘symptoms of depression.’ Other symptoms listed were feelings of hopelessness, negative thoughts, difficulty concentrating, feelings of numbness… I suddenly realised what must be going on.”

With this new information, she went back to her doctor.

“I finally had a name for these feelings. But for so long, I was doing too well for anyone to notice something was wrong. I suffered for years, believing that everyone felt like this—everyone felt a little out of breath, a little empty.”

A form of depression where people appear to function normally is called dysthymia, and it often begins in childhood. Although it may not be as debilitating as major depression, dysthymia can prevent positive feelings and interfere with daily tasks. On average, it lasts five years, does not usually resolve on its own, and requires treatment. About 75% of those with dysthymia develop severe forms of depression if left untreated.

While Kinga’s symptoms did not prevent her from continuing her usual activities, if she had not received help when she did, she may very well have developed a more serious mental illness.

In a post on Up Worthy, college student Amanda Leventhal shares a similar experience. Four years passed before she was diagnosed and treated. And Leventhal believes the process took so long because of stereotypes regarding mental illness:

“Even though we’re often told that mental illness comes in all shapes and sizes, I think we’re still stuck with certain ‘stock images’ of mental health in our heads.”

She says that ideas of how mental illness “should look” are so prevalent, it is difficult to believe that someone who doesn’t look mentally ill could be struggling. In fact, a study out of Duke University reports that only half of teenagers with mental health problems receive treatment at all.

Kinga says:

“I don’t know where I would be today if I didn’t get help. I don’t even want to think about that. I know I’m not the only one who suffered from mental illness as a kid, so I hope there is an increase in awareness of mental illness in young people.”

– Anika Rak, 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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Learning to Manage Emotions Boosts Children’s Well-being

20Child Development, Education, Emotion Regulation, Emotional Intelligence, Empathy, Featured news, Relationships February, 17

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English, Math, History, Geography…classes found in school curricula build foundational knowledge and promote future success.

Schools lay the groundwork for cognitive development, especially in academic areas. But what about emotional development? Proficiency in that is equally important for leading a successful life. Yet, little effort has been made in school to teach children how to manage their feelings.

With the introduction of RULER, this may not be the case for much longer. More and more schools around the U.S. are implementing the program aimed at teaching students—and teachers—to ‘Recognize, Understand, Label, Express, and Regulate’ emotions.

Supported by the Yale Center for Emotional Intelligence, it incorporates social and emotional skills training into the school curriculum to support child development. Specific curricula are available from kindergarten to grade 12, and ongoing implementation is necessary to solidify these skills as children get older.

“They’ve started to teach students about feelings as explicitly as they teach math and reading,” writes Seattle Times education reporter John Higgins.

The program is based on the work of two psychologists, John Mayer and Peter Salovey, who began their scientific study of emotional intelligence over two decades ago. They focus on a direct link between critical-thinking skills and emotions.

According to Meyer and Salovey emotional intelligence is the ability to identify, monitor, and manage the emotions of others and oneself, to guide actions and ways of thinking.

Studies show that those who are reluctant to understand and express their feelings experience higher levels of anxiety, depression, and certain psychiatric disorders. They also report lower levels of well-being and social support.

At school, children experience a wide range of emotions every day. In addition to the stress of managing their studies and homework, they face a number of social struggles, such as conflicts with friends, romantic relationships, and bullying.

Marc Brackett, Director of the Yale Center for Emotional Intelligence, and one of the developers of RULER, says that the way students feel at school has a profound effect on how they learn, influencing their chances of success at school, at home, and with friends. And some individuals are generally more successful at handling emotions than others.

Through different tools, RULER provides a common language for expressing emotions, for dealing with conflicts between students, and for addressing conflicts between students and teachers, making for an open and supportive environment necessary for learning. For example, the “mood meter,”—a sheet of paper divided into four coloured quadrants—is designed to help students build a vocabulary around different emotions.

“I have a teacher who checks in with the Mood Meter on Monday mornings and it’s nice to just know that someone’s listening. It gets us in the mood to work, eases us back into school,” explains a grade 11 high-school student in the program.

Other tools, such as the “meta-moment”, train students to use the few seconds following a moment of anger to take a deep breath and imagine how their “best self” would react.

One 7-year-old student talks about her experience with the meta-moment:

“When I’m not in a good mood, RULER can help me solve the problem. Like when my brother pushed sand on my sand castle and wouldn’t fix it. I felt really angry at him, but I took a meta-moment and realized it wasn’t hard to fix what he did and he didn’t do it on purpose. Then I felt a little more forgiving.”

Some are critical of social and emotional learning initiatives within a classroom setting, arguing that schools are not an appropriate venue for emotional education. Others emphasize the price-tag; an online resource and four days total of in-person training costs $10,500 per school (for up to three participants).

However, Brackett’s research shows that implementing RULER can improve a school’s climate while fostering positive development and academic achievement among its students. Some notable improvements include better relationships between students and teachers, more student autonomy and leadership, improved academic success, and fewer reports of bullying.

Students’ mental health profiles greatly improve as well. Kids and adolescents who are involved with this program have experienced reduced levels of anxiety, depression, aggression, hyperactivity, social stress, and alcohol and drug usage. And research shows how children’s ability to handle their emotions and to be mindful of others’ feelings has a significant effect on their mental health.

Not all children come with the tools necessary for academic and social success. Programs like RULER provide a platform for children to learn how to navigate emotional struggles, so they can leave their primary education with methods to succeed in their work and personal lives.

–Eleenor Abraham, 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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Fast Food Industry Demands ‘Emotional Labour’ from Employees

00Burnout, Depression, Emotion Regulation, Featured news, Health, Stress, Work October, 16

Source: Steffi Reichert on Flickr

Donna Abbott (name changed), a long-time employee at McDonald’s, does more than serve Happy Meals. She smiles politely and greets every single customer. It’s part of the job. She’s even expected to ask the customer about their day. That way, the customer can walk away feeling satisfied.

Emotional labour—strict emotional control and outward enthusiasm—may be a way of earning tips. But in some sectors, including North America’s growing low-wage service industry, emotional labour is a fundamental part of the job. Displaying concern for a customer’s needs, smiling, and making eye contact is critical to a customer’s perception of service quality.

Cheerful presence can be essential to profitability of service providers, particularly in the fast-food industry. But emotional labour may be doing more harm than good to employee emotional and mental wellbeing.

A recent research review by Alicia Grandey and colleagues at Penn State University examined the benefits and costs of emotional labour practices, including those used in fast-food services. According to the study, the self-control and regulation needed to convey a sense of artificial happiness for an extended period of time is taxing, depleting energy and resources that could be dedicated to other tasks.

In an interview with the Trauma and Mental Health Report, Donna said:

“The energy that I spend being overtly happy could be used elsewhere—I know that I’d be able to take orders faster and prepare meals quicker if I didn’t have to take that extra and, in my opinion, forced step to be emotionally friendly with customers that I don’t know.”

Emotional fatigue that detracts from the ability to do other work isn’t the only problem. Unless the employee is naturally a positive person, the act of suppressing true feelings and generating insincere ones leads to what psychologists call dissonance—a tense and uncomfortable state that can lead to high levels of stress, job dissatisfaction, and burnout.

“It’s just stressful and really frustrating,” says Donna. “It creates this push and pull within you that you really want to—but often can’t—resolve. And in trying to cope with these fake feelings, I’ve turned to things I’m not proud of and don’t admit to everyone.”

Donna reports excessive use of cigarettes and marijuana, particularly after a long and emotionally draining 10-hour shift; addictions that are not uncommon among employees in the fast-food industry. According to the Substance Abuse and Mental Health Services Association’s National Survey on Drug Use and Health, food service has the highest rate of drug use, with an estimated 17.4% of workers abusing substances.

Individuals vary in their ability to deal with inauthentic emotional expressions. This means that the effects of emotional labour on emotional and mental wellbeing do not apply to all fast-food employees. Some workers may be able to identify with the organization’s values of positive emotional communication, making them better prepared to express appropriate emotions. And people who are generally more cheerful and pleasant may be able to turn off negative emotions more easily than others.

Donna is one of the less cheerful employees:

“When I started working at McDonald’s I would say that I was happy, but still not at the level of putting a smile on randomly for just anyone. I’m not a naturally happy person. And after being there for a long time, I wouldn’t say that I’m the most pleasant employee. I’ve had my fair share of negative attitude and customer complaints, which make it very hard to pretend to be happy or care about the customer—especially since it’s not technically in my job description to do that.”

In their research, Grandey and colleagues note that there are some jobs where emotional labour may be a core requirement. Childcare workers or people who care for those who are mentally or physically ill are a common example. But, the dissonance that a fast-food employee feels is probably more than workers experience in other sectors, like care providers, who typically see the act of helping as part of their identity.

Emotional labour comes at an emotional cost. And employers who require emotional labour should do so in a supportive rather than controlling climate. By training employees to recognize mistreatment, offering down-time to help workers re-charge, and giving employees opportunities to engage in honest interaction, employers might find a positive attitude that comes about on its own.

–Veerpal Bambrah, 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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Divorce an Unreliable Predictor of Aggressiveness

20Anger, Child Development, Divorce, Emotion Regulation, Family Dynamics, Featured news, Parenting, Self-Control August, 16

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

“Tomorrow is the day of retribution, the day in which I will have my retribution against humanity, against all of you.”

Elliot Rodger spoke these words in a video he recorded before stabbing and shooting fellow students at the University of California, Santa Barbara (UCSB) in May 2014. After killing six and injuring 14 others, Rodger took his own life.

In a 140-page manifesto called “My Twisted World,” Rodger explained that he was seeking revenge for being a virgin at 22 years of age. Tormented by loneliness and rejection, he detailed many painful experiences that helped push him over the edge. In a final video, he threatened the life of every female student in UCSB’s most popular sorority house and anyone else he saw on the streets of Isla Vista.

Rodger sent this manifesto to his parents and therapist before the killing spree, blaming them for his sexual frustrations. His father, Peter Rodger, later explained that his son began dealing with mental health problems at a young age, following his parents’ divorce. In an interview with Barbara Walters on ABC’s 20/20, Rodger’s father spoke about Elliot’s fear of interaction with other children in high school:

“He felt the inability to get along with them. And this is when we realized that he had a real fear of other human beings, of other kids his age.”

Stories like those of Elliot Rodger lead us to seek explanations. We try to understand how something like this can occur. In the 20/20 interview, one explanation advanced was the idea that Rodger’s life changed when his parents divorced.

Source: Yuliya Evstratenko/Shutterstock

The idea of divorce being profoundly damaging to children offers a compelling explanation when it is otherwise difficult to understand certain individual actions. Research shows that children who experience divorce at a young age may develop separation anxiety and dependency. When they do not receive equal attention from both parents, they may become sensitized to rejection and react strongly to this same type of rejection in social situations. Over time, they may develop lower self-esteem and negative expectations regarding intimate relationships.

But even among this small fraction of children, severe aggression is rare. In fact, most children of divorce are able to cope relatively successfully with their situation and go on to develop close relationships, experiencing few behavioral problems. Yet it remains common to view divorce as being destructive for children.

Janine Bernard of Purdue University and Sally Nesbitt of the Counseling and Psychological Services Center in Texas both found no significant differences in levels of anger, aggression, and passive-aggressiveness between children of divorced or disrupted families and children of intact families. In their two-part study, they found that while all children are affected by the quality of their parents’ relationship, environmental and sociocultural factors are just as important in determining individuals’ temperament. Similarly, internal levels of maturity, personal coping styles, and other relationships can and often do counterbalance the negative impacts of divorce.

Bernard and Nesbitt note:

“For generations couples have been disillusioned by the marriage myth, which promised life happily ever after. The more recent divorce myth is equally dogmatic and suggests that divorce has inordinate powers to hurt people regardless of the mental health and maturity of the adults and children involved.”

People with such views tend to expect children from divorced families to become socially isolated and develop behavioral problems. Bernard and Nesbitt explain that this is a common hypothesis among researchers conducting divorce studies. The bias may impact their judgment and cause stilted reporting of results, with more focus on a child’s negative behavior and less on their positive qualities.

Eva Bennett on flickr

Source: Eva Bennett on flickr

Elliot Rodger is an example of one individual who was psychologically disturbed and viewed his parents as responsible for his suffering. But he is certainly not a typical example of a child of divorced parents.

His social isolation may have felt unbearable to him, and he and his family sought an explanation for his violent actions, just as we all do when we hear about tragic stories like this. But our best explanations can be misguided. Reliably predicting violent behavior is still difficult to do.

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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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

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At CAMH, Pet Therapy Helps Decrease Stigma

00Emotion Regulation, Featured news, Happiness, Law and Crime, Loneliness, Psychiatry, Therapy May, 16

Source: Ryan Faist, Used With Permission

When I tell others that I volunteer with my dog in a pet therapy program, they assume my work involves children or the elderly. I am not surprised: the benefits of animal-assisted therapy for these groups are widely known.

But my dog Rambo’s “patients” are quite different. He and I volunteer at an inpatient unit at the Centre for Addiction and Mental Health (CAMH) in Toronto. The people Rambo sees every Tuesday reside in the Secure Forensic Unit.

Accused of committing crimes ranging from shoplifting to homicide, these individuals all suffer from severe mental illness. Their treatment at CAMH is court-ordered, and they are routinely assessed by mental health professionals to determine if they can be held responsible for their crimes.

Theresa Conforti, the co-ordinator for Clinical Programs and Volunteer Resources at CAMH, explains how pets factor into the equation:

“For the past 10 years, CAMH has had their own Pet Therapy Program that is very unique and caters only to the clients at CAMH. The clients value the unconditional love and affection the dog gives them on a weekly basis. The importance is that this program bridges the gap for those who have had to leave their furry friends to come to treatment, and for those who will not be able to own a dog due to financial restrictions or housing situations. The weekly visits ease loneliness, improve communication, foster trust, decrease stress and anxiety, and are a lot of fun!”

The program assesses the volunteers for eligibility, while the dog goes through an evaluation with a professional service dog trainer. Conforti notes:

“This works because those interested in volunteering at CAMH are not here to stigmatize our patients, rather they are here to make a difference and di-stigmatize mental illness.”

To say the experience has been rewarding for volunteers like me would be an understatement. Patients are happy to see Rambo, talk to him, pet him, or just be in the same room with him. Not only does he give them a break from their daily routines and the confinement of their unit at CAMH, but he also offers unconditional affection to those in the program.

And while the benefits of pet therapy are numerous, unconditional affection is the critical point here.

When people find out where Rambo and I volunteer, I am often asked whether I fear for our safety, highlighting the common misconception that individuals with severe mental illness are dangerous and violent. Stereotypes like this further perpetuate mental illness stigmatization.

But animals do not judge. They do not care about physical appearance, diagnoses, or criminal history. Conforti recalls:

“One of our dogs went on a unit and a selective mute client—a client who chooses not to speak—had knelt down and whispered in the dog’s ear. No one heard what the client said to the dog, but it was the first time the client had ever spoken. And he had chosen to do so to a dog that will not judge nor will expect much from him. I love that story because it shows that dogs are there to help, love unconditionally, and, most importantly, they do not stigmatize.”

This may be one reason animal-assisted therapy programs are gaining popularity globally. A program in Bollate, Italy, has introduced the use of dog therapy for prison inmates. Valeria Gallinotti, the founder of the program, explains:

“My dream was to organize pet therapy sessions in prison because it’s the one place where there is a total lack of affection, where dogs can create calm, good moods, emotional bonds and physical contact.”

The program has been a hit with inmates, who look forward to the dogs’ visits and have formed a sense of close companionship with them. When asked who his favourite dog was, one of the inmates said:

“Carmela arrived and didn’t know what to do. She was so scared, sort of like us when we arrive in prison. Now, like us, she too is getting used to the experience.” 

Whether part of psychotherapy, physiotherapy, or a prison inmate program, animal assisted therapy can give people the extra motivation needed to get through the challenge of treatment or confinement. Patients and clinicians alike have a lot to gain from therapists like Rambo.

– Essi Numminen, 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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RUSH Prevention Program Helping Children of Bipolar Parents

20Bipolar Disorder, Emotion Regulation, Environment, Featured news, Health, Parenting, Stress, Therapy May, 16

Source: Rolands Lakis on Flickr

“It was just kind of not knowing what you were going to get every time. Emotionally when I was younger, I always cared about her. She was my mom. As I grew up, I kind of became disconnected because I didn’t know the real her. I only knew her from her diagnosis. I only knew her emotions. I didn’t know the real her.”

– Steven, child of a bipolar mother.

In 2004, the World Health Organization named Bipolar Disorder (BD) the seventh-leading cause of ‘disease burden’ for women between 15 and 44, a measure that combines years of life lost to early death and years lost to living in subpar health. Public Health Agency of Canada reports that BD occurs in one percent of Canadians, and their reported mortality rates are two to three times greater than the general population.

The disorder is marked by alternating periods of manic euphoria and intense depression. In a manic state, people experience elevated moods, racing thoughts, and sleeplessness, in addition to overspending and engaging in risky sex. The depressive phases make for overwhelming feelings of sadness, withdrawal, and thoughts of death and suicide.

Research has related BD to aggressive behaviour, substance abuse, hypersexuality, and suicide. But more recently, studies have been showing the kinds of challenges faced by children of those diagnosed with the disorder.

The Pittsburgh Bipolar Offspring Study reports that children of bipolar parents are 14 times more likely to develop bipolar spectrum disorder. Children of two bipolar parents are at an even higher risk.

And these children are also more vulnerable to psychosocial problems. A study by Mark Ellenbogen at Concordia University finds them at greater risk for problems with emotional regulation and behavioral control.

Ellenbogen and colleagues have explained how stressful home environments can alter biology to influence mood disorders in adolescents and adults.

In an interview with the Trauma and Mental Health Report, Ellenbogen stated that OBD individuals (that is, offspring of parents with bipolar disorder) show higher levels of daytime cortisol, a hormone that is released during times of stress. OBD are psychologically more sensitive to stresses in their natural environments.

“We have found that high cortisol levels in offspring may represent a biomarker of risk for affective disorders, particularly in vulnerable populations like the OBD. We believe that these changes in cortisol levels can be linked to stress, inconsistent parenting practices and disorganization in the family environment.”

Reducing the stressors in early childhood may help decrease elevated levels of cortisol, and ward off the development of BD and other problems.

Recognizing the need for early intervention, Ellenbogen initiated a pilot prevention program, Reducing Unwanted Stress in the Home (RUSH), which targets bipolar parents and their vulnerable children between six and eleven.

An assessment measures salivary cortisol, looks at the family environment, and evaluates the child’s behaviour. Then parents and children participate in weekly sessions.

With parents, the focus is on improving communication and problem-solving skills, and increasing structure and consistency in the home. With children, they teach skills for understanding and coping with stress through age–appropriate exercises and educational games.

“The goal of the RUSH program is to prevent the development of affective disorders and other mental disorders by intervening in families well before these serious mental disorders begin. That is, this is a prevention program for children at high risk of developing debilitating mental disorders.”

To date, children and parents have been responding well, but the research is ongoing.

Programs like RUSH aim to prevent the development of mental illness in vulnerable youth. And an ounce of prevention can mean a whole lot to quality of life down the road.

– Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

3 Teaching children about trauma-e64c0cff78bc1c36a18b5896fe10be70f88635cd

Teaching Children about Trauma: The “River Speaks” Series

00Child Development, Emotion Regulation, Family Dynamics, Featured news, Grief, Therapy, Trauma March, 16

Source: Freaktography on Flickr

In her latest series of children’s books, River Speaks, author Sandy Stream conveys the emotional turmoil that children and families go through when dealing with trauma.

Children who have undergone loss, abuse, and other traumatic experiences are often unable to fully understand or express their feelings. Their inability to verbalize the emotional impact the crisis had on them makes it difficult for therapists to determine how to best help them heal.

Although research has shown children’s literature to be a helpful tool in therapy, its use is still not particularly common.

The stories found in Stream’s books are meant to help therapists provide relatable experiences for children to help them come to terms with their own trauma. They revolve around a baby bird, Sparky, who is snatched away from his family. In dealing with his captivity, escape, and eventual return, Sparky and his family learn to articulate the complex feelings they experience.

Sparky does return home, but the series does not employ the conventional happily-ever-after ending. Instead, the stories address the turmoil felt by everyone both during his captivity and after his return.

The seven books in this series, Sparky Can Fly, Sparky’s Mama, Tweets and Hurricanes, Feathers, Flex, Roots, and The River, all feature a different main character, retelling the narrative from the perspective of the victim, the parents, the siblings, and the therapist. Each book also deals with different emotional themes, including grief, loss, isolation, and acceptance.

Many of the communication strategies seen in River Speaks can be linked to Jean Piaget’s work on child development. According to Piaget, healthy coping and a sense of self cannot exist without establishing trusting relationships during childhood. Trauma can interrupt this process, and the River Speaks series is intended to restart and re-establish healthy connections.

Research, including that of psychiatrist Bessel van der Kolk, professor at Boston University, shows that children must understand the emotions caused by trauma. This research emphasizes that therapists should teach children to regulate emotional distress, with the first step being acknowledgment of the distress’ severity.

Stream’s metaphorical approach helps children grasp the complex concepts that make the healing process. Comparing Sparky’s inability to express anger and grief to “hurricanes” and “tweets” helps make the abstract more tangible.

This strategy allows the River Speaks stories to personify complex psychological issues such as emotional defense mechanisms like denial, fear of abandonment, and Stockholm syndrome, making her books well-suited to children as young as three or four years of age.

Stream’s stories are accompanied by illustrations from Yoko Matsuoka. The colourful drawings were designed to keep the oftentimes-dark subject matter child-friendly, and work well in conjunction with Stream’s metaphorical portrayals of emotions and trauma.

Such illustrations are a common tool in dealing with childhood trauma. The use of visual art to depict emotional reactions has been found to benefit children during the normal grieving process. A paper by Cynthia O’Flynn at North Central University explains that art therapy can be especially beneficial for children suffering from serious traumatic grief.

The article cites numerous other studies reporting that art allows children to bypass the language and vocabulary needed to explain their grief or loss, making self-expression much easier. The children are able to perceive greater control over their emotions and feel safe while reflecting upon their experiences.

Alexa S. Rabin of Alliant International University reinforced these findings in 2012, stating that art is an exercise which allows children to assert themselves and their boundaries. Rabin explained that such therapy significantly decreases acute stress symptoms, noting that the purpose of trauma treatment is to help children find a way to cope.

Stream’s books bridge the two sets of findings—using both art and language to reach out to children and better their self-expression across both media. A therapist using Stream’s books would be more flexible in tailoring the therapeutic style to the child’s age and individual needs.

Feedback from psychologists such as Jacqueline A. Carlton and fellow author Cheryl Eckl, applaud Stream’s attempt at tackling such difficult subject matter. And while research would be needed to gauge the helpfulness of her specific stories, existing research suggests that her books may ease therapy for both clinicians and children.

– Olivia Jon, 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

Does Experiencing Therapy Make a Better Therapist?

00Cognitive Behavioral Therapy, Emotion Regulation, Emotional Intelligence, Empathy, Featured news, Psychoanalysis, Therapy February, 16
John Sloan on Flickr

Source: John Sloan on Flickr

It seems intuitive. Psychologically adjusted clinicians should provide better psychotherapy.

Aside from the stressors of their own daily life, therapists face the emotional struggles and traumas of their clients on a daily basis. To meet these challenges effectively and to avoid burnout, therapists need to maintain a high degree of self-awareness and personal wellbeing.

So how does experiencing therapy help clinicians with their work?

British psychotherapist Drew Coster says that personal psychotherapy has helped him broaden his repertoire of techniques and taught him to focus on achieving his clients’ goals instead of focusing on a prescriptive model of treatment. Similarly, Chicago psychologistGerald Stein has explained that going through therapy can help clinicians identify problems in their treatment approach based on their personal experiences.

Studies have also shown that the therapist’s wellbeing affects the quality of the relationship developed with the client. The clinician-client relationship is often referred to as thetherapeutic alliance and it is related to better therapy outcome regardless of the therapist’s specific style or school of thought.

Psychologists Leslie Greenberg of York University and Shari Geller of the University of Toronto, authors of the Therapeutic Presence: A Mindful Approach to Effective Therapy, argue that therapist self-care builds the foundation for developing a good therapeutic relationship with the client. Only through personal balance and stability can clinicians be fully present, attentive, and helpful during sessions.

Self-care can take many forms and can include going through therapy. For practitioners, experiencing their own therapy helps promote self-awareness and personal growth. And it allows them to address private issues and biases that would otherwise hinder progress in their clients. Becoming aware of one’s strengths and limitations can help therapists determine what clients to take on and when to refer clients to other therapists.

Traditional psychoanalysis is the only therapeutic orientation that requires the therapist-in-training to actually go through the therapy process. Self-reflection and exploration are key components of humanistic and experiential therapies. And while cognitive and behavioural approaches do not emphasize personal development on the part of practitioners, mounting evidence for the importance of solid therapeutic alliances may be shifting this tradition.

Psychiatrist Steven Reidford, argues: “At the most commonsense level, a therapist who knows what it is like to be a patient may be more empathic, and may anticipate unstated feelings more readily than a therapist without this first-hand knowledge.”

Reidford cites the requirement for practitioners of psychoanalysis to undergo therapy, explaining that the Freudian concepts of emotional transference and countertransference between patients and therapists are readily applicable to other therapeutic styles like CBT. Instead of relying on theory and patient-report data, he suggests experiencing the phenomena firsthand. He explains that therapists’ primary tool is their emotional sensitivity, which can be honed by attending psychotherapy and getting familiar with one’s own feelings and biases. He also notes that being in therapy de-stigmatizes the process and can help therapists see their patients as individuals instead of maladies.

Experiencing therapy may be helpful from a simpler, more practical standpoint. Associate professor James Bennett-Levy of the University of Sydney found in a recent study that students learning the cognitive therapy approach found personal therapy helpful in enhancing their understanding of the theory and process of treatment. They also found it helpful in gaining a better understanding of their role as a therapist, developing greater empathy, and gaining a better understanding of themselves.

Personal counselling also allows the therapist to experience what it feels like to be the client. Clinicians in Bennett-Levy’s study stated that personally experiencing the treatment process, beyond reading about it or conducting it, provided a deeper understanding of the models and techniques they were studying.

It is important to keep in mind that this research was based on the therapists’ self-evaluations. Are these benefits reflected in psychotherapy outcomes for clients?

Most research on therapy for therapists has focused on self-evaluations of the positive and negative effects. While clinicians purport to gain insight and professional skills by attending therapy, little research exists measuring the specific impacts of therapy for therapists on client satisfaction. Nevertheless, as with anyone, therapy can help clinicians gain self-awareness and empathy, which may otherwise wane as a result of life stress.

– Essi Numminen, 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