I am primarily an introvert. Growing up, I didn’t give it much thought. I just remember that I enjoyed my alone time and would get annoyed if my mother pressured me to go out and play with friends. I was having fun with my books, war toys, and train sets, and did not understand what the problem was. She seemed to think I was being antisocial, uninvolved, and perhaps depressed.

It was as if I was doing something unhealthy and it was going to be her fault if she could not find a way to change me.

The thing is, I always had a few good friends. We just got together when we felt like it. Not seeing much of each other for a week or two did not matter. We always had fun when we got together, and have remained friends across time.

There were other things we had in common:

• We liked quiet. We could hang out for long periods of time and not talk much. When we did talk, we might talk a lot. But it was fine if no one had much to say.
• We liked alone time. It was as if we had only so much being-with-others energy. Once tapped, we would head to our caves and not come out until we felt like being with others again.
• We did not like study groups. Constant conversation seemed more disruptive than helpful when it was time to study.
• We were ambivalent about extroverts. We liked that they were usually friendly; that they initiated conversations in social settings; and that they liked it when we listened to them. We did not like that they talked a lot, all the time; that they got anxious or annoyed if we did not, or could not, respond when and how they wanted us to; and that they stressed so much if we did not agree with them, like we were committing a crime or something.
• We did not understand why so many people seemed to think we should be more sociable.

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One time, an extroverted girlfriend told me that my need for downtime was unhealthy, that I had a serious problem. This bothered me, so I decided to find out what people who are supposed to know about these things had to say about my inclination to introspection. I did not like what I found.

Among the descriptive terms for introverts in both standard dictionaries and psychological glossaries were: self-centered, primarily concerned with their own thoughts and feelings; reticent; lacking in energy and positive emotion; difficulty adjusting to social situations; excessive daydreaming and introspection; and withdrawal under stress.

A particularly annoying comment was found in the American Psychological Association’s Glossary of Psychological Terms—the message being that these behaviors and processes were matters of choice and, when not, may point to an underlying pathology such as a social phobia or avoidant personality disorder.

Talk about sandbagged! I was not choosing to enjoy solitary activities, I just enjoyed them. I was not choosing to be drained at times by ongoing interactions with others, I was just drained. Furthermore, I like people. When I choose to connect, I do so at a deep level, with genuine empathy.

However, according to some “experts” on human behavior, I run the risk of being perceived as seriously disturbed. Needless to say, I did not mention this to my girlfriend.

Years passed before I happened upon information about introversion that actually made sense. This information came from Carl Jung’s theory of psychological types and is the basis for the Myers-Briggs Type Indicator, arguably the measure of personality most widely referenced over the past 30 years.

Jung noticed that human beings have a birth nature. This nature, or psychological type, is determined by an individual’s natural and normal degree of response orientation toward one pole or the other on four behavior and/or process opposite dichotomies. Introversion-extroversion is one of these dichotomies.

A solid base of empirical evidence regarding the introverted process has grown from over 40 years of experience using the MBTI in both counseling and employment settings. Natural and normal traits and characteristics associated with the introverted process include:

• Primary source of life energy derived from introspective processes.
• Have limited social interactive energy. Usually require downtime to recharge when depleted.
• Come to conclusions through reflection. Conclusions are experienced as factual reality, as self-evident, and therefore may not be expressed.
• May have difficulty accessing words required to adequately express what they are thinking or feeling.
• Interruptions may disrupt their connection to what they are thinking, feeling, or saying.
• Are inner focused and, consequently, may not be aware of their impact on others.

As a general rule, the stronger an individual’s introverted response orientation, the greater the likelihood that the characteristics and traits above will apply.

Conclusion

There is a reason introverts experience a deep sense of satisfaction, even joy, in solitary pursuits, and it is not because there is something wrong with them. It is because they are, by nature, designed to generate life energy in this manner.

As with extremes in general, there is a point where one’s drive for solitude may become problematic. However, I have been working with introverted people in individual, couples, and family counseling settings for over 14 years now and, with rare exception, have found a person’s drive for solitary pursuits to be in balance with his or her degree of introverted response orientation.

Even the most honest people are faced with lying when they are depressed. This is yet another indignity adding to the suffering of depression. The most obvious and pervasive example is the frequent, daily question, “How are you?” It is a social convention to greet friends, strangers, and acquaintances with this question. Frankly, most of us lie in response to this question, or at least shade or limit the truth, because people generally don’t want to hear the true answer when they ask. Convention tells us to answer, “I’m fine, thanks; how are you?” For most people most of the time, this isn’t a big deal. It’s just a formality that facilitates greeting people, and is understood as a friendly hello. It’s not generally a problem because mostly people are fine, and don’t need to tell someone about the rash on their butt or the dog poo they stepped in.

But for a depressed person, the lies required for social convention are constant, and they create more and more isolation and separateness from other people. They reinforce a sense of having a shameful secret that no one wants to know or help them resolve. It reinforces a sense of being a burden or unlovable. All of these thoughts are common in depression, and to have them reinforced all day long by multiple people is crushing. Many people deal with it by isolating themselves from others if they can.

Of course, we all expect to lie to store clerks and other strangers, or even coworkers or neighbors, when they ask how we are and the truthful answer is too personal. But what about when a doctor asks—or clergy, someone we’re dating, our parents, our children, or our friends? What if what we are thinking is, “I hate myself,” “I’m disgusting,” “I’m a failure,” “Everyone would be better off if I were dead,” “I can’t stand the emotional pain anymore,” or even “Day after day I can barely get out of bed, and when I do, I can’t do anything—I’m neglecting my children and spouse, doing a terrible job at work, and have no interest or joy in anything”?

[fat_widget_left]If people say these thoughts aloud, they are likely to get an upsetting response. Some will tell them they don’t really feel that way, or shouldn’t feel that way. Some will try to cheer them up. Others will shame or blame them for how they suffer. Many will get scared; some may laugh. Some will distance themselves. Even some inexperienced therapists may get distracted by their fear of suicide and shift focus to keeping the person alive rather than addressing the pain. Good friends may listen and care, but if the condition is chronic, they get tired of listening to the same scary, depressing point of view that is their friend’s experience.

Here’s an example of the kind of conversation depressed people have all the time, in this case between friends. The italics indicate unspoken thoughts.

Friend: “Hi, how are you?”

Depressed person: I feel like crap, but if I say that, she’ll think I’m being negative and tease me about being Eeyore. I don’t want to alienate her or make her depressed, and I also don’t want to answer a lot of questions to explain or justify how I feel. I’d better act like I’m OK. Maybe she won’t notice. “I’m fine, how are you?”

Friend: She doesn’t look good, but I don’t want to pry, and I don’t know what to do if I find out she’s not OK, so I’ll just wait for her to tell me what’s wrong. Exercise would probably help her—maybe I can inspire her. “I’m good—just had a great workout.”

Depressed person: Oh, god, she thinks I’m a fat slug. I don’t have the energy to brush my teeth, much less work out. I’m a worthless piece of crap. I’ll never be a normal person like her. Everyone else just goes on with their lives, and everything would go on the same way without me. I’m really not a participant in life; I’m just dead weight. “Wow, that’s awesome. I have to get back to the gym, too. How’re the kids?”

Friend: If I entertain her with stories, maybe it will cheer her up …

Depressed person (tuning in and out of stories): I’ve told her how crappy I felt—or some of it—both times I’ve seen her recently. If she knows I’m still depressed, she’ll probably be bored and overwhelmed and won’t want to see me again until I feel better. Maybe I can just talk about one problem. “Yeah, I really worry about my kids. Henry punched a kid at school the other day …”

The depressed person walks away from the visit feeling alone in her secret life and drained from keeping the secret.

This is one of the most important reasons to find an experienced, qualified depression therapist when depression lasts longer than a few weeks. It’s essential to be able to tell someone the whole truth about how much you’re suffering, without concern that the person will discount you, disbelieve, judge, get distracted by fear about what you are saying, or respond with boredom, irritation, or impatience. As obvious as that may sound, not many people can do this for others.

While traditional video games typically require only brief periods of investment from players and don’t involve developing a new persona, online role-playing games tend to be much more time-intensive and require a strong emotional investment. These games encourage players to become a character—often one who is very different from a player’s real-life persona—and often have no end point. They can be played for hours, days, or even years, with characters networking with others to develop a virtual world that may feel more comfortable than the real one. The games can prove addictive and may interfere with real-life responsibilities, but they also offer several benefits, with some people finding that they master new skills online.

Adopting a New Persona
The hallmark of a role-playing game is that players adopt personas for their characters rather than playing as one or several pre-established characters. Depending on the game, players may be able to write their character’s life story, choose their character’s specific appearance, and take on a wide variety of personality traits. Some players view this as an opportunity to experience what it’s like to be a completely different person. Men might become women, for example, and young people might choose to be elderly.

This investment in the new persona can, however, be problematic for some players. A player who feels isolated or who is unsatisfied with his or her life might become more invested in the character and the character’s friends than he/she is in real life. Players who spend too much time on the game might abandon their own personal development and friends in favor of developing their characters and making friends for their characters.

Effects on Relationships
A Brigham Young University found that 75% of people involved in a relationship with a role-playing game player wish their partner spent less time playing the game. The intense nature of these games and the fact the time commitment is limitless means relationships can take a hit. Some players may even develop romantic relationships for their characters while playing the game, and these relationships can disturb real-life partnerships.

However, all is not lost when it comes to RPGs and relationships. The same BYU study also found that 76% of couples who played role-playing games together believed that it strengthened their relationship. Working together in this new, mutually experienced environment can make a relationship feel new and fresh, and gives couples a shared pursuit.

Addictive Nature
Role-playing games, like many other behaviors, can become addictive. Successful players generally have to spend a lot of time on the game and may spend hours networking with other players. This time commitment increases the likelihood that a player may become addicted, and the pressure from other players to keep playing the game can make it difficult to pull away.

Benefits of Role-Playing Games
Although many parents are concerned about their children playing RPGs and despite a significant amount of negative press coverage, RPGs also offer some important benefits. These include:

• Improved spatial reasoning skills, particularly for female players.
• The ability to establish new friendships and practice social skills. This can be particularly helpful for people who feel awkward or lonely.
• Increased empathy toward people with different lifestyles or appearances. By adopting a new persona, a player may be able to learn what life could be like for another person.
• Developing strategy and critical-thinking skills as players develop complex solutions to ongoing challenges.

References:

1. Billieux, J., Chanal, J., Khazaal, Y., Rochat, L., Gay, P., Zullino, D., & Van der Linden, M. (2011). Psychological Predictors of Problematic Involvement in Massively Multiplayer Online Role-Playing Games: Illustration in a Sample of Male Cybercafé Players.Psychopathology, 44(3), 165-171. doi: 10.1159/000322525
2. Dupuis, E. C., & Ramsey, M. A. (2011). The Relation of Social Support to Depression in Massively Multiplayer Online Role-Playing Games. Journal of Applied Social Psychology, 41(10), 2479-2491. doi: 10.1111/j.1559-1816.2011.00821.x
3. Feng, J., Spence, I., & Pratt, J. (2007). Playing an Action Video Game Reduces Gender Differences in Spatial Cognition. Psychological Science, 18(10), 850-855. doi: 10.1111/j.1467-9280.2007.01990.x
4. Online role-playing games hurt marital satisfaction, says BYU study. (n.d.). Brigham Young University. Retrieved from http://news.byu.edu/archive12-feb-mmorpgs.aspx

Talk to any pet lover and he or she will tell you that pets make life richer and better. But pets aren’t just a source of fun and an occasional source of extra work. Animals can play important roles in helping people recover from illness, making medical visits less stressful, and relieving social isolation. Although a wide variety of animals have been used in therapeutic settings, therapy dogs are the most popular option, and there’s strong evidence that a therapy dog can make a huge difference in a person’s quality of life.

What Are Therapy Dogs?

A therapy dog is any dog used in a therapeutic setting to improve treatment outcomes. Some are trained to complete specific tasks, while others are just well-behaved dogs. There’s no specific breed, size, or age requirement for a dog to become a therapy dog. Some are raised and specifically trained to provide therapeutic services, while others are just pets visiting a nursing home or rehabilitation center over the weekend.

What Do They Do?

Therapy dogs are hugely diverse and can fill a wide variety of functions. Some visit people living in nursing homes and respite facilities, providing companionship and a brief opportunity to pet an animal. Others work with children in crisis. For example, some child-abuse centers provide a chance for children to talk to therapy dogs, rather than people, about their abuse. Some prisons have established therapeutic pet-ownership programs in which a prisoner cares for an abandoned or unwanted dog or puppy. Some dogs are highly trained and work as seizure-alert dogs for people with epilepsy or as assistance dogs for people with sensory limitations. Dogs also have been used to help war veterans experiencing posttraumatic stress and other issues. These dogs sometimes undergo years of training before they’re placed with an owner.

What Are the Benefits?

Dogs have a soothing effect on people. The simple act of petting a dog can ease symptoms of depression and anxiety. The benefits of therapy dogs are overwhelming, and include:

• Increasing independence
• Decreasing symptoms of anxiety, depression, and other mental health issues
• Reducing stress
• Improving physical health
• Providing companionship for lonely or isolated people
• Providing a safe opportunity for people—particularly children—to talk about uncomfortable topics
• Providing comfort to people who are anxious about receiving medical care

Can Your Dog Be a Therapy Dog?

There are several organizations that certify dogs as therapy dogs, but not all dogs are certified. Some nursing homes, for example, recruit owners of well-behaved dogs to bring their dogs in a few times a week or month. In most cases, though, your dog will need to pass a temperament test and show no signs of aggression or fear toward people or other animals. Some dogs may need more intense training. For example, therapy dogs that work with children might have to learn how to tolerate being hugged tightly and master the art of not jumping on a rambunctious child.

Guide dogs usually undergo a year or two of training before moving in with a permanent owner. Several organizations recruit families who are willing to put in the time and effort to train a guide dog. However, they have to give up the dog when it’s time for him or her to move in with a permanent owner.

References:

1. Getting started. (n.d.). Therapy Dogs International. Retrieved from http://www.tdi-dog.org/About.aspx?Page=Getting+Started
2. Perceptions of the impact of pet therapy on residents/patients and staff in facilities visited by therapy dogs [PDF]. (n.d.). Flanders: Therapy Dogs International.
3. Walsh, P. G., & Mertin, P. G. (1994). The Training of Pets as Therapy Dogs in a Women’s Prison: A Pilot Study. Anthrozoos: A Multidisciplinary Journal of The Interactions of People & Animals, 7(2), 124-128. doi: 10.2752/089279394787002014
4. What is a therapy dog? (n.d.). Therapy Dogs of Vermont. Retrieved from http://www.therapydogs.org/index.php?option=com_content

Although jail time might seem like a distant possibility for most people, incarceration rates in the United States are steadily rising. One study published in the journal Pediatrics found that 41% of young adults have been arrested by the time they are 23. The U.S. Department of Justice (DOJ) reports that 6.6% of people serve time in prison at some point in their lives, and the statistic rises to a shocking 32% for African-American men. More than half of inmates are diagnosed with a mental health disorder.

As state mental hospitals continue to close and mental health services remain financially out of reach for many people, this number may rise. Moreover, prison itself can exacerbate preexisting mental health issues and create new mental health challenges among those who had never experienced them.

Mental Health Care Behind Bars

Jails and prisons are required to provide basic health care for inmates, but the quality of this care varies greatly. Often, prison-based mental health care focuses on stabilizing, rather than treating, inmates. A person experiencing hallucinations or psychosis might get medication to control the most severe symptoms, but people with anxiety issues, depression, posttraumatic stress, and other mental health conditions that don’t cause radical changes in behavior may go untreated. Prisoners rarely, if ever, get therapy or comprehensive treatment, so mental health issues that were previously controlled with medication and therapy may get much worse during incarceration.

Prison and Trauma

Even for the most hardened criminals, prison can be a scary place. The DOJ reports that 70,000 prisoners are sexually abused every year, and assaults, fights, and other acts of violence are common in a prison setting. But violence isn’t limited to inmates; prison guards work in a high-stress environment that can increase their likelihood of becoming violent. With little hope for reporting abuse by guards, some inmates may endure verbal abuse, threats of physical violence, and even severe attacks. Women inmates are at an increased risk of being sexually assaulted by jail and prison guards. This ongoing climate of trauma can create anxiety, depression, phobias, and PTSD in prisoners who previously had no serious mental health issues.

Lack of Support

Prisoners are, by definition, cut off from the rest of society, and their access to supportive friends and family may be limited. Many jails have instituted mail policies prohibiting letters and magazine subscriptions, and these policies can eliminate prisoners’ ability to communicate with and receive support from loved ones. Phone calls from jail can be costly, and prisoners from impoverished backgrounds may have families who can’t afford to cover the costs of collect calls, however infrequent. There’s little hope for getting any support in prison, as many prisoners are concerned more with gaining respect and avoiding fights in a relentless pursuit of safety. Support from loved ones can play a critical role in helping people overcome mental challenges, and isolation can increase a person’s risk of mental health issues such as depression and anxiety.

Getting Out

Most prisoners have ignored basic rules of society, so it can be difficult for prisoner rights issues to garner much public sympathy. But many prisoners are incarcerated for nonviolent drug crimes that are the result of substance addiction. And even inmates incarcerated for violent crimes do not typically serve life sentences. Most prisoners are ultimately released, and the mental health issues they develop in prison can increase their risk of reoffending and make it difficult to reenter society as a productive, nonthreatening citizen. Almost 70% of people who have been incarcerated are arrested again within three years, and the dire state of mental health care in prisons could play a significant role in this high rate of recidivism.

A mental health professional can help people who have come into contact with the prison system. A therapist can help prisoners reenter society or reestablish bonds with friends and family. Loved ones of incarcerated individuals can also get necessary emotional support in therapy. Therapy is a safe and confidential place for any and all people to get help.

References:

1. Chaddock, G. R. (2003, August 18). US notches world’s highest incarceration rate. The Christian Science Monitor. Retrieved from http://www.csmonitor.com/2003/0818/p02s01-usju.html
2. Gann, C. (2011, December 19). Study: Significant number of young Americans get arrested. ABC News. Retrieved from http://abcnews.go.com/Health/arrests-increasing-us-youth/story?id=15180222
3. James, D. J., & Glaze, L. E. (2006, December 14). Mental health problems of prison and jail inmates [PDF]. Washington, D.C.: U.S. Department of Justice Bureau of Justice Statistics.
4. Purdy, M. (1995, December 19). Brutality behind bars. The New York Times. Retrieved from http://www.nytimes.com/1995/12/19/nyregion/brutality-behind-bars-special-report-prison-s-violent-culture-enveloping-its.html?pagewanted=all
5. Recidivism. (n.d.). Bureau of Justice Statistics (BJS). Retrieved from http://bjs.ojp.usdoj.gov/index.cfm?ty=tp
6. Sakala, L. (2013, February 7). Return to sender: Postcard-only mail policies in jails. Prison Policy Initiative. Retrieved from http://www.prisonpolicy.org/postcards/report.html
7. U.S.: Federal justie statistics show widespread prison rape. (2007, December 16). Human Rights Watch. Retrieved from http://www.hrw.org/news/2007/12/15/us-federal-statistics-show-widespread-prison-rape
8. U.S.: Number of mentally ill in prisons quadrupled. (2006, September 6). Human Rights Watch. Retrieved from http://www.hrw.org/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled

While not everyone’s experience is the same, when people have a major depressive episode, generally the world looks, feels, and is understood completely differently than before and after the episode. During a major depressive episode, the world can literally seem like a dark place. What was beautiful may look ugly, flat, or even sinister. The depressed person may believe loved ones, even their own children, are better off without them. Nothing seems comforting, pleasurable, or worth living for. There’s no apparent hope for things ever feeling better, and history is rewritten and experienced as confirmation that everything has always been miserable, and always will be.

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When this reality shift happens, it’s difficult to remember or believe what seemed normal before the episode. What the person believes during the episode seems absolutely real, and anything that conflicts with it is as unbelievable as a memory or message telling him or her that the sky is purple. For example, if the person is unable to feel love for a spouse, and someone reminds the person that he or she used to feel that love, the person may firmly believe he or she had been pretending to himself/herself and others—though at the time he or she really felt it. The person can’t remember feeling the love, and can’t feel it during the episode, and thus concludes he or she never felt it. The same process happens with happiness and pleasure. Attempts to tell the person that he or she used to be happy, and will feel happy again, can cause the person to feel more misunderstood and isolated because he or she is convinced it’s not true.

Even if nothing was wrong before the episode, everything seems wrong when it descends. Suddenly, no one seems loving or lovable. Everything is irritating. Work is boring and unbearable. Any activity takes many times more effort, as if every movement requires displacing quicksand to make it. What was challenging feels overwhelming; what was sad feels unbearable; what felt joyful feels pleasureless—or, at best, a fleeting drop of pleasure in an ocean of pain.

Major depression feels like intense pain that can’t be identified in any particular part of the body. The most (normally) pleasant and comforting touch can feel painful to the point of tears. People seem far away—on the other side of a glass bubble. No one seems to understand or care, and people seem insincere. Depression is utterly isolating.

There is terrible shame about the actions depression dictates, such as not accomplishing anything or snapping at people. Everything seems meaningless, including previous accomplishments and what had given life meaning. Anything that had given the person a sense of value or self-esteem vanishes. These assets or accomplishments no longer matter, no longer seem genuine, or are overshadowed by negative self-images. Anything that ever caused the person to feel shame, guilt, or regret grows to take up most of his or her psychic space. That and being in this state causes the person to feel irredeemably unlovable, and sure everyone has abandoned or will abandon him or her.

It’s difficult to describe all of this in a way that someone who’s never experienced it can make sense of it. I can’t emphasize enough that when this happens, what I am describing is absolutely the depressed person’s reality. When people try to get the person to look on the bright side, be grateful, change his or her thoughts, or meditate, or they minimize or try to disprove the person’s reality, they are very unlikely to succeed. Instead, they and the depressed person are likely to feel frustrated and alienated from one another. I do believe cognitive therapy has an important place, but generally not in the throes of a major depressive episode.

Support for People with Depression

So what does a person whose reality has shifted in this way need? Please keep in mind that I am talking about a major depressive episode—severe depression that has lasted more than two weeks. I would take a different approach for someone with milder depression, or one that is a response to a terrible loss.

For some people in a major depression, psychotropic medication works and is the only thing that works. The same could be said for electroshock treatment, though it’s not for everyone. Many people will emerge from major depression in time, though episodes seem to make more episodes more likely, so if medication works to end the episode, it’s usually prudent to take it. Nutrition, acupuncture, and other body-based treatments as well as therapy can help without the side effects of medication.

What Loved Ones Can Do

Loved ones can gently hold and show love and commitment to the depressed person, try not to take on the person’s reality, but also not argue with him or her about it. They can also gently remind the person that depression causes his or her perspective on everything to change, and he or she is unable to think outside of depression mode at the moment. It is a time for the person to avoid making decisions, or avoid doing anything significant that requires a nondepressed perspective. If this is a repeated experience for this person, it can be helpful to discuss all of this between episodes so he or she is more prepared when caught in the quicksand.

As someone who loves a person with depression, it can be emotionally difficult or stressful at times to support that person. It can be beneficial to focus on your own needs and self-care, and to reach out for help if you need it such as seeking the support of a counselor or therapist.

Thought distortions are common thinking “crutches,” or thinking habits, we fall into despite the lack of reality and truth in the thought. There are 10 common thought distortions we can all be victim to, according to Dr. David Burns, author of the self-help book Feeling Good: The New Mood Therapy. This article will address how common thought distortions can impede our sensual and sexual selves.

It is my belief that we are sensual and sexual beings throughout our life span; however, thinking patterns develop that can impede this essential part of the human experience. Falling into a pattern of thought distortions without being aware of them can prevent us from fully embracing our health and relationships.

The aforementioned 10 common thought distortions, as outlined by Burns, are as follows:

1. All-or-nothing thinking impedes sensuality and sexuality when, for example, we believe we must have “fireworks” sex in order for a sexual encounter to be worthwhile. According to Metz and McCarthy, only 40% to 60% of “well-functioning, satisfied married couples” surveyed report good-quality sex, and sometimes for only one partner. So if you are waiting for the perfect timing—when you aren’t tired or stressed, or when your  to-do list is minimal—to engage in intimacy, start breaking this thinking habit and get reconnected.
2. Over-generalizations come in the form of “always” and “never” thinking. When this distortion is applied to sensuality and sexuality, it may create unrealistic expectations. You may think or hear phrases such as, “You always want to have sex, that’s all you want from me,” or, “You are never romantic.” Over-generalizations create undo resentment and distance between intimate figures.
3. The “mental filter” gets us stuck dwelling on the negative details and filters out the positive of a situation or experience. This thought distortion promotes selectively abstracting facts, which makes for a challenge to emotional intimacy, sensuality, and sexuality. An example of a mental filter is when a person fails to see gestures of attention and romance. Sure, shoveling the walk for you or ensuring the dog is walked isn’t what fairy tales and romance movies are made of, but if we didn’t filter these gestures, could they be acts of attention and romance or other wants and needs? Another example of a mental filter that can impede our sensual and sexual selves is not engaging in a bid for sexual engagement because the last time you wanted sex, your partner wasn’t interested. Don’t allow your mental filter the power to filter out the other times your bids for sexual engagement were responded to.
4. Disqualifying the positive is a thought distortion that converts compliments or positive gestures into “flukes” or merely an anomaly, whereas any negative feedback or gesture is proof of one’s negative attributes. This is a good example of why it is important to do our own work as individuals and ensure we are showing up in a relationship with an understanding of ourselves. If we rely only on relationships, intimate partners, or sexual experiences to fortify our positive self-image, we may be more susceptible to this thought distortion.
5. Jumping to conclusions. This thought distortion is evident when we think we know what someone is thinking—“mind reading”—and then we interpret the person’s (assumed) thoughts as what someone is feeling. Take this example: A man jumps to a conclusion about his partner’s thoughts regarding love: “I know I’m not as exciting in bed as I used to be, so you aren’t in love with me as much as you used to be.” How impactful to be operating in a relationship with such a serious false conclusion. What about this set-up allows for emotional or physical intimacy?
6. Magnification and minimization. Commonly described as the “binocular trick,” in which we exaggerate our errors, mistakes, and imperfections while we see our strengths as small, unimportant, and insignificant. The common result of this thinking habit is to feel inferior or inadequate. How much do thoughts of being “not a good enough (fill-in-the-blank)” keep us from fully embracing our sensual and sexual selves?
7. Emotional reasoning is the thought distortion we engage in when our emotions are the truth, reality, and facts of a situation. When we engage in emotional reasoning, we do not challenge our emotions and we allow them to guide us as if they are facts. Consider this: A single parent feels lonely and isolated. Emotional reasoning enters the picture when the experience of loneliness and isolation is “proof” that this person is undateable, unattractive to anyone, and certainly not a sexual and sensual god/goddess. See how the cycle feeds itself? Emotions are not always related to the facts.
8. “Should” statements are fiercely common. “Should” statements are used as motivators; the cause that pressures us to act, which often results in resentment. In addition to resentment, “should” statements can result in apathy, reduced motivation, frustration, self-loathing, shame, and guilt. When we apply “should” to others, we can be left feeling bitter, self-righteous, and perhaps let down. As a sex therapist, I am often asked, “How often should my partner and I have sex?” or, “Should do stuff I don’t really want to do to make him/her happy?” “Should” statements are pressure and energy-draining. Talking in “wants/needs/desires” is far more holistic in and outside the sensuality and sexuality realm.
9. Labeling and mislabeling is another common thought distortion that can be considered extreme over-generalization (see No. 2). “I am a (fill-in-the-blank): messy person, bad person, liar, good person, perfect person, loser, better person than her, worse person than him …” How are the labels you give yourself and others, or your relationship, impeding your sensuality and sexuality?
10. Personalization creates guilt and forces us into a role of taking responsibility for the negative. When we engage in personalization, we think what happens reflects on our own inadequacy. This is a high sense of responsibility for something we may have influence over but are not in control of. Whether we are in a relationship or not, as with all of these thought distortions, we are susceptible to personalization. Personalization is a small wound we inflict on ourselves through our own thinking. By forcing ourselves into a role of taking responsibility for the negative, we are not basking in the positivity and light of our sensuality and sexuality.

So what is a person to do? The first step toward any change is awareness, so I advise you to read the preceding list a number of times. Next, start observing your own thought processes and challenge yourself to alter your thinking in order to positively impact your intimacy and your relationships with others—as well as your sensual and sexual self.

Since the beginning of recorded history, people have been forecasting the end of the world. In biblical times, many people believed that Jesus would return in a few short years, and religions throughout the world have cautioned people to repent and prepare for the end of days for as long as there have been religions.

In modern times, with science gaining popular acceptance and doomsday scenarios falling outside the mainstream, such beliefs can seem highly unorthodox. But the Daily Mail reports that 22% of Americans believe the world will end in their lifetime, and the belief that a religious figure will return to “save” a chosen few is still commonplace. The National Geographic Channel has dedicated a popular television series to people who believe the world may soon end: Doomsday Preppers follows individuals—sometimes referred to as survivalists—and their families as they plan and prepare for the end of civilization.

Psychology can offer some insight into this phenomenon.

Risk and Preparedness
We live in an increasingly complex and often frightening world. Massive tsunamis can kill thousands, and electrical outages can cripple a city, state, or country. The threat of nuclear war is omnipresent, and protests around the world can make government and order seem increasingly unstable. Many people actively fear the prospect of terrorist attacks, pandemics, fuel shortages, and societal or economic collapse.

Most people prepare to some degree for “what-if” scenarios. People buy flood insurance, swarm the grocery store before a storm, and buy generators to ensure their businesses can keep running if there’s a power outage. The difference between those who take it to the extreme—such as doomsday preppers—and those who simply plan for a rainy day may simply be a matter of degree.

Trauma and Experience
People who believe in conspiracies and doomsday scenarios likely would caution that, if they’re right, they don’t look so strange after all. And when a person’s experiences are taken into account, their worries may even seem justified. A person who has experienced war might be more frightened that war could end the world, while trauma victims and people with posttraumatic stress may have more difficulty assessing risk.

Belief Systems
People tend to accept evidence that supports their belief systems and ignore evidence that doesn’t—a phenomenon called confirmation bias. In some cases, people may believe conspiracy theories because these theories support their most fundamental or earliest-established beliefs. A person whose mother claims to have been kidnapped by aliens might, for example, fervently cling to a belief in aliens because believing in aliens allows him to believe his mother. A highly religious person who believes she experienced a prophecy that the world will soon end is unlikely to abandon such a belief because doing so undermines her religious experience.

Once a doomsday scenario or conspiracy theory becomes part of a person’s belief system, he or she is unlikely to abandon it even in the face of conflicting evidence. This isn’t unique to doomsday preppers. We all have things we believe without evidence, sometimes even in the face of contradictory evidence.

Mental Health Conditions
Some people who believe in conspiracy theories and end-of-days scenarios may be experiencing a mental health issue. Conditions that can contribute to such beliefs include:

• Schizophrenia, which can result in delusions and hallucinations that could convince a person the end of the world is near or that an entity is out to get him or her.
• Paranoid personality disorder, which manifests as constant suspicion, often in the form of fear of the government.
• Persecutory delusion, which may cause a person to believe that another person or entity is out to get him or her and will not stop until harm is done.

References:

1. Cruz, N. (2012, April 3). National Geographic’s troubling, addictive show about survivalists. Slate. Retrieved from http://www.slate.com/blogs/browbeat/2012/04/03/doomsday_preppers_on_national_geographic_is_the_survivalist_reality_show_exploitative_.html
2. Guyatt, N. (2007). Have a nice doomsday: Why millions of Americans are looking forward to the end of the world. New York, NY: Harper Perennial.
3. Hanlon, C. (2012, May 2). 22% of Americans believe world will end in their lifetime (and 10% think the apocalypse is coming this year). Mail Online. Retrieved from http://www.dailymail.co.uk/news/article-2138449/The-end-nigh–Americans-think-world-end-year.html

Integrating live animals into the therapeutic process has been gaining recognition as a viable and effective approach in a clinical setting. Equine-assisted therapy is a widely popular form of therapy that has shown remarkable results with clients who do not respond well to other types of treatment. Similarly, children who are resistant to traditional therapies have demonstrated improvement in animal-assisted therapies. For individuals who experience disassociation, animals represent an unconditional source of love and acceptance. For people who may have experienced early life trauma, especially trauma or abuse that undermined attachment relationships, animals can replace missing secure attachment bonds.

Although animals as therapy adjuncts, even pets, can help reduce anxiety, depression, loneliness, and isolation, owning or working with an animal may not be a viable option for everyone in need. Therefore, stuffed animals, which represent a source of comfort in times of stress for young people, may serve as a suitable replacement. Rose M. Barlow of the Department of Psychology at Boise State University in Idaho wanted to see if stuffed animals would serve clients equally as well as live animals. In a recent study, Barlow surveyed a sample of high and low dissociative female college students and those with dissociative identity disorder (DID) about attachment to live and stuffed animals. She found that the DID women had significantly stronger attachments to both live and stuffed animals than any of the other women. She also found that those with high dissociation and those with DID reported higher levels of attachment to stuffed animals than live animals when compared to the low dissociative group.

The findings of this study have several important clinical implications. Even though comorbid issues such as depression, anxiety, and bipolar were not considered in this research, the evidence suggests that stuffed animals may be particularly helpful to those with high levels of dissociation. Because symptoms of dissociation, even disorganized attachment, can begin in childhood and result from emotionally unavailable parents, divorce, or abuse, integrating stuffed animals into therapy for young children can provide a sense of security and help to rebuild impaired attachment bonds. “Animals, live or stuffed, can aid therapy for both children and adults by providing a way to experience and express emotions, a feeling of unconditional support, and grounding,” Barlow said.

Reference:
Barlow, Rose M., Lisa DeMarni Cromer, Hannah Prairie Caron, and Jennifer J. Freyd. Comparison of normative and diagnosed dissociation on attachment to companion animals and stuffed animals. Psychological Trauma: Theory, Research, Practice & Policy 4.5 (2012): 501-06. Print.

Depression makes it difficult to function in daily life, but adding discrimination to the equation makes it even more troublesome.

A new study in the journal The Lancet stated that out of the 1,082 adult participants with major depressive disorder, 79% reported that they have experienced discrimination. People who experienced discrimination while depressed had more depressive episodes, social difficulties, and issues finding and keeping a job. They also were less likely to reveal a diagnosis of depression.

These results suggest that more works needs to be done in the area of preventing discrimination and eliminating stigma. Discrimination can prevent people with depression, who may be worried about disclosing their diagnosis, from getting the help they need. While getting a job and growing social networks can help fight depression symptoms, those pursuits become more challenging in the face of discrimination.

How, specifically, does discrimination affect people with depression? How can the general public be more understanding? And what options do people with depression have? Mental health experts and other professionals have some answers.

Dr. David Sack, CEO of Elements Behavioral Health and Promises Treatment Centers, said by email that sensitivity toward people with depression often is lacking.

“The most common example has to do with intolerance toward peers/friends/relatives that comes from not understanding that depression is a disease that the individual cannot simply will themselves out of,” he said.

Sack said a supervisor might question an employee’s motivation and commitment due to symptoms of depression, even if those symptoms don’t reflect how the employee really is.

“How often have we heard that this or that person claims that they are depressed just so they can get time off from work or won’t have to take responsibility for mistakes they’ve made?” Sack said.

Although many people know the basics of depression thanks to widespread awareness initiatives, prejudice, bias, and stigma still are rampant.

Viola Drancoli, a clinical psychologist, said in an email that friends and family members of people with depression might exhibit discriminatory behavior with them because they may feel drained from being around someone who expresses sadness, pessimism, irritability, and a lack of motivation.

This could push someone with depression into isolation. A person with depression might prefer being alone so he or she doesn’t have to attempt to hide feelings from others.

“The social isolation often starts a vicious cycle in which the (client’s) negative outlook on life is reaffirmed, they feel let down by family and friends, and symptoms may worsen,” Drancoli said. “This is especially dangerous for individuals who have suicidal ideations and need support and monitoring.”

Drancoli said it’s important for family and friends to be supportive. She suggests volunteering to help out with chores that might be difficult for someone with depression to complete when he or she is struggling to function, as well as patiently listening without judgment. Loved ones can gently encourage a person with depression to exercise as well, as this has been shown to boost mood.

People with depression who believe they have been discriminated against have the law on their side. Sack said that discrimination against people with any disabilities, including mental issues such as depression, is forbidden by the Americans with Disabilities Act. The civil rights law, enacted in 1990, defines disability as “a physical or mental impairment that substantially limits a major life activity.” Some states have additional laws against discriminatory behavior.

“An individual who is concerned about discrimination at work will want to speak with their supervisor or the director of human resources first,” Sack said. “Most companies have strong policies to promote fairness and nondiscrimination.”

Justine Lisser, a senior attorney advisor in the Office of Communications & Legislative Affairs at the U.S. Equal Employment Opportunity Commission, said by email that if an employer has at least 15 employees, it must abide by the ADA. Employers need to provide “reasonable accommodations” for people with disabilities, as long as the employer isn’t deeply burdened as a result.

“For example, if a person with depression is hired for a position that requires an 8 a.m. start time, but due to the effects of (antidepressant) medication the person could not start until 10 a.m., it would be a reasonable accommodation to permit the employee with depression to start at 10 a.m., assuming that it would not cause an undue hardship for the employer,” Lisser said.

The EEOC has successfully enforced employee discrimination laws in a few cases involving people with mental health issues. In one case, a sales associate at a video retailer experienced harassment because of his social anxiety disorder and depression. His employer was ordered to pay $70,000 to settle the discrimination suit, according to an EEOC press release from March 2012.

Most people experience some form of irrational fear or anxiety, and many are concerned about germs and disease in particular. Amid a flurry of films and media reports about antibiotic-resistant infections and life-threatening flu strains, it’s easy to understand why some people actively worry about what they touch and breathe.

While concern about germs can motivate people to make health-conscious decisions such as frequently washing their hands, a serious germ phobia can drastically alter how a person functions and engages with society. Even actor and television host Howie Mandel concedes he has been unable to shake the grip of mysophobia—the technical term for fear of germs. Phobias are differentiated from general fears by degree. A person who is concerned about germs might wash his or her hands or get a flu shot, but a germ phobia can interfere with every area of life. Phobias are treatable, and people experiencing them should seek medical or psychological assistance.

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Symptoms
The primary symptom of mysophobia is an irrational fear of germs. This can manifest differently in different people. One person, for example, might be fixated on a specific germ or disease, while another person might be afraid of germs and dirt in general. Common behaviors associated with mysophobia include:

• Compulsive hand washing
• Excessive use of disinfectants and antibacterial soap
• Fear of physical contact with others
• Extreme fear of getting sick
• Reacting with extreme fear to media reports of new diseases
• Fear of certain locations, such as doctor’s offices and airplanes, where germs or sick people might be present or confined

Effects
Mysophobia doesn’t simply inspire fear and avoidance. The phobia can be all-encompassing and life-altering. While people with mysophobia often recognize that their reactions are irrational, they can’t control them. They may avoid going out in public, developing intimate relationships, or eating food they did not cook. Because mysophobia affects so much of a person’s life, it can lead to other mental health issues such as depression, social isolation, and anxiety. Complete avoidance of germs can actually contribute to the development of health problems. Overuse of antibacterial and disinfectant products has been implicated in the spread of new, resistant infections, and children who are not exposed to germs are more likely to develop allergies.

Causes
No one knows exactly why people develop phobias, but mental health experts have developed a few theories. Some believe that people are more likely to develop phobias that protect from danger. These phobias include germ phobias, fear of large animals, and fear of heights. People who develop phobias may take these natural fears too far and react with extreme anxiety, placing them in danger they are believed to be trying to avoid.

Early experiences also can make a person more likely to develop a phobia. Childhood illness, the death of a parent, or painful medical procedures can condition a person to be extremely fearful of germs and to take extreme measures to avoid them. Phobias also tend to run in families; they may be genetic or simply learned from parents.

Treatment
Phobias are highly treatable and often require only a few sessions with a qualified mental health professional. Cognitive behavioral therapy, which helps people to reframe intrusive and phobic thoughts, can be extremely beneficial. Desensitization, a process whereby a person is slowly exposed to a frightening stimulus, also is highly effective. Some doctors may prescribe anti-anxiety medications to help people with mysophobia cope with their fears during treatment or to enable them to function in public. Some clients also experience success with hypnotherapy, often in only two or three sessions.

References:

1. Audesirk, T., Audesirk, G., Byers, B. E. (2008). Biology: Life on earth with physiology. Upper Saddle River, NJ: Pearson Prentice Hall.
2. Overcoming your Fear of Germs. (n.d.). Fear of Germs. Retrieved from http://www.fearofgerms.com/
3. Kring, A. M., Johnson, S. L., Davison, G. C., Neale, J. M. (2010). Abnormal psychology. Hoboken, NJ: John Wiley & Sons.
4. Phobias. (n.d.). U.S. National Library of Medicine. Retrieved from http://www.nlm.nih.gov/medlineplus/phobias.html

This is the third in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

I had a client we’ll call Brian, a man in his mid-thirties with a diagnosis of Asperger’s syndrome who came to me to discuss what he referred to as “issues he was having with people at work.”

It is not an unusual request for a person with Asperger’s to want to work on the confusion that surrounds social interactions in general. Interactions at work often are more challenging because in the office, not only do the normal social protocols apply, but there often is an additional layer of a particular corporate culture overlaid upon this basic structure, invisibly directing everything.

Bryan was a pleasant and engaging man. He held good eye contact, spoke with precision, and demonstrated a light touch with humor. His demeanor changed, though, when I asked him about his colleagues in the office where he worked as a certified public accountant.

A quiet earnestness overcame him. He spoke clearly and without breaking to collect his thoughts or in expectation of response. He discussed one individual after another in great detail, including information about the kind of work they did, their areas of responsibility, and where they stood in the hierarchy. This was precisely the sort of information I expected to get from Brian on the topic of work relationships.

Then, however, he began to speak of his colleagues in more personal terms. He knew who was married and who was single. He knew who had children, their names and ages, and the schools they attended. Brian told me who had recently vacationed and where they had gone; who golfed and who played tennis; who had iPhones and who used Androids. He knew the makes and models of everyone’s cars. He knew the names of spouses. He knew which neighborhoods his coworkers called home. He even knew who had housekeepers and who did not.

It might appear surprising on first glance to read that I was given such detailed and personal information about others from a man with Asperger’s who came into my office with self-identified problems related to interpersonal relationships. But I have seen this before. Once you look at this apparent contradiction in another light, you may recognize it, too.

I’m talking about the illusion of friendship.

Further discussion with Brian demonstrated to me that he had gleaned all this information about his coworkers not from interactions with them over time, the way you or I might imagine getting to know the people we work with. Instead, Brian had developed his extensive knowledge of everyone around him by listening and even eavesdropping on conversations others were having around him, but in which he had not once been involved personally.

And he was having problems with his coworkers when he would make a statement revealing his knowledge about a person, info he had no apparently legitimate way of knowing. People became uncomfortable around him because of this and withdrew from him, which left him utterly confused.

Of course, this became the starting point for our work together. Brian had to learn about the ways that acquaintanceships and friendships develop over time. Importantly, he also had to learn the concept of reciprocity: It is not enough to know things about another person, but one must also share personal information about oneself as well in the give-and-take manner of casual conversation. This is how trust develops between people. This is the foundation from which we can make a statement such as, “Oh, yes, I know Brian,” with legitimacy.

Brian had to learn that knowing confidential or intimate facts about another person without that reciprocity was considered socially gauche, and that it had the potential even to be frightening to some individuals. Brian had to learn the difference between having friends and having the illusion that he had friends.

Once we began to tease this distinction apart, Brian began making progress in his social interactions. We used role-playing techniques and many “what-if” exercises, and Brian’s distress around the topic of his work environment noticeably decreased over time.