Open coconut and flowerSaturday April 28th was my 11th Ocha Birthday. That is to say it was the anniversary of my initiation as a Yoruba/Lucumi Priest  of Obatala (April 28, 2001). To me, it’s as important a date as my natal birthday. Traditionally, to mark the anniversary, we purchase food and cook for the Orishas (the divinities we worship), read each Orisha we have with Obi (4 quarters of coconut), and generally strive to have a peaceful and meditative day. Sometimes, if possible, we open our homes to other Orisha Priests to come and salute our Orishas and to offer their blessings. Since I was in a somewhat isolated location, I chose to spend the day with only one other person (my significant other).

My experience on the day of my anniversary was a very positive one. The Orishas were basically happy and were satisfied with my offerings of fruit, candy, and in some instances the food I had prepared for them. One or two wanted a bit more but nothing complicated.

Spending this day basically on my own, taking the risk of reading my Orishas on my own (previously I always had someone else do it) was a real boost to my confidence. I also prayed and sang and felt the presence of spirit. It reaffirmed for me that I was truly blessed. I felt truly grateful that the Orishas had guided me to them and had chosen me as their child.

Now I know this must sound kind of confusing to many of you; maybe even a little bit alarming. My religion is virtually unknown by many if not most Americans, despite the fact that there are millions of observers worldwide.  But my specific belief system is not the point of this article.

What I have in my life at this time in my life (I’m an Elder) is a solid foundation of faith, which is something I have never had before. I trust in the divinities to guide me, and I do what they say as I learn through divination. I feel protected and held. I have support and love that is unconditional. The Orishas are patient and giving as long as you are respectful and follow their advice (if you don’t, there can be consequences).

What this faith has done for me after decades of psychotherapy is help me heal. In treatment I gained a great deal of understanding, and the relationship with my therapists was healing in itself. There is great value in it. However, it was and is my faith that has taken me to the next level where I was able to finally forgive those who had wronged me; where I was able to either let go of or moderate my fear; and where I was able to accept myself and others as I am/they are.

For most of my life, psychotherapy was my higher power. That is different now. As I observe the patients I treat in my practice, I see that those who have some spiritual connection are those that make the most significant and lasting progress. Those that are what I would call spiritually bankrupt struggle the most for the longest.

People come to me knowing of my dual credentials as Psychotherapist and Ordained Yoruba/Lucumi Priest, and even though we talk about the issues and problems of the day, I believe some at least are seeking help in connecting to their spiritual selves. When they state this outright, I work with them on this. Otherwise, I am very patient.

Related articles:
Part 3: Source Energy Optimizes Life—Escalating Source Energy Through Trauma Resolution
Spirituality and Therapy: Opening the Portal with Prayer
Turning It Over

Major depressive disorder (MDD) is more prevalent in the pediatric population than previously believed. According to some estimates, between 2% and 8% of children and adolescents have mood disorders. Depression in childhood often predicts recurrent episodes of depression later in life. This population is also at heightened risk of psychiatric disorders, substance abuse, social maladjustment, homelessness, and criminality. Clearly, depression in young people is not a problem that can be safely ignored. Early therapeutic intervention is essential and usually consists of cognitive-behavioral therapy and medication. Currently, the only antidepressant medication approved for use in children and adolescents is Prozac (fluoxetine). However, the lasting effects of Prozac exposure during youth are still not completely known. Conventional wisdom suggests that the benefits of treatment likely outweigh long-term risks, particularly in cases of MDD.

The adolescent brain, just like the adolescent body, experiences profound and rapid development. Chemicals in the brain called neurotransmitters direct cellular and structural growth throughout the brain, and this process gives rise to the adult brain: a well-regulated, stable organ that manages consciousness and the central nervous system. During the period of rapid growth, any disruptions or chemical stimuli can lead to functional changes later in life. For this reason, antidepressant use in childhood has come under great scrutiny. Prozac alters the balance of neurotransmitters in the brain. Some have argued that Prozac exposure during adolescence may result in lasting, even permanent behavioral changes. Researchers conducted a controlled experiment with adolescent rats to address some of these issues.

Rats given Prozac during adolescence displayed significant behavioral changes when tested as adults. For example, they showed less response in a forced-swim test and more response to anxiety-producing situations, such as a new environment. The increased anxiety was reduced by a second exposure to Prozac. Most disturbingly, sexual behavior in adulthood was impaired by Prozac taken during adolescence. This finding was completely unexpected. However, the researchers cautioned that the relationship between brain development and behavior is enormously complicated, and the current study only highlights this complexity. How much of these results translate to humans is also an open question. Rats are typically used in these studies because they mimic human physiology and neurobiology. Still, the underlying mechanisms of behavior are not well understood.

The adolescent rat study, among others, adds powerful evidence to the argument that Prozac initiates profound changes in the brain. These changes manifest themselves as behavioral and mood alterations. Human research is necessary to determine the scope of these alterations. As it stands, prescription of this antidepressant for children with MDD is still warranted.

References

  1. PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluoxetine. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/
  2. Iniguez, S. D., Warren, B. L., Bolanos-Guzman, C. (2010). Short- and long-term functional consequences of fluoxetine exposure during adolescence in male rats. Biological Psychiatry, 67(11), 1057-1066.

 

 

 

GoodTherapy | Breathing Lessons for Coping with Grief

We breathe all the time, right? So, what’s the big deal?

Most of us are not breathing properly throughout our days for optimum health and well-being. Most of us have poor posture, we sit at our desks for long periods of time, slump in our seats, stare at screens, move very little… This is a problem for much of the population.

If grief is added on top of those bad habits, our situation becomes even more difficult. Grieving on its own makes us feel like we want to be slumped down, curled into a ball. It makes us want to protect our hearts. The chaotic yet static state sometimes even stops our breath entirely. If you are grieving, you may notice that your breathing is very shallow, or that you are holding your breath without even realizing it. You may suddenly find yourself gasping for a breath, as if you’ve been under water, reaching for the surface. This is not abnormal in grieving. Grief affects every part of us, including our breathing. Here is your chance to learn to breathe through grief.

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Finding a quiet time at any point in your day to simply breathe can be a wonderfully healing tool. Anytime you notice that you are feeling anxious, particularly tired, or that you are holding your breath, take a moment—right then and there—to breathe.

Stoplights make good cues to practice your breathing as well. In addition to helping you notice your breath and serving as reminders to practice your breathing exercises, breathing at stoplights can help to counteract the stress we experience when we are confronted with the stress of the rest of the world—other drivers, traffic jams, errands that must be run—while we are in the midst of our grief. Inside your car, you can create a space of calm and peace simply with your breath. Practicing your breathing, and any other coping techniques, when you are calm, helps you be able to put them to use when you need them, such in the midst of anxiety or a panic attack (also not uncommon in grief).

Additionally, noticing your breath and increasing your use of breathing practices can also help you to become more mindful of your own thoughts and feelings, giving you a sense of control and stability in an otherwise incredibly chaotic time of life. The more you notice how you feel, what your thought patterns are, how your body is affected by your responses to the world around you, your grief experience, your thoughts and feelings, the less out of control you can begin to feel. A greater sense of calm and control can help you along your healing process.

Many people are told, “Take a deep breath.” But in my practice, I have found that when I ask people to show me how they take a deep breath, they often suck in their stomachs and fill up their chests. This is actually the opposite of deep breathing. Breathing this way restricts our lungs’ ability to take in oxygen and to release carbon dioxide. The result is an excess of CO2 in our bodies. Not inhaling enough oxygen and failing to exhale enough CO2 can create fatigue, mental fog, and decreased tissue function. For a grieving person, this can intensify many of the normal grief reactions that we go through as part of the grief experience. Breathing deeply and fully can be a helpful tool to decrease stress, increase clarity of thought and help to counteract fatigue. Not only that, but chest breathing stimulates our sympathetic nervous system—our fight or flight stress response. Think about it: When we are startled, what do we do? We open our mouths with a sharp intake of a chest breath. This alerts our brains that there is a danger. Breathing into our chests stimulates the very response we are trying to counteract. Learning to take deep belly breaths is essential to decreasing anxiety and getting more oxygen to the brain.

Read on to learn some simple but truly effective breathing exercises to decrease anxiety, clear your mind, and counteract some of the natural symptoms of grief.

Breathing Exercise: Just Breathe

This is an exercise in simply noticing your breath, helping you to become more aware and mindful of your own breath as it moves in and out of your body.

Breathing Exercise: Simple Deep Breathing

For this breathing practice, sit in a comfortable position with your hands relaxed, either in your lap or resting on your thighs or knees. Then begin.

Breathing Exercise: The Three-Part Breath

The three-part breath is a specific breathing technique used in many yoga practices and can be very useful in times of stress or whenever you need to relax. This type of breathing triggers your parasympathetic nervous system or the “relaxation response” (the opposite of the fight/flight stress response) and allows your body and mind to more easily release stress and tension. It is physiologically impossible for your body to be in a stress mode when you practice the deep three-part breath.

Obviously, you can’t breathe this way all the time, but when you do, it can help you think more clearly and decide on another coping skill or something else you can do to move away from the anxiety you may currently be feeling. Or you may decide to use the breath to sit with the pain of grief. This is okay too. Calmness in the midst of pain can help us know that we can survive the next moment, and then the next.

If you feel dizzy or lightheaded while practicing the three-part breath, or any other breathing exercise, stop the practice immediately and allow your breathing to go back to normal. Sometimes if we are not used to a great deal of oxygen, the change can cause lightheadedness or dizziness. Know your own body and be mindful of the changes you notice.

I hope that these breathing lessons may help you through your grief journey and beyond. Just breathe.

Women have been stereotypically defined as being more emotional than men. In popular culture, women are depicted as being more emotionally volatile, often erupting into fits of sadness, anger, despair or jealousy much more frequently than their male counterparts. But is this portrayal scientifically accurate? Research has shown that there are differences in how men and women emotionally respond to situations. However, little research has addressed the core self-conscious emotions (SCE) of men and women and how they differ. Nicole M. Else-Quest of the Department of Psychology at the University of Maryland in Baltimore sought to debunk the myth that women have less emotional regulation than men. She recently conducted a study that compared male and female levels of embarrassment, shame, guilt, and pride in data gathered from over 300 studies.

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Existing research has shown that women and men differ in their risks for some mental health issues such as depression, food and eating issues, anxiety, and self-worth. How men and women experience SCEs has a direct influence on their likelihood of developing these and other psychological problems. Else-Quest analyzed over 200,000 self-reports and found that for the most part, women and men had similar levels of SCEs. The results revealed slightly higher levels of guilt and shame in the women, but minimal differences in pride and embarrassment. Else-Quest also looked at age as a factor because men and women tend to exhibit the first signs of depression, anxiety, and low self-esteem at different ages. She found that although there were relatively few differences in SCEs in early childhood, women reported higher levels of SCEs, primarily shame and guilt, during adolescence.

Overall, Else-Quest discovered that women experienced the highest levels of guilt and shame when they were asked about sex, food and eating, body image, or the environment. Although the rates of SCEs in these areas were only slightly higher for women than men, these results support existing research regarding women’s emotional perceptions about sex, body image, and eating problems. Else-Quest concluded by saying that even though women had minimally elevated levels of guilt and shame, the men and women reported levels of pride and embarrassment that were virtually identical. She added, “These findings contribute to the literature demonstrating that blanket stereotypes about women’s greater emotionality are inaccurate.”

Reference:
Else-Quest, N. M., Higgins, A., Allison, C., Morton, L. C. (2012). Gender differences in self-conscious emotional experience: A meta-analysis. Psychological Bulletin. Advance online publication. doi: 10.1037/a0027930

Young soccer playerFor children, teens, and college students, summertime is associated with freedom from school and positive emotions. However, summer can also be a time where certain mental health issues need to be tended to even more than usual. Experts share information on what mental health problems can be present more often during summer and how to prevent certain issues.

Peter Zafirides, a psychiatrist in Ohio, said he has noticed a common mental health issue for children, teens, and students during the summer. Many evaluate whether they should still take their medication for attention deficit hyperactivity disorder (ADHD).

“Stimulants are often prescribed during the school year, but depending on the severity of the underlying ADHD, the summers may provide for some time off the medications,” Zafirides said. “But it may not always be smooth-going. The combination of unmedicated ADHD symptoms, along with the less structured days of summer can be very problematic for kids and their parents. Beyond the attention symptoms that worsen, kids can experience mood changes, including anxiety and irritability.”

School can provide a consistent schedule, which can be better for children with certain mental illnesses. “The potential unstructured nature of the summer can feed in to any underlying anxiety disorders and depression present in these kids,” he added.

For children who have ADHD, Zafirides has tips to make summer more bearable. “Children and parents may benefit from sitting down at the beginning of the summer and talking about shared goals and expectations,” Zafirides said. “Have a plan ahead of time to regularly check in with each other and, in an open, nondefensive forum, talk about any changes in behavior or concerns about mood.”

He also has other suggestions that can apply to children and teens with any type of mental illness or mental health issues. “Get outside and enjoy the summer. Try to limit the amount of time online, watching TV, or playing video games,” Zafirides said. “Be active, get plenty of sleep and exercise. If medications will continue over the summer, make sure kids are taking them regularly. Again, summer is less structured, so compliance may not be as consistent, resulting in a worsening of a mental health condition. Always speak to your medical professional before either discontinuing or reducing the dosages of medication.”

Communication is key for healthy relationships and lives. “I think the most important aspect between parents and children in the summer months is to establish clear and respectful lines of communication without either side getting defensive or feeling they are not being heard,” Zafirides said. “An occasional small discussion may be all that is needed to avoid big problems over the summer.”

John Duffy, a clinical psychologist and author of The Available Parent: Radical Optimism for Raising Teens and Tweens said in an email that depression can be more noticeable during the summer. “I have found that depression driven by loneliness often becomes more pronounced in the summer,” Duffy said. “This may be due in part to the fact that people are more obviously out, about, and social in the summertime. For many young people, summer is a far less-structured time of year than any other season.”

Anxiety issues can also come to the surface. “We often find that anxiety-based issues become apparent due in part to the lack of structure,” Duffy said. “Though most young people claim this is the time of year they most look forward to, many become listless and irritable because of a lack of structured activity.”

The solution to these issues is to provide somewhat consistent structure during the summer. “This might include participation in a sport, a play, a camp or other club, volunteer activity, or a job,” Duffy said. “Kids do better when they are part of something. They are happier, less restless, and more driven. Summer also presents a unique opportunity for young people to investigate strengths and interests, and opportunity that is less open to them during the very-structured school year.”

Adults can experience the same mental health issues as children during the summer, especially depression and anxiety. “Depressed adults are more aware, for example, of the degree to which others are socially connected during the summer, and this can serve to amplify the depression,” Duffy said. “Many adults also tell me that, though they want to be more active, limitations imposed by work and other obligations prevent them from doing so. This can contribute to feelings of depression and anxiety as well.”

The National Alliance on Mental Illness website suggests that some people can actually experience seasonal affective disorder (SAD) during the summer. SAD is characterized by depressive episodes that occur during certain times of the year (typically during the winter). In the case of seasonal affective disorder that is experienced during the summer, symptoms tend to be weight loss, minimal appetite, anxiety, irritability, and insomnia. Heat and humidity could worsen this “reverse SAD,” according to the website. Some adults with bipolar disorder are more likely to experience the mania part during spring and summer as well, he said.

William Oswald, the CEO and director of Summit Malibu, a behavioral and addiction treatment center in California, said in an email that all types of mental health issues can occur more often during the summer, such as agoraphobia, addictions and compulsions, as well as the more common depression and seasonal affective disorder.

“When people have a purpose, or curriculum in this case, their minds stay occupied, and boredom is not as prevalent of an issue,” Oswald said. “When they go from being extremely busy to having nothing to do, oftentimes this boredom results in mild, or in some cases severe, forms of depression. Once untreated, depression sets in, people (teens and college students especially) end up self-medicating with drugs or alcohol as a means to simply feel better. This is true of seasonal affective disorder as well—some may not want to be outside, and in turn isolate, resulting in isolative behaviors and a depressive state.”

Oswald has specific preventative tips for each age group during the summer:

Children: “Setting play dates with other kids or sending them to a day-care program where they do outside activities can keep their minds occupied and also help with socialization. This is key to preventing isolating behaviors later on in life.”

Teens: “Having a part-time summer job is the most important thing they can do to protect their mental health. They will learn the importance of a work ethic, earn money (which they can then spend on fun activities), and [prevent] boredom—the number one offender during summer breaks.”

College students: “Having an internship or continuing to work on their educational goals will keep them focused and driven, preventing depression and other detrimental behaviors associated with the disorder.”

Unfortunately, these suggestions will not always work, and in that case it’s best to seek a mental health professional to keep any mental health issues from worsening.

For adults, it can be unfortunate to be stuck inside working when the weather is gorgeous (at least in some places). This can be just another trigger for depression and other mental illnesses like substance-related disorders. “Adults need to utilize their vacation days properly so they have something to look forward to and get to experience summertime weather on days other than the weekend,” Oswald said. “Making time for outdoor activities on the weekend and starting an exercise program will keep one’s mood elevated.”

GTimage0427124Have you seen the movie? There are a lot of parenting situations in it that we can relate to. The main one that I see is with Marlin and Nemo. Nemo has a short fin and his dad is very protective of him, which is natural. Nemo wants to show his dad what he can do in spite of his short fin, but this is a scary situation for Marlin (the dad), because he does not know how to protect Nemo.

Nemo is reacting in an age-appropriate way: He wants to show his dad what he can do; Dad won’t let him, and then Nemo does it anyway. Sound familiar? This pattern happens a lot and at different ages and stages with parents and kids. As the kids get older, we may become more comfortable with letting go, but it will still be hard.

The question is this: How do we allow our children to do more things on their own when our own fears get in the way?

At a young age, kids begin to pull away and search for independence, and as parents, we encourage that, support them, and cheer them on. When they stumble, we help pick them up and tell them to try again. When they succeed, we feel great! When they “fail,” we get discouraged and/or keep cheering them on. The latter is a healthier response: to keep cheering for and encouraging them and to allow kids to keep striving.

The challenge is when they are hurt or held back by a physical or mental challenge that as parents we want to protect them from. We may also want to protect them because of our own fears or beliefs that someone is going to hurt them even more. When a child is showing the desire to try again or to show you that he can do something, that is when it can be okay to allow it.

With Nemo, he wanted to show his father he could swim far (out to the boat) and come back. Yes, he was being oppositional and was not listening or following directions, but that is not really the point.

Marlin was afraid that Nemo would not be able to swim to the boat, and from my perspective, Marlin was afraid that he would have to go get Nemo, and Marlin was more afraid of that than anything else. So here is something to think about: we need to be aware of where our fears come from as parents. Do our fears arise from our own insecurities or doubts that we will not be able to swim to the boat? Or maybe the fear is that when our child does well, he will need us less.

Wherever Marlin’s fears were coming from, Nemo did what he believed he could do. Yes, he got caught, and his dad searched and found him; and then Nemo was able to show Dad that in spite of his short fin, he was still able to do great things. Maybe if Marlin had allowed Nemo to show him earlier, then the situation would not have had to go that far, but then the movie would not have been made.

It took Dori to point out to Marlin that maybe it was time for him to let go. Yes, they were in the whale, but Marlin got the message: Allow Nemo to show what he can do, even if Marlin has some fears.

But let’s look again at the question posed earlier: When is it okay to allow your child to have more freedom? How can parents manage their fears when a child is insisting on what he can do?

  1. Identify your fears. Be aware of them. When we look at our fears, we can do something about them. Are the fears more about your child or that you may not be able to protect him from getting hurt? You are not always going to be able to protect your child; he may get hurt, but he probably will also be okay.
  2. Focus on what your child is able to do. Look at where improvements have been made, and see how you can help encourage him. Look at how you can support him to try something new or a little more challenging.
  3. Is your child asking to try something new? Is he wanting to try more? If he is, then believe in him, and try to understand that he believes he is able to try it. You can share with him your thoughts and concerns. He may disagree and still want to try, and if so, then trust him. Yes, he may not fully succeed, and that’s okay. He will learn more about himself and become more confident in himself. When he does succeed, it will feel wonderful and he will be very proud to show you.
  4. If you have conveyed your thoughts/fears to your child and he’s still insistent that he can do whatever it is, then support him. Encourage him and be there for him.
  5. If he “fails”, do NOT say, “I TOLD YOU SO” because that would be your fears talking. Encourage him to try again; failure means not trying at all.

Back to Marlin and Nemo: Marlin learned that Nemo was able to do a lot of things, even with a short fin. He succeeded, and Marlin also succeeded: He learned that letting go is not only scary at times but also very rewarding. Nemo told him that he loved him and was thankful, and the letting go helped their relationship become more fun. Marlin also became better at telling jokes!

One last thought: When Marlin allowed Nemo to show what he could do, I think Marlin found his own “Nemo,” which I guess opens the door for another article on this topic: Finding “Nemo” Part II.

Related articles:
Increasing Children’s Self-Esteem
Importance of Coping Skills, Part 2: Building Resilience
When Not to Say “No” to Your Child

Cognitive behavioral therapy (CBT) is a widely used approach to treat symptoms of general anxiety disorder (GAD). The goal of CBT is to help an individual be more tolerant of their worrying behaviors, thus decreasing the negative psychological and physical symptoms of GAD. Applied relaxation (AR) is an alternative approach that is used for various mental health problems, including GAD. It focuses on the somatic symptoms of tension and physical discomfort associated with anxiety, with the goal of reducing worry. Both CBT and AR have been shown to be effective at diminishing the symptoms of GAD in individuals who struggle with emotional and somatic symptoms. However, few studies have compared the dynamics that cause the symptom reduction in each of these treatment approaches.

Eleanor Donegan of the Department of Psychology at Concordia University in Montreal sought to identify the mechanisms by which AR and CBT worked and also to determine if one was more effective than the other at maintaining long-term symptom reduction. For her study, Donegan evaluated 57 individuals who underwent either AR or CBT over a period of 12 weeks. She found that for both groups, the amount of time they spent worrying each day decreased from approximately 36% of the time to 20%. Additionally, both AR and CBT reduced the amount of daily anxiety by nearly 50%.

Donegan noted that even though the participants were much less anxious as a result of their treatment, they still had significantly higher levels of worry and anxiety than non–clinically anxious individuals. When Donegan looked at how the effects were achieved, she found similarities and differences. Specifically, even though both AR and CBT decreased somatic anxiety, the effect on worry was more significant in the individuals who underwent CBT. However, Donegan believes that both of these techniques could be useful to address GAD. She added, “Change in worry occurs in part because of change in somatic anxiety, and vice versa, in both CBT and AR.”

Reference:
Donegan, E., Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0028132

Bride and groom smilingThe word bridezilla has become an oft-used part of our lexicon, and many people who have never been married are confused by the panic and stress that seems to surround wedding planning. But a newly engaged couple quickly learns that the stress of wedding planning is not the overexaggerated fantasy of people who simply have no stress tolerance. Wedding planning is stressful for almost everyone, and yet people never stop to think about why this is. Here’s what is really going on.

Expectations vs. Reality
A wedding is a major rite of passage, and many people—especially women—have been raised to expect their wedding to be a perfect fairy tale. But nothing can be perfect, even a wedding, and the drive for perfection can be profoundly stressful and emotionally fraught. Many people use their wedding as an opportunity to take stock of their lives so far. If they can’t afford a dream wedding, they may feel like failures. Some people have a specific list of things they intended to do before they got married. No matter how unreasonable this list might have been, unfulfilled dreams can still cause stress when you’re planning a wedding.

A Stressful Engagement
The time before you get married should be one of the happiest, most romantic times in your life. Instead, many people spend this period frantically planning a wedding, stressing about finances, and fretting over guest lists. Wedding planning can cause you to pull away or turn on your future spouse, and constant planning certainly eliminates any opportunities for romantic time together. Thus some people arrive at their wedding day feeling pretty humdrum about their future marriage and pretty frustrated with the process that got them to the altar.

Finances
Disagreements about money are among the most common marital problems. When surveyed, people indicate that financial problems are one of the biggest stressors in their lives. Weddings are expensive, with the average wedding in the United States costing well over $30,000, so it’s no wonder people can be driven to a state of panic by weddings. Couples frequently must make huge sacrifices, compromise with their parents, and work extra hours to get the money to pay for their weddings, and all of this effort can take a toll.

Requests of Others
Many newlyweds report that it wasn’t the wedding planning itself that was stressful. It was the constant pressure, opinions, and criticism from other people, such as the mother who’s enraged that you’re keeping your maiden name or the father who insists on a traditional wedding ceremony. A wedding frequently puts the differences between parents and their children on full display. Many engaged couples worry about their parents making snide remarks just before their wedding, or spend the entire time they’re engaged bending over backward to please their parents, only to find out that nothing they do is enough.

Relying on Others
No matter how much you might want it to be just you and your fiancée, a wedding is a group event. From bridesmaids to florists, officiants to flower girls, you must coordinate with many people, not all of whom will be cooperative. Trying to get everyone to understand your vision for your wedding can be like herding cats. And even simple tasks such as getting your best man to finally get fitted for a tux can be extremely stressful. When people have to rely on others to get tasks done, their stress levels tend to rise. This reliance on others is made even worse by the stress most couples feel to create a perfect wedding.

So, no matter how simple you may try to keep the wedding plans, there will still be stressors that you should anticipate and plan for, just as you plan for your cake and photographer. Start thinking about the people and events that may create stress for you and your fiancé, and take steps to reduce those predictable conflicts. Acceptance of the things you can and cannot change is key, and practicing now can only help once you become a partner in a marriage.

Sources:

  1. Miller, R. S. (2011). Intimate relationships. New York, NY: McGraw-Hill.
  2. Reis, H. T., Rusbult, C. E. (2004). Close relationships: Key readings. New York, NY: Psychology Press.

Related articles:
The Fear of Hurting the Other and the Inhibition of Self
Embrace Conflict as a Path to Deeper Connection
Decision Making in Relationships: Three Important Values to Help you Know When to Give in or Dig in

Traumatic brain injury (TBI) represents a uniquely challenging medical condition. Repair of the physical, emotional, and cognitive damage is a long and often grueling process. In the wake of brain injury, patients often experience amnesia, altered consciousness, and profound confusion. Many of these symptoms mirror the psychotic states of schizophrenia; however, the root causes of these symptoms are, of course, quite distinct. Still, it’s not an uncommon practice for attending physicians to prescribe antipsychotic drugs such as Haldol (haloperidol) for TBI patients who exhibit aggression or restlessness. This practice is not without controversy, as several studies have shown that psychotropic medications, especially the typical antipsychotic drugs, may slow recovery from brain injury. A study published in Life Sciences adds even more compelling data to the argument against antipsychotic drugs for patients with TBI.

In a study of brain recovery rates under different conditions, a small group of rats were subjected to a controlled brain injury. The control group was anesthetized but no surgery was performed. The rats were further divided into three distinct groups. One group received a regular dose of Haldol, another received Risperdal (risperidone, an atypical antipsychotic), and a third group received neither drug. All the rats were given daily assessments of motor skills, reflexes, and cognitive functioning. Because antipsychotic drugs have a sedative effect, the drugs were only administered after each day’s performance testing. This is an important distinction because previous studies often gave drugs before testing, potentially skewing the results. Researchers sought to uncover any ill effects from these medications independent of sedation.

Although the sample size of this particular study was small, the results were quite significant. Regardless of whether the rats were given Haldol or Risperdal, their performance tests showed a slower rate of improvement than their unmedicated counterparts. They were slower to regain reflexes and slower to make their way through a specific kind of maze. It was previously argued that the newer so-called atypical antipsychotic drugs like Risperdal might be a better choice for aggressive or psychotic TBI patients. This study argues that there is no significant difference between the older and newer drugs. What does that mean for humans with brain injuries? In a nutshell, these results argue for avoidance of antipsychotic medications while recovering from TBI unless absolutely necessary.

References
Hoffman, A., Cheng, J., Zafonte, R., Kline, A. (2008). Administration of haloperidol and risperidone after neurobehavioral testing hinders the recovery of traumatic brain injury-induced deficits. Life Sciences, 83(17-18), 602-607.  doi: 10.1016/j.lfs.2008.08.007

Close up of happy woman and babyYour social life, the quality of it, was wired into your gray matter by the age of 3, according to current thinking on child development. After a minute of contemplating that statement, the immense impact of early childhood caregivers becomes clear. This subject comes to mind after reading a recent news story about Artyom Saleviev.

Artyom was first in the news in 2010. He is the Russian boy who was adopted by a U.S. couple, the Hansens, 3 years ago. After being part of the Hansen family for 5 months, Artyom was put on a plane bound for Russia by his adoptive mother. Artyom carried a letter which stated the Hansen’s no longer wanted him because of his disruptive behavior related to psychological problems. The recent news article states that Artyom is now living in a foster home (in Russia) and his behavior there is not disruptive.

In the United States, the number of children in the foster care system is close to 500,000. One-quarter of them are infants when they enter the system; 15% are age 3 or younger, some only infants. The most common reasons for removing them from a parent or relative’s home are an absence of supervision (36%) and a failure to provide (31%). What affect does this have on a baby or toddler? Are they so young they will not remember neglect or abuse by early caregivers? If only that were true.

Caregiver Influence

To understand the effect early caregivers have on infants and toddlers, we can look at the implications of attachment theory. This theory, which has been substantiated by research, states that interactions with our initial caretakers determine our future capacity to build emotional bonds with others.

By the age of 3 years, children are either secure in their attachments to their caregivers or insecure. Children who are secure have the benefit of responsive caregivers that consistently meet their needs for food, safety, and affection. In adulthood, they can form lasting emotional connections with others.

There are three types of insecure attachment: avoidant, ambivalent, and disorganized.

When caregivers discourage expressions of a child’s distress or affection, an avoidant style of attachment develops. The child learns to discourage his or her own feelings, which damps down the child’s capacity to feel loved by others. Avoidant children typically withdraw from social interaction and grow into adults who are extremely uncomfortable with feelings and intimacy.

Ambivalent attachment occurs when early caregivers give comfort inconsistently. They sometimes respond to the child’s needs and sometimes do not. With this kind of care, children become unsure whether their needs will be met. As adults, they are slow to trust and at risk for mood and eating disorders.

When a child’s needs are not responded to, or the child is abused, a disorganized pattern of attachment can lead to delayed development, social withdrawal, and aggressive or disruptive behavior. Adults with disorganized attachment are susceptible to personality disorders and chronic mental health problems. Their relationships are often chaotic or short-lived.

Our attachment style sticks with us for life, although alternative behaviors and ways of thinking can be learned to improve relationships.

Not All Memory Is Conscious

When Artyom Saleviev arrived in the United States, was he secure, avoidant, ambivalent, or disorganized in relation to others? The Hansens painted a picture of a very disorganized child, although his current foster mother in Russia does not. Regardless, his experience with the Hansens, and the ill-conceived way he was sent back to Russia, are not stand-alone events. They rest on the foundation of interactions he had, or did not have, very early in life.

Even if a school-age child like Artyom is adopted or finds his way to a nurturing foster caregiver, a pattern of connection with others is already established. It begins before the child enters foster care, as a result of the child’s experience with his first caregivers, and the pattern continues after he leaves the system.

Around one-third of those 18 to 24 who age out of foster care are homeless within 18 months (in the U.S.). Up to one-half are unemployed within 4 years of leaving, and approximately 30% to 40% have a mental disorder and likely no health insurance. More than three-fourths will become parents.

Perspective

To keep these sobering numbers in perspective, we can consider that people with less than stellar starts in life can, and do, lead productive lives and find a share of happiness. Humans are highly adaptable and resourceful. It is also a fact that people from “good” homes enter adulthood with mild to severe attachment issues, usually the avoidant or ambivalent type.

Difficulty trusting and connecting with others is not just a single family issue. It is part of the human condition and drives the drama we call history.

The foster care system is imperfect, but it is a nested problem. Looked at as a whole, the problem begins with the child’s experience of insufficient early caregiving and is later aggravated by the lack of support for these children during the transition to adulthood. The system is situated in a disorganized world where, unfortunately, such institutions are necessary. The best we can do is to strive to keep making improvements based on what we continue to learn about the special needs of these children.

References:

  1. Child Welfare Information Gateway. Available from: http://www.childwelfare.gov
  2. U.S. Department of Health and Human Services, Administration for Children and Families. Abuse, Neglect, Adoption & Foster Care Research: National Survey of Child and Adolescent Well-Being (NSCAW), 1997-2010. Available from: https://acf.gov/opre/project/national-survey-child-and-adolescent-well-being-nscaw-1997-2014-and-2015-2024
  3. Radia, K. Adopted Russian boy rejected by U.S. mother adjusts in foster care. Available from: http://gma.yahoo.com/blogs/abc-blogs/adopted-russian-boy-rejected-u-mother-adjusts-foster-110037054–abc-news-topstories.html

Related articles:
Patterns of Attachment in Adults
Understanding Difficult Behavior – For Foster and Adoptive Parents

Woman rubbing neckMost women have experienced some symptom of premenstrual discomfort at one point or another—whether it be bloating, aches and pains, breast tenderness, fatigue, tension, headaches, or sleep, eating, and/or mood disturbances. By some estimates, up to 80% of women experience at least one symptom with some regularity. For approximately 5% of women, however, symptoms are severe enough to meet criteria for premenstrual dysphoric disorder, or PMDD.

PMDD can lead to impaired functioning and quality of life during the last week of the menstrual cycle and until about 4 days after menstruation has begun. Significant anxiety, depression, and irritability are commonly reported features of PMDD. Women with either premenstrual syndrome (PMS) or PMDD frequently seek relief in one or a combination of over-the-counter medications, a prescription, or natural remedies, but too often relief is elusive.

What Causes PMS and PMDD?

Although at present there is no definitive understanding of why some develop these syndromes and others do not, a woman’s body undergoes a number of hormonal changes throughout her cycle. It is thought that disruptions in these processes may lead to the above symptoms. Specifically, disruptions in the hormone progesterone as well as in neurotransmitters (chemicals in the brain), such as serotonin and gamma-aminobutyric acid (GABA), and the stress hormone cortisol, may be responsible for PMS or PMDD.

There has also been research examining the roles of calcium and magnesium in these conditions because both minerals vary with the menstrual cycle; however, it is not entirely clear whether imbalances in calcium and magnesium directly cause PMS/PMDD. Although there is not enough data to establish a causal relationship, being sedentary, consuming large amounts of caffeine, sugar, and alcohol, and being very stressed are among the factors associated with having PMS.

Mental, Physical, or Both?

Many women with PMDD also meet criteria for major depressive disorder or seasonal affective disorder, and some have panic or other symptoms of anxiety that are quite severe. It is important to note that although PMDD is included in the Diagnostic and Statistical Manual of Mental Disorders, it is a condition that has a physiologic basis, even though it may include psychiatric symptoms or coexist with other psychiatric disorders.

[fat_widget_left]What’s a Woman to Do?

There are a number of natural remedies that are commonly used for PMS or PMDD symptoms, including chasteberry (also known as Vitex or Monk’s Pepper), evening primrose oil, saffron, St. John’s wort, soy, B6, calcium, and magnesium. Only a few of these remedies have sufficient evidence to support their use at this time, however. These include:

Discuss any herbal or vitamin supplements you take with your doctor to make sure these are appropriate for you and that they will not interfere with other supplements or medications you may be taking.

In addition to the above, the following lifestyle changes are recommended:

It goes without saying that if you have premenstrual symptoms that make it hard to do the things you want and need to do, see your gynecologist for an accurate diagnosis. He/she can help rule out other physical or psychological syndromes that may appear similar to PMS or PMDD. If your mood symptoms are severe (e.g., you experience panic or disabling anxiety, feelings of hopelessness, or suicidal thoughts), seek professional help immediately.

For more information, consult the following:

References

  1. Pearlstein, T., & Steiner, M. (2008). Premenstrual dysphoric disorder: burden of illness and treatment update. Journal of Psychiatry & Neuroscience, 33(4): 291–301.
  2. Whelan, A. M., Jurgens, T. M., & Naylor, H. (2009). Herbs, vitamins, and minerals in the treatment of premenstrual syndrome: a systematic review. Canadian Journal of Clinical Pharmacology, 16(3), e430-e431.

Baby items“Guess what?” your best couple friends ask when you’ve just sat down at an elegant restaurant. “We have an announcement. Guess who’s not having wine?” You and your partner are jolted. You just found out an hour ago that your third in vitro fertility treatment didn’t pan out, and you didn’t even know your friends were trying.

You and your partner have a quick, furtive look. Your throat is dry, and a tear slides out before you can will it to stop. “Great news,” your husband says.

You can’t think of anything you can say aloud. You know you can’t say what you’re feeling: “Why you, not us? This is your third child, and we may never have a first. Why did you have to tell us here and ruin this expensive dinner?”

You could say, “I’m happy for you, but sad for us,” if your friends know that you’ve been trying.

With more public awareness of infertility, people announcing a pregnancy or birth are sometimes more sensitive to your needs. They might tell you in a private moment and add, “It’s hard to tell you, knowing how much you want this. I hope it happens soon for you.” You may appreciate the empathy, and elaborate on your feelings, and feel supported. On the other hand, you might be embarrassed and not want to talk about it, especially if you’re not emotionally close to the woman or you have reasons not to trust her.

First we’ll talk about dealing with your own feelings. Then we’ll talk about taking some control over how you receive news of future pregnancies.

Your feelings: handle with compassion

Mixed in with feelings of disappointment and competition, you may also feel guilty. You may even fantasize about miscarriages or complications. Your partner may add to your guilt by asking “Why can’t you be happy for them?”

Give yourself a break. You’re a good person, not someone who typically goes around with ill wishes. If you’ve been trying for months or even years to get pregnant or to carry to full term, it makes sense that you would be envious. This is especially the case if your friend is complaining of an accidental pregnancy or doesn’t have as much to offer a child as you and your partner do. A compassionate thought to say to yourself is “I’m happy for her but sad for me.” You wouldn’t expect a 24 year-old whose husband died yesterday to dance up and down about a friend’s engagement. It is understandable to have good wishes for the other person while also having feelings about your own loss or disappointment.

Controlling how you receive the information

You can’t control whether your friend gets pregnant before you do, but you can have a say in how you find out. This assumes, of course, that you are aware that someone is planning a family and that they know what you’re going through. Many of my clients have benefitted from what I call “the card trick.”

Ask your friend to send you a card. Yes, an old-fashioned greeting card via snail mail. Real envelope, real stamp. A phone call is hard, because it puts you on the spot. You need to congratulate the person right away, before you’ve had a chance to digest the information. IM is no better than phone, and e-mail is only somewhat better. Even if you don’t open the message, if its subject line reads “BIG NEWS!” you may feel that you are expected to respond quickly.

Because old-fashioned snail mail is unpredictable, your friend doesn’t know what time or even which day you receive it. This gives you time to tear up the card and stomp on it, have a good cry, or do some deep breathing before you pick up the phone and hit the keyboard. You get to feel like the loving, caring person you actually are and offer sincere congratulations. Even if you don’t have any negative feelings, you still have the luxury of time to respond when you’re ready. Everybody wins. You win because you controlled how you got the news. Your friend wins because you gave her a gentler way of breaking the news. You can both feel good about her new status and sincerely celebrate.

Even though you don’t know when or if your own luck will change, you can avoid unnecessary stress and enjoy your friend’s support and good wishes for your future pregnancy success.

Related articles:
Dealing with Fertility Challenges: Coping Tips and Resources for Parents-in-the-Making
Coping with Holidays While Trying to Have a Baby
Why Should I See a Therapist? I’m Not Crazy – We Just Can’t Have a Baby!

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