The following is an open letter to my sister Andrea Haber, who died from complications due to alcoholism on 10/31/11.

Dearest Anj:

Just a note to let you know how much I miss you. It’s still so bitterly ironic to me that what killed you is the very disease I’ve devoted my life to battling. But in a way, your alcoholism never gave you a chance.

I’m sorry we never talked about it, although you can’t say I didn’t try. There was a time, a few years back, when you told me you wanted to talk about it, and my heart leapt. But that talk, like so many hoped-for moments, never materialized.

I believe when I first got sober I wrote you a somewhat long-winded, pompous letter about the perils of drinking. I’m sorry again that I preached at you like that. You handled it with grace but I cringe now at the thought of my presumptuous rambling. Newly sober people often think they can save the world with a few well-chosen phrases. I guess I thought there was really something I could do. Naïve, yes, but even at the end, and maybe even now, I often feel the same way.

I miss your letters. They really made me laugh. You were a fabulous writer and I think that you, as with so much else, underestimated yourself. Their absence has created a very loud silence.

I’m sure you’re thinking, “Gee bro, nice cheery letter!” I only wish I could be more cheery. This is an occasion I never wanted— that even with the grim medical news coming from Pittsburgh, I never really saw coming. There’s just no good way to spin the loss of someone so young, so beautiful, so amazing. Part of the tragedy for me is, I don’t think you ever truly understood just how loved you were. Mom told me you were shocked when she said to you, near the end, how much you’d be missed should the worst happen. This too, is another symptom of addiction: the disbelief that we matter to people, the certainty that we’re really “only hurting ourselves.”

Hard to be cheery when feeling so cheated…

Of course, denial is the hallmark of this loathsome affliction. We grew up with rationalizations and minimizations aplenty when it came to Dad’s drinking and the family’s Nixonian “cover up”—i.e., “Don’t talk about it, too embarrassing” (Dad’s favorite) and “It’s not that bad” and “Don’t exaggerate,” all repeated like mantras. Even I, near the end, felt that chances were good you’d come around; see the light, get sober. Your disease made a mockery of my optimism.

So hard to sit on the sidelines and simply try to accept. I’ve struggled lately with, “Did I really do enough?” Should I have gone all out and planned an intervention, John Wayne style? Should I have demanded you listen to me until “the truth” sank in? I already felt like a stick in the mud, the voice of gloom, whenever you called or wrote me and wanted to laugh or kid around; I loved the jokes but was so terribly worried about your well-being. We had a trove of inside jokes, a bulwark against the despair of growing up in that chaos and emotional violence. I cherished the humor but wondered what might be going on underneath. There is a pain we can’t hide from, I have found, no matter how clever or humorous we are. When your doctor handed you that grim prognosis last year, that you either stop drinking or die, I thought “well this is it, she can’t ignore it any longer.” Wrong again, bro!

Of course the cliché is that there’s nothing you can do to get a person to stop; no amount of begging or pleading or coercion will ever do the trick. Maybe briefly, superficially, but it’s an “inside job” (as they say) when it comes to lasting change. We can give someone just about anything, except motivation to do the hard but necessary thing. I kept thinking you’d finally “hit bottom” when the doctors told you your liver was shot…until mom told me this wasn’t the case, that she feared nothing was changing. I backed off a bit because I know how she hounded you. Maybe that was a mistake. Maybe hearing it from me would’ve got you moving.

I cringe when I see the pride and ego in that last sentence. Yes, you should have heard it from ME, your big brother, sober white knight on the West Coast, brandishing a master’s degree in psych., saving souls and fighting the good fight. I wonder if you’re chuckling as you read this.

Perhaps it’s pretentious of me to think I had the slightest idea of what might be good for you. I had no idea what was really going on in your life, and I suppose it was none of my business. Maybe the long, hard climb back to sobriety might have been too difficult; perhaps too many skeletons, whatever they were, had accumulated in the closet for any one person to face.

But saying “There’s nothing I could have done” doesn’t seem to help. Maybe that’s why I’m writing you now; perhaps, in my Jewish neurotic guilt, I struggle towards some kind of absolution. Doubt has always dogged me; so hard to not look over my shoulder in almost every instance. This is no exception. Could I have somehow said more, done more, pushed harder to help you “see the light”? (Am I hearing that chuckle again?)

Just this morning I advised the mother of a patient that there was nothing she could do to “get” her daughter to stop using and go to meetings. I thought, “Wow she really thinks there’s something she can do!” So easy to sit in one’s cozy office chair and dispense wisdom to the struggling, misguided souls asking for help…

Here’s the hard part (as if there’s an easy part!): You can detach, stop trying, accept another’s addiction, respect their “life choices” and move on. But how to really “move on” when it’s your own flesh and blood? You can stop obsessing, stop letting the person’s disease hold your serenity hostage, attend Al-Anon meetings, seek counseling…but the kind of Zen-transcendent it’s-all-good acceptance I’ve perhaps subtly advocated to others isn’t possible, at least not for me, at this point in time.

Because I can’t stop loving you. Can’t switch off the caring. How could it be otherwise?

Maybe the idea is to make room for both, the love and the acceptance. It’s not either-or (as I’m fond of telling my patients). You can love the person and hate the disease. It’s just hard to stand by and watch a loved one fall to pieces and to try and pretend it’s not happening. It’s like a fatal car accident happening in slow motion right outside your door. I prayed every night for you to find the desire to stop drinking. I struggle to accept it never happened.

I know you meant no harm, Sis, and I never took it personally. I think if you could have stopped, you would have; as I say, the odds were seriously stacked against us from the get-go. I don’t know why I hit the lucky number; I just know it’s a gift that I protect with my life, and I would have given anything to have shared it with you. I tried.

I hope you know that somehow, wherever you are, I was worried but not condemning you. There is so much shame with this thing but I always longed to say to you, How could you not be an alcoholic, with all the crap we had to deal with? Even so, I underestimated the awesome power of this thing, and can only guess at how you suffered beneath the chuckles, the jokes and that wonderful wit of yours. It’s just hard to accept that, in this case at least, love was not enough…so difficult at those times when I think of our private jokes and laugh and want to email you…hard to really accept that my kid sister—my first friend, my loyal ally—is really, undeniably gone…

 Related articles:
The Pendulum of Grieving
Over-Extended: Thoughts on Boundaries in Addictive Families
In Case of Emergency: Seeking Help When a Loved one Struggles with Addiction

All of life, all of learning and growth, all of healing follows a spiral path. We return over and over to a place of pain or suffering in order to master the lessons held therein. Each revolution of the spiral brings us more experience and perspective and skill, so that our path is smoothed and we become increasingly resilient and expansive. This sounds good, but in practice it can be quite difficult.

When we find ourselves repeating old patterns we thought we had gotten rid of, dealing with the same difficult people repeatedly, or turning into a teenager again after spending 15 minutes with certain family members, we may feel discouraged. When we are trying to change our behavior from something we dislike to something we like, or to something more functional from something less functional, it is hard to find ourselves in that familiar, rotten territory—all our hard-won awareness shines a blinding light on our foibles, while our bag of well-earned tools hangs loosely at our side, for all intents and purposes utterly empty. But these are actually opportunities for change, and so we can welcome them.

It isn’t easy to change how we do things. The older we get, the more years of habit we have keeping us in the familiar groove, whether or not it serves us. Those grooves were laid down very early on, when we were soft and spongy. Those tracks can be very difficult to obliterate or alter. But not impossible.

Fear not, and do not dismay. These seeming setbacks are natural, normal, and in fact necessary to the process of living our lives, healing our suffering, and moving along our life paths. If we can accept that we have certain lessons we need to learn, it becomes less onerous when they pop up repeatedly. Comprehending the spiral nature of self-healing and understanding the stages of change can help us recognize our successes and appreciate our own hard work.

Awareness
First, we develop awareness. We notice that something isn’t right. We aren’t happy in our relationships or we aren’t satisfied with the quality of our lives. We may search for understanding, in counseling or through contemplation or self-study, or simply wake up to what we are doing. This can be a very painful part of the process of change, but it is necessary. If we don’t know what we are doing, we can’t change anything. But at this stage, we can’t usually act differently.

If we cultivate a nonjudgmental observer’s point of view, a friendly curiosity about ourselves, we can gather a lot of information. This kind, detached attitude also helps us avoid triggering the old patterns, most of which evolved out of self-protection. Refraining from attacking ourselves when we see these patterns means we won’t aggravate them further. No salt in the wound.

Alternative
Once we understand how we get ourselves in trouble, we can choose an alternative, the next stage in the process of change. The general rule here is, “just do something different.” We are talking about change, not perfection. Doing something different is a success, even if it is not pretty or smooth. Learning to excuse ourselves to go to the bathroom instead of engaging in a habitual conflict is not the only strategy we will ever employ, but just breaking the momentum of a negative habit is a powerful experience.

Practice
The practice is up to us. This is the third stage. We have identified the problem, the alternative to it, and now we have to actually walk the path. We will not do it perfectly or have fabulous results every time. We will be clumsy and mess up. If we use our friendly awareness skills, we will notice that just practicing—whether it is meditating, thought-replacing, or lifting weights—is a reward in itself.

Practicing anything intentionally engages us with our lives. The more we practice the new action or thought, the less room we have for the old one. We realize that our work is paying off. We find ourselves automatically saying the new words, pausing where we might previously have rushed in, or stepping forward with confidence where once we might have hidden. We start to see that our work in one area spills over into other areas. Just as lifting heavy weights in the gym translates to ease in lifting grocery bags, children, furniture, and other previously immoveable objects, working consistently with our minds eventually brings more peace, more happiness, and less suffering to ourselves and those around us.

Please note that after the third stage—or any time, really—we circle back around to the first stage. There is no final stage where we win. The process never ends, but it gets easier with practice, so we might as well relax.

Dressing up can take extra effort, but it also feels good, especially if you receive extra compliments. A new study suggests what many women have experienced: dressing in nicer clothes makes you feel better.

According to a recent news release, one study has shown that women who are depressed or sad are more likely to wear baggy tops, jeans, and a sweatshirt or jumper. Women who are happy or positive are more likely to wear a favorite dress, jewelry, and jeans. These clothing choices seem to mean that women who are feeling down put less effort into what they’re wearing, and women who are in a good mood tend to try and look nicer to match their mood.

[fat_widget_right]

There were 100 women interviewed for the study, and their ages ranged from 21 to 64 years, according to the news release. The researchers also found that 73% of women in the study “shopped for clothes at least every few months.” The majority of women, or 96%, “believed that what they wear affects how confident they feel,” according to the news release.

Researchers determined from the results that there is a possibility that wearing certain clothes can affect emotional states. “The strong link between clothing and mood state suggests we should put on clothes that we associate with happiness, even when feeling low,” according to the news release. The author of the study, Karen Pine, who is the coauthor of Flex: Do Something Different and a professor in the School of Psychology at University of Hertfordshire, added in the news release that jeans are more associated with a depressed mood state and that women should consider abandoning them for a different clothing choice in order to feel better.

“Jeans don’t look great on everyone. They are often poorly cut and badly fitting,” Pine said in the news release. “Jeans can signal that the wearer hasn’t bothered with their appearance. People who are depressed often lose interest in how they look and don’t wish to stand out, so the correlation between depression and wearing jeans is understandable. Most importantly, this research suggests that we can dress for happiness, but that might mean ditching the jeans.”

In the study, 51% of women would wear jeans when they felt sad or depressed, and only 33% of women would wear jeans when they felt happy or positive, according to the news release. So if people still wear jeans when they are happy, just to a lesser degree, why are they such a bad choice? Why are baggy clothes associated with a sad or depressed emotional state and dresses and jewelry associated with a happy or positive emotional state? Pine addressed these issues in an email.

“All the findings apply, but because jeans are so ubiquitous (everyone seems to have a pair, women on average have eight pairs each) we chose to ‘lead’ on this finding. It is interesting that many women wear them a lot but there’s still a variation according to mood. I think the finding that women will only wear their favourite dress when happy or will likely wear a baggy top when depressed is just as compelling.”

She said that the research didn’t go into certain details, like the fact that some women are more into a “jeans and T-shirt” type of fashion, and other women wear skirts and dresses every day as part of their style. It’s also uncertain whether results would’ve changed if researchers took into consideration the emphasis some women put on fashion and beauty and if women who shopped less were interviewed. “Of course there will always be individual differences, but nonetheless recent research into enclothed cognition … confirms there is a strong association between what we wear and our psychological processes,” Pine said.

Results would also possibly look different if men were included in the study. “A lot of my research concerns women’s issues .. and I think the emotional link is probably stronger for women than for men, although there is research that shows men’s clothes affect how they behave (e.g. sports teams that wear all black act more aggressively),” Pine said.

Overall, Pine believes the research provides a look into how we can improve our moods. “It shows that clothes impact strongly on how we feel and may also influence how we think (as the above research also suggests), which we’ll be exploring further in our research,” Pine said. “It suggests we should give more thought to what we wear and even dress for happiness, irrespective of how we are feeling. If we knew more about which clothes could lift a person’s mood perhaps there’d be less need for anti-depressant medication.”

Shauna Mackenzie Heathman, a certified image consultant and owner of Mackenzie Image Consulting in South Carolina, said in an email that the results of the study are expected. “When we are feeling depressed or unhappy, looking our best is not on our minds,” Pine said. “In fact, it becomes a hassle and waste of time. Mental energy is turned inwards towards emotional thoughts. Dressing simply becomes function versus adornment or fun.”

She said that people shouldn’t necessarily make assumptions about the feelings and emotions of another person based on their clothing though. “We have the power to wear items that represent our personalities and feelings,” Heathman said. “With that being said, who knows how other people will interpret it. We make [judgments]/assumptions based on our own experiences. Bottom line: I would be careful to assume one’s feelings based on what they wear. To a certain extent, you can read whether someone is feeling insecure based on their clothing, but body language and nonverbal communication is much more representative of one’s feelings.”

She thinks there could also be a separate study on men that explores their clothing choices and emotional states. “I think it was okay for this study to be focused around women,” Heathman said. “A separate study on men should be considered. However, first you would need to discover the underlying differences between men and women and how they interpret clothes. Men are much more focused on functionality in their wardrobe than women, regardless of emotional state. So I do think there may be some general similarities, but overall women’s results would probably be more dramatic.”

One of the main parts of the study Pine focused on was jeans and their association with a depressed or sad mood state, and Heathman thinks this could be because jeans are an easy choice that doesn’t require a lot of thought. “I don’t think it’s the fact of wearing jeans that suggests sadness or depression as it is just wanting effortlessness and functionality,” Heathman said. “As I mentioned before, when we are depressed or sad, we’re not focused on how we look. We stop caring. We turn to what’s easy and comfortable. Prolonged long enough, you then fall in ‘the rut.’ Often, altering one’s mood by enhancing wardrobe can be done. However, it generally only has short-term results if working on one’s emotional and mental state is not at play as well.”

“The study mentions that happy clothes include well-cut, figure-enhancing items made from bright and beautiful fabrics,” Heathman said. “To this, I ponder, isn’t this obvious? If something makes our figure look poor, we generally don’t like this and thus are unhappy about it. When we don’t like what we wear, we focus on it throughout the day. It takes away the focus from the daily tasks that are important—work, relationships, family. A woman should walk out of the door and not have to think about what she’s wearing for the rest of the day. You’d be amazed at how much mental energy is exhausted pondering about how we look.”

Overall she thinks the study could have gone more in-depth to provide more useful information. “I think the study lacks depth. What is revealed seems fairly obvious,” Heathman said. “I would be curious to hear why women choose to wear a hat more often when they are happy. Is it because it’s fun? Is it because it draws attention towards them? Also, the psychology of color comes into play much more than the study presents. I think it’s informative more than it is useful.”

Donna Stellhorn, a Feng Shui expert and author of 2012 Year of the Water Dragon, interprets the study from a unique perspective involving her experience with Feng Shui. For those who are unfamiliar with Feng Shui, it is “the study of how the environment affects those who dwell in it,” according to the American Feng Shui Institute website. The “science” of Feng Shui suggests that there are “different energies” in our planet, and learning how to balance these energies can help improve various aspects of life.

“In Feng Shui we understand how you dress is associated with the five elements. Each element has an energy, and we’ll gravitate to the energy that’s in harmony with how we feel at the moment,” Stellhorn said. “The study says when we’re feeling down we’re more likely to reach for jeans and loose-fitting tops. These boxy shapes relate to the Earth element, a desire for stillness and stability. There are five elements (Earth, Wood, Fire, Water, and Metal), each with an energy, feeling, and a related style. Besides the shape of clothes, also the color and material indicates the element. For instance, animal prints are associated with the Fire element and a desire to be noticed and feel alive.”

She said for men, color would probably be more of an indicator of emotional states. “Because men tend to stick to a limited wardrobe, emotional states can be read in the choices of colors and the slight changes in what they normally wear,” Stellhorn said. “Men who usually sport a T-Shirt and suddenly start wearing a button-down shirt in greens or browns has moved from the Earth element to Wood, showing a desire to grow, to add to their life financially and socially, they’ve become curious about the world.”

She agrees that jeans are less effort when people are already preoccupied with other areas of life. “It’s not that jeans specifically suggest sadness, but that the desire to throw on a pair of jeans can indicate that life’s been too chaotic, there are too many choices and we want some quiet stillness to contemplate what’s ahead,” Stellhorn said. “When we reach for jeans we want something familiar because things around us are stressful.”

Accessories can also affect mood, like the study suggests. “Women’s hats bring attention (from others and our own) to our heads and indicate a person with power,” Stellhorn said. “A man in a ball cap might be covering thinning hair, but by wearing the hat he feels more powerful and better able to interact in the world. Jewelry and handbags also bring an energy, and therefore an emotion, to the person.”

Linda Froiland, an image consultant and personal shopper, said in an email that jeans don’t need to always be associated with depression, although sometimes it can be difficult to find the perfect fit. “Jeans are not just for tennis shoes. If you have a great fitting pair in a dark wash they can be quite sexy with an elevated heel, high heel, or wedge shoes,” Froiland said. “I wear mine out dancing, dinners at friends or restaurants, shopping, everywhere really, but they fit like a glove and have attitude. I can honestly say I am not depressed when wearing jeans, nor are my clients once they know how they should fit, what they should look like, and what to pair them with.”

Rosa Mae Neel, a stylist for professionals and the founder of Prune, agrees with Froiland that jeans don’t necessarily mean depression. “In a place like New York, where women commonly spend up to $300 for a pair of jeans and wear them with heels and a sexy top to go out at night, jeans do not necessarily equal depressive state,” Neel said. “Perhaps in other parts of the country or for older generations, jeans that are not designer jeans and that are more comfortable than flattering are a go-to for depressive states. Again, blousy tops can be trendy and hip if expensive or worn with gusto, or they can be a medium through which to hide extra pounds or negative feelings.”

Froiland said that clothing can be important in not only affecting mood but also in making impressions on other people. “Whenever I talk to a group, large or small, I always start out my presentation with telling everyone that ‘It’s in less than 3 minutes someone has already decided who and what you are. First by your appearance (87%), second your body language (8%), and then your verbal communication (5%). It takes another 20 times meeting that person to change that original perception,’” Froiland said. “So the value in our clothing is profound.”

Caroline Adams Miller, a professional coach, author of “Creating Your Best Life” and a graduate of University of Pennsylvania’s Master’s in Applied Positive Psychology program, said in an email that baggy clothes in general can indicate more of a lackluster mood. “Baggy jeans that could be perceived as asexual probably don’t correlate with happiness unless paired with more individualistic shirts or accessories,” Miller said. “The baggy tops reference doesn’t surprise me because they would ‘hide’ someone, and unhappy people don’t want to interact with people—they want to ruminate and be alone, and these clothing choices are perfect indicators of not feeling worthy of being ‘seen.’”

She believes that men could be affected by clothing choices as well, although they might put more effort into choosing a car to express their personality and mood. “I do believe that many men use clothing to express and change their moods, though, so I think a future study would find similar results,” Miller said.

Overall she believes the study makes sense and that there is a real connection between clothing and mood. “The science of happiness has found that we have ‘positive interventions’ that can change our mood, and when we deliberately intervene on our happiness by wearing things that evoke positive feelings, positive reactions from others, or that remind you of positive experiences, you will be happier,” Miller said.

Related articles:
Are You Your Own Worst Enemy?
Seven Mistakes People Often Make When They Get Depressed
Depression as Trickster and Communicator

Making a diagnosis of generalized anxiety is sometime a tricky proposition. Anxiety has many manifestations as well as many underlying causes. Anxiety may be chronic and always at the edge of a person’s consciousness or the condition may flare up in acute episodes called panic attacks. Appropriate treatment is essential and typically involves a mix of cognitive-behavioral therapy, pharmaceuticals, and careful follow-up by the treating physician. Xanax (alprazolam) is currently one of the preferred medications for dealing with many anxiety-related psychological illnesses. Anxiety should not be ignored, as the effects of nervous tension and fear include a decrease in quality of life, along with possible secondary effects such as high blood pressure.

Researchers in the Netherlands recently tested a model for understanding the nature of anxiety in humans. At the same time, the experiment highlighted the effectiveness of certain medications at reducing some aspects of anxiety. Specifically, these researchers used the startling effects of white noise and electric shocks to induce surprise or fear in the subjects. In addition to Xanax, subjects were given Lyrica (pregabalin), diphenhydramine (a common sedative ingredient in over-the-counter cold remedies), or placebo. Individual anxiety levels were measured through subjective reporting and a number of objective tests, including eye movements, pupil dilation, and skin conductance. The design of the experiment included random shocks and noises, both with and without prior warning.

As expected, shocking events preceded by a warning produced less anxiety than those that came by surprise. Both Xanax and diphenhydramine reduced overall levels of anxiety but for very different reasons. Whereas Xanax works by altering certain neurotransmitter levels, diphenhydramine has a more general, systemic effect. Surprisingly, subjects given Lyrica showed very little modulation of their anxiety levels. Researchers surmised that because Lyrica takes longer (up to 6 hours) to reach peak effectiveness, the experiment wasn’t capturing an accurate picture of events.

This experiment confirmed that Xanax is effective at reducing one manifestation of anxiety: the so-called “fear-potentiated startle response.” However, the results were less informative about anxiety in general than the researchers had hoped. The sample size was too small to uncover any new revelations about the nature of human anxiety. Ideally, research will one day make the work of quickly and accurately diagnosing anxiety disorders much easier and more straightforward.

References
Baas, J., Mol, N., Kenemans, J. L., Prinssen, E. P., Niklson, I., Xia-Chen, C., et al. (2009). Validating a human model for anxiety using startle potentiated by cue and context: the effects of alprazolam, pregabalin and diphenhydramine. Psychopharmacology, 205, 73-84.

When parents use children as pawns in their divorce, the psychological consequences can be devastating. Parental alienation (PA) is the act of deliberately alienating a child from a targeted parent (TP) by an alienating parent (AP) and can cause a psychological condition referred to as parental alienation syndrome (PAS). Although this term is relatively new, the damage this type of behavior inflicts is not. When one parent denies a child access to the TP, the child struggles with feelings of hatred and fear towards the TP. These children often live in an environment riddled with malicious and derogatory remarks about the TP, and as they age, maintain guilt over harboring these feelings toward their parent.

Research on children of divorce has shown that this pattern of behavior can cause children to have social impairments that negatively impact their quality of life as adults. But until now, no study has looked specifically at PAS and its effect on key factors of development. To address this issue, Naomi Ben-Ami of Yeshiva University in New York evaluated 118 adult children of divorce and compared the children who experienced PAS to those who did not. She assessed several areas of social and psychological well-being, including depression, trust, self-hatred/esteem, anger, guilt, marital status, and achievement and identity problems.

[fat_widget_right]

Ben-Ami found that the PA participants had substantially lower levels of achievement than the non-PA group, which was demonstrated by fewer college degrees, less overall employment, lower college enrollment, and more economic hardship. They also exhibited attachment issues, impaired relationships, and decreased self-esteem, possibly as a result of the lack of attention they received from their APs. The controlling behavior of an AP was also shown to increase feelings of anger and guilt in the PA participants. These emotions, coupled with diminished self-sufficiency, elevated the risk for depression in the children who were exposed to PAS. Ben-Ami believes these findings support previous research that shows the destructive and long-term consequences that a child must bear when he or she becomes entangled in a parent’s highly fueled emotions arising from a divorce or separation. This type of evidence, if made available to parents and involved psychological and legal experts, could help prevent this type of activity and maintain the integrity of relationships, present and future. Ben-Ami added, “Ideally, the trajectory can be interrupted successfully to allow children to maintain healthy relationships with both parents, to be loved by them and loving with them.”

Reference:
Ben-Ami, N., Baker, A. J. L. The long-term correlates of childhood exposure to parental alienation on adult self-sufficiency and well-being. American Journal of Family Therapy 40.2 (2012): 169-83.

People who have suffered childhood trauma are at increased risk for psychological problems resulting from extreme stress. Borderline personality disorder (BPD) is one such condition that has been linked to severe childhood trauma. When the trauma is inflicted by a caregiver, the child’s ability to cope is significantly impaired. The effects of unhealthy coping, attachment dysfunction, and emotional regulation can affect many areas of the child’s life as they continue into adulthood. Affect dysregulation is the inability to control one’s moods and emotions and has been linked to BPD and other mental illnesses. Underregulation of emotions is expressed by lack of control, extreme emotional overwhelm; while overregulation is the result of numbing and is exhibited by an inability to express emotions. To determine which of these factors is more indicative of BPD in adults who suffered trauma during childhood by their primary caregiver (TPC), Annemiek van Dijke of the Delta Psychiatric Hospital in the Netherlands conducted a study of 472 clients with a diagnosis of BPD.

The participants’ levels of affect regulation were documented and they were evaluated for various forms of TPC, including sexual abuse, physical abuse, and emotional trauma. Van Dijke found that 63% of the participants had experienced some form of TPC and that those with underregulation had more symptoms of BPD than the participants with overregulated affect. Although the study did not consider other factors that could influence BPD, such as family history, other traumas, and the mental health of the caregivers, the results clearly emphasize the importance of examining emotional regulation, and specifically underregulation, in clients with a history of TPC.

The findings also showed that the participants with TPC were at increased risk for posttraumatic stress (PTSD). But Van Dijke noted that no research has been conducted to determine exactly how specific forms of TPC affect the severity of PTSD symptoms or how they are indirectly affected through affect regulation as a result of TPC. In sum, Van Dijke believes that these results can benefit clients who have suffered TPC by educating clinicians on the importance of helping clients build more secure relationships and develop healthier emotional expressions.

Reference:
Van Dijke, A., Ford, J. D., van Son, M., Frank, L., & van der Hart, O. (2012). Association of childhood-trauma-by-primary caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0027256

Major depression continues to be one of the most common and debilitating chronic mood problems afflicting adults. According to the Mayo Clinic, there is no quick fix for those who have this disease. Appropriate treatment includes a long process of psychotherapy, lifestyle changes, and medication. Recently, several studies have indicated that the antidepressant drug Paxil (paroxetine) may increase the risk of suicidal thoughts or even attempted suicide in certain patients. As a member of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), Paxil is one of the most frequently prescribed treatments for depression on the market. The concern over suicide has led researchers to look back at previous studies in an attempt to reassess both the effectiveness and the safety of this particular medication.

Researchers studied the results of 40 double-blind, placebo-controlled clinical trials of Paxil. As a whole, the trials included nearly 7,000 adult participants, most of whom were diagnosed with either moderate or major depression. In a typical clinical trial of a medication, participants who leave the trial early are not taken into account; their data are incomplete and inconclusive. For the present review, however, researchers considered early withdrawal to be an indicator of either ineffective treatment or adverse effects. Surprisingly, the same proportion of trial participants left their respective studies early, regardless of whether they were taking placebo or Paxil. One would expect that more of those taking Paxil would remain in the study, but the numbers tell a different story. The researchers point out another flaw in depression research in general—the dependence on rating scales rather than overt and empirical evidence. Because depression is a psychological illness with few, if any, quantifiable symptoms, gauging its severity becomes very subjective.

When researchers pooled the results from all 40 trials together, the beneficial effects of Paxil were significant but only marginally more significant than placebo. If 100 patients are treated with Paxil, then an average of 53 of them will have a positive response, compared with 42 for placebo. In essence, this medication performs only 11% better than a sugar pill. When researchers considered the potential adverse effects of Paxil, including suicidal tendencies and attempted suicides, the picture became even murkier. Of all the SSRIs, Paxil has been shown to produce the greatest spike in suicidal thoughts, especially in young adults and adolescents.

The researchers conclude that the fields of psychology and pharmacology are in need of better experimental design. They argue that current designs overstate the effectiveness of antidepressant medications while simultaneously downplaying adverse effects. For Paxil at least, a closer look at a large cross-section of data reveals that it may not be quite as effective as once thought. As always, doctors should carefully screen their patients before prescribing any antidepressant medications. Any hint of suicidal tendencies argues against its prescription.

References

1. Barbui, C., Furukawa, T.A., Cipriani, A. (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. Canadian Medical Association Journal, 178(3), 296-305.
2. MayoClinic.com. (n.d.). Depression (major depression). Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175

Grief arises as a product of a loss that we have experienced. It is associated with losses that may include a person’s health, job, relationship, pet, or loved one. We may not be able to describe the roller coaster of emotions, yet we do know that we are not ourselves. When we feel out of sorts, sensations surface such as low self-esteem, illness, depression, and confusion, which can manifest into thoughts that our feelings are out of our control. As a result, this full-body experience may be difficult to process or verbalize. To mend this sorrow, the expressive arts can create a doorway to the unspeakable by opening all channels to the grieving body.

[fat_widget_grief_right]

Opening Up to Grief

Expressive arts therapy encourages movement of the imagination that we may struggle with during our grieving process. Our art influences how we look at, unblock, wrestle with, and shed light on the need to distance and detach from our pain. When we dodge grief to avoid, deny, or block the inevitable pain, the arts invite the imagination of these stuck places to come to the surface in images, movement, color, and sound. Our art process releases the tension of grief, allowing it to expand and contract, while providing a safe container in which this process can take place. When we create, we give ourselves permission to examine all that is happening within our grieving bodies.

“Art shows how the difficulty can contain its cure if channeled into life-affirming expression.”
-Shaun NcNiff

Understanding the Experience of Grief

There are five to seven stages often associated with the grieving process. They may be experienced as denial, pain, anger, bargaining, depression, upward turn, reconstruction, and acceptance. The experience can feel like a roller coaster ride of ups and downs, mood swings, and erratic behavior. When we drop in to our art-making, the grief is given containment—a place to be held. This containment permits the pain to speak and encourages our healing. Making sense of what is happening comes to light. We may notice this in a color that strikes a mood, or a picture that recalls a memory, or an emotion to be felt. It is an opportunity for the most vulnerable parts of a grieving body to speak, feel safe, be heard, and be externalized. Once the art is created, we can then dialogue with it further and support our need to metabolize all that is going on within us.

“The reward for attention is always healing.”
-Julia Cameron

Facing Grief and Piecing Life Together

Fragments of memories, like bits of broken glass, can be difficult to hold emotionally around anniversary dates, picture books, and mementos. They can feel like a jab to the heart, invite an unwanted memory, or open a floodgate of emotion. These fragments seek meaning and solace, yet can wander in and out, tugging and vying for attention at awkward moments. As we seek to piece our lives together after a loss, the expressive arts can heal us by giving these bits and pieces the attention they deserve and need. For a moment, we can sink into ourselves and allow our memories, thoughts, and feelings—those we desperately struggle with—an opportunity to speak, to be heard, and to be felt. Each time that we engage the process using the arts, we give ourselves a break, a breath, and a reprieve from the pain that seeks expression beyond talk therapy.

References:

1. Cameron, J. (1992). The Artist’s Way. New York: Tarcher/Putnam Publishing.
2. McNiff, S. (2004). Art Heals. Boston, MA: Shambhala Publications.

Married couples communicate in a myriad of ways throughout the world. Different countries have cultural norms that people conform to, and these norms directly influence how individuals in intimate relationships communicate. These norms also affect other behaviors and attitudes that significantly affect relationships. Chinese and American cultures are quite different, and therefore, it is assumed that couples from China might have different communication styles and beliefs about their relationships than American couples. These diverse views are important to understand in order to better address and treat the issues that plague Chinese couples in America.

To find out how attitudes and communication patterns shape the overall satisfaction of Chinese couples compared to American couples, Hannah C. Williamson of the Department of Psychology at the University of California, Los Angeles, recently led a study evaluating these factors in a sample of 41 Chinese newlywed couples and 50 newlywed couples from America. Taking into consideration that American couples are more inclined to conform to individualistic ideals and value intimacy and personal and romantic expression over the social expectations of extended family harmony and approval, as Chinese culture dictates, Williamson expected that the American couples would be more positive than the Chinese couples. This finding was not realized. Instead, all of the couples showed equal levels of positivity.

However, the results did show that the Chinese wives held more overall negative attitudes toward their husbands than the American wives. This directly impacted the levels of relationship satisfaction in the Chinese participants. Williamson believes this could be due to the collective nature of the Chinese culture, which dissuades people from directly expressing their feelings to intimate partners and family members. This nondisclosure of emotional experiences can hamper open communication and cause partners to hold on to resentments, thus negatively affecting the relationship. In contrast, American couples showed higher levels of relationship satisfaction, perhaps due to the more expressive and individualistic behaviors encouraged in American culture. Williamson believes these findings can help clinicians better understand the factors inhibiting communication in couples whose values differ with those of most Americans. She added, “The culture in which a relationship occurs therefore may be an important factor in determining how individuals behave toward their spouse and how they assign meaning to this behavior.”

Reference:
Williamson, H. C., Ju, X., Bradbury, T. N., Karney, B. R., Fang, X., & Liu, X. (2012). Communication behavior and relationship satisfaction among American and Chinese newlywed couples. Journal of Family Psychology. Advance online publication. doi: 10.1037/a0027752

If you have completed Codependency Workbook Exercise One, congratulations to you. Please take a moment to pat yourself on the back. You deserve it, because it must have taken a great deal of courage to write about your family history. Most people shed some tears in our therapy session when they share it with me. Then they feel very relieved.

Many people are not ready to share the letter with their family of origin right away. If you have a therapist available or a sponsor, discuss it with that person. If not, review it with a supportive, nonjudgmental friend. Before sharing this with your family, it is important that you be ready to deal with their reactions. Unless they are in recovery, most families will not be able to validate your experience. However, it is very therapeutic to put your family history on paper and share it with another person.

[fat_widget_right]

Now we are ready to begin the next workbook exercise, which concerns relationships. Please make a list of the most important people in your life. This may include friends, lovers, a spouse, family members, coworkers, or a boss. Spend a few minutes thinking about each relationship. How many people on your list do you believe are dysfunctional? How many are addicts, have untreated mental illness, refuse to work, even if they are able, or have other major issues? Are you taking care of some of the people on your list? Are some of the relationships lopsided, where you do most of the giving?

You may wonder why some of your relationships are lopsided. Dysfunctional people can sense that you are a caretaker and are drawn to you. It is almost as though they can smell you. You may find yourself drawn to them as well.

Last night, I saw a married couple where the wife was unsuccessfully trying to stop her alcoholic husband from drinking. She was anxious, frustrated, and very angry. Of course she would be frustrated. She was trying to control something that she had no control over. The facts are that we are powerless over other people, places, and things. Realizing this is helpful to codependents because they can learn to let go and relax. Trying to fix others is impossible, and just upsets the fixer. It also is not helpful to the dysfunctional person. Normally addicts only get help because of the consequences of their using. If the caretaker undoes the consequences, they caretaker unknowingly helps enable the dysfunctional person to remain sick.

Since caretaking may make you miserable and help your loved one stay sick, maybe we can work on not doing it. How? You can begin to learn to set boundaries. For example, you might tell the loved one that you will no longer bail him or her out if he is arrested. You may tell him that you will no longer call in sick if he is too hung over to work. You may tell her that you will only talk with her when she is sober.

I suggest that you put your list away for at least 24 hours. Then pick the relationship that causes you the most stress. Think about a boundary that you may set and write it down. Practice telling your loved one about the boundary. He or she will probably not like it, but in the long run it will be good for both of you. Be sure that you are prepared to maintain the boundary before you set it. The first time you do this, you are taking a major step in your recovery. Be sure to spend some time with someone who will support you setting a boundary.

Children who are enrolled in public schools in low-income communities are at a disadvantage both academically and psychologically. These children experience elevated rates of mental health problems due to their environments, family structures, and financial insecurity. At school, their opportunities are restricted as a result of a less than adequate learning environment, minimal resources, and external factors such as increased drug use and violence. All of these factors contribute to diminished behavioral regulation, loss of motivation, and poor academic achievement. Although there are many programs designed to address these issues in urban public schools, few have had substantial success. Obstacles such as feasibility, accessibility, funding, and implementation have prevented them from achieving success. Additionally, the majority of programs are aimed at meeting the needs of the students as a whole, and do not consider the needs of the teachers and children with disabilities.

BRIDGE, Bridging Mental Health and Education in Urban Schools, is a coaching and consultation program that was designed by a team of researchers and created to address all of these issues in urban elementary schools. To test its viability, one of the creators, Elise Cappella of the Department of Applied Psychology at New York University, led a study using 36 classrooms from five different elementary schools in urban communities. After a brief intervention, Cappella and her colleagues saw results.

BRIDGE was directly responsible for increasing emotional support in the classrooms, which gave the children a feeling of security and improved behavioral regulation. The students felt more confident and saw their teacher as an ally, which directly impacted their motivation for success. Overall, the students exceeded the academic, social, and emotional levels of their peers as a result of the teachers’ participation in BRIDGE. Cappella noted that one significant difference between BRIDGE and other programs is the fact that BRIDGE is delivered to teachers by a variety of mental health professionals. This factor makes BRIDGE a program that can be portable, flexible, and easily administered. Teachers are coached in such a way that they become empowered with valuable resources that help bridge the gap often found between students and teachers in disadvantaged school systems. Cappella added, “It is encouraging that a consultation and coaching component of mental health practice based on actual interactions in the elementary classroom and effective strategies to improve these interactions promotes children’s functioning across domains in urban schools.”

Reference:
Cappella, E., Hamre, B. K., Kim, H. Y., Henry, D. B., Frazier, S. L., Atkins, M. S., & Schoenwald, S. K. (2012). Teacher consultation and coaching within mental health practice: classroom and child effects in urban elementary schools. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0027725

For combat veterans, posttraumatic stress disorder (PTSD) is an all too common psychiatric condition. The symptoms of PTSD include high anxiety, a heightened state of arousal, aggression, and sleep disturbances. Many with PTSD report feelings similar to combat situations, as if they never really left the battlefield. When it is accompanied by moderate or major depression, those with PTSD are notoriously unresponsive to traditional therapies and medications. Self-injurious and self-destructive behaviors, even psychotic behaviors, are not uncommon events for the most severely affected veterans. Finding new and better treatment protocols is therefore essential.

Recent research indicates that Abilify (aripiprazole), a relatively new antipsychotic medication, may represent a moderately more successful approach for treating PTSD and major depressive disorder in veterans. Study authors performed a retrospective review of veterans’ charts to determine what effect, if any, the introduction of Abilify had on these patients’ PTSD and depression scores. A total of 27 charts were analyzed. Many of these patients were also receiving traditional antidepressants, anti-anxiety medications, or psychotherapy. All consented to participate in research on the use of Abilify to manage their symptoms. Most had shown very little or no response to their prior courses of treatment.

The study consisted of a 12-week trial of Abilify, with regular monitoring for side effects or improvements in mood. The overall positive response rate, both in terms of PTSD and depression, were rather low. At the end of 12 weeks, about 20% of these veterans showed significant improvement in their depression. Likewise, 37% showed improvement in their PTSD symptoms. These are not excellent results, but historically this population has been very resistant to most clinical approaches. Any improvement over failed techniques is worthwhile, and even small improvements to quality of life are deemed worth pursuing. Furthermore, Abilify has no potential for abuse and relatively few side effects. It is much better tolerated than many of the traditional antidepressants and anti-anxiety medications.

PTSD makes readjustment to civilian life an uphill battle for many veterans. Too many find themselves in a cycle of fear, self-loathing, anger, depression, and substance abuse. Abilify, originally developed as a first-line treatment for schizophrenic patients, has shown the potential to ease the symptoms of PTSD in at least some of these veterans. More research is needed, but the outlook is promising.

References
Richardson, J.D., Fikretoglu, D., Liu, A., McIntosh, D. (2011). Aripiprazole augmentation in the treatment of military-related PTSD with major depression: a retrospective chart review. BMC Psychiatry, 11, 86.