Marriages aren’t like fine wines. They are not harvested in vineyards and they do not always get better with age. However, many marriages far exceed any expiration date. According to a recent article by Matt Richtel, Pulitzer Prize-winning writer and columnist, modern marriages—which divorce at rates upward of 50%—may benefit from an exit strategy after, say, five, 10, or 20 years. Richtel said that many marriage contracts already exist. Prenuptial agreements are rampant among the wealthy, some couples who live together make paperless commitments to each other, and many celebrities and politicians have legalized business/marriage agreements. In fact, the idea of contractual marriage has been picked up in Mexico, where lawmakers recently introduced the idea of renewable marriages. Good idea or bad, the law didn’t pass.

But should it have? Should the institution of marriage be updated to keep pace with other cultural advances in areas such as medicine and technology? This was the question that Richtel asked several marriage therapists, psychologists, and divorce attorneys. The responses were varied. Author and professor Pepper Schwartz commented that marriage has been getting picked apart for decades and needs to be fully examined. Today’s marriages have less connection to religion and family, which creates a weaker support system, and modern technology encourages people to expect instant gratification from marriage. Schwartz said something like a 20-year marriage contract is an option, and that nuptial contracts including dowries and financial arrangements are not new.

Dr. Robert E. Emery, a professor of psychology at the University of Virginia, says the problem with marriage is the expectation of longevity that it comes with. Children of divorced parents bear the immediate emotional devastation of losing one parent, or having their family rhythm disrupted. If the possibility of divorce was anticipated, and marriages were not supposed to last past a certain point, it would be more culturally acceptable and emotionally tolerable. Emery says the best way to approach marriage is to understand that it is not a union filled with unlimited sex with someone who is beyond perfect, but rather an investment of every available resource that can reap emotional, sexual, and physical rewards. “There are good reasons to be romantic about marriage,” Emery said. “The big benefit of marriage is precisely the commitment over the long term.”

Reference:
Richtel, Matt. Till death, or 20 years, do us part. (n.d.): n. pag. The New York Times. 28 Sept. 2012. Web. 1 Oct. 2012. http://www.nytimes.com/2012/09/30/fashion/marriage-seen-through-a-contract-lens.html?pagewanted=all&_r=0

Sports generally are viewed as harmless pursuits, a source of social interaction and bonding, exercise, and stress relief. But in recent years, highly publicized incidents of fan violence have raised concerns about the culture surrounding sports. The vicious 2011 beating attack on Bryan Stow at Dodger Stadium in Los Angeles is just one such example. Alcohol-fueled fights and skirmishes are increasingly common at all levels of competition, from playgrounds to professional leagues. Most people who have attended a sporting event have witnessed at least one example of an out-of-control fan.

What’s behind this surge in violence? The problem may not be the nature of sports themselves, but rather the way society treats sports in conjunction with personal factors. A closer look at some factors that may contribute to fan violence:

Overidentification

For many sports fans, their teams of choice become a proxy for their own identities. Overidentifying personally with a favorite team may be a contributing factor to sports violence. A person who watches a favorite team lose, or witnesses an unfavorable referee call, may behave as if he or she has personally suffered. The advent of Facebook and other social media, as well as message boards and other gathering places for fans, may make it difficult to disengage from favorite teams or let go of bad memories. These platforms also provide more access to inflammatory views from rival teams’ fans, fueling deep feelings of loyalty, protectiveness, and anger that boil to the surface amid the emotional current of a live game.

Alcohol

Alcohol plays a significant role in many fan altercations. At National Football League games in 2011, more than 7,000 fans were ejected for inappropriate or violent behavior. Some fans spend all morning and afternoon tailgating and drinking with friends before watching the event and then celebrating—or grieving—afterward. People often are intoxicated before even entering a venue. The feelings of deep loyalty and anger that many fans feel can be exacerbated by alcohol consumption.

Hypermasculine Culture

Despite years of progress toward gender equality, many men feel pressured to meet expectations of traditionally masculine behavior. Sports can be a significant platform for masculine identity, and people who identify with hypermasculine culture may be more likely to attend sports events. Combined with adrenaline, overidentification, and ready access to fans with opposing allegiances, some men may be inclined to be violent when exposed to triggers. Likewise, women in hypermasculine environments that promote disrespectful or violent behavior may also be more inclined to engage in it.

Sociological Factors

Certain people are at a greater risk of engaging in violent behavior. People who have experienced a recent stress such as job loss, the death of a loved one, or a perceived humiliation are already on edge and more likely to react emotionally. Many people attend sporting events to alleviate stress. However, when a favored team loses, a person is heckled, or a person loses a significant bet associated with a game’s outcome, stress may explode into rage.

Group Dynamics

Millions of people attend sporting events every year, and the vast majority never commit a violent act. When 100,000 people pack a stadium, though, the odds are high that a number of them are under the influence of alcohol. Combine this with an emotional, hypermasculine environment and exposure to opposing sentiment, and you’ve created a recipe for fan violence. Proactive measures such as reporting inappropriate behavior immediately, limiting alcohol intake, and actively encouraging sportsmanship among peer groups, can help address an increasingly challenging threat to our enjoyment of sporting events.

References:

1. Aguirre, B. E. (2008). Sports fan violence in North America. Contemporary Sociology: A Journal of Reviews, 37(2), 157-158. doi: 10.1177/009430610803700235
2. Associated Press. (2012, May 31). Witnesses describe violent scene. ESPN. Retrieved from http://espn.go.com/los-angeles/mlb/story/_/id/7991565/witnesses-depict-violent-scene-bryan-stow-beating
3. Handwerk, B. (n.d.). Sports riots: The psychology of fan mayhem. National Geographic. Retrieved from http://news.nationalgeographic.com/news/2005/06/0620_050620_sportsriots.html

A client recently described how thrilling it was to take her daughter to see the Broadway musical Annie.  She recalled that her mother took her to see it when she was a child, and it had been an indelibly wonderful experience. Now she had the pleasure of providing the same thrill for her daughter. I thought how special it was for my client to share this with her daughter and how lucky my client was that her daughter had the same feelings about the experience. It also reminded me that so many parents who want to provide what they believe to be all the right things for their children are not always met with such good feelings.

I recalled another client whose desire to recreate his delight for his son was dashed when he took him to the rodeo and was met with the response, “This is stupid.” In spite of their most nurturing and positive intentions, parents may find that their wishes and rules for their children are met with rejection. This can create painful feelings, including insult, hurt, anger, and disappointment. “Drew,” a 42-year-old client, was in a prolonged struggle with his 8-year-old daughter about piano lessons she adamantly refused to take. He told me, “When I was a kid, I refused to continue piano lessons after a few months. My parents never insisted I continue. I’m not going to let that happen to my daughter. She isn’t old enough to know what she wants or what the consequences of her actions will be.”

As Drew and I explored his feelings, it became clear that he not only felt disappointed, he felt rejected by his daughter. “It feels like she is telling me, ‘Get out of here, you don’t know what’s good for me,’ ” he said. I responded: “I can see how upset you are about this, but I wonder what it is that makes you feel so personally rejected. Is it possible that your daughter is different from you?” Drew’s first response was, “She’s my daughter and she is like me. I just know this is very important for her to do. When I was a child, I didn’t know I was making a terrible mistake. My parents should have known and pushed me to continue.”

It took a lot of talking for Drew to become aware of his many disappointments about the ways his parents had been involved in his life when he was a child. He began to consider that he might not need to protect his daughter from this disappointment. He recognized that his daughter might, like him, regret not learning the piano, but forcing her to take lessons could easily turn her away from the piano. He realized that her experience and development was and will be different from his and she is a different person with her own thoughts and feelings. After all, she has different parents than he did. The more Drew could understand his daughter’s need to differentiate from him, the easier it was not to feel so rejected and hurt.

When parents assert their desires for their children, it is not unusual for them to be met with expressions of different or opposing wants and needs. Pushing back against what parents want is a necessary part of a child’s development. For a healthy sense of self to grow, children need to differentiate from their parents and become unique, separate, individual selves. This doesn’t mean children are totally different from or always in opposition to their parents. It does mean children need to develop minds of their own. Having one’s own mind is about being able to think about your needs and wants without being overly influenced by others. Ideally, the wishes of others are considered, but ultimately one makes his or her own life choices. Obviously, the degree of autonomy for a 4-year-old differs from that of a 13-year-old and again for a 20-year-old. When children are not given the space to differentiate from their parents and don’t develop a self that is confident and strong, they will not have developed the autonomy to make life choices and get what they want as they enter full adulthood.

At age 53, “Anne” was struggling with her teenage son, “Noah.” She came to therapy expressing feelings of anger and insult from their encounters. She explained that he fought her at every turn about anything she asked of him: cleaning his room, doing household chores, getting his college applications completed.  “I don’t believe how he treats me,” she said. “He says things like, ‘Leave me alone and mind your own business.’ Is that any way to speak to your mother? I feel so hurt and insulted. Doesn’t he know I only want what’s best for him?” In great distress, Anne added, “He has become a terrible person. He is so mean and inconsiderate. He seems like a completely different person than the son I felt loved me a year ago.”

As we talked, Anne described how when she was growing up she never went against her parents. When we explored her past and present relationships, Anne began to wonder if her early experiences being compliant are related to her difficulty asserting herself as an adult. She described how difficult it is for her to disagree with her husband and how she doesn’t always feel so good about herself. She realized that it wasn’t just with her son that she felt so badly treated. “I guess I don’t feel very powerful,” she said. “I have a lot of trouble believing that what I think and feel is OK. I always followed the rules with my parents. Maybe I didn’t develop what Noah needs to do—be someone who feels OK asserting himself when there is opposition.” Many parents with teenagers experience difficult feelings in their parent-teenager relationships. For Anne, the feelings of insult and rejection were intolerable. Even worse for her was the terrible shame she felt about her negative feelings toward her son: “I’m the terrible person. Mothers shouldn’t feel this way.”

How to handle this kind of situation with teenagers is controversial. Furthermore, how any parent hears what a child says is open to interpretation and may be related to how the parent differentiated from his or her own parents. While Anne felt insulted and hurt, another parent in these circumstances might shrug and think, “When will these awful teenage years pass?” On one end of the continuum of parental response, parents might believe that a child of any age should never be permitted to say anything that is hurtful, disrespectful, or angry to a parent. At the other end of the response continuum, parents might accept any expression their child makes without intervening. An extreme example might be if a teenager said, “You’re an awful parent, you have no business having children,” and a parent made no protest about being treated that way. On this far end of the continuum, the lack of a parental response to push against doesn’t provide the child with the feeling that there is a strong parental self to separate from. If there is no other out there to individuate from, it becomes difficult for a child to develop a sense of who he or she is and the ability to be autonomous. The child is left wondering, “Who am I?” Potentially more problematic, the child may be left with a feeling of powerlessness. He or she has not been given the experience of successfully asserting his or her developing self in the world.

There is a lot of room along this continuum for parents to develop responses that feel comfortable to them while allowing some room for their children to develop their unique selves. It helps if parents let their children know what behaviors are acceptable. For instance, telling a child, “You can’t talk to me that way” is not the same as saying, “You can’t be angry at me,” or “You are hurting my feelings.”

When children respond to parents in disappointing or unacceptable ways, it is important that parents stop and consider how they will meet that response. Each situation requires thought. Sometimes, interfering with the child’s wishes or experiences provides an opportunity for the child to push back against the parent and feel a sense of his or her developing self. At other times, supporting the child’s differentiation provides the child with a sense of confidence and recognition of his or her developing self. No matter the age of the child, parents who are curious and interested in why there is disparity or opposition are communicating their openness to more than one way of behaving and/or feeling. This openness to difference helps children develop into self-confident, autonomous adults. Moreover, parents are less likely to repeat the dynamics of their own childhoods if they consider their children’s behavior from a developmental perspective. They will be in a better position to not take things so personally and will feel less hurt, insulted, or disrespected by their children.

Nonsuicidal self-injuries (NSSI) are believed to be inflicted as a method of coping with distressing emotions. People who cut, burn, or otherwise harm themselves may do so in an attempt to escape overwhelming feelings of sadness, pain, guilt, depression, or shame. Although the research on NSSI is growing, little attention has been focused on the relationship between guilt and NSSI. Yoel Inbar of the Department of Social Psychology at Tilburg University in the Netherlands recently conducted an experiment to determine if people were more motivated to hurt themselves by feelings of guilt versus feeling of sadness or ambiguity.

For the study, Inbar recruited 46 college students and assigned them to either a neutral, sad, or guilty condition. The participants were instructed to recall an event that elicited the assigned emotion and write about the severity of their emotion at the time of the event and presently. They were then given one set of electric shocks, after which they were allowed to either increase or decrease the intensity of the remaining five sets of shocks. After the shock treatment, the participants were assessed for levels of sadness and guilt. Inbar found that the participants who recalled guilt-inspiring events chose to increase the shock severity, while those who remembered sad or neutral events did not. Additionally, the guilty participants reported feeling less guilt after they received the shocks than they had before.

The evidence presented in this study suggests that guilt acts as a motivator for self-injurious behavior. The participants in this experiment did not acknowledge being consciously aware of this relationship, but may have been prompted intuitively. “Such intuitively driven moral judgments are quite common,” Inbar said. Although some people who feel guilty may choose to diminish their guilt in other ways, such as doing a good deed to make up for their bad one, others may feel as if the level of their atonement must match the level of their transgression. Existing research has shown that certain emotions, such as self-anger and shame, often precede a self-injurious event. Inbar believes that future research should look at how these states influence the decision to self-injure compared to feelings of guilt. It would also be prudent to examine if people who have a history of self-injury to assuage guilt would choose a good deed if that option was available to them.

Reference:
Inbar, Y., Pizarro, D. A., Gilovich, T., Ariely, D. (2012). Moral masochism: On the connection between guilt and self-punishment. Emotion. Advance online publication. doi: 10.1037/a0029749

Many mental health professionals consider the three “A’s”—addiction, affairs, and abuse—sufficient reason to leave a partner. This blog addresses lower-level offenses related to the first two. While most couples can overcome low-level indiscretions in any area of the three “A’s,” when multiple indiscretions occur or the degree of severity is greater, it may be time to throw in the proverbial towel. As couples grapple with why one partner cheated or entered the depths of alcoholism or drug addiction, they need to evaluate the patterns of relating they have become used to, the interpersonal dynamics they engage in, the dances they dance, and the issues they may have brought into the relationship. One theme that consistently emerges is the degree to which couples are honest with each other. How much do they divulge? How important is it to tell the truth? Do you really need to tell your partner everything?

In Alcoholics Anonymous, we hear people say, “We are as sick as our secrets.” Family addiction therapists are fond of saying that there are no family secrets. By this, they mean that even when we believe that other family members don’t know a certain secret, that secret still has an impact on everyone in the family. If individual members don’t know the specifics of the secret, they are still impacted by it and sense or experience it unconsciously—and that can affect the whole family. I work with patients who learned in their twenties or later in life that they were adopted, that their parents were once married to an abusive spouse, or that they have a sibling they never knew, among other revelations.

I’ve also become aware of the extent to which sober and recovering clients keep things from their partners. Even in relatively healthy relationships, there appears to be a fair amount of small-scale concealment and deception, though the extent of the infractions often is debatable. Several clients I see—coincidentally or not, all men—have reported engaging in exercise cheating. What’s that, you ask? Exercise cheating, essentially, is exercising and not telling your partner, or not revealing how much or what type of exercise one engages in.

Even I have been guilty of cheating on my wife. A few years back, as I was setting up my new Philadelphia office, I decided to buy a painting by an artist that my wife and I liked. My wife studies art history, and I thought she would appreciate that I was acquiring a painting by a Temple University master’s graduate. And while $650 is no small chunk of change for this sort of thing, I thought it was a great investment for my new office. I thought I would surprise her with the purchase. Instead, she was angry. “You art cheated!” she cried as soon as she saw it. She was genuinely annoyed that I had not consulted with her on a purchase of this magnitude. Whether I was right or wrong in purchasing something of that cost for my office was not the issue. What is important is my partner’s perceived betrayal and need for dialogue, negotiation, and consultation.

Many hypothesize that cheating behavior is related to vestiges of evolutionary differences among men and women. While this theory would be a gross generalization in today’s society, it suggests that it was more adaptive in an evolutionary way for men to cheat than for women to cheat. Assuming evolution prioritizes any behavior designed to propagate one’s genes, men may benefit from spreading their genes in a quantity-focused way. Women, meanwhile, have long gestation and nursing periods which may temporarily move them to be more devoted and committed to their offspring. Thus, they benefit from finding a better quality mate. In other words, women are biologically, or at least evolutionarily, better at taking care of their young, especially in early developmental stages. Most people agree, and research appears to back this up, that most men think about sex more frequently than women do. While both men and women want to find a quality mate, men may be more inclined to seek quantity than women are.

According to this evolutionary perspective, neither men nor women want their mates to cheat because a mate who cheats may have more offspring, which in turn means that mate is less likely to care for the original partner’s offspring and more likely to leave and care for his or her new offspring. It is in a man’s evolutionarily best interest not to alert his partner to the fact he is cheating. Any behavior—sexual or not—that results in producing healthy offspring is powerfully reinforced to the extent that it aids in propagating an individual’s genes. So, infidelity and hiding that infidelity through the processes of natural selection and evolution can become more prevalent over time.

A fair question would be whether cheating sexually is related at all to other types of cheating. Just because a partner doesn’t tell a mate where he or she is going and what he or she is doing doesn’t mean that an affair is happening, and it doesn’t mean that a tendency toward nonmonogamous behavior is the cause of disingenuous behavior in the context of the couple. In fact, the point of this article is to lessen the impact of minor violations of the honesty contract. Putting small indiscretions of dishonesty in an evolutionary context may allow couples to see this behavior as resulting from the natural instincts of the animals we are. What is important, though, is that as humans we have the capacity to dialogue. This is precisely what can keep our natural tendencies in check. Speaking honestly to our partners about our needs and wants, while often challenging, is the hallmark of a healthy relationship.

Smoking gun example: A client once described an interaction he had with his wife after she busted him for smoking pot in the garage. She smelled the smoke even as he vehemently denied he had been smoking marijuana. When she found his metal pipe, still warm, he stuck to his story. “The lie just came out,” he explained later. “I was so used to it.” He eventually was able to talk about why he lied and why he has often felt the need to cover things up. It had nothing to do with infidelity, but was instead linked to his history of struggling to feel good about himself, to be able to ask for help with his emotions feelings and thoughts and to find purpose and meaning in his life. Beginning to discuss these issues with his wife and therapist helped him think more carefully about his tendency to lie and cover his tracks. He became better at advocating for himself and negotiating with his partner in a more healthy way.

Honesty is important in recovery from any mental health issue, whether it be depression, anxiety, or stress, but it is especially important in recovery from addiction and substance use because of the strong tendencies to hide, deny, and minimize one’s behaviors. Seeing an addiction psychologist or other specialist is an important first step in understanding one’s self. It is in this therapeutic relationship that a quick foundation can be set for the basis of an honest dialogue with one’s partner, friends, and family. Rebuilding relationships with those we love and who love us is essential to recovery from addiction. Understanding ourselves and the reasons we might cheat and lie can enable us to pause just long enough to ask ourselves whether we really want to go ahead with the behavior or if we might be able to rely on those close to us to help us through the difficult times. Honest communication with the people in our lives is the only way we can become and stay sober or make meaningful and lasting changes in our lives.

Obsessive compulsion (OCD) can begin with obsessive, irrational thoughts and fears. These irrational thoughts are followed by ritualistic actions, such as repetitive hand washing, door closing, or gestures. These rituals are the means to cope with the intrusive, irrational thoughts, but instead a vicious cycle is set into motion. Severe OCD can completely disrupt an individual’s life and also affect family and friends, as they watch their loved one become more and more consumed by compulsive behaviors.

The exact cause of OCD is unknown and may be different for each individual, but a deficit of the neurotransmitter serotonin has been identified as a likely culprit. Treatment for OCD involves both intensive cognitive behavioral therapy and high doses of antidepressant medications. Specifically, drugs belonging to the selective serotonin reuptake inhibitor (SSRI) class have shown success in achieving remission for individuals with OCD.

Luvox (fluvoxamine) is an SSRI but is structurally quite different from other drugs in the class such as Paxil (paroxetine) or Prozac (fluoxetine). Currently, it is the preferred treatment option for people with OCD. Interestingly, studies have shown that the action of Luvox and other antidepressants in treating OCD is completely independent of depression. In other words, a person with OCD need not be depressed to benefit from Luvox treatment.

Other studies have suggested that Luvox improves the response to behavioral therapy. This shouldn’t be surprising, as nearly all psychiatric conditions benefit from a multipronged treatment approach. Luvox is also safe and well-tolerated. Another antidepressant, Norpramin (desipramine), may actually be slightly more effective than Luvox, but it carries a greater risk of side effects.

With OCD, dosages near the high end of the safety guidelines are necessary to achieve improvement and eventual remission. Recently, a new, extended-release formulation of Luvox has been developed that may be well suited to the treatment of OCD. The dosage of the immediate-release formulation must be gradually increased, thereby delaying the positive effects. The extended-release version, on the other hand, offers a much faster onset of symptom improvement.

Concentrations of medication in blood plasma are a reliable indication of drug concentrations in the brain. Blood plasma measurements have confirmed that the Luvox extended-release formula achieves an effectiveness threshold much faster than the standard, immediate-release formulation. With its combination of fast action and safety, Luvox extended-release may soon be the first-line treatment for adults with moderate or severe OCD.

References:

1. PubMed Health. (n.d.). National Center for Biotechnology Information. Fluvoxamine. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
2. Ordacgi, L., Mendlowicz, M. V., Fontenelle, L. F. (2009). Management of obsessive-compulsive disorder with fluvoxamine extended release. Neuropsychiatric Disease and Treatment, 5, 301-308.

Cyber bullying has become more common with advances in technology. Messages can be posted on social networking websites, and pictures can be downloaded, altered, and made available to the world in seconds. Although there has been abundant research into the consequences of cyber bullying and traditional bullying, little has been done to determine which type may cause more psychological damage. It is well established that bullying itself—the act of terrorizing, intimidating, and ridiculing another through verbal or physical acts—can have numerous deleterious effects.

Those who endure bullying are at increased risk for internalizing problems such as anxiety, depression, and suicide ideation. Understanding how each type of bullying impacts young people is of critical importance in order to target those most vulnerable and help them deal with the ramifications. To get a better idea of the effects of cyber bullying in comparison to traditional bullying, Sheri Bauman of the University of Arizona’s College of Education recently conducted a study asking college students to rate their levels of distress based on hypothetical cyber and traditional bullying scenarios. The scenarios were similar in nature and differed only in delivery.

Bauman discovered that three main bullying themes emerged, including generalized bullying, name calling, and sexual victimization through explicit sexual images. Although the female participants reported higher levels of distress for all three types of bullying, the method of delivery did not impact emotional response. Specifically, although their responses varied by bullying scenario, all participants reported similar distress levels whether the bullying event was traditional in nature or cyber bullying.

However, Bauman found that one type of bullying was the most distressing. “We … found that bullying with sexual material, whether conventionally or by technological methods, is the most upsetting kind of incident to targets,” she said. This was especially true for female participants. Those with a history of victimization had higher distress than those without. In sum, Bauman believes that these findings demonstrate that it may not be the delivery method of bullying behavior that is most detrimental to young people, but rather the content of the message conveyed.

Reference:
Bauman, S., Newman, M. L. (2012). Testing assumptions about cyber bullying: Perceived distress associated with acts of conventional and cyber bullying. Psychology of Violence. Advance online publication. doi: 10.1037/a0029867

Generalized anxiety (GAD) is the most commonly diagnosed form of anxiety among adults. Symptoms of GAD include excessive worry or fear that interferes with daily life. For younger adults, a wealth of data exists showing the effectiveness and safety of Lexapro (escitalopram) in treating GAD. However, far less information exists regarding treatment outcomes for older adults.

Surveys indicate that at least 7% of adults in residential living centers undergo treatment for GAD. Those living on their own may experience GAD at an even greater rate. The elderly population as a whole experiences mood problems at a disproportionately higher rate. In addition, the elderly often have comorbid conditions such as dementia or major depression. For these reasons and others, elderly individuals with GAD often respond poorly to treatment. A study published in the Journal of the American Medical Association shed light on the question of whether Lexapro is a good choice for older adults, but still there are more questions than answers.

Study authors recruited 177 subjects aged 60 years or older with confirmed diagnoses of GAD. Approximately half of the participants received a 12-week treatment with Lexapro, while the remainder received placebo. A variety of psychological tests were administered to gauge response to the treatment. Self-reporting also weighed heavily in the final results.

Because adverse effects represent a potentially more serious concern among older adults, vital signs were taken at regular intervals. At the end of the 12-week study, the Lexapro group showed significant improvement in GAD symptoms. Side effects were mostly minor and included fatigue and sleep disturbances. Regular checks of vital signs confirmed that Lexapro caused no cardiac anomalies for any of the participants.

Among the interesting findings from this study is the observation that Lexapro only separated itself from placebo at week 4. This finding highlights the fact that adherence to a treatment regimen is an essential, but sometimes neglected, component of generating benefits for the individual. Geriatric individuals are in fact more likely to miss doses or stop taking medication entirely, especially if 2 or 3 weeks pass with no changes to their anxiety. Add to this circumstance the fact that elderly people often have additional diagnoses and decreased cognitive functioning, and this population becomes far more at risk.. Primary care physicians must be sure to emphasize the slow-acting nature of Lexapro as they screen the elderly for anxiety problems.

Reference:

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
2. Jenze, E. J., Rollman, B. L., Shear, M. K., Dew, M. A., Pollock, B. G., Ciliberti, C., Constantino, M. (2009). Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. Journal of the American Medical Association, 301(3), 295-303.

Let’s face it: Every woman on the planet knows about hormonal cycles. They’re difficult to ignore. Most men, on the other hand, are taught from the time they are born that being manly means denying anything in us that might be viewed as “feminine.” I still remember the taunts when I was a kid. “What’s the matter with you, Diamond, you throw like a girl.” Or, “Look, he’s going to cry, just like a little girl.”

It’s no wonder guys grow up convinced that we’re not “hormonal.” But is that true? Many of us know intellectually that we have hormones. We know we’ve got testosterone. Many of us have a vague idea that we also have estrogen coursing through our bloodstream—a fact we’d like to ignore. Hormonal cycles? That sounds too “fem” for many of us to even contemplate.

Midlife Hormonal Changes

I first began to recognize that there might be more going on inside me when I began doing research on andropause, or male menopause, in the early 1990s. I was seeing changes going on with midlife men at my health clinic that seemed similar to what I saw with women going through menopause. Many of the men were having “night sweats” and “hot flashes.” Others were on an emotional rollercoaster, up one minute and down the next. Some were having unexplained joint pain, and others were having problems becoming aroused or having intercourse.

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I began interviewing midlife men and women to find out what they were experiencing. Most of the men thought the idea that they were “hormonal” was ridiculous. Most of the women had a different view. “Well, it’s about time you guys finally figured out you’re hormonal,” one woman told me. Eventually, I interviewed more than 1,000 men and women, and 30,000 filled out a questionnaire I developed. The results were published in my books, Male Menopause, in 1997, and Surviving Male Menopause: A Guide for Women and Men, in 2000.

Do Men Have Hormonal Cycles?

Although most of us now accept that women and men have “male” and “female” hormones, it is more difficult to accept that men also have hormonal cycles. According to endocrinologist Dr. Estelle Ramey, professor at Georgetown University Medical School, “The evidence of them may be less dramatic, but the monthly changes are no less real.” But if men do have hormonal cycles, why don’t they recognize or talk about them? Dr. Ramey believes it is because men respond to their cycles in a way that is a function of their “culturally acquired self-image. They deny them.” This denial is the main reason she believes the largely male scientific and medical communities have taken so long to recognize hormonal cycles in men.

Winifred Cutler is one of the world’s leading experts on hormonal cycles. She has published more than 35 scientific papers, is co-inventor on five patents, and has authored eight books, including Love Cycles: The Science of Intimacy. “Now it is known that men show a hormonal rhythm,” she says. “A rhythm I call the hormonal symphony of men.”

A cycle might last a few minutes, a day, a week, a month, a season, a year, or a lifetime. When we go to sleep, our testosterone levels rise hour by hour until, by the time we awaken, they are at their highest (morning erections, anyone?). By the early and late morning, our levels typically level off and begin to decline. By late afternoon, our testosterone is usually at its lowest ebb. No wonder it’s more difficult for me to get up for the “afternoon delight” my wife thinks is wonderful, while I’m more interested in a morning romp.

Men’s hormones cycle throughout the year. In studies conducted in the United States, France, and Australia, it was found that men secrete their highest levels of sex hormones in October and their lowest levels in April. There was a 16% increase in testosterone levels from April to October and a 22% decline from October to April. Interestingly, although Australia, for example, is in its springtime when France and the United States are in their autumn, men in all three parts of the world showed a similar pattern of peaks in October and valleys in April.

Men also have monthly hormonal cycles, though there are some interesting differences and similarities between women’s and men’s cycles. Women’s monthly cycles are more predictable and synchronous. Women who live in close proximity find that their monthly cycles begin to align. Men’s cycles seem to be more unpredictable and individual. A study of young men showed that the majority had a discernible cycle of testosterone with repeating rises and falls, but each man who did show a cycle had a cycle unique to himself.

“Testosterone levels oscillate every 15 to 20 minutes in men, and also follow daily, seasonal, and annual rhythms,” says Theresa L. Crenshaw, author of The Alchemy of Love and Lust. “The morning highs, daily fluctuations, and seasonal cycles whip men around. Think about the moment-to-moment impact of testosterone levels firing and spiking all over the place during the day and what this must be doing to a man’s temperament. Men who so strongly need to feel in control are in fact in much less control than they realize. No wonder they can be so, well, testy!”[fat_widget_right]

I suspect that we’d all be better off if we recognized that men, like women, have our own challenges dealing with our hormones. The great philosophers tell us to “know thyself.” Knowing and accepting our hormonal cycles may be the most important knowing we can have about what it means to be a man.

Play therapy is widely recognized as an effective therapeutic approach for children who are unable or unwilling to communicate their psychological distress. Elementary-aged children represent an especially vulnerable segment of the population when it comes to mental health barriers. First, it is during these formative years that behavior patterns are set. Children who have psychological problems early on tend to have higher rates of substance misuse, aggression, risk-taking behavior, and academic challenges than their peers. Additionally, many young children who have attention-deficit hyperactivity disorder, obsessive compulsive disorder, posttraumatic stress, autism, or other difficulties may have significant academic challenges and can benefit greatly from effective and meaningful in-school therapy.

But believing in the viability of play therapy and delivering it are two different things. Many school counselors report significant barriers to play therapy. Christine Ebrahim of the Department of Counseling at Loyola University in New York wanted to take a closer look at the barriers that counselors faced and how they overcame them. Ebrahim enlisted 359 elementary school counselors from the American School Counselor Association and had them complete online surveys regarding barriers to play therapy. The participants reported barriers such as time, space allocation, financial resources, and administrative and parental support. However, nearly all the counselors who cited these obstacles also described how they overcame them. For instance, they used their own money for supplies when they could not get funding, moved sessions to alternative locations when space was limited, and provided education about the benefits of play therapy when administrative and parental support was lacking.

One barrier was more difficult to surmount: the limited availability of play therapy training. “In looking at the data, most counselors identified specifically a lack of training as their primary problem,” Ebrahim said. Play therapy courses are not part of the curriculum at all colleges. Therefore, counselors are forced to learn through textbooks or online, or they must pay for training out of their own pockets. These results are promising in that they suggest that counselors are willing to do whatever it takes to offer play therapy to students in need. However, Ebrahim believes the findings clearly demonstrate that elementary school counselors are in desperate need of more professional play therapy training.

Reference:
Ebrahim, C., Steen, R. L., Paradise, L. (2012). Overcoming school counselors’ barriers to play therapy. International Journal of Play Therapy. Advance online publication. doi: 10.1037/a0029791

A study sponsored by the University of Chicago will test the effectiveness of Lexapro (escitalopram), a selective serotonin reuptake inhibitor (SSRI), in the treatment of borderline personality (BPD). As an SSRI, Lexapro belongs to the most commonly prescribed class of antidepressant medications. In recent years, the use of antidepressants has expanded to include chronic pain conditions, irritable bowel syndrome, and other mental health issues distinct from depression. In the current study, researchers intend to show that antidepressants can reduce thoughts of self-harm in individuals with BPD. The study is currently recruiting male and female subjects aged 18 to 40 years who have not taken an SSRI in the last two months.

As a mental health condition, BPD has not always been taken seriously. Many therapists simply viewed people with borderline personality issues as difficult cases, rather than examples of a specific but little-understood condition. People with borderline often respond poorly to traditional therapies, perhaps leading to the damaging stigmatization of BPD (Kernberg and Michels, 2009). Recently, however, BPD is among the most intensely studied personality issues.

While there are still more unknowns than knowns, the recognition of BPD as a legitimate condition with both a biological and psychiatric basis is firmly established. Approved treatments include customized cognitive behavioral therapy, anti-anxiety medications, and in some instances, low doses of antipsychotic medications. An ideal, one-size-fits-all approach has yet to be discovered. Because of the variable manifestations of the condition, such an approach may not even exist.

Self-loathing, self-harm, and thoughts of suicide are unfortunately quite common in people diagnosed with BPD. The University of Chicago study will include a placebo control group and an experimental group. Both groups will undergo eight weeks of treatment, with the experimental group receiving 10 to 20 milligrams of Lexapro.

The primary outcome measure for the study will be self-harm ideation; researchers expect the experimental group to report far fewer thoughts of self-harm. A second outcome measure will be symptoms of depression. The study’s recording methods will consist of electronic diaries for each participant and weekly therapeutic interviews.

Despite mountains of research and clinical investigations, there is still a long way to go in the treatment of BPD. Therapists are in search of methods that ensure long-term improvement in patients’ symptoms. Even today’s best interventions often only deliver short-term success. Because the risk of self-harm and suicide is so very real in this population, the University of Chicago Study will hopefully offer insight into reducing these outcomes.

References:

1. Kernberg, O., & Michels, R. (2009). Borderline personality disorder. The American Journal of Psychiatry, 166(5), 505-508. Retrieved May 25, 2012, from the ProQuest database.
2. Selective Serotonin Reuptake Inhibitors (SSRIs) in Borderline Personality Disorder – Full Text View – ClinicalTrials.gov. (n.d.). Home – ClinicalTrials.gov. Retrieved May 25, 2012, from http://clinicaltrials.gov/ct2/show/NCT01103180?cond=%22Personality+Disorders%22&rank=11

Reality television programs are anything but real. Shows that depict romantic relationships or the pursuit thereof—such as The Bachelor and Real Housewives—reveal fantasy lives filled with high-octane intimacy, infidelity, and unrealistic ideals. These factors seem to add to the appeal for many people. But do these portrayals influence people’s expectations of their own, real-life relationships? Yes and no, according to a study conducted by Jeremy Osborn of Albion College in Michigan.

Osborn surveyed almost 400 married people to find out if their perceptions of relationship satisfaction and commitment were affected by what they viewed online, on television, and in movies. He found that those who believed in fictitious romance had a lower sense of relationship commitment. They expressed concerns about the high cost of losing their independence and having to sacrifice their own interests for those of their partner. Because they viewed the price of relationship commitment to be high, they also placed relationship satisfaction at a premium. This could explain, in part, why the reality romance supporters had the same level of relationship satisfaction as those who did not believe in reality romance.

Perhaps people who view relationships as emotionally costly expect more from their relationships than people who view their relationships as less emotionally expensive. In fact, if someone anticipates having to invest quite a bit into a partnership, he or she probably expects a large return. Therefore, those who see romantic relationships as requiring a big injection of time and effort may value the outcome of their efforts differently than people who do not approach relationships the same way. However, Osborn cautions that commitment is a key element to relationship satisfaction and that culture’s definition of relationships, as manifested in the media, does not demonstrate that. “We live in a society that perpetually immerses itself in media images from both TV and the web, but most people have no sense of the ways those images are impacting them,” Osborn said. Because marriage failures are holding steady in the United States, he believes it is imperative that couples take a good, long look at how everything, including reality TV, affects their relationships.

Reference:
Gannon, Megan. Commitment harder for those who watch TV romances, study claims. (n.d.): n. pag. The Huffington Post. 19 Sept. 2012. Web. 19 Sept. 2012. http://www.huffingtonpost.com/2012/09/19/commitment-issues-tv-romances_n_1896784.html