When a friend or loved one has been impacted by a traumatic event, it can be distressing and confusing to stand with them and watch them try to deal with the effects of such an experience. It can also feel overwhelming to the person trying to help or support when they don’t feel as if they have the tools necessary to respond to the traumatized person.

If you are wondering what you can do to be supportive to a person dealing with a recent trauma, here are some places to start:

1. Listen. Telling our stories is powerful and healing for human beings. It helps us to make sense of what has happened, to consolidate our memories of the events, and to feel heard and supported. Doing what we sometimes call “active listening” can be really important to survivors of trauma. This means devoting your attention to the act of listening carefully—without judging, interrupting, or making self-referencing comments. Asking questions is, however, an important part of active listening, as it shows that you are interested in getting the details right.
2. Don’t judge. Try to assume a stance of curiosity about the person’s story. Judgments are a heavy burden that trauma survivors become all too familiar with. Don’t add to this burden. Often, the person is struggling with internal judgments about the trauma and their reaction to it. You can help by simply supporting the person without implying that they should (or shouldn’t) have done something differently, that they did the right thing or the wrong thing, or that there was anything about the event(s) that was good or bad. The words in italics are words to avoid when discussing with a survivor the event(s) they are dealing with and/or how the person is coping in the aftermath.
3. Don’t pathologize. It is normal for human beings to feel grief, pain, rage, despair, and/or fear after a traumatic incident. Often, people will work through this on their own after a period of time, come to understand the event(s) in a way that works for them, and resume their typical engagement in everyday life. Give them a few weeks—don’t label what they are going through or make it sound like an “illness” or “disability.” As therapists, we don’t view having this response itself as problematic; we start to see a problem only if, after a couple of months, these responses are still interfering with the person’s ability to engage in daily life. In that case, you may wish to speak with the person about finding some professional support, but do so in a nonjudgmental way that is open to and hears the person’s thoughts about this.
4. Take care of yourself. Being a support person for a person dealing with deep pain can in itself be distressing and overwhelming. Sometimes this can even result in what we call “secondary traumatization”—feeling the effects of the trauma yourself. Give yourself permission to do the little things that nurture you and bring joy as you provide support to a person in distress. Be mindfully aware of your own level of distress, energy, and need for support. Learn a little bit about normal trauma responses (such as avoidance, arousal, and intrusions) so that you can understand what is happening. If you feel it might be helpful, you might consider seeking professional support for your own needs and keep yourself grounded. Give yourself permission to feel distressed, frustrated, overwhelmed, or confused, and take care of your own needs about this so that you are able to continue to be supportive when you would like to without making the trauma-affected person the target of your own pain or frustration—this can be a difficult cycle that causes more pain for everyone.

Navigating the aftermath of a traumatic event can be difficult for everyone affected—those directly involved in the event and those in the position of continuing to love and support people through their pain and grief. These tools are a place to start for those of you wondering how best to support a traumatized person. It is important to remember that being such a support person is a wonderful gift and a difficult place to be, and to give yourself the permission to struggle with it, to care for yourself and your needs during this time, and to seek your own support and care when you need it.

Traumatic brain injury (TBI) is defined as an “alteration in the function of the brain or other evidence of brain pathology caused by an external force,” according to the Brain Association of America in 2011. Defining brain injury has not been consistent in the medical research because of the complexity of the brain physiology. Improvements in technology has helped improve understanding of the brain but there still remain significant unknowns. Science journalist Carl Zimmer describes the brain as:

• an intricate network of billions of neurons
• a collaboration of neurons in constant communication
• a chemical labyrinth that senses the world inside and outside
• an organ that produces love and sorrow,
• keeps our hearts beating,
• keeps our lungs breathing,
• composes our thoughts,
• and constructs our consciousness.

Nobel Laureate Eric Kandel described the human brain as “the most complex organ in the universe.” Damage to this vital organ can cause significant limitations to a person’s ability to process the activities of daily living and function both mentally and physically. Traumatic brain injury (TBI) happens suddenly but can leave a lifetime of permanent disabilities.

Medical research has not successfully discovered curative interventions to repair the brain to pre-injured status. The lack of proven effective treatments for restoring impairments means focus for interventions is on treating the symptoms associated with the multiply traumatic changes associated with brain injuries. This void in medical treatments indicates the need for psychosocial support for the TBI survivor, the spouse/partner, and family members. The main focus of therapy is 1) to help facilitate adaptation to a changed life, 2) to facilitate a quality of living with limited abilities, and 3) to create a collaborative new reality of well-being.

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Impact on Family Dynamics

Traumatic brain injury does not happen in a vacuum. It is a chronic health issue that affects the entire family. Murray Bowen’s family systems theory explains how traumatic changes to one member of the family cascades throughout the family system. In nature, this is like throwing a pebble into a pond and observing how the water ripples throw out the pond. When one family member suffers traumatic changes, the stress is felt throughout the family system. The established patterns and roles are altered, changing the entire family dynamics. The heighten changes are a major stressor and cause a negative shift in the family’s well-being.

Family members are often described as the “neglected victims” of TBI. Many marriages end in divorce after brain injuries. The loss of an intact family causes further losses for the survivor. The difficulty learning to understand and cope with the monumental changes post injury are some of the reasons there is a need to conduct therapy from a family perspective. The therapeutic process needs to address loss, grief, and adaptation to creating a new life. Maintaining and developing socializations skills as well as a strong support system of family, friends, and a spiritual leader are helpful to the healing process.

‘An Invisible Disease’

There are many challenges to traumatic brain injury that sets it apart from other chronic illnesses. First, it has been described as an “invisible disease” and a “silent epidemic.” It is estimated that 1.7 million people are diagnosed each year. However, these numbers are considered an underestimate because of the lack of visible damages and the subtleties of impairments. The extent of cognitive deficits may not be apparent until much later. The insidious nature of the impairments means family members and professionals may overestimate the abilities of the survivor.

However, trauma to the brain frequently causes pervasive cognitive dysfunction and variety of personality changes, such as impulsivity, anger, fatigue, irritability, unpredictability, and depression. Lack of critical thinking, impaired social perceptiveness, and lack of empathy are also considered hindrances for the lack of awareness the survivor has about his or her own impairments and the decrease in motivation to adapt to a new reality. These problematic issues have a negative impact on martial/couple relationship, family dynamics, and relationships in general. Yet, the research indicates that a meaningful and supportive relationship can contribute to the TBI survivor’s healing from the psychological trauma.

Including Partners and Family Members

The recommended plan of care for the injured person includes psychosocial support for the caregiver, spouse, and family members. The North American Brain Injury Society (NABIS) reports a need for more effective incorporation of family support based on the last decades of research. Marriage and family research has shown that maintaining strong and supportive relationships are integral to helping the survivor cope with challenging changes, as well as for the spouse and family members to adapt to living with a new person.

References:

1. Bowen, M. (1985). Family therapy in clinical practice. Northvale, NJ: Jason Aronson.
2. Brain Injury Association of America. (nd).http://www.biausa.org/index.htm
3. Brey, R. (2006). The silent epidemic: Traumatic brain injury’s massive impact on suffers and society. Neurology Now, 5.
4. National Institute of Mental Health (NIMH). (nd). http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
5. National Institutes of Health. (2008). Traumatic brain injury: A family finds its way. National Institutes of Health: Medline Plus, 3(4), 2-7. Retrieved from NIH Medline Plus: http://www.nlm.nih.gov/medlineplus/magazine/issues/fall08/toc.html
6. Nichols, P., & Schwartz, R. (2004). Bowen family systems therapy. In Family therapy concepts and methods (pp. 119-146). Allyn & Bacon.
7. North America Brain Injury Society, NABIS. (2008). Barriers and recommendations: Addressing the challenge of brain injury in America. Washington, D.C.
8. Wood, R., Liossi, C., & Wood, L. (2005). The impact of neurobehavioural sequelae on personal relationships: Preliminary findings. Brain Injury, 19(10), 845-851.
9. Zimmerman, C. (2004). Soul made flesh: The discovery of the brain and how it changed the world. New York: Free Press.

Before a couple chooses to seek relationship help from a therapist, cost will likely be a factor. The charge for couples therapy may be the same as individual therapy, depending on the therapist, or it may be higher because of experience, length of couples therapy sessions, or the going rate for couples therapy in your area. Here, several therapists explain the cost of couples therapy:

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You may find yourself in a relationship that needs some outside guidance in order to progress in a healthy way. Couples therapy is designed to help partners overcome many relationship obstacles such as communication issues, infidelity, power struggles, or intimacy problems. These obstacles, however, are not simply limited to married couples. Here, therapists explain how couples therapy is available to any kinds of partners, regardless of whether or not you are married:

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[fat_widget_right]Many people who are beginning or seeking couples therapy struggle with getting their partner to attend session. This is common, and it occurs for a number of different reasons. Below, several couples therapists explain some of the reasons significant others may be reluctant to go to therapy, and offer their advice for helping to push them in a direction of positive growth for the relationship:

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Trust is essential to establishing a good connection with your therapist. Without trust, your therapy may never be as effective as you hope for. If you meet your therapist and do not click with him or her, you may consider searching for a new therapist after you evaluate the situation. Below, a few therapists recommend what to do if you think you may need to find a different therapist:

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About 11% of all children are diagnosed with attention deficit hyperactivity (ADHD) at some point, but some of these children grow into adults without ADHD. A new study suggests that these changes aren’t subjective. Instead, adults who recover from ADHD show distinct brain differences.

How Recovery from ADHD Changes the Brain

Researchers already know that, among adults and children with ADHD who aren’t focusing on a task, the brain’s posterior cingulate cortex and medial prefrontal cortex don’t synchronize their activity. The new study examined how these brain areas work together in adults who had previously been diagnosed with ADHD to see if recovery from ADHD changed the brain.

The study looked at 35 adults diagnosed with ADHD as children. Thirteen still had symptoms of the ADHD, while 22 had recovered. The researchers used resting-state functional magnetic resonance imaging (fMRI) to examine how the subjects’ brains behaved when they weren’t focused on a specific task. In a surprising twist, though, the new study found that adults who recovered from ADHD showed synchronicity between the two brain regions—a brain pattern identical to the brain patterns shown in people who have never been diagnosed with ADHD.

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Environment, Medication, and the Brain

This study might seem to suggest a biological basis for ADHD, and even a potential test for the condition. But environmental and lifestyle choices can change the brain. Carey Heller, PsyD, a GoodTherapy.org ADHD topic expert, points out that both medication and therapy can change the brain, and he emphasizes the way lifestyle choices can affect both the symptoms of ADHD and the way the disorder looks on a brain scan.

“Children have little control over their environments, but adults may be able to choose jobs, working environments, or habits that minimize their symptoms,” said Heller. Perhaps these changed brain scans are the result of a concerted effort to cope more effectively with ADHD. If that’s the case, then this research points to the importance of early interventions for helping children recover from ADHD in adulthood.

Heller is also skeptical about whether ADHD actually goes away, or just changes. “It’s unclear whether ADHD actually goes away in adulthood, or if the symptoms change,” he says. Maybe some adults with ADHD experience atypical symptoms that look different on a brain scan.

No matter how you interpret the data, though, brain differences in adults previously diagnosed with ADHD can help lead the way toward future research. The study was small, so more research is necessary to determine whether and how the adult brain changes in response to both ADHD and treatment for ADHD.

Reference:

Inside the adult ADHD brain: Differences between adults who have recovered, and those who have not. (2014, June 10). Retrieved from http://www.sciencedaily.com/releases/2014/06/140610112812.htm

Most everyone has at least one traumatic memory embedded in their brains. One that still resonates for me was the time my mother left me alone when I was six years old to take the babysitter home. When I looked apprehensive, she told me not to worry. “I’ll be right back,” she said, smiling brightly, and drove off. As it got dark, I became more and more frightened that something had happened to her and she wasn’t coming back.

By the time she returned I was totally terrified. She found me standing outside wailing. She scolded me and took me inside. Years later, whenever my wife was late coming home I would become worried and anxious. My heart would begin to pound, and more than once when she was particularly late, I had a full-blown panic attack.

I know I’m not alone. Some have memories from a car accident, a rape, a natural disaster, a violent parent, a drunk husband, a hospital stay, an assault, the horrors of war. Experiences like these are more common than you might think, with an estimated 60% or more of Americans who have experienced at least one of these at some point in life. Not all of these memories cause people to experience trauma later in life, but they can cause problems for many, and for some they can be debilitating. People with posttraumatic stress (PTSD) can become hypersensitive, with nerves on a permanent state of high alert. Fear and anxiety recur without warning, and nightmares can ruin sleep.

Memories and Trauma

But now there are simple, yet effective, ways to actually erase the traumatic emotions that often accompany these memories so that they can finally be put to rest. Many people can do this work on their own. For more difficult traumatic memories, working with a therapist who specializes in healing trauma can be helpful.

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In his book Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence, neuropsychologist Rick Hanson says, “Your brain was wired in such a way when it evolved, it was primed to learn quickly from bad experiences but not so much from the good ones.” It’s why traumatic memories so often stick in our brains, while positive memories seem to slip away. “It’s an ancient survival mechanism that turned the brain into Velcro for the negative, but Teflon for the positive,” Hanson concludes.

Fortunately, new findings from the field of affective neuroscience can help people heal traumatic memories that can contribute to PTSD, depression, bipolar, and even Alzheimer’s. One of the things we are learning about memories is critically important: Though the brain is particularly good at recording bad memories, they are not permanently locked into the brain’s memory banks, as we once thought. Whenever we actively recall a memory, it transforms and becomes vulnerable to modification.

When we recall a memory it becomes a little unstable and for a window of perhaps two or three hours, it’s possible to modify it before it settles down again, or “reconsolidates,” in the brain. That’s why, paradoxically, recalling bad memories can help us heal from old wounds. Reliving traumatic moments again in a condition of safety can help a person disconnect the memory from the painful “alarm” mechanisms that are the source of so much discomfort.

In the book The Archeology of Mind: Neuroevolutionary Origins of Human Emotions, Jaak Panksepp and Lucy Biven say, “Emotional memories remain forever malleable, subject to influence by future events—through a phenomenon called reconsolidation.” This is the basis of various treatment approaches for healing trauma including prolonged exposure therapy, supportive psychotherapy, emotional freedom techniques (tapping), eye movement desensitization and reprocessing (EMDR), trauma-based cognitive behavior therapy, and MDMA-assisted psychotherapy.

How to HEAL

Based on the latest in neuroscience finds Rick Hanson offers a simple, yet effective, method for rewiring the brain from the negative emotions associated with trauma to the positive emotions associated with health and wellness. In his book, he describes a four step process using the acronym HEAL.

1. Have a positive experience.

Step 1 activates a positive mental state, and steps 2, 3, and 4 install it in your brain. In step 1 we notice a positive experience that’s already present in the foreground or background of your awareness. In the example I offered at the beginning, I tuned into an experience where I felt safe and supported, and brought to mind experiences of safety and security.

2. Enrich it.

Too often we spend minutes, and sometimes hours and days, ruminating over a negative experience, but we gloss over the positive. Here we take time to deepen the positive experience. I would open myself to the feelings of support I have in my life. I would picture and my wife and friends and the many supports I have, filling my inner conscious with at least 10 to 20 seconds of positive memory.

3. Absorb it.

Here we imagine ourselves drinking in the experience. I imagine all my cells being infused with the experience. I feel it sinking into me and becoming part of my brain and all the parts of my being.

4. Link positive and negative material.

Hanson describes this as an optional step. We don’t want to become overwhelmed by the negative, but to hold the negative in consciousness while it is infused with the positive. Hanson uses the image of a garden. We imagine the beauty of beautiful flowers we are planting. We become aware of the weeds and gently pull them out so there’s room for growth. He concludes by saying, “Whenever you want, let go of all negative material and rest only in the positive. Then, to continue uprooting the negative material, a few times over the next hour be aware of only neutral or positive things that may have been associated with the negative.

I bought back the memories of being left by my mother and some of the associated experiences of getting anxious whenever someone I cared about was late. Focusing on the negative while activating positive experiences can actually “erase” the fearful feelings from the past. I still remember my mother leaving me alone and being angry with me when she returned, but it doesn’t grab me and shake me up like it used to do and I’m much less anxious when my wife is late coming home.

I describe other techniques for healing old pain in my book, Stress Relief for Men: How to Use the Revolutionary Tools of Energy Healing to Live Well. I often use them along with the ones that Dr. Hanson teaches. In this engaging TED talk Dr. Hanson describes how we can rewire the brain for joy and happiness and heal from trauma. In another show he describes how our mind can change the brain from being Velcro for the negative and Teflon for the positive.

Even when traumatic memories don’t reach a level of discomfort associated with PTSD, they can still be destructive. Hanson notes that unresolved trauma “increases inflammation, weakens your immune system, and wears on your cardiovascular system. No one has to live with traumatic memories from the past. They can truly be healed now and forever.

If you’ve ever had surgery that required anesthesia, you know the process of waking up can be a jarring one. Anesthesia induces a deep state of unconsciousness in a matter of seconds, but it can take several hours to return to normal after waking. Many people experience confusion, sleepiness, and even delirium-induced hallucinations as they awaken from surgery, but research on this waking process is limited. New research points to a complicated, meandering process through which the brain wakes up from anesthesia.

How Anesthesia Works

The state induced by anesthesia looks a lot like a deep sleep, but it’s actually quite different. Doctors rely on a variety of chemicals to induce unconsciousness, and each works slightly differently in the brain. What all general anesthesia recipes have in common is that they induce unconsciousness while preserving the body’s automatic functions, such as breathing and digestion. Anesthesia also reduces sensitivity to pain, which is why people don’t typically have dreams of being in surgery or experiencing pain when they’re under the knife.

Because a wiggly patient can quickly be injured, anesthesia also limits or eliminates your ability to move. For the one to two people out of 1,000 who briefly awaken during surgery, this paralysis can be terrifying. Fortunately, people who awake during surgery don’t typically experience pain.

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Waking from Anesthesia

Doctors have traditionally theorized that, as anesthesia is eliminated from the body, the brain’s electrical activity steadily increases until the brain returns to normal. But new research at Rockefeller University has found that the process of waking up is much more complex.

Researchers knocked rats out using a popular anesthesia called Isoflurane. As the rats awakened from the anesthesia, researchers examined electrical activity in areas of the brain believed to be associated with wakefulness. In fully awake brains, the electrical activity in neurons oscillates, but in an anesthetized or sleeping brain, electrical activity is slower.

Instead of finding a gradual increase in oscillating neurons, researchers found that oscillations occurred suddenly. While every rat’s brain eventually had oscillations in the same “hubs,” the process through which neurons became more active in each hub varied from rat to rat. Researchers believe this indicates that there’s not a single path through which the brain awakens from anesthesia. Because every rat’s brain ultimately used the same hubs, though, the research suggests that certain brain activity is a necessary prerequisite to consciousness.

While research on rats isn’t always applicable to humans, rats and humans respond in similar ways to anesthesia. While anesthesia is extremely safe, a small number of people who undergo surgery don’t wake up. Among people over the age of 65, the risk is higher. By gaining a better understanding of how the brain wakes up from anesthesia, researchers may eventually find a way to reduce the risks of undergoing surgery.

References:

1. General anesthesia. (2013, January 19). Retrieved from http://www.mayoclinic.org/tests-procedures/anesthesia/basics/risks/prc-20014786
2. To recover consciousness, brain activity passes through newly detected states. (2014, June 9). Retrieved from http://newswire.rockefeller.edu/2014/06/09/to-recover-consciousness-brain-activity-passes-through-newly-detected-states/
3. WorldCrunch.com. (2011, August 4). Under the knife: Study shows rising death rates from general anesthesia. Retrieved from http://healthland.time.com/2011/08/04/under-the-knife-study-shows-rising-death-rates-from-general-anesthesia/

Editor’s note: Tayyab Rashid, PhD, CPsych, is a clinical psychologist at the University of Toronto in Scarborough. His continuing education presentation for GoodTherapy.org, titled Positive Psychotherapy: The Application of Positive Psychology in Clinical Settings, is scheduled for 9 a.m. PDT on June 20. This event, free to GoodTherapy.org members, is good for two CE credits. For details, or to register, please click here.

Positive psychotherapy (PPT) is a therapeutic endeavor of the contemporary movement of positive psychology. While the traditional therapies target symptoms and positive interventions target strengths, PPT systematically amplifies positive resources; specifically, positive emotions, character strengths, meaning, positive relationships, and intrinsically motivated accomplishments. Positive psychotherapy neither suggests that other psychotherapies are negative nor is meant to replace empirically validated treatments. PPT is about redesigning the therapeutic landscape—allocating equal attention and effort to positives as much to negatives. It is meant to be an incremental change to balance therapeutic focus on strengths and weaknesses.

Focusing exclusively on negatives or positives in psychotherapy might be easier. But integrating both to strike a balance that captures the essence of the people we treat is challenging, if not impossible. PPT attempts to integrate symptoms with strengths, risks with vulnerabilities, weaknesses with virtues, and deficits with skills to discern inherent complexities of people in a balanced way. This doesn’t reduce people to mere conglomerate of syndromes nor enhances them to embodiments of strengths.

Positive psychotherapy acknowledges that, all things being equal, the human brain is not defaulted to neutral. It attends and responds more strongly to negatives than to positives. Psychopathology exacerbates this propensity. Cultivation of positives for people in therapy, therefore, becomes even harder, and dwelling on negatives easier. However, if psychotherapy can create a process, help people to rise above their default and learn to attend and amplify their positives, it could not only eliminate symptoms but also engender well-being. The toughest challenges of life require exploring and using the toughest internal resources, which in turn build resilience.

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Therefore, PPT’s central premise is that accentuation of strengths, along with amelioration of symptoms, is a better therapeutic approach. Much like health is better than sickness, security is better than fear, relaxation is better than stress, co-operation is better than conflict, and hope is better than despair. Indeed, there are exceptions when negatives may be more appropriate, but generally, positives are more adaptive and functional than negatives.

Positive psychotherapy is based on three assumptions. First, people inherently desire growth, fulfillment, and happiness instead of just seeking to avoid misery, worry, and anxiety. Psychopathology engenders when the growth is thwarted. Second, positive resources such as strengths are authentic and as real as symptoms and disorders. These are not defenses, Pollyanna-ish illusions, or clinical byproducts of symptom relief that lie at the clinical peripheries without needing attention. The final assumption is that effective therapeutic relationships can be formed through the discussion and manifestation of positive resources, not just thorough lengthy analysis of weaknesses and deficits.

PPT is primarily based on Seligman’s notion of happiness and well-being (Seligman, 2002 and 2012). Seligman parses highly subjective notions of happiness and well-being into five scientifically measurable and manageable components: (1) positive emotion, (2) engagement, (3) relationships, (4) meaning, and (5) accomplishment, with the first letters of each component forming the mnemonic PERMA (Seligman, 2011). These elements are neither exhaustive nor exclusive, but it has been shown that fulfillment in these elements is associated with lower rates of depression and higher life satisfaction (Bertisch et al., 2014; Headey, Schupp, Tucci, and Wagner, 2010; Sirgy and Wu, 2009).

It should also be noted that Peseschkian in Germany has also worked on positive psychotherapy for more than 20 years and is distinct from PPT discussed here. Peseschkian’s approach to therapy is inherently and systematically integrative, incorporating cross-cultural, multidisciplinary, therapeutically, and psychologically inter-theoretic (Peseschkian, 2000). PPT, on the other hand, is rooted in the current movement of positive psychology.

PPT can be divided into three phases (see Table 1). The first phase focuses on helping people to articulate a balanced narrative and by exploring their strengths from multiple perspectives. Personally meaningful goals are framed using strengths of people in therapy. The middle phase focuses on cultivating positive emotions and confronting, in a supportive way, negative memories, experiences, and feelings which keep people stuck—thwarting their growth. The final phase focuses on exploring positive relationships and facilitating processes which nurture these relationships, and on exploring meaning and purpose.

Throughout the course of PPT, people explore their strengths and gradually take deeper dives to reflect, introspect, acknowledge, attribute, and amplify them, without dismissing, minimizing, or overlooking their problems. For example, PPT engages people in discussions about, say, an injustice done whilst also focusing on recent acts of kindness. Similarly, along with insults, hubris, and hate, experiences of genuine praise, humility, and harmony are deliberately elicited. Pain associated with the trauma is empathetically attended to whilst also exploring the potential for growth. A critical component of this integration is to help people learn ways to use their strengths to solve problems that might be maintaining their symptoms. People are encouraged to develop practical wisdom and psychological flexibility through the careful consideration of which signature strength is relevant to the problem, whether it conflicts with other strengths (e.g., should one be honest or kind?), and translate abstract signature strengths into concrete attainable and sustainable actions and habits (Kashdan and Rottenberg, 2010).

PPT has been empirically validated through 13, albeit small, pilot studies, including eight randomized and five nonrandomized studies conducted by using a PPT manual, treating depression, anxiety, schizophrenia, and borderline personality. Results of these studies show that PPT is effective, with moderate effect sizes in reducing symptoms and enhancing well-being. PPT does equally well when compared with well-established treatments such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). For a summary of these studies, please see Rashid (in press; Rashid and Seligman, 2013; Seligman, Rashid, and Parks, 2006).

Exercises in PPT work due to a number of factors. For example, these exercises reeducate attention, memory, and expectations away from the negative and catastrophic, and toward the positive and optimistic outcomes. For example, when a person keeps a gratitude journal, the bias toward ruminating only about what has gone wrong is counteracted. The person is more likely to end the day remembering positive events and completions, rather than troubles and unfinished business. Similarly, the gratitude visit may shift a person’s memory away from the unfavorable aspects of past relationships to savoring the good things about interactions with friends and family. This reeducation of attention, memory, and expectation is accomplished verbally as well as via journal writing. The identification and use of signature strengths allows people to think more deeply about their positive qualities, which is likely to bolster self-confidence and prepares them to better handle adversities.

Like any therapeutic endeavor, PPT is not immune from triggering or even causing negative and uncomfortable emotions. For example, awareness of strengths may be uplifting, but this could be dampened by realization that surrounding environments are not conducive to express, use, or enhance these strengths. People may also feel uncomfortable that they are kind, forgiving, and prudent. However, these very strengths may be taken for granted by others. The therapist attends and attunes to nuances of strength expressions and invites creativity to develop insights and prepares people to behave differently and more adaptively. Thus, PPT, despite its apparent emphasis on positives, is not exclusively about positives. Rather, it is about developing refined understanding of integration of positives and negatives.

Positive psychology in general is criticized for overlooking negatives. It would be naive and utopian to conceive of a life without negative experiences. As such, PPT does not deny negative emotions nor encourage people to see the world through rose-colored glasses. Rather, it aims to validate these experiences, whilst gently encouraging people to explore their effects and seek out potential positives from difficult and traumatic experiences. During these explorations, the therapist needs to be careful to avoid offering empty platitudes, such as pointing out the positive opportunities that trauma, loss, or adversity may present for a person’s development and growth. Amid the warmth, understanding, and goodwill created in the therapeutic milieu of PPT, listening mindfully and facilitating affective expression allows the therapist to help people explore, reflect upon, and notice both successes and setbacks. In so doing, people can learn how to encounter negative experiences with a more positive mind-set and reframe and label those experiences in ways that are helpful. By working diligently to articulate the genuine and authentic positives of a person’s experience, the PPT therapist does not create a Pollyanna-ish or Pangloss-ian epitome of happiness or a caricature of positive thinking. The therapist neither minimizes, nor masks as positives, unavoidable negative events and experiences such as abuse, neglect, and suffering. Such issues are dealt with in PPT using standard clinical protocols.

In conducting PPT, some caveats are in order. First, PPT is not prescriptive. It is a descriptive approach based on converging scientific evidence which documents the benefits of attending to the positive aspects of human experience. Second, PPT is not a panacea, nor is it appropriate for all people in all situations. It is not a “one-size-fits-all” approach. Furthermore, in PPT, therapists should not expect a linear progression of improvement, as the motivation to change long-standing behavioral and emotional patterns fluctuates during the course of therapy. Finally, rigorous outcome studies are needed to extrapolate generalizability and articulate the role of mediating variables.

Table 1: Positive Psychotherapy (PPT): An Overview of PPT Model

References:

1. Bertisch, H., Rath, J., Long, C., Ashman, T., and Rashid, T. (2014). Positive psychology in rehabilitation medicine: A brief report. Neuro Rehabilitation. doi:10.3233/NRE-141059
2. Headey, B., Schupp, J., Tucci, I., and Wagner, G. G. (2010). Authentic happiness theory supported by impact of religion on life satisfaction: A longitudinal analysis with data for Germany. The Journal of Positive Psychology, 5, 73–82.
3. Kashdan, T. B., and Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30, 865–878.
4. Peseschkian, N. (2000). Positive Psychotherapy. New Delhi: Sterling Publishers.
5. Rashid, T. (in press). Positive Psychotherapy: A strength-based approach. Journal of Positive Psychology.
6. Rashid, T., and Seligman, M. E. P. (2013). Positive Psychotherapy. In D. Wedding and R. J. Corsini (Eds.), Current Psychotherapies. Pp. 461-498. Belmont, CA: Cengage.
7. Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and well-being. New York: Simon & Schuster.
8. Seligman, M. E., Rashid, T., and Parks, A. C. (2006). Positive psychotherapy. American Psychologist. 61, 774-788.doi: 10.1037/0003-066X.61.8.774
9. Sirgy, M. J., and Wu, J. (2009). The pleasant life, the engaged life, and the meaningful life: What about the balanced life? Journal of Happiness Studies, 10, 183–196.

Parents often focus so much on their children and teens having attention-deficit hyperactivity (ADHD) that they lose sight of the specific symptoms. As a result, many parents tell their kids that they cannot do something because they have ADHD. Other parents may continually remind their children about their diagnosis. Both of these parenting tactics can lead kids over time to internalize negative perceptions of themselves. In some cases, children and teens, and even adults, may learn to use having ADHD as an excuse to avoid doing certain things or attribute negative behaviors to it.

Clearly, all of this focus on having ADHD can lead to short- and long-term negative consequences. Therefore, it is important that parents focus on specific difficulties that their child or teen has in a domain, rather than blaming everything on ADHD. For instance, if you do not want your 10-year-old to walk with his or her friends to a local convenience store after school, it is recommended that you explain your concerns instead of saying, “You can’t go because you have ADHD.” It may be that your child is not attentive to watching for traffic, so you are concerned that he or she will not be careful when crossing the street. As another example, if you do not want your 13-year-old to go to the mall with his or her friends without adult supervision, explain why. It may be that he/she is impulsive, and you worry about your teen being disruptive or otherwise getting into trouble.

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It is also important to look at ways to assist your child/teen to allow him or her to participate in age-appropriate activities. Related to this, you should also determine ways for your child or teen to prove to you that he or she is capable of participating in the desired activity without difficulty. Using the example above of the 10-year-old who wants to go to the convenience store with his or her friends, one could handle the situation in the following manner: Sit down with your child and explain your concerns about his or her ability to watch for traffic. Then, provide opportunities in a controlled environment to prove that he or she can watch for traffic. You could do this by having your child walk places with you and take the lead when crossing the street. Of course, if he or she starts darting out into traffic, stop and discuss the situation in the moment, if possible. Once you feel comfortable that your child can watch for traffic in your presence, have him or her practice crossing the street when with you and a few friends. At 10 years old, it is fairly age appropriate to be walking places with an adult.

Only use the situation with your child’s friends and you if it is deemed age appropriate. For instance, if you are having the same issue with a 17-year-old, it would be much less appropriate to make him or her practice crossing the street with you and his/her friends. Also, when helping your child practice crossing the street in this situation with friends, don’t mention to the friends that you are helping your child practice crossing the street safely. Once your child proves that he or she can cross the street safely with you and friends, consider letting him/her walk independently with friends provided that he/she does not have to cross any major intersections. After a small amount of time being able to walk independently and proving that he or she is capable of being careful, you could allow your child to walk places with friends that involve crossing busier streets.

With the examples above, the point is to explain your rationale to your child or teen if you feel uncomfortable letting him or her do something. It is important that the explanation revolve around specific skills rather than concerns about having ADHD. Furthermore, it is important to discuss ways to improve these skills and then demonstrate success with them. Taking this approach, along with other strategies, will help improve your child’s confidence and make him or her less likely to fall prey to negative self-perceptions due to having ADHD.

Hypnosis is often recognized as being used by performers in comedy or entertainment and is typically seen as fun and harmless in those situations. However, hypnosis has a broader application when used in helping practices. Essentially, there are three main platforms for hypnosis:

1. Hypnosis used for entertainment.

2. Hypnosis is used by a person trained in specialized uses, such as helping people to stop smoking, manage weight, or deal with sleeping problems.

3. Hypnosis is used by a licensed mental health practitioner (hypnotherapist) as one of the tools in the counseling/therapeutic toolbox.

Hypnosis and hypnotherapy have an extensive history as reputable methods used the therapeutic process by trained and skilled hypnotists and hypnotherapists alike. The difference between hypnosis and hypnotherapy is that hypnosis is defined as a state of mind, while hypnotherapy is the name of the therapeutic modality in which hypnosis is used.

A trained hypnotist uses hypnosis to help people with issues such as smoking cessation and weight management, but is not licensed as to practice hypnotherapy. Hypnotherapy is practiced by a hypnotherapist who is a trained, licensed, and/or certified professional. Only a hypnotherapist may use hypnotherapy to work with such mental health concerns as phobias, stage fright, eating disorders, and certain medical conditions.

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How Does Hypnosis Work?

Hypnosis is defined as a harmless altered trance state characterized by very deep relaxation, highly focused attention, and an extreme openness to suggestions which are usually positive and foster positive therapeutic changes. However, a hypnotic trance is not necessarily therapeutic on its own. For example, when someone is driving to the mall, seemingly suddenly arrives, and is not sure exactly how he or she got there so soon, he/she has experienced an altered, hypnotic state. People may also experience this altered state when they are just beginning to fall asleep and are in a dreamy and drowsy state, aware but not completely focused—just focused enough to have a simple conversation but not remember talking at all.

When used for therapeutic approaches, specific suggestions and images given to people in a trance can alter their behavior in a positive manner. When in this state of hypnosis, you are more inclined to permanent change and more likely to be successful in making the lasting changes you desire. Almost all lasting changes happen in your subconscious mind.

Another example of how visualization in hypnosis works is when a hypnotherapist helps a person experiencing claustrophobia to visualize being in a very open space, without fear, when entering an elevator. By learning to positively visualize entering the elevator without fear, the person is often able to then do it in reality. The subconscious mind does not distinguish between a genuine experience and a suggested one. If you visualize it in a trance state, your body will react to it.

Who Can Be Hypnotized?

The simplest answer is that almost anyone can be hypnotized if they want to be. Modern research has shown that most people can be hypnotized to some degree and that the real question is how deep and to what degree they go into trance. Being able to be hypnotized is not a sign of being weak-minded, gullible, or giving up control. The ability to be hypnotized—or “hypnotizability”—is actually correlated with intelligence and the ability to have heightened awareness and focus while being in complete control.

For example, if while in a hypnotic trance you were asked to give the hypnotherapist your wallet or take off all of your clothes, you wouldn’t unless you truly wanted to. Likewise, if you were in the audience of a stage performance by a hypnotist and you were selected to participate in the show, you would quack like a duck only if you truly wanted to. In fact, the participants are usually chosen because the hypnotist believes you want to act silly and be part of the show. This is in contrast to someone who is not showing any indication he or she wants to be at the event or even have fun.