Psychologists are exposed to many stressors that could cause them to have a negative outlook on their careers. Dealing with long hours, extensive paperwork, and insurance companies can lead to burnout in the mental health field. Working with difficult clients and being privy to distressing information can also place psychologists at a high risk for work-related stress and job dissatisfaction. Although most of the existing research suggests that psychologists are relatively happy with their careers, Patricia A. Rupert, associate professor of psychology at Loyola University in Chicago, wanted to explore the nuances of job satisfaction among them.

Rupert assessed surveys from two groups of psychologists that were part of a larger survey. The first group of 129 psychologists reported high job satisfaction levels, while the second group, consisting of 102 psychologists, reported moderate satisfaction levels. Rupert’s goal was to analyze the factors that contributed to high satisfaction versus moderate satisfaction. She looked first at whether job satisfaction correlated with growth and income opportunities as well as working environments. Secondly, Rupert identified working hours, case load, therapeutic mode, administrative responsibilities, professional improvement strategies, and negative client interactions.

The review provided evidence that several variables contribute to career satisfaction for psychologists. Specifically, Rupert found that the majority of moderately satisfied psychologists had poor professional and personal life balances and felt little sense of control in their work environments. The most satisfied participants were those with a harmonious personal/professional structure and positive work experiences. In contrast to research that suggests high rates of burnout among mental health professionals as a result of the work stressors, this research demonstrates that there are multiple nuances that influence the overall job satisfaction of therapists and psychologists. “Our results provide encouraging evidence that, despite the many challenges providers face in this evolving health care environment, practicing psychologists, as a whole, remain very satisfied with their careers,” Rupert added.

Reference:
Rupert, P. A., Miller, A. O., Hartman, E. R. T., Bryant, F. B. (2012). Predictors of career satisfaction among practicing psychologists. Professional Psychology: Research and Practice. Advance online publication. doi: 10.1037/a0029420

Next Friday, August 31, 2012, GoodTherapy.org is thrilled to welcome Dr. Laurie Moore, who will present Healing Betrayal Caused by Infidelity, a FREE CE teleconference for GoodTherapy.org members available with 1.5 CE Credits. We encourage you to join us for this exciting event, so if you have not already, register today!

Working with clients who are suffering from betrayal caused by infidelity is complex, including grieving stages, posttraumatic stress (PTSD), and additional factors. This article refers to infidelity as a breach in agreed emotional and sexual monogamy. Some couples agree to open relationships or polyamory, which is a different situation. Infidelity as defined in Wikipedia is “a breach of an expectation of sexual and or emotional exclusivity.” This involves a lie and broken promise, causing feelings of intense betrayal for many people.

Infidelity has become a common problem. Some infidelity statistics state that over 50% of both men and women engage in infidelity (Journal of Marital and Family Therapy, 2012) and others say 30% to 60% (Wikipedia, 2012).

Those suffering from infidelity betrayal commonly go through Kubler Ross’s well-known stages of grief:

1. Denial: This didn’t really happen or it’s not really as upsetting as I feel it is.
2. Anger: How could you?
3. Bargaining : If only I had communicated differently, this would not have happened.
4. Depression : I feel helpless. Nothing I can do changes this discomfort.
5. Acceptance : I have been hurt and disillusioned but I am at peace with myself.

The experience of grief due to infidelity includes additional factors that are absent from grief occurring from a death. Grief due to death is felt in a finite situation that contains an end. It is understood that the one who is gone is gone from the body permanently. Grief due to a breach in trust has no finite or predictable container. The one suffering finds him- or herself in unpredictable circumstances, which often feel very dismantling and excruciatingly unsettling.

Feelings that challenge self-confidence and worth are more common to infidelity betrayal than loss alone. Death is socially expected. Infidelity is shunned. The one who is betrayed is prone to feel guilt, shame, and embarrassment because the situation remains privately hidden or is condemned by a variety of reactions when exposed.

When death is the cause of grief, a solo journey is required. When betrayal is the cause of grief, two people are involved, so the situation is more complicated. Once one is lied to, the relationship is uncertain. This person can’t tell whether he or she is being lied to or told the truth. The one experiencing this challenge is often upset again in the aftermath of the partner relationship. This is different than the one abandoned by a death whose loss cannot re-emerge in a repeating scenario.

Clients with heartache caused by infidelity and betrayal can also go through fight-or-flight syndrome:

Fight: Arguing with, controlling, or managing the person who betrayed me will solve this.

Flight: Leaving will solve this.

Once fight or flight proves useless, a person will seek comfort in other ways. By assisting this person to fully meet the helplessness, sorrow, anger, anguish, disillusionment, and heartache that has come, peace can be found.

I have found that client-centered talk therapy, hypnotherapy, eye movement desensitization and reprocessing (EMDR), and the 12-step program are all deeply valuable for clients healing from infidelity. I also use my own Success Love Now (SLN) process effectively in these situations. Here is how and why each of these methods is valuable.

Someone who is suffering from loss and feeling isolated due to the taboo nature of this loss needs to be witnessed compassionately and caringly. This in itself helps to relieve the tremendous burden one carries from feeling alone. When being accepted within the context and emotions one is truly feeling, without being corrected or judged, peace can start to return. Acknowledging your understanding and compassion for a clients’ diverse set of feelings can be a profound help to a suffering client.

Because the shock of betrayal can be extreme, disrupting normal life in many ways, EMDR assists the hurting person to digest the deep emotions that are arising. Just getting through the day becomes a challenge for people who are betrayed. EMDR makes the healing time for this upheaval much faster in many cases.

Hypnotherapy allows the person who was hurt to re-find stability, meet parts of him- or herself that were hurting before the situation occurred, heal parts of him- or herself that are hurting now, and find a new basis for equanimity that is deeper than the circumstances. Taking a client into a deep, relaxed state in which the client can bring in peaceful parts of him- or herself to help the hurting parts enables a client to rebuild self-esteem and strength.

S-Anon Twelve Steps allow people to find the value in surrender, the gift in their challenge, and the support of others enduring similar pain. Twelve Steps also help the one who was betrayed to find out if addiction was involved in the betrayal, as commonly is the case. Letting your client know that S-anon is an option can be a valuable part of her or his healing process.

SLN provides a new framework for the person to feel empowered and at ease within the undesired circumstances. Encouraging the client to focus on what his/her purpose and aim are for him- or herself and gratitude for the good that is occurring within the context of the undesired happenings is beneficial. This will bring a client out of a victim mode and into a creative mode.

Of course, if the person who was betrayed plans to stay in the relationship, couples counseling and counseling for the one who was betrayed are necessary.

When working with clients who have been betrayed due to infidelity, it is important to understand the complexity of loss, mixed with PTSD, combined with humiliation–this situation causes a long period of overwhelm and readjustment. When the client is treated with compassion, the healing can go well.

Sources:

1. Infidelity statistics. (n.d.). Retrieved August 20, 2012, from http://www.statisticbrain.com/infidelity-statistics
2. Infidelity. (n.d.) Retrieved August 20, 2012, from http://en.wikipedia.org/wiki/Infidelity

Related articles:
Cheating
Can a Couple Recover From Infidelity?
In-Depth Map for Three of the Eight SUCCESS LOVE NOW Steps

As people age, they face challenges that they may never have experienced before. Loss of friends due to death, loss of independence as a result of diminished income, and loss of physical health can all create significant stress in a person’s life. The way that people choose to cope with that stress is directly related to the skills they learned throughout their lives. Attachment styles developed in early childhood can dictate the response people have to a variety of stressors, including ones encountered in later years. Additionally, an individual’s ethnic origin influences how he or she will respond to stress at various stages. To better understand how attachment style affects coping and overall well-being in older adults and what role ethnicity plays, Eva-Maria Merz of the Netherlands Interdisciplinary Demographic Institute at The Hague in the Netherlands recently conducted a study of 1,116 older adults from varying cultural backgrounds.

The participants, which included European Americans, African Americans, Eastern European immigrants, and Caribbean immigrants, were examined to determine how attachment style affected their well-being. Specifically, Merz looked at secure or dismissive attachment styles in comparison to avoidant and fearful attachment styles. “As expected, secure attachment and dismissive attachment were associated with greater well-being, whereas ambivalent/fearful attachment was related to reduced well-being in this older cohort,” said Merz. The link between secure attachment and positive well-being was most evident among the Caribbean and African American participants and weakest among the other two groups. When she looked at avoidant/fearful attachment styles, Merz discovered that it negatively impacted well-being in all the ethnic groups with the exception of the Caribbeans.

The results of this study support previous research highlighting the importance of healthy attachment styles on well-being. This new evidence extends the existing data by demonstrating that attachment styles are especially important in later life when unique challenges arise. Further, attachment styles are influenced by ethnicity. Taken together, this information provides new insight into the underlying factors that contribute to the general physical and mental health of older adults and should be considered when implementing interventions to help older adults cope with life’s stressors.

Reference:
Merz, E.-M., Consedine, N. S. (2012). Ethnic group moderates the association between attachment and well-being in later life. Cultural Diversity and Ethnic Minority Psychology. Advance online publication. doi: 10.1037/a0029595

Related articles:
Patterns of Attachment in Adults
Individuation Issues with Elderly and Ailing Parents
The Importance of Attachment in Early Caregiving

If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria: http://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books:
The Mood Cure by Julia Ross
Depression-Free Naturally by Joan Mathews-Larson
Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

Related articles:
Social Anxiety Can Be a Hidden Problem in College
Breathing Lessons
The Birth of Anxiety

People in their 20s seem to have it all: youth, energy, health, and looks. But they are also still figuring themselves out, and this time of change can bring certain mental health concerns as well. Experts have information on these issues that tend to impact people in their 20s, and provide some solutions for addressing and coping with these problems.

Clinical psychologist Dean Haddock, a marriage, family, and child counselor and the executive director and founder of Community Counseling and Psychological Services, points to a fairly common activity of 20-somethings that can lead to mental health issues if it’s not checked: alcohol and drug use.

“The first problem that leads to many others is alcohol and chemical abuse, which often leads to dependency,” Haddock said in an email. “The mental disorders that follow are often depression, anxiety, and brain injury. Of course, self-esteem and body-image problems often lead to eating disorders.”

Haddock gives three tips to help people in their 20s prevent and get through some common mental health concerns:

1. Know your genetic history of mental disorders. Knowing is half the battle to avoid those disorders in yourself.
2. Be choosey about your friends, as they will influence your decisions. Healthy friends lead to healthier decisions.
3. Self-esteem is often the result of the people who matter to you. If they do not esteem you, then you will not esteem yourself.

Nerina Garcia-Arcement, a clinical psychologist and clinical assistant professor at NYU School of Medicine, suggests that the many life changes people experience in their 20s can cause mental health issues at times.

“Your 20s are filled with life transitions that can be stressful,” Garcia-Arcement said. “This is a time when young adults are solidifying their personalities, developing their independence from family, starting or finishing college, beginning new jobs, developing a career, forming romantic relationships, and learning to manage their existing family relationships and friendships within these context.”

“Individuals in their 20s don’t have a lifetime of experience to draw on when managing multiple life transitions at once,” she added. “When someone experiences these transitions, anxiety and depressive disorders can occur.”

Here are six of Garcia-Arcement’s tips to help people in their 20s cope with mental health issues more common to that age group:

1. Seek out and form strong support networks.
2. Seek out others who are going through similar experiences and share your feelings, whether you are feeling worried, nervous, scared, sad, confused, or excited.
3. Know that you are not alone in your confusion about your career and relationships.
4. Seek out mentors who have achieved their goals, and ask for advice.
5. If you are feeling stress, sadness, or anxiety, engage in activities that will help you manage those feelings such as yoga, meditation, exercise, hobbies, social activities, relaxation exercises, and deep breathing.
6. If you feel you are not getting the necessary support and feel overwhelmed or depressed, seek out mental health professionals who can help you manage the feelings related to your life transitions.

Stephanie Sarkis, a licensed mental health counselor, said in an email that anxiety and depression are some of the main mental health issues 20-somethings face.

“We have seen an increase in these issues due to the lagging economy and difficulties finding employment,” Sarkis said. “Many people in their 20s have moved back in with their parents, which can trigger feelings of failure and frustration.”

Dr. Maiysha Clairborne, a family physician and wellness and stress management coach, added in an email that eating disorders associated with body dysmorphic disorder and body-image issues are also common for people in their 20s. She has three overall tips for people in this age group:

1. Talk to someone. The worst thing that a person can do when they are feeling depressed, anxious, or alone is to isolate more. Many times when we talk with someone we trust about what’s going on, we come to realize that we are not the only ones experiencing it and then we can get support.
2. Get active. Staying physically active not only helps to keep the body fit but also helps release endorphins and serotonin in the brain, which help keep the mood elevated. Physical activity is also a good release for stress and anxiety.
3. Minimize sugar and junk food. Sugar and processed junk foods can worsen the emotions of stress, anxiety, and depression because they cause erratic changes in your body’s blood sugars. This can disrupt the normal release of hormones in the brain that keep your moods stable.

Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said there are many issues specific to people in their 20s, including problems associated with medication use.

“Many people were on stimulants/meds for their ADHD when they were younger, but they thought it was okay to stop their meds when they were done with school,” Carroll said. “Now they are struggling at work and don’t know why. I’ve also seen young adults stop all kinds of meds like their thyroid meds because they didn’t know why they were even on it, and then they have all kinds of problems.”

Bad habits involving drug and alcohol use can start to become a major substance abuse issue when people are in their 20s, and other mental health issues start coming to the forefront at this time in peoples’ lives. Examples include bipolar disorder and schizophrenia. Also, panic attacks can start for people who have a genetic predisposition and who have higher amounts of stress associated with newfound adulthood.

“The 20s are an important time of social/emotional development,” Carroll said. “Unlike previous generations, identity formation often takes the entire 20s due to the complexity of modern society. It could be said that adolescence lasts until the early 30s in today’s society due to [prolonged] periods of education (grad school, law school, med school, etc.), lack of stable job options, and delays in getting married and starting families.”

Carroll, who is also an assistant professor at the University of New Mexico School of Medicine, suggests that when it comes to serious relationships and marriage, people in their 20s should consider how their choices could eventually affect their mental health and how their brain plays a part in their decision.

“Many 20-somethings are tempted to get married, but it is generally a bad idea because the brain in not done developing until about 25 [years old] … which leaves young adults vulnerable to having their rational mind be overwhelmed by their feelings or stress,” Carroll said. “Relationship choices often dramatically change from the early 20s to the late 20s, so many people find that the person that was perfect at 22 is a disaster at 27.  This can be an incredibly hard transition, to have to break up with your former soul mate that you thought you’d love for life because you’ve changed so much over the last several years.”

Related articles:
Do I Have a Healthy Relationship With Food and My Body?
Social Anxiety Can Be a Hidden Problem in College
How Schools Could Prevent Depression

Binaural beat technology (BBT) was discovered in the early 1800s and first described in the popular literature in the early 1970s. In the last four decades, binaural beat audio programs have been touted as tools for reducing stress, improving sleep, enhancing concentration, and even fostering altered states of consciousness. In the ‘70s and ‘80s, BBT audiotapes were primarily found in more esoteric venues, such as New Age bookstores, health food emporia, and retreat centers dedicated to consciousness exploration. One such center, the Monroe Institute in Virginia, is well known for their use of Hemi-Sync recordings, which feature BBT.

Today, BBT has become more commonplace, as one can download MP3s and smartphone applications in a matter of moments. Although the prevalence and popularity of such products has waxed and waned, several studies examining the potential usefulness off BBT have been conducted with a variety of populations.

What is BBT?
The term “binaural beat” refers to the brain’s tendency to hear the difference between two similar tones that are played in opposite ears as one new tone.  Our ears hear tones in terms of hertz (Hz), or cycles (the number of times a wave repeats itself) per second. Beats played at frequencies that are characteristic of brain wave frequencies are both audible and thought to facilitate alterations in our predominant brain-wave state.

Types of Brain Waves and Their Associated States
At any given time, our predominant brain wave may be in the frequency associated with deep sleep or deep trance (delta; 1-4 Hz), meditation (theta; 4-8 Hz), relaxed awareness or daydreaming, (alpha; 8-12 Hz), a state of relaxed focus (low-beta, or sensorimotor rhythm [SMR]; 12-15 Hz), alert mental activity/concentration (mid-beta; ~15-18 Hz), anxiety (high-beta; >18 Hz), or high-level information processing (gamma; >30 Hz). Gamma brain-wave states appear to be the least well researched. There is no “best” state to be in; however, at different times we will understandably want to be able to shift into one that is appropriate to the task at hand, whether sleeping, working on a project, or relaxing.

What Type of BBT for Which Conditions?
It has been hypothesized that a number of conditions, including chronic stress, chronic and postoperative pain, migraines and other headaches, problems with attention/concentration or learning, and insomnia, to name a few, reflect an imbalance or irregularity in brain-wave states. The deliberate use of BBT to change the predominant brain-wave state is referred to as brain-wave entrainment (BWE). BWE is not limited to BBT, but discussion of other methods is outside the scope of this article. However, a 2008 review of the BWE literature found that delta stimulation was associated with improvement in migraines and other headaches and reduction in short-term stress. A single session of alpha stimulation was associated with stress reduction in some settings, but not for those undergoing root canal. Alpha stimulation was also linked to pain relief. Beta improved attention, reduced short-term stress, alleviated headaches, reduced behavioral problems, and improved performance on measures of overall intelligence. An alpha-beta protocol improved verbal skills performance and attention, and a beta-gamma protocol showed improved arithmetic skills in children who had learning disabilities or attention-deficit hyperactivity. Most of these studies examined photic stimulation (presented via flashing lights) or combined photic and BBT entrainment rather than BBT alone. Thus, it is difficult to draw a definitive conclusion about the specific utility of BBT from this review.

BBT as a Potential Tool for Reducing Anxiety and Pain
The results of a small pilot study published in 2007 found that listening to an hour-long program emphasizing delta BBT for 60 days was associated with a decrease in self-reported trait anxiety and an increase in quality of life among eight healthy adults. The level of dopamine (an excitatory neurotransmitter) was also decreased significantly and may be related to the decrease in trait anxiety scores. Interestingly, the team assessed changes in the level of growth hormone because the BBT’s producer claimed that listening would increase these levels. Growth hormone decreases with age, and thus, an increase would be considered a potentially beneficial outcome; yet, listening to this BBT program was associated with a significant decrease in growth hormone. Both the reasons for this result and it’s implications are unclear.

Perhaps two of the more intriguing studies about BBT were the following trials with patients undergoing surgery. The first is a 2005 double-blind, randomized controlled trial in which 108 patients undergoing general anesthesia for elective surgeries received either a BBT plus music audio, the same music without BBT, or no intervention other than standard care for a 30-minute period prior to their operations. The BBT audio featured a progressively slowing beat that ended with 10 minutes of delta. No adverse events were noted, and although initial state anxiety scores were higher in the BBT group (prior to the intervention), the most significant decrease in anxiety was also in the BBT group—even after adjusting for the fact that participants in this group on average had higher initial anxiety. Listening to music alone was also associated with a significant decrease in anxiety, but this decrease was of a lesser magnitude than that of the BBT group. This study showed that an inexpensive, one-time intervention of short duration was beneficial despite the stress characteristic of undergoing surgery.

The other study was a randomized controlled trial of 60 patients about to have surgery with general anesthesia. Twenty patients were assigned to each of three conditions: a Hemi-Sync BBT program, listening to the music of their choosing, or listening to a blank audiocassette for 30 minutes prior to surgery. None of the participants was offered any sedative premedication. Stereo headsets from all groups of participants were removed before the patients entered the operating room but were replaced and the respective audio programs restarted after the induction of anesthesia. Headsets were discontinued at the conclusion of surgery. The researchers found that using the Hemi-Sync programs resulted in significantly less intraoperative use of fentanyl (a very potent, synthetic opiate pain medication), lower self-reported pain scores several hours after the surgery, and being discharged from the hospital sooner. Unfortunately, the specific frequency of BBT was not described in this article.

Anecdotally, several months ago I went for my first-ever root canal and noticed considerable anxiety at the thought of having a very sensitive tooth drilled (even with anesthetic). On the way to the endodontist’s office, I listened to both a guided imagery program designed specifically for medical procedures in which one must remain awake (available via HealthJourneys.com) and also to a free delta BBT program (Napuru) I’d downloaded for my iPhone. The delta tones were played against a backdrop of ocean waves. My subjective experience was that the BBT and imagery, combined with mindfulness practice before and during the root canal, reduced my anxiety significantly and enabled me to get through what seemed like an eternity of loud drilling. I cannot say what the most “active” ingredient in this integrative approach was; however, the point is that this nondrug, inexpensive, easy-to-use adjunct was effective for me.

BBT has been around for decades and is now readily and inexpensively available. There are some data to suggest that it may be helpful for relieving anxiety in general and in the context of a stressful event. There is also some evidence that BBT or other methods of brainwave entrainment may help with pain, concentration, headaches, and other issues, and serious risks or side effects have not been reported. The current research does not definitively answer the question of whether there would be a dose-response effect or a benefit from listening to BBT more regularly versus listening once; however, this seems plausible. More research needs to be done to better elucidate whether BBT could be used as an independent therapeutic tool, however. Additionally, assuming BBT is effective, one should not drive or perform tasks requiring sharp focus when listening to delta, theta, or alpha tones, as these may induce a very relaxed state.

For More Information:

1. Dabu-Bondoc, S., Vadivelu, N., Benson, J., Perret, D.,  Kain, Z. N.  (2010). Hemispheric Synchronized sounds and perioperative analgesic requirements. Anethesia & Analgesia, 110(1), 208-210.
2. Huang, T. L., Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine, 14(5), 38-50.
3. Padmanabhan, R., Hildreth, A. J., Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anesthesia for day case surgery. Anesthesia, 60, 874-877.
4. Wahbeh, H., Calabrese, C., Zwickey, H. (2007). Binaural beat technology in humans: A pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine, 13(1), 25-32.

Related articles:
6 CAM Tools for Achieving Better Health, Emotional Balance, and Contentment
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10 Complementary Therapies That Can Help Children

As you may know, eye movement desensitization and reprocessing (EMDR) is a research- and evidence-based therapy created by Francine Shapiro, Ph.D., over 20 years ago. An integrative model, EMDR is comprehensive, including aspects of multiple psychotherapeutic approaches. With this in mind, equine experiential activities, such as those found in equine-assisted psychotherapy (EAP), support and help to facilitate EMDR’s eight-phased model, while also maintaining fidelity to standard protocol.

The EquiLateral™ protocol is brought with a deep respect and understanding of EMDR but also the power of equine-assisted therapy. I am constantly reminded that EMDR and equine-assisted therapy both have the ability to support and often deepen a client’s ability to access where those traumas are stored. In my 10 years of experience as an EMDR therapist, I am still constantly amazed and inspired by the depth of healing that can be reached through EMDR, let alone through horses, who are often our most powerful and forgiving teachers.

Current research emphasizes the importance of maintaining fidelity to EMDR’s eight-phased approach. Nevertheless, in doing so, EMDR “may be implemented in more than one way as long as the broad goals of each phase are achieved” (www.emdria.org).

EquiLateral™ is the first equine-assisted EMDR protocol. We are still doing EMDR but are incorporating equine-assisted experiences within the eight-phased, three-prong, standard EMDR protocol. For more information on this approach to healing trauma, please visit my website: www.dragonflyinternationaltherapy.com

Horses, Comfort, and PTSD
Horses are prey animals. What this means is that they are highly in tune with their environment, readily noticing changes in the world around them and being able to respond to what they notice and actively seek what horseman Buck Brannaman describes as their wanting to return to “peace.” When in this energetic state, their nervous systems are settled and calm. They can readily focus on just being in the world, in the moment, which for them means grazing, moving 20+ miles a day, and relating with herd members. In contrast, when sensing danger, their peace is threatened, and their nervous system becomes activated enabling them to react, primarily through flight, although sometimes through fight or freeze, for self-preservation.

If you are a trauma survivor or know someone who struggles with posttraumatic stress, perhaps you can relate. Our bodies have the capacity to do as horses do, react, respond, then calm down and return to “peace.” But, we humans often learned to “stuff,” “repress,” “deny” what happened when all the body really wants to do is release and move through those feelings and body sensations. Doing so actually helps the trauma memory settle in, to release the “charge” that the body stores about what happened. By nature, horses, like all animals, know how to do this.

But, when trauma is still locked in the body and blocked, our nervous systems don’t return to a baseline of calm and peace. Instead, the fight, flight, or freeze that was experienced at the time of the event continues to remain activated, leading one to feel on alert, hypersensitive, anxious, easily agitated, or constantly “on,” making it challenging and often nearly impossible to relax.

That said, horses know how to relax. But, they also instinctively know to be alert and flee when threatened. They are preyed upon in the wild and are really in tune to danger, of any kind, including that which threatens their physical and even emotional safety, and that sense of comfort and peace that is their baseline state of being. And if you are a trauma survivor, all you want is peace and comfort as well. And this is just the beginning of why the horse and the trauma survivor may just “get” each other.

In light of the powerful connection between horses and trauma survivors, I am consistently shown the power of horses to help heal humans, especially through the integration of EMDR and equine-assisted therapy via this protocol.

Keep an eye out for the Part 2 of this post coming soon!

Related articles:
EMDR: Symptoms and Phases
Common Therapy Approaches to Help You Heal from Trauma
How Trauma Impacts My Sense of “Me-Ness” – Part II

In counseling, many of the ways to address anger can also be used as tools to address anxiety. Deep breathing is one such tool. Getting that full, deep breath of oxygen will indeed help both our mind and body. Sadly, we may not stop to focus on our breathing or take in enough of that good oxygen. Furthermore, in times of distress, rapid breathing is more likely and will not help the thinking process or our ability to calmly make decisions.

When I sit in session and show clients that taking that breath is a bit more than a second or two process, they seem confused. Yet nearly everyone reports feeling remarkably calmer after trying it. Personally, I like to close my eyes so I am not focused on what is around me. Imagine as you take in that full breath through your nose that you are soaking in positive energy. Hold it a second or two, and then slowly breathe it out through your mouth. This is not a race. In fact, try to expel it slowly. Slowing down your breathing will mean you are slowing down your mind and body.

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Now, in the process of this deep breathing, let’s add some guided imagery. For this, think of a calm place. I would like this to be somewhere you feel relaxed and positive. For me, it is the beach. I want you to see yourself there without having to focus on where else you may need to be or other things you may need to be doing.

Experience as many of the senses as possible. For example, sitting on the sand, I can feel it between my toes. I can feel the warmth of the sun on my arms. I can smell the cool beach air and the scent of suntan lotion, and I can hear the gentle crashing of the waves and even children playing off in the background. I can also see the beauty of the area, as I watch the birds in the distance over the water. The beach is a calming place for me, so as I take in my deep breaths, I imagine soaking in the warmth and wonder of it, even as I am in my car, home, or wherever I am practicing.

The more senses you can envision, the easier it is to remain focused in the moment. Some people choose amusement parks or other loud venues. That’s okay as long you can focus and keep to your steady breathing pattern. The goal here is to consciously and intentionally slow our minds down while adding these positive and relaxing components. When asked if you should practice this when anxiety is creeping up, I say to try and practice these tools at least a few times a day. I don’t want you to have to wait until the anxiety is noticeable. Rather, if we are practicing relaxation, we will not only be in a better position to deal with it in those moments, but hopefully even fend some of it off in the first place via a calmer, more relaxed you.

Your mind is indeed a powerful tool. We hear about sharpening it with memory exercises and such to enhance our cognitive skills, but what about teaching it to relax? We live in a fast-paced society where expectations can be massive and relaxation is not taught in school. Rather, we learn how to be better students and thus more successful human beings. You need to teach your mind and body to calm down and be okay with relaxing once in awhile.

George W. Bush created the Healthy Marriage Initiative based on research showing that healthy, strong marriages make a positive contribution to communities. The program, funded by the federal government, was designed to help unwed parents living in socioeconomically deprived neighborhoods reap the benefits of marriage. Most of the targeted families were minorities and faced challenges with keeping and maintaining employment, adequate housing, and earning enough income to supply the basic needs of their families. They also dealt with crime and safety issues. The government believed that this vulnerable group was the most in need of programs designed to help couples develop healthy marriages. The program was implemented during Bush’s administration and fully supported by Obama when he became President.

It is only recently, however, that the results of this program are coming to light and being fully analyzed. And, as outlined in a recent article, they are not encouraging. According to data gathered by Matthew D. Johnson, an associate professor of psychology at Binghamton University, the programs were based on scant research from higher income, nonminority couples. Johnson reviewed assessments from thousands of couples who participated in the program and discovered that the framework, which was based on individuals from different socioeconomic environments with fewer challenges, did not provide a relevant foundation from which minority couples could build a strong marriage. The couples that need the Healthy Marriage Initiative most do not consider marriage more important than finding employment, meeting basic needs, and ensuring the safety of their families. “When faced with a myriad of social issues, building intimate relationships is just not high on their priority lists,” says Johnson.

The Healthy Marriage Initiative costs slightly more than $9,000 per couple to implement and has become more of a burden, both economically and socially, to the very communities that it was designed to help. Johnson believes that the intention behind the program was the right one but that the whole initiative needs to be restructured in order to achieve positive results. Specifically, Johnson believes that the program should be fully examined and reformatted based on accurate research, and if it still cannot meet target goals, it should be eliminated altogether.

If you are reading this article, then you probably have completed Codependency Workbook Exercise Two by creating a list of your troubled relationships. Congratulations for completing this. Generally, in codependent relationships there is some pain and emotional abuse. They tend to be rather lopsided, with you doing most if not all of the giving. When you realize this, you may get angry and feel as though others are using you. You may wonder why this is. It is because when they meet you, they sense that you are a caretaker who will want to help them. When you do this, it is because you care about them and believe that you can love and care some of their problems away. Most of the time this cannot be done. Often, by giving to them, you are actually making it easier for them to continue their maladaptive behavior.

If your loved one gets a DWI, you may rush out and hire a good lawyer who may get him or her off. Had this person suffered the consequences of the DWI, he or she might have been ordered to complete substance abuse treatment, which might have ended or at least interfered with the drinking. So if you are in a relationship with a person with an alcohol or drug problem, can you think of a boundary that you could set that would be good for you and, in the long run, him or her? For example, you might tell this person that if he or she has another legal problem related to substances, that you will no longer help. The person will be on his own. Of course, he or she may not like this and try to push your guilt buttons. Remind yourself that you are not only doing what is best for yourself but also for the other person. You might take your boundary a step further and tell the person that effective immediately, you will no longer undo any of the consequences of his or her using. I suggest you only set the boundary when you are ready. The hard part will come when you have to stick to the boundary. You will need some support from a therapist, your sponsor, or a friend to hold to it. Once you maintain a boundary you will find that it is easier to stick to the next one.

What are some other boundaries that you might set? Maybe you have a friend who borrows money from you and has never paid it back. The next time the friend asks to borrow money, you might tell him or her that you are unwilling to loan any more money until the person repays you the funds already owed. Maybe you have someone who always asks you for rides but never offers to pay for your gasoline. You might decide to tell this person that you cannot afford to continue giving him or her rides. Make a list of all the boundaries that you need to set to take care of yourself. While you are identifying them, do not worry about actually setting them. Try to take one step at a time. I know that the thought of setting them is very scary. You may also be scared about what will happen to your friend if you set them. If your friend is dysfunctional, something will happen to this person no matter what you do. Once you get the hang of doing this, you are going to feel an enormous sense of relief. You will realize you are not responsible for everybody, nor do you have to help someone just because that person needs it.

If you are like some people, you may fear that if you stand up for yourself, you will be abandoned by your friend. I believe that if this happens, then that person was not really a friend to begin with. Can you imagine treating someone that you care about like that? I am sure that you cannot. Now you will have more energy to direct toward taking care of yourself. You will no longer feel so angry at others. The next time you feel like a victim, you may need to check and see if you need to set another boundary.

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

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

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

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

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

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

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

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

Breathing Exercise: Just Breathe

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

• To begin, sit in any comfortable position, on the floor or on a chair, with your spine long and straight but not stiff.
• Find a comfortable position for your hands, either folded gently in your lap or resting on your thighs or knees—palms up or down, whichever feels right to you.
• You may close your eyes if that feels comfortable. If not, find a spot on the floor a few feet in front of you and allow your gaze to soften. As you sit, begin to notice the temperature of the air on your skin, notice any sounds you may hear within or outside the room. Begin to notice your body’s weight as it is supported by the chair or the floor. Notice the feel of the floor or the chair under your sitting bones, under your legs. Notice the feel of the floor beneath your feet. Expand your awareness to noticing the sensations of your entire body without feeling the need to change anything, simply notice.
• Now, begin to notice and follow the movement of your breath as it moves in and out of your body, as you inhale and exhale. As you inhale, notice the temperature and the vibration of the air as it flows through your nasal passages, down your throat and trachea, on its way into your lungs. Notice the different sensations of your belly, your ribs, and your chest as they gently expand. As you exhale, notice the temperature of the air, the movement of the tiny hairs of your nose, the feeling of your lungs empty of air as it leaves your body. Simply notice these things and any other sensations that occur as you continue to breathe, easily and naturally, in and out.
• Simply notice your breath as it moves in and out of your body without the need to change anything at all. Just Breathe.

Breathing Exercise: Simple Deep Breathing

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

• Relax your shoulders. Pull them up toward your ears, and then roll them back and down, creating space between your shoulders and your ears. Allow your shoulders to relax.
• Breathe normally in and out for a few breaths. Notice how your belly rises and falls easily as you breathe naturally. Your chest should not expand a great deal as you breathe in and out. If you like, you can place a hand on your abdomen to help notice the movement as you breathe in and out.
• When you are ready, breathe in—and on the next exhalation, breathe out slowly from your nose, counting to five. During this exhalation, tighten your abdominal muscles, and pull your diaphragm inward, toward your spine, squeezing all the excess air out of your body. When all the air is squeezed out, pause for two counts, and inhale slowly again, to the count of five, allowing your belly to expand as you breathe in. A very useful tip in learning to breathe deep into your belly is to imagine you are about to take a deep inhalation of your most favorite smell. When we smell something delicious, we almost always instinctively belly breathe.
• If you are comfortable doing so, close your eyes and continue to repeat this easy deep belly breath for 5 to 10 times.
• If you find that your mind wanders during this exercise, don’t worry. Simply bring your focus back to your breathing and begin your counts to 5 again.
• You may find it helpful to think of a happy color (such as yellow or pink) or a calming color (like blue or green) as you breathe in and a dreary color (like grey or tan) as you breathe out. Or, you might choose to imagine breathing in a calming pleasant emotion such as peace or love as you inhale and breathing out stress or anxiety as you exhale.
• As your awareness of your breath increases, it will become easier to practice your deep breathing without focusing so much of your attention on it.

Breathing Exercise: The Three-Part Breath

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

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

• Again, find your comfortable sitting position, allowing your hands to be relaxed. The three-part breath may also be done lying down. Practicing this breath while lying in bed before sleep is a good choice if you have difficulty clearing your mind and falling to sleep.
• To begin, inhale normally. Then, with your mouth closed, exhale slowly through your nose as you did with the simple deep breathing exercises, using your abdominal muscles to pull your diaphragm inward. Squeeze all the stale, excess air completely out of your lungs.
• As you prepare for your next inhalation, imagine your upper body as a large pitcher. As you inhale, you are filling the pitcher from bottom to top.
• First, fill the diaphragm and lower belly, allowing them to expand and completely fill with air. You can use the “smelling something delicious” tip here as you begin to fill your lower lungs with air, allowing your belly to expand.
• Next, continue to allow your “pitcher” to fill as you notice the lower, and then the upper, parts of the ribcage expanding outward and up.
• Next, fill the upper lungs, noticing the chest expanding, the collar bones and shoulders rising, as your pitcher is filled completely to the top.
• Pause for 2 beats.
• Exhale the opposite way, allowing the “pitcher” to empty from top to bottom.
• Slowly exhale, allowing the shoulders and collar bones to slowly drop, the chest to deflate, the ribs to move inward. Again, pull your diaphragm in, using it to completely empty the air from the bottom of the lungs.
• Repeat the process, refilling the pitcher slowly from bottom to top. Continue with the complete and full exhalations and inhalations, emptying and filling your pitcher.
• The three parts are bottom, middle, top—expanding and contracting as you slowly and completely fill your body with fresh, cell-nourishing, life-giving oxygen and then slowly and completely empty it of carbon dioxide, toxins, and tension held in the body and mind.
• As you increase your practice and the muscle movements become familiar, you may wish to add the counting of your breaths or your color visualizations. Ideally, the exhalations should be about twice as long as the inhalations. Initially, if you count to five as you inhale and exhale, gradually try to make your exhalations to the count of six, then seven, then eight, and so on until you feel more comfortable lengthening your exhalations.

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

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

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

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

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

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