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

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

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

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

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

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

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

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

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

I am getting asked more about cybersex and online pornography addiction from therapists. It seems to be a growing problem in their practices. I thought I would address some of the fundamentals regarding how the addiction is sustained by the addict, or what I call the “start-stop relapse cycle.”

Eric is a 46-year-old computer programmer who described how hard it was for him to go “cold turkey” from cybersex during work. “I always go to the same chat room for cybersex. I feel comfortable there, and I typically find a good partner quickly. I always think about cybersex when I feel stressed from work and overwhelmed on the job. I always promise to only do it for a half an hour or hour, but time just slips by. Besides, my drive is stronger than my wife’s, so it won’t hurt, actually it will help our relationship, so I don’t go looking for someone in real life. Afterwards, I realize that I should not do this to my wife and also to my work. My boss will find out one day if I don’t stop doing this in my office. Each time I log off after cybersex, I promise myself that I will never do it again. I hate myself for all the wasted time I spent online and quickly try to catch up on the lost work. I go a few weeks, then the pressure seems to build up inside. I play mind games with myself, telling myself just a little won’t hurt. No one will know what I am doing. Sometimes I actually believe that I am in control. I wear myself down, and the whole process starts all over again and I feel defeated that I will never get rid of these feelings. The temptation is constantly there and relapse is just a click away.”

Relapse is a common struggle for anyone in recovery, but the problem often seems compounded by the need to use the computer while in recovery from cybersexual addiction. The relapse process is especially difficult for the cybersex addict due to the stop-start relapse cycle. The cycle is an internal dialogue that serves to maintain the compulsive behavior.

•    Rationalization – Users will rationalize that cybersex serves as a “treat” from a long, hard day of work often making self-statements such as, “Just a few minutes won’t hurt,” “I can control my net use,” or “I am right here at the computer, what the heck?” The user will try to justify the need to look at a few pictures or chat for a few minutes, but they soon discover that time slips by and the behavior is not so easily contained.

•    Regret – After the cybersexual experience, the users experience a period of deep regret. Once they climax, the addict feels guilt or shame for the behavior such as, “I feel guilty for how this is hurting my wife” or “I can’t believe I wasted all this time,” or “I am a horrible person for what I just did.”

•    Abstinence – The addict views the behavior as a personal failure of willpower and promises never to do it again, and a short period of abstinence follows. During this time, the addict temporarily engages in healthy patterns of behavior, resumes interests in old hobbies, spends more time with his family, exercises, and gets enough rest.

•    Relapse – The addict in recovery feels tempted to return to the computer during stressful or emotionally charged moments. They begin to crave and miss cybersex. They tell themselves that cybersex is the best way to relax and feel good about themselves. Or they begin not to care about the consequences. They remember how good cybersex felt both sexually and emotionally, and they forget how bad they felt afterwards. The rationalization period starts again and the cycle repeats itself.

How does an addict kick the cybersex habit when he or she needs to be on the computer for work? How can the addict stop abusing when relapse is just a mouse click away? Similar to programs that address overeating and food addiction, the addict will need to learn how to make healthy, positive choices about his or her Internet use because complete abstinence isn’t always possible in today’s technological world. There are two basic principles to follow:

Principle One: Learn to moderate legitimate use of the Internet.
Principle Two: Abstain from all contact with sexual material online.

As in food addiction, certain types of food trigger binge behavior. Let’s say chocolate or potato chips will trigger binge behavior but celery sticks will not, so avoidance of those “trigger” foods is a necessary part of recovery. Recovery from food addiction is about relearning how to eat in order to make more informed and healthier food selections, with success being measured through objective goals such as changes in caloric intake and weight loss.

To address cybersexual abuse and addictive behavior, the same basic steps are applied. First, it is important to determine the Internet activities, situations, and emotions that are most likely to trigger net binges. A particular chat room, a certain time of day, or the mood you are in just before you go online may all serve as “triggers” that will lead to inappropriate conduct and abuse. Recovery means relearning how to use the Internet in order to make better choices about time spent online, with success being measured through objective, measurable time management goals and abstinence requirements that are achieved and maintained. Goals should include a reduction in the number of hours you spend online in total, the ability to maintain abstinence from adult online content, and an increase in other offline activities.

Second, the addict must abstain from sexual material online. In this case, it means removing all the bookmarks and favorites leading to these sites, adding filters that prohibit sexual material from getting through the browser, or possibly changing the entire Internet Service Provider (ISP) system to one that is family friendly. These family friendly ISPs stop sexual content from the server end, so there is less chance of relapse. This has been found to be the most effective way to dealing with the addiction.

Related articles:
Super-sizing Sex
The Double Bind of Sex Addiction
Sex Addiction is a Relational Disorder

Any caregiver is likely to be vulnerable to stress. However, parents who care for a child with a serious mental illness (SMI) are at increased risk for adverse physical symptoms resulting from stress. Those who care for an adult child with SMI are even more likely to experience the negative effects of stress because of the length of time that they have had to cope with the difficult task of caring for a loved one with mental health issues. Although there is a vast amount of evidence showing how caring for a child with SMI can negatively impact a parent’s psychological health, there is scant clinical evidence highlighting the deleterious physiological effects to the caregiver. Erin T. Barker of the Waisman Center at the University of Wisconsin-Madison addressed this specific dynamic in a recent study by examining the cortisol levels in individuals charged with the care of adult children with SMI.

For her study, Barker asked 61 parents of adults with depression, schizophrenia, or bipolar to complete a stress diary and submit daily saliva samples over a period of several days. The cortisol levels of the participants were compared to the levels of 321 parents of adult children who had no mental health concerns. Barker discovered that the cortisol awakening response (CAR) of the parents of adult children with SMI increased less significantly half an hour after they arose in the morning than the control group. This suggests that the caregivers had a higher stress level upon waking than did the control group. Additionally, Barker found that the cortisol levels of the caregivers declined less throughout the day than did the cortisol levels found in the parents of adult children who did not have SMI.

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“The fact that a similar pattern of hypoactivated daily cortisol in response to stress has been found across studies of parents of individuals with different diagnoses (i.e., schizophrenia, autism, developmental disabilities, and in the present analysis, SMI) and that used different measures of stress (i.e., behavioral problems of the adult child with the diagnosis, time spent with the adult child, and in the present analysis, daily stress not necessarily associated with the adult child) provides strong converging evidence for this effect,” Barker said. She added that these findings underscore the importance of addressing the mental health, physiological health, and coping needs of aging parents who care for adult children with serious mental health issues.

Reference:
Barker, E. T., Greenberg, J. S., Seltzer, M. M., Almeida, D. M. Daily Stress and Cortisol Patterns in Parents of Adult Children with a Serious Mental Illness. Health Psychology 31.1 (2012): 130-34. Print.

A death, divorce, illness, sudden unemployment, or any major loss can create chaos in your life. This emotional fracturing, as well as the practical aftershocks of dealing with estates, lawyers, housing, finances, and doctors often yields intense feelings that can be overwhelming.

When you can’t assimilate another thing, it is crucial to just stop. Even if you have never meditated, simply sitting or lying down and paying attention to your breath can calm your nervous system and give you the literal breather you need.

If it is too hard to stay still, take a walk. It is imperative you give yourself a break from the internal chatter and incessant activity that may be consuming every waking moment. When you think you do not have a minute to sit, lie down, or walk, that is when you need the break the most. Take it, and watch the world continue to spin on its axis.

Practice Beginner’s Mind, Witness Consciousness, and Self-Compassion

[fat_widget_grief_right]A big part of healing through grief is connecting with yourself while putting all the parts back together in a new way that makes you feel safe and whole. This process of reconnecting all the emotional, physical, and spiritual dots can be an exhausting and chaotic ride. One minute, there is a sense of control and growing mastery; the next, you are surfing a sea of feelings.

Part of the immediate task is showing up with what yogis call beginner’s mind and witness consciousness. Beginner’s mind refers to an attitude of openness when approaching something new—without preconceived notions—just as a beginner would. This particular grief experience is terra incognita; you haven’t had it before. By abandoning all your ideas about how you “should” feel or behave, you allow yourself to safely feel what is true in the moment. That cosmic permission slip, coupled with open awareness, allows you to fully experience the moment and all it entails emotionally. While you may want to run from it, the only way out is through it. Avoidance may provide short-term relief, but it often brings long-term pain.

Achieving witness consciousness means retraining your mind to detach enough for objectivity. It is practicing watching something with a neutral perspective and not identifying with it. Both of these yogic techniques encourage you to leave your ego outside. You might never succeed in completely detaching from your ego, but these practices can allow you to experience the freedom and joy of not taking everything personally, while enhancing your chances for greater inner peace.

Beginner’s mind, witness consciousness, and self-compassion can be the trifecta for healing from almost anything. They shore you up, increase your perspective, and allow for enough detachment to see things more clearly.

Simple Routines Can Help Ease the Chaos

Just as in yoga, where each visit to the mat reveals something new, the process of unraveling the threads of grief is fresh every minute. Whether it’s a crying spell, a fit of anger, guilt, or deep sadness, recognizing how each one is unique can keep you open to change and transformation.

The chaos of grief is sometimes caused, in part, by the old issues it triggers, such as abandonment and posttraumatic stress. During times of acute emotional turmoil, being gentle with yourself can ease the pain. Recognizing unhelpful thought patterns and challenging them as much as possible may help you to feel better and more in control.

The chaotic emotional fallout of grief can also be assuaged by establishing simple routines, such as:

•  Taking a tea break at the same time every day
• Getting some exercise
• Listening to soothing music
• Meditating
• Talking on the phone with someone supportive
• Eating at regular intervals
• Watching the sky
• Spending time with your pet

Simple and readily available tasks can have a greater chance of providing you with an enjoyable way to calm the chaos.

Related articles:
Learn to Sit with Discomfort in Your Life
Surviving Suffering
How to Be With Someone Who Is Grieving

We all, at one time or another, use food for soothing. Eating is a pleasurable experience. The problem lies in using food for comfort rather than dealing with our emotions because food only provides a temporary escape only to have emotions resurface again and again. For may people, they are taught from a young age that emotions are not meant to be expressed, but just dealt with on their own and to move on with a brave face. This is, in most cases, not done in malice, but for the sheer fact that we are uncomfortable with emotion. We are uncomfortable with our own emotions and certainly more uncomfortable with that of others. This begins a dangerous cycle, especially if you are trying to manage your weight. When we eat to soothe feelings while trying to lose weight, it begins a cycle of shame, guilt and self-loathing that pushes us further into the emotional abyss. So, let’s HALT the BS!

H- Hungry. If you are hungry, by all means eat. Choosing a balanced meal or snack rather than something high in fat or sugar, will be more satisfying.

A- Angry.   Deal with the anger directly, if at all possible. Otherwise resentment will build and become overwhelming. If it isn’t possible to deal with the anger in a direct or healthy way, find a physical outlet like a walk.

L- Lonely.   Engage in social activities. When we are lonely, some people have the tendency to withdraw, which just makes the loneliness worse. Call someone or get out of the house even if you don’t have anyone to go with you.

T- Tired or Thirsty.

• Tired- Get plenty of sleep on a regular basis. If you are tired and aren’t able to nap, get moving. The more physical activity you have, the more energetic you will feel.

• Thirsty. I add another T here because dehydration often masks itself as hunger. Make sure you are getting plenty of water; yes, plain water every day.

B- Bored. If you are bored, try the distraction technique. Find something, anything to occupy you for 15 minutes and get you away from food. The likelihood that you will still want to eat after 15 minutes greatly diminishes. If at that point, you still want to eat, go ahead, but make it a snack, not a treat.

S- Stressed or Sad.

• Stressed- So often, the stress and anxiety that accompany stress are soothed greatly by food. The problem is, when you stop eating, the stress comes back. Find something soothing to cope with stress that does not involve food like reading, a bath, talking to a friend, etc.
• Sad- I add another S here because this is a big one. It is more difficult to cope with sadness than some of the other emotions. Try any of the other coping skills discussed like spending time with others and engaging in self-nurturing activities. In winter months, make sure you get enough sun exposure. Incorporating exercise and laughter can also be helpful. If the sadness continues, seek out a counselor in your area.

While this can seem like an overwhelming pattern to change, take it one step at a time. Even the smallest changes can add up. Just remember that unless you address each of these issues directly, you will continue the same cycle. The more you practice the new skills, the more successful you will be in changing your patterns. It is about progress, not perfection!

Related Articles:
Eating Disorders and the Internet
The Role of Self-Acceptance in Eating Recovery
Vulnerability and Eating Disorders

According to a new study, people who spend more time in natural lighting than in artificial lighting have increased productivity and alertness. Light directly influences the amount of melatonin a person produces, which indirectly affects alertness. “Most people spend their days within buildings under different lighting environments, which range from daylight to artificial light only,” said Mirjam Münch of the Solar Energy and Building Physics Laboratory at the Swiss Federal Institute of Technology in Lausanne, Switzerland. “At most workplaces, there is a mixed situation between the two principal light sources.” Münch added, “For the impact of light perception on nonvisual functions such as alertness, mood, and performance, those lighting conditions are likely to significantly contribute to modulation of alertness and productivity via the retinohypothalamic tract and melanopsin-dependent pathways.” Because few studies have examined the effects of lighting on cognitive performance, Münch and her colleagues conducted a study to determine how natural and artificial light affected cognitive functioning in the evening.

Participants between the ages of 19 and 25 years old were exposed to daylight (DL) or artificial light (AL) for six hours a day for two days. Each evening, after the exposure, the researchers evaluated melatonin and cortisol levels, and rated sleepiness and cognitive functioning and found significant differences in the participants. “Subjects felt significantly more alert at the beginning of the evening after the DL condition, and they became sleepier at the end of the evening after the AL condition,” said Münch. “On their first evening, subjects performed with similar accuracy after both light conditions, but on their second evening, subjects performed significantly more accurately after the DL in both n-back versions and committed fewer false alarms in the 2-back task compared to the AL group.” Münch added, “In summary, even short-term lighting conditions during the afternoon had an impact on cognitive task performance in the evening.” She added, “Such a relationship could be crucial for workers requiring high attention levels and executive functioning, such as bus drivers, industrial workers in sensitive areas, or air-traffic control.”

Reference:
Münch, M., Linhart, F., Borisuit, A., Jaeggi, S. M., & Scartezzini, J.-L. (2011, December 26). Effects of Prior Light Exposure on Early Evening Performance, Subjective Sleepiness, and Hormonal Secretion. Behavioral Neuroscience. Advance online publication. doi: 10.1037/a0026702

Feelings of psychological defeat are common symptoms of many mental health problems. In some research, psychological defeat has been linked to the onset of psychosis and other challenges. “Defeat may also contribute to the development and maintenance of schizophrenia,” said Judith Johnson of the School of Psychology at the University of Birmingham in the UK and lead author of a recent study on defeat and emotion. “Perceptions of defeat have been associated with the onset and exacerbation of a range of psychiatric conditions and disorders, including depression, anxiety, and suicide,” said Johnson. “Thus, the aim of the current research was to investigate the extent to which the emotion regulation strategy of reappraisal moderated the impact of failure on perceived defeat among both a nonclinical sample and individuals diagnosed with a schizophrenia-spectrum disorder, for whom perceived defeat may be particularly important.”

For her study, Johnson focused on the effects of trait reappraisal, the frequency with which people use reappraisal. In the first part of the study, over 100 undergraduate students were evaluated for trait reappraisal as they completed tasks designed to elicit feelings of failure or success. “Specifically it was found that higher frequency of reappraisal was associated with greater increases in sadness and negative affect and greater decreases in calmness after an experience of failure,” said Johnson. In the second part, Johnson examined trait reappraisal in people diagnosed with schizophrenia and found similar results. “Supporting the prediction, it was found that reappraisal amplified the difference in defeat between individuals in the failure and success conditions. Specifically, results suggested that the highest increases in self-reported defeat were among frequent reappraisers who experienced failure,” said Johnson, noting that the findings have significant clinical implications. She added, “Frequent use of reappraisal may confer vulnerability to subjective defeat in response to stressful life events among nonclinical and clinical populations and could be an area for relapse prevention interventions to target.”

Reference:
Johnson, Judith, Patricia A. Gooding, Alex M. Wood, Peter J. Taylor, and Nicholas Tarrier. “Trait Reappraisal Amplifies Subjective Defeat, Sadness, and Negative Affect in Response to Failure versus Success in Nonclinical and Psychosis Populations.”Journal of Abnormal Psychology 120.4 (2011): 922-34. Print.

Many couples I work with come in with a large amount of stress and difficulty. The causes vary, but the behaviors people use to respond to the upset are often predictable. People who start out loving each other sometimes find themselves so burdened by stress and difficulty that they end up feeling frustrated in the relationship.

Research suggests that up to a third of married individuals report low marital satisfaction, and approximately 20% of all married couples experience marital distress at any given time. These numbers reflect what therapists see daily in their practices.

No one starts out being frustrated. Frustration comes after being unhappy, sometimes for a long time. Often, couples with the best intentions end up not being able to explain themselves to each other, or they won’t say what they really want to say, and as a result they feel tense, stressed and oftentimes frustrated.

The most frequent problem reported by unhappy couples is poor communication. Frustration can appear in many ways. It may come out as a curt answer to a question. Maybe it’s a rolling of the eyes, or a “whatever” response to a partner, or no response at all. Frustration can also be felt when one person ignores the other altogether.

Sometimes frustration is a slammed door, or a sigh. It’s a sign of exasperation from the frustrated person to the other telling them something is very wrong. It also broadcasts unhappiness and discontent. And it’s a problem. It keeps the frustrated person trapped in difficulty and leaves the other partner in the dark regarding the source of the problem.

What would be helpful is to discover how to talk about what doesn’t feel good in the relationship. Unfortunately, this is often difficult for couples who have not communicated with each other for a while. Over time, the breakdown in communication evolves into increased arguing, stonewalling, defensiveness, and contempt. Distressed couples tend to engage in these negative patterns of communication often and are unable to successfully repair the relationship after an argument.

If you find yourself answering your mate with frustrated gestures, you might want to think about what is happening to you. I am pretty sure you used to have very soft, loving responses in the early days. Maybe as time passed you found yourself unable to express your thoughts and feelings to your partner without worrying how he or she might react. It’s possible you may even have started keeping your thoughts and feelings to yourself, not wanting to bother your mate. But the more you kept your thoughts and feelings inside without speaking them, the more you might have felt yourself becoming stressed and uncomfortable.

This is the body’s natural response to too much tension. Marital stress can alter endocrine, cardiovascular, and immune function—key pathways from troubled relationships to poor health. This tension is a clear message about what it feels like when you can’t express yourself and you keep your feelings inside. You might have a sensation of all your feelings being trapped inside your own body and you can’t let them out, like you are frozen. You keep yourself suppressed and you suffer. At first you might be able to manage your increased stress. Maybe you exercise more or take up an activity. Maybe you yell at the kids instead or a co-worker. Perhaps you overindulge; too much alcohol, drugs, or food.

The more you figure out how to manage your challenges, the more you might be looking at your partner with disdain. You may start to believe that he or she just doesn’t care about what you think and feel. Individual and couple responses vary greatly; That’s when people start with the one word answers, or the disinterest, or the shaking of the head. These behaviors tell the other person you are not interested in them. These reactions indicate that you are unhappy.

If you are unhappy in your relationship, take stock of how you are feeling right now. Ask yourself, “Am I stressed and unable to talk to my partner about what is bothering me?” If you answer yes, start looking at the ways you do talk to your mate. Are you short and abrasive? Do you dismiss him or her? Do you just not bother because you don’t think anything will change?

If you answered yes to any of these questions, you

So how do you change your situation? You just took the first step; you recognized it. From here you might want to talk to someone: a friend, family member, religious mentor, or counselor. Get your long held feelings from inside yourself outside of your head by communicating them. Try to understand what is preventing you from talking to your mate about these feelings. Learn why you stay silent.

There are effective treatments for marital distress. No one begins as a perfect partner and a successful marriage depends on a number of skills, such as the ability to understand one’s own behavior and motives, to understand one’s partner, to argue and problem-solve productively, and to effectively negotiate differences—all of which can be enhanced by working with a marriage and family therapist.

You will likely feel better even after just a few sessions. You could also learn different ways to communicate your feelings that may give you confidence. When you leave your old behaviors – the eye rolling, sarcastic responses, non answers – and replace them with true expressions of your feelings, a number of things might also happen. Your stress and tension may decrease, and it’s possible you might even begin to experience some happiness, and that might feel pretty great.

When to Seek Professional Help

Over 98 percent of clients of marriage and family therapists report therapy services as good or excellent. After receiving treatment, almost 90% of clients report an improvement in their emotional health, and nearly two-thirds report an improvement in their overall physical health. A majority of clients report an improvement in their functioning at work, and over three-fourths of those receiving marital/couples or family therapy report an improvement in the couple relationship.

If you’re experiencing persistent relationship frustration, consider reaching out to a qualified couples therapist or marriage and family therapist. They can help you and your partner develop better communication skills and work through underlying issues contributing to your frustration.

For immediate support, you can:

Contact the Find a therapist directory

Call the SAMHSA National Helpline: 1-800-662-4357 for mental health resources

Reach out to your healthcare provider for referrals

References:

1. Regan, P., Walsh, S., Horton, R., Rodriguez, G., & Kaufman, L. (2025). Contextualizing marital dissatisfaction: Examining profiles of discordant spouses across life domains. Frontiers in Psychology, Collection date 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11961942/
2. Association for Behavioral and Cognitive Therapies. (2021). Marital distress fact sheet. https://www.abct.org/fact-sheets/marital-distress/
3. American Association for Marriage and Family Therapy. (n.d.). Marital distress. https://www.aamft.org/AAMFT/Consumer_Updates/Marital_Distress.aspx
4. Heim, C., & Heim, C. (2025). How long-term couples cope with chronic stressors and adverse life course events in marriage: A qualitative study. The American Journal of Family Therapy, Published online: 18 Feb 2025. https://www.tandfonline.com/doi/full/10.1080/01926187.2025.2459688
5. Shrout, M. R. (2021). The health consequences of stress in couples: A review and new integrated Dyadic Biobehavioral Stress Model. PMC, PMC8474672. https://pmc.ncbi.nlm.nih.gov/articles/PMC8474672/
6. American Association for Marriage and Family Therapy. (n.d.). About marriage and family therapists. https://www.aamft.org/AAMFT/About_AAMFT/About_Marriage_and_Family_Therapists.aspx

According to Randy P. Auerbach of Harvard Medical School, McLean Hospital, positive feelings and feelings of happiness are the result of intrinsic pursuits. “Intrinsically-motivated goals are thought to be inherently interesting, pleasurable, and/or meaningful,” said Auerbach. “In contrast, extrinsically-motivated goals are typically sought in order to attain a reward (i.e., material goods or money) or to avoid punishment.” Research has shown that pursuing both intrinsic and extrinsic goals can be beneficial, but not when one is at the expense of the other. Auerbach said, “Guided by self-determination theory, the research posits that the neglect of intrinsic goals ultimately thwarts the satisfaction of core, inherent psychological needs for relatedness, competence and autonomy, which in turn contributes to negative psychological outcomes including depressive symptoms.” Additionally, people who value extrinsic goals over intrinsic goals may neglect their interpersonal relationships and exert all of their time and energy in the pursuit of material objects and money. Another concern is that children whose parents value extrinsic goals above intrinsic ones may not foster sufficient interpersonal skills in their children, creating maladaptive relationship models for them as adults.

To test how the prioritization of values affected the psychological well-being of adolescents from various cultures, Auerbach and his colleagues studied over 600 teens from Canada and China. They found that the teens with the highest motivation toward extrinsic goals had elevated levels of interpersonal stress. “Further, consistent with past research examining the relationship between stress generation and prospective depressive symptoms, dependent interpersonal stress predicted higher levels of depressive symptoms over time.” The team added, “In conclusion, the present study highlights the relationship between aspirations, stress, and depressive symptoms in culturally distinct samples of adolescents. Traditional prevention and treatment programs primarily target cognitive and interpersonal vulnerability factors. However, the findings in the present study suggest that clinicians must also understand a patient’s core values as they may play an important role in shaping stress generation and subsequent symptoms.”

Reference:
Auerbach, Randy P., Christian A. Webb, Meghan Schreck, Chad M. McWhinnie, Moon-Ho Ringo Ho, Xiongzhao Zhu, and Shuqiao Yao. “ExaMining the PathWay through Which Intrinsic and Extrinsic Aspirations Generate Stress and Subsequent Depressive SyMptoMs.” Journal of Social and Clinical Psychology 30.8 (2011): 856-86. Print.

“Gay and bisexual men experience numerous negative health conditions, including high rates of mental health problems,” said Beth N. Fischgrund of the Department of Psychiatry & Behavioral Sciences at Northwestern University, and lead author of a new study examining masculinity and mental health in gay and bisexual men. “Empirical studies show that a strong adherence to masculine norms is correlated with poor health outcomes, such as mental health problems and risky sexual behaviors.” National studies have shown that gay men are nearly twice as likely to suffer from depression and anxiety as heterosexual men, and that suicide rates for these men are nearly double those of other men.

The way gay and bisexual men perceive their masculinity has a significant impact on mental health. “Society’s messages about sexuality are not the only cultural attitudes that sexual minority men are confronted with; cultural attitudes also delineate what it means to be a man,” said Fischgrund. She added that some men may exhibit hyper-masculine behaviors when they feel their masculinity is being threatened. “Gay men who endorse hyper-masculine norms might then experience identity incongruence when they are presented with general society’s norms that differ and contradict their own. In these situations, the more integral the hyper-masculine norms are to a man’s identity, the more psychological distress he may experience.”

For her study, Fischgrund recruited 311 gay and bisexual men, nearly a third of which reported an HIV positive status. “Among these gay and bisexual men, those who adhered to norms that incorporate an interpersonal aspect of masculinity (i.e., conceptions of masculinity as social behavior or as sexual  behavior) endorsed higher levels of mental health distress than did men who adhered to norms that focus on the intrapersonal aspects of masculinity (i.e., conceptions of masculinity as physical appearance),” said Fischgrund. “Additionally, men who did not know their HIV status endorsed higher levels of depression.” She emphasized the importance of her findings. “Specifically, designing programs that center on altering the social and sexual masculine norms within the gay male community are needed to decrease the mental health burden of gay and bisexual men, which has been shown to be associated with HIV risky behaviors.”

Reference:
Fischgrund, B. N., Halkitis, P. N., & Carroll, R. A. (2011, October 24). Conceptions of Hypermasculinity and Mental Health States in Gay and Bisexual Men. Psychology of Men & Masculinity. Advance online publication. doi: 10.1037/a0024836

Sometimes co-dependents may be identified by their behavior in the workplace. You may think that is impossible, because co-dependents tend to be good employees. They work harder than anyone else, they anticipate the needs of management and the are very dependable. However, there are two types of behavior that often identify them. The first type of behavior may be identified by management and, in some instances, the referral to the Employee Assistance Program may be on a mandatory basis. The second type of behavior generally comes in as a self referral unless it is extreme.

The first type of behavior involves problems with co-workers. The co-workers may complain that the employee is always angry and very stressed. The employee may be bossy, withdrawn or very short with them.. This comes to the manager’s attention and he or she refers them to the Employee Assistance Program. Why does the co-dependent person behave this way? If you remember the first two articles describing how co-dependents are affected in adulthood, you’ll recall that they feel responsible for everybody and everything. They think that it is their job to make certain that everything gets accomplished even if they are not managers. In order to ensure that everything gets done, they over-function. Of course, they expect everybody else to do the same. When people do not, then the co-dependent becomes very resentful. The co-workers can sense the co-dependent’s annoyance. Sometimes, even though it is not their job, the co-dependent may give other workers suggestions. They may also constantly complain to management, implying that the manager is not doing their job. That may or may not be true, but managers do not want that to be implied, especially by someone who reports to them. Occasionally, with this type of problem, the employee may experience enough anxiety or anger, that they decide to seek help, before they are sent to EAP.

The second type of behavior involves a meltdown. This is when the co-dependent becomes extremely upset at work. They may start crying and not stop. They may get so angry that they shout at other people. It may be a co-worker, or it may even be the boss. The co-dependent may be sent home to recover. Sometimes the manager may say to the employee something like, “If you are having some personal issues, the company provides an Employee Assistance Program to help employees with things like that. Or, if the meltdown is severe enough, the co-dependent may finally realize that they could use a little help.

So, what causes such a meltdown? The answer is similar to the last paragraph. Remember that the co-dependent feels that it is their personal responsibility to ensure that everything gets done. If work is behind, they work faster and faster and try to get the impossible done. They may work through breaks and lunch or dinner and come early and stay late. Of course, they would never ask for help because they do not believe that it is okay to do so. They also constrict their anger, frustration and worry until it is coming out of their ears. Just like a pressure cooker or a volcano, they eventually explode. Out comes all the constricted feelings, and to someone who doesn’t know what is happening, it can look pretty scary. Occasionally, I have had managers bring the employee right to our offices, because they are afraid to send them home.

Generally, when the employee comes to see me, we are quickly able to identify that they comes from a dysfunctional family. We identify how they are affected. and try to work on some of their irrational beliefs. They try to figure out what is and what is not their responsibility. This gives them quite a sense of relief. Then we work on the fact that they are powerless over other people, places, and things. Then, we redirect some of the energy they expend trying futilely to control others into working on taking better care of themselves. In just a short period of time they feel dramatically better.

The next article will begin a workbook on healing the co-dependent within us.

Related Articles:
Part I: How Co-Dependents Come into Therapy
Part II – How Co-Dependents Come to Therapy – Teens