Thursday, January 22, 2009
Many Lessons Still to Learn
Wednesday, January 21, 2009
Grateful
Monday, December 29, 2008
Maman
I wrote of Days of Christmas past in my last post. Christmases were frequently fairly enjoyable and typically only mildly tense. True, we weren't close and merry, and some years we children were somewhat ignored. For some inexplicable reason, there wasn't any huge family drama on Christmases. I'll take it.
This time of year practically begs one to think of family.
Immi over at Migrainechow.com posted of a woman who's abusive mother who had just died. It got me thinking again about my mother. For years I think I flat out hated her. She was a complete monster to me. A wicked witch of the west. There must have been some times, maybe a day or so when I didn't think that. I recall her taking me to a seaside resort town near where we lived to a patisserie for espresso and croissants, and her explaining to me what a demitasse was. I felt grown up...and...treated. Did I hate her that day? Did I love her?
I know I said for years I hated her.
My wife tells me hatred is like swallowing poison to kill your enemy.
I spent a lot of time working with my CBT therapist on finding redeeming qualities of my mother. A LOT. I think the first thing I could think of was she was clean. As in...she bathed. I wouldn't give her ANYTHING. Then, after more prompting and pulling I gave up little things one by one...she wore matching socks. She flushed the toilet after she used it. My poor CBT therapist. Well, she made a bundle listening to that.
Over time I gave her a lot more. And over a lot more time I came to understand her as a person, and came to understand her as a product of her childhood. I came to believe if she had the skills and tools to do better she would have...to think she would not have intentionally wanted to inflict the abuse she did on me, I suppose in DBT terms to think if she were of her "wise mind" and "in the present moment" she would not have done the things she did. I don't think she said to herself every morning, "what's the best way I can hurt and abuse my children to try to make them as tormented and effed up and unable to face life as I can?"
I forgave her. I became much more at peace and much less bitter because of it. Or at least more at peace with her and much less bitter towards her and what she did, to the point I could say it went away. I can't say that forgiving her was a "magic bullet" to the effects of abuse-- looking back at my post on forgiveness, and the "How do I know it's time to embrace forgiveness", section, the signs did not go away. I was (mostly behind closed doors) bitter towards other people, angry, ruminating, depressed and anxious for years after my CBT therapy. I can say I have less of those things, and that the progress I have now has been built upon the seeds sown then. I've been able to have more compassion for others and more compassion for myself.
She has mellowed with age. She also became a lot nicer, especially after a family scare where my father nearly died. It was a bit disingenuous and hard to swallow as she was afraid of having to take care of things by herself. What really changed was when she was diagnosed with an illness that is typically terminal. She became a bit more warm. She still has her moments that test my DBT skills to the fullest, for sure.
I don't know what did it. I changed. She changed. Some combination. After 3 decades and some odd years, I didn't hate, and for some inexplicable reason upon hanging up the phone I told the woman who gave birth to me that I loved her. And after 4 decades of giving birth to me, for some inexplicable reason, this woman told me she loved me back. I'll take it.
Thursday, December 25, 2008
Days of Christmas Past
Wreaths went up on the door and the hearth, and huge poinsettias went up on the porch.
All of the Christmas specials had to be watched..."I'm Hermey, and I want to be a dentist", "I'll have a blue Christmas without you", "I never thought it was such a bad little tree", "I'm Mr. Heat Miser"...
My older sister made about 20-30 different types of cookies, some started in November, as they had to be basted with liquor and aged. Some were so beautiful and elaborate, people wanted them to be made into ornaments instead of made out of dough, "it's a shame to eat them" they'd comment. A few cookies were set aside for Santa, the rests were arranged carefully on plates or in tins for gifts for neighbors and friends.
Christmas eve we would walk and drive around the neighborhood to admire all of the neighbor's lights. Then it was time for a shower, and p.j.'s and cocoa. We opened all the presents from far-away relatives while listening to Barbara Streisand's Christmas album, followed by carols from the radio. We all pulled out our books and read by the fire until the coals glowed orange, then roasted marshmallows before we turned in for bed.
In the morning we had more carols playing on the quadrophonic stereo. My Dad had taped a commercial free radio show years ago, and we listened to the same track year after year. Mom would have awoken hours earlier to roast chestnuts for the stuffing and start the turkey, and the smell of sage would fill the air. The fire would have been started again, and we would open our stockings, and then our presents, carefully documenting who got what from whom, in order to write out our thank you cards the next day.
We'd have fresh homemade scones or Irish Soda bread for breakfast and read the morning paper. I'd usually change into jeans and go outside and help dad split logs for the fire.
We'd all dress for dinner, and as the youngest, I'd set the table, remembering to put the little salad forks on the left outside, then dinner fork, bread plate above the dinner fork, butter knife horizontally on the bread plate...etc., etc. It was a little daunting, as we dragged out the formal dining set and flatware only twice a year.
Dad would haul out the camera, put it on a tripod, fiddle with it, and we'd all stand by the tree in our Christmas finery, dress and hose or suit and tie...eventually Dad would run towards us, stand with us and face the camera and smile, and the the flash would go off. Then Mom would look at him and say, "glasses". He'd frown, walk to the camera, fiddle with it, run towards us, smile and take off his glasses just a second after the flash went off. Repeat this a few times in a few variations until a family portrait was taken for posterity. Most of us would be smiling and my Dad would be captured slightly sweaty, and with a slightly forced smile on. No glasses though, of course.
We'd all sit around and crack open assorted nuts while we waited for the turkey to cook. Some years we had guests, some years we didn't. Around noon, we'd make egg-nog, and Dad would wander around cheerfully asking, "who wants nog? who wants nog?", to ask who wanted a little tipple of bouron or brandy. Mmmm, the eggnog had fresh whipped cream and was dusted with nutmeg.
At 1:00 sharp dinner was served. We'd all pass around the turkey, potatoes, yams, rolls, salad, green peas, brussels sprouts, cranberry sauce, chestnut stuffing, and homemade giblet gravy. Until around 1980 or so, we also had a layered green jello mold with pineapple, nuts and cottage cheese. Dad would pour some local wine and talk about it, why he picked it, and how he thought it would be perfect for turkey. We'd have a prayer thanking God for our family, health and food, and company. We'd raise our glasses. Then we'd eat.
We'd usually talk about some of the things from the paper of the day, and the food. Lots of talk about the food and the garden. No talking of politics or money or of personal lives.
Dessert was homemade pumpking pie and freshly whipped cream, served with rich, dark coffee.
After dinner and clean-up, we'd review our presents, reading manuals about our gifts or put things together. Then we'd sit by the tree and fire. If we had guests there was conversation, if not, we'd read. In the early evening, sherry and brandy would be brought out. As kids we'd get sips of sherry or brandy, in high school we got tiny pours. We'd let the fire die, and each retreat to shower and finish up the day reading in our own rooms until we fell asleep.
Stayed With Me
Tuesday, December 23, 2008
Holiday Distress Tolerance
Repost time!Holidays and family can bring on many negative emotions, anger, fear, guilt, shame. Anxiety can rise.
What can be done?
Try to stay well rested and fed.
Avoid Alcohol or other substances. Being under the influence can cloud your judgement and make you more vulnerable to external influences. It's also easier to say or do something you'll regret and may make you feel badly about yourself later.
Then, try some distress tolerance to pass the time without making things worse. You'll need to tolerate the distress until you can change your situation, or solve the problem.
For those in DBT, it may be helpful to review some distress tolerance, interpersonal effectiveness and emotion regulation pages specific to your particular situation and "favorite" negative emotions. You may want to try to cope in advance and rehearse what you may do and say to triggering comments or questions.
Here are some Distress Tolerance Skills that can be done while away from home.
Start with TIPS (Temperature, Intense Exercise, Progressive Relaxation)!
Temperature: Go outside for a bit if it's cold, splash cold water on your face, run cold water over your hands
Intense Exercise: Take a brisk walk, go to the bathroom and do pushups against the wall or counter or floor, do jumping jacks or if that's too noisy-- rise up and down onto your toes really fast (again, can be done in the bathroom)
Progressive Relaxation: tense a muscle deliberately and then relax it. Start with the front of the body, tensing and relaxing the muscles of the upper face, then moving on to the jaw, neck, chest, front of the arms, abdomen, thighs, lower legs, feet and toes. Then, do the same down the back of the body.
Things you can do at the table:
Breathe: Breathe in and in and in, feel the air in your lungs, exhale and count "1", repeat until 10. Lose your place? Start with 1 again.
Count colors: Count all the red things in the room, then count all the green
Eat Mindfully: Slowly chew and savor what you are eating, take time to notice-- is it salty, sweet, spicy? Is it crunchy? Slippery? Creamy? Hot? Cold?
Half Smile: relax your face and do a half smile
Encourage: Talk to yourself the way you would like others to talk to you, tell yourself you are calm, you are focused, you are o.k.
Touch: Give yourself a slow and soothing hand massage, or just stroke your hand gently and lightly
Radically Accept: Accept what is. Let go of fighting reality. Decide to tolerate the moment.
Act the opposite: Angry? Be gentle. Be calm. Be a bit nice. Afraid? Be confident. Head up. Shoulders back. Project that voice. Sad? Be confident. Head up. Shoulders back. Project that voice. Smile a little. Guilt or Shame? Approach. Don't avoid.
Clickie the link below for...
Border Life's Personal List of 25 Distress Tolerance Skills
Got more tips? Favorite tips? Please share :-)
Wednesday, December 17, 2008
Mindfulness and Preventing Depression Relapse
I recently attended a lecture on mindfulness by a professor from a highly regarded university. He is doing many studies on mindfulness, and during the lecture he mentioned there are many studies showing that mindfulness is looking like a viable treatment for preventing depression relapse. I emphasize relapse here, as he explicitly stated it was not studied as a treatment for someone currently in a depressive episode. He went on further either to say something like...mindfulness did not work for someone currently in an MDE or that the only way out of depression was to "do"... I digress. The point was he didn't want us to expect to get out of an MDE through using mindfulness.
Here's an excerpt of a new study that shows the efficacy of MBCT. Granted large trials by different researchers in different countries are warranted for MBCT to become accepted treatment. It's worth practicing, in my opinion, irrespective of trials and the medication(s) you are or aren't on. There are so many benefits to mindfulness. If preventing a MDE episode is one of them, I'm all for building up my practice. Of course, any decisions I make with respect to medications will be between me and my doctor, as it should be for anyone.
Depression Treatment: Mindfulness-based Cognitive Therapy As Effective As Anti-depressant Medication, Study Suggests [in preventing relapse-BL]
ScienceDaily (Dec. 2, 2008) — Research shows for the first time that a group-based psychological treatment, Mindfulness Based Cognitive Therapy (MBCT), could be a viable alternative to prescription drugs for people suffering from long-term depression.
In a study, published December 1, 2008 in the Journal of Consulting and Clinical Psychology, MBCT proved as effective as maintenance anti-depressants in preventing a relapse [emphasis mine] and more effective in enhancing peoples' quality of life. The study also showed MBCT to be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term.
The randomised control trial involved 123 people from urban and rural locations who had suffered repeat depressions and were referred to the trial by their GPs. The participants were split randomly into two groups. Half continued their on-going anti-depressant drug treatment and the rest participated in an MBCT course and were given the option of coming off anti-depressants.
Over the 15 months after the trial, 47% of the group following the MBCT course experienced a relapse compared with 60% of those continuing their normal treatment, including anti-depressant drugs. In addition, the group on the MBCT programme reported a higher quality of life, in terms of their overall enjoyment of daily living and physical well-being.
The study was led by Professor Willem Kuyken at the Mood Disorders Centre, University of Exeter, in collaboration with colleagues at the Centre for Economics of Mental Health (CEMH) at the Institute of Psychiatry, King's College London, Peninsula Medical School, Devon Primary Care Trust and the Medical Research Council Cognition and Brain Sciences Unit.
Members of the study team from the Institute of Psychiatry, King's College London also compared the cost of providing MBCT programmes with the cost of maintenance anti-depressant treatment. The findings suggest that MBCT provides a cost-effective alternative to anti-depressant drugs. Unlike most other psychological therapies, MBCT can be taught in groups by a single therapist, and patients then continue to practice the skills they have learned at home by themselves. Therefore, MBCT is less costly than individual treatments and is not dependent on having the large number of trained therapists needed for one-to-one psychological treatments so could help the National Health Service shorten its waiting lists for psychological therapies.
During the eight-week trial, groups of between eight and fifteen people met with one therapist. They learned a range of meditation exercises that they could continue to practice on their own once the course ended. Many of the exercises were based on Buddhist meditation techniques and helped the individual take time to focus on the present, rather than dwelling on past events, or planning for future tasks. The exercises worked in a different way for each person, but many reported greater acceptance of, and more control over, negative thoughts and feelings.
Professor Willem Kuyken of the University of Exeter said: "Anti-depressants are widely used by people who suffer from depression and that's because they tend to work. But, while they're very effective in helping reduce the symptoms of depression, when people come off them they are particularly vulnerable to relapse. MBCT takes a different approach – it teaches people skills for life. What we have shown is that when people work at it, these skills for life help keep people well."
Professor Kuyken continues: "Our results suggest MBCT may be a viable alternative for some of the 3.5 million people in the UK known to be suffering from this debilitating condition. People who suffer depression have long asked for psychological approaches to help them recover in the long-term and MBCT is a very promising approach. I think we have the basis for offering patients and GPs an alternative to long-term anti-depressant medication. We are planning to conduct a larger trial to put these results to the test and to examine how MBCT works."
MBCT was developed by a team of psychologists from Toronto (Zindel Segal), Oxford (Mark Williams) and Cambridge (John Teasdale) in 2002 to help people who suffer repeated bouts of depression. It focuses on targeting negative thinking and aims to help people who are very vulnerable to recurring depression stop depressed moods from spiralling out of control into a full episode of depression. MBCT is becoming more widely available as part of psychological treatment services in the NHS.
The study was funded by the Medical Research Council.
Case studies
Case study 1: Di
go to link below for Case study 1
Case study 2: Stephen
Stephen hopes that MBCT will be "the final piece in the jig-saw" in learning to cope with a tendency towards severe depression that he has suffered since his teens. Now 56, he experienced severe episodes between 2000 and 2002, involving hospitalisation. Having already tried a number of alternative therapies, and talking cures, as well as anti-depressant drugs, he finally agreed to try the mood-stabiliser, Lithium.
Soon afterwards, he embarked on a course of cognitive behavioural therapy, and it was via this route that he heard of MBCT. "It was the right thing at the right time", he says. Sufficiently "stabilised" by Lithium, he was able to benefit fully from the techniques taught, which he now practices on a daily basis, some six years later.
The group context of MBCT was important for him. Not only did participants share their individual experiences of depression, and find common ground in symptoms suffered and warning signs to heed, they also helped keep each other "on track" with the practical homework involved. Stephen believes that, in addition to the group's support, self-discipline helped him complete the eight week course and has been essential for him to continue regular practice at home. He says: "Persistence and determination are necessary during the course and become even more vital when you're on your own."
Stephen, who lives in Exeter, is realistic enough to suspect that, without Lithium he could not have reaped the benefits of MBCT. However, he says: "Mindfulness gave me added insight into the way I function and respond to people, and helped me become more accepting. Along the way I have gained an understanding that, much of the time, life may not be as I would like it, but an awareness – particularly a body awareness – of such situations can lead to easier acceptance of them, and sometimes to beneficial change. Maybe, one day, I'll have gained sufficient insight not to need the Lithium any more".
From Science Daily: http://www.sciencedaily.com/releases/2008/11/081130201928.htm
University of Exeter (2008, December
Depression Treatment: Mindfulness-based Cognitive Therapy As Effective As Anti-depressant Medication, Study Suggests. ScienceDaily. Retrieved December 17, 2008, from http://www.sciencedaily.com /releases/2008/11/081130201928.htm
Saturday, December 13, 2008
Defenses
Displacement -- One way to avoid the risk associated with feeling unpleasant emotions is to displace them, or put them somewhere other than where they belong. A common example is being angry at your boss. Displaying that anger could cost you your job. You might be afraid that you can not contain it, but also afraid of what will happen if you express it toward your boss. You might instead express it, but redirect it toward some other, safer source, such as your partner or best friend. You yell at them and pick a fight. They will forgive you or ignore it, and then you are able to express your anger but without risking your job.
Sublimation -
- Related to displacement is sublimation, or the healthy redirection of an emotion. Instead of punching your boss when angry with him, instead of taking out your anger on your friends, you go to the gym and punch a punching bag. Other examples include turning the painful loss of a child into a campaign to increase child safety laws, turning a generally high degree of aggression into professional football, and turning the pain and resentment of a physical injury into a drive to overcome a disability.
Projection -- Projection is something we all do. It is the act of taking something of ourselves and placing it outside of us, onto others; sometimes we project positive and sometimes negative aspects of ourselves. Sometimes we project things we don't want to acknowledge about ourselves, and so we turn it around and put it on others (i.e., "It's not that I made a stupid mistake, it's that you are critical of everything I do!"). Sometimes it is simply our experiences (i.e., "My father was a reasonable man when we disagreed, so if I use reason with my boss we can work out our disagreement").
The problem with projecting negative aspects of ourselves is that we still suffer under them. In the above example, instead of feeling inadequate (our true feeling) we suffer with the feeling that everyone is critical of us. While we escape feelings of inadequacy and vulnerability, we nonetheless still suffer and feel uneasy. The more energy you put into avoiding the realization that you have weaknesses, the more difficult it eventually is to face them. This is the main defense mechanism of paranoid and anti-social personalities.
Rationalization -- Rationalization is often called the "sour grapes defense." This comes from one of Aesop's fables. The fox wanted some grapes, but could not reach them. This caused him to feel pain, as he could not have what he wanted. He rationalized, "They were probably sour anyway" to turn them into something he didn't really want, and thus couldn't really be upset about not getting. It is an intellectual way to diminish pain or guilt. The old "They're 50% less fat so I can eat twice as many" routine is the same. You make up a "logical" argument to avoid guilt.
Fantasy -- Fantasy can be a good or a pathological defense. Fantasizing involves creating an inner world when the real world becomes too painful, difficult, or stressful. Thinking about your upcoming vacation when work gets stressful is a healthy use of fantasy. However, if you don't solve problems, but only daydream about them being solved for you, if you avoid potentially problematic responsibilities and only fantasize about having rewarding challenges and experiences, fantasy becomes too much.
Intellectualization -- Related to rationalization, intellectualization involves removing the emotion from emotional experiences, and discussing painful events in detached, uncaring, sterile ways. Someone who intellectualizes becomes very distant from their feelings, and when asked to describe their feelings may find it difficult. They may understand all the words that describe feelings, but have no idea what they really feel.
Denial -- Denial is the simplest defense to understand. It is simply the refusal to acknowledge what has, is, or will happen. "My partner didn't have an affair, but was simply traveling for work a lot." A related defense is Minimizing. When you minimize you technically accept what happened, but only in a "watered down" form. "Sure, I have been drinking a bit too much lately, but it's only due to stresses at work; I don't really have a drinking problem since this is situational and not an inner weakness or something."
Repression/Suppression -- Repression is often thought of as the parent of all defenses. Repression involves putting painful thoughts and memories out of our minds and forgetting them. All defenses do this to some extent. Traditionally, repression is unconsciously "forgetting," that is, forgetting and not even realizing that you are doing it. You have no conscious memory or knowledge of that which is repressed. Suppression is when you consciously forget something, or make the choice to avoid thinking about it.
The problem with repression is that the memory, feeling, or insight repressed doesn't go away. It continues to effect us because our unconscious gives it a life of its own. It becomes all the more powerful because we repress it, and it can effect our decisions, reactions, etc… in ways that we don't see but others may.
Withdrawal -- Withdrawal is a more severe form of defense. It entails removing yourself from events, stimuli, interactions, etc… that could remind you of painful thoughts and feelings. Withdrawal takes several forms, such as silence, running away, and drinking and drug use. Talking to friends could prompt them to ask about painful events, so you avoid them. Television, books, coworkers, etc… can all remind you of unpleasant feelings, so you avoid them. Paired with fantasy, it can be paralyzing. Withdrawal inevitably leads to strong feelings of loneliness and alienation, however, which generally means you feel more pain.
Reaction-Formation -- This is one of the most difficult defenses for some people to understand. When we have a reaction that is too painful or threatening to feel (such as intense hate for someone with power over us), we turn it into the opposite (intense liking for that person). That way, we aren't threatened by the feeling, or even the awareness of the feeling. Like denial and repression, you can begin to do this automatically and as a result never know what your true feelings are.
Summary -- Defenses are ultimately something we do to protect ourselves from pain. While we all use them when troubled, we generally come to a point when we face our problems and don't have to rely so heavily on our defenses to protect us. Defenses become unhealthy when we refuse to face our true experiences, thoughts, and feelings. Several problems develop.
1) | as noted above, sometimes relying on our defenses for too long gives our problems a life of their own and makes them more powerful than before |
2) | continued use of many of these defenses creates new problems that are as bad, or worse, than the original pain they prevent us from feeling |
3) | if we use some defenses for too long, they start to happen automatically, separating us from our true feelings |
4) | spending all our "psychic energy" on defenses leaves little energy left over for healthy and rewarding pursuits; if getting close to others reminds us of past hurts, we may avoid dating altogether and continually miss out on support, love, and understand which could make us happy and provide relief from our pain |
5) | over time, the more we close off parts of ourselves, stockpile pain and unhappiness, and avoid potentially rewarding life experiences, the more anxious, nervous, and unpredictable we become. Pent up emotions can overwhelm us, and make us feel as though we've been knocked over by a tsunami of pain. Ironically, this often pushes us to continue doing the same things (defending ourselves in unhealthy ways) in order to avoid such an experience in the future. Doing this only guarantees that |
Biographical Sketch Dr. Niolon joined The Chicago School program faculty in 2003 after serving as an adjunct faculty member for three years, twice winning the Adjunct Faculty of the Year award, and became the Clinical Psychology associate department chair in 2007
Friday, December 12, 2008
TMI
Oh, great. I have a cough that sounds like a whooping crane imitating cats mating. I hack up sticky green globs. I honk my nose until thick and bloody secretions come up. I'm sweating rivules down the side of my face and fogging my glasses.
Ya know, I don't feel real well. I dragged my ass into work (which is far away but near therapy) because I had therapy today, and I've been missing or late to therapy, and have had to talk about it ad nauseum. There are other things I'd rather talk about. I don't want to harm my therapeutic relationship and burn our my therapist. And most of all, I think I was avoiding that phone discussion where I call in sick and am told to come in for a half an hour, or am asked if I'm engaging in mood dependent behavior. On the one hand, she's doing her job. On the other, it hits my buttons.
I don't have the best immune system, stress I'm sure. I've been in the hospital before from a "cold" and have had bronchitis so much I've stopped counting. I tend to push myself and not go into the Dr. I had walking pneumonia for a whole winter before, and just got used to the constant coughing. Boy, did I have some GREAT stomach muscles though. Probably not the best way to get some defined ABs. I feared getting sick, everyone around me got sick for a week or two, I would gets sick for no less than 2 months.
I got the Pneumovax 23 vaccine (generally only given to those 65 or older). I don't get sick as often, and definatly do not seem to get bronchitis or penuemonia.
I also decided to rest when I was sick. I come from a family of workaholics. I realized that working was contributing to my illness. While I didn't do too much about the stress, I started going to the doctor, and staying home at the onset of getting sick.
I've been a lot healthier since then, I've even had a cold that was just a cold (3 weeks!).
The last time I called in sick, I was asked in therapy (after the discussion on the phone if I'd been engaging in mood dependent behavior), anyway, I was asked if I had really been sick. A few times. No. I mean. Yes. I mean no. Could I have gone in? Yes. I was again asked if I was engaging in mood dependent behavior. My commitment to my physical health over-rode my therapy. I didn't get sick. I insisted I really was sick. It was hard, because I'm used to...that level of sick being "nothing serious", where I would work through it.
I went to group last night, and sat a lot of the time when folks were standing. I stated I was sick. I really did NOT feel well, and had been sweating all night. As I left, I was told to be in tomorrow and be on time. I just kinda smiled and kinda nodded an agreeable yes.
Why? Damnit. I didn't even want to go to group because I was sick, and dragged my ass in anyway. I dragged my ass into work. I dragged my whooping crane, sweating self into my therapists office. Was it anger at my therapist? Partly. I was angry that I was not believed. Damnit, when I say I'm sick, I mean I'm sick. See? Only ended up hurting myself. Fear of conflict? Lack of skill at saying no over and over. Feeling defeated? Yeah, I did feel pretty defeated. Wanting to stick to my word and commitments (show up for therapy, show up on time)? I did feel pretty unhappy that I wasn't living up to my values of being on time. Was it shame?
And here I am, sicker than I've been in years. My therapist sent me home. She actually thought I should go to the emergency room, and tried to convince me to at least go into urgent care. I just didn't have the energy to wait in a cold waiting room for hours on end. I'll call my GP tomorrow, she'll squeeze me in.
What the hell?
Thursday, December 11, 2008
Wednesday, December 10, 2008
Emotional Intensity in Gifted Children
| Emotional intensity in gifted children | ||||||
| Author(s): | ||||||
| Source: Gifted and Creative Services, Australia 2001 | ||||||
| ||||||
Added 2 to my cocktail
So, my Cymbalta is not enough. Perhaps it's the winter. I also have been exhausted lately. My pdoc was reluctant to prescribe Wellbutrin to help give me more energy, as it can exacerbate anxiety. I've been meaning to take Topamax to help to reduce my anxiety.
With the increase in depression...we went with starting both. And because I start to get withdrawal symptoms from the Cymbalta starting in the evening, and definately feel like crap in the morning, I've switched to taking my first dose of Cymbalta and Wellbutrin upon waking, and a second dose of Cymbalta and Wellbutrin at 2pm. I take the Topamax at night for some reason. I'll probably switch that to the a.m. I can't remember if there is a "best time" to take it. I FINALLY went into the drawing station to get my blood taken. Oh, that's right, my thyroid levels are low, and I've been off my thyroxine. Another contributer to depression and exhaustion. The GP was holding out on my levothyroxine script until my blood levels were checked. Well, getting to the drawing station took a loooong time. Thanks, depression! So I'm now at the point where I'm shedding everywhere and if I touch my head lots of hair falls out. My skin is very very dry. And, I'm depressed and anxious. Hopefully I'll get the thyroid meds soon. And hopefully I'll get my ass into the pharmacy. My current chain drugstore keeps not filling my scripts and shipping them to me, cancelling my online re-orders and making me go in person. I really need to find a reliable mail order pharmacy. And a cheaper one than what I have now. I must get some broad spectrum lightbulbs. Don't you have to stare at the light for a half an hour or something in the morning? I find it hard to think that I would do that, since it's enough to drink coffee, crap, feed the pets, let the dog out, let the dog in, brush my teeth, shower, get dressed, commute, and get in to the office. Maybe I need a little light helmet that lets me walk around and do my morning business while shining light in my face. Sounds like a thinkgeek.com gadget to me.
Oh, and if I did this post right, you can clickie on the pic for a 3D model of Wellbutrin. Why you would want to do that, beats me. The site has other drugs as well. I've not really played with my meds before, food yes, meds, no. I guess here was my chance.
Monday, December 8, 2008
Weekly Target Sheet - Stage 1
This post reproduces, as best I can in plain text, my Weekly target sheet, that appears to be based on stage 1 targets (at the bottom of the post is the list of Stage 1 targets).
I find it very useful in identifying specific behaviors that are not effective and encumber my goal of a life worth living. This is a useful tool for therapy sessions (in addition to your diary card).
Weekly Target Sheet
Name:
Date:
I. Life Threatening Behaviors
A. My highest urges to die this week were:
(low) [ ] 0 [ ]1 [ ]2 [ ]3 [ ]4 [ ]5 (high)
B. My highest urges to self-harm this week were:
(low) [ ] 0 [ ]1 [ ]2 [ ]3 [ ]4 [ ]5 (high)
C. I self-harmed [ ] times this week
For each incident, the severity was:
Incident:
1 [ ]1 no medical attention [ ]2 medical attention needed [ ]3 life at risk
2 [ ]1 no medical attention [ ]2 medical attention needed [ ]3 life at risk
3 [ ]1 no medical attention [ ]2 medical attention needed [ ]3 life at risk
D. My highest urges to harm others were:
(low) [ ] 0 [ ]1 [ ]2 [ ]3 [ ]4 [ ]5 (high)
E. I was harmed [ ] times this week
For each incident, the severity was:
Incident:
1 [ ]1 no medical attention [ ]2 medical attention needed [ ]3 life at risk
2 [ ]1 no medical attention [ ]2 medical attention needed [ ]3 life at risk
3 [ ]1 no medical attention [ ]2 medical attention needed [ ]3 life at risk
II. I had the following treatment interfering behaviors this week:
A. I spent [ ] days in hospital this week
B. I was absent [ ] days from the program this week
C. I missed [ ] groups this week
D. Other treatment-interfering behaviors this week were
[ ] arriving late [ ] forgetting last week's goal
[ ] being hostile to group leader [ ] ignoring others
[ ] being hostile to therapist [ ] leaving group early
[ ] not having diary card [ ] taking too many meds
[ ] dissociating [ ] lying [ ] talking too much/little
III. I had the following quality of life interfering behaviors this week
[ ] money problems [ ] eating disorder behavior [ ] not calling peers
[ ] abused alcohol [ ] hallucinations [ ] obsessions
[ ] abused drugs [ ] homelessness [ ] other kinds of crisis
[ ] in abuse relationships [ ] intense anger [ ] paranoia
[ ] anxiety [ ] intense shame [ ] phobias
[ ] bad home [ ] interpersonal conflicts [ ] physical complaints
[ ] bad job [ ] loneliness [ ] reckless behaviors
[ ] compulsions [ ] medical illness [ ] unemployment
[ ] delusions [ ] flashbacks [ ] unsafe sex
[ ] depression
My vocational status is:
[ ] Unemployed
[ ] Volunteer Job
[ ] Part-time job/school less than 10 hours
[ ] Part-time job/school more than 10 hours
[ ] Full-time job/school
IV. Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with various life problems
What skills are you learning and practicing?
What was/were your treatment goal(s) last week?
What is/are your treatment goal(s) this week?
Please be specific
Goal / Related Target / Skills to Use
A.
B.
C.
D.
E.
++++++++++++++++++++++++++++++++++++++++++++++++++++
Below is a description of stage 1 targets
- Decreasing or eliminating life-threatening behaviors (suicide attempts, suicidal thinking, self-injury, homicidal and aggressive behaviors)
- Decreasing or eliminating therapy-interfering behaviors (missing sessions, not doing homework, behaving in a way that burns others out)
- Reducing or eliminating hospitalization as a way of handling crisis
- Decreasing behaviors that interfere with the quality of life (eating disorders, not going to work or school, addiction, chronic unemployment)
- Increasing behaviors that will enable the person to have a life worth living
- Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with various life problems
4:36 Presence Based Meditation with Tara Brach
Tara Brach leads you in a short effective presence-based meditation. I'm a big fan of guided meditation, and Tara Brach has a lovely, soothing voice.
Paraphrase of the opening and middle: One of the biggest gifts that we can give ourselves in the midst of busy-ness is the take what I call the sacred pause. In Chinese script, the word for busy is the same as the word for heart killing. ...sense a becoming still, sense a deepening attention so that you can feel your body sitting here, you might take a few full breaths, inhahling deeply, and hold for a moment, and slowly exhale, as you exhale, give yourself the gift of letting go...relax with your breath... you might find yourself letting go of tension you hold habitually in your body... feel the hands, let them rest in an easy way and soften...
Tara Brach is the founder and senior teacher of the Insight Meditation Community of Washington, D.C., and a practicing psychologist. She teaches Buddhist meditation retreats at Spirit Rock, Insight Meditation Center, and other meditation centers around the country. For further information visit the Insight Meditation Center on the web.
Sunday, December 7, 2008
Why DBT instead of CBT for BPD
Traditional CBT helped me. I did not beat myself up (as much) and I accepted my mother, I still ruminated over grief at the dissolution of my long term relationship. My last round of CBT was about 7 years with the same therapist, though I'd seen others on and off. I was still fairly lost and reactionary. The last few years in therapy did not help me change. My sessions blended together and it seemed to me I was stuck in a "replay" mode, much like a child who watches her favorite DVD over and over and over again. My therapist had made a comment to my somewhat of an ex-partner at the time that I would need life-long therapy. I didn't know quite know was wrong with me, all I knew that I was spending time and money and not getting better or showing improvement. I was in a holding pattern, and didn't see the need to continue. The sheer inexhaustable misery and inescapable thoughts of wanting to not live persisted.
DBT has been quite different. Often my behaviors were a result of not knowing how to cope, or I didn't have the awareness or skills to regulate my emotions or be interpersonally effective. I learned skills to address these...deficits or my maladaptive behaviors in skills training class, and reinforced these skills, applying them to my life via homework, 1:1 therapy sessions, and phone coaching. While I may not always follow the skills or apply them in situations where it would be effective to apply them, I do use them frequently, and have found to get more of what I want, and to have lessened the high level of anxiety that plagues me. Or at least how to "keep going" and be effective and functional with anxiety, and how to not make things worse when my emotions are high and I can't solve a problem right away.
One major difference is the focus on the skills, not processing on why or how "you got to where you are". While this subject does come up, the therapist is validating and redirects the conversation to the skills, and removing "roadblocks" that you may have to using the skills. Thoughts and emotions are examined in the context of a chain analysis, how did these thoughts and emotions lead to an unwanted behavior, and how could DBT skills be replaced for less effective behaviors.
The therapist starts with any life threatening behaviors and as time and treatment continues, moves to the goal of having a life worth living.
My therapist also participates in the weekly consultation meetings, and has another expert that she consults with, assuring proper treatment protocol and mitigation of therapist burn-out. I find that with education on emotions, distress tolerance, adaptive and maladaptive behaviors, ways to behave interpersonally-- knowing how to refuse a request, knowing how to make a request, my thinking has changed, and the knowledge that I know what to do has relieved much anxiety.
Below is an excerpt from Behavioral Tech, LLC, on some of the difficulties involved in using standard CBT therapies for those with BPD, and how DBT adresses those difficulties.
In the late 1970s, Marsha M. Linehan (1993) attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm, and self-mutilation.
Trained as a behaviorist, she was interested in treating discrete behaviors; however, through consultation with colleagues, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD). In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:
1.Clients receiving CBT found the unrelenting focus on change inherent to CBT invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop out rate. And, obviously, if clients do not attend treatment, they cannot benefit from treatment.
2.Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. In other words, therapists were unwittingly under the control of consequences outside their awareness, just as all humans are. For example, the research team noticed through its review of audio taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, or emotional withdrawal, or shame, or threatened self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they didn’t want to discuss to one they did want to discuss.
3.The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients – suicide attempts, urges to self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, etc, -- AND have session time devoted to helping the client learn and apply more adaptive skills.
Adding Validation and Dialectics to CBT. In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT. They added in new types of strategies and reformulated the structure of the treatment (see below, next section). In the case of new strategies, Acceptance-based interventions, frequently referred to as validation strategies, were added. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way.
Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal”, helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves.
The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: Clients also must change if they want to build a life worth living. Thus, the focus on acceptance did not occur to the exclusion of change based strategies; rather, the two enhanced the use of one another. In the course of weaving in acceptance with change, Linehan noticed that a third set of strategies –Dialectics --came into play. Dialectical strategies gave the therapist a means to balance acceptance and change in each session and served to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD.
Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become mired in arguments, polarizing positions, and extreme positions. Thus, these three sets of strategies and the theories on which they are based from are the three foundations of DBT.
Restructuring the Treatment. As noted above, very significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT. Below we discuss how DBT treatment is organized by Functions and Modes and by Stages and Targets. The treatment we are describing is the treatment that is considered to be Standard and Comprehensive DBT. It is the form of DBT that has been subject to the most rigorous research in terms of randomized controlled trials (RCTs). The variations of DBT that differ from the structure described below is being researched but has not yet been subjected to as rigorous a test as standard DBT. Thus, the reader should keep in mind that this is how comprehensive DBT is defined and that variations from this structure are not considered comprehensive or standard.
Functions and Modes. Briefly, Linehan (1993) hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must: a) enhance and maintain the client’s motivation to change; b) enhance the client’s capabilities; c) ensure that the client’s new capabilities are generalized to all relevant environments; d) enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities; and, e) structure the environment so that treatment can take place.
Due to space considerations, we will not review every possible mode (method) that can meet these functions. Rather, we offer the most common examples of how these functions are met in standard outpatient DBT. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most salient individual for the client. Skills are acquired, strengthened, and generalized through the combination of skills groups, phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
Therapists’ capabilities are enhanced and burnout prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions. (In DBT, a therapist is not considered to be meeting the requirements of the treatment unless he or she meets weekly in a DBT consultation team).
Finally, the environment can be structured in a variety of ways, say by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home. From: Dialectical Behavior at a Glance - Behavioral Tech LLC
For those that do not have DBT in their area, I would recommend using a DBT workbook, even though the research of effectivness of DBT includes being in a skills training group, and having phone coaching and 1:1 therapy, the skills and the material. The skills are quite good. They do take practice, practice, practice and a commitment to keep trying-- something that learning anything new requires with or without help. See: Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance (New Harbinger Self-Help Workbook) (Paperback)
Saturday, December 6, 2008
5 Functions served by DBT
DBT combines basic behavioral procedures of skills training, exposure-based procedures; cognitive modification; contingency management; and problem solving with validation, mindfulness practices, reciprocity, and a focus on the patient-therapist relationship.
As a treatment, it has been noted that DBT serves five functions (Koerner and Linehan, 2000; Lieb, et al., 2004):
- to increase behavioral capabilities by teaching specific skills to regulate emotions, tolerate emotional distress when change is slow or unlikely, be more effective in interpersonal conflicts; and control attention in order to skillfully participate in the moment
- to improve motivation to change by intensive behavioral analyses, application of exposure-based treatment procedures, and management of reinforcement contingencies
- to ensure that new capabilities are useful for day-to-day life by various strategies (e.g., use of the telephone)
- to structure the environment, in particular, the treatment network, to reinforce skillful behaviors
- to enhance the therapist capabilities and motivation with a weekly meeting of therapists for support and consultation
From: http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0388_coveragepositioncriteria_dialectical_behavoir_therapy.pdf
Also, here's a repost of the Targets of DBT treatment from the SF DBT Center:
Targets of DBT treatment:
(in order of priority)- Decreasing high-risk suicidal and self-harming behaviors
- Decreasing therapy interfering behaviors by either therapist or patient
- Decreasing quality of life interfering behaviors
- Learning and mastering behavioral skills for mood-independent life choices
- Decreasing symptoms related post-traumatic stress, other anxiety, and depression
- Enhancing and sustaining self-respect
- Additional goals set by patient to create a life worth living
Stages of DBT treatment:
Stage One- Decreasing or eliminating life-threatening behaviors (suicide attempts, suicidal thinking, self-injury, homicidal and aggressive behaviors)
- Decreasing or eliminating therapy-interfering behaviors (missing sessions, not doing homework, behaving in a way that burns others out)
- Reducing or eliminating hospitalization as a way of handling crisis
- Decreasing behaviors that interfere with the quality of life (eating disorders, not going to work or school, addiction, chronic unemployment)
- Increasing behaviors that will enable the person to have a life worth living
- Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with various life problems
- Continuing and building on Stage One skills
- Targeting and decreasing symptoms of Post Traumatic Stress Disorder (PTSD) and other Anxiety or Depression related symptoms
- Increasing love and respect for self and others
- Affirming individual life goals
- Solving ordinary life problems
- Developing the capacity for freedom and joy
- Creating a life worth living!
Thursday, December 4, 2008
Self-Compassion
Beat myself up. I can be good at it. I had a constant critic in my head, passing judgment and holding myself accountable for nearly everything. If only I hadn't.... If only I had... I endowed myself with all sorts of power to control my environment. Or rather, my parents had. I was blamed, criticized, name-called and punished for anything and everything that was negative, and told what I coulda shoulda done to have prevented negative "consequences". I was also blamed for things for which I never could have prevented, as my mother had paranoid ideas and blamed and punished me for doing things that didn't happen. My mother also had a deep need for social conformity, and deep seated shame for anything that didn't conform or she perceived as not conforming. She used intense shaming and ridicule to try to "improve" me, as well as trying to embarrass me for my bad behaviors or flaws in front of her friends and relatives and my friends. I was subjected to large chaotic verbal and/or physical assaults and subjected to "small" incidents such as being laughing at and criticized because a home-made Valentine's day card's cut-out heart was uneven. This gift from my third grade self was promptly thrown away. It makes sense to me that I did/do the same to myself...I knew/know no differently. I felt hopeless and helpless.
While I still battle guilt and shame, which I work on via DBT and by looking at some of the skills to raise my self esteem I think I would strongly benefit from some self-compassion to quiet my critical voice...
Why do some people roll with life’s punches, facing failures and problems with grace, while others dwell on calamities, criticize themselves and exaggerate problems?
“Life’s tough enough with little things that happen. Self-compassion helps to eliminate a lot of the anger, depression and pain we experience when things go badly for us,” said Mark R. Leary, a professor of psychology and neuroscience at Duke and lead author of the paper, which includes five peer-reviewed studies.
The other authors are Eleanor B. Tate and Ashley Batts Allen of Duke; Jessica Hancock of Wake Forest University; and Claire E. Adams, formerly of Wake Forest University and now of Louisiana State University.
“Rather than focusing on changing people’s self-evaluations, as many cognitive-behavioral approaches do, self-compassion changes people’s relationship to their self-evaluations,” Leary said. “Self-compassion helps people not to add a layer of self-recrimination on top of whatever bad things happen to them. If people learn only to feel better about themselves but continue to beat themselves up when they fail or make mistakes, they will be unable to cope nondefensively with their difficulties.”
Self-compassion involves three components. They are:
- self-kindness being kind and understanding toward oneself rather than self-critical
- common humanity viewing one’s negative experiences as a normal part of the human condition
- mindful acceptance having mindful equanimity rather than over-identifying with painful thoughts and feelings
Self-esteem was measured using Rosenberg’s Self-Esteem Inventory, the most widely used measure of self-esteem.
The researchers conducted five studies to investigate the cognitive and emotional processes by which self-compassionate people deal with unpleasant life events.
The experiments involved measuring participants’ reactions to recalling actual negative experiences, imagining negative scenarios, receiving unflattering feedback from another person, comparing their evaluations of themselves doing a task and someone else doing the same task, and measuring reactions of participants who were prompted to have a self-compassionate attitude.
In three of the experiments, researchers also compared reactions of people with differing levels of self-compassion to people with differing levels of self-esteem. The findings suggest that fostering a sense of self-compassion may have particularly beneficial effects for people with low self-esteem, the researchers said.
The researchers found that:
- People with higher self-compassion had less negative emotional reactions to real, remembered and imagined bad events.
- Self-compassion allowed people to accept responsibility for a negative experience, but to counteract bad feelings about it.
- Self-compassion protects people from negative events differently –- and in some cases better than self-esteem. In addition, the positive feelings that characterize self-compassionate people do not appear to involve the hubris, narcissism or self-enhancing illusions that characterize many people with high self-esteem.
- Being self-compassionate is particularly important for people with low self-esteem. People with low self-esteem who treat themselves kindly in spite of unflattering self-evaluations fare as well as, if not better than, those with high self-esteem.
- For self-compassionate people, their view of themselves depends less on the outcomes of events, presumably because they respond in a kind and accepting manner toward themselves whether things go well or badly.
The study also notes that many of the positive benefits typically attributed to high self-esteem may, in fact, be due to self-compassion.
“As you disentangle them, self-compassion seems to be more important than self-esteem, and is in fact responsible for some of the positive effects of self-esteem,” Leary said.
Researchers noted some questions raised by their research. It is unclear from the studies whether self-compassionate people are simply less likely to examine themselves deeply, or whether they maintain a more positive view of themselves in spite of their shortcomings, the paper said.
It also does not examine whether self-compassion might have drawbacks. Although these studies indicate that people with high self-compassion are willing to take responsibility for their actions, it is possible that self-compassion may make people complacent and discourage them from taking action to prevent future mistakes, researchers said.
In addition, four of the five studies looked at fairly mild negative events in an experimental setting, and future research should examine how self-compassionate people respond to more serious, real-life events, the study said.
“American society has spent a great deal of time and effort trying to promote people’s self-esteem,” Leary said, “when a far more important ingredient of well-being may be self-compassion.”
Source: Duke University
Sources:
http://en.wikipedia.org/wiki/Shame
http://www.physorg.com/news98466411.html
Tuesday, December 2, 2008
1 in 5 young adults has personality disorder
Freshman year I passed 1 class. Yup, 1. I spent many a day sleeping , and also got very ill for about a month. I went out on weekends, and sometimes studied with friends at night. I was severely depressed and very lost. During the latter half of the year, I met a really cool and beautiful girl who became a close companion. She drank. I joined her. We stayed up very late and drank and talked and smoked. I took to keeping bottles of liquor in my dorm room.
Somewhere during the latter half of the year, I was sleeping, as usual. The bright sun blocked by heavy plaid curtains. The room was hot, too hot. I hadn't the energy to get out of bed to turn down the heat. I was sticky with the sweat from being in the hot room, sticky with the dead-weight kind of sleep that only half a bottle of hard alcohol can give, sticky from sleeping far past 8 hours. I heard a knock on the door. A well-scrubbed student was standing in the harsh light when I opened the door, clipboard in hand. She wrinkled her nose. She had a few questions to ask me, she was sent by and employed by the university. I gave a her a seat and opened the curtains and windows. She asked me about why I had only passed a class. I don't know. I'm...tired. Really, really tired I offered. I've been sick. She looked around and seemed to take pause at the dirty glasses, half full vodka bottle and full ashtray. She wrote a note in her clipboard, told me to try to go to class, and left.
The next year, I moved out from the dorms. I mostly went to class, and I mostly passed classes. Those that I didn't I just didn't show up for the final. If I liked the class or the instructor, I did very well. I love to learn.
I went to the office to inquire about how to get a transcript, needed for a job I was applying to. The office worker pulled out my file, and in the middle of browsing, she got a call. I started to look through my file. I saw the evaluation from the well-scrubbed student. Her note, the reason I only passed one class? " Lazy !" She had scrawled and underlined.
No, not lazy, though that word haunted me for years. I have a life-threatening and debilitating illness. I'm not sure what I was being screened for exactly, and how the evaluation was to be used. I didn't kill myself or others on campus resulting in lawsuits and a decline in enrollment. One might imagine it was to help the student to reach the goal of graduation. I suppose her advice to try to go to class was my intervention.
I managed to graduate. I was miserable. I struggled with depression and relationships. For years. I don't know if my life would have been different had I gone into mental health treatment in college. Maybe I wouldn't have struggled for so many years, maybe I would have not stayed in high-conflict relationships. Maybe I wouldn't have been so high-conflict in my relationships. Maybe I'd have had more of a sense of self and some goals. Maybe I would have wanted to live. Maybe I wouldn't have been at the Dr.'s several times a year, year after year, with various illnesses. I'm not saying (yet) that the university was obligated to help me or provide mental health services. I can say that the right drugs and the right therapist and the right therapy have changed my life. As a society, we likely want to treat the mentally ill, even if we don't think that someone will go on a shooting spree.
1 in 5 young adults has personality disorder
CHICAGO – Almost one in five young American adults has a personality disorder that interferes with everyday life, and even more abuse alcohol or drugs, researchers reported Monday in the most extensive study of its kind.
The disorders include problems such as obsessive or compulsive tendencies and anti-social behavior that can sometimes lead to violence. The study also found that fewer than 25 percent of college-aged Americans with mental problems get treatment.
One expert said personality disorders may be overdiagnosed. But others said the results were not surprising since previous, less rigorous evidence has suggested mental problems are common on college campuses and elsewhere.
Experts praised the study's scope — face-to-face interviews about numerous disorders with more than 5,000 young people ages 19 to 25 — and said it spotlights a problem college administrators need to address.
Study co-author Dr. Mark Olfson of Columbia University and New York State Psychiatric Institute called the widespread lack of treatment particularly worrisome. He said it should alert not only "students and parents, but also deans and people who run college mental health services about the need to extend access to treatment."
Counting substance abuse, the study found that nearly half of young people surveyed have some sort of psychiatric condition, including students and non-students.
Personality disorders were the second most common problem behind drug or alcohol abuse as a single category. The disorders include obsessive, anti-social and paranoid behaviors that are not mere quirks but actually interfere with ordinary functioning.
The study authors noted that recent tragedies such as fatal shootings at Northern Illinois University and Virginia Tech have raised awareness about the prevalence of mental illness on college campuses.
They also suggest that this age group might be particularly vulnerable.
"For many, young adulthood is characterized by the pursuit of greater educational opportunities and employment prospects, development of personal relationships, and for some, parenthood," the authors said. These circumstances, they said, can result in stress that triggers the start or recurrence of psychiatric problems.
The study was released Monday in Archives of General Psychiatry. It was based on interviews with 5,092 young adults in 2001 and 2002.
Olfson said it took time to analzye the data, including weighting the results to extrapolate national numbers. But the authors said the results would probably hold true today.
The study was funded with grants from the National Institutes of Health, the American Foundation for Suicide Prevention and the New York Psychiatric Institute.
Dr. Sharon Hirsch, a University of Chicago psychiatrist not involved in the study, praised it for raising awareness about the problem and the high numbers of affected people who don't get help.
Imagine if more than 75 percent of diabetic college students didn't get treatment, Hirsch said. "Just think about what would be happening on our college campuses."
The results highlight the need for mental health services to be housed with other medical services on college campuses, to erase the stigma and make it more likely that people will seek help, she said.
In the study, trained interviewers, but not psychiatrists, questioned participants about symptoms. They used an assessment tool similar to criteria doctors use to diagnose mental illness.
Dr. Jerald Kay, a psychiatry professor at Wright State University and chairman of the American Psychiatric Association's college mental health committee, said the assessment tool is considered valid and more rigorous than self-reports of mental illness. He was not involved in the study.
Personality disorders showed up in similar numbers among both students and non-students, including the most common one, obsessive compulsive personality disorder. About 8 percent of young adults in both groups had this illness, which can include an extreme preoccupation with details, rules, orderliness and perfectionism.
Kay said the prevalence of personality disorders was higher than he would expect and questioned whether the condition might be overdiagnosed.
All good students have a touch of "obsessional" personality that helps them work hard to achieve. But that's different from an obsessional disorder that makes people inflexible and controlling and interferes with their lives, he explained.
Obsessive compulsive personality disorder differs from the better known OCD, or obsessive-compulsive disorder, which features repetitive actions such as hand-washing to avoid germs.
OCD is thought to affect about 2 percent of the general population. The study didn't examine OCD separately but grouped it with all anxiety disorders, seen in about 12 percent of college-aged people in the survey.
The overall rate of other disorders was also pretty similar among college students and non-students.
Substance abuse, including drug addiction, alcoholism and other drinking that interferes with school or work, affected nearly one-third of those in both groups.
Slightly more college students than non-students were problem drinkers — 20 percent versus 17 percent. And slightly more non-students had drug problems — nearly 7 percent versus 5 percent.
In both groups, about 8 percent had phobias and 7 percent had depression.
Bipolar disorder was slightly more common in non-students, affecting almost 5 percent versus about 3 percent of students.
Monday, December 1, 2008
Thanksgiving Report 2 of 2
Ah, back home again. Well, that was a mixed trip. I'm a bit sad and frustrated after the holiday. If I were a very paranoid person, I'd be convinced that my family were "in on" testing out my DBT skills. Nothing like practice, practice, practice.
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