Cognitive Therapy for Children

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For several weeks I’ve been writing about the need for the government’s financial stimulus efforts to be supplemented by efforts to instill some degree of confidence in severely depressed consumers and investors.

I was thinking in terms of President Reagan’s strategy upon inheriting the similar economic collapse of the 1970’s. He provided financial stimulus, including huge increases in defense spending, some of it wasted, such as launching the costly but never completed ‘Star Wars’ anti-missile system, etc., but created jobs. He augmented the spending with upbeat assurances about the greatness of America, and how the country would soon begin to pull out of the seemingly impossible mess. Similarly President Bush provided a large stimulus package after the terrorist attacks in 2001, and supplemented it with confidence-building speeches about how Americans should get out of their terrorist-inspired fear modes and spend, “to show these terrorists who would tear down our economic system that they won’t succeed.” Both times the ‘jaw-boning’ was as important as the financial stimulus in lifting the confidence and determination of consumers and investors.

My columns along those lines resulted in an avalanche of criticism, the mildest of which asked how I could advocate that the government attempt to brainwash the population, should attempt to hide the facts of how serious the situation is. That is not what I said. What I said was that for two years consumers have been fed a steady diet of doom and gloom, are well aware of the seriousness of the situation, and it’s time for the government’s financial stimulus efforts to be supplemented by efforts to instill some degree of confidence in the nation’s future.

If that is brainwashing, then the problems were created in the first place by someone brainwashing people into thinking they could safely buy a house they couldn’t afford because home prices would just keep rising forever.

Meanwhile, I have been saying since the real estate bubble burst and collapsed the economy, that the economy cannot recover until the housing industry recovers.

So I was disappointed that stimulus efforts had to begin with the rescue of banks and the financial system, then moved to bailout efforts for the auto industry.

I was delighted that rescue efforts have finally begun to focus on the housing industry, where home foreclosures are accelerating, sending home prices and buyer confidence even deeper into gloom and doom, and sinking the economy even faster. But I have been surprised that rescuing the housing industry, which mostly affects the folks on Main Street, apparently has even more opposition than bailing out Wall Street and the auto-industry.

Just how unpopular the plan is was revealed by CNBC reporter Rick Santelli on Thursday.

By now most of the country, if not the world, is aware that Santelli, noted for his daily rants from the Chicago Board of Trade about what he believes to be wrong with the country, took aim at the Administration’s housing rescue bill. During his rant he shouted this question to traders on the floor of the CBT, “How many of you want to pay for your neighbor’s mortgage because he can’t pay the bills? Raise your hands!” Amidst yells of agreement from the traders Santelli turned to the camera and shouted “Are you listening, Mr. President?”

A landslide of approving e-mails apparently encouraged Santelli to announce that he would organize a “Chicago Tea Party” demonstration, a revolution he called it.

He surely hit a nerve with his opinion that those who are losing their homes and jobs should not be bailed out by those who are in good shape on their homes, finances, and jobs, with calls of ‘Santelli for Senate’, and ‘Santelli for President’ spreading over the Internet.

It does have its amusing aspects, given that the economic mess was created by the financial industry, in part by its creation of high-risk derivatives, including mortgage-backed securities, and the wild leverage provided to hedge funds. Santelli became a CNBC reporter in June, 1999, almost at the top of the stock market bubble, leaving his position as a vice-president at Sanwa Futures LLC, where he handled institutional trading and hedge fund accounts. Prior to that, he served as managing director of the Derivatives Products Group of Geldermann Inc.

And now he is the hero of those who feel abused by the collapse of the house of cards created by the questionable products and greed of Wall Street firms?

But of more concern to me is the apparent majority opinion that “I don’t care if the value of my home keeps dropping due to foreclosures on my street. I didn’t make any mistakes, and I don’t want my tax money used to bail out those who are in over their heads. I don’t want the banks saved with my tax dollars. Let then go bankrupt. I don’t want the auto-makers bailed out. They deserve to go bankrupt. I don’t care if it causes the whole country to fall into the next Great Depression.”

I suppose the same argument could be made about giving blood, or contributing to food banks, unemployment insurance, cancer research, the Red Cross, education. Hey, I didn’t get sick, I didn’t lose my job. I’ve got my education.

Do they even realize how much worse a depression is than a recession?

The Bush Administration tried to get things turned around by spending a few trillion dollars of taxpayer money, and the new Administration is trying. The results of those efforts won’t be known for awhile. But both administrations ran into a lot of opposition from those who would rather let those with problems (banks, auto-makers and millions of individuals) go bankrupt and see if the system can recover on its own or not. One often repeated additional reason is that it’s unfair to saddle future generations with larger deficits.

If a few years from now the economy has worsened into a decades-long global depression, thanks in part to the unwillingness of even the folks on Main Street to unite in the common goal of trying to rescue the economy, because their money might go to someone less fortunate, who will they look back and blame that on? And how much worse off will their children be than if the national debt is stretched even further now?

In his rant Santelli asked, “Are you listening, Mr. President?”

I ask, “Are you listening America?”

Sy Harding publishes the financial website www.StreetSmartReport.com and a free daily Internet blog at www.SyHardingblog.com. In 1999 he authored Riding the Bear – How To Prosper In the Coming Bear Market. His new book is Beat the Market the Easy Way! – Proven Seasonal Strategies Double Market’s Performance!

Depression is often thought of as a female issue, which derives from the fact that women are twice as likely to experience this condition, but it’s also because women are more likely to seek help. It makes sense in a weird sort of way. I mean, if a guy won’t even ask for directions, how likely is it that he’ll ask for help? That being said, I do believe that, more and more, men are choosing mental health over machismo, a trend that has, no doubt, gained momentum in these times of economic hardship.

I, myself, have struggled with depression for as long as I can remember, going as far back as elementary school. Equal opportunity in nature, this illness can affect anyone, regardless of age, ethnicity or religion; although, it has been said that people with strong religious convictions do fare somewhat better when dealing with the negative thoughts associated with depression. It’s certainly understandable how the fear of going to hell would discourage someone from killing him/herself, but it’s more than that; there’s also the belief that things will work out, that eventually things will get better.

Depression can result from a combination of various contributing factors: genetic, biochemical, environmental and psychosocial.  It manifests differently for different people. A major depressive episode lasts at least two weeks and is characterized by five or more of the following symptoms:

If your or a family member’s depression is accompanied by the following thoughts and/or behaviors, you should contact a health care professional immediately.

Depression affects, not only the person experiencing this debilitating condition, but basically anyone the person comes into contact with. Children, spouses, pets and other family members may be neglected or physically/verbally abused. Coworkers may feel the brunt of a depressed person’s irritability. Mere strangers may become the victim of a depressed person’s aggressive and/or dangerous behavior.

Common methods used to treat depression are prescribed medications, psychotherapy, healthy living and, for severe cases, electroconvulsive (electroshock) therapy. Prescription medications used for this condition fall under the categories of SSRIs (selective Serotonin Reuptake Inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors). Whichever medication is prescribed, it’s important to be aware that therapeutic results can take 6-8 weeks to occur.

The two main types of psychotherapy are CBT (cognitive-behavioral therapy) which reduces depression by challenging negative beliefs and attitudes and IPT (interpersonal therapy) which helps the individual to overcome social deficiencies that may contribute to their depression.

Healthy living in the form of eating right, getting enough sleep, exercising and actively reducing stress, can go a long way in providing relief for some of the symptoms associated with depression. Unfortunately, in some cases, depression will persist despite one’s best effort. This is when one turns to ECT (electroconvulsive therapy).  ECT is a procedure that involves using electric current passed through the brain to cause a brief seizure, thereby altering the brain’s chemistry.

Whichever method you choose, it’s important to have a support system of understanding friends and family. They say it takes a village to raise a child; this, too, can apply to dealing with depression. Remember, being depressed is not a sign of weakness. There is no shame in asking for and receiving help.

Psychopathology

When we use pathology as a concept and apply it to the mind, we are in fact using a metaphor.  Pathology is either the study of the diseases of the body or a description of the whole range of diseases to which the human body is subject. Are we then saying that the mind is invaded by disease in the same way that, say, that the body is invaded by disease? Clearly not, since there are no counterparts to the body’s pathogens such as viruses, bacteria and poisons, which we could combat in order to restore the mind. And a mental disease is not a brain disease.

The mind has a function to direct the life of the individual and when this function breaks down, we are entitled to say that the mind is malfunctioning. If organic disease is ruled out, we may even go so far as to say that the mind is ill. The difference between the illness of the body and that of the mind is that the latter is the work of the mind itself.

Alfred Adler gives us a very clear yardstick by which we can measure how mentally unwell a person is. That yardstick is the sense of the self in connectedness with humanity and is expressed in the degree of courage or commitment to socially significant contributions to life. This is made visible in the actions of the individual and in the extent to which he tackles the problems of life to the mutual benefit of himself and his fellow men sub specie aeternitatis. Thus it is not in reference to what mankind may normally do but in a sense to what mankind would do if the sense of self were not held back by ego-centeredness and anxiety for its own protection and advancement at the expense of others. Fritz Künkel, writing in the ’20s and ‘30s called this the We.

Our history and our daily life deliver damning evidence of how far humanity is from this level of mental health or optimal functioning. We are all, it seems, flawed. But some are more flawed than others. We range on a continuum from what we may call normal, through neurotic, to psychotic. The differences can be both quantitative and qualitative. The kinds of mental malfunction can be different but also the degree to which a particular difficulty operates within us. The neurotic, though discouraged, is still operating in the world, having to admit his obligation to social interest. His approach is affirmative but with reservations. A case of Yes, but. Likewise his private logic has to be denied in the face of common sense. The psychotic has given up on operating in the real world and is content to live in his own fantasy, where he attempts to cut himself off from common sense entirely.

Our difficulties lie in our lifestyles, which could be expressed as self-imposed limitations that we have created to deal with our early discouragements. Feeling less than equal to the challenge of our environment we have learned in various ways to hold ourselves back from full participation in life. This feeling less than equal is the sense of inferiority or a sense of discouragement. The Adlerian, Erwin Wexberg, the first systematizer of Individual psychology, pointed out that every inferiority feeling is an anxiety. And just as Adlerians have produced schemes of typical inferiority feelings and the compensatory strivings of the individual trying to master them, so it must be also possible to produce a typology of the basic anxieties.

Fritz Riemann did exactly that in his book Grundformen der Angst. He saw that there were four fundamental anxieties:

It can be seen that the first two anxieties form a pair of opposites along the axis of distance-attachment. The  remaining two anxieties form a pair of opposites along the axis of stasis-change. In and of themselves they are none of them pathological and are shared by people we would consider to be functioning well. The problem of distance versus attachment is common to us all, since life requires that we assert our own separate existence as well as attach in mutuality to others. The problem of change versus stasis is also common to us all, since life is based on the conservation or maintenance of our selves as well as the change and development of our selves. The healthy individual works to combine the seeming opposites in a creative way.  When we feel unequal to the tasks of life, we cling grimly to one pole as our salvation and see the other as our downfall.

Thus I share both the general position of depth psychology and in particular the psychogenetic assumptions of Alfred Adler, in which, however, acknowledgment is made that organic influences may also play a part. Ailments of the body affect the mind and sometimes a physical cure alone can restore the mind to normal functioning.

However, I am suspicious of the readiness of many to find or assume physical causes. It is very easy to say that such and such is genetic. We often hear this without the slightest shred of evidence. But we must be prepared to accept such causes when they are proven or seem likely. I have myself witnessed how a doctor was able to see that a client’s problem was not a mind problem at all but physically mediated. The client exhibited strange, convulsive movements, which appeared mad to non medics. The doctor surmised that these were caused by the client’s nervous habit of over-breathing when stressed. When the client learned this he was able to relax and break the habit and rapidly those strange symptoms disappeared. Given that humanity is a mind-body unity, full or partial physical determination can never be ruled out.

But even in the cases of physical malfunction impacting on mental function, psychotherapy has often been able to help the individual to overcome or manage his difficulties.

Taxonomies of psychopathology such as DSM-IV differ greatly from Adlerian diagnoses in which an attempt is made to ascertain the psychic movement towards personal goals and away from personal felt minuses. Instead of Adler’s dynamic approach, which incorporates the development and destined crises of the lifestyle, DSM-IV is like a sorting box with subdivisions for isolated types. Like every classification system built that way it poses difficulties at the borders of the subdivisions, separates lifestyles that may have much in common, and treats these as static.  We have not really understood a person or her difficulties if all we have done is to find a general category in which they can be fit. She shares  that category with millions if not billions of others. This applies to both the DSM-IV approach and also to our own Adlerian approach if we merely assign a priority such as pleasing or controlling to her.

An approach such as DSM-IV offers a check list of symptoms for the determination of drug and medical treatment regimes. From our point of view the symptoms are not the problem. A person has selected her symptoms for her own mostly unconscious purposes. However it is useful for psychotherapists in helping to determine the degree of severity.

The psychotherapist and counsellor are dealing with only one side of the mind-body unity and the DSM-IV represents the medico-psychiatric field with which we need to cooperate in order to serve our clients well. We need access to the medical knowledge of our colleagues in the other field to guide us, especially in working with personality disorder, psychosis and clients subject to suicidal ideation. We have to be prepared to acknowledge our limits and pass on the severe and dangerous cases where institutional support and cooperation are required. Even in simpler cases we should be working with GPs so that organic aspects of the clients’ problems are not missed or misinterpreted.

Adlerians and other depth psychologists need to be able to communicate with professionals and clinicians in other disciplines. The DSM-IV categories  enable us all to use a common language and they do after all incorporate the traditional idea of a continuum from neurotic to psychotic. Furthermore the categories do remind us that psychotics such as schizophrenics, being at the the more severe end of the spectrum are likely to be more difficult to treat than the mildly schizoid neurotics.

In my experience so far it has been helpful to know that a client has been diagnosed by a psychiatrist or by his CMHT. But it should not become a distraction. We need to be able to put the diagnosis to one side while we make our own assessment, based on our own approach.

As a psychotherapist sometimes the people I see come with definite diagnoses and sometimes with rather vague ones. It has always proved better for me to put to one side the diagnosis and just first listen. The stories that I hear also remind me that a condition like personality disorder is not a box but a stage in a personal history. And the story gives us clues as to how that history could be rewritten.

Cases

Adrian is almost 40. he is a client of an alcohol service and also a patient of a CMHT. He is a problem to both. He seems to make no progress with his evident but not fully diagnosed personality disorder. And his impulsive drinking has never been brought under control. The CMHT is frustrated by his drinking and the alcohol service can never get him to commit successfully to controlled drinking or abstinence, despite his expressed willingness to be a good boy. CBT sessions fail to make an impact on his behaviour and periods of apparent stability are violently interrupted by impulsive drinking sessions with public order offences on the streets. When he is in subdued mood he is able to acknowledge that drink gives him courage. he is also able to sustain apparently stable and quiet periods, complying with both clinical services but they never last. How did he come to be like this? The files are incomplete but the scraps of evidence point to a birth family of considerable instability, neglect and violence. As a baby he suffered broken ribs, was separated from his mother, herself with severe mental problems and adopted. He was adopted by a couple who had been unsuccessful in producing children but who had a child of their own immediately after. Adrian has a growing conviction that he is not wanted and becomes the naughty child and a foreign body in the family.  The father of the family inflicts physical and humiliating punishments frequently, reserved for him alone. “My life was hell; it still is.” Adrian now has frequent nightmares of death, humiliation, blood and violence. He frequently cuts himself and at least once this has brought him close to accidental suicide. He is impulsive and acts without continuity, easily led by others and by his own moods. Before this phase of personality disorder appeared he had made a brave effort to to be normal and successful. This collapsed shortly after his wedding about 10 years ago when he fled from the strain of his new obligations.

Bob is a drinker with a drug problem. For the past three years he ha s suffered from agoraphobia. He has a jovial, matey approach to people and before the descent into problem drug and alcohol use worked as a care-worker in an old people’s home. He looks back fondly on that time, having felt useful and having enjoyed the company of those he looked after. He traces his collapse to loss of his job and the breakdown of a relationship with a woman, leading him into a short career of drifting, drug use and drinking. He feels that the early loss of his father undermined his confidence at school and made him feel inferior to others. Recently he has worked out some of the lifestyle aspects which have shaped his life and has taken the first steps to overcoming his agoraphobia. At the same time he has reduced his drug and alcohol use.

Inge is an Austrian woman living in the UK. She traces her lack of confidence to her mother’s tendency always to find fault. She was never good enough, it seems, and anything she did would be criticized. Habitually and pointedly her mother would praise the daughters of other families in her presence. Feeling where here lack of confidence originated has helped to lead her to a more positive orientation.

Adler, Alfred Der Sinn des Lebens Frankfurt am Main, Fischer: 1973

Antoch, Robert F Beziehung und seelische Gesundheit Frankfurt am Main, Fischer: 1994

Künkel, Fritz Einführung in die Charakterkunde 12e Stuttgart, Hirzel: 1959

Riemann, Fritz Grundformen der Angst Münich, Reinhardt: 1990

Sperry & Carlson (ed) Psychopathology & psychotherapy 2e Philadelphia, Accelerated Development, 1996

Eating Disorders are one of the major health issues facing the world today. Millions of people around the world are suffering from these disorders and statistics show that whilst a large percentage (86%) are aged 20 years and above, 10% of reported cases are in children 10 years and younger in age. Recent studies have indicated that the number of individuals suffering with an eating disorder may be as many as 3 times greater than the number suffering from AIDS. Many experts also believe that even these figures may not show the full extent of the problem as many men are not accurately diagnosed or not in fact diagnosed at all.

The 3 most common Eating Disorders are, Anorexia Nervosa, Bulimia nervosa and Binge Eating disorders.

Anorexia Nervosa.

Common symptoms include exhibiting irritation and becoming easily depressed. In addition to this, withdrawal from social situations and connections and the compulsive carrying out of rituals is common along with unusual eating habits. In physically mature women the menstrual cycle may become erratic or cease and in pre-pubescent females the menstrual cycle can be delayed or fail to commence. In males, the production of testosterone falls in level. Anorexia Nervosa is often a “control” issue. It is not about the food itself but by controlling the amount and type of food being ingested, the individual feels in control of their lives, this, possibly being the only way they have found to create that sense of control. Sufferers will exhibit marked weight loss which is self induced and a refusal to maintain a healthy weight and an attitude toward food and weight that is distorted and can show an intensive fear of gaining weight and becoming overweight.

Bulimia Nervosa.

Is a disorder that is characterized by excessive preoccupation with the body and worrying about weight. It can in some cases follow on from Anorexia nervosa. Sufferers may binge eat and then tries purge the food through dangerous behaviours such as vomiting, excessive exercising, laxatives, diuretics and other medications. In many cases, the individual will maintain a body weight within the normal range for their age, sex and height. Less obvious than anorexia and therefore may go unnoticed for longer. Again, In most cases of Bulimia Nervosa the issues are again not really about food but relate to other areas of the sufferers life. In many cases they suffer from low self esteem and often feel angry with themselves and the world around them. In addition to this, self destructive or potentially risky behaviour is often exhibited by bulimics and both “person” and substance addictions are common.

Binge Eating Disorders.

Whilst the binging part of Bulimia Nervosa appears the same as the Binge Eating Disorders, the major difference is that in the case of the Binge Eating Disorders, the purging does not take place and there is a marked increase in the weight of the individual leading to obesity. Individuals may become depressed about their behaviours, weight and appearance and “comfort” eat, so exacerbate the cycle of overeating and depression.

Eating Disorder Treatment

Unfortunately, there is much misleading information about Anorexia, Bulimia and other eating disorders and do not fully understand the dangers of the disorders on one hand or the fact that they can be successfully treated by skilled professionals. In addition to this, as many people who have eating disorders feel ashamed of themselves they are reluctant to engage with the services that are available to help them.

There are a variety of interventions and therapies that can be employed in the treatment of eating disorders, from brief interventions through to longer term psychotherapy, individual and group therapies and medical interventions where appropriate.

There have been many advances in all fields of therapy and treatment in recent years, one example being the controlled use of Selective Serotonin Reuptake Inhibitors (SSRI’s), which has shown positive results in the area of weight maintenance. Cognitive Behavioural Therapy (CBT) has provided successful outcomes and in some cases Psychotherapy is the appropriate course of action.

It cannot be denied that Eating Disorders are serious and in some cases life threatening but it must be remembered that as with all disorders, conditions and illnesses, the sooner they are diagnosed and professionally treated, the better the expected outcome for the sufferer.

Panic attacks and anxiety disorders are actually among a host of diseases having similar symptoms and tendencies, though to the expert they do differ widely. The ailments commonly covered under anxiety disorders are:
1. Generalized anxiety Disorder (GAD) – the commonest form, something that most people indirectly refer to as anxiety attack
2. Panic attack – the severest form, characterized by almost heart-attack like symptoms
3. Phobias – result of unknown influences, but results in insane fear of some agent
4. Post-traumatic Stress Disorder (PTSD) – result of past trauma and results in terror of the agent that resulted in the previous trauma
5. Separation Disorder – occurs usually in children as they are sent to schools or hostels
6. Obsessive and Compulsive Disorder (OCD) – has a strong genetic component and is characterized by the repetition of a certain common act an abnormal number of times within a fixed period
One can summarise commonest anxiety disorder symptoms like palpitations, sweating, nausea, giddiness, trembling limbs, feeling disassociation from surroundings and uneasiness in stomach etc. People suffering from GAD and panic attack showcase mild symptoms. In many cases they also exaggerate. These symptoms are also seen in patients suffering from PTSD and Phobia. Such aspects depend upon intensity and level of disorder besides fear. Likewise in separation disorder sufferers show same symptoms. Often degree of symptoms varies in such cases and they depend upon a situation when sufferers undergo and resultant impact of their surrounding. In OCD sufferers express symptoms with behavioural changes controlled to particular extent.
The criteria formulated by the American Psychiatric Association (APA) is a basis of anxiety disorder diagnosis. Likewise Diagnostic and Statistical Manual IV (DSM-IV) is also a type of classification which define categories of above mentioned anxiety disorder.
In fact panic attack cures are completely possible today. They are applied with utmost care and some such treatments are as follows:
1. Talking sessions with the psychotherapist – such professionals are good listeners who convince patient by portraying best sympathies through good understanding and finding out means to make a person feel comfortable. This category of Cognitive Behavioural Therapy (CBT) is supportive to develop optimism and positive strength in patients who are encouraged to cope up with their symptoms. Some more therapies of this category are:
o Exposure therapy – meant for the sufferers of post-traumatic stress disorder and phobia
o Exposure and Response Prevention Therapy – used to control patients of obsessive and compulsive disorder
2. Hypnosis – although a bit controversial but this therapy is another powerful mechanism which gets applied on particular subjects only. It should be applied by trained professionals. Use of this method helps the suffers have sound sleep once hypnotist makes it possible to control mind for investigating possible reasons of anxiety disorder
3. Warm or hot water ablutions in various forms – a seething long hot baths, spa treatments and sauna or steam baths work effectively by developing a position in which good amount of sweating, easing tensions and toxins are done through relaxant methods. Sleep is a part of these procedure in which panic attack cure is made easy.
4. Massages – when muscles are kneaded properly by trained masseuses it helps in removing toxic lactic acid out of the body. Massages from ayurvedic and aromatic oils are of best use in easing such sufferers. Several specialized techniques such as acupressure and acupuncture are used in this regard for making bodies powerful.
5. Exercises – Yoga and Thai-Chi are best exercises which release negative energy out of the body by helping it achieve better reposing of power.
6. Laughter Therapy – this therapy provides opportunity to take respite from daily life activities and get chance to control unnecessary mental burden. World Laughter Day is celebrated around the world on 3rd May. In fact laughter is good means to develop happiest atmosphere. It is best panic attack cure without incurring any expenditure.
Sometimes, however, these cures are not enough by themselves. They have to be supplemented with medicines for panic disorder, which are available at the chemist’s if prescribed by the clinician. The major groups of medicines include:
•Benzodiazepines – Alprazolam, Clonzepam, Diazepam
•Buspirone
•Selective Serotonin Reuptake Inhibitors (SSRIs) – Paroxetine, Sertraline, Fluvoxamine
•Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) – Venlafaxine, Tramadol
•Tricyclic Antidepressants – Amitriptyline, Trimipramine

Shyness and social anxiety can develop even from infancy. Everyone can remember a time when they felt shy or embarrassed at school. Perhaps you have a bad memory of being told off in front of the class? Or perhaps a time when you had to perform on stage with your parents watching you?Even babies can feel shy and embarrassed. Often babies are much more reserved around people they are not familiar with. As children grow up, they frequently face criticism and new experiences that can be daunting. Going through puberty can be a difficult period and can greatly change the behavior as well as the physiology of a child.Teenagers start feeling things physically and mentally, that are new to them. They become self-conscious around their peers and more attention to their appearance. Everyone knows what it feels like to be shy. Situations such as talking to someone important, going on a date and attending a social event can make a person feel nervous and shy.When a person has constant anticipation of doing something embarrassing in front of others they might have social anxiety disorder. Sufferers fear social situations because of possible humiliation and embarrassment, which makes everyday life hard to cope with. They may even feel anxious walking down a street.Physical symptoms include blushing, profuse sweating, shaky voice, shaking and dizziness. Symptoms of social anxiety can worsen if the sufferer is in an emotional state or in poor health. Fatigue, worry and stress can exacerbate their condition. Each social experience might also produce different levels of anxiety. For instance, visiting a family member would not create feelings of anxiety compared to going on a first date.Social phobia can often be seen as shyness but they are not the same. Sufferers of social phobia will do anything to try and avoid being in the spotlight of others. When a person experiences negative social situations frequently, shyness can become a learned response that can further develop into social anxiety disorder.Fears and anxiety only intensify when similar bad experiences arise and only reinforce a mental association. Most sufferers develop fears from one bad experience that is followed by others. Now when a similar situation arises they immediately link it to their past bad experiences and that’s when they start to panic.Facing your fears can sometimes work in overcoming certain fears but when it comes to social phobia it needs to be gradual process. In addition deep subconscious changes to a person’s behavior are needed. Therapies such as hypnosis and CBT deal with the aspect of adjusting thought patterns and behavior.One overlooked aspect of reducing social anxiety includes improving physical health. Taking care of your body through exercise and eating well can help reduce stress and anxiety. More energy and better health will only help boost self-confidence and positvity.

Studies show that 97% of rape survivors will experience PTSD. Almost 50% of survivors still meet the criteria for PTSD even three months after the rape. Nearly 1/3 of people with addictions have been raped. For many people, alcohol and drugs helps them sleep and numb the memories of the rape. So while many people can heal and move forward, a large percentage of survivors simply cannot. We all know that rape is not about sex. It is about power, control, and intimidation. Rape is a violent crime which produces painful psycho- and physio-logical reprecussions. Every person that is raped expresses fear for his or her life whether or not a weapon is used. Rape trauma syndrome usually goes through three relatively predicatable phases. The first phase “impact and disorganization” involves a great deal of chaos in the victim’s life as a result of the rape. Victims often cannot concentrate, make decisions and their short term memory is usually poor. Going to the grocery store or other mundane activities are very difficult. Fear, anxiety, guilt and anger may be prominent. During the second phase, reorganization, the victim begins to organize his or her lifestyle. A change in activities including changing residences, hobbies and beginning to have nightmares, and phobias are likely during this period. The third phase, “resolution and integration” involves the victim begining to re-establish her emotional equilibrium and regains her adapted lifestyle.
One of the immediate problems that a victim may experience is the difficulty sleeping. This problem may be heightened if the person was home asleep when he or she was attacked or if the rape took place within the home. A large number of the victims will move after they have been raped, as the fear that the man knows who they are and may return: some will resort to moving out of town or out of the state and not just across town. Another commong post-rape emotion that people experience is fear. There may be a general fear of people or of men as the person struggles with learning to trust people again. A victim may also experience a period of time immediately after the rape when he or she unwilling to come into contact with anyone,even family and loved ones. A mother may notice a sudden change in her behavior and reactions with her children. Many parents suddenly become over-protective of their children. They may also have difficulty with irritability and exaggerated anger responses to situations in which they perceives a threat to their child(ren).
Victims will often try to justify to themselves that everything is alright. By doing this they often suppresses their feelings. One way of relieving these suppressed feelings is by daydreaming or adopting a dangerous lifestyle doing things that they would not ordinarily do, just to prove to themselves that they are not afraid and can still do whatever they want. Eventually, survivors realize that they cannot go on without facing these feelings and dealing with the reality of the situation. They may drastically change their lifestyle at this point by moving, getting a dog, acquiring a roommate or lover, or by limiting or increasing physical activity.
Most rape victims experience strong feelings of guilt. This is often one of the most difficult parts of the rape to deal with. Victims of aquaintance rape or “date rape” can be even more traumatized than with other types of sexual assault because feelings or shame, guilt, fear, disbelief, and lowered self esteem are often very strong. It becomes hard for the person to know who he or she can trust. Because the perpetrator was a trusted person may cause the victim may initially deny the experience as if nothing happened. Whatever the victim’s feelings are after the assault, it is important that he or she be able to talk about them to someone who is willing to let her express his or her feelings and who will not make personal judgements or decisions about how he or she is reacting or how he or she should have handled the situation. The amount of support and understanding that a survivors receive from their family and friends is of critical importance in their recovery and restoration to their prior level of functioning.Treatment of PTSD
It is important for all counselors and addictions professionals to be aware of how rape affects people and the treatments available. Once a patient has confided in you, he or she may not want to switch to a victim advocate or other therapist to treat the PTSD. Today, there are good treatments available. Patients who have PTSD can (and usually will) find dealing with the past can be hard. Instead of telling others how they feel, they may keep their feelings bottled up. But talking with a counselor can help. Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications such as antidepressants have also been shown to be effective. Additionally, telemental health has also been shown to be helpful for some patients who would not ordinarily be willing or able to seek services.What is telemental health?
Telemedicine, also known as telehealth, uses electronic communications to provide and support healthcare when distance separates the participants (Field, 1996). Telemedicine uses various communication methods to connect clinicians and patients – in lieu of them meeting in person. The term telemental health services typically refers to behavioral health services that are provided using communication technology. These services include clinical assessment, individual and group psychotherapy, psycho-educational interventions, cognitive testing, and general psychiatry. The term telemental health describes the overall situation in which a clinician uses various technologies to deliver mental health care to a patient who is miles away. The major benefit of telemental health is that it eliminates travel that may be disruptive or costly. In addition, telemental health is a useful tool in situations, where the patient cannot get to the clinician. Telemental health also allows mental health providers toconsult with or provide supervision to one another. Telemental health may utilize a variety of technologies, and is still considered an untapped opportunity for many psychologists, social workers, and counselors (Maheu, Whitten, & Allen 2001). Telemental health can make use of electronic mail (e-mail), electronic administration of psychological tests, online self-help groups, chat rooms, blogs, and websites.Telemental Health and PTSD
While preliminary research has shown that a variety of telemental health modalities are feasible, reliable, and satisfactory for general clinical assessments and care (Frueh et al., 2000; Hilty, Marks, Urness, Yellowlees, & Nesbitt, 2004), much less is known about the clinical application and general effectiveness of telemental health for the assessment or treatment of PTSD. For individuals with a history of trauma exposure, the first step in getting the necessary treatment is to have an accurate assessment of psychiatric or psychological symptoms, related problems, and factors influencing functioning. The accuracy of a PTSD diagnosis is important for both treatment implications and benefit claims. If possible, the initial assessment should be done face-to-face or at least via video conferencing. After that, treatment may occur via telemental health. Based on early pilot studies, telemental health appears to be a promising way to offer skills-training and assessment from a distance to individuals with PTSD.Clinical considerations
Using telemental health for clinical work requires planning and preparation. It is important to consider logistics, such as preparation of the room and equipment, and to be sure there is technological and clinical backup support. It is also important to consider the patient’s convenience, privacy and access to emergency services. It is recommended that trauma-focused interventions, such as exposure therapy, not be provided using a telemental health technology. There is a great possibility that the client will experience intense emotional distress with this type of treatment, and it may be very difficult to manage the discussion and contain the situation when providing remote services. Since telemental health is offered (in most cases) because there is not adequate or specialized services at the patient’s site, it is unethical to delve into traumatic experiences without having the necessary clinical backup available. However, telemental health can be used to successfully provide clinically significant interventions such as basic PTSD education, symptom management, coping-skills training, and stress management.

I have been alarmed by the increasing incidence of alcohol and drug abuse, especially among teenagers.  Users are getting younger; even children as young as eight years old have been found using various mind-altering substances.  This article will focus on giving you information about the various treatments available for alcohol and substance abuse in the hope that it may help you or someone you know obtain the treatment needed.Drug, alcohol, and tobacco use is the cause of more deaths, illnesses, and disabilities than any other preventable health condition and seriously undermines America’s family life, economy and public safety1.  For the past few decades, national surveys have consistently shown that about 10 percent of American adults have significant problems related to their own use of alcohol.  In addition, about 25 percent of adults have reported that they use tobacco on a regular basis and about 7 percent use illegal drugs.  The following are some additional alarming statistics:In the 1960s, 7 percent of new female drinkers were ages 10 to 14.  Today the figure is at 31 percent.Inhalant use is most prevalent among young children and usually entails inhaling household items such as shoe polish or paint thinner.  More than 1,000 products widely available in households can be used as inhalants.There is a direct connection to the use of methamphetamine and the American work ethic.  As many as 9.4 million Americans have used the drug at least once. Everyday 3,000 kids start smoking and a third of them will eventually die of tobacco related causes.  Two of three 12 to 17year olds who smoked cigarettes in the last year show signs of addiction.A survey of American teens found that one in four said they had a friend or classmate who had used Ecstasy; 17 percent said they knew more than one user.Two thirds of Americans with serious substance abuse treatment needs are not being treated. 6.4 percent of Americans age 12 and older used illicit drugs or misused prescription drugs.15.3 percent reported that they had engaged in binge drinking in the past month and 5.4 percent drank alcoholic beverages heavily.Difference between Abuse, Dependence and AddictionAlcohol and drug use ranges on a continuum from use to dependence characterized by increasing loss of control and increasing functional impairment.  The term abuse is a broad term that refers to any maladaptive use of a psychoactive substance.  There comes a point where the use of the alcohol or drug is no longer voluntary and becomes involuntary and beyond the individual’s control.  When it reaches the stage where alcohol or drug use is no longer voluntary and interferes with daily functioning, we call it an addiction.  Dr. Alan Leshner, Director of the National Institute on Drug Abuse, stated that the condition of addiction is a “biobehavioral phenomenon” characterized by a movement from a state in which use is at least under some degree of voluntary control to a state in which use is both compulsive and uncontrollable.  He characterized addiction as a different state from abuse.Leshner states that with addiction there are fundamental brain changes that occur with increased use.  These brain changes create a need in the individual for increased, compulsive use of the substance.  In addiction there is a loss of control and increasing use despite negative consequences.  The term dependence refers to a more severe form of abuse characterized by habitual use of a substance that is taken more frequently and in larger amounts over time, leading to increasingly negative consequences.Historically, there have been two camps regarding the understanding of drug and alcohol addiction.  One camp, dominated by physicians, holds to the belief that addiction was based on a disease model.  It states that there is a genetic and/or biochemical basis for addictions and that the individuals cannot consistently control their drug-alcohol behavior without total abstinence.  They claim that there is no cure because addicts cannot escape the biochemical predisposition.  The other camp, dominated by psychologists, believes that alcohol and drug abuse is a learned behavior and, as such, can be unlearned, change or controlled through behavioral-learning models of treatment.Increasingly, addiction workers in the field are coming to the realization that neither approach alone may be sufficient for treating a large number of addicts.  For some individuals there may be a biochemical basis for their addiction, for some a behavioral basis, and for still others, both may be involved.  Furthermore, these workers are recognizing that treatment isn’t based on a “one size fits all” model.  While the abstinence model may be appropriate for some individuals, a moderation approach may be effective for others.  Addiction is a multivariate disorder with no simple solutions.  By offering only one approach we put addicts in the position of either adopting the only available treatment approach, whether or not it works for them, or not receiving any treatment at all.  Most professionals in the field recognize that treatment of addiction must focus on the addictive behavior itself rather than on the cause of the addiction. Drug AbuseNora Volkow, MD, of the Brookhaven National Laboratory, says:”Classically, people thought that drug addiction was a disease that involved the centers of pleasure that people are taking the drug because it’s pleasurable.  But that is not the case.  In fact, addicted people don’t have as strong a pleasure response as people who are not addicted.  Recent data are showing us that addiction entails a basic disruption of motivational circuits.”Not only does drug abuse affect the emotional centers of the brain, but also recent research shows that drug abuse alters cognitive activities such as decision-making, planning, and memory.  The evidence is clear that cocaine and marijuana use affect the frontal cortex, which is the center in the brain governing cognitive activity.  Such disruption in the frontal cortex might be responsible for the poor decision-making.  Recent research with a gambling task tested drug abuser’s making ability.  Not surprisingly it was found that drug abusers made poorer decisions on the gambling task than participants in a control group. The research is mounting that the long-term affects of drug abuse are much greater than most people believe.  It is not just that these affects occur while actively using the drugs.  Rather, these affects continue after drug use is discontinued.  It takes a long time for most drugs to clear one’s system and there may be residual physical and psychological affects long after that.Alcohol AbuseAlcohol abuse is more insidious than drug abuse. Since having a drink is socially sanctioned, there is no overt reminder that the behavior may lead to trouble down the road. With illicit drugs merely using the substance is a reminder because it is illegal.  Having a cocktail at dinner, drinking a beer at a ballgame, and celebrating a wedding with champagne are all socially supported and even encouraged.  One can receive accolades for being able to hold one’s liquor.  Becoming “shit-faced” in college is a right of passage.  There are many models of respected people enjoying alcohol.  This is not true for other substances.  Hence, it is easy to rationalize moving from the occasional beer, cocktail, or glass of wine to daily use. It is easy to go from the meal enhancing drink to using alcohol to self-medicate for social inhibition, depression, loneliness, anxiety, and other discomforting affects.  Because some people can develop a tolerance for higher levels of alcohol in their system, they may need higher doses in order to experience the same effects.  One drink becomes two, two becomes three.  Where one beer was good, for some people it can easily become three, four, or more during the week with a few extras on the weekend.Unfortunately, most alcoholics are not aware that they are alcoholics until they get into some difficulty.  And when there is some warning, they often deny it.  Often the early signs are related to work performance, health problems, social problems, legal difficulties, financial problems, or marital difficulties.Some people are born with a genetic and biochemical predisposition that leaves them more vulnerable to abusing alcohol.  They do not receive a signal from their brain that they have had enough or too much. Rather than producing sleep, nausea or other obvious physiological effect, they develop a tolerance for large amounts of alcohol.  In fact, with continued abuse they begin to crave the substance.  In addition, these people find that the alcohol temporarily comforts them by reducing shyness, anxiety, depression, and inhibition.  In a world where alcohol use is approved of and even encouraged, it becomes part of the culture.Alcoholics do not want to think of themselves as not able to control their drinking.  They want to keep up with and be part of their social group.  Declining a drink in many situations is difficult for these people.  It is not until they have developed a dependence that interferes with work, family life, and social life that they begin to recognize that they have a problem.  But by then it is often too late.  The physiological craving for alcohol becomes so great that giving it up does not seem like an option.  The centers of the brain that regulate judgment have been so affected that it takes a crisis to motivate these individuals to seek treatment. Signs of AbuseThe very nature of substance abuse is such that people do not want to admit that they have a problem.  People around them do not want to admit that there is a problem, and healthcare practitioners tend to either overlook or fail to investigate the possible existence of substance abuse.  Hence, the individual goes diagnosed and untreated.  There are several areas in which signs of abuse may appear.Problems in living: financial problems including poor financial decision-making; poor judgment; legal problems including traffic tickets (e.g., DUI) and accidents; occupational difficulties such as poor performance, absence, conflict; social problems such as inappropriate behavior, missed appointments, chronic lateness.Physical effects: increased incidence of health problems, poor dietary changes, higher tolerance for substance causing increased quantity and frequency of use; experiencing withdrawal when not using; higher incidence of nausea, dizziness, vomiting; disrupted sleep pattern.Psychological and behavior effects: emotional instability, e.g., irritability, impatience; difficulty in abstaining from use; using substances to regulate affect, i.e., to reduce social inhibition, relieve stress, reduce anxiety or depression; denial and defensiveness when substance use is suggested.TreatmentsInterestingly, the research found that all people are not affected similarly by alcohol or drug abuse.  For some the cognitive centers of the brain are more affected, for others the emotional centers are more affected.  And for some both centers are affected.  This has profound implications for treatment.  One treatment does not fit all abusers.  There is no magic bullet.  In order to determine the best fit for any given individual, a complete psychological history and history of abuse and treatment must be taken.  This places the individual into a context in order to decide what approach or approaches may be most beneficial. Most treatment approaches agree that that the focus of treatment must be on the cessation of substance abuse.  Even those experts who believe that it is possible for the alcoholic to learn to drink in moderation suggest that cessation for a period of time in the beginning of treatment is necessary in order for the patient and clinician to develop a clear picture of the role alcohol plays in the individual’s life.  Most approaches, however, have abstinence as their goal, especially for those individuals who have a family and personal history of chronic abuse.The following are some of the current treatment approaches for substance abuse:Individual skill-based treatments: these approaches help clients interact more effectively with others without using alcohol or drugs.  These approaches focus on coping and skills training to help clients quit or decrease abusing alcohol and drugs by teaching them strategies to address interpersonal, environmental and individual “skill deficits” that may provoke substance abuse.Motivational Enhancement Treatments: this approach is based on a model that encourages patients to explore the consequences of drinking in a supportive, nonthreatening environment.  One technique, called motivational interviewing, asks patients what about their alcohol or drug use causes them difficulties, enabling clients to examine their habits objectively.  Once clients see how substance abuse or dependence affects their lives, they are motivated to change.Cognitive Behavioral Treatment:  CBT states that human behavior is learned through personal experience and cognitive thought patterns.  Changing behavior requires learning how to think differently about situations and how to change dysfunctional behaviors that cause problems.  Alcohol dependent people have learned to drink in response to specific situations.  The treatment task is to identify the “alcohol triggers” and then apply techniques to develop new ways of thinking and new behavioral skills for coping with these triggers.Environmental and relationship-based treatment:  in this approach family members and significant others are taught coping skills and strategies to help influence their loved one’s drinking and motivation to change.Behavioral marital and family treatment: this approach works with both the individual and the spouse or family to decrease or eliminate abusive drinking-related consequence.Twelve-step programs: these inpatient or outpatient programs are based on the 12step model of Alcoholics Anonymous except that professionals lead them.  Some professionals in private practice also use such a model, while other practitioners use AA to supplement and support the work being done by the patient in individual treatment.Medications:  Two medications disulfiram and naltrexone have been approved by the FDA for alcoholism with a third showing promise, acamprosate, which is pending approval. Naltrexone appears to be most effective with fewer side effects.As mentioned previously, no one treatment is effective for all substance abusers.  Several variables must be taken into account in order to find the treatment that is most effective for any given person.  Such factors as duration of addiction, family history, degree of substance abuse, extent of disruption in the patient’s life, health, degree of motivation, to mention the most obvious, must be evaluated.The first step in the treatment of substance abuse, after collecting a complete psychological, health, and substance abuse history, is to focus on harm reduction.  If an individual is placing him or herself, or his or her family, in immediate danger, action must be taken to reduce the impending danger.  Sometimes this may require inpatient treatment and sometimes it may involve the entire family.  It requires developing a plan of action that can be implemented quickly.  The focus during the early sessions is on changing the addictive behavior.  In order for treatment to be effective, the individual must be sober.  That is the first goal.  Staying sober is the bulk of the work.  Once sobriety has been achieved, treatment can focus on helping the patient restructure his or her thinking, behavior, lifestyle, and focus.  Maintaining sobriety becomes a top priority especially in the early stages of treatment.Frequently substance abusers have personality difficulties in addition to their addiction.  Such concurrent psychological problems as depression, anxiety, social phobia, low self-esteem and other such personality issues, need to be addressed as well as the addiction.  Alcoholics and drug abusers often use various substances as a form of self-medication to help them cope with these issues.  In treatment, however, we first focus on the substance abuse and then work with the personality issues that may coexist. Sobriety or harm reduction is the immediate goal.ConclusionOur typical image of an addict is someone in a back alley shooting up or a drunk tottering on the street.  This depiction is grossly misleading.  Addicts are often professionals in high-powered positions.  They are surgeons, judges, lawyers, dentists, CEOs, business owners.  They are making decisions that affect the lives of thousands of individuals and costs millions of dollars in lost productivity and through faulty decisions.  Too often, these people are in denial about their abuse and do not recognize the extent to which they are cognitively impaired.There is no one cause for substance abuse and no one treatment. Substance abuse is a biosocialpsychological problem.  Genetic predisposition may be more of a factor in one individual than another.  The role of brain chemistry and genetics is different from person to person.  Social and psychological influences likewise vary.  Hence, treatment must be tailored to each person.The first priority in treatment should be harm reduction with eventual sobriety.  When the individual is “clean and sober,” s/he can collaborate in his or her treatment with full mental acuity.  A treatment plan can then be devised and a determination can be made as to what factors are influencing the abuse. Then a decision can be made as to whether moderate drinking, in the case of the problem drinker, is possible. Some approaches, however, such as AA, believe that abstinence must be a lifetime commitment. Other approaches suggest that moderate drinking is possible for some alcoholics.  In either case, a thorough evaluation is necessary and sober brain is required to make that decision.

In Great Britain the National Institute for Health and Clinical Excellence is now strongly recommending that ADHD behaviour therapy should be tried first, rather than dosing kids with doubtful ADHD drugs. Behaviour therapy or cognitive behaviour therapy (CBT) has also been shown to be more effective than anti-depressant drugs in adults suffering from anxiety and depression. Anyone who is concerned about good parenting will take comfort from this fact that ADHD behaviour therapy is now a respectable and highly recommended means of ADHD treatment.

There is still a long way to go . If you read the parenting or ADHD blogs, there are stories of children and teenagers which make your hair stand on end. There is the story of a twelve year old boy who is still on ADHD medication after three years but his behaviour has worsened and his parents live like prisoners in their own home. He is aggressive and violent and has threatened to report them to the welfare authorities if they lay a finger on him. Good parenting skills are badly needed in this family.

While hyperactivity in children with ADHD may be a problem, just think of the problem if it is left untreated and carried on into adulthood. While adult hyperactivity and multi tasking is even approved of in certain executive circles, the long term damage to careers and relationships which is caused by ADHD can be devastating.

ADHD behaviour therapy can turn many a disastrous family situation around. I know parents who have used this type of therapy which has resulted in children knowing the difference between good and bad behaviour ! If parents follow the principles and strategies in an ADHD behaviour program, they can soon learn good parenting and it will save their sanity. They will learn how to deal with defiant kids, answering back and cursing, establishing routines, behaviour charts, and many other practical tips.

The other problem is that all too often ,medication has been thought of as the be all and end all. Given the harmful effects of many of the ADHD drugs, parents need to consider alternatives. That is why homeopathic remedies for ADHD sales have rocketed in the last five years. Very often, a gentle homeopathic remedy combined with psychological interventions, such as ADHD behaviour therapy can be the way to good parenting and a happier family life.