Just Moody Or More? Are Your Child’s Moods Normal?
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Are your child’s moods normal? Lisa Meyers McClintick, USA TODAY Guide to Kids’ Health, USATODAY 8 Sept. 2013
Any parent knows: An evening can go to heck in a matter of minutes.
Our 9-year-old daughter pipes up suddenly that she needs a pink dress to play Sleeping Beauty in class the next morning. It has to be pink. It has to be pretty. And she needs it now!
Any sort of reasoning—like the suggestion to wear a wedding-worthy yellow dress—won’t work. Frustrations explode into shouting, timeouts and all-too-familiar rants of “this family sucks,” followed by heartbreaking rounds of “I hate myself!”
The next morning, when nerves calm, the yellow dress is perfectly fine and our daughter cheerfully chatters about Belle’s ball gown in Beauty and the Beast.
The difference? The anxiety attack is over.
Sneaky and insidious, anxiety seizes our daughter like a riptide pulling her out to sea. Her negative thoughts build like a tsunami, and it’s useless to swim against them with problem-solving logic.
Like a real riptide, the only escape seems to be diagonally. A surprise dose of humor—tough to summon in the midst of a blowup—can spring her free. As one therapist explained, “You can’t process anger and humor at the same time.”
It’s taken years of keen observation and research, plus the support of educators and psychologists to help our kids, ages 9 to 13, cope with mental health issues that also include Attention Deficit Hyperactive Disorder (ADHD) and depression.
Recognizing that something isn’t right and pursuing help isn’t an easy journey. But it’s necessary. In the same way you’d pursue cures and solutions to manage chronic physical conditions like cancer and diabetes for your child, you have to advocate for your child’s emotional well-being. It requires being proactive, persistent and patient.
“If you can intervene early and get proper treatment, the prognosis is so much better,” says Teri Brister, who directs the basic education program of the National Alliance on Mental Illness.
KNOW THE SIGNS
“One of the most difficult-to-recognize issues is anxiety,” says John Duby, director of Akron Children’s Hospitals Division of Developmental and Behavioral Pediatrics. “(Children) won’t say, ‘Hey, you know, I’m worried.’ You have to be tuned in.”
All-consuming worries—about parents’ safety, bullies or natural disasters, for instance—can look like a lack of focus at first. Some kids ask frequent questions about “what’s next” for meals or activities. Changes to the daily routine (a substitute teacher or a visit to a new doctor) can trigger headaches, stomachaches or a sleepless night.
At its most extreme, anxiety induces panic attacks. Kids break into sweats, have trouble breathing and feel their heart racing.
Depression may cause similar symptoms to anxiety with headaches, stomachaches, not being able to sleep or sleeping more than usual. “They may withdraw socially,” says Duby. Kids may head to their room after school and not emerge until morning. Some kids are constantly irritable and angry.
“We often think depression doesn’t happen in children, but it does,” he says.
GET HELP
Step 1: Trust your instincts
If you’re worried about your child’s mood, trust your instincts as a parent, recommends Brister.
The red flags of mental health disorders tend to pop up during school years when children have to navigate academic expectations, make friends and increase responsibilities at home.
“You have to look for (behavior) patterns,” says Brister. These can include impulsive acts, hyperactivity, outbursts, an inability to follow directions or recurring ailments that may impair how the child performs in class, extracurricular activities or simply sitting through dinner with the family.
Most concerned parents start with a visit to the pediatrician. (PETER’S EDIT For Australian parents your family GP is a good place to start) The family physician can help you analyze symptoms and understand whether there might be an underlying condition such as food allergies or a chronic lack of sleep.
Step 2: Seek professional help
(PETER’S EDIT: In Australia a referral from a GP to a psychologist via a mental health care plan or ATAPS will ensure an informed, appropriate and timely assessment. If the issue is developmental, a referral to a paediatrician may be preferred or if your GP has a serious concern a referral to a child psychiatrist may be made. Wait times for each option should be relatively short in the private sector.)
When our son was 5, we sought testing for ADHD with a referral from our pediatrician. Unfortunately, we couldn’t even get on a waiting list for a psychology appointment. We were told the list had backed up to a two-year wait, so it was eliminated. We had to call weekly and hope for an opening.
When our daughter needed help as her anxiety escalated, it took a school district triage nurse to get us an appointment with a psychiatric nurse.
This is, unfortunately, not an uncommon scenario for parents. You need to use all the leverage you have to access experts in the school system or mental health clinics to help with your situation. Stay persistent and be pleasant rather than pushy.
And when you do get an appointment, make the most of it by consistently tracking the concerns you have about your child’s behavior and putting them in writing for the physician to read. Have a list of questions ready, and always ask about additional resources you can tap into, from support groups to books.
Mental health practitioners will also be gathering resources and information about your child from report cards, checklists and questionnaires. These can help pinpoint whether a child has anxiety, depression, ADHD, bipolar disorder, is on the autism spectrum or may have a combination of these. “It allows us to have a more objective view,” says Duby.
Step 3: Find your normal
Once there is a diagnosis, families can decide how to move forward. That might mean trying medications, working with a psychologist or setting up an Individualized Education Program (IEP) at school.
Additional services that may help include occupational therapy, which can identify specific movements, such as swinging, spinning or brushing outer limbs with a soft brush that may help your child’s brain process and integrate sensory information.
These tools and approaches can help families be proactive about preventing and managing mental meltdowns. It’s also essential to help children feel a sense of belonging at school and in community groups. Families need to build up their children’s strengths so they have the self-esteem and confidence to move forward, says Duby.
And parents should stay on top of the situation, watching for changes in behavior and mood, especially as children get older, says Brister.
Hormones may help or worsen conditions, which makes it important to have a diagnosis and support network before the teen years hit.
“I can’t emphasize enough how essential it is to recognize symptoms early and treat them,” she says.
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SIGNS OF DEPRESSION AND ANXIETY
Signs in children may differ from the symptoms we commonly associate with adults who have the disorders. Depression in kids may look like irritability, anger and self-criticism, says the National Alliance on Mental Illness. It could be as subtle as her making less eye contact with you than in the past.
School performance is another important indicator. Grades can drop off dramatically; students may also visit the school nurse more frequently with vague complaints of illness.
Children who suffer from an anxiety disorder may experience fear, nervousness and shyness, according to the Anxiety and Depression Association of America. They may worry excessively about things like grades and relationships with family and friends. They may strive for perfection and seek constant approval.
HOW TO CALM IT DOWN
Whether a child has mental health struggles or not, emotions inevitably boil over—especially as preteen dramas escalate. Here are ways to help de-escalate the situation and restore calm to your family life.
• Keep your body language non-threatening and stay as even-keeled as possible. Don’t get in the child’s face or use a raised voice.
• Teach kids how to breathe slowly through the nose, then exhale gently through the mouth as if cooling a hot bowl of soup.
• Create an “away space,” a place to cool down and take a break. Consider a quiet nook in a bedroom, a spot on the stairs for kids who don’t like separation or a backyard corner for those who find comfort in nature.
• Let kids know they can’t hit others, but it’s OK to punch a pillow or punching bag or to squeeze putty or a squishy toy.
• Figure out what’s physically comforting—feeling the softness of a blanket or stuffed animal, nuzzling the fur of a family pet or piling under heavy blankets.
• Listen to favorite tunes on a music player.
• Provide a journal for writing out frustrations or doodling when the words won’t come.
• When emotions simmer down, sit side by side to talk through how the situation could have been handled differently and work on solutions together.
ONLINE RESOURCES
(PETER’S EDIT: AUSTRALIA:
HeadSpace: headspace National Youth Mental Health Foundation Ltd is funded by the Australian Government Department of Health and Ageing under the Youth Mental Health Initiative Program. A great resource for parents and teens.
BeyondBlue : Resources for young people section )
OTHER:
HealthyChildren.org from the American Academy of Pediatrics has a section dedicated to “Emotional Problems.” Parents can tap into great information on how to help their child. Audio segments recorded by experts in the field can be used as a launching point for family discussions.
TheBalancedMindFoundation.org, founded by the mother of a daughter with bipolar disorder, provides help for families. Online, private support groups offer 24/7-support and online forums are a way for parents to connect.
WorryWiseKids.org, a service of the Children’s and Adult Center for OCD and Anxiety, has a wealth of information about the different types of anxiety disorders children can have, how to understand them and how to seek treatment for them.
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Symptoms or Circuits? The Future of Diagnosis
Source Credit: PSYPOST
We live in the most exciting and unsettling period in the history of psychiatry since Freud started talking about sex in public.
On the one hand, the American Psychiatric Association has introduced the fifth iteration of the psychiatric diagnostic manual, DSM-V, representing the current best effort of the brightest clinical minds in psychiatry to categorize the enormously complex pattern of human emotional, cognitive, and behavioral problems. On the other hand, in new and profound ways, neuroscience and genetics research in psychiatry are yielding insights that challenge the traditional diagnostic schema that have long been at the core of the field.
“Our current diagnostic system, DSM-V represents a very reasonable attempt to classify patients by their symptoms. Symptoms are an extremely important part of all medical diagnoses, but imagine how limited we would be if we categorized all forms of pneumonia as ‘coughing disease,” commented Dr. John Krystal, Editor of Biological Psychiatry.
A paper by Sabin Khadka and colleagues that appears in the September 15th issue of Biological Psychiatry advances the discussion of one of these roiling psychiatric diagnostic dilemmas.
One of the core hypotheses is that schizophrenia and bipolar disorder are distinct scientific entities. Emil Kraepelin, credited by many as the father of modern scientific psychiatry, was the first to draw a distinction between dementia praecox (schizophrenia) and manic depression (bipolar disorder) in the late 19th century based on the behavioral profiles of these syndromes. Yet, patients within each diagnosis can have a wide variation of symptoms, some symptoms appear to be in common across these diagnoses, and antipsychotic medications used to treat schizophrenia are very commonly prescribed to patients with bipolar disorder.
But at the level of brain circuit function, do schizophrenia and bipolar differ primarily by degree or are there clear categorical differences? To answer this question, researchers from a large collaborative project called BSNIP looked at a large sample of patients diagnosed with schizophrenia or bipolar disorder, their healthy relatives, and healthy people without a family history of psychiatric disorder.
They used a specialized analysis technique to evaluate the data from their multi-site study, which revealed abnormalities within seven different brain networks. Generally speaking, they found that schizophrenia and bipolar disorder showed similar disturbances in cortical circuit function. When differences emerged between these two disorders, it was usually because schizophrenia appeared to be a more severe disease. In other words, individuals with schizophrenia had abnormalities that were larger or affected more brain regions. Their healthy relatives showed subtle alterations that fell between the healthy comparison group and the patient groups.
The authors highlight the possibility that there is a continuous spectrum of circuit dysfunction, spanning from individuals without any familial association with schizophrenia or bipolar to patients carrying these diagnoses. “These findings might serve as useful biological markers of psychotic illnesses in general,” said Khadka.
Krystal agreed, adding, “It is evident that neither our genomes nor our brains have read DSM-V in that there are links across disorders that we had not previously imagined. These links suggest that new ways of organizing patients will emerge once we understand both the genetics and neural circuitry of psychiatric disorders sufficiently.”
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All By Myself…The Tyranny of The Loneliness Epidemic
Credit Dr Ronald Pies, M.D. via psychcentral.com
The recent controversy over the still-developing DSM-5 — that compendium of mental disorders the media love to call, inappropriately, “The Bible of Psychiatry” –has gotten me thinking about loneliness. Now, thankfully, nobody has seriously proposed including loneliness in the DSM-5. Indeed, loneliness is usually thought of as simply an unpleasant part of life — one of the “slings and arrows” that pierce almost all of us from time to time. Loneliness, in some ways, remains enmeshed in a web of literary and cultural clichés, born of such works as Nathaniel West’s darkly comic novel, Miss Lonelyhearts, and the Beatles’ whimsical anthem, “Sgt. Pepper’s Lonely Hearts Club Band.”
But loneliness turns out to be a serious matter. And as psychiatry debates the diagnostic minutiae of DSM-5, all of us may need to remind ourselves that millions in this country struggle against the downward tug of loneliness. Yet even among health care professionals, few seem aware that loneliness is closely linked with numerous emotional and physical ills, particular among the elderly and infirm.
It’s easy to assume that loneliness is simply a matter of mind and mood. Yet recent evidence suggests that loneliness may injure the body in surprising ways. Researchers at the University of Pittsburgh School of Medicine studied the risk of coronary heart disease over a 19-year period, in a community sample of men and women. The study found that among women, high degrees of loneliness were associated with increased risk of heart disease, even after controlling for age, race, marital status, depression and several other confounding variables. (In an email message to me, the lead author, Dr. Rebecca C. Thurston, PhD, speculated that the male subjects might have been more reluctant to acknowledge their feelings of loneliness).
Similarly, Dr. Dara Sorkin and her colleagues at the University of California, Irvine, found that for every increase in the level of loneliness in a sample of 180 older adults, there was a threefold increase in the odds of having heart disease. Conversely, among individuals who felt they had companionship or social support, the likelihood of having heart disease decreased.
The young, of course, are far from immune to loneliness. Researchers at Aarhus University in Denmark studied loneliness in a population of adolescent boys with autism spectrum disorders (an area of great controversy in the proposed DSM-5 criteria). More than a fifth of the sample described themselves as “often or always” feeling lonely—a finding that seems to run counter to the notion that those with autism are emotionally disconnected from other people. Furthermore, the study found that the more social support these boys received, the lower their degree of loneliness. We have no cure for autism in adolescents–but the remedy for loneliness in these kids may be as close as the nearest friend.
And lest there be any doubt that loneliness has far ranging effects on the health of the body, consider the intriguing findings from Dr. S.W. Cole and colleagues, at the UCLA School of Medicine. These researchers looked at levels of gene activity in the white blood cells of individuals with either high or low levels of loneliness. Subjects with high levels of subjective social isolation—basically, loneliness — showed evidence of an over-active inflammatory response. These same lonely subjects showed reduced activity in genes that normally suppress inflammation. Such gene effects could explain reports of higher rates of inflammatory disease in those experiencing loneliness.
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Could inflammatory changes, in turn, explain the correlation between loneliness and heart disease? Inflammation is known to play an important role in coronary artery disease. But loneliness by itself may be just one domino in the chain of causation. According to Dr. Heather S. Lett and colleagues at Duke University Medical Center, the perception of poor social support — in effect, loneliness — is a risk factor for development, or worsening, of clinical depression. Depression may in turn bring about inflammatory changes in the heart that lead to frank heart disease. This complicated pathway is still speculative, but plausible.
Loneliness, of course, is not synonymous with “being alone.” Many individuals who live alone do not feel “lonely.” Indeed, some seem to revel in their aloneness. Perhaps this is what theologian Paul Tillich had in mind when he observed that language “… has created the word “loneliness” to express the pain of being alone. And it has created the word “solitude” to express the glory of being alone.” Conversely, some people feel “alone” or disconnected from others, even when surrounded with people.
Let’s admit that not everybody is capable of experiencing the “glory of being alone” or of transforming loneliness into “solitude.” So what can a socially-isolated person do to avoid loneliness and its associated health problems? Joining a local support group can help decrease isolation; allow friendships to form; and give the lonely person an opportunity both to receive and to provide help. This reciprocity can bolster the lonely person’s ego and improve overall well-being. Support groups geared to particular medical conditions can also help reduce disease-related complications. Although there are always risks in going “on line” to find support, Daily Strength appears to be a legitimate and helpful website for locating support groups of all types, including those for loneliness. Psych Central also provides opportunities to exchange ideas and “connect” with many individuals who feel isolated or alone. For those who feel lonely even in the midst of friends, individual psychotherapy may be helpful, since this paradoxical feeling often stems from a fear of “getting close” to others.
No, loneliness is not a disease or disorder. It certainly shouldn’t appear in the DSM-5 — but it should be on our minds, as a serious public health problem. Fortunately, the “treatment” may be as simple as reaching out to another human being, with compassion and understanding.
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Families, Alcohol, Recovery & ‘The Limits Of Love’
I have re-posted this article from psych central as it is a thorough, well written and balanced view of the impact of alcoholism in families, the hope for recovery and the role of families and the community in helping those with substance over-use illnesses: Please read!Gredit: psychcentral.com
On April 25th, Hallmark Hall of Fame will broadcast the movie “When Love Is Not Enough — The Lois Wilson Story,” starring Winona Ryder and Barry Pepper (CBS, 9:00 pm ET). The movie, which portrays the life of Lois Wilson, co-founder of Al-Anon Family Groups and wife of Alcoholics Anonymous co-founder Bill Wilson, is based on William G. Borchert’s 2005 book, The Lois Wilson Story: When Love Is Not Enough.
Borchert’s earlier screenplay was the basis of the acclaimed movie My Name is Bill W. which starred James Woods, James Garner, and JoBeth Williams. The premiere of the movie also falls during the National Council on Alcoholism and Drug Dependence, Inc.’s (NCADD) 24th Annual Alcohol Awareness Month with its theme, “When Love Is Not Enough: Helping Families Coping With Alcoholism.”
Lois Wilson fell in love with a man whose alcoholism brought his life and their relationship to the brink before he began his personal recovery and helped found Alcoholics Anonymous. Lois and many of the other wives of early AA members also began to band together for mutual support, formalizing these meetings into Al-Anon Family Groups in 1951.
When Love is Not Enough is the story of Lois Wilson and her life with Bill Wilson. The reach of her and their stories is unfathomable and inseparable from the larger stories of AA and Al-Anon and the influence their lives would exert on the larger story of the professional treatment and recovery of individuals and families affected by addiction to alcohol and other drugs. As William Borchert suggests:
“In the end, Bill Wilson’s alcoholism proved not to be the tragic undoing of this brilliant and loving couple, but rather the beginning of two of the twentieth century’s most important social and spiritual movements- Alcoholics Anonymous and Al-Anon Family Groups.”
There are presently more than 114,500 Alcoholics Anonymous groups (with a combined membership of more than 2 million) and more than 25,000 Al-Anon/Alateen groups (with a combined membership estimated at more than 340,000) hosting local meetings worldwide.
When Love is Not Enough is clearly more than a love story, though it is surely that. Readers of Psych Central and the people they serve will discover in this movie six profound lessons about the impact of alcoholism and alcoholism recovery on intimate relationships and the family.
1. Prolonged cultural misunderstandings about the nature of alcoholism have left a legacy of family shame and secrecy. Centuries of debates between those advocating religious, moral, criminal, psychiatric, psychological, medical and sociological theories of alcoholism failed to offer clear guidance to individuals and families affected by alcoholism. When Love is Not Enough is in part a poignant history of the hidden desperation many families experienced before the birth of Alcoholics Anonymous, Al-Anon, and modern alcoholism treatment. Lois Wilson and Anne Bingham helped change that history in 1951 when they organized 87 groups of wives of AA members into the Al-Anon Family Groups.
2. Alcoholism is a family disease in the sense that it also wounds those closest to the alcohol dependent person; transforms family relationships, roles, rules, and rituals; and isolates the family from potential sources of extended family, social, and community support. And, it has far reaching, long-lasting effects on the physical and emotional health of the family and children. When Love is Not Enough conveys the physical and emotional distress of those struggling to understand a loved one who has lost control of drinking and its consequences.
It vividly portrays the disappointment, confusion, frustration, anger, resentment, jealousy, fear, guilt, shame, anxiety and depression family members experience in the face of alcoholism. The recognition that significant others and their children become as sick as the person addicted and are in need of a parallel pathway of recovery were the seeds from which Al-Anon and Alateen grew.
3. The family experience of alcoholism is often one of extreme duality. When Love is Not Enough poignantly conveys this duality: brief hope-inspiring interludes of abstinence or moderated drinking, periods of peacefulness, moments of love and shared dreams for the future — all relentlessly violated by explosive bouts of drinking and their devastating aftereffects. Memories of that lost person and those moments and dreams co-exist even in the face of the worst effects of alcoholism on the family.
It is only in recognizing this duality of experience and the character duality of the alcoholic that one can answer the enigmatic question that is so often posed about Lois Wilson’s contemporary counterparts, “Why does she/he stay with him/her?” As clinicians, we can too often forget that these family stories contain much more than the pathology of alcohol or drug dependence (White, 2006).
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4. Family recovery from alcoholism is a turbulent, threatening and life-changing experience. The hope of all families and children wounded by alcoholism is that the drinking will stop and with it, the arrival of an idyllic family life. Lois Wilson’s story confirms what research on family recovery from addiction is revealing: recovery from alcoholism can destabilize intimate and family relationships. Stephanie Brown and Virginia Lewis (1999), in their studies of the impact of alcoholism recovery on the family, speak of this as the “trauma of recovery.”
People recovering from alcoholism, their families, and their children can and often do achieve optimum levels of health and functioning, but this achievement is best measured in years rather than days, weeks, or months. That recognition in the life of Lois Wilson underscored the need for sustained support for families as they went through this process.
5. We cannot change another person, only ourselves. If there is a central, singular message from Lois Wilson’s life and from the Al-Anon Family Groups program, this may well be it. Al-Anon’s defining moments came when family members stopped focusing on how they could change and control their addicted family member and focused instead on their own need for regeneration and spiritual growth, the overall health of their families and the comfort and help they could offer each other and other families similarly affected.
Their further discovery that AA’s twelve step program of recovery could also guide the healing of family members marks the birth of the modern conceptualization of family recovery. The 2009 Al-Anon Membership Survey confirms the wide and enduring benefits members report experiencing as a result of their sustained involvement in Al-Anon—irrespective of the drinking status of their family members.
6. The wonder of family recovery. As a direct result of Lois’s groundbreaking work in co-founding Al-Anon and the impact it has had on the field of alcohol and drug treatment, family recovery from alcoholism is a reality for millions of Americans today, and the hope, help, and healing of family recovery has become the most powerful way to break the intergenerational cycle of alcoholism and addiction in the family.
The growing interest in the lives of Bill and Lois Wilson — as indicated by a stream of memoirs, biographies, plays, and films — is testimony to the contributions that Alcoholics Anonymous and Al-Anon Family Groups have made to personal and family recovery from alcoholism and to the ever-widening adaptation of the Twelve Steps to other problems of living (Wilson, 1994).
Psych Central readers will find much of value in “When Love Is Not Enough — The Lois Wilson Story,” including the power of Al-Anon as a tool of support for clients living with someone else’s alcoholism. A DVD of the movie and a Viewer’s Guide, for use as a tool in family and community education, will be available at www.hallmarkhalloffame.com on April 25th, the day of the movie’s premiere.
References
Al-Anon membership survey. (Fall, 2009). Virginia Beach, VA: Al-Anon Family Headquarters, Inc.
Borchert, W.G. (2005). The Lois Wilson story: When love is not enough. Center City, MN: Hazelden.
Brown, S., & Lewis, V. (1999). The alcoholic family in recovery: A developmental model. New York & London: Guilford Press.
White, W. (2006). [Review of the book The Lois Wilson Story: When Love is Not Enough, by W. G. Borchert]. Alcoholism Treatment Quarterly, 24(4), 159-162.
Wilson, L. (1979). Lois remembers: Memoir of the co-founder of Al-Anon and wife of the co-founder of Alcoholics Anonymous. New York: Al-Anon Family Group Headquarters, Inc.
Additional Resources
Al-Anon Family Group Headquarters, 800-4AL-ANON (888-425-2666), Monday-Friday, 8 a.m. to 6 p.m., ET.
National Council on Alcoholism and Drug Dependence (NCADD).
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Sally Thibault: Author Of ‘David’s Gift’ On Tips For Parents Of Children With Aspergers Syndrome
For More Information Click Image Or Visit davidsgift.com
On April 2nd, World Autism Day, I blogged this post about the amazing new book “David’s Gift” by author, speaker and mother Sally Thibault. On Friday 16th, Sally was interviewed on the Nine Network Show ‘Today’,During the 4 minute interview she provided a number of practical tips for parents. Here’s the Video. Make sure you visit http://www.davidsgift.com !
Credit: “Today” Nine Network Australia
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Anxiety & Depression: Self-Help Internet Interventions Work!
A little while ago I posted a list of free interactive self-help web sites, all research based, which have been shown to effective in the treatment of anxiety & depression. A recent study adds to the body of evidence which supports web based intervention as a viable treatment option or adjunct.
Cognitive behaviour therapy (CBT) via the internet is just as effective in treating panic disorder (recurring panic attacks) as traditional group-based CBT. It is also efficacious in the treatment of mild and moderate depression. This according to a new doctoral thesis soon to be presented at Karolinska Institutet.
Read the original research thesis here (PDF)
It is estimated that depression affects some 15 per cent and panic disorder 4 per cent of all people during their lifetime. Depression can include a number of symptoms, such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life. Panic disorder involves debilitating panic attacks that deter a person from entering places or situations previously associated with panic. Common symptoms include palpitations, shaking, nausea and a sense that something dangerous is about to happen (e.g. a heart attack or that one is going mad ).
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It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.
The present doctoral thesis includes a randomised clinical trial of 104 patients with panic disorder and compares the effectiveness of Internet-based CBT and group CBT within a regular healthcare service. The study shows that both treatments worked very well and that there was no significant difference between them, either immediately after treatment or at a six-month follow-up. Analyses of the results for the treatment of depression show that Internet-based CBT is most effective if it is administered as early as possible. Patients with a higher severity of depression and/or a history of more frequent depressive episodes benefited less well from the Internet treatment.
Jan Bergström works as a clinical psychologist at the Anxiety Disorders Unit of the Psychiatry Northwest division of the Stockholm County Council. This research was also financed by the Stockholm County Council.
“Thanks to our research, Internet treatment is now implemented within regular healthcare in Stockholm, at the unit Internetpsykiatri.se of Psychiatry Southwest, which probably makes the Stockholm County Council the first in the world to offer such treatment in its regular psychiatric services,” says Jan Bergström.
Read the original research thesis here (PDF)
Credit: Adapted from materials provided by Karolinska Institutet.
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Bipolar Mood Disorder: How Long Does An Episode Last?
Credit:John M Grohol PsyD PsychCentral
Bipolar disorder is characterized by a cycling from depression to mania, and back again over time (hence the reason it used to be called manic depression, because it includes both mania and depression). One of the commonly asked questions […] is, “How long does a typical bipolar episode last?”
The answer has traditionally been, “Well, it varies considerably from person to person. Some may have rapid cycling bipolar disorder where that person can cycle back and forth between depression and mania in the course of a day or multiple times a week. Others may be stuck in one mood or the other for weeks or months at a time.”
New research (Solomon et al., 2010) published in The Archives of General Psychiatry sheds a little more empirical light onto this question.
In a study of 219 patients with bipolar I disorder (the more serious kind of bipolar disorder), researchers asked patients to fill out an evaluation every 6 months for five years. The evaluation survey asked a number of questions to determine the length, type and severity of the person’s mood episodes.
They discovered that for patients with Bipolar I disorder, the median duration for any type of mood episode — either mania or depression — was 13 weeks.
They also found that “more than 75% of the subjects recovered from their mood episodes within 1 year of onset. The probability of recovery was significantly less for an episode with severe onset” and for those who had a greater number of years spent ill with a mood episode.
The researchers also discovered that manic episodes or mild depressive episodes were easier to recover from than severe depressive episodes for people with Bipolar I disorder in this study. They also found that those who have a cycling episode — switching from depression to mania or vice-a-versa without an intervening period of recovery — fared worse.
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So there you have it. The average length of time someone with Bipolar I disorder spends either depressed or manic is about 13 weeks. Of course, as always, your mileage may vary and individual differences will mean that very few people will actually have this exact average. But it’s a good, rough yardstick in which to measure your own mood episode lengths.
Reference:
Solomon, DA, Andrew C. Leon; William H. Coryell; Jean Endicott; Chunshan Li; Jess G. Fiedorowicz; Lara Boyken; Martin B. Keller. (2010). Arch Gen Psychiatry — Abstract: Longitudinal Course of Bipolar I Disorder: Duration of Mood Episodes. Arch Gen Psychiatry, 67, 339-347.
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Compulsive Collecting: Finding Hope In The Misunderstood Mess of Hoarding
Compulsive collecting or Hoarding is a misunderstood and debilitating mental health issue. Many psychologists and counsellors never see someone with this condition as they very rarely present for help. This article from an Australian newspaper provides an excellent overview of the condition and issues underlying hoarding, and I have included links to two brilliant books co-authored by the researchers discussed in the article, who have developed a wholistic and novel approach to it’s treatment.
Credit: Kate Benson, Sydney Morning Herald April 8 2010
They may dress well or hold down a good job. But hoarders are unhappy people who suffer from a debilitating condition.
Every suburb has one. The elderly woman weaving through an overgrown backyard full of cardboard boxes, old tyres and discarded furniture. Cats perch on every surface; kittens roll about among the rusted drums and long grass.
Inside, behind closed curtains, the rooms are piled high with papers, cups, plates and bottles. Broken toys, old clothes and shopping bags spill across kitchen benches and floor, smothering the stove and filling the sink, neither of which has been used in years.
The stench of cat faeces, urine and food scraps fill the house.
To her neighbours, she is an oddity. Or a pest, bringing down house values and encouraging vermin.
But to therapists she is one of a growing band across Australia suffering from a debilitating condition known as compulsive hoarding, where people feel a need to collect and store items that seem useless to others.
Their homes become havens of insurmountable clutter and junk, often leaving them unable to sleep in their beds or use appliances. Many end up with electricity or gas supplies disconnected or their fridge and washing machines unusable because they fear their lifestyle will be revealed if they contact a tradesmen to make repairs.
This secrecy and shame make it difficult to know exactly how many people have the disorder.
Some experts think between 200,000 and 500,000 Australians compulsively hoard, but others put the figure closer to 800,000.
“It’s a sleeping giant,” Chris Mogan, a clinical psychologist and expert on hoarding, says. “There is no systematic estimate of how many hoarders there are in any Australian setting. I suspect there are many, many more out there than we are aware of.”
Louise Newman, the president of the Royal Australian and New Zealand College of Psychiatrists, agrees.
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“I’ve only seen one case in my career [because] these people usually only come to light when the council steps in and orders a clean-up. Hoarders desperately want to keep hoarding. They don’t want to be stopped.”
There is little research on the condition in Australia and not much in the way of funding or treatment programs, but experts are hopeful hoarding will be included in the next (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders, the bible used by mental health experts to diagnose psychiatric conditions.
Many sufferers fall between the cracks because hoarding is not a clinical diagnosis in its own right, but is seen more as an offshoot of obsessive compulsive disorder, muddled with depression, anxiety, panic disorder and low self-esteem.
“But it is different to OCD and once we get it in the DSM-V, therapists, psychiatrists, psychologists and social workers can then be trained in the management of it [and] we can attract funding for research,” Mogan says.
Jessica Grisham, a clinical psychologist who specialises in obsessive compulsive disorder, also believes compulsive hoarding should be included in the next edition as it requires specialised treatment.
She cites recent neural imaging studies in the US that showed that different parts of the brain were activated in hoarders than in obsessive compulsive disorder patients.
Mogan and Grisham agree that cognitive behaviour therapy, where sufferers are slowly taught to change their thought patterns, is more effective than medication alone.
But hoarders responded better to a specially adapted version of the therapy, developed by the American hoarding experts Gail Steketee and Randy Frost. It had been achieving success with about 60 per cent of hoarders – far more than standard cognitive behaviour therapy.
“But it has to be a long-term project. You don’t go in to someone’s place and do a sudden excavation against their will,” Grisham says.
“That’s a violation and it’s very traumatic for them. It might make great TV, but it’s not good clinically.”
Mogan agrees. A pay TV show, Hoarders, was damaging to the public’s understanding of the illness, because it focused on forcefully cleaning houses in three days.
“Within six to 12 months that house will be recluttered because it is a compulsion … they suffer a lot of grief after things are taken away.”
Mogan makes weekly home visits to hoarders, and focuses on getting them to reduce the associated dangers by ensuring their home has two exits for safety, and working appliances and smoke alarms.
“Just as we do with drugs and alcohol, we’re into harm minimisation. Once the house is safe, we gradually set more goals. If they are comfortable with that, they will continue to stay in touch and not reject us.”
Sometimes the problem extends beyond mounds of paperwork and clothes. Mogan and Grisham know patients who hoarded urine or fingernail clippings. Some stored their own faeces or collected one particular item, such as bicycles. One sufferer was hoarding so much junk, the only access to the house was a 30-centimetre gap at the top of the front door.
But for Allie Jalbert, of the RSPCA, the most distressing hoarders are those who keep scores of cats and dogs, all battling for attention and food on a crowded suburban block.
She has been calling for years to have hoarding classified as an illness in its own right to allow more people to receive treatment and put an end to the 100 per cent recidivism rate.
“Often, we find that hoarders might be treated for peripheral symptoms such as anxiety or depression, but their core problem, the hoarding, is not addressed. So once we have cleaned out the house, they reoffend, which is very, very frustrating for everyone involved,” Jalbert says.
Some people threatened suicide and had to be removed by police when faced with the prospect of giving up their animals or clutter.
“There’s a mixed bag of emotion when you deal with hoarders. Firstly, there is the concern for your personal safety but there is also a degree of empathy because often these people are quite emotional and attached to the animals. But it’s quite frustrating to see animals living in such horrific situations,” she says.
“I’ve seen bathtubs full of faeces and rubbish, sinks that no longer work, homes with no heating or cooling. Sometimes it’s quite an overwhelming experience.”
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Who develops the condition and why?
Some studies have shown that many hoarders have been brought up in households where chaos reigned. Some were neglected as children and witnessed pets being treated poorly.
Mogan accepts the aetiology is mostly unknown, but cites an Australian study that found sufferers reported failing to connect with their parents or growing up in households lacking emotional warmth.
“The lack of attachment causes them to become ambivalent about their identity and about other people. As a compensatory mechanism, they link with things, which they find more compelling, more predictable and dependable and less rejecting.”
But Grisham believes there is no real trigger, apart from children of hoarders being rewarded for saving things and getting punished for discarding. “Sometimes there is a traumatic head injury but those cases are very rare.”
The condition affects slightly more women than men but is found across all occupations, age groups and ethnicities. “And they are in relationships,” Mogan says. “Albeit strained ones.
“Some are going out to work, but they make sure no one comes to their house. They’re not agoraphobic. On the contrary, many hoarders go out a lot to escape. But their children’s lives can’t be normalised because they can never sit down for a meal or find space to do homework. It’s a real impost on the family experience.”
Mogan runs group therapy sessions in Melbourne and says that many patients do want to be cured.
“This condition is a disability and the source of quite a lot of human suffering and neglect. A lot of these people are quite relieved to get help.”
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ADHD Treatment: Behavior Therapy & Medication Seem To Positively Affect The Brain In The Same Way
(Information provided by The Wellcome Trust 1 April 2010)
Read the original research paper HERE (PDF)
Medication and behavioural interventions help children with attention deficit hyperactivity disorder (ADHD) better maintain attention and self-control by normalising activity in the same brain systems, according to research funded by the Wellcome Trust.
In a study published today in the journal ‘Biological Psychiatry’, researchers from the University of Nottingham show that medication has the most significant effect on brain function in children with ADHD, but this effect can be boosted by complementary use of rewards and incentives, which appear to mimic the effects of medication on brain systems.
ADHD is the most common mental health disorder in childhood, affecting around one in 20 children in the UK. Children with ADHD are excessively restless, impulsive and distractible, and experience difficulties at home and in school. Although no cure exists for the condition, symptoms can be reduced by a combination of medication and behaviour therapy.
Methylphenidate, a drug commonly used to treat ADHD, is believed to increase levels of dopamine in the brain. Dopamine is a chemical messenger associated with attention, learning and the brain’s reward and pleasure systems. This increase amplifies certain brain signals and can be measured using an electroencephalogram (EEG). Until now it has been unclear how rewards and incentives affect the brain, either with or without the additional use of medication.
To answer these questions, researchers at Nottingham’s Motivation, Inhibition and Development in ADHD Study (MIDAS) used EEG to measure brain activity while children played a simple game. They compared two particular markers of brain activity that relate to attention and impulsivity, and looked at how these were affected by medication and motivational incentives.
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The team worked with two groups of children aged nine to 15: one group of 28 children with ADHD and a control group of 28. The children played a computer game in which green aliens were randomly interspersed with less frequent black aliens, each appearing for a short interval. Their task was to ‘catch’ as many green aliens as possible, while avoiding catching black aliens. For each slow or missed response, they would lose one point; they would gain one point for each timely response.
In a test designed to study the effect of incentives, the reward for avoiding catching the black alien was increased to five points; a follow-up test replaced this reward with a five-point penalty for catching the wrong alien.
The researchers found that when given their usual dose of methylphenidate, children with ADHD performed significantly better at the tasks than when given no medication, with better attention and reduced impulsivity. Their brain activity appeared to normalise, becoming similar to that of the control group.
Similarly, motivational incentives also helped to normalise brain activity on the two EEG markers and improved attention and reduced impulsivity, though its effect was much smaller than that of medication.
“When the children were given rewards or penalties, their attention and self-control was much improved,” says Dr Maddie Groom, first author of the study. “We suspect that both medication and motivational incentives work by making a task more appealing, capturing the child’s attention and engaging his or her brain response control systems.”
Professor Chris Hollis, who led the study, believes the findings may help to reconcile the often-polarised debate between those who advocate either medication on the one hand, or psychological/behavioural therapy on the other.
“Although medication and behaviour therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their affect on the brain,” he says. “Both help normalise similar components of brain function and improve performance. What’s more, their effect
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is additive, meaning they can be more effective when used together.”
The researchers believe that the results lend support from neuroscience to current treatment guidelines
for ADHD as set out by the National Institute for Health and Clinical Excellence (NICE). These recommend that behavioural interventions, which have a smaller effect size, are appropriate for moderate ADHD, while medication, with its larger effect size, is added for severe ADHD.
Although the findings suggest that a combination of incentives and medication might work most effectively, and potentially enable children to take lower doses of medication, Professor Hollis believes more work is needed before the results can be applied to everyday clinical practice or classroom situations.
“The incentives and rewards in our study were immediate and consistent, but we know that children with ADHD respond disproportionately less well to delayed rewards,” he says. “This could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioural approaches using reinforcement and rewards may be less effective.”
Read the original research paper HERE (PDF)
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Asperger’s Syndrome on “Arthur”
Here’s a different look at Asperger’s as explained by Brain on the kids show Arthur!
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- “Parenthood”: Sex, Drugs, & Asperger’s (blisstree.com)
About Peter
Peter Brown BHMS (Hons) MPsychClin MAPS
I’m a Clinical Psychologist and have a private practice and consultancy in Brisbane Australia. I have 24 years experience in child, adult and family clinical psychology. I have a wonderful wife and three kids.
I am co-founder of Christian Wholeness Counselling Services.
I like researching issues of the brain & mind, reading and seeking out new books and resources for myself and my clients. I thought that others might be interested in some of what I have found also, hence this blog…
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