Psych Central Professional For mental health, psychiatric and psychological professionals. 2016-05-12T14:54:17Z Christine Hammond, MS, LMHC <![CDATA[Is Your Kid an Addict?]]> http://5.686 2016-05-12T14:54:17Z 2016-05-12T14:54:17Z AddictAccording to The National Center on Addiction and Substance Abuse, 4 out of every 25 people over the age of 12 have an addiction. When six addicts are put together, one of them will have a multiple addiction problems. This means that for every standard classroom size of 25, there are 4 middle/high school kids who are already an addict. This does not include those who will develop addiction in later years.

What is an addiction? According to the DSM-V, the word addiction is no longer clinically used. Rather, it has been replaced with Substance Use Disorder or Substance-Induced Disorder. Each individual substance (like alcohol) is further divided into use, intoxication or withdrawal with specific criterion for each.

Some common characteristics of a substance use disorder (addiction) include:

  • Having to take the substance (like drugs) in greater amounts to achieve the same desired effect (high).
  • Attempts to reduce the intake are unsuccessful for long periods of time.
  • A great deal of time, energy, money, thought, and/or effort is spent trying to obtain the substance.
  • There is a craving for the substance when not currently intoxicated.
  • Use of substance is causing impairment in relationships, work, school or community.
  • Leisure activities are given up to use substance.
  • Substance is used regardless of risks associated with it.
  • Substance is taken in spite of the consequences imposed by health, family, work or friends.
  • The tolerance for the substance has increased while the effects of the substance have decreased.

What are examples of addiction? The types of addiction can be divided into two main categories:

  1. A substance from outside the body that is put into the body which creates a physical and/or psychological dependence.
    1. Some examples include: food, prescription drugs, alcohol, inhalants, hallucinogens, caffeine, cannabis/THC, tobacco, opioids, sedatives, stimulants, chocolate, diuretics, muscle relaxants, MSG, solvents, and steroids.
  2. A behavior performed to release a chemical produced naturally by the body thereby creating a physical and/or psychological dependence.
    1. Some examples include: shopping, cutting, money, exercising, religion, working, gambling, playing video games, internet, sex, stealing, violence/criminal activities, perfectionism, starting fires, seeking approval/attention/affection, vomiting, drama/chaos, codependency, collecting/hording, bleach, daydreaming, fetishes, computers/television, lust, love, masturbation, cleaning, relationships, pleasure, high risk activities, phone/texting, power, therapy, and voyeurism.

What can be done? Confronting an addict can be a very tricky thing. Think of addiction as a sliding scale from 1 to 10 with one being slightly addicted to ten being constantly intoxicated. For a person with an addiction on a level five or higher, seek professional help in confronting the addict. For those below a five, lovingly confront them and express concern for their behavior.

Remember, an addict will lie about their addiction. The best way to gauge the intensity or severity of an addiction is to “follow the money.” Nearly all addictions require some sort of financial obligation so tracing where the money is spent and how much is spent is a good indication of how acute the has become. Next to that, follow the time. Large amounts of unaccountable time can indicate an addiction as well.

Christine Hammond is the award-winning author of The Exhausted Woman’s Handbook available from Amazon, Barnes & Noble and iBooks.

Sharie Stines, Psy.D <![CDATA[How to Fix Another Person]]> http://7.269 2016-05-12T13:18:20Z 2016-05-11T06:19:32Z How to Fix Another PersonDo you know people who believe that to help you means to fix you?  Are you one of those people?  In order to want to “fix” someone, we have to believe something is broken, and it’s very difficult to do this without believing that someone is flawed.  When you approach someone with solicitations of help, are you operating out of a misguided attempt to fix them?  If so, you will most likely bring more pain and conflict into your life as well as into the lives of those you are trying to help.

The fixer inevitably finds him or herself being misunderstood.  If you are the fixer, I’m sure your intentions are good; however, your efforts may not be quite appreciated by those you are trying to help.  There is a primary human nature law at work here.  People, in general, want their own free agency to decide who they want to be and what they want to do.  Any attempts at fixing someone else will be met with resistance, regardless of if our intentions are noble or not.

The best thing you can do to help someone else is to learn how to take care of and help yourself and to solve your own problems.  One of the areas you can work on is learning how to love another person with wisdom and without a critical or superior eye.  It is never a good place for you to be when you can see someone else’s problems and flaws more clearly than you can see your own.

Finding fault is really a product of fear, low self-worth, and anger.  We believe that by changing the other person we will eliminate the pain caused by our own negative emotions.  The end result of trying to fix someone else really causes further damage to the relationship.  To truly be of service to another person is to see beyond their fault to their need.  Many times we observe someone’s negative behavior without seeing beyond the behavior to the underlying need that is generating the behavior.  Rather than focusing on something within that other person that needs to be fixed, it is far more helpful and loving to focus on the person with love and acceptance.  We can become “safe people” around others, thus helping to create a healthy environment for people to feel safe in, so that they can face their own issues.

When we attempt to fix other people we do nothing to improve our own lives or the lives of those we are trying to fix.  Transformation in the lives of ourselves or others never occurs when we focus on what is wrong.  When people focus on their faults they never eliminate those faults.  When we focus on other people’s faults we become more critical, judgmental, and smug.  Our lives are influenced mostly by what we focus our attention on.  The best way to help others is by focusing on our own personal growth and self-care.  We are far more influential in helping others when we are accepting, encouraging, loving, and compassionate, rather than when we are fault-finding, condemning, smug and superior.

When we focus outside of ourselves for fulfillment we develop what’s called an external locus of control.  When we focus on fixing others, we are elevating ourselves at the expense of another, which gives us a false sense of security.  If you really want to help someone, begin by caring for the person and allowing him or her to feel safe with you while owning their own problem.  When you can offer a person caring acceptance they, in turn, will be open to seeing themselves for who they truly are without the need for defensiveness, denial, or cover-ups.  When people see us as critical and condemning they will feel ashamed and need to hide their flaws from our critical eye.  When people feel safe with us, with their flaws, they can begin the process of self-reflection, which is the best motivator for change.

Remember, the best way to help another person change is by who we are in the relationship.  Being influential in someone’s life involves encouragement, acceptance, teaching, role-modeling, conversations, listening, and sharing.  Being with someone in life is far more effective in helping that person than looking down at someone from a higher altitude of judgment.



Richards, J. (2001). How to Stop the Pain. New Kingsington, PA. Whitaker House

Christine Hammond, MS, LMHC <![CDATA[7 Ways Narcissists Retaliate Through Children]]> http://5.677 2016-05-10T16:45:40Z 2016-05-10T16:43:59Z children of narcissistsDivorcing a narcissist doesn’t solve everything. While the day-to-day distance can elevate the stress, anxiety, depression, and frustration of living with a narcissist, it doesn’t stop them from being narcissistic. The next party on the victimization list is often the children. But really, the narcissist is just using the children to attack the ex-spouse (ES). Here’s how:

  1. Projection – Ex-Narcissists (EN, this is not to say that the narcissist is no longer an ex, mearly that they are an ex-spouse as well) tells children that it is really the ES who is the narcissist. Any negative narcissistic traits are projected onto the ES, while the positive traits are preserved. For instance, an EN will claim the ES has no empathy and doesn’t understand what the children are feeling. However, the house they have is because of the EN’s achievements, not the joint effort of the prior marriage. It doesn’t matter what the truth is to the narcissist, it only matters how they can twist the truth to look superior.
  2. Unnecessary Generosity – When a narcissist can be recognized or admired for their generosity, they can be very lavish with gifting. This is usually done at random times so as to draw even greater amounts of attention. The recipient children in turn feed the EN’s ego with gratitude and feel a sense of obligation to be on the EN’s side. However, once the devotion has dried up, the EN becomes angry and sometimes takes the gift back. The EN will say, “The child never thanked me,” even when they did. This statement is said to elicit more praise, adoration, and keep the child committed to the EN.
  3. Excessive Discipline – On the opposite extreme of generosity is disproportionate discipline for minor infractions. The oscillating tactics of extravagant generosity verses excessive discipline keeps the child on edge. While the generosity inspires devotion (pulling the child in closer), the discipline sparks fear (pushing the child away). This mental abuse tactic is called push-pull. No doubt, this aggravates the ES who experienced and now despises witnessing it through the children. The EN knows this bothers the ES but does it anyway to maintain control of both the children and the ES.
  4. Dream Stealer – If the ES expressed a wish to take a European vacation, the EN will make it happen with the children and probably the new spouse. The EN will claim that the dream was their’s but it wasn’t. This tactic is done to show off to the ES. It also serves as a reminder that had they stayed, they too could be going on the trip. Of course, the ES won’t deny their children such a trip so they are forced to concede and let the children go. Any complaining by the ES comes off as sour grapes and only makes the EN look better. This is a checkmate maneuver.
  5. Gaslighting – A favorite line of the EN is, “That never happened, your mother/father (the ES) is making that up, they are crazy.” Without the filter of the ES present, the EN literally rewrites history and uses the push-pull tactic to cement the revision. When the ES protests the alteration, the EN blames the child for exaggerating. The confused child feels stuck between both parents, unsure which one to believe. This is a precursor to future anxiety issues in the child.
  6. Silent Treatment – Most ENs are talented in utilizing the silent treatment to get what they want by withholding love or affection. In a divorce situation, this tactic changes slightly. Now the EN will demand the ES contact them when the child is away from the EN. However, the EN will not do the same thing in return. When confronted, the EN makes excuses, blames the children, and deflects responsibility. Then the EN states the ES is just being demanding, controlling, manipulative, and overbearing. This silence is a constant reminder and fear that the ES has little to no control when the children are with the EN.
  7. Wrongful Punishment – When the EN becomes angry with the ES, the EN unjustly punishes the undeserving and unprotected children. This attack is so blatant that the ES and the children easily recognize it. But since the ES is out of reach of the EN, the EN goes after the closest target, the children. The children know they are being punished for the ES’s behavior. Sadly instead of becoming angry with the EN, the children become resentful of the ES for the lack of protection. This further alienates the ES from their kids.

Recognizing these seven ways can help an ES regain some amount of control over the situation. Better yet, having a therapist point out these methods to the children can prevent years of unnecessary anxiety.

Christine Hammond is the award-winning author of The Exhausted Woman’s Handbook available from Amazon, Barnes & Noble and iBooks.

Bret Moore, Psy.D. <![CDATA[Learn to Delegate & Live a Less Stressful and Anxious Life]]> 2016-05-12T13:20:56Z 2016-05-10T10:14:47Z Learn to Delegate & Live a Less Stressful and Anxious LifeClients present with anxiety for a lot of different reasons.  For some, it is basic genetics; they are predisposed to be anxious.  Others engage in patterns of negative self-talk and are prone to “catastrophizing” or over-generalizing. And some have been exposed to difficult life experiences that have reshaped an otherwise previously adaptive self and world view.

Anxiety is also caused, worsened, and maintained by stress.  And unfortunately, there is no shortage of stress in the daily lives of your patients.  Interspersed between the consistent, low-grade, wear you down over time type stress, your clients also experience days of fast-paced, unrelenting, and “sharp pain” aggravations.  One of the more common (and curable) aggravations is shouldering too many responsibilities.

Taking on too many family, work, school, or other life tasks is a common source of stress for many people.  When this occurs, people become overwhelmed. They start to feel helpless or hopeless.  Their aggravation levels increase, which leads to reduced work efficiency, relationship strife and a general sense of feeling that life is too much to handle.  That is why delegating tasks to others is a great way to reduce anxiety.

It is true that your client may worry about whether or not the person he or she assigns the task or tasks to gets the job done.  But, the stress associated with juggling numerous responsibilities throughout the day is less.  As a result, they are less stressed, more efficient and effectiv, and avoid the nagging thought of “how am I going to get everything done today?”

Below are a few delegation tips you can share with your clients to get them on the road to successful delegation.  If they follow each step in order, they are virtually guaranteed to gain better control of their anxiety and stress levels.

Tips on How to Better Delegate

  • Learn to let go.

    Help your client understand that he or she needs to let go of the notion that they are the only one who can do things correctly.  This is not about narcissistic tendencies or over-inflated self-esteem.  It is normal to want to manage things and not rely on others because we know we can usually trust ourselves.  But, help them see that the world is filled with lots of competent people that can be trusted.  Reassure them that they can trust those around them; people

  • Choose the right person and task.

    Before your client starts handing out responsibilities, help them figure out what they think they need to do versus what others can do for them.  For example, if a wife asking her husband to pick up their newborn from daycare will prompt a day long worry fest, then she should probably just go ahead and do it herself.  Instead, maybe she can ask him to pick up the dry cleaning.  This will relieve her burden and not cause too big of a problem if he forgets.  The goal is to let go of time intensive tasks that will have minimal consequences if they are not done while maintaining control of those responsibilities deemed to be highest priority.

  • Be clear and specific.

    It is an undeniable fact that people do better when they know exactly what is expected of them.  Therefore, when your client assigns a task to someone, make sure they are clear with the person on what they need done.  For example, instead of saying “can you help around the house tonight?” say “can you give Kaitlyn her bath, help Marie with her homework, make sure they have lunches packed for tomorrow and take the dog for a walk?” Avoid ambiguity as much as possible.  Remember, most people don’t have the power to read minds.  Keep it clear, simple and to the point.

  • Follow-up.

    There is no surefire better way to support someone in not completing a task than assigning a task and forgetting about it.  An important part of delegating responsibility is to follow-up and make sure the task is completed.  People are more likely to come through when they know someone is going to check on the final product.  Think about your work with your clients.  If you assign homework outside of sessions, and don’t ask about it, do they do it?  No, probably not.  The message you are sending is that what you have asked the person to do is not important enough for you to follow-up on it.  But, that does not mean you should badger or hound the person.  A friendly “were you able to do what I asked” will suffice.

*This article is based in part on a chapter in Dr. Moore’s book titled, “Taking Control of Anxiety: Small Steps for Getting the Best of Worry, Stress, and Fear.”

Edie Weinstein, MSW, LSW <![CDATA[Midwife at the End of Life]]> 2016-05-06T04:12:55Z 2016-05-08T10:12:30Z Praying In HospitalIn recent conversation with a long -time friend who has extensive background in hospice, ministry, massage, art and writing, we were exploring the idea of her being a death midwife who would be with someone when they pass. She has the compassion and necessary presence to be of comfort and support to those who are preparing to cross over from this incarnation to whatever awaits.

So many people, including therapists, have a difficult time handling death. It is the final frontier, a landscape of the unknown. If we are willing to examine our own beliefs about mortality, we are better able to serve our clients.

Stories from The Other Side

Even with the proliferation of books that speak on the subject written by those who say they have crossed that threshold and returned, fear and uncertainty remain.

One such is Proof of Heaven: A Neurosurgeon’s Near-Death Experience and Journey into the Afterlife by Eben Alexander, MD. Alexander succinctly describes the experience on November 10, 2008, when he fell into a comatose state, from which only a small percentage of people emerge. Seven days later, he returned, carrying memories that included meeting a deceased birth sister he had never known existed.

Another is The Toltec Art of Life and Death: A Story of Discovery, penned by don Miguel Ruiz; author of The Four Agreements. In 2002, he had a heart attack that placed him in a nine-week coma. He too emerged with a vision of what may exist on the other side of this life. His background in medicine and metaphysics were firmly in place at the time of this experience, so he was less inclined to be skeptical about what unfolded for him.

A third comes from the death defying experience of Anita Moorjani, Dying to Be Me: My Journey from Cancer, to Near Death, to True Healing. In this self-revelatory tale, Moorjani describes her four- year battle with the disease that ultimately led to organ failure. While in her own near death state, she comes to recognize the impact of her early conditioning on her health and when she returned to consciousness, she bewildered her medical team with her complete recovery and the stories she had to share about what she says transpired.

From a mainstream psychological perspective, these stories may seem incomprehensible. Consider that much which we now accept as possible in the realm of human understanding was once discounted as ‘ideas of reference’ and ‘magical thinking.’

Melvin Morse, M.D., is an Associate Professor of Pediatrics at the University of Washington. He has studied near-death experiences in children for 15 years and is the author of several excellent books on the subject: Closer to the LightTransformed by the LightParting Visions, as well as his most recent releaseWhere God Lives. His interest in the subject of what happens once the heart stops beating, was sparked by rescuing a young girl who was ‘dead’ for 19 minutes and when she was revived, she informed him “Don’t worry, Dr. Morse, heaven is fun!”

Death Doula:  Midwife at the End of Life

Dame Cicely Saunders a British physician was the founding mother of the hospice movement, which has long been the gold standard of care for those at the end of life. The origin of the word which is akin to ‘hospitality,’ harkens back to medieval times when it referenced a sense of shelter.

Dr. Saunders who had been treating patients since 1948 saw the need of palliative care for those who were facing their final days, as well as offering support for their loved ones who were on the journey with them.

In 1967, she created St. Christopher’s Hospice in London. It is a team approach that includes a physician, nurse, social worker, chaplain and aides.

Having experienced the services offered in the last months of my parents’ lives, I am moved by the dedication it takes to do this sacred work. With humor and grace, they interacted with us as a family, offering a safe place to laugh and cry, to reminisce and create new memories. Highly skilled and fully human all at once.

Consider the qualities you would want in a person who would be with you as you took your final breath:

  • Comfort with the idea of death.
  • Knowing when to speak and when to listen.
  • A witnessing presence.
  • Allowing your death to be peaceful.
  • Helping to create your environment as you would have it which might include music that soothes you, pictures that are comforting to look at, your treasured objects around you.
  • Culturally competent and knowledgeable about your personal beliefs about death.
  • Patience with the process.
  • Ability to be of support to your loved ones who may be struggling with their own feelings.
  • A sense of humor about all aspects of life, including death.
  • Knowledgeable about the stages that precede passing.
  • Nurturing touch.

I have also lost loved ones, including my husband, both parents and friends over the past few decades. Each experience has helped me to hone my skills and forced me to come face to face with the inevitability of death. My spiritual beliefs and training as both a social worker and ordained interfaith minister inform my view and make me sensitive to the needs of others who are grieving their losses, both in anticipation and in the aftermath.

I have been at the bedside of my husband, father and nursing home residents at the time of death and with a few others shortly prior. Each time was different and each one had a flavor as unique as the person experiencing it. As therapists, if we allow ourselves to be fully human and ride the waves of emotion that honors the preciousness of our own relationships and those we have with the population we serve, we will be more fully present to the reality that everyone is ‘on loan to us’.

Singer-songwriter Charley Thweatt offers a song called You Will Die Someday, with the moving line, “Take your time when you’re being with people. What’s another minute to you?” and “What matters is how we live.”

Those who hold vigil with people who are about to make their exit are offering sacred service equally as important as those who are present at the moment of our initial inhale.

An extensive list of resources is available for therapists and clients to assist in moving through what is both a profoundly beautiful and poignantly painful human experience with as much grace as possible.


Rev Sheri Heller, LCSW <![CDATA[The Termination Stage of Therapy]]> 2016-05-06T12:52:04Z 2016-05-07T10:13:17Z

Time To Say Goodbye“Promise me you’ll never forget me because if I thought you would, I’d never leave.”  — A.A. Milne

The need to move forward is an unwavering attribute in the grand scheme of human evolution and expansion. This natural directive requires a letting go of what was so as to venture forth in pursuit of subsequent relationships and experiences.

These endings, which coincide with onward momentum, can take on diverse meaning depending on circumstance and perspective. Literal or psychological deaths and losses can inspire deep grief, anxiety, a sense of completion, feelings of liberation or a developmentally significant rite of passage.

Similarly, this natural occurrence in the cycle of life outside the therapeutic milieu is also intrinsic to the process of psychotherapy.

The conclusion of the therapeutic process brings about the inevitability of separation and loss. Goals may have been reached. The client or the therapist might be moving to a new location. Or perhaps the client is bolting from frightening memories or feelings.

It could be as basic as a ‘bad fit’ or logistical issues around money and time. Questionable ethics may even come into play. The reasons are manifold, but what this article will delve into is the mutually agreed upon consummation of long-term dynamic psychotherapy and the process of termination.

A Complex Stage

Termination is a complex stage embodying reflective nostalgic dialogue and a poignant honoring of the profound interpersonal bond between therapist and client. The nature of the therapeutic alliance, the complexity of the work, in conjunction with the client and therapist’s respective histories largely determines the composition and timbre of the termination process.

Ideally it is a reparative process that could serve as a catalyst for invaluable growth.

As the emotional bond between client and therapist deepens, critical relational milestones may ensue.  For instance, the therapist’s steadfast and principled emotional investment in the client can help ameliorate poor object constancy.

Object constancy is the sustaining experience of others as predictable and available even when they are not immediately present.

For those who have avoidant attachment styles, the previously denied affective aspects of separation may become more accessible for processing.

Those with ambivalent attachment may feel ready to reclaim autonomy, having assimilated the therapeutic bond (Perls) as a good object.

Those with disorganized attachment templates may have constructed a cohesive narrative of their relational trauma and be able to adequately self-sooth and emotionally regulate, so as to safely navigate the vicissitudes of the termination process.

Relational Milestones

These relational milestones and core wounds are salient indicators of the termination trajectory and are instrumental in determining the duration and frame of the termination process. Ergo, during the termination phase, the integrity of the therapeutic bond may be most tested as past losses, unresolved grief and regressive impulses resurface.

Although the cathected secure base of the therapeutic bond (Bowlby) has provided the empathic attunement and humanity to subdue overwhelming fear, helplessness, disillusionment and aloneness, as with many of life’s endings feelings of sadness, anger, grief, rejection and/or abandonment may be aroused, particularly for those with histories of relational trauma.

Significantly, leaving treatment crystallizes the disposition of transference / counter-transference dynamics. The transference relationship can span an ample spectrum of affectively charged projections and judgments that may encompass idealization, love, envy, erotic fantasies, and hateful aggressive feelings.

Utilizing the transference and counter-transference phenomena to tease out and understand the projections, emotions, and symptoms ignited by separation, so as to understand how the unconscious and relational traumas shape the way in which loss and separation is perceived and handled, is fundamental to the termination process.

Naturally In facilitating, the therapist must grasp her own attachment style and relational predilections. Most essential, is that the therapist comprehend her emotional entanglement with the client and her inner experience, needs and wishes.  The convergence of the mental representations of the client’s transference and the therapist’s counter-transference is complex fertile ground for exploration, which can assist the client with thoughtfully identifying and managing the expectations and projections she brings to new relationships.

The closure of a therapeutic relationship entails an in-depth and emotionally profound analysis of attachment in all its multi-faceted dimensions.

It is an opportunity to assist the client with owning his accomplishments, share mutual gratitude, and revise maladaptive relational patterns. Optimally, it is a unique and rare summation of the inherent power of the therapist-client bond.

The therapeutic relationship, which serves as a template for healthy love, in a life replete with ruptured bonds, betrayal, deficits with object constancy and negative endings, is indeed an enduring reparative gift for both client and therapist.



Ronald Pies, MD <![CDATA[How Antipsychotic Medication May Save Lives]]> 2016-05-06T04:15:47Z 2016-05-06T12:42:58Z Pill MedicineOne way anti-psychiatry groups trivialize psychosis and marginalize psychiatry is by emphasizing the adverse effects of antipsychotic medications while denying or minimizing their benefits.1

To be sure, the well-recognized metabolic, neurological and cardiovascular risks associated with many antipsychotic medications must be taken very seriously.

Moreover, antipsychotics (APs) are often used when they are not needed; eg, for the treatment of anxiety disorders2; for “agitation” in nursing home patients; and for “acting out” in adolescent populations. (I spent many years as a psychopharmacology consultant trying to get doctors to reduce their over-reliance on antipsychotics.)

On the other hand, there is convincing evidence that in patients with chronic schizophrenia, APs play a crucial role in maintaining remission, averting relapse, improving quality of life, and—importantly—reducing overall mortality.3-5  

But even many psychiatrists may not realize that APs reduce the risk of suicide in patients with schizophrenia.

To back up a bit: an estimated 20% to 40% of those with schizophrenia attempt6—and 5% complete—suicide7—a risk at least 10 times that of the general public. Suicides are concentrated early in the illness course and are associated with a number of risk factors, ie:

“Risk factors with a strong association with later suicide included being young, male, and with a high level of education. Illness-related risk factors were important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide and co-morbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment.”8 [italics added].

This last point, of course, is crucial. Indeed, the authors, Hor and Taylor, add that,

“…efforts at prevention should. . .focus on optimizing adherence to medication, and possible earlier use of clozapine, as the only antipsychotic medication with demonstrated efficacy. . .  for the management of suicidality in schizophrenia.”8


Indeed, the first FDA-approved medication with an anti-suicide indication was clozapine for schizophrenia. The regulatory approval in 2003 was largely based on the International Suicide Prevention Trial (InterSePT), a randomized trial that compared clozapine with olanzapine in patients with schizophrenia and schizoaffective disorder who were at high risk for suicide. 9

Suicidal behavior (measured by suicide attempts, hospitalizations, and rescue interventions) was significantly decreased in patients treated with clozapine, which is associated with a substantially lower risk of suicide than any other antipsychotic.10

But while clozapine provides the best evidence of anti-suicidal properties in schizophrenia, there is accumulating evidence that antipsychotic medication in general is associated with decreased risk of suicide in this population.

For example, Tiihonen and colleagues11 performed an observational study of antipsychotic treatment in patients with schizophrenia and schizoaffective disorder (N= 2230, average length of follow-up =3.6 years). Excess mortality was seen mostly in patients not taking antipsychotic drugs, for whom the risk of suicide was high. There were 26 suicides in patients not taking antipsychotics compared with 1 in patients taking medication (adjusted relative risk 37.4).11

Consistent with these data, Herings and Erkins12 studied drug refill patterns in patients believed to have schizophrenia. They found a 4-fold increased risk for attempting suicide among patients who interrupted their use of olanzapine or risperidone for at least 30 days.

Recently, Tiihonen and associates13 carried out a large observational study (N=21,492) of patients with schizophrenia. The study found that antipsychotic use was associated with substantially lower overall mortality and very significantly reduced rates of completed suicide across the entire dosage range (low to moderate to high) when compared with no antipsychotic drug use (10% of the entire sample). Maximum anti-suicide benefit was seen with the higher antipsychotic doses.

Analysis of this study by Dr Bernard Carroll shows that for the group with no antipsychotic exposure, the suicide rate was 183 per 100,000 person years. In the medium-plus-high dosage AP groups, the combined rate fell to 129 suicides per 100,000 person years—roughly a 30% reduction from the no-medication group (B. Carroll MD, personal communication, 3/27/16).

Moreover, if we make the reasonable assumption that patients receiving the highest doses of AP were probably the most severely impaired—and thus, at highest risk for suicide—these findings are all the more impressive.

Of course, in non-randomized, observational studies, there is always the potential for “selection bias” and/or “reversed causality.” For example, it is possible that patients who become suicidal—for whatever reason—stop taking their antipsychotic, rather than becoming suicidal because they stopped the medication. However, the apparent dose-response seen in the Tiihonen et al data—ie, suicide rates declined as medication dose increased—plausibly suggests that medication was actually bringing down suicide rates.14

Multi-modal treatment

It would be incorrect to infer from this brief review that the optimal treatment of schizophrenia is simply a matter of giving patients antipsychotic medication.

Persons with schizophrenia have lives beyond their symptoms. They often require and benefit from a range of adjunctive psychosocial services, including assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management.15

But there is little question that, for patients suffering the chronic, debilitating symptoms of schizophrenia, antipsychotic medication is a critical component of treatment—and may literally be life-saving.

Sharie Stines, Psy.D <![CDATA[Obsessive Compulsive Personality Disorder Treatment]]> http://7.258 2016-05-06T01:17:34Z 2016-05-06T01:17:34Z meyouweObsessive Compulsive Personality Disorder (OCPD) is a psychopathology, defined as “a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.”  It is a very difficult personality to contend with.


There are a variety of therapies to use to address personality disorders. The one focused on for this article utilizes interpersonal psychology and FAP (Functional Analytical Psychotherapy), which involves using the relationship dynamics between the client and therapist as the catalyst for work and change.  The therapist uses the “transference” and “countertransference” experiences to treat the client.  In addition to this, the client implements certain cognitive behavior techniques into the process.

Once a trusting and cohesive therapeutic relationship has been established, the therapist must begin to identify the critical behaviors the OCPD person manifests.  These are those behaviors which are most troublesome in the patient’s personal life.  Identifying critical behaviors involves interviewing and observation on the part of therapist.  During therapy sessions the therapist asks the client to ascertain correlations between problems in the therapeutic relationships and similar problems in the “real world.”  The process can be daunting and may cause the client to feel attacked.  Having a strong therapeutic alliance is key to effective treatment.

Once the therapeutic relationship is established, together, therapist and client develop a list of critical behaviors that cause problems in the client’s relationships.  These particular types of behaviors can either be noticed during therapy sessions or can be self-reported by the client.  To explain what a critical behavior is, here is a sample of what a list of them would look like:

  • Intellectualizing difficult topics
  • Acting and speaking as if he/she is perfect
  • Blaming others for life’s difficulties
  • Placing demands and expectations on others

Of course this list is not exhaustive.  Use it as a sample to begin with.  Once items are noted, the therapist and client identify and discuss the antecedents, or triggers to problem behaviors.  It is important to note that people with personality disorders have very little insight, and so, identifying personal triggers, feelings and emotions will be difficult.  It is important to validate the client’s experience of difficultly and to try and be patient with the results. People with personality disorders display the following characteristics:  rigidity, blame of others, and lack of insight.  Be aware of these traits and realize that these are as difficult to contend with in therapy as they are in real life.

Along with identifying negative critical behaviors, the therapist should also identify positive critical behaviors. These are behaviors to encourage. Following, is a sample of positive critical behaviors:

  • Inquiring about other people’s feelings and thoughts
  • Showing empathy
  • Listening intently and showing interest
  • Sharing vulnerable thoughts and emotions
  • Asking for help

As with the other list, this is not exhaustive. In order for change to occur, the therapist will teach and reinforce these positive critical behaviors to the client.  The process of healing is in vivo, which means that it happens in the session.  In summary, the steps for treating OCPD using the interpersonal relationship of the therapist and techniques from FAP are:

  1. Develop a close and trustworthy relationship with client.
  2. Identify critical behaviors – both “good” and “bad.”
  3. Teach and encourage healthy critical behaviors to client by education and reinforcement.
  4. Continuously repair relationship disruptions.

Because personality disorders involve problems in interpersonal relationships, the relationship between therapist and client is paramount in treating these disorders. While a therapeutic alliance is necessary for treatment, it is difficult to both establish and maintain with a person with OCPD. Disruptions are expected and should be repaired. Actually, disruptions and repairs in the therapeutic relationship can be a “corrective experience” to disconfirm maladaptive schemas.

The primary goal in treating OCPD is to lessen the person’s rigid expectations and learn how to value close relationships, recreation, and fun, with less of an emphasis on work and productivity.


International OCD Foundation. (2010). Retrieved from:

Manduchi, K., Schoendorff, B. (2012). First steps in FAP: Experiences of beginning Functional Analytic Psychotherapy therapist with an obsessive-compulsive personality disorder client. International Journal of Behavioral Consultation and Therapy, 7(2-3), 2012. Special Issue: Functional Analytic Psychotherapy. pp. 72-77.

Samuel, D. Widiger, T (2011). Conscientiousness and obsessive-compulsive personality disorder. Personality Disorders: Theory, Research, and Treatment, 2(3), Jul, 2011. pp. 161-174.

Strauss, J. L., Hayes, A. M., Newman, C. F., Brown, G. K., Barber, J. P., Laurenceau, J., (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2), 2006. pp. 337-345.

Christine Hammond, MS, LMHC <![CDATA[Five Things to do Today When in a Relationship with a Narcissist]]> http://5.671 2016-05-05T12:39:58Z 2016-05-05T12:39:58Z tribblesIt’s hard to avoid narcissists. They seem to be everywhere, multiplying in great numbers. It reminds me of the old Star Trek episode with the Tribbles who reproduced at such a rapid rate that the ship was in danger of being overtaken in a matter of days. At first the Tribbles were cute to watch but then they became threatening. And so it is with narcissism.

What can a person do to counteract this perilous environment? Here are five things a person can do today:

  1. Guard self-talk. The innately persistent and persuasive nature of a narcissist allows them to effortlessly influence others. Unfortunately, some of the narcissistic talk is negative attacks designed to intimidate others into an inferior position to their superior one.
    1. Solution: To counteract the effects, a person must guard their self-talk especially if it mirrors anything the narcissist has declared about the person. Of every negative thought, ask: “Where did this come from? Who does this sound like?” Anything that resembles a narcissistic statement must be immediately discarded and replace with positive self-talk. Remember, their perception is not accurate.
  2. Don’t compare. A favorite abusive tactic of narcissists is to compare their accomplishments with others. Of course, they exaggerate their success far beyond what is accurate to demonstrate their superiority. At the same time, they minimize other’s accomplishments to further widen the gap of difference.
    1. Solution: There are two points of advice to handle this situation: don’t point out the inaccuracies and don’t internalize the comparison. First, don’t waste time arguing or refuting the inaccurate perception of the narcissist. This will only result in a heated or volatile situation. A narcissist will not admit they might be wrong even when the evidence is clear. Second, it is not unusual for a person to absorb the comparison and place themselves in the inferior position. Because neither position is accurate, there is no reason to segregate. There are many paths to success beyond what the narcissist declares.
  3. Reset boundaries. Narcissists are famous for setting ridiculous boundaries or limitations on others while refusing to accept any. They believe that the rules are for other people who need such guidance, not them. As a result, they tend to have unrealistic expectations of what others should and should not do.
    1. Solution: A person needs to filter each expectation, limitation or boundary a narcissist places on them to see if it is fair, realistic, or practical. Ask: “Is this a standard that I would place on someone else? How does this rule make me feel?” If the answers are: “No and angry,” then reset the standard to a more reasonable level. The new level does not need to be immediately communicated with the narcissist; again this would just incite an argument. Rather, get comfortable with the standard first and then if needed communicate later after evidence has been gathered to demonstrate that this is a more sensible approach.
  4. Do right. Ethics and morality at the hands of a narcissist are colored by what works for them in the moment. Even religious narcissists tend to have one set of standards for them and another for everyone else. When caught doing something wrong, the narcissist uses blame, justification and minimization to dismiss any concerns.
    1. Solution: Don’t follow their immoral or unethical lead. Instead have a set of standards that are guiding principles for how to live a principled life. Refuse to do what is wrong, indecent, improper, or dishonorable regardless of the consequences the narcissist has imposed. There is always a choice to be made in every difficult circumstance and choosing to do what is virtuous will bring far greater satisfaction then the opposite.
  5. Take responsibility. A narcissist will not take responsibility for their actions, words, behavior, or reactions. Everything is about shifting blame to someone else or dumping their duties onto others so they don’t have to be held accountable. However, narcissists will say that they are the most responsible person they know and that is usually because they have taken credit for things they did not accomplish.
    1. Solution: Be different from the narcissist. When a person makes an error in judgement or behavior, be willing to take responsibility for the mistake and accept the consequences. Do not however, accept responsibility for a narcissist’s mistake no matter how much they try to be convincing that it is not their fault.

Relationships with narcissists require an enormous amount of self-control to keep all of these things in check. At first, this is hard to do but with time, energy and effort, all five of these items become easier.


Christine Hammond is the award-winning author of The Exhausted Woman’s Handbook available from Amazon, Barnes & Noble and iBooks.

Edie Weinstein, MSW, LSW <![CDATA[Why is it Important for Therapists to Walk Their Talk?]]> 2016-05-03T17:23:22Z 2016-05-05T10:23:01Z therapists walk their talkAs clinicians who sit in offices with clients who are experiencing emotional pain and turmoil, we are called on to offer solace and support, guidance and ideas for making positive change.

They look to us for answers that they have not been able to bring forth on their own.

There are times when the expectation is that we glue together what they perceive as the shattered fragments of their lives. Choices made unconsciously or by habit have led to addiction, relationship fragmentation, job loss, as well as estrangement from family and friends.

Combined with multiple mental health diagnoses that may be at the core of their chaos, they frequent inpatient and outpatient services at growing rates.

“According to SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH) (PDF | 3.4 MB) an estimated 43.6 million (18.1%) Americans ages 18 and up experienced some form of mental illness. In the past year, 20.2 million adults (8.4%) had a substance use disorder. Of these, 7.9 million people had both a mental disorder and substance use disorder, also known as co-occurring mental and substance use disorders.”

Wisdom Gained in the Trenches

When this now seasoned therapist dipped her toes in the waters of inpatient acute care psychiatric treatment, her supervisor reminded her that she was just naïve and caring enough to be ‘sucked in’ by the needs of the patients who were admitted in crises; some by choice, others by involuntary commitment.

When he saw that she was crossing the line into enabling, he would walk past her with an imaginary straw and slurping as if sucking in liquid. Laughing, she would roll her eyes and recognize her pattern.

In yet another psychiatric setting, a long time nurse cautioned, “If you are doing more for them than they are doing for themselves, there is something wrong with this mix.”

Although this guidance is sound, it sometimes slips from the mind like so much water from between clenched fingers. A few years after leaving the hospital setting for an outpatient substance abuse practice, she was facilitating a support group for women in recovery that met each Wednesday evening. One year, it fell on New Years’ Day. She offered to the participants that she would hold the meeting, rather than forgo it since it was a holiday, telling them that if they were committed enough to be there, she would as well.

Out of the 10 women who regularly attended, five showed up. Since it was a fee for service group, she was understandably frustrated with that outcome. The next year, she made the choice to cancel the group on the holiday, rather than engage in the all too common in this field inclination to go above and beyond the call of duty.

Vicarious Traumatization Hits Home

An occupational hazard is known as vicarious traumatization  or secondary trauma and reflects the dynamic of taking on the pain and suffering of others such that it actually feels as if the therapist is experiencing the same symptomology.

Listening for hours at a time each day, to stories of trauma and loss, while holding space for the client to safely express their feelings, can take its toll on the clinician.

In the lives of clients, Post -Traumatic Stress Disorder (PTSD) can emerge as a result of a number of excessively distressing incidents, from being in a war zone to sexual assault. According to the Diagnostic and Statistical Manual, 5th edition (DSM-5), to be diagnosed with PTSD, a person must have experienced or witnessed a traumatic, physically threatening event or have learned that a traumatic event happened to a close friend or family member, and display specific symptoms for at least one month. Four types of symptoms are listed in the DSM-5:

  • Avoidance Symptoms:

Avoiding specific locations, sights, situations, and sounds that serve as reminders of the event

Anxiety, depression, numbness, or guilt

  • Re-experiencing Symptoms:

Intrusive thoughts, nightmares, or flashbacks

  • Hyperarousal Symptoms:

Anger, irritability, and hypervigilance

Aggressive, reckless behavior, including self-harm

Sleep disturbances

  • Negative Mood and Cognition Symptoms:

Loss of interest in activities that were once considered enjoyable

Difficulty remembering details of the distressing event

Change in habits or behavior since the trauma

Once the session is over, the therapist’s work continues in the form of documentation, scheduling, billing and utilization review. Often, there is no time to regroup before the next person walks in the door. Shifting gears mentally and emotionally to greet the new client may need to happen in the blink of an eye.

It is not uncommon for the professional to work in excess of 12 hour days and when they head for home, sometimes find their clients ‘accompanying’ them in their minds.

Despite being consciously aware that she was not responsible for the choices her clients made, a therapist who had worked in the mental health field for several decades, would find herself persistently thinking about interventions she could offer to prevent them from making destructive decisions. It, among other factors, was a contributing factor to serious health problems that she encountered.

Christine Hammond, MS, LMHC <![CDATA[Difference between Obsessive Compulsive Personality Disorder and Obsessive Compulsive Disorder]]> http://5.665 2016-05-05T12:38:00Z 2016-05-04T13:44:55Z OCPD and OCDIt is amazing the difference one word can make. Add the word “Personality” to Obsessive Compulsive Disorder (OCD) and it changes the definition and classification. There are some similarities such as obsessive and compulsive traits, thoughts and actions. However the underlying disorder is extremely different.

Here is the DSM-V definition of both:

Obsessive Compulsive Personality Disorder (OCPD) is classified as a type of personality disorder:

  • A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
  • Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
  • Is unable to discard worn-out or worthless objects even when they have no sentimental value
  • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
  • Shows significant rigidity and stubbornness

Obsessive Compulsive Disorder (OCD) is classified as a type of obsessive compulsive related disorder:

  • Presence of obsessions, compulsions, or both:
    • Obsessions are defined by:
      • Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
      • The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action.
    • Compulsions are defined by:
      • Repetitive behaviors (hand washing) or mental acts (counting) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
      • The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
    • The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The similarities are:

  • Both can create significant relational issues and make it difficult to interact with others.
  • Both have intense, obsessive, and racing thoughts that are difficult to manage or prevent.
  • Both develop internal rules to be strictly followed in an effort to reduce stress or anxiety.
  • Both do compulsive behaviors to self-sooth such as hording or excessive cleaning.
  • Both have extremely high expectations of self to the point of requiring perfectionism.
  • Both can have “meltdowns” if a compulsion is not followed or their image is tarnished.

The big differences are:

  • OCPD can be seen in every environment and is pervasive whereas OCD is usually isolated to a few specific things or locations.
  • OCD is a learned behavior usually done as a way of coping with extreme stress whereas OCPD is part biological and part environmental beginning in early childhood and continuing through out adulthood.
  • A person may change OCD behaviors as they age whereas OCPD behaviors cannot be changed without significant effort and therapy.
  • OCD behaviors can cause significant impairment at work whereas OCPD behaviors are usually praised at work because of their strong devotion to it.
  • OCD behaviors are frequently done out of fear to avoid an undesirable outcome whereas OCPD behaviors are done out of fear of not living up to internal perfectionist expectations.
  • By outward appearance alone, it is difficult to identify an OCD person whereas OCPD persons are usually extremely well groomed, dress impeccably, and are very aware of the perfectionist image they portray.
  • OCD people know their behaviors or fears tend to be irrational whereas OCPD people believe their thinking is more correct than others and have a difficult time accepting the idea that their reasoning might be inaccurate.

The good news about both disorders is that they tend to do very well with therapy and the prognosis can be quite good.

Christine Hammond is the award-winning author of The Exhausted Woman’s Handbook available from Amazon, Barnes & Noble and iBooks.

Susan Gonsalves <![CDATA[Recovery Programs: Empathy as a Necessary Tool]]> 2016-05-02T20:09:30Z 2016-05-04T10:57:45Z recovery programs and empathyRecovery can be defined as a return to a normal state of mind, strength or health[i], which indicates that the focus of recovery programs should be on a return to the normal, or original state, prior to the onset of a mental illness.  With the recent popularization of neuroplastic change[ii] recovery has become more feasible, and realistic.

Michael Kirby declares that: “recovery requires appropriate patient support, including peer-to-peer support, family or caregiver support, community interventions and supportive housing programs [iii],” and should be focused on assisting patients solve their problems on their own, instead of solving the problems for them iii.

This concept mirrors Rogers’ client-centered approach, whereby, clients are drawn to the conclusions on their own, with the support of the therapist. This is done through empathy and unconditional positive regard, two components that play a major role in recovery programs.

Empathy is one of the strongest emotions a client can be offered. It demonstrates to them that we are truly listening to, and hearing what they are saying, and that we are trying our best to understand their situation. It is an admission that we will never know fully what they are going through, but that we acknowledge the difficulty they are facing, and that we are there for them in times of need.

Unconditional positive regard [iv] acts as a way to build confidence in the client; it says that we accept them as a positive and good person, no matter the circumstance. This does not mean that we accept negative behavior as positive or that we encourage it, but that we accept the person as a wholly positive being, whose behavior may be negative from time to time – just like everyone else.

I have found that these two components play a significant role in a clients understanding of their self within a therapeutic setting, and translate well into their lives outside of therapy, counseling, etc.

Unconditional Positive Regard

By employing both empathy and unconditional positive regard, we are actually building the clients confidence so that outside of therapy sessions, they will be more able to cope, and deal with new negative and stressful situations they may face.

In my experience, when I have offered clients my empathy, and unconditional positive regard, they have reacted in a much more positive way, and have ended up recovering from the emotional crisis much quicker than they otherwise would have.

Further, empathy and unconditional positive regard work together in strengthening the client-therapist relationship, or therapeutic alliance (therapist, confidant, counselor etc), which only has positive effects on the client receiving care. This too, builds the client’s confidence, and ability to cope because it demonstrates to them that they are able to confide in someone without being judged – even their deepest, darkest secrets.

How does all of this translate to recovery programs? Recovery programs are similar to traditional therapy in that they are meant to assist clients in facing and coping with their issues or crises.

These programs may be more structured than traditional therapy (for instance, psychoanalytic therapy does not focus, necessarily, on re-framing a persons mind, whereas cognitive behavioral therapy, or CBT, does).

If we are following from Kirby’s iii understanding of recovery, then most programs use CBT’s methodology. For instance, WRAP[v] is a self-maintenance program that focuses on dealing with issues (for the sake of this article we will focus solely on mental health issues). The 5 key recovery concepts that are listed are: hope, personal responsibility, education, self-advocacy and support.


As you can see, empathy is not mentioned as a key recovery concept. Although it could be argued that empathy is included in one of the 5 key concepts, it should be its own, and should be a major focus area in any recovery program – whether it be peer or self led.

Rogers has shown us that empathy proves very powerful when assisting a client iv so we should be employing it in every therapy-based situation we find ourselves in, including recovery programs. In recovery programs the focus is, of course, the client, (the focus should always be the client) and empathy can only encourage and support the client even more.

Patricia Deegan conceptualizes recovery perfectly in her article “Recovery: The Lived Experience of Rehabilitation.”

She says: “they experience themselves as recovering a new sense of self and of purpose within and beyond the limits of the disability[vi].” This can be achieved through finding support, and encouragement in your peers, mental health professionals, and community – which will undoubtedly translate into your personal understanding and conceptualization of your self.

The encouragement and support given to you by your peers, for example, is empathetic. They attempt to understand your troubles and acknowledge that you are important enough that they do not meddle. Although we are there to assist clients, and we are there to aid in their recovery, we acknowledge that we are powerless in these situations, and the reason for this is because our power is relinquished, and given to our clients. Because in recovery, the only power we have is through our empathy and understanding.

[i] Recovery. (n.d). In Oxford Dictionaries online. Retrieved from

[ii] Doidge, Norman. (2007). The Brain that Changes Itself. New York, NY: Viking Press.

Doidge, Norman. (2015). The Brain’s Way of Healing. New York: NY: Viking Press.

[iii] Kirby, M. (2008). Mental Health in Canada: out of the shadows forever. CMAJ, 178 (10) pp. 1320-1322.

[iv] Rogers, Carl. (1951). Client-Centered Therapy: Its Current Practice, Implications and Theory. London: Constable. ISBN 1-84119-840-4.

Rogers, Carl. (1959). A Theory of Therapy, Personality and Interpersonal Relationships as Developed in the Client-centered Framework. In (ed.) S. Koch,Psychology: A Study of a Science. Vol. 3: Formulations of the Person and the Social Context. New York: McGraw Hill

[v] Copeland, M. E. (1995). WRAP is…Retrieved from

[vi] Deegan, P. E. (1988). Recovery: The Lived Experience of Rehabilitation. Psychosocial Rehabilitation Journal 11 (4), 1119.

Nikki Zalewski/Bigstock

Susan Gonsalves <![CDATA[After the Death of Dr. Rose Polge: Who has a Duty of Care to Doctors?]]> 2016-05-02T17:43:02Z 2016-05-03T10:41:46Z the death of Dr. Rose PolgeThe UK media are reporting that a body found at the seaside in Dorset has been formally identified as that of missing junior doctor Rose Polge. The press had stated that when she first went missing she may have written a note that mentioned Health Secretary Jeremy Hunt.

Jeremy Hunt, the UK Minister for Health is currently locked in a battle with the British Medical Association – the ‘doctors’ union’ – over proposed changes to the doctors’ contract with the National Health Service.

Among many reasons the medical profession is resisting these proposals is doctors argue these changes will make their lives even more stressful just as working conditions for physicians in the UK become ever more impossible.

The family Of Dr. Rose Polge has requested their privacy at this very difficult time.

Speculation as to what happened would be inappropriate. But it is inevitable that this kind of tragedy draws attention to the stress junior doctors are under and their campaign over working conditions.

A study published in the Journal of Epidemiology and Community Health entitled, “Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995,” found that the suicide rate in female doctors was higher than in the general population, whereas the rate in male doctors was less than that of the general population.

This investigation, by a team led by Professor Keith Hawton, from the University of Oxford found the difference between the mortality ratios of the female and male doctors was statistically significant. There were also significant differences between specialty with community health doctors, general practitioners and psychiatrists having significantly increased rates compared with doctors in general hospital medicine.

Keith Hawton, Aslog Malmberg and Sue Simkin from the Centre for Suicide Research, Department of Psychiatry, University of Oxford, published a study in 2004 that remains one of the largest psychological investigations into suicide in doctors.

Psychological Autopsy

The authors describe their research as a “psychological autopsy study,” of 38 working doctors who died by suicide in England and Wales between January 1991 and December 1993. Most of the deaths appeared to have been planned and two thirds of doctors had left a suicide note, while a third were known to have spoken of suicide before their deaths, most within the week beforehand.

Twenty-five of the doctors had significant problems related to work, 14 had relationship predicaments and 10 had financial difficulties.

Given the current working atmosphere in the NHS, it is particularly interesting that the study found most doctors had significant problems at work. Seven were facing complaints, which in five cases appeared to have been a key factor leading to suicide. Most of these doctors were also facing other difficulties at work or home.

Other common professional problems included feeling overloaded by the volume of work, long hours and struggling with the responsibility of the job.

The study, “Suicide in doctors: a psychological autopsy study,” was published in the Journal of Psychosomatic Research’. It investigated 28 men and 10 women.  44% were under 35. 47% were married, 29% single and 10% divorced or separated. Of 25 who worked for the NHS, 15 were consultants or principals in general practice and 10 were junior staff. Twelve worked in general practice.

The pattern of diagnoses was similar to other studies, but with lower rates of psychotic illness and personality disorder, as would be expected, the authors of the study contend, in such a professional group.

The authors argue that physicians, in general, tend to minimize their own health problems, often fail to seek suitable help, do not take time off work and distrust occupational health services.

The doctors in this sample, the authors explain, reflected this pattern. They were less likely to have consulted their GPs shortly before death than people in other population-based studies of suicide.

A surprisingly high proportion, the authors say, had received treatment for depression compared with subjects in other studies. However, their probable ability to conceal the profundity of their hopelessness and suicidal drive from others might explain why so few had been admitted to hospital or seen by their GPs before death.

The authors of the study conclude that the impact of complaints, overwork and burden of administration on some of the doctors studied is of great concern. Given the study was done in 2004, David Casey and Kartina Choong from the University of Central Lancashire, in their more recent investigation of doctor’s suicides, quote a report issued by the Royal College of Physicians in 2012.

This demonstrated that there were one-third fewer acute trust beds than 25 years ago yet a 37% increase in hospital admissions over the last 10 years.

Under More Pressure?

David Casey and Kartina Choong’s study cites evidence that 75% of medical consultants reported being under more pressure than three years ago and 25% of medical registrars reported their workload as unmanageable.

Robyn Brickel, MA, LMFT <![CDATA[Substance Use and the Teenage Mind: A New Look at Treating Adolescents in Therapy]]> 2016-05-02T17:37:14Z 2016-05-02T05:40:16Z substance abuse and the teenage mindAdolescence arrives with a surge of emotional energy.  It can empower youth to expand their capabilities, make new friends, depend less on parents, and live more passionately.  The influence of parents remains important in a child’s life, and is necessary to support teens in making good choices.

Adolescence is also a time when some teens look to experience alcohol or drugs (such as heroine, cocaine, marijuana and prescription medicine, among other substances). All too often, tragic results follow.

As therapists, how can we help more teens and families avoid or repair the damage and danger of substance abuse?  What can we know about adolescent development to better understand the needs, risk factors and vulnerabilities at this life stage, and respond effectively?

Adolescence Spans More Years Than Most People Realize

Adolescence starts at about age 11 in girls, 12 1/2 in boys, and continues into a person’s mid-twenties. Neuroscience tells us that the brain changes dramatically during this time and does not fully develop until age 27.

Brain remodeling refers to the process of physical and neurological transformation. Excess neurons that formed during childhood die off naturally — a process of synaptic pruning.  A performance-enhancing sheath (myelin) grows along the remaining active neurons — a change called myelination. The myelin sheath allows impulses to flow up to 3000 times faster along the brain’s circuits. The brain becomes more specialized, efficient and more integrated.

New Thoughts, Feelings and Vulnerabilities Emerge

We also know that new ways of thinking, feeling and behaving appear — sometimes dramatically — during this time. Four qualities emerge with adolescence: “Novelty seeking, social engagement, increased emotional intensity and creative exploration,” says Daniel Siegel in his book Brainstorm: The Power and Purpose of the Teenage Brain.

These qualities inspire many young people to do amazing and wonderful things. However, without the benefit of healthy attachments, these drives can also misguide others toward dangerous, high-risk, even deadly behavior.

How vulnerable are adolescents to risky and dangerous substance use behaviors?  The numbers are staggering.  While they do not predict the risk for any one person, they reveal unmet needs for education and appropriate guidance for adolescents:

  • One in five youth between the ages of 12 and 17 in the US have an abusive/dependent or problematic use of illicit drugs or alcohol
  • Alcohol poisoning and related incidents cause 4,358 deaths each year for youth under age 21, and lead to emergency-room injuries for another 190,000 people in this age group each year (NIAA, Underage Drinking)
  • Over 27% of 8th, 10th and 12th graders in the US report past-year use of an illicit drug other than alcohol (NIDA DrugFacts, December 2014)
  • After marijuana, prescription and over the counter medications account for most illegal drug use by 12th graders in 2013
  • Underage drinking accounts for 11% of all alcohol consumed in the US, 90% of which is consumed in binge drinking (CDC Fact Sheets – Underage Drinking)
  • Youth who drink or use drugs are more likely to become victims of sexual or physical assault
  • The average onset of first use of drugs or alcohol for boys is 12, for girls it is 12 1/2
  • For those who began consuming alcohol by age 15, 47% experienced alcohol dependence later in life, compared to 9% who began at age 21 or older (NCADD FAQ)

Adolescents make decisions, choose behavior and experience consequences differently than adults do. It can be very perplexing for adults to look on and try to make sense of a young person’s journey.

Heather Gilmore, MSW, LLMSW, BCBA <![CDATA[Natural Teaching or DTT in ABA (Applied Behavior Analysis)?]]> http://3.636 2016-04-30T18:20:20Z 2016-04-30T18:20:20Z

When providing applied behavior analysis services to children with autism spectrum disorder, it is so important to provide intervention that is based on scientific research, intervention that is the most likely to be effective and that is also least intrusive to the individual client.

In practice, applied behavior analysis can look different based upon of course the child, but also based upon the behavior analyst’s preferences, training, clinical judgment, and ability to modify their approach based upon research findings.

Applied behavior analysis is often perceived as only representing “discrete trial training” (DTT). DTT is an intervention that incorporates fast-paced learning trials most often occurring at a desk or table. The idea is that with the frequent repetition and practice (with the use of behavioral principles such as positive reinforcement) that the child will learn new skills.

Another ABA approach is natural teaching. This approach relates more to teaching during the activities that the child would “naturally” participate in, such as while playing with toys. In particular, one specific form of natural teaching is called Pivotal Response Treatment.

Here’s a summary of a research study that was conducted to compare the two approaches in ABA.

Title of Study: Pivotal response treatment for children with autism spectrum disorders: A systematic review.


Accumulating studies are documenting specific motivational variables that, when combined into a naturalistic teaching paradigm, can positively influence the effectiveness of interventions for children with autism spectrum disorder (ASD). The purpose of this study was to compare two applied behavior analysis (ABA) intervention procedures, a naturalistic approach, pivotal response treatment (PRT) with a structured ABA approach in a school setting. A randomized clinical trial design using two groups of children, matched according to age, sex and mean length of utterance was used to compare the interventions. The data showed that the PRT approach was significantly more effective in improving targeted and untargeted areas after 3 months of intervention. The results are discussed in terms of variables that produce more rapid improvements in communication for children with ASD.

This is one of the many studies that support the use of natural teaching strategies. DTT can also be effective. However, as Mohammadzaheri, et. al. note, there can be side effects that come with the use of DTT (or more highly structured interventions). For instance, these approaches may have the following issues:

“(a) gains are extremely slow (often requiring many thousands of trials to teach a single word);

(b) when gains occur they often do not generalize; and

(c) the children typically are often unmotivated to be involved in the teaching sessions, frequently exhibiting escape-motivated disruptive behaviors (Koegel, et al. 1998)”

One of the highlights of this study was the higher rates of improvements in social communication skills that occurred in the PRT group. Since communication deficits are a defining characteristic of autism spectrum disorder, this study provides support for the use of natural teaching strategies, especially Pivotal Response Treatment (PRT), to improve this skill area.


Koegel, R. L., Camarata, S., Koegel, L. K., Ben-Tall, A., & Smith, A. E. (1998). Increasing speech intelligibility in children with autism. Journal of Autism and Developmental Disorders, 28(3), 241–251.

Mohammadzaheri, F., Koegel, L. K., Rezaee, M., & Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism. Journal of Autism and Developmental Disorders, 44(11), 2769-77. doi:

image credit: moodboard Premium via Fotalia

Steve Greenman, MA, LPC, NCC <![CDATA[More Research Than Practice in Problem Solving Consultation?]]> 2016-04-30T17:48:41Z 2016-04-30T17:46:29Z more research than practice in problem solving consultation?

“Man is a game playing animal and a computer is another way to play games” -Scott Adams  

Markeda Newell (2010) in his article entitled “Exploring the Use of Computer Simulation to Evaluate the Implementation of Problem-Solving Consultation”  brings up the concern that problem solving consultation research has proliferated over the last 20 years but there is a severe lack of evidence in the use of this research by front line school psychologists.

Kratochwill, Sladeczek and Plunge (1995) in their article entitled, “The Evolution of Behavior Consultation” state that there are “more advances in research and theory than in actual implementation of consultation in practice.

One is left to wonder what questions are being used in consultation and even more importantly if the questions are the right ones” (p. 146).

Newell (2010) shares that three themes emerged from data analysis and interviews from the school psychologists that participated in this qualitative case study:

  • use of behavioral approach to problem conceptualization
  • individualized approach to intervention design
  • minimal attention to plan evaluation.

The Divide

Newell found the latter three points disturbing and shares that the divide between current research data and practice techniques used in the field may be to blame.

Gutkin (2002) shares that there is an inability to make comparative or summative analyses about consultation outcomes because different people are doing different things, which fosters uncertainty about whether consultants implement the process effectively.

Newell (2010) shares Gutkin’s premise and believes answers may come from inventive new ways to collect data (computer simulation) and that “qualitative inquiry into the consultation process can lead to better understanding of the implementation and outcomes of problem solving consultation” (p. 229).

Critical Analysis

Newell (2010) states that one of the major challenges in conducting a qualitative consultation research study in current practice settings is not being able to get a picture of the whole process that school psychologists use in creating an evaluation and implementing a support plan for their clients.

Simulation to Newell represents a midpoint between “the decontextualized artificiality of the laboratory setting and the sometimes intractable and inaccessible real world setting” (Robson, 2002, p. 363).

The beauty to Newell (2010) of using computer simulation is the ability to identify how well consultants “adhered to the problem-solving model, how they conceptualized the problem, and how they selected and evaluated the intervention” (p. 231).

The methods used in this study consisted of:

  • recruitment practices used
  • research design style
  • procedures used
  • how data analysis was collected and analyzed

Criterion sampling was used to recruit participants for the study. Patton (2002) in his book Qualitative research & evaluation methods (3rd ed)” states that criterion sampling is the process of selecting cases that meet specific criteria that can illuminate the focus of the case.

With the latter in mind, recruitment consisted of three important criteria chosen school psychologists need to have to be selected:

  • work in an elementary school (case simulations were set up for elementary clients)
  • trained in problem solving consultation (and really used it!)
  • had access to a personal computer (Newell, 2010).

Research design style was a case study. What has been stated earlier  was the need for a “whole picture” snapshot of the variables that affected choices taken by the school psychologists for their clients.

Research style such as case studies specialize focus on being able to “gather comprehensive, systematic, and in depth information about each case of interest” (Patton, 2002, p. 447). Through the use of case study methodology coupled with computer simulation, stage by stage analysis could be conducted to provide data in detail to properly research the problem-solving consultation process used by the four school psychologists chosen for this study (Newell, 2010).


Sharie Stines, Psy.D <![CDATA[Breaking Free from an Abusive Relationship]]> http://7.253 2016-04-30T02:30:51Z 2016-04-30T02:30:51Z flowerFollowing are ten steps to take to break free from an exploitive, abusive, or toxic relationship.  While you may believe that your primary problem is the other person, let me emphasize, your primary prisoner is not another person, but rather, your belief system. Once you can get rid of faulty thinking and allow yourself to think differently, you can begin to heal.  Here are ten steps to take to begin your road to freedom:

  1. Find a healing partner or group of people to help you walk through this journey of healing. Make sure you have emotionally healthy friends, counselors, or some significant people who you can share your inner most thoughts and feelings with.
  2. Develop grace for yourself. You cannot heal without grace. You must eliminate self-condemnation, no matter what. It’s okay for you to see your weaknesses, but don’t criticize yourself for having them. Everyone has imperfections and no one is perfect. Don’t try to be and don’t put undue pressure on yourself to be someone you’re not. Be honest with who you are and embrace yourself.  This is necessary to do before you begin to address your repressed emotions, such as feelings of shame, fear, and rage. These feelings or emotional states need to be processed in order to heal.
  3. Begin with a relationship inventory. Take an inventory of your toxic relationship. You can start by creating a Relationship Diagram.  Draw a horizontal line on a piece of paper, on the left end of the line, put the approximate date when your toxic relationship began.  On the right end put the present date.  This horizontal line represents the duration of your toxic or abusive relationship.  The left side is the beginning and the right side is the end. Now, draw vertical lines throughout your relationship timeline. Vertical lines going above the line are positive events, and vertical lines extending below the relationship line are negative events.  Write your feelings about each event once they’ve been identified. This relationship diagram will help you begin the process of seeing and knowing what you are dealing with.  Include descriptive feelings regarding significant events in your relationship and also notice how your relationship dynamics have contributed to what is known as a trauma bond, or perhaps even, Stockholm Syndrome.
  4. Write a letter to your toxic person stating everything they mean to you and everything you want from them. Write your hopes, dreams, wants, desires, wishes, fantasies, etc.; all of the aspects of the person you appreciate. Do not give this letter to your person; this exercise is for you alone, in order to identify and process your strong emotions. It is important for you to admit to yourself that this person is significant to you and why.  Identify the hope, the promise, you have been holding on to within the relationship. Identify why you find it so hard to leave the relationship.
  5. Write another letter outlining all of the negative aspects of the relationship, including how you’ve been hurt, disrespected, devalued, ignored, and rejected. Write, without censorship, all the different ways this person has offended you and all the different ways you’ve tolerated abuse and compromised your values in order to remain in the relationship.
  6. Begin a daily journal and answer the following questions. The purpose of this exercise is to help you “know what you know” and complete the grief brought on by this relationship:
    1. What unfulfilled dreams do I have with regards to this relationship?
    2. What has been missing from my relationship and how has its absence affected my life (e.g., compassion, collaboration, empathy, concern, safety, trust, etc.)?
    3. What have I been too afraid to say out loud (either to myself or others) with regards to this relationship?
    4. What are the different types of abuse I’ve experienced in this relationship – sexual, financial, physical, emotional, spiritual, psychological, mental, other?
    5. What are my feelings today? Describe them in great detail.  Do not evaluate or judge them.
    6. What goals do I have for myself outside of my relationship?
    7. What can I begin doing today to heal? What baby steps can I take?
    8. What are my triggers? These are those things that the toxic person does that cause you to either under or over react.
    9. If possible, see if you can identify any familiar patterns or feelings in this relationship that you’ve experienced before, such as in a childhood relationship with one or both parents (or some other significant person.)
  7. In addition to writing your feelings each day, also make sure you start “rewiring your brain” by inputting new thoughts in it. Begin by developing a list of positive affirmations and repeating them to yourself each day (or each hour.)  Using Scripture is a great resource for this. Here are some examples:
    • I can do this. I will do this. I am doing this.
    • Everything is going to be okay.
    • Feelings are fleeting.
    • One day at a time.
    • I am strong and capable.
  8. Understand that healing from abuse involves developing a healthy relationship with yourself and with others. To do this, do not say anything derogatory or hurtful to yourself, ever. Resolve to be kind and compassionate to yourself. Do not continue on with a verbal dialogue inside your head that replicates the one you had with your abuser. Also, start forming healthy connections with others. Unhealthy relationship dynamics can only be broken once alternative, healthy relationships have been formed.
  9. Read books, internet sites, and any other materials you can get your hands on to inform you, keep you in reality, and break the cognitive dissonance you experience from being with an abuser.
  10. Take baby steps. Never give up. Keep moving forward. Remember, this is a process and a journey, not a destination. Enjoy something about each day and do something positive for your recovery each day. Do not beat yourself up for setbacks, and do not expect yourself to be perfect or to recover from abuse flawlessly each day.

“What we obtain too cheap, we esteem too lightly: it is dearness only that gives every thing its value. Heaven knows how to put a proper price upon its goods; and it would be strange indeed if so celestial an article as freedom should not be highly rated.”

― Thomas Paine

Heather Gilmore, MSW, LLMSW, BCBA <![CDATA[5 Great Resources for PECS materials]]> http://3.633 2016-04-30T01:41:56Z 2016-04-30T01:41:56Z

This post will provide you with some great resources for getting materials to teach and use PECS (Picture Exchange Communication System) with the kids that you work with.


  • Find the four steps of PECS
  • Use a flow chart to figure out if you should use PECS with someone
  • Sample Pictures
  • And more

National Autism Resources

  • Find lots of PECS-related products and more

PECS Youtube Videos

  • Watch informative videos about training with PECS

Indiana Resources Center for Autism

  • Learn about PECS and picture exchange

Speech and Language Kids

  • Learn about how to use PECS to encourage speech

If you have any other resources regarding PECS, please share! Thanks!

image credit: WavebreakMediaMicro via Fotalia

Christine Hammond, MS, LMHC <![CDATA[How to Live with an Anxious Person]]> http://5.660 2016-04-29T14:28:12Z 2016-04-29T14:28:12Z anxious personIt is normal to feel anxious when highway traffic goes from full speed to a screeching halt in a matter of seconds. Or when your child’s school gets placed on lockdown and all you get is a notification from the media. Or when the credit card bill statements come in larger than expected. Or when the doctor’s office leaves a message that the doctor wants to deliver test results in person. These are anxious moments and it is normal to feel apprehensive about the next course of events.

But some people are anxious about nearly everything. An ordinary conversation about where to go for dinner sparks fretfulness over who will and won’t be there. A regularly scheduled annual visit to a doctor expands to concern that cancer will be discovered. A routine phone call from a boss strikes fear that termination is emanate. This type of anxiety produces intense feelings of fear which can greatly impair decision making.

Having it is one thing, but living with a person who has it can be frustrating.  So how can such attacks be handled?

  • Keep fears at a distance. Allow the anxious person to express their fears but don’t absorb it. Think of their fear as beading up like water off a duck’s back. Because of the oily feathers, it just rolls right off without penetrating.
  • Don’t add to the worry. Remember that the anxious person’s fear does not need to spread. When others give the nervousness weight, it can grow to a size much larger than anticipated. Don’t feed it.
  • Express boundaries. Don’t be afraid to insert a boundary when the anxious person is speaking. For example, “This is not the time for this discussion,” or “Can we talk about this later this evening?” Boundaries give a chance for reflection before things get out of control.
  • Step away. When the downward spiral of anxious thinking takes over in an obsessive manner, walk away. This will likely frustrated the anxious person but that is their share of the responsibility. Stepping away is self-care.
  • Don’t replay. No matter how hard a person tries to get distance from the projected anxiety, a bit still seems to creep in. Allow for a few minutes of reflection but come to a decision quickly and then stop replaying the conversation.
  • Use logic. Apply logic to the anxiety. Is it well founded? Does any of it have merit? Keep the parts that do and discard the rest. Usually there is an ounce of truth in each anxious attack so acknowledge that and place the rest aside.
  • Find calm. After an anxious engagement, find some calm. A personal favorite of mine is going outside and breathing in a natural environment. There is something about nature that helps to put things into perspective and reset heightened senses.
  • Don’t reengage. One observation about anxious people is that usually after the worry is expressed, they feel better while others feel worse. There is no need to rehash the moment if the anxious person is done. Leave it be or things might get more intense on the second go around.
  • Understand anxiety. Some anxiety is a manifestation of a mental disorder, a learned behavior from a parent, a triggered trauma memory, an allergic reaction to food, an undiagnosed medical condition, an addiction, or unresolved depression/anger/guilt. The initial reasons for the restlessness may not be apparent and do require some expert opinion to properly diagnosis. Encourage the anxious person to see treatment. Some anxiety can be easily resolved.

There is always hope for the anxious person and those living with the anxiety. Properly addressing the issue takes some time but is worth the effort in the end.


Christine Hammond is the award-winning author of The Exhausted Woman’s Handbook available from Amazon, Barnes & Noble and iBooks.

Jessica Dore <![CDATA[Mindfulness for Relapse Prevention]]> 2016-04-28T13:15:05Z 2016-04-28T13:15:05Z mndfulness for relapse preventionAddiction relapse prevention approaches have traditionally focused on challenging the thoughts that contribute to and exacerbate addictive behaviors as well as helping those in recovery develop healthier coping strategies in challenging situations.

These approaches, which are rooted in the cognitive behavioral tradition, have rarely co-existed with Buddhist or third wave approaches in relapse prevention protocols.

But during the last several years, an integrative mindfulness-based relapse prevention (MBRP) program has emerged. This approach, which is based largely on the research of addiction expert Alan Marlatt, Ph.D, combines mindfulness meditation and the cognitive behavioral-oriented relapse prevention therapy. It has been developed by Sarah Bowen, Ph.D, Neha Chawla, Ph.D, Joel Grow, Ph.D, and Katie Witkiewitz, Ph.D.

The following principles, which are adapted from the edited volume, Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions, provide the foundation for understanding a mindfulness-based approach to addiction.

  1. Nonacceptance

From a traditional mindfulness perspective, the unchecked urge to grasp for what we don’t have or to escape from situations that we don’t want is at the heart of addictive behaviors.

“Addiction might thus be viewed as a non willingness or perceived inability to accept what exists in the present moment. There is a grasping for something that we think will deliver the experience we yearn for instead of the one we currently have,” write Bowen, Chawla, and Witkiewitz.

The practice of mindfulness meditation provides a way out of this trap. When we practice noticing the way our thoughts, emotions and physical sensations constantly change, we begin to transform our relationship to the activity of our minds.

With time and sustained practice, we become privy to the fickle nature of our internal experiences and therefore less likely to allow them to dictate our behavior.

Even when our internal experiences are not the way we’d prefer them to be, certain kinds of mindfulness meditation can help us relate to such unwanted experiences with a sense of curiosity and compassion. This allows us to behave in more flexible ways, even in the presence of challenges.

  1. Negative Reinforcement

Let’s face it, when the primary goal is to escape unpleasant thoughts and feelings, substance use is, in fact, highly effective. It is temporary, and it most often always makes things worse, but it works for instant, fast-acting relief.

Research shows that the urge to escape or avoid unpleasant emotional states is the most common trigger for relapse, and addiction as traditionally been viewed as a way of self-medicating, meant to treat emotional discomfort.

When difficult thoughts or feelings are dulled, numbed or soothed through substance use, the addictive behavior is reinforced as a useful method. But of course, in the long-term, this is a dangerous trap.

Relying on substances to treat distressing thoughts or feelings may provide immediate relief, but the cost of that relief is typically more distressing thoughts like shame, depression and stress, which will also beg to be numbed. Because substances do provide temporary relief, it is easy to fall into the trap of continuing to rely on them as a coping tool.

Simply building awareness around these behavioral patterns is useful for those struggling with addiction. Understanding why the temptation to use substances is so strong, particularly in moments of stress or other emotional discomfort, is an important part of recovery and relapse prevention.

Understanding the relationship between substance use and the very human desire to avoid difficult feelings has the potential to short circuit the automatic urge to use when things become challenging.

  1. Positive Reinforcement

Of course, addiction is not always motivated by the urge to escape discomfort. For some, addiction is about chasing pleasant feelings or things like excitement, intensity and other appetitive experiences. From a mindfulness perspective, this is another case of nonacceptance or wanting things to be other than what they are in the present moment.

Once again, mindfulness can help.

“Mindfulness practice may help clients find the naturally reinforcing or nourishing aspects of day-to-day life that are often deemed trivial and thus unworthy of attention of presence. By bringing purposeful attention to what gives us pleasure, not only is contact with natural positive reinforces increased, but we may also notice pleasure where previously we had missed it,” write Bowen, Chawla, and Witkiewitz.

The present moment can be a surprising source of pleasure for people who are used to going through their days on autopilot. Feeling the warm water run over your hands when you’re washing dishes on a chilly fall day, for example, can feel great.

Or being aware of a cool breeze blowing through the office window on a hot summer day, can be a source of pleasure. These moments certainly don’t guarantee euphoria, but they can also help ease or regulate otherwise stressful times that may otherwise challenge sobriety.

If you’d like to learn more about mindfulness-based relapse prevention and other mindfulness- and acceptance-based approaches to treating substance abuse, check out the book Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addiction

Sunset photo available from Shutterstock