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Dealing with Dissociative Symptoms

2011-10-13T14:42:00--11:00

Nature of dissociative symptoms
Some of the most distressing symptoms that clients report include dissociative symptoms. These symptoms include persistent daydreaming, forgetfulness and amnesia for recent events, feelings as though one's body does not belong to oneself, feelings as though things (perhaps even the world itself) are not real, and a sense of acting so differently on occasion that it seems as though they were another person. Often people do not report these symptoms because they may fear how others might respond. Otherwise they may assume that everyone reacts in a similar fashion. They may also sense that health professionals whom they see will not understand or believe them. Indeed, dissociative symptoms are probably the least understood symptoms by mental health professionals despite there having being much research on such reactions spanning over 100 years.

People with dissociative conditions are often diagnosed with many other conditions including depression, anxiety disorders, substance abuse, eating disorders, bipolar disorder, somatic conditions (including fibromyalgia) and borderline personality disorder. Sometimes individuals may indeed have such difficulties, but sometimes these diagnoses may result from health professionals not understanding the potential alternative of a dissociative disorder to help account (at least in part) for a person's difficulties.

Dissociative symptoms can range considerably in their severity. For example, approximately 4 percent of psychiatric hospital in-patients would suffer from a severe dissociative condition called Dissociative Identity Disorder (whereby the person may feel or act as though they have a number of quite distinct and separate personalities). Approximately 15 per cent of psychiatric outpatients would have some form of dissociative condition. Many highly capable individuals from many walks of life also have dissociative conditions which they may be experts in disguising. Otherwise they may assume that everyone has such reactions as extended blank spells or no memory for some significant past events (dissociative amnesia) or having difficulty recognizing oneself in a mirror or looking at oneself from a distance as though looking at another person (depersonalization).

Causes of dissociative symptoms
Dissociative symptoms commonly result from repeated trauma, abuse and/or neglect in early childhood years. However, it is possible for such symptoms to emerge in later years, but most commonly after severe traumatic experience. Dissociative symptoms sometimes relate to an attempt to block out painful emotions associated with overwhelming or traumatic events.

Individuals suffering from dissociative disorders may be very confused or perplexed about aspects of their behaviour such as why they might suddenly act in aggressive ways, why they might suddenly feel panicky and extremely threatened until they leave a particular situation, why they might feel helplessly immobile when they feel threatened or why they might have offered little resistance when others have treated them in an abusive way. Such reactions typically seem to make little sense or to be very strange, but they may relate to survival mechanisms shared by humans and other animals in response to extreme threat (i.e. "fight", "flight", "freeze" and "submit" responses). Such responses can be triggered by reminders of earlier traumatic situations, even when individuals are not consciously aware that such memories are being triggered. This can cause people to act in an extreme way to a seemingly harmless situation and to question whether they are losing their mind. However, usually such reactions are temporary and brief and the person is functioning at a normal level at other times.

Dissociative symptoms are commonly related to hypnotisability or the potential to experience hypnosis. Hypnotic capacity is greatest when people are aged from approximately 8 to 12 years. Under hypnosis it is normal for people to experience such phenomena as amnesia for what has happened immediately beforehand or feeling as though a part of one's body does not belong to oneself. People can even feel as though they are a different person, or can feel as though they are the same person, but at an earlier stage in their life. These reactions may seem interesting or even amusing if people are deliberately inducing them by undergoing hypnosis, but such reactions are generally much more distressing if they occur spontaneously or automatically without the person's sense of conscious control over them.

If a young child experiences trauma and has limited available supports to comfort them at the time or to talk about their experience, that child is more likely to dissociate or use hypnosis-related strategies (including imagining that they are in a different place at the time) to help deal with their distressing experience. If this happens many times over, such as if someone is repeatedly sexually or physically abused, the person may develop an entrenched habit of responding to distressing circumstances by dissociating. If a person then experiences further trauma in later life they are far more likely to react to such circumstances with increased levels of dissociation. Such reactions themselves are so unsettling that they can add greatly to the impact of the initial trauma.

Whereas dissociative strategies or reactions may help diminish pain at the time, if such habits are over-developed this can be at great cost to the individual's coping strategies in later life. When a person later faces distressing circumstances, they would then be less likely to learn to tolerate and adjust to the emotional pain of such circumstances, but would tend to develop indirect ways of the dealing with the difficult situation. They would more likely try to mentally remove themselves from the situation or distort their perception of that situation to neutralise it using dissociative strategies. They therefore have much less practice at developing other more reliable coping strategies such as slowing one's breathing, seeking to relax tension from one's body and engaging in coping self-talk whilst developing a plan to help deal with the current situation. Other more healthy coping strategies include ensuring that one is protecting oneself in a threatening situation, seeking to communicate with others who are potentially supportive and engaging in a problem-solving process to more effectively deal with one's current stressful circumstances.

Sometimes it is very difficult to identify earlier trauma, abuse or neglect that may have contributed to dissociative symptoms. In rare circumstances there may have been no such trauma, neglect or abuse. Sometimes people have blocked out negative experiences so strongly that they may not remember them at all. In some circumstances they may only start to remember early trauma if they come to be reminded of these experiences by other circumstances, including engaging in a therapy relationship where a person talks about what they remember of their childhood. Sometimes people seem to have developed dissociative conditions without past trauma if they have had a parent who suffered from marked post-traumatic stress or dissociative symptoms when they were growing up. Sometimes children can be very sensitive to the emotions and reactions of those around them. Children may pick up the unexpressed emotions of a parent and learn to block out the pain of such emotions in a similar fashion to their dissociating parent.

Treatment of dissociative symptoms
The treatment of dissociative conditions involves a number of steps, many of which overlap with the general treatment of trauma conditions. The first step involves psychoeducation, or learning more about dissociative experiences and their relationship to past distressing events. This may follow an initial assessment using a range of questionnaires to help establish the person's initial level of dissociative symptoms, trauma-related thoughts, anxiety and depression. It may also involve an assessment of the person's potential for absorption, a personality dimension related to one's capacity to use dissociative strategies. In the first instance the most important thing is to learn about and gain a greater understanding of dissociative symptoms and their potential protective purpose for the individual. Although this may bring up considerable distress (often associated with reminders of earlier trauma or abuse) it helps the person to start to be more accepting of themselves and their reactions. People may then be more mindful of how they are reacting to particular situations, and whether they might be using dissociative strategies. That helps to recognise the potential harm or costs that could follow from using dissociative strategies as opposed to other more reliable ways of dealing with emotionally challenging situations.

In order to limit the excessive use of dissociative strategies despite high levels of distress it is important to learn to use "grounding" techniques (such as looking at one's shoes whilst shuffling one's feet on the floor, standing up and looking around or briskly rubbing one's hands together). It is particularly important for clients to develop a trusting relationship with their therapist as the person has often felt let down by others in a position of trust from whom they might have expected greatest support. It is important that the client have an opportunity to talk with their therapist about past distressing experiences, especially any past trauma, abuse and/or neglect. It is important that this is discussed only at a rate that the client feels ready and able to tolerate.

It is also important to learn anxiety management strategies such as slow breathing, relaxation techniques and coping self-statements to manage with stress. This is assisted by understanding a "graded exposure" model to deal with past trauma. This can include talking about past distressing experiences in a gradual or step-by-step fashion so that the person does not have to talk about the most distressing or overwhelming experiences right from the start. In practice, this is what tends to happen anyway as people have a natural tendency to protect themselves from engaging in unnecessarily overwhelming experience. People also have ways of gauging the level of trust they might have in another person (including a health professional) by seeing how they respond to earlier disclosures before deciding whether to let them know about even more personal and overwhelming experiences. Some of the most important strategies for managing with dissociative symptoms relate to developing more awareness (or mindfulness) about one's feelings, thoughts, perceptions and impulses to act in certain ways. Individuals with dissociative tendencies can come to recognise circumstances in which they are feeling stressed and may come to find that they can stay present and grounded enough in the situation to use more reliable and adult strategies for managing their reactions.

As part of the therapy process clients will at times be going well beyond the "comfort zone" in discussing a whole range of topics. Some treatment techniques may involve a person directly re-living past traumatic experiences in some detail. Whereas such "exposure-based" techniques may be very challenging, they commonly are very effective in helping to reduce the emotional impact of past distressing experiences. These techniques are only used when the client is well prepared and clearly understands their purpose. Individuals commonly feel uncomfortable (and may dissociate more!) prior to therapy sessions, and may feel disoriented or very distressed for some time afterward. It is good for clients to consider what they might do after a therapy session to help them manage their reactions in the hours afterwards. This may include having some time out or schedule activities that will give them a chance to come to feel more settled. A key treatment principle is that the therapist and client work together to ensure that each person can progress at their own pace.

One of the ways of gauging progress is to note how well the person is managing to establish boundaries for their own well-being and safety. This includes setting limits on ways in which others might act disrespectfully toward oneself. It can also include becoming more assertive and being more direct or open with others in expressing one's feelings or reactions. In other circumstances it might include choosing not to have much to do with certain people. A key issue is how the person goes about observing appropriate boundaries in their own actions and noting whether others are also observing appropriate boundaries or limits in their interactions.

Although dissociative conditions can be severe in their impact individuals can commonly greatly improve their circumstances. It is typically best for people to pursue changes over a long period of time, perhaps focusing on more frequent (e.g. weekly) therapy contact in the first three or four months to develop alternative coping skills. Beyond that time it is important that individuals continue to work on the changes they seek for a period of two years or so. This is because it takes people approximately four months to establish a new habit in any aspect of their functioning, but it takes approximately two years for someone to be confident that they have truly shifted an underlying aspect of their personality functioning. Dealing with dissociative conditions commonly means attempting to alter one's personality functioning in a significant way, particularly with regard to mindfully and directly applying various coping strategies to manage with emotionally challenging and distressing circumstances. There may be some benefits in those with dissociative conditions meeting some others who have had to grapple with similar difficulties. For this purpose there may be benefit in an individual participating in a specific brief group therapy involvement with others who have suffered dissociative conditions to help demystify their difficulties and to appreciate that they are not alone in their reactions. Where individuals are in established relationships it can be very helpful and important for one's partner to be informed about dissociative symptoms and the potential causes of such symptoms. It may also help if loved ones are aware of strategies (e.g., grounding techniques) to help the person overcome the more negative effects of such conditions. Partners have typically adapted somewhat to the person's dissociative symptoms but will commonly feel very confused as to why such reactions may occur.

Key steps to recovery
Even when dissociative conditions have had a severe impact on someone's life over many years, there are usually good prospects of recovery in response to psychological therapy. In more severe cases the path to recovery can be slow and gradual over several years. In less severe cases individuals can often make significant progress within a period of several months by focusing on the following steps. In order to consolidate progress it is helpful to maintain occasional follow-up therapy sessions over a period of at least a year.

In summary, the key goals for those with dissociative conditions to pursue in therapy may include to:

Develop a greater understanding as to how they may have developed such difficulties (usually to do with repeated childhood trauma, abuse and/or neglect).
Develop more reliable strategies for dealing with painful emotions (and being able to feel them "from inside one's skin").
Develop more appropriate ways of appropriately asserting oneself to deal with interpersonal conflict.
Establish and maintain clearer boundaries in one's own and others behaviour — this includes being appropriately self-protective.
Acknowledge and talk about some experiences related to past trauma, abuse and/or neglect to defuse their negative emotional impact.
Learn to better curb impulsive behaviour (or inhibit inappropriate impulses).
Seek to act mindfully (with full conscious awareness) across a range of situations as this helps to establish and reinforce one's sense of identity.
Focus on managing with the broad roles in one's life (managing with one's role functioning as a parent, friend, worker, etc).
Where a person is a parent, appreciate one's efforts as limiting the impact of past abuse and/or trauma on the next generation.
Appreciate the significance of one's efforts generally. The extent of one's efforts to rise above dissociative reactions will typically not be visible to others.

Identifying Signature Character Strengths

2011-10-13T14:35:00--11:00

One of the most useful and widely used Positive Psychology strategies for promoting wellbeing is to identify and draw upon our signature character strengths, which relate to our enduring key virtues. These character strengths are the kind of virtues which are recognized by all cultures.

There is an accessible scientific method of identifying signature character strengths which involves completing a Character Strengths Survey. This is obtained by accessing the Authentic Happiness website of Martin Seligman at http://www.authentichappiness.sas.upenn.edu/Default.aspx. It is also the first link on the links page of our website at http://www.chrismackey.com.au/pages/links.html. When we act on our most developed, or signature, character strengths to address challenges or goals we are more likely to be engaged, effective and to find satisfaction in what we are doing.

The steps are:

Access the Authentic Happiness website.
Click on the "Register" button at lower left and complete relevant details to register.
Click on the VIA Survey of Character Strengths
Complete the questionnaire (it takes about 45 minutes)
Print off the findings (your list of 24 character strengths in order).

Then - consider your top five (and especially your top two) signature strengths.
Do these fit with your expectations?
Have people previously remarked that you have these characteristics?
When you have been "at your best", were these strengths on display or helping you to achieve goals?
When you act on these strengths do you tend to feel more assured or confident?
How might you draw on these strengths further?
What are some ways you could use your top strengths in a new way?
Are there further ways you can use your top two strengths in combination, perhaps to deal with a challenging situation, or an opportunity?

Perhaps listen to the podcast on character strengths on our website.

Further information on the relevance of and ways of using our signature character strengths is detailed in Martin Seligman's book, "Flourish".

Positive Being

2011-08-02T12:34:00--11:00

Positive Being is based on a simple credo

"Be and Let Be".

It has just two strictures:

"Just Be" and

"Be Just".

It’s philosophical basis is that we have but two choices in any situation…

Love

Fear

Positive Being is attained by an attitude of Loving Surrender

It is not helpless

It is not servile

It is not in control

It is not out of control

It simply is

It is not free of pain as it involves accepting the "is"s in life

But it transcends suffering

It’s scientific basis is quantum theory

It’s experiential basis is flow

It may involve synchronicity

Or it may not

I don’t know

Addressing Avoidant Tendencies

2010-10-15T08:38:26--11:00

It is understandably common for people to seek to avoid at least some anxiety provoking situations. However, tendencies to avoidance can become entrenched over a period of time to become quite self-defeating. This is because the urge to avoid situations can be strengthened by the short-term relief that escape from such situations may bring. As a consequence, avoided situations can become even more anxiety-provoking. Avoidant patterns of behaviour can lead to greater imbalance and dissatisfaction in people's lives if such patterns or habits become entrenched as avoidant personality characteristics. Such avoidant characteristics include: avoiding work activities which have significant interpersonal contact, being unwilling to become involved with others unless certain of being liked, being restrained in intimate relationships, being preoccupied with being criticized or rejected in social situations, being inhibited in new social situations because of feelings of inadequacy, viewing oneself as personally unappealing or inferior, and being unusually reluctant to take personal risks or engage in new activities which may prove embarrassing. Those with strong avoidant personality tendencies experience at least four of these characteristics.

Those who develop avoidant personality characteristics in adult life have commonly been shy in their childhood and teenage years. Their shyness generally continues into adult life. Such individuals commonly wish for close and intimate relationships with others and may have a somewhat painful sense of loneliness. However, they may feel unconfident or be somewhat reluctant to seek closer relationships owing to a fear of being embarrassed or of being found to be inadequate. People with avoidant personality characteristics are commonly not confident about their social skills. Those with avoidant tendencies may also experience significant levels of anxiety and or depression. Individuals may attempt to avoid, repress, or distract away from thoughts or feelings associated with such painful emotions. However, avoiding emotionally uncomfortable reactions can interfere with the more consistent development of reliable coping strategies for managing with painful emotions.

Fortunately, there are ways of helping to counter avoidant personality tendencies which can significantly improve a person's emotional and interpersonal wellbeing. However, any changes in personality patterns require active effort over a long period of time. If a person alters their behaviour in any area for a few weeks they will have merely demonstrated a capacity to change a specific behaviour. If an individual persists to alter a pattern of behaviour for four months, it could be said that they have changed a habit: most relapses to former harmful patterns of behaviour happen within that time frame. If a person has been able to sustain change in a general pattern of behaviour for a period of two years they might be said to have changed their personality functioning. Those with avoidant personality characteristics will need to persist in their efforts for a period of two years or more to be confident of effecting lasting change. This requires a considerable degree of motivation. Seeking to counter avoidance and to face anxiety provoking and other uncomfortable situations is difficult for anybody, let alone for those who have a particular difficulty with dealing with emotional discomfort. Therefore it is important that people pursuing such changes adopt reasonable expectations, seek to be both fair and supportive to themselves, and give themselves good encouragement for their efforts to face uncomfortable situations and to act and think in a different manner. Acknowledging and gaining satisfaction from any forward steps will help speed up and consolidate the process of change.

Therapeutic steps to countering patterns of avoidance

It initially helps for individuals to have some understanding as to how they might have developed avoidant patterns in the first place. Sometimes people will have encountered

extremely difficult or traumatic experiences in their childhood which have influenced their motivation to avoid emotional distress. Those with avoidant tendencies commonly have difficulty in directly and effectively dealing with interpersonal conflict. It is more difficult for individuals to learn to act assertively (which means being able to identify and stand up for ones own rights whilst respecting the rights of others) unless at least one of their parents has modelled an assertive style of dealing with conflict. Those with avoidant tendencies have commonly been raised in a family environment where conflict was avoided by both parents, or was managed in a less effective manner. Those with avoidant tendencies are commonly very self-critical and may expect to be rejected by others: this will occur more often where an individual has experienced a parent to be critical and or rejecting.

Gaining an understanding of factors which may have contributed to the development of avoidant tendencies can be assisted by at least two sessions of assessment with a clinical psychologist experienced in assisting those with such personality difficulties. Individuals often experience some degree of relief (along with their discomfort!) from the opportunity to discuss avoidant aspects of their reactions in a matter-of-fact way and in a non-judgemental setting. It is clear that those who engage in such frank discussions have already taken some very constructive steps to face at least some uncomfortable situations and are genuinely seeking to counter their self-defeating avoidance. There may also be a particular advantage in individuals with avoidant tendencies joining a group therapy setting: this involves an even greater degree of exposure to the uncomfortable situation of meeting with others and leaving oneself open to others scrutiny and the potential judgements that others might make. However, such therapy settings are commonly very supportive given that other individuals have similarly declared themselves to be interested in challenging such patterns of behaviour within themselves. Attending a therapy group may represent a constructive step in learning to directly tackle fears of disapproval, for example, by acknowledging ones difficulties in front of others. It is important that group settings provide a safe, constructive, and confidential space to make this easier, especially knowing that other participants have shared similar experiences.

Specific therapy techniques

It is important to learn about the potential role of particular attitudes, thought patterns and habits which perpetuate avoidant behaviour and contribute to psychological difficulties. A cognitive-behavioural therapy (CBT) approach aims to help individuals improve their emotional, interpersonal, and other aspects of their psychological functioning by helping them change their patterns of thinking or behaviour. Cognitive-behavioural therapy has a strong initial focus on education about the potential influences and consequences of avoidant patterns of thinking and behaviour on their overall functioning and wellbeing. The educational focus also aims to promote a systematic and effective approach in altering such avoidant patterns.

It is most important that individuals with avoidant patterns adopt a persistent and long-term perspective on achieving change. To do this, people need to be forgiving toward themselves if and when they are disappointed by lapses to old habits along the way. It helps to have a more intensive period of therapy support for 2-3 months to assist individuals to make a constructive start in challenging avoidant tendencies. After this, individuals can benefit from follow-up support.

Facing feared situations:
There are two main areas for individuals to address to change avoidant patterns. In the first instance it is important for people to develop a strong interest in facing situations or exposing themselves to situations which might be uncomfortable and provoke anxiety, but which nonetheless might be worthwhile for them. Such situations might involve expressing opinions to

others more frequently, accepting work tasks or roles which involve a greater degree of challenging interpersonal contact, or situations which involve addressing a conflict a little more directly. As with facing any previously avoided or feared situations, it can be important to set realistic goals in a step-by-step fashion: in other words, it may help to aim to make more modest gains initially by tackling less threatening situations before choosing to tackle situations which are much more daunting or anxiety-provoking. It is important to adopt a coping as opposed to a mastery approach: a coping approach involves acknowledging that one feels uncomfortable whilst still making active efforts to deal with any ensuing discomfort and having some confidence that one will manage. A mastery approach involves the unfair expectation that one should be very confident to tackle any difficult situation and to manage it easily. This is not realistic when facing longstanding emotionally-challenging situations.

Developing relevant skills:
Another area to address in therapy is the development of particular everyday living skills to manage with uncomfortable situations. In the first instance this involves developing coping skills including anxiety management techniques. Techniques for dealing with anxiety include breathing techniques and relaxation techniques as well as encouraging oneself with coping self-talk. Coping skills also involve developing realistic goals and using problem-solving strategies when dealing with challenging situations. Another key area of skill-development focuses on social skills. It is generally easier to engage in social and other interpersonal situations when one is more confident about being able to converse with others and is more confident about their non-verbal presentation and demeanour.

Countering negative thoughts:
In order to counter avoidant personality patterns it is particularly important to recognise and to counter negative attitudes which contribute to avoidance. Individuals with avoidant tendencies often have very negative attitudes or reactions to uncomfortable or painful feelings, even though such feelings are a part of regular human experience and everyday life. For example, avoidant thoughts include believing, "I shouldn't have to feel anxious", or, "I should always feel good". People can fear that if they start feeling anxious or sad that their emotional reactions will get out of control and they won't be able to function. This only adds to one's sense of anxiety and unease in dealing with painful feelings. Anxious feelings may be uncomfortable, but they are not dangerous.

Avoidant thinking includes making excuses or rationalising about one's avoidance of situations, for example by thinking, "I won't enjoy doing that activity", or, "I'll be too tired", or, "I don't feel like doing it now I'll do it later". Such thinking only perpetuates and strengthens the avoidance. It helps to develop a few simple phrases (e.g. "It's worth making an effort", "I might enjoy it", "I'll feel stuck if I don't take risks", "Procrastinating doesn't help", etc.) to counter such thoughts.

Other examples of avoidant thinking are tending to engage in wishful thinking and choosing to believe that one's interpersonal difficulties will one day be eased without recognising the extensive effort which might be needed to learn to manage more easily with one's emotions.

Even though they wish to be closer with others, avoidant individuals may believe it is very likely that they would rejected by others and might view such potential rejection as unbearable. Avoidant thinking includes self-deprecating thoughts such as, "I'm not good enough", "I'm unlikeable", or, "I don't belong here". Other self-critical thoughts commonly include, "I'm unattractive", "I'm boring", or, "I'm not clever". Avoidant individuals often overestimate other people's tendencies to be critical and may believe such thoughts as, "Other people would reject
me if they knew me better". Fears of rejection may also come across in such thoughts as, "If they think I'm unintelligent or unattractive then that must be true", or, "That person rejected me because I'm inadequate". Other self-critical thoughts commonly include, "I'm unattractive", "I'm boring", or, "I'm not clever".

Avoidant individuals often make assumptions about relationships such as that one must please others all the time in order to be liked, that someone might only like you if you do whatever they want and that others would view them negatively and end their friendship if they made a single mistake. Such assumptions intensify anxious feelings related to the threat of rejection.

Avoidant individuals also commonly have difficulty gauging others' reactions to them and may adopt an overly negative perception of others' opinions of them. They might interpret reactions as being negative or anticipate criticism about their competence or qualities. They might attribute compliments they receive to the other person not knowing them well or being somehow fooled by them. Needless to say such patterns of thinking would only reduce an individual's self-esteem and confidence to manage with a range of interpersonal situations. This may lead individuals to avoid challenging situations even more: this further interferes with their development of friendships and confidence in their social skills.

Practical exercises for dealing with avoidant patterns include developing and recording an "exposure hierarchy" which lists situations one might wish to face which have been graded from less threatening to more threatening situations. The person might then seek to face these situations in incremental steps. It may be important for individuals to develop breathing and relaxation techniques to help manage physical aspects of anxiety, to develop one's own coping self-statements, to give oneself encouragement, and to learn to directly counter negative thoughts. It may be useful for individuals to keep a diary to help identify negative thoughts which contribute to avoidance: monitoring such thoughts promotes awareness of them and helps to counter them.

In summary, the key issue for countering avoidant patterns is to act and to keep taking action in the direction of facing challenging situations. Many such situations might nonetheless be enhancing to one's social life, family life, work roles, or recreation. Any changes of behaviour toward facing such situations provide clear evidence of countering avoidant tendencies. Taking practical steps toward specific behavioural goals is a key. A coping approach will facilitate this. It is important for individuals to recognise and build on successes. Countering avoidance is a long-term quest. It is important to support one's persistence in pursuing such a goal. Finally, it is very important for individuals to allow for lapses because lapses will certainly occur along the way. Recovering from lapses and making renewed efforts to face challenging situations is a very clear way for a person to demonstrate that they are strongly countering their past habit of avoidance.

Those who have engaged in therapy to specifically address avoidant patterns of behaviour have already taken a major step forward in pursuing significant and hopefully lasting changes which are likely to enhance one's general wellbeing and appreciation of life in a range of areas.

At Chris Mackey and Associates we offer a ten-session therapy group on an annual basis, the "Taking A Step Forward Group", which is specifically designed to help people tackle avoidant tendencies. Many of those who complete such groups describe striking life changes down the track such as gaining job promotions, starting new positive relationships, improving family relationships whilst asserting themselves, and generally no longer feeling ruled by avoidant tendencies. Those wishing o enquire about the group can contact us on our email address.

Effectiveness of Psychological Therapy for Anxiety and Depression

2010-09-08T09:31:07--11:00

Chris Mackey and Associates released the following information as a press release to numerous media outlets throughout Australia on September 1st, 2010.

New study supports clinical and cost effectiveness of psychological treatment under the Better Access Scheme

The Better Access (Medicare rebate) scheme funds psychologists and other mental health practitioners to offer treatment in private practice settings. The scheme has already been accessed by two million Australians, rendering it the most widely used form of mental health service provision in Australia, however it has not been without controversy. A number of prominent individuals within the mental health field have strongly asserted that the scheme is too expensive, of questionable effectiveness and targets the wrong people. However, such claims have been made ahead of any released evidence of the effectiveness or otherwise of the scheme and are in stark contrast to new findings released by Chris Mackey and Associates, an award-winning specialist psychology practice in Geelong.

Chris Mackey, Principal Psychologist of Chris Mackey and Associates, says, "Our study has provided the first substantial body of objective treatment outcome evaluation data on the Better Access scheme. It shows that well targeted psychological interventions, at least when offered by specialist psychologists, are likely to be both clinically and cost effective for a wide range of the most prevalent mental health conditions, including anxiety disorders and depression".

Key findings (based on 525 adult client treatments) include:

The average client reduced their anxiety and depressive symptoms from a mild to moderate level at the start of treatment to a non-clinical level (normal range) by the end of treatment, thus showing good recovery from significant mental heatlh problems.
The average length of treatment was 7.5 sessions, costing the taxpayer approximately $750 on average for each course of treatment sessions.
Clients treated for Major Depressive Disorder without medication made an equivalent recovery to such clients treated with medication.
The average client at the end of treatment fared better than 88% of those at the start of treatment with regard to depressive symptoms (better than 83% of those for anxiety).
Much improvement occurred within the first five to six sessions after which the average client reported mild distress just within the clinical range, showing a rapid response to treatment interventions.
The average client improved from a low level of subjective wellbeing to an average level of subjective wellbeing suggesting that they were flourishing by the end of treatment.

Detailed slides reporting more fully on our findings can be accessed on the research page of our website, at http://www.chrismackey.com.au/pages/research.html.

Chris Mackey and Associates have presented numerous research papers at national and international scientific conferences, including our recent research presentation on the Better Access scheme at the 11th International conference of the Australia and New Zealand Mental Health Association in Surfers’ Paradise on August 19th, 2010.

Enhancing Marital Relationships

2010-05-27T00:00:00--11:00

The question might be asked, "Why marry?". As Kierkegaard said about marriage, "If you do it you'll regret it — if you don't do it you'll regret it.” But the British Office of National Statistics in 2007 reported that married couples live longer, that younger married men have half the mortality rate of unmarried men, that married people commonly enjoy better health, that children living with married parents are healthier, and that those children stay in education longer. Marriage is also reportedly associated with better psychological adjustment, reduced violence, increased wealth and reduced welfare dependency. There are clearly many community benefits to marriage which help justify society’s efforts to support the institution. However, a distinction needs to be made between happy and unhappy marriages. Research shows that those who are unhappily married are more prone to illness than others, and that unhappy marital partners live on average four years less than happy ones. Therefore whether or not to marry might not be the key question, but how might one go about having a happy, long-term union.
Of all the things I have heard and read about marriage after 25 years or so of offering marital therapy, a few in particular stand out. First of all, a healthy marriage is essentially based on a deep friendship. Yet it is nonetheless important to continue to appreciate the “otherness” of one’s partner in order not to be lulled into an overly cosy or complacent familiarity which may stifle passion. A key issue is the way in which marital partners respond to the challenges of marriage which involve sacrifice. As suggested by the American philosopher, Joseph Campbell, when marriage is appreciated by each partner as a higher order entity than the partners themselves, then they may sacrifice to the relationship as opposed to sacrificing to each other. This in turn strengthens the marriage from which each partner derives benefit.

Regardless of our own views of marriage and intimate relationships in general, there is a greater level of understanding these days as to what kinds of things will lead to a marriage being a happy long-term union or failing, either through divorce or by living unhappy parallel lives. The most convincing research in this area has been conducted by John and Julie Gottman and their colleagues at the Gottman Relationship Institute, which has been reported in such books as “The Seven Principles for Making Marriage Work”. It used to be thought that marital partners mainly required good communication and conflict management skills to promote a happy marriage: indeed, much previous marital therapy focused on promoting communication skills including active listening described below. Having good communication skills may be an advantage, but many people (including many of our grandparents’ generation) could be considered to have relatively modest communication skills whilst having very happy marriages, and many people with excellent communication skills may end up divorced. This blog highlights principles and practices, largely drawing from the work of John and Julie Gottman and others, which have seemed most useful in offering relationship therapy. These principles can be taken to apply just as well to those in de facto or same sex relationships.

Active listening skills

Marital therapists have historically focused on the quality of the couple's communication to address troubled relationships, commonly by encouraging “active listening”. This process involves each partner practising ways of expressing and listening to their respective concerns, wishes, thoughts and feelings to promote feelings of connection between them and to heal disconnection. Partners would be encouraged to find a conducive time and setting to support a sense of relative safety (initially that might be a therapist’s consulting room), and be encouraged to communicate in dialogues rather than parallel monologues with an attitude of curiosity about the other’s perspective rather than judgment. Partners would be encouraged to take turns practising their capacity to speak clearly about their conflict-related thoughts whilst the other’s role would be to actively listen. The listener would then check that they had accurately grasped the intended message by paraphrasing what they understood their partner to be saying, and then directly checking to see that they had fully appreciated the underlying message their partner had intended to convey. For example, after paraphrasing what they believed their partner was wanting to convey, they might ask, “Have I got that?”, or, “Is there anything else?”. Then, when the speaker’s message was well understood, the listening partner would take their turn to speak about the issue being discussed. Each partner might also be guided to show appreciation for what their partner had shared.

There seems little doubt that such dialogue could support partners’ empathic attunement and feelings of connection with each other, especially if each partner were indeed to willingly communicate in such a collaborative fashion about important issues which had aroused painful emotions, and if each partner’s expressed understanding of the other’s views were relatively accurate. But this might be a tall order! Such a process might be much more difficult than it seems, especially if the issues being discussed and underlying conflicts associated with them were to arouse deep or longstanding painful emotions. Discussing challenging topics with one’s partner can be difficult without feeling criticized. The challenge is greater if either partner has longstanding tendencies to avoid conflict.

Indeed, the Gottmans’ research suggests that marital therapy based on coaching in active listening skills tends to meet with little success in preventing separation and divorce. Having good active listening skills is neither necessary nor sufficient for a happy long-term relationship. Even though the Gottmans’ own work revealed that they too spent considerable time coaching their clients in ways to improve their verbal communication and conflict management skills, they demonstrated that there were many other practical and more reliable ways in which partners could enhance their relationship whether their marriage was troubled or not.

Key features of happy and unhappy marriages

Following extensive objective research with hundreds of couples, the Gottmans and their colleagues highlighted the key features which differentiated happy and unhappy marriages and which helped predict whether couples would experience ongoing happiness or separation and divorce. They emphasized that a happy marriage appears to be primarily based on a deep friendship. This would be reflected in partners feeling connected to each other, feeling safe, and believing that their partner truly cares for them. Happily married partners would tend to support each other’s hopes and have a sense of shared purpose. Happily married couples do not necessarily have similar values or interests. They will still have disagreements and at times feel frustrated or irritated with each other. In particular, healthy couples relate in ways which demonstrate a "positive sentiment override", meaning that each partner’s underlying positive feelings toward the other will help override uncomfortable or conflictual situations. They will also make effective attempts at "repair", or active ways to improve the situation if there are lingering uncomfortable feelings. Under such circumstances couples may manage relatively well even with areas of conflict that are not easily resolved at all, recognizing that the impact of such conflicts can be transcended as a result of their underlying respect for and appreciation of each other.

The Gottmans highlighted a number of factors that help predict divorce. One is when couples typically have a harsh start-up to their arguments which may involve yelling, blaming, sarcasm or other more intense negative reactions. They found that the outcome of an argument can be predicted with 96% accuracy in the first three minutes (which obviously means that if an argument is not going well after three minutes it is usually best to discontinue at that point, at least until emotions have further settled!). The Gottmans identified four different types of negative interactions which were most destructive to marriage. Expressions of contempt were perhaps the most destructive. Such expressions include sneering, eye rolling, name-calling, sarcasm and hostile humour. Other negative patterns included persistent criticism, defensiveness and stonewalling according to which a partner might block attempts at communication. Vicious cycles might develop such as a pattern of one partner criticising and the other being defensive or stonewalling. Regardless of one's potential communication skills these reactions, especially when prolonged, tend to harm a marital relationship. When combined with harsh start-ups to arguments, they were highly predictive of divorce. Another predictor of divorce which is commonly associated with the negative interactions described above is "flooding", which involves either partner feeling overwhelmed by intense emotions during their interactions. This will partly be reflected in very heightened levels of bodily arousal and distress and failed attempts at repairing a situation. Couples might then focus on the present and past negatives in their relationship, perhaps rewriting their history in an exaggeratedly negative light. They might then become pessimistic about their prospects of improving their marital situation. They may view their problems as severe, consider that talking over such problems will lead to little benefit and then start to adopt parallel lives with increasing feelings of loneliness. Under such circumstances there is understandably a greater risk of either partner having an affair, commonly leading to further hurt and alienation.

Strategies to enhance marital relationships

Fortunately, the Gottmans and their colleagues have spent much time researching and describing ways of helping people enhance their marital interactions through such means as the following.

Enhance your “love maps” (or close personal knowledge and understanding of your partner):This means showing an active interest in the details of each other’s life such as by catching up with each other to discuss the day’s events. It also means knowing about each partner’s views and preferences in a wide range of areas as well as their joys, fears and stresses. Knowing each partner’s character strengths would be an additional valuable way of deepening each partner’s understanding of the other. A practical way of identifying each partner’s character strengths is to access the “Authentic Happiness” website developed by Dr Martin Seligman (see the first link on the links page of this website, or http://www.authentichappiness.sas.upenn.edu), and accessing and completing the VIA Signature Strengths Questionnaire, an objective way of identifying one’s most meaningful and enduring positive attributes. Recognizing how each partner’s character strengths are apparent in everyday life, and sharing such views with each other, can have a particularly beneficial impact.

Nurture your fondness and admiration: This relates to cultivating and appreciating the ways you like your partner and see them as being worthy of respect. Such feelings add to a store of goodwill that can help counter negative feelings and transcend conflict. This includes reminding yourself of your partner’s good qualities for which the Signature Strengths exercise described above can also be of particular benefit. In everyday interaction, nurturing one’s fondness is commonly reflected in putting a positive spin on things that your partner has said or done.

Turning toward each other rather than away: This relates to the ways that partners attempt to stay connected and engaged in their interactions with each other, despite potentially competing demands or interests. The Gottmans described how partners may make “bids for attention”, or offer a comment, gesture, request or other attempt (which may be subtle) to engage their partner. In happy marriages, partners tend to notice and respond to such bids for attention, affection or support which further contributes to their store of goodwill toward each other, or “emotional bank account”. This is one area where active listening can indeed be helpful, but of most importance is perhaps the regular attempt to connect in even simple or mundane ways, such as chatting whilst eating a meal together. Making time for conversation with each other about the day’s events when reconnecting at the end of the day can be particularly helpful.

Let your partner influence you: Happy marriages will likely reflect a preparedness to share power which may be demonstrated by yielding to the other’s influence. Historically and culturally, women may have tended to manage this more readily: the Gottmans’ research shows that the majority of marriages in which men are not prepared to share power will likely end in separation and divorce. Men in general are also more prone than women to respond to a raised issue of conflict with escalating negativity. Therefore the onus may commonly be more on the husband to recognize that accepting his wife’s influence and appreciating her interest in asserting herself may bolster the marriage and strengthen their friendship.

Solve your solvable problems:

Some problems are more readily solvable whereas others are more likely to be enduring and require long-term compromise. It helps to appreciate the difference, and yet in each case to look for at least some common ground. Common areas of conflict relate to money, sex, housework, children, stress spilling over from work, and conflict with in-laws. A number of such problem areas can be helpfully addressed through constructive dialogue and perhaps some compromise, especially if each partner shows a genuine understanding of the other’s views and interests and allows for them having different preferences. A win-win attitude helps. For example, conflicts about different attitudes to spending or saving money might be at least partly addressed by making a budget to bolster one partner’s sense of economic security, whilst planning to set money aside for spending on a trip which helps satisfy the other partner’s desire for freedom or adventure. Conflicts about housework and interest in sex are often assisted, at least in part, by the husband doing more housework!

Some problems might not ever be solvable in terms of allowing for a relatively full resolution and are therefore perpetual. This might include partners having deeply rooted differences in personality attributes, lifestyle preferences or beliefs, e.g., each partner having very different ways of expressing emotions, very different preferences for amount of socializing with others relative to time together, or some fundamentally different beliefs about the best ways to raise their children. Addressing such conflicts may relate to accepting their enduring presence, but making various compromises or adaptations so that each partner feels that their respective views, interests and preferences have been acknowledged and that attempts have been made to optimally accommodate their core priorities. It can help to remember the theme of sacrificing to the relationship rather than to one’s partner. In addressing conflicts, whether ultimately solvable or not, it helps to manage the intensity of one’s own and one’s partner’s emotions by adopting a relatively soft start-up to discussions, helping contain your own and your partner’s level of emotional arousal (e.g. by considering your tone of voice) and making repair attempts.

Address intractable problems or “overcome gridlock”: Some problems may be particularly disruptive through being unsolvable and leading to repeated painful arguments and disagreement as a result of being based on unfulfilled dreams or deeper unmet needs. For example, one partner may wish to have children whereas the other doesn’t, there might be long-term conflict between one partner’s career aspirations and the other’s desire for more time together, or there may be fundamentally different attitudes to money, etc. In such situations, it helps to recognize and respect each partner’s deep wishes or dreams that may underlie their stance which may relate to past experiences in their family of origin (e.g. one partner was raised in a family with little economic security whereas the other felt stifled in their childhood environment, leading to very different priorities in saving for the future relative to funding an adventurous holiday to enhance one’s sense of freedom). It helps if such deep wishes or dreams are identified, openly acknowledged and respected rather than ignored or dismissed in which case conflicts based on underlying unmet needs are likely to painfully recur. When each partner’s potentially conflicting dreams are recognized and openly acknowledged, there may be scope to find some kind of compromise or common ground which revolves around each partner recognizing their “bottom line”, or core areas on which they are not prepared to yield, whilst identifying ways in which they can show flexibility to also accommodate their partner’s non-negotiable areas. The problem might not be solved as such, but a compromise may be found which each partner feels they can accept whilst respecting the other’s deeper wishes.

Create shared meaning: This relates to developing a shared marital, and perhaps family, culture incorporating values that build further depth to a friendship through shared meaning. This may include developing shared rituals of connection such as how mealtimes, weekends or holidays are planned and shared; patterns of socializing and celebrating; and typical routines around watching TV, bedtime, etc. Meaning is also cultivated by considering the compatibility or sharing of various roles undertaken by each partner. Shared goals and values around such areas as child rearing, career aspirations and connections with family or community groups and others are also relevant. Shared symbols which convey compatible philosophies or values can further provide meaning, whether in the form of photos, cultural or religious symbols or other objects or even repeated stories which reflect an underlying bond.

In summary, as described by the Gottmans, couples can go a long way to enhancing their satisfaction in their relationship by creating predictable, routine and happily anticipated daily ways of connecting. Practical strategies include finding out something about each other’s day on parting, having a half-hour, stress-reducing conversation when reuniting and communicating genuine affection and appreciation in other ways each day. Such interactions cultivate and support the depth of friendship between marital partners in the longer term over and above any particular verbal or problem-solving or conflict management skills.

Other perspectives on marriage

There appear to be increasing challenges to the traditional societal “ideal” of marriage and the expectation of people to “live happily ever after” in a single, long-term monogamous relationship. This is reflected in increasing divorce rates over several decades, the prevalence of extramarital sexual liaisons (which research estimates suggest may occur at some stage in approximately 20% – some say up to half – of all marriages), a greater acceptance of varying relationship arrangements including same sex and de facto relationships, and seemingly increasing questioning about the viability of long-term monogamous relationships, especially given the ageing of the population. It is increasingly common for individuals to have two, or three sequential long-term relationships in adult life.

Whereas the Gottmans and other marital therapists commonly emphasize the notion of connecting with each other in marriage, Esther Perel, a therapist and writer, emphasized the importance of balancing the goals of seeking intimacy and security in a relationship with allowing for novelty and adventure. She elaborated on such views in her book, “Mating in Captivity” as well as when interviewed on the former ABC television interview program, Enough Rope, in an interview which can be accessed via the link, http://www.abc.net.au/tv/enoughrope/transcripts/s2058313.htm). She suggested that an over familiarity with one's partner could stifle sexual interest and passion in a relationship. The state of heightened lust, or what is known as "limerence", typically lasts no more than two or three years in an exclusive long-term relationship. Esther Perel suggested that to retain passion in a relationship it was important to be able to continue to view one’s partner as an “other”, and to allow for each partner to relate positively to others outside the relationship. This might also include situations whereby each partner could acknowledge sexual attraction between themselves and another person outside the marriage, whether by acknowledging fantasies, flirting and even in some cases, accepting more open relationships. She contrasted the taboo against even consensual non-exclusive relationships with the seeming relatively ready acceptance of divorce. It helps for partners to be direct and accepting of each other in negotiating any such boundaries in their relationship, showing mutual respect whilst still hopefully allowing room for some adventure and novelty. Acknowledging attraction to others is, of course, more likely to be fraught with tension and conflict if the couple’s relationship does not already have a stable foundation reinforced by the kinds of connections described by the Gottmans. Most writers would agree on the potential benefits of partners at least being able to share fantasies and requests for playfully exploring different sexual experiences with each other, at least within the bounds of their relationship. The seemingly conventional expectation that marital partners retain an exclusive sexual attraction to each other throughout a lengthy lifespan might reflect an overly rigid expectation which could contribute to reduced passion in marital relationships and paradoxically lead to greater marital dissatisfaction and breakdown.

Whereas Esther Perel’s views about marriage and sexual relationships might seem unconventional and confronting, it is important for couples to consider the ways they allow themselves to differentiate from each other as well as to link and connect. Partners can differentiate themselves by allowing themselves and their partner to cultivate different interests, to develop connections with others, and to express differing preferences and opinions. Indeed, we may be more likely to maintain or revive an interest in our intimate partner if we appreciate them as an “other”, including accepting that we don’t know all there is to know about them. Even in conflict situations, we might consider their contrasting views as a means to open ourselves to different or novel perspectives. Perel highlights that often people report finding a partner most attractive when they look at them from a comfortable distance such as seeing them play with their children, engaging in physical activity, or performing the work role or other role in which they are skilled. As Perel suggested, Considering the “otherness” of one’s partner may help a relationship grow and evolve in a manner where each partner might, in a sense, experience two or three relationships with the same long-term partner.

Engaging in dialogue

Engaging in dialogue is a key to constructive communication. This blog, among other things, will hopefully serve as a discussion point for partners to have a worthwhile conversation about the ways in which they relate to each other. Many of the strategies described have been found to not only help address serious marital problems and decrease the likelihood of separation and divorce, but also to enhance marital satisfaction in circumstances where couples are already relatively happily married.

How to Worry Less

2009-09-28T11:53:00--11:00

Statistics suggest that approximately one in five adults suffers from an anxiety-based condition of which a prominent feature is some form of worry. Approximately twice that number of people would worry on a regular basis. Therefore, worry is one of the most common forms of psychological distress. Some level of worry may be normal and productive. For example, worry can be productive if we are considering a very important issue where a potentially negative outcome is likely to happen if we do not take action and there is something which we can do about the situation. By this definition of productive worry it may be healthy to reflect on concerns about our environment or our children’s safety or our health if there are signs that these things are under immediate threat. We may then be constructively motivated to do something to improve the situation. It helps if we are focused on a specific situation and are willing to accept imperfect solutions, taking into account what we can and cannot control. By contrast, worry will commonly not be helpful if we are ruminating about relatively minor matters or about situations which are not likely to occur or when facing circumstances which we can do little about. Worry may also be unproductive if we continue to ruminate excessively and expect ourselves to have an unrealistic level of control over our circumstances or expect ourselves to find an ideal solution to complex problems.

What is worry?

We could define worry as:
- a chain of thoughts
- accompanied by feelings of anxiety
- about future events
- where the outcome is uncertain and
- where there is a focus on potential negative consequences
- in the hope of reducing danger

Therefore we can help contain excessive worry by a range of means including disrupting a negative chain of thoughts, focusing more on the present (including on the task at hand), accepting uncertainty about the future, not overly focusing on negatives, having realistic views about the actual danger we face and further developing anxiety management strategies. This blog is focused on a range of strategies to help reduce unproductive worry and its impact on us.

Worry-related stress relates to our perception of

the risk of a negative outcome
how bad that outcome would be

Therefore our worries will be particularly intensified if we have an exaggerated view of the likelihood of a negative outcome or of the potential harm which might result. A realistic view of the actual dangers we face will help contain worry. Therefore it may help to ask ourselves how likely is it that a particular event will happen and if it did, what would be the worst thing about that. We can also ask whether worrying will alter the likelihood of a negative event occurring. We might then test our negative predictions and factor in our experience to our future predictions. Research suggests that approximately 95% of feared outcomes which people worry about do not actually happen.

Commonly, worry is experienced as repetitive concerns about particular circumstances such as worry about the welfare of family or friends, about work or school, about home-related issues, about finances, about health issues or about a forthcoming event. Worry is sometimes compounded by concerns about the worry itself, or worrying about worry. For example, people may view their worry is uncontrollable or as harmful or as indicating a failure to cope. This can create a vicious cycle where worry just leads to more worry.

The single most important strategy in countering worry is shifting from a focus on our worrisome thoughts to taking some productive action. For example, rather than worrying about our health or finances we can think of what we might do to improve our circumstances. If we are concerned about our relationship with a family member, we could think of what we might do, even symbolically, as an action to help improve that relationship.

What makes worry worse

Thoughts which may compound the negative effects of worry include:

Catastrophizing: This commonly involves an escalating pattern of increasingly exaggerated concerns about what negative outcomes may occur.
Overvaluing worry as a coping strategy: we may have an inflated view of the potential of worry to help us cope or be prepared for possible negative outcomes. Worry may commonly be merely adding further to the stress we are experiencing.
Anticipating negative events as a form of control: this may include anticipating the worst in the hope that we will be ready for even the most adverse outcome. In fact this strategy tends to make the lead-up to challenging events extraordinarily stressful.
Misinterpreting worry as a failure to cope: such judgements typically only add to one’s stress.
Intolerance of uncertainty: Much of life involves uncertainty and we will typically experience a greater level of well-being if we are focused on what we can productively or enjoyably do in the present rather than having exaggerated expectations of predicting or controlling an uncertain future. We can nonetheless take constructive action in the present to sensibly reduce future risks.
Other common thinking errors: Apart from catastrophizing, common thinking errors include selectively focusing on negative rather than positive information, jumping to conclusions, overgeneralising from past negative experiences, all-or-nothing thinking or personalising situations whereby we take excessive responsibility for the outcome of situations including events over which we had minimal control. Such distress-inducing thinking patterns can lead us to feel as bad as if our exaggerated negative thoughts were true. This is because our emotional reactions to a particular situation or set of circumstances are affected by our subjective perception of those circumstances, not by the objective situation itself.

Behaviours which may compound the negative effects of worry include:

Overly seeking reassurance: if we do not receive that reassurance we may worry more. If we do receive that reassurance we may think that is the reason that we have managed with a situation. Either way, this can lead us to overly focus on receiving reassurance from others in future rather than finding our own ways of coping with a situation.
Avoiding situations related to worry: If we avoid challenging work or social situations which we are worried about we will typically not be further developing our coping skills and strategies for managing more effectively with such situations. Furthermore, our avoidance of situations may further convince us that they are in fact dangerous as opposed to being merely challenging and potentially uncomfortable.
Overly seeking information as a form of control: For example, if we repeatedly and persistently seek information on the internet to allay a health concern we may be at risk if intensifying unrealistic fears rather than seeking reliable and balanced information in a contained way.
Use of alcohol, drugs or comfort eating: Such means of attempting to reduce intrusive thoughts or anxiety represent another form of unhelpful avoidance which commonly compounds worry and may lead to worsened additional problems.

Attitudes which contribute to worry and ways to address them

Fears of failure or perfectionism: People are more prone to worry if they have harsh expectations of themselves or unrelenting standards related to their performance. Aiming to do one’s absolute best all the time would inevitably lead to anxiety. It is worth comparing our expectations of ourselves to what we would consider to be acceptable in terms of other’s performance. It is worth considering what things are so worth doing that they are worth doing less than perfectly, which also enables us to get more things done. As commonly emphasised by successful entrepreneurs we can learn much from our failures. In general it helps to separate our sense of self-worth from our performance on a task or activity. As Mark Twain suggested, we might treat success and failure as twin imposters.
Fears of disapproval: It is also important to separate our sense of self-worth or self-acceptance from the perceived approval we receive from others. Others will vary in their subjective opinion of us, but that does not mean that our inherent worth changes as a result. When people experience social anxiety or avoidance and worry about others’ potential disapproval it can be helpful to face avoided social situations, to take risks such as venturing alternative opinions and to practise asserting oneself in conflict situations. It can then help to compare one’s experience of such interpersonal situations to what you might have predicted. Whenever facing potentially challenging situations it is worth giving oneself credit for one’s efforts and for any ensuing benefits such as improved social interactions and increased enjoyment.
Exaggerated fears of discomfort: In general, discomfort is uncomfortable as opposed to dangerous. If we have avoided or shied away from situations as a result of anxiety it can be helpful to gradually face such situations and recognize the progress that comes from allowing oneself to experience a degree of discomfort. It generally helps to face challenging situations whilst staying in the moment or “being in our own skin” rather than trying to block out our feelings; we can then develop further emotional strength and resilience. Gaining increased confidence in facing challenging situations and dealing with any ensuing anxiety is commonly the most effective way of reducing worry in the longer term. We can then perceive a wide range of situations as being less threatening and dangerous.

Other attitudes more common amongst those with more disruptive patterns of worry include:

Viewing worry as uncontrollable: Given that worrying is influenced by a conscious desire to improve our future circumstances it involves a degree of will and at least partial control. Perhaps the most effective way of gaining an increased sense of control over worrying is to repeatedly practise disrupting a chain of worrisome thoughts by initiating some other activity which engages our attention. This might include some activity which either practically or symbolically could help improve the circumstances that we are worried about. Otherwise it can involve engaging in any alternative pleasurable task. Disrupting worries in this way has been found to alter our brain functioning in a manner to reduce future worries.
Another way of increasing our sense of partial control over worrying is to postpone our worry to a period later in the day. For example, one may set aside 30 minutes in the evening to sit in a particular “worry chair” and to postpone contemplating one’s concerns about a particular situation to that time. Containing or limiting worry as opposed to attempting to completely block it or stop it can sometimes be a more effective way of gaining a sense of further control over worry.

Viewing worry as dangerous: People may be concerned that worry in itself may lead to some serious harm either mentally or for their physical health. This may be influenced by hearing that there can be long-term physical complications from prolonged stress reactions. Reactions such as intrusive thoughts, reduced energy and increased physical tension are uncomfortable more than dangerous. A person may fear developing debilitating physical ailments or losing their mind from worry. In a therapy context people may be encouraged to challenge such fearful predictions by attempting to lose control and to actually “lose” their mind in a particular way such as deliberately inducing a psychotic state. After a brief experiment people typically abandon their efforts as it becomes evident how unrealistic such fears are. People can consider whether friends or others who have acknowledged tendencies to worry appear to be uncommonly plagued by harmful physical illnesses and conditions.

Additional strategies to counter worry

Prediction testing: Given that worry commonly involves overestimating the risk of danger or likely harm it can help to make a prediction as to how a particular situation will unfold and then face that situation and see what actually happens.
Characterise persistently intrusive thoughts as a visitor: For example, if particular thoughts return you might say to yourself, “There’s Fred again”, and pretend that the thoughts are a visitor who might be invited to sit in the room or to be alongside you whilst you nonetheless engage in another activity.
Convert the worrisome thought to a picture: Rather than thinking over and over the worrying thoughts, it may be helpful to instead form of picture or envisage a scene which involves the challenging situation you are worried about and then imagining yourself dealing with it in some way.
Grieve when facing losses you cannot change: For example, if someone has been diagnosed with a very serious illness which would likely markedly reduce life expectancy, it is natural to allow oneself to grieve whilst contemplating potential or likely losses including a curbing of realistic future hopes and altered plans. Allowing oneself to grieve can help gain greater acceptance of a seriously adverse situation which may in turn help the person to make the most of what opportunities remain.
Gratitude exercise: You may imagine losing absolutely everything which is important to you including family members, your home, your job, and even your senses of sight and hearing. Allow yourself to imagine only regaining these one by one, but only after fully experiencing and expressing gratitude for each thing which is to be returned.
Generating other positive emotions: Given that positive emotions tend to “wash away” residual negative feelings, it can help to do anything which involves the experience or expression of other positive emotions including love, faith, trust, hope, joy, forgiveness, compassion and awe.
Anxiety management strategies: Given that worry is associated with anxiety, any strategies which reduce arousal or tension levels may be helpful including breathing and relaxation strategies or coping self statements (e.g., “I’ll be okay”, “Let it be”, “Focus on now”, “I’ll get through it”, “Breathe”, etc). However, it is important to combine such strategies with other techniques which more directly challenge worry-inducing thoughts and behaviours.

People typically make the greatest progress by repeatedly facing challenging situations whilst allowing themselves to tolerate associated discomfort and testing their predictions about feared outcomes. It seems that progress is more reliable if it is allowed to be gradual and imperfect, but is nonetheless backed up by genuinely appreciating and acknowledging one’s efforts.

The most important strategy

The most important thing to remember when addressing patterns of worry is to repeatedly practise ways of interrupting a chain of worrisome thoughts by taking some alternative action, preferably by doing something which is productive or enjoyable.

Dealing with addictions

2009-05-21T00:00:00--11:00

Dealing with addictions involves more than just willpower. It also involves having practical strategies which can assist a person to gain a greater return from their efforts in reducing or eliminating addictive behaviour. This blog aims to provide information and outline strategies which can be helpful in dealing with addictive behaviours.

There are many types of addictions including addiction to alcohol, cigarettes or certain other drugs. People can also be addicted to certain behaviours such as gambling and particular sexual behaviours including accessing Internet pornography. Sometimes addictions occur in the context of other mental health problems such as depression and anxiety disorders. For example, individuals suffering from psychological trauma reactions are approximately four times more likely to abuse alcohol and other substances. It can be especially helpful to talk to your general medical practitioner or other mental health professional when addictive behaviours are accompanied by other mental health problems.

Characteristic signs of addictions include compulsively seeking out the addictive drug or activity despite clearly negative consequences such as financial loss, health problems, legal problems, increased conflict in relationships and/or increasingly risky behaviour. The addictive behaviour may interfere with work performance, relationships and other roles such as parenting. People when addicted generally spend more time on the activity than intended and develop an increased tolerance for the addictive substance (seeking more of it for a similar effect). The addicted person would likely experience signs of withdrawal, such as cravings and feelings of anxiety, when unable to access the substance or activity. Those addicted may commonly tend to minimise or downplay the difficulties associated with their addiction.

It is increasingly being understood that addictions are commonly accompanied by changes in the brain including changed brain cell connections and changed brain chemistry. By repeatedly practising the addictive behaviour in stages of excitement the addictive behaviour becomes paired with the activation of pleasure centres in the brain. This applies not only to the use of addictive substances, but also behaviour such as gambling and repeatedly accessing Internet pornography. These changes in the brain help account for why it can be so difficult to curb addictive behaviours. When people are aware of starting to develop a pattern of addictive behaviour there are great advantages in curbing the behaviour at an early stage. However, by learning to deal with high risk settings in ways other than engaging in the addictive behaviour, and by instead pursuing other healthy and rewarding behaviours which enhance pleasure, this can help reverse some of the changes described above.

Readiness for change

In order to help oneself or others to deal with an addiction it is especially useful to consider the person’s readiness for change. Therapists commonly consider the following stages of change:
Pre-contemplation: when the person has no intention to make changes and appears to avoid talking or thinking about the addictive behaviour and may deny or minimize the behaviour.
Contemplation: the person is considering some advantages or disadvantages of change, but seems ambivalent and not yet ready to take clear action.
Preparation: the person intends to take action in the near future and has perhaps bought a self-help book or made an appointment with a GP or other health professional.
Action: this involves some actual change in behaviour such as switching from heavy beer to light beer, avoiding a particular poker machine venue or discontinuing smoking cigarettes in particular settings. The person can then continue to build on their constructive actions, potentially to the point of overcoming the addiction.
Maintenance: This involves maintaining the changes that have been made, in part by being vigilant about relapse. This may involve anticipating challenges and developing new strategies to manage with such challenging situations. It is helpful to remind yourself of the changes you have already made.
Relapse: When this occurs, it involves slipping back to the point of a recurrence of the earlier pattern of addictive behaviour. There can be a sense of going back to the start even though the person may have learnt valuable skills and strategies in the previous action stage. Most relapses occur within the first four months, so it is especially encouraging when people have discontinued or markedly reduced an addictive substance or behaviour for four months or more. Following relapse a person may revert to one of the earlier stages, such as pre-contemplation, or may have renewed efforts to take action.

Lapse versus relapse

One of the most helpful strategies in dealing with addictions is to recognize the difference between a lapse, which is a brief or more minor slip, and a relapse. Lapses or occasional slip-ups are not uncommon when acting to change any persistent behaviour. It is important that people don’t become overly disappointed or harsh on themselves after a lapse. Otherwise they may think that now they have slipped up, they might as well give up because they have now “blown it”, or clearly failed in their attempts. This is commonly called the “abstinence violation effect”. In the long run lapses can serve some purpose in reminding people why it is important for them to change their behaviour. People can learn what particular circumstances have triggered the lapse and can use this understanding to redouble their efforts in such situations in future. People can then “use a lapse as a lever” for further change. The most important thing is not whether people have lapses, but how they respond to them. Most people who successfully overcome addictions have had lapses along the way.

Specific psychological strategies for change

Some of these strategies aim to increase your awareness of the impact of the addiction on your life, and therefore the importance of addressing it. Other strategies are geared towards increasing your sense of “self-efficacy”, or confidence in managing with addictive urges. As you experience some success in managing with addictive urges using strategies such as these, your sense of at least partial control and self-efficacy will grow.

Consider your reasons for change: it helps to clearly recognize why discontinuing or reducing the addictive behaviour is important to you. It is worthwhile to write down the advantages and disadvantages of discontinuing or markedly reducing an addictive behaviour. It is important that your reasons are personally relevant and meaningful for you (but you can of course take into account the feelings of those closest to you).

Consider high-risk situations: It helps to recognize the circumstances in which you are most likely to lapse including negative emotional states, such as anxiety, depression or boredom; social pressure; interpersonal conflict; positive emotional states, such as when in a mood to celebrate and situations involving ready access to the addictive behaviour, such as meeting friends in a bar or at a casino as compared to somewhere else.

Monitoring: this is always a helpful strategy for changing any persistent unwanted behaviour. When you have made a decision to take action, simply recording the number of standard drinks you consume per day, the number of cigarettes smoked or the amount spent on gambling can be enough to help you start to enact significant change.

Urge surfing: this is probably the single most important strategy for overcoming addictions. Any addictive behaviour will be accompanied by urges. The key point is, if you do not give in to an urge (using whatever means possible) it will not continue at the same strength. It will reduce. It may well return, and may return often, but it will not continue at the same peak level indefinitely. Each individual urge will reduce from its peak. The urge will tend to first increase, then level off, then decrease (like a rising and falling wave). Riding out the urge is called “urge surfing”. This may take place over an hour or two and may be very uncomfortable. It may help to distract from the urge by engaging in other behaviour. By persistently and repeatedly resisting individual urges, in time they will reduce in intensity and become fewer and further between. By breaking the connection between a particular situation and subsequent addictive behaviour, the addictive urges will reduce in that setting, even if this takes weeks and months. For example, people who used to smoke cigarettes in settings where it has long been banned (such as on public transport or in meeting rooms at work), may recognize a generally lesser urge to smoke whilst in such settings than they used to have when smoking there was allowed. If not completely resisting an urge until it passes, at least delaying acting on an urge can increase your sense of partial control over addictive urges.

Coping self-statements: This involves using a helpful mantra, a word or phrase, to help bear with the urge and get beyond it. This could include, “The urge will pass”, “Breathe”, “It’s not worth it”, or “Hold On” (a phrase referred to in the colourful novel about severe drug addiction by James Frey, “A Million Little Pieces”). Such coping self-talk helps counter negative inner dialogue, perhaps in the form of self-sabotaging thoughts or a persistent and harshly self-critical “voice”.

Stimulus control: this involves limiting its use for the addictive substance or behaviour or access to it, such as having no alcohol in the house or driving a different way home to avoid the club with poker machines. It can also involve changing the settings in which you use the substance such as only smoking whilst outdoors.

Social supports: let someone know that you’re interested in addressing an addictive behaviour. It can help to have someone to whom to report your changes in behaviour, whether it be a health professional or supportive friends. You might elicit support from a partner to, for example, avoid high-risk situations for a while.

How others can help

Partners and concerned family members can help in a number of ways, for example, by encouraging the addicted person to talk to a health professional about their addictive behaviour, by pointing out relevant information if the person seems open to it and by encouraging the person in any active efforts they are making. It helps not to get caught up in a pattern of nagging or acting in ways that one’s partner might view as overly controlling as they are then more likely to resist one’s efforts to help them change their behaviour. Partners of those with serious addictions might seek out support for themselves.

Final tips

In summary, people are more likely to overcome problems related to addiction when they recognize that changing their addictive behaviour is very important to them and when they are ready to take action. To increase one’s confidence it can be very helpful to pick one way of taking action – preferably using your own idea of how to do this – then monitoring your change and giving yourself credit when you have acted differently. By making a constructive change in any way at all you have created some success to build on. Then some additional change may help to add further positive momentum. It is important to not be overly discouraged about lapses. Lapses are normal. You can learn from them. By putting positive energy into changes that you have decided upon, and by persisting in the long term despite occasional lapses, and by learning from the lapses without being too hard on yourself, you are increasingly stacking the odds of beating an addiction in your own favour. It can also help to seek professional assistance to explore barriers to change and to help stay on track with reaching your goals.

For those interested in relevant practical strategies for dealing with alcohol addiction in particular, see www.acar.net.au, the website of the Australian Centre for Addiction Research, a very useful resource for those contemplating or ready to take further action.

Tackling Challenging School Issues

2009-04-30T00:00:00--11:00

The following is a revised version of an article published in The Geelong Advertiser “Education Guide” supplement on May 13, 2008. Chris Mackey responded to questions put to him by journalist, Margaret Linley, who edited the original article. Additional input has been provided by Laura Capitanio, Child Clinical Psychologist.

As parents we can struggle to know what is the right thing to do if our child encounters seemingly insurmountable problems at their school and is miserable and frustrated. Should we tell them to stick it out or do we transfer them to another school? Is there a right time to bail from a school or are we just teaching our children to run away from their problems?

Chris Mackey, Geelong psychologist, looks at some big issues and discusses way to tackle them.

Bullying

My child is being bullied and excluded from the group. She is no longer happy to go to school and wants to change to another school where she says she will be happy.

Your child can gain a lot by attempting to deal with the problem in the current school environment. Your child can learn additional resources and strategies to tackle such problem issues. The list below provides a few examples.

The child can learn the various channels that are available to voice his/her concerns (such as parents and academic staff). To achieve an effective outcome, it is important that collaboration between parents, academic staff and the child occurs. It also informs others (e.g., academic staff) about the problem issue, and indicates that it is being monitored.
The child can learn adaptive strategies (with the input from adults) that help build upon his/her own emotional resilience, and strengthen optimism and hope. Strategies include management of emotional wellbeing and perspective, and encouragement to maintain social networks. Strategies in conflict resolution and assertiveness via a combination of humour and deflection can be most useful. These strategies show the child how to respond to such problem issues without avoidance. These strategies may also help the child attain a greater level of academic achievement, social and emotional wellbeing, and physical health.
The child can learn that appropriate assistance and support can be given (as either a school or individual intervention) to identify appropriate and inappropriate behaviours to student peers, and to help create positive change in the school environment.

The child can thus learn that it is possible to face such problem issues that may seem insurmountable, and learn strategies for the future. However, there are ongoing risks if the issue continues to be unresolved even after active attempts to address it. The child can begin to experience a sense of helplessness. The child’s psychological state may worsen, and he or she may experience a constellation of associated problems including academic and social difficulties (e.g., social withdrawal and disconnection). It may then be far preferable for the child to attend another school. The child can learn the constructive lesson that s/he does not have to accept the problem issue indefinitely because active attempts were made to improve it. It is important to acknowledge that if the child has chosen to attend another school, there would need to need to be ongoing effort from the parents and child to assist the change to be worthwhile.

Strained teacher-child relations

There is a teacher at school who is making my child’s life hell. He no longer wants to go to school and is losing all interest.

If it is an isolated situation (i.e., just one teacher rather than several teachers), discuss with your child about how they approach the class and how they might manage their responsibility for their own behaviours and actions. Your child might then consider strategies to help them be less of a target.

If the difficulty continues, it might be worthwhile to discuss concerns with the teacher and perhaps the principal. This informs others (e.g., the teacher) about the problem issues, and indicates that it is being monitored.

If the negative interaction with the teacher persists but the child has still been able to learn in other classes and interact well with others, then the goal might be to limit (or contain) the negative effects. Encourage your child to accept that all individuals cannot get along well with each other, and that the negative effects are temporary as next year they will have another teacher. It is also important to maintain perspective and balance whereby the child can acknowledge positive aspects in their own life, and that it is a specific dislike of the teacher and not of the particular subject or school itself. This approach can help build upon his/her own emotional resilience. It is sometimes good to persist with some difficulty because enough appears to be going well at that school; however, if your child has an unwarranted negative reputation from one year to the next, then consideration of the options might lead the child to attend another school.

Failing to thrive
My second child is very sporting but because her elder sibling is not, the school overlooks her when it comes to sporting activities. She feels very frustrated and it is starting to impact on her schoolwork.

Often it is important to convey a message to the school. Use a positive approach to highlight to the teacher that the younger sibling is different from the older child; that is, each child have their own talents, interests, and strengths. Explain that, if the child is given a chance to participate more in sports, there may be improvements in all other areas of the child’s performance.

The child learns that s/he has been heard, and can influence others around them and make a difference to their own world. It can often be useful to adapt to circumstances that are a bit adverse and then use strategies that attempt to improve it, because this can provide an optimal opportunity to learn; however, if the issue continues even after active attempts to resolve it and the child experiences a range of associated problems (such as withdrawal from learning opportunities and social discouragement), it may be preferable for the child to attend another school.

How to talk to my child’s teacher
What is the best way to approach my child’s teacher when there is a problem causing a lot of concern for us at home?

It is important that there is collaboration between the parents and teacher. Parents might best approach teachers in a way that says, “I think I have some ways that may make things work better. My child may be more effective in the classroom if these concerns are taken on board.”

It is important to remember that teachers appreciate knowing because it gives them more chance to attend to that problem issue before it escalates. Teachers do all they can to work with the child and the approach needs to be a positive experience.

Conclusion
“The first thing for parents to recognise is when you have a choice (e.g., stay or change schools) each with significant consequences, it causes a degree of stress. It is natural for parents to go through a degree of agonising,’’ Mr Mackey says. Perhaps being prepared to agonise on occasion about our children’s welfare is one aspect of good parenting. “However once the choice is made, the aim is to accept it and then work hard to make that decision worthwhile.’’

Summary suggestions

Any kind of change produces stress so try to work through the least disruptive choices first. If the child can stay at the school with the problem fixed, you have likely reached the best outcome.
Listen closely to your child’s concerns and, especially for older children, involve them actively in any decisions about how you might address a difficult situation whilst letting them know you will not accept an ongoing situation that is seriously affecting their wellbeing. Approach the challenge with a tone of optimism that longer-term acceptable solutions can be found.
Work together with teachers and other involved school staff wherever possible and respect that their view may be informed by a great deal of experience of your child in the school environment. Teachers will also commonly be well motivated to find good solutions for any difficulties your child has at school.

Each decision you make will teach your child a lesson. They can learn a constructive lesson – you don’t have to put up with an intolerable situation indefinitely if you’ve made your best effort to improve with it. Or they might learn ways of avoiding situations and not develop as much resilience.

Use a problem solving approach to making your decision. Seek lots of good information, find out alternatives, and weigh up the costs and benefits. Once the decision is made, accept that it is the best decision you could make at the time, and then work hard to make it work.

There is no right or wrong answer. It’s about weighing up all the options and considering the consequences of each choice.

Dealing with Panic

2008-08-22T12:51:00--11:00

Panic attacks are not such a problem. That may seem a ridiculous statement when panic reactions can be so exceedingly uncomfortable and disruptive. However, it is commonly not panic symptoms themselves which are the most unsettling aspect of panic attacks. The main problem is panic about the panic. A key goal of dealing with panic attacks is to allow some of the distress to be there. Panic reactions are not dangerous. Panic attacks will pass, usually within a matter of minutes. It may feel as though one is losing ones mind or might have a heart attack, but panic is not dangerous. Panic attacks may be very, very unpleasant, but panic is not dangerous. The goal is to help get this message through to the back of ones mind, even when one is experiencing panic symptoms. That is not easy, and takes practice. Commonly it takes months and months of practice before a person can experience repeated panic reactions and yet feel some confidence that the distressing feelings will soon pass.

Panic attacks represent one of the more common difficulties for which people seek psychological treatment. Panic attacks involve a sudden bout of anxiety or intense fear in the absence of real danger. They typically reach a peak within a few minutes. Panic attacks involve experiencing a number of characteristic symptoms which may include heart palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, feeling dizzy or lightheaded, chills or hot flushes, feelings of unreality or of feeling detached from oneself, numbness or tingling sensations and fears of losing control of either one's mind or one's body. Panic attacks tend to worsen when a person becomes preoccupied about the possibility of further attacks and becomes increasingly sensitive to any physical changes in their body which suggest that such an attack might recur. Again, the key difficulty at that point is not so much the impact of particular panic symptoms themselves, but that people may tend to panic about the panic. This can further interfere with one's brain functioning by leading to further activation of the limbic system, a part of the brain which is important for mobilising a fight or flight response to escape danger. In addition to the person feeling like fleeing the situation, their frontal lobes may become less active which may lead to them feeling a marked loss of control of their reactions and perhaps losing their more usual sense of self.

It may greatly help if the person can manage to stay in the situation rather than flee, perhaps using anxiety management strategies described below, as that helps one learn that panic symptoms will typically pass in a matter of minutes.

Specific anxiety conditions where panic may occur

One common anxiety-related condition, panic disorder, is experienced by approximately 1 in 30 people. This occurs when people have recurrent panic attacks and remain especially fearful that they will experience another such attack. In just under half of such cases this may also lead to agoraphobia when the person comes to avoid situations in which they are fearful that an attack may recur. People may also have a phobia, or excessive fear of such situations as heights, enclosed spaces or encountering spiders, and may experience panic-like reactions when encountering the prospect of entering the feared situation. People can also experience panic reactions in the context of having a post-traumatic stress disorder. This condition involves marked anxiety when somebody is reminded of a past traumatic event, such as a car accident or other life-threatening situation, about which they have ongoing intrusive and painful recollections which they seek to block out of their mind. Obsessive-compulsive disorder involves exaggerated distressing thoughts about potential threatening situations such as a fear of leaving the gas on at home, not properly locking ones front door or excessive concerns about contamination from dirt: people may then engage in unnecessary time-consuming activities to neutralise their anxiety feelings such as compulsive hand-washing or compulsively checking door locks which they have already checked. Social anxiety occurs when a person feels somewhat panicky if they are forced to be the centre of attention or fears consequences of coming under other people's close scrutiny. People may also experience panic-type reactions associated with performance anxiety before or during an event in which they have high expectations of performing well such as before an exam or a competitive event. When such conditions are especially disruptive, it can be worth seeking psychological assistance which in most circumstances can lead to substantial gains in approximately eight to twelve therapy sessions, depending on the severity and chronicity of the condition. Although most anxiety disorders appear to improve somewhat from approximately 55 years of age, there are fewer remissions without treatment.

Strategies for dealing with panic

Mindset

Managing well with anxiety-related reactions has a lot to do with ones mindset. It has a lot more to do with letting go than controlling ones reactions. Dealing constructively with anxiety or panic commonly involves allowing some discomfort to be there, bearing with it, grappling with a situation or muddling through it. It is about coping rather than mastery. Coping means allowing oneself to feel the anxiety, but recognizing that one has ways of handling it. Mastery is about trying to be on top of a situation, trying to succeed in controlling it, or aiming to eliminate bad feelings. Aiming to master anxiety reactions often makes the situation worse. There is no need to Be Positive! so to speak. It is more about hanging in there when you feel bad. When disruptive symptoms pass, that then allows you to get on with whatever you were doing. Such an approach helps reinforce the understanding that panic is not dangerous.

Breathing

Panic symptoms are commonly influenced by disrupted patterns of breathing. In particular, if people are facing ongoing stresses they will tend to be at greater risk of overbreathing. At rest, people generally need no more than about 14 breaths per minute. If people commonly experience dizziness during panic attacks, it is likely that panic symptoms have been induced by overbreathing. Overbreathing can include rapid breathing or frequent sighing or yawning. This may lead to a complicated range of bodily reactions associated with reduced carbon dioxide in the blood and reduced oxygen to the brain. Many panic symptoms can be directly caused by overbreathing. In a psychological therapy session, a client who has had panic attacks may be encouraged to hyperventilate for a minute or so to demonstrate the extent to which panic symptoms can be caused just by changing breathing patterns alone. To help counter overbreathing, it can help to take in 10 to 12 breaths per minute (one breath every five or six seconds), preferably breathing relatively lightly through the nose, and breathing more from the diaphragm (as though breathing through the belly button) than from the chest. Practising an exercise of slowing breathing for a few minutes each day (perhaps counting each breath in and saying, Relax, for each breath out) can help prepare oneself to slow ones breathing when experiencing panic symptoms. This exercise might best be repeated daily for several weeks.

Coping self-statements It can be particularly helpful to draw on coping self-statements to help manage with anxiety. This helps further activate frontal lobe influence on more primitive brain functioning (geared toward escaping danger) which may in turn allow the person to gain greater feelings of partial control. Coping self-statements may be in the form of a mantra, or a word or phrase that a person may repeat to themselves, such as, "Let it pass", Breathe, Ill be OK, or Let it be. People can simultaneously use relaxation or breathing techniques to reduce tension.

Medication

Sometimes it may be helpful to combine psychological strategies incorporating the cognitive-behavioural techniques described above with medication as an adjunct, but often in the first instance it is helpful to address panic reactions without using medication. People may be at increased chance of relapse if they have used medication and then the medication is discontinued. In many cases medication is not necessary. Medication may sometimes be a useful aid to treatment as it can provide some symptom relief whilst the person further applies psychological strategies, but medication is not a complete treatment in itself.

Practising experiencing discomfort as a goal

When people are aiming to further develop their ways of dealing with anxiety and panic it can help to seek to practise experiencing discomfort as a goal rather than as a problem to be overcome. When people gain much greater confidence that they are able to manage with discomfort, then they are much less likely to experience fear about the fear and are less likely to panic in the face of panic. This can help reverse a vicious cycle and may increase the person's confidence that they can deal with whatever situations they may face. This may involve muddling through or grappling with those situations and coming out the other side, perhaps uncomfortable, but relatively unscathed.

Exposing oneself to challenging situations

When dealing with any persistent difficulty related to anxiety it can aid recovery for the person to deliberately enter various challenging situations (a therapy strategy called exposure), perhaps whilst using the aforementioned strategies. The person may then gain confidence or increase their sense of self-efficacy or effectiveness in dealing with such situations, which in turn leads those situations to seem less threatening. People might best vary their exposure to challenging situations, such as by entering different types of situations for varying lengths of time. If a person feels they must leave a situation, it is best to engage in a strategic retreat. This involves briefly withdrawing from a situation, preferably moving slowly rather than rushing, to a point of having regained some further composure, and then re-entering the original situation. It can sometimes help for a person to focus their attention on their planned actions or behaviour as opposed to their feelings in a particular situation. By having the focus outside of oneself, at least temporarily, this may help to distract oneself from internal uncomfortable feelings.

In summary, a key goal for managing with panic is to aim to tolerate anxiety rather than to try to control it or necessarily reduce it. This involves allowing some fear to remain. The aforementioned strategies, especially including the use of a brief coping mantra, are best practised for a period of six months or so to help them become habitual and automatic.

Dealing with "Burnout"

2008-05-16T00:00:00--11:00

"Burnout" is a term which relates to symptomatic distress we may experience after being in stressful circumstances associated with persistent demands placed on us. Burnout occurs when the demands on us outstrip our resources including strategies for coping. For example, we may become "burnt out" after a period of excessive work demands, especially when there has been limited time for oneself. We may feel overwhelmed and wish for more time or more support. We may experience ourselves and others as falling short of expectations. This can be combined with a range of symptoms associated with increased stress described below.

Before considering symptoms of burnout it is worth considering a number of issues related to stress in general. First of all, stress is universal. Stress relates to our level of arousal. Any form of effort, challenge or adjustment may increase our level of arousal. Therefore stress is part of living: we would be inert without it. Stress is not all bad. With very low stress our arousal is very low so we are not likely to be at all productive. As our arousal level increases from a low point our performance is also likely to improve and we are likely to be the more productive and effective at achieving various goals. This may help one's achievement on the sporting field, during an examination or completing a number of physical tasks in a particular period of time. However, as our arousal level increases beyond a certain point we will no longer benefit from improved performance: in fact our performance will decline. If our arousal level then increases even further we can become very unproductive as a result of excessive stress.

We vary in the level of stress which we can tolerate before it has an unhealthy impact on us. It is important for us to be able to recognize signs which may indicate undue levels of stress so that we can seek to reduce demands on us or bolster our resources, including strategies for coping. We each have our own characteristic "stress signature", or typical pattern of symptoms we might experience when our stress levels are increasing up to a mild, moderate, and then severe level. It is especially helpful to recognize early signs of burnout as useful signals to note and then plan to make stress-reducing adjustments in one's activities and lifestyle. If burnout reactions become more severe and persist they are at risk of developing into anxiety or depressive disorders.

Burnout symptoms include physical, emotional, mental, relational and spiritual symptoms. Physical symptoms can include muscle tension, headaches, other aches and pains, poor sleep, fatigue, restlessness, teeth grinding, changing appetite, rashes, stomach complaints, and susceptibility to colds and other illnesses. Emotional symptoms include anxiety and worry, frustration, irritability, depressed moods, a sense of discouragement and experiencing little joy. Mental symptoms may include forgetfulness and poor concentration, boredom, confusion, negative self-talk, spacing out, dulled senses and lower productivity. Relational symptoms may include increased withdrawal and isolation, intolerance of others, fewer social contacts, and loneliness, distrust, resentment, nagging, arguments and reduced intimacy. Spiritual symptoms may include feelings of emptiness and loss of meaning, loss of direction, cynicism, martyrdom, apathy, being unforgiving or feeling a need to prove oneself.

When addressing stress and burnout we might best aim to find a balance in our priorities so that we can be effective in what we set out to achieve yet still allow room for our own rest, recuperation and leisure as well as time with friends and loved ones. Our response to burnout may prove to be helpful or unhelpful. Unhelpful responses may include worrying, increased use of alcohol or cigarettes, poor eating habits, continuing to work too hard, ignoring the problem (perhaps thinking there is not enough time to address it), blaming oneself or others, neglecting relationships and becoming more avoidant or isolated. Helpful strategies include recognizing the symptoms as signs of persistently increased stress and committing to do something about it. It is important to be forgiving of oneself for having developed such stress reactions in the first place. Specific strategies may involve time management and problem-solving techniques, seeking social support, practising relaxation or meditation techniques, physical exercise, using humour, giving to oneself (including engaging in positive self-talk), engaging in other restful activities or doing anything that one experiences as "recharging one's batteries". Other issues to consider in a work setting are containing our availability and responsiveness to e-mails and phone calls and other demands on our time.

For health professionals and others in caring roles it can be important to find a balance in aiming for helping versus "rescuing" our clients, meaning being careful not to take excessive responsibility for others, especially in areas where they might take responsibility for themselves. When in challenging supportive roles it is generally also important to build supports around oneself. It can be of particular benefit to develop some kind of ritual or transition after work to help let go of a demanding work role at the end of the day. Sometimes the question is put, "Who cares for the carers?" Ultimately it is up to carers to find ways at times of putting themselves first. It may be relevant to consider the analogy of using an oxygen mask on a plane. Parents are commonly advised in case of emergency to put on their own oxygen mask before they fit the mask on their children. We are likely to be of less benefit to others in challenging circumstances if we have not taken care of our own health and well-being.

Other strategies from the field of positive psychology include drawing on one's signature character strengths to address current challenges (see podcast on character strengths in Podcast section of this website) and exploring ways of inducing positive emotions including gratitude faith, love, hope joy, forgiveness and compassion. When we experience such positive emotions in our everyday lives this helps counter some of the lingering negative effects of stress. One such positive psychology exercise includes writing down three things each day for which we have felt grateful. These can be small and simple things such as enjoying a joke with a friend or appreciating some support from others or a skill one relied on to complete a task that day.

When considering burnout at work it is relevant to consider job satisfaction. A degree of job satisfaction is likely to depend on the range of aspects of work which we find uplifting relative to those aspects which we experience as unpleasant or draining. It helps to enhance our awareness of what we find positive compared to what we dislike. Professor Martin Seligman's "Authentic Happiness" model described in the aforementioned podcast outlines strategies to help us become more aware of our signature character strengths which we may draw on at work.

In summary, burnout occurs when the demands on us outstrip our resources. Some level of stress is a universal part of living. If we recognize from our characteristic signs of escalating stress (or “stress signature”) that our wellbeing is suffering, we can consider a range of practical and helpful strategies to address this. Exploring stress management strategies is an exercise in experimenting and learning what works best for each of us as an individual.

What is a mid-life crisis and what is so good about it?

2008-04-28T00:00:00--11:00

All of us will face periods of transition in our lives which involve particular challenges. Some psychological adjustments relate not so much to external events, but to more internal challenges, perhaps associated with life stages and the aging process. Early last century Carl Jung spoke of psychological challenges which occur in our lives around mid-life, around 40 years of age give or take two or three years or after around 13 years of marriage. It is commonly a period of both upheaval and potential growth.

A mid-life crisis commonly relates to a sense of turmoil that someone may have within themselves as they increasingly ponder spiritual questions such as, "Who am I?”, "What is life about?", "Am I living the right way for me?", "What are my priorities in life?, or " What direction might I take in life from here?" People would be more inclined to ask such questions more keenly with a greater awareness that, even with a relatively long life span, their life would likely be half over. This increases one's sense of mortality, often combined with a sense of loss of youth. People might be in a better position to ponder such questions having reached a stage of their lives where they could likely reflect on how they personally might wish to lead their lives more independently of the impact of past influences and decisions. Until the late 30’s many people would be leading their lives in a way which would be strongly influenced by their upbringing in terms of their parents’ influence, where they grew up, the influence of peer groups, and the impact of earlier decisions that they made in terms of career choices, choice of partner and the patterns and routines in their lives which they have already established. Towards 40 years of age people have a greater potential to understand themselves more as a person somewhat independently of these influences. Furthermore, people would generally be able to anticipate several decades further of life expectancy which may help justify making decisions which could cause great upheaval. People may then be more likely to ask themselves questions about how they are conducting their lives with greater poignancy or impact than usual. People may question whether they're married to the right partner, whether they have chosen an appropriate career for themselves and whether they are acting in accordance with their own underlying interests and values. People may have a sense of regret about past decisions which have shaped their lives in a particular direction. When people are experiencing distress in the form of depression or anxiety related to other life challenges, such mid-life questions and challenges may add to a sense of confusion and perhaps despair.

A key thing to understand about a mid-life crisis is that it relates to an inner struggle in terms of the person's relationship with themselves. Individuals around that time of life may be reviewing the extent to which they adapt to other peoples’ wishes and accommodate others relative to pursuing their own personal directions or interests which may assist them to feel that they are living their own lives in a more authentic manner. It may be confusing and at times distressing to weigh up potential sacrifices between one’s own goals and one’s key relationships when such interests appear to conflict. Individuals may recognize potential conflicts related to the persona and the self, that is the way one presents to the outer world and how one is seen by others (persona), and the way that they experience themselves from within. People may experience considerable conflict between other people's expectations and views of them relative to how they see themselves.

At the time of the mid-life crisis there is likely an inner striving for the person to become more balanced, rounded or whole in their personality functioning. Men and women may be drawn to further developing complementary aspects of their character more commonly related with the other gender: for example, women may become more goal-focused and assertive and participate more in activities outside the family. Men may be more inclined to make adjustments in their approach to work, may become less competitive and may focus more on their relationships. As Jung described, people may also be inclined to balance out other aspects of their personality to achieve a more integrated self, such as their relative emphasis on complementary ways of processing information and relating to the world including thinking versus feeling and using intuition versus sensation (practicality). These personality characteristics are explored in a widely used personality test, the Myers-Briggs Type Indicator. People may be confused as they face some, often unconscious, inner struggle to promote their less developed qualities. People may become drawn to others who either represent, or help them to develop, their less developed personality characteristics. This may lead some people to be more susceptible to having an affair with an individual who further stimulates their interest in developing their less developed qualities. Again, it helps for the person to be aware that the key issue is one’s development of one’s relationship with oneself in order to have a more integrated and rounded personality. Our dreams may offer us clues as to how we might draw on and further develop aspects of our personality to become more rounded.

Ultimately a mid-life crisis is about growth; although such challenging experiences can be unsettling and confusing there are many benefits which can result. Sometimes it is by acknowledging and mourning losses that we are in the best position to truly renew ourselves. The sense of psychological upheaval that people may experience around mid-life years can lead them to be more curious about and able to reflect on internal questions and experiences. People are more likely develop a greater awareness of themselves as a result of such questioning. People are likely to become more rounded as individuals and to develop further balance between the emphasis they place on goals they wish to achieve and nurturing their relationships. As a result of questioning one's direction people can make decisions about changes that they wish to make in their lives. People can use this stage of relative flux to be more determined to make the changes that may help them in the future. People may find a better fit or match between and their own interests and their environment including whom they choose to associate with. People can gain a renewed energy from having a more refined purpose about their sense of direction in life. As a result of a greater awareness of mortality people can be more appreciative of what is most important to them. By facing uncomfortable and at times confusing feelings people may be better able to tolerate uncertainty and emotional discomfort whilst remaining reflective. This can help people to manage with future challenges.

Further relevant and detailed insights are well described in books by a Melbourne psychotherapist, Dr Peter O'Connor, including, “Understanding the Mid-life Crisis” and “Dreams”.

Psychological Reactions to Traumatic Accidents

2007-12-14T00:00:00--11:00

It is common for people to suffer from a range of psychological reactions after a traumatic experience such as a motor vehicle accident or any other life-threatening incident. In the first instance, individuals may feel anxious and apprehensive. They may suffer from such symptoms as sleep disturbance, poor concentration, irritability, and loss of interest in activities. They may experience intrusive thoughts or images related to the traumatic experience. Such recollections are commonly distressing and individuals will often make efforts to block such thoughts or recollections from their mind. People affected by traumatic accidents may feel sad and withdrawn and may be more detached from others. Having an understanding of such reactions can assist people's psychological recovery. The support of other people including friends and family members can be especially important in aiding psychological recovery from accidents.

Sometimes the aforementioned reactions and other forms of psychological distress can be sufficiently debilitating or long-lasting that it can be worth seeking psychological therapy. This would especially be the case if individuals are suffering persistent nightmares related to trauma, if they are resorting to alcohol or illicit drugs to manage with painful feelings, if symptoms are persisting beyond a month or two, or if the person has limited social supports. More disruptive psychological reactions following traumatic accidents include such conditions such as Post-traumatic Stress Disorder or Depression which can further limit people's capacity to work or to interact with others. Clinical psychologists or other psychologists who have received specific additional training have specialized skills and experience in assisting individuals to recover from such conditions. Therapy commonly includes an educational component to help individuals further understand their symptoms. Treatment also typically includes the teaching of strategies to manage anxiety including breathing techniques, relaxation techniques, and other coping skills. Therapy sometimes encourages individuals to deliberately recall aspects of their traumatic experience in a manner that helps to reduce the emotional impact of such recollections. It is not uncommon for people to feel depressed at some stage of their recovery associated with losses such as restrictions from any injuries, the loss of one’s previous sense of wellbeing or a temporary incapacity to continue with work or other interests. Individuals may experience a sense of guilt or shame associated with the accident or their reactions to it. Various therapy techniques can assist individuals to deal with such negative experiences by recognizing and altering any unduly negative patterns of thinking which can contribute to such difficulties. Finally, therapy focuses on other strategies to assist individuals to resume previous routines and interests. Recovery from accidents can be further complicated when individuals suffer from physical injuries and pain. There are a range of pain management strategies which can assist people to cope with such additional difficulties. Individuals sometimes benefit from being involved in a group therapy process where they might meet others who were seeking to cope with similar challenges.

It is important to understand that the vast majority of individuals make a good psychological recovery from traumatic accidents. Even those who have suffered from long-term or severe trauma reactions will commonly recover to the point where their symptomatic distress is relatively mild in the longer term. However, it may take considerable patience to accept slow and gradual progress during the rehabilitation process, especially if physical injuries are involved. Following their recovery from trauma reactions, individuals may have a heightened sense of their own resilience and a deeper understanding of their priorities in life: this commonly includes a heightened recognition of the importance of significant relationships and an appreciation of everyday activities which offer a sense of pleasure and fulfillment.

Parenting Teenagers

2007-11-28T00:00:00--11:00

What comes to mind when we hear the term ‘generation gap’? Parents and children of any age are likely to experience at least some degree of frustration and conflict in their everyday interactions because we are not always going to want the same thing. It is normal and healthy for parents and children to have different wants or interests. There are likely to be extra tensions in the household where those children are of teenage years. It might be then considered to be in their ‘job description’ to test the limits and push the boundaries as it were. It is during these years, often in the relative safety of the home, that teenagers will be testing out their range of ways of having an impact on others and their world in general, and seeking to establish an identity separate from their parents. It is all a part of healthy growing up. It is also in the relative safety of a home environment that teenagers can allow themselves to explore different ways of managing with emotions, including painful emotions, in a more independent way. Running to one’s parents for a soothing hug is probably getting past its use-by-date as a means for handling hurts of whatever sort. Allowing one’s negative emotions or behaviours to be on display and withdrawing somewhat from direct communication with one’s parents can also be a way of creating more space for a teenager to explore their own emerging identity and engaging in the long-term task of gradually separating from their family. This is not to say that direct communication, understanding and support is not just as important as at any other time. Recent social research reported in newspapers indicated that teenagers’ families are especially important to them, along with their friendships.

Teenagers face many stresses associated with various life adjustments. They may be concerned about such issues as drugs, sexuality, bullying, relationships and mental health issues. They may have particular concerns about their relative achievement and the potential expectations of themselves and others. It is not only the actual expectations of their parents or actual perceptions of them that may concern them, but the perceived expectations or views of their parents that can be a source of stress. This is where it can be especially important for parents to directly convey their acceptance, love, appreciation and concern for their children in unambiguously positive terms, even around times of increased conflict. I have seen numerous families over the years where it is blatantly obvious that the teenager and parents love each other and wish to relate closely to each other, but where this is not recognized by the family members themselves owing to the extent or intensity of arguments or conflicts.

Even the best of parents may struggle amid the joy of their relationship with teenage children. A few basic guidelines may help. Children of any age benefit from their parents’ understanding and support. As children reach teenage years it is increasingly important to use a problem-solving approach in negotiating and discussing issues around appropriate limits with them. With regard to
such issues as expectations about tidiness, use of alcohol, curfews or contribution to household chores, it helps to have a balance of flexibility along with a preparedness to establish some limits. It is important that parents show due concern about their children being involved in risk-taking behaviour around drugs, alcohol, driving or sexuality. It is helpful to have open and frank discussions about such topics, expressing concerns, but being genuinely interested in each other’s views. Parents might be rightfully wary of sounding overly rigid or judgmental, but it may be important to not be overly permissive which can appear to their children and others as a sign of benign neglect. It helps when parents support each other in trying to strike an appropriate balance on such issues whilst seeking to engage their teenage children in dialogue about what expectations might be fair or reasonable.

Parents of teenagers might benefit from applying principles of positive psychology articulated by Martin Seligman (see free website www.authentichappiness.org and the VIA Signature Strengths questionnaire). Seligman describes a number of key character strengths or positive qualities that may be particularly important for parents to recognise in their children and acknowledge. By completing the questionnaire themselves, parents may also recognize what positive qualities they bring to their parenting. These qualities may include such virtues as love of knowledge, social intelligence, creativity, sense of humour, persistence, courage, kindness, and zest. There may be particular benefits in openly acknowledging such qualities in one's children when they are strongly seeking to establish their separate sense of identity. It would likely also be beneficial for parents to encourage their children to pursue work and study interests or other activities which draw on their children's signature character strengths. When individuals engage in such strengths they are likely to be absorbed in the activities they are pursuing and to experience a resulting sense of meaning and fulfilment.

Turning a Bigger Problem into a Lesser One

2007-11-14T18:35:00--11:00

Many people find it very difficult to make a decision to see a psychologist. Often when they do so, this has already started a process of turning a bigger problem into a lesser one. Because commonly when people see a psychologist for the first time, they have two problems, or layers of problems. The first problem is what they are seeking help for, perhaps a panic or anxiety reaction, a depressive condition, an anger or behavioural problem, or perhaps a relationship issue or a life adjustment problem. But in addition to that, people commonly have a second problem which relates to their reaction to the first - commonly in the form of non-acceptance or shame. And it is this non-acceptance of the first problem which is the bigger stumbling block, or at least a significant barrier to progress. Reactions to the original problem can also include feeling very anxious about having panic reactions, feeling helpless about ones relationship problem, or even being depressed about being depressed.

Acknowledging a problem openly, and particularly acknowledging it to someone who has a very informed understanding of such issues, is perhaps the most important step toward acceptance. Commonly when people reveal such a personal aspect of their experience, they may learn that many others have felt or reacted a similar way. They may learn that many others have successfully addressed such difficulties. They might find themselves sitting opposite someone who has a deep and genuine appreciation of the nature of their difficulties, yet clearly remains optimistic about their prospects of overcoming them. When clients have the experience of being understood and accepted despite revealing something about themselves that they might have found wanting or shameful, they commonly experience greater hope. The experience of standing back from a problem and gaining an increased understanding of it with a therapist's help can shift a burden from feeling potentially insurmountable to a set of circumstances that might be actively addressed in some way, even though the path of recovery may not be clear at first. Once someone is able to accept themselves having a particular problem, and has reduced their sense of shame associated with having it, the practical steps for best addressing the first problem more readily unfold. At that point, the first problem has become a lesser one.

The Relevance of Positive Psychology

2007-11-14T17:06:00--11:00

This is a particularly interesting time in the development of the psychology field. People are only just beginning to understand the potential power of positive or optimistic thinking. Dr Martin Seligman has done some wonderful work over many years which demonstrates that people can develop more optimistic ways of thinking which helps them to win football competitions, win presidential elections, better survive potentially fatal illnesses and generally feel happier. He has extended his work on learned optimism to highlight ways in which people can have more happy and fulfilling lives by drawing on their signature character strengths. His recent book, Authentic Happiness, outlines ways in which people can reliably seek to experience a greater sense of gratification, as opposed to mere pleasure, in their everyday lives. His website can also be accessed on www.authentichappiness.org.

In my view our prevailing mental health models are unduly pessimistic. It is not uncommon to hear of people described as having mental health conditions which are caused by genetics and which will likely require them to take medication for the rest of their lives. Whereas a proportion of people would likely remain better off to allow for themselves to have to manage a mental health condition for the rest of their lives, I believe that an increasing proportion of people in future will find that their conditions are temporary, only impact on some, and not all, areas of their lives and can ultimately come under their partial control. I believe that improving our mental health systems will have a lot more to do with developing more optimistic models of treatment than simply throwing more money at the problem. This said, I believe that much more money should be spent on mental health, at least to be more on parity with what is spent on physical health. After all, the vast majority of our physical health complaints are dramatically affected by our psychological, social and spiritual experiences and beliefs. Our spiritual wellbeing largely relates to our sense of purpose in life, identity and values. We can often tap into our spiritual experience far better by using our intuition than simply drawing on rational thinking that can interfere with aspects of our awareness if overused.

It is heartening that so many young people are these days studying psychology from late secondary school years onwards. Young people tend to be naturally more hopeful and are not yet encumbered by outdated pessimistic ways of thinking in the mental health and other related fields. To the extent that they study models of positive psychology in addition to developing a very sound clinical understanding of the range of mental health conditions from which people may suffer they will likely help develop more creative ways of promoting positive mental health. It is important to acknowledge that many people who have suffered mental health problems end up making full recoveries and report experiencing a greater understanding of themselves in a manner which leads them to feel no regret about having had the mental health problem in the first place. Just as in our media we are used to hearing more stories which are based on pessimism and threat. As human beings we are first oriented to picking up cues of some threat to ourselves. Therefore negative news stories about terrorism and other problems may be helpful in selling newspapers. I believe that healthy communities should insist on ensuring that positive and optimistic stories receive more exposure. In general our mental health is most enhanced by having the most optimistic stories about ourselves and our lives that nonetheless still fit the facts. Therefore, the better our education and the more enriched our art and culture, the wider range of potentially positive stories we will have to account for our experience.

Chris Mackey, Clinical Psychologist
Chris Mackey and Associates, Specialist Psychology Services