![]() AUTHOR Deborah Farmer Kris In the last decade, rates of anxiety-related disorders in teenagers have steadily risen, particularly in girls. Researchers and psychologists posit several hypotheses about why these rates are on the rise -- from digital hyperconnectivity to heightened external pressures to simply a greater awareness, and therefore diagnosis, of mental health concerns. Whatever the causes, Dr. Lisa Damour has hopeful news for parents and teens: first, some degree of stress and anxiety is not only normal but essential for human growth. And if those levels become untenable, there are tested strategies for reining anxiety back in. Reframing Anxiety Damour, a psychologist and author of the new book "Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls," has spent decades working with adolescent girls and their families. In recent years, she has noticed a change in how society views stress. “Somehow a misunderstanding has grown up about stress and anxiety where our culture now sees both as pathological,” said Damour. “The upshot of that is that we have adults and young people who are stressed about being stressed and anxious about being anxious.” Anxiety is a normal and healthy function, according to Damour, and much of the anxiety that teenagers express is a sign that they are aware of their surroundings, mindful of their growing responsibilities, and frightened of things that are, in fact, scary. Adults can make a difference simply by “reassuring them that, a great deal of time, stress is just operating as a friend and ally to them.” Change and stress go hand in hand -- even if a change is positive. Teenagers' lives are filled with change: Their bodies and brains are transforming, they usually switch schools at least once between grades 5 and 12, their academic workload is increasing, and social relationships are constantly evolving. The anxiety that comes with stretching to face these and other challenges is part of how humans develop strength, said Damour. When she talks with teenage girls, she uses the metaphor of exercise: To develop physical strength, you have to slowly push your levels of physical endurance, building up strength through resistance training. Similarly, said Damour, “you should see [a challenge] as an extraordinary weight training program for your mind. You are going to walk out of it tougher and stronger than you have ever been.” Stress, Emotion and the Teenage Brain Sometimes anxiety and stress reach levels that impede a girl’s ability to navigate life effectively. That said, Damour cautions that an emotional outburst -- in and of itself -- is not a reliable indicator of mental health. “If you are raising a normally developing teenage daughter, she will have meltdowns. And there’s nothing you can do to prevent that,” said Damour. Of course, when it’s your daughter who is sobbing on the bathroom floor, it’s hard to keep this in perspective. “When it’s your kid, it’s terrifying,” Damour said. “A lot of parents are frightened and paralyzed in that moment. They wonder: Is this a sign that something is really wrong or that my kid is really out of control?” This is where a little neuroscience might be helpful, said Damour. “The adolescent brain is very gawky and vulnerable to emotion.” That gawkiness stems from the extraordinary brain development that happens in adolescence. “The brain is upgrading, but in the same order as it initially developed,” said Damour, from the more primitive regions that house emotions to the more sophisticated regions that regulate perspective and problem-solving. The result? “When she’s calm, a teenage girl can outreason any adult. When she’s upset, her primitive regions can hijack the whole system and take it down.” When your daughter is emotionally overwhelmed, give her a little time. Damour said it’s easy to see a meltdown as a fire that’s about to turn into a conflagration. But a storm is a more accurate metaphor. “You can’t stop a storm,” she said. “You have to wait it out. But these storms do pass. The brain will reset itself. Don’t try to stop the storm or fix it in the moment.” Instead, sit with her, go on a walk together, watch a funny show, or offer her a cup of tea, advised Damour. After weathering a few storms successfully, “parents and teenagers get to discover that -- all by itself -- the storm will pass. At that point, either the problem completely evaporates and she moves on, or the girl can now look at the problem with clear eyes, assess it with her prefrontal lobe back online, and figure out what she wants to do.” Responding Instead of Reacting Teenage girls are particularly sensitive to the cues they receive from parents and teachers – from words to facial expressions. How adults respond to teens’ emotional reactions matters a lot, said Damour. When adults become anxious in response to a teen’s anxiety, it exacerbates the situation. Helping girls weather stress storms can be “excruciating for parents,” and Damour said she understands the almost primal desire to alleviate the pain, solve the problem for them or remove the stressor -- such as letting them stay home from school if they are anxious about a test. But avoidance feeds anxiety. Girls often feel stressed because they overestimate the difficulty of a situation and underestimate their ability to deal with it, said Damour. When they avoid a situation, they miss the opportunity to correct that perception and recognize their own strength. Damour has found two words helpful in helping keep teens in the driver’s seat: “stinks” and “handle.” “ ‘That really stinks’ is a very simple phrase that cuts right through it. It says, ‘I hear you and I’m just going to sit here for a moment and acknowledge that what you are up against isn’t that great,’ ” said Damour, “Empathy goes very, very far in helping them contain what is upsetting them.” Often, there is no simple solution to a stressor, so “the next step may simply be acceptance – acceptance of the situation and of their strength to persist through it. It’s the ability to say to yourself, ‘This stinks, but this is something I can handle.’ ” Damour said the word “handle” is empowering. Girls learn that “by enduring this, I’ll be able to endure more down the line. I’ll build up my capacity to handle unpleasant situations.” Build in Recovery Time In strength training, “you can’t just lift weights day after day after day,” said Damour. “In order to get the full benefits from the workout, your muscles need a chance to recover and repair.” The same holds true for the brain. If teens accept that some level of stress is inevitable, they can spend less time worrying about stress and more time focusing on how they can build in recovery time. “The good news is your mind recovers a lot faster than your muscles do. But you need to restore yourself so you can go right back in for another workout. Your job is to figure out how you like to recover. What’s the system that really works for you?” For some teens, playing sports gives them the reboot they need to focus on academics. Another student might benefit from a watching a 22-minute episode of a sitcom, playing with a dog, going on a walk or listening to a favorite music playlist. Having conversations with stressed-out teens about this type of downtime redirects the attention away from the stress and toward the recovery. Students can’t always control the stressors in their life, said Damour, but they can have a say over how they choose to restore themselves. The Restorative Power of Sleep Sleep deprivation is one of the simplest explanations for the rise in anxiety-related concerns, Damour said. “Sleep is the glue that holds human beings together.” The research is unambiguous: When we are sleep-deprived, we are less emotionally resilient. According to Damour, the first question many clinicians ask teens who come in for anxiety is, “How much sleep are you getting?” If they are consistently getting less than seven or eight hours, that’s the first line of intervention. “Teenagers need nine hours a night, middle-schoolers need 10, and elementary students need 11. Caffeine doesn’t make up for that.” When it comes to sleep, she says, small changes can make a big difference, including completing as much homework as they can during the school day, making judicious choices about how much time they spend on any given assignment, and monitoring social media use in the evening. “Technology is very hard on sleep,” said Damour. “I’m not anti-social media, but it makes a tremendous difference for teens to not have a phone and computer in the bedroom at night. Teenagers have texts waking them up.” Because of the melatonin-suppressing effects of blue light emitted from smartphone screens and other devices, Damour encourages teens to turn off social media notifications well before going to sleep. But it’s not just the blue light. “Girls will often see something on social media that will keep them up at night -- and if you ask them, they’ll usually admit this.” Growing Up Brave According to Damour, the most powerful force for good in a teenager’s life is a “caring, working relationship with at least one loving adult.” Within that context, adults can offer teenagers empathy, grounded perspective and a vote of confidence as they work through challenges -- helping them aim for courage, not avoidance. “Brave is a positive word -- it’s something we aspire to be,” said Damour. “Built into the word is the understanding that the person is scared and yet they are doing something anyway. Scared is here to stay. Anxiety is part of life. It’s not our job to vanquish these feelings. It’s our job to develop the resources we need to march forward anyway.” https://www.kqed.org/mindshift/52994/how-to-help-teenage-girls-reframe-anxiety-and-strengthen-resilience?fbclid=IwAR0XztoDP0n-KnHTPBqYhFl4HZYqIS982nDNsyEYIjSN9txEi9Nykr8tmG0
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![]() MATTHEW LOFTUS | NOVEMBER 23, 2016 Christianity Today, excerpt Is Addiction a Disease? Yes, and Much More. Understanding addiction as a disease does not mean that prayer and moral discipline are any less potent or important in recovery. Many people see addiction . . . as a character flaw or a bad choice. They don’t recognize that addiction is in fact a chronic disease of the brain.” That statement by Vivek Murthy, surgeon general of the United States, reflects the current medical and scientific consensus about addiction. Murthy and others believe the language of moral choices only increases shame and decreases funding for more scientifically rigorous treatments. To make progress in saving lives, they argue, we need to change the way we think about addiction. In fact, we need to recognize at least four dimensions in addiction: moral, social, biological, and spiritual. Addicts are moral agents, in community, with biology working against their spiritual goals. Biological science gives us insight into the particular ways an addict’s body makes a normal life that much harder to live. Public health can describe how a community and its institutions make recovery more accessible to people trapped in addiction. A moral framework helps us understand how addiction harms ourselves and the people we love, while also providing the basic routines of living free. Most importantly, spirituality helps us to understand God’s love for everyone (no matter how lost they are) and gives us the power to live healthy, whole lives. Biology and the BrainOur brains were created with neurotransmitters to help us enjoy the physical pleasures of life, adapt to stressful situations, and direct us to do what is necessary to maintain our bodies’ physical and mental health. Addictive substances (and, to a lesser degree, other addictions like pornography or gambling) pervert all of these basic brain functions, breaking the biological systems we depend on to think and choose as we ought. It is important to differentiate between dependence and addiction. Dependence refers to the basic physiological need that some drugs create in our bodies when used over time, leading to measurable physical symptoms when the drugs are withdrawn. Dependence is almost negligible for certain drugs, but it can make complete withdrawal fatal for others. Such physical dependence on heroin and prescription painkillers creates severe withdrawal symptoms when a user tries to stop. (Some people with severe chronic pain—from cancer, for example—can be physiologically dependent on opioids but not addicted.) Some medications available for treating addiction work primarily by preventing these withdrawal symptoms. The biochemical effects of addiction, as Timothy King’s cover story for CT illustrates, tend to be more complex. The most obvious effect of many addictive substances is pleasure, but even that isn’t so simple: Drugs can overstimulate and alter the pathways that normally connect pleasure with healthy activities. Over time, the brain’s reward system becomes tied more exclusively to the drug of choice, decreasing an addict’s ability to experience natural pleasures while heightening the effect of the drug. At the same time, the pleasure centers of the brain adapt so that using a drug is itself rarely euphoric anymore. Instead, the altered neurochemical reward pathways that once led to pleasure are instead fruitlessly stimulated over and over until other areas of the brain—such as systems linked to critical thinking and decision-making—are hijacked into supporting this never-ending cycle. Many drug addicts will describe the routine of using a needle as nearly as important as actually getting high, just as porn addicts will spend hours looking at pornography without masturbating. Both are fruitlessly reenacting the reward pathways that normally teach our brains to seek out good things, corrupting them so we merely anticipate and want instead of actually enjoy. At the same time, drugs especially subject to abuse also tend to tamp down stress factors in the brain. When the drugs are no longer present, these neurochemicals are often released in greater volumes, heightening anxiety and creating another set of incentives to keep using. This makes the initial withdrawal that much harder, and makes addicts more likely to relapse in stressful situations. Just like drinking nothing but soda will rot one’s teeth until one cannot even bite an apple, so using drugs will alter the physical and neurochemical structures of our brains until many of our personal resources for doing the right thing are impaired. Many of these biochemical alterations have been found to persist for months after an addict stops using. Addiction is not simply about “getting high.” One of the most important (and controversial) treatments for opioid addiction is medication-assisted treatment—using methadone or buprenorphine (Suboxone) to prevent physical withdrawal symptoms while addicts learn how to manage their lives without abusing drugs. At first, it may seem counterintuitive to use one powerful drug to treat addiction to another. Many people stigmatize the use of methadone or Suboxone as “just another kind of addiction.” However, in cases of addiction (versus dependence), these medications can be very useful. Medication-assisted treatment, when used in conjunction with a rigorous treatment program, has been shown by many studies to help people stop abusing drugs and live healthy, functional lives. That does not mean it makes recovery easy. When I was practicing medicine in Baltimore, my patients often described craving heroin even when they were on a strong dose of Suboxone. I had to explain again and again that the drug would not necessarily prevent cravings. They had to do the work of recovery to retrain their brains and bodies to manage without abusing drugs. Still, these drugs are a powerful adjunct in some people’s recovery. They are not the right choice for everyone, but to extend my earlier dental metaphor, they are like a set of false teeth that makes good nutrition more accessible. Public Health and CommunityJohann Hari, author of Chasing the Scream, has said that “the opposite of addiction isn’t sobriety—it’s connection.” This is true, as long as we’re talking about a healthy community, not codependent connections with family and friends (some of whom may also be addicted). Connection and community are very important in overcoming addiction, but not always in the way that we might think. An addict’s internal personal judgment and decision-making are corrupted, making other people necessary to reality-test the patterns of thought that would otherwise reinforce addiction. The church has an important opportunity here, not just in helping connect addicts in need with loving friendships but also in re-centering us in our basic human purpose of worship. Whether one walks in on Sunday morning five years sober or still a little intoxicated from Saturday night, our brains and bodies were created to worship God. It is by living in the typical patterns of life and worship that our bodies can be healed. Recovering addicts always require this basic level of community support, but many also need a more intensive regimen. Many small groups and churches have implemented an explicitly Christian 12-step program like Celebrate Recovery (though there is no robust evidence that 12-step programs, as popular as they are, are superior to other treatment programs like cognitive-behavioral therapy). What is important is ensuring that some sort of treatment is widely available. Waiting lists for treatment programs are often months long, meaning that someone who decides they want to get better has to wait to get the help they need—often still using and occasionally dying of an overdose before they get into treatment. We cannot expect our national addiction problem to get better until treatment is better funded and more accessible, including making sure medication-assisted treatment is available to anyone who wants it. Morality and SpiritualityAddiction and recovery also have moral and spiritual components, and it is useful to distinguish them. As Eve Tushnet says, “Selfishness and idolatry are moral categories, in which . . . the proper hierarchy of our loves is disrupted. That’s different from addiction as a misdirected expression of a spiritual longing, an attempt to feed a spiritual hunger.” All people—addicts in particular—are called to start with the gospel that satisfies our hunger, trusting in God’s love for us and repenting of our sin. Many people recover without trusting in Christ, yes, but those who are grasped by the gospel have a significant head start in sorting out the “hierarchy of our loves” as they untangle the particular ways in which sin has created strongholds in their lives. One of those strongholds, undoubtedly, is the perverted biochemistry of addiction. Our reward pathways and pleasure centers didn’t simply evolve to help us eat and reproduce; they were created to glorify God and enjoy him forever. Addiction cripples our brain’s ability to mediate the moral and spiritual ends we were intended for, which means that in recovery, we don’t just obey and worship but work to regain the capacity to obey and worship. Understanding addiction as a disease does not mean that prayer and moral discipline are any less potent or important in recovery. But it does underscore the ways that medication and therapy can be helpful, and helps us to appreciate just how difficult and costly recovery can be. The process of an addict recognizing their need for help, finding a treatment program, and walking through the recovery process (including relapses, which are very common) will usually take more time, energy, and money than one person with a broken brain can bear. Not everyone will need all of these different elements, but our current crisis demands that kind of holistic response. King’s CT essay reflects this complex interaction of body, mind, and soul. His doctors had to show him that the opioids were doing him more harm than good and acknowledge the role they had played in his addiction. They had to use their professional skills to develop a medical plan for dealing with his pain and his addiction that complemented the support from friends and family. But he also chose to get better, committed to the plan, and was willing to do the work necessary to confront the way that painkillers had changed his mind and body for the worse. To help addicts heal, we have to bring all the forces available to us to bear—sometimes even to the extent of using medications like methadone and Suboxone. Loving people who have become trapped in biochemical bondage is not easy or cheap, but love never is. And when we use every possible resource God has given us to combat addiction, we also demonstrate the goodness and power of God, who seeks to transform us in every way—even the neurons in our brains. Matthew Loftus, MD (MatthewandMaggie.org) teaches health workers and practices family medicine in South Sudan with his family. BY CHRIS ZEIGLER DENDY, M.S.
Many children with ADHD, battered by daily criticisms and admonitions, have low self-esteem as early as second grade. As that child’s parent or teacher, make a powerful difference with these reframing strategies. Children with attention deficit disorder (ADHD or ADD) who struggle in school get lots of negative feedback. As a result, their self-esteem is battered as early as second grade. Adding insult to injury, many parents may get caught up pushing their children to work harder to make top grades. This adds another layer of negativity at home. I lost my perspective when my son was struggling in high school. At times, I found myself thinking that he was lazy and just didn’t care. I was focused on monitoring his homework, hoping he would make better grades. I met him at the front door every day when he came home from school and asked, “Did you bring home your books and assignments?” I never bothered to ask him how his day went. When he started avoiding me at the front door, by going in through the basement, a light bulb went on. I had lost sight of my most important duties as a parent: loving my son and building his self-esteem. We should all be investing in our children’s emotional bank account. Your job as a parent is to keep the most important things in mind: nurturing your child’s self-esteem and maintaining a strong relationship with him or her. Your loving relationship may one day save your child’s life. Investing In and Nurturing Our ChildrenStephen Covey, author of The 7 Habits of Highly Effective People and other best-selling books, coined the phrase “emotional bank account,” and Russell Barkley, Ph.D., recently used it in one of his top 10 tips for grandparents of children with ADHD. Just as we make regular deposits into our savings account, so we have money when times get tough, adding to our children’s emotional bank account serves the same purpose. Are you making deposits, or emptying his account? Offer lots of positive statements and fun activities. Catch your child being good. When you do, say, “Great job. You put all your dirty clothes in the hamper.” “You’re getting better at making up your bed.” “Thank you for taking out the garbage!” “You make me proud. You’ve been reading that book for a long time, and you didn’t give up when there were words you didn’t know!” Find joy again in spending time with your child. Enjoy a special meal, just the two of you, with no nagging. Attend a concert or sporting event together. Let your child teach you a video game. Reframe negative thoughts about your child. When your child struggles, stop and look at her in a new light, focusing on her strengths and talents. Remember that your child’s traits, which may not be valued in school, may be useful in the work world. Here are a few examples of reframing: Bossiness may be an indication of potential leadership skills. Hyperactivity may mean that your child can approach workplace projects with high energy and the ability to work longer on more projects. A strong-willed child brings tenacity to his job and career. And who knows? Maybe an argumentative child will one day be a great lawyer. Recruit others to help you. Parents alone can’t fill this bank account, so enlist willing siblings, grandparents, relatives, friends, co-workers, coaches, teachers, or members of your religious group. If parents are lucky, grandparents can be their strongest and most helpful allies. By calling weekly via “FaceTime,” grandparents can be active in the child’s life when distance separates them. Believe in the goodness of your child, encourage her, and show affection. Hugs, pats on the back, or holding her on your lap gives the child a sense of self worth. Take photos of your child when she is engaged in happy activities, and hang them on the refrigerator. How to Invest In Your Child’s “Emotional Bank Account”Many children with ADHD, battered by daily criticisms and admonitions, have low self-esteem as early as second grade. As that child’s parent or teacher, make a powerful difference with these reframing strategies. BY CHRIS ZEIGLER DENDY, M.S. ADHD or ADD) who struggle in school get lots of negative feedback. As a result, their self-esteem is battered as early as second grade. Adding insult to injury, many parents may get caught up pushing their children to work harder to make top grades. This adds another layer of negativity at home.I lost my perspective when my son was struggling in high school. At times, I found myself thinking that he was lazy and just didn’t care. I was focused on monitoring his homework, hoping he would make better grades. I met him at the front door every day when he came home from school and asked, “Did you bring home your books and assignments?” I never bothered to ask him how his day went. When he started avoiding me at the front door, by going in through the basement, a light bulb went on. I had lost sight of my most important duties as a parent: loving my son and building his self-esteem. We should all be investing in our children’s emotional bank account. Your job as a parent is to keep the most important things in mind: nurturing your child’s self-esteem and maintaining a strong relationship with him or her. Your loving relationship may one day save your child’s life. Investing In and Nurturing Our ChildrenStephen Covey, author of The 7 Habits of Highly Effective People and other best-selling books, coined the phrase “emotional bank account,” and Russell Barkley, Ph.D., recently used it in one of his top 10 tips for grandparents of children with ADHD. Just as we make regular deposits into our savings account, so we have money when times get tough, adding to our children’s emotional bank account serves the same purpose. Are you making deposits, or emptying his account? [Your Free Guide to Parent Training Programs] Offer lots of positive statements and fun activities. Catch your child being good. When you do, say, “Great job. You put all your dirty clothes in the hamper.” “You’re getting better at making up your bed.” “Thank you for taking out the garbage!” “You make me proud. You’ve been reading that book for a long time, and you didn’t give up when there were words you didn’t know!” Find joy again in spending time with your child. Enjoy a special meal, just the two of you, with no nagging. Attend a concert or sporting event together. Let your child teach you a video game. Reframe negative thoughts about your child. When your child struggles, stop and look at her in a new light, focusing on her strengths and talents. Remember that your child’s traits, which may not be valued in school, may be useful in the work world. Here are a few examples of reframing: Bossiness may be an indication of potential leadership skills. Hyperactivity may mean that your child can approach workplace projects with high energy and the ability to work longer on more projects. A strong-willed child brings tenacity to his job and career. And who knows? Maybe an argumentative child will one day be a great lawyer. Recruit others to help you. Parents alone can’t fill this bank account, so enlist willing siblings, grandparents, relatives, friends, co-workers, coaches, teachers, or members of your religious group. If parents are lucky, grandparents can be their strongest and most helpful allies. By calling weekly via “FaceTime,” grandparents can be active in the child’s life when distance separates them. Believe in the goodness of your child, encourage her, and show affection. Hugs, pats on the back, or holding her on your lap gives the child a sense of self worth. Take photos of your child when she is engaged in happy activities, and hang them on the refrigerator. [Free Resource: What Not to Say to a Child with ADHD] Identify and facilitate your child’s interests and talents. If your son is interested in sports, music, dance, drama, or debate, make certain he has a chance to participate in those joyful activities. The successes he will achieve doing something he loves put deposits in his emotional bank account. Ensure your child’s school success. If your child is struggling and stressed by school, be a persistent detective and advocate. Work with the school to figure out what is causing the struggles. Up to 50 percent of our children with ADHD also have learning disabilities that are overlooked. How Teachers Can Make DepositsGreet each student by name as he or she comes into class. Set the child up for success in the classroom. Talk to the student privately and have him answer the question that will be asked in class the next day. When students know the answer, they feel good about themselves. Address and accommodate academic and executive function deficits. Post the names of five students you’ve caught working hard or being kind on the board. Rotate names so everyone gets on the board. Use “encouraging” words more than praise. Examples include: “Wow! You figured out how to do that.” “You did it. Tell me how you did it.” “This is hard for you, but you are sticking with it.” “Super progress.” Create a booklet of students’ best work. Print and send the booklet home to parents during the holidays. Visualize your child’s emotional bank account right now. Is it full or nearly empty? Your goal as parent, grandparent, or teacher is to make regular deposits in the child’s account. And if it gets low, you now know what to do. Teachers: Avoid Making “Withdrawals!” Avoid sarcasm or criticizing a student in front of the class; drawing “frowny faces” or highlighting mistakes on papers with lots of red ink; making negative facial expressions or gestures; punishing a child for behaviors caused by his disability—inattention, forgetfulness, slow writing and reading, losing papers, and other executive function deficits. Never withhold recess as punishment. Our children need downtime and outside activity to re-energize their brains. Having recess increases brain activity, resulting in better grades and behavior. The CDC is strongly against withholding recess for any reason. Chris A. Zeigler Dendy, M.S., a member of ADDitude’s ADHD Specialist Panel, is a former educator and school psychologist. She is the author of Teenagers with ADD & ADHD: A Guide for Parents. You can reach her at chris@chrisdendy.com. The waiter appeared at our table again, this time offering a basket full of bread rolls just pulled from the oven. I picked out my third piece of the night, and carved out a heap of cultured butter, flecked with sea salt.
“What have you been up to at work?” I asked my boyfriend Scott. This was last June. We were at a corner table at a Michelin-star restaurant in New York. We’d been dating for three years, and living together in San Francisco for a little over a year. I’d temporarily moved to New York to participate in the four-month TED Residency. He’d surprised me with this dinner to celebrate the end of the program. It was a grand gesture, and one I appreciated, because we were not doing well. Our relationship had been shaky since January, turned upside down by several big changes in my life. After almost a decade in the corporate world, I’d quit my job to pursue my passion. I’d gone from earning a tech salary to earning no salary, and from working in an office with thousands of people to working alone at home. We’d had several long, difficult conversations over the past few months. I told him what I needed from him and the relationship. I stated my values that I felt weren’t being met (community, friends, travel) and asked him if he could meet me halfway. We even went to a terrible couples therapist. He quoted his own Facebook posts to us and suggested that we, neurotic Jews, should start doing extreme sports together to reconnect. Ironically, we bonded over our mutual dislike of him. During one of those difficult conversations, Scott mentioned that I never seemed to listen to him when he talked about work. “You think what I do is boring,” he said. “It’s not. We’re trying to help save women’s lives by improving breast cancer screening.” He was right. I never really understood what he did. I worked in tech but I’m not a particularly technical person. I could barely work my DSLR camera. When people asked me about my boyfriend’s job in artificial intelligence at Google, I replied with a word salad of “machine learning,” “computer vision,” and “medical imaging,” until they nodded sympathetically and the conversation moved on. Finally the four months of long distance were over. Scott had flown across the country to see my TED talk, which focused on romantic relationships. I work as a dating coach and researcher, studying ways we can make better decisions in our love lives. The irony wasn’t lost on me that I was helping others create lasting love while my own relationship faltered. There, at that corner table at that fancy restaurant, I finally decided to learn what my boyfriend did for a living. He provided the basics of his job—what he does and why it’s different from traditional radiology. When I asked more questions, he explained that mammograms consist of four pictures—one of each breast from above and from the side. Radiologists usually look all four images together to look for cancer, but Scott’s artificial intelligence team only looked at the two images from each breast, not the pair. I began to ask him what the radiologists gained from looking at the four together, which the machine learning algorithms were missing out on. “Sometimes a pattern appears in both breasts in the same place, which makes it less likely to be malignant,” he said. “Oh,” I said. “So why don’t you train the model to take one set of images and compare it to the other to see if it’s symmetrical? Then you can rule out cancer if it is.” “How would you do that?” “Take one set, flip it, and put it on top of the other.” He put down his forkful of “foraged seaweed” and stared at me in disbelief. “What?” I said. “Wow, I’m just so impressed. That exact idea was used by one of the most competitive entries in a recent machine learning competition.” I sat there, proudly listening to him explain the intricacies of his role on the mammography team. I felt connected to him, wondering why I’d never cared to ask him about his work before. I felt he too was seeing me in a new light, pleased with my newfound interest in his job. I realized how much I’d asked him to change for our relationship, without being willing to put in the work myself. And I knew this was the work. The paying attention, the asking questions, the listening. I knew this because of innovative research conducted by John Gottman, one of my relationship science heroes. Earlier that spring, I made a video with The Gottman Institute about “bids,” which are attempts a person makes to connect with their partner. Gottman’s groundbreaking ideas about bids were born from his 40-year-long quest to answer one question: What separates the relationship masters from the relationship disasters? He conducted this research with his colleague Robert Levenson at the University of Washington. He brought couples into an observation facility, dubbed the Love Lab by the media, and recorded them discussing their relationship. He asked them to share the story of how they met and then to recount a recent fight. He even had some couples spend a week in an apartment decked out with cameras (with their permission) to see how they interacted during everyday moments. Six years later, the researchers followed up with the couples and divided them into two camps: the masters, couples who were still happily married, and disasters, couples who had either broken up or remained together but were unhappy. When he studied the tapes of these two types of couples, he looked for differences in the content of their conversations. What did the masters discuss that the disasters didn’t? In his book The Relationship Cure, Gottman writes, “But after many months of watching these tapes with my students, it dawned on me. Maybe it’s not the depth of intimacy in conversations that matters. Maybe it doesn’t even matter whether couples agree or disagree. Maybe the important thing is how these people pay attention to each other, no matter what they’re talking about or doing.” Simply put, successful couples are attentive. They listen, and they put their phones down when the other person wants to chat. This research led Gottman to develop one of the core tenets of his philosophy for building successful relationships: healthy couples constantly make and accept bids to connect. What’s a bid?Gottman refers to bids as “the fundamental unit of emotional communication.” Bids can can be small or big, verbal or nonverbal. They’re requests to connect. They might take the form of an expression, question, or physical outreach. They can be funny, serious, or sexual in nature. For example, your partner might say, “Hey, whatever happened with that situation at work with your manager?” or, “Do you want to talk about our plans this weekend?” or simply, “Can you pass the water?” They could also give you a loving squeeze, pat you affectionately on the head, or tease you with a wink. Bids are often purposely subtle because people are afraid to be vulnerable and put themselves out there. It’s scary to say, “Hey! I want to connect! Pay attention to me!” so instead, we ask a question or tell a story or offer our hand for connection. We hope we’ll receive connection in return, but if not, it’s less scary than pleading, “Connect with me, please!” How should I respond to a bid?There are three ways you can respond to a bid:
When your partner reads their email and sighs audibly, they’re making a bid. You could turn towards them and ask, “What’s wrong?” Now imagine you’re tidying up the kitchen and your partner asks you how your day was. You could pause, look up from what you’re doing and respond with details about the challenging phone call you had that day. That’s turning towards. You’re telling your partner you see and value them. Turning away from your partner, in the same situation, would be ignoring them or just grunting and continuing what you were doing. Turning against them takes the form of an attack, such as replying, “Why are you always interrupting me when I’m trying to get things done?” Why do bids matter?A tendency to turn towards your partner forms the basis of trust, emotional connection, passion, and a satisfying sex life. Gottman found a critical difference in how masters and disasters respond to bids for connection. In the Love Lab, masters turned towards each other 86% of the time. Disasters turned towards each other only 33% of the time. None of us are perfect at accepting all of our partner’s bids, but the masters are better at it than the disasters. Some people think they can put their relationship on ice and then thaw it out with the occasional romantic date night. But relationships are built and maintained with daily attention, not grand gestures. It was the bids we made and received at dinner in New York, not the fancy dinner itself, that saved my relationship with my boyfriend. How often should I make bids?Bid often. Master the art of the tiny moment. Reach out to show you care. Send a good luck message before a meeting. Leave an encouraging note on the fridge. Kiss your partner when they walk in the door—Gottman recommends a kiss that lasts at least six seconds. Bids can be super short and simple, but they hold great power. The key is to make many bids per day to show your partner you want to connect. In fact, happy couples bid all the time. Gottman found that at the dinner table, masters bid as many as one hundred times in a ten minute period, while disasters engaged each other only sixty-five times. What happens when bids are ignored?When our partner denies our bids, we internalize the experience. Our brains subconsciously keep track of how many bids are accepted or rejected by our partners. When our partner constantly turns away or against our bids, we begin to feel frustrated. We are more inclined to criticize our partners, which pushes them to be defensive and may result in an argument. Gottman found when couples break up, it’s usually not because of issues like big fights or infidelity. More often, it’s a result of the resentment and distance that builds up over time when partners continually turn away from bids for connection. The lesson here is to make many small bids every day. Pay attention and turn towards your partner’s bids. Listen for their sighs and look out for their winks. Make eye contact when they ask you a question. Engage with them when they point something out. The power of bids Prior to that dinner, I was guilty of the critique in that old saying, “The shoemaker’s children go barefoot.” In my attempt to help others with their relationships, I’d forsaken my own. That night in New York I made a bid to connect with my boyfriend about his job. He turned towards me and we had one of the best conversations of our relationship. I see that dinner as the turning point in our relationship, the moment when I realized I’d been taking him for granted and prioritizing my work, emails, and dating coaching clients over him. Our entire relationship is different now. We are, as couples therapist Esther Perel would say, “on our second relationship” with each other. We are happier than we’ve ever been. I take the time to make more bids. But more importantly, I pay attention to his bids. I put down my phone. And I listen. Logan Ury is a writer, researcher, and dating coach who applies insights from behavioral science to help people have more meaningful relationships. She’s currently conducting research for her forthcoming Simon & Schuster book on how to make better decisions in romantic relationships. She was a 2018 TED Resident and formerly ran the Irrational Lab, Google’s behavioral economics team, alongside Dan Ariely, author of Predictably Irrational. Her interview series Talks at Google: Modern Romance, where she speaks with world-renowned dating and relationship experts, earned 1M+ YouTube views. By Julie Compton
One morning last fall, Kyle Benson, 30, sat in his home office, lost in his work. His cat was meowing because its litter box wasn’t clean. As his girlfriend was rushing out the door to get to work, she asked him why he hadn’t cleaned it. He thought she was criticizing him. She thought he didn’t care about the cat. And that’s how the couple got into a heated argument, Benson recalls — over a litter box. It might sound silly, says Benson, a relationship coach in Seattle, Washington, but the argument revealed a lot about their relationship and how they handle conflict. “What’s interesting is the research has shown it’s not necessarily conflict that’s bad, it’s how couples interact in conflict,” Benson tells NBC News BETTER. “The first goal, before even starting to resolve the conflict or try to understand what went wrong, is to try to make a repair attempt …, so then you can actually engage in a dialogue to actually work towards resolving the issue,” he says. Later that night, Benson and his girlfriend, Heather, used five steps recommended by The Gottman Institute to resolve their conflict. STEP 1: EXPRESS HOW YOU FEELThe first step, according to Benson, is to discuss how each of you felt during the argument. “By just listing off some of the feelings and not going into the details, it kind of helps both partners start to understand what emotions were present in the conflict and sometimes what was lurking below the surface in terms of the feelings that were there and the perceptions that people had,” says Benson. Benson explains that their cat was sick and elderly, and has been a source of stress for his girlfriend. “She’s kind of overwhelmed with losing that cat, kind of grieving that,” he says, adding that “[she felt] I wasn’t really caring about our cat and even about her.” Benson told Heather that he felt misunderstood and unappreciated. “I had done a lot for our cat, and so that was a big thing for me to express,” he says. STEP 2: SHARE YOUR REALITIES AND VALIDATE EACH OTHER The second step, says Benson, is to listen with intention. You and your partner had two separate experiences during the argument, he says, and you need to understand your partner’s experience rather than only your own. “One of the things about conflict communication with couples is often the big problem is partners aren’t really listening to each other, and one person is speaking and the other is waiting until their turn to speak, and so you have two monologues going on instead of dialogue,” says Benson. During this step, you and your partner will take turns acting as listener and speaker, he says. Speaker: Focus on what you perceived and felt during the argument. Avoid criticizing or blaming the listener. Listener: Focus on how the speaker experienced the argument, not how you think they should have experienced it. Really try to understand things from their perspective, and validate it. Say things like, “When I see this from your perspective, it makes sense that you felt that way.” “What that does is it actually slows down the conversation and really helps the listener focus on what their partner is saying rather than interpreting it and bringing in their own personal conversation and dialogue,” he says. STEP 3: DISCLOSE YOUR TRIGGERSDuring this step, while you are taking turns as speaker and listener, each of you should discuss what triggered a strong reaction in you, says Benson. The couple’s cat used to belong to Heather’s father, who suffers from Parkinson’s disease. She explained to him that she felt stressed about having to care for both her father and the cat, and that seeing the cat cry was a big trigger for her. Benson explained to his girlfriend that when she demanded he stop working and clean the cat’s litter box, that he felt his boundaries were being violated. “I felt my personal needs weren’t being addressed, and I talked about my boundaries and what I can and cannot do and how to work with that in a relational way with my partner,” he says. STEP 4: TAKE OWNERSHIP OF YOUR ROLEDuring this step, Benson says, you both need to take responsibility for the role you played in the conflict. “She really apologized for how she talked to me,” he says. “She was critical … and she apologized for that.” Benson acknowledged to his girlfriend that he shouldn’t have responded defensively. “I owned up to that,” he says, “and we got to a place where we both accepted each other’s apologies.” STEP 5: PREVENTATIVE PLANNINGDuring this step, you’ll both discuss ways to argue about the issue more constructively if it happens again, says Benson. Make “positive, actionable” requests, and avoid criticism, he says. Benson says he and Heather decided to make time at the end of each day to talk about their feelings. “We can actually start to talk more about … those emotions in our relationship rather than letting them build and potentially cause other issues like this event,” says Benson. Benson says that using the aftermath of their fight to repair their relationship helped them understand one another’s perspectives and brought them closer together. “Underneath a lot of these conflicts — even things that seem really silly —there’s often a lot of feelings and deeper meanings and often couples will argue about the content or what happened or who’s right and who’s wrong, and that often makes things worse,” says Benson. “Whereas when we slow down and try to understand each other’s experiences, we can start to bridge the misunderstanding and actually turn that conflict into material for building a much stronger relationship.” by Ashley Case
There is a scene in the movie Bridesmaids when one of the characters (Becca) gushes over her new husband. She predictably annoys the single and bitter main character (Annie) who couldn't have been less interested. I think Annie's character is relatable in this scene because for many couples, married or not, this sort of fairy tale love isn't realistic. Luckily for me, fairy tale love isn't a prerequisite for a happy marriage, but it took my husband and I a while to uncover what is. I don't remember gushing over my husband when we were dating or during the "honeymoon phase" of our marriage. Our relationship grew out of friendship. It was easy, without the college drama that I was used to. We were together for almost four years before getting married and we never doubted our ability to stay together through the hard times. But at some point in those first few years ofmarriage, something changed. We found ourselves laughing less and bickering more.We became expert score-keepers, held grudges and let small disagreements turn into big battles. We were so wrapped up in our own perspectives, feelings and needs that we neglected each other. We were in denial that we were equally responsible for our pointless arguments and fights. We were not the same couple that we were in the beginning. Without realizing it, I was making things worse.The way I dealt with conflict set my husband up for failure and caused further disconnect between us. I held on to his faults and the things I took offense to, waiting for him to make up for all of the ways he let me down. I unloaded my feelings, demanded empathy and then shut down or walked away when he didn't respond in the way I wanted. I convinced myself that he was the problem—he wasn't sensitive enough, romantic enough, or available enough. I blamed him for the change in our relationship.I blamed him each time we traded a goodnight kiss for the silent treatment and a cold space between us in bed. During the height of a memorable argument in our second year of marriage, the word divorcebroke through the silence. The word was more like a plea and a threat, but also a question. We were both consumed with anger and hurt—feelings that eventually faded into confusion anddefeat from yet another misunderstanding. But the idea of a life without each other was the wake-up call we needed. We decided our relationship was worth the struggle. Our marriage felt broken, but it wasn't. We had become so focused on ourselves and everything we thought we were supposed to be doing that we left our marriage alone to fend for itself. We thought the hard work of choosing the "right" person had already been done—as if we could cross it off our to-do lists. Instead of growing together, we began to grow apart. We acted more like roommates than husband and wife—two people who spent more time loving on their dog than each other. We needed to change the way we thought about marriage. It took us a while to figure out where we went wrong and how we could repair some of the damage to our relationship, but admitting that we were lost was the first step. At first we looked at other couples—the ones who seemed happy—and we wondered what they were doing differently than us. We wondered how they made it look so easy. Maybe we just needed to go on more vacations, have more sex, or exchange more gifts? Ultimately, there wasn't a quick-fix for our problems. It wasn't until we put our focus back on each other that we uncovered some habits and behaviors that needed to change. The first (and hardest) step was to let our egos take a back seat and own up to the reasons why we were so defensive and quick to blame each other. The second was to stop avoiding hard conversations and hiding from our problems. And the third step was to stop comparing our relationship to other couples (real or fictional), which inevitably left us feeling inadequate. We had to adjust our priorities so that we could work on repairing our relationship. We had to set an intention to create the kind of relationship we wanted—a relationship in which we truly appreciate each other, support each other and feel safe sharing our hopes and dreams and fears. We realized that taking a walk or sitting in the backyard was far more rewarding than zoning out in front of the TV. We realized that ignoring each other until Friday night wasn't exactly the best way to start the weekend or inspire any type of intimacy. We realized that the only way to move beyond our struggles was to make time for the uncomfortable, vulnerable and sometimes painful conversations that we so often avoided. We realized that making our marriage a priority meant that we had to be willing to admit our mistakes and trust each other to move beyond them. Once we became parents, we had to relearn the importance (necessity) of making time for each other. It has been tempting to ignore our needs in an effort to give our boys what they want (aka all of the attention we can give them), but what they really need are two parents who love each other, trust each other and fight for each other more than they fightwith each other. They need parents who are less concerned with how they look on Facebook and more concerned with how they look to each other. We can see now that we don't need a fairy tale marriage to be happy or even to be good parents. We just need to love each other for who we are, forgive each other for what we lack and celebrate the marriage we have. If we can do that, our happily ever after should take care of itself. by Mark Tyrrell
Megan came to see me for help with insomnia. She had the drawn look of the chronically tired. Sometimes people can't get off to sleep, and sometimes they can't stay asleep once they do manage to finally get there. Megan often veered between the two. "Sometimes I get off to sleep okay, but then it's as if I'm worrying about stuff in my sleep and I wake up again and then I can't get back to sleep. Often, though, I just lie awake for hours and, even though I'm exhausted, I just can't get to sleep. I know it sounds dramatic, but I feel like insomnia is ruining my life!" Megan was not alone. A silent epidemic How many folks do you know or simply pass in the street who are chronically sleep deprived? You can't always tell, of course, just by looking. One study found that almost 10% of people (12.9% of women and 6.2% of men) are suffering from insomnia at any one time.[1] And these are just the ones we know about. Another study estimates that it affects 10 to 15% of the population.[2] It has been found that cognitive behavioural approaches are effective in treating insomnia without, of course, the risks of sleeping pills – including that of dependency.[3] In the same study, the authors described insomnia rather neatly as the "behaviours, cognitions and associations that patients adopt as they attempt to cope with poor sleep but that end up backfiring". This is interesting. It's often the reaction to not sleeping, the worry, even anticipatory anxiety, that drives away the very thing we need. So why do so many people have problems sleeping? Sleep thieves I have seen countless insomniacs over the years. Some have had physical problems. Insomnia affects around 44% of people with hypertension and cardiac disease and over 41% of those with breathing problems (not surprisingly!).[4] So it's always important to check our client's medical profile by asking them if they are physically well or whether they have been medically assessed. But, as we'll see in a moment, insomnia can have not just physical but also emotional causes, as well as effects. Many clients, though, for no apparent reason, simply cannot sleep. Perhaps they're prone to that self-made stimulant worry, or have simply gotten into the habit of not sleeping. Megan certainly spent a lot of time worrying about the effects of not sleeping. So what are the common effects of sleeplessness? Consequences of poor sleep It will come as no comfort for insomniacs that the potential effects of chronic insomnia are worryingly plentiful, from greatly increased risk of daytime anger[5] and therefore heart disease,[6] to poor concentration and therefore risk of accidents,[7] through to compromised immune function and therefore susceptibility to illness.[8] Of course, the stress produced by insomnia can have effects on clients' emotional lives, making them more labile and leaving them with a sense of loss of control of their feelings. Not at all surprisingly, insomnia is associated with low levels of positive emotion and high levels of negative emotion.[9] Megan told me she found herself weeping at work over "stuff that wouldn't normally matter!" As is the case for many insomniacs, her relationship had suffered as she had less spare capacity to focus on her lover. "When the insomnia's really bad I can barely function at all!" she told me plaintively. Of course, we need good quality and quantity of sleep: that means about 6 to 8 hours of the right ratio of REM or "dream sleep" (about 25% sleep time) to recuperative deep sleep, during which the body's healing and repair takes place. Megan needed my help. Here are some of the cognitive behavioural therapy (CBT) approaches I used alongside my hypnotherapeutic ones. Technique one: Encourage basic sleep hygiene Actually, this is not so much a technique as an array of considerations. Our nighttime psychology and physiology is, in many ways, a reflection of what we do and how we are during the daytime. Ensure your insomnia clients do the following: * Get outside in natural light. A study found that people who are exposed to natural light during morning hours sleep better at night than those who don't get much morning light.[10] * Exercise, early. Getting outside and moving your body seems to help nighttime sleep. Regular morning exercise sets us up not only for the day but also for the night by helping us produce the sleep-promoting hormone melatonin earlier in the evening.[11] Check that your client isn't exercising intensely in the evening, though, as this may elevate adrenaline for hours afterwards, driving sleep away.[12] * Cut out screen time in the evening. Too much screen light around bedtime impedes melatonin production, giving the body the impression that it's not yet time to sleep. Screen light can make the brain feel it is still daytime and encourage alertness.[13] * Don't lie in on the weekend. Yes, your client has a sleep debt, but don't let them try to repay it on weekends. Sleep needs to be regular and habitual. * Cut out booze. Alcohol may get people off to sleep, but it tends to compromise sleep quality and can make people wake up later in the night.[14] * Limit caffeine and other stimulants such as sugar. * Ensure your client's bedroom is dark enough. Keep the lighting level low – the darker the better. * Wind down. Check your client's wind-down routine. Have them cease screen time an hour before bed. A warm bath can help warm up the extremities relative to the body core, which aids sleep onset. Wearing socks in bed, while not sexy, may also aid sleep onset in this way.[15] Megan told me something else, something I've heard over and over: "It's got to be like a kind of performance anxiety. Bedtime kind of hangs over me; it's on my mind hours before." "Do you feel anxious now if you close your eyes and picture your bedroom?" I asked. Megan closed her eyes, looking as if she was in danger of sliding into slumber there and then! "Yes," she said, "I feel a sort of lump in my stomach picturing my room." Megan had built up an association between tension and her sleeping environment. Not great for promoting restful sleep. Obviously, we needed to address this. Technique two: Help them change automatic associations Some insomniacs, Megan included, have told me they sleep better away from where they normally sleep. I'm never surprised. The brain is a pattern-matching organ par excellence. It builds associations. I have been in the local store, seen a product and automatically heard in my head some bland and annoying jingle. I bet you have too. From PTSD to phobias, addictions to skill building, the mechanism in our brains for forming associations is immense and constant. There are two ways we can use this to our advantage. First, I asked Megan if she'd be happy changing her bedroom around: putting the bed in a new position and so on. She was. Secondly, I taught her how to relax deeply , then had her build a new calm association when she thought about her bedroom. She found this useful, she said. But she asked me what she should think about when "trying" to fall asleep. On the principle that with some things the more you try the more you scare it off, I next wanted to take the trying out of the insomnia. After all, who needs the pressure? Technique three: Help them stop trying It's a catch-22. A double bind. The more you need to go to sleep the more awake you feel. The more you try the harder it gets. In fact, people may be more likely to fall asleep when they try to stay awake! I suggested to Megan that there are certain things in life we need to let happen. People fall in love, but you can't make someone fall in love with you, any more than you can make yourself love someone who isn't right for you. We let our digestions work – we can't forcibly make them hurry up. And it may be that fertility increases when it becomes less of a stressful, sole focus.[16] Sleep is not something you can try to do. All we can do, I think, is create the conditions to invite sleep. When I told Megan this, she nodded. "What I'd like you to do is stay awake tonight as long as possible [it was, I think, a Friday night]. Whatever you do, don't fall asleep until you have logged some of your thoughts. Maybe write down the main ones when you are lying awake. If you can, stay awake the whole night to see how your thoughts differ in the wee small hours compared to earlier in the night." Note that I used a paradoxical intervention. If Megan succeeded in her task she would stay awake; if she "failed" she would fall asleep. And anyway, itwould be useful to discover what she thinks about during the night. This brings us smoothly to the next technique. Technique four: Teach passive wakefulness When we simply observe and let reality come to us, rather than try to impose our own thoughts or biases or habits onto reality, we are said to be mindful. We can watch our thoughts and even feelings, thereby distancing our association with them. We can develop the 'observing self'. I encouraged Megan to simply watch and observe her own thoughts as she invited sleep but never demanded it come to her. I taught Megan about depressive and anxious thinking styles, which tend to be absolutist, all or nothing.[17] I wanted her to be able to 'see through' and detach from these kinds of extremist thoughts, as she was prone to worry. I taught her a ritual of writing down any worries she had before bedtime and locking them away in a drawer. The next day she was to tear up the sheet of paper. The mind is symbolic, and this kind of simple ritual can have amazing therapeutic effects. I never want my insomnia clients to become too hung up on whether they are conscious or unconscious. I sometimes suggest that staying awake and relaxing deeply may even do more good than having fitful sleep. Again, we want to gently remove the pressure. And finally... Technique five: Encourage a trip to hypnagogia As we fall asleep we pass through a world of semi-dreams called hypnagogia. We experience hallucinogenic 'dream fragments' rather than proper dreams (which don't usually start until 50 or so minutes after we drift off). Self-hypnosis encourages and invites the hypnagogic process (of which we often have no conscious recall). The old technique of counting sheep in your mind does the same thing. As laborious as it may be, it encourages imagery in the brain and so may kickstart the journey into hypnagogia. I taught Megan some self-hypnosis techniques, which encouraged both the hypnagogic state and relaxation, and she became well versed in using these techniques for herself. She also enjoyed using the visualizations we practised similar to the ones in our sleep sessions to promote healthy sleep (simply asking your client to visualize some unstimulating activity can calmly lead them into hypnagogia). Pretty soon, I'm happy to say, Megan started to sleep through the night again. She said she felt like a new woman, like she really was, before sleeplessness had robbed her of happiness. Of course, you wouldn't necessarily use all these techniques or approaches with every client, but I hope you have found something of value here. C-PTSD: From Stigma to Healing
Traumatized people often suffer from anxiety and depression, among other symptoms. Others might accuse them of being rude or hypersensitive. After hearing such comments, traumatized people feel worse about themselves. This stigma makes it difficult to heal. However, life doesn’t have to be that way, and first impressions are not necessarily accurate. In order to understand why traumatized people might come off as rude or hypersensitive when they didn’t intend to, it is necessary to examine what’s going on inside them. What Is C-PTSD?Most people think of trauma as something primarily war veterans experience. We’ve all heard of PTSD (post-traumatic stress disorder), which is limited to single traumatic incidents. But did you know that repeated trauma over time during childhood results in C-PTSD? Another factor to consider is that everyone processes trauma differently and is at a different stage of the healing process. One person being able to handle their trauma seemingly easier than someone else with a similar trauma does not mean that it was not harmful to them. Sometimes, the phrase “What doesn’t kill me, makes me stronger” doesn’t apply. And it’s okay to admit a lack of strength in dealing with trauma. That’s where a professional diagnosis comes in. ComorbidityC-PTSD can be misdiagnosed as Borderline Personality Disorder. Dr. Bessel van der Kolk has theorized that BPD and C-PTSD are one and the same. C-PTSD can also be misdiagnosed as ADD or ADHD. Regardless, many trauma victims have more than one issue at once. This is known as comorbidity. Brain DevelopmentAfter a traumatic incident, the brain can remember it or blackout the memories. A blackout occurs when the body reacts against the harm of trauma by forcing the victim to forget what happened. This is also known as psychogenic, dissociative or functional amnesia. It is a disorder that affects one’s identity, memory, consciousness, and perception. As a result, trauma victims are often disbelieved because they often remember sensations over specific personal or circumstantial details, such as time. The after-effects of trauma are not limited to the specific incident or incidents in question and can continue for years — even for the rest of one’s life. Dr. Bessel van der Kolk once explained it this way: “…their problems primarily have to do with attention; being able to focus in on something and engage with something in a very steady, consistent way. So they get thrown off, they have a hard time focusing on things, concentrating on things, filtering irrelevant stuff out, so they get hijacked. That’s one very big issue that deserves its own special series of treatments.” Children experience developmental issues from C-PTSD, such as a lack of socialization, but it does not mean they are lacking in intelligence any less than other people. In fact, they can have a high IQ. It’s just not very important for the whole picture: Emotional intelligence also matters, and it is emotional intelligence which therapists address. It is difficult for trauma victims to regulate their emotions. According to Dr. Bessel van der Kolk: “The second thing is the core issue of affect regulation. That is, we have our emotions in order to tell us what to do or where to go, to orient our bodies and minds to the reality around us. Traumatized people’s emotions become too large, too extreme, or they become too quiet.” Because they experienced repeated traumatic incidents and did not have the support necessary to process that trauma, people with C-PTSD do not activate the same areas of the brain non-traumatized people do; namely, the amygdala, which governs the emotions. They also have an increase of the hormones cortisol and norepinephrine. Brain scans show a decrease in the function of the areas governing the autonomic nervous system, memory, emotion, impulse control, empathy, decision-making, planning, social moderation, self-expression, and cognition. That is why cognitive and awareness exercises such as mindfulness are so helpful. TriggersAn incident, word, or anything else that reminds the victim of their trauma is a trigger. A trigger activates their traumatic stress response in various ways:
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Jeff Stull DMin PhDDr. Jeff Stull is an Individual, Marriage and Family Counselor who enjoys assisting his clients in developing creative alternatives to everyday life, love and work challenges. As a Licensed Professional Counselor and Mental Health Counselor he has specialized trainings in Relationship Repair, Abuse Recovery, Adolescents, and Mindfulness. He holds certifications including Professional Counseling Supervision, Clinical Sexology, Professional Christian Counseling and Accelerated Resolution Therapy(ART). He serves his clients in Alpharetta, Cumming and Dahlonega, Georgia and all over the world via Skype. Archives
October 2020
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