Decisions in Recovery: Treatment for Opioid Use Disorder

SAMHSA, U.S. Department of Health and Human Services January 2017

Decisions in Recovery: Treatment for Opioid Use Disorder

FACT SHEET

The Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with individuals in recovery, clinicians, researchers, and other subject matter experts, has developed a person-centered, recovery-oriented decision support tool for individuals with opioid use disorder. Decisions in Recovery: Treatment for Opioid Use Disorder (Decisions in Recovery) is an online interactive aid for people who want information about the role of medications in treating opioid use disorder. The web-based tool and its accompanying handbook are designed to help people with opioid use disorder: (1) learn about medication-assisted treatment (MAT); (2) compare treatment options; (3) decide which options are best for them and their recovery; and (4) discuss their preferences with a provider. The target audiences for this tool are primarily individuals in or seeking recovery from opioid use disorder and their service providers. Secondary audiences include administrators, planners and policymakers, members of national and community advocacy organizations, researchers, and others interested in promoting quality community behavioral health care. This decision support tool includes a number of exciting features: • Easy to understand information from the literature about three primary medications used for MAT, along with their outcomes, risks, and benefits • Tools to assist the person in recovery to identify and consider personal values and preferences in relation to the available options • Brief videos of recovery stories that provide a range of views and lived experiences from individuals in various stages of recovery and providers • Downloadable worksheets to assist anyone in their recovery journey Decisions on Recovery is an important resource to further the aim of the 2016 Surgeon General’s Report titled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health to prevent and treat substance use disorders. The purpose of this decision support tool is to make objective, research-based information accessible to individuals facing specific decisions about medication for opioid use disorder, rather than to promote any single treatment option. In addition, SAMHSA emphasizes that scientific evidence demonstrates medications are best used in combination with recovery support, lifestyle changes, and professional treatment. Decisions in Recovery supports shared decision-making between individuals in or seeking recovery and their providers. By providing accurate, easy to understand information, first person testimonials, and worksheets to help individuals weigh their options and communicate their preferences and values effectively to providers, Decisions in Recovery can support individuals and providers in developing treatment plans that are the best possible fit for their values, preferences, needs, and recovery goals.

FREQUENTLY ASKED QUESTIONS (FAQS)

What is Decisions in Recovery: Treatment for Opioid Use Disorder (Decisions in Recovery)? Decisions in Recovery is an innovative multimedia tool for people who want information about the role of medications in treating opioid use disorder. It includes a printable handbook that mirrors the web-based content. Decisions in Recovery is person-centered and recovery-oriented. It focuses on “whether” medication-assisted treatment (MAT) is an informed treatment choice by a person in or seeking recovery from an opioid use disorder; and if so, “which” medication is the best fit for that person. Decisions in Recovery is designed to help individuals: (1) learn about MAT; (2) compare treatment options; (3) decide which options are best for them and their recovery; and (4) discuss their preferences with a provider. Who developed Decisions in Recovery? This decision support tool was developed with funding from the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The Center for Social Innovation with Advocates for Human Potential, Inc. prepared this tool under Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS); contract number HHSS 280201100002C, SAMHSA, U.S. Department of Health and Human Services (HHS). Cathy Nugent, Marsha Baker, Wanda Finch, Sharon Amatetti, and Deepa Avula served as the Contract Officer Representatives. SAMHSA worked in collaboration with people in recovery from substance use disorder, researchers, clinicians, and other experts to develop this innovative webbased tool. Who can benefit from Decisions in Recovery? This resource can benefit individuals facing important decisions about their own recovery. It also supports service providers by enhancing communication with the individuals that they serve, clarifying information, and promoting informed, collaborative decision-making. In addition, Decisions in Recovery is a useful resource for administrators, planners and policymakers, members of national and community advocacy organizations, researchers, and others interested in promoting quality community behavioral health care. Who is the focus audience for the tool? The focus audiences for this tool are primarily individuals in or seeking recovery from opioid use disorder and their service providers. Secondary audiences include administrators, planners and policymakers, members of national and community advocacy organizations, researchers, and others interested in promoting quality community behavioral health care. How does Decisions in Recovery differ from other medication-assisted treatment resources? The Decisions in Recovery: Treatment for Opioid Use Disorder tool is based on the model of shared decision-making. Shared decision-making is a collaborative process that allows 4 individuals to make informed choices about their treatment in partnership with their providers, taking into account the best scientific evidence available, as well as individual values, preferences, and lifestyle. Shared decision-making honors both the provider’s expert knowledge and the individual’s right to be fully informed of all treatment options and their potential risks and benefits. Unlike other MAT resources, Decisions in Recovery is a tool that helps both providers and patients to share information about treatment options, preferences, and next steps. Decisions in Recovery can help structure dialogue and enhance communication and treatment decision-making. When used in conjunction with other innovative resources, such as SAMHSA’s new MATx app http://store.samhsa.gov/apps/mat/?WT.mc_id=SAMHSAGOV_20160802_MATx_MAT, Decisions in Recovery can enhance the ability of providers to offer evidence-based information and resources to the individuals that they serve. How can agencies, organizations, and treatment providers use the tool in their practice? The Decisions in Recovery tool is an important resource to further the aim of the 2016 Surgeon General’s Report titled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health to prevent and treat substance use disorders. In addition, the tool can facilitate the interactive process of shared decision-making by supporting a person in recovery from an opioid use disorder in making informed choices about MAT as a treatment choice to aid their recovery from a substance use disorder. How does recovery fit into MAT? Decisions in Recovery offers a wide variety of resources on recovery, recovery support, and opioid use disorder treatment. It offers a framework for individuals and practitioners to consider treatment as an important part of recovery and to recognize recovery as a process of change. Decisions in Recovery encourages people in or seeking recovery from opioid use disorder to talk with their providers about the treatment options that will work best for their unique needs and recovery goals. What are the main features of Decisions in Recovery? This decision support tool includes a number of exciting features: • Easy to understand information from the scientific literature about the three primary medications used for MAT in the United States, along with their outcomes, risks, and benefits • Tools for people in recovery to identify and consider personal values and preferences in relation to the available treatment options • Brief videos of recovery stories that provide a range of views and lived experiences from individuals in various stages of recovery and providers • Downloadable worksheets to assist individuals in making decisions about treatment options with a provider • A downloadable PDF companion handbook that reflects information from the web-based multimedia tool Where can I find the tool? 5 There are a number of places to locate the Decisions in Recovery tool or the companion handbook on the SAMHSA website. After December 15, 2016 – options for accessing the Decisions in Recovery tool and companion handbook include: • To access Decisions in Recovery, please go to the SAMHSA website at http://www.samhsa.gov/medication-assisted-treatment and click on Decisions in Recovery: Treatment for Opioid Use Disorder. • To download the handbook, please go to the SAMHSA website at http://www.samhsa.gov/medication-assisted-treatment and click on Decisions in Recovery Handbook. • More information about Decisions in Recovery: Treatment for Opioid Use Disorder is available on the SAMHSA/BRSS TACS website at http://www.samhsa.gov/brsstacs/shared-decision-making How can I learn more about Decisions in Recovery? You can participate in a SAMHSA webinar to better understand the information in the new resource, navigate the web-based tool, and download worksheets for personal or provider use. To register for the Recovery LIVE! – Opioid Use Disorder, Medication, and Recovery webinar – please cut-and-paste the following URL into a web browser: https://opioid-use-disordermedication-and-recovery.eventbrite.com Can I reproduce or copy material from the tool for use in my practice? All material in Decisions in Recovery is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this material may not be reproduced or distributed for a fee without the specific written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services. What is the recommended citation for the tool? Substance Abuse and Mental Health Services Administration. (2016). Decisions in Recovery: Treatment for Opioid Use Disorder. (Electronic Decision Support Tool) (HHS Pub No. SMA- 16-4993), 2016. Available from: http://www.samhsa.gov/brss-tacs/shared-decision-making

How to Relieve Anxiety in Children

by Angela Zaffer, MA, NCC, LPCC   August 8, 2016

With children going back to school after the summer break, stress associated with homework, taking a test and or social relationships, maybe something some parents are thinking about.  This article should help guide parents on how to help their child cope with these overwhelming feelings.

What is Anxiety?  Anxiety  is a thought that causes someone to worry or feel nervous or upset. Stressed out is a word people often use to describe anxiety.  Everyone feels anxious from time to time.  It’s a normal emotion. Many people feel nervous when faced with a problem at school or work, before taking a test or going to the doctor.  But for children with anxiety,  worry and fear are constant and can be overwhelming.  For some it can be disabling and lead to feelings of panic. But with simple interventions, children can learn to manage these feelings.

One in eight children has an anxiety disorder. Parents whose children show symptoms of anxiety want to help but don’t always know what to do or where to turn. This guide can help you make sense of the available treatment options and includes some easy tips you can start using right away.

Recommended Treatments for Children With Anxiety

 Recommended forms of Treatment

• Cognitive Behavioral Therapy (CBT) is the most recommended treatment technique for anxiety in children.
• Acceptance and commitment therapy, or ACT, uses strategies of acceptance and mindfulness (living in the moment and experiencing things without judgment) as a way to cope with unwanted thoughts, feelings, and sensations.
• Dialectical behavioral therapy, or DBT, emphasizes taking responsibility for one’s problems and helps children examine how they deal with conflict and intense negative emotions.

Cognitive Behavioral Therapy (CBT)

• Cognitive therapy examines how negative thoughts, or  Cognitions, contribute to anxiety.
• Behavior therapy examines how you behave and react in situations that trigger anxiety.

Cognitive Behavioral Therapy (CBT) is a type of therapy that can be used with children to teach interventions to identify and replace  negative thoughts. In cognitive behavioral therapy, children can learn different ways to calm themselves and learn to worry less.  CBT is effective in children as young as 6.  Most children need between 5 and 20 therapy sessions. Depending on the age of the child, a session typically last about 30 to 55 minutes

According to some studies, CBT is as effective as medication in treating anxiety. Unlike medication, CBT has no physical side effects. CBT does require practicing the interventions taught in each session.   Most counselors will teach the parent the interventions as well.  A parent can be quickly oriented in the last five or ten minutes of each session on what the child worked on learning in the session. Also, having the child teach the parent the interventions is also a good way for the child to remember the interventions taught.

Some Typical CBT Interventions include:

• What is Anxiety
• How  Anxiety gets started
• Physical Symptoms
• Breathing techniques
• Relaxation techniques
• Using logic to fight worry thoughts
• Thought stopping
• Redirecting thoughts-Distraction

Interventions to Use at Home

•  Help the child to recognize the physical symptoms of anxiety. A few physical symptoms of anxiety are—upset stomach, racing heart, out of breath, crying, sweaty hands, headache. Sometimes children with anxiety visit the school nurse for these symptoms. Teach your child to  use coping strategies, such as deep breathing when these symptoms occur.
• Listen and Validate  Let your child know you hear their worries and are empathetic to what that the child is feeling.  Let the child know they can share their worries for one time a day for fifteen minutes.  The late afternoon or early evening is usually in the best time.  After they have shared the worries, the child needs to know you will not discuss their worries again until the next day.  This helps the brain learn to re-wire itself from a worry brain to a non-worry brain.  The brain has to be trained to worry less.
• Worry Box:  Create a worry container  The child can write down the worries on a piece of paper and put them in a box or other container.  If they are worrying at school, a worry folder made to hold these  worry notes works really well. The child can also write positive notes and coping skills  on the front outside of the worry folder.
• Breathing Techniques:  Deep breathing can help decrease the stress response in the body.  Take a deep breathe with your child and breath the air out slowly.  Pretend you are breathing out through a straw.  You can also have the child blow the air out slowly on their hand.
• Excercise:  Go for a walk together.  Your child can use this time to discuss what they are worrying about during the walk.  Also, excercise is a great way to get ride of the stress chemicals that build up in the body.
• Modeling ways to cope with stress:  A child who sees his parents take some deep breaths to calm down may learn to do the same.
• Should Medication be Used?
• The  medications that are commonly used to treat anxiety in children are antidepressants. However, because all medications have side effects, medication is rarely prescribed as a first treatment for anxiety. Medication is most often used when other interventions have not been successful, or as a complement to therapy.Depending on your child’s level of anxiety,  professional counseling may be needed to find the treatment and coping strategies that work best for your child and your family.

Medications

Your doctor or counselor may recommend one or a combination of treatments.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):  These are commonly known as second generation antidepressants.

Another antidepressant that is commonly used is bupropion. Bupropion ,or Wellbutrin, is a third type of antidepressant which works differently than either SSRIs or SNRIs. Bupropion affects the dopamine neurotransmitters whereas SSRIs affect serotonin nerotransmitters.

SSRIs, SNRIs, and Bupropion are popular because they do not cause as many side effects as older classes of antidepressants, and seem to help a broader group of depressive and anxiety disorders. These medications are thought to work by targeting chemicals in the brain called neurotransmitters. These chemicals affect mood and emotion. Experts have traditionally thought that they restore a chemical imbalance.   But new research suggests that stress may actually destroy the connections between nerve cells — and even the cells themselves. They believe that antidepressants work by restoring these nerve pathways.  These medications take 4 to 6 weeks to reach their full effectiveness. Anyone taking an antidepressant should be closely monitored, especially children, in the first few weeks.

Medication may allow your child to participate in activities he or she would otherwise avoid. Medication can help get symptoms under control while a child is learning new coping techniques in therapy.  Ask your child’s doctor about the risks and benefits of any suggested medication. Also ask about follow-up appointments and medication monitoring.

Like other medical conditions, anxiety disorders tend to be chronic unless properly treated. Most kids find that they need professional guidance to successfully manage and overcome their anxiety.

Written by Angela Zaffer MA, NCC, LPCC

Angela Zaffer is a nationaly certified (NBCC) and Licensed Professional Clincal Mental Health Counselor in Rio Rancho, New Mexico.  She specializes in treating anxiety disorders in children.  Angela also treats children, teenagers and adults with depression, low self esteem, grief and trauma/PTSD.  She is the CEO and Clinical Director of Counseling Solutions.  Angela can be contacted at:  info@riorancho-counseling.com

Resources:

Counseling Solutions: Counseling and Psychotherapy for Children, Teenagers and Adults

www.Riorancho-counseling.com

http://www.webmd.com

Finding a Counselor or Therapist for Treating Trauma

Why is it Important to Find a Therapist Who Specializes in Treating Trauma?

Treating Trauma is different than treating other diagnosis.  People who have experinced trauma can react differently in theraputic situtaions and react differently to theraputic interventions.

Why Trauma Treatment is Tricky

Unlike the medical model, the trauma model is an empowerment model that recognizes the therapeutic relationship is requisite to healing.  Although the clinician should possess and provide many things-professional training, skill, useful information, empathy, insight, intuition, etc.-it is the client who is the expert on the client and the primary agent of change.

Whether choosing a psychiatrist, psychologist, social worker or counselor, steer clear of authoritative clinicians.

The therapeutic relationship is paramount to successful treatment. If it isn’t collaborative it’s doomed to failure.

Linda Curran, Trauma 101

First steps

• Make sure the provider has experience treating people who have experienced a trauma.
• Try to find a provider who specializes in evidence-based treatments or effective psychotherapy for Trauma or PTSD   (e.g., Mindfulnessbaded cognitive behavioral therapy (MCBT); eye movement desensitization and reprocessing (EMDR), prolonged exposure therapy (PE) etc). There is a list of  recommended treatments at the bottom of this page.
• Find out what type(s) of insurance the provider accepts and what you will have to pay (out-of-pocket costs) for care.
• Contact your family doctor to ask for a recommendation. You can also ask friends and family if they can recommend someone.
• If you have health insurance, call to find out which mental health providers your insurance company will pay for. Your insurance company may require that you choose a provider from among a list they maintain.

Make sure the therapist or counselor understands effective trauma treatment

Trauma-Informed Care is not just about the specific therapeutic techniques—it is an overall approach, a philosophy of providing care.

• A safe therapeutic environment is essential to aid in recovery. 
• Trauma-related symptoms and behaviors originate from adapting to traumatic experiences.
• Recovery from trauma is identified as a goal in treatment.
• Resiliency and trauma-resistant skills training are part of treatment. 
• Trauma-Informed Care includes a focus on strengths rather than pathology.
• Trauma recovery is a collaborative effort.

Finding a provider using the internet

These resources can help you locate a therapist, counselor, or mental health provider who is right for you. Note: These resources can be used by anyone.

• Internet search looking for a therapist or counselor  who treats Trauma or PTSD
• Psychology Today Website
• Integrative Trauma Treatment
• Sidran Institute  Help Desk will help you find therapists who specialize in trauma treatment. Email or call the Help Desk at (410) 825-8888.
• EMDR International Association has a locator listing professionals who provide EMDR  or to search more locally, Google EMDR
• Search For EMDR  in your web browser for local listings
• ISTSS Clinician Directory is a service provided by the International Society for Traumatic Stress Studies (ISTSS) that lets you consider many factors in searching for a clinician, counselor, or mental health professional.

Here is an example as  written by Barbara Markway, Ph.D of a client seeking therapy for trauma.  

Caitlyn had been to several mental health professionals for ongoing depression, but hadn’t gotten better. She felt that none of the therapists understood her. In addition to her mood symptoms, Caitlyn experienced periods of time where she felt very out of control, sometimes cutting her arms with a razor blade. She did not want to die, but some of her past therapists had hospitalized her every time she talked about her cutting.

Caitlyn was about ready to give up all hope of counseling helping her when she had a different experience with a new therapist. Caitlyn hesitated in mentioning her “self-mutilation,” as her other therapists called it, but when she finally did, this therapist responded differently than the others. The previous therapists had asked questions suggesting there was something wrong with her, but this one gently said, “I wonder if something traumatic has happened to you. Would you like to talk about it?”

In that transformative moment, Caitlyn felt safe enough to begin discussing her traumatic childhood experiences. Through her tone and her words, the therapist communicated that there was nothing wrong with her, and that her cutting behavior was a way she had learned to cope with a horrific experience.

What made the difference? Her therapist had been trained in Trauma-Informed Care (TIC).

• A safe therapeutic environment is essential to aid in recovery. Caitlyn had not felt safe with past therapists. She felt that she was considered a “problem client” who sometimes needed more that the therapist was willing and/or able to give. Therapists guided her away from certain topics because they feared “opening up” her pain. On the other hand, her new therapist recognized that learning to cope with her pain was an essential part of her recovery.
• Trauma-related symptoms and behaviors originate from adapting to traumatic experiences. Caitlyn sometimes withdrew and “shut down” when she felt overwhelming pain. The therapist accepted that this was a coping skill. Also, the therapist recognized that cutting served to soothe Caitlyn’s emotions. While these behaviors were not ideal coping strategies, they did serve a purpose. Trauma-informed care gives individuals an opportunity to see how resourceful they were in managing a very difficult experience.
• Recovery from trauma is identified as a goal in treatment. Recall that Caitlyn initially came to therapy because of depression. She hadn’t connected the dots between her past trauma history and her current difficulties.  The therapist expresses hope that Caitlyn can recover, and that dealing with past trauma is part of the recovery process.
• Resiliency and trauma-resistant skills training are part of treatment. There are many alternative coping strategies that can be learned to cope with past trauma. The therapist works with Caitlyn to develop a repertoire of such skills.
• Trauma-Informed Care includes a focus on strengths rather than pathology.Caitlyn’s therapist noted that she had survived the trauma and asked questions such as: “What would you say are your strengths? What characteristics have helped you manage your experiences? How have you coped with your feelings? What are some of your accomplishments that make you feel proud?” With a therapist using such positive language, Caitlyn was able to recognize that she had coped quite well with very difficult experiences.
• Trauma recovery is a collaborative effort. The therapist asked Caitlyn about her personal goals for treatment, about what recovery would look like for her.

All of these factors enabled Caitlyn to see herself as a person deserving of respect, as a strong individual capable of recovery.  As Published in Psychology Today by  Barbara Markway, Ph.D. Dec 29, 2015

 

Angela Zaffer, MA, NCC, LPCC

http://www.Riorancho-counseling.com

Some of the recommended treatment modalities from the Intergrative Trauma Treatment website

Accelerated Experiential Dynamic Psychotherapy

Acceptance and Commitment Therapy

Brainspotting

EMDR

Focusing

Hakomi

Hypnosis & Hypnotherapy

Mindfulness Based Cognitive Therapy

Somatic Experiencing

Somatic Trauma Therapy

Trauma Focused Cognitive Behavioral Therapy

 

 

 

A Deathbed Exercise: A tool for evaluating your life

Imagine you’re on your deathbed.

1. You’re reviewing your life.

What are you glad and sad about your worklife?

Your relationships?

Your charitable efforts?

Your hobbies?

Does any of that make you want to make any changes now?

2. Imagine that the person who knows you best is by your bedside.

What might that person say to you if s/he were honest?

What would you say to that person?

What would you ask that person?

Does that make you want to change anything about how you’re living your life?

3. What would you last wish be? Could you get that now or soon?

So now, having completed this exercise, is there anything you want to do differently?

Published on May 21, 2014 by Marty Nemko, Ph.D. in How To Do Life

ww.Riorancho-counseling.com

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S.A.D. or Depression: The result of impaired communication between brain cells.

Seasonal Affective Disorder (SAD) – Topic Overview

What is seasonal affective disorder (SAD)?

Seasonal affective disorder, or SAD, is a type of depression that affects a person during the same season each year. If you get depressed in the winter but feel much better in spring and summer, you may have SAD.

Anyone can get SAD, but it is more common in:

• People who live in areas where winter days are very short or there are big changes in the amount of daylight in different seasons.
• Women.
• People between the ages of 15 and 55. The risk of getting SAD for the first time goes down as you age.
• People who have a close relative with SAD.

What causes SAD?

Experts are not sure what causes SAD, but they think it may be caused by a lack of sunlight. Lack of light may upset your sleep-wake cycle and other circadian rhythms. And it may cause problems with a brain chemical called serotonin that affects mood.

What are the symptoms?

If you have SAD, you may:

• Feel sad, grumpy, moody, or anxious.
• Lose interest in your usual activities.
• Eat more and crave carbohydrates, such as bread and pasta.
• Gain weight.
• Sleep more and feel drowsy during the daytime.

Symptoms come and go at about the same time each year. For most people with SAD, symptoms start in September or October and end in April or May.

How is SAD diagnosed?

It can sometimes be hard to tell the difference between nonseasonal depression and SAD, because many of the symptoms are the same. To diagnose SAD, your health professional will want to know if:

• You have been depressed during the same season and have gotten better when the seasons changed for at least 2 years in a row.
• You have symptoms that often occur with SAD, such as being very hungry (especially craving carbohydrates), gaining weight, and sleeping more than usual.
• A close relative-a parent, brother, or sister-has had SAD.

How is it treated?

Doctors often prescribe light therapy to treat SAD. There are two types of light therapy:

• Bright light treatment. For this treatment, you sit in front of a “light box” for half an hour or longer, usually in the morning.
• Dawn simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.

Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within a week or so after you start light therapy. But you need to stick with it and use it every day until the season changes. If you don’t, your depression could come back.

Other treatments that may help include:

• Antidepressants. These medicines can improve the balance of brain chemicals that affect mood.
• Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn more about SAD and how to manage your symptoms.

If you need help deciding if you are depressed and what you should do about it, then make an appointment for an initial consultation with me today.  Just click here to be redirected:  Riorancho-counseling.com  Appointments can be made in person or through skype/facetime.

Angela Zaffer, MA, NCC, LPC

What Happy People Do Differently

By Robert Biswas-Diener, Todd B. Kashdan,

The Real Rewards Of Risk: When anxiety is an optimal state

Truly happy people seem to have an intuitive grasp of the fact that sustained happiness is not just about doing things that you like. It also requires growth and adventuring beyond the boundaries of your comfort zone. Happy people, are, simply put, curious. In a 2007 study found that those who frequently felt curious on a given day also experienced the most satisfaction with their life—and engaged in the highest number of happiness-inducing activities, such as expressing gratitude to a colleague or volunteering to help others.

Curiosity, it seems, is largely about exploration—often at the price of momentary happiness. Curious people generally accept the notion that while being uncomfortable and vulnerable is not an easy path, it is the most direct route to becoming stronger and wiser. In fact, a closer look at the study by Kashdan and Steger suggests that curious people invest in activities that cause them discomfort as a springboard to higher psychological peaks.

Of course, there are plenty of instances in life where the best way to increase your satisfaction is to simply do what you know feels good, whether it’s putting your favorite song on the jukebox or making plans to see your best friend. But from time to time, it’s worth seeking out an experience that is novel, complicated, uncertain, or even upsetting—whether that means finally taking the leap and doing karaoke for the first time or hosting a screening of your college friend’s art-house film. The happiest people opt for both so that they can benefit, at various times, from each.

A Blind Eye To Life’s Vicissitudes:The benefit of seeing the forest but not the trees

A standard criticism of happy people is that they’re not realistic—they sail through life blissfully unaware of the world’s ills and problems. Satisfied people are less likely to be analytical and detail-oriented. A study led by University of New South Wales  found that dispositionally happy people—those who have a general leaning toward the positive—are less skeptical than others. They tend to be uncritically open toward strangers and thus can be particularly gullible to lies and deceit. Think of the happy granny who is overcharged at the car dealership by the smiling salesperson compared with more discerning, slightly less upbeat consumers.

Certainly having an eye for the finer points can be helpful when navigating the complicated social world of colleagues, acquaintances, and dates—and it’s something the less sunny among us bring to bear.  Depressed people are more likely than others to reflect on and process their experiences—and thereby gain insight into themselves or the human condition—albeit at an emotional price.

Yet too much attention to detail can interfere with basic day-to-day functioning, as evidenced by research from Queen’s University psychologist Kate Harkness, who found that people in a depressed mood were more likely to notice minute changes in facial expressions. Meanwhile, happy people tend to overlook such second-to-second alterations—a flash of annoyance, a sarcastic grin. You probably recognize this phenomenon from interactions you’ve had with your partner. While in a bad mood we tend to notice the tiniest shifts and often can’t seem to disengage from a fight (“I saw you roll your eyes at me! Why did you do that!?!”), whereas when we’re in a good mood, we tend to brush off tiny sleights (“You tease me, but I know you love being around me”). The happiest people have a natural emotional protection against getting sucked in by the intense gravitational pull of little details.

Similarly, the happiest people possess a devil-may-care attitude about performance. In a review of the research literature by Oishi and his colleagues, the happiest people—those who scored a 9 or 10 out of 10 on measures of life satisfaction—tended to perform less well than moderately happy people in accomplishments such as grades, class attendance, or work salaries. In short, they were less conscientious about their performance; to them, sacrificing some degree of achievement seems to be a small price to pay for not having to sweat the small stuff.

This is not to say that we should take a laissez-faire attitude to all our responsibilities; paying attention to detail is helpful. But too much focus on minutiae can be exhausting and paralyzing. The happiest among us (cheerfully) accept that striving for perfection—and a perfectly smooth interaction with everyone at all times—is a loser’s bet.

The Unjealous Friend: We’re buoyed by others’ good fortune

The happiest people are the ones who are present when things go right for others—and whose own wins are regularly celebrated by their friends as well.

Support for this idea comes from psychologist Shelly Gable, of the University of California, Santa Barbara, and her colleagues, whose research revealed that when romantic partners fail to make a big deal out of each other’s success, the couple is more likely to break up. On the flipside, when partners celebrate each other’s accomplishments, they’re more likely to be satisfied and committed to their relationship, enjoying greater love and happiness.

The process of discussing a positive experience with a responsive listener actually changes the memory of the event—so after telling you about it, your friend will remember that night with the model as even more positive than it was, and the encounter will be easier for him to recall a few years down the line when he’s been dumped. But equally important, you’ll get to “piggyback” on your friend’s positivity. Just as we feel happier when we spend money on gifts or charitable contributions rather than on ourselves, we feel happier after spending valuable time listening to the accomplishments of friends.

In life, it seems, there are an abundance of Florence Nightingales waiting to show their heroism. What’s precious and scarce are those people who can truly share in others’ joy and gains without envy. So while it might be kind to send flowers to your friend when she’s in the hospital for surgery, you’ll both derive more satisfaction out of the bouquet you send her when she finishes medical school or gets engaged.

A Time For Every Feeling: The upside of negative emotions

The most psychologically healthy people might inherently grasp the importance of letting some things roll off their backs, yet that doesn’t mean that they deny their own feelings or routinely sweep problems under the rug. Rather, they have an innate understanding that emotions serve as feedback—an internal radar system providing information about what’s happening (and about to happen) in our social world.

Happy, flourishing people don’t hide from negative emotions. They acknowledge that life is full of disappointments and confront them head on, often using feelings of anger effectively to stick up for themselves or those of guilt as motivation to change their own behavior. This nimble mental shifting between pleasure and pain, the ability to modify behavior to match a situation’s demands, is known as psychological flexibility.

For example, instead of letting quietly simmering jealousy over your girlfriend’s new buddy erode your satisfaction with your relationship, accept your feelings as a signal, which allows you to employ other strategies of reacting that are likely to offer greater dividends. These include compassion (recognizing that your girlfriend has unmet needs to be validated) and mindful listening (being curious about what interests her).

The ability to shift mental states as circumstances demand turns out to be a fundamental aspect of well-being. Columbia University psychologist George Bonanno found, for instance, that in the aftermath of 9/11, the most flexible people living in New York City during the attacks—those who were angry at times but could also conceal their emotions when necessary—bounced back more quickly and enjoyed greater psychological and physical health than their less adaptable counterparts.

Opportunities for flexible responding are everywhere: A newlywed who has just learned that she is infertile may hide her sense of hopelessness from her mother but come clean to her best friend; people who have experienced a trauma might express their anger around others who share similar sentiments but conceal it from friends who abide by an attitude of forgiveness. The ability to tolerate the discomfort that comes from switching mind-sets depending on whom we’re with and what we’re doing allows us to get optimal results in every situation.

Similar to training for a triathlon, learning the skill of emotional discomfort is a task best taken on in increasing increments. For example, instead of immediately distracting yourself with an episode of The Walking Dead or pouring yourself a whiskey the next time you have a heated disagreement with your teenage son, try simply tolerating the emotion for a few minutes. Over time, your ability to withstand day-to-day negative emotions will expand.

The Well-Being Balancing Act

Pleasure and purpose work together

Even the most ardent strivers will agree that a life of purpose that is devoid of pleasures is, frankly, no fun. Happy people know that allowing yourself to enjoy easy momentary indulgences that are personally rewarding—taking a long, leisurely bath, vegging out with your daughter’s copy of The Hunger Games, or occasionally skipping your Saturday workout in favor of catching the soccer match on TV—is a crucial aspect of living a satisfying life. Still, if you’re primarily focused on activities that feel good in the moment, you may miss out on the benefits of developing a clear purpose. Purpose is what drives us to take risks and make changes—even in the face of hardship and when sacrificing short-term happiness.

Working to uncover how happy people balance pleasure and purpose, Colorado State’s Steger and his colleagues have shown that the act of trying to comprehend and navigate our world generally causes us to deviate from happiness. After all, this mission is fraught with tension, uncertainty, complexity, short bursts of intrigue and excitement, and conflicts between the desire to feel good and the desire to make progress toward what we care about most. Yet overall, people who are the happiest tend to be superior at sacrificing short-term pleasures when there is a good opportunity to make progress toward what they aspire to become in life.

If you want to envision a happy person’s stance, imagine one foot rooted in the present with mindful appreciation of what one has—and the other foot reaching toward the future for yet-to-be-uncovered sources of meaning. Indeed, research by neuroscientist Richard Davidson of the University of Wisconsin at Madison has revealed that making advances toward achievement of our goals not only causes us to feel more engaged, it actually helps us tolerate any negative feelings that arise during the journey.

Nobody would pretend that finding purpose is easy or that it can be done in a simple exercise, but thinking about which activities you found most rewarding and meaningful in the past week, what you’re good at and often recognized for, what experiences you’d be unwilling to give up, and which ones you crave more time for can help. Also, notice whether your answers reflect something you feel that you ought to say as opposed to what you truly love. For example, being a parent doesn’t necessarily mean that spending time with your children is the most energizing, meaningful part of your life—and it’s important to accept that. Lying to yourself is one of the biggest barriers to creating purpose. The happiest people have a knack for being honest about what does and does not energize them—and in addition to building in time for sensory pleasures each day, they are able to integrate the activities they most care about into a life of purpose and satisfaction.

There’s More To Life Than Being Happy

Critics argue that the pursuit of happiness is a misguided goal—it’s fleeting, superficial, and hedonistic.

Research backs up some of these claims. People actually pay an emotional price for intensely positive events because later ones—even moderately pleasant ones—seem less shiny by contrast. (Sure, getting a raise feels terrific, but it might mean you fail to fully appreciate your son’s performance in the school play that afternoon.)

Perhaps more damning is a series of studies led by University of California, which revealed that people who place a premium on being happy report feeling more lonely. Yes, being happy might be healthy—but craving happiness is a slippery slope.

A well-lived life is more than just one in which you feel “up.” The good life is best construed as a matrix that includes happiness, occasional sadness, a sense of purpose, playfulness, and psychological flexibility, as well autonomy, mastery, and belonging.

While some people will rank high in happiness and social belonging, others will find they’ve attained a sense of mastery and achievement. This approach appreciates that not only do people differ in their happiness matrices—but they can shift in their own respective matrices from moment to moment.

By Robert Biswas-Diener, Todd B. Kashdan, published on July 02, 2013 – last reviewed on July 08, 2013

For the entire article go to PsychologyToday.com

Re-posted by Angela Zaffer:  Riorancho-counseling.com

The Queen B: Folate/ B vitamin tied in multiple ways to brain function. Impaired intake is linked to severe mental disorders, including Autism, Schizophreinia and Bi-polar Disorder.

The Queen B:  Folate is a B vitamin tied in multiple ways to brain function. Impaired intake is linked to severe mental disorders, including autism.

By Melinda Wenner Moyer, published on July 02, 2013 – last reviewed on September 02, 2013 Psychology Today

What, exactly, does folate do? “Believe it or not, we still don’t fully know why and how it works,” says Rebecca Schmidt, a public health scientist who studies folate at the University of California at Davis. One of the vitamin’s most important jobs is orchestrating the way DNA is read. Folate delivers molecular tags known as methyl groups to genes, thereby regulating the amount of protein the body makes from them. “What makes your ear your ear and your nose your nose—even though they have the exact same genetic code—is DNA methylation,” Schmidt explains.

Scientists are still working to solve many of folate’s molecular mysteries, but here are some insights gleaned from recent studies.

Stamp of Starvation

If nutrient deficiency in utero affects the way DNA is methylated, then people conceived during the Dutch Hunger Winter should have abnormal DNA methylation patterns even as adults. Studying 60 people who were conceived during the Hunger Winter and 60 of their same-sex siblings who were not, researchers analyzed methylation patterns of an oft-methylated gene, insulin-like growth factor 2 (IGF2), which regulates growth. Methylation of the gene indeed averaged 5.2 percent lower among those conceived during the famine.

Minding Methylation

Do people suffering from mental illness have DNA methylation abnormalities? UK and Danish researchers compared DNA methylation patterns in 22 sets of identical twins, one of whom had schizophrenia or bipolar disorder. They found significant differences between the healthy twins and those with mental problems. Affected sibs had lower methylation levels in certain genetic regions than healthy sibs. Since folate abets methylation, the findings suggest that prenatal folate deficiency may affect brain development by impairing gene regulation.

Autism Protection

Over 85,000 Norwegian women who took folic acid supplements from four weeks before conception through the first eight weeks of pregnancy were 40 percent less likely to have autistic children than mothers not taking folate. A U.S. study finds that the autism link is strongest among mothers or babies who have common variations in genes that impair folate metabolism. It may be extra important for the nearly 50 percent of women said to have genetic variations in folate metabolism to consume adequate amounts of the vitamin during pregnancy.

Brain Boost-Autism and increased Folate 

Autism has been tied to low prenatal folate exposure, but it also may result from the presence of antibodies that keep folate from doing its job. U.S. researchers recently analyzed the blood of 93 autistic children and found that three-quarters of them had antibodies in their blood blocking folate from crossing the blood-brain barrier and entering brain cells. When the researchers treated the children with a chemical form of folate that the so-called “auto-antibodies” spare, folate could enter the brain cells and autism symptoms diminished.

Depression Cure

Depressed adults often have low folate blood levels. But is folate deficiency causing their symptoms? A group of depressed adults who were not responding to treatment with a selective serotonin reuptake inhibitor (SSRI) were additionally given 15 mg a day of L-methylfolate, an active form of the nutrient. A similar group was given a placebo. Those who took the folate were more than twice as likely to report improvements in symptoms. Researchers speculate that folate alleviates depression by boosting a chemical precursor of serotonin and dopamine.

Appetite Link

Rodents exposed to low levels of folate in the womb are more likely to become obese later in life. For yet-unknown reasons, the folate-deficient animals consume more fat. The low-folate, high-fat mix does a double whammy on animals’ brains. It lowers levels of DNA-repair enzymes. Folate-deficient rats also suffer more oxidative damage to the brain, which can destroy tissue and set the stage for DNA mutations. The findings suggest that a low-folate diet predisposes animals to poor dietary decisions that ultimately put their brains at multiple risk.

Getting Your Folate Fix

In addition to its contribution to brain function, folate acts as an antioxidant, helping the body eliminate the dangerous byproducts of metabolism known as free radicals, which damage body tissues and degrade DNA, setting the stage for new mutations and disease. The vitamin also helps to synthesize DNA and repair genetic damage, which could reverse disease-causing mutations that arise in the womb.

Adults should aim to consume 400 micrograms of folate every day, but pregnant or breastfeeding women should consume slightly more (600 micrograms and 500 micrograms daily, respectively). So where, exactly, can you get your folate fix?

Dark leafy greens like spinach, collard and turnip greens, brussels sprouts and broccoli are rich with the vitamin—spinach contains a whopping 263 micrograms of folate per cup and asparagus is close behind—because the vitamin is essential for plants’ growth and metabolism, just as it’s important for our own. (But unlike humans, plants can make their own folate.) There’s good reason to eat a folate-rich diet even if you’re not pregnant: Some research suggests that the vitamin reduces cancer risk by facilitating DNA repair.

Beans—garbanzo, black-eyed, pinto, black, and navy—are also packed with folate; beans are plant seeds, where nutrients tend to be concentrated. Doctors frequently recommend beans as a way to boost heart health, and folate could have something to do with their benefits: A 2012 meta-analysis of 14 studies found that for every 200 extra micrograms of folate consumed per day—a cup’s worth of cooked beans—a person’s risk of developing heart disease drops by 12 percent.

On the sweeter side, some fruits—specifically, oranges, papayas, bananas, and cantaloupes—also contain moderate amounts of folate. When European researchers compared the blood levels of folate in more than 5,500 adults with what they ate, they found that those who consumed the most fruit had folate levels twice as high as those who consumed the least.

Since 1996, flour and grains have been fortified with folate. Bran flakes typically provide more than 600 micrograms per cup. Long-grain white rice delivers 716 micrograms per cup.

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People like me don’t cry; we just carry on. Don’t be ashamed of not being happy.

This is a partial article that I found fascinating.  Follow this link if you would like to read the full article.

…I didn’t feel as though I could complain – People like me don’t cry: we cover our emotions and carry on.On the surface things looked fine, but I was ignoring a rising panic within….

Mellody House, in Arizona…..A new generation of psychological therapies [are] being pioneered… I learned that conditions we have traditionally called “mental health” problems, such as anxiety and depression, are now beginning to be understood differently.

Increasingly, they are seen as being rooted in the neurobiology of our nervous systems, and in this respect all mammals are almost identical. When faced with stress, the body does what it needs to respond and ensure survival. However, when there is no chance to allow stressful experiences to resolve themselves naturally, many of us are unable to turn off our “neuroception” of threat long after the threat itself has been survived. This means we get stuck in a frozen state that our system struggles to resolve, resulting in a biological meltdown (aka “trauma”).

Outwardly, this can manifest itself as many symptoms including anxiety (when the system overreacts to perceived threat); depression (when it under reacts); OCD (obsessive compulsive disorder); ADHD (attention deficit hyperactivity disorder); and “medically unexplained symptoms”. These almost always arise from a failure of the nervous system to regulate itself.

Many people unknowingly make things worse by medicating the symptoms with drugs and alcohol as they try to bring themselves back to a balanced “normal”.

At the Arizona center..[treatment involves] ..working with the body from the “bottom up” (upwards through the brainstem) rather than from the “mind down”, and…so‑called mental health problems [are] restored by a new generation of therapies, such as sensorimotor psychotherapy, somatic experiencing and EMDR (eye movement desensitisation and reprocessing).

The difference between these and other therapies is that the therapist tries to engage with the mammal part of the brain and biology, not the human thinking or “mind”. The instruction to patients is often to engage with “sensation” rather than “thought” and in doing so the therapists are helping us to resolve problems in our mammalian brain rather than in the human neocortex. This is radically new because it puts the primal, animal instinct before the brilliant, overdeveloped human in the chain of solving this particular problem. And it works.

Anxiety; depression; bipolar: in my clinic we no longer think solely in terms of these recognised conditions. We think of “incomplete stress cycles”. Our patients are overwhelmed, responding to life as if it is a constant threat, and they cannot cope.

*How I F—– Up My Life and Made It Mean Something by Benjamin Fry is published this month. See khironhouse.com; getstable.org for more information

 

 

When the body heals the mind: Two alternative methods address PTSD symptoms.

When the body heals the mind: Two alternative methods address PTSD symptoms..

When Should I see an EMDR Certified therapist for Counseling?

What kind of problems can EMDR treat?

Scientific research has established EMDR as effective for post traumatic stress.  However, clinicians also have reported success using EMDR in treatment of the following conditions:

• Panic attacks
• Complicated grief
• Dissociative disorders
• Disturbing memories
• Phobias
• Pain disorders
• Performance anxiety
• Stress reduction
• Addictions
• Sexual and/or Physical abuse
• Body dysmorphic disorders
• Personality Disorders