The Middle Path

New study released on PTSD

A new PTSD study suggests that some individuals may pre-disposed to traumatic stress disorders due to the presence of biochemical PACAB in the brain that may affect the way the brain responds to stress. The research may lead to diagnostic tests that determine what individuals may be pre-disposed, in addition to medical treatments for PTSD.

In the meantime MIndfulness based psychotherapies and Eye Movement Desensitization Reprocessing (EMDR) have proven effective in treating PTSD.

NEW YORK (WABC) -- Suffering an expected trauma can leave many of us with side effects and health damages that can last a lifetime.

via abclocal.go.com

Psychotherapy, Untitled

Attachment styles and relationships

Our relationships and interactions during our early development are so important in determining our attachment style. Attachment style is about how we experience and are experienced in relationships. If one grows up in a nurturing and caring family, most likely that individual will have secure attachment. On the other hand if someone grows up not getting enough caring and nurturing interactions the individual's attachment may be insecure. Insecure attachment styles sometimes explain why individuals have difficulties in present day relationships. Attachment styles are not permanent. With psychotherapy / counseling and experiencing healthy relationships attachment styles can change. The link to the article below is a great introduction to attachment and attachment styles.

As a psychotherapist and couples therapist I assess for my patient's or couple's attachment style. Often disorganized or ambivalent attachment styles may indicate trauma/abuse, neglect or inconsistent parenting. When working with couples who are parents (especially expecting or new parents) I always impress upon the couple how important that they not argue in front of their children and they also learn how to argue fairly and make 'repairs' after an argument. Not only can parent's fighting and arguing affect attachment styles but also the health of the child. One study found that individuals who grew up in chaotic families died on average four years earlier than individuals that grew up in healthy families.

The bottom line - one's attachment style can explain why an individual may have problems or issues in present day relationships and interactions. The good news is that attachment styles are plastic, or attachment styles are not permanent. Psychotherapy / counseling and healthy relationships can help individuals develop a more secure attachment style and satisfying relationships.

People tend to think of "attachment" and "bonding" as the subjects of child psychology, but in fact, these factors are just as important to adult health and happiness. So what defines the healthy adult relationship — is there such a thing as too "clingy" or "dependent?" — and can people change in order to find lasting love?

via healthland.time.com

Obama seeks $7.2 billion for PTSD/TBI treatment

Sunday's New York Times had a great article about the poor care for troops who have experienced PTSD and Traumatic Brain Injury. The President's new budget includes $7.2 billion for treatment and research for PTSD and Traumatic Brain Injury.

Definitely a step in the right direction.

President Obama's fiscal 2012 budget proposes $7.2 billion in funding to research and treat the invisible wounds of war: post-traumatic stress disorder and traumatic brain injury.

via www.nextgov.com

What is an ACOA?

ACOA, Adult Children of Alcoholics are individuals who grew up in dysfunctional families that were affected by addiction. I would broaden the term ACOA to include individuals who grew up in a dysfunctional family. While addiction certainly creates dysfunction in a family, children growing up with parents with soft addictions that are not typically associated with alcoholism and drug abuse can also affect children. These children can also have the same relationship traumas that Dayton discusses in her article (the link is below). In addition to soft addictions, parents with depression, anxiety, psychosis, and personality disorders can also affect children.

Attachment theory is about long-term dynamics in relationships, especially the relationship between infant and parents. It is important that infants receive warm and caring interactions with at least one parent for healthy development or secure attachment. If an infant does not receive warm and caring interactions children can develop an insecure attachment style which causes psychological, emotional and adjustment issues as the child develops and as an adult.

These relationshop traumas that occur in infancy and throughout one's development are not unlike Post-Traumatic Stress DIsorder (PTSD) a soldier may experience after going through a horrific experience on the battle field. While maybe not as pronounced as PTSD, the effects of relationship trauma can be seen later in life in present day relationships and interactions. An example of this might be how an individual stays in abusive relationships after experiencing abuse as a child. Often individuals who seemingly are well-adjusted experience distress with the coming or birth of a new child. The birth of a baby or pregnancy can trigger unresolved issues and repressed memories that have been buried for years. Individuals with depression, anxiety, addiction, and a history of failed or chaotic relationships may also be affected by growing up in dysfunctional families.

ACOA meetings are a great place to get support. Unfortunately, there are not many meetings in the Orlando area. Psychotherapy in a safe and nurturing environment can also help these individuals. Relationship / couples counseling can also help individuals who grew up in dysfunctional families. Just as important couples counseling and parenting classes can help parents provide their children the warm and caring interactions needed for healthy development.

In 1980, when the term adult child of alcoholic, ACOA was coined, ACOAs literally came out of the woodwork, testifying in droves to confusion, resentment and hurt that the child within them still hung onto. They reported feeling, at times, like "children walking around in the bodies of grown ups". Both scared and relieved they were admitting how much, after all these years, they still felt haunted by issues from their past. By growing up in families where alcohol had turned the homes they cherished into scary places and the parents they loved into scary people. The tears flowed as they realized that they weren't the only ones who avoided bringing friends home, hid when their parent was drunk and envied classmates with "normal" families.

via www.huffingtonpost.com

For Some Troops, Powerful Drug Cocktails Have Deadly Results - NYTimes.com

Reading this article this morning has reinforced my opinion that the men and women serving in that armed services are getting the short end of the stick when it comes to mental health care.  My expereince in dealing with the VA is that it is a bureacatic system that is often slow or unresponsive to the mental health needs of vets.  This article is another example of how the system is failing veterans.

While medications are necessary to treat depression,anxiety, and PTSD the VA seems to be over-relying on psychothropic drugs. In a recent article written by Keith Alblom, a psychiatrist, he said in  no uncertain terms that depression cannot be treated with medication alone.  The VA is not providing the psychotherapy and counseling that should be part of veterans' treatment.

Lack of funding and too few trained counselors is part of the problem. The article states that the Army is offering non-drug alternatives like yoga and and accupuncture. Even so it seems like the VA is slow to use newer approaches like mindfulness based therapies and EMDR; two appraoches which have been effective in treating PTSD.

The bottom line is that depression, anxiety, PTSD, addiction and other mental health problems will be increasingly affecting veterans of the wars in Iraq and Afgahanistan.  The current system of care for veterans is not adequate and changes are needed.

In his last months alive, Senior Airman Anthony Mena rarely left home without a backpack filled with medications.

via www.nytimes.com

The last word: Rescue me - The Week

This article about Michael Ferrara and his struggle with PTSD is very inspiring but also points out how the public often views PTSD as a disorder that affects primarily combat veterans. Combat veterans certainly are at high risk for PTSD but civilians are too. Anyone who witnesses a traumatic event or is traumatized by abuse or violence can have PTSD. According to the DSM-IV individuals who experienced or witnessed death or serious injury or the threat of death or serious injury including the threat of physical integrity to self or others can have PTSD.

The article describes his long struggle with PTSD, how he found relief and ho he has empowered himself to help others with PTSD. Ferrara found relief through physical activities that involved repetitive back and forth motions. This is not unlike EMDR, a psychotherapy that has proven effective in treating PTSD and other anxiety disorders. When an individual undergoes treatment with EMDR they deal with distressing memories, images, emotions in a safe environment. Part of the process involves repetitive motion by following the side to side motions of the therapist's fingers, similar to Ferrara's use of repetitive back and forth motions.   

EMDR is effective in the treatment of PTSD if you have any questions please contact me. I would also like to know your thoughts about PTSD.

MICHAEL FERRARA HAS trouble pinpointing the exact moment when his life began to unravel. A plausible starting point, though, might be March 29, 2001.

via theweek.com

9/11 Counseling - More is Not Necessarily Best

The article below discusses research that suggests that 9/11 PTSD patients did not benefit from counseling when the client received too much counseling. Based on my experience I would agree with the research. Some therapists believe that patients need to process their trauma by talking about it in detail. I would imagine if someone discusses their trauma to frequently it will only serve to re-traumatize the patient.

EMDR a cutting edge therapy for PTSD and anxiety disorders helps patients process their trauma without having to re-live their trauma by discussing the trauma in detail. EMDR is conducted in a safe environment where the patient is empowered. The patient is able to halt the process if the patient feels he or she is flooding with emotions related to their trauma. EMDR is effective an effective therapy and often cuts the time the patient spends in psychotherapy.

Please leave a comment and let me know your thoughts.

OF THE MORNING CAL

via www.mcall.com

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Anxiety and Depression Together

Yesterday I received a telephone call from the mother of a young man who had been treated for anxiety but now his anxiety had become depression. She said to me, "this is not my son". In counseling and psychotherapy it is not uncommon to see clients with mixed symptoms of anxiety and depression. Sometimes a client's anxiety is so severe it causes depression. This occurs almost always with individuals with post traumatic stress disorder (PTSD). This article from Psychology Today goes into specific detail about anxiety and depression as co-occuring disorders.

If you have any questions please contact me or leave a comment to let me know what you think.

Over the past couple of years, clinicians and researchers alike have been moving towards a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder.

via www.psychologytoday.com

Five Great Books to Read After a Counseling Session

Often a client will ask me are there any books I should read? There are all sorts of books on counseling, psychotherapy, and self-help books. Here are five books I recommend to clients when they ask (and sometimes don't ask) for something to read outside of their counseling sessions:

1. Man’s Search for Meaning by Viktor Frankl – I recently re-read this book. Each time I read this book I am inspired and energized. Viktor Frankl was a Jewish psychiatrist who lived in Vienna prior to the World War II. When the Nazi’s invaded Austria the Frankl was forced into a concentration camp like as were most of the Jews in Europe. The book does not necessarily chronicle his experiences living in the concentration camp but is more about how he survived the brutal physical and mental conditions of the concentration camps. Frankl's book helps individuals consider their own situation and how they might approach it differently.

2. Emotional Intelligence by Daniel Goleman - Drawing from neuroscience and behavioral research, "Emotional Intelligence" how qualities like self-awareness, self-discipline, and empathy often trumps a high IQ. Emotional intelligence can be developed, nurtured, and strengthened at any time in our life with immediate benefits for our health, relationships, and career.

3. EMDR by Francine Shapiro and Margot Forrest - I use Eye Movement Desensitiization and Reprocessing (EMDR) in my practice. This book is a great introduction to this cutting-edge therapy. EMDR has shown to be effective in treating anxiety, stress, and trauma. If a client is interested in learning more about EMDR I recommend this book because it is written in terms a lay-person can understand.

4. Full-Catastrophe Living by Jon-Kabat Zinn - Jon-Kabat-Zinn introduced the Buddhist practice of mindfullness to the US in this book and through his clinic at the University of Massachusetts in Worcester. His therapy Mindfulness Based Stress Reduction is effective in helping individuals manage stress, anxiety, depression, and chronic pain. I integrate mindfulness based therapies in my practice and I encourage my clients to read this book to learn more about and to practice mindfulness meditation and other mindfulness practices.

5. Radical Acceptance by Tara Brach - In short this is book is about a clear and practical way for clients to develop self-awareness while also developing compassion for one's self and others. The book discusses how critical self-judgments, conflicted relationships, isolation, perfectionism, and addictions help to keep us stuck; but more importantly how to get unstuck using principals of Buddhist Psychology. Tara Brach's style of writing is clear, understandable but also warm and caring.