PsyDoctor: the official blog of Psychological Recovery Clinic, Toronto

Overcoming Phobias...

2010-07-27T11:58:00.000-04:00

How to Overcome Fear of Driving?

2010-07-27T11:53:00.002-04:00

How to get Better Sleep?

2010-07-21T15:29:00.000-04:00

Tips for being Assertive

2010-07-21T00:23:00.009-04:00

Dealing with Driving Phobia

2009-06-28T12:09:00.007-04:00

One of the common consequences of being in a motor vehicle accident is the development of a Driving / Passenger / Pedestrian Phobia. There may be a fear of driving, of riding in a vehicle as a passenger, or being a pedestrian, or all the above. Driving Phobia is an abnormally high level of anxiety and phobic response to road driving, and it can become a severe psychological condition. This irrational fear is driven by our emotions, which is why will-power, facts and reassurance tend to have little impact. Of course, this doesn’t stop us trying to intellectually ‘understand it’ so we examine the past and try to remember or figure out how the phobia developed in the belief that a rational understanding will reduce its impact, it rarely does. This search for an explanation is quite natural – especially when we don’t know any other way of tackling it.

This fearful response is rarely based on objective facts or reality; which can happen to anyone – it is not a reflection on one’s strength or character, intelligence, will-power, etc. and may develop at any age. While some realize that these fears are irrational, they often find that facing, or even thinking about facing, the feared situation brings on a panic attack or severe anxiety. The fear of driving / passenger / pedestrian following a motor vehicle accident, or the fear of driving / passenger in particular situations such as over bridges or on highways is one of the most common fears. Most sufferers of in-vehicular phobia are surprised to learn that they are far from alone in this surprisingly common, although often unspoken, phobia. These kinds of fears can manifest themselves from mild nervousness to debilitating full blown panic. They are all learned behaviours, and so, all are very treatable.

For someone who is affected by a phobic reaction to driving, one of the biggest horrors is not feeling in control of the ability to control the vehicle, as this will strike terror into the heart. Have you experienced the belief you will involuntarily swerve across the road into the path of other vehicle, perhaps even had a slight urge of wanting to do that, even though your head will be screaming at you to the effect it is highly dangerous. Have you ever felt your body will disobey you? A distorted perspective of responsibility towards fellow road users, or even vehicle passengers, is another common symptom, as the phobic driver may develop an exaggerated fear they will cause a crash that will hurt someone else, and yet may feel they want to do something irrational. It may be extremely difficult to drive at a speed over 80kmph or to move out of lane one. There is often an urge to drive on the hard shoulder and a feeling of intensified panic when driving passed entry and exit slip roads, again with all the other physical symptoms kicking in. The whole thing reaches the height of despair and embarrassment when the terror intensifies to the point of having to pull the car to the hard shoulder and be driven away from the highway by a police patrol.

In-vehicular phobia sometimes is activated in response to circumstances that contain perceived elements of intense danger and where no such level of danger is actually present. As a result of phobia the subject will often experience episodes of extreme anxiety and stress, and therefore exhibit irrational and unpredictable behaviours in response to intrusive thoughts, which have been triggered by that extreme anxiety. The phobic response can arise from situations that unaffected people will happily judge to be insignificant or otherwise trivial in nature. In severe anxiety and phobia cases the condition can be linked to a life changing event or experience, and in severe cases, such an event that can be significant enough to create a condition that may be diagnosed as Posttraumatic Stress Disorder (PSTD). The situation can sometimes be exaggerated by already present personal emotional difficulties, which again fuel the continuation of a downward spiral of diminishing self–esteem and self–belief. This fuels further anxiety and stress, therefore adding to an already worsening condition, making it impossible to break the cycle. As stressed survivors, post traumatic stress disorder cases need expert handling and that means seeking the help of an experienced psychologist.

Some symptoms of driving phobia include:

An absolute feeling of weirdness
Severe heart palpitations
Feel as if you are going to faint
Chest starts paining
Sweat excessively and your throat becomes dry
Unable to breathe properly and your legs start shaking
You can’t even hear or see properly

Your fear of driving / riding in a car can also result in breathlessness, dizziness, nausea, dry mouth, feeling sick, shaking, inability to think clearly, a fear of dying, becoming mad or losing control, a sensation of detachment from reality or a full blown anxiety attack. In car, you may also experience a sense of not being in control of your arms and legs, feeling as though they are turning to jelly, visual distortion, hyperventilating, a sensation that the car is going to tip over, or is actually tipping over, cramps in the stomach, all being brought on through a fear of driving / being a passenger.

Following are some thought patterns of how the fear of driving can manifest itself:

These days I am generally very nervous about driving/being a passenger/being a pedestrian.
I simply fear being in a car, whether driving myself or being driven by others.
I once had a panic or anxiety attack while driving, and constantly fear that it will happen again
I do not have a fear of driving on roads that are familiar, but I fear that I may lose control on unfamiliar roads.
I can drive and feel fine, but only within a certain distance from where I live.
I am afraid of driving on highways/freeways.
I am afraid of driving in heavy traffic or being stuck in traffic jams.
I am afraid of driving at night.
I am very worried about driving in difficult weather (rain, snow, fog etc).
I have a fear of driving over bridges.
I worry about driving down narrow lanes.
I always fear that other drivers are going to lose control.
I am afraid of being a pedestrian.
I am terrified to cross a busy intersection.
Even walking through a sidewalk makes me feel uncomfortable, as I think that an accident can happen to me anytime.
Due to fearing an accident, I don’t dare to ride my bike anymore.

In fact, modern day driving can be stressful. There are the hidden stresses that build gradually each time we drive and more obvious stresses that result from involvement in an accident or road-rage incident, or simply from getting lost or having a bad day at the wheel. The cumulative effect of this driver stress and fear of driving can cause all sorts of discomfort in our lives. Somehow most people tend to think that we should be immune to all that surrounds us on the road; that we should not let ‘road stress’ creep into our lives. People who can’t sleep, have recurrent ‘nightmares’ with accident themes or who have ‘flashbacks’ reliving traumatic incidents might feel that they should ‘pull themselves together’. Often people who suffer discomfort or delayed trauma after a road accident feel alone. “I must be silly letting it affect me this way”. Feeling embarrassed and foolish they will almost certainly try to keep their concerns to themselves, not even admitting to the phobia to family or close friends, through the worry of being ridiculed. The inability to cope creates even more stress, which then perpetuates the further deterioration in the ability to cope. But you can gain some comfort in the knowledge that there are thousands of people who have problems that arose as a result of, or that were compounded by, an incident on the road - a crash, a near miss, a child running out, a road rage. If you are one of these people, you are not alone.

Self-help Tips: You might have already tried to change, you might have had treatment or training that has not worked or only been partially successful; you might be coping be taken medications to manage anxiety. Whatever your current position, its time to move forward. To gently let go of old, self limiting thoughts, beliefs and behaviours. Or perhaps all you need is a renewed belief in your ability behind the wheel. Whatever problems you have had behind the wheel, you can move forward again. Whether you need to recover from a past trauma, uncover the underlying confidence that is present in other areas of your life and apply it to driving, or discover a confidence that was never ‘taught’ when you first learnt to drive. The starting point is understanding where you are now.

The beginning for change is to shift your perspective by becoming aware of the things that you can do successfully in the car. This might be simply sitting in the driving seat and starting the engine. If you can drive (i.e., if you have valid driving license) you can do some things successfully in order to start recognizing your successes, take a trip in the car for no other reason than to drive.
After each drive write down five things that felt good and two things that didn’t.
Figure out solutions for the two things that didn’t feel good.
If you are starting to gain confidence (no matter how much or how little) from this, repeat it three times and then raise the challenge slightly by increasing the time by five minutes or by driving in a different location (you know where it is safe for you).
The key is taking small, easy steps. Only stretch yourself a little bit each time you go out.
The above method might not successfully work with everybody. If not, always seek professional help as early as possible.

Treatment Considerations: Unlike other phobias, the fear of driving treatment must be approached differently due to the nature of the activity. While driving, there is a limitation to how relaxed an individual should or can be, while still maintaining safety and control of the vehicle. The types of progressive muscle relaxation techniques typically advised by various programs or resources on anxiety are impractical, if not impossible while driving.

Using modern psychological methods combined with in car re-training focused at response prevention can help you to get back on the road and get on with your life. It is also important to work on eliminating any avoidance patterns that are maintaining the phobia. This involves repeated driving / being a passenger, particularly in situations that are presently avoiding. Seeking help from a “Registered Clinical Psychologist” can help you to gain confidence and a new belief that although the past is fixed in place now, your future is waiting for change.

The most recognized method to get over a phobia is to expose yourself (in a graded manner) to the feared object or situation and to tolerate the anxiety until it starts to decrease. Some people find that they can do this on their own, perhaps with the help of self-help books, support groups and friends and family. Others may need professional help from a combined team of psychologist and a specialized driving instructor. For many people, the best treatment for phobias is behavioral therapy involving exposure with response prevention. Behavioral therapy involves a one-to-one session with a Psychologist trained in treating phobias, followed by training in-vivo strategies with a specialized driving instructor. During the sessions, you learn to tolerate the anxiety triggered by exposure with the help of specialized relaxation techniques. It also involves techniques to alter the inappropriate patterns of thinking you have developed and the behavior that stems from them.

This is a Compiled Article

Selfhelp for PTSD

2009-01-04T19:46:00.003-05:00

You may have probably noted (link) that there are many symptoms of PTSD, and very few people have all of them. Also, it is normal to experience times of greater anxiety in your life, particularly when you are under a lot of stress. Some of the symptoms of PTSD, such as sleep or concentration problems, for example, are also seen in other anxiety disorders. So how do you know if you might have PTSD? Here are two tips that might be helpful: (1) If you have at least one symptom in each of the major categories, and your symptoms only started after a traumatic event, then you might have PTSD. If your anxiety symptoms were already present before the trauma, then it is probably not PTSD. (2) It is normal to feel more anxious right after a trauma. But over time, these anxious feelings will settle down. Not everyone who lives through a trauma will develop PTSD. But if your symptoms have been present for over one month, and you find that they are interfering significantly in your life, then you might have PTSD.

Some facts. Several studies have shown that a majority of people will likely experience at least one traumatic event in their lives; but many of them will NOT develop PTSD. The chance of developing PTSD goes up if the trauma was very severe, chronic (that is, lasted a long time), or you were physically close to the event, that is, if the trauma happened right next to you or in front of you. Certain traumas are more likely to lead to PTSD than others. For example, you are more likely to develop PTSD if the trauma you experienced was a rape/sexual assault, combat exposure, or childhood neglect/physical abuse. If you develop PTSD symptoms within one month of a traumatic event, this is called acute PTSD. If you don't develop any symptoms until at least six months after the trauma, this is called delayed onset PTSD. Adults with PTSD can have other problems as well, including depression, drug and alcohol abuse, or other anxiety problems (for example, panic disorder, social anxiety).

How can I recognize if I have PTSD? Many adults with PTSD have strong feelings of shame, guilt, or despair about what happened. It is also not uncommon to have increased feelings of hostility or anger, this is sometimes directed towards entire groups of people (for example, you might find yourself being very angry and suspicious of men if you were raped, or you might get extremely angry at drivers who speed if you were in a serious car accident). Because living through a trauma can be such a life-changing experience, some adults with PTSD find that their relationships with others are different after a trauma. For instance, you might have difficulty maintaining a romantic relationship or trusting other people and their intentions following a sexual assault, or you might have some sexual or intimacy problems. Adults with PTSD can sometimes feel like they are "going crazy" or are "broken" following a trauma. But it is important to keep in mind that PTSD is a treatable anxiety disorder. No matter how bad you feel or how hopeless it seems, there is help for PTSD.

Treatment options. Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling for PTSD includes education about the condition and provision of safety and support. Cognitive therapy shows good results, and group therapy may be helpful in reducing isolation and social stigma. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced ones. The psychotherapy programs with the strongest demonstrated efficacy include psychodynamic therapy, cognitive behavioral programs, variants of exposure therapy, stress inoculation training, variants of cognitive therapy, eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures. EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed. Exposure treatment involves assisting trauma survivors to therapeutically confront distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders. Early intervention after a traumatic incident, known as Critical Incident Stress Management is used to attempt to reduce traumatic effects of an incident, and potentially prevent a full-blown occurrence of PTSD. Some benefit was found from being connected early to cognitive behavioral therapy, or for some medications such as propranolol.

Why do I have flashbacks and upsetting intrusive thoughts? When you live through a traumatic experience, your mind processes and stores the memory a little differently than it stores regular experiences. Sensory information about the trauma, that is, smells, sights, sounds, tastes, and the feel of things, is given high priority in the mind, and is remembered as something threatening. Once this happens, whenever you are faced with a touch, a taste, a smell, a feel, or a sight that reminds you of your trauma, the memory (and the feeling of threat) comes back up and you might have vivid memories or flashbacks about the trauma. This is just the way the mind works. It is not dangerous or a sign that you are going crazy. Following are some selfhelp strategies to deal with PTSD.

Strategy 1: Educate yourself. Learning about anxiety & PTSD. No matter what type of anxiety problem you are struggling with, it is important to know the facts about anxiety. Anxiety is a normal and adaptive system in the body that tells us when we are in danger. This means that dealing with your anxiety NEVER involves eliminating it, but rather managing it. Anxiety can become a problem when our body tells us that there is danger when there is no real danger. As an important first step, you can start by understanding that all of your fears and physical feelings have a name: ANXIETY. Because PTSD can include scary symptoms such as nightmares, flashbacks, or dissociation (that is, acting or thinking as if you are living the trauma all over again), you might be worried that you are going crazy. For this reason, it is so important to educate yourself about all of the feelings that are common to PTSD. The problem is not that you are crazy. Rather, the problem is that you have anxiety because of a traumatic event you have experienced. The good news is that there are skills that you can learn to help you cope with this anxiety.

Strategy 2: Building your Anxiety Management Skills. Learning to calm anxiety by slowing down your breathing (see How to do Relaxation). If you have PTSD, you might find that you are anxious throughout the day. Calm breathing is a quick and portable tool that you can use to “bring the volume down” on some of those anxious feelings. If you experience flashbacks or dissociation, it is a good idea to keep your eyes open when doing calm breathing. Learning how to calm your anxiety by relaxing the muscles in your body is also very useful because many people with PTSD are tense and jumpy throughout the day, it can be very helpful to learn how to relax your body.

Strategy 3: Grounding techniques. Grounding is a very helpful technique if you are experiencing flashbacks and you find yourself sometimes losing touch with the present moment. Having this symptom of PTSD is not only terrifying for you, but it can also be scary for people around you, such as friends and family. Grounding teaches you to stop losing touch with the present moment by concentrating and focusing on the present or by directing your attention to something else. Here's how to do Grounding. (1.) Eyes open. When doing grounding techniques, make sure to keep your eyes open, so that you can see and focus on what is around you right now. It is also a good idea to speak out loud, describing what you are seeing and doing. (2.) Practise: Like any other skill, it is important to practise grounding techniques. It will be most useful if you have tried using this skill when you were calm, and you practised it often. That way, when you find yourself needing to use it, you already know how. (3.) Enlist help: Teach a friend or family member about grounding and why you need to use it. If someone you trust understands when grounding is useful, they can remind you to use it (and do it with you) if you are starting to lose touch with the present. For example, they might say, “I think you might want to do some grounding now… can you describe what you are wearing? What am I wearing? Where are we right now?” Some examples of Grounding - Touch objects around you, and describe them (texture, colour)... “I’m sitting on a black chair, and the fabric is very smooth; it’s soft cotton... The carpet is brown, and there is a painting in the corner.” Run water over your hands, and describe aloud how it feels... Name all the different types of animals you can think of (e.g., lion, tiger, cat, dog, cow, etc…), or types of flowers, name of all cities, etc… Say the alphabet backwards...

Strategy 4: Getting back into your life. Sometimes adults with PTSD will stop doing the things that they used to enjoy, and isolate themselves by avoiding friends and family. Although this is an understandable reaction after living through a trauma, it is not helpful. Even though it might be difficult, it is important to get back into the normal routine of your life as soon as possible; this includes going to work, socializing with friends, and keeping up with hobbies or sports that you enjoy. It is also important that you take proper care of yourself. Some people with PTSD stop paying attention to what they eat, when they sleep, or whether they are getting enough. If it feels too difficult to get back to your usual activities, such as going to work, start with short pleasant activities that will take you out of the house for a brief period of time. These might include: going for coffee with a friend, going to see a movie or renting a movie, or going out for a walk. Even a small step toward getting back into your life is a positive step forward!

Strategy 5: Facing your fears. Some adults with PTSD will find themselves avoiding situations that are associated with the trauma they experienced. Some examples of this avoidance include: If you were in a car accident, you might be avoiding driving, being in cars, walking in areas where there is a lot of traffic, or being in the neighbourhood where the accident took place; Avoiding general places, situations or people associated with your trauma, such as parks, crowded places, and people of a particular ethnicity, age, or gender; Avoiding trauma reminders such as movies, TV, conversations. The best way you can help yourself to deal with these fears is by facing them, rather than avoiding them. Normal activities such as driving or being in a car or reading the newspaper are best addressed by gradually approaching these situations.

Strategy 6: Building on bravery. Remember that any progress you make in managing your anxiety and PTSD symptoms comes from a lot of hard work. If you are noticing improvements, take the time to give yourself some credit: reward yourself! The best way to see your progress is to record all the work you are doing with your PSTD management skills. For example, write down how often you use relaxation or grounding techniques, and how effective it was each time. If you are trying to get out and socialize more, keep a record of the activities you have participated in each week. Set realistic goals for yourself, and reward yourself when you achieve those goals.

Strategy 7: Avoid alcohol and drugs. When you’re struggling with the difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But while alcohol or drugs may temporarily make you feel better, they make post-traumatic stress disorder worse in the long run. Substance use worsens many symptoms of PTSD, including emotional numbing, social isolation, anger, and depression. It also interferes with treatment and can add to problems at home and in your relationships.

Strategy 8: Challenge your sense of helplessness. Overcoming your sense of helplessness is key to overcoming post-traumatic stress disorder. Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times. One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that contributes to trauma.

Strategy 9: Knowing when to ask for help. Although the skills listed here can be very effective in helping you to manage your anxiety, sometimes they are not enough. For example, you might feel completely unable to be around others or to face some of your fears by yourself. This is understandable, since dealing with PTSD can feel like an overwhelming struggle. If this is the case for you, it might be a good idea to consult with your family doctor, or a qualified psychologist to get some help in dealing with your PTSD. Working with someone trained in dealing with PTSD can also give you a chance to talk about any feelings of guilt, shame, or self-blame you might have because of your traumatic experience. Many people with PTSD think that they are either responsible for what happened in some way, that they could have prevented it, or that others would blame them if they knew “the whole story”. For example, it is not uncommon for people who have been sexually assaulted to think that they didn’t “fight back” enough, or that they acted in a careless way that invited or encouraged the attack. Thoughts of guilt about a traumatic event can lead to strong negative feelings of sadness, depression, and shame.

Strategy 10: Practise! Practise! Practise! The PTSD management skills presented above are designed to teach you new and more effective ways of dealing with your anxiety. If you practise them often, they can become new habits that are a part of your daily routine. Like an exercise program, it is important to “keep in shape” even when you are feeling better and you have reached your goals.

Remember: Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes. PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life. PTSD can be related to other health problems. PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.

This is a Compiled Article

Identifying PTSD

2009-01-04T18:12:00.003-05:00

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after an individual has experienced or witnessed a major trauma. PTSD distinct from Traumatic Stress, which has less intensity and duration, and combat stress reaction, which is transitory. In the past, PTSD has been recognized as shell shock, battle fatigue, traumatic war neurosis, or post-traumatic stress syndrome. PTSD is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve some one's actual death; a threat to the client's or someone else's life; being in, or seeing, a serious car accident; being sexually assaulted/raped, experiencing long-term sexual or physical abuse; undergoing major surgery (bone marrow transplant, extensive hospitalization, severe burns); experiencing or witnessing natural disasters (earthquakes, hurricanes, floods, fire); experiencing torture, a terrorist attack, or being a prisoner of war; experiencing or witnessing a violent crime (kidnapping, physical assault, assault or murder of a loved one); being involved in a war or witnessing violence or death during wartime or threat to physical or psychological integrity, overwhelming psychological defenses. In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, the two are combined.

There is no one type of trauma that can lead to PTSD. Rather, there are several different kinds of traumatic situations that can do this, all of which have certain common elements: The trauma was life threatening or it led to an actual or potentially serious injury; The individual reacted to the trauma with intense fear, helplessness, or horror; You can develop PTSD if you have been directly involved in a serious traumatic event, or if you witnessed a traumatic event. There are many different types of symptoms that someone can have after a trauma, but PTSD symptoms fall into 3 categories: (1) Reliving or re-experiencing the trauma; (2) Attempts to avoid thoughts, situations, or people that are reminders of the trauma; (3) Increased anxiety or arousal, including being constantly on guard for danger, and being easily startled. People with PTSD will have at least one or more symptoms of each of these categories. The diagnostic criteria for PTSD, per the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as: (A.) Exposure to a traumatic event (B.) Persistent re experience (e.g. flashbacks, nightmares) (C.) Persistent avoidance of stimuli associated with the trauma (e.g. inability to talk about things even related to the experience, avoidance of things and discussions that trigger flashbacks and re experiencing symptoms fear of losing control) (D.) Persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hyper vigilance) (E.) Duration of symptoms more than 1 month (F.) Significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.) Notably, criterion A (the "stressor") consists of two parts, both of which must apply for a diagnosis of PTSD. The first (A1) requires that "the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others." The second (A2) requires that "the person’s response involved intense fear, helplessness, or horror." The DSM-IV-TR criterion differs substantially from the previous DSM-III-R stressor criterion, which specified the traumatic event should be of a type that would cause "significant symptoms of distress in almost anyone," and that the event was "outside the range of usual human experience." Since the introduction of DSM-IV, the number of possible PTSD traumas has increased and one study suggests that the increase is around 50%. Various scales exist to measure the severity and frequency of PTSD symptoms.

Possibility of PTSD cannot be ruled out, if you are currently experiencing at least one symptom from each of the following three categories. Although most people with PTSD develop symptoms within three months of the traumatic event, some people don't notice any symptoms until years after it occurred. A major increase in stress, or exposure to a reminder of the trauma, can trigger symptoms to appear months or years later.

1. Symptoms of reliving or "re-experiencing" the trauma

Upsetting memories about the event. This usually involves having vivid images about the trauma come up again and again even when you do not want to have them. For example, if you were physically attacked, you might keep remembering your attacker's face. Or, if you were in a car accident, you might have strong memories about the sound of the crash or a vivid picture of blood all over yourself or someone else involved.

Nightmares about the trauma. People with PTSD will often have very vivid nightmares of either the trauma or themes surrounding the trauma. For example, if you were in a car accident, you might have frequent nightmares about being in the accident yourself, or about other people being involved in accidents. Some people with PTSD who were assaulted will have nightmares of being chased, and the person chasing them in the dream might not be the person who assaulted them.

Acting as if the trauma were happening again ("reliving the trauma"). This is also called "dissociation", where an individual loses touch with the present, and feels as if they are living through the trauma again. Some people with this symptom might speak and act as if they are physically in the traumatic situation, whereas others might appear to simply stare off into space for a period of time. Some people with PTSD will also have "flashbacks", which are very vivid images of the trauma they experienced. Flashbacks can seem very real, and some people describe it as a picture or movie that they can see clearly in their minds.

Anxiety or distress when reminded of the trauma. Some people with PTSD become extremely upset or feel very anxious whenever they are confronted with a person, place, situation, or conversation that reminds them of the trauma. This can include becoming very upset when hearing tires squeal if you were in a car accident, or feeling anxious when watching violence on TV if you were assaulted.

2. Symptoms of avoidance

Avoiding reminders of the trauma. Many people with PTSD will try very hard to avoid anything that is associated with, or reminds them of, the traumatic event they experienced. Reminders can include - Circumstances (e.g., the actual date of the event, clothes worn, place where the event occurred, etc.); Things associated with the trauma (e.g. being in a car if the trauma was a car accident); General signs of danger (e.g. TV shows about violence, news programs, police or fire department sirens, fire alarms, etc.); Avoiding thoughts, feelings, or memories related to the trauma. Although many people with PTSD will avoid any reminders of their traumatic experience, it is also common for people to avoid even thinking about what happened. For example, you might avoid talking to anyone about the trauma, and if you have thoughts or memories about what happened, you might try to push them out of your head.

Not able to recall parts of the trauma. It is not uncommon for people who have lived through a trauma to have difficulty remembering parts of it, or the entire trauma, or to be confused about the timeline of events.

Reduced interest in previously enjoyed activities. For example, after a trauma, you might stop wanting to spend time with friends and family, or you might stop all activities that you used to enjoy (such as sports or hobbies).

Feeling detached/estranged from others. People with this symptom describe feeling cut off from others, even though they might have family and/or friends around them.

Feeling numb/unable to experience feelings. Some people with PTSD will say that they generally feel numb, and don't experience loving feelings anymore (such as love, joy, or happiness). People with this symptom might have a hard time even describing how they feel, and are not able to recognize when they are happy, sad, or angry.

Feeling of foreshortened future. It is not uncommon for people with PTSD to say that they have a feeling of "impending doom"; that is, they say that they don't expect to live long, that something bad is likely to happen again soon, or that they feel hopeless about the future.

3. Symptoms of increased anxiety or "hyper arousal"

Sleep difficulties. Some people with PTSD will have trouble falling asleep or staying asleep. This often happens when you feel quite anxious throughout the day.

Anger outbursts or irritability. It is not uncommon for people with PTSD to feel more irritable and angry. If you have this symptom, you might find yourself snapping at people, or getting extremely angry in a situation that reminds you of your trauma. For example, if you were in a car accident, and while driving someone cuts you off, you might get very angry and even yell or act inappropriately.

Concentration difficulties. Many people with PTSD report that they have a hard time paying attention or concentrating while completing daily tasks. This is often the result of being very anxious; it is not a sign that there is something wrong with your memory.

Hyper vigilance. Often, people with PTSD feel as if they are "on guard" or "on alert" all the time. People with this symptom will be very easily startled, and will jump at the slightest sound (for example, the telephone ringing, someone tapping you on the shoulder).

Self-help and/or treatment portion of this article is posted elsewhere

This is a Compiled Article

Understanding Self! (Esteem)

2008-10-27T21:16:00.003-04:00

Few of us feel BAD about oneself time to time... feelings of low self-esteem may be triggered by being treated poorly by someone else, or by a person’s own judgments of him or herself. This is normal. However, low self-esteem is a constant companion for too many people, especially those who experience depression, anxiety, phobias, psychosis, delusional thinking, or who have a chronic illness or a disability. If you are one of these people, you may go through life feeling bad about yourself needlessly. Low self-esteem keeps you from enjoying the quality of life, doing the things you want to do, and working toward personal goals. You have a right to feel good about yourself. However, it can be very difficult to feel good about yourself when you are under the stress of having symptoms that are hard to manage, when you are dealing with a disability, when you are having a difficult time, or when others are treating you badly. At these times, it is easy to be drawn into a downward spiral of lower and lower self-esteem. For instance, you may begin feeling bad about yourself when someone insults you, you are under a lot of pressure at work, or you are having a difficult time getting along with someone in your family. Then you begin to give yourself negative self-talk, like "I'm no good." That may make you feel so bad about yourself that you do something to hurt yourself or someone else, such as getting drunk or yelling at your children. By using the folowing ideas and activities, you can avoid doing things that make you feel even worse and do those things that will make you feel better about yourself.

Why do some people have low self-esteem? Self-esteem encompasses beliefs (for example, "I am competent/incompetent") and emotions (for example, triumph/despair, pride/shame). Behavior may reflect self-esteem (for example, assertiveness/timorousness, confidence/caution). Psychologists usually regard self-esteem as an enduring personality characteristic (trait self-esteem), though normal, short-term variations (state self-esteem) occur. Self-esteem can apply specifically to a particular dimension (for example, "I believe I am a good writer, and feel proud of that in particular") or have global extent (for example, "I believe I am a good person, and feel proud of myself in general"). Self-esteem is distinct from self-confidence and self-efficacy, which involve beliefs about ability and future performance. It is very common to receive lots of negative messages as a child. It is fairly common for parents to tell active children "You are doing it the wrong way. Look at the mess you've made! Can't you can do anything right etc!" And those messages end up being stored (along with other childhood memories) in the back of your mind, a bit like a tape recording. In addition to these verbal messages, if you were made to feel worthless or unwanted though abuse or neglect, those experiences can also have a lasting impact. Our early years are our most impressionable. Even when our adult lives provide good reasons to feel positive about ourselves the earlier messages tend to outweigh the recent. So in adult life, when you go out to meet friends, or attend a job interview, or enrol in further study, the old thoughts and feelings come back. The messages become activated. Something tells you that you're not as good as other people, that you will fail, that you will look stupid, that you don't deserve what others have. Whatever the original cause of your low self-esteem, it is kept low today by your present day belief system. Your own current self-talk keeps the early programming alive.

How can I improve self esteem? There are many high achieving people suffering low self-esteem. The answer is not simply more achievement. The key to changing low self-esteem is to tackle the negative self-talk causing it. However, if you try to move from believing you are worthless to thinking you are wonderful it won't work. You don't (yet) believe you are wonderful so it feels meaningless to pretend so. Start small with believable changes that you know to be true. For example, you might think you are an unworthy or bad person. But you can also admit Adolf Hitler was worse. So, assuming you haven't committed mass murder lately, you can genuinely accept you aren't the worst person ever, even if it sometimes feels like you are. So the realisation that "There are far worse people than me" becomes your own personal affirmation. An affirmation is a statement of truth that you are on your way to believing. Start your day telling yourself this (or something similar). Write it down on some little yellow sticky notes and place them in on your fridge, mirror, or your desk and recite your affirmation often each day. Gradually you are on your way to believing it. It won't happen overnight but it will happen!! It's a great start if you can lift your self-esteem off the floor, just a little bit! This may not seem very uplifting to some people. But if you have spent your life thinking you are worthless it makes a huge difference to modify that belief, just a little bit. It is like a single candle being introduced to a dark room. The initial impact of the first candle is more profound than fifty more candles. Eventually you can move onto increasingly positive affirmations.

Let's try this exercises... Dr. Dyer, author of some of the world's best selling self-help books, suggests the following exercise for rethinking self-esteem, self-confidence and approval. Nominate one person you greatly admire or approve of. It could be someone you know well, or someone famous. It may be some historical figure like Lincoln, Gandhi, or Mandela. Now ask yourself how much time that person is likely to have spent seeking approval from other people? - Without exception we respect straight talking people who back their own judgment, and stick to their guns regardless of disapproval. Dyer calls this the "Supreme Irony of Approval-Seeking Behaviour." The people we approve of are the ones who have their own sense of worth and don't check to see we approve. Fritz Perls; founder of Gestalt Therapy, defines anxiety as that moment when we don't know if we are going to get applause or tomatoes! The truly self-confident person, the person who radiates genuine confidence and charisma, is the one who doesn't need to know. Here are few things you can do Every Day!

Attent to your own needs and wants. Listen to what your body, your mind, and your heart are telling you. For instance, if your body is telling you that you have been sitting down too long, stand up and stretch. If your heart is longing to spend more time with a special friend, do it. If your mind is telling you to clean up your basement, listen to your favorite music, or stop thinking bad thoughts about yourself, take those thoughts seriously. Take very good care of yourself. As you were growing up you may not have learned how to take good care of yourself. In fact, much of your attention may have been on taking care of others, on just getting by, or on "behaving well." Begin today to take good care of yourself. Treat yourself as a wonderful parent would treat a small child or as one very best friend might treat another. If you work at taking good care of yourself, you will find that you feel better about yourself.

Take good care of yourself. Eat healthy foods and avoid junk foods; Exercise. Moving your body helps you to feel better and improves your self-esteem; Take time to do things you enjoy. You may be so busy, or feel so badly about yourself, that you spend little or no time doing things you enjoy - things like listening to music, playing a musical instrument, doing a craft project, flying a kite, or going fishing etc.; Get something done that you have been putting off; Do things that make use of your own special talents and abilities. For instance, if you are good with your hands, then make things for yourself, family, and friends; Dress in clothes that make you feel good about yourself; Give yourself rewards — you are a great person; Spend time with people (friends) who make you feel good about yourself — people who treat you well; Make your living space a place that honors the person you are. Whether you live in a single room, a small apartment, or a large home, make that space comfortable and attractive for you; Display items that you find attractive or that remind you of your achievements or of special times or people in your life; Make your meals a special time. Turn off the television, radio, and stereo. Set the table, even if you are eating alone. Light a candle or put some flowers or an attractive object in the center of the table. Arrange your food in an attractive way on your plate. If you eat with others, encourage discussion of pleasant topics; Take advantage of opportunities to learn something new or improve your skills; Begin doing those things that you know will make you feel better about yourself — like going on a diet, beginning an exercise program or keeping your living space clean; Do something nice for another person; Make it a point to treat yourself well every day. Before you go to bed each night, write about how you treated yourself well during the day. You may be doing some of these things now. There will be others you need to work on. You will find that you will continue to learn new and better ways to take care of yourself. As you incorporate these changes into your life, your self-esteem will continue to improve.

Final thoughts on Self-esteem... The whole notion of self-esteem can be seen as a bit silly. The idea that one individual can have higher or lower worth than someone else is offensive to commonsense, to most religions, and to anti-discrimination legislation. We would do better to encourage people to pursue happiness and make the most of life without worrying about self-worth! If you really must measure your worth try this formula. You are one person. There are 6.5 billion other people on earth. So you're exact worth is one 6.5th billionth. Not much really! But then, if a couple of large countries like China and India were to wage nuclear war, your worth would increase dramatically to say, one in four billion. Would this make you a happier and more worthwhile person? Of course not! Don't be ridiculous!. Forget self-worth. Learn to not take yourself too seriously and be aware of enjoying each and every moments of this beautiful existence called "life"!

This is a Compiled Article

Manage Stress Quickly

2008-09-28T17:18:00.002-04:00

Stress refers to the consequences of the failure to of a living being to respond appropriately to emotional or physical threats to the organism, whether actual or imagined. Common symptoms include irritability, muscular tension, inability to concentrate and a variety of physical reactions, such as headaches and accelerated heart rate. The term is commonly used as a catch-all for any perceived difficulties in life and covers a huge range of phenomena from mild irritation to the kind of severe problems that might result in a real breakdown of health. In popular usage almost any event or situation between these extremes could be described as stressful. Most of our lives are filled with family, work, and community obligations, and at some point we feel as though we are "running on empty." Here are some simple stress busters to help "fill up the tank!" So take deep relaxing breath and read on...

Stress Buster 1: Sit and breathe for 5 to 20 minutes. You may count your breaths up to 10 and then restart at 1. You may say the words inhale and exhale silently. Try using a word with your exhalation, like peace or relax or calm. Select words that fit your goal.

Stress Buster 2: Take a walk and spend 15 to 45 minutes in nature. Walk slowly without purpose. Notice all the natural beauty – a flower, breeze, a tree. Really take in the wonder of all creations. You may even try coordinating your breath with your step. It helps to keep your focus on the present, not allowing your mind to wander. It also slows down your walk. Exhale on the right step 1-2-3. Inhale on the left step 1-2-3.

Stress Buster 3: Watch for the next instance in which you find yourself becoming annoyed or angry at something trivial or unimportant. Then practice letting go, making a conscious choice not to become angry or upset. Do not allow yourself to waste thought and energy where it isn't deserved. Effective anger management is a tried-and-true stress reducer.

Stress Buster 4: Hold your loved one’s hand. Studies show the contact provides immediate relief from stress.

Stress Buster 5: Whenever you feel overwhelmed by stress, practice speaking more slowly than usual. You'll find that you think more clearly and react more reasonably to stressful situations. Stressed people tend to speak fast and breathlessly; by slowing down your speech you'll also appear less anxious and more in control of any situation.

Stress Buster 6: Play a simple child's game. If you have no one to play with, try singing a child's song or nursery rhyme.

Stress Buster 7: Drink plenty of water and eat small, nutritious snacks. Hunger and dehydration, even before you're aware of them, can provoke aggressiveness and exacerbate feelings of anxiety and stress.

Stress Buster 8: A great child relaxation technique that is equally fun for adults is the Wiggling. Wiggle your forehead. Wiggle your ears. Wiggle your fingers, hands, and arms. Wiggle your toes, feet, and legs. Wiggle your torso. Then wiggle everything you can all at once.

Stress Buster 9: Dance. Put on your favorite music and go for it. Choose music that helps you go wild if you need energy or have excess energy to use up. Choose slow flowing music if you would like to have a gentle feeling.

Stress Buster 10: List all the things you have accomplished today. Look only at the list done and not the list not done. This is a simple act of appreciating ourselves and what we are able to do. Feel how this changed your mind and body.

Stress Buster 11: Rub the palms of your hands together vigorously to create heat. Quickly place hands over each closed eye and relax for a full minute.

Stress Buster 12: Do a quick posture check. Hold your head and shoulders upright and avoid stooping or slumping. Bad posture can lead to muscle tension, pain, and increased stress. If you're stuck at a desk most of the day, avoid repetitive strain injuries and sore muscles by making sure your workstation reflects good ergonomic design principles.

Stress Buster 13: Soak a hand towel and microwave for two minutes until steamy. Place on back of neck, on face or computer-achy hands.

Stress Buster 14: Ball Massage: Lie on your back and position a tennis ball under the tense points – your lower back, between your shoulder blades, etc. Roll gently up and down and side to side.

Stress Buster 15: Drink green tea - packed with an amino acid named Theanine, which increases the brain’s output of relaxation-inducing alpha waves and reduces the output of tension-making beta waves.

Stress Buster 16: Tap the tips of your fingers together to clear your head. Or, hold one finger at a time between your other thumb and finger and roll the finger like a pencil. In reflexology, this is thought to relax neck muscles and improve circulation.

Stress Buster 17: Take abdominal breaths. Sit or lie down. Put one hand on your upper chest and one hand on your abdomen. Breathe deep into your lung cavity. Keep the hand on your upper chest still and see the hand on your abdomen moving in and out with your breath. Take 10 breaths in this manner.

Stress Buster 18: Allow a pleasant memory to come to mind, one that brings a pleasant, relaxed feeling with it. Was it the time at the ocean when you had a day to yourself? Was it when you baked chocolate chip cookies with your child? Spend a few minutes recalling and allow your body to luxuriate in the pleasant feelings.

Stress Buster 19: Listen to a SLOW and favorite song. Studies confirm that people who listened to slow-paced tunes had lower heart rate and blood pressure than those who listened to faster songs.

Stress Buster 20: Plan something rewarding for the end of your stressful day, even if only a relaxing bath or half an hour with a good book. Put aside work, housekeeping or family concerns for a brief period before bedtime and allow yourself to fully relax. Don't spend this time planning tomorrow's schedule or doing chores you didn't get around to during the day. Remember that you need time to recharge and energize yourself. You'll be much better prepared to face another stressful day.

This is a Compiled Article

Exploring Anxiety

2008-09-08T21:09:00.003-04:00

Anxiety is a physiological and psychological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create the painful feelings that we typically recognize as uneasiness, apprehension, or worry. When anxiety becomes excessive, it may fall under the classification of an anxiety disorder. Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder. Anxiety disorder is a blanket term covering several different forms of abnormal, pathological anxieties, fears, and phobias. Clinically "fear", "anxiety" and "phobia" have distinct meanings, though the words are often used interchangeably in casual discourse to describe ubiquitous emotions. A phobia is defined as a "persistent or irrational fear." Clinically, fear is defined as an emotional and physiological response to a recognized external threat. Anxiety is an unpleasant emotional state, the sources of which are less readily identified. Distinguishing among different anxiety disorders is important, since accurate diagnosis is more likely to result in effective treatment and a better prognosis.

Anxiety disorders are frequently accompanied by physiological symptoms that may lead to fatigue or even exhaustion. Clinical depression is frequently comorbid with anxiety disorders.Anxiety disorders are often debilitating chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress. A professional assessment is essential for the initial diagnosis of an anxiety disorder, preferably using a standardized interview or questionnaire procedure alongside expert evaluation by a clinical psychologist and the views of the affected person. There should be a medical examination in order to identify possible medical conditions that can cause the symptoms of anxiety. A family history of anxiety disorders is often suggestive of the possibility of an anxiety disorder. Anxiety can be accompanied by headache, sweating, palpitations, and hypertension. It is important to note that a patient with an anxiety disorder will often exhibit symptoms of Clinical Depression and vice-versa. Rarely does a patient exhibit symptoms of only one or the other.

Panic attacks and anxiety attacks are characterized by acute development of several of the following anxiety attack symptoms reaching peak severity within 10 minutes:

Escalating subjective tension
Chest pain or discomfort, palpitations, "pounding heart", tachycardia
Sweating, chills, or hot flushes
Tremor or "shakes"
Feeling of choking, smothering or shortness of breath
Nausea, "butterflies", or abdominal distress
Dizziness, feeling light headed or faint
Derealisation, depersonalisation
Paraesthesias (feelings like an ant crawling on your body)
Feeling of dying, loss of control or "going crazy"

Please Note: Many of the similar symptoms can be caused by a heart attack. Panic attack and heart attacks can be difficult to distinguish.

Treatment: Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives. The choices of treatment include psychotherapy (such as cognitive behavioral therapy); lifestyle changes; or sometimes pharmaceutical therapy. If you think you have an anxiety disorder, the first person you should see is your physician, who can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both. If an anxiety disorder is diagnosed, the next step is usually seeing a clinical psychologist, who have training in cognitive-behavioral therapy and/or behavioral therapy, and who are open to using medication if it is needed.

If you do not have a therapist you can try to identify your feelings as follows:

Take the opportunity when you feel physically bad.
Lie down in a quiet room and close your eyes.
You will probably get a most unpleasant feeling.
This feeling of unpleasantness may become almost unbearable but concentrate on your real feeling in spite of this. You will gradually become more and more aware of of your real feelings.
Worry, loathing, shame, anger, fear and grief are examples of suppressed feelings.
The unpleasantness feels dangerous but it is in reality the suppressed feelings which are dangerous, not those you aware of.
Let the feeling of unpleasantness spread and make intensive contact with it. Allow yourself to express these feelings by making sounds and movements.
Within a quarter of an hour the feeling of unpleasantness will have probably disappeared and you have learnt what to do to begin solving your problems.

Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend can also provide support, but it is not a substitute for care from a professional. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. The family is also very important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one’s symptoms.

This is a Compiled Article

New diagnosis at the corner: "Discomgoogolation"

2008-09-02T15:14:00.002-04:00

Are you feeling stressed or anxious at an inability to access the Internet?

You might be suffering from 'discomgoogolation'. Discomgoogolation is defined as a "feeling of distress or anxiety when unable to gain immediate information access". It's a new syndrome explained as being unable to find an instant answer to a question or a problem because you're not near an Internet connection. The term comes from "discombobulate," which means to confuse or frustrate, and "Google".

A recent study has found a alarming number of people suffer from increased stress when they are unable to get an online 'hit'. In the study, 76% of Britons admitted that they could not live without the internet. Nearly 45% of those polled said they felt frustrated and confused whilst unable to get online and more than one in four admitted to increased stress levels. Psychologist Dr David Lewis, who was involved with the study, said: "The proliferation of broadband has meant for the first time in history we have entered a culture of 'instant answers'. A galaxy of information is just a mouse click away and we have become addicted to the web. When unable to get online, discomgoogolation takes over".

It was surprising to see the stress this led to - brain activity and blood pressure in participants both increased in response to being cut off from the internet." Commissioned by information service 118118, the YouGov poll questioned 2,100 Britons during the first week of July. The study also revealed that one in five admitted to paying the internet more attention than their partner - and in the case of Londoners, it was more than one in four. More than 45% of those polled believed the internet was more important in their lives than religion. And a further 17% said they missed the internet more than friends when they could not get access. The study even revealed that more half of those polled counted the loss of the internet in their home as more stressful than the loss of gas, water or electricity.

So, don't you think it's a perfect time for Google to launch the "more-an-operatingsystem-than-browser" CHROME, aimed to control the world?

Some Stress Reduction Tips

2008-08-31T16:02:00.003-04:00

Nature
Sometimes all that is needed when you’re stressed out is a little quiet time. Getting away from the hustle and bustle of the city for a walk along a quiet path in the woods or a stroll through the gardens in a park or along a beach can help to bring about a calm mood, washing away tension. Natural surroundings, sounds and smells, fresh air, and the exercise of walking can provide a welcome break from the hectic pace and encroaching cares of the day.

Diet and Rest
A balanced diet that contains a variety of nutritious foods can help you to think clearly and as a result, cope with stress. It is important to eat essential nutrients as proteins, carbohydrates, vitamins, minerals and fibre, in order to maintain a well-balanced diet. Although some fat is required to keep your body healthy, a diet with too much fat leads to fatigue and lethargy. Here are some important food tips to help you fight stress:

Begin the day with a glass of pure fruit juice and drink plenty of water throughout the day. Your body requires extra vitamin C when under stress and plenty of water intakes will counteract dehydration.
Eat a good breakfast to get your day off to a good, energetic start.
Don’t consume too much food or beverages containing caffeine. Too much caffeine is stress inducing and increases anxiety levels.
Avoid sugary snacks. When we are under stress the body will crave sugar. Eating a bagel, whole grain bread or pasta will reduce your sugar cravings.
Get some exercise. Exercise in any form is a significant stress reducer.
Avoid drinking alcohol. Alcohol, like caffeine, is a stress inducer.

Sleep Hygiene
Getting enough sleep is also important for your mental health, because it is nature’s own stress-management technique. When you sleep you breathe more deeply and slowly. Your body temperature drops slightly, and your heart rate and blood pressure go down too. Most people have experienced a stressor that seems impossible to handle before we went to sleep only to wake up with a solution. Thus the expression, “sleep on it”.

Stick to a regular sleep schedule - even on weekends.
Relax in the hour or so before going to bed.
Spending 20 minutes in a hot tub may promote sleep.
Go to bed only if you are sleepy.
Do not read, watch television, or eat in bed.
Avoid “trying” to sleep. If you do not feel sleepy, get up and read, watch television, or listen to some relaxing music until you are definitely sleepy and then return to bed. If you still can’t sleep, get up again and wait until you are sleepy.
Sometimes a light bedtime snack can promote sleep, particularly one high in carbohydrates. A glass of warm milk is often effective.
Avoid food and beverages containing caffeine, and avoid alcohol that can fragment your sleep.
Avoid sleeping in day time.
Sleep in a comfortable environment. Avoid temperature extremes - a bedroom that is too warm or too cold.
Mask annoying background sound with a “white noise” device, i.e. an electric fan.
Avoid illuminated bedroom clocks so that you are not always checking the time.

Relaxation Methods

2008-08-31T15:56:00.004-04:00

The result of relaxation is relaxation response which in effect, is the opposite of the “fight or flight” response to stressful or threatening situations that over time may produce hypertension, cardiac and other problems which may seriously affect our health. It was found that relaxing just 20 minutes each day could be beneficial to both your physical and mental health. The Relaxation Response can be practised by anyone, at any time.

Here is what you need: (i) A quiet environment - This can be a quiet room at home or at the office, a place of worship, or a place outdoors where you can be completely alone with no distractions. (ii) A comfortable position - Assume a comfortable position. Sitting with a straight spine is preferable, although you can also sit cross-legged or in the lotus position. Do not lie down as this may result in falling asleep. (iii) A point of focus - This can be a special word or phrase that you repeat throughout the session. You can practise with your eyes closed or focus them on an object. (iv) A passive attitude - Do not worry about your thought processes during a relaxation session. Distracting thoughts are difficult to eliminate. Just let them happen but continue to concentrate on your chosen point of focus.

There are a variety of methods to relieve your stress and you may need to explore different techniques to discover which one best suits you. Once you have found a technique that works for you, it is important to take the time and effort to make such practise a regular routine, as benefits compound over time. Here are a few of the relaxation techniques you may wish to try, all of which are a variation on the relaxation response.

Simple Relaxation Technique: Relaxation techniques are a great way to help your quest for stress management. Relaxation isn't just about peace of mind or enjoying a hobby. Relaxation is a process that decreases the wear and tear of life's challenges on your mind and body.

Sit in a comfortable position (keeping a straight spine)
Close your eyes
Scan your body for any tightness
Progressively relax all the muscles of your body
Begin to breath slowly, inhaling and exhaling through your nose.
As you exhale, repeat your chosen word or phrase (for e.g., ‘relax’). If thoughts keep intruding don’t dwell on them, simply note them and continue to repeat your chosen word(s).
Continue doing this for 10 to 20 minutes.
Practise this technique early or late in the day for optimum results but wait at least two hours after having a meal.

Deep Breathing Exercise: Deep breathing can be done anytime, anywhere. Deep breathing provides extra oxygen to the blood and causes the body to release endorphins, which are naturally occurring hormones that re-energize and promote relaxation.

Slowly inhale through your nose, expanding your abdomen before allowing air to fill your lungs.
Reverse the process as you exhale.
Do this exercise for three to five minutes whenever you feel tense.

Visualization: Visualization is the art and skill of creating a mental model of an event or situation. It is controlled, directed, and purposeful.

Find a quiet place where you feel comfortable.
Sit down.
Close your eyes.
Breathe slowly.
Become aware of each breath.
Concentrate on how your body feels.
Now try focusing on one peaceful thought, or create a picture in your mind of a beautiful place.
If your mind wanders back to the problem creating the stress, make yourself return to the peaceful thought and stay there for a few minutes.

Refute Irrational Thinking

2008-08-31T15:42:00.003-04:00

This world is a series of events… the Way You Think, You Feel!

(i) Thoughts: You interpret the events with a series of thoughts that continually flow through your mind. This “internal dialogue or self-talk” which colours and tells you your world as neutral, positive or negative;

(ii) Mood: Your feelings are created by your thoughts and not the actual events. All experiences must be processed through your brain and given a conscious meaning before you experience any emotional response

Sample scenarios for practise:

Going to work, on a day which is full of appointments and potentially stressful meetings
Recovering from a serious illness, admitted bed-ridden in a hospital.
Going very urgently to meet somebody, on the way having a Flat Tyre
Forced to talk/perform in a public meeting tomorrow

“What are the possible thoughts that may come to you?”. Let's now analyze and categorize them... Some of the most common thinking styles (cognitive errors) are as follows:

ALL OR NONE THINKING: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.

OVER GENERALIZATION: You see a single negative event as a never-ending pattern of defeat.

MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively, so that your vision of all reality become darkened, like the drop of ink that discolours the entire glass of water.

DISQUALIFYING THE POSITIVE: You reject all your positive experience by insisting they “don’t count” for some reason or other. In this way you can maintain a negative belief that is contraindicated by your everyday experiences.

JUMPING TO CONCLUSIONS: You make a negative interpretation even though there are no definite facts. That convincingly supports your conclusion... (a) Mind reading: You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out; (b) The fortune-teller error: You anticipate that things will turn out badly, and you feel convinced that your prediction is an already- established fact.

MAGNIFICATION OR MINIMIZATION: You exaggerate the importance of things, or you inappropriately shrink things until they appear tiny. This is also called the “binocular trick”.

EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: “I fell it, therefore it must be true”.

“SHOULD” STATEMENTS: You try to motivate yourself with “Should” and “Shouldn’t”, as if you had to be whipped and punished before you could be expected to do anything. “Must” and “Ought” are also offenders. The emotional consequence is guilt. When you direct “should” statements toward others, you feel anger, frustration, and resentment.

LABELLING AND MISLABELLING: Instead of describing your error, you attach a negative label to yourself: “I’m a loser!” When someone else’s behaviour rubs you the wrong way, you attach a negative label to him; “He’s god-dam crack”. Mislabelling involves describing an event with language that is highly coloured and emotionally loaded.

PERSONALIZATION: You see yourself as the cause of some negative external event; that in fact you were not primarily responsible for.

Try this simple, “WHAT THEN” exercise for Changing Your Thought

Look at example: An important meeting at office, the train is late by 2 hours.
“The train is going to be two hours late”
“What then?”
“I will have rush for a taxi”
“What then?”
“I will get stuck in traffic”
“What then?”
“I will arrive one hour late for the meeting. Sweating all over”
“What then?”
I will apologize to everyone and explain what happened”
“What then?”
“I may be force fix another meeting, as time may be over”
“What then?”
“I will collapse in my chair, utterly exhausted, a total waste day”
“What then?”
“Then… there’s tomorrow”

Try to practise “What Then” Exercise with other Scenarios

Constructive Self-Talk Alternatives

1. To work, on a day which is full of appointments and potentially stressful meetings.
Today looks like a busy day
The day should be made very productive
I will get a lot accomplished today
I will earn a good night’s rest today

2. Recovering from a serious illness, admitted bed-ridden in a hospital.
I did not die; I made it through
The doctor says I will be able to get back to normalcy soon
I can keep active and gradually get back to most of my old spirits

3. Going very urgently to meet somebody, on the way having a Flat Tyre
Bad time for a flat (begins to get tools out to start working)
I will call and cancel the appointment at the nearest booth
I can ask for another appointment very soon

4. Forced to talk/perform in a public meeting tomorrow
This is a positive challenge in my career
I will take a deep breath and relax
Audience will enjoy my presentation
Each presentation goes a bit better
I can learn the from every experience

Decision Making & Problem Solving

2008-08-31T15:29:00.004-04:00

Life can be viewed as a constant series of decisions that determines the outcome of one’s life. Rational decisions enable one to “take charge” of their lives.

Process of Decision Making. Understand the problem and goals clearly; therefore consider wide variety of alternative courses of action, the creation of many possible solutions to the problem. Collect all the available information. Weigh the pros and cons of each course of action and then decide on one that you can commit yourself to fully. The purpose of decision making are:

To make decisions more rationally and wisely.
To recognize that we really do have a choice about many important things in our lives
To avoid making decisions sloppily or by default
To avoid a variety of irrational ideas, false assumptions, fears, needs and other emotions that block good decision-making.

Step One
Decide if there is a problem. A problem well stated is half solved. If so, describe and understand the problem; See some solutions; and accept the challenge to tackle the problem.

Is there a problem?
Am I exaggerating or minimizing the problem?
If serious difficulties involved, ask- are there solutions to the problem?
Is it a manageable, solvable problem?
Am I overly optimistic or pessimistic?
The situation may be an opportunity rather than a problem.
Am I willing to accept the challenge with enthusiasm
List down helpful forces and harmful forces pushing you / restraining you from reaching your goal.

Step Two

Now decide what you want in the future?
What do you value?
Set major goals in terms of specific behaviours.
What should take priority in your life? (Socializing, work, romance, sex, family, money, health, children, being alone, comfortable, status, looks, education, religion, playing, thinking, art, music, excitement or pleasure). If you do not know your priorities, you can’t decide where to go in life.

Step Three

Think of as many solutions and courses of action as you can.
If you can’t find any good solution, gather ideas from experts or experienced people. Brainstorming in a group is a better way (The more solutions generated the better, Suspend judgement and the quality of idea, The greater variety of ideas, more likely to find a good solution)
Identify most promising ideas, combine solutions and improves each alternative with possible approaches to problem.
No good idea or compromise is overlooked.
If the problem is tough, give yourself time.
Build up faith in your ability to eventually decide and cope.
Avoid thinking in terms of ‘either’ ‘or’ (e.g. either I go to college or I don’t)

Step Four
Every decision maker needs to know the psychological forces that block intelligent decisions in order to guard against the pitfalls.

When people become resigned or detached” I don’t care”
They are paralysed - unfeeling, unemotional, uninvolved and indecisive.
Self-doubt and self-defeating acts - anxiety, depression, suppressed anger, lack of hope interferes with decision.
An exaggerated notion of one-self may lead to bad decisions
Being overly dependent – handicaps the decision-maker
Wishful thinking in many forms messes up decision-making
Blaming/ abusing oneself after making a poor decision may lead to avoidance of making decisions in the future.
If certain outcomes scare us, the tendency is not to consider those alternatives.
Emotions cause us to rush decisions
Group decisions may solve problems better than individual decisions – if the group members are competent and work well together.
Group decisions inhibited by overenthusiastic pleasing group members or when there is negative atmosphere.

Step Five

Consider carefully each of the alternatives
What are the pros and cons of each choice?
How does each choice fit with your priorities?
How do you feel about each choice?

Two aspects to consider:

Facts about each choice (How you feel about the future implied by each choice? Consider your assets and resources to overcome the problem and opposing force. Whether the course of action is in keeping with or in conflict with your values)
Consider subjective, intuitive or vague feelings-oriented reactions. (Ask yourself- what is the best that could happen if I make this choice? What is the worst that could happen? Are there ways to improve the ‘wrong’ that could happen if I make this choice? Your feelings, needs and wants must be given serious attention)

Step Six
Select the best solution from among the alternatives you have considered.

Dreaming about a problem they are trying to solve.
Consciously think about the situation;
The alternatives
Their feelings and different choices
Possible long-range outcome

Step Seven

Accepting the best choice
Let it sink in…
Stop obsessing about the decision
Let go of the unselected options
Give yourself a time limit to make a decision;
Receive all the information and go with what seems like the best choice
Quickly give up the rejected alternatives.

Step Eight

Throw yourself into carrying out the decision
Make a specific plan and schedule the work
No decision if there is no action (Solutions don’t usually end with decision - they begin there - “a poor decision well executed is better than a good decision poorly executed”)
Need a well thought out and detailed plan re: how to succeed and how to deal with possible problem
You need energy, hope time and dedication (Frequently evaluate the effectiveness of your action and make changes in your plans accordingly)
Take pride in your decisiveness.

Active Meditation

2008-08-31T15:14:00.004-04:00

This is an awareness arousing meditation technique... simple, but very effective!. To put it straight, meditation may be considered as a relaxation by arousing and sustaining awareness. The idea of meditation is to focus your thoughts on one relaxing thing for a sustained period of time. This rests your mind by diverting it from thinking about the problems that have caused stress. Meditation gives your body time to relax and recover and clear away toxins that may have built up through stress and mental or physical activity.

Lets’ first learn to differentiate Tense and Relax! (Fist Exercise – Hold your hands suspended and tighten your fist. Now close your eyes and go on increasing pressure on your fist for one minute. Then, slowly release your fist so that you can experience the difference between relaxed and tensed).

Unlike hypnosis, which is more of a passive experience, meditation is an active process that seeks to exclude outside thoughts. In all cases meditation helps if you to attain persistent relaxation response. It should be in a position that you can comfortably sustain for a period of time (20 - 30 minutes is ideal).

WARNING: This technique should never tried by people with cardiac (heart) related and/or seizure (epilepsy) related illnesses.

Step 1: On the Spot Running - Rigorous movement of muscle groups leading to enhanced oxygen supply for somatic cells. This is jogging without moving forward. Sustain your attention to your toes.
Time: Preferably minimum of 5 minutes; increase the duration by 1 minute every other week in continuous practise to 10 minutes maximum

Step 2: Forced Breathing - Constant forced breathing or Hyperventilation increases oxygen supply to nerve cells. Sustain your attention to breath stronger and faster.
Time: Preferably minimum of 5 minutes; increase by 1 minute every other week in continuous practise to 10 minutes maximum

Step 3: Cease! - Now stop all your activities! Complete Silence. Just watch (with closed eyes) all that is happening in your body. Start mentally scanning from toes to head. Be aware of each and every things happening to you and around you. Slowly shift you awareness to look at your own thoughts!
Time: Preferably minimum of 10 minutes – Time for final session is the sum of time for 1st and 2nd sessions.

Time Management Skills

2008-08-31T15:00:00.001-04:00

If you are able to control your time, you control your life! A planned, organized day is more fruitful than one lived whimsically without any carefully considered goals. “The person who concentrates entirely on sawing wood is likely to forget to sharpen the saw”. Productive people have set their priorities and scheduled their time accordingly. Unsuccessful, unskilled worker and procrastinating students are present-oriented and unorganized, fatalistic and hedonistic. Our situation and needs influence our time orientation, but our time orientation (and needs) can be changed, leading to more success in life. Time is a precious commodity; everyone gets an equal share but we use it very differently. We also look at time very differently: 57% of us are present and future oriented; 33% are mainly future oriented; 9% are present oriented; 1% focuses on the past.

Common Problems. Lot of people waste time, lot of problem managing time! Many people have little experience organizing their lives because parents, teacher, bosses and friends have done it for them. They do not see the need for a scheduled. Many people resent any barrier that interferes with their doing whatever they feel like doing at the moment. Thus a schedule is seen as stifling by some and resisted. Some of us are pushed by pressing needs - a need for love and attention, a need to avoid responsibility and work, a need to believe that future will take care of itself (so I can do whatever I want to right now), a need to escape real life by listening to music, watching TV, or reading a novel and so on. In some cases, a new determination to schedule your timing will. Greater self-awareness/psychological help may be required for some. Many of us spend our days handling what appears to be “urgent” problem such as answering the phone or mail, meeting the deadlines for never read reports, attending meetings, etc. which in the broader sense not very important or useful. If your schedule is filled with unimportant urgencies you won’t have time: to learn new things, to do long range planning, to be creative and original, to do research, to exchange ideas with others, to rethink your major objectives, to invent new opportunities, to try to prevent future problems, to help others. These activities result in greater productivity and more benefits to everyone; they are the essence of a thoughtful life. Some people make their daily schedule too rigid and overly demanding. Your schedule should make you feel as if you have got it together, not like a failure or an incompetent. Make time an opportunity, a chance - to talk with the boss, to become involved in a project, to meet someone.

Method of Time Management. Time management is aimed at making better use of your time, both in terms of devoting time to high priority activities and avoiding wasting time or spending your time on less important things. To be time effective, by selecting the best thing to do at this moment from among the infinite possibilities. Steps of time management are as follows:

Step 1: Set your priorities. List your major goals for the next few months. Rate each goal. Ask, ‘what are the most important things for me to do?’

Step 2: List what needs to be done this week in order to reach your top priority goals. Rate each activity.

Step 3: Observe how you spend your time.

Step 4: Make a master schedule of fixed activities for the week.

Step 5: Keep a running list of assignments, things you need to get done this week.

Step 6: Make a “to be done list” every day.

Step 7: Follow your daily “to be done list”. Reward yourself.

You must be ready to explore any good opportunity; otherwise life can become a dig. Priorities and assignments and deadlines change everyone; thus the use of your “free” time everyday must change a little too. Time Management makes you more fruitful. Danger may be that you make a hard decision; might regret that you have lost that time. Advantage is that you have at least given your brain a chance to influence your life!

Assertive Skills Training

2008-08-31T14:49:00.003-04:00

Assertiveness:

Is a skill that can be learned, not a personality trait.
Clearly represents what one is thinking and feeling.
No apology for expressing emotions and thoughts.
Refuses to be manipulated by false guilt when communicating.
Never sacrifices others’ rights to get their own way.

Seven Rights of the Assertive Person:

The right to be human and take full responsibility for your decisions and action
The right to be wrong
The right to tell others what you are thinking and feeling
The right to change your mind
The right to stand in judgement of your thoughts and actions
The right to express yourself without intimidation or guilt
The right not to accept responsibility for others

First, understand the Basic Interpersonal Styles:

(1) Aggressive style:

Opinions, feelings and wants are honestly stated but at the expense of someone else’s feelings.
The message - “I’m superior and right and you’re inferior and wrong.”
They are given what they want in order to get rid of them.
They make enemies.
If they cannot be avoided, others will be dishonest with them in order to avoid confrontation.

(2) Passive style:

Opinions, feelings and wants are withheld/expressed indirectly and only in part.
The message is “I am weakened inferior and you’re powerful and right.”
Minimizes responsibility for making decisions and the risk of taking a personal stand on an issue.

Senses of impotence, lowered self-esteem, have to live with the decisions of others.

(3) Assertive style:

Clearly state your opinion, how you feel and what you want without violating the rights of others.
The message ‘you and I have differences, but we are equally entitled to express ourselves to one another’.
Active participation in making important decisions, getting what you want without alienating others

Assertiveness is an antidote to fear, shyness, passivity and anger

Script for Change

Look at your rights
What you want what you need, your feelings about the situation.
Let go of blame, the desire to hurt to indulge in self-pity.
Define your goal and keep it in mind when you negotiate for change
Arrange a time and place to discuss your problems that is convenient for you and for and for you and for the other person
Define the problem - be specific. State the facts as you see them. Share your opinions and beliefs.
Describe your feelings so that the other person has a better understanding of how important an issue is to you. You become less of an adversary.
Your feelings once expressed help you to get what you want. Use ‘I’ messages that express your feelings.
Express your request in one or two easy to understand sentences.
Be specific and firm. Instead of expecting others to read your mind and magically meet your needs
Reinforce the other person to give you what you want - describe positive consequences.
Develop your Self-Image by self-awareness, self-esteem and self-confidence

Powerful messages about you come from Parents, Peers and Self-talk

“Children should be seen and not heard”
“You can do it”
“Don’t you ever think before you do something”
“Just do your best – that is always good enough for us”
“Wait until your father gets home”
“We love you”
“How could you do something like this after all we have done for you?”
“We do not expect you to be perfect”
“You are a bad boy/girl”
“Whatever you decide we will support you!”

Scenarios for Practise

You are in the middle of a queue, having waited for more than an hour. A young couple come along and casually walks into the queue right in front of you.
You have just brought a new CD player. It didn’t work, so you took it back. The replacement warranty ends after first week. When you take that back, the shop manageress says she won’t replace the player, but will send it off to be repaired.
A child you are looking after for the afternoon demands some sweets, but you had been asked not to give him away.

Dealing with "Silent Killer"

2008-08-30T20:35:00.003-04:00

High blood pressure or Hypertension is known as the "silent killer" and is one of the most common diseases of the cardiovascular system. It is defined as a condition of sustained elevated pressure in the arteries of 140/90 or higher. In this case, 140 is the systolic pressure. Simply put, systolic pressure represents the blood pressure against the arteries while the heart is contracting or beating. The number 90 is the diastolic pressure, meaning the blood pressure while the heart is relaxing or between beats.

High blood pressure is both a sign, as well as a causal factor. As hypertension in the body becomes prolonged, the risk for heart failure, vascular disease, kidney (renal) failure, and stroke increases, which makes it the leading associated cause of death and disability. Although there has been no cause identified for hypertension in 90 percent of people, dietary factors have been shown to influence blood pressure. People with hypertension can use the following food guidelines:

Avoid foods high in sodium: Sodium causes vasoconstriction, the narrowing of blood vessels. Therefore, the amount of space blood has to travel through decreases. This decrease creates an increase in the resistance the blood has to overcome. This increased resistance makes it more difficult for the arteries to expand with each beat of the heart, causing the internal pressure to rise. High sodium foods include processed meats, salted snack foods, cheeses, and canned foods.

Eat foods high in potassium: Good dietary sources of potassium include bananas, potatoes, avocados, tomato juice, grapefruit juice, and acorn squash. Potassium helps maintain intracellular osmotic pressure, which is the force required to stop the flow of water across a membrane.

Use salt substitutes: Eat calcium and magnesium rich foods to help reduce blood pressure. Food sources rich in calcium include low-fat milk, green beans, sardines with bones, broccoli, spinach, and tofu. Good sources of magnesium-rich foods include any legumes and seeds, such as navy beans and sunflower seeds.

Lower saturated fat intake: Saturated fat increases the level of low density lipoproteins (LDL), which tend to stick to the sides of the arterial wall. This deposit of fat is known as atherosclerosis. Atherosclerosis begins with the accumulation of fatty streaks on the inner arterial walls. When this fatty buildup enlarges and becomes hardened with minerals, such as calcium, it forms plaque. Plaque stiffens the arteries and narrows the passages through them. Thus, blood pressure rises. This rise in blood pressure is due to the arteries' lack of elasticity.

Apart from diet, Stress is an obvious contributor to hypertension and chronic anger is especially problematic. Studies have shown that those who have developed the "habit of anger" but who are unaware of it are the most prone to hypertension. The first step of anger management is becoming aware of your own anger patterns. The following tips are also found to be very useful.

Relaxation: simple relaxation tools, such as deep breathing and relaxing imagery, can help calm down and manage physiological arousal. Once you learn the techniques, you can call upon them in any situation. If you are involved in a relationship where both partners are hot-tempered, it might be a good idea for both of you to learn these techniques. Some simple steps you can try:

Breathe deeply, from your diaphragm; breathing from your chest won't relax you. Picture your breath coming up from your "gut."
Slowly repeat a calm word or phrase such as "relax," "take it easy." Repeat it to yourself while breathing deeply.
Use imagery; visualize a relaxing experience, from either your memory or your imagination.
Practice these techniques daily. Learn to use them automatically when you're in a tense situation.

Cognitive Restructuring: means changing the way you think. Tempered people tend to curse, swear, or speak in highly colorful terms that reflect their inner thoughts. When you're irritated, your thinking can get very exaggerated and overly dramatic. Try replacing these thoughts with more rational ones. For instance, instead of telling yourself, "oh, it's awful, it's terrible, everything's ruined," tell yourself, "it's frustrating, and it's understandable that I'm upset about it, but it's not the end of the world and getting angry is not going to fix it anyhow." Be careful of words like "never" or "always" when talking about yourself or someone else. "This thing never works," or "you're always forgetting things" are not just inaccurate, they also serve to make you feel that your anger is justified and that there's no way to solve the problem. They also alienate and humiliate people who might otherwise be willing to work with you on a solution. Remind yourself that getting angry is not going to fix anything, that it won't make you feel better (and may actually make you feel worse).

Logic Defy Anger: because anger, even when it's justified, can quickly become irrational. So use cold hard logic on yourself. Remind yourself that the world is "not out to get you," you're just experiencing some of the rough spots of daily life. Do this each time you feel anger getting the best of you, and it'll help you get a more balanced perspective. Angry people tend to demand things: fairness, appreciation, agreement, willingness to do things their way. Everyone wants these things, and we are all hurt and disappointed when we don't get them, but angry people demand them, and when their demands aren't met, their disappointment becomes anger. As part of their cognitive restructuring, angry people need to become aware of their demanding nature and translate their expectations into desires. In other words, saying, "I would like" something is healthier than saying, "I demand" or "I must have" something. When you're unable to get what you want, you will experience the normal reactions — frustration, disappointment, hurt — but not anger. Some angry people use this anger as a way to avoid feeling hurt, but that doesn't mean the hurt goes away.

Problem Solving: anger and frustration might be caused by very real and inescapable problems in our lives. Not all anger is misplaced, and often it's a healthy, natural response to these difficulties. There is also a cultural belief that every problem has a solution, and it adds to our frustration to find out that this isn't always the case. The best attitude to bring to such a situation, then, is not to focus on finding the solution, but rather on how you handle and face the problem. Make a plan, and check your progress along the way. Resolve to give it your best, but also not to punish yourself if an answer doesn't come right away. If you can approach it with your best intentions and efforts and make a serious attempt to face it head-on, you will be less likely to lose patience and fall into all-or-nothing thinking, even if the problem does not get solved right away.

Better Communication: Angry people tend to jump to — and act on — conclusions, and some of those conclusions can be very inaccurate. The first thing to do if you're in a heated discussion is slow down and think through your responses. Don't say the first thing that comes into your head, but slow down and think carefully about what you want to say. At the same time, listen carefully to what the other person is saying and take your time before answering. Listen, too, to what is underlying the anger. For instance, you like a certain amount of freedom and personal space, and your "significant other" wants more connection and closeness. If he or she starts complaining about your activities, don't retaliate by painting your partner as a jailer, a warden, or an albatross around your neck.

Manage Criticism: It's natural to get defensive when you're criticized, but don't fight back. Instead, listen to what's underlying the words: the message that this person might feel neglected and unloved. It may take a lot of patient questioning on your part, and it may require some breathing space, but don't let your anger—or a partner's—let a discussion spin out of control. Keeping your cool can keep the situation from becoming a disastrous one.

Using Humor: "Silly humor" can help defuse rage in a number of ways. For one thing, it can help you get a more balanced perspective. When you get angry and call someone a name or refer to them in some imaginative phrase, stop and picture what that word would literally look like. If you're at work and you think of a coworker as a "dirtbag" or a "single-cell life form," for example, picture a large bag full of dirt (or an amoeba) sitting at your colleague's desk, talking on the phone, going to meetings. Do this whenever a name comes into your head about another person. If you can, draw a picture of what the actual thing might look like. This will take a lot of the edge off your fury; and humor can always be relied on to help unknot a tense situation. What these techniques have in common is a refusal to take yourself too seriously. Anger is a serious emotion, but it's often accompanied by ideas that, if examined, can make you laugh.

Changing Your Environment: Sometimes it's our immediate surroundings that give us cause for irritation and fury. Problems and responsibilities can weigh on you and make you feel angry at the "trap" you seem to have fallen into and all the people and things that form that trap.

Give Yourself a Break: Make sure you have some "personal time" scheduled for times of the day that you know are particularly stressful. One example is the working mother who has a standing rule that when she comes home from work, for the first 15 minutes "nobody talks to Mom unless the house is on fire." After this brief quiet time, she feels better prepared to handle demands from her kids without blowing up at them.

This is a Compiled Article

Psychosocial Risk Factors of Epilepsy

2008-08-27T08:36:00.003-04:00

The history of epilepsy - probably the longest history in medical literature to which any single disease, unless it be malaria, can lay claim - might well be said to stand as a monument to human error, to human fallibility; as lamentable evidence of the unnumberedness of those whispers of fancy to which the human mind has ever listened with credibility (Bunker, 1965). Epilepsy, once termed the ‘sacred disease’, might more accurately be described as the most ancient disease. One of the fascinations, and part of frustration, inherent in epilepsy research is the multiplicity of forces that impinge on people with epilepsy. The modern view of epilepsy originated in the work of the mid-nineteenth century neuro-scientists, the most important among them being John Hughlings Jackson. At present, the word epilepsy is used to refer to a class of epileptic disorders characterized by recurrent epileptic seizures.

Epileptic seizures can be defined as the clinical manifestations of excessive and/or hypersynchronous, usually self-limited, abnormal activity of neurons, predominantly located in the cerebral cortex (Engel, 1995). These concepts of epilepsy, however, are by no means fixed, nor are they noncontroversial. Wide differences exist in the prevalence rates of epilepsy in Asian countries, from 1.28 to 9.78 per thousand (Mani and Rangan, 1990). A large number of potential risk factors for salient problems in living, are found among patients with epilepsy. Each patient with his or her own unique combination of potential risk factors, and, on clinical grounds alone, it appears difficult to identify those variables that actually represent causal factors. Patients with epilepsy frequently experience psychosocial difficulties, especially in the realms of familial and socio-occupational functioning. Interictal symptoms of epilepsy are influenced by the ictal event and other neuropsychiatric and psychosocial factors, such as coexisting psychiatric or neurological disorders, the presence of psychosocial stressors, and the premorbid personality traits.

Intrapersonal factors
Epilepsy, like some other chronic disorders with episodic manifestations (e.g., asthma) can lead to special stresses. Specifically, seizures can occur anytime, anywhere, with little or no warning. Further, the seizures are associated with significant embarrassment and loss of personal dignity. This unpredictability associated with the disorder has been hypothesized to alter the patient’s perceived locus of control. Patients with epilepsy have been found to manifest a more external locus of control than do healthy control subjects and those in other patient groups, e.g., diabetics (Matthews and Barabas, 1986). Individual’s perception and understanding of his/her illness forms another intrapersonal risk factor for epilepsy. Some patients act on the harboured misconceptions of their epilepsy in ways that are either self-defeating or dangerous, either of which would be expected to affect adversely the quality of their lives. Fear of seizures is a potent predictor of maladjustment in adults with epilepsy (Mittan, 1986).Patients vary enormously in their resources and strength in coping with epilepsy. Even though some individuals are able to proceed through life relatively unencumbered by their epilepsy, others feel resentful, believe that their lives have been ruined by epilepsy, and continually dread the occurrence of a seizure. It has been hypothesized that these characteristics are associated with the adequacy of emotional and social adjustment of the individual.

Extrapersonal factors
Individual with epilepsy may be treated quite differently by friends, family, and society in general because of their condition. This differential treatment may be well-meaning in some cases, hostile in others, but may be expected to alter the patient’s adjustment in either instance. Well-meaning parents may be extremely overprotective of their children with epilepsy. Their expectations for the child may be lowered and patterns of familial interaction altered (Ritchie, 1981). At school the child may be teased, harassed, and socially excluded, and the seizures may be feared by teacher. These alterations in development surely constitute potential risk factors for poor adjustment. Stigma and discrimination directed against individuals with epilepsy are the most obvious of the extrapersonal psychosocial risk factors: there is often clear abject social exclusion of the individual with epilepsy, difficulty in gaining entrance to various occupations, and discrimination in various other areas. Sociologists have begun to discuss stigma/discrimination in terms of real versus perceived, which may represent a mixture of explicit versus subtle stigma/discrimination, or, real versus imagined stigma. Individuals with epilepsy may at increased risk for a greater number of stressful life events. Additionally, given the financial stresses of this chronic medical condition and increased probability of employment difficulties, financial stress would clearly seem to be an added risk factor (National Commission for the Control of Epilepsy and its Consequences, 1978).

How to help with your Depression?

2008-08-26T15:51:00.002-04:00

Depression has one major characteristic that you need to be aware of when thinking about what you can do to defeat it. It can feed on itself. In other words, you get depressed and then you get more depressed about being depressed. Negative thoughts become automatic and are difficult for you to challenge. Being in a state of depression can then, itself, become a bigger problem than the difficulties that caused it in the first place. You need to break the hold that the depression has on you. An important thing to remember is that there are no instant solutions to problems in life. Solving problems involves time, energy and work. When you are feeling depressed, you may well not be feeling energetic or motivated to work. But if you are able to take an active part in your treatment, it should help your situation.

Fighting negative attitudes
Try to recognise the pattern of negative thinking when you are doing it, and replace it with a more constructive activity. Look for things to do that occupy your mind.

Activity is good for the mind
Although you may not feel like it, it’s very therapeutic to take part in physical activities, for 20 minutes a day. Playing sports, running, dancing, cycling, and even brisk walking can stimulate chemicals in the brain called endorphins, which can help you to feel better.

Caring for yourself
You need to do things that will improve the way you feel about yourself. Allow yourself positive experiences and treats that reinforce the idea that you deserve good things. Pay attention to your personal appearance. Set yourself goals that you can achieve and that will give you a sense of satisfaction.

Healthily eating patterns
Oily fish, in particular, may help alleviate depression. Don’t abuse your body with tobacco, alcohol or other drugs, which make it worse.

Alternative and complementary therapies
Practitioners of complementary and alternative medicine concern themselves with the person as a whole, and don't merely treat their symptoms. They can take more time with you than your medical doctor can. Practitioners may offer treatments such as acupuncture, massage, homeopathy and herbal medicine that many people with depression have found helpful. But if you are already taking other medication, it may not be safe to combine them. Consult your pharmacist or doctor for more information.

Self-help groups
It can be a great relief to meet and share experiences with other people who are going through the same thing you are. It can break down feelings of isolation and, at the same time, show you how other people have coped. Finding that you can support others can help you, too. These groups are often led by people who have overcome depression themselves. For help in locating local self-help groups, call mental health/counseling centre near you.

Find out: Are you Depressed?

2008-08-26T15:44:00.003-04:00

Around the world, depression is the most common mental health disorder. Each year it affects millions people of all age groups, races, and economic backgrounds. We often use the expression "I'm feeling depressed" when we're feeling sad or miserable about life. Usually, these feelings pass in due course. But, if the feelings are interfering with your life and don't go away after a couple of weeks, or if they come back, over and over again, for a few days at a time, it could be a sign that you're depressed in the medical sense of the term. In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life, but makes everything harder to do and seem less worthwhile. At its most severe, major depression (clinical depression) can be life-threatening, because it can make people suicidal or simply give up the will to live.

If someone has the following symptoms maybe they have depression as an illness and they do not simply feel sad or low: Pervasive low mood and tearfulness, unresponsive to and out of keeping with current circumstances. Other mood tensions including tension, irritability and anxiety. Insomnia (typically waking early) Reduction in appetite, weight loss and constipation Lack of energy and tiredness/lack of stamina Loss of libido Loss of concentration/forgetfulness Feelings of low self-esteem, guilt and helplessness Thoughts of suicide A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

People who are depressed tend to view the world in an excessively pessimistic or hopeless light; there is no expectation that things will improve and often this dismal state of affairs is perceived as being their own responsibility. Most generally the individuals judge themselves harshly and underestimate their own positive attributes in favour of this self-disparaging and critical view. Such thoughts may range from a scarcely noticeable pessimistic tainting of normal statements and opinions to unpleasant and unwelcome preoccupations which make life a misery. These might include ideas of sinfulness and wickedness, ideas which are quite out of proportion and which may reach delusional intensity (i.e. be perceived by others to be obviously false). Such preoccupations may logically lead individuals to thoughts of delivering themselves from such a shameful or tormenting situation by ending their life, and suicidal behaviour and the danger of self-destructive acts as well. If you recognize some of the problems and symptoms of depression described below, it may be worth investigating whether you are depressed. If in doubt, consult your doctor.

Psychological signs of depression

persistent low/blue mood
low self-esteem
tearfulness
feelings of guilt
intolerance of others
poor motivation
poor interest
lack of enjoyment
irritability
hopelessness
helplessness
suicidal thoughts
thoughts of harming someone else, such as a baby
reduced sex drive
feeling worse first thing in the morning
anxiety
obsessional worries, acts, ruminations, or images
difficulty making decisions
worries about a child

Physical signs of depression

slowed movement
disturbed sleep
slowed speech
change in appetite (usually decreased but sometimes increased)
change in weight (usually a decrease but sometimes weight gain)
aches and pains
lack of energy
constipation
menstrual disturbance
lack of interest in sex
multiple physical symptoms

Social signs of depression

lack of ability to work
lack of social activities
few hobbies and interest
few friendships
home difficulties

Employer Intervention in Stress

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There are no single approaches that an employer can adopt to prevent stress occurring at work. Regular assessment is worthwhile to monitor the risks, and the following steps are generally necessary to achieve low stress in workplaces.

Good Management
Good management should include openness and a sincere regard for all employees. There is nothing wrong with informing all your employees that they are paid to work and to work hard. Acknowledging this may be stressful from time to time and adopting a high profile for stress management, allows for earliest intervention and provides employees with a strong sense of control.

The Organization of Work
An ad hoc approach to work without clear targets and plans will either produce high stress or turn employees off. The work must be acknowledged by employees to be achievable and the employees must have the knowledge and skills necessary for the tasks. Targets are necessary together with clear policies, plans and recognition for achievement.

A Healthy Corporate Attitude
A healthy and fit workforce is more motivated and productive. Let all employees know that the organization takes fitness seriously and is committed to assisting any employee experiencing difficulties. Take the necessary steps to ensure that no employee feels guilty about being stressed and provide encouragement for them to seek assistance and relief.

Successfully Manage Change
Commitment to continuous improvement and increased access to information has required organizations to make changes more frequently in order to stay competitive and meet customer needs. Unfortunately people have not yet adjusted to the process of frequent and rapid change and often find the uncertainty of change stressful. The successful management of change includes employee involvement in the decision, the planning and the process of implementing change.

An Appropriate Management Style
Many employees do not come to work only for the income. They also look for stimulation, satisfaction and meaningful social contact. Employers have benefited considerably from this shift, however it needs a certain management style to retain a productive and interested workforce. Autocratic and bullying tactics are not tolerated. Employers need to demonstrate a genuine interest in their workforce without inconsistency or indifference.

In summary, then, to reduce or remove unnecessary stress, an employer could:

Ensure the confidence and competence of employees is not eroded;
Provide a consistent approach in management style;
Make sure to have good two-way communication;
Provide well-defined tasks with clear responsibilities and authority with adequate relief if the job is excessively monotonous or boring;
Use targets that are challenging but achievable;
Use flexible work schedules that are planned and agreed;
Define objects and advertise them widely;
Be prepared to negotiate adjustments if approached;
Treat people fairly, with equity and without bullying or harassment;
Ensure managers and supervisors do the same;
Provide positive feedback when appropriate.

Ways to Respond to Stress

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Most people don’t usually plan how to respond to stress. They tend to react without thinking. What is your usual practice… avoiding the situation, taking emotions out on others, withdrawing, or confronting the situation head on. Largely, it may depend on the situation and potential consequences as to how you respond. It may be easier to confront a friend about his or her irritating tendency to borrow your clothes and leaving you nothing to wear when you really need it than confronting your mother about re-organizing your bedroom. Both may be stressful to you (e.g., lack of control over your belongings). However, the “power” structure is a little different. To determine your best strategy for a given situation incorporate the following outline in your decision process – assess what is important, determine what areas render you vulnerable to stress, and be clear about your expectations.

Assess Your Priorities
By knowing what is of primary and secondary importance, you can order your activities and expectations in light of your energy on a given day. A structure to follow makes it easier to engage in daily tasks. The stress of trying to remember what you should be doing is eliminated.

Stress Vulnerability
If you know that presentations make you nervous or know that negotiating a car deal petrifies you, do not wait until it happens to incorporate your ‘skills’. Practice is essential. By envisioning the stressful condition and acting out your reaction to anticipated stressors, you can become better prepared for the actual event.

Expectations
Align your expectations of yourself in a given situation with a reality-based view. If you did not study adequately for an exam, rarely attended class, and infrequently turned in homework assignments, it may not be realistic to expect a top grade on the test. Expecting too much of yourself or others can be disappointing if those expectations is not realized. Maintain a realistic perspective to offset misunderstandings. A key problem in this area is perfectionism. Stress is highly anticipated if you feel a need to produce ‘perfectly’ on a consistent basis, try to be someone your are not, or become inflexible with your priorities.

Incorporate Healthy Practices
By incorporating a healthy level of exercise, appropriate eating practices, and relaxation techniques (e.g., yoga, meditation, or free breathing), you lower your risk for becoming over stressed. These techniques can lower blood pressure, strengthen muscles, and reduce tension.

In addition to these areas of stress prevention, consider adopting a “recharge regime” (re-nourishes your emotional battery), accepting change as a part of life, developing a support system, and believing in oneself (you are your best advocate!).

Consequences of Stress

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Psychological Consequences of Stress

Anxiety
Boredom
Low Self-Esteem
Forgetfulness
Depression
Anger
Apathy
Worry

Physical Consequences of Stress (85% of physical illness is stress related)

Headache
Diabetes
Fatigue
Hypertension
Chest and Back Pain
Ulcers
Infectious Disease

Behavioral Consequences of Stress

Overeating - Loss of Appetite
Smoking
Alcohol Abuse
Sleeping Disorders
Emotional Outbursts
Violence and Aggression

Organizational Consequences of Stress

Absenteeism
Accidents
Job Turnover
Low Morale
Poor Work Relations
Poor Organizational Climate
Reduced Productivity