Breakingthecycles.com – Changing the Conversations

The following is a cross post of Elisha Goldstein, Ph.D., a Clinical Psychologist who conducts a private practice in West Los Angeles. He is co-author of A Mindfulness-Based Stress Reduction Workbook (New Harbinger, February 2010) and can be reached through his website. His post, originally appearing on MentalHelp.net, and is reprinted here with permission of Dr. Goldstein.

Change Your Mind, Your Brain and Your Life!

Here’s a formula: Thoughts form actions, and actions form consequences. One of the consequences is the formation of neural connections in our brains which make it easier for neurons to fire in a particular direction the next time. If the mind automatically reacts to being complemented by shutting down, then that continues to strengthen those connections so that happens again and again the next time. Why is this and what can we do about it?

One of the ways we can understand this is with Donald Hebb’s quote, “neurons that fire together wire together.” However, it’s not as if we can do anything initially about those neurons that are firing because they happen so quickly. The judgment that the complement is dangerous or bad in some way doesn’t come up consciously; we just notice a sense of wanting to retreat from the situation. So now what?

Well, it’s important to understand that what we learn, practice and repeat becomes automatic after some time. That’s how we are who we are today. At some point we learned how to ride a bike, we practiced and repeated it and now we don’t have to think about it. In the same way we learned right and wrong, good and bad, and fair and unfair, we practiced it and repeated it and now it just comes up automatically. Sometimes these snap judgments are healthy and sometimes they are unhealthy.

There is a way to influence these snap judgments and one of the ways is through changing our minds and brains through intentional priming.

Priming means setting up the mind to be in a place to see things a particular way.

Mindfulness practices seem to correlate with the 9 functions of the middle prefrontal cortex of our brains.

1. Body regulation: Balance of the sympathetic (accelerator) and parasympathetic (brakes) branches of the autonomic nervous system.
2. Attuned communication: Enables us to tune into others’ states and link minds.
3. Emotional balance: Permits the lower limbic regions to become aroused enough so life has meaning, but not too aroused that we become flooded.
4. Response flexibility: The opposite of a “knee-jerk” reaction, this capacity enables us to pause before acting and inhibit impulses giving us enough time to reflect on our various options for response.
5. Empathy: Considering the mental perspective of another person.
6. Insight: Self-knowing awareness, the gateway to our autobiographical narratives and self-understanding.
7. Fear extinction: GABA (an inhibitory neurotransmitter) fibers project down to the amygdala and enable fearful responses to be calmed.
8. Intuition: Being aware of the input of our body, especially information from the neural networks surrounding intestines (a “gut feeling”) and our heart (“heartfelt feelings”) enables us to be open to the wisdom of our non-conceptual selves.
9. Morality. The capacity to think of the larger good, and to act on these pro-social ideas, even when alone, appears to depend on an intact middle prefrontal region.

So in practicing how to intentionally pay attention, without judgment, we activate the part of our brains that over time, with practice and repetition will allows to more automatically see a situation with greater balance, empathy, response flexibility, reliable intuition, and less fear, among other things.

So we can positively influence the thoughts that automatically happen which go on to change the actions and consequences toward a healthier life.

As always, please share your thoughts, stories and questions below. Your interaction provides a living wisdom we can all benefit from.

This is a guest post from The Discovering Alcoholic, who writes a top rated recovery blog, www.discoveringalcoholic.com, covering alcoholism, substance abuse, treatment and recovery issues.

Inevitably I have someone come up after a recovery meeting to ask me what is the secret to long term sobriety and recovery. It is usually someone new to the program, that has attended meetings routinely on the weekends for a while, and has decided that now they are “really serious” about recovery. I know I did the same thing many years ago, asking my temporary sponsor as he explained his thoughts on the twelve steps, “but how do you do it for the rest of your life?” Apparently I didn’t get an exactly inspirational answer since I can’t remember his response. Neither did I stay in AA after I had finished my ninety meetings in ninety days after rehab, but I still credit much of my successful recovery program to the things I learned in those meetings.

In retrospect it is easy for me to see why my sponsor didn’t exactly wow me with a response to my question because I was already doing what it took to stay sober. I just needed to keep doing for the rest of my life, but oh how I craved that there was something more. There had to be some kind of ancient magic, secret society, or a mystical panacea that was necessary- I mean surely it had to be a pretty complex solution to solve this problem I had battled over the years… but it’s not.

The recovering alcoholic is no different than the professional athlete or concert pianist in the fact that we must train every day. Practice. Practice. Practice. Same workout, same practice routines, and an unending dedication to the single purpose of improving one’s life- we must constantly train our brains to respond quickly to temptation, instinctively avoid dangerous situations, and maintain a solid emotional balance.

Regardless if it is NA, AA, or a personal recovery program the key to its effectiveness is action and dedication. Like the back of the shampoo bottle- wash, rinse, repeat. If the routine becomes too monotonous, mix it up! There is only one person responsible for recovery and that is you. NO program will keep you sober; no counselor can keep you safe.

What is TDA’s secret of long term sobriety? Find a program, make a program, any program… and just do it.

by Lisa Frederiksen

Thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least one serious mental illness, such as depression, PTSD, bipolar, anxiety, schizophrenia. (1) (2)   The common term for this condition in treatment circles is a “dual diagnosis,” which refers to someone having both a mental illness and an addiction. Often what happens is the person starts to drink or use drugs to self-medicate the mental illness. This self-medication can sometimes make the mental illness worse; however it does not cause the mental illness. Mental illness is also a brain disease with its own brain changes.

If your loved one has a dual diagnosis, it will be important that both be treated at the same time, preferably by the same treatment team (when care is being provided at a treatment facility). For if the substance is removed but the mental illness is not treated, their chances of relapse increase significantly. The same is true if the mental illness is treated but the substance misuse continues. The treatment provider needs to help the patient understand their addiction, their mental illness and the impact one has had on the other.  (3)

Resources:
The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services offers a Locator database with comprehensive information about mental health services and resources in the United States.

The National Alliance of Mental Illness (NAMI) offers excellent, free self-help programs. Visit www.nami.org for information and locations in your community.

Sources:
(1) “Factsheet: Dual Diagnosis,” Mental Health America, <http://www.nmha.org/index.cfm?objectid=C7DF9405-1372-4D20-C89D7BD2CD1CA1B9>
(2) “Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder,” National Alliance on Mental Illness, <http://www.nami.org/Content/ContentGroups/Helpline1/Dual_Diagnosis_and_Integrated_Treatment_of_Mental_Illness_and_Substance_Abuse_Disorder.htm>

(3) Ruiz, M.D., Pedro, et al., The Substance Abuse Handbook, Philadelphia: Lippincott Williams & Wilkins, 2007, pgs. 403-404.

The following is a guest post by my friend, Bill White, M.S., a counselor, author, mentor, blogger and speaker specializing in depression, anxiety and general mental health issues. He hosts a blog, http://chipur.com, and does E.R. psychiatric emergency work in Chicago’s suburbs where he also spends time with his two teenage children.

“I am almost 25 but I feel like a scared little kid. In the mornings I have trouble getting out of bed, sometimes I don’t get up until 2pm. I clutch my blanket or a pillow and these thoughts come into my head that if I stay in bed I will be safe.”

And so began a heart-wrenching email I received today from a woman who’d read an article I’d written on a web resource site. Receiving such emails is not at all uncommon, and I can tell you I never become immune to their emotional impact. I’ve begun an email helping relationship with this woman; however, I have some thoughts I’d like to share with all of you.

How ’bout I paint this picture…

Your life is in shambles. I mean, the list goes on and on – relentless anxiety, mood lower than a rattlesnake’s belly, very scary thoughts zooming in and out of your head, weird physical phenomena, hair-trigger nerves, and intense fear.

And to make matters worse, you’re in financial turmoil and you have no idea how you’re going to keep your job, feeling as you do. And if you don’t have one, you’re not at all motivated or inspired to look. In fact, you find your motivation to do most anything has taken the last train for the coast.

Actually, at this point you wonder if it would be better to just curl-up into a ball and roll away. It’s so tempting, isn’t it?

So what now?

Well, I can tell you I’ve been smack-dab in the middle of it; and it’s about as hopeless, helpless, cold, and lonely a feeling as one could ever conjure up.

To me, this isn’t the time for “what to do,” it’s the time for “what not to do.” That said, here’s looking at you kid.

The chipur “I’m in the midst of hell on earth” NOT To Do List…

1. Do not expect to feel hopeful – and trash that “everything’s okay” look and attitude. Everything isn’t okay and every component of your mind and body are telling you so. How else do you think you’d feel?
2. Do not attempt to solve all 9,000,000 issues just now. Not only will you fail, you’ll implode.
3. Do not in any way assign your immediate circumstances to who you really are as a person (mom, dad, spouse, etc.). Never forget how powerful our inboard “butt-kicking” mechanisms are.
4. Do not prognosticate on how you’ll feel in, say, two weeks based upon how you feel now. I mean, that’s like trying to imagine one day feeling well as you’re doing all you can to survive a gastrointestinal flu bug.
5. Do not go to folks for insight and counsel in whom you have questionable trust.
6. Do not hesitate to talk with someone, even if it’s on a crisis-line, should you feel in any way unsafe.
7. Do not turn to substances for relief. I know it sounds awfully good, but every time you dodge a growth episode (and that’s what this is), major opportunities for positive change are missed. And besides, you don’t need anything messin’ with your judgment just now.
8. Do not do the “24-hour stay indoors” thing. Get out-and-about even if you have no reason to. And if you’re not up to driving, find someone who is or take a walk. I assure you, you’ll more than survive the outing.
9. Do not believe this is the end of the line for you. Believe me, others have endured the same and made it out. What makes them more deserving of good things than you?
10. Do not push away those you love, and who love you. As much as you may want to isolate, you’re shooting yourself in the foot.

Bottom-line is this – I don’t care how cooked you may think your goose is, it ain’t over ’til you say it’s over! And managing the immediate caving-in of the walls is a lot less complicated than you might think.

So there you have it, chipur readers – the latest in Top 10 lists. It’d be great if you’d come up with #’s 11-100 in a comment (or two).

Click here to link back to Chipur.com to read more terrific articles.

by Lisa Frederiksen

I regularly meet alcoholics who also have a mental illness and/or family members whose loved one is an alcoholic with a mental illness. This is called a “dual diagnosis” in the world of addiction treatment. Please see previous post, “What Is a Dual Diagnosis?” for more information. The reason for this post, however, it to bring your attention to NAMI — the National Alliance on Mental Illness.

NAMI provides a wealth of information on various mental illnesses, medications and advocacy efforts. NAMI’s Family-to-Family program is especially helpful for family members and friends of a loved one with a dual diagnosis.  Through this free, 12-week course family members and caregivers will learn:
* Current information about schizophrenia, major depression, bipolar disorder (manic depression), panic disorder, obsessive-compulsive disorder, borderline personality disorder, and co-occurring brain disorders and addictive disorders
*  Up-to-date information about medications, side effects, and strategies for medication adherence
* Current research related to the biology of brain disorders and the evidence-based, most effective treatments to promote recovery
* Empathy from program leaders who have lived with and cared for a person with mental illness
* Help for problem solving, listening, and communication techniques
* Strategies for handling crises and relapse
* Strategies for coping with worry, stress, and emotional overload
*Guidance on locating appropriate supports and services within the community
* Information on advocacy initiatives designed to improve and expand services

Click here to learn more about this and other NAMI programs.

by Lisa Frederiksen

As you have likely read in previous blog posts of mine, mental health problems (anxiety, depression, bipolar, PTSD, ADHD) are one of the risk factors for developing an alcohol misuse problem. More than half of alcoholics/alcoholic abusers have a co-occurring mental illness — a dual diagnosis. Often the alcohol misuse starts in an attempt to self-medicate the mental illness symptoms.

So, please join the National Federation for Children’s Mental Health in celebrating this coming week as National Children’s Mental Health Awareness Week. The theme for the 2010 celebration is “Promoting Positive Mental Health From Birth to Adulthood” and emphasizes the following messages:

• Mental health is essential to overall health and well being.

• Serious emotional and mental health disorders in children and youth are real and treatable.

• Children and youth with mental health challenges and their families deserve access to services and supports that are family driven, youth guided and culturally appropriate.

• Values of acceptance, dignity and social inclusion should be promoted throughout all communities for children, youth and families.

• Family and youth voice is a valued asset in determining appropriate services and interventions.

Like the stigma that shrouds the disease of addiction (whether an addiction to alcohol and/or drugs), the stigma surrounding mental illness keeps people from getting the help they need. Please, do what you can to help spread the word. For more information about celebration activities and mental health issues and programs for children and adults, visit the following resource websites:

National Federation of Families for Children’s Mental Health

Bring Change 2 Mind

National Alliance on Mental Illness (NAMI)

Substance abuse and Mental Health Services Administration (SAMHSA)

by Lisa Frederiksen

As you’ve read in previous posts on this site, mental illness is one of the key risk factors for a person’s developing an alcohol abuse or alcohol addiction problem. We often do not realize that young – really young – children can suffer mental health problems. To that end, the U.S. Department of Health and Human Services’ SAMHSA (Substance Abuse and Mental Health Administration) is sponsoring the 5th Annual National Children’s Mental Health Awareness Day on May 6.

Quoting from their website page, Children and Adolescent Mental Health:

Mental Health Is Important
Mental health is how people think, feel, and act as they face life’s situations. It affects how people handle stress, relate to one another, and make decisions. Mental health influences the ways individuals look at themselves, their lives, and others in their lives. Like physical health, mental health is important at every stage of life.

All aspects of our lives are affected by our mental health. Caring for and protecting our children is an obligation and is critical to their daily lives and their independence.

Children and Adolescents Can Have Serious Mental Health Problems
Like adults, children and adolescents can have mental health disorders that interfere with the way they think, feel, and act. When untreated, mental health disorders can lead to school failure, family conflicts, drug abuse, violence, and even suicide. Untreated mental health disorders can be very costly to families, communities, and the health care system.

Mental Health Disorders Are More Common in Young People than Many Realize
Studies show that at least one in five children and adolescents have a mental health disorder. At least one in 10, or about 6 million people, have a serious emotional disturbance.¹

One of the key factors affecting a child’s mental health is growing up in a family with a loved one who abuses alcohol or is an alcoholic. If the problem is not addressed, everyone’s feelings are dismissed in an attempt to keep the peace while the drinking is seemingly ignored or minimized, or conversely, is constantly the source of fights and tension in the home. As The National Institute on Drug Abuse states on its website page, Drug Abuse and Addiction, “Children’s earliest interactions within the family are crucial to their healthy development and risk for drug abuse.”

To  learn more about children’s mental health issues or to get involved in this national celebration, click here – for our children’s sake.

by Lisa Frederiksen

As you’ve read in various posts on this blog and elsewhere, I’m sure, mental illness is one of the risk factors for developing the disease of alcoholism and/or alcohol misuse problems. Mental illness (ADHD, bipolar, depression, anxiety) is also present in just over half of those with alcoholism and/or alcohol abuse problems in what is known as a dual diagnosis. For these reasons, I wanted to use today’s post to draw your attention to Victoria Costello’s post, “The Dangerous ‘Upside’ of Denying Mental Illness,” posted on Psychology Today’s website, March 10. To give you a sense of her article, please find the following excerpt:

I’ve been disturbed of late by a print media trend towards what looks an awful lot like a reactionary bandwagon on mental illness. A prime example was the NY Times Magazine story of 2.28.10 titled, “Depression’s Upside.”

If the reader can get past the feeling of revulsion that depression need have an “upside,” there’s plenty more in this story to anger anyone who’s ever battled this disease or dealt with it in a family member.

This block quote sums up Jonathan Leher’s main point… “The depression might be worth it if it helps you better understand social relationships. Maybe you need to be less rigid or more loving.”

In light of the direct connection between depression and suicide (60 percent of the 33,000 Americans who die by suicide each year suffer from clinical depression), if Lehrer can’t think of another less dangerous way of improving social relationships, I pity anyone who consults with him about their depression. But I’m also very concerned about his message, and how it appears to be part of a trend (back) towards the denial of mental illness, especially the debilitating disease of depression.

Click here to finish…

The following is a guest post by Bill White, M.S., a counselor, author, mentor, blogger and speaker specializing in depression, anxiety and general mental health issues. He hosts a blog, http://chipur.com, and does a lot of E.R. psychiatric emergency work in Chicago’s suburbs where he also spends time with his two teenage children.

This can be one brutal time of the year for so many reasons. Do I  really have to tell you that? I don’t think so.

Hmmm, let’s see. For many of us it’s bitterly cold, and when you throw cloudy and windy days on top of that you’re in for some major melancholy. And let’s not forget about the very short hours of sunlight (if there is any).

Then there’s the post-holiday letdowns. Now, for some, having the holidays in the rear-view mirror is reason to celebrate. But for others,  it’s the only thing that made life in any measure bright, and worth participation. Finally, there’s the small matter of facing a brand new year, which is likely to be miserable, just like the last one. Or so we think anyway.

Well, I don’t know about you, but I don’t like feeling icky. So what can we do to maintain a sense of, well, chipur (had to throw that in). How ’bout a few starters, in no particular order…

1. Create and get yourself in the midst of as much light as possible. I know it may let a bit more cold air in, but keep those curtains and blinds open during the day (you can keep the doors closed, though).
2. Avoid long periods of sleep, with the exception of normal sleep time (I know, “who sleeps?”). Keep regular sleep hours and get yourself up and get going.
3. Burn scented candles day and night. Listen to comforting music. Soothing is the word.
4. Take a warm bath with a scented oil. And don’t forget the candles.
5. Exercise in some manner. You don’t have to join a gym or buy one of those body-slaying contraptions you see on infomercials. Get creative.
6. Eat and drink well. You may be tempted to indulge in high simple sugar “comfort foods” and/or alcohol (or other substances), but it’ll only cycle around to make you feel terrible.
7. Buy a plant and personalize it. Maybe you already have one that’ll work. A friend of mine has a plant his dearly-departed mother bought thirty-seven years ago. It’s “Pauline,” and it’s very much a loved one to him.
8. Catch a movie, preferably at a theater.
9. Start a project. Man, there are so many possibilities. Write,  craft, scrapbook, sew, crochet, genealogy, take a class, find a social cause.
10. Absolutely do not isolate! Connect with family and friends. If you don’t have any, or you can stand the ones you have, find places where you can connect (preferably not online).

No doubt, this is a very tough time of the year for so many of us. And if we’re already enduring depression and/or anxiety (don’t really see how you can have one without the other…check-out this post), our  situation can quickly spiral downward. Do not allow that to happen (yes, we’re authorized to intervene)!

I don’t care how desperate our circumstances are, we can improve them…if we choose (three key words). So get after it, will ya’? Get the job done!

This can be one brutal time of the year for so many reasons. Do I  really have to tell you that? I don’t think so.

Hmmm, let’s see. For many of us it’s bitterly cold, and when you throw cloudy and windy days on top of that you’re in for some major melancholy. And let’s not forget about the very short hours of sunlight (if there is any).

Then there’s the post-holiday letdowns. Now, for some, having the holidays in the rear-view mirror is reason to celebrate. But for others,  it’s the only thing that made life in any measure bright, and worth participation. Finally, there’s the small matter of facing a brand new year, which is likely to be miserable, just like the last one. Or so we think anyway.

Well, I don’t know about you, but I don’t like feeling icky. So what can we do to maintain a sense of, well, chipur (had to throw that in). How ’bout a few starters, in no particular order…

1. Create and get yourself in the midst of as much light as possible. I know it may let a bit more cold air in, but keep those curtains and blinds open during the day (you can keep the doors closed, though).
2. Avoid long periods of sleep, with the exception of normal sleep time (I know, “who sleeps?”). Keep regular sleep hours and get yourself up and get going.
3. Burn scented candles day and night. Listen to comforting music. Soothing is the word.
4. Take a warm bath with a scented oil. And don’t forget the candles.
5. Exercise in some manner. You don’t have to join a gym or buy one of those body-slaying contraptions you see on infomercials. Get creative.
6. Eat and drink well. You may be tempted to indulge in high simple sugar “comfort foods” and/or alcohol (or other substances), but it’ll only cycle around to make you feel terrible.
7. Buy a plant and personalize it. Maybe you already have one that’ll work. A friend of mine has a plant his dearly-departed mother bought thirty-seven years ago. It’s “Pauline,” and it’s very much a loved one to him.
8. Catch a movie, preferably at a theater.
9. Start a project. Man, there are so many possibilities. Write,  craft, scrapbook, sew, crochet, genealogy, take a class, find a social cause.
10. Absolutely do not isolate! Connect with family and friends. If you don’t have any, or you can stand the ones you have, find places where you can connect (preferably not online).

No doubt, this is a very tough time of the year for so many of us. And if we’re already enduring depression and/or anxiety (don’t really see how you can have one without the other…check-out this post), our  situation can quickly spiral downward. Do not allow that to happen (yes, we’re authorized to intervene)!

I don’t care how desperate our circumstances are, we can improve them…if we choose (three key words). So get after it, will ya’? Get the job done!

by Lisa Frederiksen

Psychopharmacology is a term that appears in discussions with family members who have a loved one with a dual diagnosis. To answer the question, here is the definition from American Society of Clinical Psychopharmacology:

Psychopharmacology is the study of the use of medications in treating mental disorders. The complexity of this field requires continuous study in order to keep current with new advances. Psychopharmacologists need to understand all the clinically relevant principles of pharmacokinetics (what the body does to medication) and pharmacodynamics (what the medications do to the body). This includes an understanding of:

* Protein binding (how available the medication is to the body)
* Half-life (how long the medication stays in the body)
* Polymorphic genes (genes which vary widely from person to person)
* Drug-drug interactions (how medications affect one another)

Since the use of these medications is to treat mental disorders, an extensive understanding of basic neuroscience, basic psychopharmacology, clinical medicine, the differential diagnosis of mental disorders, and treatment options is required. Psychopharmacologists also must be skilled in building and utilizing a therapeutic alliance with the patient.

Who Qualifies as a Psychopharmacologist?

In a generic sense, any physician who treats patients with psychotropic medication is a psychopharmacologist. Physicians who have completed residency training after medical school have a high level of understanding and expertise in pharmacology, including psychopharmacology. Psychiatrists (who have completed four years of advanced training after medical school) have an even higher level of understanding and expertise in psychopharmacology.

For additional information, the American Society of Addiction Medicine (ASAM) offers “Patient Placement Criteria.”
Here is their product description:

ASAM’s Patient Placement Criteria Second Edition Revised (2001, revised 2004) provides a framework for placing patients with addiction disorders into proper treatment settings, both outpatient and inpatient. This new publication focuses on patients with alcohol use disorders, using the ASAM criteria. Chapters address pharmacotherapies and behavioral therapies for alcohol withdrawal and for prevention and management of relapse. Case examples bolster understanding of the recommendations made.

Other references specific to mental illness, include:
Bring Change 2 Mind
National Institute on Mental Illness (NAMI):  Medications