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Archive for the ‘Well-being’ Category

How Can Teachers Overcome Depression and Strife? – Living in Dialogue – Education Week Teacher

In Education advocacy, Pedagogy, School Psychology, School reform, Well-being on Friday, 15 February 2013 at 09:01

great advice on the article below.  

i have never seen a greater level of stress and lower morale than this school year.  i worry every day for my teachers and staff and hope, no matter what “they” throw at us, that the good ones will stay because even if you feel your system doesn’t appreciate you, those kids do.  sometimes, we school employees might be the only people who give a kid attention or show he or she is cared about.  some might not have parents in the house (maybe raised by an older sibling or another family member), some might not have food most days, clean clothes, some don’t even have a house or place to sleep.  

in the end, it’s all about the kids and i do know most teachers and support staff feel that way.  but i also realize that it is difficult to be in a career where teachers are blamed for “outcomes” when teacher/school influence only accounts for 15-25% of student outcome (i have not seen any study that can account for more than that).  how is it then, that teachers are going to be evaluated and paid based on something that they only have 15-25% control of?  the other 75-85% obviously has a greater effect.  all the teachers i know do it for the love of the kids and try very hard to keep this at the forefront.  but…when you are being told that it’s all about test scores, outcome, academic improvement, it’s difficult to focus on things that make teachers who they are…those who chose a profession, not to make money or get rich because they never will, but for the love of learning and the love of children and our future.  the way our country is going with education “reform” breaks my heart and i am saddened for all the wonderful and inspirational teachers that might just decide it’s no longer worth it.

How Can Teachers Overcome Depression and Strife? – Living in Dialogue – Education Week Teacher.

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Consequential Growth

In Fitness/Health, General Psychology, Happiness, Mindfulness, Well-being on Thursday, 14 February 2013 at 11:12

Consequential Growth

By: Timothy J. Wachtel

Written for the Texas Association for Adult Development & Aging

I’m older now. A little more pale, a little more frail, but I got my wits. The ebbs and flows of life have taken their course and have strewn me all over the place. It didn’t seem fair then and it doesn’t seem fair now. What do I have to show for it? I still try to keep my head held high and I smile a lot. Boy, life sure has a way of serving up its fair share of bumps and bruises . . . kinda glad in a way.

*****************************************

Have you ever found yourself in this reflective space? Have you ever not found yourself in this place? I think that everyone can agree that any individual who reaches the midpoint of adulthood and beyond is never immune to the trials and tribulations of life. It comes with the travel package. There always tend to be those pinnacle times of life; the times where the emotions get bruised, the spirit gets suffocated, the isolation looms large, the mind runs wild, and the rug from underneath you is no longer there. These life events and novel experiences come in many forms, as you very well know. Divorce, death of a family member, religious conversion, relocation, job transfer, job loss, injury or disease, natural disasters, kids move out, spouse goes off to war, traumatic stress, conflict; the list seems forever endless.

Is there a silver lining to all of this? I believe the answer is emphatically YES! We oftentimes don’t realize the goodness in these types of life events while we’re a part of the process. And it is a process; these situations, events, and experiences have a necessary starting point and oftentimes tend to be phases or stages throughout the process. Some people reach the productive end to the process, while others don’t quite reach the same successful terminal point. Today, science is doing more than ever before to inform us of these types of processes. More and more research is demonstrating evidence of the fact that many of these types of inexplicable occurrences in life result in very positive outcomes.

Research has found that individuals going through “troubled waters” over the course of a significant period of their lives tend to develop a greater sense of altruism and resilience, many experience more satisfaction or well-being in their life, and still others are finally able to come to terms with the meaning of their life. Scientists and practitioners use a battery of different terms to identify some of these events, some of which include: critical life eventsposttraumatic growthstress-related growthspiritual emergencytransformational crisisposttraumatic positive adjustmentgrowth through adversity, and the positive outcomes of one’s battle with Post-Traumatic Stress Disorder (PTSD).

I recently came up with a term that I believe helps to encapsulate the upsides to many of the downsides of life. “Consequential Growth” is the term I use to describe the results of these processes. Consequential Growth seems to semantically emphasize the necessary consequences we oftentimes experience throughout the growth process. The term broadly identifies the “dark nights” and the cognitive, spiritual, and emotional hardships we face during these times of duress.

Many books have been written on the positive results of these types of experiences in one’s life. Notably, the individual and collective works of Calhoun, Tedeschi, and Joseph talk much to these processes; especially in terms of Posttraumatic Growth. Moreover, many naturalistic and experimental research studies have found conclusive evidence of consequential growth. They inform us that those who are able to grow through their perceived negative experiences oftentimes maintain a more positive orientation toward life, are generally more optimistic, and tap into healthy coping strategies to get through the hardship(s). These individuals often have strong social circles and are seen by others as stronger and wiser as a result of going throughthe consequential growth process, even though they never signed-up for the turbulence.

The aging process is indeed complex. Life situations can catapult us right off our comfortable life. This is the stuff of character, wisdom, virtue, transformation, transcendence, higher consciousness, emotional resiliency, generativity and care for your fellow human beings. I wish you well on your next tumble.

References:

Tedeschi, Richard G.; Lawrence G. Calhoun (1995). Trauma and Transformation: Growing in the Aftermath of Suffering. SAGE Publications, Inc.
Joseph, Stephen (2011). What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth. Basic Books
Timothy “Tim” J. Wachtel

Executive Director

The Center for Optimal Adult Development

www.optimaladult.org

Retrieved from: http://www.optimaladult.org/index.cfm/knowledge-center/coad-news-notes/consequential-growth/

 

stressed is just “desserts” spelled backwards!

In Fitness/Health, Mindfulness, Well-being on Monday, 4 February 2013 at 12:14

ignore the drama. anger is deathly. practice gratitude. view with compassion. do unto others…

http://www.huffingtonpost.com/2013/02/04/stress-health-effects-cancer-immune-system_n_2599551.html?ir=healthy-living&utm_campaign=020413&utm_medium=email&utm_source=Alert-healthy-living&utm_content=Title

puppy cam…

In Animal Rescue, Animal Welfare, Life with dogs, Meditation, Mindfulness, Pets, Well-being on Sunday, 27 January 2013 at 09:13

colleges now have “puppy rooms” during final so that students (and staff) can go in and spend time with puppies during what is a stressful time with finals and late nights studying.

http://www.cnn.com/2012/12/07/tech/social-media/apparently-this-matter-puppy-room/index.html  

http://news.yahoo.com/blogs/sideshow/college-offering-puppy-room-stressed-students-225038015.html

http://www.huffingtonpost.com/2012/05/12/colleges-turn-to-dogs-to-help-finals-stress_n_1512156.html

http://www.npr.org/2012/12/04/166470837/puppies-may-help-students-ace-finals

just spending time with animals has been shown to lower blood pressure, heart rate, anxiety, heighten feelings of well-being…the research consistently supports the use of “animal assisted therapy” time and time again.  i can also speak from my own experiences with my very own pet therapist, linus, who has been working in the schools with me since he was a baby (this is his 11th year!).

linus, my pet therapist...

linus, my pet therapist…

while it would be great if all places of business, schools, colleges, etc. could have a puppy room (or a pet therapist/professional pet cuddler), two of my wonderful rescue friends have created “puppy cam.”  so far, there was puppy cam I, featuring liza and her puppies who all got adopted…then puppy cam II, with the two feist puppies, and now, puppy cam III where mia has JUST HAD PUPPIES starting at about 0100 this morning!!!  so, now we have new puppies to watch!  

so, in the same vein, i am posting the link to the angels among us puppycam so that, hopefully, you can watch when you are feeling stressed or just in need of watching the unconditional and instinctual love of a mom for her pups and watch the pups as they grow and develop. 

PUPPY CAM LINK: http://www.badferret.net/puppycam/

i hope you enjoy watching mia and her babies as much as we all do!  for more information, please visit http://www.angelsrescue.org or like our facebook page https://www.facebook.com/angelsrescue?fref=ts

for information regarding some of the many benefits of pet ownership, please see : http://wp.me/p2IpfL-2q

four questions to ask…

In Fitness/Health, Mindfulness, Well-being on Wednesday, 23 January 2013 at 07:56

http://www.johnclarkiii.com/Notable-Quotes-11-from-John-Clark-III.html

Depression, Other Psychosocial Disorders Linked to Stroke

In Anxiety, Mood Disorders, Well-being on Friday, 14 December 2012 at 08:35

Depression, Other Psychosocial Disorders Linked to Stroke

Pauline Anderson

Older adults who are depressed, stressed, or dissatisfied with their life are at increased risk of suffering a stroke and of dying from a stroke, a new study has found.

The study showed that those who faced the highest level of psychosocial distress had a significantly increased risk of having a stroke and up to 3 times the risk of stroke mortality compared with those with the least amount of distress.

“Our findings clearly document important adverse effects of psychosocial distress on cerebrovascular disease risk in the elderly,” write the authors, including senior author Susan Everson-Rose, PhD, associate professor of medicine and associate director of the Program in Health Disparities Research, University of Minnesota, Minneapolis.

The study is published online December 13 in Stroke.

Distress Score

The study used data from the Chicago Health and Aging Project (CHAP), an ongoing, longitudinal study investigating chronic illnesses in elderly residents of 3 adjacent neighborhoods in Chicago, who represent a broad range of socioeconomic backgrounds. Researchers conducted baseline interviews to gather information on medical history, cognitive health, socioeconomic status, behavioral patterns, and psychosocial characteristics, repeating the interviews in 3-year cycles.

The second cycle of interviews (1997 to 1999) assessed the broadest range of psychosocial characteristics and served as the baseline for the current analysis, which included 4120 mostly black and female participants whose average age was 77 years. Most had a high school education and an average of 1 chronic condition; 13.1% reported a history of stroke.

For information on stroke hospitalizations, researchers accessed the Centers for Medicare and Medicaid Services Medicare Claims data (because some participants were involved in a health maintenance organization, only 2649 participants were analyzed for rates of incident stroke). To verify deaths, the authors used linkages with the National Death Index.

To assess psychosocial distress, investigators created a distress score that factored in 4 psychosocial measures: depressive symptoms, perceived stress, neuroticism (a personality domain characterized by anxious, angry, and vulnerable traits), and life satisfaction. The higher the score is, the higher the distress.

The study showed a dose-response pattern of risk for incident stroke. Relative to the least distressed quartile, the hazard ratios (HRs) for the second, third, and fourth quartiles were 1.27 (95% confidence interval [CI], 0.98 – 1.65; P = .067), 1.44 (95% CI, 1.10 – 1.87; P = .0068), and 1.54 (95% CI, 1.16 – 2.04;P = .0025), respectively, in a model adjusted for age, race, and sex. Associations were reduced after adjustment for stroke risk factors.

With distress modeled categorically and adjusting for age, race, and sex, participants in the highest quartile had nearly a 3 times (HR, 2.97; 95% CI, 1.81 – 4.88; P < .0001) greater risk of dying from stroke relative to those with the lowest distress scores. Those in the third quartile had nearly 2 times the risk (HR, 1.98; 95% CI, 1.19 – 3.30; P = .0091).

Analyses of stroke subtypes revealed that distress was significantly related to incident hemorrhagic strokes, but not to ischemic strokes after adjustment for covariates.

Behavioral Factors

Psychological and behavioral factors may play a role in raising stroke risk. Very distressed people may be less likely or less able to comply with treatment recommendations or to maintain a healthy lifestyle.

“Our most distressed participants were less physically active, and had a higher prevalence of cardiovascular disease and diabetes mellitus, suggesting potentially greater disease burden in this group, which could make lifestyle management more challenging,” the authors write. However, in this study, controlling for these factors had little effect on the relationship between distress and either stroke mortality or hemorrhagic strokes.

The pathways by which distress increases stroke risk are not fully understood, said the authors. Possible mechanisms may involve hypothalamic-pituitary-adrenal dysregulation related to stress that may increase circulating catecholamines, endothelial dysfunction, and platelet activation, culminating in a hypercoaguable state.

Neuroendocrine and inflammatory effects of chronic stress and negative emotional states may also contribute to the increased risk. However, the authors pointed out that these pathways are probably more important for ischemic than hemorrhagic stroke and that the current study found much stronger findings for hemorrhagic stroke.

The study lacked data on inflammatory and neuroendocrine biomarkers that might have shed more light on pathways that may link psychosocial distress to stroke risk. Another limitation was that CHAP doesn’t include imaging data that might provide important information about the types of strokes experienced by study participants. Also, the study assessed psychosocial distress at just one point in time, so it couldn’t determine whether distress levels changed or whether such changes influenced stroke risk.

Dr. Everson-Rose is supported in part by a grant from the National Institute on Minority Health and Health Disparities (NIMHD).

Stroke. Published online December 13, 2012.

Retrieved from: http://www.medscape.com/viewarticle/776137?src=smo_neuro

age really might be “just a number”

In Fitness/Health, Happiness, Well-being on Wednesday, 21 November 2012 at 09:30

You’re Only As Old As You Feel

By: Jennifer Warren

Nov. 20, 2012 — The old saying “You’re only as old as you feel” has new life, backed up by a new study.

Researchers found older people with positive views on aging were 44% more likely to recover fully after severe disability than those with negative views on aging.

People with positive attitudes about aging also had a slower decline in their ability to do daily tasks such as dressing and bathing.

“It may be something worth considering that might help people’s recovery,” says researcher Becca Levy, PhD, associate professor at the Yale School of Public Health.

Upside to a Positive Attitude

Until now, experts say, most of the research on attitudes about aging and health has looked at the health risks and losses linked to a negative outlook.

But this study suggests there may be tangible health benefits to having a more positive view about aging.

“It’s not just about reducing the losses associated with aging, but also about making gains in one’s health or disability status and regaining what might have been lost,” says Tara L. Stewart, PhD, assistant professor ofpsychology at Idaho State University.

“These people with positive stereotypes about aging experienced health gains and better recovery, not just a reduction of health losses,” Stewart says.

Views on Aging Affect Recovery

In the study, researchers periodically surveyed 598 people aged 70 or older about their views on aging over a period of about 11 years.

None were disabled when the study started, but later on, all of them had at least one month when they needed help with daily tasks such as bathing, dressing, or walking. In some cases, their disability was severe; other cases were mild.

They were asked for the first five words or phrases that come to mind when they think of old people. The researchers rated their responses on a five-point scale as most positive, like “spry,” or most negative, like “decrepit.”

The results appear in the Journal of the American Medical Association.

The findings were strongest for older people with the most severe types of disability.

They were 44% more likely to fully recover from severe disability than those with negative age stereotypes.

Also, older people with positive views on aging were more likely to progress from severe disability to mild disability or mild disability to no disability.

Older people with positive age stereotypes also had a slower rate of decline in their ability to perform daily activities as they got older.

Of course, many factors affect whether or to what extent a person recovers from disability. This study does not prove that a positive attitude about aging made a difference. But it showed the strongest relationship between age stereotypes and recovery was among those people with positive age stereotypes and the most severe type of disability.

Attitude and Aging

Positive views on aging may help people bounce back from disability and promote independent living in a variety of ways, the researchers say.

One of the biggest ways may be psychological. Stewart says a person’s attitudes about aging say a lot about how much they believe their health is under their own control.

For example, people who view seniors as spry rather than decrepit may be more likely to live a healthy lifestyle, keep up on their doctor appointments, and take their medicines as prescribed.

“Holding a negative stereotype about aging, like believing illness is caused by aging, would cause them to feel less in control and responsible for their health and lead to different sorts of strategies,” Stewart says.

Levy also says there may be a physiological side to it.

“People who have more positive age stereotypes tend to have the advantage in experiencing stress,” says Levy. “They tend to suffer from less cardiovascular stress.”

Researchers say the next step is to look at how people can upgrade their attitudes about aging.

“We need to emphasize some of the positive as we get older instead of focusing on the developmental losses that may happen with aging,” Stewart says.

Retrieved from: http://www.webmd.com/healthy-aging/news/20121120/old-as-you-feel?ecd_tw_112112-am_new_nofeelold

extend your life!

In Happiness, Mindfulness, Well-being on Tuesday, 20 November 2012 at 12:34

http://medicalxpress.com/news/2012-11-positive-mental-health-boosts-lifespan.html

find your grit…

In Fitness/Health, Happiness, Inspiration, Mindfulness, Well-being on Thursday, 15 November 2012 at 16:55

http://positivepsychologynews.com/news/renee-jain/2012110824569

The disastrous behaviour of the memory

In Fitness/Health, Mindfulness, Well-being on Tuesday, 6 November 2012 at 16:32

The disastrous behaviour of the memory (Click the photo to enlarge).

and i bet you thought this was another neuro article…

What to knit your life with?

In Happiness, Mindfulness, Well-being on Monday, 5 November 2012 at 07:22

What to knit your life with?.

teach happy!

In Education, Fitness/Health, Mindfulness, Pedagogy, Well-being on Saturday, 3 November 2012 at 11:57

Why We Need to Add Happiness to the School Curriculum

By: OLGArythm

http://olgarythm.blogspot.com/2012/10/why-we-need-to-add-happiness-to-school.html

Young people graduate from school equipped to solve mathematical equations, arrange chemical experiments, and write essays. But often they graduate to the adult life not equipped with skills that will help them deal with everyday struggles, emotions, and difficulties. They are not equipped to be happy individuals.

Happiness is arguably the ultimate meaning of our life. Is there anything we want more for our kids than to be happy? If given a choice, would a parent prefer that her child knows capital cities of all countries or knows how to be a happy person? The ultimate purpose of the traditional academic education is to instill children with knowledge needed for for their future careers. But it does not teach kids the good attitude to deal with the many future personal experiences that make up our life. Inner well-being and peace are as crucial and necessary as the academic skills. It does not make sense to pay no attention to the development of happiness skills.

In 2011, United Kingdom published a report that confirms that lots of kids face serious emotional problems by the time they graduate school. Based on UK statistics, which probably does not differ too much from the situation in the USA, by the time an average class of 30 young people reach their 16th birthdays:

  • 10 of them will have witnessed their parents separate
  • 3 will have suffered from mental health problems
  • 8 will have experienced severe physical violence, sexual abuse or neglect
  • 3 will be living in a step family
  • 1 will have experienced the death of a parent
  • 7 will report having been bullied.

Relate (a leading provider of counseling, therapy, and education in UK)  cites research evidence which shows that emotional and mental health problems developed in childhood and adolescence go on to affect adults later in life. The resulting problems with poor emotional adjustment and general feelings of unhappiness are bad enough. But that is not all the consequences our kids are facing. Unhappiness and emotional imbalance can cause young people to do badly in exams or drop out of education altogether, with consequent damage to their long-term employment prospects and health. For more on the report, see http://www.optimus-education.com/can-schools-promote-happiness.

I agree with Relate’s specialist that schools are the best places to reach young people, and early intervention is effective. But I believe that the most effective solution is prevention. Adding the subject of happiness to school curriculum can help children better deal with their issues, and develop coping mechanisms for the future.

Usually, the kids get emotional guidance and character building from interacting with families and friends. As parents, we always try our hardest to raise good people: continuously pass our wisdom to our kids, indoctrinate our values to them, tell them what is good and what is bad, teach them manners, help them with the choice of profession and life partner (if they let us). But do we teach them how to be happy, joyful, grateful, peaceful? Do we live our lives with contentment and moderation, leading our children by example? Parents are people too, and not all of us are happy ourselves. Unfortunately, we do not always have the time, the vision or the skills to instill the basics of happiness into our children. So both the adults and the kids go about the pursuit of happiness by the trial and error method.

There are more and more politicians, organizations and individuals who believe that happiness skills can be learned and should be included in traditional educations. On his Facebook page, the Dalai Lama says that education is the proper way to promote compassion, piece of mind and tolerance in society, which bring a sense of confidence and reduce stress and anxiety (https://www.facebook.com/DalaiLama) . England requested that schools and colleges promote wellbeing to students (http://www.optimus-education.com/can-schools-promote-happiness). The US army uses classes developed by the “Authentic Happiness” program at the University of Pennsylvania to increase resilience levels of the troops (http://www.authentichappiness.sas.upenn.edu/newsletter.aspx?id=1552).

School is the place where our kids grow up, and where they are formed as individuals as much as they are at home. The school system has the infrastructure for influencing entire generations, letting out better adjusted and happier people. Unfortunately, schools spend most of their efforts on achieving high test results and good rankings. There is little emphasis on personal or emotional development. I believe happiness skills are among some of the most important skills a person possesses. To me it is obvious that the school system must help develop happiness skills as much as literacy skills in all children. I would like to see USA schools and schools all over the world to add happiness lessons to their curricula and deliver it to every kid. It will make for better adults and for better societies, and ultimately, for better world.

To see this happen, I plan to open an organization to raise public support, develop happiness curriculum and promote it to schools and departments of education in the US and possibly, worldwide.

If you think this idea is important and worthwhile, and you would like to help, please contact me. I am looking for anyone who can contribute their skills, knowledge, and advice in the fields of not-for-profit organizations, school curricula, marketing, public relations, legal aspects and more!

Retrieved from: http://olgarythm.blogspot.com/2012/10/why-we-need-to-add-happiness-to-school.html

the brain in love…

In Brain imaging, Brain studies, Well-being on Sunday, 21 October 2012 at 09:30

Love, Sex, Relationships and the Brain

Does neuroscience hold the key to a lifetime of passionate love?

Published on October 18, 2012 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express

Let me not to the marriage of true minds Admit impediments. Love is not loveWhich alters when it alteration finds, Or bends with the remover to remove:O no! it is an ever-fixed mark That looks on tempests and is never shaken;It is the star to every wandering bark,Whose worth’s unknown, although his height be taken. Shakespeare, Sonnet 116

The qualities of true, romantic love have inspired playwrights, poets, and philosophers throughout the ages. Love is an ideal; an inspiration — a feeling of passion and commitment that adds richness and joy to life. A loving relationship provides a secure base from which to grow, expand and explore the world. Yet, until recently, we did not know for sure whether romantic love could last, or whether it inevitable transformed into companionate love — enduring friendship characterized more by shared interests, commitments and values than passion and excitement. Or, even more disappointing, perhaps love inevitably fades and couples stay together in miserable or passionless relationships because of social convention, convenience, and duty.

Are Kids Relationship Ruiners?

Research suggests that all of these patterns are possible. First, the bad news! Researchers at Bar Ilan University in Israel studied couples with children from pregnancy to 14.5 years after the child’s birth in two overlapping large-scale studies.  Overall, marital satisfaction decreased following the birth of the first child and continued to decline steadily, reaching an all-time low when the kids became teenagers. The more kids, the greater the decline in marital satisfaction. Dissatisfied couples did not inevitably divorce, however. Marital dissatisfaction was not significantly related to breaking up, except if husbands had especially low satisfaction during the first child’s transition to school.  Those couples with stronger relationships to begin with had less decrease in satisfaction.  The take home message is that marriage with kids is not just a bed of roses. While children can provide much pleasure and meaning, they can also take time away from couple bonding activities, place stress and emotional demands on parents, and lead to fights over parenting strategies and division of labor. Financial stress and a routine of errands and driving kids around can further erode relationship glamor and romance. Parents may be too tired for sex or even, conversation.  Thus, romantic love between parents, if left untended will diminish in intensity during childrearing years, most of the time. Shared commitment to parenthood, pride in kid’s achievements, and involvement in kids’ social, academic, and sporting activities can provide alternative sources of fulfillment and friendship during these years. When kids leave the home and couples have more time together, they can often rebuild closeness and intimacy.

Can Romantic Love Last?

At the other end of the spectrum,brain imaging studies provide proof that romantic love can last, at least for around 5-12 percent of couples, according to researcher Art Aron, the romantic love guru from Stony Brook University, in New York, whose studies look inside the brains of couples in love.  In a touching side-note, Aron often collaborates in these studies with his wife of 37 years, Elaine Aron, also a researcher at Stony Brook.

The Brain in Love

A groundbreaking study by Aron and his colleagues, published last year in the journal Social Cognitive and Affective Neuroscience sought to uncover the mysteries of how our brains process love. The researchers recruited couples that had been together more than 20 years as well as those recently fallen in love. After completing questionnaires assessing closeness, romantic love intensity, and sexual frequency, the couples entered brain scanning machines. Using functional magnetic resonance imaging to look inside the brain in real-time, the researchers compared the reactions of new, and long-time lovers, while they viewed pictures showing faces of their loved ones, and faces of close friends, and long-time acquaintances. This methodology was used to make sure that the brain effects seen were due to romantic love, rather than to affection or familiarity. Results showed that indeed, love can last, and has a unique physiological profile in the brain.  The brain scans of both long-term and recent couples showed activity in the ventral tagmental area (VTA), an area with high dopamine concentration, which is associated with reward and motivation. Partner pictures produced distinct and more powerful responses than friend and acquaintance pictures. Romantic partners, therefore, appear to have unique and lasting reward value! Also, those long-term couples that reported the highest levels of romantic love and closeness on questionnaires had levels of brain VTA activity similar to those of newly in love partners.

Sex and the Brain

This study also revealed some interesting findings related toattachment and sexuality. Compared to new partners, long-term partners showed activity in brain areas associated with attachment that demonstrated greater calmness and less tension. Thus, long-term partners may become more securely attached and less likely to fear abandonment.  Higher sexual frequency was associated with greater activity in the posterior hippocampus — an area associated withhunger, cravings, and obsession. Thus, romantic love appears to be different than sexual attraction, although this may be a component of it. Taken together these findings suggest it is important to build a strong romantic bond early on, so that love can withstand the challenges ofaging and family development. Since we know that our brains can change in adulthood and possess neuroplasticity, it is also likely that we can rebuild and renew love in relationships that have deteriorated.

How Do We Keep the Spark of Love Alive?

Research findings suggest we can rebuild or enhance love in relationships by:

  1. Generosity – Being helpful and considerate in small and large ways, doing our fair share of chores, stepping in to allow our partner to take a break.
  2. Positivity – Focusing on and communicating about our partner’s positive qualities. Showing appreciation and affection on a regular basis.
  3. Attachment – Allowing our partners to turn to us and depend on us when they are vulnerable; providing a secure emotional base and reassurance of worth.
  4. Expansion – Helping our partners to expand their worlds by engaging in novel and challenging activities together and bringing in our own passion for life.

My next post will provide concrete tools for using these research-based strategies to strengthen your own romantic relationships.

About The Author 

Melanie Greenberg, Ph.D. is a Clinical Psychologist, and expert onMindfulness, Attachment. & Relationships with expertise in the Gottman approach and Emotion-Focused Therapy for couples. Dr Greenberg provides workshops and speaking engagements for organizations and nonprofits, and coaching and therapy for individuals and couples in person or via skype.

Visit my website:

 http://melaniegreenbergphd.com/marin-psychologist/

Retrieved from: http://www.psychologytoday.com/blog/the-mindful-self-express/201210/love-sex-relationships-and-the-brain

 

STOP…and be happy!

In Fitness/Health, Inspiration, Mindfulness, Well-being on Saturday, 20 October 2012 at 07:50

Be Happier: Ten Things to Stop Doing Right Now

Jeff Haden

Sometimes the route to happiness depends more on what you don’t do.

Happiness–in your business life and your personal life–is often a matter of subtraction, not addition.

Consider, for example, what happens when you stop doing the following 10 things:

1. Blaming.

People make mistakes. Employees don’t meet your expectations. Vendors don’t deliver on time.

So you blame them for your problems.

But you’re also to blame. Maybe you didn’t provide enough training. Maybe you didn’t build in enough of a buffer. Maybe you asked too much, too soon.

Taking responsibility when things go wrong instead of blaming others isn’t masochistic, it’s empowering–because then you focus on doing things better or smarter next time.

And when you get better or smarter, you also get happier.

2. Impressing.

No one likes you for your clothes, your car, your possessions, your title, or your accomplishments. Those are all “things.” People may like your things–but that doesn’t mean they like you.

Sure, superficially they might seem to, but superficial is also insubstantial, and a relationship that is not based on substance is not a real relationship.

Genuine relationships make you happier, and you’ll only form genuine relationships when you stop trying to impress and start trying to just be yourself.

3. Clinging.

When you’re afraid or insecure, you hold on tightly to what you know, even if what you know isn’t particularly good for you.

An absence of fear or insecurity isn’t happiness: It’s just an absence of fear or insecurity.

Holding on to what you think you need won’t make you happier; letting go so you can reach for and try to earn what you want will.

Even if you don’t succeed in earning what you want, the act of trying alone will make you feel better about yourself.

4. Interrupting.

Interrupting isn’t just rude. When you interrupt someone, what you’re really saying is, “I’m not listening to you so I can understand what you’re saying; I’m listening to you so I can decide what I want to say.”

Want people to like you? Listen to what they say. Focus on what they say. Ask questions to make sure you understand what they say.

They’ll love you for it–and you’ll love how that makes you feel.

5. Whining.

Your words have power, especially over you. Whining about your problems makes you feel worse, not better.

If something is wrong, don’t waste time complaining. Put that effort into making the situation better. Unless you want to whine about it forever, eventually you’ll have to do that. So why waste time? Fix it now.

Don’t talk about what’s wrong. Talk about how you’ll make things better, even if that conversation is only with yourself.

And do the same with your friends or colleagues. Don’t just be the shoulder they cry on.

Friends don’t let friends whine–friends help friends make their lives better.

6. Controlling.

Yeah, you’re the boss. Yeah, you’re the titan of industry. Yeah, you’re the small tail that wags a huge dog.

Still, the only thing you really control is you. If you find yourself trying hard to control other people, you’ve decided that you, your goals, your dreams, or even just your opinions are more important than theirs.

Plus, control is short term at best, because it often requires force, or fear, or authority, or some form of pressure–none of those let you feel good about yourself.

Find people who want to go where you’re going. They’ll work harder, have more fun, and create better business and personal relationships.

And all of you will be happier.

7. Criticizing.

Yeah, you’re more educated. Yeah, you’re more experienced. Yeah, you’ve been around more blocks and climbed more mountains and slayed more dragons.

That doesn’t make you smarter, or better, or more insightful.

That just makes you you: unique, matchless, one of a kind, but in the end, just you.

Just like everyone else–including your employees.

Everyone is different: not better, not worse, just different. Appreciate the differences instead of the shortcomings and you’ll see people–and yourself–in a better light.

8. Preaching.

Criticizing has a brother. His name is Preaching. They share the same father: Judging.

The higher you rise and the more you accomplish, the more likely you are to think you know everything–and to tell people everything you think you know.

When you speak with more finality than foundation, people may hear you but they don’t listen. Few things are sadder and leave you feeling less happy.

9. Dwelling.

The past is valuable. Learn from your mistakes. Learn from the mistakes of others.

Then let it go.

Easier said than done? It depends on your focus. When something bad happens to you, see that as a chance to learn something you didn’t know. When another person makes a mistake, see that as an opportunity to be kind, forgiving, and understanding.

The past is just training; it doesn’t define you. Think about what went wrong, but only in terms of how you will make sure that, next time, you and the people around you will know how to make sure it goes right.

10. Fearing.

We’re all afraid: of what might or might not happen, of what we can’t change, or what we won’t be able to do, or how other people might perceive us.

So it’s easier to hesitate, to wait for the right moment, to decide we need to think a little longer or do some more research or explore a few more alternatives.

Meanwhile days, weeks, months, and even years pass us by.

And so do our dreams.

Don’t let your fears hold you back. Whatever you’ve been planning, whatever you’ve imagined, whatever you’ve dreamed of, get started on it today.

If you want to start a business, take the first step. If you want to change careers, take the first step. If you want to expand or enter a new market or offer new products or services, take the first step.

Put your fears aside and get started. Do something. Do anything.

Otherwise, today is gone. Once tomorrow comes, today is lost forever.

Today is the most precious asset you own–and is the one thing you should truly fear wasting.

Retrieved from: http://www.inc.com/jeff-haden/how-to-be-happier-work-10-things-stop-doing.html

The Hill and the Concrete Stairs

In Inspiration, Mindfulness, Well-being on Friday, 19 October 2012 at 06:57

The Hill and the Concrete Stairs

Posted by: Anoop Alex

I climbed up the stairs. Well, I have been climbing for a long time now. Still, the top was not seen. I was tired, moody and desperate. They call it the stairs to success and happiness. I read many books, articles and listened to great people talking about life and its intricacies. I was inspired, and really wanted to reach those heights they talked about. I wanted to realize my dreams, be happy and then fulfil myself. No time to rest, there was much more to go…

The sky was grey, the clouds were limping over the stairs as if they were old and impaired. I looked back at my shadow; it was long and reached many steps down. I wondered, “Is there really a topmost step? What happens when I reach there? Will I be really happy? Enlightened, shall I be?!”

No time for distractive thoughts, I lifted my legs as high as I could and consumed more of my strength and agility up the stairs. Still nothing in reach, I sat down and for once I looked around. That was the first time I looked somewhere else other than up and down.

Life unfurled around me. There were people, funny, nice, rude and all sorts; all of them around everywhere, but far from me. I did not care, for all I wanted to look was at me in the mirror on the topmost step, where I can be seen happy and successful.

As I rushed ahead, I became tired and frustrated. I was forced to sit down once more. I was so angry at all those who inspired me to become great and known. I wanted to despise all those who tried to motivate people. What do they give all those glowing quotes for? I sat in desperation; hopeless and sad. The night fell, and I did not know when my eyes closed.

The morning light knocked my eyes open; I could still see all those around me. I was not amused or astonished to see that they were not climbing. Well, everyone is not ambitious! For a second, their shadows caught my eyes; much shorter than mine! They looked joyous and in high spirits!

The next moment, I took a decision. Risky, but at least it should turn out adventurous!

For the first time, I took a step aside the stair. The moist clouds helped me down. The environment changed, so different from the concrete stairs! The ground felt less solid and rigid.  My feet were on soil, green and fertile. I started walking towards the house afar, feeling affluent and comfortable with every step I took.

The house looked familiar. The door was old and plain but had a soothing impression on me. I smiled and knocked on the door.

My parents were surprised but happy to see me. They have become old. Their loving eyes appraised me and I was in a warm embrace, one after another. My wife’s graceful eyes prayed silently how much she missed me. My kids’ cheers were genuine music to me.

My life so far had been very busy, and after a long time I got time for free. My breathing was slow and calm. The air I breathed in was soothing and replenishing. The food, homely and the moments were splendid.

My parents were very happy to see me, and half-heartedly let me go for a stroll. Not often I realized how patient and lovely my woman could be, she reminded me with a soft kiss. My children grew up fast I thought; they too understood me well and left me for a walk alone!

I walked, round and around the land. There were no specific lanes or roads. Far ahead, the vastness of the plain led me to a small hill. The hill was a favourite spot for me in childhood; my friends and I used to raid the area for different amusements then.

I was not ready for another climb up, but this time there was nothing impending. I felt light and the hill-top was awaiting me. The blue sky spread vast, as esteemed as always, and misted the horizon. Clouds, fair and white giggled tenderly at my coming.

The hilltop gave a wonderful panoramic view of the hemisphere. The breeze atop was refreshing and brushed past me gently. I closed my eyes for a while and all those lovely moments of life rushed in; my life in vista. The memories were sweet and I missed all my friends, teachers, neighbours, relatives and… myself. The bitter turned sweet, what I used to perceive hard became soft and comfortable, the anxious and worried times made me smile and the heaviness was lifted away. I accepted all that was left behind, the happy moments, those embarrassing incidents, irritating comments, fleeting love, hurtful breakups, sad and upsetting thoughts, the shame and pain. I no longer resisted. I accepted who I was. I forgave all those who hurt me. I cherished those memories where I felt nice, happy, confident and proud. I felt my body becoming relaxed, my heart was beating smooth and I breathed easily.

It was noon when I opened my eyes. I looked down. The rock where I stood bore no shadow on it! Once I was amazed, then I understood! The sun was just above me and I was enlightened. Realizing what I had missed, I felt happy and content in claiming what was mine – my own self.

Far in the horizon the concrete stairs were visible and I could see someone climbing up. More than the person, I could see a long shadow. The stairs were leading farther from the sun!

Striding down the hill, my legs carried me faster and further. The flowers smiled, the grass swayed at my go as if they were dancing and my feet were well welcomed by the mud. The stretch ahead was to home, I ran faster, gaining more and more upon myself and it was real. I was once again myself and the leap I took kept me happy and content.

Retrieved from: http://mindmattersindia.com/the-hill-and-the-concrete-stairs/

40 things to say before you die

In Meditation, Mindfulness, Well-being on Tuesday, 9 October 2012 at 06:27

40 Things To Say Before You Die

Before you’re sprawled on your deathbed, there are some things you really have to say. They’re not complicated. They’re not poetry.

They’re just short sentences with big meaning.

I hope they get you talking.

http://www.forbes.com/sites/jessicahagy/2012/10/04/40-things-to-say-before-you-die/

The effect of hate…~be love~.

In Inspiration, Mindfulness, Well-being on Monday, 1 October 2012 at 08:22

The Effect of Hate on Children

Dr. Asa Don Brown, Ph.D., C.C.C.

 “I have decided to stick to love…Hate is too great a burden to bear.”~ Dr. Martin Luther King, Jr.

Webster’s Dictionary (2012) defines hate as an “intense hostility and aversion usually deriving from fear, anger, or sense of injury.  It is an extreme dislike or antipathy (and in most cases, there is) an object of hatred.”

Children who are exposed to hate are prone to a world of disorder, conflict, turmoil, strife, and an array of injustices.  Hate is the catalyst for human depravity and personal decay.  The typical foundations of hate begin in adolescence, they begin to blossom in the early life of a child.  Hate is rarely founded and always based on an indifference between peoples.

DEFINING HATE CRIMES

The National Association of Social Workers definition is:  “Hate violence crimes are those directed against persons, families, groups, or organizations because of their racial, ethnic, religious, or sexual identities or their sexual orientation or condition of disability.” (Barnes & Ephross, 2012, Online)

Hate knows no friend; it breaches the wellbeing of both the hated and the hater. Children who are taught to hate, whether implied or through an act of projection, are forced to live lives in constant opposition.   Hate stifles their ability to fully live a life engulfed with love and security.  Hate not only permanently skews their cognitive perceptions of the world, but it causes personal distress leaving a stain on one’s ideological viewpoints of that world.  Fortunately, while the senseless act of hate can have a permanent effect upon the emotional welfare of the individual; those who hate, or are being groomed to hate, can experience lifelong reprieve from the shackles of hate.

HATE’S ROTTING EFFECT

Hate’s effect can be passed down through the generations of a family, a community, or a civilization.  It is hate that acts as rust on the human mind and spirit.  Hate slowly causes an oxidation on the natural process of love, peace, and acceptance from within a person.  It is hate that transforms the natural order of the human condition, causing an internal and external strife within the very fabric of humanity.

Hate has caused wars and created rumors of wars; it has pitted children against children and adult against adult; it is hate that allows for teachers to bully their students and student’s to bully one-another.  Hate is often confused with pride, while genuinely positive pride, is “the consciousness of one’s own dignity,” (Webster’s Dictionary, 2012), as well as, having a source of intense approval for one’s achievements and personal successes.  Hate has no relationship to pride.

While hate is the decayer, love and acceptance are the cure.  Hate cannot know the light of the world, rather hate itself is an opponent of darkness.  What does darkness symbolize?  Darkness is the unknowing, the instigator of our greatest fears, the promoter of our worse nightmares, and the master of human dysfunction.   Darkness emphasizes our insecurities, our worries, our negative contemplations, and in general, anything contrary to our positive nature.  Hate in itself cannot force the hand of humankind, rather it entices the worst of the human condition to become the prominent player in one’s overall life.

OVERCOMING HATE

Overcoming any negative emotion or thought pattern takes deliberate effort.  Children who are either taught or influenced to hate have a greater chance of changing their ideological viewpoints, than someone who has reached adulthood.  Sadly, adults who have hate as the foundation of their personal character; are all too often imprisoned by their hate.  Hate is the ultimate virus, infecting the very essence of the person.  However, hate is not a totalitarian regime, and fortunately because of human resiliency, hate can be overcome.  Overcoming hate starts with the individual.  Through a deliberate and conscious effort on the part of the individual, hate can be eliminated from the mind and very conscious of that individual.

The Steps to Overcoming Hate 

  1. Unconditional Acceptance:  Accept as though you were the recipient.  Do not place acceptance in a fish bowl, otherwise you are always limiting the amount with which you offer your hand.
  2. Unconditional Forgiveness:  When you forgive, forgive.  Do not shelter hateful thoughts, otherwise you have not allowed your unconscious and conscious minds to be free of the negative event or person.
  3. Unconditional Love:  Unconditional love knows no rights or wrongs.  Unconditional love says, I will love you beyond all words, deeds, actions, or reactions.  It is the sort of love that a father or mother should have for their child.  This sort of love is not offered up only in the good times, but excels to be exhibited in the bad times.
  4. Review your thought patterns.  How do you perceive the world around you?  What are the guidelines with which you judge your corner of the world?  Are you hyper critical of others?  Do you wear your emotional sleeve on your shoulder?  Do you see yourself as better than or superior to others?  If so, reevaluate your thought patterns, and consciously make an effort to eliminate them from your mindset.  Be a good steward of your thoughts, and helpful steward of your children’s thoughts.
  5. Move Forward: Do not be combative with the negative event or person, rather consciously drive your virtual mind down an opposite path of positivity.  Therefore, intentionally seeking positive messages, images, and solutions for your life.
  6. Be Diverse:   Be a model of diversity; teach your children through your verbal and nonverbal messages to be diverse.  Allow them to see you positively interact with others of cultural and gender diversities.  Do not limit your friendships, your acquaintances, or your associates to one cultural paradigm.
  7. Challenge Negative Thought Patterns:  Be willing to consciously and unconsciously challenge thoughts that are skewed or indifferent to others.  Question, the whybehind your biases or subtle discriminatory thoughts.
  8. Correct Negative Thoughts in Your Children:  If you become privy of a negative thought that your children may hold; be diligent to help your children to review their negative or hateful thoughts, replacing them with a more positive ideological viewpoint.
  9. Be a Proponent of Positivity:  Everyone deserves a right to live in a positively influential environment.
  10. Offering an Environment of Safety and Care:  The environment with which care and safety are provided should make a profound difference.

When there is hate, a child’s right of safety and care is breached.  Schools should intentionally and purposefully foster an environment of safety and care.  When a school avoids advocating for its children, it extinguishes their individual rights.  It is vital to recognize that “All students are harmed by being in a school environment where discriminatory behavior is allowed, not just those students who are singled out for such harassment and victimization.”  (Wieland, 2007, p. 241)  Children should always be provided an environment of unconditional love, acceptance, and approval.  Remember, what occurs in one’s childhood is often indicative of things to come.   If we avoid addressing messages of hate in childhood, then there is little deterrence for children from amplifying the same messages of hate in their adulthood.

Helping your children to recognize the verbal and nonverbal messages is critical for combating the hate.  Be certain to teach your children to recognize the key features ofhateful and violent messages; whether they are communicated verbally or nonverbally; casted disparagingly through stereotypes, stigmas, guilt, or shame; it is essential to know and recognize when other’s are offering us platters of hate.

“What are some general ways that hate speech can be used in the offline (or online) world? Sample responses:

  • Calling people names based on their race, religion, national origin, disability, gender, sexual orientation, or any other type of group that is disenfranchised in our society
  • Saying things about people that are based on social identity stereotypes.”  (Common Sense Media, 2012, Online)

Children who are not taught to recognize the clutches of hate, will often fall prey unto such messages.  As parents and teachers, we are obligated to gird up the loins of our children to protect them from the possibility of harm.  Moreover, it is equally important for children not only be taught to protect themselves, but to play a critical in offering positive lessons unto their classmates.  If so, such children will prove advocates not only for themselves, but for the lives of everyone they encounter.

We must be hyper-vigilant when training our children.  As parents and teachers, we should keep a watchful eye out for danger and difficult times.  It should be expected that teachers and parents use due diligence to protect their children.

Author:   Dr. Asa Don Brown, Ph.D., C.C.C.

REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th ed., text rev.). Washington, D.C.: Author

Barnes, A. & Ephross, P. H. (2012) The impact of hate violence on victims, Emotional and behavioral responses to attacks.  Retrieved September 22, 2012 fromhttp://www.socialworkers.org/pressroom/events/911/barnes.asp

Common Sense Media (2012) Lesson: Breaking down hate speech. Retrieved September 22, 2012 fromhttp://www.commonsensemedia.org/educators/lesson/breaking-down-hate-speech-11-12

Wieland, J. (2007) Peer-on-Peer hate crime and hate-motivated incidents involving children in California’s public schools:  Contemporary issues in prevalence, response and prevention.  UC Davis Journal of Juvenile Law & Policy 11(2), 235-269

Retrieved from: http://www.ccpa-accp.ca/blog/?p=2454

“you are responsible, forever, for what you have tamed…”

In Education, Well-being on Sunday, 23 September 2012 at 08:30

reply to gpicone…thanks for giving me things to blog about!

gpicone:  “Thanks for your support and for this post. I haven’t written about it yet but in my final year I was sent to work in what was basically a prison compound for students that the district no longer wanted to pay to have sent to outside programs where they might receive help for their emotional and behavioral problems. 2 teachers were set on fire (their hair lit with lighters) and both were fired (pun intended? How could it not be!) for being flammable I suppose! And with our big fat popular governor of NJ (ironic that a man who indulges himself to his own detriment should be the leader of austerity for everyone else and no one notices) bad mouthing us and cutting our benefits I had no choice but to leave after 33 years in teaching. I didn’t want to go but…”

***

i hear so many stories just like yours.  teachers who were forced to retire because of the lack of support in the system.  teachers who are over worked and under paid.  teachers who have just been beaten down by the system.  more and more, i see great teachers being forced out of teaching because, while they dreamed of teaching children and spent their schooling studying to do so (and love it), have become nothing more than paper pushers and glorified babysitters.  it’s tragic. 

i am assigned to two “traditional” schools (a middle and high school) as well as our alternative program (i work with both the middle and high school there).  ironic that you mention the ‘hair on fire’ incident because we have a kid who set a girl’s hair on fire and was sent to us (this is NOT a program for severe emotional and behavioral issues….we have a different program for that).  so, we end up with many kids who make/made poor choices.  i say that because many of the kids we get really DID just make a bad choice (you brought alcohol for you and your friends to drink during lunch…bad choice) but we also have kids with felony records (from rape to firearm charges and everything in between), probation officers, babies at 12 years old (sometimes second babies at 12, first at 10 or 11), etc.  some of these kids have one brush with the law and realize that is NOT where they want to be and end up going back to their home schools after they are with us (they are given a length of time they are to be with us, usually a semester) and are successful.  and some…well, let’s just say i have seen quite a few former students on the news as well (carjacking with a baby in the car, breaking and entering, name it, i’ve probably seen/heard it).  what i do notice is the great majority of these kids aren’t “bad” kids but have little guidance or support from home and are just following in their brother/sister/mother/father’s footsteps.  if dad is in a gang, you are gong to be in a gang.  that’s just life to them and it’s all they know.  and i will also say that i have met some kids for whom, and i hate to say/feel this, we just don’t know what to do with.  you can’t reach them and they have little regard or empathy for others.  but, even for those few kids, there are moments when you can see them trying to care or trying to do the right thing, they just don’t get it.  as a whole, though, these are the kids who will likely wind up in the penal system or worse.  it is rare that you can’t reach most of these kids on some level and see the person they could become, but it happens. 

the overarching difference i notice between the kids who end up “flying right” and realizing that their behavior isn’t going to get them anywhere and those that appear to just not care and continually get into trouble, have failing grades, brushes with the law, etc. is the family environment.  i am generalizing here, but the kids who have parents that actually show up when you call or bother to come to a meeting, those are the kids who usually end up going back to their home schools and graduating or at least not coming back to the alternative school aagin.  the kids who have parents that you never see (and frankly appear to be bothered when you actually do get in touch with them and ask them to come to a meeting/pick up their sick child/check on homework), those kids get the message that they don’t matter.  if their own parents don’t care enough about them, why should they care about anyone and why should anyone care about them?  those are the kids i see on the news.  and they are the kids who are “repeaters” in and out of our school because they continue to do things that get them sent back to the alternative program.

look, i’m not going to sit here and say that all kids just make poor choices and, in the end, turn out to be successful and contributing members of our society.  it’s a bell curve just like most things…there are the outliers.  but, when a kid has to go to the hospital because of an injury (or a drug overdose, a result of a fight, etc.) and you call and call the parent/emergency contact/guardian and they either refuse to come or don’t answer their phone (even when calling for 5 hours)…what message does that send to that kid?!  that your own parents don’t even care about you, so why should you care about anyone?  you’re not worth it.  

the point of this (wordy, i know) response is NOT to make excuses for these kids.  ALL BEHAVIOR HAS CONSEQUENCES, positive or negative, and i don’t believe you get a free pass if you have a crap home life (it is my experience that the apple and the tree are never far apart), but kids usually do what they see.  from my observations, parent involvement is KEY to a successful outcome for children (however “success” is defined).  i am not going to say that parental involvement is a panacea and “cures all ills” but it is a huge factor in a child’s outcome.  so, ask yourself, HOW INVOLVED ARE YOU IN YOUR CHILD’S LIFE?  do you know their friends?  if you work, do you know what your child does when he/she gets home from school and you are not there?  do you know where your child is at any given time?  are you parenting or trying to be their friend?  while having a good relationship with your child is important, i have also seen those who try so hard to appear “cool” and be their child’s friend that they are not respected by their kids or seen as any kind of authority.  their children do not see them as an someone they need to listen to and, thus, have no regard for any kind of rule their parents try and implement (if, on that rare occasion they do try to set a boundary or make a rule) and this filters down to others in positions of authority, i.e. teachers, administrators, police.  so, be your child’s friend, someone they feel they can come to and share openly, but…MAINTAIN THE PARENTAL ROLE.  these kids need guidance and many of their behaviors appear to be a cry for attention…the attention they are not getting elsewhere.  and, remember, negative attention is still attention.

as antoine de saint-exupery said in “the little prince” (if you have not read this gem of a book, do!  such a beautiful story with so many life-lessons), “You become responsible, forever, for what you have tamed” in relation to the prince and his beautiful rose (really, if you haven’t, go read it).  be it the tiny puppy who was SO adorable (that has now become older, maybe less adorable, and possibly wreaking havoc in the house), the cute kitten you rescued from the gutter who now needs care, or the baby you chose to have.  you should not take that dog to the pound to be killed (see: http://www.aspca.org/about-us/faq/pet-statistics.aspx) and you certainly can’t take your child to the pound.  but…disassociated parents do greater harm, in my opinion.  you have just increased the likelihood that your child will be less successful academically, have more behavior problems, a greater chance of being involved negatively with the law, the list goes on and on.  just as that now grown puppy that relied on you for feeding, walking, and care can’t take care of itself, neither can your child.  they need you and you have a responsibility to them.  that puppy had no say in whether or not you took him home and that child did not have a say when you became their parent.  you chose this, TAKE CARE OF YOUR RESPONSIBILITIES.  be FOREVER responsible.  even if it means breaking the cycle and raising your child in a way different from the way you were raised (the old, “i got beat as a kid, so i beat my kid” cycle).

become an ACTIVE participant in your child’s education and school life.  an ACTIVE participant in your child’s social life.  an ACTIVE participant in your child’s spiritual/moral/ethical life.  demand to know who your child’s friends are (up until i graduated high school, my mother had to meet every single person i went out with, was friends with, dated…while i may have been embarrassed at my mom calling my prospective date’s mother and requiring to meet the person before we went out, i knew that this was only because she cared about me. and, as far as i knew, this was normal because all my friends had to do the same), be involved in their schooling (demand to see homework, keep up with their grades and attendance, have some sort of presence at school, even if it’s just emailing teachers to let them know you are involved and supportive and will be there if needed).  believe that these things have a direct impact on your child’s future.  the child you chose to bring into this world.  the child you “tamed.”

more so, know that should you decide that this is not your priority (you have your own life to live and you send your child to school to learn life lessons you should be teaching…yes, there are many parents who expect the schools/teachers/coaches to “raise” their children)…you WILL have to deal with them at some point.  be it via a phone call from jail or the morgue.   gruesome, i realize, but a fact.  at the very least, the less involved you are in their education, the more likely it is that they will not be as successful in school and may not have as many options open to them after.  one way or another, you will have to deal with your child.  do you want to do it now and help mold them into who they could become or when it might be too late and they (and you) are paying for their mistakes later (i.e. not able to get a job, not able to go to college, have a police record, are in jail…you can imagine the host of outcomes).  am i saying that parental involvement is a panacea and end-all-be-all?  absolutely no…not at all.  but, don’t you want to give your child every opportunity to be successful in their life and happy?  to be a contributor to society and not a burden?  this is one way to do so.
please…be it a child, animal, or rose…be responsible for what you have tamed.

***

for information on parental involvement and student outcome, please see:

http://www.hfrp.org/content/download/1340/48835/file/fi_adolescent.pdf 

for information on parenting styles and outcomes, please see:

http://www.athealth.com/practitioner/ceduc/parentingstyles.html

“You become responsible, forever, for what you have tamed.”

how to look lovely

In Inspiration, Mindfulness, Well-being on Thursday, 20 September 2012 at 05:58

Get moving!

In Fitness/Health, Psychiatry, Well-being on Tuesday, 18 September 2012 at 16:29

The exercise effect

Evidence is mounting for the benefits of exercise, yet psychologists don’t often use exercise as part of their treatment arsenal. Here’s more research on why they should.

By Kirsten Weir

December 2011, Vol 42, No. 11

When Jennifer Carter, PhD, counsels patients, she often suggests they walk as they talk. “I work on a beautiful wooded campus,” says the counseling and sport psychologist at the Center for Balanced Living in Ohio.

Strolling through a therapy session often helps patients relax and open up, she finds. But that’s not the only benefit. As immediate past president of APA’s Div. 47 (Exercise and Sport Psychology), she’s well aware of the mental health benefits of moving your muscles. “I often recommend exercise for my psychotherapy clients, particularly for those who are anxious or depressed,” she says.

Unfortunately, graduate training programs rarely teach students how to help patients modify their exercise behavior, Carter says, and many psychologists aren’t taking the reins on their own. “I think clinical and counseling psychologists could do a better job of incorporating exercise into treatment,” she says.

“Exercise is something that psychologists have been very slow to attend to,” agrees Michael Otto, PhD, a professor of psychology at Boston University. “People know that exercise helps physical outcomes. There is much less awareness of mental health outcomes — and much, much less ability to translate this awareness into exercise action.”

Researchers are still working out the details of that action: how much exercise is needed, what mechanisms are behind the boost exercise brings, and why — despite all the benefits of physical activity — it’s so hard to go for that morning jog. But as evidence piles up, the exercise-mental health connection is becoming impossible to ignore.

Mood enhancement

If you’ve ever gone for a run after a stressful day, chances are you felt better afterward. “The link between exercise and mood is pretty strong,” Otto says. “Usually within five minutes after moderate exercise you get a mood-enhancement effect.”

But the effects of physical activity extend beyond the short-term. Research shows that exercise can also help alleviate long-term depression.

Some of the evidence for that comes from broad, population-based correlation studies. “There’s good epidemiological data to suggest that active people are less depressed than inactive people. And people who were active and stopped tend to be more depressed than those who maintain or initiate an exercise program,” says James Blumenthal, PhD, a clinical psychologist at Duke University.

The evidence comes from experimental studies as well. Blumenthal has explored the mood-exercise connection through a series of randomized controlled trials. In one such study, he and his colleagues assigned sedentary adults with major depressive disorder to one of four groups: supervised exercise, home-based exercise, antidepressant therapy or a placebo pill. After four months of treatment, Blumenthal found, patients in the exercise and antidepressant groups had higher rates of remission than did the patients on the placebo. Exercise, he concluded, was generally comparable to antidepressants for patients with major depressive disorder (Psychosomatic Medicine, 2007).

Blumenthal followed up with the patients one year later. The type of treatment they received during the four-month trial didn’t predict remission a year later, he found. However, subjects who reported regular exercise at the one-year follow-up had lower depression scores than did their less active counterparts (Psychosomatic Medicine, 2010). “Exercise seems not only important for treating depression, but also in preventing relapse,” he says.

Certainly, there are methodological challenges to researching the effects of exercise, from the identification of appropriate comparison groups to the limitations of self-reporting. Despite these challenges, a compelling body of evidence has emerged. In 2006, Otto and colleagues reviewed 11 studies investigating the effects of exercise on mental health. They determined that exercise could be a powerful intervention for clinical depression (Clinical Psychology: Science and Practice, 2006). Based on those findings, they concluded, clinicians should consider adding exercise to the treatment plans for their depressed patients.

Mary de Groot, PhD, a psychologist in the department of medicine at Indiana University, is taking the research one step further, investigating the role exercise can play in a particular subset of depressed patients: those with diabetes. It’s a significant problem, she says. “Rates of clinically significant depressive symptoms and diagnoses of major depressive disorder are higher among adults with diabetes than in the general population,” she says. And among diabetics, she adds, depression is often harder to treat and more likely to recur. The association runs both ways. People with diabetes are more likely to develop depression, and people with depression are also more likely to develop diabetes. “A number of studies show people with both disorders are at greater risk for mortality than are people with either disorder alone,” she says.

Since diabetes and obesity go hand-in-hand, it seemed logical to de Groot that exercise could effectively treat both conditions. When she reviewed the literature, she was surprised to find the topic hadn’t been researched. So, she launched a pilot project in which adults with diabetes and depression undertook a 12-week exercise and cognitive-behavioral therapy (CBT) intervention program (Diabetes, 2009). Immediately following the program, the participants who exercised showed improvements both in depression and in levels of A1C, a blood marker that reflects blood-sugar control, compared with those in a control group. She’s now undertaking a larger study to further explore exercise and CBT, both alone and in combination, for treating diabetes-related depression.

Fight-or-flight

Researchers have also explored exercise as a tool for treating — and perhaps preventing — anxiety. When we’re spooked or threatened, our nervous systems jump into action, setting off a cascade of reactions such as sweating, dizziness, and a racing heart. People with heightened sensitivity to anxiety respond to those sensations with fear. They’re also more likely to develop panic disorder down the road, says Jasper Smits, PhD, Co-Director of the Anxiety Research and Treatment Program at Southern Methodist University in Dallas and co-author, with Otto, of the 2011 book “Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-being.”

Smits and Otto reasoned that regular workouts might help people prone to anxiety become less likely to panic when they experience those fight-or-flight sensations. After all, the body produces many of the same physical reactions — heavy perspiration, increased heart rate — in response to exercise. They tested their theory among 60 volunteers with heightened sensitivity to anxiety. Subjects who participated in a two-week exercise program showed significant improvements in anxiety sensitivity compared with a control group (Depression and Anxiety, 2008). “Exercise in many ways is like exposure treatment,” says Smits. “People learn to associate the symptoms with safety instead of danger.”

In another study, Smits and his colleagues asked volunteers with varying levels of anxiety sensitivity to undergo a carbon-dioxide challenge test, in which they breathed CO2-enriched air. The test often triggers the same symptoms one might experience during a panic attack: increased heart and respiratory rates, dry mouth and dizziness. Unsurprisingly, people with high anxiety sensitivity were more likely to panic in response to the test. But Smits discovered that people with high anxiety sensitivity who also reported high activity levels were less likely to panic than subjects who exercised infrequently (Psychosomatic Medicine, 2011). The findings suggest that physical exercise could help to ward off panic attacks. “Activity may be especially important for people at risk of developing anxiety disorder,” he says.

Smits is now investigating exercise for smoking cessation. The work builds on previous research by Bess Marcus, PhD, a psychology researcher now at the University of California San Diego, who found that vigorous exercise helped women quit smoking when it was combined with cognitive-behavioral therapy (Archives of Internal Medicine, 1999). However, a more recent study by Marcus found that the effect on smoking cessation was more limited when women engaged in only moderate exercise (Nicotine & Tobacco Research, 2005).

Therein lies the problem with prescribing exercise for mental health. Researchers don’t yet have a handle on which types of exercise are most effective, how much is necessary, or even whether exercise works best in conjunction with other therapies.

“Mental health professionals might think exercise may be a good complement [to other therapies], and that may be true,” says Blumenthal. “But there’s very limited data that suggests combining exercise with another treatment is better than the treatment or the exercise alone.”

Researchers are starting to address this question, however. Recently, Madhukar Trivedi, MD, a psychiatrist at the University of Texas Southwestern Medical College, and colleagues studied exercise as a secondary treatment for patients with major depressive disorder who hadn’t achieved remission through drugs alone. They evaluated two exercise doses: One group of patients burned four kilocalories per kilogram each week, while another burned 16 kilocalories per kilogram weekly. They found both exercise protocols led to significant improvements, though the higher-dose exercise program was more effective for most patients (Journal of Clinical Psychiatry, 2011).

The study also raised some intriguing questions, however. In men and women without family history of mental illness, as well as men with family history of mental illness, the higher-dose exercise treatment proved more effective. But among women with a family history of mental illness, the lower exercise dose actually appeared more beneficial. Family history and gender are moderating factors that need to be further explored, the researchers concluded.

Questions also remain about which type of exercise is most helpful. Most studies have focused on aerobic exercise, though some research suggests weight training might also be effective, Smits says. Then there’s the realm of mind-body exercises like yoga, which have been practiced for centuries but have yet to be thoroughly studied. “There’s potential there, but it’s too early to get excited,” he says.

Buffering the brain

It’s also unclear exactly how moving your muscles can have such a significant effect on mental health. “Biochemically, there are many things that can impact mood. There are so many good, open questions about which mechanisms contribute the most to changes in depression,” says de Groot.

Some researchers suspect exercise alleviates chronic depression by increasing serotonin (the neurotransmitter targeted by antidepressants) or brain-derived neurotrophic factor (which supports the growth of neurons). Another theory suggests exercise helps by normalizing sleep, which is known to have protective effects on the brain.

There are psychological explanations, too. Exercise may boost a depressed person’s outlook by helping him return to meaningful activity and providing a sense of accomplishment. Then there’s the fact that a person’s responsiveness to stress is moderated by activity. “Exercise may be a way of biologically toughening up the brain so stress has less of a central impact,” Otto says.

It’s likely that multiple factors are at play. “Exercise has such broad effects that my guess is that there are going to be multiple mechanisms at multiple levels,” Smits says.

So far, little work has been done to unravel those mechanisms. Michael Lehmann, PhD, a research fellow at the National Institute of Mental Health, is taking a stab at the problem by studying mice — animals that, like humans, are vulnerable to social stress.

Lehmann and his colleagues subjected some of their animals to “social defeat” by pairing small, submissive mice with larger, more aggressive mice. The alpha mice regularly tried to intimidate the submissive rodents through the clear partition that separated them. And when the partition was removed for a few minutes each day, the bully mice had to be restrained from harming the submissive mice. After two weeks of regular social defeat, the smaller mice explored less, hid in the shadows, and otherwise exhibited symptoms of depression and anxiety.

One group of mice, however, proved resilient to the stress. For three weeks before the social defeat treatment, all of the mice were subjected to two dramatically different living conditions. Some were confined to spartan cages, while others were treated to enriched environments with running wheels and tubes to explore. Unlike the mice in the bare-bones cages, bullied mice that had been housed in enriched environments showed no signs of rodent depression or anxiety after social defeat (Journal of Neuroscience, 2011). “Exercise and mental enrichment are buffering how the brain is going to respond to future stressors,” Lehmann says.

Lehmann can’t say how much of the effect was due to exercise and how much stemmed from other aspects of the stimulating environment. But the mice ran a lot — close to 10 kilometers a night. And other experiments hint that running may be the most integral part of the enriched environment, he says.

Looking deeper, Lehmann and his colleagues examined the mice’s brains. In the stimulated mice, they found evidence of increased activity in a region called the infralimbic cortex, part of the brain’s emotional processing circuit. Bullied mice that had been housed in spartan conditions had much less activity in that region. The infralimbic cortex appears to be a crucial component of the exercise effect. When Lehmann surgically cut off the region from the rest of the brain, the protective effects of exercise disappeared. Without a functioning infralimbic cortex, the environmentally enriched mice showed brain patterns and behavior similar to those of the mice who had been living in barebones cages.

Humans don’t have an infralimbic cortex, but we do have a homologous region, known as cingulate area 25 or Brodmann area 25. And in fact, this region has been previously implicated in depression. Helen Mayberg, MD, a neurologist at Emory University, and colleagues successfully alleviated depression in several treatment-resistant patients by using deep-brain stimulation to send steady, low-voltage current into their area 25 regions (Neuron, 2005). Lehmann’s studies hint that exercise may ease depression by acting on this same bit of brain.

Getting the payoff

Of all the questions that remain to be answered, perhaps the most perplexing is this: If exercise makes us feel so good, why is it so hard to do it? According to the Centers for Disease Control and Prevention, in 2008 (the most recent year for which data are available), some 25 percent of the U.S. population reported zero leisure-time physical activity.

Starting out too hard in a new exercise program may be one of the reasons people disdain physical activity. When people exercise above their respiratory threshold — that is, above the point when it gets hard to talk — they postpone exercise’s immediate mood boost by about 30 minutes, Otto says. For novices, that delay could turn them off of the treadmill for good. Given that, he recommends that workout neophytes start slowly, with a moderate exercise plan.

Otto also blames an emphasis on the physical effects of exercise for our national apathy to activity. Physicians frequently tell patients to work out to lose weight, lower cholesterol or prevent diabetes. Unfortunately, it takes months before any physical results of your hard work in the gym are apparent. “Attending to the outcomes of fitness is a recipe for failure,” he says.

The exercise mood boost, on the other hand, offers near-instant gratification. Therapists would do well to encourage their patients to tune into their mental state after exercise, Otto says — especially when they’re feeling down.

“Many people skip the workout at the very time it has the greatest payoff. That prevents you from noticing just how much better you feel when you exercise,” he says. “Failing to exercise when you feel bad is like explicitly not taking an aspirin when your head hurts. That’s the time you get the payoff.”

It may take a longer course of exercise to alleviate mood disorders such as anxiety or depression, Smits adds. But the immediate effects are tangible — and psychologists are in a unique position to help people get moving. “We’re experts in behavior change,” he says. “We can help people become motivated to exercise.”


Kirsten Weir is a writer in Minneapolis.

Retrieved from http://www.apa.org/monitor/2011/12/exercise.aspx

 

The state of sleep in the U.S.

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment, Anxiety, Fitness/Health, Medication, Well-being on Tuesday, 18 September 2012 at 05:04

stress, anxiety, and depression are but three related etiologies for insomnia.  people with ADHD also suffer from insomnia, either as a side-effect of psychostimulants or because of the ADHD itself.  insomnia can have significant effects on quality of life, work/school life, and health.  statistics show that insomnia is a growing problem in the U.S. today and sleep aids are being prescribed at an increasing rate.  the following are some statistics related to insomnia as well as a case-study/research article on insomnia. 

to be followed by an article about hypnotic use and associated risk-factors.

***

General Insomnia Statistics

  • People today sleep 20% less than they did 100 years ago.
  • More than 30% of the population suffers from insomnia.
  • One in three people suffer from some form of insomnia during their lifetime.
  • More than half of Americans lose sleep due to stress and/or anxiety.
  • Between 40% and 60% of people over the age of 60 suffer from insomnia.
  • Women are up to twice as likely to suffer from insomnia than men.
  • Approximately 35% of insomniacs have a family history of insomnia.
  • 90% of people who suffer from depression also experience insomnia.
  • Approximately 10 million people in the U.S. use prescription sleep aids.
  • People who suffer from sleep deprivation are 27% more likely to become overweight or obese. There is also a link between weight gain and sleep apnea.
  • A National Sleep Foundation Poll shows that 60% of people have driven while feeling sleepy (and 37% admit to having fallen asleep at the wheel) in the past year.
  • A recent Consumer Reports survey showed the top reason couples gave for avoiding sex was “too tired or need sleep.”

Financial Implications of Insomnia

Insomnia statistics aren’t confined to the relationship between insomnia and health. This sleep disorder costs government and industry billions of dollars a year.

  • The Institute of Medicine estimates that hundreds of billions of dollars are spent annually on medical costs that are directly related to sleep disorders.
  • The National Highway Traffic Safety Administration statistics show that 100,000 vehicle accidents occur annually drowsy driving. An estimated 1,500 die each year in these collisions.
  • Employers spend approximately $3,200 more in health care costs on employees with sleep problems than for those who sleep well.
  • According to the US Surgeon General, insomnia costs the U.S. Government more than $15 billion per year in health care costs.
  • Statistics also show that US industry loses about $150 billion each year because of sleep deprived workers. This takes into account absenteeism and lost productivity.

These sobering insomnia statistics underscore the importance of enhancing sleep disorder awareness and why individuals need to seek immediate treatment for the health and the well-being of others.

Sources: National Sleep Foundation, Better Sleep Council, Gallup Polls, Institute of Medicine, National Highway Traffic Safety Administration, US Surgeon General’s Office

http://www.better-sleep-better-life.com/insomnia-statistics.html

Manifestations and Management of Chronic Insomnia: NIH State-of-the-Science Conference Findings and Implications

Authors: William T. Riley, PhD; Carl E. Hunt, MD

http://www.medscape.org/viewarticle/517618

Introduction

The Problem of the Inadequate Identification and Treatment of Chronic Insomnia

Despite considerable advances in the understanding of and treatments for chronic insomnia, this condition remains inadequately identified and treated. Approximately one third of US adults report difficulty sleeping, and 10% to 15% have the clinical disorder of insomnia.[1] Among primary care patients, approximately half have sleep difficulties, but these difficulties often are undetected by health professionals.[2,3] Even if detected and appropriately diagnosed, these patients are more likely to receive treatments of questionable safety and efficacy rather than treatments with substantial, evidence-based support for safety and efficacy.

The inadequate identification and treatment of chronic insomnia has serious medical and public health implications. Chronic insomnia results in impaired occupational performance and diminished quality of life.[4,5] Insomnia is associated with higher healthcare usage and costs, including a 2-fold increase in hospitalizations and physician visits.[6] Insomnia is also a risk factor for a number of other disorders, particularly psychiatric disorders, such as depression, and an important sign or symptom for a range of medical and other psychiatric disorders.[7]

In a recent review, Benca[8] identified the following 5 barriers to the recognition, diagnosis, and treatment of insomnia in primary care settings:

  • Inadequate knowledge base: In the 1990s, about one third of medical schools had no formal sleep medicine training. A majority of practitioners rate their knowledge of sleep medicine as only “fair.”
  • Office visit time constraints: Unless sleep difficulties are the presenting complaint, visit time may be inadequate for sleep difficulties to be addressed.
  • Lack of discussion about sleep: Less than half of patients with insomnia have discussed this problem with their physicians, and most of these discussions were patient-initiated.
  • Misperceptions regarding treatment: Health professionals may have greater concerns than warranted about the safety and efficacy of pharmacologic treatments, and they may not be aware of or have access to effective nonpharmacologic approaches.
  • Lack of evidence for functional outcomes: Although treatments for insomnia reduce symptoms in the short term, there is inadequate evidence for long-term efficacy, improvements in daytime functioning, or the impact on comorbid disorders.

Addressing these barriers could lead to improved recognition and treatment of chronic insomnia and may substantially reduce the personal and public health burden of this disorder.

The Importance of Appropriate Recognition and Treatment of Chronic Insomnia: NIH State-of-the-Science Conference Statement

The purpose of this Clinical Update is to emphasize the importance of appropriate recognition of and treatment for chronic insomnia based on the recently published statement from the National Institutes of Health (NIH) State-of-the-Science Conference on the Manifestations and Management of Chronic Insomnia in Adults.[9] An independent panel of health professionals convened in June 2005 to evaluate the evidence from (1) systematic literature reviews prepared by the Agency for Health Research and Quality, (2) presentations by insomnia researchers over a 2-day public session, (3) questions and comments by conference attendees during the public sessions, and (4) closed deliberations by the panel. This process resulted in a State-of-the-Science (SOS) Conference Statement on chronic insomnia, including implications for clinical and research efforts.

The SOS Conference proceedings and statement were organized around the following 5 questions, which serve as the outline for this Clinical Update:

  • How is chronic insomnia defined, diagnosed, and classified, and what is known about its etiology?
  • What are the prevalence, natural history, incidence, and risk factors for chronic insomnia?
  • What are the consequences, morbidities, comorbidities, and public health burden associated with chronic insomnia?
  • What treatments are used for the management of chronic insomnia, and what is the evidence regarding their safety, efficacy, and effectiveness?
  • What are important future directions for insomnia-related research?

The SOS Conference focused on adults with chronic insomnia, not acute or episodic manifestations, which typically resolve in a few weeks, often without intervention. Although secondary or comorbid insomnia (insomnia associated with other conditions) was considered with respect to diagnosis and classification, the conference focused on the treatment of primary insomnia, not on any existing comorbid conditions. This Clinical Update, therefore, follows the scope of the SOS Conference and focuses on chronic primary insomnia in adults. Information in the SOS Conference Statement is augmented by the research literature, including a number of excellent, recent reviews on the clinical management of insomnia.[8,10-14]

How Is Chronic Insomnia Defined, Diagnosed, and Classified, and What Is Known About Its Etiology?

Case Study: Part 1

A 56-year-old woman presents for routine monitoring of postmenopausal symptoms and bone density, following a 2-year course of hormone replacement therapy that was initiated 5 years ago when she began experiencing hot flashes and depressive symptoms. During the visit, she is asked about her sleep and reveals that she has difficulty falling asleep most nights and sometimes awakens in the middle of the night, and is unable to go back to sleep. She notes frustration at her inability to get a good night’s sleep, particularly because she often feels tired and has difficulty concentrating at work. She reports that her insomnia began about the time of her menopausal symptoms, but has continued even though her other menopausal symptoms have resolved.

What steps should be taken to diagnose her condition?

Detecting Sleep Difficulties

The patient in the case above has a distinct advantage over many patients who suffer with insomnia because her healthcare professional specifically asked about her sleep. As early as Hippocrates, sleep has been an important indicator of patient health. “Disease exists, if either sleep or watchfulness be excessive”: Hippocrates, Aphorism LXXI.[12] In a recent study of adult primary care patients with insomnia, only about half reported discussing insomnia with their physicians.[15] Other studies have found that only 10% to 30% of those with insomnia discussed this problem with their physicians,[16] and most healthcare providers fail to ask about sleep.[2] Asking a simple question, such as “How have you been sleeping?” can lead to the detection of insomnia and a range of other sleep-related conditions.[17]

Definitions and Diagnostic Criteria for Chronic Insomnia. Insomnia is a sleep disturbance that most often manifests as difficulty initiating sleep, but also manifests as difficulty maintaining sleep or experiencing early-morning awakenings.

How much sleep disruption is sufficient for the diagnosis of insomnia? Normal sleep needs vary greatly from individual to individual. Moreover, the degree of sleep disturbance in those with insomnia can be quite variable from night to night, including nights without any sleep disturbance. Although quantitative indices for sleep-onset latency (≥ 30 minutes) and for sleep efficiency (percentage of total time asleep over total time in bed ≤ 85%) have been used for research purposes,[18] these indices do not correlate well with the patient’s experience of insomnia.[19] Therefore, the subjective experience of inadequate sleep is frequently more important than quantitative sleep indices in diagnosing insomnia.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) defines primary insomnia as a difficulty initiating or maintaining sleep or experiencing nonrestorative sleep that results in clinically significant distress or impairment in functioning.[20] Based on these criteria, someone who does not appear to have objective manifestations of sleep disturbance but whose sleep is sufficiently inadequate or nonrestorative to produce distress or dysfunction would meet the criteria for insomnia. In contrast, someone who gets only a few hours of sleep each night but feels rested and without associated distress or dysfunction does not meet the criteria for insomnia. Therefore, subjective impressions of nonrestorative sleep with associated distress or dysfunction are important symptoms of insomnia.

These complaints of disturbed sleep also must occur in the context of adequate opportunity and circumstances for sleep. Although disruption of sleep from environmental perturbations may place someone at risk for insomnia, sleep disruption is not classified as insomnia unless there is adequate opportunity to sleep. Resident physicians on call or mothers of newborns commonly experience sleep disturbances, nonrestorative sleep, and daytime distress or impairment from inadequate sleep, but these problems are not diagnosed as insomnia because they are the result of having an inadequate opportunity to sleep.

Many people experience insomnia on occasion, but most of these “acute” or “episodic” forms of insomnia are transient and typically resolve without treatment. The duration required for insomnia to be “chronic” has varied from as little as 1 month to as long as 6 months. Based primarily on recent Research and Diagnostic Criteria (RDC) for insomnia,[21] the SOS Conference Statement concluded that insomnia lasting 1 month or more is clinically important and indicates the need for professional attention.

The SOS Conference Statement concluded that insomnia lasting 1 month or more is clinically important and indicates the need for professional attention.

RDC for insomnia. The Academy of Sleep Medicine recently developed RDC for insomnia[21] in an effort to merge different nosologies and improve the diagnostic reliability of insomnia. The RDC criteria also provide 3 subclassifications of primary insomnia: Psychophysiologic Insomnia, Paradoxical Insomnia (Sleep State Misperception), and Idiopathic Insomnia, which may facilitate research on potential etiologies of this disorder. These diagnostic criteria will be included in the second edition of the International Classification of Sleep Disorders (ICSD-2) and will likely be adopted in the next International Classification of Diseases (ICD) version. The RDC diagnostic scheme first delineates the criteria for an insomnia disorder and then specifies the exclusion criteria for primary insomnia. Compared with the DSM-IV criteria, the RDC insomnia criteria specify the requirement for adequate opportunity or circumstances for sleep and provide greater detail of the distress or functional impairment criteria. The RDC criteria for primary insomnia also clarify that the presence of a comorbid disorder does not exclude the diagnosis of primary insomnia unless the insomnia can be attributed exclusively to the comorbid disorder.

Comorbid insomnia. Primary insomnia is a diagnosis of exclusion. Numerous other conditions can contribute to the onset or maintenance of insomnia, including psychiatric disorders, substance abuse, other sleep disorders, or medical conditions/treatments. In the past, insomnia was considered “secondary” if it appeared due to another condition, but this was often difficult to determine clinically.[22] In addition, the relationship between insomnia and various comorbid disorders is complex and multidirectional. For example, insomnia may be a symptom of comorbid depression, but it may also be a separate and predisposing condition for depression.[23]

Given these complexities, the SOS Conference Panel recommended that “comorbid insomnia” replace the term “secondary insomnia.” The practical implication of this terminology for clinicians is that insomnia should not be relegated to secondary status whenever a comorbid disorder exists. The presence of comorbid disorders needs to be evaluated, and temporal relationships between the course of the comorbid disorder and the insomnia may shed light on possible etiologic relationships between them,[7] but it cannot be assumed that treating only the comorbid disorder will result in resolution of the insomnia as well.

The SOS Conference Panel recommended that “comorbid insomnia” replace the term “secondary insomnia.”

Clinical assessment of insomnia. The diagnosis of insomnia is based primarily on the patient’s history. Reports by family members, particularly the bed partner, can augment the assessment of sleep behavior and daytime functioning. Medical history and physical examination are also useful for determining the presence of possible comorbid syndromes.[7]

Sleep diaries are frequently used to document sleep-and-wake behaviors. In addition to providing data to support a diagnosis, these data are often used to devise treatment plans and to monitor treatment outcomes. Patients are typically instructed to complete the diary each morning after awaking and provide their best estimates of variables, such as time in bed, time of sleep onset, awakenings, and wake time. These data are only estimates by patients and tend to underestimate actual sleep time, but they are useful for assessing individual sleep patterns, possible factors associated with poor sleep, and changes in sleep over time. There are also a number of self-report instruments, a few of which have been adequately standardized and validated for monitoring outcomes.[24]

To provide more objective measures of sleep behavior, actigraphs or accelerometers have been used in research trials to infer sleep-and-wake behaviors from changes in the amount of movement. Although useful, actigraphs have not been fully validated and may underestimate sleep time if sleep is restless or fitful (eg, with comorbid restless legs syndrome). Actigraphs and other automated measures of sleep behavior have not typically been used in routine practice, but can provide more objective measures of sleep patterns, especially when the patient’s report is in question (eg, sleep-state misperception).[25]

Polysomnography remains the gold standard for measuring sleep-wake states; however, the American Academy of Sleep Medicine does not recommend polysomnography for the assessment of insomnia except when needed to rule out a comorbid disorder, such as sleep apnea.[26] In addition to expense, polysomnography is unlikely to provide an accurate representation of an insomnia patient’s sleep difficulties given the night-to-night variability of sleep behavior and influence of the sleep environment on insomnia symptoms.

The American Academy of Sleep Medicine does not recommend polysomnography for the assessment of insomnia except when needed to rule out a comorbid disorder, such as sleep apnea.

Etiology of insomnia. Although there is growing consensus about the appropriate diagnostic criteria and procedures for insomnia, the possible etiologic factors for insomnia remain poorly understood. Spielman’s 3 Ps — predisposing, precipitating, and perpetuating factors — is a useful model for organizing various etiologic factors.[27]

Very little is known about possible predisposing factors for insomnia. Other than some limited research suggesting familial aggregation,[28,29] there are no data on genetic predisposition for insomnia. There is considerable research on the neurobiology of sleep-wake states, including the inhibitory feedback loop involving the GABA and galanin neurons in the ventrolateral preoptic nucleus of the hypothalamus and the orexin or hypocretin neurons in the posterior hypothalamus, which serve as a “flip-flop” switch of major cortical arousal systems.[30,31] It remains unclear, however, how these systems are dysfunctional in insomnia. Deficiencies in endogenous melatonin or benzodiazepine receptors and hyperactivity of corticotropin-releasing factor neurons are possible etiologic factors, but further research is needed to better understand these potential etiologies for insomnia.[32]

The possible etiologic factors for insomnia remain poorly understood, and little is known about possible predisposing factors for insomnia.

Hyperarousal appears to be an important mechanism for insomnia. Research has shown increased brain glucose metabolism when awake or asleep, increased beta and decreased theta and delta during sleep, and increased adrenocorticotropic hormone activity.[33,34] Results from recent functional imaging studies provide additional support for the central nervous system hyperarousal hypothesis.[35]

Potential precipitating factors for insomnia are numerous and include many of the possible disorders that are comorbid with insomnia, such as psychiatric disturbance, sleep-wake schedule changes, medical conditions and their treatments, other sleep disorders, and substance use. Substances, including caffeine, theophylline and other stimulants, steroids, antihypertensives, and antidepressants, can also precipitate insomnia.[12] A recent study found that family, health, and work-school-related events were the most common precipitating factors for insomnia, and that even positive events can precipitate insomnia.[36]

There is general agreement that insomnia, regardless of how it is precipitated, is perpetuated by cognitive and behavioral mechanisms. Cognitive factors involved in perpetuating insomnia include misconceptions about normal sleep needs and stability, misattributions about the causes of sleep disturbance, and catastrophic worry about the daytime effects of inadequate sleep.[18,37] These dysfunctional beliefs often promote behaviors that are intended to improve sleep but are disruptive to sleep homeostasis and a consistent sleep-wake cycle (eg, taking naps and sleeping in late to “catch up” on sleep). These sleep-disruptive behaviors are further perpetuated by behavioral conditioning, which produces conditioned arousal to stimuli that would normally be associated with sleep.[38] It is important to recognize that these cognitive and behavioral perpetuating factors may be present in both comorbid and primary

What Are the Prevalence, Course, Incidence, and Risk Factors for Chronic Insomnia?

Prevalence of Chronic Insomnia

Estimates of the prevalence of insomnia vary depending on the definition used. Approximately one third of the general population complains of sleep disruption, and 9% to 15% of the population report associated daytime impairment consistent with the diagnosis of insomnia.[1] However, the proportion of those reporting sleep disturbance with daytime impairment who would meet the diagnostic criteria for insomnia is unclear. Among patients in primary care, the prevalence rates for insomnia are much higher, as high as 50%.[4] In a large survey of managed care participants, over one third experienced symptoms of insomnia, although less than 1% presented with an insomnia complaint.[39]

Incidence, Natural Course, and Duration of Chronic Insomnia

The SOS Conference Statement noted that there is very little known about the incidence, natural course, and duration of insomnia. Limited evidence suggests that insomnia is a chronic and persisting condition with low rates of spontaneous remission and possible recurrence after a period of remission, but these processes are poorly understood.

There is very little known about the incidence, natural course, and duration of insomnia.

Risk Factors for Chronic Insomnia

Given that most research on risk factors for insomnia is cross-sectional, not longitudinal, it is difficult to know whether potential risk factors are causal or correlational. The prevalence of insomnia is higher in divorced, separated, or widowed adults, and in those with lower education and income levels.[1] Insomnia is also more likely to occur in women, especially postmenopausal women.[1] There is an increased prevalence of insomnia in older adults, but it remains unclear to what extent this is independent of declining health and comorbid influences. Sleep patterns, however, do change with age. Older people experience more awakenings during the night, lower sleep efficiency, less sleep, more variable sleep, and lighter sleep than younger adults.[40]

Several psychiatric and medical disorders are associated with insomnia. As noted earlier, however, these relationships are complex and multidirectional. For example, research on the relationship between insomnia and depression indicates that it is more likely that insomnia is a risk factor for depression than that depression is a risk factor for insomnia. Insomnia appears to be predictive of a number of disorders, including depression, anxiety, alcohol abuse/dependence, drug abuse/dependence, and suicide.[41] Medical and sleep disorders that potentially disrupt sleep (eg, chronic pain conditions, such as arthritis, or sleep apnea) may be precipitants of or risk factors for insomnia. Substance abuse and the use of prescribed medications that can disturb sleep also can be risk factors for insomnia.

It is difficult to know whether potential risk factors are causal or correlational. Several psychiatric and medical disorders are associated with insomnia, but these associations are complex and multidirectional.

What Are the Consequences, Morbidities, Comorbidities, and Public Health Burden Associated With Chronic Insomnia?

Economic Costs of Insomnia

Insomnia is associated with high healthcare utilization. Walsh and Ustun[42] estimated annual direct total costs for insomnia at about $12 billion for healthcare services and $2 billion for sleep-promoting agents. People with insomnia have more medical problems and use more medications than those without insomnia, and they have double the number of office visits and hospitalizations as those without insomnia.[6,43]

The relative contribution of insomnia and comorbid conditions to these costs remains unclear. Indirect costs of insomnia are even less clear. In 1994, the economic costs of insomnia were estimated at $80 billion annually.[44,45] These indirect cost estimates are higher than those for other chronic conditions, such as rheumatoid arthritis,[46] but there are limited data available to reliably estimate the indirect costs of insomnia.

Effects of Insomnia on Functioning and Quality of Life

Sleep loss does result in impaired psychomotor and cognitive functioning, but these impairments are less pronounced for insomnia.[47] Despite the equivocal impact of insomnia on memory and cognitive functioning, insomnia is related to occupational role dysfunction, including increased absenteeism and decreased work performance.[4,43] These daytime impairments, however, may be more related to the chronic hyperarousal state[48] or to perceptions of sleep deprivation[49] than to actual sleep loss from insomnia.

In considering the consequences of insomnia, it is important to differentiate being sleepy from being tired or fatigued. Sleepiness involves recurrent episodes of being drowsy and involuntarily falling asleep in nonstimulating environments (ie, dozing off). Sleepiness is more often associated with other primary sleep disorders, such as narcolepsy, sleep apnea, and periodic limb movement disorder. In contrast, those with insomnia are often tired or fatigued but not sleepy.[48,50]

Insomnia is associated with substantial impairments in quality of life. Although insomnia is often considered more benign than most other chronic medical and psychiatric disorders, the impairments in quality of life in insomnia are comparable to those observed in diabetes, arthritis, and heart disease.[5] Quality of life also improves with treatment for insomnia, although not to the level of the normal population.[51]

Insomnia is associated with substantial impairments in quality of life that are comparable to the impairments observed in other chronic medical disorders.

Comorbidities and Morbidities

Approximately 40% of adults with insomnia also have a diagnosable psychiatric disorder.[16] In addition, approximately three quarters of people presenting to sleep clinics or general medical practices with insomnia have a comorbid psychiatric disorder.[52] Although there are a number of psychiatric disorders that are comorbid with insomnia (eg, generalized anxiety disorder, attention-deficit/hyperactivity disorder, and schizophrenia), depression has received the most attention. Insomnia was once considered only a symptom of depression or secondary to depression. Recent research, however, has consistently shown that insomnia is a predisposing factor for depression. Insomnia often occurs prior to the onset of depression,[53] and often precedes depression relapses.[54,55] Those with persistent insomnia are also much more likely to develop depression at a later time.[16,56] In addition to depression, insomnia is associated with an increased risk for suicide[57] and is a precipitant of manic episodes in those with bipolar disorder.[58]

Insomnia is common in other primary sleep disorders, such as sleep apnea (sleep-disordered breathing [SDB]), restless legs syndrome, and periodic limb movement disorder. In these cases, insomnia may be secondary or fully attributable to the underlying sleep disorder, but often is a comorbid disorder precipitated by the other primary sleep disorder but perpetuated by cognitive and conditioning factors.[59] SDB typically presents clinically with nonrestorative sleep complaints and disturbed sleep maintenance with normal sleep onset. Snoring and/or apnea episodes are often reported by the bed partners, but patients are typically unaware of their sleep-related symptoms. If positive indications of SDB are found during a clinical interview, then overnight sleep recording is typically performed to establish the diagnosis and determine its severity.[7,59] SDB may be exacerbated by benzodiazepines, so it is important to rule out this condition before proceeding with insomnia treatment.

A number of chronic medical conditions are associated with insomnia, including chronic pain syndromes, coronary heart disease, asthma, gastrointestinal disorders, vascular disorders, chronic fatigue, and endocrine and metabolic disorders.[7] In addition, substances, including caffeine, theophylline and other stimulants, steroids, antihypertensives, and antidepressants, can precipitate insomnia.[12]

Although many of the disorders comorbid with insomnia are associated with increased mortality rates, insomnia itself does not appear to be associated with higher mortality. In a recent longitudinal study, neither insomnia nor the use of hypnotics for insomnia increased the risk for mortality over a 6-year period.[60] Higher mortality has been associated with either too much or too little sleep, but not with insomnia disorder per se.[61,62]

Insomnia is frequently comorbid with psychiatric disorders, other primary sleep disorders, and chronic medical conditions.

What Treatments Are Used for the Management of Chronic Insomnia, and What Is the Evidence Regarding Their Safety, Efficacy, and Effectiveness?

Case Study: Part 2

The patient’s medical history reveals menopausal symptoms that were controlled on hormone replacement therapy and did not recur following discontinuation 3 years ago. Her insomnia symptoms, however, have continued and worsened in the past 5 years. The patient is otherwise healthy. She does not report pain at night, snoring or gasping for air during sleep, or restless legs. She does report awakening at least once a night to urinate, but indicates that she is sometimes unable to return to sleep after awakening.

The clinical interview reveals no other psychiatric disorder. She has no history of substance abuse or dependence, but does indicate that she has begun drinking a glass or 2 of wine at night to help her fall asleep. She describes primarily being unable to fall asleep, and says it takes her an hour or 2 to fall asleep most nights. She also describes awakening during the night, sometimes being unable to go back to sleep, and that these sleep-maintenance symptoms have worsened in the past 6 months. She reports hearing that older people can get by on less sleep, but that she feels tired and irritable after nights of inadequate sleep. She is beginning to believe that she is not functioning as well at work because of her sleep difficulties. She reports feeling particularly distressed in the evening as her bedtime approaches and worries whether she will get enough sleep to perform well the next day.

The patient is provided with general information about sleep and insomnia and reassured that her sleep difficulties can be managed. She is provided with a sleep diary and asked to record her sleep-wake patterns for 2 weeks and then to return with her husband to complete the evaluation.

At the second visit, her husband confirms that she does not snore loudly or excessively and does not appear to experience short bouts of not breathing while asleep. He reports that she does have difficulty going to sleep and will toss and turn for an hour or so before falling asleep. On 2-3 mornings each week, he wakes up and finds that she is not in bed but that she got up during the night and later fell asleep while watching television downstairs. On weekends, he usually lets her sleep in late. He reports that she is sometimes so tired after a bad night that she will come home from work and take a nap before dinner. Her sleep diary reveals an average sleep-onset latency of about 45 minutes each night, that she is awake for over an hour during the night on about half the nights, a mean total sleep time of 6 hours and 30 minutes per night, and a mean sleep efficiency of 82%.

Based on this assessment, what treatment approaches should be considered?

Cognitive Behavioral Therapy

Cognitive behavioral therapy for insomnia (CBTI) addresses the hyperarousal, cognitive, and conditioning factors that appear to perpetuate the disorder. CBTI typically consists of 5 major components:[38]

  • Sleep-hygiene strategies to promote a sleep environment and routine that promote sleep.
  • Relaxation therapy (progressive muscle relaxation, visual imagery, etc) to reduce physiologic arousal.
  • Cognitive restructuring to change dysfunctional attitudes about sleep (eg, attempting to will oneself to sleep or excessive worrying about the effects of not sleeping).
  • Stimulus control to reassociate the bed and bedroom with going to sleep instead of staying awake. These instructions include (1) going to bed only when sleepy, (2) establishing a standard wake-up time, (3) getting out of bed whenever awake in bed for 15 minutes or more, (4) avoiding doing sleep-incompatible behaviors (reading or watching television) while in bed, and (5) refraining from daytime napping.
  • Sleep restriction to condense time in bed to the average time typically asleep. For this component, the time to bed is set based on the average time asleep but not less than 5 hours, and then it is gradually increased as sleep efficiencies improve.

The American Academy of Sleep Medicine Task Force on nondrug alternatives for primary chronic insomnia[63] found that CBTI produced reliable and durable improvement in chronic insomnia. Nearly 80% of those treated with CBTI show measurable benefit, but the magnitude of the benefit varies. CBTI produces objective improvements as well as subjective improvements in sleep and appears to improve homeostatic sleep regulation.[64] Although most of the research on CBTI is with primary insomnia, CBTI has been shown to produce benefits for the comorbid condition as well as for the insomnia.[65]

Sleep hygiene is the component of CBTI that is most often provided by healthcare providers,[66] and patients tend to like and adhere to sleep-hygiene strategies.[67] Unfortunately, sleep hygiene appears to be the least effective CBTI component. Stimulus control and sleep restriction are the most effective CBTI components,[68] but patients have the most difficulty adhering to these components.[67]

When CBTI is compared with medications, sedative hypnotics appear to produce more rapid improvements, but the long-term safety and efficacy of sedative hypnotics are less well established than CBTI.[69,70] The efficacy of CBTI, particularly long-term, and the minimal apparent adverse effects of this treatment have resulted in it being considered a first-line treatment for primary insomnia.[70]

Challenges with CBTI. Although CBTI is clearly efficacious, accessibility to this treatment has been severely limited by a general lack of knowledge regarding efficacy, inadequate coverage of this treatment by insurance carriers, and a lack of professionals trained in CBTI, even at certified sleep disorder centers.[38] The treatment is generally well accepted by patients when they are provided this option,[71] and the treatment is relatively short. Although session dosage remains unclear, Edinger and Means[38] have suggested that 4 sessions at 2-week intervals may be optimal based on their review of this treatment approach.

To increase availability, researchers have experimented with alternative methods of CBTI treatment delivery. Treatment delivery in individual, group, or phone-based sessions appears to be equally helpful.[72] Although self-help interventions appear less effective than professional assistance, self-help versions of CBTI still provide modest benefit over controls.[73] Delivery of CBTI via the Internet and other technologies is a promising new approach area for potentially improving the accessibility of this efficacious treatment for insomnia.[74]

Although CBTI is not typically provided by primary care health professionals, recent efforts show this to be another potential strategy for providing this treatment to those with insomnia. Indeed, allied healthcare providers have been trained to deliver CBTI with some success.[75] Recently, Edinger and Sampson[76] devised a “primary care friendly” form of CBTI. This abbreviated form of CBTI involves two 25-minute sessions 2 weeks apart. Session 1 consists of reviewing sleep logs and providing sleep education, stimulus control, and sleep-restriction instructions, such as eliminating activities that are incompatible with sleep, avoiding daytime naps, and setting up a consistent sleep-wake schedule (including sleep restriction). Session 2 consists of reviewing progress, addressing adherence difficulties, and modifying sleep strategies accordingly. This abbreviated treatment was significantly better than sleep-hygiene instructions alone for most insomnia measures and resulted in reductions of insomnia symptoms to normal levels in over half of patients.[76]

Although CBTI is efficacious, accessibility to this treatment has been severely limited by a general lack of knowledge regarding efficacy, inadequate coverage of this treatment by insurance carriers, and a lack of professionals trained in CBTI, even at certified sleep disorder centers.

US Food and Drug Administration-Approved Medications

Benzodiazepine and nonbenzodiazepine hypnotics. Both benzodiazepine and nonbenzodiazepine hypnotics have been approved for the treatment of insomnia.

Benzodiazepine hypnotics. The benzodiazepine hypnotics approved by the US Food and Drug Administration (FDA) for the treatment of insomnia are estazolam, flurazepam, quazepam, temazepam, and triazolam. These medications have been found effective in a number of double-blind, placebo-controlled trials, but these trials have typically been short-term (4-6 weeks).[77] Even with longer term use, there is a reduced effect after 4-8 weeks.[78] Except for triazolam, these benzodiazepine hypnotics have long half-lives, which contribute to their efficacy for maintaining sleep, but also result in higher rates of next-day impairments, such as morning sedation, cognitive impairment, and motor incoordination.[79] Temazepam is the most commonly prescribed benzodiazepine hypnotic,[80] but, despite its long half-life, it appears to have minimal impact on number of awakenings, and produces tolerance, morning sedation, and cognitive impairment.[8] Triazolam, the only short half-life agent in this group, has more of an impact on sleep onset than maintenance, but possible amnestic effects have been a concern.[81,82]

Except in those with a history of substance abuse, abuse liability from these benzodiazepine hypnotics appears to be minimal.[83] However, due to concerns about abuse liability, the FDA has indicated that these medications should be limited to 7-10 days of use with reevaluation if used for more than 2-3 weeks. Some have argued that these limitations were based on now obsolete guidelines,[84] and that longer term use may not increase the risk for abuse liability,[85] but the long-term effects of these medications on tolerance and abuse liability require further study.

Nonbenzodiazepine hypnotics. Nonbenzodiazepine hypnotics are a new class of hypnotics that act on specific benzodiazepine receptor subtypes, but have a nonbenzodiazepine structure. Three nonbenzodiazepine hypnotics — zaleplon, zolpidem, and eszopiclone — have been approved by the FDA for the treatment of insomnia. As a class, these medications generally have shorter half-lives than their benzodiazepine predecessors, which results in greater effects on sleep onset than sleep maintenance and minimal morning sedation and other daytime impairments. Nonbenzodiazepine hypnotics also may have less abuse liability potential than benzodiazepine hypnotics, although further research is needed.[86]

Zolpidem is the most commonly prescribed agent for insomnia,[80] and due to its rapid onset and short half-life (1.5-4 hours), it has more of an effect on sleep onset than sleep maintenance.[87] Modified-release formulations may provide better sleep-maintenance effects, but data on these formulations are still needed.[88] Efficacy data do not extend beyond 1-2 months, so the effects of longer term use are unknown.[89]

Zaleplon has a very short half-life of only about 1 hour and, therefore, affects primarily sleep onset.[90] Higher doses may affect sleep maintenance and may increase the risk for side effects.[91] Although studies of zaleplon have been of longer duration than zolpidem, long-term safety and efficacy beyond 1-3 months have not been established.[92,93]

Eszopiclone is the newest medication in this group, and it has the longest half-life (5-6 hours). Studies show that this half-life appears adequate to produce effects on sleep maintenance as well as sleep onset while also resulting in minimal morning sedation.[94,95] Eszopiclone does not have a limitation on duration of use, and recent findings have shown efficacy and safety with minimal tolerance or abuse liability over 12 months of use.[96]

As a group, these medications appear to produce minimal sedation effects or psychomotor impairment.[97,98] These reduced side effects relative to benzodiazepine hypnotics appear to be due to their short half-lives more so than their selective receptor agonist effects.[99] Nonbenzodiazepine hypnotics also may produce potentially fewer or less severe drug interactions than many of the benzodiazepine hypnotics because they rely less exclusively on CYP3A4 metabolism.[100] Substantial proportions of these medications, however, are still metabolized through CYP3A4; so these medications, as is the case with the most traditional benzodiazepine hypnotics, should be carefully monitored if CYP inducers (rifampicin) or CYP3A4 inhibitors (ketoconazole, erythromycin, and cimetidine) are also being prescribed.[100] Alcohol also potentiates the effects of all hypnotics, so patients should be instructed not to drink, and if they do, to understand that they will feel more sedated the next morning, potentially affecting their ability to drive.

Medications for insomnia are typically taken every night on a prophylactic basis to manage insomnia. Due to the rapid onset and minimal abuse liability of nonbenzodiazepine hypnotics, nonnightly or as-needed use has been considered and appears safe and efficacious in preliminary trials.[101] Further trials, however, are needed to substantiate the safety and efficacy of long-term, nonnightly administration.

Nonbenzodiazepine hypnotics have shorter half-lives, which result in greater effects on sleep onset than sleep maintenance and minimal morning sedation and other daytime impairments. They may also be associated with fewer or less severe drug interactions, and may have less abuse liability than benzodiazepine hypnotics.

Discontinuation of hypnotics. Little research has been conducted on the persistence or reappearance of symptoms after prescription therapy is discontinued. Discontinuation of hypnotics, whether benzodiazepine or nonbenzodiazepine, generally results in relapse of symptoms. Many of the benzodiazepines also produce rebound insomnia, insomnia that is worse than pretreatment levels, for a few days. Rebound insomnia also may be reduced with the newer nonbenzodiazepine hypnotics, although further research is needed.[78] CBTI has been used to reduce relapse rates after benzodiazepine discontinuation.[102]

Melatonin receptor agonists. The FDA recently approved ramelteon for the treatment of chronic insomnia. Ramelteon is a selective melatonin receptor agonist (MT1, MT2) that is rapidly absorbed (< 1 hour) and has a relatively short half-life (2-5 hours). Initial studies of ramelteon have shown reduced sleep-onset latency compared with placebo, with a low rate of side effects and adverse events.[103] Abuse liability also appears to be minimal. Ramelteon should not be prescribed concomitantly with strong CYP1A2 inhibitors, such as fluvoxamine. Although ramelteon is a promising alternative to sedative-hypnotics, further research on its safety and efficacy, particularly long-term, is needed.

Prescription Drugs Without FDA Approval for Insomnia

Trazodone is one of the most commonly prescribed medications for the treatment of insomnia, comparable to zolpidem.[80] The low cost of antidepressant medications along with unrestricted long-term use and minimal abuse liability may be factors leading to the increased use of these medications for insomnia.

Trazodone is sedating, but there is a paucity of data on its effects on insomnia. Research has usually been performed with small, comorbid, depressed samples with short and equivocal effects on sleep.[104,105] Trazodone can have significant side effects, including orthostatic hypotension, blurred vision, nausea, dry mouth, constipation, drowsiness, headache, and (rarely) priapism. These side effects also increase the risk for falls and accidents, which can have serious consequences in the elderly. Although these risks are less pronounced at the lower doses typically used for insomnia, the risk-benefit ratio may be too great in some situations to use trazodone for insomnia.[106] There are also limited data on the short-term effects of doxepin[107] for insomnia. The potential adverse effects from trazadone, doxepin, and other antidepressants overshadow the limited efficacy data on these medications. Dose-response relationships of antidepressants for insomnia also are poorly understood.[108,109]

The SOS Conference Statement notes that various other medications have been used in the treatment of insomnia, including barbiturates (phenobarbital) and antipsychotics (quetiapine and olanzapine). These medications, however, have serious side effects and adverse risks with little to no data supporting their efficacy. Therefore, these medications are not recommended for the treatment of insomnia.

According to the SOS Conference Statement, the risk-benefit ratio may be too great in some situations to use trazodone or other antidepressants for the treatment of insomnia. In addition, barbiturates (phenobarbital) and antipsychotics are not recommended for the treatment of insomnia.

Over-the-Counter Medications

Over-the-counter (OTC) medications are frequently used for insomnia. About one fourth of US adults with sleep difficulties use OTC sleep aids.[110]

Antihistamines (H1 receptor agonists, such as diphenhydramine) are the most commonly used OTC medications for insomnia. There is, however, no systematic evidence of efficacy for insomnia, and there are significant side effects, including dry mouth, blurred vision, urinary retention, constipation, and a risk for increased intraocular pressure in patients with narrow angle glaucoma.[111]

Alcohol is often used to reduce sleep-onset latency. Although alcohol does reduce sleep latency, it also results in poorer quality sleep and nighttime awakening. Alcohol also is clearly not appropriate for someone with a risk for substance use. Therefore, alcohol cannot be recommended as a sleep aid.[112]

Melatonin is a natural hormone that is produced by the pineal gland that has a role in circadian rhythm control. Melatonin may be helpful for reducing symptoms of jet lag, but there is minimal evidence of efficacy for insomnia. Melatonin appears to be safe for short-term use, but long-term safety is unknown. Except for the recently FDA-approved ramelteon, melatonin compounds are unregulated, and preparations may vary.[113]

L-tryptophan is an endogenous amino acid sometimes used as a hypnotic. Evidence of efficacy for insomnia, however, is extremely limited and there are possible toxic interaction effects with some psychiatric medications.[114]

Valerian is derived from the valeriana plant root and thought to promote sleep, but there is no proven benefit for insomnia. Valerian is unregulated and possibly associated with hepatotoxicity. Other herbal products are sometimes used for insomnia, but there are no data supporting their efficacy and there are similar concerns about safety and drug interactions.[115]

Other alternative treatments, such as tai chi, yoga, acupuncture, and light therapy, have been used to treat insomnia, but they have not been adequately evaluated.[114,116]

OTC products, alternative treatments, and complementary therapies are often used to treat insomnia. These therapies, however, have not been systematically evaluated; efficacy data are lacking; and there are concerns about side effects.

Case Study: Part 3

Following the clinical assessment, the patient is advised regarding treatment approaches. Although menopausal symptoms appear to have been a precipitant of the insomnia, these symptoms have resolved and no longer appear to be related to the insomnia. The patient is counseled about cognitive behavioral and sedative-hypnotic approaches for insomnia. Given the minimal risks, she would prefer to try CBTI first, but the nearest specialist with expertise in CBTI is 2 hours away. Therefore, she agrees to try one of the newer sedative-hypnotics and to obtain an abbreviated form of CBTI from the nurse practitioner who has some limited training in this approach.

Because she presents with both sleep-onset and sleep-maintenance difficulties, and may require long-term medication use to control her insomnia, she is started on an agent appropriate for long-term administration immediately before bed each night, and advised that it may be necessary to increase her prescription if her sleep difficulties, particularly sleep maintenance difficulties, persist.

The patient meets with the nurse practitioner who provides information about sleep hygiene and instructs her to refrain from using alcohol to fall asleep, particularly in combination with her medication. A consistent wake time of 7:00 am is agreed to and a time to bed of 12:30 am is determined based on her average time asleep from her sleep diaries. The patient is concerned that she may be more tired than usual if she goes to bed this late, but is reassured that she will be getting the same amount of sleep as she usually does, just more consolidated. She is also instructed to get out of bed if she does not fall asleep within 15 minutes, to do something restful, and then return to bed when she feels sleepy again. She is assured that she can function adequately the next day if she does not get much sleep, which she has been doing for years, and that she can only control getting in and out of bed, not if and when she falls asleep while in bed. She is encouraged not to take naps and to maintain her regular wake time even if she did not sleep well the night before or can sleep later that morning.

After 2 weeks, the patient’s sleep diary shows that she has generally adhered to her new sleep schedule and that her sleep efficiencies are above 90% as a result of her bedtime restrictions. She is instructed to adjust her bedtime 15 minutes earlier and to readjust her bedtime earlier each week if her sleep efficiencies average above 90%. She is encouraged to continue the strategies that appear to be working, particularly maintaining a consistent bedtime, not taking naps, and getting out of bed if she is unable to fall asleep.

At a follow-up visit 1 month later, the patient reports sleeping well and feeling rested although her total sleep time is only 7.5 hours, less than she thought was adequate. She is reassured that sleep needs change over time and that her sense of feeling rested and restored is more important than how much sleep she gets. She is encouraged to continue the CBTI strategies that she has found helpful thus far. She wonders whether the medication is still needed to control her sleep. She is instructed to shift from taking it every night to taking it as needed after getting out bed if she is unable to fall asleep within 15 minutes.

At a follow-up visit 3 months later, the patient reports that she no longer takes the medication for sleep, that she continues to get about 7.5 hours of sleep per night with little to no difficulty initiating or maintaining sleep, and that she feels rested and refreshed most mornings.

What Are Important Directions for Insomnia-Related Research?

Based on what is known about the manifestations and management of insomnia, the SOS Conference Panel made a number of recommendations for future research needs:[9]

  1. Developing and validating instruments to assess chronic insomnia, particularly measures of outcome and diurnal consequences;
  2. Conducting more research on possible genetic and neural mechanisms of insomnia;
  3. Conducting longitudinal observational studies to better understand the incidence, course, and correlates of insomnia, including the adoption of sleep-disturbance items in national health survey research;
  4. Obtaining more information on the impact of insomnia on quality of life and the indirect and direct impact on individuals, caregivers, and society as a whole;
  5. Providing better estimates of the cost of illness to determine cost-effectiveness of treatments;
  6. Obtaining more long-term outcome data, particularly following discontinuation of treatment;
  7. Performing large-scale, multisite comparative treatment trials, including studies of the efficacy of combined or sequenced administration of medications and CBTI;
  8. Conducting more research on OTC and alternative remedies for insomnia;
  9. Conducting efficacy trials in subpopulations, such as children, nursing home residents, and postmenopausal women, and in those with comorbid as well as primary chronic insomnia; and
  10. Assessing clinician decision making with insomnia patients; although much is known that can inform clinical decision making, much more research is needed in this area.

Conclusions

Insomnia is a major public health problem affecting millions of individuals, their families, and their communities. Little is known about etiologic mechanisms, but hyperarousal, cognitive processes, and behavioral conditioning have some support as possible factors. Current evidence supports the efficacy of CBTI and sedative-hypnotics for the treatment of insomnia. Despite widespread use, there is very little evidence supporting the use of other treatments, such as antidepressants and OTC agents, for the treatment of insomnia.

Although there are a number of efficacious medications for insomnia, the SOS Conference Panel noted concern about the mismatch between the chronic, long-term nature of the disorder and the short duration of most clinical trials. Only eszopiclone has been evaluated in trials lasting 6-12 months. Newer medications not yet approved, such as indiplon (a short-acting nonbenzodiazepine hypnotic), provide additional options for the treatment of chronic insomnia, but there remains a clear need for new and more targeted drug therapies that can be used safely and effectively long-term. CBTI shows promising long-term effects with minimal safety concerns, and accessibility to this treatment option should be expanded.

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The Cost of Disatisfaction at Work

In Mindfulness, Well-being on Monday, 17 September 2012 at 07:36

Happy Employees Are Critical For An Organization’s Success, Study Shows 

ScienceDaily (Feb. 4, 2009)

 One’s happiness might seem like a personal subject, but a Kansas State University researcher says employers should be concerned about the well-being of their employees because it could be the underlying factor to success.

 Thomas Wright, Jon Wefald Leadership Chair in Business Administration and professor of management at K-State, has found that when employees have high levels of psychological well-being and job satisfaction, they perform better and are less likely to leave their job — making happiness a valuable tool for maximizing organizational outcomes.

“The benefits of a psychologically well work force are quite consequential to employers, especially so in our highly troubled economic environment,” Wright said. “Simply put, psychologically well employees are better performers. Since higher employee performance is inextricably tied to an organization’s bottom line, employee well-being can play a key role in establishing a competitive advantage.”

Happiness is a broad and subjective word, but a person’s well-being includes the presence of positive emotions, like joy and interest, and the absence of negative emotions, like apathy and sadness, Wright said.

An excessive negative focus in the workplace could be harmful, such as in performance evaluations where negatives like what an employee failed to do are the focus of concentration, he said. When properly implemented in the workplace environment, positive emotions can enhance employee perceptions of finding meaning in their work.

In addition, studies have shown that being psychologically well has many benefits for the individual, Wright said. Employees with high well-being tend to be superior decision makers, demonstrate better interpersonal behaviors and receive higher pay, he said. His recent research also indicates that psychologically well individuals are more likely to demonstrate better cardiovascular health.

Wright said happiness is not only a responsibility to ourselves, but also to our co-workers, who often rely on us to be steadfast and supportive. In addition, Employee well-being affects the organization overall. Studies have shown that after controlling for age, gender, ethnicity, job tenure and educational attainment level, psychological well-being still is significantly related to job performance, according to Wright.

Wright said psychologically well employees consistently exhibit higher job performance, with significant correlations in the 0.30 to 0.50 range. Not only are these findings statistically significant, they are practically relevant as well, he said. A correlation of 0.30 between well-being and performance indicates that roughly 10 percent of the variance in job performance is associated with differences in well-being, while a correlation of 0.50 points to a substantial 25 percent of the variance.

In some of Wright’s academic and consulting work, he has used a form of utility analysis to determine the level of actual savings tied to employee well-being. For example, in a sample of management personnel with average salaries in the $65,000 range, he found that being psychologically distressed could cost the organization roughly $75 a week per person in lost productivity. With 10 employees that translates to $750 per week in performance variance; for 100 employees the numbers are $7,500 per week or $390,000 per year.

When employees have low levels of well-being and job satisfaction, they are more likely to quit their job. Wright said employee turnover could be extremely costly for an organization losing a disproportionate share of its better employees. In one study, Wright found that the possibility of turnover was 0.57 times smaller for any one-unit increase in well-being. As with job performance, the knowledge of an employee’s well-being can be highly useful in helping human resource personnel determine cost-effective employee retention strategies, he said.

Well-being has shown to be stable over time, though it can be influenced by situational circumstances through psychological-based interventions, Wright said. Methods to improve well-being include assisting workers so they fit their jobs more closely, providing social support to help reduce the negative impact of stressful jobs, and teaching optimism to emphasize positive thought patterns.

 Wright said one controversial approach to improving well-being in the workplace is by seeking and hiring employees who have high levels of well-being.

Wright’s findings on psychological well-being and job satisfaction have appeared in several publications, including the Journal of Management, Organizational Dynamics, the Journal of Occupational Health Psychology, the Journal of Applied Psychology and the Journal of Organizational Behavior.

Reference:  Kansas State University (2009, February 4). Happy Employees Are Critical For An Organization’s Success, Study Shows. ScienceDaily. Retrieved September 17, 2012, from http://www.sciencedaily.com­ /releases/2009/02/090203142512.htm?goback=.gde_2047935_member_164235829

some days you’re the pigeon…

In Fitness/Health, Humor, Inspiration, Mindfulness, Well-being on Sunday, 16 September 2012 at 10:23

i can’t recall where i found this but i really like it!

***

A lecturer, when explaining stress management to an audience, raised a glass of water and asked, “How heavy is this glass of water?”

Answers called out ranged from 20g to 500g.

The lecturer replied, “The absolute weight doesn’t matter. It depends on how long you try to hold it. If I hold it for a minute, that’s not a problem. If I hold it for an hour, I’ll have an ache in my right arm. If I hold it for a day, you’ll have to call an ambulance. In each case, it’s the same weight, but the longer I hold it, the heavier it becomes. And that’s the way it is with stress management. If we carry our burdens all the time, sooner or later, as the burden becomes increasingly heavy, we won’t be able to carry on. As with the glass of water, you have to put it down for a while and rest before holding it again. When we’re refreshed, we can carry on with the burden.

So, before you return home tonight, put the burden of work down. Don’t carry it home. You can pick it up tomorrow. Whatever burdens you’re carrying now, let them down for a moment if you can. Relax; pick them up later after you’ve rested. Life is short. Enjoy it!”

And then he shared some ways of dealing with the burdens of life:

  • Accept that some days you’re the pigeon, and some days you’re the statue.
  • Always keep your words soft and sweet, just in case you have to eat them.
  • Always read stuff that will make you look good if you die in the middle of it.
  • Drive carefully. It’s not only cars that can be recalled by their maker.
  • If you can’t be kind, at least have the decency to be vague.
  • If you lend someone $20 and never see that person again, it was probably worth it.
  • It may be that your sole purpose in life is simply to serve as a warning to others.
  • Never put both feet in your mouth at the same time, because then you won’t have a leg to stand on.
  • Nobody cares if you can’t dance well. Just get up and dance. Melody:
  • Since it’s the early worm that gets eaten by the bird…sleep late.
  • The second mouse gets the cheese. (so, don’t always be in such a hurry)
  • You may be only one person in the world, but you may also be the world to one person.
  • We could learn a lot from crayons. Some are sharp, some are pretty and some are dull. Some have weird names, and all are different colors, but they all have to live in the same box.
  • A truly happy person is one who can enjoy the scenery on a detour.

ABC’s

In Well-being on Saturday, 15 September 2012 at 09:28

I found this among my notes from grad school.  Good advice!

ABC’s:

  1. All behavior is purposeful
  2. Thoughts cause feelings

The “A-B-C” approach to helping yourself:

A= the situation or person or event

B= the beliefs or self-talk about A

C= feelings and behavior-the consequence of the self-talk

B causes C, but most people believe that A causes

  1. Get your expectations in line with reality
  2. You teach people how to treat you
  3. Don’t guarantee anyone’s behavior other than your own
  4. Life is a series of choices
  5. Don’t guarantee anyone’s behavior other than your own
  6. Life is a series of choices

My “Pet” Project

In Life with dogs, Pets, Well-being on Tuesday, 11 September 2012 at 06:22

This is a paper (edited) that I wrote as part of my proposal for my dissertation.  Unfortunately, I was told my topic was not “scientifically relevant” and I ended up having to choose a different topic.  I find it quite ironic that, recently, there has been a great deal of research (even in the mainstream press) about living with pets and the impact they have on our lives.  Maybe I will  carry out my study anyway one day…

 

Pet Ownership Benefits: A Brief Review of the Literature

Lorie Ederr

2007

In the year 2006, Americans shared their homes with 68 million dogs, 73 million cats, 19 million birds, 19 million pocket pets, 9 million reptiles, and 165 million fish (Frischman, 2007).  Additionally, Americans spend approximately $36.3 billion on their pets annually on things such as food, veterinary care, boarding, and gifts (Densa, 2007).  While pets are an important part of many American’s lives, research regarding all aspects of pets (ranging from the benefits of pet ownership to pet bereavement) has been seemingly absent from the empirical literature.

Animal studies progresses without the blessing of mainstream clinical psychology.  Although authors publish in a variety of journals, relatively little appears in academic clinical psychology journals…it is not clear whether this “furry ceiling” is due to Animal Studies professionals being affiliated with areas other than clinical psychology, academics not submitting to clinical journals, or to journals’ being reluctant, for content or research designs, to publish work in this field.  Funding for research appears scarce and tends to be internal or from humane organizations (Raupp, 2002, p. 355).

While research on animal abuse and resulting conduct disordered behavior has been given some attention, research related to more positive aspects of companion animals and the use of therapy animals is scant (Raupp, 2002).  Raupp (2002) searched the PsychINFO database for “animal-assisted therapy” and did not find any references in clinical psychology journals, although a broader search found references in health service journals.  Additionally, a search of about 30 clinical journals for references to “animal abuse,” “animal collectors,” and “animal-assisted therapy” showed only three references for the years 1991 through 2001 (Raupp, 2002).  Furthermore, it appears that the majority of references are older and there is a lack of current empirical research on this topic.  As stated above, there is scant research on the positive aspects of pet ownership and how pets positively affect peoples’ lives.  This study attempts to determine whether or not pet ownership is related to an increase in overall well-being.

Do people that own pets evidence higher overall well-being scores than non pet-owners?  The literature is not abundant in this area and the studies have conflicting data based on sample demographics (elderly versus adult; low SES vs. higher SES; attachment to pet).  This literature review is designed a meager attempt to answer that question.  Allen, Blaskovich, Tomaka, and Kelsey. (1991) were interested in exploring the differences for women who were exposed to a stress task alone in a lab and again at home in the presence of a pet, a friend, or neither varied in their autonomic responses.  They found that autonomic reactivity was moderated by the presence of a companion, the nature of whom was critical to the size and direction of the effect.  Ss in the friend condition exhibited higher physiological reactivity and poorer performance than subjects in the control and pet conditions.  Ss in the pet condition showed less physiological reactivity during stressful tasks than Ss in the other conditions (Allen, et al., 1991, p. 582).

Demello (1999) showed that the presence of a pet after the termination of cognitive stressors resulted in reduction in heart rate and blood pressure than when the pet was not present.  Garrity, Stallones, Marx, and Johnson (1989) discovered that, in people aged 65 and older, “pet ownership failed to predict depression and illness behavior, while pet attachment significantly predicted depression but not illness experience” (p. 35).  Ory & Goldberg (1983) found that pet possession and well-being in elderly women evidenced a positive correlation when the attachment to the pet was strong and the women had a higher SES.  Sable (1995) concluded that “pets may supply ongoing comfort and reduce feelings of loneliness during adversity or stressful transitions such as divorce or bereavement.  They can also provide an opportunity to nurture others.”  Serpell (1990) established that pet owners reported a significant reduction in minor health problems at one and ten months following pet acquisition, as well as improvements in psychological well-being and self-esteem.  Siegel (1990) discovered that “respondents who owned pets reported fewer doctor contacts over the 1-year period than respondents who did not own pets.  Furthermore, pets seemed to help their owners in times of stress” (p. 1081).

Conflicting studies also exist.  Johnson and Rule (1991) hypothesized that “pet owners may be perceived by the general public as more lively, extraverted, and social, with higher self-esteem than non-owners even if this is not true” because of a “social stereotype” that illustrates the consensus of public opinion, not actual research, on the subject of the positive benefits of pet ownership (p. 249).  Straede and Gates (1993) studied 92 cat owners and 70 non-owners and did not find significant differences for owners versus non-owners on measures of depression, anxiety, sleep disturbance, nurturance, social desirability, or life events.  Parslow, Jorm, Christensen, Rodgers, and Jacomb (2005) used survey information for 2,551 individuals aged 60-64 years and who did or did not own pets.  Parslow, et al. (2005) discovered that “female pet owners reported worse physical health than their counterparts who did not have any pets” (p. 45).  It was also discovered that pet owners reported a higher incidences of usage of pain medications than non-owners (Parslow, et al., 2005).  Another finding from the Parslow, et al. study (2005) was that “owning or caring for a pet was not associated with any reduction in numbers of GP services obtained over a 12-month period” (p. 45).   Moreover, “an unexpected finding was that owners and carers of pets reported significantly higher levels of psychoticism than non-owners and non-carers” (Parslow, et al., 2005, p. 46).  The authors concluded that “there are no health benefits associated with pet ownership for this age group” (Parslow, et al., 2005, p. 47).  Johnson and Rule (1991) compared pet owners and non-owners on self-esteem, extraversion, neuroticism, and social self-esteem.  Findings indicated that no significant differences were found between the two groups in any of the areas (self-esteem, extraversion, neuroticism, and social self-esteem) and that “theorists may tend to rely on assumed stereotypical personality traits of pet owners, creating false assumptions about the therapeutic effects of pets” (Johnson & Rule, 1991, p. 250).  Tucker, Friedman, Tsai, and Martin (1995) examined longitudinal data of 643 men and women with a mean age of 67 and discovered that playing with pets was not associated with better health and that those who reported playing with pets regularly did not have a lower mortality rate than those who did not interact with pets.  The authors concluded that “the present results do not support previous research that has found an association between human-pet interaction and physical health” (Tucker, et al., 1995, p. 6).  Hirsch and Whitman (1994) found that pet owners reported more headaches and chronic pain than non-owners.

Statement of the Problem

Millions of Americans share their homes with companion animals although the benefits and positive aspects of doing so have received little attention in the literature up to this point.  Studies that have been conducted relating to pet ownership are dated and more current research is needed.  As Raupp (2002) pointed out, very little was found in the academic clinical psychology journals related to companion animals, positive aspects of pet ownership, and animal-assisted therapy.  While it appears that pets are a major part of people’s lives, the research community does not seem to show a great interest in the effects companion animals have on all aspects of an individual’s life and development.  Outwardly, it would not appear that pets would be of great benefit to their owners.  Responsibilities such as caring for them, feeding them, obtaining necessary veterinary care, and the costs associated with having a pet would appear to be drawbacks for owners and reasons not to acquire a pet.  In spite of these “drawbacks,” Americans live with 68 million dogs, 73 million cats, 19 million birds, 19 million pocket pets, 9 million reptiles, and 165 million fish (Frischman, 2007).  The total amount Americans spent on their pets in 2006 was approximately $36.3 billion (Densa, 2007).  So, it would follow to that there are many benefits people gain from their pets despite costs, care, and related issues. The research community should show an interest in exactly what the specific benefits are as well as quantifying them.

Companion animals appear to be a very important part of many people’s lives.  While there are many anecdotal stories and personal experiences that support the benefits of pet ownership, the clinical research community should follow with empirical evidence to support these claims.  More research is needed looking at companion animals and the associated benefits to children, adolescents, adults, older people, and therapeutic populations.  Studies supporting companion animals’ positive effects, effects on child development, effects on empathy and prosocial behavior, and effects on physical and psychological health will hopefully lead to more positive attitudes towards animals as well as more humane treatment of animals, a decrease in animal abuse and neglect, and lead to less animals being killed in shelters every year.  Information regarding whether or not owning a pet contributes to one’s positive well-being would be important when determining therapeutic treatments for those who might be in danger of decreased feelings of well-being.  Research has repeatedly shown that sharing a home with a companion animal has positive effects (Allen, et al., 1991; Demello, 1999; Garrity, et al., 1989; Ory & Goldberg, Sable, 1995; Serpell, 1990) while others have found no correlation or a negative correlation (Hirsch & Whitman, 1994; Johnson & Rule, 1991; Parslow, Jorm, Christensen, Rodgers, & Jacomb, 2005; Straede & Gates, 1993; Tucker, Friedman, Tsai, & Martin, 1995).

 

REFERENCES

Allen, K., Blascovich, J., Tomaka, J., & Kelsey, R.  (1991).  Presence of human friends and pet dogs as moderators of autonomic responses to stress in women.  Journal of Personality       and Social Psychology, 61 (4), 582-589.

 

Bordens, K. & Abbott, B.  (1991).  Research designs and methods: A process approach.  Second Ed.  Mayfield Publishing Company: California

 

DeMello, L.  (1999).  The effect of the presence of a companion animal on physiological   changes following the termination of cognitive stressors.  Psychology and Health, 14, 859-868.

 

Edgington, E.  & Ezinga, G.  (1978).  Randomization tests and outlier scores.  Journal of Psychology, 99, 259-262.

 

Fleenor, J.  (n.d.).  Review of the Friedman well-being scale.  Retrieved on 8/1/07 from             http://ezproxy.libraary.capella.edu/login?url=http://search.ebscohost.com.library.c   apella.edu/login.aspx?direct=true&db=loh&AN=14121949&site=ehost-live

 

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Garrity, T., Stallones, L., Marx, M. & Johnson, T.  (1989).  Pet ownership as supportive factors in the health of the elderly.   Anthrozoos, 3 (1), 35-44.

 

Hirsch, A. & Whitman, B.  (1994).  Pet ownership and prophylaxis of headache and chronic pain.  Headache, 34, 542-543.

 

Howell, D.  (1992).  Statistical methods for psychology.  Third Ed.  Duxbury Press: California

 

Huck, S.  (2000).  Reading statistics and research: Third edition.  Harper Collins: NY.

 

Johnson, S. & Rule, W.  (1991).  Personality characteristics and self-esteem in pet owners and non-owners.  International Journal of Psychology, 26 (2), 241-252.

 

Key, J.  (1997).  Experimental research and design.  Retrieved on 11/28/06 from http://www.okstate.edu/ag/agedcm4h/academic/aged5980a/5980/newpage2.htm

 

Leedy, P. & Ormrod, J.  (2005).  Practical Research: Planning and design.  Ninth Ed.  New Jersey: Pearson.

 

Mind Garden (n.d.).  The Friedman Well-Being Scale.  Retrieved on 10/6/06 from http://www.mindgarden.com/products/fwbss.htm

 

Ory, M. & Goldberg, E.  (1983).  Pet possession and well-being in elderly women.  Research on Aging, 5 (3), 389-409.

 

Parslow, R., Jorm, A., Christensen, H., Rodgers, B., & Jacomb, P.  (2005).  Pet ownership and     health in older adults: Findings from a survey of 2,551 community-based Australians aged 60-64.  Gerontology, 51, 40-47.

 

Sable, P.  (1995).  Pets, attachment, and well-being across the lifecycle.  Social Work, 3, 334-341.

 

Serpell, J.  (1990).  Evidence for long term effects of pet ownership on human health.  Reprinted from Pets, Benefits and Practice, Waltham Symposium 20, April 19, 1990.

 

Siegel, J.  (1990).  Stressful life events and use of physician services among the elderly: The moderating role of pet ownership.  Journal of Personality and Social Psychology, 58 (6), 1081-1086.

 

Sproull, N.  (2002).  Handbook of research methods: A guide for practitioners and students in the social sciences (2nd. ed.).  Latham, MD: Scarecrow Press, Inc.

 

Straede, C. & Gates, R.  (1993).  Psychological health in a population of Australian cat owners.  Anthrozoos,6 (1), 30-41.

 

Tucker, J., Friedman, H., Tsai, C., & Martin, L.  (1995).  Playing with pets and longevity among older people.  Psychology and Aging, 10 (1), 3-7.

 

 

The Law of Attraction

In Mindfulness, Philosophy, Well-being on Monday, 10 September 2012 at 07:10

THE  LAW OF ATTRACTION

The Law of Attraction is one of the most powerful and fundamental laws in this physical universe. Many of the “mysteries of life” can be clarified by a basic knowledge of this  important concept.
Fundamental principles of the Law of Attraction:

1) Definition  — “ That which is like unto itself is drawn “ * (see note at bottom)
2) Thoughts are energy and act like magnets, drawing to them thoughts of similar vibration.
3) When enough thoughts accumulate upon a given topic, it is drawn into the life experience. The more thought, the faster that topic is drawn.
4) The emotions act as amplifiers to thought. Powerful emotion, positive or negative, will draw the thought(s) behind them more quickly into the life experience.  Positive thoughts generate positive emotion and draw positive life experience, negative thoughts generate negative emotion and draw negative life experience.
5) Everything in the physical universe is composed of energy, and ultimately, of thought. Energy and mass are convertible. Each pattern of energy has a unique frequency or vibration. Thoughts are energy and each likewise has a unique frequency or vibration. Emotions are strong vibrational energy patterns which are powerful attractors of like energy.   Leading to  1).
6) When thought is in agreement with a persons inherently divine nature, positive feeling is the result. When thought is in opposition or contradiction to one’s inherently divine nature, negative feeling or emotion is felt.
7) Feelings are therefore the infallible guideposts which will lead inevitably toward the discovery of the true self and one’s inherently positive, divine nature.
8) Each being in the physical co-creates his/her universe by thought. Co-creation is actually attraction, utilizing the Law of Attraction.
9) Deliberate creation is the conscious and knowing use of the Law of Attraction.
10) Victimization, luck, or chance is the unconscious or unknowing application (or mis-application) of Law of Attraction.
11) Probability and statistics are less relevant in the presence of Creative Will (proven by experiment). Said differently, deliberate creation may overcome probability or chance.
12) That which is observed to be happening to another, but which is not present in the observer’s life experience, is the co-creation of the other, else it would be present in the observer’s life experience  (1).
13) The Law of Attraction is a natural result of the Law of Free Will. The ability to generate thought upon any topic (co-creation)  will attract similar thoughts like  it, and so into the life experience.  This acts as protection against anything that is unwanted, for by focusing upon that which is wanted,  that which is not wanted is not drawn.
14) That which is resisted persists, because that which is focused upon is drawn into the life experience. Fighting something that is not wanted always leads to its persistence in the life experience  (1)
15) That which is focused upon is attracted, whether it is wanted or not ( 1 – 5, 13, 14).
16) To get what you want, focus upon it.  Focusing upon what is not wanted, will invite that which is not wanted into the life experience (15)
16a) Protection from something unwanted is impossible, for one immediately activates the vibration of the unwanted thing, and so begins to attract more of it.
16b) De-activation of something not wanted is impossible, for in the attempted deactivation of the unwanted thing, one immediately activates the vibration of the unwanted thing, and so begins to attract more of it. “Try not to think of an elephant.”
17) No one or no thing can create in the experience of another, because no one can think another’s thoughts. Similarly,  no one or no thing can create in your experience, because no one can think your thoughts. Leads to free will (13)
18) Therefore the Law of Attraction protects us from everyone and everything, unless we choose to invite it through our thought. (17)
19) Each being cocreates what will be called a Sphere of Creation, with that being at the center, utilizing the Law of Free Will and the Law of Attraction.
20) The intersection of all Spheres of  Creation creates the common reality.
21) To ‘change the world’, first change your own reality. This will change one of the intersecting Spheres of Creation (your own)  and so influence the Whole.
22) The universe does not distinguish vibrationally between that which is offered from observation and that which is offered from imagination. The house you are living in is composed of vibrating energy patterns . The dream house you imagine in your mind is also composed of vibrating energy patterns. The Law of Attraction works equally well for both. Effective visualization can result in manifestation. To change your reality, practice visualization of what is wanted along with the feeling of what it would be like to have what is wanted.
23) Group meditation or visualization is an effective way to achieve change on a large scale. As the vibration of many Spheres of Creation are raised, the intersection of these with the other spheres comprising the Whole raises the overall vibration of the common reality.
24) All action is the result of a prior thought or thoughts, not the other way around.
25) To change your life experience, alter your thoughts about it before going into action. Altering your vibration can be 95% of the change process, resulting in an alignment of your energy with what is wanted, leading to action along the path of least resistance.
26) Duality or Polarity is simply the not-having and the having. Focusing on lack does not draw what is wanted (leading to not-having)  and focusing upon that which is wanted draws the having – of.
27) All scarcity is the focus upon lack. All abundance is the focus upon having that which is wanted.
28) All feeling is the result of prior thought. To change how you are feeling about an area of life , change your thought(s) upon it
29) The point of attraction is the point of feeling. E.G., If you are feeling poor, you cannot attract prosperity. To attract prosperity, you must feel prosperous. This may seem like a contradiction, but it is a natural result of Law of Attraction – that which is like unto itself is drawn.
30) Every single thing that is in your life experience is attracted by you, and is a reflection of your thoughts and emotions, there are no exceptions
31) Your present reality is  the result of all of your prior thoughts and feelings
32) A belief is a long-standing thought pattern
33) Karma is just a long-standing thought pattern  or patterns in an area of life, which keep attracting the same energy. To change karma, identify and change beliefs. Karma is an unnecessary, but  natural, consequence of Law of Attraction
34) Feeling good is a state of beingness, not doingness. Many think that in order to feel good they must  do something that makes them feel good, but it is just the opposite. First you think of doing something that makes you feel good, the doing of it only helps to hold your thoughts in the positive
35) All trauma has behind it, the Basic Thought(s) which created it. Effective therapy always empowers the client by clearing the trauma and uncovering the Basic Thought(s) which attracted the trauma. Uncovering the Basic Thought(s) behind the trauma will always lead to cognition, which is just recognition by the client of the Basic Thought(s) . This is simply Law of Attraction in reverse
36)  The universe is 100% fair. All things  in your experience are the result of the attractive power of your vibration in that area.  (1 – 5), (8), (9), (17)
37) There is no injustice. All beings are receiving exactly those things upon which they are focusing their attention.   (36)
38)  Scientific objectivity is a myth. Experiments which purport to prove hypotheses actually work by Law of Attraction. The experimenter attracts to him or her the energy or subjects which are in harmony with the experimenter’s intent. This is how  independent experimentation can “prove” opposite conclusions.
In a time-space universe, no two objects can occupy the same spatial coordinates at the same time. Therefore no two observers can have the same viewpoint, even if every observer in the universe were to view an event at the same time.  Objectivity is defined as “of, or having to do with a known or perceived object as distinguished from something existing only in the mind of the subject, or person thinking.” (Webster’s New World Dictionary, College Edition,  1962). Since every observer has a different viewpoint, there cannot  be complete agreement as to the true nature or reality of an object. True objectivity requires an observer who can perceive the entirety of space-time all at once, as a whole, in any moment of time. But this is the definition of God. Since no observer can have the status of God, and since science rejects God, there can be no true scientific claim of objectivity. Stated another way:
39) The scientist performs an experiment and attempts to prove or refute RESULT_X. He is focusing on RESULT_X, therefore Law of Attraction is already working to deliver what the scientist is focused upon. The scientist uses rigorous procedures to ensure objectivity, all the while wondering whether or not RESULT_X will prove true by experimentation. And all the while Law of Attraction is busy giving him the energies or subjects corresponding to RESULT_X. The scientist proclaims  objectivity by saying :“I will not declare RESULT_X to be true until it actually manifests.” Meanwhile, a clairvoyant has written an article asserting that RESULT_X is true. The scientists laughs, scoffing at this unprovable assertion, and showing many pages of mathematical equations showing that there is only a 42% probability that RESULT_X will be proven true. The clairvoyant responds: “ I can see the energy  vortex  with the properties of RESULT_X around the scientist, therefore I know it will manifest.” The scientists hoots and scornfully tells the clairvoyant to “face reality”, and tells her she does not understand the mathematics behind RESULT_X and so is ignorant of the matter. All the while Law of Attraction is delivering to him the energies and/or subjects corresponding to RESULT_X, for he is focusing upon RESULT_X. When RESULT_X manifests, the scientists claims “I have objectively proven RESULT_X.” The clairvoyant says: “I already knew that!”  It’s all a result of Law of Attraction.

 

 

I have no actual reference/citation for this post as it has been cited in SEVERAL sources and never with reference to the original author.  Even so, it is an extremely powerful concept!

Balance

In Mindfulness, Well-being on Sunday, 9 September 2012 at 09:06

Ah, yes…

 

Balance.

Mastering anxiety

In Anxiety, Meditation, Mindfulness, Well-being on Sunday, 9 September 2012 at 05:58

Mastering Anxiety – By Dr. Neil Kobrin, Author of “Emotional Well-Being, Embracing the Gift of Life”

September 8, 2012

Retrieved from: http://drneilkobrin.com/mastering-anxiety/?goback=.gde_2047935_member_161038898

Anxiety is something everyone deals with, potentially on a daily basis. Some people encounter it more than others, and everyone deals with it differently. In order to master anxiety, one must be able to return to peace.

This reminds me of a great story of a monk from a monastery in the deep, back woods of India.

One day, the monk finds out that he’s going to be celebrated by the greatest master of his time. The master is going to visit the monastery and honor him with an award for all of the great work that he’s done in his lifetime. The monk is very flattered, and the whole monastery spends the entire day preparing for the master’s arrival. They clean and cook and get the whole place set up for this wonderful feast in honor of their monk. The master comes to the table and sits to the right of the monk and begins praising him for dedicating his life as someone who takes a vow to eliminate suffering for all beings.

The entire feast goes well, the master is very impressed. Soon, everyone is off to their individual chambers to sleep. That night, a disciple hears a sound by the windows and runs over to see what’s going on. He sees his master with a rucksack on his back heading out to the woods. The disciple climbs out of the window and runs up to his master and asks, “Where are you going, Master?” The master looks deeply into his disciple’s eyes and replies, “I failed today.” The disciple is confused. “What are you talking about, Master? Everybody honored you. It was beautiful.” The master looked at his disciple and reflected, finally saying, “That may be true my son, but just at the height of the ceremonies I looked down and noticed my palms were sweating. I have much work to do.” And so he went into the woods to sit in meditation and contemplation.

Now this story is confusing for some because it’s ending is ambiguous. That’s one of the things I like best about it, different people can interpret it different ways.

Similarly, mastering anxiety is done differently by different people. The monk was anxious, even while being praised by the great master. Perhaps it was because he was being praised by the great master and all of the preparation that went into the feast. Regardless, he was anxious and needed to return to his peaceful state. For him, meditation and contemplation worked. Perhaps they will also work for you.

Do you have a method you use to master anxiety and return to your own peaceful state?  Respond by commenting here, or feel free to join the conversation on my Linkedin Group http://bit.ly/MindfulMomentsGroup

Until next time, Dr. Neil Kobrin

 

The Awakening

In Well-being on Saturday, 8 September 2012 at 14:01

Someone gave this to me and I have always kept it.  Passing it forward…

The Awakening
by unknown

A time comes in your life when you finally get it—when, in the midst of all your fears and insanity, you stop dead in your tracks and somewhere the voice inside your head cries out “ENOUGH!” Enough fighting and crying or struggling to hold on. And, like a child quieting down after a blind tantrum, your sobs begin to subside, you shudder once or twice, you blink back your tears and begin to look at the world through new eyes.

This is your awakening.

You realize it’s time to stop hoping and waiting for something to change or for happiness, safety, and security to come galloping over the next horizon. You come to terms with the fact you are neither Prince Charming nor Cinderella. That, in the real world, there aren’t always fairy tale endings (or beginnings, for that matter). That any guarantee of “happily ever after” must begin with you—and in the process, a sense of serenity is born of acceptance. You awaken to the fact you are not perfect and not everyone will always love, appreciate, or approve of who or what you are… and that’s OK. They are entitled to their own
views and opinions.

You learn the importance of loving and championing yourself—and in the process, a sense of newfound confidence is born of self approval. You stop complaining and blaming other people for the things they did to you (or didn’t do for you) and you learn the only thing you can really count on is the unexpected.

You learn people don’t always say what they mean or mean what they say, and not everyone will always be there for you, and it’s not always about you. So you learn to stand on your own and to take care of yourself—and in the process, a sense of safety and security is born of self-reliance. You stop judging and pointing fingers and you begin to accept people as they are and overlook their shortcomings and human frailties—and in the process, a sense of peace and contentment is born of forgiveness.

You realize much of the way you view yourself and the world around you is as a result of all the messages and opinions that have been ingrained into your psyche. You begin to sift through all the junk you’ve been fed about how you should behave, how you should look, how much you should weigh, what you should wear, what you should do for a living, how much money you should make, what you should drive, how and where you should live, who you should marry, the importance of having and raising children, and what you owe your parents, family, and friends.

You learn to open up to new worlds and different points of view. You begin reassessing and redefining who you are and what you really stand for. You learn to go with your instincts. You learn it is truly in giving that we receive. That there is power and glory in creating and contributing and you stop maneuvering through life merely as a “consumer” looking for your next fix. You learn principles such as honesty and integrity are not the outdated ideals of a bygone era but the mortar that holds together the foundation upon which you must build a life.

You learn you don’t know everything, it’s not your job to save the world and you can’t teach a pig to sing. You learn to distinguish between guilt and responsibility and the importance of setting boundaries and learning to say NO. You learn the only cross to bear is the one you choose to carry and that martyrs get burned at the stake. Then you learn about love. How to love, how much to give in love, when to stop giving and when to walk away.

You learn to look at relationships as they really are and not as you would have them be. You stop trying to control people, situations, and outcomes. You learn alone does not mean lonely. You also stop working so hard at putting your feelings aside, smoothing things over and ignoring your needs. You learn feelings of entitlement are perfectly OK, and it is your right to want things and to ask for the things you want—and sometimes it is necessary to make demands. You come to the realization you deserve to be treated with love, kindness, sensitivity, and respect—and you won’t settle for less.

And you learn that your body really is your temple. And you begin to care for it and treat it with respect. You begin to eat a balanced diet, drink more water, and take more time to exercise. You learn being tired fuels doubt, fear, and uncertainty and so you take more time to rest. Just as food fuels the body, laughter fuels our soul. So you take more time to laugh and to play. You learn for the most part, you get in life what you believe you deserve—and much of life truly is a self-fulfilling prophecy. You learn anything worth achieving is worth working for and wishing for something to happen is different from working toward making it happen. More importantly, you learn in order to achieve success you need direction, discipline, and perseverance.

You also learn no one can do it all alone—and that it’s okay to risk asking for help. You learn the only thing you must truly fear is the greatest robber baron of all: FEAR itself. You learn to step right into and through your fears because you know whatever happens you can handle it and to give in to fear is to give away the right to live life on your own terms. You learn to fight for your life and not to squander it living under a cloud of impending doom. You learn life isn’t always fair, you don’t always get what you think you deserve, and bad things sometimes happen to unsuspecting, good people.

On these occasions you learn to not personalize things. You learn God isn’t punishing you or failing to answer your prayers. It’s just life happening. You learn to deal with evil in its most primal state—the ego. You learn negative feelings such as anger, envy, and resentment must be understood and redirected or they will suffocate the life out of you and poison the universe that surrounds you. You learn to admit when you are wrong and to build bridges instead of walls. You learn to be thankful and to take comfort in many of the simple things we take for granted, things millions of people upon the earth can only dream about: a full refrigerator, clean running water, a soft warm bed, a long hot shower.

Slowly, you begin to take responsibility for yourself by yourself and you make yourself a promise to never betray yourself and to never, ever settle for less than your heart’s desire. You hang a wind chime outside your window so you can listen to the wind. You make it a point to keep smiling, to keep trusting, and to stay open to every wonderful possibility. Finally, with courage in your heart and God by your side, you take a stand, you take a deep breath, and you begin to design as best you can the life you want to live.

Fear of being alone and learning to love myself

In Well-being on Thursday, 6 September 2012 at 11:06

Fear of being alone and learning to love myself.

Interesting insights from the author.

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