Stress Made Easy
For most we are lucky enough not to experience real major traumatic events in our lives, this is not to say that we do not routinely experience stress. Stress can be considered as a reaction to stimuli that threatens our psychological or physical well being. This stimulus can be an event, situation or object that we perceive as a threat to our own equilibrium, and this varies from person to person.

We have three components in how we perceive stress.

Behavioural Response. This is termed by our coping ability, be it our ability to address how we think of stress and change this thinking pattern, or by coping with stress by trying to avoid the stressors in our lives or just asking for help in changing the stressful situation. We can also look at the emotions around stress and take part in breathing exercises adapting our way of life to include exercise and healthy living and engaging in activities that bring about pleasure in our lives. It should be noted that coping works when we have control over a situation.

Physiological Responses. Our physical responses to stress are more or less the same. The initial phase as most will know is the fight or flight phase in which our bodies prepare for conflict by increasing our heart rate which leads to sweating, quickened breathing, perspiration and our pupils dilate. All of which prepares us to fight or run from the perceived stress. The second stage is when the stress continues, in this phase we adapt to the prolonged stress reaction, however the physiological responses are still high, if we can not get past this we then reach exhaustion which heightens are risk of disease and illness. Our bodies are susceptible to such conditions and our ability to fight new stressors is depleted.

Emotional Responses. We can experience many emotions during times of stress which need to be brought into perspective and control. Frustration can lead to anger, this can be seen in working situation were one can become frustrated with for example a colleague which may lead to anger. Stress from such life changes can lead to Anxiety and Fear.

Stress related illness is all too common in our lives today. We are bombarded by stressors each day, we work longer hours, are more pressured by technology such as mobile phones that bring pressure straight to us wherever we happen to be. It is therefore vital that we understand the issue of stress in order to be more aware of it and to allow us to take appropriate measures to ensure against it or to reduce it from our lives.

Mark Reddy

Am I in a “High- Risk” Job?

By Dr Jo Clarke and Dr. Michael Carroll


There are some jobs which, of their very nature, leave individuals open to danger. Often called “critical occupations”, these jobs are unique in that professionals can encounter traumatic events which may, under certain circumstances, exert critical impact on their psychological well-being. It’s not difficult for most of us to name the kinds of jobs we are talking about. Emergency service personnel and disaster responders are two clear examples where front-line workers face acute risk owing to the nature of their work. Body recovery after natural disasters, removal of victims from vehicle crashes, attending scenes of terrorist activity can all be readily identified as situations likely to challenge any individual’s psychological equilibrium. Drawing up an inclusive list of ‘critical occupations’ would be a considerable challenge, but no doubt Garda would feature high on the list.

An organisational strategy to enhance the well-being of staff working with the most difficult, disruptive and damaged prisoners held in High Security prison discrete units in England has been devised. Much of what is now in place is very applicable to organisations and individuals in other environments e.g., police, fire brigade.

Traumatic Events and Well Being

A traumatic event is one that is outside of the range of usual human experience and that would be markedly distressing to almost anyone. Examples given of such events include threat to life or physical integrity or seeing another person being seriously injured or killed. Clearly, front line emergency responders (like the Garda) face such events frequently.

From research and from reviewing backgrounds to help outline and implement the well being strategy above a number of factors has merged:

• It’s not just the events that can traumatise. How individuals react to events is vitally important (there will be individual differences here). Age, gender, length or service and previous history of trauma are all factors in how stressful an event can be.

• Interestingly, organisational practices will also impact e.g., For example, organisations characterised by high levels of bureaucracy, internal conflicts regarding responsibility, persistent use of established procedures (even in novel situations), and a strong motivation to protect the organisation from blame or criticism, have all been found to increase the risk of poor post-trauma outcome Conversely, positive organisational practices, such as adoption of autonomous response systems, consultative leadership styles, training to develop adaptive capacity, and tolerance of procedural flexibility, can all enhance the likelihood of positive outcomes

• Finally, events removed from the work context, but significant to the individual, also need to be understood if risk potential is to be managed. For example, in a study of prison and community-based sex offender treatment providers, respondents who had experienced a non-work related adverse event in the previous six months, also reported significantly higher levels of dissatisfaction with their organisations. Such events included illness, relationship breakdown, house moves and so on.

An engaged workforce is identified by high levels of resilience, characterised in turn by the ability to bounce back from negative emotional experiences despite threats to the individual. This is illustrated by staff who are competent, autonomous, understand the difference they can make to their work place and have personal values and beliefs that fit the needs of the role they undertake. Consequently, an engaged and resilient workforce is one that has low rates of turnover, low levels of sick absence and high levels of performance. The development and maintenance of such should arguably then be the number one priority for both individuals and organisations in the critical occupations business. How can we ensure such a workforce exists?


Our well-being model included three sets of interventions: primary, secondary and tertiary. The first two aim to prevent stress occurring in the first place. Tertiary interventions are those put in place to support individuals if distress is experienced.

Primary interventions are concerned with the individual. They cover issues of selection, training and preparation of the individual to undertake a critical role. In addition to skills and competencies to do the job, self-care skills also need to be considered (psychological self-maintenance). The aim here is not to deselect staff who have yet to acquire the requisite skills, competencies or values to stay psychologically well and perform highly, but to generate a profile that enables the individual and organisation to work together to achieve such a position if potential is shown to do the job.

Further interventions concerns the job itself, and relate to the workplace, the work force and the work people do. Here, consideration needs to be given to the environment, organisational policies and procedures, on-the-job support, frequency of exposure to traumatic events, recognition of distress and so on. However, recognition and understanding of the impact that dynamic factors can have on well-being enables appropriate responses at both the individual and organisational level. Disclosure by a worker of difficult family circumstances, for example, can enable a manager to initiate different support options; understanding the impact on the team of a new manager can allow apposite preparation and so on. Intervention here would be an example of secondary prevention. Tertiary responses might include referral to a mental health professional or counsellor, adjustment of work demands, retraining and so on.


With the support of the prison’s senior managers (essential to the perception of meaningful intervention), a five stage process was initiated. This included:
1. Focus groups with frontline staff to identify their perceptions of barriers to well-being and high performance.
2. Examination of which of these (if any) could be removed or changed.
3. Use of training in how to manage the demands of work that cannot be adjusted.
4. Consideration of best methods to support managers.
5. Consideration of new ways of working to encourage resilience.

Practical Strategies

A number of practical interventions were proposed. To aid the management of physical energy, regular formalised breaks were introduced. Five to 10 minutes in every 90 was recommended, with team members physically leaving their work stations for that period of time. Some team members additionally opted to undertake a lunchtime exercise programme to augment their physical energy. To assist with the renewal of emotional energy, formal debriefs were recommended to provide team members with an opportunity to off-load the issues at the end of each day. Voluntary sessions with a mental health professional or counsellor were also offered on an ‘as needed’ basis. To help staff remain mentally engaged, a rotation system was recommended, whereby team members moved between the tasks needing to be undertaken. In addition to the above, preparedness training was also advised. Training in psychological self-maintenance skills, emotion management and the nature of psychological distress can enable staff to feel equipped and empowered to manage their emotional reaction as it arises, rather than feel overwhelmed or baffled by it.

Training focused on the development of psychological self-maintenance skills. As most practitioners in high risk jobs would probably affirm, training in the skills to do ones job is often comprehensive, but in the skills to look after oneself, non-existent. Based on the principles of emotional detachment, the programme describes the behavioural and psychological process of stressful responding. Attendees generate their own risk profile and then practice methods for managing risky elements and enhancing protective ones. An empirical evaluation of the programme when used with police officers demonstrated significant increases in job satisfaction and reduced absenteeism.

Well-being in critical occupations

Clearly, organisations have a duty of care to their employees to generate working environments that are as safe as possible. Individuals also have a duty of care to themselves to ensure they avail themselves of all opportunities to stay psychological well in the work context. These responsibilities are likely to be most effectively executed where there is a genuine desire to enhance performance and well-being through consultation and collaboration. Organisations that impose support structures from the top down are unlikely to reap the benefits of their intentions. It should not be surprising that many of the interventions included in our Well-being strategy, were also recommended by frontline staff –testament to staff’s wisdom, experience and intuition for what works in enhancing their well-being.

Many thanks to both Dr Jo Clarke and Dr. Michael Carroll for allowing me to publish their article.

"Recession and its Impact" (Garda Review)

Recession and its impact

Published in the Garda Review March 2009

Mark Reddy writes on the impact of recession on our mental welfare.

Ireland has been dealt a blow from which we will not fully recover for many years; it impacts us financially, but to a much greater extent mentally.

Life involved working long hours, spending money and getting on the property ladder. We dialled a phone to have our dinner delivered. Those that delivered our meals drove bigger cars than us. Our TVs are flat, our floors wooden and our homes expensive; we were unconcerned taking loans and banks offered us credit beyond the norm; the most frugal of us living beyond our means, and why not? Sure weren’t we all in the same boat.

But then the unimaginable happened. We have at least one friend on the dole, you can’t pick up a paper without reading of cutbacks, a failing housing market, increased levies and pending strikes and disputes. Everyone has an opinion but few a long term solution.

Faced with decreased salaries and a high cost of living, some invested in a second home and now have this added burden, others involved family in guaranteeing loans, plans for retirement may now be completely halted. The impact of this on our sense of worth and social status brings pressure on ourselves and our families, bringing despair.

We might find ourselves completely exhausted, overrun by stress and in fear for the future. This change in our circumstances impacts on our sense of security to adapt and meet these new challenges. Some are able to cope and adapt but others are not and these are the people we need to support. Failure to adapt will impact on our abilities to see anything positive in life. Blinded by our inability to cope and adapt results in helplessness and this sense of insecurity, worry and stress will, if not treated lead the vulnerable to the onset of other psychiatric illnesses.
We may comfort seek unhealthy behaviours such as alcohol and drug abuse, overeating or other addictive behaviours, all of which will add to our difficulties.

Untreated, the long term negative impacts of anxiety can lead to depression and a sense of hopelessness. Hopelessness can be a predictor to suicide and needs addressing. Depression can impact on health and ability to fend off illness. Hopelessness will increase the risk of those we place most demands on; they risk deterioration in their own health and mental well being. The impact of not addressing our issues will have a greater impact on our loved ones.

When we are aware of the facts we are better able to adapt and change our behaviours and outlooks in order to be better able to deal with the issues at hand. It’s imperative to know that firstly that none of us are alone in this.

If you find yourself in this position seek help. Don’t overcomplicate by imaging others don’t want to know. An ability to express fears and concerns will give the opening to others to do the same. Look to family for support; ask yourself would you give help to someone in need, if so then you can bet that others will do the same for you. Deal first with stresses that are impacting on you and your health.

Deal with the practical worries in a practical way, gardaĆ­ have several agencies they can approach, primarily the garda Employee Assistance Service. Outside of this there are many services established to provide professional care and advice.

Don’t be afraid to seek advice and support and believe in yourself that you have the strength to get through this and learn some valuable lesson while doing so. We are at a time when we have to assess what is valuable to us. Some things are more important than others.

Many thanks to Neil Ward Editor of the Garda Review for his kindness and support.

Researchers-again-pinpoint why stress kills

Researchers-again-pinpoint why stress kills

(February 9, 2004)–BETHESDA, MD– As Valentine's Day approaches, one prevailing argument for marriage may well be that studies show married people are less depressed than their single counterparts. Behind this string of scientific reasoning for matrimony is a proven fact: the prevalence of depression in patients with coronary artery disease (e.g., myocardial infarction and heart failure) is approximately five times that of the general population.

Major depression is a significant predictor of mortality after myocardial infarction. Its predictive ability on subsequent cardiovascular events, for example, myocardial infarction, arrhythmias, ischemia, or sudden cardiac death, is comparable to that of left ventricular dysfunction, previous myocardial infarction, and smoking. Even more alarming is the finding that depression is a significant risk factor for coronary artery disease in patients without a history of heart disease. In other words, the risk for a heart attack or other cardiac disease for depressed but otherwise healthy patients is similar to the risk for patients with established cardiovascular disease.

Gender does play a role. Psychological depression is a common mood disorder affecting 2–3% of males and 5–9% of females. Depression is the leading cause of disability worldwide (quantified by years lived with a disease) and is exceeded only by coronary artery disease as the leading cause of disability in the United States. So, in addition to all the social and medical costs of depression, the disorder is considered a risk factor for coronary artery disease.

Why? Past studies to establish the link between cardiac disease and depression have focused on hypothalamic-pituitary-adrenal axis dysfunction associated with increased sympathetic activation, an imbalance in parasympathetic and sympathetic inputs to the heart (i.e., increased sympathetic tone and/or decreased parasympathetic tone), manifest as reduced heart rate variability, and altered serotonin activity affecting platelet function.

Scientists have noted an important interaction between stress and ventricular arrhythmias, or loss of rhythm to the heart. This relationship has been supported by animal studies and in observation of some human patients with postmyocardial infarction, where the presence of depression in combination with premature ventricular complexes greatly increases the likelihood of a recurrent heart attack.

A New Study

However, none of these suppositions are well established. A team of University of Iowa researchers set out to ascertain whether an increased susceptibility to life-threatening cardiac arrhythmias in depressed patients influences the risk of morbidity and mortality in coronary artery disease. The findings of their research are reported in "Increased Susceptibility to Ventricular Arrhythmias in a Rodent Model of Experimental Depression," authored by Angela J. Grippo, Claudia M. Santos, Ralph F. Johnson, Terry G. Beltz, James B. Martins, Robert B. Felder, and Alan Kim Johnson, all from the University of Iowa, Iowa City, IA. Their findings appeared in the February 2004 edition of the American Journal of Physiology--Heart and Circulatory Physiology. The journal is one of 14 peer-reviewed scientific journals published each month by the American Physiological Society (www.aps.org).

Because stressful life events are known to be predisposing factors for depression as well as predictors of the severity of depression, the researchers used a stress-induced rodent model of depression to examine the influence of this disorder on ventricular arrhythmias. Chronic mild stress (CMS) is a rodent model of depression that was developed to mimic particular defining features of mood disorders, such as anhedonia (the reduced responsiveness to pleasurable stimuli) and reduced activity level. Behavioral changes are induced via a combination of seemingly mild annoyances or stressors (e.g., strobe light, white noise, damp bedding, and paired housing) presented in an unpredictable manner.


A control group and a CMS group of rats were established. To generate stress, the CMS group was exposed to the following mild stressors each week, in random order: 1) continuous overnight illumination and 40 degree cage tilt along the vertical axis; 2) paired housing; 3) soiled cage; 4) exposure to an empty water bottle immediately after a period of acute water deprivation; 5) stroboscopic illumination; and 6) white noise. The CMS procedure was carried out for a total of four weeks. Control animals were left undisturbed in their home cages with the exception of routine handling (i.e., regular cage cleaning and measuring of body weight), which was matched to that of the CMS group.

This CMS model provided an opportunity to examine a potential link between experimental anhedonia (absence of pleasure from the performance of acts that would ordinarily be pleasurable) and the susceptibility to ventricular arrhythmias in rats. This entailed the employment of aconitine, in rats exposed to CMS. Aconitine is arrhythmogenic in cardiac myocytes due to enhanced sodium influx into myocardial cells on both depolarization and repolarization and as a result of an increase in active Na+ current during depolarization. The utility of aconitine for the study of electrocardiographic activity is well documented. This drug has been used experimentally in anesthetized rats to investigate the vulnerability to ventricular arrhythmias as well as the efficacy of antiarrhythmic drugs.


The researchers found the following:

Sucrose intake was significantly reduced in rats exposed to four weeks of CMS. The reduced sucrose intake and sucrose preference in the CMS group is a specific indication of decreased responsiveness to a pleasurable stimulus.

Anhedonic rats displayed elevated heart rate and reduced heart rate variability. These alterations in CMS rats are similar to changes found in human depressed patients as well as results from our laboratory, which describe cardiovascular and behavioral effects associated with CMS in conscious rats.

Rats that displayed anhedonia in the current study also showed a reduced threshold for specific ventricular arrhythmias after the fourth week of CMS exposure.

The current study was undertaken to determine whether rats with CMS-induced anhedonia (i.e., experimental depression) were more susceptible than control rats to experimentally induced cardiac arrhythmias. Both behavioral and cardiovascular changes were observed in rats exposed to CMS. This stress appears to produce a reduced threshold for ventricular arrhythmias that may signal an increased risk of detrimental cardiovascular outcomes (e.g., myocardial infarction, heart failure, and sudden cardiac death).

The researchers believe that further research should focus on determining the central nervous system mechanisms that are driving the changes in sympathetic tone and susceptibility to cardiac arrhythmias in the CMS model. The use of controlled experimental methods may shed light on the mechanisms that underlie the increased risk for coronary artery disease in individuals with mood disorders, and may aid in the development of beneficial treatments for these patients.

Source: February 2004 edition of the American Journal of Physiology--Heart and Circulatory Physiology.

The American Physiological Society (APS) was founded in 1887 to foster basic and applied science, much of it relating to human health. The Bethesda, MD-based Society has more than 10,000 members and publishes 3,800 articles in its 14 peer-reviewed journals every year.

Police Work Undermines Heart Health


It is well documented that police officers have a higher risk of developing heart disease:
The question is why.

In the most recent results coming out of one of the few long-term studies being conducted within this tightly knit society, University at Buffalo researchers have determined that underlying the higher incidence of subclinical atherosclerosis -- arterial thickening that precedes a heart attack or stroke -- may be the stress of police work.

"We took lifestyle factors that generally are associated with atherosclerosis, such as exercise, smoking, diet, etc., into account in our comparison between citizens and the police officers," said John Violanti, Ph.D., UB associate professor of social and preventive medicine, who has been studying the police force in Buffalo, N.Y., for 10 years.

"These lifestyle factors were statistically controlled for in the analysis. This led to the conclusion that it is not the 'usual' heart-disease-related risk factors that increase the risk in police officers. It is something else. We believe that 'something else' is the occupation of policing.

"Results of the study appear in the June issue of the Journal of Occupational and Environmental Medicine.

Violanti and colleagues have been studying the role of cortisol, known as the "stress hormone," in these police officers to determine if stress is associated with physiological risk factors that can lead to serious health problems such as diabetes and cardiovascular disease.

In a study accepted for publication in Psychiatry Research that looked at the male-female differences in stress and signs of heart disease, Violanti found that female police officers had higher levels of cortisol when they awoke, and the levels remained high throughout the day. Cortisol normally is highest in the morning and decreases to its lowest point in the evening. The constantly high cortisol levels were associated with less arterial elasticity, a risk factor for heart disease, Violanti noted.

"When cortisol becomes dysregulated due to chronic stress, it opens a person to disease," he said. "The body becomes physiologically unbalanced, organs are attacked and the immune system is compromised as well. It's unfortunate, but that's what stress does to us."Results showed that police work was associated with increased subclinical cardiovascular disease -- there was more plaque build-up in the carotid artery -- compared to the general population that could not be explained by those conventional heart disease risk factors.Subclinical atherosclerosis means that the disease shows progression but does not qualify yet as overt heart disease.

"In this case we examined the thickness of the carotid artery as an indicator of increasing risk for atherosclerosis," noted Violanti.

"The plaque buildup was greater in police than the citizen population."In future work, we will measure the carotid artery thickness again to see how much it has increased. At some point in time, the thickness may reach a stage of possible blockage, which will require medical intervention and treatment. We think that police officers will likely reach that stage quicker than the general population.

"P. Nedra Joseph, Ph.D., a former postdoctoral researcher at UB, now at the Centers for Disease Control and Prevention (CDC), is first author on the study. Additional contributors to the study were: from UB -- Richard Donahue, Ph.D., and Joan Dorn, Ph.D., from the UB School of Public Health and Health Professions; Michael E. Andrew, Ph.D., and Cecil M. Burchfiel, from the CDC; and Maurizio Trevisan, M.D., formerly of UB, now head of the University of Nevada Health Sciences System.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus.

What is Mental Illness?

Mental illness can be defined as the experiencing of severe and distressing psychological symptoms to the extent that normal functioning is seriously impaired, and some form of help is usually needed for recovery. Examples of such symptoms include anxiety, depressed mood, obsessional thinking, delusions and hallucinations. Help may take the form of counselling or psychotherapy, drug treatment and/or lifestyle change.

Professor Anthony Clare, psychiatrist and broadcaster defines mental illness as follows:

“A diagnosis of mental illness usually means in practice that:

a) A person is experiencing symptoms characteristically regarded as psychological, such as anxiety, depression, elation, hallucinations, delusions, obsessions, compulsions;

b) The symptoms are severe and disabling; that is to say, the individual is distressed by them, cannot function, and feels ‘unwell’. The layman’s term is ‘breakdown’ and it is a good one for it suggests that the individual’s normal ability to cope with stress or a setback has broken down, that he/she has lost the normal ability to ease tension, lift mood, regain control, cope;

c) The individual is so afflicted that he or she cannot ordinarily recover control without external help [be it by means of talking, listening and learning (psychotherapy, behaviour therapy), physical treatment, (drugs, ECT) and/or social interventions (attention to stresses at work, in the home, within marriage or relating to money, status, power)];

d) The ill health can be caused by genetic factors; by loss such as bereavement or unemployment or financial disaster; by catastrophic stress such as war, disasters like the Lockerbie air tragedy or the Stardust fire; by physical illness; or indeed, a combination of some or all of these factors.

e) Rarely is there a single cause of a psychiatric illness and rarely, too, a single treatment.”

Written by Mental Health Ireland 2007
(Link found on Left)

Adoption Stress

Adoption Stress

Unfortunately, far too many adoptive children have faced traumatic events including, but not limited to, neglect, physical and sexual abuse and various degrees of abandonment. In recent months, I have accompanied Dr. George Rogu on a speaking tour with AdoptionDoctors.com. As the “Adoption Psychologist,” I regularly explain to adoptive parents that by having an understanding of the symptoms suggestive of traumatic exposure, we can identify children who may be experiencing traumatic stress reactions. Ultimately, by identifying symptoms early, we can address emotional, social, behavioral and educational needs. As I often say to parents, we certainly don’t wait to address physical trauma. And, in the same way, we must not wait to address traumatic stress.

How is traumatic stress manifested in adoptive children?

In the young adopted child, we see immature and regressive behaviors—behaviors that have been abandoned in the past are often observed again (e.g., thumb sucking, bed wetting, fear of the dark, loss of bladder control, speech difficulties, decreases in appetite, clinging and whining, and separation difficulties). Older children may manifest periods of sadness and crying, poor concentration, fears of personal harm, aggressive behaviors, withdrawal/social isolation, attention-seeking behavior, anxiety and fears, etc.

So, what is “Adoption Stress”? Does it refer solely to the experience of so many adoptive children?

The reality is, when we look closely at adoption, we realize that traumatic stress is pervasive - often impacting several, if not all, of the parties involved. Unfortunately, this traumatic stress, “adoption stress,” is generally not recognized and its impact is misunderstood. Consider the following….
Birth parents, who surrender a child for adoption, typically experience a great deal of stress. Oftentimes, due to their circumstance, they have little choice or control and must surrender their child for adoption.

Adoptive parents often bring to the table a history of stress. For example, pre-adoption stressors, which may include fertility problems, losses and significant relationship conflicts. There is also stress associated with the acquisition of an adoptive child. For example, there may be serious medical concerns, “misunderstandings,” and heartbreaking disappointments. Finally, post-adoption stress may center around the realization of a dream, tremendous life changes with new responsibilities, and a future marked by uncertainty and fear.

Adoption stress is manifested in the feelings, thoughts, actions and physical reactions of all parties associated with the adoption process—by birth parents, adoptive parents and certainly, adoptive children. By understanding adoption stress and recognizing the symptoms, we can intervene early, educate and empower victims, and prevent acute difficulties from becoming chronic problems.

Dr. Mark Lerner is a Clinical Psychologist and Traumatic Stress Consultant who focuses on helping people during and in the aftermath of traumatic events. He is the President of the American Academy of Experts in Traumatic Stress (www.aaets.org) and the originator of the Acute Traumatic Stress Management intervention model (www.atsm.org). Dr. Lerner wrote and produced the newly released audio book, Surviving and Thriving: Living Through a Traumatic Experience (www.DrMarkLerner.com). He is the Editor and Publisher of Trauma Response, the Academy’s official publication, and the author of five books. Dr. Lerner consults regularly with individuals, schools and organizations—where he specializes in the education, training and implementation of Acute Traumatic Stress Management and the development of organizational and school-based crisis management teams. Dr. Lerner has conducted numerous interviews, including CNN Headline News, the Los Angeles Times, Newsweek, Self Magazine, Stars & Stripes, Reuters, the Associated Press and U.S. News & World Report. Most recently, he appeared on Dateline NBC. Dr. Lerner lives in New York with his wife and three children.

Post Adoption Depression

The term "Post-Adoption Depression" has been used to explain the feelings of sadness that are experienced by many adoptive parents subsequent to the adoptive process. Unlike postpartum depression, which may be caused by significant physiological and hormonal changes (e.g., a sudden decrease in estrogen and progesterone in the bloodstream), Post-Adoption Depression cannot. Post-Adoption Depression focuses on the feelings of sadness that are experienced after the attainment of a long-term goal that has required time, money, effort, emotional strain and patience.

New York Post-Adoption Depression is a symptom that falls under a much larger umbrella - what I have called "Adoption Stress." The latter refers to the feelings, thoughts, actions and the physical and spiritual reactions of all parties who are involved in the adoption process (e.g., a mother who surrenders her child for adoption, an adoptive child, an adoptive parent, a compassionate case worker, etc.).

We can better understand and appreciate the depressive symptomatology experienced by many adoptive parents if we first consider 1) pre-adoption stressors, 2) stress associated with the acquisition of an adoptive child and 3) post-adoption stress. By focusing solely on Post-Adoption Depression, we miss the causative or related stressors that contribute to the adoptive parent’s feelings of sadness. For example, the attainment of a long-term goal of having an adoptive child often opens the door to seemingly insensitive questions from others about infertility and prior losses. These questions will likely stimulate unresolved feelings, and may cause adoptive parents to revisit pre-adoption stress. The acquisition of an adoptive child is often colored by serious medical concerns, "misunderstandings" and heartbreaking disappointments. And, the post-adoption experience is often marked by tremendous life changes, new responsibilities and a future marked by uncertainty and fear.

During a recent therapeutic session with a group of adoptive parents, we explored a number of participants’ feelings of sadness. Suddenly, one mother exclaimed, "I didn't sign-up for this!" Her comment was met by applause from several of the participants. Her statement underscores the complex continuum of "before, during and after stressors" that are faced by adoptive parents.

How can we prevent Post-Adoption Depression? First, we must educate all people involved in the adoptive process about Adoption Stress. If more people understood that the feelings, thoughts, actions and the physical and spiritual reactions were a normal response to a very stressful, multifaceted experience, fewer people would struggle with conflicted feelings. We must also focus our attention on parents who have been prone to feelings of depression and do not fare well when faced with considerable stress. We must encourage them to become involved in support groups or counseling. If we do this prior to parents entering into the adoptive process we can ultimately decrease the post-adoption stress that is experienced by many adoptive parents.

Written By Mark Lerner, Ph.D.

Considering suicide?

Considering Suicide How to stay safe and find treatment

Despair and hopelessness may lead you to think about suicide. Learn how to stay safe, get through a crisis and find treatment.By Mayo Clinic staff

When life doesn't seem worth living anymore or your problems seem insurmountable, you may think that the only way to find relief is through suicide. You might not believe it, but you do have other options — options to stay alive and feel better about your life.

Maybe you think you've already tried them all and now you've had enough. Or maybe you think your family and friends would be better off without you. It's OK to feel bad, but try to separate your emotions from your actions for the moment. Realize that depression, other mental disorders, despair and hopelessness can distort your perceptions and impair your ability to make sound decisions. Suicidal feelings are the result of treatable problems. So try to act as if there are other options instead of suicide, even if you may not see them right now.
No, it may not be easy. You might not feel better overnight. Eventually, though, the sense of hopelessness and thoughts of suicide can lift. You can find support, appropriate treatment and reasons for living.

Immediate help for thoughts of suicide

If you're considering suicide right now and have the means available, talk to someone first. The best choice is to call 911 or your local emergency services number.
If you simply don't want to do that, for whatever reason, you have other choices for reaching out to someone when you feel suicidal:
Contact a family member or friend.
Contact a doctor, mental health provider or other health care provider.
Contact a minister, spiritual leader or someone in your faith community.
Go to your local hospital emergency room.
Call a crisis center or hot line.

Crisis centers and suicide hot lines are often listed in the front of your phone book or on the Internet. They generally offer trained volunteer counselors who can help you through an immediate crisis. While some crisis centers with an Internet presence offer e-mail contact, remember that responses may not be as prompt as they are with telephone support.
Talking to someone about your suicidal feelings can help relieve the burden of despair and isolation, even if just temporarily. It may help you shift perspective and more clearly see that you have options instead of suicide.

Daily coping strategies

You may struggle with suicidal feelings frequently, perhaps many times a day if you're in the depths of depression. Develop a strategy to cope with those feelings in a healthy way. Consider asking a doctor, family member or friend to help create a strategy tailored to your specific situation that will help you cope with thoughts of suicide.

That strategy may mean doing things you don't feel like doing, such as making the effort to talk to friends when you'd rather stay in your bedroom all day. Or it may mean going to the hospital for a mental health evaluation. But stick to your strategy, especially when you're in the grips of despair and hopelessness. And if you're already in treatment, be certain to go to all of your psychotherapy appointments and take medications as directed.

As part of your strategy, consider these measures:

Keep a list of contact names and numbers readily available, including doctors, therapists and crisis centers that can help you cope with suicidal thoughts.

If your suicide plans include taking an overdose, give your medications to someone who can safeguard them for you and help you take them appropriately.
Rid your home of knives, guns, razors or other weapons you may consider using for self-destructive purposes.

Schedule daily activities for yourself that have brought you even small pleasure in the past, such as taking a walk, listening to music, watching a funny movie, knitting or visiting a museum. If they no longer bring you at least a modicum of joy, however, try something different.
Get together with others, even if you don't feel like it, to prevent isolation.

Avoid drug and alcohol use. Rather than numb painful feelings, alcohol and drugs can increase suicidal thoughts and the likelihood of harming yourself by making you more impulsive and more likely to act on your self-destructive feelings.

Write about your thoughts and feelings. Remember to also write about the things in your life that you value and appreciate, no matter how small they may seem at the time.

Keeping yourself safe

Some mental health providers and support organizations recommend creating a "plan for life," "safety contract" or similar plan of action that you can refer to when you're considering suicide or are in a crisis. Such plans offer a checklist of activities or actions you promise yourself to take in order to keep yourself safe when you have thoughts of suicide.

For instance, your plan may require that you contact certain people when you begin considering suicide. It may also include commitments to take medication as prescribed, to attend treatment sessions or appointments, and to remind yourself that your life is valuable even if you don't feel it is.

Also, consider creating a list of specific activities to try when negative thoughts start to intrude. The key is to engage in activities you find soothing for your negative feelings. Don't wait to do these activities until you've reached the point of suicidal thoughts. Engage in healthy activities when the first negative thoughts start to creep in. Also, make certain they're activities that would normally offer enjoyment and that can help comfort you, not cause additional stress.
Then, do each item on your list until you feel like you can go on living.

Your list can include such things as:

Practicing deep-breathing exercises
Playing a musical instrument
Taking a hot bath
Eating your favorite food
Writing in a journal
Going for a walk
Seeing a funny movie
Contacting family, friends or other trusted confidantes

Even if the immediate crisis passes with your self-care strategies, consult a doctor or mental health provider, or seek help through a hospital emergency room if your community doesn't offer good access to mental health providers. They can help make certain you're getting appropriate treatment for suicidal thoughts and feelings so that you don't have to continually operate in a crisis mode.

Beyond thoughts of suicide

The despair and hopelessness you feel as you consider suicide may be the side effects of illnesses that can be treated. These emotions can be so overpowering that they cloud your judgment and lead you to believe that taking your own life is the best, or only, option.
But even people who've had suicidal thoughts for months or years can learn to manage them and to develop a more satisfying life through effective coping strategies. Take an active role in saving your own life, just as you would help someone else. Enlisting others for support can help you see that you have other options and give you hope about the future. Remember that suicide isn't a solution — it's an ending.

Stress: Can We Cope?

As modern pressures take their toll doctors preach relaxation
"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."

—University of Nebraska Cardiologist Robert Eliot, on how to cope with stress
It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.

It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.

The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."
Indeed we have.

In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple

Depression in men less frequent than women

Depression occurs in the young and the old and in men and women. We do know that the rate of depression in men is less than for women.

The symptoms that men experience can be different from those that women experience. Symptoms including anger, irritability, and feeling discouraged are more common in men than symptoms of hopelessness or helplessness.

Typical symptoms we associate with depression such as depressed mood may not be present in depression in men. This can make it more difficult to recognize depression in men. Many famous men, including President Abraham Lincoln and Winston Churchill, had depression and still lived successful lives.

Unfortunately, men are not as likely as women to admit to having depression. Even if they do admit to having depression, they may be less likely to seek treatment. Men may stuff their feelings instead of verbalizing them. They may work more, gamble, or use alcohol or drugs to avoid their feelings. Their sleep and or appetite may change. They may suddenly begin talking about divorce or separation.

Women attempt suicide more often than men, but the rate of completed suicide in men is 4 times that of women. Suicide rates peak in mid life and again later in life. Men age 85 and older have the highest suicide rate.

Men want and need to be strong for their families; they don't want to appear weak or vulnerable. If they are the primary bread winner, they can feel pressure to provide for their dependents. Of course, these general statements can be applied to women as well.
Depression in men is treatable. If you suspect a friend or loved one may be depressed, urge them to seek a professional evaluation. There are many options, including medication, therapy or a combination of the two.

By Gabrielle J. Melin, M.D.

Panic Disorder, Your Questions Answered

Answers to Your Questions About Panic Disorder

Panic Disorder is a serious condition that around one out of every 75 people might experience. It usually appears during the teens or early adulthood, and while the exact causes are unclear, there does seem to be a connection with major life transitions that are potentially stressful: graduating from college, getting married, having a first child, and so on. There is also some evidence for a genetic predisposition; if a family member has suffered from panic disorder, you have an increased risk of suffering from it yourself, especially during a time in your life that is particularly stressful.

Panic Attacks: The Hallmark of Panic Disorder

A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience. Symptoms of a panic attack include:

racing heartbeat
difficulty breathing, feeling as though you 'can't get enough air'
terror that is almost paralyzing
dizziness, lightheadedness or nausea
trembling, sweating, shaking
choking, chest pains
hot flashes, or sudden chills
tingling in fingers or toes ('pins and needles')
fear that you're going to go crazy or are about to die
You probably recognize this as the classic 'flight or fight' response that human beings experience when we are in a situation of danger. But during a panic attack, these symptoms seem to rise from out of nowhere. They occur in seemingly harmless situations--they can even happen while you are asleep.

In addition to the above symptoms, a panic attack is marked by the following conditions:
it occurs suddenly, without any warning and without any way to stop it.
the level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated.

it passes in a few minutes; the body cannot sustain the 'fight or flight' response for longer than that. However, repeated attacks can continue to recur for hours.
A panic attack is not dangerous, but it can be terrifying, largely because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and also because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild word or social impairment to a total inability to face the outside world.

In fact, the phobias that people with panic disorder develop do not come from fears of actual objects or events, but rather from fear of having another attack. In these cases, people will avoid certain objects or situations because they fear that these things will trigger another attack.

How to Identify Panic Disorder
Please remember that only a licensed therapist can diagnose a panic disorder. There are certain signs you may already be aware of, though.
One study found that people sometimes see 10 or more doctors before being properly diagnosed, and that only one out of four people with the disorder receive the treatment they need. That's why it's important to know what the symptoms are, and to make sure you get the right help.

Many people experience occasional panic attacks, and if you have had one or two such attacks, there probably isn't any reason to worry. The key symptom of panic disorder is the persistent fear of having future panic attacks. If you suffer from repeated (four or more) panic attacks, and especially if you have had a panic attack and are in continued fear of having another, these are signs that you should consider finding a mental health professional who specializes in panic or anxiety disorders.

What Causes Panic Disorder: Mind, Body, or Both?

There may be a genetic predisposition to anxiety disorders; some sufferers report that a family member has or had a panic disorder or some other emotional disorder such as depression. Studies with twins have confirmed the possibility of 'genetic inheritance' of the disorder.

Panic Disorder could also be due to a biological malfunction, although a specific biological marker has yet to be identified.

All ethnic groups are vulnerable to panic disorder. For unknown reasons, women are twice as likely to get the disorder as men.

Mind: Stressful life events can trigger panic disorders. One association that has been noted is that of a recent loss or separation. Some researchers liken the 'life stressor' to a thermostat; that is, when stresses lower your resistance, the underlying physical predisposition kicks in and triggers an attack.

Both: Physical and psychological causes of panic disorder work together. Although initially attacks may come out of the blue, eventually the sufferer may actually help bring them on by responding to physical symptoms of an attack.

For example, if a person with panic disorder experiences a racing heartbeat caused by drinking coffee, exercising, or taking a certain medication, they might interpret this as a symptom of an attack and , because of their anxiety, actually bring on the attack. On the other hand, coffee, exercise, and certain medications sometimes do, in fact, cause panic attacks. One of the most frustrating things for the panic sufferer is never knowing how to isolate the different triggers of an attack. That's why the right therapy for panic disorder focuses on all aspects -- physical, psychological, and physiological -- of the disorder.

Can People with Panic Disorder lead normal lives?
The answer to this is a resounding YES -- if they receive treatment.
Panic disorder is highly treatable, with a variety of available therapies. These treatments are extremely effective, and most people who have successfully completed treatment can continue to experience situational avoidance or anxiety, and further treatment might be necessary in those cases. Once treated, panic disorder doesn't lead to any permanent complications.

Side Effects of Panic Disorder
Without treatment, panic disorder can have very serious consequences.
The immediate danger with panic disorder is that it can often lead to a phobia. That's because once you've suffered a panic attack, you may start to avoid situations like the one you were in when the attack occurred.

Many people with panic disorder show 'situational avoidance' associated with their panic attacks. For example, you might have an attack while driving, and start to avoid driving until you develop an actual phobia towards it. In worst case scenarios, people with panic disorder develop agoraphobia -- fear of going outdoors -- because they believe that by staying inside, they can avoid all situations that might provoke an attack, or where they might not be able to get help. The fear of an attack is so debilitating, they prefer to spend their lives locked inside their homes.
Even if you don't develop these extreme phobias, your quality of life can be severely damaged by untreated panic disorder. A recent study showed that people who suffer from panic disorder:

are more prone to alcohol and other drug abuse
have greater risk of attempting suicide
spend more time in hospital emergency rooms
spend less time on hobbies, sports and other satisfying activities
tend to be financially dependent on others
report feeling emotionally and physically less healthy than non-sufferers.
are afraid of driving more than a few miles away from home

Panic disorders can also have economic effects. For example, a recent study cited the case of a woman who gave up a $40,000 a year job that required travel for one close to home that only paid $14,000 a year. Other sufferers have reported losing their jobs and having to rely on public assistance or family members.

None of this needs to happen. Panic disorder can be treated successfully, and sufferers can go on to lead full and satisfying lives.

How Can Panic Disorder Be Treated?
Most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases.

The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they're 'going crazy' or that the panic might induce a heart attack. 'Cognitive restructuring' (changing one's way of thinking) helps people replace those thoughts with more realistic, positive ways of viewing the attacks.

Cognitive therapy can help the patient identify possible triggers for the attacks. The trigger in an individual case could be something like a thought, a situation, or something as subtle as a slight change in heartbeat. Once the patient understands that the panic attack is separate and independent of the trigger, that trigger begins to lose some of its power to induce an attack.

The behavioral components of the therapy can consist of what one group of clinicians has termed 'interoceptive exposure.' This is similar to the systematic desensitization used to cure phobias, but what it focuses on is exposure to he actual physical sensations that someone experiences during a panic attack.

People with panic disorder are more afraid of the actual attack than they are of specific objects or events; for instance, their 'fear of flying' is not that the planes will crash but that they will have a panic attack in a place, like a plane, where they can't get to help. Others won't drink coffee or go to an overheated room because they're afraid that these might trigger the physical symptoms of a panic attack.

Interoceptive exposure can help them go through the symptoms of an attack (elevated heart rate, hot flashes, sweating, and so on) in a controlled setting, and teach them that these symptoms need not develop into a full-blown attack. Behavioral therapy is also used to deal with the situational avoidance associated with panic attacks. One very effective treatment for phobias is in vivo exposure, which is in its simplest terms means breaking a fearful situation down into small manageable steps and doing them one at a time until the most difficult level is mastered.
Relaxation techniques can further help someone 'flow through' an attack. These techniques include breathing retraining and positive visualization. Some experts have found that people with panic disorder tend to have slightly higher than average breathing rates, learning to slow this can help someone deal with a panic attack and can also prevent future attacks.

In some cases, medications may also be needed. Anti-anxiety medications may be prescribed, as well as antidepressants, and sometimes even heart medications (such as beta blockers) that are used to control irregular heartbeats.

Finally, a support group with others who suffer from panic disorder can be very helpful to some people. It can't take the place of therapy, but it can be a useful adjunct.

If you suffer from panic disorder, these therapies can help you. But you can't do them on your own; all of these treatments must be outlined and prescribed by a psychologist or psychiatrist.

How Long Does Treatment Take?
Much of the success of treatment depends on your willingness to carefully follow the outlined treatment plan. This is often multifaceted, and it won't work overnight, but if you stick with it, you should start to have noticeable improvement within about 10 to 20 weekly sessions. If you continue to follow the program, within one year you will notice a tremendous improvement.

If you are suffering from panic disorder, you should be able to find help in your area. You need to find a licensed psychologist or other mental health professional who specializes in panic or anxiety disorders. There may even be a clinic nearby that specializes in these disorders.

When you speak with a therapist, specify that you think you have panic disorder, and ask about his or her experience treating this disorder.

Keep in mind, though, that panic disorder, like any other emotional disorder, isn't something you can either diagnose or cure by yourself. An experience clinical psychologist or psychiatrist is the most qualified person to make this diagnosis, just as he or she is the most qualified to treat this disorder.

This Article is designed to answer your basic questions about panic disorder; a qualified mental health professional will be able to give you more complete information.

Panic disorder does not need to disrupt your life in any way, you are not alone and there are both those who can help and those who understand. Contact me for information on a No Panic Service offered both in Ireland and the UK

Staying Sane May Be Easier Than You Think

As modern pressures take their toll doctors preach relaxation
"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."

—University of Nebraska Cardiologist Robert Eliot, on how to cope with stress
It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.

It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.

The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."
Indeed we have. In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple

Studying such kids for more than a decade, the researchers discovered that those who became schizophrenic were most often from families that, when first interviewed, displayed "communication deviance" (unclear, unintelligible or fragmented speech) and highly critical and intrusive parenting. These weren't merely families that argued with difficult sons and daughters; they were families that had lost all ability to cope.

McFarlane and others began working with some of the families to address their interactions and teach them how to communicate better — more slowly, with less anger and intrusion. Even after they are on medication, people with schizophrenia have a difficult time tracking rapid, highly emotional speech, yet that's the kind they often hear from frustrated family members. These patients would improve in hospitals but relapse once they got home, even when they continued to take antipsychotics.

For several years, McFarlane developed and tested the Multi-Family Group approach, which brought several families together at a time to learn from one another how they sounded to outsiders. In twice-monthly sessions, the families modeled greater clarity and compassion and troubleshot daily-living problems like kids' marijuana use or sexual activity. It was a simple intervention that, when combined with antipsychotic drugs, worked to reduce schizophrenic relapse rates significantly more than the drugs alone.

McFarlane wondered if the treatment could work even earlier, to help prevent the illness in largely asymptomatic kids who were at risk for schizophrenia. Such prediagnosis would not be easy, but McFarlane knew that once a patient's perception of reality has cracked for the first time, it becomes exceedingly hard to walk back to normality. Indeed, a major study just published in the journal Neuropsychology shows that the signature cognitive problems of schizophrenia — deficits in verbal learning and memory along with processing speed — actually begin days or weeks before a first psychotic episode, making the earliest possible detection all the more urgent.

And so in the 1980s, McFarlane began canvassing schools in the New York City area to try to get the staffs excited about preventing schizophrenia among their students. A number of the superintendents "practically threw us out the window," he says. "They just kept saying, 'We don't have mental illness in our high school.'" It was dispiriting: based on the epidemiological data, McFarlane knew that each year about 12 in 10,000 young people suffered a first episode of psychosis. Some of the kids were clearly in those schools, but if he couldn't get through the door to screen them, he couldn't prevent any illness.

A Theory Goes WideEven as McFarlane was exploring his schizophrenia-prevention idea, other researchers were having similar what-if moments with respect to other, more routine conditions. Suppose irritable infants who become fearful toddlers who become shy children somehow could be stopped from becoming adults with anxiety disorders. Suppose men and women who go to war or become cops in inner cities could be helped before developing posttraumatic stress disorder. Could you, similarly, identify the children of depressed parents early and give them skills to prevent their own first depressive episode?

In any given year, approximately 17% of Americans under 25 have a mental, emotional or behavioral disorder. (Over our lifetime, 46% of us will receive such a diagnosis.) If we reduce the proportion of young people who become mentally ill by even one-quarter, that would mean about 3.8 million saved each year from what can turn into a lifelong struggle.

But if most mental illnesses have a genetic origin, isn't even that modest 25%-reduction goal unlikely? The science can get tricky here, but the simple answer is that genes aren't destiny. You can't do anything to change your genome, but your environment and experiences have powerful effects on the way those genes are expressed. A susceptibility to cancer may remain just a susceptibility — until you start smoking and kick the disease process into motion. Similarly, change a child's emotional experiences for the worse and you can trigger mental illness; change them for the better and you may hush the problem genes. One concrete example of this: in 2003, a study in Science found that the larger the number of copies an individual carries of a serotonin-transporter gene called 5-HTTLPR the greater the risk of developing major depressive disorder and suicidality — but only if the individual suffers stressful early-life experiences like abuse.

How long is the window between first symptoms and actual diagnosis? The National Academies report says that across several mental illnesses — including obsessive-compulsive disorder, depression and substance dependence — we have about two to three years to intervene and keep short-term symptoms from becoming long-term afflictions.

Depression offers particularly good evidence of this idea at work. Currently, about 5% of adolescents experience an episode of clinical depression in any given year. Rates of depression are three to four times as high among the children of depressed parents as among those whose parents aren't depressed. Dr. William Beardslee of Children's Hospital Boston, one of the authors of the National Academies report, has spent more than 25 years studying how some kids of depressed parents avoid the illness, and he has found that resilience is key. The kids who don't develop depression are "activists and doers," Beardslee says. Even growing up in the darkness of a depressed home, they muster the capacity to engage deeply in relationships. They also are likelier than other kids to understand that they aren't to blame for their parents' disorder — and that they are free to chart their own course.

How do you foster resilience in order to prevent depression? Over the past 17 years, Beardslee's team has developed an early intervention that targets kids from families in which at least one parent is depressed. Like McFarlane, he uses a family-based approach because a bad home environment tends to be more predictive of adolescent mental illness than dysfunctional peer relationships are. Beardslee's Family Talk Intervention includes both separate meetings with parents and kids as well as family meetings with social workers or psychologists that focus in part on demystifying depression — explaining that it is a treatable illness, not a beast that will necessarily crush a family. In a randomized trial, Beardslee found that just seven sessions of this intervention decreased predepression symptoms among the kids and improved the parents' behavior and attitudes. All this makes kids more resilient.

Tackling SchizophreniaMcFarlane hadn't gotten far with the New York City schools in the 1980s, and his prevention work waned for a few years as he taught at Columbia University and wrote articles on his Multi-Family Group approach to treating psychosis. Eventually, he moved to Portland, Maine, where he had been offered the chairmanship of Maine Medical Center's psychiatry department. There, he settled into quieter, less paradigm-changing work.
It wasn't until 1996 that his prevention work resumed. That year, a team of researchers in Norway — one that included Dr. Thomas McGlashan of Yale — approached McFarlane about training therapists to use the Multi-Family Group approach with patients who had just suffered a first psychotic episode. These patients already had the illness, so it was too late for prevention. But the Norwegians had succeeded where McFarlane had failed in New York: they had connected with schools and other local institutions to identify the first signs of psychosis and refer patients to the team immediately.

In October 1998, the picture grew still more promising when NATO sponsored a major psychotic-disorders conference in Prague, where McFarlane learned that several groups around the world, including one in Australia, had also been trying to prevent first episodes of psychosis. He returned from Prague and tried again to set up an early-detection system with schools, this time in Portland. By now, the stigma against mental illness had eased a bit; schools had seen a dramatic rise in emotional and behavioral problems during the '90s. Unlike their New York counterparts, Portland school superintendents welcomed McFarlane.

At about the same time, McGlashan's team at Yale was working on a screening interview that might distinguish kids who would become psychotic from those who wouldn't. McGlashan tested his questions at various sites in North America, including with teens who sought treatment in McFarlane's department in Portland. By 2001, McGlashan and his team had completed their "Structured Interview for Prodromal [pre-disease] Symptoms" (SIPS) — a two-hour assessment involving various oral tests and a family history. Those who meet SIPS criteria for risk are about 30 times as likely as the general population to develop a diagnosable psychotic disorder. SIPS allows for the careful scoring of warning signs, some of which are obvious (hearing mumbling that isn't there) and some of which are less so (changing your behavior because of a superstition).

McFarlane and his team connected with most of Portland's principals and pediatricians. The message was simple: If you encounter kids who seem slightly off — prone to jumbled thoughts, maybe even hearing voices — send them our way. Among those referred to him, McFarlane found that 80% of those who met SIPS criteria for prodromal psychosis would receive a diagnosis of schizophrenia within 30 months. He put kids who met a certain SIPS threshold into Multi-Family Group psychoeducation. At first, he intended not to use drugs with these prediagnosis kids, particularly since the meds can cause side effects like weight gain, acne and uncontrollably shaky legs. But McFarlane found that once symptoms like auditory hallucinations started, he couldn't correct them with only psychosocial interventions. (Today, virtually everyone enrolled in his Portland Identification and Early Referral prevention program is prescribed psychiatric medication.)

The combination of the family approach and drug support seems to be working well. The National Institute of Mental Health is funding a trial of McFarlane's work, and while he is still writing up his data for publication, his anecdotal results are promising: most of the kids are so far avoiding a first psychotic episode. Even those who have heard voices and nearly dropped out of high school are going to college and getting jobs.

But this approach doesn't come cheap. The kids who are enrolled are bombarded with care: social workers help them at school or work; therapists guide them and their families in individual and group sessions; a psychiatrist or nurse practitioner carefully calibrates their medication based on response rates and side effects.

When members of McFarlane's clinical team gather each day to discuss cases, they know virtually everything about their kids: they know about boyfriends, girlfriends and summer plans. They know the kids' grades in English class, how much pot they smoke, what they did on a recent trip to Disneyland. They know whether Dad just lost his job and if Mom's grandmother killed herself. This is what prevention of mental illness looks like: unwavering, sweeping, complicated. But it works.

One Family at a TimeThe Robert Wood Johnson foundation is so impressed with McFarlane's program that it has devoted $15 million to its national expansion. It is the foundation's single largest mental-health initiative. McFarlane's approach costs about $3,500 per patient per year, but compare that with the $150,000 a year to care for a hospitalized schizophrenic or severely bipolar patient.

Still, not all the kids McFarlane sees can be helped. Patti White is a plainspoken 47-year-old Mainer who works for McFarlane as an administrative coordinator. She has a son who began experiencing psychotic symptoms a few years ago, and he might have seemed like a perfect fit for her boss's program. He wasn't; prevention isn't that easy. Instead, White's son Tyler, who turns 20 this month, was too far along in his illness — eventually diagnosed as schizoaffective disorder, a relative of schizophrenia — to benefit from prevention therapy. A social worker on McFarlane's team helped Tyler get into treatment, and he is doing better and holding down a job in food service.

But White has another son, Jacob, who causes her to worry. A few months ago, Jacob, 10, started to withdraw. He was getting paranoid. At school, he started seeing complicated machinations where none existed. And even though White works for one of the world's leading prevention experts, she at first resisted having Jacob take the SIPS test. "If his brother had had diabetes, I wouldn't have thought twice about having Jacob screened for diabetes," she says. "But I just couldn't deal with the idea that another one of my kids would have" — she pauses — "this enormous thing."

Three weeks ago, Jacob took SIPS. The good news: he showed no red flags for psychosis. He does have depressive symptoms and is now taking a low dose of Prozac to help prevent a full-blown depression. But for Jacob — and millions of other Americans with all manner of mental ills — intervention can now come in time

Substance Related Disorders

Substance Related Disorders

Common Characteristics
The two disorders in this category refer to either the abuse or dependence on a substance. A substance can be anything that is ingested in order to produce a high, alter one's senses, or otherwise affect functioning. The most common substance thought of in this category is alcohol although other drugs, such as cocaine, marijuana, heroin, ecstasy, special-K, and crack, are also included. Probably the most abused substances, caffeine and nicotine, are also included although rarely thought of in this manner by the layman.

Substance Abuse

There is evidence that genetic factors play a role in both dependence and abuse. Other theories involve the use of substances as a means to cover up or get relief from other problems (e.g., psychosis, relationship issues, stress), which makes the dependence or abuse more of a symptom than a disorder in itself.

A pattern of substance use leading to significant impairment in functioning. One of the following must be present within a 12 month period: (1) recurrent use resulting in a failure to fulfill major obligations at work, school, or home; (2) recurrent use in situations which are physically hazardous (e.g., driving while intoxicated); (3) legal problems resulting from recurrent use; or (4) continued use despite significant social or interpersonal problems caused by the substance use. The symptoms do not meet the criteria for substance dependence as abuse is a part of this disorder.

Research suggests that no treatment method is superior, but that social support is very important. An openness to accept the abuse is also paramount in successfully treating the illness. Organizations such as AA and NA have had better than average success in reducing relapse.

Variable. Both substance abuse and dependence is difficult to treat and often involves a cycle of abstinence from the substance and substance use.

Substance Dependence

There is evidence that genetic factors play a role in both dependence and abuse. Other theories involve the use of substances as a means to cover up or get relief from other problems (e.g., psychosis, relationship issues, stress), which makes the dependence or abuse more of a symptom than a disorder in itself.

Substance use history which includes the following: (1) substance abuse (see below); (2) continuation of use despite related problems; (3) increase in tolerance (more of the drug is needed to achieve the same effect); and (4) withdrawal symptoms.

Detoxification treatment may need to be administered due to the dangerousness of some withdrawal symptoms. Research suggests that no treatment method is superior, but that social support is very important. Organizations such as AA and NA have had better than average success in reducing relapse

Variable. Both substance abuse and dependence is difficult to treat and often involves a cycle of abstinence from the substance and substance use.

Bipolar Disorder



Research has shown a strong biological component for this disorder, with environmental factors playing a role in the exacerbation of symptoms.



Bipolar Disorder has been broken down into two types:

Bipolar I: For a diagnosis of Bipolar I disorder, a person must have at least one manic episode. Mania is sometimes referred to as the other extreme to depression. Mania is an intense high where the person feels euphoric, almost indestructible in areas such as personal finances, business dealings, or relationships. They may have an elevated self-esteem, be more talkative than usual, have flight of ideas, a reduced need for sleep, and be easily distracted. The high, although it may sound appealing, will often lead to severe difficulties in these areas, such as spending much more money than intended, making extremely rash business and personal decisions, involvement in dangerous sexual behavior, and/or the use of drugs or alcohol. Depression is often experienced as the high quickly fades and as the consequences of their activities becomes apparent, the depressive episode can be exacerbated.

Bipolar II: Similar to Bipolar I Disorder, there are periods of highs as described above and often followed by periods of depression. Bipolar II Disorder, however is different in that the highs are hypo manic, rather than manic. In other words, they have similar symptoms but they are not severe enough to cause marked impairment in social or occupational functioning and typically do not require hospitalization in order to assure the safety of the person.



Medication, such as Lithium, is typically prescribed for this disorder and is the corner stone of treatment. Therapy can be useful in helping the client understand the illness and it’s consequences and be better able to know when a manic or depressive episode is imminent and to prepare for this. As with all disorders, poor coping skills and lack of support will make the illness more pronounced, and this is often a focus of therapeutic treatment.



For more severe cases, prognosis is poor in terms of ’curing’ the illness, as most people need to remain on medication for their entire lives. The manic episodes may slow down as a result of the natural aging process. With medication, the illness can be kept at a minimum level, with some people not experiencing any overt symptoms for months and even years.

However, there are definitely varying degrees of this illness and it is not difficult to misdiagnose due to it's similarity to other mood disorders. If the illness is not severe, often times medication and therapy can do very well in terms of treatment. And, life experience, strong support, and an openness to improve can be enough sometimes to
make a difference in outcome.

Psychotherapy the Basics


Psychotherapy is a set of techniques intended to improve mental health, emotional or behavioral issues in individuals, who are often called "clients". These issues often make it hard for people to manage their lives and achieve their goals. Psychotherapy is aimed at these problems, and solves them via a number of different approaches and techniques; commonly psychotherapy involves a therapist and client(s), who discuss their issues in an effort to discover what they are and how they can manage them. Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect patient privacy and client confidentiality.
General description

Given that psychotherapy is a kind of treatment restricted mostly to verbal exchanges, practitioners do not have to be medically qualified. In most countries, however, psychotherapists must be trained, certified and licensed with a range of different licensing schemes and qualification requirements in place around the world. Psychotherapists may be psychologists, social workers, trained nurses, psychiatrists, psychoanalysts, or professionals of other mental health disciplines. Psychiatrists' training focuses on the prescription of medicines, with some training in psychotherapy. Psychologists have special training in mental health assessment and research in addition to psychotherapy. Social workers have special training in mental health assessment and treatment as well as linking patients to community and institutional resources.

Recent trends in drug development to treat chemical imbalances have led to a more wide spread use of pharmaceuticals in conjunction with psychotherapy by medically qualified mental health nurse practitioners, psychiatrists, and in some states prescribing psychologists . While having benefits for patients with ailments such as bipolar disorder, impulse problems, schizophrenia and obsessive compulsive disorder, drugs of late have begun to be used as a 'quick fix' and are gaining less favor in the therapeutic community.

There are at least five main systems of psychotherapy:
Brief counseling


For a comprehensive view of the different kinds of psychotherapies, see the List of psychotherapies. For a view of the development of psychotherapy see the Timeline of Psychotherapy history Most psychotherapies are either direct descendants of psychoanalysis, or their founders started out in areas of psychoanalysis before developing their own theories. Therefore, when describing the history of psychotherapy, most traditionally start with Freud.

Although there are some bodies of thought in psychology without Sigmund Freud in their legacy, most can be traced back to his work starting in the 1880s in Vienna. Trained as a neurologist, Freud began noticing neurological problems in patients that had no biological basis. Seeing blindness, paralysis and anorexia with no apparent physical cause, he looked towards the mind for answers. Finding some evidence that those who were mentally ill could exhibit physical symptoms, he discovered colleagues and teachers who were equally perplexed and interested in such matters like Josef Breuer and Jean-Martin Charcot.

Freud opened up a private practice in 1886 until 1896 that mostly treated women who showed symptoms of hysteria (which, at that time, was very loosely defined). Using such techniques as dream interpretation, free association, transference and analysis of the id, ego and superego, his colleagues developed a system of psychotherapy termed 'psychoanalysis'. Students and colleagues of his such as Alfred Adler, Otto Rank and Carl Jung became psychoanalysts themselves, and formed their own differentiating systems of psychotherapy. These were all later termed under a more broad label of 'psychodynamic', meaning anything that involved the psyche's conscious/unconscious influence on external relationships and the self. Psychodynamic psychotherapy and psychoanalysis are considered to be particularly effective at treating certain mental disorders, such as personality disorders and mood disorders.
Current psychodynamic approaches continue to develop and change. Contemporary Freudian approaches usually retain Freud's emphasis on sexuality, aggression, and mental conflict, and often prefer insight-oriented, uncovering psychotherapy to more supportive techniques. Contemporary Freudians, for the most part, continue to believe that psychotherapy is most effective when it leads to increased self-knowledge on the part of the patient. Other current psychodynamic approaches -such as object-relational and self-psychological approaches- prefer techniques designed to change the patient's habitual patterns of living by building an especially authentic or supportive relationship with the analyst that is believed to help the patient learn new ways of relating to others and to life in general.