Helping Your Child Beat the Back-to-School Blues

September heralds the end of the lazy days of summer and the beginning of the traditional academic calendar.  This reality presents a mixed bag of emotions not only for students, but also parents. Today’s post will focus on some tips to remember as you launch your child into uncharted territory.   The following post will focus on parental reactions.

Pre-School/Kindergarten

Careful planning, visits to the school and classroom, clothes shopping and embellishing the positive associations of school (fun activities, friends & big boy/girl status) are often initially clouded by the reality of separation from mom and/or dad.  Remember that young children do not adhere to the same sense of time that we as adults know too well.  Three hours in their young lives, especially when missing their primary love attachments feels like a lifetime!

Some children will march right off on the first day and seemingly not look back only to balk the following Monday after the first weekend home.   Other children will become emotional, yet - with some expert teacher/aide distractions - will settle once their parent leaves.  Another possible scenario is that your child bounces out of the car and excitedly enters his/her classroom only to be met by several classmates who are experiencing a meltdown, prompting your child to follow suit.  All of these scenarios may feel extremely frustrating yet are very normal!

Some Useful Tips

Exercise patience and keep your own separation anxiety under wraps. Do not underestimate your child’s sensitivity to your mood, a tear in your eye or even your hesitancy to leave him/her.  Resist the temptation to cruise the parking lot hoping to catch a glimpse of your child at play.  Even a preschool child can recognize the family vehicle and this sighting may escalate an existing meltdown or heighten your child’s anticipation of returning home.  

Make certain that you are either early or on time to pick up your child at the end of their school day!  Especially if they suffer from separation anxiety, do not tell them how much you missed them. This is not about you!  Avoid talking about what “fun” activities their younger siblings engaged in while he/she was at school.  Initially, down play life at home to highlight that school is the more engaging option. Make “special” time with your child to learn about their day.  Rather than focusing on a possibly frustrating emotional first day, praise your child’s positive moments and reassure him/her that tomorrow will be a great day.

Until your child adapts to the new environment, do not overbook them!  Lunch with the playgroup may be a great idea, but not the first week of school!  Depending on your child’s adaptability to school, reintroduce structured activities like sports, music and dance gradually. Recall the last time you embarked on a new adventure.  Even amazing experiences initially require a considerable amount of emotional energy.  The same holds true for your child! 

What about rewarding your child for staying in the classroom or not having a meltdown?  This can be a delicate situation.  There is a fine line between bribing your child and rewarding them.  Commemorating their first school experience with a keepsake (video games aren’t not commemorative) is a great idea if it is not conditional.  Bribing a child during a meltdown often reinforces their association of high emotion and rewards.  Remember: there are many years of first days of school ahead and this could be very unhealthy and costly (emotionally and practically).

If your child continues to have unrelenting adjustment issues as the first month of school approaches, perhaps a re-evaluation for school readiness would be appropriate.

Elementary Years

You made it through the kindergarten year but do not be surprised if entering first grade causes similar issues.  Again, the goal in treating separation anxiety is to work with the anxiety rather than react against it.  Reassure and express love and confidence in your child’s abilities.  Quite often, the adjustment process is minimized with each school year.

Exceptions to this rule of thumb would be during times of transitions at home.  Deaths, births, major illnesses, divorce, major changes in a family’s financial situation, relocations and even the addition of a family pet may cause a temporary escalation of separation anxiety.    Keep your child’s teacher in the loop and, if necessary, do not hesitate to seek professional support for your child.

Sudden resistance to school may be related to poor peer interactions, academic problems and/or some escalation of insecurity.  As your child moves into the tween years, physical development and hormonal changes must also be considered.  Supervise but do not hover!

Junior High and High School

Understand at these developmental stages, it is very uncool to display anxiety and/or insecurity.  Most teens would rather eat a balanced meal than have their parent visible on the first day of school even though they secretly desire support.  Expect the anxiety to surface as moodiness, a hypercritical attitude, multiple wardrobe changes prior to leaving the house, meltdowns that focus on body image and uncharacteristic nastiness toward younger siblings. 

The first day of tryouts, first dances of the school year and the first rounds of exams and report cards are also potential precipitating events that may cause heightened anxiety and the internal conflict of needing support versus not wanting to accept it.

Enlist the same tips for dealing with separation anxiety.  Back off from extra-curricular activities, regulate sleep and eating routines, and remain connected.  If your child has become noticeably more independent, perhaps this is an appropriate time to schedule “down time” together.  Again, if anxiety persists and is coupled with plummeting self-esteem, do not hesitate to seek professional advice.

Concluding Thoughts

The beginning of the school year often marks the passage of time in very tangible ways.  Look at the photos you have snapped each year on your child’s “ first day.”  Realize that most children and parents have mixed emotions about this transition.  Whether your child is obviously impacted or makes seamless transitions, your connection to them is very much present even if it doesn’t appear obvious on the surface. 

School is to children as work is to an adult.  Memories from your “first days” may be an extremely useful guide to how to assist your child in their transition.  Regardless of our age, when faced with a new challenge, we all benefit from empathy, support and reassurance from those who love us most.  Patience is never more necessary and valued than at these times.

Happy first weeks of school!!!  Stay tuned for the care givers perspective!

Managing Anxiety - Treatment Basics

The relationship between worry and anxiety was outlined in the last blog.  Common symptoms of anxiety were also discussed, as were markers for predisposition.  One of the most important points in my last blog was that anxiety has served as an effective warning system for our mind and body to communicate about impending danger.  It is only when that communication system gets over aroused or stuck in constant danger mode that anxiety becomes a diagnosable condition.

Treatment for anxiety is not dependent on meeting diagnostic criteria. Cognitive –behavioral therapy (CBT) has become the most widely validated treatment option for anxiety related thoughts and symptoms. Let’s explore some fundamentals!

A primary premise of CBT involves identifying, challenging and revising our automatic thoughts.  Automatic thoughts just “pop” into our heads, they are so second nature to us that we neither actively think about them nor question their accuracy.  For example, an automatic thought might be: “If I fail this exam, I’ll never graduate.”  Well, it is almost a certainty that if this individual does not “catch” that thought and challenge it (i.e. asking yourself “really?”) that his or her body will react with symptoms of anxiety.  Underlying our automatic thoughts is our core belief.  In this example a core belief may be: “Only losers fail.”  Those core beliefs are rarely motivating and frequently paralyzing.  The key is to catch the automatic thought – it will lead to the core belief.  Getting there takes practice though.  Initially we often don’t catch the thought until after we begin to feel anxious!  It all begins with identification of both the automatic thought and the core belief.

In phase two, the goal is to challenge the automatic thoughts and their underlying core beliefs.  Sometimes it can be as simple as asking yourself: “really?”  Frequently these thoughts are very exaggerated and their perceived assumptions extremely dire!  In the above example, it is highly unlikely that one exam would prevent an individual from graduating.  It is also a faulty assumption to connect one failed exam with identifying oneself as a loser.  The goal is not to deny reality; it is to challenge the faulty assumptions or the exaggeration of those assumptions so that our bodies don’t inadvertently prepare for battle.  We have come to understand that when the mind prepares for battle (worry), the body reacts with undesirable physical symptoms (anxiety).

When recognizing and challenging our automatic thoughts becomes second nature, the final task becomes to revise those automatic thoughts and the core beliefs.  The premise is to remove the exaggerated thoughts and replace them with more balanced thoughts and a more accurate core belief.  For instance, one failed exam does not equate with failure as a person.   A revised automatic thought could be; “I need to spend more time studying this topic.”  The core belief could be “ It takes effort to become successful.”   The goal of these revisions would be reducing the likelihood of any physical reactivity to the thought. Ultimately, the process trains the mind-body alarm mechanism to exercise discretion in responding.  This often results in a more empowered and confident individual!

Today the outline of this process has been simplified and is meant to give a brief overview of one of the effective strategies utilized in anxiety management.  It is also often utilized in concert with techniques of thought stopping (refocusing), visualization and relaxation training.  There are several user-friendly workbooks that I have found to be a great adjunct to therapy.  It is often very helpful when learning the techniques of how to reframe our thoughts to be able to label the automatic thought, the core belief, the challenge and the revised core belief in some visible record.  A workbook that offers that template would be advisable.

If you are struggling with worry and anxiety, seek the support of a licensed mental health professional that has received training in Cognitive–Behavioral Therapy.  Become a wise consumer.  Do not assume that all therapists have received this training or that all therapists are equally comfortable with this modality.  Ask them! Take the time to learn the foundations from a qualified mental health professional.  Then seek out the self-help workbooks as practice tools if recommended by your therapist.

Remember that your anxiety did not occur over night; it will take some time and considerable effort on your part to manage it!  Be patient with yourself during the process.  Negativity and self-criticism only compounds the very symptoms you are seeking to eradicate! The sooner you begin the process, the sooner you can reap the rewards.

Are Worry and Anxiety Related?

What is the relationship between anxiety and worry?  Can an individual worry and not feel anxious?  Similarly, can an individual feel anxious but not worried?  The age-old debate of which came first…the chicken or the egg once again applies.  In today’s post, I will discuss anxiety, theories of anxiety’s relationship to worry, its physiological symptoms and its origins.  The next post will discuss treatment options.

WHAT IS WORRY?

Is worry merely a different name for anxiety?  Worry is an integral component of anxiety, although worry is a process that can exist in the absence of anxiety.  Let’s identify worry as a primarily mental (thinking) activity.  When an individual worries, their mind is preoccupied with fear or dread. Often thoughts have a prevailing theme of negativity - rehearsing the worse case scenarios. Worry can range from the nagging little voice inside your head to unrelenting obsessions that can neither be ignored nor quieted.  Depending upon the severity of the negative thoughts and the permanency of those thoughts (statements that begin with never or always) some level of physiological reaction frequently follows.  Ultimately the mind convinces the nervous system to prepare for battle.  This then triggers a fairly predictable sequence of autonomic physical symptoms that characterize anxiety (e.g., fear, racing heart, sweating & tingling sensations).  In this theoretical framework, anxiety is identified as the reactive symptoms an individual feels within their body in response to their mental state of worry.

An alternative theory suggests that when an individual feels a myriad of undesirable physical symptoms that seemingly “come out of the blue” they often question their origin (a mental process) and may begin to either hyper-focus on the severity of the physical sensations or obsess about an ultimately fatal outcome when these symptoms worsen. Worry is the mental process triggered by feeling anxious rather than the cause of the anxiousness. Ultimately when worry sets in the autonomic system prepares either to take flight or to fight.  Some individuals may then experience the very scary physical symptoms known as a panic attack.  Following this logic, a panic attack is an extreme physical manifestation of anxiety. Understand that an individual may feel both worried and anxious and not experience a panic attack.

What conclusions can we draw from this chicken or egg debate?  Both positions identify a relationship between the mental processes and the physical symptoms that define the term anxiety.  Anxiety is neither all bad nor is it always a diagnosable condition!  Historically it has served as an alerting and preparation mechanism to safeguard us from impending danger.  For anxiety to meet DSM-V diagnostic criteria symptoms must be frequent, extreme and a source of ongoing distress (at least six months).

SYMPTOMS

Many symptoms of anxiety can mimic those of a heart attack - if you experience them seek medical attention immediately! Anxiety can present as chest pain or tightness in the chest, numbness and/or tingling in the arms and/or legs, labored breathing (as if an elephant is sitting on your chest), racing heart, cold sweats, dizziness, chills, tightness in the throat, elevated blood pressure, ringing in the ears, restlessness and/or agitation, gastrointestinal distress and most frequently a profound sense of impending doom.

Remember that when we’re anxious our bodies are activated to either flee or fight. A great illustration of this phenomenon has been captured by many National Geographic documentaries that feature hunting behaviors of animals in the wild.  The predator (lion) stalks and takes chase after unsuspecting prey (gazelle).  The gazelle exhibits the flight mode, the lion the fight mode.  Our brains have not yet evolved beyond these basic primal responses!

Additional physical symptoms of anxiety may include a cluster of symptoms characterized by tension: feeling keyed up or on edge, irritability, muscle tension, fatigue and sleep impairment.  Sleep impairment may range from difficulty falling asleep to early awakening to unsatisfying sleep (sleeping but not feeling rested).  Cognitive symptoms of anxiety may often include a temporary inability to recall names, events and previously over-learned information (mind going blank). The best example of this phenomenon is test anxiety-despite knowing the topic, the test appears to be written in a foreign language because the student cannot remember anything.  When a person feels anxious, it can also seem that any attempt to learn or take in new information is impossible.  This is another example of the mind going blank.  Once the anxiety dissipates, cognitive abilities return to their normal level of functioning. In summary, while the symptoms of anxiety are specific to the individual, general themes involve cardiac-like symptoms, tension symptoms and cognitive symptoms. Now let’s look at who, what and where regarding anxiety.

ORIGINS

Recent statistics indicate as of 2011, anxiety surpassed depression as the primary complaint identified by patients to their general practitioner.  Historically, women have been twice as likely as men to present with symptoms of anxiety.  Recent literature also suggests that men may be closing this gap as anxiety becomes less stigmatized within the general population.  Anxiety appears to be more prevalent in developed countries and spreads across lifespans.  The differentiating factors are age-related concerns.  For example, children may exhibit anxiety regarding school concerns while adolescents may be more likely to report anxiety regarding dating, school and independence.  Adults may report anxiety regarding advanced education, professional growth, marriage, families and aging parents.  The elderly may exhibit anxiety regarding their declining health status, grief from significant losses and their own death. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, cites “childhood adversities and parental overprotection” as risk factors for developing anxiety.  Also reported in this edition is that one-third of the risk of developing a diagnosable anxiety disorder may be related to genetic transmission.  This is roughly equivalent to the genetic factors associated with a diagnosis of major depression. The balance of the contributing influences may be related to personal temperament.  This means that certain individuals who are harm avoidant, behaviorally inhibited and display negative affect may be more susceptible to developing an anxiety disorder compared to individuals who are more comfortable with risk, are behaviorally extroverted and display positive affect.

CONCLUSION

As I stated earlier in this post, if you intermittently worry and feel anxious, that may simply be a reaction to specific life events and completely normal: life can be stressful!  To meet diagnostic criteria, symptoms must be extreme, chronic and incapacitating.  The presence of panic attacks, symptoms that necessitate frequent emergency room visits and symptoms that render an individual unable to maintain appropriate daily self-care and social relatedness are of significant concern to both behavioral health and primary care professionals. In these instances, after a thorough evaluation, a diagnosis of anxiety may be warranted.

Stay tuned for Part II where I will discuss treatment options.  Specifics regarding panic attacks will be discussed in a dedicated post on that topic.

Is Quantity More Important Than Quality?

Over the past decade, this question has elicited the most animated discussions among clients in my practice.  It mostly refers to time management, usually regarding primary relationships: children, parents (including in-laws) and spouses.  This post will explore the relationship of quality to quantity as well as pose questions that will assist you in uncovering your motivation as it relates to these choices.

For the sake of clarity, I will first describe the terms that form the basis of this discussion.  Quantity broadly refers to things that can be measured, whereas quality is more discreet and refers to a peculiar or essential element.  Time management refers to the ability of an individual to allot their personal resources in the form of energy and focus in their life.  For purposes of this discussion, I will make one important assumption: that the individuals who are struggling to balance quality and quantity are truly seeking what is in the best interest of their loved ones and not using quantity v. quality simply as a justification for selfishness. 

Children

The primary dilemma that I hear voiced in my practice by parents is how to maximize interactions with their children while engaging in demanding careers. An unfortunate reality is that in the lives of infants and especially toddlers their “firsts” (i.e. smiling, standing, crawling, walking) cannot be scheduled.  As most parents can attest, sometimes stepping into the next room can be too far away from the action, let alone across town!  Therefore, with these developmental stages, quantity seems to trump quality.  Parents have attempted to maximize quantity through job share opportunities, split shifts and telecommuting.  Video streaming has also been a way that some parents have been able to remain connected despite demanding careers.  Yet another option has been childcare delivered by family members. During these developmental stages consider that quantity is quality.

An interesting juxtaposition occurs as your child enters school.  As the child’s interests broaden their preferences may transition to quality time rather than sheer quantity with their parents.  The parental problem at this developmental stage is what constitutes quality time?  Is it the 10 to 15 minute commute to and from music lessons, dance or sports?  Is it observing from afar their child’s extra-curricular activities?  Or does quality time refer to time spent playing video games with them or supervising homework? 

Each family needs to define what constitutes quality interactions.  I would hope that the definition includes a movement away from activities that involve coaching, critiquing and/or instructing.  Focus more on activities that require interaction with each other – board games, walks, hikes and gardening.  This is also a good time to begin rituals like family dinner hours, dedicated times for quieting of electronic devices and pre-bedtime rituals.  Remember that even though children may be completely capable of reading to themselves, reading with their parent at bedtime often remains a significantly fond memory years later. 

With adolescence and emerging adults the potential for a complete role reversal with their child may occur.  It is often the parent who complains of little if any time spent with their child.  Parents may suffer from “separation anxiety” when their teen leaves the house because as parents they cannot assure their child’s safety.  It is also a pivotal time when guilt may be used by both parents and their children to leverage opportunities for quality time. 

Parents who have traditionally assuaged their own guilt about the quantity/quality debate during their child’s earlier years may now consciously ramp up these efforts because their child is more vocal.  If buying “things” or attempting to create quality time with extravagant getaways became an avenue from which to engage with your child, the tables may turn when they become teenagers.  The child who has become accustomed to this parental behavior may now raise the ante to capitalize on their parent’s feelings of guilt.  This may be an example of a ritual that began in the early years that became unhealthy.  Why not focus on getting to know your teen and allow them to know you beyond your parental role? For parents, it may stave off feelings associated with the impending doom of empty nest.

Parents and In-Laws

In my post  “When the Child Becomes the Parent,” I explained the fundamental shift that occurs as our parents decline with age.   As senior parents decline, they may project more emotional dependency upon their adult children.  They are at risk for increased loneliness and this often translates into depression and anxiety that in turn affects their physical health. This is especially true when they live alone. In this case, quantity rather than quality is once again preferred, especially if their memory has been affected.  It is more difficult for them to know whether you visited last month or yesterday because their sense of time often becomes impaired.

Active seniors however, may have established a satisfying social life prior to their decline.  A considerable number of my clients report feeling angry that their parent(s) “don’t have time for their family.” My suggestion would be to book your time with them!  Quality would be the primary goal at this life stage.

Spouses/Significant Others

Ideally, couples want to spend time together.  I believe that there is often an assumption about what constitutes quality time rather than a mutually agreed upon decision.  If one partner believes that co-habitating addresses both the quantity and quality dimensions while the other partner actually expects some undivided attention, this could become a recipe for disaster!  Risks of assuming that your partner adopts your viewpoint increases with years spent together.     

If your relationship pre-dates the era of electronic devices, I highly suggest you discover how your mate really feels about their usage while spending time together.  If you are familiar with the book The Five Love Languages, it is safe to assume that therein lays valuable insight into what defines quality to each partner. If you are interested in this topic but have yet to complete the surveys at the back of the book, follow this link: http://www.5lovelanguages.com.

SUMMARY

This discussion has suggested two important points regarding quality and quantity in significant relationships: (1) One size does not fit all and (2) Quantity and quality are interrelated.  Not only do our life stages dictate our needs and desires for time, energy and dedicated focus, our temperaments also serve as a barometer for need. Thus the nature of the relationship and the key people affected dictate which choice is most necessary.  Since relationships are constantly evolving, what may be relevant one year may not be entirely relevant five years from now.  The last and most important point is that quantity and quality are interrelated.  I propose that quality time is not dependent upon extensive planning or exciting activities, but rather a spontaneous shared moment whereby a precious memory is created. Most frequently it involves sharing simple pleasures (sunsets, star gazing, sunrises). A simple pleasure requires the gift of time to occur naturally. Your life will become exponentially richer when you create an opportunity for spontaneity.  This requires chunks of non-dedicated time not only to experience simple pleasures but also share them with your cherished loved ones!

The Trap of Perfection

In my opinion, perfection is highly overrated.  It assumes that a comparison must be made of someone or something – a personal value judgment.  Perfection also implies a judgment of ultimate success or ultimate failure.  Take a moment and define perfection. Does your definition include both positive and negative descriptors (ex. what is and is NOT perfect)? There are many downsides when perfection becomes the goal!   Frequently these downsides are not in our conscious awareness.  This post will explore some of the potentially hidden pitfalls in the quest for perfection and the negative effects they can have on our self-worth and happiness.

The quest to either become perfect or secure the perfect mate, career, physique or even golf swing can be a solitary process.  Often the sheer dedication and focus required in pursuit of perfection promotes isolation. Perfecting any specialized technique, whether it is a three-point shot or a pirouette often demands hours of focused activity.  The sacrifice is social connectedness. Frequently outsiders represent distraction rather than support.   If you happen to be shy or a bit insecure, it is a great way to justify why you need to remain alone. 

The obvious downside to this cover-up is that as an individual you deny yourself the opportunity to challenge your fears or insecurities.  For instance, overcoming shyness or timidity requires practice in various social situations. Isolating to perfect you obviously limits opportunities to develop social confidence.  So what happens when an individual believes they have perfected whatever technique they set out to master? Self-confidence often rises!  However, confidence does not always erase social insecurity and it also does not generate instant friendships. Why?  While focusing on the process of perfection, little if any energy was spent either in creating new or nourishing existing friendships.  So when seeking to celebrate their new found confidence and their perfect technique, this individual may unfortunately remain a party of one. 

The second downside to this particular cover-up is once again based on a relative value judgment.  If you are engaged in the solitary pursuit of perfection, how do you know whether your idea of perfect aligns with someone else’s?  Observing the behaviors of similarly talented individuals can be a great comparative tool, but when do you incorporate outsiders into your quest? Sooner than later would be ideal!  An individual may have attained their personal best, yet may not be able to compete among an equally talented peer group.  This could be a two-fold blow to self-confidence with the realization that: (1) your personal best was not regarded as perfect and (2) the time spent in isolation did not produce the anticipated benefits (acceptance, happiness or popularity).  For example, while you may now have a perfect physique, the attention you imagined you’d receive is not happening in the real world.  The result may be disillusionment and bitterness.  Neither of those energies attracts the type of positive attention you imagined, and again you remain alone.

In the context of personal relationships, seeking perfection may cleverly mask deeper commitment issues.  There is a vast difference between holding fast to personal standards and finding fault with every potential mate while “holding out” for Mr. or Ms. Perfect.  If you find that no one ever measures up: (1) your standards for perfection may be unrealistic; (2) you may be over-estimating your own personal value; or (3) you are unwilling to commit, period. Perfectionists impose far too many rules on themselves and these rules unfortunately spill over onto others.  Rarely will anyone live up to the perfectionist’s fantasy of possibilities. 

One of the many faulty assumptions of perfectionism is that if an individual obeys the rules, then they deserve the long awaited reward (happiness, marriage, wealth, success). Often despite securing the perfect mate or job they are dissatisfied and only marginally happy.  How can this be? The simple answer is that reality rarely measures up to our fantasies.  Perfection is a product of our imagination, our personal beliefs and the norms we learned within our families. It is colored by our personal life experiences and therefore no two definitions are exactly alike. 

The obvious impact of this cover-up is self-imposed chronic isolation!  It can also create a pseudo superiority that masks either an individual’s fear of commitment or simply a lack of desire to commit to anyone.  In both instances the potential mate has been set up for failure – missing the mark of perfection. This is a lose-lose proposition: (1) the self-esteem of the potential mate takes a hit based upon the perceived rejection, and (2) the perfectionist is allowed to avoid taking responsibility for their own commitment issues while focusing on the flaws of the potential mate.  In time, this emotional manipulation may be disguised as a quest for perfection.  

So far we have seen that the pursuit of perfection often backfires and may actually result in a decline in self-esteem, limit potential happiness and promote social isolation.  Yet when many individuals set out to perfect some aspect of themselves, they expect to feel quite the opposite – bountiful happiness, increased confidence and social acceptance.  As adults we are capable of challenging this faulty thinking with the guidance of a mental health professional.  What about our children?

Examine how you may be perpetuating the misguided notion that perfection is the only valuable performance goal.  Reduce the frequency of your use of the word perfect.  How many events, behaviors, grades and performances can be perfect?  Again, overuse of this term sets up unrealistic expectations for our children!  It can actually negate the small victories that drive sustained motivation towards the bigger goal.  It also may lead to a rigidly structured life that over-emphasizes the value of delayed gratification and cements a pattern of chronic disappointment when the rewards are finally granted.  Protect your children from these unnecessary assaults to their self-esteem. Teach them to celebrate each step that is completed towards the larger goal. Reinforce their uniqueness but refrain from idolizing them as perfect.

I believe that our goal both as adults and parents needs to be balance – strive to give your personal best and create meaningful relationships.  Also develop a conscious awareness and acceptance of your vulnerabilities without judging them.  That is a much more attainable goal than the illusion of perfection! 

Understanding Bipolar Disorder

Are you plagued by significant mood swings that surprise even you? Do you feel as if your emotions have a life of their own, meaning that simple anger can escalate into rage in minutes?  Is it common for you to feel either boundless bursts of energy or debilitating fatigue?  Among my clients, one of the most widely misunderstood and feared diagnoses is Bipolar Disorder.  Let’s understand what it is, its’ symptoms and treatment options. 

Simply put, the definitive feature of Bipolar Disorder is the cycling of polar opposite emotions (think ecstasy/despair or rage/meekness).  Humans experience a broad spectrum of emotions, although individuals with Bipolar Disorder report experiencing cycles of emotional extremes.  Many individuals report feeling “crazy” because, despite their best attempts to balance their thoughts and feelings, their emotions frequently overpower their thoughts and drive unwanted behaviors.  A diagnosis of Bipolar Disorder is not based upon a single snapshot in time but rather, observation of patterns of behaviors characteristic of both depression and mania.  To receive this diagnosis a myriad of diagnostic criteria must be met.  Let’s briefly examine the symptoms of depression and mania.

Depression

I doubt that anyone who has experienced life is unfamiliar with feeling depressed. Today the term depression will be limited to the experience of an overwhelming sadness and even despair regarding the past and present as well as a profound sense of hopelessness regarding the future.  Behaviors associated with depression can include sleep disruption, appetite impairment (too much or too little) and inability to focus and/or concentrate.  Often an individual may question whether life is worth living and possibly become 
actively suicidal.  Emotions may range from irritation to rage, 
increased tearfulness to feeling  “numb.”  Social isolation frequently occurs, as does a noticeable disengagement from  once pleasurable activities.  For example, the avid runner may stop all physical activity.  Physical symptoms like unexplained pain, gastrointestinal distress and migraines may appear without obvious triggers. 

Mania

The polar opposite of depression is mania.  Some hallmarks of mania include: scattered thoughts (so many wonderful ideas that you cannot focus on just one) and heightened creativity (many projects are begun but not completed).  Speech may be pressured (you interrupt others while they are speaking because you have too much to say and no time to waste) and emotions run high (bouts of uncontrollable laughing or crying).  Sleep and appetite may become erratic based upon elevated energy levels.  There is also frequently an increased motivation to engage in reckless behaviors like speeding, daring sports and/or illegal activity without
considering the possible consequences. Physical symptoms may include a sense of restlessness (feels like an engine is running inside of you), irritability (shorter than normal fuse), agitation and increased anxiety (nervousness, racing heart, sweaty palms & pacing).

Cycles

A qualification of Bipolar Disorder is an observed history of both mania and depression. An individual’s transition from depression to mania and vice versa is known as cycling.

While some individuals may experience both mood states at the same time, that is not common. Cycles are directly related to brain chemistry and therefore are specific to each person.  A cycle may occur several times a day to once per year.  Again, this is highly dependent on the individual.  Often my clients will report feeling restless or agitated and/or significantly fatigued prior to the onset of a cycle. An increased vulnerability to self-medicate through alcohol, food, illegal drugs, promiscuity or gambling may occur in an attempt to mask these uncomfortable feelings during a transition.

Origins

Bipolar Disorder is a physiological imbalance within the brain.  Some research suggests that there may also be structural abnormalities within the brain. Research findings also predict a genetic contribution among blood relatives.  There is an equal likelihood of occurrence among males and females.  Stress, significant life events and a history of significant childhood trauma may also contribute to the development of Bipolar Disorder. 

Treatment Options

Clearly Bipolar Disorder is a dis-equilibrium in the naturally occurring neurochemicals within the brain.  Therefore a primary treatment consideration is effective medication management.  Psychiatrists specialize in highly specific medication protocols that are tailored to an individual’s symptom profile.  It is not uncommon to be prescribed a mood stabilizer as well as an antidepressant and perhaps an anti-anxiety medication.  As a patient, it is vital to develop an open and collaborative relationship with your psychiatrist in order to effectively manage your symptoms.
   

Therapy is the second component of treatment. Mood swings can be exhausting not only for the client, but also for those that they love.  Ongoing therapeutic support that combines identifying and then understanding the cycles and the accompanying risky behavioral responses is the first step in mood management.  The next step is learning and then implementing less risky behaviors as alternative coping strategies.  Research indicates exponentially greater success when a team approach to treatment is utilized.

An obstacle to treatment is often a client’s reluctance to forgo the manic cycle.  Although maladaptive, it had often served as motivation for task accomplishment as well as increased feelings of well being. Similar to the patient-psychiatrist relationship, the client-therapist relationship must also feel comfortable and collaborative.  A client’s treatment team often becomes an enduring relationship.

Conclusion

The stigma attached to Bipolar Disorder needs to be eradicated! The fears attached to being labeled “crazy” prevent far too many individuals who would benefit from treatment to seek it out.  Stereotypes of “crazy” within the entertainment industry have reinforced the stigma. Why?  Mania has been sensationalized!

The Oscar award winning film, Silver Linings Playbook has begun to challenge this stigma.  Bradley Cooper, Jennifer Lawrence and Robert DeNiro brought to life the real struggle of Bipolar Disorder within families.  Catherine Zeta-Jones, Robin Williams, Jean-Claude Van Damme and Jane Pauley are celebrities who have publicized their personal challenges in managing their cycles.  Their goal has been to “break down the stigma.” 

The diagnosis itself does not necessarily limit personal growth and success.  Once an individual understands and takes responsibility for their symptoms, effective management begins.  Refusing or halfheartedly following a treatment regime will ultimately impact relationship, professional and personal success. 

If this post has raised questions about yourself or someone you love, don’t delay – schedule an appointment with your physician and/or a licensed psychologist.  NOW is the perfect time!

The ABC's of Attention Deficit Disorder

Today I will discuss a commonly misunderstood condition, Attention Deficit Disorder.  There is much confusion, fear and misinformation floating on the web that either stereotypes, catastrophizes or minimizes this condition.  This post will outline the disorder; explain some of its more unusual symptoms and explain how it is diagnosed.

Description and Symptoms:

Attention Deficit Disorder (ADD) is a medical diagnosis associated with significant difficulty in sustained focus, listening and concentration. Additional symptoms often include forgetfulness, a propensity for losing or misplacing personal possessions and an inability to accurately estimate the time it takes to complete a given task. A consistent pattern of difficulties with planning, organizing and executing activities is also evident.  Challenges with visual-spatial processing are frequently exhibited as confusion with geographical directions as well as academic challenges in the areas of math and reading comprehension.

Are these deficits caused by the way an individual thinks? Could permissive parenting styles generate Attention Deficit behaviors?  Is it possible that these symptoms are a response to where we live and work?  Let’s examine these possibilities. 

The Thinking Brain:

The frontal lobe of the brain is also known as the hub for executive functioning.  Executive functioning is the process of how we (1) generate an idea; (2) then formulate a plan; (3) organize that plan into functional steps; and (4) finally execute that plan.  In essence, it is our ability to transform a creative thought into a substantive product.  Normal frontal lobe development occurs from approximately age four through age 20.  Research suggests that symptoms associated with Attention Deficit Disorder may reflect a lagging development of the frontal lobe.  That would explain why some children with ADD seem to “catch up” with their peers in the areas of executive functioning during college.  Attention Deficit Disorder is not related to intelligence.  It is related to how we process information!

Visual-spatial ability is the way our brains can “see” dimensions (think geometry) as well as how we read maps and even comprehend what we read.  Our ability to differentiate left from right and east from north, west and south are also a function of “picturing” spatial relationships within our brain.  Reading skills are very dependent upon visual-spatial acuity. In order to comprehend what we read, we transform words into mental pictures that have meaning.  When the ability to translate words into meaningful pictures is compromised, deficits in understanding what we read are very possible.

While there are not structural differences in the brains of individuals who are diagnosed with Attention Deficit Disorder, clearly how the brain processes incoming information is involved in this diagnosis.

Behavioral Origins:

Is it possible that an individual’s behavior causes Attention Deficit Disorder?  No! The connection with what may seem like unruly behavior and Attention Deficit Disorder is more likely the impact of how mental distraction and disorganization affects behavior. This is often observed when an individual seemingly jumps from one activity to another or forgets important materials needed to complete a given task when compared to their peers.   For example, your child may forget to bring their workbook home (the one they needed) although they do remember to bring home the textbook! 

An adult with Attention Deficit Disorder may return to the market several times while preparing a meal because they “forgot” key ingredients despite being there hours earlier!  These examples more accurately reflect an inability to plan and organize their activities rather than deliberate oppositional or defiant behavior. 

  

Unfortunately, to the frustrated parent these behaviors may appear to be intentional; a behavior that could be remedied with more discipline. An individual with Attention Deficit Disorder often feels frustrated and embarrassed by their behavior. In this situation, firmer discipline is rarely effective. I believe it is important to understand that these seemingly scattered behaviors are the outward expression of what the brain is internally struggling to keep straight. 

Environmental Origins:

What about our environment?  Could it cause Attention Deficit Disorder? Highly unlikely!  Is there a definite correlation between the environment and the exacerbation of ADD? Absolutely!  Recall that individuals with Attention Deficit Disorder struggle with organizing and processing information within their brains.  Living in a cluttered home or attempting to function in a chaotic academic or work environment further stresses their ability to organize yet another system in their lives.  The options are: (1) to spend precious time and emotional energy attempting to organize the chaos prior to tackling their assignments; (2) attempt to ignore the chaos and focus on the task at hand; or (3) become caught up in the chaos and accomplish nothing. 

An individual with Attention Deficit Disorder may valiantly attempt to organize their clutter by purchasing organizational tools such as bins and specifically designed organizers only to get side-tracked when determining which color to buy.  A student may dive into a project and then become

overwhelmed by the thought of how to organize their outline. They may choose to escape this internal chaos by focusing on a video game. In both of these examples, little re-organizing will occur without assistance from family and/or friends.

An alternative approach to manage a chaotic environment may be to extract themselves from the chaos and hyper-focus on the task at hand. The mental exhaustion required to complete the original task amid the chaos depletes the energy required to then reorganize their environment.  This may be incorrectly identified as laziness, when it may be emotional and mental exhaustion! 

The least healthy approach is to get lost in the chaos.  This may look like halfhearted attempts to organize the environment followed by halfhearted attempts to focus on their work with little impact on either situation.  Generally this approach is followed by surrender on both fronts. Therefore, we may conclude that Attention Deficit Disorder is definitely affected but certainly not caused by the environment.

Interactions Between the Brain, Behavior and Environment:

Attention Deficit Disorder is a neurological disorder that originates in the brain that challenges the processing of information as well as affecting sustained attention and concentration. Often loved ones first observe behaviors that may prompt concern.  Environmental factors, especially chaos and clutter certainly may exaggerate symptoms and further compromise functioning.  But neither behavior nor the environment causes ADD.  Who then is qualified to diagnose Attention Deficit Disorder?

The Diagnostic Process:

In most states, a medical professional is qualified to diagnose Attention Deficit Disorder.  However, many physicians refer their patients to a psychologist who will administer tests and evaluate relevant family history prior to making a recommendation of this diagnosis.  Research suggests that there may be a genetic transmission of Attention Deficit Disorder.  Most recent research also suggests that maternal smoking and alcohol consumption during the second trimester of pregnancy may also be correlated with Attention Deficit Disorder in children. These are several reasons that a comprehensive familial history is important when evaluating this diagnosis. It is also important to rule out the possibility of depression and anxiety. These emotional conditions may also impact an individual's ability to focus and process information and thus may mimic symptoms of Attention Deficit Disorder.  A psychologist is also qualified to assess as well as rule out emotional issues that may confuse the diagnostic picture.

CONCLUSION:

An adolescent or an adult cannot suddenly develop Attention Deficit Disorder!  While this diagnosis may not be determined until adolescence or even adulthood, symptoms must have been present prior to age seven to meet diagnostic criteria. Frontal lobe development, family history, behavioral observations, academic and home environments, and possible emotional issues must be considered prior to confirming this diagnosis. If you or your loved one seems to be struggling despite conscientious efforts to succeed, consider an evaluation for Attention Deficit Disorder.  A variety of treatment options are now available that may make the road to success more clear and more readily attainable!