The applicability of psychology to daily life

I teach an introductory level class in Adult Development and Aging that, like many classes, has a host of possible textbooks to guide students through the materials. Each text offers an instructor's manual that summarizes each chapter and a test bank offering a selection of multiple-choice questions - all presumably created to ease the instructor's workload. I could get by with that, and would perhaps conform to many classes taught at colleges and universities if I solely rehashed the chapters for the students and asked them to regurgitate the material via multiple-choice exams. But teaching in that manner clearly fails to serve up an adequate university education.

One simple, yet powerful, addition to classroom lectures began as a challenge to myself during my first semester teaching this class. I read the Calgary Herald before leaving for work, and each day found articles that related directly to the topics I was covering in class. Thus, I began to bring in a news item each day, and I began the class by discussing how the things going on in the local and global worlds were directly related to the things we were learning in class. For example, there were relevant news stories that described or discussed the demographics of our aging population, articles on many issues of retirement (pension plans, changes in health care, and adaptation to change), frequent updates on medical advances in the areas of osteoporosis or heart disease, ample advances and discussion of Alzheimer's disease, many descriptors of death and the forces that surround death, and images of older adults (both good and bad). My simple challenge was easily accomplished. By the end of the semester, I had proven to my students, as well as to myself, that within a rather small sample (the Calgary Herald), I could find a relevant article each day.

With that first test under my belt, I expanded the challenge the second time I taught this class. I now challenged the students to join me in this exercise. Not only did I find something again each day, I asked the students to do the same by bringing in some media or personal event relevant to our class. The response was tremendous. More in-depth discussions ensued, even from the shiest of students. Creativity began to blossom in both myself and the students. Media were expanded to include video clips, WWW sites, magazines, and many personal accounts of people and events related to older adulthood and development. The course evaluations were full of positive comments about the experience, providing me with encouragement to continue the challenge.

It is unfortunate that this class has been faced with a tremendous increase in size. The first year, I taught this class to 50 individuals; 75 enrolled in year two. The enrolment is 250 students this term. Instructors are continually faced with finding a balance between serving the student and maintaining sanity (or, at the very least, making some time for research!). It is impossible for 250 students to be able to share their findings in a single term. Yet, this technique of bringing context into the classroom is possible in the larger classes. Also, this simple application of bringing a social context into the classroom works in other classes just as easily.

Natalie Safertal (l) and Caroline Brookes
violating norms by acting like airplanes in Dr. Lahar's Psychology 353 class.

Introductory Psychology is one of the classes particularly plagued by enormous class size (400 students were enrolled last time I taught this class). In this introductory class, we sample bits of most areas of psychology. These areas are also simple to apply to the everyday lives of students. Social psychology is perhaps one of the most obviously applicable areas. As we discuss social phenomena, such as bystander apathy and social norms, I challenge the students to violate some norms. Indeed, students have returned with a variety of innovative violations of social norms. One pair of students entered a theatre-sized classroom mid lecture and ran through the theatre yelling and acting like airplanes (honest!). This was particularly funny since they happened upon a social psychology class, giving the professor a great basis for a lecture topic as well as providing the violators with an understanding audience. Other students have reported back more mundane examples, such as standing backwards in elevators or walking up to strangers and asking for a bite of their lunch. But beyond the social realm, almost any area of psychology has some real-world context in which to frame the everyday nature of the lectures in terms of the external world. Even when I describe parts of a neuron and neurotransmitter systems, I can easily pluck from the media some application of these materials to the students' lives. These examples can arise from discussions of drug use or from simply eating turkey for dinner. It's easy to find that biological, social, cognitive, health, and clinical psychology are well represented in the news if one keeps an eye open.

I also teach classes in research methodology and statistics. One might think that in this area it would be more difficult to make use of the daily paper. However, again each day I can find ample statistical references in the news. There are of course charts, graphs, and statistics provided with many news stories. These can all be examined with a critical eye. Yet there is applicability of methodological lecture topics. Consider the normal curve: for indeed, most things around us are normally distributed. We select an orange from the produce section, and we look for the larger, or better-coloured selections from hundreds that vary in size or in colour from each other in a way that is normally distributed. Beyond preparing our students to be intelligent media consumers, it is useful to consistently demonstrate the applicability of those things learned in the classroom to outside the classroom.

Since students tend to read, hear, and watch a tremendous amount of information via the media, it is important to assist them as intelligent consumers and to prepare them to question what is read and not to passively accept it. In a university system where it has become more and more difficult to teach critical thinking, I think it is the least we can do for the students to provide mentorship in making use of what they are learning in the classroom. One way to do this is to allow students to evaluate and consider the context in which they live and learn by incorporating the media with what we are teaching in the classroom. The social sciences are truly about society, and examining outside media reports is one accessible and inexpensive alternative that represents applying the university experience to everyday experience.

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Helping children cope with disaster

APF funding is helping the Population and Community Development Association of Thailand use a mountain resort camp to help Thai children recover from the tsunami's lingering affects.

BY ZAK STAMBOR
Monitor Staff
Print version: page 34

When Yugoslavian psychologist Nila Kapor-Stanulovic, PhD, asked Thai children who had lived through the Dec. 26 tsunami to draw a picture at a psychological rehabilitation camp three months after the disaster, more than 70 percent of the 44 campers depicted the tsunami's giant waves crashing ashore.

Kapor-Stanulovic, the camp's trauma therapist and trainer, used the drawings to allow the campers to tell their stories of horror, survival, despair, loss, grief and guilt.

The Population and Community Development Association of Thailand funded the camp through a $5,500 grant from the American Psychological Foundation (APF) and grants from other organizations. The association selected two children from each of 10 villages in southern Thailand to attend the camp in Sup Thai, a city in the mountains of northern Thailand, from Feb. 27 to March 5.

Kapor-Stanulovic, who created psychosocial recovery programs during the collapse and outbreak of armed conflicts in the former Yugoslavia and developed U.N. Children's Fund mental health recovery programs in Serbia, Armenia and other war-torn and natural disaster areas, volunteered to join the project when asked by her friend, psychologist Henry David, PhD. Kapor-Stanulovic and David then prepared the grant proposal to APF on behalf of the association. The American Jewish Joint Distribution Committee funded Kapor-Stanulovic's expenses.

Soon after arriving at the site, Kapor-Stanulovic was struck by the children's unease.

"Looking around, the children's faces were scared, lost and uncertain about what would happen next," she says.

But by the end of the seventh day, the camp staff of psychologists, mental health professional volunteers and 10 local teenage counselors had created an empathetic and understanding environment that helped campers--like Sampop and Ruchet, two boys from the same village in Thailand's Phang Nga province--deal with their stress and trauma and allowed them to talk about their experiences and learn coping strategies, says Kapor-Stanulovic.

"A simple intervention can produce fascinating, amazing recoveries," she says.

Dealing with tragedy

Both Sampop and Ruchet began describing their tsunami experiences with the same two sentences, "It was a quiet sunny morning that 26th December. Nothing unusual."

Sampop was selling souvenirs to tourists at the beach to earn money for his family. Ruchet was home while his older brother went out on their family fishing boat. Then the waves rose.

Sampop watched as a wave swallowed countless people from the spot he had been standing just minutes before. Ruchet watched the sea rise higher and higher as his brother's boat turned upside down. His brother waved before being overtaken by the water. Ruchet never saw his brother again.

"Those memories cannot be forgotten," says Kapor-Stanulovic, the first recipient of the APA International Humanitarian Award in 1999. "We had to open up the topics so that the children could slowly start to exchange their stories."

After the campers drew pictures on the first day, they broke into groups of 10 to write a puppet show based on the tsunami. The activity encouraged the children to share their tsunami experiences.

The volunteers also held workshops to explore the children's experiences. One, for example, explored using metaphors to express traumatic experiences, while another focused on understanding stress-related symptoms.

It took time, Kapor-Stanulovic says, but by the end of camp the counselors saw the children's behavior shift from introverted and removed to normal, childlike romping.

"They had gained the energy to enjoy themselves as young people," says Kapor-Stanulovic. "Quite simply, they had begun to recover."

On the camp's final day, the children performed their puppet show, as well as a fashion show of makeshift clothing.

"Studies have shown that children and youths with strong emotional support from others are better able to cope and adjust in stressful situations," she says. "The relationships they developed helped decrease their isolation and allowed them to react and cope."

Foundation aid

APF's grant contributed significantly to the Population and Community Development Association of Thailand's psychosocial rehabilitation program, says David.

Dorothy Cantor, PsyD, APF president, adds that the foundation was eager to help the association achieve its goals.

"We were happy to be able to ensure that psychology could play a role in helping the victims of trauma recover," she says.

As a result of APF's funding, the association sponsored a second camp from May 9 to 13 and aims to support eight more camp sessions, for which Kapor-Stanulovic will direct the psychological first aid.

"What we're doing is necessary," she says. "We're providing people with relief and support. We're giving them the energy and resolve to return to normal life."

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Controlling Anger -- Before It Controls You

We all know what anger is, and we've all felt it: whether as a fleeting annoyance or as full-fledged rage.

Anger is a completely normal, usually healthy, human emotion. But when it gets out of control and turns destructive, it can lead to problems—problems at work, in your personal relationships, and in the overall quality of your life. And it can make you feel as though you're at the mercy of an unpredictable and powerful emotion. This brochure is meant to help you understand and control anger.

What is Anger?

The Nature of Anger

Anger is "an emotional state that varies in intensity from mild irritation to intense fury and rage," according to Charles Spielberger, PhD, a psychologist who specializes in the study of anger. Like other emotions, it is accompanied by physiological and biological changes; when you get angry, your heart rate and blood pressure go up, as do the levels of your energy hormones, adrenaline, and noradrenaline.

Anger can be caused by both external and internal events. You could be angry at a specific person (Such as a coworker or supervisor) or event (a traffic jam, a canceled flight), or your anger could be caused by worrying or brooding about your personal problems. Memories of traumatic or enraging events can also trigger angry feelings.

Expressing Anger

The instinctive, natural way to express anger is to respond aggressively. Anger is a natural, adaptive response to threats; it inspires powerful, often aggressive, feelings and behaviors, which allow us to fight and to defend ourselves when we are attacked. A certain amount of anger, therefore, is necessary to our survival.

On the other hand, we can't physically lash out at every person or object that irritates or annoys us; laws, social norms, and common sense place limits on how far our anger can take us.

People use a variety of both conscious and unconscious processes to deal with their angry feelings. The three main approaches are expressing, suppressing, and calming. Expressing your angry feelings in an assertive—not aggressive—manner is the healthiest way to express anger. To do this, you have to learn how to make clear what your needs are, and how to get them met, without hurting others. Being assertive doesn't mean being pushy or demanding; it means being respectful of yourself and others.

Anger can be suppressed, and then converted or redirected. This happens when you hold in your anger, stop thinking about it, and focus on something positive. The aim is to inhibit or suppress your anger and convert it into more constructive behavior. The danger in this type of response is that if it isn't allowed outward expression, your anger can turn inward—on yourself. Anger turned inward may cause hypertension, high blood pressure, or depression.

Unexpressed anger can create other problems. It can lead to pathological expressions of anger, such as passive-aggressive behavior (getting back at people indirectly, without telling them why, rather than confronting them head-on) or a personality that seems perpetually cynical and hostile. People who are constantly putting others down, criticizing everything, and making cynical comments haven't learned how to constructively express their anger. Not surprisingly, they aren't likely to have many successful relationships.

Finally, you can calm down inside. This means not just controlling your outward behavior, but also controlling your internal responses, taking steps to lower your heart rate, calm yourself down, and let the feelings subside.

As Dr. Spielberger notes, "when none of these three techniques work, that's when someone—or something—is going to get hurt."

Anger Management

The goal of anger management is to reduce both your emotional feelings and the physiological arousal that anger causes. You can't get rid of, or avoid, the things or the people that enrage you, nor can you change them, but you can learn to control your reactions.

Are You Too Angry?

There are psychological tests that measure the intensity of angry feelings, how prone to anger you are, and how well you handle it. But chances are good that if you do have a problem with anger, you already know it. If you find yourself acting in ways that seem out of control and frightening, you might need help finding better ways to deal with this emotion.

Why Are Some People More Angry Than Others?

According to Jerry Deffenbacher, PhD, a psychologist who specializes in anger management, some people really are more "hotheaded" than others are; they get angry more easily and more intensely than the average person does. There are also those who don't show their anger in loud spectacular ways but are chronically irritable and grumpy. Easily angered people don't always curse and throw things; sometimes they withdraw socially, sulk, or get physically ill.

People who are easily angered generally have what some psychologists call a low tolerance for frustration, meaning simply that they feel that they should not have to be subjected to frustration, inconvenience, or annoyance. They can't take things in stride, and they're particularly infuriated if the situation seems somehow unjust: for example, being corrected for a minor mistake.

What makes these people this way? A number of things. One cause may be genetic or physiological: There is evidence that some children are born irritable, touchy, and easily angered, and that these signs are present from a very early age. Another may be sociocultural. Anger is often regarded as negative; we're taught that it's all right to express anxiety, depression, or other emotions but not to express anger. As a result, we don't learn how to handle it or channel it constructively.

Research has also found that family background plays a role. Typically, people who are easily angered come from families that are disruptive, chaotic, and not skilled at emotional communications.

Is It Good To "Let it All Hang Out?"

Psychologists now say that this is a dangerous myth. Some people use this theory as a license to hurt others. Research has found that "letting it rip" with anger actually escalates anger and aggression and does nothing to help you (or the person you're angry with) resolve the situation.

It's best to find out what it is that triggers your anger, and then to develop strategies to keep those triggers from tipping you over the edge.

Strategies To Keep Anger At Bay

Relaxation

Simple relaxation tools, such as deep breathing and relaxing imagery, can help calm down angry feelings. There are books and courses that can teach you relaxation techniques, and once you learn the techniques, you can call upon them in any situation. If you are involved in a relationship where both partners are hot-tempered, it might be a good idea for both of you to learn these techniques.

Some simple steps you can try:

* Breathe deeply, from your diaphragm; breathing from your chest won't relax you. Picture your breath coming up from your "gut."

* Slowly repeat a calm word or phrase such as "relax," "take it easy." Repeat it to yourself while breathing deeply.

* Use imagery; visualize a relaxing experience, from either your memory or your imagination.

* Nonstrenuous, slow yoga-like exercises can relax your muscles and make you feel much calmer.

Practice these techniques daily. Learn to use them automatically when you're in a tense situation.

Cognitive Restructuring

Simply put, this means changing the way you think. Angry people tend to curse, swear, or speak in highly colorful terms that reflect their inner thoughts. When you're angry, your thinking can get very exaggerated and overly dramatic. Try replacing these thoughts with more rational ones. For instance, instead of telling yourself, "oh, it's awful, it's terrible, everything's ruined," tell yourself, "it's frustrating, and it's understandable that I'm upset about it, but it's not the end of the world and getting angry is not going to fix it anyhow."

Be careful of words like "never" or "always" when talking about yourself or someone else. "This !&*%@ machine never works," or "you're always forgetting things" are not just inaccurate, they also serve to make you feel that your anger is justified and that there's no way to solve the problem. They also alienate and humiliate people who might otherwise be willing to work with you on a solution.

Remind yourself that getting angry is not going to fix anything, that it won't make you feel better (and may actually make you feel worse).

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

Problem Solving

Sometimes, our anger and frustration are caused by very real and inescapable problems in our lives. Not all anger is misplaced, and often it's a healthy, natural response to these difficulties. There is also a cultural belief that every problem has a solution, and it adds to our frustration to find out that this isn't always the case. The best attitude to bring to such a situation, then, is not to focus on finding the solution, but rather on how you handle and face the problem.

Make a plan, and check your progress along the way. Resolve to give it your best, but also not to punish yourself if an answer doesn't come right away. If you can approach it with your best intentions and efforts and make a serious attempt to face it head-on, you will be less likely to lose patience and fall into all-or-nothing thinking, even if the problem does not get solved right away.

Better Communication

Angry people tend to jump to—and act on—conclusions, and some of those conclusions can be very inaccurate. The first thing to do if you're in a heated discussion is slow down and think through your responses. Don't say the first thing that comes into your head, but slow down and think carefully about what you want to say. At the same time, listen carefully to what the other person is saying and take your time before answering.

Listen, too, to what is underlying the anger. For instance, you like a certain amount of freedom and personal space, and your "significant other" wants more connection and closeness. If he or she starts complaining about your activities, don't retaliate by painting your partner as a jailer, a warden, or an albatross around your neck.

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

Using Humor

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

The underlying message of highly angry people, Dr. Deffenbacher says, is "things oughta go my way!" Angry people tend to feel that they are morally right, that any blocking or changing of their plans is an unbearable indignity and that they should NOT have to suffer this way. Maybe other people do, but not them!

When you feel that urge, he suggests, picture yourself as a god or goddess, a supreme ruler, who owns the streets and stores and office space, striding alone and having your way in all situations while others defer to you. The more detail you can get into your imaginary scenes, the more chances you have to realize that maybe you are being unreasonable; you'll also realize how unimportant the things you're angry about really are. There are two cautions in using humor. First, don't try to just "laugh off" your problems; rather, use humor to help yourself face them more constructively. Second, don't give in to harsh, sarcastic humor; that's just another form of unhealthy anger expression.

What these techniques have in common is a refusal to take yourself too seriously. Anger is a serious emotion, but it's often accompanied by ideas that, if examined, can make you laugh.

Changing Your Environment

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

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

Some Other Tips for Easing Up on Yourself

Timing: If you and your spouse tend to fight when you discuss things at night—perhaps you're tired, or distracted, or maybe it's just habit—try changing the times when you talk about important matters so these talks don't turn into arguments.

Avoidance: If your child's chaotic room makes you furious every time you walk by it, shut the door. Don't make yourself look at what infuriates you. Don't say, "well, my child should clean up the room so I won't have to be angry!" That's not the point. The point is to keep yourself calm.

Finding alternatives: If your daily commute through traffic leaves you in a state of rage and frustration, give yourself a project—learn or map out a different route, one that's less congested or more scenic. Or find another alternative, such as a bus or commuter train.

Do You Need Counseling?

If you feel that your anger is really out of control, if it is having an impact on your relationships and on important parts of your life, you might consider counseling to learn how to handle it better. A psychologist or other licensed mental health professional can work with you in developing a range of techniques for changing your thinking and your behavior.

When you talk to a prospective therapist, tell her or him that you have problems with anger that you want to work on, and ask about his or her approach to anger management. Make sure this isn't only a course of action designed to "put you in touch with your feelings and express them"—that may be precisely what your problem is. With counseling, psychologists say, a highly angry person can move closer to a middle range of anger in about 8 to 10 weeks, depending on the circumstances and the techniques used.

What About Assertiveness Training?

It's true that angry people need to learn to become assertive (rather than aggressive), but most books and courses on developing assertiveness are aimed at people who don't feel enough anger. These people are more passive and acquiescent than the average person; they tend to let others walk all over them. That isn't something that most angry people do. Still, these books can contain some useful tactics to use in frustrating situations.

Remember, you can't eliminate anger—and it wouldn't be a good idea if you could. In spite of all your efforts, things will happen that will cause you anger; and sometimes it will be justifiable anger. Life will be filled with frustration, pain, loss, and the unpredictable actions of others. You can't change that; but you can change the way you let such events affect you. Controlling your angry responses can keep them from making you even more unhappy in the long run.


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Weight Loss and Faulty Thinking (page1)

Americans are highly motivated to lose weight—as a growing list of best-selling books and highly trafficked dieting Web sites attest. We're just not approaching it the right way. The pressure we put on ourselves to succeed—and the self-criticism we indulge in when we fall short of the mark—can have dire emotional and dietary repercussions.

Consider that pair of jeans hanging reproachfully in the closet. You realize they don't fit, and you feel unattractive and worthless. This tendency to evaluate yourself too harshly will only make you give up altogether. You want to head to the fridge for solace.

You need to identify the things you're telling yourself that cause you to feel discouraged and to throw in the towel. Don't beat yourself up when you overeat. Accept that you acted in a self-defeating way, then establish better methods to meet your goal. Review what you'd like to do and work toward that goal.

Perhaps you're not (yet) berating yourself for failures, but putting inordinate pressure on yourself to succeed. When you tell yourself, "I must lose 25 pounds by Valentine's Day, or I'll never get a date," you're setting yourself up for emotional turmoil, as well as weight-loss failure. Losing weight in a prescribed amount of time is a worthy goal, but the perfectionistic premise that sneaks into your thinking may well interfere with sensible eating and exercise.

In a perfect universe, the sight of those jeans, or the knowledge that Valentine's Day is around the corner, would elicit rational thoughts like, "I'm going to look great soon, and I'm going to enjoy the challenge of eating sensibly and exercising along the way." But few of us think that.

PT spoke with Nando Pelusi and Mitchell Robin, clinical psychologists in New York City, about what we really tell ourselves, sabotaging our own best efforts to lose weight—or meet any goal.

• "I must be thin."

  This creates desperation, which undermines a healthy long-range approach to sensible eating. Also, perfectionism pervades this thinking (I must not only be thin, but also perfect).

• "I must eat until sated."

  Early humans lived in an environment in which food resources were scarce. While our ancestors had to hunt down squirrels and eat them, we can supersize a Whopper meal and skip the workout.

• "I need immediate results."

  The demand for immediate improvement undermines commitment to a long-term goal. Quick fixes are hard to pass up: "This cupcake will make me feel good right now." We think, why bother eating healthfully, when the reward is far off? Dieting requires present-moment frustration and self-denial with little immediate reward.

• "I need comfort."

  People eat to avoid feelings of loneliness, depression and anxiety. Fatty and sugary food provides immediate comfort and distraction from other issues. Resolving some of these problems may help you overcome poor eating habits.

• "I feel awful."

  "It's terrible being heavy." For some, being overweight is the worst thing imaginable; it can immobilize you and leave you dumbstruck. That's a reaction more suited to tragedy. Weight loss is best achieved without that end-of-the-world outlook.

• "It's intolerable to stick to a diet."

  "It's just too hard to diet." This thinking renders you helpless. People who are easily frustrated want easy solutions. We're seduced by fad diets because they appeal to that immediacy. Yet people who rely on fads suffer high failure rates. When you diet with the short term in mind, you don't learn strategies that require patience and persistence.

• "I am no good."

  "Because I am having trouble in this one area I am worthless." Being overweight can be viewed as a sign of weakness or worthlessness, and most people aren't motivated when they feel that way. Another form of worthlessness: "My worth is dependent on my looks." This idea confuses beauty with thinness, a concept played out endlessly in the media.

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Weight Loss and Faulty Thinking (page2)

Get Moving

Now that you've thrown out your irrational thinking, a little motivation is key to change. But how do you make that leap? Psychologist and marathon runner Michael Gilewski has found that the brain can achieve a state of habitual behavior through small successes—turning a once extraordinary effort into mere routine.

"Even when someone climbs Mount Everest, it's usually not his first time climbing," he points out. Perhaps motivation may simply be the product of positive reinforcement and repeated success.

PT asked five expert motivators—including an active-duty drill sergeant and a rock-climbing instructor—how they rally everyone from first-time dieters to hard-core soldiers.

Inspiration From Within

Deborah Low is a certified weight management and lifestyle consultant in Vancouver, British Columbia.

"We have an all-or-nothing attitude: If we don't do our full hour at the gym, we may as well sit around and eat junk food. If you feel guilty and punish yourself, you may eat 10 cookies instead of 2. If you criticize yourself, you'll never change.

"Motivation is something we get from other people; but inspiration swells within us. Thinking 'I'll lose weight and then I'll be happy' is not enough. If we respect and love ourselves, independent of our weight, it's easier to make healthy choices.

"We struggle because we're fixated on the end result. We force ourselves to go to the gym, restrict food, measure and weigh ourselves. You let that number on the scale determine how your day's going to go. I ask clients to remember what it was like to play as a kid. You ran around, climbed on things—your goal was not to lose weight, it was to have fun. Being active gave you a sense of freedom, excitement and amazement. You have to reconnect with that emotion."

Being a Team Player

Chris Broadway instructs an Outward Bound outdoor classroom on Hurricane Island, off the coast of Maine.

"I set the tone of team spirit in the beginning; I teach one person a skill, and his or her responsibility is to teach everyone else. We let the students make their own mistakes. We expect students to have problems, as the activities we construct are a challenge. Discouragement can occur, but we celebrate accomplishments. Students set their own level of achievement. Some have a focus on the end result, but not everyone is results-oriented. Some want to measure success by relationships they form, by the process itself.

"Another motivating factor is how their experience here connects to their lives. We create situations where there are actual risks and perceived risks, as in sailing. We let the group navigate ahead of a storm, deciding when to pull back and when to move forward. We show them how to apply these situations to their own businesses or personal lives—calculate the risk, know when to take it or when to step back.

"It's so much more powerful when another student steps up to deliver the message of leadership. As instructors, we're always building their tool kit so they have the means to do that. With a group of 12, it's difficult to hide in the background. Even if someone's in a slump, he or she absolutely needs to fill a role."

Savor Every Mountain

John Joline is a climbing instructor at Dartmouth College.

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Suicide Terrorism

In 1983, when Shiite Muslims died in suicide attacks on American military barracks in Beirut, psychologists labeled them mentally unstable individuals with death wishes. Today experts agree that the acts of suicide bombers are more attributable to organizational masterminds than to personal psychopathology. Yet they continue to debate just how religion and social reinforcement transform sane human beings into sentient bombs.

Ariel Merari, Ph.D., a professor of psychology at Tel Aviv University in Israel, argues that terrorist groups such as Hamas appeal to recruits' religious piety or patriotic sentiments, but neither fanaticism nor nationalism alone are ?necessary or sufficient? to foment suicide terrorism. The key ingredient may be susceptibility to indoctrination. In a recent study of 32 suicide bombers, Merari found no illuminating socioeconomic or personality factors, such as social dysfunction or suicidal symptoms. But almost all the subjects were young, unattached males, a cohort vulnerable to violent organizations in any society.

Attempts to understand suicide terrorism are understandably culture-bound. Western media emphasize a Palestinian society awash in calls to self-destruct: Iraq and Saudi Arabia pay thousands of dollars to the families of suicide terrorists, and schools teach reverence for martyrs alongside arithmetic. Palestinian mental health professionals counter that Westerners ignore the despair inherent in this logic. Mahmud Sehwail, M.D., a psychiatrist in Ramallah, says that post-traumatic stress disorder abounds among the potential ?? and eventual ??s uicide bombers he treats and cites surveys indicating that more than a quarter of all Palestinians are clinically depressed.

But the rationale of despair is a ?double discourse aimed at Western audiences,? according to Scott Atran, Ph.D., an anthropologist at the National Center for Scientific Research in France. ?Muslims are told that these bombers have everything to live for, otherwise the sacrifice doesn't make sense.? Atran's book, In Gods We Trust: The Evolutionary Landscape of Religion, cites a recent study of 900 Muslims in Gaza who were adolescents during the first Palestinian intifada(1987 to 1993). Exposure to violence correlated more strongly with pride and social cohesion than with depression or antisocial behavior. Indeed, the Gaza teens expressed more hope for the future than did a control group of Bosnian Muslims.

Ultimately, profiling suicide bombers may be a fascinating but futile psychological parlor game. Terrorism experts such as Ehud Sprinzak, Ph.D., an Israeli professor of political science, argue that the best way to halt the attacks is not to study suicide bombers themselves, but the terrorists who press these young men and women into their last, ghastly service.

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Weight Loss and Faulty Thinking (page3)

"Certain kinds of teaching are done from below—telling people what to do but being removed from the activity. I try to teach from above—I climb with my students, participating fully in the activity. I make my enthusiasm infectious.

"Even a climb well within your physical limits—if you strive to climb it beautifully—can be challenging and rewarding. Our culture puts emphasis on goals, on absolutes. We're taught to believe competition should be ferocious. But if we lose that sense of fun, of delight, all the haranguing in the world from an instructor won't give a student lasting motivation. The bottom line is to savor the movement, the physical sensation of moving up the rock and over the stone. That itself becomes a reward compelling enough to keep one involved.

"For someone in his or her mid-30s or older, climbing is still seen as a potentially dangerous sport, daring and terrifying. It's a mental construct that can be inhibiting. Plus, for white-collar workers, running hands and fingers over rough rock could be shocking to the system."

Coming Home Alive

Billie Jo Miranda is a U.S. Army drill sergeant in Fort Jackson, South Carolina.

"The goal is being prepared for war and coming home alive. The [desire to] drop out occurs in the first few weeks. Once they learn they have a comfort zone, get along and trust people, we're pretty much over the hump. We motivate through example; we do it next to, in front of and behind them. We tailor training around the weakest soldier. It may not be beneficial for the soldier who was a college athlete, but everybody is part of a team, they push each other.

"There will be those who do the minimum. Today's youth are Nintendo children. Training requires them to get out of bed and walk an extra mile. The more rigor you put into training, the more a soldier knows what he can accomplish in combat. They shouldn't enjoy training. It should hurt physically and mentally. And they hate it. But we want them to enjoy the accomplishment.

"If you have heart, you have the motivation and the desire to get through anything. It's a patriotic thought process: What we're doing is for the betterment of America. When they say, 'I don't want to do this anymore,' just give me 10 minutes with a soldier and she'll do a 180. We use their being volunteers as a motivational tool: 'Soldier, I didn't ask you to come here. You obviously joined the military for a reason, you wanted to do something for your country.'"

Think Like a Thermostat

Peter Catina is a professor of exercise physiology at Pennsylvania State University.

"Most elite athletes are already at the top of their sport, and to reach the next level is a challenge. But it's difficult to sustain your level when you're at your pinnacle—novice or expert. Everyone must have both physical and mental discipline.

"Self-regulation is key; you can make it simple by being your own monitor. You have to think like a thermostat—be able to detect a discrepancy between the environment and your internal standard. It's the difference between your current state and where your mind and body would like to be. You can then adjust—raise your standards to meet your expectations—through strategy and action. Some of us are born with high self-regulatory skills, but I can identify clients who lack the know—how and I teach them. Awareness is the first step: noting how many calories you've consumed, how effective your exercise is, how frequently and intensely you've exercised.

"Aerobics is no longer the panacea for losing weight. It's the change in body composition that makes you look better, and for that, strength training is more effective. Don't constantly weigh yourself, since muscle weighs more than fat. Instead, measure your body mass index—or even your waist—and only once every four to six weeks. I've had many female clients gain five pounds but go down three dress sizes."

www.psychologytoday.com

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Dissociative Identity Disorder (Multiple Personality Disorder)

Definition

Dissociative Identity Disorder (DID) is a severe condition in which two or more distinct identities, or personality states, are present in -- and alternately take control of -- an individual. The person also experiences memory loss that is too extensive to be explained by ordinary forgetfulness. The disturbance is not due to the direct psychological effects of a substance or of a general medical condition, yet as this once-rare disorder has become more common, the diagnosis has become controversial. Some believe that because DID patients are easily hypnotized, their symptoms are iatrogenic, that is, they have arisen in response to therapists' suggestions. Brain imaging studies, however, have corroborated identity transitions in some patients. DID was called Multiple Personality Disorder until 1994, when the name was changed to reflect a better understanding of the condition -- namely, that it is characterized by a fragmentation, or splintering, of identity rather than by a proliferation, or growth, of separate identities.

DID reflects a failure to integrate various aspects of identity, memory and consciousness in a single multidimensional self. Usually, a primary identity carries the individual's given name and is passive, dependent, guilty and depressed. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters' characteristics -- including name, reported age and gender, vocabulary, general knowledge, and predominant mood -- contrast with those of the primary identity. Certain circumstances or stressors can cause a particular alter to emerge. The various identities may deny knowledge of one another, be critical of one another or appear to be in open conflict.
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Symptoms

* The individual experiences from 2 to more than 100 different identities. Half of the recorded cases, however, report 10 or fewer.
* The various personality states exhibit distinct histories, behaviors and even physical characteristics.
* Transitions from one identity to another are often triggered by psychosocial stress.
* Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories than hostile, controlling or protective identities.
* Symptoms of depression or anxiety may be present.
* In childhood, problem behavior and an inability to focus in school are common.
* Self-mutilation and suicidal and/or aggressive behavior may take place.
* Visual or auditory hallucinations may occur.
* The average time that elapses from the first symptom to diagnosis is six to seven years.

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Causes

The disturbance is not due to the direct psychological effects of a substance or of a general medical condition. Why some people develop DID is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, especially during childhood. Though the accuracy of such reports is disputed, they are often confirmed by objective evidence. Individuals with DID may also have post-traumatic symptoms (nightmares, flashbacks, and startle responses) or Post-traumatic Stress Disorder. Several studies suggest that DID is more common among close biological relatives of persons who also have the disorder than in the general population. As this once rarely reported disorder has grown more common, the diagnosis has become controversial. Some believe that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic, that is, prompted by their therapists' probing. Brain imaging studies, however, have corroborated identity transitions.
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Treatment

The primary treatment for DID is long-term psychotherapy with the goal of deconstructing the different personalities and uniting them into one. Other treatments include cognitive and creative therapies. Although there are no medications that specifically treat this disorder, antidepressants, antianxiety drugs or tranquilizers may be prescribed to help control the mental health symptoms associated with it.

Sources:

* American Psychiatric Association
* National Institute of Mental Health
* Handbook of Psychology, Vol. 8 (John Wiley)

www.psychologytoday.com
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Borderline Personality Disorder

Definition

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.
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Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes toward family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Most people can tolerate ambivalence where they experience two contradictory states at one time. People with BPD, however, shift back and forth to a good or a bad state. If they are in a bad state, for example, they have no awareness of the good state.

Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to mild separations. Even a vacation, a business trip, or a sudden change in plans can spur negative thoughts. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.
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Causes

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgment in choosing partners and lifestyles.

Neuroscience is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The brain's amygdala, a small almond-shaped structure , is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.
top of page

Treatment

Treatments for BPD have improved. Group and individual psychotherapy are at least partially effective for many patients. A new psychosocial treatment termed dialectical behavior therapy (DBT) has been developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and, or, labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.

Source: National Institute of Mental Health

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Borderline Personality Disorder

Definition

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.
top of page

Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes toward family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Most people can tolerate ambivalence where they experience two contradictory states at one time. People with BPD, however, shift back and forth to a good or a bad state. If they are in a bad state, for example, they have no awareness of the good state.

Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to mild separations. Even a vacation, a business trip, or a sudden change in plans can spur negative thoughts. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.
top of page

Causes

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgment in choosing partners and lifestyles.

Neuroscience is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The brain's amygdala, a small almond-shaped structure , is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.
top of page

Treatment

Treatments for BPD have improved. Group and individual psychotherapy are at least partially effective for many patients. A new psychosocial treatment termed dialectical behavior therapy (DBT) has been developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and, or, labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.

Source: National Institute of Mental Health

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The Art of the Argument

The Promise

Fight clean: Disagree without bickering, sniping, rehashing or destroying your relationship.

One of the greatest threats to satisfying relationships, says Anthony Wolf, a practicing clinical psychologist, is our overwhelming need to be right when we disagree. This innate characteristic, which he defines as our "baby self," can damage or destroy relationships, especially with those closest to us. In his latest book, Why Can't You Shut Up? How We Ruin Relationships—How Not To, Wolf shows how we go wrong: by not letting go when we're not getting our way.

The Test

I decided to try out Wolf's theories on a recent dispute with my wife.

Our children, ages 7 and 10, love watching television. If allowed, they'd sit in front of the set until their brains melted. While I try to get them to stick to time limits, my wife is more lax about enforcing these rules. I worry they're becoming TV addicts and she thinks I should cut them some slack.

But then she started letting them watch American Idol, which meant they stayed up past bedtime two school nights a week. Rather than a levelheaded conversation addressing this particular difference of opinion, the disagreement escalated into a nasty spat that dragged in other conflicts and past grievances. Filled with righteousness, I wanted not only to prove her guilty of this offense, but also of other outstanding crimes and misdemeanors, such as covert adjustments to various household budgets, using her car as a moving trash bin and helping the kids think of chocolate as a kind of daily vitamin.

Wolf's advice is to stay on subject. This was about our children and TV, not whether she overindulges them or I'm too strict or who needs more therapy. So we both had to resist claiming who was right and who was wrong, which he says is a lose/lose situation.

When my wife and I focused on the issue at hand, we realized we're both concerned about the kids turning into tube zombies. We agreed to have them watch most of their favorite programs on TiVo, eliminating commercials and cutting viewing time by 25 percent.

Wolf also says it's not always necessary to resolve an argument, but that it must end—that is to say, it's essential to let it drop. My wife and I both had to let go of the tempting but unproductive desire to get in the last word. Instead, we made sure that we each got to speak our mind. After that, the discussion was over.

While we haven't totally resolved this issue, we've had our say, listened and disengaged. Wolf reminds us that successful arguing isn't about being right as much as feeling all right about the outcome.

The Verdict

Wolf offers helpful insights (along with wry humor) on managing our closest relationships. Although there aren't any major revelations, you can't really argue with such practical advice.

www.psychologytoday.com
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Noah Wyle and Real-Life Trauma (page1)

Popularly known for his role as a doctor on television's top-rated drama, "ER," Noah Wyle has put his bedside manner to the test by helping real trauma victims.

Noah Wyle is not a doctor. Nor is he a psychologist. And he's not suffering from a mental illness. But he has seen, firsthand, the face of one poignant and prevalent disorder, and it was enough to spur him into action.

"There isn't a face -- it's every face," Wyle responds when I ask him to describe the face of post-traumatic stress disorder, or PTSD, a debilitating condition that some people develop after experiencing or witnessing an extremely traumatic event. The 30-year-old actor and star of NBC's "ER" had flown to New York City the day before to speak out about recognizing and treating the disorder. And these days, everyone is listening.

When terrorists attacked the country on September 11, naturally our first concern was rescuing victims, particularly those who might be alive amid the World Trade Center rubble. Soon, however, it became apparent that not only had few survived the collapse but that there was another population of survivors to worry about: those left to grapple with memories of the tragedy. Mental health practitioners rushed to Ground Zero to aid those on the front lines -- firefighters, police officers, even journalists covering the story -- and soon many were predicting an epidemic of PTSD.

The disorder is by no means a new one. It was first described during the Civil War as "irritable heart" by an army surgeon treating soldiers displaying symptoms including chest pains, disturbed sleep, depression and irritability. Many refer to it as "combat fatigue" or "shell shock," and it's often associated with war veterans.

But PTSD isn't always a result of an act of war or terrorism. In fact, some of the most common traumas that lead to the disorder include being raped, being sexually or physically assaulted and experiencing the sudden, unexpected death of a loved one. About 20 percent of people who experience an extreme trauma will develop the disorder, according to one study published in the Journal of Consulting Clinical Psychology, and women seem twice as susceptible to PTSD, most likely because they are more often victims of rape, sexual assault and child abuse.

Women also make up the majority of PTSD sufferers with whom Wyle has come into contact. In 1999, Wyle spent three weeks in a Macedonian refugee camp during the war in Kosovo with Doctors of the World, a nonprofit organization that provides medical care to the needy and had approached him about doing charity work.

"I was supposed to be there in an observing capacity so that I could speak intelligently about their work," Wyle admits. "But a bus would pull up with 600 people in it and women were handing their kids to me, people were running for ambulances and medical supplies, and I'm there just to watch? I don't think so." Of the camp's 10,000 refugees, most were women and many of them had witnessed the murder of their husbands or confided they had been sexually assaulted.

"There was a certain hollowness in their eyes, a certain manic behavior," Wyle says. "I would see women scrubbing the wash, the same patch of a piece of clothing, for two or three hours. They were trying to get back into some routine of normal life, but in the refugee camp nothing was familiar." This kind of behavior is typical of a PTSD sufferer and falls into one of three sets of diagnostic symptoms associated with the disorder: avoiding reminders of the traumatic event.


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Noah Wyle and Real-Life Trauma (page2)

"PTSD is stimulus-driven," explains Matthew Friedman, M.D., Ph.D., the executive director of the Department of Veterans' Affairs National Center for PTSD and a psychiatry and pharmacology professor at Dartmouth Medical School. "Stimuli that resemble the trauma are going to bring that trauma back to the victims. So part of PTSD involves numbing, emotional shutdown and avoidance." The second set of symptoms focuses on sufferers' tendency to continually relive the event, both while sleeping in the form of nightmares and while awake, when flashbacks occur. These images cause extreme emotional or physical reactions, including shaking, chills, heart palpitations and panic. The final set concentrates on hyper-arousal, as victims are prone to irritability, sudden anger, startling easily or being unable to concentrate.

How an individual responds to a traumatic event depends, in part, on what he or she brings to the table, Friedman points out. For instance, people who have experienced a prior trauma, have a family history of psychiatric problems or grew up in a disruptive household or with abusive parents are at greater risk for developing symptoms. Amount of social support and degree of resiliency -- which has both a genetic and experiential component -- also play important roles.

"Most of us were impacted by September 11," says Ray Monsour Scurfield, D.S.W., L.C.S.W., an assistant professor of social work at the University of Southern Mississippi. "But after a few months, it started taking somewhat of a backseat for some people and less of a backseat for others. The key is questioning whether a person feels their memories are beyond their control. If they're wallowing in isolation and denial and painful memories -- if they're a prisoner to them -- it's time to seek help."

This psychological imprisonment is something Wyle likens to piecing together jigsaw puzzles. "If you do the same puzzle every day, you get the same picture every day because you've got the same pieces," he says. "But if you wake up one morning and something traumatic happens, when you put your pieces together, nothing fits right. And when you do get them to fit it makes a different picture, one somewhat grotesque. Ultimately, you just want your picture to look like it always did, but it's never going to look that way again."

After witnessing the refugees' anguish, Wyle knew he wanted to do more to help victims of trauma and violence. So when he returned to the U.S. he began working with Human Rights Watch, a human rights advocacy group. Then Dr. Carter, the character he plays on "ER," was stabbed on the show, and Wyle found himself portraying many of the symptoms he'd witnessed in Macedonia. That's when Moving Past Trauma (MPT), a community outreach program that works to increase awareness about and treatment of PTSD, asked him to be one of their spokesmen. He agreed and soon began working with Kellie Greene, another program spokeswoman.

What's noteworthy about Greene is that she's also a PTSD survivor, though by looking at her today one would never guess that there was a time when she was afraid to step foot outside of her apartment. The energetic, outgoing, 36-year-old is constantly smiling and seems ready and able to take on the world. But on January 18, 1994, Greene was attacked and brutally raped by a stranger who had followed her home. She was traumatized and subsequently unable to concentrate or make simple decisions. She also began isolating herself from her family and friends and was plagued by nightmares and flashbacks of her rape.


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Noah Wyle and Real-Life Trauma (page3)

"Flashbacks are powerful and very frightening," Greene tells me the same morning I meet Wyle. The two were scheduled to speak throughout the day at several venues including "The Today Show" and the YWCA, which helped launch MPT's program. "You go back to the moment the trauma was happening and re-experience it; your body has all of the senses of it reoccurring." Her symptoms were unrelenting for about six months, until one night she found herself sobbing uncontrollably in the shower and contemplating suicide. Greene called her mother for help, who made an appointment for her with a psychiatrist the next morning.

"I told him everything I was going through, and then he opened a book and read all of my symptoms back to me," Greene says. "He said, 'It's post-traumatic stress disorder,' and just having him validate it calmed me down." She was prescribed Zoloft, an antidepressant and selective serotonin re-uptake inhibitor (SSRI), to help assuage her symptoms. Zoloft and Paxil, also an antidepressant and SSRI, are currently the only two drugs approved by the FDA for treating PTSD. Greene's psychiatrist then worked with her for six months using cognitive restructuring -- a form of cognitive behavioral therapy -- along with teaching her breathing exercises that helped alleviate her panic attacks.

"The classic principle that applies to almost every PTSD therapy is therapeutic re-experiencing of an aspect of the original trauma," explains Scurfield. "The person has to learn to master the memory and be able to revisit the trauma in a way that's not overwhelming." Fortunately, the rate of recovery from PTSD is high--particularly if recognized early on -- and there are numerous types of therapy for treating it. But because this field of research is relatively new, there is little empirical evidence confirming what works best and for whom.

"The evidence suggests that cognitive behavioral treatments are most effective for PTSD," Friedman says. "But a large number of people in treatment receive two types of treatment, maybe even more." The most typical combination is some form of psychotherapy plus pharmacotherapy, one that seems to have done the trick for Greene.

"I feel really good today," Greene now says. Fully recovered, she devotes her time to promoting awareness of PTSD. She began speaking publicly about her own experiences seven years ago when she joined the speakers' bureau of the Rape, Abuse & Incest National Network. She also formed her own organization, Speaking Out About Rape, where she works daily with other rape survivors.

"It was difficult at first to talk in front of a large group because the wounds were so fresh," Greene confesses. "But by sharing my experience, it was no longer a random act of violence; it had a purpose." That purpose has taken on added meaning since the events of September 11, which Greene watched unfold on television.

"I could really identify with what firefighters were feeling," she says. "I knew the dark place that these people were going to go in the months that followed. It's hell." Wyle, too, had a strong personal response to the attack. He observed the aftermath while in Los Angeles after his mother called and told him to turn on his television.

"I was shocked when I saw one shot of a thousand people walking across the Brooklyn Bridge; it looked just like a thousand refugees going across the border from Kosovo to Macedonia," Wyle says. "I was pretty dedicated [to MPT] before the attack, but if anything, I feel validated in that what we were talking about before was timely and important."

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Noah Wyle and Real-Life Trauma (page4)

Fortunately, research suggests that most people will not develop PTSD in response to September 11. Studies show that the severity and duration of an individual's exposure to a traumatic event strongly influence the likelihood of developing PTSD. Consequently, people closest to it -- those in the World Trade Center when the planes hit, for instance, or those who witnessed people jumping from windows -- are more susceptible than are the majority of Americans who watched the tragedy on television.

For those who develop PTSD, symptoms most likely appear within a few days of the traumatic event. Friedman emphasizes, however, that symptoms can take months and sometimes years to surface. Even so, experts now assert that the original prediction of a PTSD epidemic after September 11 was premature and that most of us should expect normal and full recovery to take place. They also stress that experiencing symptoms of stress, anxiety and depression is a fairly predictable, well-understood response to a catastrophic event. But that doesn't imply we should ignore symptoms if they arise and linger.

"New York City has been inspirational in so many ways to people in the rest of the country," Wyle says. "But if I was going to speak to anybody here about PTSD, I'd say, 'Really check in with yourself.' If you're having trouble sleeping, if images are invading your life, if you find yourself becoming desensitized, then definitely seek out medical help. The city seems to be coping very well, but that doesn't mean we should forget that there are a lot of people suffering that need not be."

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Eat Right To Fight Stress

Stress is inevitable. However, there are ways to minimize its grip on your life, starting with your diet.

Most of us recognize that certain foods have brutal effects on the brain—for productivity, mood and mental energy. Too much chocolate can leave you dragging after the sugar and caffeine jolts fade away. An overdose of salty chips dehydrates the body and the brain, bringing on fatigue. High fat meals raise stress hormone levels and keep them high.

The problem is that these are precisely the foods we reach for at exactly the wrong times, as they exacerbate tension from work and daily life just when we seek relief.

The Food and Mood Project, a nutrition research group in the U.K., identified "food stressors" and "food supporters," foods that exacerbate stress from the inside and those that help people under stress. The lists were drawn on the basis of personal experience among 200 people surveyed.

Nearly 90% of those surveyed reported that their mental health had improved significantly with changes in diet they had made on their own.

Participants reported that cutting down or avoiding "food stressors" like sugar (80%), caffeine (79%), alcohol (55%) and chocolate (53%) had the most impact on mental health. So did having more "food supporters" like water (80%), vegetables (78%), fruit (72%) and oil-rich fish (52%).

The survey also found some dietary strategies particularly helpful in encouraging a healthful diet: eating regular meals, carrying nutritious snacks and planning meals in advance.

"Despite evidence suggesting that dietary and nutritional interventions can provide symptom relief and benefits to health, these approaches remain alternative or complementary," says Amanda Geary, a nutritional therapist with the Food and Mood Project, which advocates dietary changes to boost mood before turning to medication.

Nevertheless, quality research now underway is seriously tackling how the foods we consume affect our internal chemistry. We already know that stress hormones like cortisol actually rob the body of vitamins, hijacking them to support such classic stress responses as the tensing of muscles and the rise of blood pressure, reactions fundamental to the fight-or-flight response.

Thus at times when we're experiencing the nervous-system workout of anxiety, we are in special need of B vitamins, which help maintain our nerves and brain cells. B vitamins also used up in converting food into energy for the body.

It's double whammy for the body if calories consumed during stressful times don't come from nutritious foods, as they'll then be depleted even more quickly. Even a slight vitamin B deficiency—say, from a few days of overloading on chips and soda—upsets the nervous system and compounds stress, according to Elizabeth Somer, R.D., a nutritionist in Salem, Oregon.

A better bet at trying times: bananas, fish, baked potatoes, avocados, chicken and dark green leafy veggies. All are loaded with B vitamins.

Extreme stress can create even more nutritional havoc. The "fight or flight" effect on our bodies is drastic. Some 1400 chemical changes occur as stress hormones sap the body of important nutrients, such as those B vitamins, vitamin C, vitamin A and the mineral magnesium.

The hormones released in response to stress can cause carbohydrate cravings by lowering levels of serotonin, the calming hormone. Increasing carbohydrate intake can strengthen tolerance to stress by boosting levels of serotonin, says Somer, but it can also cause weight gain and overeating, particularly of sugary foods.

When the pressure is on, it's difficult not to turn to junk food for solace. But sticking to highly nutritious, low fat, low sugar, and low caffeine diet will be its own reward.

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A Lesson from Aviation

A pilot in charge of flying an aircraft is called the pilot in command (PIC). All pilot training involves coping with equipment failures and other emergencies. Emergencies can happen no matter how well-prepared and competent the pilot may be.

When an emergency occurs, physiological changes resulting from the threat to life favor strong surges of energy in the large muscles, and they foster a narrow focus of attention on the “blood rage” necessary for survival.

In a crisis, however, a pilot needs precise hand and foot movements—not gross physical strength—and he or she needs clear thinking—not the tunnel vision of rage. Consequently, the “natural” survival skills triggered by an emergency can actually contribute to a pilot losing control of the aircraft.

Therefore, in order to manage SNS arousal in an emergency, a pilot—or any person—needs a third option, a sort of “unnatural” option: not fleeing the problem, and not fighting the problem either, but taking command of it. In an emergency, a person should be “pilot in command” of his or her body as one essential step in coping with the overall problem.

Taking command of breathing.
• Being aware of breathing rate
• Taking slow, deep breaths

Taking command of muscle tension.
• Being aware of which muscles are tense
• Letting go of muscle tension

Taking command of cognitive processes.
• Being aware of internal “self-talk”
• Being honest about the situation
• Changing focused, negative thinking and self-defeating thoughts to open, positive thinking and intuitive creativity

www.guidetopsychology.com
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Mindfulness Meditation

Mindfulness in general means to be fully aware of what you are doing, while you are doing it. This means, for example, that while eating breakfast you would be “mindful” only of the various sensory experiences of eating the food; you wouldn’t be thinking of that upcoming business meeting.

Mindfulness meditation is a term often used in the practice of psychology so that meditation can be taught without seeming to have any religious implications. Many meditation techniques, such as “centering prayer,” Zen Buddhism, and even Transcendental Meditation, are quite similar to the idea of mindfulness meditation, and yet there is nothing religious about any of them. They are all nothing more than psychological techniques to achieve some form of relaxed, focused mind.

Mindfulness can be relaxing because if you focus just on the one thing that occupies you in the moment you don’t have to deal with the anxiety of future concerns. Mindfulness meditation draws on this realization and allows you to relax by focusing just on your body in its immediate surroundings: heartbeat, breathing, environmental sounds, etc. The idea is to notice these things without judging or interpreting them. Random thoughts, for example, are noticed as transitory things that simply come and go. If you don’t focus on them, they soon go away as easily as they came, and so they don’t bother you—or cause SNS arousal. Accordingly, mindfulness meditation is a very passive process.

Stress-Performance Curve -- Click your browser «Refresh» if image or background fails

Performance-Stress
Relationship Curve


There is, however, a problem with mindfulness meditation: since it’s a passive process, you cannot stay relaxed unless you do nothing but meditate.

The explanation for this odd fact can be found in the traditional Performance-Stress Relationship Curve, which looks like an inverted “U”. At zero arousal, you have zero performance—which means that you’re either sleeping or meditating. At maximum arousal, you also have zero performance—here, you’re incapacitated by panic. So, curiously enough, the only way to have any performance is to have some arousal.



This curve idea is really just common sense about physiological arousal, and it may not represent anything particularly scientific about what “stress” may or may not be.


This means that if you are performing any activity with a moderate to high level of arousal, such as driving a car, being in a state of mindfulness does not in itself reduce SNS stimulation. (Remember that mindfulness while sitting quietly can be relaxing because sitting quietly is not inherently threatening.) Therefore, although mindfulness can help to increase performance—because it increases focus and awareness—to have optimal performance you also need to use an active form of relaxation, such as progressive muscle relaxation, autogenics, or prayer, to keep SNS arousal from becoming excessive. Read More..

The Psychology of “Stress”

It might seem like a simple concept. We toss the word around every day. Stress. But what does stress really mean? Is it the same thing as physiological arousal? Is it the same thing as “workload”? Is it any different from anxiety or unconscious anger? Is it the cause of trauma? Is it anything at all? Is it just a “myth”? [1]


Change

Let’s begin with the concept of change, because life is a process of change. Therefore, anything that involves change contains within it the “demand” that we adapt to it, in one way or another. Graduating from school can be as demanding as starting school, and starting a new job can be as demanding as losing a job.

How we perceive the change really determines how we manage to adapt to it.

If the perception is positive, we generally embrace the change with open arms and relief. And the story essentially ends there.

If the perception is negative—that is, if the change challenges our stamina or resources—the body will automatically—and dramatically—respond to this perceived threat with a variety of physiological responses.


Physiological Responses to Change

Walter CannonEarly in the 20th century, Walter Cannon’s research in biological psychology led him to describe the “fight or flight” response of the Sympathetic Nervous System (SNS) to threats.[2] Cannon found that SNS arousal in response to a perceived threat involves several elements which prepare the body physiologically either to take a stand and fight off an attacker or to flee from the danger:
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Heart rate and blood pressure increase
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Perspiration increases
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Hearing and vision become more acute
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Hands and feet get cold, because blood is directed away from the extremities to the large muscles in order to prepare for fighting or fleeing.


Hans Selye [3] first popularized the concept of “stress” in the 1950s. Selye theorized that all individuals respond to all types of threatening situations in the same manner, and he called this the General Adaptation Syndrome (GAS). Hans SelyeHe claimed that, in addition to SNS arousal, other bodily systems such as the adrenal cortex and pituitary gland may be involved in a response to threat. For example, chemicals such as epinephrine (adrenaline) may serve to focus the body’s attention just on immediate self-preservation by inhibiting such functions as digestion, reproduction, tissue repair, and immune responses. Ultimately, as the threat wanes, Selye suggested, body functions return to normal, allowing the body to focus on healing and growth again. But if the threat is prolonged and chronic, the SNS arousal never gets “turned off,” and health can be impaired. With a continuously suppressed immune system, for example, a person would be more vulnerable than usual to infection—which is one explanation of why some individuals get sick so often.[4]

And, regardless of whether Selye was right or not, psychology, as well as medicine and popular culture, have accepted the concept of “stress” as an unpleasant fact of life.


Reducing Physiological Arousal

Physiological arousal can be uncomfortable and distracting in situations that might feel threatening but don’t involve an actual threat. Fortunately, this sort of arousal can be reduced by practicing some form of relaxation. A basic relaxation technique such as Progressive Muscle Relaxation (PMR) consciously helps muscles to relax, and, because muscle tension is one of the triggers of arousal, the PMR process, by decreasing muscle tension, essentially tells the body that the perceived danger is over and that systems can return to normal. More advanced forms of relaxation, such as autogenics and prayer, cause muscle relaxation through mental imagery.

Hence these forms of relaxation don’t just help to turn off the physiological symptoms of arousal—in the imagination they can actually change one’s view of change, so to speak, so that a change isn’t perceived as a threat in the first place. This is why the benefits of advanced relaxation techniques extend beyond their physiological benefits and can lead to enhanced performance, greater self-esteem, and serenity of mind.


What is “Stress”?

Given what we know about the physiology of arousal due to perceived threats, and given what we know about relaxation techniques to diminish that arousal, what can be said about the concept of “stress”?

Well, actually, not much.

A person could, for example, experience a job loss and respond to its perceived threat not with healthy problem-solving but with anger. This anger may be conscious or unconscious, but as long as it persists a state of physiological arousal will be maintained. In addition, perhaps this unfortunate person will experience a Major Depressive Episode or will develop an Anxiety Disorder.

In traditional terms it could be said that this person is under intense stress. In fact, because of Selye’s influence, psychology and medicine have tended to regard “stress” as if it were some “thing” that could destroy our health and happiness even against our wills.

But it could just as well be said that the person in the example has simply failed to accept change in a healthy, adaptive manner.

So maybe “stress” isn’t any “thing” at all. Maybe it’s just a descriptive term that our culture uses to normalize unconscious anger, a fear of love, a lack of forgiveness, a desperate clinging to a vain identity, and an absence of a spiritual life. Maybe “stress” is just a convenient myth to shift responsibility for life away from ourselves and onto something so vague that everyone can love to hate it.

But those who accept the discipline of a relaxation technique are at least taking a positive step—not to fighting “stress,” but toward living responsible lives. Read More..