The Power of "What" written by our Guest Psychologist from New York, Dr Deborah Serani and Author of "Living With Depression".

Sometimes the question "why?" is a good one. Like, why can't we live in a more peaceful world? Or why did I eat *all* those cookies? And why don't we call mustaches mouthbrows?

But there are times - especially during a crisis - when "why" may not the best puzzle to solve. When you're in an emotional entanglement, a difficult predicament or a physical hardship, asking "what" will do more.

What has directionality.

Why keeps you stuck in circular thinking.
What offers solutions.

Why offers no game plan.

So, the next time you find yourself in a bad place, ask yourself:

"What can I do to make things better?

                          not

"Why is this happening to me?

Once the crisis is over THEN you can search for the "Why".

Dr Deborah Serani, Psy.D.
Psychologist
12 Ivy Hill Drive
Smithtown, NY 11787 USA
1.631.366.4674
http://www.deborahserani.com/
http://www.drdeborahserani.blogspot.com/
www.psychologytoday.com/blog/two-takes-depression

"Laughter Yoga"....Can it really help?

I was reading an article today in one of my local magazine titled, Laughter is the best medicine. Essentially, it was an article promoting Laughter Yoga in New Farm Park Brisbane Australia, as a way to improve one's emotional and physical wellbeing.

So, can "Laughter Yoga" really help with your stress and depression?

In my mind....YES as this is a form of Behavioural Therapy.  In essence, it is the Behavioural part of Cognitive Behavioural Therapy (CBT).

So what do I mean by behavioural therapy?

Our behaviour is "what we do", and "what we do" affects our thinking, thoughts, and feelings.  For example, look up, shoulders back, chest out, and try to be sad.  Now look down, slump, and try to be sad.  Did you notice that it was much more difficult to be sad when you are looking up.  Why?

Because when you look up, you feel more confident, strong and hopeful perhaps.  It is probably not a message of sadness.  Hence, it is harder to feel sad when looking upwards.

When you laugh, you are happier.

When you smile, you are happier.

I would love to see more evidence and research in laughter yoga.  Besides, it costs nothing or very little to apply!

A Psychologist's perspective on "Questions of Faith" written by our Guest Psychologist Fabienne Green in Springfield Ipswich

In life, people often have questions of faith.  Now putting religion and all expectations associated with that topic aside, I would like to say that, as a Psychologist, I have faith in people.

Having spent the last nine years working in the most challenging areas, I must say that the endurance of the human spirit still has the ability to fill me with awe.

People struggle with the most difficult circumstances.  They may have become lost in the mire of depression or caged by anxiety.  Others have experienced grief, loss, trauma. Sometimes, I have been overwhelmed by sadness at the capacity of humans to damage each other.

But even during those times, I have been struck by a realisation.  That is, despite all odds, the person sitting across from me managed to get out of their house and attend the session that day.  By rights, it's a miracle that some people are still here at all, let alone taking steps towards changing their existence to lead a rich and full life once more.  It is during those times that I feel humbled by the strength of people who are enduring their weakest moments.

And everytime I witness this, it strengthens my faith in people...fallible, vulnerable, imperfect.  People.


Fabienne Green
Registered Psychologist
Associate Member of the Australian Psychological Society

www.fabiennegreenpsychologist.com/index.html
http://www.priorityhealthmedicalcentre.com.au/

ADHD Attention Deficit/Hyperactivity Disorder written by our Guest Clinical Psychologist Dr Nicole Arthur @ New Directions Psychology Jindalee Brisbane

Today, I have invited Dr Nicole Arthur from New Directions
Psychology to write about Attention Deficit/Hyperactivity Disorder.


ADHD

Children are normally active.  With high energy, they constantly move around responding to their environments.  Their attention tends to be shorter and can wander from one subject to another.   Sometimes, they also get carried away by their imagination.  All in all, these characteristics keep children ready for constant learning.  However, sometimes these behaviours exceed the level commonly expected in the children's age group and can interfere with various areas fo life eg social and school.

ADHD is characterized by a set of behaviours including persistent over-activity, impulsivity, and difficulties maintaining attention.  Children with ADHD may experience challenges only with their:

1. Overactivity and impulsivity ie ADHD, predominantly hyperactive-impulsive type
2. Attention ie ADHD, predominantly inattentive type
3. For others, the challenges may include all of the above ie ADHD, combined type

Normally, children will receive a diagnosis of ADHD only when the challenges outlined affect them in two or more settings eg at home and at school and present before and continue until after they are 7.  The diagnosis cannot be given when the children are under 7.

Symptoms of ADHD
In general, ADHD involves a mixture of physical, emotional, and thought symptoms, including:

Symptoms of inattention

• Carelessness
• Failure to give attention to details
• Short attention span
• Difficulties maintaining attention
• Being easily distracted
• Difficulties following instruction
• Avoidance of tasks that require mental effort ie homework, school work
• Losing or misplacing things
• Forgetfulness

Symptoms of hyperactivity-impulsitivity

• Being "on the go" or acting as if "driven by a motor"
• Fidgetiting
• Difficulties remaining in seat
• Excessive and inappropriate running or climbing
• Talking excessively
• Difficulty playing quietly
• Interrupting or intruding others
• Difficulties awaiting turn

Commonly Associated Symptoms

• Low tolerance of frustration
• Excitability, poor regulation of emotion, and poor impulse control
• Compromised intellectual abilities (e.g., poor estimation of time, difficulties foreseeing consequences, poor planning skills and organization)
• High risk-taking behaviour
• Social and academic difficulties
• Poor motor coordination
• Proneness to accidents
• Low self-esteem
• Low motivation
• Low mood or high anxiety

Prevalence

Increased prevalence of ADHD has been reported, with the current estimation of approximately 3-9% of children diagnosed with ADHD. Higher vulnerability is consistently reported in boys.

Causes of ADHD

As with many mental health conditions, the exact cause of ADHD is not fully understood. Different children develop ADHD for different reasons. It is unlikely that one factor can fully explain the cause of ADHD. Combinations of factors should be considered. These include:

Biological factors:

Findings initially suggest that the brain of children with ADHD might structure or operate in a unique way which leads them to be particularly vulnerable to hyperactivity/impulsivity and/or inattention. Additionally, ADHD seems to run in families, so it may be inherited.

Psychological factors:

Environmental factors might aggravate or maintain the difficulties that children with ADHD experience in inhibiting behaviour. Additionally, lack of intellectual, social, or emotional maturity might not allow them to regulate their motivation, emotion, or behaviour effectively.

It is important to note that, although the exact cause of ADHD is not fully identified, ADHD is not caused by poor parenting. Still, as outlined below, positive family relationship and effective parenting strategies are associated with positive outcomes for the treatment of ADHD.

Treatments

Although there is no cure for ADHD, there are several types of treatments that help parents and children manage and reduce the symptoms of ADHD. To achieve this, the use of a combination of medication and psychotherapy is most effective.

Medical intervention:

Medical intervention for ADHD is normally in the form of psychostimulants (e.g., Ritalin, Dexedrine) which act on the chemicals in the brain. Findings have shown improvement in children’s attention and concentration as well as reduction in their excessive activity and impulsivity. Although dependency on these medications is reportedly rare, the long-term benefits remain limited. Some children may also experience, to a varying degree, common side effects of appetite loss, dry mouth, and nausea.

Psychological intervention:

Both parents and children with ADHD benefit from psychological intervention which equips them with effective strategies in effectively managing ADHD symptoms and related difficulties.

Child support: Strategies can be provided to children with ADHD to enhance their abilities to regulate behaviour and emotion as well as to equip them with social skills.

Parent support: Strategies can be provided to parents to assist them to modify their environments so as to best manage their children’s ADHD symptoms. Parenting strategies as well as strategies for reward management also help the parents to enhance their children’s desirable behaviour.

Treatment outcome

The course of ADHD varies across children. About 30-50% children will still have ADHD as adults. For other children, symptoms will gradually decrease over the course of childhood.

Still, unmanaged ADHD is associated with increased use of alcohol and drugs, unemployment and legal problems. Such problems, however, are not inevitable and the probability of occurrence can be greatly reduced with proper medical and psychological intervention. Medical intervention of ADHD has been shown beneficial in the management of its symptoms for approximately 70% of children with moderate to severe ADHD. These benefits increase substantially when presented with psychological intervention.

Dr Nicole Arthur
Clinical Psychologist
Website http://www.newdirectionspsychology.com.au/
BHMS(Ed) B Arts(Psych)(Hons)D Psych(Clinical) MAPS

Interest in:
Chronic health, Depression
Grief and loss, Peri and Postnatal Depression
Child and Parenting issues.

Severe "shyness" in kids can be a sign of anxiety

Severe anxiety or "shyness" in kids can affect their ability to learn new things and hence, can severely affect their performance at school.

So early intervention here is definitely worthwhile.

In Australia, Fun Friends program is an option for parents to consider for their child, and it is based on Cognitive Behaviour Therapy (CBT) principles.  It is a group based program.  It helps the child to learn more about how to be "brave", how to understand thoughts and feelings are related, how to relax, how to learn new things through small achieveable steps, and in essence, learning how to be more emotionally intelligent and resilient.  This program is not suitable for every child so explore it with the facililator prior to starting. In Australia, these programs maybe available through your local schools or kindergarten so enquire there. 

You can also click on this link to find out more about the Fun Friends Program.

In my practice, I prefer to do this one on one rather than group based.  This is probably because I have never been trained in "crowd control"!  I try to highlight to parents that anxiety is neither good or bad.  It can be very good if you can "harness" it.  Overall my approach is to help parents to understand Cognitive Behavioural Therapy (CBT) and Acceptance Commitment Therapy (ACT) concepts, and then help parents to "coach" their child through co-regulation with these techniques and strategies.

This process helps both the child and the parent to become more "emotional intelligent"and resilient, because teaching is one of the best ways to learn.

Doctor, does positive affirmation really works?

"So Doctor, does positive affirmation really works and helps me with my depression?"

I think it really depends.

In my opinion, it is more likely to be effective if you keep the following simple rules in mind:

• It has to be realistic
• It has to be believable by you.  This is what I think is the most important feature.  For example, you cannot tell yourself that you still look young like a 21yo when you are 50.  But what is more "believable" is that you can say, "Iam pretty good for a 50yo."
• We communicate with our "subconscious mind" through a number of senses, so the more senses we employ, the better.  What do I mean by this?  Well, when you try to say something positive to yourself, say it, hear it, feel or sense it, and visualize it. 
• Your behaviour has to be congruent with what you say.  For example, you cannot say, "Iam going to feel great today. and things will be great!" when your body posture and tone of voice is more congruent with hopelessness and despair.
• You have to mean it because if you don't, your "positive affirmation" will just come across as sarcasm perhaps.

In essence, the use of "positive affirmation" is one of the tools of Cognitive Behavioural Therapy (CBT) in my opinion.

Try to do it more often.  A gratitude diary is in essence the same.  I think that it can be a useful tool to remind our "subconscious mind" that not everything is doom and gloom.  Unfortunately, the media sometimes does not help with this aspect.

Thought of the day..."Everything I have in life is on lease"

One of the best thing about my job as a Doctor, is that I get the privilege to learn so much from my patients.

I would like to share with you one of those stories.....

One of my patients introduced me to this concept of, "We have our children on lease".  She said that we cannot own or control our children forever.  Our children is "on lease" for us until they become fully independent.  Even with everything else we own, what happens to it when we pass.

So, I have taken this concept a little further by suggesting that "Everything we have in life is on lease".

Why can this be a helpful way of thinking? 

Well, if we have been conditioned to believe that we own something, then when it is gone, we will have a deeper sense of loss.  If it is on lease, then the sense of loss will be less and more importantly, the fear of loss will be less.

Just food for thought.....

Not everyone with symptoms of Depression has Depression....A case of Addison's Disease

I have read in my journal about a case where someone with Addison's Disease presented with depression.

This is why it's so important for your Doctor to rule out any physical or organic problems before we can be more certain about the diagnosis of depression or any other mental health disorders. 

One of the things I consider screening for is Addison's Disease.  It is a very serious condition which is characterized by a deficiency of a body hormone call cortisol.  One of the main symptoms for this condition is tiredness.  We check for this by ordering a cortisol level .  Now this is extremely rare and as you know "rare things happen rarely", so please do not be alarmed or panic.  In the last 13years of my practice, I have only seen 2 cases of this,  so we do have to put this in perspective.

This article was just to highlight the importance of getting things properly assessed by your Doctor.

Part of Good Parenting is About Having Realistic Expectations

Part of good parenting is about having realistic expectations.  But the problem is...."What is realistic?"

I often say that life is a balancing act of a lot of things.  If life is not challenging enough, then the child does not thrive.  If it is too challenging, then they might get overwhelmed and get traumatised by the experience.  The trick is to set some challenges, but to have the support behind them in order to help them get up if they fail, and eventually help them to succeed in that challenge.  If they are getting distressed, anxious, and depressed from the experience, then we may have to ask the following:

1 Are they at the right developmental age for what I expect them to do?
2 They might be good at other things but do they actually have the skills in this area?
3 Do they have enough support in order to learn the skills to overcome the challenges?
4 Are we pushing them too much?

Depending on what the answer is, will dictate our next line of action...

Working on the relationship with your child..."The Foundation"

I would like to recommend parents to look up a local parenting program like Positive Parenting Program (PPP) founded by Dr Matthew Sanders.

As part of the TripleP program, one of the foundation of parenting is to look at building that positive relationship with your child.  This can be thought as preventative strategies to prevent bad behaviours.

So let us list them out....

1 Spend frequent quality time with your children.  By quality time, we mean short 2-3mins and frequently where you are fully engaged and be present with your child.  Ideal quality time is not about going to the beach or a holiday once in a while.

2 Give them plenty of hugs and kisses.

3 Give them attention when they are good and not just when they are bad.

4 Use incidental teaching ie when they come up to you to show you something, stop what you are doing if possible, and be engaged with them.  Use this momentum to teach them other things associated with what they are showing you.  For example, if they come up to you and show you a toy, you can then ask them what colour, what shape, and other features for example.  This can form part of quality time.

5 Give your kids lots of descriptive praises eg You are such a good boy for cleaning up instead of just saying, that is good.

6 Reward them from time to time when they are doing something good.  Pitfall... Make sure you do not do too much of this as it might become an expectation.

7 Be a good role model for them and modelling the behaviours that you want to cultivate in your household.  For example, be mindful not to scream out, "Don't scream!"

8 Last but not least, look after yourself.  Being an effective parent requires you to be well, calm and in control.  If you are unwell, stressed and sleep deprived, then it can be very difficult to be a mindful parent as oppose to being a reactive parent.

The above is not new to most of you but the trick is to remind ourselves to do it more often.


For your local PPP provider, I have include the follow link for your convenience.  It is an international organization so you might find one near your side of the world.....TripleP


Under the TripleP program, they will "coach" you on how to manage misbehaviours through strategies like setting simple and fair house rules, appropriate use of reward systems like star charts, directed discussion, active ignoring, implementing logical consequences, and appropriate use of quiet time and time out.

What is the main principle of parenting?

Parenting is one of the hardest job in the world, so investing more time in this area is definitely worthwhile for ourselves and our children's well-being.  The best part is that if we become more effective parents, then our stress levels will go down, and there is good evidence, that this will also help with depression or anxiety.

So what is the "best" way?

Depends is probably the best answer, but let's look at the general principles.

I often ask my patients to reflect on what kind of parents they are.

• Are you passive?  With this style, you may "go with the flow".  You may be warm, nurturing, caring, but lacks the assertiveness or the ability to set clear boundaries for your children.
• Are you authoritarian? With this style, you tend to expect them to follow strict rules and regulations, and if they don't, there is usually some form of consequences.  It is more of a "military" style of parenting.
• Are you somewhere in between, and some may refer to this as the "balanced" type.
• Do you tend to be passive and then, when things get out of hand, become more authoritarian, and when you feel sorry for your children, you swing back to being passive again?

Can you relate to any of the above?

There are pros and cons with any of the above strategies.  The question is, which one is more helpful for you and your family?

In my opinion, the nurturing, caring, and responsive approach, is the foundation of good parenting.  It is about building that relationship.  Just like building a house, you need to have a good foundation.  A house without a good foundation might be okay for a short period of time, but eventually, will probably collapse.  At the same time, building a house requires erecting a good roof and walls, and this is analogous to the "discipline" part of parenting.

So in essence, both are very important, but my general advice here is to focus on the relationship as the core parenting strategy.  Then reinforce this with behavioural strategies to help with the assertive discipline for your child.  From my clinical experience, parents tend to search for good parenting techniques on discipline, but do often forget to focus on what is also extremely important, which is, to develop that good, loving relationship with your child as highlighted above.

Most parents will understand that if you are too "passive" without the assertive discipline, then the child may go "off the rails".  On the other hand, if you are too authoritarian, you may have a rebellion on your hands.  In my opinion, without a good relationship as your foundation, it is often difficult to implement effective, assertive discipline, without giving the wrong message.  Imagine a child who does not "feel loved", and you ground him/her as a consequence.  What message are we giving him/her?  Is it "Mum and dad hates me and it is so unfair." or is it, "I have done something wrong and now I have to live with that consequence. I will try better next time?"

Antidepressants in the Elderly

I was reading an article today with the title, "Caution with antidepressants in the elderly".

It was based on a large UK study which showed a higher incidence of side effects in the elderly taking antidepressants.  However, this is not "new" information.  It has always been our usual clinical practice to "caution with the elderly".  My approach with the elderly has always been, "start low, go slow, and reassess ongoing need" with all medications, and not just with antidepressants.

So my advice here is, talk to your Doctor about your antidepressants, and reassess it on a regular basis in order to weigh up the pros and cons of continuing with the medication.  Your Doctor can talk to you about the option of counselling with a psychologist or counsellor, and see if this can lessen your reliance on medications.

Remember that caution does not mean that you should go off it, so please do not just stop it.  It just means that you need to be cautious and liase with your family Doctor about it on a regular basis.

Structured Problem Solving... CBT strategy

"God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference."  The Serenity Prayer

The serenity prayer for me captures the essence of what we are trying to convey when we counsel people with depression and anxiety.  We help people learn how to fix things through structure problem solving, helping them to accept the things which they cannot change through Acceptance Commitment Therapy (ACT), and helping them to develop an in depth understanding of self and the people around them, in order to increase their own awareness of when to fix, and when to accept.

In this post, we are going to concentrate on the "fixing" through structured problem solving.

So what is it?

Structured problem solving is a simple process that we all do subconsciously when we are "well".  When we are faced with a problem, we automatically assess the situation, we identify the cause of the problem, we work out our available options with its pros and cons, and then finally, we pick out the best option and follow through with that option.  We usually do this quickly and subconsciously.

However, when we are stressed, depressed and anxious, this process tends to "malfunction".  We become confused, overwhelmed, indecisive and then ultimately procrastinate.  We are forever searching for the perfect solution and unfortunately, there isn't any.

So what can we do?

1. First of all stop, think, before we act
2. Think about "What is/are the issues here?"
3. What are my options?
4. Write down the pros and cons with each option
5. Try to pick out the "best option" ie the one with the most pros and the least cons.  Please remember that the "best option" may still not be a good option but, it is still the "best option".
6. Take action (be realistic and take baby steps first and gradually work towards your goal)
7. Reflect and review the process above and reimplement as appropriate

Doing this with a Psychologist, Counselor or Therapist will help further....