Depression Treatment Options


However the client should be aware of the treatment options so that he /she can discuss with the consultant. Broadly speaking, the treatment of depression rests on two factors Medication, and Psychotherapy or Counselling.

  • Medication is required for moderate and severe depressive disorder cases.
  • Counseling and psychotherapy serves as an edge in treating depression and need to be started simultaneously along with medicines.
  • You should continue the full course of psychotherapy even if you are feeling better to prevent a relapse.
  • Suddenly stopping antidepressants can precipitate a relapse. Medication needs be tapered gradually under your doctor’s supervision.

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Dealing with rejection



What makes Priyanka Chopra rejected by the wives of her co actors? Is there really a flaw in her character or is she a victim of the wives’ insecurities. Decide yourself in the article dealing with rejection.
Rejection is experienced as a deep blow to self esteem as it involves blaming you as a person. It is difficult to deal with it because it conveys the message of non-acceptance and that there is something wrong with you and you are not good enough or worse still there is something wrong with you, that you will never change and that you do not belong to this group and you’ve done something wrong or unacceptable. This leaves you with a deep sense of helplessness. There is nothing that you can do to change another person’s biases and perceptions and you are left to deal with all these emotions yourself. More often than not, these perceptions are often backed by societal or religious norms justifying the persons rejection.
Often people who are a victim of rejection keep going in circles feeling victimized and angry and are unable to get over it easily. Psychotherapy helps such individuals to differentiate between what is intrinsic to themselves and that which is not. This goes a long way in handling difficult emotions of rejection. By understanding ones ownself and how one uses psychological defense of projection and introjection one realizes that the emotions thrown into him by the person rejecting actually form the dark and unknown side of the rejecting individual’s personality which is unfortunately being flashed onto your character screen. Although not aware, the person has sense that he can succumb to these very biases and therefore fights it externally whenever he sees it. Unfortunately in the process does not cure himself and accumulates greater fear of the same biases. Therefore no logical argument is able to convince the person to give them up. The reason being, if they give up these biases, maybe there is a fear that he will have to face it within himself. After all isn’t it much easier to fight the devil on an external screen than to have him within yourself.
Equipped with this understanding by experiencing it within ones ownself, the individual is able to detach oneself from the influences of these negative emotions projected on him by the world and is able to restore his self esteem. Of course talking about these emotions forms the initial part of the cathartic therapy but psychotherapy does not stop at that alone. In fact if the therapist is unable to take the client beyond catharsis, the client keeps experiencing the wound in his mind but is unable to come out of it.
Understanding the mechanisms of rejection and knowing that it is never, and I repeat, never warranted or earned are the most fundamental keys to safeguarding your self esteem and sense of self worth. This is a choice. You have to make a choice about how you are going to understand the messages of rejection you receive everyday, and how you are going to, or not going to, integrate these messages into your psyche.
Remember that facing your fears, expressing and sharing your experience, no matter how shameful, is vital in overcoming the aloneness that rejection creates and which sustains its impact.
Make a choice today to focus on the dynamic you and your untapped potential and you will be unscathed by any experiences of rejection.

SURVING CANCER



Being diagnosed with cancer affects a patient not just physiologically but also psychologically, and has a deep impact on the emotional status of the patient and his family for an extended period of time. And while there are treatments for the physiological symptoms of the patient, dealing with the psychological trauma associated with cancer is another story altogether. Cancer is an experience of repeated traumas and for undetermined length, unlike an accident. The patient may experience posttraumatic stress disorder (PTSD) symptoms anytime from diagnosis through completion of treatment and cancer recurrence.

As is seen in the case of our Indian skipper Yuvraj Singh how the misdiagnosis and then the reconfirmation of the cancer must have been a series of highs and lows. Especially for a sportsperson who works under tremendous pressure to be fit and putting out an outstanding performance, trauma such as this can be doubly difficult psychologically rather than physically. Any ones guess would be whether he will be able to return to the stadium fit enough to play his best innings. Here is a glimpse of what he might be undergoing…

Although, the end of treatment is often marked with a sense of relief, accomplishment, and even joy in having gotten through a difficult experience. Yet for many cancer survivors, it is also a stressful time filled with new routines to learn, as well as mixed feelings about what they’ve just gone through. Many people find themselves unsure of how to move forward, wondering, “Now what?” Therefore, effects of PTSD are long-lasting and serious. It does not end with the end of the treatment. It may affect the patient’s ability to have a normal lifestyle and may interfere with personal relationships, education, and employment even after the patient is ‘cured’. Because avoiding places and persons associated with cancer is part of PTSD, the syndrome may prevent the patient from seeking medical treatment or psychotherapy. It is therefore important that cancer survivors and their family receive information about the possible psychological effects of their cancer experience and early treatment of symptoms of PTSD.

Also, as a patient, they may have been so busy learning about their diagnosis, working with the medical team, and going through treatment that they didn’t fully feel the emotional impact of the diagnosis until after end of the treatment. It’s common for many cancer survivors to have a variety of complex and often conflicting feelings about their diagnosis, treatment, and recovery. It is normal to feel relieved that treatment is over, yet angry or sad about having gone through such a serious illness. Or, they may feel guilty about surviving a diagnosis that other people do not. The patient may also feel anxious and fearful about the cancer coming back, or worried that the treatment didn’t work. It is normal, too, to feel confused about what they’ve been through and to be concerned about the future. Family and friends can provide much comfort and support during this time. However, survivors often feel a bit isolated from loved ones and the world around them. Loved ones usually mean well, but they might not be fully aware of all the emotional challenges that can arise for you after overwhelming, interfering with your day-to-day activities and even your health.
Another concern faced by many cancer survivors is the realization that life after their diagnosis and treatment never really goes back to what it was before cancer. Many survivors find they are not able to return to their old “normal” life but must adapt to a “new normal.” Understanding what your new normal is can take time. This process may involve: Reflecting on what you’ve been through. Identifying changes you might want to make in your life. Recognizing what you’ve learned and what’s changed about yourself. Re-evaluating personal relationships or professional goals.
Discovering new ways of finding meaning and fulfillment.
In India, we find that patients usually resort to prayer, fasting, performing ceremonies in order to deal with their illness as against proactively seeking information from the doctor, reading up on the net and medical journals, exercising, eating healthy, meditating or seeking professional help to deal with their emotions. (Stress and Coping amongst infertile women Research conducted by Dimple Shah for Mumbai University, 1994.). Although these actions mimic active coping mechanisms, in essence it is passive coping mechanisms resigning pessimistically and blaming fate for their misfortune and instilling deep fear and helplessness, therefore unable to relieve the person of stress. Patients and their family needs to be informed of these inactive and potentially stress inducing coping mechanisms and be guided to utilize proactive coping mechanisms mentioned above from the beginning.

Therapies used to treat PTSD are those used for other trauma victims. Treatment may involve more than one type of therapy. Feelings of sorrow, grief, hopelessness; coupled with mood swings, fear of losing life, leaving behind loved ones and anxiety and depression are very common amongst patients fighting against cancer. Serious psychosocial distress was seen 40% more among cancer survivors of 5 years or more than in those who have never had cancer. About 10% develop major depressive disorder; others experience an adjustment disorder. In young adult cancer survivors, one small study found that 20% of participants met the full clinical diagnosis of post-traumatic stress disorder (PTSD), and 45% to 95% displayed at least one symptom of PTSD. Survivors of adult cancer are at an increased risk of suicidal ideology (having thoughts about suicide), while as many as 13% of childhood cancer survivors experience suicidal ideology.

The prognosis of cancer it is proven scientifically that an emotionally stable person reacts better to the medication and treatment modalities of cancer. This is where a person’s inner strength becomes paramount. Yet it is expected that the person who has been diagnosed with cancer will initially at least crumble under the stress of the trauma. Here the key is, the support system that has a tremendous impact to help the patient bounce back to fighting cancer is the family and friends. Psychotherapy from the time of diagnosis to surgery and post treatment is crucial in providing this supporting network. When one member of a family has cancer, the whole family is affected and, in fact, psychotherapists consider these family members to be “secondary patients.” Cancer affects an entire family, not only because there are genetic links to cancer and cancer risk, but because when one member of a family has cancer the whole family must deal with the illness.

The therapist focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient. Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Some of these methods include helping the patient understand symptoms, teaching coping and stress management skills (such as relaxation training), teaching the patient to reward upsetting thoughts, and helping the patient become less sensitive to upsetting triggers. Therapist may also use group work and introspective art therapy help the patient express their emotions. Sometimes having someone paying attention to the painful emotions itself is healing and patients show tremendous resilience once they are able to confide in someone who can demonstrate strength to listen to their pain, which family members are unable to do so at that point of time.

Most importantly cancer trauma, like other life threatening traumas bring back the past and often unconscious hurts and losses and therefore the psychological effect appears long lasting and compounded. Often people close to the patient find the person overreacting and are unable to understand where they are coming from. They feel hurt, angry and confused. But if you make an effort to understand that these emotions of hurt, anger and confusion that you are experiencing are not really incident related or even yours; that they belong to the person who is suffering from cancer you will be better able to deal with both the patient and the emotions thrown into you. Doing this is not as easy as it sounds and this is also where the psychotherapists step in. Psychotherapists help the family to experience and deal with these emotions that are thrown into them and also help them make better response choices. Therefore the psychological treatment on which the prognosis of cancer depends is strengthened using multifaceted psychotherapy approaches. It is beneficial to start with these sessions from the time of diagnosis and continue till post treatment; as although we expect psychological reactions to emerge within the first three months of diagnosis, there is no fixed rule and if not brought into the forefront of therapy may remain suppressed and resurface later on after many years, often with unconceivable strength.
Follow up article on Yuvraj singhs recovery from cancer
https://revivallife.wordpress.com/2012/04/14/surviving-cancer-2/

COPING WITH TRAUMA IN THE SCHOOL SET UP



In 2001 when the 9/11 attacks took place in USA, most of us were glued to the television sets, not realizing that our children who prima face seemed involved in their play were a witness to the trauma and were being affected by it. It mattered little that the incident took place in a different continent, miles away; the trauma was experienced by everyone around the world, including children. I have treated many children and adults alike after the earthquake of Latur in 1993 or more recent still 26/11 in Mumbai and the German bakery attack in Pune who were emotionally suffering after the traumatic terrorist attacks. But one of the most striking of them was this because we often think that a toddler who seems to be engrossed with his play is unaware and thereby immune to such events in our lives.

However, it is a well researched fact that stress is transferred from parents / care givers to children. They may viscerally transmit their own feelings of anxiety, rage and helplessness, and in doing so, colour the child’s internal model of self and the world. When caregivers are threatened or frightening, the intentional human to human quality of the trauma causes more severe negative consequences for the child than trauma from accidental causes (for example, a flood, fire or injury). In truth, however, all trauma may engender feelings of victimization, loss of control, despair and hopelessness and beliefs that the world is unsafe and life unfair. Young trauma victims often come to believe there is something inherently wrong with them, that they are at fault, unlovable, hateful, helpless and unworthy of protection and love. Such feelings lead to poor self image, self abandonment, and self destructiveness. Ultimately, these feelings may create a victim state of body mind spirit that leaves the child/adult vulnerable to subsequent trauma and re victimization.
In my next group Play Therapy session I saw to the trauma unfold itself. Rohan, 2 years old was a toddler having difficulty adjusting to the play school and was referred to me by the play school. He had been coming to me for the past 2 months and was gradually transferred to group play therapy sessions as he was now seemingly adjusting to the school. That day I was shocked at the emerging theme in the play session. As usual the 5 children assembled on the mattress and removed individual toys to play with. Shilpa started playing with blocks. Suddenly Rohan who was playing with an aeroplane and was keeping an eye on that Shilpa was making a tower; ran towards her with his hands outstretched and banged his plane on the tower that she had made and breaking instantaneously into hysterical laugh once the tower fell. Tears filled Shilpa’s eyes and she started crying softly while the others looked on. I was surprised by Rohan’s behavior as he had never in the past shown any signs of aggression, usually keeping to himself and playing with his cars / aeroplanes. I encouraged him to verbalize what he was playing and he referred to the bombings of the twin towers.

Play is a very powerful and natural medium through which children communicate. What happened in the group play session was an enactment of what the Rohan was observing around him. Enactment such as this helps children to understand the complex world around them. It also helps them to grasp and cope with difficult emotions of elders as well as their own reactions. In play children feel safe enough to demonstrate all this as it is an indirect manner of communication. Play session also helps them to work out their emotions and replace some with more constructive manner of communication. Instead of reprimanding the child (as usually the caregivers do), the play therapist attempts to understand the play and communicate the same to the child. This helps him to develop a thinking awareness about himself giving him the possibility to choose his actions. The failure of caregivers to sufficiently protect a child may be experienced as betrayal and further contribute to the adversity of the experience and effects of trauma. Traumatic stress may be transmitted by parents to their children.

School Principal and teachers play the role of care givers in school. Their function therefore goes much beyond the traditional belief of imparting knowledge or looking after their physical safety. Incident such as the recent attack by the MNS workers on the principal of DAV school can be quite traumatic for the children. This is especially true when the conflict is against the authorities (caregivers/ teachers / Parents) who are supposed to look after them. Children’s sense of safety both physical and emotional is thereby severely disturbed. If this is an ongoing conflict, the disturbance is more; effects of which mimic those of children of divorce. Those who are not addressed directly by the caregivers and kept in the dark face greater stress. Their curious minds seek information available through grape vines and media, leaving them more confused, misinformed and feeling disoriented. When the caregivers, in this case the principal and teachers directly impart information about the incident and address their anxieties, it reinstills faith in the protector’s ability to safeguard the child. Schools need to think along these lines too along with the safety drill. Just doing the terror drill without providing the emotional support needed by the topmost schools leaves a huge gap in the holistic development of the child.

Posttraumatic symptoms may encompass one or more of a broad range of behaviors, including the following:
§ Difficulty sleeping, eating, digesting, eliminating, breathing or focusing
§ A heightened startle response and hyper alertness
§ Agitation and overarousal, or underarousal, withdrawal or dissociation
§ Avoidance of eye contact and/or physical contact
§ Terrified responses to sights, sounds or other sensory input that remind the child of the traumatic experience(s),
§ Preoccupation with or re-enactment of the traumatic experience
Reestablishing safety or creating it for the first time involves setting up an external structure that provides a predictable, consistent routine for a child/youth and making sure their basic physical, emotional and social needs are met. Thus having their normal school routine is crucial. This also means to pay emotional attention to the individual child’s needs and allowing them to express their emotions in an appropriate manner. This could be done by the counsellor or a professional play therapist in group therapy sessions which could be short term weekend session or divided into 4 sessions spanned over the next one month.
Play therapy plays an important role in healing trauma victims, children use play powerfully to better emote their feelings rather than talk about them. It also provides an emotional distance to the children necessary to express threatening and negative emotions and thoughts. Thus through the use of play, we can reach out to both the younger children and the teenagers alike. Unfortunately this is a language that we as parents and teachers, have long forgotten and need to relearn it in order to understand what our child is feeling to help them.
This play way is used by a therapist trained in Play therapy to help children and parents understand and deal with their thoughts, feelings and behaviours. It aims to increase resilience and self esteem within each child enabling him / her to use this as a springboard to deal with difficulties in real world more confidently and to bridge the communication and emotional gap created by the trauma.

UNDERSTANDING THE RELATIONSHIP BETWEEN FOOD AND EMOTIONS



We subconsciously associate food with nurturing. Tasty food brings about a sense of deep gratification and we associate it with filling a hungry gap, rewarding ourselves for effort spent or simply a good social time.

Due to our strong mind-body connection we literally program our living cells moment to moment via our thoughts and especially our feelings. If you find yourself running for something to eat every time you feel emotionally upset, disappointed or hurt, you might be a comfort eater and use food to lift your mood. If you are really keen on changing negative food habits, the place to begin is to understand what food represents emotionally to you. Without this, any diet change will only be temporary and but fail to induce life style change and the weight will eventually come back.

Comfort foods, like chocolate and biscuits or starchy foods, increase the body’s natural feel-good neurotransmitter, seretonin. Unfortunately like all quick fixes and addictions, the instant gratification is soon followed by a strong sense of guilt and feeling like a failure, which brings on depression. Thus for a person suffering from depression related obesity, you need to take care of the depression first or simultaneously with the diet regime inorder to ensure successful weight reduction and maintainence.

Just as, common cold cannot be cured by treating only the symptoms of cold such as sneezing or irritation in the nostril but requires the infection to be taken care of first and the symptoms will cease on its own. Similarly diets without understanding the reason for the obesity are sure to fail. The saying goes that inside every fat person is a thin person dying to come out. Psychologists call this inner person your “inner child” which probably needed a lot of cover up at some point in time in order to deal with difficult life circumstances. If we connect with this inner child and become aware of what causes him/her to run for the fridge in the first place, we can start to reprogram ourselves by tending to our real hurts and needs instead.

Take “LILA” for example, who was sexually abused as a child. She grew up to be an attractive and voluptuous woman. Yet every time a man leered at her she felt shame and repulsion. Lila started eating, subconsciously motivated to put on weight as a barrier between her and the outside world and also to hide her curvaceous figure in order to avoid lecherous stares. Yet at the same time she has grown accustomed to using her sexuality to control and manipulate men.
Lila’s primal need is for respect, love and healthy affection from an intimate relationship, yet she is programmed to associate intimacy with sexuality and thereby she keeps compromising herself sexually in order to get her basic needs for love “fulfilled”. This discrepancy between her need for respect and love versus her tendency to self-sacrifice in sexual behavior increases her sense of shame and the need for her inner child to resort to various defense mechanisms as well as her compulsive eating disorder.
Lila needs to honor and respect herself by focusing on what really makes her happy. She needs to practice hobbies and develop talents where she could meet men who share the same interests and value her for other qualities than just her (physical) body. Lila also needs to change her attitude towards men as sexual predators in order to break free from meeting the “wrong” type of men who perpetuate her one-sided perception and overemphasis on sexuality. Thus the cycle keeps on repeating itself and keeps her entrapped in her negative habits.

For many people, like Lila, food has become a means to self-destructive behavior or self-punishment. Research indicates that sexual abuse victims often feel responsible, shame and guilt for the abuse. In order to cope with these emotions our mind unconsciously replays them in various circumstances in hope to resolve this trauma. Thus, in Lila’s case self punishment is an unconscious motive attained and re experienced via obesity.

There is another unconscious motive. Obesity also makes her appear not so attractive and therefore less likely to be sexually abused. Thus we derive some benefit from our seemingly troubling behavior. That is, “symptoms” or “issues” can be construed as both “maladaptive” and “adaptive”. At first glance, symptoms look maladaptive, but closer scrutiny reveals that in some way, the individual “benefits” from them. That is, in some way the individual is protected by her “symptoms”. In effect, the “symptoms” represent a solution to a problem, albeit a far-from-ideal solution. The maladaptive aspects of “unwanted” behaviors are easy to recognize.

We need to ask ourselves what it is that we dislike so much in ourselves that we need to punish ourselves. Why are we so hard on ourselves that the simple bit of self-discipline required to stop eating when we are full, becomes such a difficult task that we would rather abandon all reason and give over to our rebellious inner child? By becoming aware of how and when we felt trapped under excessive discipline and criticism in our past, we can break the pattern of such an unnecessary authority that we’ve subconsciously internalized. Pay attention to your real needs. Are they really excessive or out of line? Wouldn’t a different approach of gentle encouragement and the focus on our good qualities have better results in our behavior?

Another reason why we put on weight is when our nurturing needs as an infant, baby or child were not met. Our mother may, unintentionally and very well meaning, either fed us too often and too much or too seldom and little or simply the wrong kinds of food in order to entice us to do something or to reward us. This lack of being in sync with the child’s natural needs, may lead the child to experience anxiety and the inability to perceive the natural call of hunger and sense of satiety.

Often this goes hand in hand with an overprotective or controlling mother towards whom we always feel indebted or striving to please in our behavior. Our inner child feels neglected and not understood, so we grow up trying to please through our “doing” instead of realizing how lovable we are in just “being” ourselves.
Are you able to say “No” when you don’t feel up to a request? We might struggle to communicate our feelings and needs and have problems with our personal boundaries allowing people to take advantage of us and then becoming resentful afterwards. And guess what, the quickest relief again becomes the fridge or some stacked chocolate bar.
There are many more reasons why people become obese. What I am suggesting is that before we look for the quickest and easiest diet available to lose weight, we must first make sure we are happy wholesome human beings, and love the body that we’re in despite it’s extra few bulges and curves.

Next time you run for the fridge, ask yourself:
 How do I feel right now?
 What is my reason for wanting to eat something?
 Is the food that I am about to consume really beneficial and nourishing to my body or am I trying to substitute food for feeling hurt, frustrated, angry, disappointed, bored etc?

Have a notepad ready in the kitchen and write down your feelings and motivation for eating.
This simple exercise will break the habit of compulsive eating and will buy you those few extra minutes which enables your conscious mind to intervene.

The exercise above provides you with a framework for thinking about the meaning of a puzzling symptom. At first blush, these questions seem ludicrous to many people. However, over time, they begin to make sense. Answering these steps can be a wonderful beginning to changing an unwanted behavior or situation. Talk your fears over with a trusted friend. Develop a plan for overcoming your “symptom”. Give yourself a timeframe for overcoming your “symptom” or achieving your goal. If after your most assiduous efforts, you are unable to take any of these steps, consider seeking psychotherapy from an experienced clinician. We know enough about psychodynamics and unconscious motivations that most symptoms can be understood and effectively addressed.

HOW TO IMPROVE YOUR MEMORY



Ramesh (37 years old) had been coming for therapy for depression for a week now. One evening he came for the session really frustrated. He asked tentatively whether loss of memory could be due to his depression or the related antidepressants that he was given by his psychiatrist. He then went on to explain that he had excellent memory as far as numbers were concerned, so much so that as a child he could remember almost all 49 children’s marks in the class as the teacher called them out aloud before handing over the papers. Yet the previous evening when he had to give his new office number to his very important client he could not just get it right. It almost cost him his contract as the client got offended.

When I asked him when he started noticing this forgetfulness in him, he mentioned that a little before his divorce 3 years ago he had been noticing his forgetfulness but had been too emotionally wrapped up to pay further attention to it. He now realizes that the forgetfulness has been increasing over the years. Initially he thought that he was preoccupied and later brushed it off as a sign of early ageing and even hereditary. But yesterday’s incident was disturbing him.

First and foremost any physical disorder needs to be eradicated. Secondly causal factors as well as the mechanism of forgetting need to be understood. Usually mental decline begins by the age of 40 or 50. However people who are undergoing high emotional stress for an extended period of time also experience these symptoms as early as in their 30’s. Some of the stressors one cannot do away with given the stressful and competitive environment we live in, however we can counter them with certain changes in lifestyle. Health conscious people interested in living quality life introduce yoga/ physical exercises to their routine along with dietary changes. Similarly for mental health one needs to introduce what is called Neurobics in their life, a mental gym. Also contrary to popular belief, the mental decline most people experience is not due to the steady death of nerve cells. Instead, it usually results from the thinning out of the number and complexity of dendrites, the branches on nerve cells that directly receive and process information from other nerve cells that forms the basis of memory. Dendrites receive information across connections called synapses. If connections aren’t regularly switched on, the dendrites can atrophy.

The function of memory is primarily carried out by the cortex and the hypothalamus in the brain. Hypothalamus is the emotional seat of the brain. Anything which is emotionally laden is usually easier to recall, however if there is a flood of emotions it leads to confusion however if this flood continues for extended period of time, it can even cause atrophy in dendrites. This reduces the brains ability to put new information into memory as well as to retrieve old information. The good news is that aging brain, however, continues to have a remarkable ability to grow, adapt, and change patterns of connections. Therefore establishing associations and new pathways for connection have a healing effect on the brain.

The exercise program calls for presenting the brain with nonroutine or unexpected experiences using various combinations of your physical senses—vision, smell, touch, taste, and hearing—as well as your emotional “sense.” It stimulates patterns of neural activity that create more connections between different brain areas and causes nerve cells to produce natural brain nutrients, called neurotrophins, that can dramatically increase the size and complexity of nerve cell dendrites. Neurotrophins make surrounding cells stronger and more resistant to the effects of aging. Also, using multisensory approach, retrieving from the memory becomes easier with a web of associations supporting the matter. More often than not, adults don’t exploit the brain’s rich potential for multisensory associations. Think of a baby encountering a rattle. She’ll look at it closely, pick it up, and run her fingers around it, shake it, listen to whether it makes a sound, and then most likely stick it in her mouth to taste and feel it with her tongue and lips. The child’s rapidly growing brain uses all of her senses to develop the network of associations that will become her memory of a rattle. Adults miss out on this multisensory experience of new associations and sensory involvement because we tend to rely heavily on only one or two senses. As we grow older, we find that life is easier and less stressful when it’s predictable. So we tend to avoid new experiences and develop routines around what we already know and feel comfortable with. By doing this, we reduce opportunities for making new associations to a level that is less than idea. Simultaneous sensory input creates a neural “safety net” that traps information for future access.

Social interactions are also non routine and therefore socializing has similar effect. However we find more often than not that people who are undergoing emotional stress / depression want to be left alone and withdraw from social contacts. Is it any wonder why Psychiatrists suggest going for a walk rather that doing a fitness workout alone in your gym? Going for a walk allows one to experience all 5 senses and also provides the brain with social nutrients necessary to heal the brain.

Here are some of the ways in which you can use mental gym to improve on your memory:

1. Involve one or more of your senses in a novel context.
By blunting the sense you normally use, force yourself to rely on other senses to do an ordinary task. For instance: Get dressed for work with your eyes closed. Eat a meal with your family in silence.
Or combine two or more senses in unexpected ways: Listen to a specific piece of music while smelling a particular aroma.

2. Engage your attention. To stand out from the background of everyday events and make your brain go into alert mode, an activity has to be unusual, fun, surprising, engage your emotions, or have meaning for you. Turn the pictures on your desktop upside down. Take your child, spouse, or parent to your office for the day.

3. Break a routine activity in an unexpected, nontrivial way.
(Novelty just for its own sake is not highly Neurobic.)
Take a completely new route to work. Shop at a road side market instead of a supermarket. Normally, placing a key in a lock uses vision and “motor memory”—an unconscious “map” in the parts of our brain that control movement—which provides an ongoing feedback that allows us to sense where parts of our body are in space. (This is called the proprioceptive sense.)

Neurobics is recommended as a lifestyle choice, not a crash course or a quick fix. Simply by making small changes in your daily habits, you can turn everyday routines into “mind-building” exercises. It’s like improving your physical state by using the stairs instead of the elevator or walking to the store instead of driving.

Ramesh worked on these mental gym exercises for about 6 months and started regaining confidence in himself and also noticed his stress reducing, life feeling more meaningful, increase in interest and involvement in routine as well as novel things and social interactions and in general an elevated mood.

DEALING WITH JEALOUSY IN YOUR MARRIAGE



As Akash explains his marital relationship, there are tears brimming in his eyes. He looks down, unable to look the therapists in eye as he talks about why his marriage was not consummated even though they had been married for nearly 4 years now. They met at a wedding and he was instantly drawn towards Alka. Before the week ended he proposed to Alka through a common family friend. Alka and Akash met a couple of times before they committed to get married. As they courted, Akash sensed that Alka seemed disinterested in him and he asked her about her lack of enthusiasm, but she brushed it aside. They got married shortly and didn’t get much time to discuss this further in all the wedding preparations.
The wedding night Alka seemed to be very scared of sexual intercourse and Akash thinking that she will overcome it as time goes by, focused on making her feel comfortable in his joint family. Despite Alka’s efforts to be an ideal wife and Akash’s efforts to break the ice between the family members and Alka, she was unable to mingle with her family. Soon there began arguments which turned into huge fights between his mother and Alka. Initially he tried to explain to Alka that his mother used strong words to express her disappointments and that if she just let things be, it would help bridge gaps. But Alka was unable to digest this and started withdrawing and/ or getting righteous whenever she was criticized. Often they would end up in an argument wherein Alka felt that Akash was unable to stand up for himself and her. She complained of feeling unprotected in the family environment and they decided to move out on their own to maintain peace, sanity and intimacy in his marriage.
He got the desired benefits and they became closer to each other in their own house. Alka also started coming out of her shell and shared her feelings of how she thought that Akash was very naïve and not smart. He felt extremely hurt initially but also started matching up with her expectations of a husband. So he started learning dance, grooming himself well and even life coaching for his business. They now seemed to share some fun moments, however he was perpetually falling short of her expectations. He seemed to have gotten out of his mothers rows of criticism only to fall in love with a person who only could match his mother in being critical.
Soon he started feeling insecure and jealous of all his friends and cousins who seemed to evoke respect and / or interest of his wife. He found himself often in the periphery of their life events and withdrew further into his depression. He would often wonder with whom his wife talks to when he was at office. So he started giving ‘surprises’ to his wife when she least expected to check on her activities. On one such visit, he found his cousin cum business partner and wife in a compromising position. This is when he totally lost his faith and he started hurling abuses at her and at the same time criticizing himself. She unable to bear the abuse in a no – love marriage decided to move out into a rented apartment by herself. This made him even more insecure. He started begging and pleading at times in hope of getting her back and at other times he would shower her with violent abuses.
He blamed himself viciously for the break up of the marriage at times in his therapy and at other times he felt absolutely justified as she seemed to have evoked / instigated all this. It was now at a point wherein he did not know how mend their marriage. He was unable to forgive or forget her. He felt like an animal and was ashamed and scared as well as angry. Let us look at some of the theories to understand how and what this jealousy is and how one can overcome it.
Jealousy is a complex monster that develops from the melding of three other emotions – fear, anger and love. Romantic jealousy can be defined as “a perception of a threat of loss of a valued relationship to a real or imagined rival”. Jealousy in committed relationships is cultural and universal as a boundary-setting mechanism to protect certain relationships as important and exclusive. to protect the relationship of physical intimacy and self-disclosure from trespassers. In fact, all committed relationships, where physical and emotional intimacy exists (including purely sexual relationships), will be subjected to jealousy. Early attachment problems with significant others are known to profoundly affect feeling secure in future relationships, particularly the capacity to initiate and maintain loving relationships in adulthood. Given that attachment relates to anxiety regulation, support, and intimacy, it is not surprising that attachment also relates to jealousy.
According to the attachment theory of love, an adult becomes a secure lover, avoidant lover or an anxious-ambivalent lover in his or her romantic relationships based on the quality of his or her childhood parental relationship. Secure lovers are people who are comfortable with intimacy and have no problems with others feeling close to them. In contrast, avoidant lovers feel uneasy when close to another person. They have difficulty trusting or depending upon a partner. The third type, anxious-ambivalent lovers want to desperately get close to a partner, but often find that the partner does not reciprocate the feeling. This insecure relationship is often due to too much anxiety within the relationship stemming from the feeling that the partner does not really love them.
When “paranoia” or extreme distrust, arises in a relationship there are many factors which can be causing it. It is absolutely necessary to understand where these feelings are coming from, or else it is easy to act out in the relationship, blame the partner, put all kinds of unhealthy demands upon him, and even believe that he is cheating on you when he is not. Not only does this destroy his trust in himself and good feelings about himself, but he can easily grow to feel there is no way he can please you, or make you secure and happy.

When an individual gives into these feelings of paranoia, (or extreme fear, suspiciousness and jealousy,) and begins to create more and more restrictions upon the partner, or demand more and more information about what he is doing, this is often the beginning of the end.

Loving another person does not mean possessing them, or having them there simply to help you feel better about yourself. This does not take their needs into account. It is not loving or respectful of them, of who they are.

In all relationships each individual needs time alone, time with friends and of course time together. When we take away a person’s individuality and freedom to enjoy all aspects of their lives and grow, we are not behaving in a loving way. Sooner or later the individual begins to feel it, and can feel trapped, misunderstood and blamed falsely. Naturally, they then often think of ways of getting out of a relationship such as this.
Much like infidelity, distrust can leave an indelible mark on a relationship and challenge even the strongest of marriages. Depending on a variety of circumstances, such as whether or not distrust and dishonesty have become a constant in the relationship, couples can work through past hurts to become closer together if both are committed to making positive changes.

If one requires that their partner take away the pain they are feeling, they will be disappointed sooner or later. They are looking in the wrong direction. No matter how loving a person is, no matter how solid the relationship, they cannot take away pain and confusion that exists within oneself. We have to take responsibility for our feelings and work them through on our own. Psychotherapy is an insight oriented process and helps couples achieve this. Do not hesitate to take professional help of a psychotherapist if you find yourself going around in circles.
Handling insecurity and jealousy in a relationship can be difficult. However, change is possible once you understand their underlying causes. In order to overcome insecurity, people need to:

* Be willing to be put in vulnerable positions in life where they might get hurt.
* Take risks to change their current behavior.
* Trust others enough to expose themselves to them, risking vulnerability and the possibility of being hurt.
* Have a healthy and humorous belief in themselves in order to overlook their exaggerated need for acceptance and approval.
* Take a rational approach to each problem they face so that they are no longer inhibited by debilitating fears or beliefs.
* Practice assertive behavior in their lives, earning respect and the acknowledgment of their rights.
* Arouse the courage to take small steps in learning to experience success and overcoming their lack of belief in self. Once the success is experienced, they can build on it to gain the courage to act out of a strong conviction in their self-goodness and worth.
* Break the barrier or outer shell of the self-doubt they have hidden behind and reach out to others. Breaking out of their “shells” requires letting go of past hurts (real or imagined) and moving on with life.
* Open themselves to the possibility of success and accomplishment. Visualize or make a prophecy of winning at life so their energies are focused in a growth direction.
* Reward themselves for who they are and capitalize on their strengths, attributes, skills and competencies.

Answer the following questions to handle insecurity:
a. What behavior traits signal my insecurity?
b. What happened in my past to make me insecure?
c. What are some of my beliefs that account for my insecurity?
d. What are some negative consequences I’ve experienced due to my insecurity?
e. What behavior traits do I need to develop in order to overcome my insecurity?

Even in a loving and open relationship, it is normal to experience some paranoia or doubt. However, if you find yourself overwhelmed with distrust and suspicion, it’s time to confront your spouse. Whether he or she is guilty or not, it is important that you clear your conscience and put yourself at peace.
Confront your spouse but avoid making accusations at all costs. Your spouse will automatically react defensively, and if you are wrong, which you very well may be, you run the risk of making some painful and potentially permanent dents in your relationship. It is never a good idea to hurl unfounded accusations at your spouse. Instead, approach him or her with compassion and trust. Tell your spouse that you have been experiencing some worries in your relationship. Make sure and let your spouse know that you are approaching him or her out of love and a genuine concern for your relationship. It is extremely important that you do not attack them or judge them before finding out all of the facts. Specify what concerns you, keeping in mind not to accuse.
Accordingly, if your spouse is the one experiencing doubt, the most important thing to remember is that he or she is simply concerned out of love for you. Instead of immediately lashing out in defense, take time to consider what your spouse is saying and consider how it might make you feel if the situation were reversed. Instead of getting offended, be compassionate and empathetic. Your spouse will calm down when he or she sees that you have truly have nothing to hide. A defensive response, even if you are not guilty, makes you look as if you’re trying to divert attention from the issue at hand.
Doubt in a relationship has serious and obvious consequences, and you and your spouse must work together to eradicate these feelings and concerns. Jealousy is a very strong emotion and often a culprit in leading to marriage breakups. It helps if there are intense emotions and hurts to take help of a psychotherapist who can sit down with both of you to help each of you gain objective insights into your own thoughts, emotions and behaviours which are causing this drift in your marriage and help you both arrive at a solution.

UNDERSTANDING COMMITMENT ISSUES IN A COUPLE



Fear of commitment? Why am I still single? You are doing the work that you love for a good salary. Your career is on track. Now, you’ve decided that you’d like to do something about your personal life. You are thinking about a committed relationship or marriage and maybe children. You are accustomed to articulating your goals and achieving them. You take personal stock. You have a lot going for you. You are attractive, personable, fun, smart and outgoing. You think that you have met Mr. or Ms. Right. You share common interests, common friends and common ideas and, you believe, common goals. Then somehow, much to your dismay, things go awry. You learn that your partner isn’t interested in marital vows. Or worse still I notice that I am getting involved in relationships where the only common thread is that I am being ditched / cheated by my partner, basically my partner is unable to remain committed to me.
Whether you were several months into the relationship or several years, that kind of disappointment is truly hurtful. Its worse, if this is not the first time. This is not something that you want to repeat. So, you talk it over with your closest friends, the ones who you really trust. And, to your surprise, many of them admit that they saw the warning signs but “didn’t think that it was their place to say anything”, especially because it seemed so trivial incident or because you were so strong on the relationship and didn’t want to hurt you.
You’re a little miffed because you wish they would have said something. But, you can understand why they might feel that that would backfire. And too, you wonder, why didn’t you see those elusive warning signs. After all, they were apparently obvious to everyone else. You note that you are generally a perceptive person — can readily see the foibles in the relationships of others. So, what has happened here? And, how can you prevent it from, ever, happening again.
As you talk it over with your friends they each give you a list of “warning signs”. “Don’t date anyone over 35 who has never been married,” one cautions. Don’t date anyone who hasn’t had a previous long-term relationship another warns. As well intended as they may be, the lists may lead to a mis-focus. Because the real thing to consider here is probably not the “mate-selection” process that is important, rather, it is: why have you, although probably unconsciously, been drawn to someone who is unavailable. Assuming that you are a bright, competent person, this is probably not a problem of the “wrong list”. You might think of the problem with “mate-selection” as a symptom of something else that has gone awry. Think of it as the tip of the iceberg. That is, there is more to it than meets the eye.
Fear of commitment lies beneath the surface
If you have chosen a partner who turns out to be unavailable more than once, chances are there’s a reason why you chose someone who is unavailable. It’s painful to think about. The good news is as painful thinking about it can be: thinking about it, rather than sweeping it under the rug and going blithely along to the next relationship can allow you to understand it. And, understanding it can allow you not to repeat it. You can address and/or overcome it, and truly move toward the kind of relationship that you seek.
So, why are you, in effect, playing tricks on yourself? Although each individual and each situation is unique, odds are, as strange as it sounds, there may be a part of you who truly wants a relationship and another part of you, a less conscious part, who does not. That is, there may very well be a part of you who has a fear of commitment. As a starting point to your self-discovery process, ask yourself a difficult question, “what are the advantages to NOT being in a relationship?” And, in what ways do you have fear of commitment? At first blush, most people see these as ludicrous questions. If the answers were immediately apparent, you would have already dealt with them. Why aren’t you in a committed relationship and what can you do to overcome your fears. These reasons may include:
1. You are terrified of intimacy.
People who are terrified of intimacy may not always be, consciously, aware of it. If you grew up in a household in which your parents behaved in ways that were hurtful to each other, to you or to a brother or sister than you may be more afraid of intimacy than you realize. This is an extremely common problem among successful young professionals who often become quite successful in their careers. Without realizing it, they allow their careers to take precedence over their lives. Work becomes to the worker as alcohol is to the alcoholic; balm to soothe the anxiety and fear. Of course, this sort of “workaholism”, quite common here in Washington, is highly rewarded. Workaholism can be a cover for a fear of commitment.
2. You don’t feel that you deserve a relationship.
This is a close cousin to the fear of intimacy. Many people, who are otherwise successful in life, do not feel that they deserve a relationship. Unfortunately, most of the time, though not always, this belief is unconscious. Thus, it is difficult to learn more about it and to resolve it. Often this type of belief comes from experiences in childhood. The person may feel responsible for something bad that happened in the family such as the death of a parent or a sibling, or the illness or drug or alcohol problem of a parent. Alternatively, the basis for the guilt might be far more subtle such as guilt for resenting a needy or vulnerable parent or sibling. Similarly, individual may feel guilty over outstripping a parent or sibling.
3. You fear that any relationship is destined to end in hurt or failure.
Another cousin to the first two apprehensions is the belief, again unconscious, that any relationship will end in failure or loss. This is a common concern among people who moved around a lot as children, such as those with parents in the military or in an industry where such moves were required. These people often report that every time they began to make friends and become emotionally invested they were, often over their strenuous objections, forced to uproot themselves. For some these moves were so painful that they learned to make only superficial attachments. Also, this is a common problem among individuals who had significant early losses such as a loss of a parent through death or divorce. It is important to note that the loss does not necessarily entail an actual separation, it could entail a loss of a role or status. It’s understandable that individuals with this tyoe of experience have a fear of intimacy.
4. You don’t know much about what you think and feel. Consequently, you are unable to use your reactions as a guide.
Often times people who come for psychotherapy or counseling know little about what they think and feel. People with this difficulty typically report, “I don’t know why I have these problems. I had a very happy childhood”. They may have had a stressful childhood but they have denied that to themselves. Such individuals became proficient, at an early age, at turning off painful feelings. They may avoid painful feelings by throwing themselves into activities in which they are busy and successful such as work and sports. Unfortunately, not knowing much about what you think and/or feel has serious drawbacks inasmuch as feelings and thoughts often inform and guide important decisions.
5. You are frightened by the prospect of learning more about some aspect of your sexuality.
Another reason why an individual might select unavailable partners is to avoid learning more about some aspect of their sexuality. An intimate relationship holds the possibility of self-discovery and this can be frightening to many people.
So if you are afraid of a committed relationship, if you recognize yourself in one of the descriptions what steps might you take? How do you go about teasing apart the nature of your fear of intimacy?
Ask yourself the following questions:
1. What about an intimate relationship do you feel might be hurtful?
2. What is your worst fear?
3. How did your parent’s relationship work? In what ways was it successful? In what ways was it hurtful?
4. What were your relationships with your parents like when you were a small child? In what ways were they loving and supportive? In what ways were they hurtful?
5. Are you, in some way, repeating a script of what you observed with your parents? For example, do you find yourself doing everything and feeling “walked on” like your mother?
The answers to these questions may give you some insight into your fear of commitment. Talk them over with a trusted friend. Sometimes talking with a friend can help us to learn more about ourselves. However, if selecting unavailable people as prospective partners has been a recurring problem for you, seriously consider seeking an consultation with a therapist. These intensive treatments allow individuals to develop the requisite trust to deepen their understanding of themselves so that they can make real and enduring changes.
Why do some people have profound difficulties with commitment while others seem to embrace it? True commitment can come about only when one has a clear sense of oneself. That is, a person knows who they are and what they want and need is more available for a committed relationship. Many single people intuitively recognize this and choose to work on themselves prior to entering into a committed relationship. Also, a committed relationship isn’t for everyone. Some who know themselves well find it deeply enriching to take a solo flight. The key here is: just as individuals can remain unpartnered as a way of avoiding a host of painful experiences, they can marry or partner for a host of defensive reasons, such as avoiding aloneness or self-discovery. Self-understanding can help one to recognize when marriage or partnering is a growing experience and when it is a way of avoiding knowing oneself.

USING PLAY THERAPY TO DEAL WITH ENURESIS (BED WETTING) & ENCOPRESIS (SOILING OF CLOTHES)


Rahul was 12 years old when he was referred for bed wetting (enuresis) and passing stools (encopresis). He was referred by the family doctor who found a non medication approach to his bedwetting and encopresis a better solution, especially considering the long term side effects of the medicines and the fact that there were no physiological causes to his problem.
His problem had escalated soon after they had shifted into this new house. Parents didn’t think that shifting house could have been the reason for the same as he always wanted to shift back to this house. In fact he had many friends here and would initially quickly finish off his homework to go down to play. But soon he started wetting his bed in the night more often and the ‘accidents’ at school too increased.
By the time he started with play therapy, he was regularly wetting his bed in the night and the soiling his pants at least once a month. Rahul was so unsure of his own bowel movements that he refused to go for school trips or for a sleep over at his friends or cousins house. Off late he was fearful of going to school too, as he was now teased for being a sissy boy. At home too, he would play with his play station for hours on end and would be generally. His parents had tried every thing from making him visit the toilet at bed time and before going to school to more frequent visits when outside, but to no vain. Normally an active boy was now unsure and irritated most of the times.
During the case history on enquiring about any traumatic history the parents recalled that just before they had shifted the house he lost his grand mother and around that time the van in which the school children traveled had met with an accident. Although no one was injured Rahul had recounted the incident in great detail. They found it difficult to believe that these could again be the reasons as it was not the first time he was dealing with a loss of a grand parent or meeting with an accident. In fact he had lost his grand father the previous year, to whom he was more attached. Since his grandmother suffered from Alzheimer he hardly ever interacted with her over the years.
Bedwetting is considered to be problematic for children only above 6 years of age. Till about 5 it is considered normal if the child occasionally wets the bed. Usually children have considerable bowel control by the age of 4 and do not soil their clothes. Enuresis can be primary (the child did not grow out of using diapers) or secondary (child stopped wetting beds but suddenly after a period of time started wetting them again, as in Rahul’s case).
It is often connected to psychological issues of emotional stress / anxiety. Often the causes remain unknown to both the child and the therapist. Therefore using cognitive or reasoning approach is difficult with these children and it is not in their awareness or consciousness. Also emotions of shame and guilt are quite complex for the children to express verbally. This coupled with threats or punishment from parents (who feel an extreme sense of concern and frustration dealing with this problem) can become quite traumatic for the child. Play therapy, being dynamic, non directive and symbolic allows the child to reenact and work out his emotional issues leading to the problem in a safe and trusting environment without having to get into verbal communication. This is further supported by some parenting sessions where parents are usually asked to bring about certain changes in the child’s routine to support the sessions proves extremely effective.
The following are some of the changes that parents are requested to introduce:
• Having liquids at least 4 – 5 hours before the bed time.
• Setting up alarms at regular intervals and encouraging Rahul to visit the toilet.
• Keeping an extra pair of clothes and bed sheets so that Rahul need not wake his parents every time he had an accident.
• Not humiliating / threatening / asking too many questions to the child to rectify his behaviours .

Rahul began his play sessions. Initially he found it quite boring to play with toys that were around and often asked if he could carry his video games or whether there was access to computers. But slowly as the sessions progressed he started playing with animals, clay and balls. The therapist noticed that in most of his sessions he would give instructions to the therapist to follow. He would make loud noises and fight with the wild animals. With the clay he would often make snakes and then turn them into turbans which the therapist was instructed to wear and become the care taker of the animals. Some times he used the ball to knock down the animals. After many such sessions, he moved on to drawing. He initially drew only symmetric drawings but soon moved on to draw themes. Most of the themes again reflected anger, punishment and morality issues.
Around the 8th session, the mother mentioned that Rahul had wetted his bed only once and had soon woken up to change his clothes and the bedsheet. The therapist had given a list of instructions to the parents to follow. Soon after that Rahul showed greater interest in his play and also in the sessions.
After his summer break when he returned for the first session, he sent a message containing smiley face and to inform the therapist that they were on their way to the clinic. He seemed to have settled down with not a single mishap of soiling his clothes or wetting the bed. He had returned to his original confident self and seemed less tentative about things. Although he was apprehensive on the first day of school, he settled into his new routine pretty soon. On the follow up terminating sessions, the bedwetting and soiling behaviours had consistently shown improvement with no further accidents. His academic marks also returned to their earlier levels.