Worst Stress Relievers: Pain Medication

painmeasurementscale Who is to say for sure how much pain I have right now, I had yesterday morning, or will have this afternoon?   Only I can know for sure the pain I am feeling—and I can lie, to myself and to others.  Herein lies the greatest challenge of addiction to pain medication. There is no objective measuring tool for pain. The best we can do is to ask the person to rate his or her own pain on a scale of 1 to 10, with all the accuracy that can be expected from such a subjective assessment, which isn’t very much because pain can always feel more intense than it actually is, physically or sometimes just psychologically.

The sad result of the greater availability of pain medication, its greater potency, the beneficial effects felt by the individual by taking what amounts to a legal hit of morphine is an ever increasing number of people who are dying from abusing or misusing pain medication.  Among some groups, deaths from prescription drug overdoses are more than ten times higher than they were in the late 1960s. These are the results of an age-period-cohort analysis using data from the US Vital Statistics and the US Census, available online.

In the absence of significant pain, prescription painkillers are ingested because of their very powerful relaxing effects on the central nervous system and for the sensations of well-being that characterize their action. The presence of hydrocodone, which is the equivalent of synthetic opium, in these drugs makes them highly addictive. The first signs of a painkiller overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in the upper stomach, dark urine, and yellowing of the skin or the whites of the eyes. Overdose symptoms may also include extreme drowsiness, pinpoint pupils, cold and clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, coma, blue lips, shallow breathing, or no breathing.

The rapid increase in mortality due to accidental poisoning that has been observed since 2000 is almost tenfold for whites and threefold for blacks over the study period. This appears to result at least in part from the coming of age of baby boomers who, as they age, are becoming addicted to prescription medications, most especially pain killers. The majority of prescription drug abuse involves painkillers, according to the Drug Enforcement Administration. In the US, Vicodin (containing acetaminophen and hydrocodone) is the most commonly abused prescription drug.

The greatest proportion of overdoses appears to occur in people in their 40s and 50s. While in 1968 about one per 100,000 white women in their early 50s died from accidental poisoning, the number has risen to 15 per 100,000 in 2007. Among black women of the same age, accidental poisoning deaths increased from about two per 100,000 to almost 17 per 100,000.

getty_rm_photo_of_woman_taking_prescription_pain_medication What’s the fix for this nationwide epidemic?  In the absence of an objective pain measure, it is hard to imagine how anyone can take exception to the screams of pain that can come from someone who is in the process of becoming addicted to pain medication, or already is.  Many doctors have taken the no-hassle course of prescribing, rather than questioning the veracity of the patient’s pain.  Many other medical practitioners, such as dentists and surgeons, have taken to dispensing large quantities of “samples” to patients who have had even the simplest procedure, “just in case you feel any pain.”  Of course, the patient takes the stuff, the pain (if any) goes away, and the powerful effects of the drug go to work by inducing a high that feels incredibly good. At this point, and in many sad cases, only a few short steps separate the patient from the addict.

More recently, the DEA has cracked down on pharmacies and doctors, with the intent of reducing the supply of these medications. More needs to be done to stop the flow, but also and most especially to educate the public on the potential addictive nature of these substances. They do work extremely well against pain, but at what cost?

Stress Software: Of Mice and Men

Baeder_1999_EmpireDiner

Animals, and particularly rodents that are routinely used in   observations and experiments, tell us a lot of what we know about our own psychology. Rodents? How can a mouse or a rat know the first thing about what motivates and directs human reactions and behaviors? As a matter of fact, no rodent has yet provided any evidence of self-awareness or consciousness of the elevated kind, the sense of self that we attribute to ourselves and that is often used to explain why we do the things we do. And that is the very reason why rodents make such reliable exemplars of human psychology.

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Type A and Hi-Tech: A Dangerous Mix

Tower of Babel by Bruegel at Stresshacker.comWhat does the relentless push of technology into our lives do to our ability to manage stress and to our health in general? It depends on the personality. For individuals who have a type A personality, multiple e-mail addresses available from any platform, high-speed anywhere Internet access, smart mobile phones, tablets, and e-readers have enabled even greater flexibility and mobility in teleworking and telecommuting. In effect, traditional boundaries between the different roles at work, in the family, at leisure have been blurred or even removed.

In addition to the advancing technology, economic conditions have made short-term employment, work on time-limited projects, and working two or even three part-time jobs simultaneously increasingly more common.

Type A individuals claim that this new rhythm of life has produced beneficial effects in terms of greater task variety and flexibility. Thanks to these ubiquitous and always-on hardware devices and the software tools they provide, there often is no break of continuity between work and non-work states, between being somewhere dedicated to work activities and being somewhere else, where relationships or relaxation are possible. Again, for the type A personality, this is just fine–at least in theory and by their own admission.

Type A Individuals Thrive…At Their Own Peril?

Type A personality is characterized by an extreme sense of time urgency, frequent impatience with one’s self and others, high competitiveness, and more frequent aggression and/or hostility (either in the form of overt outbursts, or constricted and internalized through tight behavioral control). Clinical evidence indicates that there is at least an increased risk of stress in these individuals due to their proneness to work overload, disruption of natural circadian patterns, role conflicts, lack of time for relationships, for sufficient rest and energy replenishment through sleep or relaxation activities.

This particular personality type, given the current availability of communication and connection devices, appears to thrive in this environment that promotes maximum efficiency, high productivity, a faster pace of work output, and competitiveness.

Is this a competitive advantage for individuals who happen to possess these personality traits, or is this a potential problem? Apparently, higher productivity and efficiency are desirable outcomes. From a business efficiency point of view, they most definitely are. This may explain why significant technological resources are being devoted by an increasing number of companies toward making this always-on-the-job state of affairs a reality for their employees. It is seen as a competitive advantage over other companies (which are fewer and fewer) that shut down at a reasonable hour and do not work on weekends.

Most type A individuals proclaim to “love” this uninterrupted access to the marketplace and the instantaneous availability that is demanded of them.

There are however potentially serious health consequences, unless the individual can set and maintain reasonable and appropriate boundaries.

Type A personality have long been known to be at risk in terms of elevated blood pressure, increased heart rate, higher blood lipids, and near-continuous catecholamine (stress hormone) output. Intensive, frequent, and sustained activation of these physiological stress responses can contribute to the atherosclerotic process and to blood clotting. This prolonged state of arousal can cause, with type A behavior, an elevated risk of myocardial infarction. A longitudinal study by Barefoot et al., found that medical students with high scores on the Cook-Medley hostility scale of the Minnesota Multiphasic Personality Inventory (MMPI)–which would indicate type A personalities– had a six fold increase in mortality when followed up 25 years later, mainly due to coronary heart disease.

The negative psychosocial and socioeconomic factors in which type A behavior appears to thrive is associated with increased risk of serious illness and mortality because of the elevated activity of the hypothalamic-pituitary-adrenocortical (HPA) system and the increased secretion of the stress hormone cortisol. A very high workload, such as regularly working more than 10 hours of overtime per week, is also associated with markedly elevated cortisol levels. Prolonged and sustained activity of the HPA system is related to a series of endocrine and metabolic effects, causing, among other things, increased storage of fat in the abdominal region.

It is a mixed blessing, to say the least, for type A personality to see modern technology facilitate and indeed augment their relentless rhythm of activity. Is the risk really worth the reward?

Fear and Attraction: Racial Stress

The-Pirates-AttackThe coastal populations of Mediterranean countries lived for decades, stretching into centuries, with the fear of pirates, the strange invaders suddenly appearing from the sea.  Inhabitants of regions bordering with sparsely settled or frontier territories lived in fear of the sudden appearance of “barbarians” or “savages,” variously labeled according to time and locale.  With the increased sameness of living conditions brought on by progress and technological advance, there now remain far fewer parts of the world where the fear of strange invaders is part of daily life.  But is the fear of people that are unlike us still in the background, perhaps below the threshold of full awareness, but active nonetheless in driving our reactions, and sometimes our prejudice and discrimination?

The Strange Attraction of the Strange

barbarians-at-the-gatesWithout attempting a comprehensive definition of racial diversity, at a very minimum, physical differences in appearance often appear to be the first (and sometimes the only) trigger of a psychological defense mechanism.  In most human beings, there appears to be an innate drive to self-preservation that may be activated in the presence of individuals we may not recognize as familiar to us.

Often, there appears to be an instinctive and uncontrollable stress reaction that mobilizes our psychological, and at times also physical defenses against what we perceive as a possible threat from another human being.  This is by no means a new phenomenon.  As the coastal villagers and the frontier dwellers, we know that our own survival depends on being able to accurately assess any potential threat to ourselves and to our families and possessions, and take the most appropriate action (fight, flee or do something else) toward self-protection.

Clearly, not everyone we meet who is not like us is automatically a physical or psychological threat to our well-being.  Indeed, even those who appear to be exactly like us, in race, language, culture and background, may turn out to be a severe threat.  In ensuring survival, it pays to be alert to any potential danger. As President Reagan once put, Trust But Verify is a wise policy to live by, in politics but also in business and in interpersonal relations.

In some ways, we are attracted to the strange and the unfamiliar.  Our attention is automatically directed to it, out of simple curiosity, concern or fear.  When a different physical appearance is thrown in the mix, the perceived threat may be magnified by real or imaginary thoughts of danger and risk.  Paradoxically, there is also a part of us that is attracted to risky or dangerous situations, which does nothing to simplify the cacophony of feelings that are triggered by the sudden appearance in our midst of the strange and the mysterious.

A Universal Phenomenon

racially-diverse-babiesIt appears that no particular group of human beings is immune to this type of consideration when coming in contact with strangers.  There is certainly also an economic factor that plays a role, as when the need to defend one’s income or property, ends up taking precedence over solidarity and cooperation with the stranger.  It has been observed that people down on their luck, destitute, physically ill, or in need of urgent help seem to exhibit a tendency to be far less discriminating or threatened by the stranger than those who, by their own definition, may have a lot more to lose in such encounters.  Thankfully, human solidarity seems to shed at least part of its suspicions and reservations in the face of natural disasters or man-made calamities.  There are indeed moments in time when we realize that we are all humans, that we share a common identity, and that we inhabit this small planet together, if not always at peace with each other.

Awareness Normalizes

Our God-given capacity to muster our defenses against potential threats is a powerful asset, whose importance should not be overlooked even in a world where physical danger has been greatly diminished (though certainly not eliminated) by the safeguards of civilization.  Imagine would it would be like to automatically and unthinkingly assume that everyone we meet is friendly, honest, kind and has our best interest at heart.  Unrealistic, naive?  Yes, and I would also say, definitely dangerous to our personal and collective well-being.

Being aware that we possess the gift of discriminating between the real and the perceived, the dangerous and the annoying, the severe and the trivial can help us realize that it is the way we normally are and to make the best use of it.  Racial discrimination may be caused by an overuse of this important asset.  To automatically assume that anyone not like us (by various definitions) is a dangerous threat is clearly discriminatory, exaggerated and ultimately detrimental to our own well-being.  We are societal beings, by nature, and isolating ourselves from large swatches of humanity may be an attempt at self-defense, but one that clearly exceeds the intent and the practice of reasonable threat assessment. Unreasonable fear and loneliness often travel together.

Stress and Breast Cancer

Chenonceau Castle at Stresshacker.com Learning how to better cope with stress had a significant positive impact on the lifespan and quality of life of a group of women with recurrent breast cancer. Researchers at Ohio State University’s department of psychology reported the results in the latest issue of Clinical Cancer Research Journal, published by the American Association for Cancer Research.

"Patients [who learned how to reduce stress] evidenced significant emotional improvement and more favorable immune responses in the year following recurrence diagnosis. In contrast, stress remained unabated and immunity significantly declined in the assessment-only group," said Dr. Barbara L. Andersen, principal researcher at the Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute.

Analysis of the data of the 11-year-long study showed that of 227 women in the study group, the women who had received stress management training had a 59 per cent lower risk of dying of breast cancer.

This excellent news, reported by Medical News Today, is further confirmation that treating the symptoms of the stress reaction through cognitive (psychoeducational) and behavioral interventions can have a powerful effect on health. It is especially beneficial to learn how to directly manage the stressor that is causing the reaction, how to reduce its impact by a combination of stress-reducing techniques of relaxation, appropriate nutrition, adequate sleep, and the affirmation of positive statements about one’s ability to cope and overcome the challenge.

Best Omega-3 Against Depression

aaInness_1878_AutumnOaksThe polyunsaturated fatty acid omega-3 is an important weapon in combating inflammation, the principal cause of stress-related illness. However, when it comes to helping lift depression, not all types of omega-3 fatty acids are equal. According to a study presented at the 49th Annual Meeting of the American College of Neuropsychopharmacology which took place Dec. 5-9 in Florida, only eicosapentaenoic acid (EPA) has been shown to produce significant mood improvement in patients with depression. The other type of omega-3 fatty acid, docosahexaenoic acid (DHA), has no effect on depression.

The two omega-3 fatty acids EPA and DHA are found together in food (primarily fish and nuts) in a 1:1 ratio, but man-made supplements contain either EPA or DHA or a combination of both, in a ratio that may favor one vs. the other and may vary by manufacturer. In order to take advantage of omega-3’s antidepressant effects, it is therefore important to choose supplements that have an EPA-predominant formulation.

Among the many Omega-3 supplements that are rich in EPA for antidepressant effects, some of the highest rated are NutraSea Herring Oil (with a 3:1 EPA to DHA ratio), AST Bioactive Omega-3 EPA Amino Hybrid (with a 5:1 EPA to DHA ratio), and Pharmax High EPA Fish Oil.

Sigmund Freud: What a Funny Guy!

freud-of-the-pampas_357025Sigmund Freud lived and worked in the Austrian capital, Vienna until the Nazi Anschluss of 1938 placed him and his family in great peril. Freud was allowed to leave Austria with his family through the intercession of his patients Princess Marie Bonaparte and William Bullitt, and diplomatic pressure by the United States. One condition imposed by the Germans for his safe conduit was that Freud state that he had been treated with due respect. In response, Freud is reported to have declared, ‘‘I can heartily recommend the Gestapo to anyone.”

Freud viewed humor as an outlet for discharging psychic energy and reducing the emotional impact of negative events. He regarded humor as one of the most adaptive defense mechanisms.

The essence of humor is that one spares oneself the affects to which the situation would naturally give rise and overrides with a jest the possibility of such an emotional display. Freud, S. (1916)

In his groundbreaking study of humor, Jokes and Their Relation to the Unconscious, Freud hypothesized that jokes and dreams serve to satisfy our unconscious desires. Jokes provide their unique pleasure by allowing a temporary release of inhibitions and permitting the safe expression of sexual, aggressive, playful, or cynical instincts that would otherwise remain hidden and inexpressible. Laughter is the release of defensive tension that has been aroused by the circumstances that precede it. Tension can be elicited by behaviors, feelings or thoughts associated with anger and sexuality—in situations where their expression would be inappropriate. When ego defenses that inhibit their expression become unnecessary, as when the joke’s punch line is revealed, the energy that would be normally suppressed can be released in laughter.

There are two ways in which the process at work in humor may take place. Either one person may himself adopt a humorous attitude, while a second person acts as spectator, and derives enjoyment from the attitude of the first; or there may be two people concerned, one of whom does not himself take any active share in producing the humorous effect, but is regarded by the other in a humorous light. To take a very crude example: when the criminal who is being led to the gallows on a Monday observes, ‘Well, this is a good beginning to the week’, he himself is creating the humor; the process works itself out in relation to himself and evidently it affords him a certain satisfaction. Freud, S. (1928)

Freud also wrote “Humor” (1928), a brief paper in which humor is distinguished from wit and comicality, whereby humor represents an internalized form of forgiveness that changes one’s perspective and provides some relief from emotions associated with disappointments and failures. Likewise, humor permits the reinterpretation of failures as being of lesser importance or seriousness than initially believed, thereby transforming such failures, said Freud, into “mere child’s play.”

Successful Leadership: What Does It Take?

David_NapoleonSt-Bernard In reporting the results of a global survey, Michael Haid discusses the factors that contribute most to exceptional leadership performance. It turns out that it is not what leaders know, i.e. their skill set, but it is how they fit in their company’s culture, how they are motivated by opportunities within the organization, and how they interact with those around them that result in high performance. Read more

The Compound Interest of Stress

Wood_1930_AmericanGothic What makes chronic stress potentially lethal is its duration and the constant accumulation of its effects. Stress upon stress grows like compound interest on a loan. When only the minimum payment is made, the balance continues to grow and can never be fully repaid.

Humans respond to stressors such as physical or perceived danger, an infection, or a crowded and noisy environment, by initiating a complex biopsychosocial adaptation and coping response. This response is initiated by the sympathetic nervous system and leads to release of excitatory stress hormones (the catecholamines) and glucocorticoids from the adrenal cortex (the well-known adrenaline rush).

The objective is to engage with the situation, resolve it and return to the status quo. This process of regaining stability through change and adaptation is called allostasis. The arousal and mobilization of biopsychic resources is intended to be temporary and is shut off when the challenge has passed.

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When Stress Matters Most, What Do You Do?

NeuschwansteinStress is the physiopsychological reaction to a challenge or a threat. It is particularly acute when the stressful event triggers the perception that one’s available resources are insufficient or poorly matched to successfully face it. Take for example our job, a purposeful activity that we engage in as a means of livelihood. On the job, our resources (finances, physical and mental abilities, time, image, and self-concept) are allocated and expended to adequately meet its demands, which carries great potential for stress. Being able to pay attention to warning signs of trouble, of which stress is certainly one of the most prominent, may make a difference in our ability to respond quickly and effectively.

Stress on the job is of the same kind as the threat of a saber-toothed tiger—not the same, but of the same kind. Should we ever find ourselves face to face with the feline, our body would instantly spring into full mobilization mode. The heart rate would go up, respiration would increase in depth and frequency, muscles would tense and pupils dilate, the stomach would contract, and adrenaline and other excitatory hormones would flood into the bloodstream. We would be faced with three possible choices: fight, flight or freeze.

When face to face with a job challenge of a serious nature (loss of a major client, a sudden promotion, the loss of the job itself, a major breakthrough), we are alerted to a threat and our body instantly springs into full mobilization mode, with the same biological changes as when in a close encounter with the wild cat. The threat or challenge may be very different, with linoleum under our feet instead of savanna grasses, but the body doesn’t care—a threat is a threat. We are faced with the same three possible choices: fight, flight or freeze.

Even when we know we are not going to suffer physical harm, the body can’t help but to prepare for the worst. Our chances of being killed by wildlife or to compete with the tiger for our lunch are abysmally small. The last saber-toothed tiger became extinct sometime between the Oligocene and the Pleistocene epoch. Yet, we humans continue to be instinctively and instantly mobilized when we perceive a threat of any kind. Which is a good thing.

The usefulness of stress throughout or history is undeniable. Many more of our ancestors would have been killed had they not perceived the appearance of predators as a possible threat. A great many probably did get killed when they chose the option to freeze. Others, owing to inadequate weapons, got killed while exercising their option to fight. And still others were not fast enough to take full advantage of the opportunity to flee. To be sure, one hundred percent of those who saw no threat in the approaching tiger and lingered to consider the size of her teeth, or in other words, those who felt no stress in the situation, were swiftly eliminated from the genetic pool by a process of natural selection.

Fast forward to the present, and General Motor and Chrysler executives must have felt pretty safe from the saber-toothed tigers of competition and market change, because up until the last minute they felt no real stress from their falling sales (except for SUVs) and dwindling customer base (except for SUV buyers). How many people lost their job in the current recession and never saw it coming? Or saw it coming and froze? Or didn’t flee soon enough, or did not fight for change? Stress told Ford executives to come up with a plan, a better plan as it turns out. One wishes that GM and Chrysler executives had felt a little bit more stressed out, a bit more mobilized into action, less complacent and relaxed. Stress is a bright amber light on the dashboard of our life that simply says, something requires our attention—NOW. More often than not, the light is right.

Theo Pallake at Stresshacker.com

Top 11 reasons to love yourself

You must love yourself because…

1…you’re the only one you’ve got

You were born, you grew up, you became an adult…and there you are…you!  There’s no escaping the reality of it.  You are the only one in the world who is… you. Your uniqueness, your particular blend of talents, skills, shortcomings, idiosyncrasies, background, and experience is unmatched by anyone else on the planet. Doing something positive with this unique treasure of a life begins by accepting that you are the only one you are and will ever be.

2… it is a prerequisite to loving anyone else

If you are a Christian, and even if you’re not, you may have heard that Jesus said, “Love your neighbor as you love yourself.”  The key word in that sentence is the shortest word, the word “as.”  It means that unless you know how to love yourself, and are capable of loving yourself, you won’t know how to love anyone else, nor will you be able to.

3… it makes you happier

If you’ve ever wondered how some people just seem to be much happier than others with the way life is, and how they seem to manage their problems and adversities so much better, others have wondered the same thing. This has prompted a significant amount of research on happiness and on what makes it happen, what maintains it, and what it takes to have it.  While there are many factors that contribute to happiness, there is one characteristic of happy people that seems to be there across cultures, times and personalities: happy people do not hate themselves. Instead, they are rather fond of who and how they are, and many actually have a healthy love of self that doesn’t make them arrogant or conceited.

4… it adds to your lifespan

Happy, well-adjusted people seem to prefer lifestyles that add to their longevity rather than detract from it.  Perhaps one important explanation is that they cherish their lives, truly enjoy being with themselves, and are able to form lasting and secure bonds with others.  These are all protective factors that may help explain their longer lifespan.

5… it ensures better physical health

Loving yourself means first doing no harm. To the person who respects the fragility of the body, the need to ensure its optimal functioning, and the precious and irreplaceable gift of good health, harming the self is not even an option. This is why love of self generally leads to good decision-making skills on matters of alcohol and drug use, nutrition, exercise, medication, and risky behaviors. Love of self is also an extremely important component in avoiding major depression, in reducing the impact of stress, and in ensuring better mental health.

6… it agrees with those who love you

Sadly, many people who don’t care very much for themselves often argue with those who care about them. It is not unusual to see people suffering because a loved one insists on maintaining a harmful lifestyle, bad habits, and unhealthy behaviors. To accept someone else’s love, to accept that you are lovable enough for someone else to love you is the greatest joy for those who love you…and for you, too!

7… it helps you get over pain and hurt more quickly

A healthy attitude toward your life’s inevitable challenges comes from a good degree of self-confidence, which helps muster your available resources when the time comes.  Knowing that you can handle a crisis because you believe yourself to be strong, capable and good enough to manage it is the key to reducing the impact of the momentary hurts and pains of life.

8… you can’t be anyone else

Much effort and sorrow may go into trying to be someone you’re not. This effort produces very limited results at best, and at worst it can lead to tragicomic choices.  The reason?  It doesn’t fool anyone into believing that you are actually someone else.  Ultimately, everyone still knows that it is just you, trying to be someone you’re not. And how could it be otherwise?  Think about how much more credible and acceptable to everyone is to be just who you are.

9… it is easier than hating yourself

Hate takes a lot of work. I’ve heard it compared to a cancer that eats away at you from the inside. It is probably something very much like that, at the mental and often even at the physical level. Being unable to forgive yourself for your mistakes, being unable to accept your shortcomings, hating your looks, despising your personality…all this takes an enormous amount of emotional and intellectual energy that could be used towards more productive and enjoyable aims.

10… it makes you look better

When unhappy people are portrayed in movies, plays and novels they invariably are made to look unattractive either in obvious or more subtle ways.  Scriptwriters and authors put something in their demeanor, in their eyes, in their voice, in their mannerisms to indicate that we are seeing someone who is in pain. Self-loathing is visible to others: facial muscles are tense, actions are often contrived or insincere, and stress barely lives under the surface.  Contrast this image with that of someone who has a healthy love of self, and you will see someone who is comfortable with just being and who conveys this sense of comfort to everyone else.

11… it makes you more lovable by others

Who doesn’t love being with someone who can laugh, who can cry, who can be genuinely present?  And who doesn’t dread being with someone who’s always gloomy, depressed, unhappy, or self-critical?  The choice is yours to be one or the other.  Certainly, we all know that positiveness begets positiveness, love begets love, and happiness is truly contagious. Won’t you be that person who is so easy to love because you obviously know how to love yourself?

The Valor of Stress

James_DixonUnlike for physical injuries, no formal recognition is currently given by the US military for the biopsychosocial injuries sustained in combat, known as posttraumatic stress disorder or PTSD.  It is as if the many behavioral, emotional, and social consequences of traumatic stress are perceived to be of lesser impact, and thus less deserving of acknowledgement.  That they can be serious enough to warrant medical and psychological attention is now fairly well established.

The evidence is certainly not lacking, as serious outcomes of PTSD continue to occur. Most recently, the blog The Soldier’s Load reported  the story of  James “Rooster” Dixon III, an ex-Marine and long-time sufferer from PTSD who was killed by a State Police SWAT team in front of his house in Baxley, Georgia.

James sought treatment from the VA for his Post-Traumatic Stress Disorder (PTSD), but was unable to shake the constant anxiety and depression that are hallmarks of the disorder. On February 19, 2012 James decided to end his struggle by walking into the bullets of law enforcement: as much a casualty of the war as any service member who died in Iraq.

The blog’s editor, as someone with direct experience of war zone and combat stress and its psychological consequences, also offer insights into his own struggles with PTSD.

I became a functional recluse—avoiding social situations and new experiences that might trigger a panic attack. Friends and acquaintances got accustomed to me declining their invitations to socialize. Eventually they stopped asking. I drank heavily and destroyed romantic relationships in a depressing cycle of thrilling novelty, fear of entrapment and cold dismissal. After three years of struggling with the symptoms of my unknown malady, I chose to leave the Marine Corps. On my way out the door, the VA finally diagnosed me with combat-induced PTSD.

A Purple Hart for PTSD?

images Events such as the tragic end of James Dixon highlight the important questions that still surround how PTSD is perceived, labeled, acknowledged and treated—including the idea of awarding a Purple Hart in recognition of this very serious constellation of injuries that are sustained by so many service men and women. According to the Military Order of the Purple Heart, the Purple Heart medal “is awarded to members of the armed forces of the US who are wounded by an instrument of war in the hands of the enemy and posthumously to the next of kin in the name of those who are killed in action or die of wounds received in action. It is specifically a combat decoration.”  Should this wording be applicable to PTSD?

The Soldier’s Load asks,

Why do we fail to classify veterans with PTSD as combat wounded? I suggest that the reason has less to do with logic and more to do with the emotions surrounding a small bronze portrait suspended from a narrow purple ribbon. (…) Until we correctly label combat-induced PTSD as a “wound” suffered from contact with the enemy, we as a society will continue to view its sufferers as a shadow legion of men with strange habits and questionable character. We will not methodically identify the trauma, apply medical treatments, and provide appropriate rehabilitation and therapy during the recovery process. In short, we will draw distinctions between segments of combat veterans based on an arbitrary and antiquated determination that only the visible wounds of war are worth recognition, honor and treatment. Such a view will not be helpful to the thousands of combat veterans waging a daily war within, nor prevent some from ending that struggle before victory is won.

Read the full blog post. Do you support a Purple Hart for PTSD?

How is talking about my problem going to help? 10 reasons why it is better than not talking at all.

1. Talking about issues forces us to put them into words and thus can focus the mind on important details of the problem. This works very well in all circumstances, but especially if you have trouble concentrating your attention or if your thoughts and feelings about the issue feel like they are all jumbled together. Talking about thoughts and feelings helps bring more clarity to the situation and may be of significant help in coming up with possible solutions.

2. Telling the story to someone else, instead of just telling it to yourself over and over (also known as ruminating), helps you sort out what is often a confused mix of thoughts, emotions, opportunities and challenges. In solving a problem, the first step is to lay out as clearly as possible its dimensions, i.e., its scope, frequency and intensity. Talking about it helps you take this first step much more efficiently.

3. Talking about something that is heavy on our mind help release tension. Most people say that they feel better, and think more clearly, after they’ve had a chance to talk about a bothersome issue. Although just talking about the problem isn’t per se a solution, it is that crucial pre-requisite to finding just the right approach to solving it.

4. Talking is often perceived as an unburdening of the mind. The exploratory process that is inherent to putting things into words not only helps a person understand subtle and often unnoticed emotions, but it also helps in discovering alternative ways to manage strong and often uncomfortable feelings.

5. Talking to someone who’s a good, unbiased listener puts the talker in a position to receive someone’s care, compassion and undivided attention. Any problem is usually made much worse if we feel misundesrtood and uncared for. There are times in which keeping things to one’s self (perhaps motivated by a false need for privacy) may be the worst possible choice.

6. Talking opens up the possibility of receiving some useful advice. It is hard to see things clearly and objectively from within (as in, “not seeing the forest because of all the trees”). Moreover, none of us have all the experience and wisdom needed to address a situation in the most effective way, especially when we are stressed, tired, depressed, or anxious. Talking to someone who’s trained to listen and to counsel may not be the easiest thing to do, but it is almost invariably one of the best choices.

7. Talking and exploring the problem with someone else can help develop ideas and look at all possible strategies and solutions. You’ve heard the saying, “there is nothing new under the sun.” This happens to be true of all things human. Chances are, your problem has been successfully solved by many other people with the same challenges and in the same circumstances. Talking about your particular situation may allow you to take advantage of someone else’s experience.

8. Talking to someone relieves feelings of isolation and aloneness. These feelings are often caused by the very special circumstances or characteristics of the problem itself, which can give us the impression that “nobody would understand it.” This feeling can cause a person to isolate, refuse to address the issue, or resort to alcohol or drugs in an ill-advised attempt to get some relief. Talking is a much safer and more effective solution.

9. Talking about a serious issue with a professional makes you feel better very quickly. The very fact that you’ve taken the steps to make the appointment, go to the counselor’s office, and talk about your situation has an immediate beneficial effect. Most people report “feeling much better” after the very first session of counseling.

10. It’s better than medication alone. Major studies have found an effect size (which is a measure of treatment benefit) of up to 0.97 for talk therapy. For antidepressant medication, the average effect size is 0.31.

Army Suicides Highest Ever and Rising

aaCarignano_CrimeaThe number of suicides among active duty US soldiers is very high and it is rising at a faster rate: 125 Army soldiers have taken their own lives in the first eight months of this year. If suicides continue at this pace they will exceed the total for 2009, when there were a record 162 suicides. The trend shows little sign of abating, despite a now 20-month-old suicide prevention program and work aimed at removing the stigma of psychological counseling, the New York Times reports

Medical corps Army officers familiar with the situation have identified several factors that may be involved in the rising rate of suicides. While there is a widespread belief that repeated deployments are the principal cause of suicides, Army records show that 80% of soldiers who killed themselves were deployed in combat zones only one time or not at all. A significant number of the soldiers had experienced serious problems in their marriage. Many had sought counseling from Army psychologists for anxiety and posttraumatic stress symptoms. Interviews with family members indicate that in many cases, the soldiers believed that a diagnosis of posttraumatic stress disorder would ruin their careers. Additionally, many believed that their counselor or psychologist would not treat their condition as confidential, but would convey up the chain of command what the soldiers reported in private counseling sessions.

Stuck On Wide Open: Emotional Dysregulation

domesticviolenceEmotional regulation is perhaps the most dramatically visible and the prototypical feature of an individual’s personality. Many people appear to be mostly in command of their emotions at critical moments, while others appear to be particularly (and sometimes explosively) reactive to environmental and interpersonal challenges. In general, affective or emotional instability, inordinate bursts of anger, intense efforts to avoid real or perceived abandonment, and unstable interpersonal relationships point to an underlying attribute of emotional dysregulation. This set of features has been popularized as belonging to “drama queens,” or persons who tend to react to every situation in an overdramatic or exaggerated manner.

Sometimes, instances of emotional dysregulation in children (“acting out” behaviors) or in adults under the most severe stressors can be viewed as the only available response in circumstances in which overwhelmingly strong emotion must be expressed, such as in the context of an emotionally abusive family environment or in times of great personal upheaval.

DramaQueen1A large body of research suggests that alcohol use can increase underlying emotional disturbance and disrupt cognitive functions that are very important in emotional self-regulation. Support for this hypothesis comes from studies that find associations between alcohol use and short- and long-term emotional change. In the short term, alcohol can disrupt emotional stability by effectively removing barriers against violence, verbal abuse, and inappropriate behaviors. In the long term, alcohol dependence and addiction can create a false persona in which it becomes difficult if not impossible to distinguish between the individual’s genuine personality traits and those modified or instigated by alcohol use.

Emotional disorders, particularly when they are characterized by pervasive emotional dysregulation, are often characterized by high negative emotionality and low positive emotionality. A significant challenge in trying to downregulate negative emotions is to become less vulnerable to negative or distressing emotions, with the objective of increasing calmness and resilience in stressful situations.

To achieve better emotional regulation, biological change and contextual change are needed. Biological change is achieved by reducing individual reactivity to emotional stimuli. Even when this reactivity may be due to genetic dispositions (temperament) and early developmental experiences (nurture), most people can learn ways to better control their emotional expression. There is a combination of skills and interventions that is particularly helpful in promoting biological homeostasis and emotional stability. These include treating any underlying physical illness that may have a negative effect on mood, balancing nutrition and eating to replenish and maintain physical resources, staying off non-prescribed mood-altering substances, getting sufficient but not excessive sleep, and getting adequate physical exercise.

Contextual change refers to learning and practicing emotional resiliency, which is the ability to minimize negative effects of stressful events and situations, and to maximize the positive effects of positive outcomes and opportunities. The skill of resiliency is learned and reinforced by intentionally accumulating positive life events, i.e., making a conscious and deliberate catalog of what’s positive in one’s life and referring to it often until it is present and readily available in time of need. It also consists of developing practical skills that build a sense of generalized mastery and promote self-esteem, e.g., completing school, obtaining additional job training, taking an assertiveness course, and the like.

What Causes (And Cures) Emotional Dysregulation

The amygdala has been implicated in emotional dysregulation, aggressive behavior, and psychiatric illnesses such as depression. Anxiety disorders and dysregulation may be the result of too much activity in the amygdala and not enough activity in the prefrontal cortex (PFC), which is the executive center of the brain that sets boundaries of behavior and responds to criteria of calm, assertiveness, and emotional regulation.

BDNFStress, coupled with a genetic vulnerability, decreases the production of brain-derived neurotrophic factor (BDNF). BDNF is a protein that acts on the nervous system by helping the survival of existing neurons and promoting the growth and differentiation of new neurons and synapses. A reduction in BDNF production causes a thinning of neuronal structures, which can results in emotional disturbance. These structural changes make the prefrontal limbic governing system vulnerable to disruption and dysregulation. Thus, emotional stress, loss, or  other significant psychological factors cause the system to lose self-regulation.

Treatments such as antidepressant medications, lithium, electroconvulsive therapy, exercise, psychotherapy and good social support can reverse this process, increase the production of BDNF, renew neuronal growth, build more resilient self-regulating circuits, and return the individual to a healthy mood.

Disorders of Emotional Dysregulation

PTSD, or posttraumatic stress disorder, is characterized by very significant emotional dysregulation. Its sufferers experience unwarranted arousal—often caused by stimuli processed Depressed-Soldier-02outside of conscious awareness—and exhibit an exaggerated startle response, vivid intrusive thoughts, and flashbacks and nightmares related to past traumatic events. PTSD victims may frantically try to avoid physical or psychological reminders of their trauma, and may experience dissociative symptoms or emotional numbing. PTSD is a disorder of emotional dysregulation characterized by excessive fear, triggered by a severe and often life-threatening traumatic event.

Borderline personality disorder (BPD) is characterized by emotional dysregulation, the temporary but frequent inability to change or regulate emotional cues, experiences, actions, verbal responses, and nonverbal expressions. Individuals with BPD experience greater emotional sensitivity, greater emotional reactivity, and slower return to normal levels of arousal after intense stimulation.

Frontal lobe disorders, which have become rather common among combat survivors, are the product of traumatic brain injury and are characterized by emotional dysregulation, attention deficit, impulsivity, lack of inhibition,  poor insight, impaired judgment, and low motivation. These frontal-subcortical disorders can result not only from war zone trauma, but also from infection, cancer, stroke, and neurodegenerative disease. Explosive violence, often directed at family members, is a common occurrence, particularly in individuals in whom impulsivity, disinhibition, and emotional dysregulation are the most dominant features.

Finally, obsessive-compulsive disorder (OCD) is characterized by emotional as well as cognitive dysregulation, brought on by a disruption of both the “thinking” prefrontal and the “feeling” paralimbic networks.

In these and other disorders that feature emotional dysregulation, it is interesting to note that the anatomic structures that are affected have emotional as well as cognitive functions. This coincidence highlights once again the close interdependence of affective and cognitive operations in the human brain. We can’t feel deeply without thinking intensely, and vice versa.