Archive for January 2018

How to keep your relationship healthy

Romantic relationships are important for our happiness and well-being. Yet with more than 40 percent of new marriages ending in divorce, it’s clear that relationships aren’t always easy.1 Fortunately, there are steps you can take to keep your romantic partnership in good working order.

Talking openly

Communication is a key piece of healthy relationships. Healthy couples make time to check in with one another on a regular basis. It’s important to talk about more than just parenting and maintaining the household, however. Try to spend a few minutes each day discussing deeper or more personal subjects to stay connected to your partner over the long term.

That doesn’t mean you should avoid bringing up difficult subjects. Keeping concerns or problems to yourself can breed resentment. When discussing tough topics, though, it pays to be kind. Researchers have found that communication style is more important than commitment levels, personality traits or stressful life events in predicting whether happily married couples will go on to divorce. In particular, negative communication patterns such as anger and contempt are linked to an increased likelihood of splitting up.2

Disagreements are part of any partnership, but some fighting styles are particularly damaging. Couples that use destructive behavior during arguments — such as yelling, resorting to personal criticisms or withdrawing from the discussion — are more likely to break up than are couples that fight constructively. Examples of constructive strategies for resolving disagreements include attempting to find out exactly what your partner is feeling, listening to his or her point of view and trying to make him or her laugh.3

Keeping it interesting

Between kids, careers and outside commitments, it can be difficult to stay connected to your partner. Yet there are good reasons to make the effort. In one study, for example, researchers found couples that reported boredom during their seventh year of marriage were significantly less satisfied with their relationships nine years later.4

To keep things interesting, some couples plan regular date nights. Even dates can get old, though, if you’re always renting a movie or going to the same restaurant. Experts recommend breaking out of the routine and trying new things — whether that’s going dancing, taking a class together or packing an afternoon picnic.

Intimacy is also a critical component of romantic relationships. Some busy couples find it helpful to schedule sex by putting it on the calendar. It may not be spontaneous to have it written in red ink, but setting aside time for an intimate encounter helps ensure that your physical and emotional needs are met.

When should couples seek help?

Every relationship has ups and downs, but some factors are more likely than others to create bumps in a relationship. Finances and parenting decisions often create recurring conflicts, for example. One sign of a problem is having repeated versions of the same fight over and over. In such cases, psychologists can help couples improve communication and find healthy ways to move beyond the conflict.

You don’t have to wait until a relationship shows signs of trouble before working to strengthen your union. Marital education programs that teach skills such as good communication, effective listening and dealing with conflict have been shown to reduce the risk of divorce.

If you’d like professional help improving or strengthening your relationship, use the APA’s Psychologist Locator to find a psychologist in your area.

How to deal with anger

What is anger?

Anger is a natural response to feeling attacked, deceived, frustrated or treated unfairly. Everyone gets angry sometimes – it’s part of being human. It isn’t always a ‘bad’ emotion; in fact it can sometimes be useful. For example, feeling angry about something can:

  • help us identify problems or things that are hurting us
  • motivate us to create change
  • help us defend ourselves in dangerous situations by giving us a burst of energy

When is anger a problem?

Anger only becomes a problem when it harms you or people around you. This can happen when:

  • you regularly express your anger through unhelpful or destructive behavior
  • your anger is having a negative impact on your overall mental and physical health

If the way you behave when you feel angry is causing you problems in your life or relationships, it’s worth thinking about ways you can choose to manage anger, and learning about your options for treatment and support.

What is unhelpful angry behavior?

How you behave when you’re angry depends on how well you’re able to identify and cope with your feelings, and how you’ve learned to express them (see our page on causes of anger for more information). Not everyone expresses anger in the same way. For example, some unhelpful ways you may have learned to express anger include:

  • Outward aggression and violence – such as shouting, swearing, slamming doors, hitting or throwing things and being physically violent or verbally abusive and threatening towards others.
  • Inward aggression – such as telling yourself that you hate yourself, denying yourself your basic needs (like food, or things that might make you happy), cutting yourself off from the world and self-harming.
  • Non-violent or passive aggression – such as ignoring people or refusing to speak to them, refusing to do tasks, or deliberately doing things poorly, late or at the last possible minute, and being sarcastic or sulky while not saying anything explicitly aggressive or angry.

If you find you express your anger through outward aggression and violence, this can be extremely frightening and damaging for people around you – especially children. And it can have serious consequences: it could lose you your job or get you into trouble with the law. In this case it’s very important to seek treatment and support.

But even if you’re never outwardly violent or aggressive towards others, and never even raise your voice, you might still recognise some of these angry behaviours and feel that they’re a problem for you.

How can anger affect my mental and physical health?

Anger isn’t a mental health problem – it’s a normal part of life. However:

  • Anger can contribute to mental health problems, and make existing problems worse. For example, if you often struggle to manage feelings of anger it can be very stressful and might negatively effect your self-esteem. This can lead to you experiencing problems such as depression, anxiety, eating problems or self-harm. It can also contribute to sleep problems, and problems with alcohol and substance misuse.
  • Anger can also be a symptom of some mental health problems. For example, if you experience borderline personality disorder (BPD), other personality disorders, psychosis or paranoia (especially if this leads you to feel very threatened), you might often feel very angry, and find it very hard to cope with angry feelings.

Experiencing strong anger regularly or for prolonged periods can also affect your physical health, contributing to illnesses such as:

  • colds and flu
  • gastro-intestinal (digestive) problems
  • high blood pressure

Equestrian Therapy (Equine-Assisted Therapy)

Equestrian therapy (also known as equine therapy or Equine-Assisted Therapy [EAT]) is a form of therapy that makes use of horses to help promote emotional growth. Equestrian therapy is particularly applied to patients with ADD, anxiety, autism, dementia, delay in mental development, down syndrome and other genetic syndromes, depression, trauma and brain injuries, behavior and abuse issues and other mental health issues.

In many instances, riders with disabilities have proven their remarkable equestrian skills in various national and international competitions. This is the reason why equestrian therapy has been recognized as an important area in the medical field in many countries.

Equestrian or equine therapy is also an effective technique for many therapists to teach troubled youth on how they learn, react and follow instructions. For example in a  beginners’ horse therapy, the students were asked to get the horse move outside of a circle without even touching it. Students tried to clap, yell and whistle but the horse didn’t heed the signal. In the same manner, parents, friends and others who are part of a troubled youth’s therapy would learn that yelling, clapping and forcing would notbe  the best way to make the person do something.

Horses are the most popularly used animal for therapy although elephants, dolphins, cats and dogs may also be used. This is because, horses have the ability to respond immediately and give feedback to the rider’s action or behavior. Horses are also able to mirror the rider’s emotion.

The basis of the therapy is that because horses behave similarly like human beings do in their social and responsive behavior; it is always easy for patients to establish connection with the horse.

People with cognitive, psycho-motor and behavioral disabilities have shown positive results when equestrian or equine therapy is taught correctly by certified equine therapists. Just like other therapies such as physical, occupational and speech-language therapy, people with disabilities are being helped or assisted by certified therapists to cope with their disability like regular or normal people can. However, equine therapy combines all three in such a way that the patients or students do not feel that they are actually under therapy.

In the process, equestrian or equine therapy aims for its patients or students to:

  • Build sense of self-worth, self-concept
  • Improve communication
  • Build trust and self-efficiency
  • Develop socialization skills and decrease isolation
  • Learn impulse control and emotional management
  • Set perspective
  • Learn their limits or boundaries

Sleep and Mental Health

Americans are notoriously sleep deprived, but those with psychiatric conditions are even more likely to be yawning or groggy during the day. Chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared with 10% to 18% of adults in the general U.S. population. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).

Traditionally, clinicians treating patients with psychiatric disorders have viewed insomnia and other sleep disorders as symptoms. But studies in both adults and children suggest that sleep problems may raise risk for, and even directly contribute to, the development of some psychiatric disorders. This research has clinical application, because treating a sleep disorder may also help alleviate symptoms of a co-occurring mental health problem.

The brain basis of a mutual relationship between sleep and mental health is not yet completely understood. But neuroimaging and neurochemistry studies suggest that a good night’s sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability.

Key points

  • Sleep problems are more likely to affect patients with psychiatric disorders than people in the general population.
  • Sleep problems may increase risk for developing particular mental illnesses, as well as result from such disorders.
  • Treating the sleep disorder may help alleviate symptoms of the mental health problem.

The benefits of sleep

Every 90 minutes, a normal sleeper cycles between two major categories of sleep — although the length of time spent in one or the other changes as sleep progresses.

During “quiet” sleep, a person progresses through four stages of increasingly deep sleep. Body temperature drops, muscles relax, and heart rate and breathing slow. The deepest stage of quiet sleep produces physiological changes that help boost immune system functioning.

The other sleep category, REM (rapid eye movement) sleep, is the period when people dream. Body temperature, blood pressure, heart rate, and breathing increase to levels measured when people are awake. Studies report that REM sleep enhances learning and memory, and contributes to emotional health — in complex ways.

Although scientists are still trying to tease apart all the mechanisms, they’ve discovered that sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — wreaks havoc in the brain, impairing thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders, and vice versa.

Sleep disorders in psychiatric patients

More than 70 types of sleep disorders exist. The most common problems are insomnia (difficulty falling or staying asleep), obstructive sleep apnea (disordered breathing that causes multiple awakenings), various movement syndromes (unpleasant sensations that prompt night fidgeting), and narcolepsy (extreme sleepiness or falling asleep suddenly during the day).

Type of sleep disorder, prevalence, and impact vary by psychiatric diagnosis. But the overlap between sleep disorders and various psychiatric problems is so great that researchers have long suspected both types of problems may have common biological roots.

Depression. Studies using different methods and populations estimate that 65% to 90% of adult patients with major depression, and about 90% of children with this disorder, experience some kind of sleep problem. Most patients with depression have insomnia, but about one in five suffer from obstructive sleep apnea.

Sleep problems also increase the risk of developing depression. A longitudinal study of about 1,000 adults ages 21 to 30 enrolled in a Michigan health maintenance organization found that, compared with normal sleepers, those who reported a history of insomnia during an interview in 1989 were four times as likely to develop major depression by the time of a second interview three years later. And two longitudinal studies in young people — one involving 300 pairs of young twins, and another including 1,014 teenagers — found that sleep problems developed before major depression did.

Sleep problems affect outcomes for patients with depression. Studies report that depressed patients who continue to experience insomnia are less likely to respond to treatment than those without sleep problems. Even patients whose mood improves with antidepressant therapy are more at risk for a relapse of depression later on. Depressed patients who experience sleep disturbances are more likely to think about suicide and die by suicide than depressed patients who are able to sleep normally.

Bipolar disorder. Studies in different populations report that 69% to 99% of patients experience insomnia or report less need for sleep during a manic episode of bipolar disorder. In bipolar depression, however, studies report that 23% to 78% of patients sleep excessively (hypersomnia), while others may experience insomnia or restless sleep.

Longitudinal studies suggest that insomnia and other sleep problems worsen before an episode of mania or bipolar depression, and lack of sleep can trigger mania. Sleep problems also adversely affect mood and contribute to relapse.

Anxiety disorders. Sleep problems affect more than 50% of adult patients with generalized anxiety disorder, are common in those with post-traumatic stress disorder (PTSD), and may occur in panic disorder, obsessive-compulsive disorder, and phobias. They are also common in children and adolescents. One sleep laboratory study found that youngsters with an anxiety disorder took longer to fall asleep, and slept less deeply, when compared with a control group of healthy children.

Insomnia may also be a risk factor for developing an anxiety disorder, but not as much as it is for major depression. In the longitudinal study of teenagers mentioned earlier, for example, sleep problems preceded anxiety disorders 27% of the time, while they preceded depression 69% of the time.

But insomnia can worsen the symptoms of anxiety disorders or prevent recovery. Sleep disruptions in PTSD, for example, may contribute to a retention of negative emotional memories and prevent patients from benefiting from fear-extinguishing therapies.

ADHD. Various sleep problems affect 25% to 50% of children with ADHD. Typical problems include difficulty falling asleep, shorter sleep duration, and restless slumber. The symptoms of ADHD and sleeping difficulties overlap so much it may be difficult to tease them apart. Sleep-disordered breathing affects up to 25% of children with ADHD, and restless legs syndrome or periodic limb movement disorder, which also disrupt sleep, combined affect up to 36%. And children with these sleeping disorders may become hyperactive, inattentive, and emotionally unstable — even when they do not meet the diagnostic criteria for ADHD.

Lifestyle and behavioral interventions

In some respects, the treatment recommended for the most common sleep problem, insomnia, is the same for all patients, regardless of whether they also suffer from psychiatric disorders. The fundamentals are a combination of lifestyle changes, behavioral strategies, psychotherapy, and drugs if necessary.

Lifestyle changes. Most people know that caffeine contributes to sleeplessness, but so can alcohol and nicotine. Alcohol initially depresses the nervous system, which helps some people fall asleep, but the effects wear off in a few hours and people wake up. Nicotine is a stimulant, which speeds heart rate and thinking. Giving up these substances is best, but avoiding them before bedtime is another option.

Physical activity. Regular aerobic activity helps people fall asleep faster, spend more time in deep sleep, and awaken less often during the night.

Sleep hygiene. Many experts believe that people learn insomnia, and can learn how to sleep better. Good “sleep hygiene” is the term often used to include tips like maintaining a regular sleep-and-wake schedule, using the bedroom only for sleeping or sex, and keeping the bedroom dark and free of distractions like the computer or television. Some experts also recommend sleep retraining: staying awake longer in order to ensure sleep is more restful.

Relaxation techniques. Meditation, guided imagery, deep breathing exercises, and progressive muscle relaxation (alternately tensing and releasing muscles) can counter anxiety and racing thoughts.

Cognitive behavioral therapy. Because people with insomnia tend to become preoccupied with not falling asleep, cognitive behavioral techniques help them to change negative expectations and try to build more confidence that they can have a good night’s sleep. These techniques can also help to change the “blame game” of attributing every personal problem during the day on lack of sleep.

Medication options

If such nondrug interventions are not enough, an additional option is medication. A variety of medications are available to treat sleep problems. In some cases, both a sleep disorder and a psychiatric problem can be treated with one drug.

Depression. Although selective serotonin reuptake inhibitors (SSRIs) are a mainstay of treatment for depression, some may cause or worsen insomnia. Alternatives without this side effect include serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and mirtazapine (Remeron).

Something else to be aware of: an insomnia drug that works at melatonin receptors, ramelteon (Rozerem), may exacerbate depression.

It may be possible to combine antidepressant therapy with a sleeping medication. One placebo-controlled study of 545 patients with depression found that combining eszopiclone (Lunesta) and fluoxetine (Prozac) improved both mood and sleep. Another study found that treating insomnia with zolpidem (Ambien), after successful SSRI treatment, improved sleep and daytime functioning.

Bipolar disorder. Researchers have not done much testing of sleep aids in patients with bipolar disorder. The agents most often prescribed for insomnia in bipolar patients are the newer benzodiazepine-like drugs, such as eszopiclone, zaleplon (Sonata), and zolpidem. Two anticonvulsants, gabapentin (Neurontin) and tiagabine (Gabitril), might also treat insomnia in patients with bipolar disorder. Tricyclic antidepressants, though often prescribed to alleviate sleep problems because they are sedating, can trigger mania in patients with bipolar disorder. Likewise, antipsychotics may worsen sleep-related movement disorders in this population.

Anxiety disorders. Benzodiazepines such as alprazolam (Xanax) and temazepam (Restoril) not only help treat insomnia but also are used to treat anxiety, so these are options to consider when a patient suffers from both disorders. Case reports indicate that pregabalin (Lyrica), a fibromyalgia drug, and the anticonvulsant tiagabine might also help treat insomnia in generalized anxiety disorder.

ADHD. Stimulants such as methylphenidate (Ritalin) are often prescribed to treat children with ADHD, but can cause insomnia. Taking stimulants only early in the day or using a time-release formulation may help.

Want to keep your New Year’s resolutions? Here’s how

As we all know from experience, making a New Year’s resolution is easy. Sticking with it and actually achieving your goal is hard – very hard.

People have been struggling to keep New Year’s resolutions for a long time. The practice is at least as old as ancient Roman times, when such resolutions were made as pledges to the pagan god Janus, the namesake for the month of January.

And knowing human nature, I imagine people have been setting goals for changes in their behavior for much longer – likely for as long as people have been around.

 Unfortunately, only about 8 percent of us who set goals achieve them. But the good news is that research shows people who make resolutions are 10 times more likely to change their behavior than those who never commit.

So go ahead and make some New Year’s resolutions – it’s an important first step. And read on to see how you can increase your chances of doing what you resolve.

You’ve probably wondered: Why do some people succeed in keeping their resolutions while most of us fail? The answer is that success comes to those who think and plan. It’s not just dumb luck.

There is no guaranteed path to success. But here are some tips I’ve discovered over the years through research; talking and working with many successful people; and my work in psychology, business, radio and TV.

Timing helps. The beginning of a new year is a good time to make a resolution to change your behavior in some way, because you know millions of people are doing the same thing. So you get positive reinforcement when family members, friends and co-workers talk about making and trying to stick with resolutions. You feel like you’re part of a worldwide self-improvement movement – and you are!

Be realistic and plan. Think about the resolution you want to make and how you can succeed in reaching your goal. If you weighed 40 pounds less in high school 20 years ago, dropping that much weight might be more than you can handle. So set a goal of losing 15 or 20 pounds. That would be real progress. And you can always try to lose more once you’re reached the more achievable goal. Then prepare yourself psychologically over a few days or weeks. Think about steps you will need to take to reach your goal.

Consider two linked goals. Scientists used to think that having one major resolution was more effective than a couple of smaller, interrelated goals. But recent studies by Dr. John Norcross at the University of Pennsylvania at Scranton show that having two goals – naturally linked to one another and more specific – may lead to better success. If you want to lose weight, for example, resolve that you will cut sugar and carb consumption, and that you will keep a journal listing everything you eat and drink. That will statistically increase your chances of following through with both actions and shedding a few pounds.

In my own anecdotal research in working with those at the top of their fields, I have noticed that they often couple their goals and usually make them very specific. Documenting their progress in reaching their goals can be a great add-on resolution, because other studies prove that accountability is a tool used by the most successful people in business. I have seen this in my work and research of successful people over and over again.

Make a public declaration. Telling people you have resolved to lose 20 pounds, run a marathon, learn how to speak a foreign language, or achieve some other goal will make you more reluctant to abandon that goal. Social media can be a useful tool. Post your new diet plan. Text those who can pray for you, encourage or network with you. This can be the reminder and motivator to keep you on track.

If at first you don’t succeed, try, try again. These words, from a proverb taught to children in schools in the 1800s, remain true today. We all fail at times – no matter how hard we try – to keep our resolutions and reach our goals. Your response to failure is critical. “Getting back on the horse” when you fall makes you strong and will increase your chances of ultimate success. Don’t trash your whole self-improvement plan when things go badly and go through the psychological setback of a failure.

Reward yourself.  Planning a reward for progress in achieving your goal increases your probability of success. And reward yourself based on the time you have continued trying, as well as actual marked achievements. In other words, don’t wait until you have lost the full 20 pounds to reward yourself. Set small calendar or journal reminders for simply sticking to your plan every day for a week, a month, and so on. Then you will most assuredly see results.

In my experience, people who have attained success tend to focus on behaviors, rather than outcomes. For example, a business owner won’t simply set a goal of making $1 million in profit in a year. The owner will focus on taking specific steps needed to achieve the goal – whether attracting enough customers to make purchases at his restaurant, car dealership, or consumer electronics store. The specific steps will differ depending on the business, but the successful owner will come up with a game plan and then execute it.

Identifying behaviors that you can control, rather than lofty goals without knowing how to achieve them, can prove effective. Think of reaching your goal like traveling to a destination. For example, if you are in Chicago and want to drive to Disney World for a family vacation you need a car in good working order, a GPS or maps to tell you what roads to take, money and motel reservations. You don’t just leave on the spur of the moment and drive aimlessly. Grandma was right about planning ahead.

New research informs and expands the way success is attained. Coupling goals, keeping them simple, holding yourself accountable, and measuring incremental victories are critical steps to get you off to a strong and successful start in 2018.

Good luck, be strong and Happy New Year!