Minggu, 30 April 2017

Substance abuse management in Kenya



Anxiety avoidance and the brain



The excellent Anxiety series from The New York Times recently included a piece called "For the Anxious, Avoidance Can Have an Upside" by Joseph LeDoux, a neuroscientist I've referred to a number of times in the past here on PANIC! The article posits that avoidance isn't always maladaptive:
...people with social anxiety often cope with their problem by avoiding social situations altogether.  This is not practical or beneficial.  But neither is forcing oneself to show up at parties and just try to ride out the anxiety.  A more effective treatment approach might be to combine anxiety-producing exposure with strategies that allow one to gain control over the anxiety trigger cues.

Michael Rogan, who was a researcher in my lab when the active coping work was first being done, currently treats people with social anxiety. He suggests to his clients with social anxiety that they should, when at a party, identify strategies for temporary escape and avoidance (go into the bathroom, step outside to make a call), and also use previously learned relaxation techniques (controlled breathing, imagery, mindfulness), to “chill out.” In this way, as in the rat studies, behaviors that succeed in reducing anxiety are reinforced, and each subsequent social event is a bit more tolerable.
Here's how it works in the brains of rats (and by implication in the human brain), according to LeDoux:
Much has been learned about the brain mechanisms underlying passive and active coping in rats.  Freezing, the rat’s version of passive coping, is known to depend on a specific set of connections in the brain — specifically, between two regions of the amygdala: the one that processes incoming signals about the external world and the one that regulates innate reactions like freezing (via outputs to the lower brainstem). The active coping response, proactive avoidance, by contrast, requires that the information processed in the input region be redirected to a different output controller in the amygdala, one that engages goal-directed actions.... 
A major conceptual issue is how the re-routing takes place naturally within the amygdala, allowing the shift from freezing to active coping and thereby preventing pathological avoidance and allowing proactive avoidance and agency.  Recent work has shown that connections from the prefrontal cortex, a region important in behavioral control, to the amygdala are important in allowing the shift to take place. 
The amygdala has long been thought of as the accelerator on the threat train, and the prefrontal cortex the brakes.  But the new work suggests that the prefrontal cortex is not just the brakes, but also the switch that controls the track on which the train travels.  Figuring out how to more effectively engage the prefrontal cortex in this switching will hopefully suggest new treatment approaches.

Your Children Like to Give You What You Seem to Expect From Them





During the times when parents are making major parenting errors, they are often giving their children a double message in one way or another. The parents, usually because of their own ambivalence about rules they themselves learned in their own families of origin as they grew up, say one thing but seem to act in ways that contradict what is being said verbally.

In this situation, children make sense of their parents’ confusing expectations of them by taking into account the entire context of the family’s interactions. They use three rules to sort out and hierarchically rank double messages that are given on a consistent basis. These rules are described in detail in my post of March 8, 2011, How Children Respond to Double Messages From Parents, Part I.

The parents’ behavior may seem to indicate to children that the parents have certain expectations about how the children are supposed to turn out, and children will not want to disappoint the parents by defying their apparent expectations. This will happen in spite of the fact that the parents verbally instruct the children not to act in the way the parents seem to expect, and criticize and/or severely punish them when they do. Admonishments, especially verbal ones, will be disregarded. Actions speak louder than words (Principle #1 from the earlier post).

In this post, I am going to list several examples of frequently-seen problematic parenting practices, as well as the consequences that such practices frequently lead to. They may cause relatively mild problems, but often they cause major issues. These patterns have been described to me over and over again by my adult patients as they discuss their family’s behavior over time.

The problems I list all have a common theme: parents trying to micromanage their children's behavior in one way or another. Parents may protest: "I have to focus on my child's troublesome behavior because they won't stop it." They don't realize that it actually works the other way around: the child won't stop the behavior because the parent keeps focussing on it!

After one of these problems goes on for a while, the situation gets more complicated. The parents and children begin to feed into one another's anxiety and compulsive behavior simultaneously.

In order to solve such a problem, the parents have to be the ones who calm down about the issue first, or the children will be very unlikely to ever calm down and start behaving differently. When the parents do stop micromanaging, other difficult but solvable problems predictably ensue. These are discussed in the last paragraph of this post.

In discussing any problematic parenting issues, there is always a rather devilish and perplexing conundrum that makes any such conversation frought with peril. Many troublesome parenting behaviors are driven by a parent's guilt over their own thoughts and feelings concerning their role as parents, and if one discusses what they may be doing wrong, this adds to their sense of guilt. They therefore often become very defensive and, if anything, dig in their heels. Their problematic practices then get even worse than before!

On the other hand, if they do not really understand what they are doing wrong, they also continue doing it. 

A real lose-lose proposition this.

Parental guilt is often increased by negative comments about their parenting practices that come from their own parents, the children's grandparents. This in turn is caused by certain changes in western culture which have been rapidly evolving over the last few decades. I describe these cultural issues in more detail in my last book, in Chapter Two, Don't Blame Us.

Really, looking for someone to blame for family problems is a complete waste of time. The most important questions is, which would you rather do: find fault with people, or actually solve the problems? It is damn near impossible to do both. To naysayers I say, "Grow up!" 

The problems are created over several generations, so let's all just blame Adam and Eve, and be done with it.

And so I proceed.

Some additional points: Some psychologists and parenting experts intuitively understand the type of consequences that I list below, but IMO they miss the real reason why they occur. Most seem to think that the parents are somehow “gratifying” their children in a counterproductive way. However, in my experience, children who are in many of these situations are anything but gratified. 

They are almost always quite miserable, and behave in self-destructive ways to boot. Feeling good and being self destructive are for the most part mutually exclusive.

Rather than being gratified, I believe - as I have said many times in this blog - that the children are sacrificing themselves to give the parents what the parents seem, in the estimation of the child, to desperately need. 

Another frequent explanation, particularly by cognitive-behavioral therapists, is that the problematic parenting practices prevent children from acquiring certain social skills. While that explanation may at times have some truth, many of the "skills" such children are supposed to lack are not exactly rocket science. And these same children often demonstrate in other interpersonal and environmental contexts the very skills they are not supposed to have ever learned!

Critics of course will also point to examples in which the types of parental behavior described in the post do not or did not seem to be followed by the predicted negative consequences. As usual, I need to put in a disclaimer: The consequences of the parental behavior I mention do not alwaysresult in every situation in which the parenting problem is seen. They are not hard and fast. 

Kids have minds of their own. Other adults in the house or even in the community may provide a counterweight. Some parents behave more consistently, others much less so. Some are consistently inconsistent. Parents might get sick and tone down their rhetoric for extended periods. A zillion other things may come into play.

There is a chaos effect: small changes in initial conditions can lead to big changes down the line. However, if parents make the kind of errors I describe, the odds are very high that the predicted consequences will indeed occur. We’re talking probabilities here!

So, without further ado, here’s a list of common parenting errors created by parental ambivalence about their own behavior. By no means is it a complete one:

If you constantly try to fix a child, the child will find different ways to keep being broken so you can continue in your efforts.

If you continually bail children out of their own messes, they will continue to make messes for you to bail them out of.

If you give your kids money whenever they ask and almost never say no, they will continue to ask you for money, and may seem to develop problems supporting themselves when they grow up.

If you constantly try to mediate disputes between your children, they will continue to fight one another so you can continue to mediate.

If you blame yourself for your children’s failings, your children will blame you for their own woes. (In a perverse and ironic way, their problems are partly your doing. But it’s your guilt about your own behavior that creates the problem, not your basic character or intrinsic worth).

If you repeatedly tear apart your child’s room looking for drugs when there is no evidence that he or she is using, just to make sure he or she is not using, the child is more likely to use drugs so you can find what you are looking for.

If you continuously help children with their homework instead of telling then to figure it out for themselves, they will continuously need your help.

If you keep making a huge deal about something your children do or say, they will keep repeating whatever it was so you can continue to obsess about it.

If you instantly replace any items lost by your child, your child will continue to lose things.

If you do nothing when your children disrespect you, or if you just whine and scream at them about it, they won’t ever respect you.

If you look uncomfortable getting presents on holidays and birthdays, your children won’t give you any, or will give you thoughtless gifts. (If you then question them about it, they will get angry or passive aggressive, and may start giving you things, but looking as if they are only doing so because you asked, not because they care about you).



If you seem to get a kick out of a child’s misbehavior, they will continue to misbehave, no matter what else you say about it.

If you set a low bar in your expectations for your child (academically, for example), they may meet the bar, but they will not exceed it.

If you compulsively pay more attention to your children's needs than you do to those of your spouse, they will make gallant efforts to regulate the amount of intimacy you have in your marriage by inserting themselves between the two of you.

Last - and this is perhaps the most pernicious of all - if you constantly give in to your children's demands out of guilt, but then get angry at them because they are too demanding, then they will fear for your mental stability. In response, they will try to regulate your emotions like a thermostat: If you start to get too angry they will try to make you feel guilty, but if you start to feel too guilty, they will try to piss you off royally.

Whenever you try to stop doing any of these things after having done them for a long time, expect a negative reaction, because you will be confusing your children. They thought they had you all figured out, and suddenly you are not performing to their expectations. Therefore, their behavior will get even worse in order to see if you really mean what you say and are going to continue to be different. Their behavior will, however, eventually get better if you stay the course.

Sabtu, 29 April 2017

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Monday


Hello! Its Monday night!
ON Friday my partners sister came round with her boyfriend. It was nice to see them both. I then went next door to my friends for a drink.
On Saturday and Sunday I mostly cleaned the house for when my partner comes home! Its been quite relaxing to be honest.
Today I was quite anxious about travelling to hospital with my friend for her hospital appointment, but I kept telling myself that it was a serious appointment and she really needed me there so I just got on with it. Months ago I would have panicked I was too far away from home and would have had to let her down and feel really bad about it, instead I knew I had a mobile phone so I couldnt get 'stuck' anywhere and I was in a hospital - if anything its the safest place to be haha! When she was in her appointment I read my magazine and did a crossword. This really helped me to distract myself from thinking negative thoughts. We got a taxi home and I didnt panic once during the journey!
Tonight Im going to get on a bus, which is the 'homework' my CBT therapist gave me for tomorrow morning. I know Ive left it late but Ive had a busy week and aslong as I actually do it then thats fine, no point stressing myself out with it. After my CBT session Im going bakc to the hospital with my friend. I think doing this again will reinforce the fact that nothing bad will happen to me and that I can travel again. Yipee!
Getting on with things and not thinking up excuses is really helping me to 'quit' anxiety. Instead of thinking "what can I say to get out of this" I just do it instead.
My CBT therapist told me that If I stay in a situation for long enough my anxiety will start to decrease and if I repeat that situation again and again eventually Ill have no anxious feelings towards it. This is my mantra at the moment and im sticking with it.
Again I will repeat what I always say. In October I really thought I shouldnt be here anymore because I was just 'existing' by not fullfiling any of my goals and not going out, now Im beginning to live again. If I can do it so can you!!!! Trust me, Ive been there.
xxx

Jumat, 28 April 2017

How Do You Do It And How Do You Want It


I'm talking about beta-reading, of course.

I knew nothing about critiquing fiction when I hooked up with my first and primary crit partner, JD. I'd been a voracious reader all my life, but I'd never taken a writing course or spent time around writers. The only thing I knew about critique was from my years in academia. Guess what? People are harsh in academia.

The first time I got ahold of JD's writing, I think I frightened her. But she's really brave and totally open, and it ended up working out just fine for both of us. I've been a beta-reader for a few others, too ... with mixed results.

Every beta-reader has a different style. Here's mine: I do several things at once because I CAN'T ignore ... anything.

I line-edit:
  • Surface stuff: missing words, simple typos and spelling errors.
  • Simple mechanics: I have a low tolerance for grammatical errors. I have a lower tolerance for complacency about making them.
  • Word choice and language precision: choosing the proper word, phrase, and image is key to strengthening a sentence, a scene ... and sometimes, I do not think that word means what you think it means. I mark clichés and things that just sound off to me.
  • Unintended repetition: I mark words, phrases, and dialogue tags if they occur more than once in the same chapter or ... if they bug me.
  • Sentence construction and flow: Variation is lovely, and precision is essential. A present participial phrase (if indefinite) must reflect simultaneous action, for example. I'll mark awkward/clunky constructions, flabby prose, say-nothing sentences.
I also mark all the turns of phrase and images I think work really well, passages that are particularly powerful, and lines that make me laugh or pause.

Next comes:
  • Scene: it had better be necessary and multifunctional (e.g., not just to show me more about a character, but showing me more about the character while moving the plot forward). I might comment on length if it feels draggy or redundant and suggest a way to trim or rearrange so the scene is tighter. Sometimes I suggest deleting scenes altogether.
  • Backstory: only when it's needed, and no more than is essential ... but enough so I can understand what the heck is going on. I comment on the timing and extent of the backstory.
  • Setting: Must. Have. Sense. Of. Place. But it must be integrated into the story so the pace is preserved.
  • Dialogue: stilted, redundant, boring and purposeless, cover for info-dump, inconsistency in vocabulary/voice/pattern of speech, or anything that just doesn't sound like natural conversation will get marked.
  • Characterization: consistency within the character and with the character arc, including intensity of emotion, inner thoughts, mannerisms and other external behaviors, and relationships with other characters. If there are child characters ... I will comment on whether that child's behavior and language is consistent with what I know of child development. And if there is psychopathology or trauma, I will address it both from a technical perspective and a story perspective. For good or ill, I will describe how I feel about the character at any given point.
  • Plot arc: I will comment on general plausibility and tension, and identify things that seem illogical or inconsistent (plot holes). I might make predictions for what I think will happen so the writer can see how I'm understanding and interpreting the story--and so the writer can get a sense of how predictable the story is.
I tend to leave a lot of red ink on the page. I thought this was how everybody did it. I was wrong (and
naïve).
Now ... as I mentioned, I've had various reactions to my crits. Some were met with gratitude, and a few were met with radio silence or defensiveness. It was an important lesson: writers have different goals and needs, and different betas serve different purposes (you all probably knew that already).

There are lots of reasons writers seek beta-readers:
  • Simple validation--they just need someone to tell them they're good
  • Encouragement--they need gentle suggestions and a ton of positive feedback
  • Tell-me-if-I'm-crazy or genre questions--they need someone to honestly tell them if an idea is crap (JD does this one for me all the time) or to help them decide the genre of the piece
  • General impression/overall style--more of a broad review of theme, voice, style, plot, and/or characters/relationships
  • Specific questions/expert review--review of smaller-scope issues like making sure something is correct from a technical perspective
  • Getting the piece ready for agent or editor eyes--this would be the no-holds-barred crit

Which brings me to: BETA, know thyself (no such thing as being all things to all writers)

Followed closely by: Writer, know THYself (if you don't, you're going to get frustrated. Or hurt.)

I'll tell you where to shove
that red pen ...
When you are seeking a beta, ask yourself what you need (it may not be the same as what your writing needs), and be really honest in your answers (about both you and your writing, preferably). Then seek a beta who can meet those needs. Know which need you're meeting.

If you are the beta-reader, know what you can offer and communicate that to the writer. Know when to tell the writer you might not be the best match. It could save you some grief.

What kind of beta are you? What do you do well, and when are you not the best fit for a writer?

What are you looking for in a critique, and why? Do you have different beta-readers for different stages of your process, or who have different purposes? What makes you trust your beta(s)? What makes that relationship work?

On the Sisterhood front: be sure to check out Deb Salisbury's post on her writing goals for 2011!

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Dairy 5


Hello all,
I had another counselling session today which focused mainly on confidence. Although I have come to terms with panic, understand it and know how to challenge it, I lacked the confidence to do anything about it.
This is where our old friend avoidance crops up. Its so much easier to avoid 'scary' situations rather than address and confront them. I would constantly refuse to walk the dog, wouldn't travel to university or make excuses because I was frightened of feeling the panic again. Doing this just suffocated me and prevented me from experiencing life. It is a depressing and bleak situation to be in, believe me I know.
But, I am beginning to regain my confidence by talking down the gravity of the situation. I do this by reassuring myself with positive statements and rationality. "I can breathe, I can get to uni, Nothing will happen to me"
I have found doing things independently has also helped me greatly, like when I walked to the hospital by myself and going on jogs. This has shown me I do not have to rely on anybody else. It has also strengthened the reason why I think I am in this situation.
As a child I was very happy but I hardly went to other kids parties, night stay school trips, sleepovers, but did go out with my dad a lot. This helped me to fortify the bond with my parents but not to develop an Independence and over the years prevented me from developing a strong self confidence and belief. I would be the last person to blame my parents because obviously they have protected me, done the best for my life and I love them dearly but I think the refusal to cut the cord right up until university is what caused the stress and ultimately the panic of living in the real world without the emotional and mental tools to do this.
I may be wrong& it could be codswallop as I'm not a psychiatrist but one thing I firmly believe is that stress causes panic attacks. If I feel stressed I let it out instead of 'putting on a brave face'. If I want to cry Ill go and have a cry and I will always talk about how I feel. If you hold your emotions in, it's like a ticking time bomb waiting to explode. It's so important to talk to anybody you can about the way you feel. Don't be worried they'll think your silly or weird, there are thousands of people like you!

Hello there stranger s


You may not remember me. I was this blogger/writer/psychologist who disappeared a month ago, buried under deadlines and copy edits and wild new project excitement.

I'm back!

How are you guys? I feel so disconnected, and have thought of you often in the past few weeks. How about if I give you my updates--and then you can give me yours?

Here are mine:

First round revisions for SCAN are DONE. Hoping the editor is pleased!

I have the just-about final cover for SANCTUM! It's so beautiful, and I'm absolutely thrilled. This cover process could not have been better, and I can't wait to unveil it! More details on that in the very near future.

Copy edits for SANCTUM are done! In fact, the ARCs are being printed! Meep! I'm both giddy and horrifically nervous.

I have some very exciting website/SANCTUM extra things in the works, and I will be talking about those later this month!

I AM GOING TO BE AT BEA at the beginning of June. Oh, man. When I got that call from my editor, I was (am) both terrified and over-the-moon excited. Amazon party at this place. Book signing. Having to wear pants and look presentable. Gah.

Also, this happened:

And this happened:
(Oscar Bestseller is an imprint of Mondadori)

That's mostly it for me. There are a few more things I'll talk about in separate posts. And wow--the happenings in the YA and general publishing community over the last few weeks! I'll be posting my thoughts on some of those in the near future.

But now--what's happening with you? Anything exciting to report?

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Themes of This Blog Seen In Newspaper Advice Columns The Principal of Opposite Behaviors






In Amy Dickinson’s advice column of 4/5/17, she published a letter which serves as a good, simple and straightforward illustration of something I call the principle of opposite behaviors, described in several previous posts, as well as illustrating how seemingly opposite behaviors are actually just two sides of the same ambivalent coin.

The principle states that completely opposite behavior patterns can lead to the exact same result. If you’re afraid of being dependent on others, you can refuse to let anyone help you with anything. Or you can ask for way too much, annoying and eventually driving off people who might want to help you. In either case, you will end up with no help!

This principle comes into play when someone is ambivalent about certain rules of behavior in specific social situations. If this ambivalence is pervasive and frequently seen as a problem, said people who exhibited it were once called neurotics. The psychoanalysts who were the first to describe intrapsychic conflicts as a phenomenon missed the fact that these conflicts were usually shared by all the members of their patients’ entire family. 

In some cases, the conflict is expressed by compulsive or polarized behavior at one end of the spectrum - or at the exact opposite end. Some highly ambivalent people go back and forth between the two extremes, while in other cases, one generation goes to one extreme, the next to the other, and the third back to the first one.

In the letter, the father in the family was ambivalent how involved he should be with his son, and his conflictual behavior became apparent at his son’s little league games. His behavior was polarized and seemingly the exact opposite of that of his fatherAmy’s answer points out that trying not to be like your own parents in some way that you didn’t like can lead to a situation in which you try to do the exact opposite – and get the exact same result. Here, in abbreviated form, is the letter and the relevant response.

Dear Amy:  ...when we go to our son’s Little League games…my husband is the loud one on the sidelines — pacing, swearing and turning red; he micromanages our son, and shouts belittling comments at him and other kids on our team. He argues with the umpires, and complains about the coaches… he has been ejected from games during those seasons. I’ve tried asking him to be calmer...He says that he’s a lot better than his own dad, who never showed up for anything…


Dear Exhausted: Your husband claims that he is “better” than his own father was, but how is getting ejected from a game better than not showing up for the game? Either way, Dad is not at the game!

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Kamis, 27 April 2017

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