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Borderline Personality Disorder: The ‘Perfect Storm’ of Emotion Dysregulation

Getting bigger and biggerOriginally, the label “borderline personality disorder” was applied to patients who were thought to represent a middle ground between patients with neurotic and psychotic disorders. Increasingly, though, this area of research has focused on the heightened emotional reactivity observed in patients carrying this diagnosis, as well as the high rates with which they also meet diagnostic criteria for post traumatic stress disorder and mood disorders.

New research now published in Biological Psychiatry from Dr. Anthony Ruocco at the University of Toronto and his colleagues paints perhaps the sharpest picture we have so far of the patterns of brain activity which may underlie the intense and unstable emotional experiences associated with this diagnosis.

In their report, the investigators describe two critical brain underpinnings of emotion dysregulation in borderline personality disorder: heightened activity in brain circuits involved in the experience of negative emotions and reduced activation of brain circuits that normally suppress negative emotion once it is generated.

To accomplish this, they undertook a meta-analysis of previously published neuroimaging studies to examine dysfunctions underlying negative emotion processing in borderline personality disorder. A thorough literature search identified 11 relevant studies from which they pooled the results to further analyze, providing data on 154 patients with borderline personality disorder and 150 healthy control subjects.

Ruocco commented, “We found compelling evidence pointing to two interconnected neural systems which may subserve symptoms of emotion dysregulation in this disorder: the first, centered on specific limbic structures, which may reflect a heightened subjective perception of the intensity of negative emotions, and the second, comprised primarily of frontal brain regions, which may be inadequately recruited to appropriately regulate emotions.”

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Men are from Mars, Women are from Venus, still they make their lives happy on Earth!

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Jamal Hassan

Hey! Looking much weird statement isn’t? Ya … I am talking about the wired condition of their brains which stems their behavior pattern and the emotional responses to the issues differently. What males perceive in a situ is entirely different from female point of view. How the relational issues are measured up differently by males and females in some relationship issues illustrates this vital difference. We therapists shall make use of this new found wisdom for the betterment of the apt solution through our sessions differently for them in individual sessions and joint sessions.

The newly found brain mapping and neural networking image analysis brought new insights by Dr. Ragini and her teams at University of Pennsylvania. Her team published the latest findings in the neurological “connectome” mapping and imagery. Though the brain neural network is considered as one there are sub networks too. And they are able to visualize inter hemispheric connectedness and intra-hemispheric connectedness. A simple behavior pattern of a male/female is finally explained as how many neurons are fired in a neural network to change the state like a on/off switch in a digital network and what kind of information process taken place to reach a net result (secretion of some specific brain chemistry at synoptic levels too: the back ground brain chemistry). We can’t get much simpler explanation than this. So to say, receive info; process info; and exhibit (transmit) a particular pattern of behavior unique to that personality. This is what happens in the neural networks. Here I wish to draw the attention to Allport ‘s definition on  personality as “the dynamic organization within the individual of those psycho-physical systems that determine his characteristic behavior and thought.”

men are from marsSo the physical system as such wired and connected in different pattern for males and females attributes the basic male female personality changes unique to them. If any crossover and mixed match is found that is unique to the personality. In general the researcher found that the males have front to back connectivity in the male brain and hemispherical connectivity is high in the female brains. Inter hemispheric connectivity found more in female brain and intra hemispheric connectivity found more in male brain. Above all there is always basic neural front and back and hemispherical connectivity in every human being irrespective of the gender difference. Respectively males’ decision making and behavioral pattern are perceptive and coordinated and that of women are intuitive and analytical. It is about the cerebrum and in cerebellum it is vice versa. Hence the males are stable in motor actions.  Men are single tasking but women are multi tasking in their thinking as well action too. This research proves as it the effect of the basic difference in neural connectivity pattern.  They are complementary to each other too.

This new wisdom shall be used in gender specific mental disorders as well couple counseling to sort out the relationship issues and compatibility issues.  By nature male and female are complementing each other and may the couple complement themselves to make harmony by understanding the rule of the Mother Nature. For more info the readers may contact the researcher Dr. Ragini Verma at Penn State University.

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New Year Eve Blues

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Morgan Sutton, LPC

Privileged ProvenTherapist

Many assume that New Year’s Eve is anticipated by most with a sense of celebration, enthusiasm, joyful anticipation and excitement, yet I have found that for a large percentage of the population this simply is not true! Client’s have repeatedly asked, “is something wrong with me because I don’t like New Years Eve? I don’t feel like celebrating; I feel sad and depressed.”

If you find yourself among those who suffer from the New Years Eve Blues, let me suggest that nothing is wrong with you!

These may be a couple of the reasons to explain why you feel as you do:

  1. Human beings are creatures of habit, and sense a familiarity with the year that’s ending. We’re uncomfortable with change and have the illusion we know what to expect from the year we’re about to lose. Change and uncertainty lay ahead creating a sense of anxiety, even dread, for some.
  2. The preparation and anticipation of the holiday season is over leaving others with a feeling of let down, much like the ending of a long awaited vacation.

Perhaps knowing that you are among a large group of like minded people will ease some of your discomfort this New Years Eve, and as you do absolutely nothing to celebrate, you will allow yourself to feel just fine about that!!

10 Tips to Build Your Resilience

rabbit_img1Resilience is that ineffable quality that allows some people to be knocked down by life and come back stronger than ever. Rather than letting failure overcome them and drain their resolve, they find a way to rise from the ashes. Psychologists have identified some of the factors that make someone resilient, among them a positive attitude, optimism, the ability to regulate emotions, and the ability to see failure as a form of helpful feedback. Even after a misfortune, blessed with such an outlook, resilient people are able to change course and soldier on (Psychology Today).

Here are the ten steps to build your resilience:

  1. Have the courage to be imperfect
  2. Take time for yourself
  3. Join a social club; do some course if you are not working.
  4. Be active in as many ways you can
  5. Have good company. Find time with your friends.
  6. Be aware that laughter is the best medicine! Find reasons to laugh out louder!
  7. Sleep at least 8 hours everyday (Read Sleep Hygiene Handout)
  8. Seek help when you need; asking help is a positive behavior!
  9. Remember, this too shall pass…
  10. Don’t bottle up. Talk to someone who you can trust. Remember, today’s friend could turn tomorrow’s enemy. So, think twice before sharing all your too personal and private things with a friend. This is where counseling with a trained professional is recommended.

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The trigger link between the synthetic Cannabis to “Spiceophrenia”

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Jamal Hassan – Privileged ProvenTherapist

In the recently concluded 24th annual symposium of American Association of Addiction Psychiatry on 07 Dec 2013 the case presentation confirmed the close link between the eruption of symptoms similar to that of schizophrenia and the synthetic cannabis. In fact the synthetic cannabis has a variant chemical structure ten times severe in potency than the natural cannabis which has the chemical structure of  THC (Tetrahydrocannabinol: C21H30O2: MOLECULAR WEIGHT: 314.47: BOILING POINT: 200°C (392°F) LD50: ). Hence  the severity shall be assessed  how easy prey  our  youngsters who just experiment to smoke it as it is hyped as legal high and  nick named as  “ spice” and K2. But our therapeutic community recently reported that there is no link between cannabis use and schizophrenia. But in acutlity either natural or artificial cannabis they have their triggers hidden and open to the schizophrenic episodes such as delusion and illusion even for the first timer to develop such  symptoms associated with their first time exposure to the deadly drugs consumed in any form.

But the awareness of its deadliness and the severe and stringent law of the present times controlled the usage and reported cases are in less number in USA. My question now is what about countries like India, Thailand and other third world countries where the syndicates run this business as a big industry in manufacturing , filtering, purifying (as quality conscious to certify their produces and supplies!) and making it to lanes in the hands of peddlers?  Thanks to the apparatus which put this effect into reality in US. Together with the law and the awareness programme we shall also make a positive pro-social change in any challenges faced in the field of addiction. When our scientific community is mislead with the super titles appearing with a picture of a girl smoking the cannabis titled as “No link established between marijuana and schizophrenia” in leading and widely read magazines is definitely misleading one. What is our responsibility to educate the youth and the addticted victims already sucked in the whirlpool of addiction? This is a deep search for the truth after meeting the claims and counter claims related to the addiction issue. I submit my humble courtesy to the AAAP published paper on the case study and the team of researchers. In spite of WHO and other agencies sincere advertising campaigns the smokers strength is alarmingly increasing year by year. I wish draw the attention of that fact too here as simple smoking habit later take the shape of smoking the pot too.

I too wish to accept the new term “Spiceophrenia” like the original authors if fellow clinicians have aversion to use the disorder schizophrenia on the lighter side of this write up.  The spade shall be called with other names too still spade is a spade!

Is Your Relationship Ready for Online Counseling?

Gina Lorenzo

Gina Lorenzo

All couples experience some problems with communication, intimacy, beliefs, personality-conflicts, etc. at one time or another. Are the differences strong enough to create chaos or even the inability to co-exist? There are a few ways to assess whether your relationship needs and is ready for on-line counseling. The underlying initial question is Do I want to continue the relationship?

1. Do both partners agree that the relationship is worth saving?

If one partner has made up their mind to leave the relationship then long term therapy is not the answer although a session with a therapist to close the relationship is worth the investment. If each person wants to continue the relationship then therapy is for you.

2. If each person can admit that the issues in the relationship have not been solvable together, then a third party needs to help.

Arguing, tuning out or just existing in the same house are no way to live together. If the communication problems won’t go away or if the same argument repeats itself then a counselor will help to mend the issues.

3. Can you embrace the fact that accepting a therapist’s help isn’t a sign of weakness but a positive step forward?

Friends and family are a great resource- a good outlet if you need to share problems but they will always give subjective advice no matter what their intentions are. Often times they will be surprised and perhaps judge why you would seek a professional. Keep in mind that their judgments may have deep personal roots and that you are making a positive step. Your decision will only result in a happier partnership.

4. Do you each agree that you are responsible for the problems?

Relationships are a partnership. Placing all blame on the other is counterproductive. Even if a specific event or personality trait is what is leading you to therapy, both participants will need to explore their feelings, behavior, and reaction.

5. Are your expectations for the therapist positive and realistic?

While the therapist will help guide you, explore the origins of your behavior and feelings and give suggestions for better communication, child-rearing, intimacy, etc. it is you that needs to complete the ‘homework’ and take ownership. The therapist cannot ‘fix’ you or your relationship without your participation.

6. Are your expectations for change in the relationship realistic?

Are you ready to accept and adopt changes in behavior? Are you ready to change while (and not wait for) your partner also takes steps forward? Tell your partner that you are willing and hoping to do this for the relationship and agree that this will not be an overnight process.
The advantage to on-line counseling is that you can speak or email a counselor when the time is convenient and complete homework and experience change in a timely way.

Congratulations and enjoy the positive process.

Contact Gina

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The Five Ingredients of an Effective Apology

The Five Ingredients of an Effective Apology

Why our apologies don’t work and how to fix them
Published on November 21, 2013 by Guy Winch, Ph.D. in The Squeaky Wheel

Apologies are important in any society and children are taught to say “I’m sorry” pretty much as soon as they are capable of constructing a full sentence. Unfortunately, our skill level does not improve very much from there. More often than not apologies made by adults are just as insincere and unconvincing as those made by children.

Why are we so bad at apologizing?

Effective Apologies as the Antidote to Guilt

Ask yourself (or someone else) why you (or they) are offering an apology in a given situation and the answer is likely to be, “I’m apologizing because I was wrong/mistaken/at fault,” or “One should/must/is expected to apologize in such situations,” or “It’s the right/mature/responsible thing to do.” And therein lays the problem. Because while such motivations are well and good, none of them reflect what the apology actually aims to achieve.

Consider that if you’re apologizing you must have done something to distress, hurt, offend, disappoint, frustrate, upset, anger, startle, or disrupt another person’s emotional equilibrium in some way. Therefore, the primary goal of your apology should be to ease that person’s emotional burden and garner their authentic forgiveness. As a bonus (and an important one), and only if your apology is effective, your own feelings of guilt or regret will ease.

However, for apologies to be effective, they have to be focused on the other person’s needs and feelings, not your own. This fundamental misunderstanding of who should be the focus of the apology is the reason so many politicians, athletes, and other celebrities sound blatantly insincere when offering them publically, and why so many of our own efforts are ineffective—because we’re not trying to make the other person feel better, we’re trying to make ourselves feel better.

The Keys to Constructing an Effective Apology

Apologies are tools with which we acknowledge violations of social expectations or norms, take responsibility for the impact of our actions on others, ask their forgiveness, and by doing so, repair ruptures in our relationships, restore our social standing, and ease feelings of guilt. This formulation implies that for an apology to be effective it must have the following key ingredients:

1. A clear ‘I’m sorry’ statement.

2. An expression of regret for what happened.

3. An acknowledgment that social norms or expectations were violated.

4. An empathy statement acknowledging the full impact of our actions on the other person.

5. A request for forgiveness.

The most important of these five ingredients and sadly, the one we tend to omit most often, is the empathy statement. In order for the other person to truly forgive us, they need to feel as though we ‘get’ the full implications of our actions on them (read How to Test Your Empathy here). Doing so convincingly is harder than it might seem. Let’s see how you do with the following example:

Setup: You had a horrible day at work, you’re in a terrible mood, you get home late and feel too wiped out and irritable to go to your very good friend’s birthday party. Besides, you figure your presence will only be a downer, so why ruin the event for everyone else? You wake up the next morning flooded with guilt and feel even worse when you realize you didn’t even let them know you weren’t coming.

Apology: What points do you need to cover in order to convey you ‘get’ the full impact of your actions on them?

Make a list of points you would mention before you continue reading. When you’re compiled your list, check key #4 to see how many of the necessary points you identified. Here are the five key ingredients an effective apology should have:

1. I am so incredibly sorry…

2. …I didn’t make it to your birthday party last night.

3. I had a terrible day and was in such a bad mood I just went to bed—but there’s no excuse for not showing up and for not even calling to tell you I wasn’t coming.

4. I can only imagine how (a) upset and (b) hurt, (c) disappointed, and (d) angry you must feel. (e) I know how much work you put into the party. (f) You must have been wondering when I would show up and (g) where I was. (h) I’m sure people asked you where I was and (i) I feel terrible for putting you in such an awkward and embarrassing position. I hope you weren’t worried (j) and that you were able to enjoy yourself but I feel awful that my (k) selfish behavior affected your (l) mood, (m) your night, or (n) the party in any way. I am so sorry I (o) wasn’t there for you as a friend should be and that I (p) wasn’t at your side to celebrate your birthday.

5. I know it might take you a while, but I just hope you’ll be able to forgive me.

Although it might seem intimidating to ‘own up’ to bad behavior so completely, doing so will not only help mend important relationships and ease feelings guilt, but taking responsibility and doing the right thing can feel extremely empowering. That said, be aware that effective apologies and especially empathy statements require practice, so plan for a learning curve.

And if you know any politicians, athletes, or celebrities who screw up or put their foot in their mouths—feel free to give them these five keys—they could probably use them….

For more about repairing relationships check out the chapters on Guilt and Loneliness in, Emotional First Aid: Practical Strategies for Treating Failure, Rejection, Guilt, and Other Everyday Psychological Injuries (Hudson Street Press, 2013).

Staying engaged

Ryan’s love [for his girlfriend] was audacious. It was whimsical. It was strategic. Most of all, it was contagious. Watching Ryan lose himself in love reminded me that being “engaged” isn’t just an event that happens when a guy gets on one knee and puts a ring on his true love’s finger. Being engaged is a way of doing life, a way of living and loving. It’s about going to extremes and expressing the bright hope that life offers us, a hope that makes us brave and expels darkness with light. That’s what I want my life to be all about – full of abandon, whimsy, and in love. I want to be engaged to life and with life.

5 Ways to Stay Engaged Once You’re Married

Lack of sleep linked to higher risk of illness in teenagers

Newly released findings from Bradley Hospital published in the Journal of Sleep Research have found that acute illnesses, such as colds, flu, and gastroenteritis were more common among healthy adolescents who got less sleep at night. Additionally, the regularity of teens’ sleep schedules was found to impact their health. The study, titled “Sleep patterns are associated with common illness in adolescents,” was led by Kathryn Orzech, Ph.D. of the Bradley Hospital Sleep Research Laboratory.

Orzech and her team compared three outcomes bSleep disturbanceetween longer and shorter sleepers: number of illness bouts, illness duration, and school absences related to illness. The team found that bouts of illness declined with longer sleep for both male and female high school students. Longer sleep was also generally protective against school absences that students attributed to illness. There were gender differences as well, with males reporting fewer illness bouts than females, even with similar sleep durations.

Orzech’s team analyzed total sleep time in teens for six-day windows both before and after a reported illness and found a trend in the data toward shorter sleep before illness vs. wellness. Due to the difficulty of finding teens whose illnesses were spaced in such a way to be statistically analyzed, Orzech also conducted qualitative analysis, examining individual interview data for two short-sleeping males who reported very different illness profiles. This analysis suggested that more irregular sleep timing across weeknights and weekends (very little sleep during the week and “catching up” on sleep during the weekend), and a preference for scheduling work and social time later in the evening hours can both contribute to differences in illness outcomes, conclusions that are also supported in the broader adolescent sleep literature.

“Some news reaches the general public about the long-term consequences of sleep deprivation, such as the links between less sleep and weight gain,” said Orzech. “However, most of the studies of sleep and health have been done under laboratory conditions that cannot replicate the complexities of life in the real world. Our study looked at rigorously collected sleep and illness data among adolescents who were living their normal lives and going to school across a school term.”

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Mending ruptures in client-therapist relationship during PTSD treatment has positive benefits

Online Counseling ServicesIn order for prolonged exposure therapy, an evidence-based psychotherapy for PTSD, to reach its full potential, any misperceptions or ruptures in trust and communication between therapist and client need fixing, according to a new Case Western Reserve University study.

The study, reported in the Journal of Consulting and Clinical Psychology online article, “Patterns of Therapeutic Alliance: Rupture-Repair Episodes in Prolonged Exposure for PTSD,” is among the first to examine how ruptures in the relationship between the therapist and client can damage a patient’s treatment outcome.

An alliance rupture may occur when there is a break in the therapist-client bond. For example, ruptures in the therapeutic relationship may occur when therapeutic progress stalls, negative feelings arise between the therapist and client, or when the work in therapy becomes challenging.

“We want therapists to know that a rupture in the therapeutic relationship isn’t a bad thing, as long as the therapist tends to it,” said Stephanie Keller, one of the study’s researchers and a Case Western Reserve doctoral student in clinical psychology. “However, if the rupture is not repaired, then your patient may not do as well in treatment.”

The research study included 116 people who experienced a traumatic event such as childhood sexual or physical abuse, physical assault, or combat exposure, and had a primary diagnosis of PTSD. Participants engaged in a 10-session treatment program called prolonged exposure (PE) therapy.

To help therapists chart progress and examine the therapeutic relationship, each client assessed his or her own PTSD symptoms and perception of their relationship with the therapist during treatment. This helped researchers to identify those clients who experience no ruptures in the therapeutic relationship (a stable relationship), clients who experienced a rupture that was subsequently repaired, and those with ruptures that went unrepaired.

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Counseling at ProvenTherapy.com should be an easy journey, provided you take the first step! The first step is to contact a Therapist... this could be the hardest part because you have to break your mental barrier... but, the journey is sure to be relaxing and comfortable for you! --- the ProvenTherapy Team