Friday March 20th 2015 - NYBH Staff
Predictors of Psychological Adjustment in Adopted Children
A recent study has focused on the factors that predict psychological adjustment in children who were placed for adoption before they were 1.5 years old. The researchers aimed to find out what affected adopted children’s internalizing (sadness, withdrawal) and externalizing symptoms (acting out, defiance).
Friday March 13th 2015 - NYBH Staff
Prolonged Grief Disorder/Complicated Grief
Process of Grief
Many types of loss can have profound effects on people’s psychological functioning, but the loss of another person through death is probably the most difficult loss most people will have to face during their lifetime. Bereaved individuals often yearn intensely for the lost loved one and can experience sadness, guilt, crying as well as many other symptoms.
Friday March 13th 2015 - NYBH Staff
Social Anxiety Treatment
Social Anxiety and 3 Dysfunctional Beliefs
Social anxiety, also known as social phobia, is defined as a continuous fear of social situations that might embarrass or expose one to scrutiny (APA, 2000). It is the most common anxiety disorder and one of the world’s largest mental health concerns (Bener, Gholoum, & Dafeeah, 2011). If affected individuals do not receive treatment for social anxiety, they can experience chronic anxiety as well as significant social and occupational disadvantages (Wong, Sarver, & Beidel, 2012).
Friday March 6th 2015 - NYBH Staff
Domestic Violence/Partner Abuse Treatment
Current Treatment and Assumptions
Whenever a battery/domestic abuse case in brought in front of a court, mandated treatment is usually part of the sentence in every jurisdiction of the United States (Dankwort & Austin, 1999). The most common model of treatment in state-sanctioned programs is called the Duluth model. It is a 12-52-week mandatory intervention following arrest that presumes battery to be a male offense influenced in large part by patriarchal values.
Friday March 6th 2015 - NYBH Staff
INTIMATE PARTNER VIOLENCE – CHARACTERISTICS OF ABUSERS AND VICTIMS
Partner abuse is a worldwide problem; between 10% and 50% of all women report having been abused by their intimate partners at some point in their lives (World Health Organization, 2001). In the US, intimate partner violence is reported by 1.5 million women and 800,000 men (Gondolf & Jones, 2002). In addition, there are many more cases that are unreported to the police, mental health professionals and even researchers. Victimization is often kept secret due to embarrassment, fear of retaliation by the perpetrator, the wish to avoid legal intrusions into their lives, and the belief that abuse is unavoidable and universal.
Friday February 27th 2015 - NYBH Staff
Worrying vs. Problem-Solving
Worrying is simply a negative thought process. When we worry, we usually focus on worst-case scenarios, and possible future problems. These negative thoughts often play in our minds like an IPod on shuffle. And even though we keep on focusing on these future ‘terrible things’, we are too anxious to think clearly and find real solutions. Instead, we just dwell in our worst fears. So worrying makes us anticipate and fear things that are unlikely to happen in the future, yet it leaves us unprepared to deal with any real problems.
Problem-solving, however, is different.
Friday February 27th 2015 - NYBH Staff
Infidelity and Couple Therapy Outcomes 5 Years Following Therapy
Infidelity is a common marital problem in the United States, with prevalence rates estimated between 20-40% (Atkins, Baucom, & Jacobson, 2001). Approximately 42% of all divorcees reported more than one extramarital affair during the course of their marriages (Janus & Janus, 1993). Infidelity is linked to increased marital distress, conflict and divorce (Amato & Rogers, 1997).
Friday February 27th 2015 - NYBH Staff
Paternal Post-Partum Depression
Post-partum depression has long been identified as a serious condition after the birth of a child. There has been extensive research on maternal post-partum depression, which has revealed many predictors (Beck, 2001). However, there have not been a lot of studies conducted on what causes fathers’ post-partum depression. From the little data available, it seems that maternal post-partum depression is the strongest predictor of paternal post-partum depression (Paulson & Bazemore, 2010).
Wednesday February 11th 2015 - NYBH Staff
Traditional Sports Psychology for College Athletes
College student athletes are a unique group in terms of being at increased risk for emotional and behavioral difficulties (Proctor & Boan-Lenzo, 2010). Not only do college athletes have to juggle academic responsibilities, interpersonal relationships and athletic endeavors, they are also under pressure to present the idealized public image of a college student athlete (Parham, 1993). Studies show that student athletes, especially at highly competitive levels, tend to engage in riskier behaviors (such as binge drinking or drug use) than their non-athlete counterparts (O’Connor & Beck, 2006). Because stress unrelated to sports can have a significantly negative impact on student athletes’ performance, psychological interventions can be particularly useful for this group.
Traditional sports psychology, also known as psychological skills training, emphasizes the control of internal states (Whelan, Mahoney, & Meyers, 1991). Athletes learn how to control or reduce their negative emotions, thoughts and sensations in order to increase their potential for achieving an “ideal” mental state for optimal performance (Hardy, Jones, & Gould, 1996). The idea is that by reducing negative mental states, athletes can minimize distractions and create opportunities for positive experiences and confidence building. However, trying to control or altogether suppress negative experiences may actually be counterproductive for improving performance. Avoiding unpleasant experiences may provide temporary relief from distress, but when it is done consistently, it can create a rebound effect and increase these unwanted states (Marx & Sloan, 2005). When such ineffective and dysfunctional strategies are used often, one’s cognitive resources can get depleted, which in turn can prevent one from adapting to situational demands and promotes a rigid mindset also known as psychological inflexibility. Psychological inflexibility can lead to a variety of mental health problems, may hinder the pursuit of meaningful and value-based behaviors (Hayes, Strosahl, & Wilson, 1999) and may even be detrimental to athletic performance.
The Current Study
A recent study (Goodman, Kashdan, Mallard, & Schuman, 2014) has investigated the effectiveness and efficacy of a different kind of intervention, namely a comprehensive mindfulness program called Mindfulness-Acceptance-Commitment (MAC). The MAC program was originally developed by Gardner and Moore (2007) specifically for student athletes and it teaches athletes ways to be more mindful and accepting of negative thoughts and emotions, as well as identifying values and committing to behaviors that are in line with those values. The current study changed the original MAC program by condensing its 8-week protocol into 5 weeks (keeping the number of total sessions the same) and adding an hour-long yoga session each week to incorporate more physical movement into the program. Yoga was also added due to its central message of learning how to listen and respond to bodily sensations and learning mindfulness through increasing one’s awareness of their physical and mental states while performing certain movements and poses (Shiffman, 1996). Moreover, regular yoga practice has been associated with more positive emotions, fewer negative emotions, and increased satisfaction with life (Impett, Daubenmier, & Hirschman, 2006) in addition to reduced levels of depression and anxiety (Pilkington, Kirkwood, Rampes, & Richardson, 2005).
The intervention consisted of 8 sessions as outlined below:
Session 1 – Introducing mindfulness
• Explanation of the fundamental concepts of mindfulness and practicing mindful breathing
Session 2 – Introducing cognitive defusion
• One goal of mindfulness is to create cognitive defusion, which is a state of mind characterized by psychological distance from subjective experiences (Blackledge, 2007). This mental state allows one to perceive thoughts and feelings as fleeting mental events instead of facts of reality.
Session 3 – Introducing values and values-based behavior
• Values-driven behaviors are behaviors in line with one’s values (30 minutes of cardio training to improve conditioning even when fatigued), whereas emotion-driven behaviors are actions in response to emotions and may not be in line with one’s values (avoiding training because it is difficult)
Session 4 – Costs of avoidance and benefits of acceptance
• Experiential avoidance is one’s attempt to control or eliminate unwanted, negative thoughts and feelings, while experiential acceptance is the willingness to tolerate those experiences in order to stay aligned with one’s values and goals
Session 5 – Enhancing commitment
• Growth mindset refers to an orientation toward embracing challenges, moving through setbacks and learning from experiences. In contrast, a fixed mindset is an orientation to avoid challenges, giving up easily and ignoring feedback.
Session 6 – Enhancing flexibility
• Exercises to learn how to redirect attention from internal processed to an external task (e.g.: if one was avoiding lifting weights, creating a plan to life even more weights by focusing attention on the task instead of negative emotions)
Session 7 – Attention and reinforcing mindfulness
• Different types of attention necessary in sports are discussed along with exercises to envision a sporting situation and identifying how to best direct attention
Session 8 – Maintaining and enhancing mindfulness, acceptance, and commitment
• Setting performance goals and action plans to achieve them
Yoga after each session
Following the intervention, the members of the athletic team reported greater mindfulness, greater goal-directed energy and less perceived stress than before the intervention. They also reported greater tolerance of negative experiences (i.e.: greater comfort with disgust and anxiety). Several players expressed that mindfulness exercises were the most useful part of the intervention. Through mindfulness participants learned to allow their experiences to occur without judgment and accept them as they naturally unfold. They learned to cultivate an open and receptive attitude that promotes the acceptance of negative states (Kabat-Zinn, 1990). Such openness is important for athletes as it helps them navigate the fluctuating demands of the competitive sporting environment. The reported lower levels of perceived stress is also crucial as it might equip athletes with an increased ability to cope with negative events. Participants also reported increased levels of importance of valued life domains. Since college athletes have only a finite amount of resources to devote to multiple competing life domains, it may be helpful to clarify and identify the ones that are the most personally meaningful. Then they can develop goals and channel more energy into the life domains that they value the most.
Mindfulness, Yoga, and Cognitive Behavioral Therapy References
Goodman, F.R., Kashdan, T.B., Mallard, T.T., & Schumann, M. (2014). A brief mindfulness and yoga intervention with an entire NCAA Division I athletic team: An initial investigation. Psychology of Consciousness: Theory, Research, and Practice, 1, 339-356.
Proctor, S. L., & Boan-Lenzo, C. (2010). Prevalence of depressive symptoms in male intercollegiate student-athletes and non-athletes. Journal of Clinical Sport Psychology, 4, 204–220.
Parham, W. D. (1993). The intercollegiate athlete: A 1990s profile. Counseling Psychologist, 21, 411–429.
Whelan, J., Mahoney, M., & Meyers, A. (1991). Performance enhancement in sport: A cognitive-behavioral domain. Behavior Therapy, 22, 307–327.
Hardy, L., Jones, J. G., & Gould, D. (1996). Understanding psychological preparation for sport: Theory and practice of elite performers. New York, NY: Wiley.
Marx, B. P., & Sloan, D. M. (2005). Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43, 569-583.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.
Kashdan, T. B., Goodman, F. R., Machell, K. A., Kleiman, E. M., Monfort, S. S., Ciarrochi, J., & Nezlek, J. B. (in press). A contextual approach to experiential avoidance and social anxiety: Evidence from an experimental interaction and daily interactions of people with social anxiety disorder. Emotion.
Gardner, F. L., & Moore, Z. E. (2007). The psychology of human performance: The mindfulness-acceptance-commitment approach. New York, NY: Springer Publishing.
Shiffmann, E. (1996). Yoga: The spirit and practice of moving into stillness. New York, NY: Simon & Schuster.
Impett, E. A., Daubenmier, J. J., & Hirschman, A. L. (2006). Minding the body: Yoga, embodiment, and well-being. Sexuality Research & Social Policy, 3, 39–48.
Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2005). Yoga for depression: The research evidence. Journal of Affective Disorders, 89, 13–24.
Blackledge, J. T. (2007). Disrupting verbal processes: Cognitive defusion in acceptance and commitment therapy and other mindfulness-based psychotherapies. Psychological Record, 57, 555–577.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Dell.
Tuesday February 3rd 2015 - NYBH Staff
A panic attack is a brief period that involves a sudden onset of intense apprehension, fear, or terror and the sense of impending doom. During a panic attack, symptoms of heart palpitations, shortness of breath, chest pain, choking sensations, and the fear of going crazy or losing control can be present. Panic attacks can be triggered by external (phobic object or situation) or internal (physiological arousal) stimuli (APA, 1994). While initial panic attacks are often triggered by biological factors affecting the nervous system, later on most clients develop a strong fear of additional panic attacks. Certain psychological factors, such as anticipatory anxiety and behavioral avoidance, tend to play a role in the recurrence of panic symptoms. For a diagnosis of panic disorder, there are two main criteria. One, the individual experiences recurrent unexpected panic attacks. Two, at least one of the attacks has been followed by a month of persistent concern or worry about additional panic attacks or their consequences; and/or maladaptive change in behaviors related to the attacks (behaviors designed to avoid having panic attacks by avoiding unfamiliar situations, for example) (APA, 2013).
CBT for Panic Disorder
Cognitive-behavioral therapy has a proven track record when it comes to treating panic disorder. CBT is an effective treatment method that offers fast relief (Penava, Otto, Maki, & Pollack, 1995), has a high success rate, low drop-out rate and few side effects (Zuercher-White, 1997). CBT can help clients reduce their symptoms of panic, avoidance behavior, and co-occurring depression as well as provide lasting change (Craske, Brown, & Barlow, 1991). CBT can be very effective for clients who do not respond to medication well or those who choose psychological treatment alone because of its low risks and side-effects (Pollack, Otto, Kaspi, Hammerness, & Rosenbaum, 1994). Cognitive-behavioral therapy can be administered in individual or group formats, and both seem to provide equal benefits (Barlow, Craske, Cerny, & Klosko, 1989).
Cognitive-behavioral therapy for panic disorder can be conceptualized in terms of four components as outlined below. These components are not distinct stages and can be combined as needed to create optimal therapeutic success.
Initial Preparation for Therapy
The initial therapy sessions tend to focus on establishing rapport between client and therapist and to help prepare clients for the more active components of treatment. Clients need to feel that their therapist is competent, skilled, and experienced in the treatment of panic disorder. A strong alliance is helpful because clients are more likely to reveal their vulnerabilities and work on important issues with a supportive therapist. Moreover, a relationship based on trust will provide a calming influence in later sessions when clients are required to face feared situations.
It is also important for clients to learn about the nature of panic attacks and anxiety and correct their misconceptions about them. Most clients find it helpful to find out that panic symptoms are not indicative of them having a heart attack or going crazy (Rapee, Craske, & Barlow, 1989). Panic attacks are simply false-alarm reactions triggered by the misperception of danger. Clients also learn to recognize anticipatory anxiety and disrupt the process in which normal feelings of anxiety can lead to panic attacks. Sometimes, clients are encouraged to get a medical evaluation to rule out any physical conditions that can contribute to their symptoms, however, most patients will have already done that before turning to therapy.
Another essential part of the initial sessions is conducting a thorough assessment of the client’s presenting issue, history of treatment, previous diagnoses, medical conditions, etc. Therapists often use standardized questionnaires to inquire about client’s symptoms. Clients are often asked to self-monitor their anxiety symptoms, which can help identify precipitating factors to panic attacks.
Coping Skills Training
Relaxation training is often useful in the treatment of panic attacks. While relaxation training alone does not seem to be enough in itself to control panic attacks (Arntz & VanDenHout, 1996), it can produce a reduction in the general feelings of anxiety (Taylor, Kenigsberg, & Robinson, 1982). As part of relaxation training, clients can learn about progressive muscle relaxation as well as guided imagery to manage feelings of anticipatory anxiety.
Diaphragmatic breathing is similar to deep breathing used in relaxation but often counting is used to guide the rate of the client’s breathing. It can be done in an alert state with eyes open, which some clients find easier than relaxation.
Clients, who suffer from panic attacks, often misperceive and misinterpret normal reactions of tension or anxiety and mislabel these feelings as a panic attacks (Clark & Ehlers, 1993). These misinterpretations need to be challenged through discussion and behavioral exercises (Salkovskis & Clark, 1991) or by estimating the likelihood that the catastrophic event will actually occur (Clum, 1990). Then clients can learn to replace these faulty interpretations with more realistic ones (Clark et al., 1994).
Coping statements can also be helpful by cultivating a sense of safety, predictability, and control over events and physical sensations. Moreover, clients can learn to view stressful situations as opportunities to change and grow.
Exposure to the Feared Stimuli
Exposure sessions help clients learn that they can experience the symptoms of arousal without the feared consequences (Barlow & Cerny, 1988). Interoceptive exercises allow clients to confront the physical sensations associated with panic without letting them spiral into a panic attack. For instance, bodily spinning or hyperventilation can be used in session to induce feelings of dizziness or lightheadedness.
In imaginal exposure, the therapist reads the script of the feared situation to the client in session over and over until the client’s anxiety subsides.
In vivo exposure is used to help clients reduce their tendency to avoid situations that often elicit a panic attack (Clum, 1990). Sometimes a hierarchy of challenging situations is created and the client gradually works through the steps with the help of the therapist. Eventually clients develop the attitude that they will deliberately seek out and confront difficult situations.
When clients have made considerable headway in therapy, they may not need weekly sessions anymore. However, temporary lapses can occur and clients need to learn that these can be useful areas for continued growth and learning and do not mean that they have lost all progress. Relapse prevention also includes helping clients seek out situations that are perceived as threatening. Learning to view difficult situations as challenges makes clients stronger and more able to utilize their coping skills on a regular basis.
OVERHOLSTER, J.C. (2000). Cognitive-behavioral treatment of panic disorder. Psychotherapy, 37, 247-256.
PENAVA, S., OTTO, M., MAKI, K., & POLLACK, M. (1998). Rate of improvement during cognitive-behavioral group treatment for panic disorder. Behavior Research and Therapy, 36, 665-673.
ZUERCHER-WHTTE, E. (1997). Treating panic disorder and agoraphobia: A step-by-step clinical guide. Oakland, CA: NewHarbinger.
RASKE, M., BROWN, T., & BARLOW, D. (1991). Behavioral treatment of panic disorder. A two-year follow-up. Behavior Therapy, 22, 289-304.
POLLACK, M., OTTO, M., KASPI, S., HAMMERNESS, P., &
ROSENBAUM, J. (1994). Cognitive behavior therapy for treatment-refractory panic disorder. Journal of Clinical Psychiatry, 55, 200-205.
BARLOW, D., CRASKE, M., CERNY, J., & KLOSKO, J. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20, 261-282.
RAPEE, R., CRASKE, M., & BARLOW, D. (1989). Psychoeducation. In C. Lindemann (Ed.), Handbook of phobia therapy: Rapid symptom relief in anxiety disorders (pp. 225- 236). Northvale, NJ: Jason Arooson.
RNTZ, A., & VANDENHOUT, M. (1996). Psychological treatments of panic disorder without agoraphobia: Cognitive therapy versus applied relaxation. Behavior Research and Therapy, 34, 113-121.
TAYLOR, C. B., KENTOSBERO, M., & ROBINSON, J. (1982). A controlled comparison of relaxation and diazepam in panic disorder. Journal of Clinical Psychiatry, 43, 423-425.
CLARK, D. M., & EHLERS, A. (1993). An overview of the cognitive theory and treatment of panic disorder. Applied and Preventive Psychology, 2, 131-139.
SALKOVSHS, P., & CLARK, D. (1991). Cognitive therapy for panic attacks. Journal of Cognitive Psychotherapy, 5,215- 226.
CLUM, G. A. (1990). Coping with panic: A drug-free approach to dealing with anxiety attacks. Belmont, CA: Brooks/Cole.
CLARK, D. M., SALKOVSKIS, P., HACKMANN, A., MIDDLETON, H., ANASTASIADES, P., & GELDER, M. (1994). A comparison of cognitive therapy, applied relaxation, and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759-769.
BARLOW, D., & CERNY, J. (1988). Psychological treatment of panic. New York: Guilford.