Through my research for my upcoming book, I found a substantial amount of article which discussed the conditioning factors behind addictive behavior. I feel the reason for the amount could be the fact that the idea of conditioning is almost as old as the study of psychology.
This theory is based in the ideas and research of Ivan Pavlov and his hungry salivating dogs (which most of us may remember from high school psychology class). Pavlov discovered and documented the principles governing how animals, and then adapted to humans, learn. Two basic kinds of learning or conditioning occur: operant and classical.
Classical conditioning, was the initial type of association first discovered by Pavlov as he noticed a relationship between a bell and the salivation of his dogs. Specifically, the animal learns to associate a neutral stimulus (like the ringing of a bell) with a stimulus that has great, even survival meaning based on how closely in time the two stimuli are presented. Dogs are able to learn the association between bell and food, (as humans are between two yellow arches and high calorie hamburgers) and will salivate immediately after hearing the bell once this connection has been made.
Marketers are well aware of classical conditioning. Next time you watch commercials on television, think to yourself, “What is the hidden message in this commercial?” For example, I once saw a beer commercial where a man began to drink the competitor's beer and women around him ran away, next to him was a man who began to drink the advertised beer, and those same women ran up to him and began to take off his shirt—what message is being sent? Sex definitely sells, especially beer!
Operant, also know as instrumental conditioning is a little more obvious than classical. In operant conditioning an animal or human learns to perform particular behaviors in order to obtain an intrinsically rewarding stimulus. For example, why do many people work jobs that they don't enjoy—to get a paycheck.
Many therapist have used the Classical, or Pavlovian conditioning theory to understand the nature of addictions. Truly, there are many obvious examples which would support the classical conditioning aspects of developing a dependence, especially on drugs. The inebriating or “drunk” effects of people given non-alcoholic drinks (such as “near beer”), when the individuals were told they were getting alcoholic drinks can be evidence for this type of conditioning. As with the individual addicted to cocaine, who begins to sweat at the sight of sugar or flour. I have noticed a strong association between “good times” and food. Just think of any typical Christmas party, what comes to mind? If you thought chocolate treats in the shape of Santa Claus, you have experienced the affects of conditioning.
Situational cues and conditioning have an important role in our understanding of addiction. As previously eluded to, there is evidence that many behaviors such as alcohol and drugs can be produced by placebo doses and have to same effects on the person taking them.
Even after long periods of abstinence, a person could still struggle with the affects of addiction conditioning. For example, I once had a client, who after 40 years of sobriety came in to see me because he “scared himself”. He reported how on a previous day, he was driving past an old bar he used to drink at, “without thinking” he found himself parking his car and approaching the door of the tavern. He stated, “It was like I was in a zombie mode... I couldn't think straight!” As he walked through the door, the smell of alcohol reached his senses “I don't remember ever wanting a beer so much in my life!” Fortunately, his wife call his phone and asked, “Where are you?” This was enough “reboot [his] brain”, and he said to her “Wow, I am in a bar”. She calmly replied, “Well, you better get out of there.” Again, he was shocked that this old association was still so very strong. This is the power of conditioning.
Wednesday, April 28, 2010
Saturday, April 17, 2010
Avoidant Personality Disorder: A Defense Against the Social Anxiety Attacks
I have been meeting with a lot of clients who either have an avoidant personality disorder, or live with someone who does - since the majority of people with this type of personality will not meet with a therapist, I thought I would blog on it and give some insights into this issue.
In Avoidant Personality Disorder, the person maintains a systematic avoidance of social contacts and any situation which might result in embarrassment or anxiety. Even with people who are close, he or she avoids a more intimate involvement.
The permanent expectations of being ridiculed, criticized, rejected puts the person constantly at the borderline of suffering anxiety attacks. Then he develops a permanent scheme of self-protection against anxiety.
Some signs and symptoms are found in these people. Sometimes the symptoms predominate and the disorder goes unnoticed by the majority of people with whom the bearer has contact (because symptoms are subjectives).
– They tend to live alone
– Contact with family and friends can be enjoyable, but only for a short period of time (minute or hours) and anxiety can be aroused at any moment.
– They avoid contact with strangers. They are extremely kind when such contact occurs and they do everything possible to make sure that such contact is brief.
– They develop at least one phobia (for animals or objects) whose origin is connected with the earlier appearance of anxiety attacks in social situations. The animal or object connected with such situations unleashes the anxiety and this assumes phobic characteristics.
– They are aware that they have abdicated certain experiences in life in order to avoid suffering.
– They often fantasize about the situations they avoid and yet would like to experience – in their fantasies they exclude the anxiety-provoking stimuli.
– They can be professionally successful, but they could be even more successful if they did not turn their backs on opportunities.
What is the difference between Avoidant Personality Disorder, Shyness, Social Anxiety, Generalized Social Phobia and Introverted Personality?
Shyness – As I see it, the difference is that in Shyness the person still tries to face situations which generate fear, even if only to show others what she is capable of getting. The situation may be uncomfortable yet the person tries to convey the message to those around him that he is liking or enjoying it. The desire to integrate oneself is so intense that the anxiety takes a back seat. Above all, the person has to show that she can get the same things other people can and enjoy them as much as they do.
Social Anxiety – In Social Anxiety, the person avoids social contacts and performance, mainly those that unleash extreme anxiety like panic attacks, but he wants to have such contacts and preserves the potentialities of affective involvement and feels comfortable with people who are close.
Generalized Social Phobia – In Generalized Social Phobia, a.k.a. Generalized Social Anxiety, the person suffers anxiety attacks due to exposure to many social situations. There is avoidance, to protect oneself, but the person wants to live like the others and have the same opportunities.
Avoidant Personality Disorder – In Avoidant Personality Disorder, besides the behaviors and attitudes described, we can see that the person has given up altogether on facing situations that generate fear and does not undergo anxiety attacks simply because she avoids any anxiety-generating situation that is possible. Additionally, she does everything possible not to be noticed.
Introverted Personality - Avoidance Personality Disorder has external similarities to the Introverted Personality. Nevertheless, within people there are differences. The main one is that the person with introverted personality does not feel anxiety when it is necessary to maintain social contact.
In my clinical observation, Avoidant Personality Disorder is preceded by anxiety attacks and even some panic attacks, which become occasional attacks or even stop due to the avoidance mechanisms that are developed.
Source:
www.social-anxiety-shyness-info.com
In Avoidant Personality Disorder, the person maintains a systematic avoidance of social contacts and any situation which might result in embarrassment or anxiety. Even with people who are close, he or she avoids a more intimate involvement.
The permanent expectations of being ridiculed, criticized, rejected puts the person constantly at the borderline of suffering anxiety attacks. Then he develops a permanent scheme of self-protection against anxiety.
Some signs and symptoms are found in these people. Sometimes the symptoms predominate and the disorder goes unnoticed by the majority of people with whom the bearer has contact (because symptoms are subjectives).
– They tend to live alone
– Contact with family and friends can be enjoyable, but only for a short period of time (minute or hours) and anxiety can be aroused at any moment.
– They avoid contact with strangers. They are extremely kind when such contact occurs and they do everything possible to make sure that such contact is brief.
– They develop at least one phobia (for animals or objects) whose origin is connected with the earlier appearance of anxiety attacks in social situations. The animal or object connected with such situations unleashes the anxiety and this assumes phobic characteristics.
– They are aware that they have abdicated certain experiences in life in order to avoid suffering.
– They often fantasize about the situations they avoid and yet would like to experience – in their fantasies they exclude the anxiety-provoking stimuli.
– They can be professionally successful, but they could be even more successful if they did not turn their backs on opportunities.
What is the difference between Avoidant Personality Disorder, Shyness, Social Anxiety, Generalized Social Phobia and Introverted Personality?
Shyness – As I see it, the difference is that in Shyness the person still tries to face situations which generate fear, even if only to show others what she is capable of getting. The situation may be uncomfortable yet the person tries to convey the message to those around him that he is liking or enjoying it. The desire to integrate oneself is so intense that the anxiety takes a back seat. Above all, the person has to show that she can get the same things other people can and enjoy them as much as they do.
Social Anxiety – In Social Anxiety, the person avoids social contacts and performance, mainly those that unleash extreme anxiety like panic attacks, but he wants to have such contacts and preserves the potentialities of affective involvement and feels comfortable with people who are close.
Generalized Social Phobia – In Generalized Social Phobia, a.k.a. Generalized Social Anxiety, the person suffers anxiety attacks due to exposure to many social situations. There is avoidance, to protect oneself, but the person wants to live like the others and have the same opportunities.
Avoidant Personality Disorder – In Avoidant Personality Disorder, besides the behaviors and attitudes described, we can see that the person has given up altogether on facing situations that generate fear and does not undergo anxiety attacks simply because she avoids any anxiety-generating situation that is possible. Additionally, she does everything possible not to be noticed.
Introverted Personality - Avoidance Personality Disorder has external similarities to the Introverted Personality. Nevertheless, within people there are differences. The main one is that the person with introverted personality does not feel anxiety when it is necessary to maintain social contact.
In my clinical observation, Avoidant Personality Disorder is preceded by anxiety attacks and even some panic attacks, which become occasional attacks or even stop due to the avoidance mechanisms that are developed.
Source:
www.social-anxiety-shyness-info.com
Friday, April 9, 2010
Asperger's Relationship
Are Asperger relationships difficult to maintain? The social skill and communication issues inherent in Asperger's syndrome can challenge some relationships. However, there are ways for both the person with Aspergers and loved ones to successfully work through the issues. A person with Aspergers can form meaningful and close relationships with parents, spouses, extended family and friends.
Common Asperger Relationship Issues
A person with Aspergers and his loved ones may find themselves in conflicts that have root in key aspects of the condition. The conflicts are often misunderstandings that stem from differences in emotional responses, communication and social skills problems, routines and obsessive behaviors. The person without Aspergers or neurotypical and the person with Aspergers may have different sets of expectations and ways of relating in a relationship. Learning about Asperger characteristics can help family members and friends better understand their loved one.
Emotional Response
A person with Aspergers has problems understanding another person's emotions. He may not be able to properly interpret facial expressions, body language or gestures. The inability to interpret others emotions is often referred to as mindblindness. This may lead a neurotypical person to misunderstand his reactions to an emotional situation and view a response as inappropriate or negative.
Sometimes a neurotypical person may mistakenly interpret a person with Aspergers' emotional response or lack of response as an inability to feel emotion. This is not true. A person with Aspergers feels emotion but he may have trouble expressing his emotion or find unusual ways to express it.
Communication and Social Skills Problems
Asperger's syndrome causes problems with language, communication and social interaction. A person with Aspergers may not be able to make friends easily and may also find two-way conversation difficult. He may appear to talk at people, rather than with them and fixate on favorite topics even if the other party shows distinct signs of disinterest or distress. He continues to talk about the topic and is oblivious to the other party's reaction. He also may misunderstand language at time and taking many things literally, missing subtlety.
In a relationship, the communication problems can easily lead to misunderstandings. In relationships, the neurotypical person often takes on the role of helping the person with Aspergers and others understand each other better in social situations. Some romantic relationships also become strained because the neurotypical person gets frustrated with being the couple's main social connection to the rest of the world.
Routines and Obsessive Behaviors
Routines and obsessive behaviors are aspects of Aspergers that can also challenge relationships. A person with Aspergers may get extremely upset over interruptions in daily routines or any attempt to redirect him away from an obsessive behavior. The neurotypical person may see the negative reaction to the interruption as irrational. However, the person with Aspergers may see the interruption as a personal insult or an attempt to take away something essential to daily functioning.
Asperger's syndrome may involve obsessive behaviors or sensory issues that some neurotypical people find disturbing. Examples of obsessive behavior include a fixation on an activity like memorizing sports trivia and talking about it for hours or ritualistic hand washing.
It is important for a loved one show some sensitivity in her reaction to the routines and obsessive behavior.
How to Help Relationships Thrive
The most important way to help a relationship thrive is to never give up hope. Learn about Asperger's syndrome through research and talking with therapists. Since each case of Aspergers is unique, pay attention to a loved one's specific concerns and personality. Figure out what is important to him and try to respect necessary boundaries. Find common ground whenever possible and cherish it. Consider participating in family or couple's therapy for Aspergers and autism. Experts can help families find better ways to relate to each other.
Resources For Family Members and Couples
A number of Asperger and autism support organizations have information on local support groups for people with Aspergers and their families and friends. The following websites provide helpful information on relationships:
* FAAAS: Families of Adults Affected by Asperger's Syndrome (FAAAS)has forums, articles and resources for spouses and other family of people with Aspergers.
* IAN Community: The Interactive Autism Network (IAN) site provides articles and a discussion forum with information provided from people with autism spectrum disorder, families and autism experts. The site has a interesting article on a couple dealing with Aspergers.
* ASPEN: Asperger Syndrome Education Support Network (ASPEN) has helpful resources for families and friends of people with Aspergers.
* OASIS: Online Asperger Syndrome Information and Support (OASIS) has detailed articles and support group information.
Hope for Relationships
A person with Aspergers can have healthy and happy relationships with a spouse, parents, extended family and friends. For relationship success, everyone needs to work together. The neurotypical person should gain a strong understanding of both the Aspergers condition and the person involved. The person with Aspergers should be willing to participate on some level. There is always hope when people love each other and have a determination to try to make a relationship succeed.
Sources:
McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010 (inactive 2008-06-25). PMID 17030291.
Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis 3 (1): 1–7. PMID 16596080.
Asperger H; tr. and annot. Frith U (1991) [1944]. "'Autistic psychopathy' in childhood". in Frith U. Autism and Asperger syndrome. Cambridge University Press. pp. 37–92. ISBN 0-521-38608-X.
Adrienne Warber (2009) "aspergers in relationships" Needtoknow.com
Common Asperger Relationship Issues
A person with Aspergers and his loved ones may find themselves in conflicts that have root in key aspects of the condition. The conflicts are often misunderstandings that stem from differences in emotional responses, communication and social skills problems, routines and obsessive behaviors. The person without Aspergers or neurotypical and the person with Aspergers may have different sets of expectations and ways of relating in a relationship. Learning about Asperger characteristics can help family members and friends better understand their loved one.
Emotional Response
A person with Aspergers has problems understanding another person's emotions. He may not be able to properly interpret facial expressions, body language or gestures. The inability to interpret others emotions is often referred to as mindblindness. This may lead a neurotypical person to misunderstand his reactions to an emotional situation and view a response as inappropriate or negative.
Sometimes a neurotypical person may mistakenly interpret a person with Aspergers' emotional response or lack of response as an inability to feel emotion. This is not true. A person with Aspergers feels emotion but he may have trouble expressing his emotion or find unusual ways to express it.
Communication and Social Skills Problems
Asperger's syndrome causes problems with language, communication and social interaction. A person with Aspergers may not be able to make friends easily and may also find two-way conversation difficult. He may appear to talk at people, rather than with them and fixate on favorite topics even if the other party shows distinct signs of disinterest or distress. He continues to talk about the topic and is oblivious to the other party's reaction. He also may misunderstand language at time and taking many things literally, missing subtlety.
In a relationship, the communication problems can easily lead to misunderstandings. In relationships, the neurotypical person often takes on the role of helping the person with Aspergers and others understand each other better in social situations. Some romantic relationships also become strained because the neurotypical person gets frustrated with being the couple's main social connection to the rest of the world.
Routines and Obsessive Behaviors
Routines and obsessive behaviors are aspects of Aspergers that can also challenge relationships. A person with Aspergers may get extremely upset over interruptions in daily routines or any attempt to redirect him away from an obsessive behavior. The neurotypical person may see the negative reaction to the interruption as irrational. However, the person with Aspergers may see the interruption as a personal insult or an attempt to take away something essential to daily functioning.
Asperger's syndrome may involve obsessive behaviors or sensory issues that some neurotypical people find disturbing. Examples of obsessive behavior include a fixation on an activity like memorizing sports trivia and talking about it for hours or ritualistic hand washing.
It is important for a loved one show some sensitivity in her reaction to the routines and obsessive behavior.
How to Help Relationships Thrive
The most important way to help a relationship thrive is to never give up hope. Learn about Asperger's syndrome through research and talking with therapists. Since each case of Aspergers is unique, pay attention to a loved one's specific concerns and personality. Figure out what is important to him and try to respect necessary boundaries. Find common ground whenever possible and cherish it. Consider participating in family or couple's therapy for Aspergers and autism. Experts can help families find better ways to relate to each other.
Resources For Family Members and Couples
A number of Asperger and autism support organizations have information on local support groups for people with Aspergers and their families and friends. The following websites provide helpful information on relationships:
* FAAAS: Families of Adults Affected by Asperger's Syndrome (FAAAS)has forums, articles and resources for spouses and other family of people with Aspergers.
* IAN Community: The Interactive Autism Network (IAN) site provides articles and a discussion forum with information provided from people with autism spectrum disorder, families and autism experts. The site has a interesting article on a couple dealing with Aspergers.
* ASPEN: Asperger Syndrome Education Support Network (ASPEN) has helpful resources for families and friends of people with Aspergers.
* OASIS: Online Asperger Syndrome Information and Support (OASIS) has detailed articles and support group information.
Hope for Relationships
A person with Aspergers can have healthy and happy relationships with a spouse, parents, extended family and friends. For relationship success, everyone needs to work together. The neurotypical person should gain a strong understanding of both the Aspergers condition and the person involved. The person with Aspergers should be willing to participate on some level. There is always hope when people love each other and have a determination to try to make a relationship succeed.
Sources:
McPartland J, Klin A (2006). "Asperger's syndrome". Adolesc Med Clin 17 (3): 771–88. doi:10.1016/j.admecli.2006.06.010 (inactive 2008-06-25). PMID 17030291.
Baskin JH, Sperber M, Price BH (2006). "Asperger syndrome revisited". Rev Neurol Dis 3 (1): 1–7. PMID 16596080.
Asperger H; tr. and annot. Frith U (1991) [1944]. "'Autistic psychopathy' in childhood". in Frith U. Autism and Asperger syndrome. Cambridge University Press. pp. 37–92. ISBN 0-521-38608-X.
Adrienne Warber (2009) "aspergers in relationships" Needtoknow.com
Thursday, April 8, 2010
Emotional Avoidance and Traumatic Stress
PTSD and emotional avoidance go hand-in-hand. Many people with PTSD try to get away from or avoid their emotions. Emotional avoidance is part of the avoidance cluster of PTSD symptoms.
Avoidance symptoms make up one cluster of PTSD symptoms. Specifically, the avoidance cluster of PTSD symptoms include:
* Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
* Making an effort to avoid places or people that remind you of the traumatic event.
* Having a difficult time remembering important parts of the traumatic event.
* A loss of interest in important, once positive, activities.
* Feeling distant from others.
* Experiencing difficulties having positive feelings such as happiness or love.
* Feeling as though your life may be cut short.
The first symptom includes the avoidance of emotional experience, which is common among people with PTSD.
Emotional Avoidance in PTSD
It has been found that people with PTSD often try to avoid or “push away” their emotions, both emotions about a traumatic experience and emotions in general. Studies have found that people with PTSD may withhold expressing emotions. In addition, it has been found that the avoidance of emotions may make some PTSD symptoms worse or even contribute to the development of PTSD symptoms after the experience of a traumatic event.
Why Emotional Avoidance Does Not Work
It is important to recognize that we have emotions for a reason. Our emotions provide us with information about ourselves and the things going on around us. For example, the emotion of fear tells us that we may be in danger. The emotion of sadness tells us that we may need some time to take care of ourselves or seek out help from others. Given the important role they play in our lives, our emotions are there to be experienced and they want to be experienced.
Therefore, while emotional avoidance may be effective in the short-run and may provide you with some temporary relief, in the long run, the emotions you're trying to avoid may grow stronger. Basically, your emotions may “fight back” so they can be be experienced and listened to. If someone is determined to avoid his emotions, he may then turn to more drastic and unhealthy ways of avoiding emotions, such as through substance use.
Avoiding our emotions also takes considerable effort, especially when those emotions are strong (as they often are in PTSD). As avoided emotions grow stronger, more and more effort is needed to keep them at bay. As a result, little energy may be left for the important things in your life, such as family and friends. In addition, using all your energy to avoid certain emotions may make it difficult to manage other experiences, such as frustration and irritation, making you more likely to be “on edge” and angry.
What Can Be Done
The most important thing to do is to reduce the extent that you try to escape your emotions. Of course, this is a lot easier said than done. If you have been avoiding your emotions for a long time, it may be difficult to release them. Sometimes, when we let our emotions build up, they may escape all at once, like a dam breaking. This may lead to our emotions feeling out of control.
It is important to find ways to release your emotions. Therapy of all kinds can be very helpful in this regard. Cognitive-behavioral and psychoanalytic/psychodynamic therapies all give you the opportunity to express and understand your emotions, as well as examine the sources of those emotional responses. In addition to examining emotions connected directly to the traumatic event, cognitive-behavioral approaches may address how certain thoughts or ways of evaluating a situation may be contributing to your emotions. Acceptance and Commitment Therapy (or ACT), a particular type of behavior therapy, focuses on breaking down avoidance and helping a person place his energy into living a meaningful life (and being willing to experience whatever emotions arise as a result). Psychoanalytic/psychodynamic approaches may pay more attention to early childhood experiences and their influence on your emotions. Either way, therapy can provide you with a safe place to express and approach your emotions. Seeking social support from trusted loved ones can also provide a safe way to express your emotions. Finally, writing about your feelings can also give you a safe and private way to release your deepest feelings.
If your emotions feel really unclear or unpredictable, self-monitoring may be a useful strategy for you. It can give you a sense of what situations bring of certain thoughts and feelings. Finally, if your emotions feel too strong, try distraction instead of avoidance. Distraction can be viewed as “temporary avoidance.” Do something to temporarily distract you from a strong emotion, such as reading a book, calling a friend, eating comforting food, or taking a bath. This may give the emotion some time to decrease in strength, making it easier to cope with.
Sources:
Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25. Hayes, S. C., Strosahl, K.D., Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.
Roemer, L., Litz, B. T., Orsillo, S. M. & Wagner, A. (2001). A preliminary investigation of the role of strategic withholding of emotion in PTSD. Journal of Traumatic Stress, 14, 149-156.
Salters-Pedneault, K., Tull, M.T., & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders.
Applied and Preventive Psychology, 11, 95-114.
Tull, M.T., Gratz, K.L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192, 754-761.
Avoidance symptoms make up one cluster of PTSD symptoms. Specifically, the avoidance cluster of PTSD symptoms include:
* Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
* Making an effort to avoid places or people that remind you of the traumatic event.
* Having a difficult time remembering important parts of the traumatic event.
* A loss of interest in important, once positive, activities.
* Feeling distant from others.
* Experiencing difficulties having positive feelings such as happiness or love.
* Feeling as though your life may be cut short.
The first symptom includes the avoidance of emotional experience, which is common among people with PTSD.
Emotional Avoidance in PTSD
It has been found that people with PTSD often try to avoid or “push away” their emotions, both emotions about a traumatic experience and emotions in general. Studies have found that people with PTSD may withhold expressing emotions. In addition, it has been found that the avoidance of emotions may make some PTSD symptoms worse or even contribute to the development of PTSD symptoms after the experience of a traumatic event.
Why Emotional Avoidance Does Not Work
It is important to recognize that we have emotions for a reason. Our emotions provide us with information about ourselves and the things going on around us. For example, the emotion of fear tells us that we may be in danger. The emotion of sadness tells us that we may need some time to take care of ourselves or seek out help from others. Given the important role they play in our lives, our emotions are there to be experienced and they want to be experienced.
Therefore, while emotional avoidance may be effective in the short-run and may provide you with some temporary relief, in the long run, the emotions you're trying to avoid may grow stronger. Basically, your emotions may “fight back” so they can be be experienced and listened to. If someone is determined to avoid his emotions, he may then turn to more drastic and unhealthy ways of avoiding emotions, such as through substance use.
Avoiding our emotions also takes considerable effort, especially when those emotions are strong (as they often are in PTSD). As avoided emotions grow stronger, more and more effort is needed to keep them at bay. As a result, little energy may be left for the important things in your life, such as family and friends. In addition, using all your energy to avoid certain emotions may make it difficult to manage other experiences, such as frustration and irritation, making you more likely to be “on edge” and angry.
What Can Be Done
The most important thing to do is to reduce the extent that you try to escape your emotions. Of course, this is a lot easier said than done. If you have been avoiding your emotions for a long time, it may be difficult to release them. Sometimes, when we let our emotions build up, they may escape all at once, like a dam breaking. This may lead to our emotions feeling out of control.
It is important to find ways to release your emotions. Therapy of all kinds can be very helpful in this regard. Cognitive-behavioral and psychoanalytic/psychodynamic therapies all give you the opportunity to express and understand your emotions, as well as examine the sources of those emotional responses. In addition to examining emotions connected directly to the traumatic event, cognitive-behavioral approaches may address how certain thoughts or ways of evaluating a situation may be contributing to your emotions. Acceptance and Commitment Therapy (or ACT), a particular type of behavior therapy, focuses on breaking down avoidance and helping a person place his energy into living a meaningful life (and being willing to experience whatever emotions arise as a result). Psychoanalytic/psychodynamic approaches may pay more attention to early childhood experiences and their influence on your emotions. Either way, therapy can provide you with a safe place to express and approach your emotions. Seeking social support from trusted loved ones can also provide a safe way to express your emotions. Finally, writing about your feelings can also give you a safe and private way to release your deepest feelings.
If your emotions feel really unclear or unpredictable, self-monitoring may be a useful strategy for you. It can give you a sense of what situations bring of certain thoughts and feelings. Finally, if your emotions feel too strong, try distraction instead of avoidance. Distraction can be viewed as “temporary avoidance.” Do something to temporarily distract you from a strong emotion, such as reading a book, calling a friend, eating comforting food, or taking a bath. This may give the emotion some time to decrease in strength, making it easier to cope with.
Sources:
Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25. Hayes, S. C., Strosahl, K.D., Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.
Roemer, L., Litz, B. T., Orsillo, S. M. & Wagner, A. (2001). A preliminary investigation of the role of strategic withholding of emotion in PTSD. Journal of Traumatic Stress, 14, 149-156.
Salters-Pedneault, K., Tull, M.T., & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders.
Applied and Preventive Psychology, 11, 95-114.
Tull, M.T., Gratz, K.L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192, 754-761.
Thursday, April 1, 2010
Stages of Grief and Loss
The progression of states are:
1. Denial – "I feel fine."; "This can't be happening, not to me."
Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of situations and individuals that will be left behind after death.
2. Anger – "Why me? It's not fair!"; "How can this happen to me?"; "Who is to blame?"
Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Any individual that symbolizes life or energy is subject to projected resentment and jealousy.
3. Bargaining – "Just let me live to see my children graduate."; "I'll do anything for a few more years."; "I will give my life savings if..."
The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just have more time..."
4. Depression – "I'm so sad, why bother with anything?"; "I'm going to die... What's the point?"; "I miss my loved one, why go on?"
During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect oneself from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed.
5. Acceptance – "It's going to be okay."; "I can't fight it, I may as well prepare for it."
This final stage comes with peace and understanding of the death that is approaching. Generally, the person in the fifth stage will want to be left alone. Additionally, feelings and physical pain may be non-existent. This stage has also been described as the end of the dying struggle.
Elizabeth Kübler-Ross, famed grief psychiatrist, originally applied these stages to people suffering from terminal illness, later to any form of catastrophic personal loss (job, income, freedom). This may also include significant life events such as the death of a loved one, divorce, drug addiction, an infertility diagnosis, as well many tragedies and disasters.
Kübler-Ross claimed these steps do not necessarily come in the order noted above, nor are all steps experienced by all patients, though she stated a person will always experience at least two. Often, people will experience several stages in a "roller coaster" effect—switching between two or more stages, returning to one or more several times before working through it.
Significantly, people experiencing the stages should not force the process. The grief process is highly personal and should not be rushed, nor lengthened, on the basis of an individual's imposed time frame or opinion. One should merely be aware that the stages will be worked through and the ultimate stage of "Acceptance" will be reached.
However, there are individuals who struggle with death until the end. Some psychologists believe that the harder a person fights death, the more likely they are to stay in the denial stage. If this is the case, it is possible the ill person will have more difficulty dying in a dignified way. Other psychologists state that not confronting death until the end is adaptive for some people. Those who experience problems working through the stages should consider professional grief counseling or support groups.
Reference:
Santrock, J.W. (2007). A Topical Approach to Life-Span Development. New York: McGraw-Hill.
1. Denial – "I feel fine."; "This can't be happening, not to me."
Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of situations and individuals that will be left behind after death.
2. Anger – "Why me? It's not fair!"; "How can this happen to me?"; "Who is to blame?"
Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Any individual that symbolizes life or energy is subject to projected resentment and jealousy.
3. Bargaining – "Just let me live to see my children graduate."; "I'll do anything for a few more years."; "I will give my life savings if..."
The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just have more time..."
4. Depression – "I'm so sad, why bother with anything?"; "I'm going to die... What's the point?"; "I miss my loved one, why go on?"
During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect oneself from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed.
5. Acceptance – "It's going to be okay."; "I can't fight it, I may as well prepare for it."
This final stage comes with peace and understanding of the death that is approaching. Generally, the person in the fifth stage will want to be left alone. Additionally, feelings and physical pain may be non-existent. This stage has also been described as the end of the dying struggle.
Elizabeth Kübler-Ross, famed grief psychiatrist, originally applied these stages to people suffering from terminal illness, later to any form of catastrophic personal loss (job, income, freedom). This may also include significant life events such as the death of a loved one, divorce, drug addiction, an infertility diagnosis, as well many tragedies and disasters.
Kübler-Ross claimed these steps do not necessarily come in the order noted above, nor are all steps experienced by all patients, though she stated a person will always experience at least two. Often, people will experience several stages in a "roller coaster" effect—switching between two or more stages, returning to one or more several times before working through it.
Significantly, people experiencing the stages should not force the process. The grief process is highly personal and should not be rushed, nor lengthened, on the basis of an individual's imposed time frame or opinion. One should merely be aware that the stages will be worked through and the ultimate stage of "Acceptance" will be reached.
However, there are individuals who struggle with death until the end. Some psychologists believe that the harder a person fights death, the more likely they are to stay in the denial stage. If this is the case, it is possible the ill person will have more difficulty dying in a dignified way. Other psychologists state that not confronting death until the end is adaptive for some people. Those who experience problems working through the stages should consider professional grief counseling or support groups.
Reference:
Santrock, J.W. (2007). A Topical Approach to Life-Span Development. New York: McGraw-Hill.
Subscribe to:
Posts (Atom)