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Stigma and suicide-let’s get talking!

Posted on September 10, 2013 in Uncategorized - 0 comments - 0

candelAn Interview with Clinical Psychologist Dr Eve Klopper     World suicide prevention day- September 10 2013

Q: The theme for World Suicide Prevention Day in 2013 is “Stigma: A major barrier to suicide prevention.”  How does the stigma associated with suicide impede suicide prevention?

A: Unfortunately, many people are uncomfortable discussing or directly considering issues surrounding suicide.  This limits awareness of risk factors or “red flags” that someone may be suicidal, and can make people who are suicidal less likely to seek help.  Feeling rejected and isolated can increase the risk that a person who has previously attempted suicide will make another suicide attempt.  Social stigma can also isolate those who have lost a loved one to suicide.

Q: So how can we respond to this?

A: Key steps to reducing stigma include understanding why people attempt or commit suicide; being able to identify risk factors and warning signs and knowing how to respond; knowing how to respond to someone who has attempted suicide and knowing how to support those who have lost loved ones to suicide.

Q: Why do people attempt or commit suicide?

A: Suicide is sometimes seen as the “only way out” of unbearable psychological or physical pain.  This can include people experiencing severe mental illness, such as clinical depression or schizophrenia, or intense mental anguish, for example loss, shame or guilt, people facing extremely difficult life events, as well as those undergoing chronic or terminal physical illnesses.  Some other reasons for suicide include attempting to benefit others, expressing ambivalence about continuing to live, attempting to “send a message” or achieve an outcome by one’s death, or exercising control over the timing or manner of one’s death.

Q: What are risk factors and warning signs we should be aware of?

A: While some suicides are impulsive actions with no warning, others are planned carefully.  People feeling suicidal may or may not express their feelings to other people.  Factors which put a person at greater risk of considering suicide include having mental health difficulties, alcohol and substance abuse, being male, being isolated geographically or socially, experiencing financial stress or family violence or bereavement, and having attempted suicide previously or having a family history of suicide.  Warning signs that a person may be contemplating suicide include expressing the intention to harm or kill themself or saying goodbye to family and friends; preoccupation with death or dying; expressing strong feelings of hopelessness, of the pointlessness of living, of feeling trapped or of anger and revenge; withdrawal from other people; increased alcohol or substance use; undertaking reckless, risky or self-harming behaviours; dramatic mood changes, including suddenly changing from long-term depression to happiness; and extreme anxiety or agitation.  It is also important to be aware of the kinds of events which may “trigger” a person to commit suicide.  These include traumatic life events, relationship breakdown, job loss, diagnosis or recurrence of severe physical or mental illness, major change in life circumstances, financial or legal stress, and the death or suicide of a loved one or public figure.

Q: What can we do if we suspect someone is suicidal?

A: If you observe warning signs in someone you know, it is important to remain calm but act immediately.  Ask the person if they are feeling suicidal, whether they have made a plan to kill themselves and whether they have the means to carry out that plan.  Contrary to popular belief, talking calmly with someone in this way will not increase the chance of them carrying through with a suicide plan.  If the person has a clear plan and intends to carry it out imminently, call 000 or a health professional who can see the person immediately, or take the person to hospital.  Do not leave the person alone.  If the person is at lower risk of suicide, talk with them about their suicidal thoughts and help them to plan how they will stay safe, including assisting them to find appropriate support services.  Acknowledge their feelings but express your hope that, with help, they will be able to cope.

Q: How do we respond to someone who has attempted suicide?

A:  While it is normal to feel a range of emotions including shock, guilt and anger when a loved one has attempted suicide, providing acceptance, care and support can help them to recover and reduce the risk they will attempt suicide again.  Practical support includes encouragement to attend appropriate medical and psychological help, making sure the person cannot access means to attempt suicide again, if possible, preventing access to alcohol or drugs and assisting the person to manage re-building their lives, for example returning to work or school.  Providing such support can be psychologically tiring, so access help wherever possible.

Q: How does suicide affect loved ones, and how do we help those bereaved by suicide?

A:  Bereavement following suicide is usually intense and complex, including feelings of shock, disbelief, anger, guilt, sadness and shame.  Loved ones may have many “unanswered questions” and may also be experiencing trauma from discovering the deceased.  The most important thing we can all do to help is to express support and demonstrate our care.  We may feel awkward but it essential to say (or write) something to show our love and concern.  Let the bereaved person talk – when they are ready – and listen supportively.  Try to understand how they are feeling and allow them to grieve in their own way.  Be patient – understand that it may take years for the person to work out how to live with their loss.  Don’t avoid talking about the person who has died, but don’t press for details or make judgments – it is important to honour and accept both the person who has died and those left bereaved.  Offer practical support.  With children and teenagers, answer questions honestly and take their concerns seriously.  And remember – it is never too late to approach someone bereaved by suicide in the past and say “I didn’t know what to say to show you that I cared, and I’m sorry.  How are you going now?”

Q: What part can psychologists play?

A:  Psychologists can assist people who are feeling suicidal, and those who have attempted suicide, to address the causes of their pain and distress and to build their coping skills.  This includes providing treatment for mental illness, often in consultation with GPs or other doctors; providing coping strategies to manage life stressors or psychological or physical pain; and helping people to build relationships and social support networks.  Psychologists can also help those who have been bereaved by suicide to cope with grief and other emotional reactions, to build social support networks and to rebuild their lives.

Q: What should a reader do if they are feeling suicidal?

A: Please don’t suffer alone – help is available to you.  Tell someone you trust how you feel, or call one of the free, confidential counseling lines listed below.  If possible, stay with someone supportive.  Seek help from your doctor, a psychologist or another health professional.  Avoid drugs and alcohol, try to exercise and eat healthily.  You may find it helpful to write down your thoughts and feelings.  And if you need immediate, urgent help, call 000 or ask someone to take you to a hospital emergency department.

Q: Where can people get more information?

A: Confidential, 24/7 support is available at Lifeline: 13 11 14; Kids Helpline: 1800 55 1800; Mensline Australia: 1300 78 99 78 and the Suicide Call Back Service: 1300 659 467.

Useful information and further resources: www.wspd.org.au; www.livingisforeveryone.com.au; www.beyondblue.org.au

 

 

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Stigma and suicide-let's get talking!

Posted on September 10, 2013 in Uncategorized - 0 comments - 0

candelAn Interview with Clinical Psychologist Dr Eve Klopper     World suicide prevention day- September 10 2013

Q: The theme for World Suicide Prevention Day in 2013 is “Stigma: A major barrier to suicide prevention.”  How does the stigma associated with suicide impede suicide prevention?

A: Unfortunately, many people are uncomfortable discussing or directly considering issues surrounding suicide.  This limits awareness of risk factors or “red flags” that someone may be suicidal, and can make people who are suicidal less likely to seek help.  Feeling rejected and isolated can increase the risk that a person who has previously attempted suicide will make another suicide attempt.  Social stigma can also isolate those who have lost a loved one to suicide.

Q: So how can we respond to this?

A: Key steps to reducing stigma include understanding why people attempt or commit suicide; being able to identify risk factors and warning signs and knowing how to respond; knowing how to respond to someone who has attempted suicide and knowing how to support those who have lost loved ones to suicide.

Q: Why do people attempt or commit suicide?

A: Suicide is sometimes seen as the “only way out” of unbearable psychological or physical pain.  This can include people experiencing severe mental illness, such as clinical depression or schizophrenia, or intense mental anguish, for example loss, shame or guilt, people facing extremely difficult life events, as well as those undergoing chronic or terminal physical illnesses.  Some other reasons for suicide include attempting to benefit others, expressing ambivalence about continuing to live, attempting to “send a message” or achieve an outcome by one’s death, or exercising control over the timing or manner of one’s death.

Q: What are risk factors and warning signs we should be aware of?

A: While some suicides are impulsive actions with no warning, others are planned carefully.  People feeling suicidal may or may not express their feelings to other people.  Factors which put a person at greater risk of considering suicide include having mental health difficulties, alcohol and substance abuse, being male, being isolated geographically or socially, experiencing financial stress or family violence or bereavement, and having attempted suicide previously or having a family history of suicide.  Warning signs that a person may be contemplating suicide include expressing the intention to harm or kill themself or saying goodbye to family and friends; preoccupation with death or dying; expressing strong feelings of hopelessness, of the pointlessness of living, of feeling trapped or of anger and revenge; withdrawal from other people; increased alcohol or substance use; undertaking reckless, risky or self-harming behaviours; dramatic mood changes, including suddenly changing from long-term depression to happiness; and extreme anxiety or agitation.  It is also important to be aware of the kinds of events which may “trigger” a person to commit suicide.  These include traumatic life events, relationship breakdown, job loss, diagnosis or recurrence of severe physical or mental illness, major change in life circumstances, financial or legal stress, and the death or suicide of a loved one or public figure.

Q: What can we do if we suspect someone is suicidal?

A: If you observe warning signs in someone you know, it is important to remain calm but act immediately.  Ask the person if they are feeling suicidal, whether they have made a plan to kill themselves and whether they have the means to carry out that plan.  Contrary to popular belief, talking calmly with someone in this way will not increase the chance of them carrying through with a suicide plan.  If the person has a clear plan and intends to carry it out imminently, call 000 or a health professional who can see the person immediately, or take the person to hospital.  Do not leave the person alone.  If the person is at lower risk of suicide, talk with them about their suicidal thoughts and help them to plan how they will stay safe, including assisting them to find appropriate support services.  Acknowledge their feelings but express your hope that, with help, they will be able to cope.

Q: How do we respond to someone who has attempted suicide?

A:  While it is normal to feel a range of emotions including shock, guilt and anger when a loved one has attempted suicide, providing acceptance, care and support can help them to recover and reduce the risk they will attempt suicide again.  Practical support includes encouragement to attend appropriate medical and psychological help, making sure the person cannot access means to attempt suicide again, if possible, preventing access to alcohol or drugs and assisting the person to manage re-building their lives, for example returning to work or school.  Providing such support can be psychologically tiring, so access help wherever possible.

Q: How does suicide affect loved ones, and how do we help those bereaved by suicide?

A:  Bereavement following suicide is usually intense and complex, including feelings of shock, disbelief, anger, guilt, sadness and shame.  Loved ones may have many “unanswered questions” and may also be experiencing trauma from discovering the deceased.  The most important thing we can all do to help is to express support and demonstrate our care.  We may feel awkward but it essential to say (or write) something to show our love and concern.  Let the bereaved person talk – when they are ready – and listen supportively.  Try to understand how they are feeling and allow them to grieve in their own way.  Be patient – understand that it may take years for the person to work out how to live with their loss.  Don’t avoid talking about the person who has died, but don’t press for details or make judgments – it is important to honour and accept both the person who has died and those left bereaved.  Offer practical support.  With children and teenagers, answer questions honestly and take their concerns seriously.  And remember – it is never too late to approach someone bereaved by suicide in the past and say “I didn’t know what to say to show you that I cared, and I’m sorry.  How are you going now?”

Q: What part can psychologists play?

A:  Psychologists can assist people who are feeling suicidal, and those who have attempted suicide, to address the causes of their pain and distress and to build their coping skills.  This includes providing treatment for mental illness, often in consultation with GPs or other doctors; providing coping strategies to manage life stressors or psychological or physical pain; and helping people to build relationships and social support networks.  Psychologists can also help those who have been bereaved by suicide to cope with grief and other emotional reactions, to build social support networks and to rebuild their lives.

Q: What should a reader do if they are feeling suicidal?

A: Please don’t suffer alone – help is available to you.  Tell someone you trust how you feel, or call one of the free, confidential counseling lines listed below.  If possible, stay with someone supportive.  Seek help from your doctor, a psychologist or another health professional.  Avoid drugs and alcohol, try to exercise and eat healthily.  You may find it helpful to write down your thoughts and feelings.  And if you need immediate, urgent help, call 000 or ask someone to take you to a hospital emergency department.

Q: Where can people get more information?

A: Confidential, 24/7 support is available at Lifeline: 13 11 14; Kids Helpline: 1800 55 1800; Mensline Australia: 1300 78 99 78 and the Suicide Call Back Service: 1300 659 467.

Useful information and further resources: www.wspd.org.au; www.livingisforeveryone.com.au; www.beyondblue.org.au

 

 

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Irritable Bowel Syndrome

Posted on August 1, 2013 in Uncategorized - 0 comments - 0

IBS-There is hope for people suffering with this often debilitating condition. 

Clinical Psychologist  Dr Matthew Evans

Clinical Psychologist
Dr Matthew Evans

Matt Evans, Clinical Psychologist, has worked for several years in a specialist gastroenterology outpatient clinic providing psychological support services for people with Irritable Bowel Syndrome (IBS). Below he writes about what he has learned along the way.

There is hope for people suffering from IBS. Over the last decade, the evidence has mounted to support a variety of different pharmacological, non-pharmacological and psychological treatments to help with the management of this condition. Unfortunately, health professionals, sufferers and the general public are not fully aware of this evidence and IBS remains often misunderstood.

There are probably many people with IBS who could be feeling better, but, without the knowledge of some of these more recent findings, haven’t had the opportunity to access the kinds of supports that we now know might help. Below are a few findings that are well-worth knowing about and considering for people with IBS.

First, IBS is not as rare as some people might think. It has been found to affect about 1 in 10 Australians, although more than that suffer from unexplained gastrointestinal symptoms1. It is important to identify these problems to then access the appropriate treatments.

Second, the severity and impact of IBS varies from one individual to another; from quite manageable to almost intolerable. Despite this variation, studies have found that IBS has a significant impact on health-related quality of life with issues such as low energy/fatigue, role limitations caused by physical health problems, bodily pain, and negative general health perceptions being common consequences 2,3,4.

Third, IBS has clearly defined diagnostic criteria called the Rome criteria. In the past, clinicians tended to rule out all other possibilities before diagnosing IBS. This often involved lots of tests and procedures. With better definitions of IBS symptoms and improved identification of IBS, the need for extensive testing has decreased5,6. If concerned, see a doctor familiar with diagnosing IBS.

Fourth, it was originally thought that IBS was “psychosomatic”, which means caused by psychological distress. More recent research findings show that this is not the case. Although the exact cause of IBS not been identified, studies have now found reliable biological markers for the condition7. However, psychological distress does appear to make symptoms worse in people with IBS. Often distress about IBS symptoms can make those symptoms worse leading to more distress. Psychological treatments aim at helping patient break this “vicious cycle”.

Finally, it is no longer the case that there is nothing that can be done to help alleviate the symptoms of IBS. It is true that IBS is a chronic disease, in that it is ongoing and there is no cure. However, there exist several pharmacological and non-pharmacological treatments that have been shown to significantly help manage the symptoms and improve quality of life8,9.

There is also increasing research showing that psychological interventions can be effective. Despite not knowing exactly how they work, psychological interventions do seem to work in improving quality of life in people with IBS. Psychological interventions often recommended include cognitive behavioural therapy, psychodynamic psychotherapy and hypnotherapy.

The American College of Gastroenterology, following their review of the research evidence for the treatment of IBS concluded, “use of psychological therapies can be strongly recommended for most patients in most circumstances”11 It is, of course, vital to have IBS properly assessed, diagnosed and medically treated. Psychological treatments can also offer added benefits that complement these medical treatments, providing further hope for people suffering with IBS.

References:

1 Lovell RM, Ford AC (2012). Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol , 10:712-21.

2 Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA (2000). The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. Sep;119(3):654-60.

3 Chang L. (2004). Review article: epidemiology and quality of life in functional gastrointestinal disorders. Aliment Pharmacol Ther. Nov;20 Suppl 7:31-9.

4 El-Serag HB (2003) Impact of irritable bowel syndrome: prevalence and effect on health-related quality of life. Rev Gastroenterol Disord.;3 Suppl 2:S3-11.

5 Ford AC, et al. (2008).Will the history and physical examination help establish that irritable bowel syndrome is causing this patient’s lower gastrointestinal tract symptoms? JAMA, 300:1793-1805.

6 Ford AC, et al. (2009) Yield of diagnostic tests for celiac disease in subjects with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med, 169:651-58.

7 Ford AC, Talley NJ. (2011). IBS in 2010: advances in pathophysiology, diagnosis and treatment. Nat Rev Gastroenterol Hepatol, 8:76-78.

8 Brandt et al. (2009). An evidence-based systematic review of the management of IBS. The American Journal of Gastroenterology, 2009, vol 4, supp 1, s1-s25

9 Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 2011;106:915-22.

10 http://s3.gi.org/patients/ibsrelief/treatmentmatrix/treatment_matrix.pdf, pg2

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Getting out of our heads: ACT and Defusion

Posted on July 25, 2013 in Uncategorized - 0 comments - 0

By Clinical Psychologist Erika Fiorenza

Erika Fiorenza Clinical Psychologist

Erika Fiorenza
Clinical Psychologist

There is a great scene in Finding Nemo where Nemo’s dad, Marlin, and his newly found friend, Dory, have been swallowed by a whale and are holding on for their lives.

Dory: “It’s time to let go! Everything is going to be alright”

Marlin: “How do you know? How you know something bad isn’t gonna to happen?”

Dory: “I don’t!”

For me, this scene sums up Acceptance and Commitment Therapy or ACT.  It’s about opening up and accepting fearful or painful thoughts and feelings while taking action towards our values, which in Marlin’s case was love for his son Nemo.  In ACT, this is referred to as ‘Psychological Flexibility’.

Acceptance and Commitment Therapy, said “act”, is an evidence based therapy which teaches clients ways to handle painful thoughts and feelings and take action with full awareness of what is important.  One of the core processes taught in ACT is called ‘defusion’.

Our thoughts can often get in the way of living the life we want to live.  Thoughts can be like bullies – pushing us around, telling us what to do.  ‘Defusion’ means separating from our thoughts, and seeing them as just that – thoughts.  In ACT, we teach clients ways to look at, rather than from their thoughts.  We ask clients to look at what their mind is telling them.  For clients with depression, their mind may say things like “I’m worthless” and “what is the point”.  There are a number of exercises psychologists use to help teach the process of defusion.

A simple defusion exercise (Harris, 2009):

I invite you to think of a thought that may bully you around, and say that thought in the form of “I am X”. For example, “I’m a bad mum”

Now, in front of that thought say “I notice I’m having the thought that…” For example, “I notice I’m having the thought that I’m a bad mum”

What did you notice when you did this?

Painful or unwanted thoughts are part of being human.  It is important to emphasize that the aim of defusion is not to get rid of these thoughts, but to hold them lightly so they have less hold over us, and we can be present and engaged with our world.

I recommend checking out www.actmindfully.com for more on ACT and defusion, or the CD ‘Mindfulness Skill Volume 1’ which can be ordered from the site

Harris, R (2009). ACT made Simple. Oakland, CA: New Harbinger

 

 

 

 

 

 

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Striving for control of food and body

Posted on July 11, 2013 in Uncategorized - 0 comments - 0

 

Psychologist Cathy Dart

Psychologist Cathy Dart

By Clinical Psychologist Cathy Dart

We are taught subliminally from a very young age that being thin is good.  Advertising, the media, celebrities and society place huge importance on physical appearance and the drive for perfection.

So it’s not surprising to hear that eating disorders affect 9% of Australian population and 15% of women. That is 2 million people across the nation experiencing an eating disorder (Eating Disorders Victoria, September 2012).

The statistic we don’t know is what percentage of Australian’s will seek medical help to resolve the eating disorder. Speaking to a Psychologist or Doctor about your eating disorder can significantly improve your quality of life but the first step is recognising that you have a problem.

Clinical eating disorders like anorexia and bulimia are very serious with life threatening health risks, they often require intervention from a family member and many years of medical help.

However, more recently clinicians have found that there is a much wider spectrum of non-clinical eating disorders that derive from body image distortion and a drive for thinness.

A ‘drive for thinness’ or in some cases overeating a ‘drive for self protection’ are often primary issues or impediments to recovery for a person with an eating disorder.

The person with an eating disorder often experiences significant alterations in their ability to rationally appraise their bodies. They actually feel and see a very different shape to what exists. Their feelings and thoughts about their bodies are nearly always extremely negative and critical.

Commonly the person with an eating disorder initially finds some benefit in their restrictive eating, overeating or compensatory behaviours that may include purging, exercise, laxative and diuretic abuse.  Ironically they may experience a noticeable decrease in other mental health issues including symptoms of anxiety, depression or low self-esteem.

Fuelled by an overwhelming drive to achieve very specific goals usually relating to eating, weight, sport, academic or vocational achievements the person may experience a sort of artificial euphoria associated with chemical changes and reduced circulation in the brain and body.  This affect is caused by “Starvation Syndrome.”

The first step to recovery is recognising that you have a problem, whether it is big or small. The next is asking for help and this is one of the most difficult steps for a person with an eating disorder.

Often awareness of the disorder can be very delayed for both the individual affected and their family and friends.  Health practitioners will often struggle to identify and/or achieve the patient’s agreement that there is a problem.

Patients have often said to myself and other health professionals “I thought it was all ok, I would stop when I was ready.  It was only when I couldn’t stop that I realised that it was a problem.”

Reversing starvation or poor nutrition alone does not ‘cure’ an eating disorder. The emotional relationship and psychological factors that contributed to the condition need to be addressed.

Shifting awareness and developing insight into the traps created by an eating disorder and/or severe body image distortion can be extraordinarily difficult for a person with eating disorder symptoms and their carers- but it can be achieved.

Establishing a network of support that may include an experienced psychologist, general practitioner, dietitian and psychiatrist is a critical factor in achieving wellness.

Carers and family members also play a very significant role in the recovery of a loved one with an eating disorder. Family Based Therapy involving the whole family in the recovery process is the primary evidence-based approach to intervention for children and teenagers.

It can also be very important for parents, partners and carers supporting a loved one with an eating disorder of any age to access their own support.  Regular appointments with an experienced psychologist who is aware of the complexities of eating disorders can be very beneficial.

For many persons with eating disorders meeting others with similar illnesses and joining in with the activities provided by community organisations can be an important step in reconciliation and recovery.

Some of the support services available here in Brisbane include:

The Butterfly Foundation. This is Australia’s only national charity for the support of people with eating disorders and their families and carers.  The Butterfly foundation is dedicated to bring about change to the culture, policy and practice in the prevention, treatment and support of those affected by eating disorders and negative body image.

http://thebutterflyfoundation.org.au

The Eating Disorders Association Inc (Qld) is a non-profit organisation funded by Queensland Health, to provide information, support, referrals and support group services for all people affected by eating disorders in the state of Queensland, Australia.  The EDA also provides tailored workshops for positive body image and eating disorders to schools, universities, health professionals and the community.

Telephone (07) 3394 3661 or 1300 550 236.

12 Chatsworth Rd, Greenslopes Q 4120.

http://eda.org.au

Isis – The Eating Issues Centre Inc.  Isis works therapeutically with women and men of all ages from 17 years onwards. 
As the majority of those with eating issues are women, Isis offers more women-focused time at the centre: 
Please telephone first before visiting.

Telephone (07) 3844 6055

58 Spring Street, West End 
Q 4101

 http://www.isis.org.au

Eating Disorders Outreach Service and North Brisbane Outpatients Cognitive Behaviour Therapy Program. EDOS is a publicly funded state-wide health service that plays a significant leadership role and service development in Queensland including a state-wide specialist consultation liaison service which facilitates patient access to local general medical and psychiatric facilities, and a specialist outpatient clinic for patients residing north of the Brisbane River.

Telephone (07) 3114 0809
Rosemount, Windsor QLD

www.health.qld.gov.au/rbwh/services/mental_health.asp

Additional information is available:

F.E.A.S.T. – Families Empowered And Supporting Treatment of Eating Disorders is an international organisation of and for parents and caregivers to help loved ones recover from eating disorders by providing information and mutual support, promoting evidence-based treatment, and advocating for research and education to reduce the suffering associated with eating disorders.

http://www.feast-ed.org

Australian and New Zealand Academy of Eating Disorders (ANZAED) is a the peak body for eating disorder professionals committed to leadership and collaboration in research, prevention, treatment and advocacy.

http://www.anzaed.org.au

If you are experiencing body image distortion or think you may have an eating disorder, Psychology Consultants can help you overcome what can be an all consuming, negative force in your life.

To see our full team of Psychologists visit: www.psychologyconsultants.com.au or call 3395 8633 to make an appointment.

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Why do we spend so much time worrying?

Posted on June 10, 2013 in Uncategorized - 0 comments - 0
Elizabeth Galt

Clinical Psychologist
Elizabeth Galt

Worry is something that almost everyone will do from time to time. However, sometimes people find that their worry has become a large and interfering part of their daily life. They may not like it but might believe that it is a part of who they are – to be a worrier. Or they may think that it is necessary to worry as much as they do. Sometimes it is hard for people to acknowledge how much they are worrying because the thoughts seem to be justified if about their real life problems. Often their worrying is pointed out to them by other people.

Frequent and interfering worry is associated with anxiety but not all people who worry a lot are aware of feeling anxiety in their body. Some people may have habituated to a higher level of daily anxiety, accepting it as their normal.

Worry is different from constructive problem solving. Problem solving is “here and now” action. Worry typically becomes repetitive and looping patterns of thought that don’t resolve to any practical action or outcome. For example, problem solving a bill that might be difficult to pay could look like calling the company and making a payment arrangement. In the same scenario a worry pattern would look like repeated thoughts of “what if I can’t pay it?” “what will happen if I can’t pay it?” and similar.

Not all situations that provoke worry will be able to be problem solved. Some situations may be completely out of our control or may require time or other events to unfold. Often people get into the worry habit because it paid off for them a few times. Maybe they were prepared for a situation or felt partly protected from disappointment when something went wrong. It might seem counterintuitive but often people will have some positive ideas or beliefs about the value or benefits of worry. Unfortunately worry tends to get worse over time and then people find themselves worrying more and more about minor things. Then they can become worried about how much they are worrying, or feel stressed about how easily they are getting stressed.

The good news is that worry doesn’t have to keep its hold and reduce a person’s quality of life. A psychologist can assist an individual when their worry has become so severe that is causes considerable anxiety, feels uncontrollable and has an impact on their daily life. The psychologist can identify you worry pattern and what triggers it and then provide strategies and activities that reduce the worry pattern.

There are also self-help approaches that target worry. Resources for these can be accessed at many reputable mental health websites. The Black Dog Institute has some tip sheets available (see http://www.blackdoginstitute.org.au) and the Centre for Clinical Interventions has full modules and workbooks available in their Resources section (see http://www.cci.health.wa.gov.au)

Listed below are a few ways to identify if worry is a real problem for you.

·       Do you feel a sense that worry is taking over and filling up too much of your day? Are events that are positive or likely to be enjoyable overshadowed by too much worry?  e.g- what if we can’t get a car park, what if something goes wrong with our booking.

·       Are you bothered by, or preoccupied with, all of the things that seem to be going wrong in the world and those that could go wrong? e.g- natural disasters, disease, accidents.

·       Have other people commented on how much you worry or indicated that it has an impact on them? e.g- I wish you wouldn’t worry so much.

·       Sometimes there may be a lonely or isolating feeling to the worry e.g., why isn’t anyone else worrying that her plane might crash or she might get robbed? They’re all so happy for her.

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We Say No to workplace bullying on national Know Bull Day!

Posted on June 3, 2013 in Uncategorized - 0 comments - 0

Today, 3 June is ‘Know Bull Day’ marking the start of Workplace Bullying Awareness Month.
Helenweb
Clinical Psychology Helen Perry shares her professional experience on this serious issue and how we can begin to combat it.

 

Matthew* a 37 year old project manager sits across from me, sleep deprived, anxious and jobless- a broken man.

Over the past few months going to work every day had become a nightmare for Matthew. He had fallen victim to workplace bullying, his new senior manager was the main offender, but the effects trickled down resulting in complete isolation from his colleagues.

Seeing no alternative but to resign, Matthew sought help from his GP who referred him to see me with reports of insomnia, anxiety and low self-esteem.

In our first session he told me how he had been struggling to sleep, was having frequent headaches, was worrying about almost everything and was having panic attacks when he went anywhere near his old work place or saw his work colleagues.

Despite wanting to move on and seek new employment, Matthew struggled to focus, sitting at his computer for hours consumed in anger, animosity and regret at this unfair situation.

Matthew worried about how he would get a fair reference from his old manager and was angry with himself for not confronting his manager or making a formal complaint. His decision to resign seemed like the only option, he was aware of another colleague who complained in a similar situation and the result was not in his favour.

Psychologists see countless men and women each year who have similar experiences. People from a wide range of settings, including government, schools, building sites, hospitals, retail, police, army and academia fall victim to work place bullying.

They tell of many kinds of bullying which occur regularly and on an ongoing basis, sometimes by an individual and sometimes by a group of people.

The bullying behaviours described include being belittled both privately and publicly, being overloaded with work, having rumours spread about them, being insulted, verbally abused, sworn at or called names, being monitored excessively (“micromanaged”), being threatened, falsely accused, criticized publicly, being retaliated against after filing a complaint or being ignored.  Men are more frequently reported as the bullies though when women bully, they tend to bully other women.

Sadly, despite laws that set out to prevent this, workplace bullying is common and comes at large expense to our society, resulting in poor physical and mental health and resultant days off by the victims.

It is also true to say that most people don’t do anything about it, as reporting it often leads to an escalation of the problem rather than a resolution of the problem.

How can a Psychologist help?

A Psychologist can help to manage and treat any symptoms or the psychological impact from the situation and perhaps prevent these problems from escalating.

They can also help with problem solving: brainstorming and exploring different possible responses and action plans to address the bullying issue.  A very important role of the Psychologist is to provide a safe and confidential place for a person to unburden about what they are experiencing and to provide impartial support.  Some Psychologists (with particular training and experience in Organizational Psychology) specialize in issues relating to work places so could be particularly skilled in assisting you to deal with the issues related to workplace bullying.

What can I do about it?
There is no right or wrong way to respond and any action you take may help or could result in an escalation of the problem. It is often a good idea to discuss any action you might take with an impartial person before you do anything. The following is by no means advice, but merely a list of some of the sorts of things people often try with varying degrees of success:

1)    Educate yourself about workplace bullying and find ideas from experts in the field (both in person or through on-line resources, books etc.) on how to manage particular situations.  For example, see http://www.bigbadboss.com http://www.psychology.org.au/publications/inpsych/workplace_bullying/
http://www.beyondtheofficedoor.com for tips, articles, actions you can take, advice and other resources.

2)    Keep a detailed diary of the bullying and any relevant correspondence including emails and text messages.  Keep doing this even if you have already filed a complaint.  Document any conversations with supervisors, human resources etc.  For a template and an example of a diary, visit:

http://www.know-bull.com/images/bullydiary.pdf
(Don’t try and secretly record conversations as this may be illegal or result in dismissal if the company has a policy about this).

3)    Refer to your job description so that you know what your responsibilities are and always have phrases like, “any other duties as assigned” clarified so that you know what is expected of you and whether you are being exploited or manipulated.

4)    Know what is written about you on the internet (via blogs, online forums, social media etc.) to be sure that those in your workplace are not using personal information about you to target you in some way.  Google yourself and see what’s out there!  Be careful what you post online about yourself and others.

5)    Talk to the person bullying you if you think this might help, requesting that they cease certain behaviours (be specific about what they are doing rather than talking about “attitudes” and ask them to be specific about what behaviours you might change if they accuse you of having “attitude problems”).

Perhaps saying how stressed you are might not help, as knowing you are suffering may be their goal! Let them know that customers and sales are being affected by their behavior e.g. setting you unrealistic targets results in customers feeling they are being pressurized to buy; criticizing or ignoring you in front of a customer reduces customer’s confidence in the company etc.

Document your conversation or do it by email making sure you send the email when you are clear-headed and that you have not included inflammatory or accusatory statements.  Be sure to not retaliate or spread defamatory information about the person bullying you.

6)    Escalate the complaint to a supervisor or Human Resources if the bullying does not stop.
7)    Consult a lawyer who specializes in employment law and is experienced in dealing with workplace bullying.
8)    See your GP immediately if you start to suffer with significant stress that is affecting your physical and mental well-being.  You may need some support through this experience.

*  Matthew is not a real client, but represents a number of different clients and their stories as heard over the years.

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Can a psychologist help you quit smoking?

Posted on May 30, 2013 in Uncategorized - 0 comments - 0

Today- 31st May is World No Tobacco Day, so we’ve interview Dr Stan Steindl about how a Psychologist may help you give the habit up for good!

I-Quit

1.  Generally speaking, how can a Psychologist help a person quit smoking?

Psychologists can sometimes help at three critical stages when a person starts to consider giving up smoking.

First, finding the motivation to quit can be a challenge. A psychologist can help a person to consider what the major motivating factors are for them. Exploring what the person would like to change, why they’d like to change and what makes it important can help create the motivation and willingness to commit to change.

Second, a psychologist can help in the planning and action phase. A discussion around how to make the change, action planning and then confidence building can all help the person take that next step.

Finally, like all behaviour change, relapse is a real consideration. A psychologist can help with relapse prevention, which often involves identifying situations that might trigger relapse and planning ahead to cope better or differently with those situations. Importantly, a person trying to quit smoking has to manage their reaction to any lapses. For example, the Abstinence Violation Effect relates to a person’s feeling of failure and resignation that can come from a lapse, and managing that is an important part of staying on track with quitting.

2.  What are some different approaches to quitting smoking that have proven successful with your clients?

The most successful clients seem to be those who have a combination of a medical managed approach and a behavioural approach. For example, nicotine replacement therapy (NRT) and psychological therapy often work well in combination. The NRT helps the person to gradually reduce the nicotine in their body over several days, and the psychological therapy helps develop coping strategies. A vital contribution of psychological therapy relates to the fact that smoking often provides a function for the person, for example, managing stress. If they try to give up without having an alternative method of managing stress, then the chance of relapse is much greater. A psychologist can help the person identify those functions of smoking and develop alternatives.

3.  What are some common reasons for relapse once a smoker has quit?

People often have their own unique risk factors for relapse, and identifying them early and planning ahead is the key. For some, it is emotional factors such as stress or anxiety, or even boredom. For others it is social situations and pressures, such as living with a partner who smokes. And for others, simple opportunity and access can be a critical factor. I have often heard people say they thought they could ‘just have one’, and this can put people at a major risk of relapse just by itself.

4.  Are there ways to combat a relapse or some self help methods to prevent this from happening?

Effective, evidence-based approaches to combating relapse have been available since the mid-1980s. “Relapse Prevention” is a body of work that covers how people can identify triggers, plan ahead for them, and manage relapses when they occur. More recently, the Relapse Prevention approach has been coupled with mindfulness-based strategies, which are all about dealing with being on autopilot. It seems that being on autopilot and reacting to urges and cravings without thinking is a major risk for relapse, and mindfulness strategies helps the person to be aware of urges and then have the presence of mind to consider what’s important to them and respond accordingly.

5.  Is relapse related to the number of years the person has been smoking? (ie- how bad the addiction is)

The severity of nicotine dependence can influence how difficult it is for a person to quit smoking. This does not necessarily just include how long they have been smoking, but also how much they are smoking and how early in the day they have their first cigarette. No matter how long the person has smoked for, and how much they have smoked, it is never too late to quit.

On the flip-side, and although there is no hard and fast rules about this, often time passing of no smoking after quitting does reduce the risk of relapse. In fact, there does seem to be something about the passing of 9 to 12 months that starts to reduce the risk of relapse significantly.

6.  Is cigarette addition harder to ‘cure’ in those who have drug and alcohol addiction/substance abuse?

Quitting smoking is a difficult task, and it can be made more difficult when other factors are in the mix of a person’s life. Certainly, if a person is misusing alcohol or other drugs, then quitting smoking can be more difficult. Sometimes a person may wish to prioritise what changes they might make first, and this may or may not be smoking. Other factors might include mental health issues, chronic disease issues, and general life stressors. Where a person is facing multiple challenges with quitting, a psychologist may be of particular assistance in helping them cope.

7. What are five things a smoker should consider when they decide they want to quit?

1. What would YOU like to do about your smoking? What is your preference? How would you like your life to be?

2. What are your personal reasons for quitting smoking? How would things be better as a non smoker? How might things be worse if you continue smoking?

3. What makes quitting smoking important for you? How does smoking really fit with who you want to be? Putting aside what others say, what is the clincher for you?

4. If you were to make such a change, how would you go about it? What might work for you? What sorts of things need to be addressed to up your chances of success?

5. What will you do? What is going to be your next step?

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Having your heart in the right place

Posted on May 19, 2013 in Uncategorized - 1 comment - 0

 Motivational Interviewing and Compassion

By Dr Stan Steindl

I recently presented at the International Symposium on Motivational Interviewing (ISMI) in Melbourne on the topic of Motivational Interviewing (MI) and Compassion.

As many will know, MI is a communication style in which clinicians can explore with clients the client’s own motivations for change, helping the client to articulate to themselves what they’d like to change, why, what makes it important to them and how they might go about it. Ultimately, MI helps the client to resolve feelings of ambivalence about change and make a commitment to what actions they will take next.

The presentation at ISMI was all about the role of the clinician’s compassion in all of this. As Miller and Rollnick (2012) have written in their core text on the topic, “To be compassionate is to actively promote the other’s welfare, to give priority to the other’s needs.” (p. 20).

Why Add Compassion?

The MI Spirit, previously comprised of collaboration, evocation and respect or autonomy support, was thought to not completely differentiate what the MI practitioner might be doing from, say, the approach of a salesperson.

A salesperson might work in partnership with their customer, might evoke the customer’s own arguments for buying, and can ultimately accept that the person will make the choice whether to buy or not. In fact, people in sales are often very astute at discerning those customers who are unlikely to buy and moving on to the next potential customer.

Not that there’s anything necessarily wrong with that. It’s just that MI is different…perhaps more. MI is essentially all about the promotion of the other’s welfare, setting aside ourselves, and setting aside creating any benefit for ourselves.

As Miller and Rollnick (2012) pointed out, the MI practitioner endeavours to have their “heart in the right place”. (p. 20).

What Is Compassion?

While I, like many clinicians, have long pondered compassion and its role in the clinical work I do, its recent formal inclusion in the spirit of MI has brought the topic into sharp focus for me. So what is compassion? It seems to me that it is made up of a variety of aspects, and so, just to name a few:

•   Kindness – “Be kind, for everyone you meet is fighting a harder battle.” – Plato

•   Acceptance – “A truly compassionate attitude toward others does not change even if they behave negatively or hurt you.” – Dalai Lama

•   Equality – “Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.” – Pema Chödrön

•   Action – “Compassion is a verb.” – Thich Nhat Han

I also asked my mother, a GP of 40 years. Despite being put on the spot at her Mother’s Day dinner recently, she said, “Compassion is a feeling of understanding, and of sorrow, for the difficulties somebody else is experiencing…and trying to do something about it.” And I think this highlights the two key components of compassion. There is a feeling component in which we feel for, and with, the other person. And there is an action component, where we do something about it.

A Definition of Sorts

While I am no expert on the topic of compassion, I thought I would put out there a definition of sorts for others to consider and elaborate upon.

Compassion is the capacity to see clearly into the nature of another’s life…their values and strengths, dilemmas and challenges, as well as their suffering. It is a recognition that one is both separate from, and not separate from, that suffering, given the shared experience of being a part of humanity. It is being fully present to the whole story, including all aspects that might influence what the other person goes on to do. It is an aspiration towards transforming that suffering, and active efforts to do so, while at the same time not being attached directly to the outcome of that transformation.

Strong Back; Soft Front

We are not eggs! Eggs have a hard shell, protecting an inner softness and vulnerability, but the hard shell is fragile and brittle and breaks easily under too much pressure. The characteristics of a compassionate person is the opposite, involving a strong back and a soft front.

The strong back is about the emotional strength, courage and wisdom to be with a person and their suffering. It is about being able to see clearly the whole person, and with both conviction and humility provide support.

The soft front is about love, the kind of “non-possessive love” that Carl Rogers spoke about. It is about approaching the other person with kindness and care, acceptance and open-heartedness, and calmness and patience. It is treating the other person with respect and being able to empathise, demonstrating an understanding of what they might be thinking or feeling.

And compassion has enemies. Judgement is an enemy of compassion. Negative judgement of course, but also sometimes positive judgement, which can still put the clinician into a position of superiority. Feelings of pity or fear can also undermine compassion, or moral outrage at the person or their behavioural choices. Also arrogance or thinking that we know best…these and other characteristics are like white ants eating away at the core of our compassion.

Cultivating Compassion

With a growing sense of what compassion is, then we consider how to cultivate compassion. Cultivating compassion includes feeling empathy and concern for others, and it goes beyond this. Steps can be taken to foster the strong back to be present with another person and their suffering, as well as the the soft front of acceptance and positive regard. Further, personal commitments to take compassionate action can be developed and solidified. And clinicians can develop the resilience to prevent ‘compassion fatigue’.

The Center for Compassion and Altruism Research and Education (CCARE) at Stanford University (www.ccare.stanford.edu) has been developing and researching practices for cultivating compassion by combining our knowledge of neuroscience, psychological science and spirituality. The Compassion Cultivation Training (CCT) incorporates:

•   mindfulness practices such as breathing, imagery and loving-kindness meditations,

•   colleagial discussion, reflection and communication, and

•   real-world homework practicing compassionate thought, feeling and action.

Practicing Compassion Through Meditation

“I don’t like that man. I must get to know him better.” – Abraham Lincoln

I invite you to close your eyes.

Think of someone you are currently working with. Perhaps someone with whom the work has been challenging.

Develop a picture of that person in your mind. Feel the presence of that person in your life, in this room.

Now consider and say to yourself:

“This person is just like me. Just like me, they have a history…they were a child once, too. And just like me, this person has had ups and downs in their life. Just like me, this person has had goals and dreams. Just like me, they have strengths and qualities…fears and vulnerabilities…they have had successes and they have made mistakes.”

Good Practice of MI

It seems to me now, that with compassion being formally added to the spirit of MI, good practice will include taking active steps to cultivate compassion.

First, the importance of cultivating compassion for ourselves, for self-compassion is itself a key ingredient in being able to feel compassion for others.

Second, cultivating compassion for our colleagues, all of whom come from the same well-intended place and are facing the same challenges as we are.

And finally, cultivating compassion for our clients, and significantly the client we are just about to see, who comes offering us the privilege of being with them while they consider their own question of change.

 

 

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