Month: September 2018

The role of childhood trauma on health and diseases

Introduction
Traumatic events of the earliest years of infancy and childhood are not lost but, like a child’s footprints in wet cement, are often preserved lifelong. Time does not heal the wounds that occur in those earliest years; time conceals them. They are not lost; they are embodied. Only in recent decades has the magnitude of the problem of developmentally damaged humans begun to be recognized and understood.
The influence of childhood experience, including often-unrecognized traumatic events, is as powerful as Freud and his colleagues originally described it. That influence is long lasting, and the researchers describe the intermediary mechanisms, the neural pathways, that these stressors activate for their clinical manifestation. Unfortunately, and in spite of these findings, the biopsychosocial model and the biomedical models of psychiatry remain largely at odds rather than taking advantage of the new discoveries to reinforce each other.
Many of our most intractable public health problems are the result of compensatory behaviors such as smoking, overeating, promiscuity, and alcohol and drug use, which provide immediate partial relief from emotional problems caused by traumatic childhood experiences. That relationship is straightforward: early trauma to depression or anxiety, to obesity, to diabetes, to heart disease; trauma to smoking, to emphysema or lung cancer. But, apart from various common compensatory actions, the chronic life stress of the underlying developmental life experiences is generally unrecognized and hence unappreciated as a second and separate etiological mechanism underlying many biomedical diseases.

What is childhood trauma?
The National Institute of Mental Health (USA) defines childhood trauma as: “The experience of an event by a child that is emotionally painful or distressful, which often results in lasting mental and physical effects.” Childhood trauma can occur when a child witnesses or experiences overwhelming negative experiences in childhood. Many childhood experiences can overwhelm a child. This can happen in relationships e.g. abuse, neglect, violence. This is called interpersonal trauma. Children can also experience traumatic events. These include accidents, natural disasters, war and civil unrest, medical procedures or the sudden loss of a parent/caregiver.
Interpersonal trauma can be understood in this way:
1. Trauma from something done to a child:
– sexual, physical or emotional abuse at home or elsewhere
– witnessing or experiencing violence in family or home
– witnessing or experience violence in community e.g. civil unrest or war, refugee or asylum seeker trauma
2. Trauma from something that doesn’t happen e.g. child is not well nurtured:
– physical and emotional neglect
3. Trauma because a child’s parent or caregiver is affected by their own trauma. This can mean that they are unable to meet their child’s emotional needs. Often these parents have good intentions. Their own trauma stops them connecting securely to their child, which limits the child bonding or attaching securely:
– parental ill-health
– a parent who misuses substances e.g. alcohol or drugs- a parent put in prison
– separation of parents or divorce.

Early childhood trauma
Trauma in early childhood can be especially harmful. Early childhood trauma generally means trauma between birth and the age of six. A child’s brain grows and develops rapidly, especially in the first three years. Young children are also very dependent on the caregivers for care, nurture and protection. This can make young children especially vulnerable to trauma. When trauma occurs early it can affect a child’s development. It can also affect their ability to attach securely, especially when their trauma occurs with a caregiver.
The relationships between childhood trauma and aggressive behavior in adulthood are partially explained by the observation that traumatic stressors during early development may contribute to an impaired capacity for self-regulation in later life.15,16 This impaired capacity would explain the diffuse associations between childhood trauma and the number of reported aggressive behaviors in adulthood. However, our finding that specific forms of trauma (witnessing violence, emotional abuse) are associated with aggression scores is unexplained.
Although adults often say things like, “He was so young when that happened. He won’t even remember it as an adult,” childhood trauma can have a lifelong effect. And while kids are resilient, they’re not made of stone. That’s not to say your child will be emotionally scarred for life if he endures a horrific experience. With appropriate interventions, adults can help kids recover from traumatic experiences more effectively. But it’s important to recognize when your child may need professional help dealing with a trauma.
Post-Traumatic Stress Disorder
Many children are exposed to traumatic events at one point or another. While most of them experience distress following a traumatic event, the vast majority of them return to a normal state of functioning in a relatively short period of time.
But some children—between 3 and 15 percent of girls and 1 to 6 percent of boys—develop post-traumatic stress disorder (PTSD). Children with PTSD may re-experience the trauma in their minds over and over again. They may also avoid anything that reminds them of the trauma or they may re-enact their trauma in their play. Sometimes children believe they missed warning signs predicting the traumatic event. In an effort to prevent future traumas, they become hyper-vigilant in looking for warning signs that something bad is going to happen again.
Children with PTSD may also have problems with:
-Fear
-Depression
-Anxiety
-Anger and aggression
-Self-destructive behavior
-Feelings of isolation
-Poor self-esteem
-Difficulty trusting others
Even children who don’t develop PTSD may still exhibit emotional and behavioral issues following a traumatic experience. Here are some things to watch out for during the weeks and months after an upsetting event:
-Increased thoughts about death or safety
-Problems sleeping
-Changes in appetite
-Anger issues
-Attention problems
-School refusal
-Somatic complaints like headaches and stomach-aches
-Loss of interest in normal activities
-Irritability
-Sadness
-Development of new fears
-Effect on Long-Term Health
Traumatic events can affect how a child’s brain develops. And that can have lifelong consequences.
ALSO Studies show that the more adverse childhood experiences a person has, the higher their risk of health and wellness problems later in life. Childhood trauma may increase an individual’s risk of:
-Asthma
-Depression
-Coronary heart disease
-Stroke
-Diabetes
Additionally, a study published in 2016 in Psychiatric Times noted that the prevalence of suicide attempts was significantly higher in adults who experienced trauma, such as physical abuse, sexual abuse, and parental domestic violence, as a child.

How to Help a Child Who Has Been Traumatized?
Family support can be key to reducing the impact trauma has on a child. Here are some ways to support a child after an upsetting event:
-Encourage your child to talk about his feelings and validate his emotions.
-Answer questions honestly.
-Reassure your child that you’ll do everything you can to keep him safe.
-Stick to your daily routine as much as possible.
If your child has been exposed to traumatic circumstances and you’ve noticed changes in her mood or behavior, talk to her pediatrician. A physician can evaluate your child’s health and, if necessary, make a referral for mental health treatment.

Depending on your child’s age and needs, she may be referred for services such as cognitive behavioral therapy, play therapy, or family therapy. Medication may also be an option to treat your child’s symptoms.
Effects of Childhood Trauma on Adulthood life
Experiencing abuse or neglect as a child can have a significant impact on an adult’s quality of life. The impact can be felt across several areas, such as emotional health, physical health, mental health and personal relationships.

Emotional Health
Survivors of childhood abuse can often experience feelings of anxiety, worry, shame, guilt, helplessness, hopelessness, grief, sadness and anger.
Mental Health
Surviving abuse or trauma as a child has been linked with higher rates of anxiety, depression, suicide and self harm, PTSD, drug and alcohol misuse and relationship difficulties.
Physical Health
Children who are exposed to abuse and trauma may develop what is called ‘a heightened stress response’. This can impact their ability to regulate their emotions, lead to sleep difficulties, lower immune function, and increase the risk of a number of physical illnesses throughout adulthood.
How to deal with childhood trauma in adulthood
Trauma generates emotions, and unless we process these emotions at the time the trauma occurs, they become stuck in our mind and body. Instead of healing from the wounding event, the trauma stays in our body as energy in our unconscious, affecting our life until we uncover it and process it out. The healthy flow and processing of distressing emotions, such as anger, sadness, shame, and fear, is essential to healing from childhood trauma as an adult.
The healthiest response to childhood emotional wounds is also the rarest: When the trauma first occurs, we recognize the violation it has caused to our sense of self, feel the natural emotions that follow, and then realize that the violation doesn’t say anything about us personally — and thus we don’t make negative meaning of it and can let it go.
But because emotions like anger and sadness are painful — and because crying or confronting others is often not socially acceptable — this process doesn’t happen automatically. Instead, we may suppress our emotions, rather than feel and process them.

Trauma-Focused Cognitive Behavior Therapy

What Is Trauma-Focused Therapy?
As its name implies is a form of cognitive behavioral therapy that addresses the specific emotional and mental health needs of children, adolescents, adult survivors, and families who are struggling to overcome the destructive effects of early trauma. Trauma-focused cognitive behavioral therapy (TF-CBT) is especially sensitive to the unique problems of youth with post-traumatic stress and mood disorders resulting from abuse, violence, or grief. Because the client is usually a child, TF-CBT often brings non-offending parents or other caregivers into treatment and incorporates principles of family therapy.

What to Expect

TF-CBT is a short-term intervention that generally lasts anywhere from eight to 25 sessions and can take place in an outpatient mental health clinic, group home, community center, hospital, school, or in-home setting. Cognitive behavioral techniques are used to help modify distorted or unhelpful thinking and negative reactions and behaviors. At the same time, a family therapy approach looks at interactions among family members and other family dynamics that are contributing to the problem and aims to teach new parenting, stress-management, and communication skills.

How It Works
The trauma-focused approach to psychotherapy was first developed in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino, whose original intent was to better serve children and adolescents who had experienced sexual abuse. TF-CBT has expanded over the years to include services for youths who have experienced any form of severe trauma or abuse.
Early trauma can lead to guilt, anger, feelings of powerlessness, self-abuse, acting out behavior, and mental health issues, such as depression and anxiety. Post-traumatic stress disorder, which affects children and adults, can manifest in a number of ways, such as bothersome recurring thoughts about the traumatic experience, emotional numbness, sleep issues, concentration problems, and extreme physical and emotional responses to anything that triggers a memory of the trauma. By integrating the theories and techniques of several therapeutic interventions, TF-CBT can address and improve the symptoms of post-traumatic stress in youth.

Gathering & compilation
Marzieh Ahankoob,PhD (Clinical Psychologist)

Depression and physical chronic pain

Depression and physical chronic pain

 

What is depression?
People casually use the phrase, “I’m so depressed!” to say they are feeling down. But a temporary case of the blues – something we all experience has nothing to do with real depression. True depression is not the blues, sadness or even grief. It is an overwhelming despair so bleak that people who have experienced it say that it is the worst pain they have ever endured. Depression is a treatable mental illness. While there have been changes in people’s attitudes, the stigma associated with mental illnesses has meant that many people with depression never seek treatment. Yet, those who do have an excellent chance of recovery. Researchers estimate that people who receive treatment for depression respond well.

What Are the Symptoms Like?
There is no x-ray or blood test for depression. Instead, you, your family and friends will notice that your mood, functioning, attitude and thoughts have changed. Many of the symptoms of depression are a case of too much – or too little. For example, you may…

• Be sleeping too little or sleeping too much.
• Have gained or lost weight.
• Be highly agitated or sluggish and inert.
• Be extremely sad or very bad tempered – or both.
You may also feel….
• A loss of interest in the pleasures of life, as well as work, family and friends.
• Unable to concentrate and make decisions.
• Negative, anxious, trapped, unable to act.
• Despairing, guilty and unworthy.
• Fatigue and an overall loss of energy.
• Suicidal – expressing thoughts and sometimes, making plans.
• Numb – an awful feeling of emptiness.
• Unexplained aches and pains. A diagnosis of depression is arrived at when a person has been experiencing at least five of these symptoms for a period of two weeks or more.

What Causes Depression?
The causes of depression raise the old nature – nurture debate. Is it a result of family history (genes) or difficult life experiences? The experts say that we must consider nature and nurture: Family History – If close family members have experienced depression, you may have an inherited tendency yourself. Your inherited physiology is also involved in life changes such as the birth of a baby or menopause – both instances are associated with a greater risk of depression. Recent Events – a divorce, the death of a loved one, job loss, chronic illness, retirement, or attending a new school. Past History – experiences of childhood sexual, physical or emotional trauma, extreme neglect or abandonment. Also experiences of trauma in adulthood such as domestic abuse, living with drug or alcohol abuse, rape, robbery, war, kidnapping, or witnessing violence – to name only a few of the traumatic events that people can be exposed to.

What Is Chronic Pain?
Chronic pain lasts much longer than would be expected from the original problem or injury. When pain becomes chronic, you may have:
Unusually high levels of stress hormones
Low energy
Mood disorders
Muscle pain
Lower-than-normal mental and physical performance.
Chronic pain gets worse as changes in your body make you more sensitive to pain. You may start to hurt in places that used to feel fine. It can disrupt sleep and cause you to wake up at night. This can make you tired during and not as productive during the day. The ongoing pain can cause additional irritation and make it difficult for you to deal with others. If you have to care for children or work full-time, all this may make your life seem too challenging. These feelings can lead to irritability, depression, and even suicide.

What Happens?
Depression is one of the most common mental health problems facing people with chronic pain. It often makes someone’s other medical conditions and treatment more complicated. Consider these statistics:

According to the American Pain Foundation, about 32 million people in the U.S. report to have had pain lasting longer than a year. From one-quarter to more than half of the population that complains of pain to their doctors are depressed. On average, 65% of depressed people complain of pain. People whose pain limits their independence are more likely to get depressed. Because depression in people with chronic pain frequently goes diagnosed, it often goes untreated. Pain symptoms and complaints take center stage on most doctor visits. The result is depression — and sleep disturbances, loss of appetite, lack of energy, and decreased physical activity, which may make pain much worse.
Pain provokes an emotional response in everyone. If you have pain, you may also have anxiety, irritability, and agitation. These are normal feelings when you’re hurting. Usually, as pain subsides, so does the stressful response. But with chronic pain, you may feel constantly tense and stressed. Over time, the stress can result in different emotional problems associated with depression. Some of the problems individuals with both chronic pain and depression have include:
Altered mood
Anger
Chronic anxiety
Confused thinking
Decreased self-esteem
Family stress
Fatigue
Fear of injury
Financial concerns
Irritability
Legal issues
Physical reconditioning
Reduced sexual interest and activity
Sleep disturbances
Social isolation
Weight gain or loss
Work problems

The Association between Depression and Physical Pain
Researchers believe that there is a shared neural pathway for pain and depression with serotonin and norepinephrine involved in both mood and pain. People who are actually depressed may often talk to their physicians only about their physical pain. Research has shown that the higher the number of unexplained physical symptoms a person is experiencing, the more likely that they are suffering from depression. Depression is strongly suspected when physicians cannot find a physical source for the pain patients say they are experiencing. It is thought that depression may increase a person’s sensitivity to pain or may increase the suffering associated with pain. Studies have also shown that, of those reporting nine or more physical pain symptoms, 60% had a mood disorder. When only one physical symptom was reported, only 2% were found to have mood disorder. A high number of physical pain symptoms are also predictive of further; people who experience chronic pain as part of their depression are more likely to also have suicidal thoughts. In addition, people with diagnosed physical illnesses such as stroke, diabetes, heart disease, or cancers (to name only a few) suffer depression in disproportionately higher numbers than the general population.

Descriptions of psychological therapies for pain
Operant-behavioral therapy: Treatment focuses on extinguishing maladaptive behavioral responses and fostering of adaptive behavioral responses to pain. Behavioral responses are altered through reinforcement and punishment contingencies and extinction of associations between threat value of pain and physical behavior.
Cognitive-behavioral therapy (CBT): Treatment applies biopsychosocial approach to pain that targets behavioral and cognitive responses to pain. CBT protocols involve psychoeducation about pain, behavior, and mood, strategies for relaxation, behavioral pacing, behavioral activation, positive event scheduling, effective communication, and cognitive restructuring for distorted and maladaptive thoughts about pain.
Mindfulness-based stress reduction: Treatment promotes a nonjudgmental approach to pain and uncoupling of physical and psychological aspects of pain; teaches “non striving” responses to pain through experiential meditations and daily mindfulness practice intended to increase awareness of the body and proprioceptive signals, awareness of the breath, and development of mindful activities.
Acceptance and commitment therapy: Based on psychological flexibility model, treatment focuses on development of acceptance of mental events and pain and ceasing of maladaptive attempts to eliminate and control pain through avoidance and other problematic behaviors; emphasizes awareness, defusing, and acceptance of thoughts and emotions as well as behavioral engagement in pursuit of personal goals.

Gathering and compilation:
Marzieh Ahankoob, PhD (clinical psychologist)

Emotional Divorce

 

6

Introduction

Emotional Divorce is a psychological mechanism some spouses use when they feel the marriage has become a threat to their well-being.When you divorce yourself emotionally from your spouse, you have separated your emotions from the marriage. For some spouses, this happens before the divorce. For others, it doesn’t happen until after the divorce process. Most divorces are one-sided. Very rarely, will a couple sit down and come to the decision to divorce, together.

Some spouses struggle for years with feelings of emotional distance before they come to the conclusion that divorce is the solution to the marital problems or the way they are feeling emotionally. These spouses are commonly referred to as a “walk-away spouse.”

The spouse who is left to deal with her/his emotions after the legal divorce is commonly referred to as the “left behind spouse.” No matter which role you find yourself playing, you have to come to grips with the end of your marriage and begin to view yourself as a separate individual, no longer a husband/wife. The basic instinct of a left behind spouse is to control the situation. They failed to see the warning signs, signs that the marriage was in trouble and don’t know how to respond effectively. As a result, they respond in ways that pushed the walk-away spouse further away emotionally.

It is important to understand that a spouse who has already divorced himself/herself from the marriage is not an evil person. They are not carrying around an agenda of hurt and pain. They are looking for an escape from a situation that is causing them hurt and pain. And, this may cause them to respond to their spouse’s shock and pain in what appears to be a cold and calculating manner. Their desires and needs can’t be controlled by irrational, bizarre behavior. The best thing a left behind spouse can do is come to terms with the fact that, they only have control over their own emotions.

 

 

When an Emotional Divorce happens?

Unresolved sustained conflicts and disagreements that stack up over time can become magnified and toxic, infecting the spousal relationship which effective communication, trust and respect can be lost.

There is no predictable timeline for how long a marriage can remain in this breakdown crisis, but many couples eventually arrive at a crossroad where they feel pressured to choose a path of resolution or disengagement.If the option of separation is chosen, one or both parties has given up trying to work on the relationship and have resigned themselves to the fact that the marriage is over.

Types of Separation

Legal Divorce, which involves the court system, housing and financial changes, and custody arrangements if children are involved… OR

Emotional Divorce, which is a separation phenomenon where one or both partners have suspended in most interactions that involve any discussion of marital resolution, expectations or core topics of disagreements.

The Factors of the Emotional Divorce

Individual variables such as; nervousness, hypocrisy, lying, aggression, stubbornness, niggardliness and other individual factors that have been effective to create a sense of intolerance and emotional divorce or separation. (Abbey;2010)

 

  1. Spiritual intelligence;

One of the variables used in the monitoring is the role of spiritual intelligence and religious attitudes of individuals as the causes of emotional divorce. Studies shows emotional divorce rate among couples with low levels of spiritual intelligence or lack of spiritual intelligence, has more than others (Hann;2007).

  1. Theory cognitive factor;

There are Increasing evidence that the ways of perception, interpretation and evaluation of the couple together, and events in their relationships unfolding significant puts impact on the quality of their relationship (Bavcom, Epstein, Sayerz& Sher (1989, quoted by the Turks 2006). Albert Ellis states “irrational beliefs” or the unrealistic standards lead to the negative impact on people who are involved in the interaction patterns about their intimate relationships and consent of the partners (1976, cited in Epstein et al., 2005)

 

  1. Personality Characteristics Theory;

Although many individual differences are normal and does not lead to large differences in satisfaction of relationship, but there are two cases which have been found to have a significant impact on communication problems and divorce; one is inability to regulate negative emotions (tension)and the other with insecure attachment styles (Halford3112) Attari & et al research (2006). AS studies, personality neuroticism factors and marital satisfaction negatively associated and the personality factors, including extraversion, agreeableness and conscientiousness are positively associated with marital satisfaction (Hunler, O. S., & Gencoz, T).

 

 

Restoring the emotional intimacy as the most important tool

The first thing you must do to avoidance of emotional divorce is to restore intimacy between the couples, partners or most important relationships, which is practicable through the increase of the amount of time that they spend together. Partners often come into counseling complaining that they have grown apart, that they are not feeling loved, or that they do not feel important to the other partner.

Of course, many couples are in chronic conflict with each other. Chronic conflict makes it difficult to enjoy the moment with your partner when you are primed and ready to see everything they say or do as negative and motivated by a desire to hurt you in some way. Ongoing conflict and negative feelings about the partner and the relationship play a role in avoiding spending time with each other. This couple has to work through the conflict to restore a desire to spend time together.

 

 

Quality Time

Not only is spending time together essential for restoring intimacy and marital happiness, the way you spend time together is also important. For one partner, spending time in the same room watching the same television program may count as quality time together. For the other spouse, this activity does not count at all, and may serve as a source of hurt and anger. You do not have to be doing anything “special” like taking a vacation or going on a “date night” to be engaged in establishing closeness in your relationship. Quality time equals time engaged meaningfully with each other. Do you have to be talking to spend quality time? No. If you are both together, connected in some meaningful way, where you both believe it is meaningful, you have quality time. Couples share meaningful exchanges throughout the day, that may not add up to very little actual time together, but that account for feeling close and connected.

 

Quantity Time

Partners also enter relationships with their own emotional baggage, which may include insecurities and a higher need for closeness than the other partner. Conversely, one partner may have a much lower need for closeness than the other partner, based on his/her own emotional baggage. A couple will rarely have the same level of need for closeness vs. distance at the same time. In the beginning couples share that same desire for closeness as they are establishing the relationship. It is often described as the process of “falling in love”, when each is excited about seeing the other, pays a lot of attention to what the other is thinking/feeling, and is very conscious of relationship dynamics.

When couples come into counseling, one will often say that s/he just wants to feel like s/he did when they first got together. S/he wants to re-experience that sense of falling in love or being in love. Couples can regain a sense of falling in love or being in love, but desire to have that experience does not magically make it happen. It takes much time and effort.

In conclusion, couples that desire a return of closeness or emotional intimacy, can make that happen by slowing down and dedicating the time and energy that it will take to accomplish it. If they don’t have anything to talk about, or are having awkward silence in your time together, try some couple communication exercises, a couple’s retreat, or a joint activity. they can take a dance class or learn a foreign language. Break out of the rut and do something different. By restoring the emotional closeness and intimacy, many couples will notice an improvement in their sex life. Emotional intimacy and sexual intimacy are usually interwoven.

 

Gathering and Compilation by:

Marzieh Ahankoob, (Clinical psychologist, PhD)

The role of childhood trauma on health and diseases

Introduction Traumatic events of the earliest years of infancy and childhood are not lost but, like a child’s footprints …

Depression and physical chronic pain

Depression and physical chronic pain   What is depression? People casually use the phrase, “I’m so depressed!” …

Emotional Divorce

  6 Introduction Emotional Divorce is a psychological mechanism some spouses use when they feel the marriage has become …