Pilot Light

I have been wanted to write a post for such a long time but I have been unable to sit down and find time to write a post. It sounds silly but sometimes I do have to plan, research and then physically find time to write. Sometimes I find the words or an idea and think that would be such a good post but then sadly it does not come to fruition! Since writing this blog I have found stability and I have grown, I no longer suffer from Depression and suffer very little with my anxiety. For what of a better phrase I have lost my role within this blog. When I set out on this venture, this was not only to help at least one person but to find some peace within myself, to put my thoughts, feelings and opinions out into the universe. As I say that I know I have succeeded.

I still have such an enormous passion for mental health and ‘sharing is caring’ rule. Sharing my experiences with mental health has given some insight in how it truly feels and I know has reached a lot of people…more than I ever envisioned would follow my fumbling musings. Some things I still have yet to discuss and talk about some things are kept on the back burner of my little soul, some that I may never discuss…who knows.

But for now, whoever may be reading this know that I have not given up. I am still an advocate wherever and whenever I can,  perhaps not on this platform but in reality.

Nobody is alone when it comes to mental health you just have to find the support that you can and for many online is the first port of call, hence why I began this blog. Just call and I will always be here. When I say call google search. I know plenty of people don’t like looking up illnesses online some may even sarcastically refer to it as ‘DR Google’ but when and if you find this post perhaps know that no matter how unwell you are, how dark, dull and useless you may feel there is always a light at the end of the tunnel. It’s hard to believe right now in this very second but you will find it, you just have to have hope (and perhaps some medical intervention and support). I have been in the the very depths of despair sat alone on a bathroom floor crying, wondering will I ever feel ‘normal’ again and I do, I look back at those moments and think how silly. I can honestly say I am a better person now then perhaps I ever would have been. Every person has darkness and light within their souls irrespective of mental health, so yes I still have days when I am down but the good days outweigh the bad for me now. And if ‘normality’ exists then I have found my normal.

This post as I say may be the ramblings of some person you may never know or will ever meet but, never give up. You are worth it. You can find stability. You can find your normal. No matter what anyone says to you just keep that little pilot light flickering. Do not let it falter or fade out because there is always hope of a better tomorrow and it will come…eventually. Just have hope.

Dissociative Identity Disorder

Dissociative Identity Disorder is the most complex dissociative disorder it is also referred to as multiple personality disorder. This has lead to many seeing the disorder as one to do with personality and thus a personality disorder. However, this disorder is categorised within the ‘dissociative’ disorders of the DSM. The defining feature of this disorder is a severe change in identity.

When a person experiences DID they may experience the shifts in identity as separate personalities. Each identity may be in control of the persons behaviour and thoughts at differing times yet, each has a distinctive pattern of thinking and relating to the world around them. If a person also suffers from amnesia they may not have any memories of what has happened during the shifts in identity. A person whom suffers from DID must have two distinct personality states known as alters to be diagnosed with Dissociative Identity Disorder. 

Diagnostic Features

A. A disruption to ones identity characterised by two or more distinct personalities (in some cultures this may be known as an experience of possession). The disruption in identity involves marked discontinuity in sense of self and sense of agency accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition and/or sensory-motor functioning. This signs and symptoms may be observed by others or reported by the individual.

B. Recurrent gaps in recalling everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.

E. The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Typical Signs and Symptoms

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person’s behavior. With dissociative identity disorder, there’s also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which fluctuate with the person’s split personality.

The “alters” or different identities have their own age, sex, or race. Each has his or her own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals’ behavior and thoughts, it’s called “switching.” Switching can take seconds to minutes to days. When under hypnosis, the person’s different “alters” or identities may be very responsive to the therapist’s requests.

Typical symptoms are:

• feeling like a stranger to yourself
• being confused about your sexuality or gender
• feeling like there are different people within you
• referring to yourself as ‘we’
• behaving out of character
• writing in different handwriting

Causes

While the causes of dissociative identity disorder are still vague, research indicates that it is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9).

Prevalence, Risk and Prognostic Factors

The ISSTD in their updated Treatment Guidelines (2011) place the prevalence of dissociative identity disorder at about 1-3% of the general population. Females with dissociative identity disorder dominate in adult clinical settings. Adult males with dissociative identity disorder may deny their symptoms and trauma histories, and this can lead to elevated rates of false negative diagnosis.

Females with dissociative identity disorder present more frequently with acute
dissociative states (e.g., flashbacks, amnesia, fugue, hallucinations, self-mutilation). Males commonly exhibit more criminal or violent behavior than females; among males, common triggers of acute dissociative states include combat, prison conditions, and physical or sexual assaults.

Due to the nature of DID environment plays a large role with regards to the onset of the disorder; trauma and abusive acts increase the risk of Dissociative Identity Disorders.

 

 

Acute Stress Disorder

…Didn’t have to wait too long for this post..this was one already in the pipeline. It may be beneficial to have a look at my previous post about  ‘Stress‘.

Acute stress disorder is characterised by the development of severe anxiety, dissociation and other symptoms after exposure to a traumatic stressor (read about what constitutes a traumatic experience here). ASD usually occurs within one month post-trauma/ exposure to a traumatic incident. As a response the person may develop a number of symptoms which may contribute to ASD. The presentation of this disorder may vary by individual but typically involves an anxiety response which may include some form of ‘reexperience or reactivity’. However in some individuals a dissociative or detached presentation may dominate. Despite the presentation all individuals will typically display strong emotional or physiological reactivity in  response to traumatic reminders. The full symptom picture must be present for at least 3 days after the traumatic event and can be diagnosed only up to 1 month after the event. Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder.

Diagnostic Criteria

A. Experience Trauma

Exposure to acutual or threatened death, serious injury or sexual violation in one or more of the following ways; directly experiencing the trauma, witnessing in person the events to others, learning the events occured to a close family member or friend, experiencing repeated or extreme exposure to aversive details of the traumatic event for instance; first responders collecting human remains, police officers exposed to details of child abuse).

Note: This does not apply to exposure through electronic media, television, movies,
or pictures, unless this exposure is work related.

B. Symptoms

The diagnostic criteria outlines 9 or more of the following symptoms from the 5 categories to be begin or worsen following the traumatic event.

Intrusion Symptoms;

These symptoms as their title denotes any symptom which is seen to be intrusive to the individual. For instance;

1. Experiencing recurrent, involuntary and intrusive memories of the traumatic event or for children repetitive play may occur where themes or aspects of the event is expressed.

2. Recurrent distressing dreams in which the content or affect of the dream are related to the event. In children this may be frightening dreams without recognisable content.

3. Dissociative reactions (flashbacks) where the individual feels or acts as if the traumatic event was occurring. These reactions may occur continuously with the more extreme expression being a complete loss of awareness of present surroundings. In children reenactments may occur within play.

4. Intense or prolonged psychological distress or reactions in response to internal or external cues which may symbolise or resemble aspects of the trauma.

The recollections are spontaneous or triggered in a response to a stimulus that is reminiscent of the traumatic experience e.g. fireworks may trigger memories of gunshots. These memories often include sensory (sensing heat from a traumatic house fire), emotional (the fear of believing that the individual is about to be raped) or physiological (shortness of breath if the individual suffered from near- drowning). Whilst distressing dreams may contain themes that are representative or thematically related to major threats involved in the traumatic event. For instance, in the case of a motor vehicle accident survivor the distressing dream may involve cars crashing generally.

Negative Mood

Negative mood is solely based on the individuals inability to experience positive emotions for example; happiness, joy or loving emotions.

Dissociative Symptoms 

Dissociation in the DSM is defined as the splitting off of clusters of mental contents from conscious awareness. The term is used to describe the separation of an idea from its emotional significance and affect. These symptoms may;

1. Alter the sense of reality of one’s surroundings and oneself. For example, seeing yourself from another’s perspective, being in a daze or experience time slowing.

2. The individual may be unable to remember important aspects of the trauma which is typically due to dissociative amnesia. Dissociative amnesia occurs when a person blocks out certain information, usually associated with a stressful or traumatic event, leaving him or her unable to remember important personal information. With this disorder, the degree of memory loss goes beyond normal forgetfulness and includes gaps in memory for long periods of time or of memories involving the traumatic event.

Dissociative states may last from a few seconds to several hours, or even days, during
which components of the event are relived and the individual behaves as though experiencing the event at that moment. While dissociative responses are common during a traumatic event, only dissociative responses that persist beyond 3 days after trauma exposure are considered for the diagnosis of acute stress disorder.

Alterations in awareness can include depersonalisation, a detached sense of oneself (e.g.,
seeing oneself from the other side of the room), or derealisation, having a distorted view of
one’s surroundings; perceiving that things are moving in slow motion, seeing things
in a daze.

Avoidance Symptoms

These symptoms directly relate to triggers of the trauma whereby the individual may consciously choose to avoid situations which may remind them of the trauma. These symptoms include efforts to avoid distressing memories, thoughts or feelings and efforts to avoid external reminders (people, places, conversations, activities, objects of situations) which may arouse distressing memories, thoughts or feelings closely associated with the traumatic event.

The individual may refuse to discuss the traumatic experience or may engage in avoidance strategies to minimise awareness of emotional reactions (e.g., excessive alcohol use when reminded of the experience). This behavioural avoidance may include avoiding watching news coverage of the traumatic experience, refusing to return to a workplace where the trauma occurred, or avoiding interacting with others who shared the same traumatic experience.

Arousal Symptoms

These symptoms are related to the individuals arousal of certain physiological aspects. The individual may suffer from sleep disturbance (difficulty falling or staying asleep), irritability and anger outbursts (with little or no provocation) typically verbal of physical aggression towards people or objects, hypervigilance, problems with concentration and exaggerated startle response (being on edge).

Some individuals with the disorder do not have intrusive memories of the event itself,
but instead experience intense psychological distress or physiological reactivity when
they are exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., windy days for children after a hurricane, entering an elevator for a male or female who was raped in an elevator, seeing someone who resembles one’s perpetrator). The triggering cue could be a physical sensation (e.g., a sense of heat for a burn victim), particularly for individuals with highly somatic presentations.

C. Duration

Duration of the disturbance/ symptoms is 3 days to 1 month after trauma
exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.

D. Impairment

The disturbance/symptoms cause clinically significant distress or impairment in social, occupations and/or other important areas of functioning.

E. No Other Causes

The symptoms are not attributable to the physiological effects of a substance or other medical condition and is not better explained by another mental disorder.

Prevalence

The prevalence of acute stress disorder in recently trauma-exposed populations (i.e.,
within 1 month of trauma exposure) varies according to the nature of the event and the
context in which it is assessed.

Risk, Cause and Prognostic Factors

There are psychological and physical reasons for the extreme way some people react to trauma. For example, flashbacks are the brain’s way of determining how best to be prepared should such an experience happen again. The adrenaline the body produces following a trauma is the body’s flight-or-flight response, designed to help you defend against danger. If your trauma was extreme, then this response can stay on and leave you constantly edgy. It’s as if the body expects more danger and can’t relax. But it’s not known exactly why some people develop PTSD and others  experience ASD or stress.

The DSM discusses three areas which account for developing ASD; temperamental, environmental and genetic/physiological factors. With regards to a persons’ temperament risk factors include prior mental disorders, high levels of negative affectivity (neuroticism), greater perceived severity of the traumatic event and an avoidant coping style. Catastrophic appraisals of the trauma characterised by exaggerated appraisals of future harm, guilt, or hopelessness are strong predictors for ASD. Firstly a person must have experienced or been exposed to trauma to present with acute stress disorder. Therefore this is the main focus of environment. However, a history of prior trauma may increase the likelihood of developing ASD. According to the DSM genetic factors of ASD females are at a greater risk for developing this disorder. Sex-linked neurobiological
differences in stress response may contribute to females’ increased risk for acute stress disorder. The increased risk for the disorder in females may be attributable in
part to a greater likelihood of exposure to the types of traumatic events with a high conditional risk for acute stress disorder, such as rape and other interpersonal violence. The cultural bias of males openly discussing mental health may contribute to the over representation of females amongst the sample.

Treatment

As with many mental health conditions accessing the right form of help and assistance is beneficial to alleviating symptoms, coping with the disorder and readjusting important areas of functioning. CBT is seen to be the most effective in treating trauma related illnesses including ASD. It aims to find strategies to help cope with symptoms of ASD such as; relaxation arousal symptoms, cognitive restructuring for avoidance and intrusive symptoms. Desensitisation is also increasingly helpful in coping with intrusion memories and nightmares. Pharmocotherapy has also been found to be helpful in treating ASD and alleviating symptoms. SSRIs can be helpful in dealing with the core symptoms (including anxiety, depression, withdrawal, and avoidance) and can play a central role in longer-term treatment. Beta-blockers may also prove beneficial in treating hyperarousal in ASD sufferers.

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is categorised as a anxiety disorder which is caused by; stressful, frightening or distressing events. These stressors or events can be caused by a multitude of various causes. The diagnostic criteria for this disorder is extensive tries as many mental health disorders to encapsulate, categorise and define a disorder which for each individual person affects them in varying ways.

Now PTSD has been widely portrayed in many media platforms; t.v., film, radio and news articles or reports. Many of these representations focus on the armed forces and combat with due to the distressing events which occur during warfare. However, understanding is coming to depict that anyone experiencing directly or indirectly a ‘stressful’ or ‘traumatic’ event can develop PTSD or show symptoms relating to this disorder.

PTSD akin to many mental health illness can affect people of any race, background, gender and age although children under the age of 6 have a specified list of PTSD differing from the conventional diagnostic criteria.

Diagnostic Criteria

Criterion A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains: police officers repeatedly exposed to details of child abuse).

Note; Criterion A4 does not apply to exposure through electronic media, television,
movies, or pictures, unless this exposure is work related.

Explanation; A person whom develops PTSD can be directly exposed, witnessed (in person) or indirectly by learning of a close friend or relative being exposed to trauma or the person repeatedly experiences extreme exposure to aversive details of the event.

Criterion B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
   Note: In children older than 6 years, repetitive play may occur in which themes or
   aspects of the traumatic event(s) are expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are
   related to the traumatic event(s).
   Note: In children, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if
   the traumatic event(s) were recurring. (Such reactions may occur on a continuum,
   with the most extreme expression being a complete loss of awareness of present
   surroundings.)
   Note: In children, trauma-specific re-enactment may occur in play.
4.  Intense or prolonged psychological distress at exposure to internal or external cues
   that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

Explanation; One of the following symptoms of PTSD is required to fulfil the diagnosis of post-traumatic stress disorder. The person may experience; involuntary, intrusive distressing memories of the event, traumatic nightmares, flashbacks, distress after exposure to traumatic triggers and marked physiological reactions to triggers for example; panic attacks, anxiety related symptoms.

Criterion C; Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about
   or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders (people, places, conversations,
   activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

Criterion D; Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others,
   or the world (e.g., “I am bad,” “No one can be trusted,” ‘The world is completely
   dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic
   event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5.  Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience
   happiness, satisfaction, or loving feelings).

Criterion E; Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behaviour.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

Criterion F; Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

Criterion G; The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion H; The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Prevalence

According to the NHS Choices, one in three people (within the UK) who experience a traumatic event will develop post-traumatic stress disorder. However, it is not fully understood as to why some people progress to PTSD whereas others experience a seemingly “normal” stress response. Initially, symptoms are seen as a ‘normal’ response to an abnormal event but the longevity, effect on a person’s life, associated complications e.g. depression, psychological and physiological stress is where the condition becomes problematic.

Development and Course

PTSD can occur at any age, after the first year of life. Symptoms usually begin within the
first 3 months after the traumatic event. However, there may be a delay of months or years but the criteria for a diagnosis to be met. Frequently, an individual’s reaction to a trauma initially meets criteria for acute stress disorder in the immediate aftermath of the trauma. The symptoms of PTSD and the dominance of certain symptoms develop after a period of time.

Risk and Prognostic Factors

According to the DSM, risk and prognostic factors are three-fold; pre-trauma experience (pretraumatic), during the time of the trauma (peritraumatic) and after the traumatic experience (posttraumatic)

Pretraumatic Factors; 

Temperamental; These include emotional problems during childhood (prior PTSD, anxiety and externalising) and prior mental disorders e.g. panic disorder, depressive disorder or obsessive compulsive disorder.

Environmental; Lower socio-economic status and lower education. Exposure to prior trauma; childhood adversity (economic deprivation, family dysfunction, parental separation or death); cultural characteristics (fatalistic or self-blaming strategies); lower intelligence; minority racial or ethnic status; family psychiatric history. Social support prior to traumatic event is protective.

Genetic and Physiological; These include female gender and younger age at initial exposure to trauma.

Peritraumatic Factors;

Environmental; These include severity of the trauma (magnitude or trauma or likelihood to develop PTSD), perceived life threat, personal injury, interpersonal violence (particularly trauma perpetrated by a caregiver or involving a witnessed threat to a caregiver in children), and, for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy. Finally, dissociation that occurs during the trauma and persists afterwards is a risk factor.

Posttraumatic Factors; 

Temperamental; These include negative appraisals, inappropriate coping strategies,
and development of acute stress disorder.

Environmental; These include subsequent exposure to repeated upsetting reminders, subsequent adverse life events, and financial or other trauma-related losses. Social support (including family stability, for children) is a protective factor that moderates outcome after trauma.

Conclusion

As this is quite a weighty post I thought I would conclude here for now. There is so much written on PTSD and the experience of sufferers/survivors. I am planning on writing a few posts on this topic; explanation of diagnostic criteria, causes and treatments available.

If you are concerned for yourself or a loved one please seek medical help.

The Power of Music

Music has the power to evoke emotions and feelings, transport you to a moment in time, soothe, express and can fleetingly remind you of  various people for various reasons. Music for me well it can do a multitude of things…it can encourage me to write both academically or for pleasure; whilst at university I often listened to music to get me through deadlines and even know I tend to listen to Spotify whilst writing this blog. It can have the power to impede my mood and emotions both positively and negatively.

Whilst on the bus home from shopping a few days ago I put my headphones in; a reaction which comes natural to me nowadays. I tend to listen to my music on shuffle…every song with the ability to invoke emotions, transport me to a particular time or place in my life or remind me of certain people. Now there were songs which I was quick to skip over those which could negatively affect my mood but others I ruminated on…songs which reminded me of Summer, nights out and memories with friends both those which made me smile to recall and those which made me smile to remember those whom were a big part of my life whom sadly are no longer. This got to me thinking why is Music so  influential in a person’s mood, behaviour and emotions…it seems relatively obvious to most people and I am sure that I am not the only person to ponder on this notion.

Whilst reading a book recently music was brought to the forefront of my mind; the book is an autobiographical account of a daughter whom is learning to cope and understand dementia and it’s affects on her mother. She noted that when her mother was feeling uneasy and anxious she could quite quickly change her mood by singing a song which her mother used to sing her when she was a young child. Then when the progression of dementia took over her loving mother, the life and soul of the party where seemingly she had lost her sense of self music had the power to not only bring her back but was found to be a great therapeutic technique for many degenerative diseases such as Dementia. The book didn’t really look into scientific studies but the basic premise was that due to the different areas of the brain which music can affect it would be more likely to cause a reaction and spark the memory which otherwise was compromised. I’ve since lent the book to another person so can’t directly quote what was said but the daughter spoke to a specialist whom stated that due to the differing areas which music can affect; tone, beat, rhythm, lyrics and the memories associated are most likely to affect some area of the brain and can be compelling in seeing a spark of a person pre-symptoms of diseases.

Despite the focus of Dementia surely as I know myself this happens to all of us. I know that; ‘I’ve had the time of my life’ from Dirty Dancing can take me back to my college prom as it was the last song, similarly ‘Sing’ by Gary Barlow and The Military Wives can take me back to my last few days at college- our form tutor played it us on our last day, ‘Come on Eileen‘ invokes memories of irritating my Mum- it’s not her favourite song in the world, ‘Bohemian Rhapsody‘ reminds me of English Literature classes at college- we were studying Paradise Lost by John Milton refers to Beelzebub similarly as Queen does it was sang frequently during our studies of Paradise Lost likewise Colplay’s ‘Paradise‘ in the same vain, any song by Westlife reminds me of my Grandma and conjures memories of her, The Housemartins ‘Caravan of Love‘ takes me back to year 7 we all had to sing a song when we first started at secondary school-that was ours, Queen ‘Crazy Little Thing Called Love‘ and ‘Brown Eyed Girl’ by Van Morrison reminds me of my Aunt and Uncle, ‘Rotterdam‘ by The Beautiful South reminds me of being in Amsterdam with my best-friend, Alicia Keys ‘Empire State of Mind‘ takes me back to Year 9 when we went on a school trip to New York, ‘Build me up Buttercup‘ by The Foundations reminds me of my friends from university, again songs with names in also evoke memories of people which I shall not name as it would be obvious whom they are related to, any Eminem or 50 Cent Song can take me back to going camping with my brother and my Dad, ‘Peanut Butter Jelly‘ by Galantis and David Zowie’s ‘House Every Weekend‘ takes me to my 21st birthday in a sunny field with my two best-friends at Creamfields, ‘Nessun Dorma‘ by Pavorotti, ‘Fast Car‘ by Tracey Chapman and ‘I love it‘ by Icona Pop also conjures images of my best-friend driving when he first got his car, ‘Poker Face‘ by Lady Gaga and ‘My Girl‘ by the Temptations remind me of my Dad and memories associated with him and those songs, ‘Bangerang‘ by Skrillex, ‘Ni**as in Paris‘ by JayZ and Kanye West and ‘212‘ by Azelia Banks takes me to my first year at university, similarly individual songs I have unconsciously paired with people in my life and when those come on they are the person which first comes into my mind for example, a very old song called ‘Waiting at the Church‘ makes me think of my Gran as she has sung it to me numerous times, ‘Let it Go‘ by James Bay and any song my Catfish and the Bottlemen reminds me of someone who also liked those artists and songs and finally, ‘Valerie‘ by Amy Winehouse reminds me of my best-friend’s Grandma who meant a lot to me.

Music has the power to improve, challenge and affect a person’s mood I know one song which I can no longer listen to due to me listening to it when I wasn’t too well- I imagine that it would be difficult to listen to due to the memories and emotions associated with it.I know for me personal upbeat music can empower and energise me to get things done, soothing and calming music does just that, music can also get me in the mood to go on a night out and finally music can also shut you out from the world and forget what’s on the other side of your headphones.

Music and lyrics especially has the power in conveniently puts into words what you cannot express and sometimes seems to explain your life or a part of your life more than you can say.  I by no means am a musical person I can at best press the ‘DJ’ button on a keyboard- a staple of growing up in the UK when having loosely referred to music lessons. I at a time also had singing lessons again ‘Downtown‘ by Petula Clark takes me back to that time in  my life. As you have already figured out I am by no means a singer other than in the shower and when no one is around but music itself if you can play, write or sing (well or otherwise) has the ability to express and free yourself from societal ties which we are all affected by nowadays. Even throughout writing this blog I have lent towards lyrical quotes from songs to explain or portray what I am trying to express.

Now for Music and Mental Health, Mind released information that when listening to music the neurotransmitter Dopamine (the feel-good hormone) is released and volunteers whom listened to music they liked their Dopamine levels were 9% higher in those individuals. Therefore Mind and the researchers carrying out that study are linking music and mental well-being. So music has the power to affect our mood, emotions and behaviours and seemingly is being introduced in the treatment of mental health and has been used in degenerative disease therapies for a while now. So bare in mind that the song your listening to at the moment in 10 years to come you may hear it and it will take you back to this time in your life, a song you sing as a joke like me with ‘Candy Shop‘ by 50 Cent (in a posh voice may I add) or ‘Three Little Birds‘ by Bob Marley will remind others of you and songs you specifically listen to when your down may always have that negative affect on your life so bare it in mind when your next listening to music.

To put it bluntly music has the power to; empathise, express, energise, motivate, soothe, calm, uplift, capture moments and feelings, take you back to a particular time in your life, affect your mood both positively and negatively, and lets face it it makes the world a little more bearable…I do wonder how we would all cope without music…it does really affect a person’s soul doesn’t it? If you really think about it. Now put on a song which makes you think of me – if you need to and know I am with you wherever you are perhaps not in body but in spirit and through the lovely voices of those singing- hopefully you’ve not put some god awful scream music on right now! Let me know what it is! Or just put on Louis Armstrong ‘What a wonderful World’ or Bill Withers ‘Lean on Me‘ I find they are quite uplifting songs- listen to the lyrics.

Good bye for now! 

*Note; I have a very eclectic mix of music tastes and this is just a snapshot of songs which immediately make me think of of time, place or people in my life. Like a walk back through memories getting all the links for the songs.

Further Information;

Mind; http://www.mind.org.uk/information-support/your-stories/why-music-is-great-for-your-mental-health/

News Article; http://www.bbc.co.uk/news/health-12135590

Tremors’; the perks of anxiety

So this post is dedicated to ‘tremors’ a particular symptom that I experienced when suffering from anxiety and still do when I am generally anxious. I have always wondered why when your mind is tormenting you does your body may you look like a fool; sweating, shaking and stuttering etc. But, my friends that’s just how the cookie crumbles…and I will explain why your body does these things further in the post.

What are tremors? 

An ‘essential tremor’ referred to on the NHS Choices website is an uncontrollable, involuntary shake or tremble in a particular part of the body. This can be; hands, legs, lips etc voice tremors in the vocal box (larynx) can also happen. Other areas of the body can be affected but the areas outlined above are most common.

Anxiety and stress cause many different changes in the body, and one of the symptoms of these changes can be tremors. Tremors when relating to anxiety can be disruptive and cause a considerable amount of added stress. A shaking tremor are an extremely common symptom of anxiety and can be caused by multiple reasons. Yet, others may experience cramping, spasms and twitching.

What causes tremors’? 

Adrenaline; The most common link between anxiety and tremors is the hormone adrenaline. Anxiety activates the ‘fight or flight‘ system, this response triggers a rush of adrenaline which feeds our body with the energy to fight or run, it also constricts our blood vessels and feeds our nerves.

All of these can cause our body to start shaking. Most often this shaking is temporary as long as you are experiencing anxiety, although it may last a little while longer as you recover from your anxiety symptoms.

A tremor can also caused by excess adrenaline within our bodies which hasn’t been used effectively and therefore the shaking can also prove to release the excessive energy.

Muscle Tension; Anxiety and stress also causes muscle tension. Muscle tension puts a great deal of strain on your muscles and in some cases this type of tension can lead to unusual muscle movements. Muscle twitching may occur when the muscle is exhausted from stress, leading to a tremor or tremor-like experience.

Vitamin Deficiencies;  Although not entirely common, some theories suggest that anxiety can actually create vitamin deficiencies, particularly magnesium. During times of significant stress, the body uses up magnesium and other minerals. Magnesium, especially, plays a role in nerve function. It’s possible that those with anxiety are more prone to low levels of magnesium, possibly leading to nerve twitching and muscle tremors.

Cognitions; It’s possible that even the mere act of thinking about the tremor can actually cause tremors.

Dehydration;  Dehydration can cause tremors. Generally dehydration is not an anxiety symptom, but anxiety can cause you to sweat more which may exacerbate dehydration, and dehydration itself may lead to an increase in anxiety symptoms, creating a link between the two conditions.

How to control your tremor?

Let me first start of by saying that please seek medical help, as tremors can also be caused by other medical conditions…so it’s always best to first get it checked out.

Controlling tremors can be hard if you have not at first recognised and addressed your anxiety as a whole-what is feeding these anxiety driven thoughts and how can these cognitions and behaviours can be reduced.

However, you can speed up the recovery process by reducing your stress, practising relaxed breathing, increasing your rest and relaxation, and not worrying about this feeling. It can be startling, unsettling and even bothersome. But again, when your body has recovered from the hyper-stimulation of anxiety or stress,the tremors should subside and ease.

Me and My Tremor

So when I was actively anxious I used to get an uncontrollable shaking in my right hand, often it was the first sign that I was starting to get anxious. Now I am able to control my anxiety and for the most part it has gone away when I do get stressed or anxious (generally) it often returns but like I outlined above once the source of stress or anxiety has subsided so to does the tremor. When I first started to experience it, it was worrying it was also confusing me and my diabetes as I was unsure whether it was a symptom of low blood sugar. The tremor occurred before I understood that it was anxiety that I was suffering from.

So, that was a brief little post on a symptom that some of you may experience due to anxiety. Hopefully it has helped you understand why it occurs and how to potentially reduce the likelihood of it affecting your life.

Further Information; 

NHS Choices; http://www.nhs.uk/conditions/Tremor-(essential)/Pages/Introduction.aspx 

Anxiety; https://thegreyareasite.wordpress.com/2015/10/23/anxiety/ and https://thegreyareasite.wordpress.com/2015/11/24/generalised-anxiety-disorder/ and https://thegreyareasite.wordpress.com/2015/11/24/anxiety-disorders/

Images; the presentation of mental health

What I’m discussing tonight?

Similar to my other posts on Depression, Anxiety and OCD. I thought I would look at the presentation of Bipolar Disorder through images shared through social media platforms.

If you are unsure as to what Bipolar is have a look at a more in-depth BLOG post I put together a good few weeks ago.

1. 
   The constant ‘see saw’ that people with Bipolar Disorder may experience. The instability in emotional and mood regulation and of a cyclical disorder.
2. 
   I find this image to be good in displaying the varying often lack of controlled emotions and mood and lets face it the lady seems as if she is moving. Someone with Bipolar Disorder may struggle daily to seem stable and not moving through the ups and downs of emotions and mood.
3. 

This image does it’s best to visually explain many mood disorders and the use of the height of the horse and person riding around the merry go round also is a symbolic of the varying mood disorders; highs, lows and cyclical nature of rapid cycling…moving from moods up and down.

4. 

This MRI scan displays the activity within the brain of a person whom has Bipolar Disorder…I would suggest that this is someone whom endures manic episodes…the over-activity displayed within the red areas of the MRI.

5. 

This artistic image displays the extremity of emotions someone with Bipolar Disorder may experience…the darkness portraying the Depression and the brightly coloured side portraying mania. A visual depiction of Bipolar Disorder.

Only a short post tonight, I am afraid. However, these images I feel portray Bipolar Disorder in some way. Do take a look at the in-depth post if you want to know more about the disorder.

The Struggle is Real

The ever so famous line that has been made popular by social media and stardom not only depicts the sarcasm when the struggle is not necessarily so much of a struggle. I myself as the comedienne that I am have used this line to mark my sarcasm and belittle the monatanous task that I am undertaking e.g. Getting out of bed *note not due to mental health just the struggle from working til 10.30 getting in at 12 and leaving the house again the next day at 6.45…that my friends although is a challenge is not truly a struggle.

A struggle is the infinite knowledge that you yourself tell yourself everyday…that you are not worth the life that you have been given. A struggle is not physically feeling able to get out of bed in the morning and face the day. A struggle is looking in the mirror and hating every inch of your body. A struggle is the irrational thoughts that your brain is telling you, the anxiety you feel, the stupid way your body makes you feel. The struggle is not being able to tell anyone how you feel for fear of stigma and being judged. A struggle is being passed around medical appointments, waiting lists aiming to get a diagnosis but being palmed off on every other person. The struggle is when you feel a burden, to your family and friends. The struggle is truly real when all you can see around you is darkness, pure despair, that’s it just you and the darkness. The struggle is painting a false smile across your face everyday just so you don’t put your problems on others, so you don’t affect someone else’s mood to try and supress the guilt that you may feel if, you open up to that one person. The struggle in this day and age is…mental health in all its entireity; the symptoms, the shame, the stigma, the desolation, the loneliness, the inability to seek help…accurate help at the time that you need it, the guilt, the irrational thoughts…that is truly a struggle.

Now I am not going to say that the struggle that is faced when accepting and understanding mental health is not nearly as overwhelming as the list above, because it is…more so. But, with the right support, the right diagnosis, the waiting for the right care you can no longer feel a burden, guilty and not worthy. You can learn to understand your condition, how it makes you think, feel and behave and you can be a better person on the other side. One with one of the greatest gifts around, empathy, understanding and the ability to truly understand such a complex condition not only from the sufferer but the supporter’s side too.

When I was ‘unwell’ I used to look at motivational quote pictures and a few used to stay in my mind. I even had one as the wallpaper on my phone for a while and eventually got a tattoo surrounding the meaning of another…

Now, motivational quotes aren’t for everyone, and now even looking back they are a little cringey. However, they are well intended words and something that I have drawn strength from many times.

The struggle that you may be facing right now or have faced in the past has made you the person you are today, mostly for the better I am sure. You are stronger. You have so many more skills; empathy, understanding of the most vulnerable people you may come across. And you too could be in the position that I am in now in the future; telling your story, explaining complex diagnostic criteria and potentially helping another person. So, I must tell you yes your struggle may be very real right now but sooner or later; the depression, anxiety, PTSD etc will lift; you will learn to control, understand and cope with your condition and you will be the rainbow, the stars or the flower. You will be someone, someone with a great future, someone with hope, with people whom love you…you are above all worthy to live your life and make the most of the tedious hours and days and those hours and days will add up to be the many days you look back fondly on.

So, if you’re reading this wondering is it your time to tell your story, speak openly about mental health then you probably already know the answer. The more we talk about it the reduction in stigma that is still around today, the easier it is to understand and normalise these conditions that seem foreign and abnormal. By all means continue to use the phrase, ‘the struggle is real’ for the mediocre, comedic benefits but remember that however small you feel your struggle is there is another person somewhere in this world truly suffering.

Words are extremely powerful things, I mean look at the great orators of the world;

Dr Martin Luther King JNR managed to combine nations and races across the world in the attempt of creating and succeeding in equality and ending racial segregation his most famous speech ‘I have a dream‘ is one of the most well known speeches given.

Winston Churchill, was a man of fiery proclamations and great determination. His most famous speeches are his, “Iron Curtain,” and “Their Finest Hour,” to the House of Commons. Churchill was Prime Minister during a time of austerity, war and extreme uncertainty. His speeches although powerful, managed to uniting the people of the UK and supporting nations in resilience, ‘If you’re in hell, keep going.’

Oddly, putting this man next to the others doesn’t seem right…although a man whom created and caused so much devastation to many lives and nations, Adolf Hitler still a man whose words found him to the highest position in the Nazi Party leading them to war, ensuring people followed his obscene demands and one of the most powerful malicious man this world has ever seen.

My point here is to show you how powerful anyone’s words can potentially be; how two lines of a motivational quote were to me in an awful time of my life. Now finding the words, although hard can give you relief, can help another and share what it means to live, recover and understand a mental illness. Just bare it in mind; in the positives and the negatives…your words can mean so much to a person and can cause so much upset. Just use them wisely.

I honestly don’t really know where this post has come from; seemingly I did have a bit to say and hopefully it makes sense…just remember however funny saying something can be, there is always another side to remember…there are  people that may be affected negatively by what you have said. And throughout the struggle of mental health, sometimes the benefits eventually do make you feel that it wasn’t such a bad time in hindsight however, bad you feel at the moment. It will form you into a person someone with empathy and strength and the ability to understand the most inner disorders a person can have.

Reactive Attachment Disorder

Reactive Attachment Disorder (RAD) in it’s most basic explanation is where a child usually under the age of 5 has not formed healthy attachments to their primary caregivers; usually their mother. Failure in these attachments being formed can come from an array of reasons; neglect, abuse, abrupt separation from caregivers through loss of a parent- orphaned, frequent change of caregivers; lack of continuity and stability or the lack of responsiveness from the child’s communicative efforts.

This lack of attachment can affect a child in various ways; the inability to trust others, awareness of others feelings and needs, regulation of emotions and negative self-image. Negative attachments can affect a child’s entire future. Symptoms may show a child as presenting; detached, unresponsive and resistant to comforting, excessively inhibited in withholding emotion and withdrawn or shows clear signs of avoidance.

What is attachment?

Attachment is a deep and enduring emotional bond that connects one person to another across time and space (Ainsworth, 1973; Bowlby, 1969).

Attachment is the emotional bond which is formed between caregiver and infant, it is the means by which a ‘helpless’ infant gets their primary needs met. This subsequently becomes the engine for social, emotional and cognitive development. The early experiences of the infant and attachment helps  to stimulate growth within the brain and shapes emerging mental pathways. It establishes in the infant’s brain the neural pathways that will sculpt what are likely to be lifelong patterns of response to many things. The attachment experience affects personality development and the ability to form stable relationships throughout life.

Diagnostic Criteria for RAD

A. A consistent pattern of inhibited, emotionally withdrawn behaviour toward adult caregivers, manifested by both of the following:

1. The child rarely or minimally seeks comfort when distressed.
2. The child rarely or minimally responds to comfort when distressed.

B. A persistent social and emotional disturbance characterized by at least two of the following:

1. Minimal social and emotional responsiveness to others.
2. Limited positive affect.
3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even
   during non-threatening interactions with adult caregivers.

C. The child has experienced a pattern of extremes of insufficient care as evidenced by
at least one of the following:

1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).

E. The criteria are not met for autism spectrum disorder.

F. The disturbance is evident before age 5 years.

G. The child has a developmental age of at least 9 months.

 Diagnostic Features

RAD in infancy and early childhood is characterised by a pattern of markedly disturbed and developmentally inappropriate attachment behaviours in which a child rarely or minimally turns to a ‘attachment figure’ for comfort, support, protection and nurturance. The essential feature is absent or grossly underdeveloped attachment between the child and care-giving adults. Children with RAD are believed to have the capacity to form selective attachments however, because of limited opportunities during early childhood they fail to show the behavioural manifestations of these attachments. For example, when they are distressed they show no consistent effort to obtain comfort etc from the caregivers. When distressed the child with RAD will not respond more than minimally to the comforting efforts of their caregivers. Therefore, this disorder is associated with the absence of expected comfort seeking and response to comforting behaviours.

Furthermore, children with this disorder show diminished or absent expression of positive emotions during routine interaction with their main caregivers. In addition the regulation of emotions is compromised as the child may display episodes of negative emotions; fear, sadness or irritability that are not able to be explained.

A diagnosis of Reactive Attachment Disorder should not be able to be made to children who are developmentally unable to form selective attachments; therefore, the child must have a developmental age of at least 9 months.

Prevalence, Development and Course

This disorder has been described as ‘extremely rare’ (Metlzer et al. 2005). Skovgaard (2010) a leading researcher of mental health within infancy has estimated prevalence to be 0.9%  in 1.5-year-olds, but prevalence is unknown beyond infancy.

Despite preliminary attempts, large mental health surveys of school-age children have previously been unable to estimate the population prevalence of the disorder because appropriate measures were not available (Meltzer et al. 2005).

The DSM confirms this statement as this disorder is ‘…seen relatively rarely in clinical settings’ (DSM, p266). The disorder is predominantly found in young children exposed to severe neglect before being placed in foster care or raised within social care institutions. However, within the ‘neglected population’ the DSM suggests that the disorder is uncommon occurring in less than 10% of the children under this condition.

Conditions of social neglect is primarily present in the first months of life in children diagnosed with RAD. The clinical features of the disorder manifest in a similar fashion between the ages of 9 months and 5 years. These included are the signs of absent-to-minimal attachment behaviours and associated emotionally aberrant behaviours are evident within children throughout this age range. However, due to cognitive and motor abilities effect how these behaviours are expressed. Without remediation and recovery through normative caring environments, it may appear that the signs of the disorder may persist at least for several years. It is still unclear to whether RAD occurs in older children therefore the DSM advises caution to be taken with children whom are older than 5 years.

Cause of RAD

Neglect; As one may expect neglect of a child in early infancy has the potential to effect how a child forms fulfilling attachments in the future due to a lack of trust and understanding of these relationships.

Lack of consistent caregiver; Also noted is the frequent changes in caregivers therefore children within institutional care such as social services and foster care may contribute to reactive attachment disorder.

Treatment 

Treatment usually comes in two parts;

Part 1; The first goal is to make sure the child is in a safe environment where emotional and physical needs are met.

Part 2; Once that is established the next step is to change the relationship between the caregiver and child. If the caregiver is the problematic area e.g. not meeting the child’s needs classes on parenting may help give the skills required to understand the child’s needs and how to bond with their child.

The caregiver should also receive counselling to work on any current problems such as; drug abuse or family violence.

Parents whom are adopting a child should be aware of this condition and be sensitive to the child’s need for consistency, physical affection and love. These children may be initially frightened of people and find physical affection overwhelming therefore parents should not view this as rejection. It is a normal response in someone whom has been abused or lacked physical contact to avoid contact initially.

The outlines set out in 2005 by the American Academy of Child and Adolescent Psychiatry based on their findings and diagnosis of RAD. Recommendations include;

1. “The most important intervention for young children diagnosed with reactive attachment disorder and who lack an attachment to a discriminated caregiver is for the clinician to advocate for providing the child with an emotionally available attachment figure.”
2. “Although the diagnosis of reactive attachment disorder is based on symptoms displayed by the child, assessing the caregiver’s attitudes toward and perceptions about the child is important for treatment selection.”
3. “Children with reactive attachment disorder are presumed to have grossly disturbed internal models for relating to others. After ensuring that the child is in a safe and stable placement, effective attachment treatment must focus on creating positive interactions with caregivers.”

Boris and Zeenah (2005)

 

Further Information;

Meltzer H, Gatward R, Corbin T, Goodman R & Ford T. (2005) The Mental Health of Young People Looked After by Local Authorities in England. The Report of a Survey carried out in 2002 by Social Survey Division of the Office for National Statistics on behalf of the Department of Health. Department of Health; TSO (The Stationary Office).

Boris NW, Zeanah CH, Work Group on Quality Issues (2005). “Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood” (PDF). J Am Acad Child Adolesc Psychiatry 44 (11): 1206–19. doi:10.1097/01.chi.0000177056.41655.ce.PMID 16239871

PsychCentral; http://psychcentral.com/disorders/reactive-attachment-disorder-symptoms/ 

Dialectical Behavioural Therapy (DBT)

Dialectical Behavioural Therapy is a form of talking therapy similar to that of CBT however, is more adapted to meet the needs of those whom experience emotions intensly. Most commonly this form of therapy is utilised within the UK to treat people whom have Boderline Personality Disorder (BPD).

This form of therapy focuses on helping the individual manage emotions by allowing them to experience, acknowledge, recognise and accept them. As the person learns to regulate their emotions they are in a better position to adapt and change harmful behaviours. To achieve this a dialectical behavioural therapist a person uses a balance of acceptance and change techniques.

History of DBT

DBT was developed in the late 1980’s by American psychologist Marsha Lineham. As a trained behavioural therapist she tried to apply standard CBT techniques the women who were struggling with suicidal ideation, suicide attempts and non-suicidal injury now know as self-harm. However, these CBT techniques were plagued with problems when treating people with these overwhelming urges. In response to these problems Lineham and team made significant modications to the standard CBT treatment. They added acceptance based or validation strategies to the change based approach of CBT. Furthermore, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play.

Dialectics; ‘a method of examining and discussing opposing ideas in order to find the truth’.

Merriam-Webster Dictionary

Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviours. Dialectical strategies and a dialectical world view, which emphasises holism and synthesis, this view enables the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment; therefore improving the treatment for those whom suffer from extreme emotions or BPD.

The difference between CBT and DBT

DBT helps a person change unhelpful thinking patterns and behaviours but places a lot of importance upon accepting the person as they are. This form of therapy also places importance on the relationship between client and therapist as it is used actively to promote positive change.

Goals of DBT

As mentioned previously the goals of DBT is to learn to accept and regulate emotion through the use of balancing therapeutic techniques such as; acceptance and change.

Acceptance techniques helps the individual to understand them as a person and make sense of their behaviours. A DBT therapist may suggest that behaviours that a person may display may have been the only way they learned to deal with the intense emotions that they are feeling; so although these behaviours such as self-harm etc may be damaging, the persons’ behaviour may actually make sense.

Whilst change techniques are used to encourage a person to make a change in their behaviour and learn more effective ways in dealing with their emotions and distress. The DBT therapist may encourage a person to replace harmful behaviours to other behaviours which may encourage the change to take place. For example, distraction techniques may be put in place during times of crisis.

The actual treatment

Standard dialectical behavioural therapy consists of four core elements;

Individual Therapy
This therapy is utilised for the person to understand and gain some control over their behaviour. Usually individual therapy is on a weekly basis which lasts between 40 minutes-1 hour. This is usually goal based and over these sessions you work with the therapist to solve these goals.

Skills training (within a group)
DBT therapists usually offer skills training within group settings; unlike group therapy it is more like coaching or teaching sessions. There are typically four skill modules; distress tolerance- teaching a person how to deal with a crisis in a more effective way, interpersonal effectiveness- teaching a person how to ask for things and have the ability to say no whilst still maintaining self-respect, emotion regulation- a set of skills which can be utilised to be aware, understand and control emotions and mindfulness- a set of skills that help you focus your attention and live your life in the present, rather than being distracted by worries about the past or the future.

Telephone crisis coaching with a therapist
DBT sometimes uses crisis coaching to support an individual in using  skills taught through skills training and utilise them in real-life situations.

A therapist consultation group
Due to the nature of the people whom DBT therapist works with (suicidal ideations, attempts and harmful behaviours) a team of therapist usually meet with each other where they can discuss any problems that have come up during weekly individual sessions. This is a way to share information whilst gaining advice and insight from other professionals which allows them to treat their clients more effectively.

DBT therapy according to MIND website is offered to a person for usually a year to ensure the course of therapy.

Evidence and Effectiveness of DBT

Linehan’s original randomised controlled trial demonstrated efficacy for this form of therapy compared with treatment as usual in reducing the frequency of parasuicidal behaviour, in retaining patients in therapy and in reducing in-patient bed-days (Linehan et al, 1991).

In a further randomised controlled trial (Linehan et al, 1999), dialectical behaviour therapy was shown to be more effective than treatment as usual in reducing drug misuse in a group of patients with borderline personality disorder.

The first replication study by an independent group, although only a small pilot study, provided further support for the efficacy of the model (Koons et al, 2001).

Limitations

Scheel (2000) critiqued DBT and found that there were significant methodological difficulties in the studies presented above. Most studies of efficacy also focused on a small population sample mostly women suffering from BPD or suicidal ideation. Therefore, truly testing the efficacy for other population samples and other illnesses may differ in outcome.

This form of therapy also requires that the DBT therapist is highly trained due to the significant theoretical knowledge required and clinical skills required for it’s application. Therefore implementing these techniques in a broad range of services and of people from various training backgrounds may be difficult (Verheul et al. 2003).

Concern arises as to how long the gains of standard 1-year out-patient dialectical behaviour therapy programmes may last, given that the outcomes in patients given dialectical behaviour therapy and a control group were similar a year after the discontinuation of treatment (Linehan et al, 1993). Research is awaited to ensure the long-term gains of this approach.

Conclusion

This form of therapy seems to be effective in treating people with a focused set of requirements; further research is required to establish if this therapy is effective in treating other illnesses and people outside of the usual population sample. Further independent studies are also required to ensure that researcher biases aren’t involved when ensure the efficacy of such a therapeutic regime.

Below, Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

References; 

MIND; http://mind.org.uk/information-support/drugs-and-treatments/dialectical-behaviour-therapy-dbt/what-is-dbt/#.Vpv0eSqLTIU

Linehan, M. M. (1993a) Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford.

Linehan, M. M. (1993b) Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford.

Linehan, M. M., Armstrong, H. E., Suarez, A., et al (1991)Cognitive–behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48,1060– 1064.

Linehan, M. M., Heard, M. L. & Armstrong, H. E. (1993)Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50, 971– 974.

Linehan, M. M., Schmidt, H., Dimeff, L. A., et al (1999)Dialectical behavior therapy for patients with borderline personality disorder and drug dependence. American Journal of Addictions, 8, 279– 292.

Koons, C. R., Robins, C. J., Bishop, G. K., et al (2001)Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder: a randomized controled trial. Behavior Therapy, 32, 371– 390.

Scheel, K. R. (2000) The empirical basis of dialectical behavioural therapy; summary, critique, and implications.Clinical Psychology: Science and Practice, 7, 68– 86.

Verheul, R., Van Den Bosch, L. M. C., Koeter, M.W. J., et al (2003) Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182,135– 140.