How Career Dreams are Born: Study shows how to convince those with low self-confidence to pursue their career choice

What do you think of this article by Jeff Grabmeier? Published on September 29, 2014 "COLUMBUS, Ohio – A new study shows just what it takes to convince a person that she is qualified to achieve the career of her dreams. Researchers found that it’s not enough to tell people they have the skills or the grades to make their goal a reality. Instead, many people need a more vivid and detailed description of just how pursuing their dream career will help make them successful. This is especially important for people who have the skills and potential to pursue a particular career, but lack the self-confidence, said Patrick Carroll, author of the study and associate professor of psychology at The Ohio State University’s Lima campus. Students who have chronic self-doubt may need an extra boost to pursue the dreams they are certainly able to achieve,” Carroll said. Dr. Patrick J. Carroll Patrick Carroll “This study finds that what they really need is a vivid picture of what will happen if they succeed.” The study was published online this week in the journal Basic and Applied Social Psychology. The study involved 67 undergraduate business and psychology students at Ohio State. The students signed up to meet with a career adviser to learn about a supposedly new master’s degree program in business psychology that would train them for “high-paying consulting positions as business psychologists.” However, the program didn’t actually exist. The goal was to get the students interested in the program, and see how they reacted when faced with varying levels of validation to their new dreams of becoming a business psychologist. (The researchers followed a protocol to help students who may have been disappointed that there wasn’t a real program. More on that below.) All the students read a brochure about the program and then filled out several questionnaires. They were asked to rate their self-confidence that they could become a business psychologist, whether they were excited about the possibility of becoming a business psychologist, whether they thought they could be admitted to the business psychology program and whether they intended to apply. They also reported their overall GPA. The students were then separated into four groups. Students in the control group were given an information sheet indicating no GPA requirement for the program. The other three groups were given sheets indicating the GPA requirement was .10 below whatever they had listed as their own GPA. In one of these groups, the “career adviser” –- who actually worked with the researchers -- simply pointed out that the students’ GPA was higher than the requirement. In another group, the validation was raised slightly: The adviser told the participants that they were exactly what the program was looking for and that it was unlikely they would be rejected if they applied. The last group received the strongest validation to their hopes of becoming a business psychologist: They were also told they were qualified and were unlikely to be rejected if they applied. But the adviser added that it was likely that the student would be accepted with full funding and excel in the program and would graduate with numerous job offers in business psychology. Afterward, the participants once again filled out forms asking how confident and excited they were about becoming a business psychologist and whether they expected they would be admitted. In addition, the students were given the opportunity to actually apply to the program. The results were striking. The students in the control group and those who were simply told their GPA exceeded the program requirements didn’t embrace the possible new goal of becoming a business psychologist. These participants did not show any elevations in self-confidence related to becoming a business psychologist and were unlikely to apply to the program or even ask for more information. Even when students learn that they exceed some external admissions requirement to become a business psychologist, they still have to decide whether that means they should pursue that career dream instead of any others,” Carroll said. “They may need more validation than that to pursue this career goal.” However, when the adviser clearly detailed the vivid prospect of success, the students were willing to embrace the pursuit of that new business psychology goal. Specifically, students given the most vivid validation had higher levels of self-confidence immediately after meeting with the adviser and were more likely to actually apply to the business psychology program. “Self-confidence played a key role here. Students felt more confident that they could really be successful as a business psychologist when they received a detailed picture from their adviser,” Carroll said. Following the study, the researchers thoroughly debriefed all participants on why it was necessary to use deception to study how students, like them, naturally respond to social validation to pursue new career goals. In addition, researchers provided all participants with detailed information on career counseling services that they could utilize on campus for help in making future career choices. This extensive debriefing was designed to remove any adverse influence of the study feedback on participants before they left, Carroll said. After the purpose of the study was explained to them, many participants were enthusiastic about the research and its relevance in revealing how others can shape their own career decisions, he said. Carroll said he sees the relevance of this research nearly every day, as students seek his input about career plans or the possibility of graduate school. “Sometimes students have the grades, the motivation and the ability but simply lack the necessary self-confidence to whole-heartedly invest in the pursuit of a realistic new goal,” he said. “This work shows how parents, teachers and counselors can steer students into the right direction to achieve their dreams.” The findings are especially relevant now as students prepare for an uncertain job market and they, along with their teachers and guidance counselors, try to find the best career choices for them. “Educators are trying to lead students to the most realistic career options,” Carroll said. “This research is important to understanding how students make revisions in their career goals and decide which career possibilities they should embrace.” This research was supported by a grant from the National Institute of Mental Health." For more informatio0n on mental health and social work topics, please visit Aspira Continuing Education and LPC Continuing Education

Most teen mental health problems go untreated

Less than half of teenagers with mental health problems receive any sort of treatment DURHAM, N.C. -- More than half of adolescents with psychiatric disorders receive no treatment of any sort, says a new study by E. Jane Costello, a Duke University professor of psychology and epidemiology and associate director of the Duke Center for Child and Family Policy. When treatment does occur, the providers are rarely mental health specialists, says the study, which was based on a survey of more than 10,000 American teenagers LPC Continuing Education The country's mental health system has come under scrutiny in recent years, following a string of mass shootings, such as the murders at Columbine High in Colorado, in which mental illness seems to have played a role. The new study underlines the need for better mental health services for adolescents, Costello said. "It's still the case in this country that people don't take psychiatric conditions as seriously as they should," Costello said. "This, despite the fact that these conditions are linked to a whole host of other problems." Costello noted that not all teens in the study fared the same. Treatment rates varied greatly for different mental disorders, for instance. Adolescents with ADHD, conduct disorder or oppositional defiant disorder received mental health care more than 70 percent of the time. By contrast, teens suffering from phobias or anxiety disorders were the least likely to be treated. Results also varied greatly by race, with black youths significantly less likely to be treated for mental disorders than white youths. The care that teenagers received also varied greatly. In many cases, care was provided by pediatricians, school counselors or probation officers rather than by people with specialized mental health training. There simply are not enough qualified child mental health professionals to go around, Costello said. "We need to train more child psychiatrists in this country," Costello said. "And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion's share of the work." The study draws on data from the National Comorbidity Survey Adolescent Supplement, a nationally representative face-to-face survey of 10,148 adolescents between the ages of 13 and 17. It was published online Nov. 15 in Psychiatric Services Youth with Co-occuring Substance Abuse and Mental Health Disorders CE Course ### The research was supported by NIDA (grants U01-DA024413, DA011301, and DA022308), NIMH (grant MH083964), and the NIMH Intramural Research Program. CITATION: "Services for Adolescents With Psychiatric Disorders: 12-Month Data From the National Comorbidity Survey–Adolescent," E. Jane Costello, Jian-ping He, Nancy A. Sampson, Ronald C. Kessler and Kathleen Ries Merikangas. Psychiatric Services 2013. doi: 10.1176/appi.ps.201100518

Depression Therapy Effective for Poor, Minority Moms

Faced with the dual demands of motherhood and poverty, as many as one fourth of low-income minority mothers struggle with major depression. But the stigma associated with mental illness coupled with limited access to quality treatment prevent the majority of these struggling women from receiving help. Now a new study shows that screening for the disorder and providing short-term, relationship-focused therapy through weekly home visits can relieve depression among minority mothers, even in the face of poverty and personal histories of abuse or violence. Such help can have far reaching benefits not only for mothers, but also for their children, say the authors. "It's amazing, really," says psychologist Sheree Toth, lead author and executive director of the University of Rochester's Mt. Hope Family Center. "This research tracked a 14-week intervention for mothers who are terribly overwhelmed, surrounded by high-crime neighborhoods, lacking social support, and often traumatized—my fear was, 'this is never going to work.'" But to the surprise of Toth and her Rochester team, the series of convenient, one-hour therapy sessions relieved depression in participants much better than standard clinic-based care. The study participants also continued to improve eight-months after the treatment ended, regaining a sense of hope and control over their lives and reporting feeling more connected to and supported by others. For example, on the Beck Depression Inventory (BDI), a widely used questionnaire in which a score of 19 or above indicates major depression, women in the study group saw their depressive symptoms decline from an average of 27 at the beginning of therapy to 9.6 eight months after the program concluded. By contrast, women who received community care remained clinically depressed, with an average BDI score of 21 at the follow-up.

Women who received home-based interpersonal therapy saw their depression subside by the end of treatment and continue to improve eight months later. Women who received standard care experienced much less relief. The results, says Toth, point to the need for screening high-risk populations. None of these women were seeking treatment, but were identified instead through a questionnaire and an interview at physicians' offices and clinics for the Women, Infants, and Children (WIC) subsidized nutrition program. Says Toth: "When I go to the doctor, they ask me if I use my seatbelt. Why would we not be asking questions about depression when we know the chances of being hit by a car are way less than the chances of being hit by depression? People are suffering needlessly." Published online November 8 in Development and Psychopathology, the findings are good news for mothers and their children alike. "Extensive research has shown that young children whose primary caregivers are depressed often begin life on the wrong foot," explains Toth. "They may fail to develop secure attachments, setting them up for a cascade of difficulties, from behavior problems during childhood and failure in school to involvement in the juvenile justice system and major psychiatric problems down the road." Despite the widespread prevalence of depression among minority mothers, researchers have largely overlooked this vulnerable population. "In fact, studies that formed the empirical base for the American Psychiatric Association guidelines for depression treatment included 3,860 participants, with only 27 identified as African American and none as being of Latina descent," the authors write. To address the imbalance, the researchers tracked 128 low-income mothers of one-year-olds, 60 percent of whom were Black, 20 percent Hispanic, and 20 percent Caucasian. In addition to poverty, the vast majority of these mothers faced extensive life challenges. All but 6 percent had been depressed for more than a year, 87 percent reported histories of child abuse, 30 percent had been raped or sexually assaulted by a relative, and 27 percent suffered from posttraumatic stress disorder. The study tested the effectiveness of interpersonal psychotherapy, a short-term depression treatment that has worked with more advantaged populations. "A big part of this approach is instilling hope," says Robin Sturm, a co-author and one of the family therapists who worked on the study. She and other therapists first help clients recognize that feelings, such as a lack of energy or motivation, are symptoms of depression not signs of laziness or other character flaws. "If they can separate themselves from the symptoms, it helps them see that they can get better," says Sturm. The bulk of the intervention then focuses on identifying and easing one or two key relationship problems in clients' lives. This could be overcoming the loss of a loved one, reconnecting with a family member, or learning how to resolve conflicts with a partner. Using a variety of tools, from role-playing to analyzing arguments, participants practice more effective ways to interact. "The aha moment is when these women realize, 'I have a sense of control,'" says Sturm. "Perhaps there is domestic violence. They can't control what the other person does, but they can control what they do. That stuck feeling is the hallmark of depression." A critical element of the study model was to offer therapy in clients' homes, an option chosen by 85 percent of participants. "It sends a powerful message that I am willing to come to you," explains Sturm, who, if needed, also met with clients in her car or drove them to the clinic for their appointment. "When people are depressed, it may be too hard to have the energy to make it to appointments," she says. The program's flexibility also reduced the need for childcare and transportation, resulting in a compliance rate of 100 percent, the authors report. Therapists were also sensitive to the stigma of mental illness in minority communities. If clients appeared uncomfortable with a diagnosis like depression, therapists used terms like overwhelmed or moody instead and stressed that such feelings were common for parents faced with the demands of childrearing. Instead of therapy, they sometimes describe their appointments as "spending some time talking about how you are feeling." The program involved no anti-depressants or other medication, further distancing the intervention from psychiatric care, says Sturm. To assess the effectiveness of this flexible, problem-solving approach, the study randomly assigned a second group of mothers to standard community care, matched by race, education, age, and other factors. The control group received clinic-based counseling or cognitive behavior therapy, a common short-term treatment for depression, along with a variety of other interventions, including medication, support groups, and marital and family counseling. The comparison was clear: home-based, interpersonal psychotherapy lifted depression much more effectively than standard care. The findings underscore the importance of actively screening and offering culturally sensitive, convenient care for our most vulnerable populations, says co-author Fred Rogosch, associate professor of psychology at the University of Rochester and director of research for Mt. Hope Family Center. In one clinical trial, 83 percent of low-income young minority women referred for treatment for depression did not attend even one session. "Most of these women don't even like to talk about depression. Most of these women would never have asked for treatment," says Rogosch. "When I go to the doctor, they ask me if I use my seatbelt," says Sheree Toth. "Why would we not be asking questions about depression when we know the chances of being hit by a car are way less than the chances of being hit by depression? People are suffering needlessly." "We also are concerned about the children of mothers who feel isolated, helpless, and angry. That is not the ideal emotional environment for infants and toddlers to grow up in. Reaching out to these mothers is critical for their children," says Rogosch. Even with the creative accommodations offered in this study, Rogosch notes that 40 percent of mothers identified as depressed declined all care. The authors suggest that future research should explore ways to make the interview process even more welcoming. Assaf Oshri and Julie Gravener from the University of Rochester and Antonio Alexander Morgan-López from the University of North Carolina at Chapel Hill also contributed to the paper. The research was supported by the National Institutes of Mental Health, grant MH091070 LPC Continuing Education About the University of Rochester The University of Rochester (www.rochester.edu) is one of the nation's leading private universities. Located in Rochester, N.Y., the University gives students exceptional opportunities for interdisciplinary study and close collaboration with faculty through its unique cluster-based curriculum. Its College, School of Arts and Sciences, and Hajim School of Engineering and Applied Sciences are complemented by its Eastman School of Music, Simon School of Business, Warner School of Education, Laboratory for Laser Energetics, School of Medicine and Dentistry, School of Nursing, Eastman Institute for Oral Health, and the Memorial Art Gallery.

For some women, genes may influence pressure to be thin

EAST LANSING, Mich. — Genetics may make some women more vulnerable to the pressure of being thin, a study led by Michigan State University researchers has found. From size-zero models to airbrushed film stars, thinness is portrayed as equaling beauty across Western culture, and it's an ideal often cited as a cause of eating disorder symptoms in young women. The researchers focused on the potential psychological impact of women buying into this perceived ideal of thinness, which they call thin-ideal internalization. Changes in self-perception and behavior, caused by this idealization, can lead to body dissatisfaction, a preoccupation with weight and other symptoms of eating disorders. "We're all bombarded daily with messages extoling the virtues of being thin, yet intriguingly only some women develop what we term thin-ideal internalization," said Jessica Suisman, lead author on the study and a researcher in MSU's Department of Psychology. "This suggests that genetic factors may make some women more susceptible to this pressure than others." To explore the role of genetic factors in whether women "buy in" to the pressure to be thin, the idealization of thinness was studied in sets of twins. More than 300 female twins from the MSU Twin Registry, ages 12-22, took part in the study. Suisman and colleagues measured how much participants wanted to look like people from movies, TV and magazines. Once the levels of thin idealization were assessed, identical twins who share 100 percent of their genes were compared with fraternal twins who share 50 percent. The results show that identical twins have closer levels of thin idealization than fraternal twins, which suggests a significant role for genetics. Further analysis shows that the heritability of thin idealization is 43 percent, meaning that almost half of the reason women differ in their idealization of thinness can be explained by differences in their genetic makeup. In addition to the role of genes, findings showed that influences of the environment are also important. The results showed that differences between twins' environments have a greater role in the development of thin ideal internalization than wider cultural attitudes, which women throughout Western societies are exposed to. "We were surprised to find that shared environmental factors, such as exposure to the same media, did not have as big an impact as expected," Suisman said. "Instead, non-shared factors that make co-twins different from each other had the greatest impact." Although the study did not look at specific environmental triggers, non-shared environmental influences typically include experiences that twins do not share with one another. This could include involvement by one twin in a weight-focused sport like dance, one twin being exposed to more media that promotes thinness than the other, or one of the twins having a friendship group that places importance on weight. "The take-home message," Suisman said, "is that the broad cultural risk factors that we thought were most influential in the development of thin-ideal internalization are not as important as genetic risk and environmental risk factors that are specific and unique to each twin." Kelly Klump, MSU professor of psychology and co-author on the study, said it is well established that a broad range of factors can contribute to the development of eating disorders LPC Continuing Education "This study reveals the need to take a similar approach to the ways in which women buy in to pressure to be thin, by considering how both genetic and environmental factors contribute to the development of thin-ideal internalization," Klump said. ### The study, funded by the National Institute of Mental Health, appears in the International Journal of Eating Disorders. Co-authors include Shannon O'Connor, Alexandra Burt and Cheryl Sisk from MSU; Steffanie Sperry and Kevin Thompson from the University of South Florida; Pamela Keel from Florida State University; Michael Neale from Virginia Commonwealth University; and Steven Boker from the University of Virginia.

Girls with ADHD more prone to self-injury, suicide as they enter adulthood

Visible symptoms can go undercover, UC Berkeley psychologists find Girls with Attention Deficit Hyperactivity Disorder (ADHD) – and their families – often look forward to the likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women. However, new findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide LPC continuing education "Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood. "Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound," he added. The study is published today (Tuesday, August 14) in the Journal of Consulting and Clinical Psychology. Its results are consistent with earlier findings by the UC Berkeley team that, as girls with ADHD grow older, they show fewer visible symptoms of the disorder, but continue to suffer in hidden ways. The findings challenge assumptions that girls can "outgrow" ADHD, and underscore the need for long-term monitoring and treatment of the disorder, Hinshaw said. The longitudinal study, which began when the girls were ages 6 to 12, is funded by grants from the National Institute of Mental Health. Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood. In addition to this new study, many others have been published by the team about the girls every five years. In the United States, more than 5 million children ages 3-17 – approximately one in 11 – have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is characterized by poor concentration, distractibility, hyperactivity, impulsiveness and other symptoms that are inappropriate for the child's age. Evidence-based treatment includes stimulant medications and various forms of behavior therapy. The new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged the symptoms of two major ADHD subtypes: Those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity. The study's major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said. "A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm … Impulse control problems appear to be a central factor," the study said. In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely monitored as they partook in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants did not know which of them had been diagnosed with ADHD. That study found that girls with ADHD were more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. The five-year follow-up study, when the girls were 12 to 17 and experiencing early to mid-adolescence, found that the fidgety and impulsive symptoms tended to subside in the early teen years, but that the learning gap between girls with ADHD and their non-ADHD peers had widened, and eating disorders and substance abuse had surfaced. For the latest study, in which 95 percent of the original sample of girls participated, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior. Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions. While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said. "The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood," the study concluded. "Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood." That said, Hinshaw added, "ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years." ### In addition to Hinshaw, authors and researchers of the study are Elizabeth Owens, Christine Zalecki, Emily Schrodek and Erika Swanson at UC Berkeley; Suzanne Perrigue Huggins at the University of Maryland and Adriana Montenegro-Nevado at Palo Alto University

A Peek into the Hoarding Brain

Brain Hubs Boil when Hoarders Face Pitching Their Own Stuff Under-Activate when Making Decisions about Others’ Possessions In patients with hoarding disorder, parts of a decision-making brain circuit under-activated when dealing with others’ possessions, but over-activated when deciding whether to keep or discard their own things, a NIMH-funded study has found. Brain scans revealed the abnormal activation in areas of the anterior cingulate cortex and insula known to process error monitoring, weighing the value of things, assessing risks, unpleasant feelings, and emotional decisions. NIMH grantee David Tolin, Ph.D., of Hartford Hospital, and colleagues, report on their functional magnetic resonance imaging (fMRI) study in the August 2012 issue of the journal Archives of General Psychiatry. Hoarding disorder, a proposed diagnosis under DSM-V, is characterized by avoidance of decision-making about possessions. The new findings pinpoint brain circuit activity suspected of underlying the lack of self-insight, indecisiveness, sense that the wrong decision is being made, inflated estimates of the desirability of objects, and exaggerated perception of risk that are often experienced with the disorder. In the study, brain activity of 43 hoarding disorder patients was compared to that of 31 obsessive compulsive disorder (OCD) patients and 33 healthy controls while they had to decide whether to keep or discard their own or others’ junk mail and newspapers. Notably, such ownership did not appear to differentially affect brain activity in the OCD patients. Hoarding disorder patients, as expected, decided to keep many more items than the other groups. The implicated brain areas are hubs of a “salience network” that weighs the emotional significance of things and regulates emotional responses and states. Hoarding patients’ severity of symptoms, self-ratings of indecisiveness, and feeling of things being “not just right” were correlated with the degree of aberrant activity in these hubs. The results add to evidence of impaired decision-making in hoarding disorder and may help to disentangle its brain workings from those of OCD and depression. Anterior cingulate cortex (center) over-activated when hoarding disorder patients had to decide whether to keep or discard their own possessions; it under-activated during decision-making about others’ possessions. The left and right insula (upper left and right) similarly differentially activated in hoarding disorder patients during this task. Picture shows fMRI data superimposed on structural MRI scan LPC Continuing Education Source: David Tolin, Ph.D., Hartford Hospital Reference Neural Mechanisms of Decision Making in Hoarding Disorder Tolin DF, Stevens, MC, Villavicencio AL, Norberg MM, Calhoun VD, Frost RO, Steketee G, Rauch SL, Pearlson GD. Arch Gen Psychiatry. 2012;69(8):832-841. doi:10.1001.

Psychologists Stress the Importance of Memory in Preventing Relapse after Therapy

Addictions, phobias, post-traumatic stress disorder—such painful and harmful problems are recalcitrant to treatment. In the clinic, a person may suppress the association between the stimulus and the response—say, a bar with ashtrays and smoking—by learning to pair the stimulus with a new memory not involving smoking. But once out in the world, faced with bars and ashtrays aplenty, he relapses into the old behavior. Some treatment aims at helping the patient avoid locations and stimuli that trigger the harmful behavior LPC Continuing Education

A new article in Current Directions in Psychological Science, a journal published by the Association for Psychological Science, says this is not the most effective route. “The therapist really has little control over the context in which the patient finds himself,” says Ralph R. Miller, distinguished professor of psychology at the State University of New York at Binghamton, who wrote the article with SUNY colleague Mario A. Laborda. A more promising method, then, is: “Make the treatment memory stronger.”

Experimentalists like the authors use the term “extinction” for the process, as Miller puts it, of “teaching the subject new memories that oppose the old memories.” Clinicians call it “exposure therapy.”

The article reviews the psychological literature supporting four ways to make the extinction memory stronger and therefore more enduring: Give more therapy (or in the experimental context, more trials). Conduct the therapy in different locations and contexts—for instance, different rooms rather than always the same office. Space the extinction exercises—or in the lab, the experimental trials—over the therapeutic session. And finally, provide the treatment sessions separated by more time. These methods exploit established principles of learning: that increased practice enhances learning, and “spaced practice results in better memory than when the learning trials are massed,” says Miller.

Miller stresses the importance of animal laboratory research in finding new treatment methods. “We are developing excellent means in the animal lab to model human psychopathology, not just for screening drugs but for screening behavioral treatments. We additionally now have models of the treatment and the limitations of the treatments,” he says. Determining how to reduce those limitations using rats rather than humans is faster and requires fewer subjects, he says. Numerous clinical studies, moreover, “certify that our findings with rats also apply to humans.”

The research cited in Miller and Laborda’s paper is suggestive of a powerful theory: “It appears that memories are forever,” says Miller. It then ratifies those proven facts about learning. “We are providing alternate memories that compete with the deleterious memory”—say, a new, automatic mental image of having a drink and a conversation in a bar without picking up a cigarette, perhaps accompanied by a feeling of relaxation. “The trick is that the newer memory when it is retrieved will be stronger than the deleterious memory.”

Current Directions in Psychological Science, a journal of the Association for Psychological Science, publishes concise reviews on the latest advances in theory and research spanning all of scientific psychology and its applications. For a copy of "Preventing Recovery From Extinction and Relapse: A Product of Current Retrieval Cues and Memory Strengths"

Social Phobia Patients Have Heightened Reactions to Negative Comments

In a study using functional brain imaging, NIMH scientists found that when people with generalized social phobia were presented with a variety of verbal comments about themselves and others ("you are ugly," or "he's a genius," for example) they had heightened brain responses only to negative comments about themselves. Knowledge of the social cues that trigger anxiety and what parts of the brain are engaged when this happens can help scientists understand and better treat this anxiety disorder. LPC Continuing Education
Background

Generalized social phobia (GSP) is the most common of all anxiety disorders. It is marked by overwhelming anxiety and self-consciousness in social situations. One approach to understanding anxiety disorders is to use functional brain imaging (fMRI) to explore how the brain responds to different types of social signals. fMRI can provide information on the relative activity—and thus the engagement—of different parts of the brain by tracking the local demands made for oxygen delivered by circulating blood. Scientists using this technology have reported, for example, that people with GSP have heightened responses to a variety of positive, negative, and neutral facial expressions, not just expressions that others perceive as threatening.

Results of this Study

People with GSP had heightened responses to negative comments (relative to a comparison group without the disorder) in two brain areas: the first, the medial prefrontal cortex (MPFC), is involved in the sense and evaluation of self; the second, the amygdala, is central to emotional processing. The responses revealed by scanning paralleled the participants' self-report of how they felt after seeing the various positive, negative, and neutral comments presented.

Significance

This work, conducted by NIMH intramural investigators Karina Blair, Ph.D., Daniel Pine, M.D., and colleagues, provided information on the specific social cues that trigger anxiety in people with GSP. It adds to previous evidence that the amygdala is involved and, in implicating the MPFC, gives clues for further research to explore on how people with GSP interpret social cues. Functional brain scanning can thus help to define patterns of brain functioning that underlie anxiety disorders, providing information that can inform treatment.

What's Next?

A previous study by these investigators found that the reaction of the brain to facial expressions was different in people with GSP than in those with general anxiety disorder (GAD). This suggests that the two disorders do not represent mild and severe forms in a single spectrum of anxiety disorders, but two neurologically different disorders.

Continuing research will reexamine these differences to see if they occur across different tasks, providing confirmation for understanding them as different disorders, which could lead to more targeted and effective forms of treatment for each disorder. Future studies will also explore more deeply the nature of the thought process underlying the reaction of people with GSP to negative comments about themselves and the interaction of the amygdala and MPFC. Finally, brain scanning offers a means to study the effects of treatment; scanning can, for example, provide information on the effects of medications in these parts of the brain.


Left amygdala (left) and medial prefrontal cortex (circled in yellow, right) activated strongly in people with social phobia (in comparison to those without GSP) in response to criticism of themselves.

References
Blair, K. et al. American Journal of Psychiatry. 2008 Sep;165(9):1193-202. Epub 2008 May 15. PMID: 18483136

Blair, K. et al. Archives of General Psychiatry. 2008 Oct;65(10):1176-1184.

Key Molecule in Inflammation-Related Depression Confirmed

Scientists have confirmed the role of an immune-activated enzyme in causing inflammation-related depression-like symptoms in mice. The work clarifies how the immune system can trigger depression and, more broadly, demonstrates the potential of this animal model for exploring the relationship between chronic inflammation—a common feature of diseases such as heart disease, cancer, and diabetes—and depression. LPC Continuing Education
Background

When an individual is infected with viruses or bacteria, cells of the immune system respond by secreting proteins called cytokines. These cytokines not only trigger inflammation and orchestrate the body's immune response against the infection, but they also cause changes in behavior, such as fatigue and withdrawal. Beyond these commonly experienced behavioral signs of illness, previous research has shown that cytokines can also cause depression in people with physical illnesses but who have no prior history of mental illness. For instance, around one-third of patients receiving the cytokine interferon-α for treatment of cancer or hepatitis C develop major depression. Clinical evidence has suggested that an enzyme (IDO) activated by these same cytokines might be a key player.

This Study

In this work, scientists used a weakened form of the tuberculosis relative, bacille Calmette-Guérin (BCG), to model chronic inflammation. This strain of bacteria is used outside the U.S. as a vaccine for tuberculosis. Infection of mice with high doses of BCG persistently activates the immune system; as a consequence, the mice develop depressive-like behavior after initial signs of illness have subsided. This study demonstrated that mice in which the gene for IDO is knocked out, or in which IDO is chemically blocked, do not exhibit depressive-like effects. The authors conclude that IDO is a necessary step in the development of this immunity-related depression.

Significance

The compound used in this work to block IDO may have potential as a treatment for depression in instances when immunotherapy such as interferon-α is used. In addition, chronic, low-grade inflammation is a feature not only of infectious diseases, but conditions like cancer, diabetes, obesity, and heart disease. Depression co-occurs frequently with these common diseases and is associated with poorer prospects for future health. Work in this animal model has the potential to provide insight into the role of chronic inflammation in precipitating depression that is often associated with these chronic conditions.

Scientists at the University of Illinois, Urbana-Champaign, led by Jason O'Connor, Robert Dantzer, and Keith Kelley, conducted this work with collaborators at the Centre National de la Recherche Scientifique, Bordeaux, France, and Miles Herkenham at the National Institute of Mental Health. The National Institute of Mental Health and the National Institute on Aging funded this research.

What's Next

The use of BCG in this mouse model offers a means to explore the molecular cascade induced by IDO that leads to inflammation-associated depression. The exact mechanism by which IDO causes these depressive behaviors is not yet clear; exploration of the downstream effects of IDO may provide additional avenues for developing approaches to blocking the development of immune-related depression.

Reference
O'Connor, J.C., Lawson, M.A., Andre, C., Briley, E.M., Szegedi, S.S., Lestage, J., Castanon, N., Herkenham, M., Dantzer, R., and Kelley, K.W. Induction of IDO by Bacille Calmette-Guerin Is Responsible for Development of Murine Depressive-Like Behavior. Journal of Immunology 2009 Mar 1;182(5):3202-12. PMID: 19234218

Autism Intervention for Toddlers Improves Developmental Outcomes

Children with autism who receive a high intensity developmental behavioral intervention starting by age 18-30 months show major improvements in IQ, language, adaptive behavior, and severity of their diagnosis, according to an NIMH-funded study. Continuing Education for Counselors

Background
Current guidelines by the American Academy of Pediatrics recommend screening children for autism spectrum disorder (ASD) by age 18 months. However, no randomized clinical trials of intensive interventions for this age group had been conducted.

To address this gap, Geraldine Dawson, Ph.D., who was at the University of Washington at the time of the study, and colleagues randomly assigned 48 children, ages 18-30 months, to one of two intervention groups:

Early Start Denver Model (ESDM), a comprehensive, developmental behavioral intervention designed for toddlers with ASD as young as 12 months old. ESDM combines aspects of applied behavioral analysis (ABA) with developmental and relationship-based approaches.
Assess and Monitor (A/M), the comparison group intervention in which parents received recommendations on ASD interventions for their children, as well as referrals to local community providers of the interventions. A/M represents typical community-based care.
Children in the ESDM group were provided 20 hours per week of therapy from study clinicians, while their parents received related training to use ESDM strategies for at least five additional hours per week during their daily activities. Parents of all study participants were also free to receive other community services they thought appropriate.

All children in the study had been diagnosed with autism or a milder form of ASD called pervasive developmental disorder not otherwise specified (PDD-NOS). They were assessed yearly for two years or until the child turned four years old, whichever was longer.

Results of the Study
By the first- year assessment, children in the ESDM group gained 15.4 IQ points on average, while children in the A/M group gained an average of 4.4 points.

Over the two-year study period, children in the ESDM group consistently improved on measures of communication skills. They also showed improvements in motor skills, daily living skills, and other adaptive behaviors.

While children in the ESDM group were significantly delayed in their adaptive behaviors compared to typically developing children, they showed similar rates of improvement. In contrast, children in the A/M group fell further and further behind over time.

By the end of the study, more children who had received ESDM received improved diagnoses than children in the A/M group—seven children initially diagnosed with autistic disorder had their diagnosis change to PDD-NOS after receiving ESDM (30 percent), compared to only one child in the A/M group (5 percent).

Significance
According to the researchers, this is the first randomized controlled trial to study a potentially useful intensive intervention for very young children with ASD.

The study's findings suggest that ESDM can help children with ASD achieve better outcomes in terms of IQ, language, and behavioral skills, and in severity of their ASD diagnosis, than if they receive community-based care. Compared to research on other, similar interventions, this study showed greater differences between groups, suggesting that ESDM, delivered at a very young age, may be more effective than other approaches. The researchers noted that parents' use of ESDM strategies at home may have been key to this intervention's effectiveness.

What's Next
The University of Washington research team has been funded through the NIH Autism Centers of Excellence (ACE) program to follow this study's participants to determine whether the effects of ESDM can be sustained over time. In addition, Dr. Sally Rogers, Ph.D., a co-author on the study and co-developer with Dr. Dawson of the ESDM model, is leading a multi-site, randomized clinical trial of ESDM, also funded through the NIH ACE program. With a larger sample size, the investigators hope to better understand factors that predict level of response to the ESDM intervention.

Reference
Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics. 2009 Nov 30. [Epub ahead of print] PubMed PMID: 19948568.

Runaway Vigilance Hormone Linked to Panic Attacks

Translational Experiments in Rats, Humans Suggest New Medication Target
A study has linked panic disorder to a wayward hormone in a brain circuit that regulates vigilance. While too little of the hormone, called orexin, is known to underlie narcolepsy, the new study suggests that too much of it may lead to panic attacks that afflict 6 million American adults. LPC Continuing Education
"Targeting the brain's orexin system may hold promise for a new generation of anti-anxiety treatments," said Thomas R. Insel, M.D., Director of the National Institute of Mental Health (NIMH), part of the National Institutes of Health. "This is a good example of how translational experiments in rats and humans can potentially yield clinical benefits."

NIMH grantee Anantha Shekhar, M.B., Ph.D., and colleagues at Indiana University and Lund University, report on their findings online Dec. 27, 2009 in the journal Nature Medicine. They showed that blocking orexin gene expression or its receptor prevented panic attack-like responses in rats. The study also revealed that panic disorder patients have excess levels of the hormone.

Background
Orexin, also called hypocretin, is secreted exclusively in a circuit emanating from the brain's hypothalamus, known to regulate arousal, wakefulness and reward.

Panic attacks can be experimentally-induced by infusing susceptible humans with a normally innocuous salt called sodium lactate. The salt similarly triggers panic-like anxiety behaviors in susceptible rat strains, suggesting that something is altered in their arousal circuit. Since sodium lactate activated orexin-secreting neurons in panic-prone rats but not in control rats, the researchers hypothesized that something might be orexin.

Results of This Study
The investigators first discovered that increased gene expression in orexin-secreting neurons correlated with increases in anxiety-like behavior in panic-prone rats following sodium lactate infusions. Using a technique called RNA interference, they then protected the panic-prone rats from developing anxiety behaviors following the infusions by first injecting them with a genetically-engineered agent that prevented orexin genes from turning on. Blocking orexin receptors with a drug that specifically binds to it also blocked the anxiety like behavior following the infusions. This mirrored effects, seen in both rats and humans, of benzodiazepine medications used to treat panic disorder.

The excess sleepiness of narcolepsy, traced a decade ago to loss of orexin-secreting neurons in the arousal circuit, might seem to be an opposite state of a panic attack. However, the researchers demonstrated in rats that such sedation could not account for orexin's effects on anxiety. Also in rats, they traced orexin neurons to their end target to pinpoint the specific brain site that accounts for the anxiety effects, disentangled from cardio-respiratory components of the panic response.

Finally, by measuring orexin in cerebrospinal fluid of 53 patients, the researchers showed that those with just panic disorder had higher levels of orexin than those with both panic disorder and depression.

Significance
Taken together, these results and other evidence suggest a critical role for an overactive orexin system in producing panic attacks, say the researchers.

What's Next?
Medications that block the orexin receptor may provide a new therapeutic approach for the treatment of panic disorder, they add.

The research was also supported, in part, by NIH's National Center for Research Resources.

Reference
A key role for orexin in panic anxiety. Johnson PL, Truitt W, Fitz SD, Kelley PE, Dietrich A, Sanghani S, Traskman-Bendz L, Goddard AW, Brundin, L, Shekhar A. Nature Medicine. Epub 2009 Dec 27.

National Survey Confirms that Youth are Disproportionately Affected by Mental Disorders

About 20 percent of U.S. youth during their lifetime are affected by some type of mental disorder to an extent that they have difficulty functioning, according to a new NIMH survey published in the October 2010 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The data support the observation from surveys of adults that mental disorders most commonly start in early life. CCS Continuing Education
Background
Many regional surveys conducted in the United States have indicated that about one in four to five children experience a mental disorder sometime in their life. But until now, no nationally representative surveys had been conducted to determine if these prevalence rates of a wide range of mental health problems hold true across the nation.

Kathleen Merikangas, Ph.D., of NIMH and colleagues analyzed data from the National Comorbidity Study-Adolescent Supplement (NCS-A), a nationally representative, face-to-face survey of more than 10,000 teens ages 13 to 18. They used standard diagnostic criteria set by the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) to determine lifetime prevalence of mental disorders among the teens. To follow up on the teens' responses, they also collected data via mailed questionnaires completed by one parent or guardian of each teen surveyed.

Results of the Study
Overall, nearly half of the sample reported having met diagnostic criteria for at least one disorder over a lifetime, and about 20 percent reported that they suffered from a mental disorder with symptoms severe enough to impair their daily lives. In addition,

11 percent reported being severely impaired by a mood disorder (e.g., depression or bipolar disorder),
10 percent reported being severely impaired by a behavior disorder such as attention deficit hyperactivity disorder or conduct disorder,
8 percent reported being severely impaired by at least one type of anxiety disorder.
In addition, about 40 percent of those who reported having a disorder also met criteria for having at least one additional disorder. Those with a mood disorder were more likely than others to report having a coexisting disorder. Underscoring the notion that mental disorders manifest early in life, the researchers also found that symptoms of anxiety disorders tended to emerge by age 6, behavior disorders by age 11, mood disorders by age 13, and substance use disorders by age 15.

The researchers also noted strong links between parental characteristics and their teen's disorders. For example, children of parents with less education (e.g., no college degree) were at an increased risk for having any kind of mental disorder. And compared to teens with married or cohabiting parents, those with divorced parents also were at higher risk for a disorder, especially anxiety, behavior and substance use disorders.

Significance
The NSC-A results provide a broader and longer-term outlook compared with last year's National Health and Nutrition Examination Survey (NHANES), which asked respondents about diagnosed disorders and service use within a 12-month window only, and was limited to six disorders.

According to the NCS-A researchers, the percentage of youth suffering from mental disorders is even higher than the most frequent major physical conditions in adolescence, including asthma or diabetes. The results reiterate the importance of developing prevention strategies and promoting early intervention for at-risk children and adolescents.

What's Next
More research is needed to better understand the risk factors for developing a mental disorder in youth, as well as how to predict which disorders may continue into adulthood. In addition, the researchers acknowledge the need for more prospective research to tease apart the complex interplay among socioeconomic, biological and genetic factors that may contribute to the development of mental disorders in youth.

Reference
Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry. 2010 Oct. 49(10):980-989.

Managing Stress: Popular New Year's Resultions

Manage Stress

The Basics
Preventing and managing stress can help lower your risk of serious health problems like heart disease, high blood pressure, and depression. You can prevent or lessen stress by:

Planning ahead
Preparing for stressful events
Some stress is hard to avoid. You can find ways to manage stress by:

Noticing when you feel stressed
Taking time to relax
Getting active and eating healthy
Talking to friends and family
What are the signs of stress?
When people are under stress, they may feel:

Worried
Irritable
Depressed
Unable to focus
Stress also affects the body. Physical signs of stress include:

Headaches
Back pain
Problems sleeping
Upset stomach
Weight gain or loss
Tense muscles
Frequent or more serious colds
Use this tool to better understand your stress (http://www.mentalhealthamerica.net/llw/stressquiz.html).

What causes stress?
Stress is often caused by some type of change. Even positive changes, like marriage or a job promotion, can be stressful. Stress can be short-term or long‑term. LPC Continuing Education
Common causes of short-term stress:


Too much to do and not much time
Lots of little problems in the same day (like a traffic jam or running late)
Getting lost
Having an argument

Common causes of longer-term stress:


Divorce or problems in a marriage
Death of a loved one
Illness
Caring for someone who is sick
Problems at work
Money problems

What are the benefits of managing stress?
Managing stress can help you:

Sleep better
Control your weight
Get sick less often and heal faster
Lessen neck and back pain
Be in a better mood
Get along better with family and friends
Take Action!
Being prepared and in control of your situation will help you feel less stress. Follow these 9 tips for preventing and managing stress.

1. Plan your time.
Think ahead about how you are going to use your time. Write a to-do list and decide which tasks are the most important. Be realistic about how long each thing will take.

2. Prepare yourself.
Prepare ahead of time for stressful events like a job interview or a hard conversation with a loved one.

Picture the event in your mind.
Stay positive.
Imagine what the room will look like and what you will say.
Have a back-up plan.
3. Relax with deep breathing.
Find out how easy it is to use deep breathing to relax (http://www.helpguide.org/mental/stress_relief_meditation_yoga_relaxation.htm#deep).

4. Relax your muscles.
Stress causes tension in your muscles. Try stretching or taking a hot shower to help you relax. Check out these stretches you can do at your desk (http://dohs.ors.od.nih.gov/ergo_computers.htm#muscular).

5. Get active.
Physical activity can help prevent and manage stress. It can also help relax your muscles and improve your mood.

Aim for 2 hours and 30 minutes a week of moderate aerobic activity, like walking fast or biking.
Be sure to exercise for at least 10 minutes at a time.
Do strengthening activities (like sit-ups or lifting weights) at least 2 days a week.
6. Eat healthy.
Give your body plenty of energy by eating fruits, vegetables, and protein.

7. Drink alcohol only in moderation.
Don’t use alcohol and drugs to manage your stress. If you choose to drink, drink only in moderation. This means no more than 1 drink a day for women or 2 drinks a day for men.

8. Talk to friends and family.
Tell your friends and family if you are feeling stressed. They may be able to help.

9. Get help if you need it.
Stress is a normal part of life. But if your stress doesn’t go away or keeps getting worse, you may need help. Over time, stress can lead to serious problems like depression, post-traumatic stress disorder (PTSD), or anxiety.

If you are feeling down or hopeless, talk to a doctor about depression.
If you are feeling anxious, find out how to get help for anxiety (http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml).
A mental health professional (like a psychologist or social worker) can help treat these conditions with talk therapy (called psychotherapy) or medicines.

Lots of people need help dealing with stress – it’s nothing to be ashamed of!



Learn more about how you can keep your heart healthy.

Start Today: Small Steps
Find out how positive thinking can lower your stress (http://www.mayoclinic.com/health/positive-thinking/SR00009/METHOD=print).
Test your stress smarts (http://www.apa.org/helpcenter/stress-smarts.aspx).
Check out these tips for dealing with stress (http://familydoctor.org/online/famdocen/home/common/mentalhealth/stress/167.printerview.html).
You May Also Be Interested In
Content last updated on: December 20, 2010


National Health Information Center
P.O. Box 1133, Washington, DC 20013-1133
healthfinder@nhic.org

FAA Certifies Santa’s NextGen-Equipped Sleigh for Christmas Eve

Press Release – FAA Certifies Santa’s NextGen-Equipped Sleigh for Christmas Eve
PrintEmailFor Immediate Release
December 20, 2010
Contact: FAA Press Office
Phone: 202-267-3883


--------------------------------------------------------------------------------

WASHINGTON – Federal Aviation Administration (FAA) safety inspectors at the North Pole certified Santa One, the reindeer-powered sleigh piloted by Santa Claus, for its Christmas Eve round-the-world delivery mission.

Santa One, led by Rudolph the Red-Nosed Reindeer, is outfitted with new satellite-based NextGen technology, which will allow Santa to deliver more toys to more children with improved safety and efficiency.

“Children around the world will get their gifts on time, regardless of the weather, thanks to NextGen,” said U.S. Transportation Secretary Ray LaHood. “We’re proud to say NextGen is bringing Santa Claus to town.”

Rudolph’s red nose has been outfitted with avionics that will broadcast Santa One’s position via satellites to air traffic controllers around the world with improved accuracy, integrity and reliability.

“Santa’s cockpit display will help improve his situational awareness by showing him and his reindeer flight crew their precise location in relation to other aircraft, bad weather and terrain,” said FAA Administrator Randy Babbitt. “NextGen will help make this an extra-safe Christmas Eve.”

The sleigh’s onboard systems have been upgraded with state-of-the-art, NextGen technology that will allow Santa One to maintain cruising altitude for as long as possible before making a continuous descent into cities and towns around the world. While maneuvering on rooftops, an advanced, onboard runway safety system will help reduce the risk of incursions between the sleigh and chimneys.

Santa’s reindeer-powered sleigh is already energy-efficient, but the NextGen technologies will further reduce Santa One’s carbon hoofprint. The shorter, faster routings means that Rudolph and the other reindeer will consume less hay, resulting in fewer greenhouse gases.

Unlike any other pilot, Santa has special permission from the FAA to fly thousands of domestic and international short-haul and long-range flights in one night. In keeping with the FAA's science-based proposal to give pilots more rest, Santa will arrange his flight plan based on his circadian rhythm. Mrs. Claus also assured FAA safety inspectors that she’ll make sure he gets plenty of rest before the flight on Christmas Eve.

Follow Santa’s progress on Christmas Eve at the NORAD Tracks Santa website: www.noradsanta.org

See how NextGen is going to improve the safety and efficiency of Santa’s rooftop descents: http://www.faa.gov/go/santa

LPC Continuing Education

Coping with the Holidays After the Death of a Loved One or when you Are a Victim/Crime Survivor

You Can Make It Through the Holidays
Many among us have struggled with the cloud of sadness that may surround the holidays when a friend or family has experienced a tragedy such as a sudden violent death or a serious physical or emotional injury. The onslaught of holiday cheer may seem too much to bear. Holidays may give rise to new or returning bouts of depression, panic attacks, and other forms of anxiety for those whose lives have been affected. Victims of crime, family members, friends, and work colleagues may re-experience life-changing traumas through flashbacks, nightmares, and overwhelming sadness. Some have trouble sleeping, while others don't want to get out of bed. Tears may come easily, often when least expected. Old ailments, including headaches, gastrointestinal problems, and other aches and pains may return.

Many victims and families, however, have found that holidays can be manageable if they take charge of the season, rather than letting it take charge of them.

Families who have made this difficult journey offer some suggestions to help those who may be just starting down this path.

Change Traditions

Trying to make this holiday seem like holidays of the past can intensify the difference. Gather the family together early and decide which traditions to keep and which to let go. Change holiday plans to accommodate the needs and wishes of those who are hurting the most. Pay particular attention to the physical needs of someone who has acquired a disability as a result of victimization.

Create a Special Tribute

Some families light a special candle and place it on a holiday table to honor the memory of a loved one who has died. Others keep a chair empty and place a flower or other memorial on the seat. Some write treasured remembrances and place them on a special plate or in a bowl for those who wish to read them. Families of a surviving victim may want to honor that person by openly expressing gratitude for his or her presence.

Consider Carefully Where to Spend the Holidays

Many people think going away will make the holidays easier. This may be helpful if you are traveling to a place where you will feel loved and nurtured. However, if travel is arranged as a means of trying to avoid the holiday atmosphere, remember that American holidays are celebrated throughout this country and in many parts of the world. It is impossible to escape holiday reminders.

Accept grieving friends and family members as they are; don't try to tell them how they should feel or state that you "understand" how they feel. Focus on giving unconditional support.

Balance Solitude With Sociability

Rest and solitude can help renew strength. Friends and family, however, can be a wonderful source of support. If you are invited to holiday outings, make an effort to go. Attend concerts or other cultural events that lift your spirits. You may surprise yourself by enjoying special outings, even if you feel like crying later.

Relive Fond Memories

Attempting to go through the holidays pretending that nothing has happened can be a heavy and unrealistic burden. Think about holiday seasons you have enjoyed in the past and identify memories you want to hold in your heart forever. No one can take those away from you. Celebrate them and be grateful. If feelings of sadness pop up at inappropriate times, such as at work or in a public gathering, try thinking about what you have, rather than what you have lost. Focus on the blessing of the memories in your heart.

Set Aside Some "Letting Go" Time

Schedule time to be alone and release sad and lonely, pent-up feelings. You may want to cry or write about your thoughts and feelings. If someone has died, you may choose to write a letter to say "goodbye," "I love you," or "I'm sorry." Even though it may feel strange, allow your loved one to write back to you through your pen. You may be surprised at what you write. By setting aside special times to allow painful feelings to surface, it becomes easier to postpone expressing them in public.

Counter the Conspiracy of Silence

Family members may consciously or unconsciously conspire to avoid mentioning the tragedy in your family. This is usually a well-intentioned but misguided attempt to protect your feelings. If this seems to be happening, take the initiative and talk to your family about the importance of talking openly about what has happened and sharing your feelings of loss or sadness. Encourage them to tell stories about your loved one and to look for opportunities to refer to him or her by name.
LPC Continuing Education
Notice the Positive

Some people conclude that facing the holidays is simply "awful." But deciding prematurely that "everything about life is awful" is too strong a generalization from a personal tragedy. Although you may have difficult times during the holidays, you also may experience joy. Accept the love and care of others. Reach out to someone else who is suffering. Give yourself permission to feel sad and to experience joy.

Consider shopping online as an alternative to the frenzy of mall shopping-but don't try to "buy" your way out of sad feelings.


Find a Creative Outlet

If you have difficulty talking about your feelings, look for a creative way to express yourself. Write a poem or story that you can share with others. Buy watercolors or oils and put your feelings on paper or canvas, even if only splashes of color. Contribute to a favorite charity or organization in your loved one's memory-either financially or by volunteering to help. Buy gifts for less fortunate children, a hospital, or a nursing home.

Remember the Children

Listen to them. Celebrate them. Cherish them.

Children may have deep feelings that can be overlooked if you spend all your time focusing on yourself. Putting up holiday decorations can be a draining emotional experience, but these symbols are very significant to children. A friend or relative likely will be happy to help decorate or purchase and wrap gifts.


Protect Your Health

Physical and emotional stress changes the chemical balance in your system and can make you ill. Eat healthy food and avoid over-indulging in sweets. Drink plenty of water, even if you don't feel thirsty. Avoid alcohol, which can be a depressant. Take a multivitamin. Get 7 to 8 hours of sleep each night. Talk with your doctor about an antidepressant or anti-anxiety medication if you think it will help. If you are unsure how a medication will affect you, talk to your doctor about your concerns.


The most valuable help usually comes from someone who shares a common experience or understands something about what you're going through.


Call Upon Available Resources

People of faith are encouraged to observe services and rituals offered by their church, synagogue, mosque, temple, or other faith community. Many "veterans of faith" offer serenity, a quiet presence, and healing wisdom. You may want to look for a support group of persons who have suffered similar experiences. The Mental Health America has affiliates around the Nation that keep lists of such local groups. If a group does not exist in your area, you can establish your own short-term group to focus on getting through the holidays. Spend as much time as possible with the people you love the most.

Most important, remember that you can't change the past, but you can take charge of the present and shape the future.

Easy Ways to Reduce Holiday Stress

For many families, the holiday season can feel more stressful than joyful. Stress comes from many directions at this time of year: too much rich food and drink, not enough exercise or sleep and all the rushing around to find the perfect gifts at the lowest prices.

“Although stress is common at this time of year, it is not inevitable,” says registered dietitian Crystelle Fogle of the Cardiovascular Health Program for the Montana Department of Public Health and Human Services. “Virtually every mental health expert agrees that lifestyle habits can help with stress reduction. This is the perfect time to step back from the holiday hustle and find ways to insure that your family is getting daily physical activity, plenty of nutrient-rich foods, and enough sleep every night.”

The typical holiday pattern of overindulgence and sleep deprivation combined with low activity actually adds stress in multiple layers. First, there is the actual physical stress from your body not getting what it needs for optimal health and energy. On top of that stress is layers of guilt and frustration brought on because you’re doing things that are unhealthy. Then, these feelings often lead back to more overeating or additional alcohol consumption.

Fogle points out that stopping this vicious cycle is easier than you may think. “It starts with setting priorities for your family – like fitness, nutrition, and sleep –and then saying ‘no’ to some of the holiday events that interfere with these healthy habits,” Fogle said. “The simple act of taking more control over your daily life can lower stress levels almost immediately.”

Here are a few real easy ways to have your holiday fun and reduce your stress too:

•Eat well. Family meals and nutrient-rich foods are even more important at this time of year. Enjoy simple meals, like steaming soup with salad and rolls, together as often as possible. Take time to establish new family traditions, like making bread from scratch.
•Play well. Being active together creates special memories and improves moods at the same time. Holiday fitness fun is as easy as a family game of Twister® or a stroll around the neighborhood to sing some holiday songs or carols for friends.
•Sleep well. Most adults do best with seven to eight hours sleep a night, while young children need significantly more. Develop family routines that promote healthy sleep habits, like reading holiday stories or listening to calming music together before bedtime.

“The ‘togetherness’ of these stress reduction tips is an important aspect of healthy, happy holidays,” Fogle notes. Connections to family and friends are much more important to holiday comfort and joy than lots of new stuff or plates of high-calorie treats. Starting new family traditions that reduce stress, such as cooking a meal or playing active games together, are gifts that will truly keep on giving for years to come.

Five Easy Ways to Enjoy More Tasty Holiday Nutrition
Although calorie-rich treats and overflowing tables can be the norm during holidays, you can get the nutrition that your body needs. The key is to concentrate on nutrient-rich foods. With bright colors and delicious flavors, nutrient-rich foods are a gift on any holiday table.

Calorie for calorie, these stars of the nutrition world offer more of the vitamins, minerals, protein and fiber that your whole family needs to maintain weight, enhance health, and reduce stress during this hectic time of year. Here are five easy ways to add nutrient-rich foods to all your seasonal feasts and treats.

•Start every day (and holiday) with breakfast. For a high-energy day, always include protein in your morning meal. Enjoy an egg or two, a serving of low-fat yogurt, a handful of nuts on whole grain cereal, or some lean meat, like a sliced turkey and Swiss on whole wheat wrap or bread.
•Snack smart throughout the holidays. Nutrient-rich snacks provide energy, while reducing the tendency to overeat at your next meal. Start with a piece of fresh fruit or some sliced veggies. Add a serving of protein, like a string cheese, a glass of low-fat milk, or leftover meats.
•Feature festive holiday salads at every meal. Fruit salads (any combo of canned, dried, frozen, or fresh fruit) are delicious any time of day. Green salads, bean salads, and veggie salads add color and crunch to lunch and dinner (and they make tasty leftovers for super smart snack times).
•Pack your holiday breadbasket with nutrition. The nutrient-rich goodness of whole grains, nuts, seeds, and dried fruits makes for tasty breads, rolls, and muffins. Bake some at home or check grocery shelves for sunflower whole wheat bread or bran muffins with raisins and walnuts.
•Warm up the holiday with winter vegetables. Root veggies (sweet potatoes, beets, and carrots) and hard winter squashes, like acorn, butternut, pumpkin, and spaghetti, are some the least expensive and most nutritious produce options. Enjoy them roasted, mashed, and made into soup!
Five Ways to Enjoy 10 Minutes of Holiday Fitness Fun
Physical activity is even more important during the holidays than other times of the year. Being active helps relieve holiday stress – and helps balance out the usual increase in holiday calories. To maintain fitness levels and emotional well-being, enjoy at least three 10-minute activity breaks a day – preferably with family or friends.

•Take a brisk 10-minute stroll with a loved one. Something as simple as a 10-minute walk can make all the difference in your physical and mental state. A brisk walk around the block at work or around your neighborhood can improve your mood and kick-start your metabolism in just a few simple steps. For extra holiday fun, invite someone you’ve been missing!
•Play a child’s favorite active game for 10 minutes. It’s often said that holidays are “all about the children.” What better way to be active than to have festive fun with one or more young people! Children often have extra energy to burn during the holidays and even serious adults can enjoy some sledding, get tied up in game of Twister®, or toss around a Koosh® ball.
•Dance for 10 minutes to your favorite holiday tunes. You could “Rock around the Christmas Tree” and just go “Walkin’ in a Winter Wonderland.” Use music to pick up the pace when you are walking or working outside with headphones – or cleaning up the house for a holiday gathering. For the best holiday break of all, take a spin on the dance floor with your sweetie.
•Walk for 10 minutes between stores. You can even fit fitness into a busy shopping day. Take a 10-minute ‘breather’ between each store on your list. Enjoy a quick lap around the perimeter of the mall or a walk around a couple of downtown blocks. You’ll have more energy – and you just might make more reasonable spending decisions too!
•Take a 10-minute stretch break at home or work. Holiday tension can take a toll on backs, shoulders, and jaws. A quick break can relieve physical and mental stress. Check these sites for gentle moves that can be done anywhere you need a stretch: www.lib.msu.edu/ergomsu/stretch.htm and www.will-harris.com/yoga/everyday_yoga.html
BRN Continuing Education http://www.aspirace.com
LPC Continuing Education http://www.aspirace.com

Easy Ways to Reduce Holiday Stress

For many families, the holiday season can feel more stressful than joyful. Stress comes from many directions at this time of year: too much rich food and drink, not enough exercise or sleep and all the rushing around to find the perfect gifts at the lowest prices.

“Although stress is common at this time of year, it is not inevitable,” says registered dietitian Crystelle Fogle of the Cardiovascular Health Program for the Montana Department of Public Health and Human Services. “Virtually every mental health expert agrees that lifestyle habits can help with stress reduction. This is the perfect time to step back from the holiday hustle and find ways to insure that your family is getting daily physical activity, plenty of nutrient-rich foods, and enough sleep every night.”

The typical holiday pattern of overindulgence and sleep deprivation combined with low activity actually adds stress in multiple layers. First, there is the actual physical stress from your body not getting what it needs for optimal health and energy. On top of that stress is layers of guilt and frustration brought on because you’re doing things that are unhealthy. Then, these feelings often lead back to more overeating or additional alcohol consumption.

Fogle points out that stopping this vicious cycle is easier than you may think. “It starts with setting priorities for your family – like fitness, nutrition, and sleep – and then saying ‘no’ to some of the holiday events that interfere with these healthy habits,” Fogle said. “The simple act of taking more control over your daily life can lower stress levels almost immediately.”

Here are a few real easy ways to have your holiday fun and reduce your stress too:

•Eat well. Family meals and nutrient-rich foods are even more important at this time of year. Enjoy simple meals, like steaming soup with salad and rolls, together as often as possible. Take time to establish new family traditions, like making bread from scratch.
•Play well. Being active together creates special memories and improves moods at the same time. Holiday fitness fun is as easy as a family game of Twister® or a stroll around the neighborhood to sing some holiday songs or carols for friends.
•Sleep well. Most adults do best with seven to eight hours sleep a night, while young children need significantly more. Develop family routines that promote healthy sleep habits, like reading holiday stories or listening to calming music together before bedtime.
“The ‘togetherness’ of these stress reduction tips is an important aspect of healthy, happy holidays,” Fogle notes. Connections to family and friends are much more important to holiday comfort and joy than lots of new stuff or plates of high-calorie treats. Starting new family traditions that reduce stress, such as cooking a meal or playing active games together, are gifts that will truly keep on giving for years to come.

Five Easy Ways to Enjoy More Tasty Holiday Nutrition
Although calorie-rich treats and overflowing tables can be the norm during holidays, you can get the nutrition that your body needs. The key is to concentrate on nutrient-rich foods. With bright colors and delicious flavors, nutrient-rich foods are a gift on any holiday table.

Calorie for calorie, these stars of the nutrition world offer more of the vitamins, minerals, protein and fiber that your whole family needs to maintain weight, enhance health, and reduce stress during this hectic time of year. Here are five easy ways to add nutrient-rich foods to all your seasonal feasts and treats.

•Start every day (and holiday) with breakfast. For a high-energy day, always include protein in your morning meal. Enjoy an egg or two, a serving of low-fat yogurt, a handful of nuts on whole grain cereal, or some lean meat, like a sliced turkey and Swiss on whole wheat wrap or bread.
•Snack smart throughout the holidays. Nutrient-rich snacks provide energy, while reducing the tendency to overeat at your next meal. Start with a piece of fresh fruit or some sliced veggies. Add a serving of protein, like a string cheese, a glass of low-fat milk, or leftover meats.
•Feature festive holiday salads at every meal. Fruit salads (any combo of canned, dried, frozen, or fresh fruit) are delicious any time of day. Green salads, bean salads, and veggie salads add color and crunch to lunch and dinner (and they make tasty leftovers for super smart snack times).
•Pack your holiday breadbasket with nutrition. The nutrient-rich goodness of whole grains, nuts, seeds, and dried fruits makes for tasty breads, rolls, and muffins. Bake some at home or check grocery shelves for sunflower whole wheat bread or bran muffins with raisins and walnuts.
•Warm up the holiday with winter vegetables. Root veggies (sweet potatoes, beets, and carrots) and hard winter squashes, like acorn, butternut, pumpkin, and spaghetti, are some the least expensive and most nutritious produce options. Enjoy them roasted, mashed, and made into soup!
Five Ways to Enjoy 10 Minutes of Holiday Fitness Fun
Physical activity is even more important during the holidays than other times of the year. Being active helps relieve holiday stress – and helps balance out the usual increase in holiday calories. To maintain fitness levels and emotional well-being, enjoy at least three 10-minute activity breaks a day – preferably with family or friends.

•Take a brisk 10-minute stroll with a loved one. Something as simple as a 10-minute walk can make all the difference in your physical and mental state. A brisk walk around the block at work or around your neighborhood can improve your mood and kick-start your metabolism in just a few simple steps. For extra holiday fun, invite someone you’ve been missing!
•Play a child’s favorite active game for 10 minutes. It’s often said that holidays are “all about the children.” What better way to be active than to have festive fun with one or more young people! Children often have extra energy to burn during the holidays and even serious adults can enjoy some sledding, get tied up in game of Twister®, or toss around a Koosh® ball.
•Dance for 10 minutes to your favorite holiday tunes. You could “Rock around the Christmas Tree” and just go “Walkin’ in a Winter Wonderland.” Use music to pick up the pace when you are walking or working outside with headphones – or cleaning up the house for a holiday gathering. For the best holiday break of all, take a spin on the dance floor with your sweetie.
•Walk for 10 minutes between stores. You can even fit fitness into a busy shopping day. Take a 10-minute ‘breather’ between each store on your list. Enjoy a quick lap around the perimeter of the mall or a walk around a couple of downtown blocks. You’ll have more energy – and you just might make more reasonable spending decisions too!
•Take a 10-minute stretch break at home or work. Holiday tension can take a toll on backs, shoulders, and jaws. A quick break can relieve physical and mental stress. Check these sites for gentle moves that can be done anywhere you need a stretch: www.lib.msu.edu/ergomsu/stretch.htm and www.will-harris.com/yoga/everyday_yoga.html
BRN Continuing Education http://www.aspirace.com
LPC Continuing Education http://www.aspirace.com