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.

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.

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

Holiday Safety Tips

National Crime Prevention Council
1000 Connecticut Avenue, NW
13th Floor
Washington, DC 20036
www.ncpc.org

This holiday season, don’t let the spirit of giving lull you into giving burglars, muggers, nor pickpockets a chance to do their dirty work.

Criminals love the holidays as much as everyone else, chiefly because it’s a perfect opportunity to commit a crime.

Keep these tips in mind for a safe and happy holiday season.


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If You’re Traveling . . .
* Set an automatic timer for your lights.

* Ask your neighbor to watch your home, pick up newspapers, collect mail, and park in the driveway from time to time.

* Be sure to hide any gifts that may be left in the house while you’re gone.


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If You’re Out for the Evening . . .
* Turn on lights and a radio or the TV so that it appears that someone is home.


* Lock all doors and windows while you’re out, even if you’ll be gone for just a few minutes.


* Do not place packages or gifts near windows or in other high-visibility sites.


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If You’re Shopping . . .
* Don’t let your guard down just because you are rushing.


* Stay alert and be aware of everything around you at all times.


* Park in well-lighted spaces and as close to the store as possible, lock your car doors, and hide packages in the trunk or under the seats.


* Do not carry large amounts of cash; pay with a check or credit card if possible.


* Make sure that you do not carry all your packages at the same time.


* Carry your purse close to your body, not dangling by the straps. Put a wallet in an inside coat or front pants pocket.


* If you take your children shopping, teach them to go to a police officer or a store security guard if they get separated or get lost.


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If a Stranger Comes to the Door . . .
* Stay alert to suspicious-looking couriers delivering packages to you or your neighbors.


* Many con artists take advantage of holiday generosity by going door-to-door. Ask for identification and get specifics to how and where the donations will be spent/used.


* If you feel uncomfortable, just say “no thank you” and shut the door.


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If You’re at Home . . .
* Turn on outside lights to deter burglars.


* Report any suspicious behavior to the police or local community watch groups.


* Make sure your homeowners (or renters) insurance is up-to-date and everything is inventoried properly.

LPC Continuing Education http://www.aspirace.com

Avoiding Holiday Depression

The holiday season is a time of joy, cheer, parties and family-oriented gatherings. But it can also be a time of self-evaluation, loneliness and anxiety about an uncertain future, causing "holiday blues."

Many factors cause holiday blues such as increased stress and fatigue, unrealistic expectations, over-commercialization, financial constraints and the inability to be with family and friends. Increased demands of shopping, parties and houseguests can also cause tension. Even people who do not become depressed can develop other stress reactions during the holidays, such as headaches, excessive drinking, overeating and difficulty sleeping.

Although many people become depressed during the holiday season, even more respond to the excessive stress and anxiety once the holidays have passed. This post-holiday letdown can be the result of emotional disappointments experienced during the preceding months, as well as the physical reactions caused by excess fatigue and stress.

There are several ways to identify potential sources of holiday depression that can help you head off the blues:

s Keep expectations manageable. Set realistic goals for yourself. Pace yourself. Organize your time. Make a list and prioritize the most important activities. Be realistic about what you can and cannot do.

s Remember that the holiday season does not automatically banish reasons for feeling sad or lonely. There is room for these feelings to be present, even if you choose not to express them.

s Let go of the past. Don’t be disappointed if your holidays are not like they used to be. Life brings changes. Each holiday season is different and can be enjoyed in its own way. Look toward the future.

s Do something for someone else. It is an old remedy, but it can help. Try volunteering some time to help others.

s Enjoy holiday activities that are free, such as driving around to look at holiday decorations. Go window shopping without buying anything.

s Don’t drink too much. Excessive drinking will only make you more depressed.

s Don’t be afraid to try something new. Celebrate the holidays in a way you have not done before.

s Spend time with people who are supportive and who care about you. Reach out to make new friends if you are alone during special times. Contact someone you have lost touch with.

s Find time for yourself. Don’t spend all of your time providing activities for your family and friends.

Signs of depression can also include: noticeable weight loss/gain, difficulty sleeping, lack of energy, loss of interest in usual activities and thoughts of suicide. If someone exhibits any of these signs, a Primary Care Manager at Keller should be contacted immediately for proper treatment.
LPC Continuing Education http://www.aspirace.com

Editor’s note: The information in this article came from a Sierra Military Health Care article and from information provided by the Mental Health Association.

Holiday Season May Raise Anxiety For People With Social Phobia

Who’s always missing at your holiday party? Aunt Betty? Your reclusive neighbor? They may have declined your invitation because they are among the millions of Americans living with social phobia. For these people, the holiday season can spark such intense feelings of anxiety and dread that they avoid social gatherings altogether.

"A lot of people have anxiety in social situations, such as when meeting new people at a holiday party, but the fear is not severe and typically passes," said Una McCann, M.D., chief of the Unit on Anxiety Disorders at the National Institute of Mental Health (NIMH). "For people with social phobia, however, the fear of embarrassment in social situations is excessive, extremely intrusive and can have debilitating effects on personal and professional relationships."

People with social phobia have an overwhelming and disabling fear of disapproval in social situations. They recognize that their fear may be excessive or unreasonable, but are unable to overcome it. Symptoms of social phobia include blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea or other stomach discomfort, lightheadedness, and other symptoms of anxiety.

To uncover the biological and behavioral causes of social phobia, NIMH is conducting and supporting research on this disorder.

"Without treatment, social phobia can be extremely disabling to a person’s work, social and family relationships. In extreme cases, a person may begin to avoid all social situations and become housebound," said Dr. McCann. "But the good news is that effective treatment for social phobia is available and can be tremendously helpful to people living with this disorder."

Effective treatments include medications, a specific form of psychotherapy called cognitive-behavioral therapy, or a combination. Medications include antidepressants called selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as drugs known as high-potency benzodiazepenes. People with a specific form of social phobia, called performance phobia, can be helped with drugs called beta-blockers. Cognitive-behavioral therapy teaches patients to react differently to the situations and bodily sensations that trigger anxiety symptoms. For example, a type of cognitive-behavioral treatment known as "exposure therapy" involves helping patients become more comfortable with situations that frighten them by gradually increasing exposure to the situation.

At least 7.2 million Americans experience clinically significant phobias in a given year, many of them have social phobia. Phobias are persistent, irrational fears of certain objects or situations; they occur in several forms.

While social phobia is a fear of embarrassment, humiliation, or failure in a public setting, specific phobias involve fear of an object or situation. These include small animals, snakes, closed-in spaces, or flying in an airplane.

Phobias are one of five major anxiety disorders that are being addressed in a national education program conducted by NIMH. In addition to phobias, these disorders include:

Panic Disorder -- Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.

Obsessive-Compulsive Disorder -- Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.

Post-Traumatic Stress Disorder – Persistent symptoms that occur after experiencing a traumatic event such as rape or other criminal assault, war, child abuse, natural disasters or crashes. Nightmares, flashbacks, numbing of emotions, depression and feeling angry, irritable, distracted and being easily startled are common.

Generalized Anxiety Disorder -- Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea. Marriage and Family Therapist Continuing Education Ca http://www.aspirace.com
For more information about social phobia and other anxiety disorders, see the NIMH Anxiety Disorders Web site at http://www.nimh.nih.gov /anxiety or call NIMH’s toll-free number, 1-88-88-ANXIETY, for a free packet of information. The National Institute of Mental Health is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services.

Tips for Smart Holiday Shopping

In these tough economic times, smart shopping during the holiday season is more important than ever. Whether consumers are shopping online, by phone, or in stores, the Federal Trade Commission, the nation’s consumer protection agency, has some advice to avoid both debt and unneeded stress.

First, make as accurate and comprehensive a budget as possible – don’t forget to include the cost of incidentals like postage, gift wrap, and decorations. Then, learn to navigate holiday sale ads, make sure to keep careful track of your spending, and make the best of layaway opportunities.

To learn more about smart holiday shopping, see the consumer alert “Holiday Shopping, Circa 2008: Tips from the Federal Trade Commission,” at
http://www.ftc.gov/bcp/edu/pubs/consumer/alerts/alt082.shtm. For more general information about wise money management and savvy shopping, visit ftc.gov/consumer.

The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC's online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,500 civil and criminal law enforcement agencies in the U.S. and abroad.
LPC Continuing Education http://www.aspirace.com

Health Department Offers Holiday Mental Health Tips

The holiday season is here, and although this is usually a joyous time of year, it can be an especially stressful time for those who experienced loss because of the recent hurricanes in Louisiana. To help people cope, the Department of Health and Hospitals-Office of Mental Health is offering counseling services and stress-relief tips. LPC CEUs, LPC Continuing Education

“We know this holiday season will be a difficult one for many of our citizens,” said DHH Secretary Dr. Fred Cerise. “The holidays can intensify feelings of grief and loneliness. Also, the contrast to past holidays may aggravate the losses people have experienced in recent months, and the stress of preparing for holidays when money is short and family members are scattered can be overwhelming. We want to let people know that help is available during this time.”

To be able to enjoy the holidays despite these feelings, DHH mental health officials advise citizens to think ahead about ways to adapt traditions to meet the current circumstances. “Don’t put pressure on yourself to have the ‘perfect’ holiday. Planning celebrations that accommodate your feelings can reduce stress and make the holiday a day of healing,” said Dr. Cheryll Bowers-Stephens, DHH-OMH assistant secretary. “Have a holiday that fits how you feel.”

To turn Thanksgiving and other upcoming holidays into a time of healing, it is important for people to acknowledge that things have changed in the past year.

“Prior to the holiday, each person should consider the question, ‘How did I get to this day in this place?’ The answer will include the many traumas of upheaval, but it will also include moments of help, support, togetherness and kindness with loved ones,” Dr. Bowers-Stephens said. “Citizens also can come up with ways to honor those who lost their lives during the hurricanes as part of their activities, as this will help them celebrate their lives. The journey from disaster to recovery takes a long time, but being aware of even small kindnesses is empowering and will help everyone tackle the difficult rebuilding that lies ahead.”

Such observations of the holiday may not help everyone to manage their emotions. Anyone experiencing overwhelming feelings of sadness or loss is encouraged to call the statewide crisis hotline at 1-800-273-TALK (8255) to speak to a certified mental health counselor.

Resilience

What Is Resilience?

Resilience is the ability to:
Bounce back
Take on difficult challenges and still find meaning in life
Respond positively to difficult situations
Rise above adversity
Cope when things look bleak
Tap into hope
Transform unfavorable situations into wisdom, insight, and compassion
Endure

Resilience refers to the ability of an individual, family, organization, or community to cope with adversity and adapt to challenges or change. It is an ongoing process that requires time and effort and engages people in taking a number of steps to enhance their response to adverse circumstances. Resilience implies that after an event, a person or community may not only be able to cope and recover, but also change to reflect different priorities arising from the experience and prepare for the next stressful situation.

Resilience is the most important defense people have against stress.
It is important to build and foster resilience to be ready for future challenges.
Resilience will enable the development of a reservoir of internal resources to draw upon during stressful situations.
Research (Aguirre, 2007; American Psychological Association, 2006; Bonanno, 2004) has shown that resilience is ordinary, not extraordinary, and that people regularly demonstrate being resilient.

Resilience is not a trait that people either have or do not have.
Resilience involves behaviors, thoughts, and actions that can be learned and developed in anyone.
Resilience is tremendously influenced by a person's environment.
Resilience changes over time. It fluctuates depending on how much a person nurtures internal resources or coping strategies. Some people are more resilient in work life, while others exhibit more resilience in their personal relationships. People can build resilience and promote the foundations of resilience in any aspect of life they choose.

What Is Individual or Personal Resilience?
Individual resilience is a person's ability to positively cope after failures, setbacks, and losses. Developing resilience is a personal journey. Individuals do not react the same way to traumatic or stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies to build their resilience. Because resilience can be learned, it can be strengthened. Personal resilience is related to many factors including individual health and well-being, individual aspects, life history and experience, and social support.

Individual Health and Well-Being Individual Aspects Life History and Experience Social Support These are factors with which a person is born.

Personality
Ethnicity
Cultural background
Economic background

These are past events and relationships that influence how people approach current stressors:
Family history
Previous physical health
Previous mental health
Trauma history
Past social experiences
Past cultural experiences

These are support systems provided by family, friends, and members of the community, work, or school environments:
Feeling connected to others
A sense of security
Feeling connected to resources
(Adapted from Simon, Murphy, & Smith, 2008)


Along with the factors listed above, there are several attributes that have been correlated with building and promoting resilience.

The American Psychological Association reports the following attributes regarding resilience:
The capacity to make and carry out realistic plans
Communication and problem-solving skills
A positive or optimistic view of life
Confidence in personal strengths and abilities
The capacity to manage strong feelings, emotions, and impulses

What Is Family Resilience?
Family resilience is the coping process in the family as a functional unit. Crisis events and persistent stressors affect the whole family, posing risks not only for individual dysfunction, but also for relational conflict and family breakdown. Family processes mediate the impact of stress for all of its members and relationships, and the protective processes in place foster resilience by buffering stress and facilitating adaptation to current and future events. Following are the three key factors in family resilience (Wilson & Ferch, 2005):

Family belief systems foster resilience by making meaning in adversity, creating a sense of coherence, and providing a positive outlook.
Family organization promotes resilience by facilitating flexibility, capacity to adapt, connectedness and cohesion, emotional and structural bonding, and accessibility to resources.
Family communication enhances resilience by engaging clear communication, open and emotional expressions, trust and collaborative problem solving, and conflict management.

What Is Organizational Resilience?
Organizational resilience is the ability and capacity of a workplace to withstand potential significant economic times, systemic risk, or systemic disruptions by adapting, recovering, or resisting being affected and resuming core operations or continuing to provide an acceptable level of functioning and structure.

A resilient workforce and organization is important during major decisions or business changes.
Companies and organizations, like individuals, need to be able to rebound from potentially disastrous changes.
The challenge for the incorporation of resilience into a workplace is to identify what enhances the ability of an organization to rebound effectively.
Measuring workplace resilience involves identifying and evaluating the following:
Past and present mitigative mechanisms and practices that increase safety
Past and present mitigative mechanisms and practices that decrease error
Necessary redundancy in systems
Planning and programming that demonstrate collective mindfulness
Anticipation of potential trouble and solutions to potential problems

What Is Community Resilience?
Community resilience is the individual and collective capacity to respond to adversity and change. It is a community that takes intentional action to enhance the personal and collective capacity of its citizens and institutions to respond to and influence the course of social and economic change. For a community to be resilient, its members must put into practice early and effective actions so that they can respond to change. When responding to stressful events, a resilient community will be able to strengthen community bonds, resources, and the capacity to cope. Systems involved with building and maintaining community resilience must work together.
mental health and social work ceus

How Does Culture Influence Resilience?
Cultural resilience refers to a culture’s capacity to maintain and develop cultural identity and critical cultural knowledge and practices. Along with an entire culture fostering resilience, the interaction of culture and resilience for an individual also is important. An individual’s culture will have an impact on how the person communicates feelings and copes with adversity. Cultural parameters are often embedded deep in an individual. A person’s cultural background may influence one deeply in how one responds to different stressors. Assimilation could be a factor in cultural resilience, as it could be a positive way for a person to manage his/her environment. However, assimilation could create conflict between generations, so it could be seen as positive or negative depending on the individual and culture. Because of this, coping strategies are going to be different. With growing cultural diversity, the public has greater access to a number of different approaches to building resilience. It is something that can be built using approaches that make sense within each culture and tailored to each individual.

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What Factors Promote Resilience?
Resilience involves the modification of a person's response to a potentially risky situation. People who are resilient are able to maintain high self-esteem and self-efficacy in spite of the challenges they face. By fostering resilience, people are building psychological defenses against stress. The more resources and defenses available during a time of struggle, the better able to cope and bounce back from adverse circumstances people will be. A person’s ability to regain a sense of normalcy or define a new normalcy after adverse circumstances will be partially based on the resources available to him/her. Resilience building can begin at any time. Following is information regarding applicable ways to implement resilience practices, as well as situations that could inhibit resilience, situations that enhance resilience, and people who help facilitate the growth of resilience.

Resilience


Demonstrating Resilience Vulnerability Factors Inhibiting Resilience Protective Factors Enhancing Resilience Facilitators of Resilience
Individual Resilience
The ability for an individual to cope with adversity and change
Optimism
Flexibility
Self-confidence
Competence
Insightfulness
Perseverance
Perspective
Self-control
Sociability
Poor social skills
Poor problem solving
Lack of empathy
Family violence
Abuse or neglect
Divorce or partner breakup
Death or loss
Lack of social support
Social competence
Problem-solving skills
Good coping skills
Empathy
Secure or stable family
Supportive relationships
Intellectual abilities
Self-efficacy
Communication skills

Individuals
Parents
Grandparents
Caregivers
Children
Adolescents
Friends
Partners
Spouses
Teachers
Faith Community

Organizational Resilience
The ability for a business or industry, including its employees, to cope with adversity and change
Proactive employees
Clear mission, goals, and values
Encourages opportunities to influence change
Clear communication
Nonjudgmental
Emphasizes learning
Rewards high performance
Unclear Expectations
Conflicted expectations
Threat to job security
Lack of personal control
Hostile atmosphere
Defensive atmosphere
Unethical environment
Lack of communication

Open communication
Supportive colleagues
Clear responsibilities
Ethical environment
Sense of control
Job security
Supportive management
Connectedness among departments
Recognition

Employers
Managers
Directors
Employees
Employee assistance programs
Other businesses

Community Resilience
The ability for an individual and the collective community to respond to adversity and change.
Connectedness
Commitment to community
Shared values
Structure, roles, and responsibilities exist throughout community
Supportive
Good communication
Resource sharing
Volunteerism
Responsive organizations
Strong schools

Lack of support services
Social discrimination
Cultural discrimination
Norms tolerating violence
Deviant peer group
Low socioeconomic status
Crime rate
Community disorganization
Civil rivalry
Access to Support services
Community networking
Strong cultural identity
Strong social support systems
Norms against violence
Identification as a community
Cohesive community leadership
Community leaders
Faith-based organizations
Volunteers
Nonprofit organizations
Churches/houses of worship
Support services staff
Teachers
Youth groups
Boy/Girl Scouts
Planned social networking events

(Adapted from Kelly, 2007)
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How Is Personal Resilience Built?
Developing resilience is a personal journey. People do not react the same way to traumatic events. Some ways to build resilience include the following actions:

Making connections with others
Looking for opportunities for self-discovery
Nurturing a positive view of self
Accepting that change is a part of living
Taking decisive actions
Learning from the past
The ability to be flexible is a great skill to obtain and facilitates resilience growth. Getting help when it is needed is crucial to building resilience. It is important to try to obtain information on resilience from books or other publications, self-help or support groups, and online resources like the ones found in this resource collection.

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What Can Be Done to Promote Family Resilience?
Developing family resilience, like individual resilience, is different for every family. The important idea to keep in mind is that an underlying stronghold of family resilience is cohesion, a sense of belonging, and communication. It is important for a family to feel that when their world is unstable they have each other. This sense of bonding and trust is what fuels a family's ability to be resilient. Families that learn how to cope with challenges and meet individual needs are more resilient to stress and crisis. Healthy families solve problems with cooperation, creative brainstorming, openness to others, and emphasis on the role of social support and connectedness (versus isolation) in family resiliency. Resilience is exercised when family members demonstrate behaviors such as confidence, hard work, cooperation, and forgiveness. These are factors that help families withstand stressors throughout the family life cycle.

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How Is Community Resilience Fostered?
Fostering community resilience will greatly depend on the community itself and involves the community working as a whole toward preparedness. It is the capacity for the collective to take preemptive action toward preparedness. Community resilience involves the following factors:

Connection and caring
Collective resources
Critical analysis of the community
Skill building for community members
Prevention, preparedness, and response to stressful events
Resilience is exercised when community members demonstrate behaviors such as confidence, hard work, cooperation, and resourcefulness, and support of those who have needs during particular events. These are factors that help communities withstand challenging circumstances. There are other tips about how to foster community resilience in this resource collection.

Developing resilience is a personal journey. All people do not react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies. Resilience involves maintaining flexibility and balance in life during stressful circumstances and traumatic events. Being resilient does not mean that a person does not experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. Stress can be dealt with proactively by building resilience to prepare for stressful circumstances, while learning how to recognize symptoms of stress. Fostering resilience or the ability to bounce back from a stressful situation is a proactive mechanism to managing stress.

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References
Aguirre, B. (2007). Dialectics of vulnerability and resilience. Georgetown Journal of Poverty Law and Policy, 14(39), 1–18.

American Psychological Association. (2006). The road to resilience. Retrieved March 20, 2009, from " target="_blank">http://www.apahelpcenter.org/featuredtopics/feature.php?id=6.

Bonanno, G. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20–28.

Kelly, S. (2007). Personal and community resilience: Building it and sustaining it. Retrieved March 23, 2009, from the University of California Los Angeles Bureau for Behavioral Health and Health Facilities at " target="_blank">http://www.wvdhhr.org/healthprep/common/resiliency.ppt#256.

Simon, J., Murphy, J., & Smith, S. (2008). Building resilience: Appreciate the little things in life. British Journal of Social Work, 38, 218–235.

Wilson, S., & Ferch, S. (2005). Enhancing resilience in the workplace through the practice of caring relationships. Organization Development Journal, 23(4), 45–60.

Getting Through Tough Economic Times

This guide provides practical advice on how to deal with the effects financial difficulties can have on your physical and mental health -- it covers:

•Possible health risks
•Warning signs
•Managing stress
•Getting help
•Suicide warning signs
•Other steps you can take
Possible Health Risks
Economic turmoil (e.g., increased unemployment, foreclosures, loss of investments and other financial distress) can result in a whole host of negative health effects - both physical and mental. It can be particularly devastating to your emotional and mental well-being. Although each of us is affected differently by economic troubles, these problems can add tremendous stress, which in turn can substantially increase the risk for developing such problems as:

•Depression
•Anxiety
•Compulsive Behaviors (over-eating, excessive gambling, spending, etc.)
•Substance Abuse
Warning Signs
It is important to be aware of signs that financial problems may be adversely affecting your emotional or mental well being --or that of someone you care about. These signs include:

•Persistent Sadness/Crying
•Excessive Anxiety
•Lack of Sleep/Constant Fatigue
•Excessive Irritability/Anger
•Increased drinking
•Illicit drug use, including misuse of medications
•Difficulty paying attention or staying focused
•Apathy - not caring about things that are usually important to you
•Not being able to function as well at work, school or home
Managing Stress
If you or someone you care about is experiencing these symptoms, you are not alone. These are common reactions to stress, and there are coping techniques that you can use to help manage it. They include:

•Trying to keep things in perspective - recognize the good aspects of life and retain hope for the future.
•Strengthening connections with family and friends who can provide important emotional support.
•Engaging in activities such as physical exercise, sports or hobbies that can relieve stress and anxiety.
•Developing new employment skills that can provide a practical and highly effective means of coping and directly address financial difficulties.
Getting Help
Even with these coping techniques, however, sometimes these problems can seem overwhelming and you may need additional help to get through "rough patches." Fortunately, there are many people and services that can provide help. These include your:

•Healthcare provider
•Spiritual leader
•School counselor
•Community health clinic
If you need help finding treatment services you can access our Mental Health Services Locator for information and mental health resources near you. Similarly, if you need help with a substance abuse problem you can use our Substance Abuse Treatment Facility Locator.

Specific help for financial hardship is also available, on issues such as:

•Making Home Affordable
•Foreclosure
•Reemployment
•Financial assistance
There are many other places where you can turn for guidance and support in dealing with the financial problems affecting you or someone you care about. These resources exist at the federal, state and community level and can be found through many sources such as:

•Federal and state government
•Civic associations
•Spiritual groups
•Other sources such as the government services section of a phone book
Suicide Warning Signs
Unemployment and other kinds of financial distress do not "cause" suicide directly, but they can be factors that interact dynamically within individuals and affect their risk for suicide. These financial factors can cause strong feelings such as humiliation and despair, which can precipitate suicidal thoughts or actions among those who may already be vulnerable to having these feelings because of life-experiences or underlying mental or emotional conditions (e.g., depression, bi-polar disorder) that place them at greater risk of suicide.

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These are some of the signs you may want to be aware of in trying to determine whether you or someone you care about could be at risk for suicide:

•Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself
•Looking for ways to kill oneself
•Thinking or fantasying about suicide
•Acting recklessly
•Seeing no reason for living or having no sense of purpose in life
If you or someone you care about are having suicidal thoughts or showing these symptoms SEEK IMMEDIATE HELP. Contact your healthcare provider, mental health crisis center, hospital emergency room or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for help.

Other Steps You Can Take
•Acknowledge that economic downturns can be frightening to everyone, but that there are ways of getting through them - from engaging in healthy activities, positive thinking, supportive relationships, to seeking help when needed from health professionals.


•Encourage community-based organizations and groups to provide increased levels of mental health treatment and support to those who are severely affected by the economy.


•Work together to help all members of the community build their resiliency and successfully return to healthy and productive lives.
For further information on mental health or substance abuse issues please visit The Substance Abuse and Mental Health Services Administration (SAMHSA).


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Special Note to Journalists
For ideas on how to best cover sensitive issues like suicide prevention in a thoughtful and constructive manner you can check out suggestions developed by the Annenberg Public Policy Center in conjunction with leading suicide prevention experts and journalists.

NIDA InfoFacts: Understanding Drug Abuse and Addiction

Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction—that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives.

Drug abuse and addiction are a major burden to society. Estimates of the total overall costs of substance abuse in the United States—including health- and crime-related costs as well as losses in productivity—exceed half a trillion dollars annually. This includes approximately $181 billion for illicit drugs,1 $168 billion for tobacco,2 and $185 billion for alcohol.3 Staggering as these numbers are, however, they do not fully describe the breadth of deleterious public health—and safety—implications, which include family disintegration, loss of employment, failure in school, domestic violence, child abuse, and other crimes.


What is drug addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by repeated drug abuse can affect a person’s self control and ability to make sound decisions, and at the same time send intense impulses to take drugs.

It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing drugs. Fortunately, there are treatments that help people to counteract addiction’s powerful disruptive effects and regain control. Research shows that combining addiction treatment medications, if available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.

Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And, as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal failure—rather, it indicates that treatment should be reinstated, adjusted, or that alternate treatment is needed to help the individual regain control and recover.

What happens to your brain when you take drugs?

Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by imitating the brain’s natural chemical messengers, and/or (2) by overstimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.

Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns.

Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that “teaches” people to repeat the behavior of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine’s impact on the reward circuit is lessened, reducing the abuser’s ability to enjoy the drugs and the things that previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug than they first did to achieve the dopamine high—an effect known as tolerance.

Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Drugs of abuse facilitate nonconscious (conditioned) learning, which leads the user to experience uncontrollable cravings when they see a place or person they associate with the drug experience, even when the drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decisionmaking, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse consequences—in other words, to become addicted to drugs.

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Why do some people become addicted, while others do not?

No single factor can predict whether or not a person will become addicted to drugs. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

Biology. The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.


Environment. A person’s environment includes many different influences––from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life.


Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And because adolescents’ brains are still developing in the areas that govern decisionmaking, judgment, and self-control, they are especially prone to risk-taking behaviors, including trying drugs of abuse.


Prevention is the Key

Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs that involve families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. It is necessary, therefore, to help youth and the general public to understand the risks of drug abuse, and for teachers, parents, and healthcare professionals to keep sending the message that drug addiction can be prevented if a person never abuses drugs.