Advice to divorcees: Go easy on yourself

Divorce is tough, for just about everyone. But some people move through a breakup without overwhelming distress, even if they're sad or worried about money, while others get stuck in the bad feelings and can't seem to climb out. What accounts for the difference? LPC CEUs

Self-compassion, says an upcoming study in Psychological Science, a journal published by the Association for Psychological Science. Self-compassion—a combination of kindness toward oneself, recognition of common humanity, and the ability to let painful emotions pass—"can promote resilience and positive outcomes in the face of divorce," says psychologist David A. Sbarra, who conducted the study with University of Arizona colleagues Hillary L. Smith and Matthias R. Mehl. Independent of other personality traits, that one capacity predicts better adjustment shortly after divorce and up to nine months later.

The findings have implications for helping people learn to weather breakups in better health and better spirits.

"We're not interested in the basic statement, 'People who are coping better today do better nine months from now.' That doesn't help anybody," says Sbarra. "The surprising part here is that when we look at a bunch of positive characteristics"—such as self-esteem, resistance to depression, optimism, or ease with relationships—"this one characteristic—self-compassion— uniquely predicts good outcomes."

The study involved 105 people, 38 men and 67 women, whose mean age was about 40; they'd been married over 13 years and divorced an average of three to four months. On the first visit, participants were asked to think about their former partner for 30 seconds, then talk for four minutes about their feelings and thoughts related to the separation.

Four trained coders listened to the audio files and rated the participants' levels of self-compassion, using a standard measure of the construct. The participants also were assessed for other psychological traits, such as depression and their "relationship style." At the initial visit, three months later, and then after either six or nine months participants reported on their adjustment to the divorce, including the frequency with which they experienced intrusive thoughts and emotions about the separation and their ex-partner.

As expected, the people with high levels of self-compassion at the start both recovered faster and were doing better after a period of months.

How can these data help people going through divorce? Sbarra's friends, knowing what he studies, often ask for such advice.

"It's not easy to say, 'Be less anxious.' You can't change your personality so easily. We also know that women do better than men. But you can't change your sex. What you can change is your stance with respect to your experience." Understanding your loss as part of bigger human experience helps assuage feelings of isolation, he says. Mindfulness—noting jealousy or anger without judgment or rumination—lets you turn your mind to life in the present without getting stuck in the past.

Can all this be taught? The researchers are unsure but optimistic. Says Sbarra: "This study opens a window for how we can potentially cultivate self-compassion among recently separated adults" and help smooth the journey through one of life's most difficult experiences.


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For more information about this study, please contact: David A. Sbarra at sbarra@email.arizona.edu.

The APS journal Psychological Science is the highest ranked empirical journal in psychology. For a copy of the article "When Leaving Your Ex, Love Yourself: Observational Ratings of Self-compassion Predict the Course of Emotional Recovery Following Marital Separation" and access to other Psychological Science research findings, please contact Lucy Hyde at 202-293-9300 or lhyde@psychologicalscience.org.

Manic Phase of Bipolar Disorder Benefits from Breast Cancer Medication

The medication tamoxifen, best known as a treatment for breast cancer, dramatically reduces symptoms of the manic phase of bipolar disorder more quickly than many standard medications for the mental illness, a new study shows. Researchers at the National Institutes of Health's National Institute of Mental Health (NIMH) who conducted the study also explained how: Tamoxifen blocks an enzyme called protein kinase C (PKC) that regulates activities in brain cells. The enzyme is thought to be over-active during the manic phase of bipolar disorder. Professional Counselor Continuing Education.

By pointing to PKC as a target for new medications, the study raises the possibility of developing faster-acting treatments for the manic phase of the illness. Current medications for the manic phase generally take more than a week to begin working, and not everyone responds to them. Tamoxifen itself might not become a treatment of choice, though, because it also blocks estrogen — the property that makes it useful as a treatment for breast cancer — and because it may cause endometrial cancer if taken over long periods of time. Currently, tamoxifen is approved by the Food and Drug Administration for treatment of some kinds of cancer and infertility, for example. It was used experimentally in this study because it both blocks PKC and is able to enter the brain.

Results of the study were published online in the September issue of Bipolar Disorders by Husseini K. Manji, MD, Carlos A. Zarate Jr., MD, and colleagues.

Almost 6 million American adults have bipolar disorder, whose symptoms can be disabling. They include profound mood swings, from depression to vastly overblown excitement, energy, and elation, often accompanied by severe irritability. Children also can develop the illness.

During the manic phase of bipolar disorder, patients are in "overdrive" and may throw themselves intensely into harmful behaviors they might not otherwise engage in. They might indulge in risky pleasure-seeking behaviors with potentially serious health consequences, for example, or lavish spending sprees they can't afford. The symptoms sometimes are severe enough to require hospitalization.

"People think of the depressive phase of this brain disorder as the time of risk, but the manic phase has its own dangers," said NIMH Director Thomas R. Insel, MD. "Being able to treat the manic phase more quickly would be a great asset to patients, not just for restoring balance in mood, but also because it could help stop harmful behaviors before they start or get out of control."

The three-week study included eight patients who were given tamoxifen and eight who were given a placebo (a sugar pill); all were adults and all were having a manic episode at the time of the study. Neither the patients nor the researchers knew which of the substances the patients were getting.

By the end of the study, 63 percent of the patients taking tamoxifen had reduced manic symptoms, compared with only 13 percent of those taking a placebo. Patients taking tamoxifen responded by the fifth day — which corresponds with the amount of time needed to build up enough tamoxifen in the brain to dampen PKC activity.

The researchers decided to test tamoxifen's effects on the manic phase of bipolar disorder because standard medications used to treat this phase, specifically, are known to lower PKC activity — but they do it through a roundabout biochemical route that takes time. Tamoxifen is known instead to block PKC directly. As the researchers suspected would happen, tamoxifen's direct actions on PKC resulted in much faster relief of manic symptoms, compared with some of the standard medications available today.

"We now have proof of principle. Our results show that targeting PKC directly, rather than through the trickle-down mechanisms of current medications, is a feasible strategy for developing faster-acting medications for mania," said Manji. "This is a major step toward developing new kinds of medications."

Findings from another recent NIMH study strengthen the results. This previous study showed that the risk of developing bipolar disorder is influenced by a variation in a gene called DGKH. The gene makes a PKC-regulating protein known to be active in the biochemical pathway through which standard medications for bipolar disorder exert their effects - another sign that PKC is a promising direct target at which to aim new medications for the illness.

"Mania isn't just your average mood swing, where any of us might feel upbeat in response to something that happens. It's part of a brain disorder whose behavioral manifestations can severely undermine people's jobs, relationships, and health," said Zarate. "The sooner we can help patients get back on an even keel, the more we can help them avoid major disruptions to their lives and the lives of people around them."



Reference
Zarate Jr. CA, Singh JB, Carlson PJ, Quiroz J, Jolkovsky L, Luckenbaugh DA, Manji HK. Efficiency of a Protein Kinase C Inhibitor (Tamoxifen) in the Treatment of Acute Mania: A Pilot Study. Bipolar Disorders, online ahead of print, September 2007.
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The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

New study shows that most substance abuse treatment programs accept private health insurance

Study indicates that most will be ready to adapt to greater health care coverage provided by the Affordable Care Act and Mental Health Parity and Addiction Equity Act
A new nationwide survey of substance abuse treatment facilities reveals that in 2008 nearly two thirds (65 percent) accepted some private health insurance payment. The survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) also indicated that there were significant differences in the level of private insurance payment acceptance among different types of substance abuse treatment facilities. Professional Counselor Continuing Education
For example, private insurance payment was accepted by 85 percent of facilities with a primary focus on mental health services, 82 percent of facilities offering general health care, and 78 percent of facilities offering a mix of mental health and substance abuse treatment services. On the other hand, private insurance payment was accepted by only 56 percent of facilities primarily focused on substance abuse treatment services and 37 percent of facilities focused on other services (e.g., providing shelter for people experiencing homelessness).

"The ability to bill third party payers including private insurers and Medicaid is critical to the survival of treatment facilities," said SAMHSA Administrator Pamela S. Hyde, J.D. "The dramatic increase in numbers of people covered with health insurance that includes coverage for mental and substance use disorders will revolutionize the behavioral health field. Treatment facilities need to be preparing now and SAMHSA has technical assistance resources available to help."

The study noted that substance abuse treatment facilities that accepted private insurance payments were far more likely than those that did not to accept payment from other sources such as Medicaid (68 percent versus 31 percent), state-financed health insurance (53 percent versus 14 percent) and Medicare (48 percent versus 12 percent).

This capacity of substance abuse programs to bill Medicaid may become more critical as Medicaid’s coverage of substance abuse services becomes more comparable to its coverage of mental health services.

Other significant differences between treatment programs that accepted private insurance payment and those that did not include the use of cognitive-behavioral therapy services at their facilities (70 percent versus 58 percent). Facilities accepting private insurance were more likely than others to accept adolescents into their programs (58 percent versus 33 percent).

The study also showed that treatment facilities located in more central large urban areas were less likely than rurally situated facilities to accept private insurance payment (54 percent versus 78 percent). In general the further away facilities were from central city areas, the more likely they were to accept private insurance payment.

The study, Acceptance of Private Health Insurance in Substance Abuse Treatment Facilities is based on data from SAMHSA’s Treatment Episode Data Set (TEDS) -- a reporting system involving treatment facilities from across the country. The study was developed as part of SAMHSA’s strategic initiative on data, outcomes, and quality -- an effort to inform policy makers and service providers on the nature and scope of behavioral health issues

Symptoms of Bipolar Disorder May Go Undiagnosed in Some Adults with Major Depression

Nearly 40 percent of people with major depression may also have subthreshold hypomania, a form of mania that does not fully meet current diagnostic criteria for bipolar disorder, according to a new NIMH-funded study. The study was published online ahead of print August 15, 2010, in the American Journal of Psychiatry. LPC CEUs
Background
Mania is a symptom of bipolar disorder. According to the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), it is generally defined as a discrete period of increased energy, activity, euphoria or irritability that leads to marked impairment in one’s daily life. The DSM-IV states that a manic episode lasts for one week or more, and may sometimes require hospitalization. Hypomania is defined as a milder form of mania that lasts for four days at a time, but does not interfere with one’s daily activities. The majority of people diagnosed with bipolar disorder experience repeated episodes of hypomania rather than mania.

For this new study, Kathleen Merikangas, PhD., of NIMH, and colleagues aimed to characterize the full spectrum of mania by identifying hypomanic episodes that last less than four days among those diagnosed with major depression. They described this type of hypomania as subthreshold hypomania. Merikangas and colleagues used data from 5,692 respondents of the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of American adults ages 18 and older.

Results of the Study
The researchers found that nearly 40 percent of those identified as having major depression also had symptoms of subthreshold hypomania. Compared to those with major depression alone, those with depression plus subthreshold hypomania tended to be younger at age of onset and to have had more coexisting health problems, more episodes of depression and more suicide attempts. They also found that among those with subthreshold hypomania, a family history of mania was just as common as it was among people with bipolar disorder.

Significance
According to the researchers, the findings indicate that many adults with major depression may in fact have mild but clinically significant symptoms of bipolar disorder. In addition, because many with subthreshold hypomania had a family history of mania, the researchers suggest that subthreshold hypomania may be predictive of future hypomania or mania. Previous research has indicated that young people with subthreshold hypomania symptoms are more likely to develop bipolar disorder over time, compared to those without subthreshold hypomania, said the authors.

What’s Next
The researchers suggest that depression and mania may be defined as dimensions, rather than as discrete diagnostic categories. Clinicians should be aware that patients who report repeated episodes of subthreshold hypomania may have a risk of developing mania, the researcher concluded.

Reference
Angst J, Cui L, Swendsen J, Rothen S, Cravchik A, Kessler R, Merikangas K. Major depressive disorder with sub-threshold bipolarity in the National Comorbidity Survey Replication. American Journal of Psychiatry. Online ahead of print August 15, 2010.

Dept of Consumer Affairs Offers Consumer Coping Strategies to Help Keep Holiday Rush from Becoming "Holiday Blues"

The holiday season can be stressful for many people. Often it's the stress of trying to live up to unrealistic expectations. Many factors can take their toll on emotional well being: rushing around; attending to extra social obligations; being alone; spending too much money; or overindulging in food and drink.

The California Department of Consumer Affairs has tips on dealing with the holiday blues, and advice for consumers who may need to seek professional help. The Department's Board of Psychology licenses psychologists, while the Board of Behavioral Sciences licenses clinical social workers, and marriage and family therapists.

Experts say coping with the holidays starts with simply being aware of your expectations, both for yourself and for friends and family.

"It's an illusion that everyone's holidays are perfect. You may not be able to relive past holidays or create the "perfect" holiday season," explains Jacqueline Horn, Ph.D., president of the California Board of Psychology. "But the holiday blues are usually short-lived and should pass. If you don't feel better soon after the holiday season is over, you may want to seek professional help."

Dr. Horn, a practicing clinical psychologist and lecturer for the UC Davis Department of Psychology, says even those who are isolated and have no support group can brighten their holidays by going out in public. They can go to the mall, attend no-cost or low-cost community events, or volunteer their time to help others during the holidays.

Since days are shorter and the hours of darkness longer, another way to keep the blues at bay is to simply get some sunlight with a daytime activity, experts say.

Following are some tips from psychologists on how to cope with holiday stress:

TIPS TO HELP YOU HANDLE THE HOLIDAYS

■Set realistic goals for yourself
■Find time for yourself.
■Volunteer to do something for others
■Let go of the past. Approach the holidays with a fresh outlook and try something new
■Don't over-indulge by drinking or eating too much
■Spend time with people who are supportive
■Get your sleep
■Get some exercise
■Connect with your community.


However, if your typical coping skills are ineffective and you become overwhelmed by stress, anxiety or depression, it may be a sign that you should consider seeking professional help. Other warning signs include:

■Weight loss or gain
■Thoughts of suicide
■Feelings of worthlessness
■Difficulty thinking or concentrating
■Difficulty sleeping or increased sleeping
■Depression symptoms lasting more than two weeks
If you think you need professional help, start by getting a referral for a qualified therapist from friends, family members, clergy or your physician. Consumers should confirm a therapist is licensed so they meet the professional standards set by the state. Also check that the license is in good standing.

The California Department of Consumer Affairs licenses thousands of professionals who can help. To check license status or get more information, visit the Psychology Board Web site at www.psychboard.ca.gov or the Board of Behavioral Sciences site at www.bbs.ca.gov. Psychiatrists are medical doctors licensed by the Medical Board of California, www.mbc.ca.gov. Licensed Professional Counselor LPC CEUs
For more tips on how to "Be a Safe and Smart Holiday Consumer," check the Department of Consumer Affairs' Web site. The California Department of Consumer Affairs promotes and protects consumer interests. Call(800) 952-5210 or visit the Department's Web site for information on a variety of helpful consumer topics.