In true “Sri Lankan cultural” tradition, especially as we developed during times when there were few services in the community. We have needed to gain experience and expertise in treating a wide range of presenting issues and conditions.

Although we would see ourselves as a general practice capable of responding to most client needs, our regular work with emergency service personnel (such as Police and Ambulance workers), victims of crime, road trauma victims and general “critical incident” work, has tended to focus a deal of our emphasis on the treatment of trauma, the range of anxieties including panic and phobias, depression, pain management, and substance/alcohol abuse.

In addition, over the past decade or so, we have acquired an extensive array of equipment and expertise related to modern Biofeedback and Neurofeedback modalities, which has considerably extended the range of treatment options we offer. Whilst these technologies can be applied to many client requirements, we mainly use them as a natural means to treat children (and adults) with diagnosed ADHD, as well as obsessive compulsive (OCD) symptoms, epilepsy, and the range of anxiety and depression related conditions.

The list on the following pages provides a more detailed display of the major issues that we treat in our practice. Visitors to our website can learn more about each of these issues by selecting (“clicking on”) any of the items. The treatments we use to treat these issues are shown in the Treatments We Offer section.

	Anxiety		ADHD (Attention Deficit Hyperactive Disorder)
	Bedwetting		Depression
	Critical Incidents		Drugs and Alcohol
	Migraines/ Headaches		Panic Disorder and Panic Attacks
	Parenting		Phobias
	Post Natal Depression		Sleep Disorders
	Stopping Smoking		Post Traumatic Stress Disorder (PTSD)
	Relationships		Stress: in its various forms
	Post Traumatic Stress Disorder (PTSD)

1. Anxiety

experiencing anxiety is part of being human. We all feel anxious and under stress from time to time. Pressures and obligations from day to day living tend to increase as we get older and as our responsibilities grow.

The increasing pace of our lives and change in the world also increases our levels of uncertainty. These are all factors which combine to bring about uncertainty and anxious feelings.

In its mildest everyday form, anxiety is important. It helps us to survive. The experience of being a little anxious can involve a heightened alertness and greater focus, which assist us to plan, manage and negotiate our way through life’s challenges. Anxiety has to do with things that matter to us. If it didn’t matter you wouldn’t bother. Sometimes, it’s the “bothering” that’s the problem.

So when does the experience of anxiety become a problem?
We can all relate in our own way to times when our experience of anxiety has interfered with our lives. When our suffering has reached such heights that we are unable to manage our lives in a way that we might choose.

When we are preoccupied, fearful or worried to the point of distraction. When our body might feel like it is out of control. When we can recognize that our fears are unreasonable yet they still prevent us from doing things that we want to do.

Shortness of breath, racing metabolism/heart rate, sweaty palms, tingling, dizziness, disorientation, persistent negative thinking, the “re-experiencing” of traumatic events, the re-occurrence of disturbing dreams or disturbing themes in dreams. These aspects of anxiety can tend to trip us up, and prevent us from doing what we want or need to do. Persistent symptoms like these can be quite debilitating and may severely impact on a person’s capacity to function effectively. Panic Attacks, Phobias, Obsessive Compulsive tendencies and Post Traumatic Stress, are some of the diagnoses that are considered to be related to the broader banner of debilitating anxiety.

Fortunately, these symptoms are generally quite treatable. There are of course a variety of approaches used to treat these symptom patterns. Some treatments tend to focus on learning new behaviours and de-emphasizing “old” patterns (Behaviour Therapy). Whilst other treatments will focus more on identifying and changing unhelpful thought patterns and altering one’s responses to them (Cognitive Behaviour Therapy, CBT). Learning a variety of relaxation strategies can also make significant inroads to overcoming the debilitating aspects of the problem.

Some treatments we offer: Relaxation; CBT; Solution Oriented Counselling; Hypnosis; Meditation; EMDR; TFT; Bio-Feedback; Neuro-Feedback; Critical Incident Counselling; BSFF; ACT; Voice Dialogue; Stress Management; Debriefing; and a Combination Lock Approach

2. ADHD (Attention Deficit Hyperactive Disorder)

School-aged children who have behavior and learning problems may show signs of hyperactivity and/or inattention. If these problems are severe enough, they may be diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The disorder impairs social and academic functioning and is often noticed in children who are failing to learn at school.

ADHD has received a lot of attention; discussion and debate amongst parents, teachers and the wider community in Australia because of the apparent recent increase in the diagnosis of the condition. Controversy has arisen over the use of medication, such as Ritalin, to control symptoms and help manage behavioral and learning problems in children.

What are the key symptoms?
There are two main criteria used to make a diagnosis: attention symptoms and hyperactivity symptoms.

The key features associated with symptoms of inattention include:

	failing to give close attention to details and difficulty sustaining attention in tasks or play
	not listening when spoken to
	not following through on instructions and failure to finish tasks
	difficulty organizing tasks and activities
	avoiding, disliking or being reluctant to engage in tasks that require sustained mental effort
	losing things necessary for tasks or activities
	easily distracted

The key features associated with symptoms of hyperactivity (sometimes known as hyperactivity-impulsivity) include:

	fidgeting with hands or feet, squirming in seat
	leaving seat when remaining sitting is expected
	running about or climbing excessively
	difficulty playing or engaging in leisure activities and often ‘on the go’
	talking excessively and blurting out answers before a question is completed
	interrupting others

To fulfill a diagnosis of ADHD, each symptom must persist for six months or more.

While ADHD is recognized as a disorder that is distinct from other childhood disorders, it frequently overlaps with other conditions such as Conduct Disorder. This can make diagnosis difficult. Also, many of the symptoms of ADHD are shared by other disorders.

How is ADHD Assessed/Diagnosed?
Usually a medical professional such as a pediatrician or child psychiatrist, conducts the initial assessment or diagnosis of ADHD. It is also common for psychologists to be involved. Psychologists focus mainly on how the disorder affects behavior and learning, and what can be done to improve this.

There are various ways to measure ADHD. Psychologists use rating scales, questionnaires and other tests for collecting information from the children themselves, their parents/caregivers and their teachers. Children are observed at home and school.

How is ADHD treated?
Treatments can include medication, training for parents/caregivers/teachers, and tailored behavior management programs for children. Medication is generally used in more severe cases to help focus the child’s attention. Psychological treatments generally aim to develop skills for successful behavior at school.

Medication
Typically, the most commonly prescribed medication is a stimulant such as dexamphetamine and methylphenidate (Ritalin). The high level of prescribing of these medications has caused some community concern.

Psychological treatment
Psychologists commonly provide the following treatments:

	parent/caregiver education about the nature of the disorder and training in behavior management techniques
	teacher education about the nature of the disorder as well as training in behavior management techniques and appropriate learning interventions
	Counselling and psychological treatment of the child, including education and advice, and skills training to improve concentration. Addressing issues of self-esteem, anxiety and peer relationships is also a crucial element of counselling.

Medication should generally not be regarded as sufficient on its own for treatment of ADHD. Even children with severe ADHD should have access to long-term behavioral programs, as should their families and school. Close collaboration and consultation between professionals involved with children with ADHD can ensure medical and psychological interventions are coordinated, to maximize the benefits and outcomes for each child.

Who can help?

It is important that children who may have ADHD are able to access treatment promptly. The APS Psychologist Referral Service can help you find an APS Psychologist with experience in treating and managing ADHD.

Psychological intervention – an alternative to drugs in the fight against ADHD

As concerns arise regarding the increasing trend to prescribe drugs for children and adolescents who display evidence of ADHD, the Australian Psychological Society (APS) is urging General Practitioners and parents to consider the benefits of psychological assessment and intervention.

A US study has recently found the use of drugs to treat ADHD had more than tripled worldwide since 1993 and Australia was among the heaviest users of these drugs. It was reported that about 30 per cent of Australian children diagnosed with ADHD were misdiagnosed and one in 100 children were medicated for it. The reason ADHD was often misdiagnosed was through a misunderstanding of the disorder.

“There is little doubt that at times medication is prescribed over-zealously when a child presents with symptoms of concern. Psychological assessment is needed to support a diagnosis that may then benefit by psychological therapy - often without drugs, which may have significant side-effects.," says Amanda Gordon, APS President.

Significant progress has been made in developing reliable and accurate methods for assessing childhood mental illness. Furthermore, psychological programs have been shown to assist children and adolescents to develop skills for managing and overcoming anxiety and depression. These incorporate parent education and training in behavior management principles to address behavioral problems in young children, and the addition of cognitive behavioral techniques for supporting older children and adolescents.

Clinical practice guidelines recommend parent education and training in behavior management and Cognitive Behavioral Therapy (CBT) as treatments of choice for children and adolescents because they are supported by evidence from rigorous research. "Treatment for anxiety and depressive disorders in children and adolescents should involve short-term psychological and targeted interventions involving the child, parent and school environment," says Gordon.

"Because of the risk of side effects and misuse, the administration of medication to treat childhood disorders should be rated less favorably than psychological treatments which have been shown to be as effective, and in some instances more effective than drug treatment," according to Gordon.

"Psychologists are trained practitioners in this area and their potential contribution needs to be recognized," Gordon says.

School-aged children who have behavioral and learning problems may have symptoms of hyperactivity and/or inattention. If these problems are severe enough, a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) may be made. The behavioral syndrome known as ADHD causes impairment in social and academic functioning and is often noticed in school-aged children who are failing to learn at school.

ADHD has received a lot of attention, discussion and debate amongst parents, teachers and the wider community in Australia in recent years because of the apparent increase in the diagnosis of the condition. Further, the use of stimulant medication (such as Ritalin) to control the symptoms and to aid the management of behavioral and learning problems in children is controversial.

Measurement of ADHD

There is much debate over the most appropriate ways to measure ADHD. Psychologists use rating scales, questionnaires and other tests that have different versions for collecting information from the child, their parents/caregivers and their teachers (both in the home and in the classroom). Observation of the child’s behavior is usually undertaken to supplement the tests. Cognitive tests of attention and its impact on memory and learning can be helpful in establishing and analyzing the attention disorder. Other measures used by psychologists include IQ tests; tests of learning, reading and mathematics; scales that assess behavior and social interactions; as well as information about the child’s birth and early developmental milestones, including any significant life events such as injuries and hospitalization.

Diagnosis

The formal diagnosis of ADHD is complex. There are two main criteria, or symptom groups, that are currently used to make a diagnosis - attentional symptoms and hyperactivity symptoms.

Most ADHD children display characteristics of both hyperactivity and inattention. In the first instance, many cases of ADHD come to the attention of parents/caregivers, teachers and psychologists when children are excessively active, impulsive, inattentive and act in a non-compliant, defiant way.

Key Symptoms

Each symptom (inattention and hyperactivity) must persist for six months or more and be exhibited across various settings.

The key features associated with symptoms of inattention include:

	Failing to give close attention to details and difficulty sustaining attention in tasks or play;
	Not listening when spoken to;
	Not following through on instructions and failure to finish tasks;
	Difficulty organising tasks and activities;
	Avoiding, disliking or being reluctant to engage in tasks that require sustained mental effort;
	Losing things necessary for tasks or activities; and
	Being easily distracted.

The key features associated with symptoms of hyperactivity (sometimes known as hyperactivity-impulsivity) include:

	Fidgeting with hands or feet and squirming while seated;
	Getting up when remaining seated is expected;
	Running about or climbing excessively;
	Difficulty playing or engaging in leisure activities and always ‘on the go’;
	Talking excessively and blurting out answers before a question is completed; and
	Interrupting others.

While ADHD is recognised as a disorder that is distinct from some of the other childhood disorders, it frequently overlaps with other conditions such as Conduct Disorder. This can make diagnosis difficult. Further, many ADHD symptoms are not unique to the disorder. This means that symptoms of ADHD can be non-specific indicators of other childhood disorders, including behavioural difficulties or learning disorders.

Assessment or diagnosis of ADHD is often undertaken in the first instance by a medical professional such as a pediatrician or child psychiatrist. It is also common for child clinical psychologists, clinical neuropsychologists and educational and developmental psychologists to be involved in the diagnosis of ADHD. Clinical neuropsychologists are more likely to be involved where brain or cognitive deficits are implicated. Educational and developmental psychologists are involved when there are educational and learning difficulties and behavioral problems at school, and clinical psychologists where behavioral or emotional disturbances are the obvious outcomes of the disorder and should be included in the treatment/intervention.

Psychologists involved in the treatment and management of the disorder focus primarily on how the disorder affects behavior and learning and what can be done to improve them. They assess the impact on the family and assist the parents/caregivers to manage the child.

Assessment of the child’s behavior at home and in school must also be undertaken.

These are the places where treatment will take place and where behavioral improvements will be noticed. Accurate diagnosis is essential for successful treatment/intervention.

Difficulties associated with the assessment of children with ADHD include:

	The changing definition of diagnostic criteria over time;
	Changes in the disorder as the child grows older;
	Differences in expectations regarding children’s behaviour; and
	The focus of research predominantly on young, white, middle class boys.

Diagnosis is also influenced by consideration of the causal factors believed to be involved in ADHD. In the past research concentrated on finding an underlying brain dysfunction that could account for ADHD, but more recently research has begun to examine how cognitive impairments such as learning difficulties and memory problems are linked with the disorder.

Treatment/intervention

Treatments range from medication through to training for parents/caregivers and/or teachers, as well as cognitive and/or behavioral management programs for the child.

Pharmacological treatment is generally used in more severe cases to help focus the child’s attention. Psychological treatments are primarily oriented towards developing skills for adaptive behavior at school, at home and with peers. These treatments are appropriate for nearly all cases as they are focused on the management of behavior and learning and are directed at the individual child, the parents/caregivers and school personnel.

The most commonly prescribed medication is typically a stimulant such as dexamphetamine and methylphenidate (Ritalin). The high level of prescription of these medications has caused community concern, and has been associated with an overemphasis on the biological aspects of ADHD.

What psychologists offer

One treatment intervention aimed at improving behavior in children diagnosed with ADHD is parent/caregiver training about the nature of the disorder, and in behavior management techniques. Psychologists develop programs aimed at assisting parents/caregivers in managing their child's behavior. These have been shown to have both short and long-term beneficial effects. Such programs train parents/caregivers to set limits for their child, to provide structured routines, to deal with non-compliance, temper outbursts and other disruptive behaviors, and to find other appropriate services.

Education for teachers

Teachers can benefit from programs aimed at assisting them to manage children whose behavior is disruptive in the classroom. Like parent/caregiver training, teachers are trained to deal with the learning and behavioral problems frequently associated with ADHD. Behavioral problems are frequently noticed at school and it has been found that

ADHD children perform best in a highly structured classroom environment. Educational interventions include the use of praise and reward for on-task behavior, using behavioral management techniques such as monitoring via score cards, ways of improving self-regulation (both at home and at school), and enhanced encouragement and support from the teacher. Educational and developmental psychologists can assist by devising suitable programs for the teacher and by monitoring the child's behavior. Many schools have access to educational and developmental psychologists (sometimes referred to as a school psychologist or a guidance officer).

Tailored support and psychological treatment for children with ADHD

Psychologists also offer individual counselling and specific psychological treatments for children with ADHD. Counselling includes educating them about their behavior, discussing issues related to medication, expectations about acceptable behavior and helping the child to achieve insight and self-regulation, as well as skills training to improve concentration and decrease impulsivity. Cognitive-behavioral techniques assist children to improve their behavior and social skills, both at school and at home. These techniques work by enabling children to think about their behavior, develop more effective self-control strategies and to act appropriately. Addressing issues of self-esteem, anxiety and peer relationships is also a crucial element of counselling.

Treatment and intervention should be based on accurate diagnosis. Indeed, any behavioral problem that affects a child's social relations, academic skills or learning, can benefit from a carefully designed program. That program may or may not include medication. The immediate impact of medication makes it an attractive short-term solution for behavioral problems associated with ADHD. This can help the psychologist who then works with a more compliant and focused child. However, programs must also address issues of behavior management or problems that may return when medication ceases or is withdrawn.

Medication should generally not be regarded as sufficient in itself for treatment of ADHD. Even children with severe ADHD should have access to long-term behavioral programs, as should their families and teachers. Close collaboration and consultation between professionals involved with children with ADHD can ensure medical and psychological interventions are coordinated to maximize the benefits and outcomes for each child.

Seeking professional assistance

It is very important that children who have symptoms of inattention or hyperactivity are properly diagnosed so that appropriate treatment and management can commence. A clinical psychologist who works with children, an educational and developmental psychologist, or a clinical neuropsychologist who specializes in the diagnosis of childhood brain disorders, can make the diagnosis. Psychological assessment is usually undertaken in conjunction with a medical assessment in order to provide an accurate and comprehensive diagnosis. A clinical or educational and developmental psychologist can provide the necessary programs for the management of ADHD in the school and at home, working with teachers and parents to assist the child's social and academic development.

Your APS psychologist has at least six years of education and training to equip them to provide a professional and efficient service. You can access an APS psychologist for professional assistance in understanding and managing ADHD in children. Refer to the APS Find a Psychologist service.



3. Bedwetting

Bedwetting (or nocturnal enuresis or sleep wetting) is involuntary urination while asleep. It is the normal state of affairs in infancy, but can be a source of embarrassment when it persists into school age or the teen years.

Primary enuresis is when the child has never been dry at night or would not sleep dry without being taken to the toilet by another person or has some dry nights but continues to average at least two wet nights a week with no long periods of dryness.

Secondary enuresis occurs when a child goes through an extended period of dryness and begins to experience night-time wetting again. Secondary enuresis is often (though by no means always) caused by emotional stress.

Regulation and individual differences

Children usually achieve nighttime dryness by developing one or both of two abilities. There appear to be some hereditary factors in how and when these develop.

One is a hormone cycle in which a minute burst of antidiuretic hormone happens daily at about sunset reducing kidney output of urine well into the night so the bladder doesn't get full until morning. This hormone cycle is not present at birth. Many children develop it between the ages of two and six, others between six and the end of puberty, and some not at all.

The other is the ability to awaken before sleep wetting. For some children this is a natural extension of learning to be aware of and control their bladders while awake. For others, a variety of factors suppress or disrupt this awareness when asleep, and they are unlikely to develop it. Taking children to use the toilet while not fully awake can prolong dependence on that by encouraging them to urinate while nearly asleep.

Prevalence

Figures commonly cited suggest that enough children sleep wet at age six (perhaps one in three) so that it is within normal expectations. Because of this, supportive management can be seen as appropriate until a child is seven or eight or has the maturity and desire to take an active role in planning and implementing specific treatment. Also, even with no active treatment, about 15% (one in seven) of children who do sleep wet will stop each year through natural development. Some sources indicate that 5-10% of teenage children experience occasional sleep wetting.

Conventional Treatment

Some psychologists and experts recommend the use of night-time training devices such as a bedwetting alarm to help condition the child first to wake up at the sensation of moisture and then at the sensation of a full bladder. Success with alarms is increased and relapses reduced when combined with programs which may include bladder muscle exercises, dietary changes, mental imagery, stress reduction, and other supportive activities.

Using absorbent products such as padded night-time pants usually helps bedwetting children feel less embarrassed about their accidents. Although these products will not treat or cure bedwetting, they make it easier for children and their families to deal with the issue.

The use of disposable training pants without any other treatment is not considered unusual until about 6 to 10 years of age. After that point, other treatments may be used with or without absorbent products, such as the aforementioned medication or alarm systems. Occasional bedwetting such as once a month to once a year is normal for a child between 4 and 16 and nothing to get alarmed at.

There is however, a growing number of voices against the use of such products, because some parents feel that they can hinder, rather than help the process of assisting with bedwetting; since some children appear to treat them and indeed use them, as a substitute nappy.

Experts generally agree that parents' understanding that sleepwetting is not the child’s fault strongly increases the child's willingness to help deal with it. Although historically, physical punishment such as spanking was the normal method of motivating older

children to stop sleep wetting, anti-spanking advocates have discouraged any corporal punishment for this purpose.

Punishments including restrictions, teasing, or shaming, whether actual or threatened, are counterproductive. Encouragement of self reliance allows for the child's own natural and native development to acquire the ability to sleep dry on his or her own terms.

What we offer

Over the 20 years of clinical practice we have had some clinical success with using a combination of the following approaches with children who have been assessed by their treating physician as being a suitable candidate for such interventions.

	Hypnosis is a gentle, safe and highly effective first approach that we will often offer
	Relaxation, anxiety and stress reduction strategies
	CBT to address distressing beliefs, shame or stress
	For the late maturing bladder biofeedback can make a difference
	We can help parents or carers to set up for success and decide on realistic regimes and time frames.

A suitable candidate might be

	A child over 7 years
	A child previously dry who regresses to bed wetting after an emotional disturbance
	When there is a family history of bed wetting

4. Critical Incidents

Debriefing and Defusing are terms referring to therapeutic processes that are employed following a severely traumatic event, or what is often called a “Critical Incident”.

The major purpose of Debriefing is to bring together a group of people who have shared a traumatic experience, where they can openly discuss their reactions and derive mutual support from the process.

Defusing refers to a less formal process of support. It may simply involve “checking in” with a colleague as one passes in the corridor, or offering to get a friend a coffee or snack. The act of Defusing, as the name suggests, will generally involve helping another feel supported, and perhaps even allow for informal situations to arise that offer opportunity for them to release thoughts and feelings.

Listening is a key to effective Debriefing and Defusing.

Debriefing is usually a single session crisis intervention that is designed to reduce and prevent debilitating psychological symptoms by: promoting the processing of emotions; the ventilation, acknowledgement and validation of reactions; the design of any therapeutic actions that may be important for participants in the immediate future; and the preparation and planning for possible future experiences.

Debriefing can often circumvent common attempts to be helpful that may in fact prove otherwise. Too often in our attempts to help friends or colleagues we can feel pressured to offer suggestions, make explanations, or “fix” their discomfort. Such comments as “you’ll get over it” or “just don’t think about it” can be offered with the best of intentions, yet can often contribute to the person feeling unheard and not understood, thus even more alone.

Effective Debriefing requires a deal of skill. The process typically occurs when high levels of emotion, vulnerability, uncertainty and confusion can readily cloud the progress and judgement of those who have experienced the trauma. For this reason, research findings as to the effectiveness of the process have tended to be variable.

In our experience, we have found that the effectiveness of any Debriefing process can be greatly enhanced when:

	intervention is prompt and occurs as soon as possible following the incident;
	the participants are given ample opportunity to express their reactions and support each other in an open and permissive atmosphere;
	attention is given to any immediate steps that may be useful for participants to take to assist in their recovery;
	any further steps that may be useful for the group to consider and put into action.

5.Depression

Depression is a term we are talking more and more about. There is increasing debate, research and awareness contributing to how we understand its symptoms. For some, and perhaps more traditionally, we have seen depression as a medical condition, a condition associated with chemical imbalance, and as such responsive to pharmaceutical treatment.

There is however, a growing body of hard evidence and opinion that point to social factors being strongly implicated with the pattern of symptoms that we understand as depression.

Depression is a word used to describe a whole range of feelings. For most of us it would include feelings of sadness, feeling miserable and unmotivated, or just generally feeling flat. These are not uncommon feelings that we all experience from time to time.

The question for us is to what degree are the symptoms being experienced? To what degree are the symptoms interfering with the person’s quality of life - and/or the meaning they may derive from their daily activities? We would see treatment as being a useful option when symptoms like these begin to interfere with the way of life the person considers normal, purposeful and productive.

The Australian Psychological Society advise that people who may be diagnosed as depressed could be experiencing a range of symptoms that could include:

	Feeling sad or empty
	Sleeping problems
	Worrying and negative thinking
	Feeling helpless and hopeless
	Irritability and agitation
	Loss of interest and energy
	Change in appetite
	Loss of confidence
	Feeling guilty and worthless
	Suicidal thoughts

These days we understand that the experience of depression is common. We are more aware now that the symptoms we associate with depression are strongly linked with our increasing rates of suicide. Unfortunately, depression is often not recognised or treated. The good news is that current treatments for depression are safe and effective.

The two major modes of treatment for Depression are Psychological and Pharmaceutical Methods, and it is common for these two approaches to be used in combination.

Much of the research that is emerging indicates that Psychological Treatments have matched, and in some cases exceeded pharmaceutical treatments.

As a Psychological Practice there are a range of treatments we offer. These treatments can be targeted, individually or in combination to best suit the client.

Importantly, we have found that Psychological Treatments not only help people to recover, they can also help to prevent a recurrence of the symptoms. We feel it is important for people to learn and to adopt new strategies that not only assist them to identify the symptoms should they begin to re-appear, but give them techniques to address them at this time.

Major Treatments we offer include: Counselling; CBT (Cognitive Behavior Therapy); Hypnosis ; EMDR; TFT; BSFF; Neuro Feedback; Bio- Feedback; Relaxation; Meditation; Breath Training; Voice Dialogue; Mindfulness; and ACT

Helpful sources can be found: www.beyondblue.org.au and www.psychology.org.au




6. Drugs and Alcohol

Many people use drugs or alcohol as a way of trying to cope with their problem(s). Drugs or alcohol can act as emotional or physical painkillers. However, they can also cover up and distort our experiences of ourselves and the world.

So there are times when we might use drugs or alcohol to cover, avoid or dampen underlying problems - such as, unhappiness; a sense of hopelessness; emotional pain; or physical pain. These circumstances usually relate to situations that we see no solutions or any way we might effect change.

Addiction

A drug is any substance that when taken into a person’s body may modify one or more of their functions. Drugs can provide temporary relief from unhealthy symptoms. However, some drugs produce unwanted side affects, and can increase our physical, emotional and psychological reliance on their use.

Heavy reliance on drugs or alcohol can distract the user from focusing productively on their life and the issues at hand. When this occurs we might often see someone in this position hiding their drug use from their friends and family members. These actions are usually accompanied by feelings of dishonesty and guilt which can heighten the likelihood of anxiety, hopelessness and feelings of depression – experiences that in turn can fuel the pattern of drugs abuse. When this occurs it is not unusual for the person to be experienced very differently by those who know them. These changes may not be apparent to the person themselves.

Any useful treatment will likely involve helping the person get more in touch with managing their life and their experience of themselves. Our approach would emphasize working closely with the person and often their families to design ways of achieving this.

Treatments may include: Counselling; Hypnosis; CBT; EMDR; TFT; BSFF; Voice Dialogue; Neuro-feedback; Bio-feedback; ACT; Relaxation; Meditation; and Mindfulness.

9. Memory/ Concentration
Information Updating…..


10. Migraines/ Headaches

Migraines: Myth vs. Reality
An Understanding of Migraine Disease & Tips for Migraine Management

"One pill makes you larger, and one pill makes you small and the ones that mother gives you, don't do anything at all," words the Cheshire-Cat could have uttered, but they came to us from Grace Slick in her iconoclastic lyrical interpretation of 'Alice In Wonderland'. Over a hundred years ago a fine art photographer took us on a wonderful journey through the eyes of Alice. The photographer-turned-writer drew from his personal experience with the disease he so suffered from, that of Migraine. His name was Lewis Carroll, and one may argue that if it were not for his constant Migraine attacks, he may not have been inspired to give us these gifts of fantasy by writing Alice's Adventures in Wonderland and Through the Looking-Glass and What Alice Found There.

After a century of society and the medical community blaming Migraines on their sufferers, advanced technology and the age of information gave us the knowledge to begin to understand this debilitating disease. However, dangerous and outdated myths surrounding the Migraine disease have not yet been dispelled on a widespread basis. Not only are such myths believed by many loved ones and co-workers of those with Migraines, but by those with Migraines themselves (Migraineurs). Furthermore, such myths continue to be unwittingly reported in the media. The Migraine disease is a serious health and disability problem that affects approximately 32 million Americans, most of whom are women, with up to 38 million Americans having Migraine genetic propensity. There is no known cure for the Migraine disease, only treatments for the symptoms. Furthermore, such treatments are not yet wholly effective and Migraineurs may show a diminished tolerance to a variety of medications, treatments, and pain management regiments.

Dr. Joel R. Saper, M.D., F.A.C.P., Director, Michigan Head-Pain & Neurological Institute, summarized for M.A.G.N.U.M. the problems associated with Migraine: "There is no condition of such magnitude that is as shrouded in myth, misinformation, and mistreatment as is this condition [Migraine], and there are few conditions which are as disabling during the acute attack."

In addition to being disabling, Migraines can be life-threatening. To put this in perspective, more people died from Migrainous Stroke last year than were murdered with handguns. The World Health Organization in 2004 in a Blue Book report noting that Migraine & Headache disorders are a global public health calamity. Dr Peer Tfelt-Hansen, president of IHS, explained:

"They are common neurobiological and often life-long conditions occurring throughout the world that affect men, women and children. They have been shown to cause a huge burden of disability. WHO ranks Migraine as one of the top twenty causes of years of healthy life lost to disability. And Migraine is but one headache disorder Ð all headache disorders together cause at least double the disability of Migraine alone."

Celebrities and historical figures with the Migraine disease include, among many, Vincent Van Gogh, Claude Monet, Julius Caesar, Napoleon, Ulysses S. Grant, Robert E. Lee, Virginia Wolfe, Lewis Carroll, Mary Todd Lincoln, Elvis Presley, Loretta Lynn, and beloved American President John F. Kennedy just to name a few.
It is important to arm yourself with the real facts and mechanics of this disease to improve your quality of life.

Set forth below are a few of the most common and devastating myths surrounding Migraine, and the corresponding facts that counter such myths. Once the facts are known, proper treatment can be sought by Migraineurs, both through medication and management of controllable Migraine triggers. You would be surprised how understanding your combination of trigger mechanisms will do more to reducing the number and frequency of attacks than a prophylactic drug regiment (taking multiple drugs several times a day, every day, as a preventative treatment).

MYTH: A MIGRAINE IS JUST A BAD HEADACHE.

REALITY: MIGRAINE IS A DISEASE, A HEADACHE IS ONLY A SYMPTOM. IN ADDITION, THE CAUSE OF MIGRAINE PAIN IS THE OPPOSITE OF THE CAUSE OF HEADACHE PAIN.

Migraine is disease, a headache is only a symptom. Migraine pain is caused by vasodilation in the cranial blood vessels (expansion of the blood vessels), while headache pain is caused by vasoconstriction (narrowing of the blood vessels). During a migraine, inflammation of the tissue surrounding the brain, i.e., neurogenic inflammation, exacerbates the pain. Therefore, medicine often prescribed to treat a headache, such as beta-blockers, dilate the blood vessels and therefore can make a Migraine worse.

Unlike a headache, the Migraine disease has many symptoms, including nausea, vomiting, auras (light spots), sensitivity to light and sound, numbness, difficulty in speech, and severe semihemispherical head pain. One Migraine attack alone can last for eight hours, several days, or even weeks.

Migraine is a genetically-based disease. We first learned this in the mid-90's, as it was specifically stated in correspondence with M.A.G.N.U.M. by Dr. Stephen J. Peroutka, M.D., Ph.D., President & CEO of Spectra Biomedical, Inc., a group of research physicians dedicated to understanding the genetic basis of Migraine and other illnesses, the "data are unequivocal: Migraine is a genetically-based illness. Individuals with a single parent having Migraine have approximately a 50% chance of having Migraine. This susceptibility is neither psychological nor induced by environmental causes."

The the really exciting genetic discoveries where yet to come! And it came from down under by an Australian genetic research team at Grithiths University, north of Sydney. The Millennium year was a breakthrough year for Migraineurs as the Australian team, lead by Professor Lynn Griffiths, discovered not one, not two, but three genes for Migraine disease! MAGNUM had the opportunity to interview Dr. Lyn Griffiths, one of the world's top experts on Migraines and genetics. Dr. Griffiths is the director of the Genomics Research Center at the Gold Coast campus of Griffith University, in Queensland, Australia. She told us that the research clearly shows that almost all Migraineurs have a close relative who is also a Migraineur. Migraineurs have a real ally in Dr. Griffiths as we where very impressed with her resolve for follow her research as far it goes, which just may lead us to a cure in the future.

A Migraine is induced by various controllable and uncontrollable triggers. Uncontrollable triggers include weather patterns and menstrual cycles, and controllable triggers include bright light, aspartame, and alcohol. The severity and frequency of Migraines for one person depends upon how many triggers an individual must experience before a Migraine is induced. The combination of triggers is different for each person.

MYTH: MIGRAINE IS CAUSED BY PSYCHOLOGICAL FACTORS, SUCH AS STRESS AND DEPRESSION.

REALITY: MIGRAINE IS A NEUROLOGICAL DISEASE, NOT A PSYCHOLOGICAL DISORDER.

Migraine is a true organic neurological disease. A Migraine is caused when a physiological (not psychological) trigger or triggers cause vasodilatation in the cranial blood vessels, which triggers nerve endings to release chemical substances called neurotransmitters, of which the neurotransmitter serotonin (5-HTT) is an important factor in the development of Migraine.

Dr. Saper stated in his endorsement letter to M.A.G.N.U.M. that "[Migraine] is not a psychological or psychiatric disease but one which results from biological and physiological alterations." Similarly, Dr. Fred D. Sheftell, M.D., Director and Founder for the New England Center for Headache specifically stated in his letter of endorsement that "Migraine is absolutely a biologically-based disorder with the same validity as other medical disorders including hypertension, angina, asthma, epilepsy, etc. Unfortunately, there have been many myths perpetrated in regard to this disorder. The most destructive of which are 'It is all in your head,' 'You have to learn to live with it,' and 'Stress is the major cause.'"

Misdiagnosis of Migraine as a psychological disorder can lead to a doctor prescribing unnecessary, counterproductive, and even dangerous medication. It is common for a Migraineur to be diagnosed, for example, with clinical depression and prescribed unnecessary drugs, leaving the Migraines unaffected. The continued presence of the Migraines may lead the doctor to believe that the Migraineur is unable to "handle" problems and is still "depressed", leading to continued unnecessary drug treatment ... and so on.

As mentioned above, the Migraine disease is induced by various trigger mechanisms. Trigger mechanisms can be broken down into two primary categories: uncontrollable and controllable. The Migraine triggers usually work in combinations.

Remember, Migraine is a disease that involves a heightening of one's senses, all of one's senses. A Migraineur is more sensitive to his or her surroundings, including light, sound, smells, taste (chemicals in foods), and touch (including the touch of the atmospheric pressure on one's body). Awareness of one's environment is critical for a Migraineur.

A good example of an uncontrollable Migraine trigger is weather patterns. Germany, for example, offers a telephone number that people such as weather-sensitive Migraine sufferers can call to find out the risk to their health of that day's weather pattern. A recent study entitled "The Effects of Weather on the Frequency and Severity of Migraine Headaches" conducted in Canada arrived at the following conclusions: 1) "Phase 4" weather, characterized by a drop in barometric pressure, the passing of a warm front, high temperature and humidity and oftentimes rain, is closely associated with higher frequency and severity of Migraine attacks.; 2) a high humidex discomfort index during the summer is associated with an increased frequency of Migraine attacks; 3) wind from the southeast was shown to be associated with more attacks than wind from any other direction; and 4) a number of Migraine sufferers may be sensitive to extreme rates of barometric pressure changes.

Another common uncontrollable trigger is the menstrual cycle. As explained by Dr. Stephen D. Silberstein, M.D., F.A.C.P., Co-Director, The Comprehensive Headache Center at Germantown Hospital and Medical Center, Migraine usually develops around the time of the first menstrual period, called the menarche. The Migraine appears to be the result of falling levels or reduced availability of estrogen. Migraine sometimes becomes worse in the first trimester of pregnancy, but many women are Migraine-free later in their pregnancy. Menstrual Migraine is often more difficult to treat than other types of head pain. Women who have Migraines only with their period can often achieve relief by taking preventive (prophylactic) medication just before their period begins. If severe menstrual Migraine cannot be effectively controlled by any of these medications, hormonal therapy is a possibility.

Controllable triggers, on the other hand, include bright light, chemical smells, second-hand smoke, particular alcohols such as red wine and some hard alcohols such as scotch, foods that are known vasodilator such as fish, some chocolate, aged cheese, and foods which contain nitrates and/or the radical vasodilator MSG.

Therefore, if one avoids controllable triggers during Migraine-weather or menstrual cycles, one may be able to escape a Migraine attack. Another tip: take abortive medication prescribed for Migraine at the earliest sign of a Migraine attack. Oftentimes, if one waits to take the medication until the attack has matured, the medication may prove practically ineffective. The drugs commonly prescribed to Migraineurs fall into two groups: abortive and preventative (prophylactic). There are some common problems and adverse effects associated with a host of the medications. Some of the more pronounced are: from abortive drugs, dizziness from Stadol, tolerance to barbiturates, rebound headache from overuse of Ergotamine and over-the-counter non-narcotic analgesics (e.g., Tylenol, aspirin and NSAIDS); and from preventative drugs, beta-blockers and calcium channel-blockers can trigger headaches/Migraines. Get to know your pharmacist, he or she can be an important source of information.


MYTH: MIGRAINE IS NOT LIFE THREATENING, JUST ANNOYING.

REALITY: MIGRAINE CAN BE LIFE THREATENING, INDUCING SUCH CONDITIONS AS STROKE AND COMA.

Migraine can induce a host of serious physical conditions: strokes, aneurysms, permanent visual loss, severe dental problems, coma and even death.

According to the New England Journal of Medicine, "migraine can sometimes lead to ischemic stroke and stroke can sometimes be aggravated by or associated with the development of migraine." Twenty-seven percent of all strokes suffered by persons under the age of 45 are caused by Migraine. Stroke is the third leading cause of death in this country. In addition, twenty-five percent of all incidents of cerebral infarction were associated with Migraines, according to the Mayo clinic. Most recently the British Medical Journal reported that after evaluating 14 major Migraine & stroke studies in the U.S. and Canada that Migraineurs are 2.2 times greater risk for stroke than the non-migraine population. That risk goes up to a staggering 8 times more stroke risk for women Migraineurs on the pill!

Migraine and epileptic seizure disorders are also interrelated. The most intimate interrelationship between the two being Migraine-triggered epilepsy. Migraine affects up to 15% of the epileptic population. In basic terms, Migraine and Epilepsy are both disorders characterized by paroxysmal, transient alterations of Neurologic function, usually with normal Neurologic examinations between events (attacks).

Not only can the Migraine disease be life threatening, but it can have a devastating and disruptive effect on normal living. Migraine sufferers experience not only excruciating pain, but social ostracism, job loss, disruption to personal relationships, and prejudices in the workplace.

Oftentimes people think that those with Migraines just can't handle life, or, in reality, are drug addicts or alcoholics. Such perception can be formed when, for example, people see a Migraineur wearing sun glasses indoors (photo sensitive), lying in a dark and silent room (photo and sound sensitive), making frequent trips to the rest room (nausea and vomiting), leaving early, working late, slurred speech, all what they may think is erratic behavior. According to Dr. Sheftell, "Historically, patients with the most intractable Migraines experience a downward spiral in terms of income and contributions to society at large."

Also, a recent study showed that the loss of labor time and lost productivity of Migraine sufferers may exact a significant toll on U.S. business. According to a position paper signed by the American Academy of Pain Medicine, et. al., 150 million work days per year, equivalent to 1,200 million work hours, are lost each year to head pain. The corresponding annual cost to industry and the health care system due to Migraine amounts to $5 to $17 billion.

MYTH: ANY DOCTOR WILL RECOGNIZE AND PROPERLY TREAT MIGRAINE.

REALITY: MIGRAINE IS ONE OF THE MOST MISDIAGNOSED, MISTREATED AND LEAST UNDERSTOOD DISEASES.

The fact that so many doctors don't take Migraine seriously can be as disabling to the Migraineur as the disability itself. The leading d