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 doctors in the areas of neurology and head pain have themselves stated that this disease is grossly misunderstood and misdiagnosed. In fact, 60% of women and 70% of men with Migraine have never been diagnosed with this disease. This medical ignorance and corresponding inaccurate writings unfortunately perpetuate the myths and misunderstandings about Migraine and convey this to the general public.

Dr. Saper stated that "Migraine is a serious and underestimated health problem ... Patients with Migraine are shunted along an assembly line of misdiagnosis, undertreatment, or frank mismanagement. They are subjected to unnecessary procedures and preventable consequences." And as Dr. Silberstein wrote to

M.A.G.N.U.M., "Migraine sufferers must not only cope with their pain, but also with society's misunderstanding of the disorder. Migraineurs are frequently dismissed as neurotic complainers who are unable to handle stress. The truth is that they frequently battle against great odds in order to hold down jobs and support families ... Young Migraine sufferers sometimes miss enough school so that they are unable to graduate with their peers."

Similarly, Dr. Sheftell stated "In addition to misdiagnosis and under-diagnosis, Migraine sufferers will bear the brunt of discriminatory policies by a variety of health care agencies." Such agencies may deny reimbursement for emergency room visits and for hospitalizations for the most severe sufferers. It is not uncommon for doctors to think that a Migraine sufferer is in the emergency room to receive drugs, and dangerously turn them away.
Because Migraine is a genetically-based disease, severe Migraine, according to Spectra Biomedical, "will be diagnosable by objective DNA tests with in the next few years. These tests should also lead to a significant improvement in the disease management of this common and often disabling illness."

Improved health care related to the Migraine disability is one way in which M.A.G.N.U.M. is working to improve the life of Migraineurs. M.A.G.N.U.M. is working with U.S. Senator Charles Robb to include Intractable Migraine in the Code of Federal Regulations "Listing of Impairments" Parts A & B. This is an immediately achievable health care reform on which Senator John Warner (R-VA) & Congressman James Moran (D-VA) have committed to work with M.A.G.N.U.M. on.

According to the world’s leading Migraine disease epidemiologist, Dr. Richard Lipton, of the Albert Einstein College of Medicine of Yeshiva University, -- "Education and empowerment are the keys to successful Migraine management. Patients, who understand their disease, identify their triggers and learn to use both behavioral strategies and medications effectively can dramatically reduce their burden of illness." MAGNUM in working hard to continue to empower Migraineurs by keeping access to quality information about their disease ever available and current.

We are far from a cure, let alone a sure-fired treatment, for Migraine. But understanding that Migraine is a real and debilitating disease goes a long way toward improving the quality of life for Migraineurs and their loved ones.

And if you are not a Migraine sufferer, then remember the next time you offer advice to the person in your life that suffers from Migraines, make sure it's not toxic (i.e., you need to avoid stress, cheer up, don't drink Coke, or other well-meaning but emotionally debilitating statements). Rather, offer to turn down the lights and the TV, and let them know you understand. Remember: Migraine is an "invisible" disorder. "Well! I've often seen a cat without a grin," thought Alice; "But a grin without a cat! It's the most curious thing I ever saw in all my life!" Like Alice's Cheshire-Cat who sat in a tree revealing himself only to Alice, he nonetheless had great impact on her daily travels, as Migraines do on individuals who suffer from them.




13. Panic Disorder and Panic Attacks

Panic Disorder is not the same thing as having a panic attack. Some research has suggested that panic attacks are a relatively common experience, where as many as 1 in every 3 people can have the experience of a panic attack in a year. So, many people experience occasional panic attacks, and if you have had one or two such attacks, there probably isn't any reason to worry.

The key symptom of panic disorder is the persistent fear of having future panic attacks, especially if this effect is interrupting the everyday functioning of your life. If you suffer from repeated (four or more) panic attacks, and perhaps particularly if you have had a panic attack and are in continued fear of having another, these are signs that you should consider finding a mental health professional who specializes in panic or anxiety disorders.

The escalation of a few panic attacks into a “panic disorder” can often occur during the teenage years or early adulthood, and while the exact causes are unclear, there does seem to be a connection with major life transitions that are potentially stressful: academic pressures, getting married, having a first child, and so on. In some circles, there is argument for a genetic predisposition. This point of view suggests that if a family member has suffered from panic disorder, you may have an increased risk of suffering from it yourself, especially during a time in your life that is particularly stressful.

Panic Attacks: The Hallmark of Panic Disorder

A panic attack is a sudden surge of overwhelming fear that can come without warning and may not be associated with any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience.

Symptoms of a panic attack can include:

	racing heartbeat
	difficulty breathing, feeling as though you 'can't get enough air'
	terror that may be almost paralyzing
	dizziness, lightheadedness or nausea
	trembling, sweating, shaking
	choking, chest pains
	hot flashes, or sudden chills
	tingling in fingers or toes ('pins and needles')
	fear that you're going to go crazy or are about to die

You may recognize this as the classic 'flight or fight' response that human beings experience when we are in a situation of danger. But during a panic attack, these symptoms can rise from out of nowhere. They may occur in seemingly harmless situations—and for some, the symptoms can appear during sleep.

In addition to the above symptoms, a panic attack is often marked by the following conditions:

	it occurs suddenly, without any warning and without any way to stop it.
	the level of fear is way out of proportion to the actual situation; often, in fact, it's completely unrelated

It seemed to us that this focus would also reflect the positive and practical approach that we take to treatment in our clinic, and provide a practical way for visitors to our website to think about and experiment with their own parenting issues.

It seems easy sometimes for us to idealize childhood as a carefree time, but youth alone offers no shield against the emotional hurts and traumas many children face. Children can be asked to deal with problems ranging from adapting to a new classroom to bullying by classmates or even abuse at home. Add to that the uncertainties that are part of growing up, and childhood for many of our children can be anything but carefree. The ability to thrive despite these challenges arises from the skills of resilience.

The good news is that resilience skills can be learned.

Building resilience -- the ability to adapt well to adversity, trauma, tragedy, threats, or even significant sources of stress -- can help our children manage stress and feelings of anxiety and uncertainty. However, being resilient does not mean that children won't experience difficulty or distress. Emotional pain and sadness are common when we have suffered major trauma or personal loss, or even when we hear of someone else's loss or trauma.

8. Keep things in perspective and maintain a hopeful outlook
Even when your child is facing very painful events, help him look at the situation in a broader context and keep a long-term perspective. Although your child may be too young to consider a long-term look on his own, help him or her see that there is a future beyond the current situation and that the future can be good. An optimistic and positive outlook enables your child to see the good things in life and keep going even in the hardest times. In school, use history to show that life moves on after bad events.

9. Look for opportunities for self-discovery
Tough times are often the times when children learn the most about themselves. Help your child take a look at how whatever he is facing can teach him "what he is made of." You may find a way opening conversations that illuminate what has been learned after facing a tough situation.

10. Accept that change is part of living
Change often can be scary for children and teens. Help your child see that change is part of life and new goals can replace goals that have become unattainable. For example, you might point out how children change as they get older and move up in year levels and discuss how that change has had an impact on them.

Resilience and Pre-school Children

Very young children will only recently have mastered the skills of walking and talking, and they may not be able to express their anxieties and fears. Although you may think they are too young to understand what is happening, even very young children can absorb frightening events from the news or from conversations they overhear. This effect is known as Vicarious Trauma.

Watch your children for signs of fear and anxiety they may not be able to put into words. Have your children become extra clingy, needing more hugs and kisses than usual? Have your children started wetting the bed or sucking their thumb after you thought they had outgrown that behavior? They may be feeling the pressure of what is going on in the world around them. Use play to help your children express their fears and encourage them to use art or pretend games to express what they may not be able to put into words.

Use your family like a security blanket for your children: wrap them up in family closeness and make sure your children have lots of family time. During times of stress and change, spend more time with your children playing games, reading to them, or just holding them close.

Young children especially crave routine and rituals. If bedtime is the time you read stories to your children, make sure you keep that time for stories. Your child may be less able to handle change when he or she is going through a particularly rough time.

Resilience and the early school years

During their early years at school, children may be starting to bump into the cliques and teasing that can occur as children begin to establish the "social order" of their schools. As they start to study subjects about the world outside of their homes, they look to teachers as well as to parents to make them feel safe and to help sort it all out.

Make sure your child has a place he or she feels safe, whether that is home or school (ideally, discussion about feelings of safety in both environments would be best).

Talk to your children. When they have questions, answer them honestly but simply and with reassurance that includes black-and-white statements that leave no room for doubt, such as "I will always take care of you." Don't discount their fears when they bring them to you.
When there is a situation outside of the home that is frightening, limit the amount of news your children watch or listen to. You don't need to hide what's happening in the world from your children, but neither do they have to be exposed to constant stories that fuel their fears.

Realize that extra stresses may heighten normal daily stresses. Your children might normally be able to handle a failed test or teasing, but be understanding that they may respond with anger or bad behavior to stress that normally wouldn't rattle them. Reassure them that you just expect them to do their best.

Resilience and the mid school years

Even without larger traumas, middle school can be an especially difficult time for many children as they struggle to meet extra academic demands and avoid new social pitfalls. They look to teachers and friends as well as to parents to make them feel safe.

Reinforce empathy and help your child keep perspective. When your child is a victim of the shifting social alliances that form in the middle school years, help him or her understand that other children may be feeling just as lonely and confused, and help her see beyond the current situation - alliances that shift one way may shift back again the next week at this age.

Talk with your child about your own feelings during times of extraordinary stress such as the death of a loved one. Your children probably are old enough to appreciate some grey areas in your own feelings, but you should leave no room for doubt when you talk about how you will do whatever it takes to keep them safe.

Enlist your children's help, whether it's a chore or an opinion about a family activity. Include your children in any volunteer activity you do. Make sure your children know how their actions contribute to the entire family's well-being. If your children know that they have roles to play, and that they can help, they will feel more in control and more confident.

Resilience and the Teenage years

Although your teens may tower over you, they still are very young and can keenly feel the fear and uncertainty of both the normal stresses of being a teen, as well as events in the world around them. Emotions may be volatile and close to the surface during the teen years and finding the best way to connect to your teen can be difficult.

Talk with your teens whenever you can, even if it seems they don't want to talk to you. Sometimes the best time to talk may be when you are in the car together; sometimes it may be when you are doing jobs together, allowing your teens to focus on something else while they talk. When your teens have questions, answer them honestly but with reassurance. Ask them their opinion about what is happening and listen to their answers.

Make your home a safe place emotionally for your teens. In the High School years, taunting and bullying can intensify -- home should be a haven, especially as your teen encounters more freedoms and choices and looks to home to be a constant in his or her life. Your children may prefer to be with their friends rather than spend time with you, but be ready to provide lots of family time for them when they need it and set aside family time that includes their friends.

When stressful things are happening in the world at large, encourage your teen to take "news breaks," whether he or she is getting that news from the television, magazines or newspapers, or the Internet. Use the news as a catalyst for discussion. Teens may act like they feel immortal, but they are likely to still want to know that they will be alright. Honest discussions of your fears and expectations can help your teenager learn to express his own fears. If your teen struggles with words, encourage him or her to use journaling or art to express emotions.

Many teens are already feeling extreme highs and lows because of hormonal levels in their bodies; added stress or trauma can make these shifts seem more extreme. Be understanding but firm when teens respond to stress with angry or sullen behavior. Reassure them that you just expect them to do their best.

The Journey of Resilience

Developing resilience is a personal journey and you should use your knowledge of your own children to guide them on their journey. An approach to building resilience that works for you or your child might not work for someone else. If your child seems stuck or overwhelmed and unable to use the tips listed above, you may want to consider talking to someone who can help, such as a psychologist (see our Choosing a Psychologist section) or other mental health professional. Turning to someone for guidance may help your child strengthen resilience and persevere during times of stress or trauma.

Some additional Communication Tips for Parents

Be available for your children

	Notice times when your kids are most likely to talk - for example, at bedtime, before dinner, in the car - and be available.
	Start the conversation; it lets your kids know you care about what's happening in their lives.
	Find time each week for a one-on-one activity with each child, and avoid scheduling other activities during that time.
	Learn about your children's interests - for example, favorite music and activities - and show interest in them.
	Initiate conversations by sharing what you have been thinking about rather than beginning a conversation with a question.
	Let your kids know you're listening
	When your children are talking about concerns, stop whatever you are doing and listen.
	Express interest in what they are saying without being intrusive.
	Listen to their point of view, even if it's difficult to hear.
	Let them complete their point before you respond.
	Repeat what you heard them say to ensure that you understand them correctly.
	Respond in a way your children will hear
	Soften strong reactions; kids will tune you out if you appear angry or defensive
	Express your opinion without putting down theirs; acknowledge that it's okay to disagree.
	Resist arguing about who is right. Instead say, "I know you disagree with me, but this is what I think."
	Focus on your child's feelings rather than your own during your conversation.
	Remember:
	Ask your children what they may want or need from you in a conversation, such as advice, simply listening, help in dealing with feelings, or help solving a problem.
	Kids learn by imitating. Most often, they will follow your lead in how they deal with anger, solve problems, and work through difficult feelings.
	Talk to your children - don't lecture, criticize, threaten, or say hurtful things.
	Kids learn from their own choices. As long as the consequences are not dangerous, don't feel you have to step in.
	Realize your children may test you by telling you a small part of what is bothering them. Listen carefully to what they say, encourage them to talk, and they may share the rest of the story. Parenting is hard work
	Listening and talking is the key to a healthy connection between you and your children. But parenting is hard work and maintaining a good connection with teens can be challenging, especially since parents are dealing with many other pressures. If you are having problems over an extended period of time, you might want to consider consulting with a Registered Psychologist (see our section on Choosing a Psychologist).

15. Phobias

What are phobias?

A phobia is an excessive or unreasonable fear of an object, place or situation. Simple phobias are fears of specific things such as insects, infections, flying. Agoraphobia is a fear of being in places where one feels "trapped" or unable to get help, such as in crowds, on a bus, or standing in a queue. A social phobia is a marked fear of social or performance situations.

Phobias are extremely common. Sometimes they start in childhood for no apparent reason; sometimes they emerge after a traumatic event; and sometimes they develop from an attempt to make sense of an unexpected and intense anxiety or panic (e.g. "I feel fearful, therefore I must be afraid of something").

When the phobic person actually encounters, or even anticipates being in the presence of the feared object or situation, s/he experiences immediate anxiety. The physical symptoms of anxiety may include a racing heart, shortness of breath, sweating, chest or abdominal discomfort, trembling, etc. and the emotional component involves an intense fear - of losing control, embarrassing oneself, or passing out.

Commonly people try to escape - to avoid the feared situation wherever possible. This may be fairly easy if the feared object is rarely encountered (e.g. fear of snakes) and avoidance will not therefore restrict the person's life very much. At other times (e.g. agoraphobia, social phobia) avoiding the feared situation limits their life severely. Escape and avoidance also make the feared object/situation more frightening, and reinforce the fear.

With some phobias the person may have specific thoughts which attribute some threat to the feared situation. This is particularly true for social phobia where there is often a fear of being negatively evaluated by others, and for agoraphobia when there may be a fear of collapsing and dying with no one around to help, or of having a panic attack and making a fool of oneself in front of other people.

With other types of phobias there may be accompanying frightening thoughts (this plane might crash; I'm trapped; I must get out). Yet, it is more difficult with some phobias to identify any specific thoughts which could be associated with the anxiety (e.g. it is unlikely that a spider phobic is afraid of making a fool of themselves in front of the spider). With these phobias the cause seems to be explained more as a conditioned (learned) anxiety response which has become associated with the feared object – more likely an automatic “body” response to a stimulus.

Treatments

There are several counselling and hypnotic approaches to helping a phobic person. Traditional treatments involving the use of “Systematic Desensitization” techniques are very effective and can generally be completed in relatively short periods of time (several weeks in some cases). Clients can learn powerful relaxation techniques and begin to gradually desensitize themselves, under instruction, to an increasing range of (previously) stressful stimuli. Someone with a fear of snakes may begin treatment by first learning to associate a relaxation response with viewing pictures of snakes and gradually progress, as each hierarchical stage is managed, to perhaps handling a snake. The stages may for example involve: firstly reading about snakes; then viewing and touching a photograph of a snake; looking at and touching a plastic model of a snake; looking at and touching a jar with a small snake in it; picking the snake out of the jar; picking up and handling a large snake.

This technique is based on replacing the previously learned and automatic stressful or panic response with a newly learned response of relaxation.

Cognitive behavioral approaches will also involve some level of exposure or confrontation with the feared situation, and will emphasize some new, “rational” methods of examining and dealing with stressful and frightening thoughts.

Other useful treatments, discussed elsewhere on this website could involve the use of Hypnosis, Bio-Feedback and Neuro-Feedback techniques, a range of relaxation strategies, and other forms of energy therapies.

When and where to seek further help

	If your phobias are interfering with your ability to lead a full, normal life and you don't make any progress in challenging them yourself
	If you are experiencing a lot of anxiety or distress, and you seem to be feeling like this often
	If you are avoiding situations that matter
	If you suffer from overwhelming blushing/trembling/sweating in social situations or feel that you lack social skills.

Major Treatments we offer include: All of the above, including: Counselling; CBT; Hypnosis; EMDR; TFT; BSFF; Neuro-feedback; Bio-feedback; Relaxation; Meditation; Breath Training; Voice Dialogue; Mindfulness and ACT

16. Post Natal Depression

Our clinic offers support and information for parents affected by anxiety or depression during pregnancy and in the two years following childbirth. Pre-pregnancy counselling is also valuable for those women who are worried about becoming pregnant or the possibility of suffering from Post Natal Depression(PND)

We assist families in their journey through parenthood where they experience joy, love and a sense of achievement and where each mother can choose her own personal style of mothering with confidence in her unique capacity. We acknowledge for one in every seven women (and their families) this journey may be side-tracked by negative moods, exhaustion, loss of confidence and depression. Often self-doubt and perfectionism join forces and wreck a potentially satisfying experience.

Working with her GP or specialist, we can help a woman identify the situation and provide psychological support and strategies to assist women in finding the right balance for herself and her family and to identify and release any old emotional blocks to present happiness.

With the benefit of the right psychological support at the right time a new family should expect

	Enhanced social and emotional well-being during these early years and beyond
	Support for parents in their relationships with each other and their families
	Increase parenting satisfaction and coping skills

What we offer

	counselling, support and information
	Antenatal Postnatal anxiety and depression therapeutic group
	Couples counselling
	Individual assessment
	Individual therapy

17. Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder, or PTSD as it is now commonly known, refers to a combination of symptoms that may arise following the experience (either by witnessing or participation) of events involving death, serious injury or threat to oneself and/or others.

Typically, such an experience will be unexpected and involve responses that incorporate intense fear, helplessness and horror. Common experiences that will frequently bring clients into treatment tend to include: sexual and physical abuse; road and industrial accidents; and the witnessing of / involvement in criminal scenarios such as bank robberies, murders and assaults.



18. Relationships

We have provided below some information that may assist you to get a sense of how we work with those in conflict (“On our Approach to Relationship Work”).

We have included researched information on qualities that tend to be associated with a good marriage (“Nine Psychological Tasks for a Good Marriage”), and some further comments, based on research, about “Making Step Families Work”.

On our approach to Relationship Work

Whenever we are asked about how we deal with couples in our relationship work, we are frequently reminded that in our experience, a couple will usually put off getting help for too long. (It is quite rare, yet always delightful, when we see a couple who indicate that their relationship is going along nicely, and that they would like to do some work to improve a particular aspect of their life together). More often than not, things are usually quite desperate and critical by the time a couple takes the step of seeking counselling.

We find that factors such as these tend to heighten the urgency for change and we will often place importance therefore on assisting a couple to begin to make positive changes in their relationship right from the outset of our work. This focus means that we are unlikely to spend a lot of time analyzing childhoods, guessing motives, speculating on who is at fault and the “real underlying causes” in the early (or even latter) stages of counselling. It is probably worth mentioning that we have found most couples to have already spent a deal of their own time doing this without our assistance.

In essence, our approach to relationship work is drawn from the same ideas that guide our work with individuals (see sections on Our Approach; Life/Personal Coaching; Acceptance and Commitment Therapy). Whether the relationship is defined by: a marriage; a living arrangement; a broken agreement; parent/child; co-workers; employer/employee; or a partnership of any sort, we will generally find it helpful to assist the parties clarify what they want from the counselling process and what they want from each other. We not only want to identify the triggers that interfere in the relationship, we want to clarify what happens in the relationship when things have gone well or OK. We want to get a vivid image, from each of our clients, of how the relationship would function if it were operating in a way that each party would really value, and focus our time on designing with the couple how we might bring that about. We see this as the primary domain of our work.

Our task as we see it, is to assist those in the relationship to efficiently design lasting, relevant and meaningful change that contributes in an ongoing way to the relationship they are seeking.
In most cases, the process will involve that each person obtains a deeper or clearer understanding of the other’s needs, perceptions and experience. We have found that couples may often need the assistance of a skilled counsellor to achieve this effectively. These conversations are not the conversations of conflict or blame. They are conversations designed for deepening understanding and providing opportunity for each in the relationship to feel heard and understood by the other, without necessarily agreeing with the other’s position. Blame and the allocation of fault do not usually lead to change, and will rarely assist in the process of encouraging a cooperative, committed and accepting approach to the design and achievement of shared goals. We see this as the task of therapy, as these conversations, in our experience, are usually the conversations that are missing. They are conversations can be learned. These are the conversations that tap the essence of cooperation and quality of experience in any relationship. Yet, often, these are the conversations that seem to be the most elusive to us all.

Nine Psychological Tasks for a Good Marriage

The following comments are based on research by Judith S. Wallerstein, PhD, co-author of the book The Good Marriage: How and Why Love Lasts.

Research on what makes a marriage work shows that people in a good marriage have completed these psychological "tasks":

	Separate emotionally from the family you grew up in; not to the point of estrangement, but enough so that your identity is separate from that of your parents and siblings.
	Build togetherness based on a shared intimacy and identity, while at the same time set boundaries to protect each partner's autonomy.
	Establish a rich and pleasurable sexual relationship and protect it from the intrusions of the workplace and family obligations.
	Individual assessment
	Individual therapy
	For couples with children, embrace the daunting roles of parenthood and absorb the impact of a baby's entrance into the marriage. Learn to continue the work of protecting the privacy of you and your spouse as a couple.
	Confront and master the inevitable crises of life.
	Maintain the strength of the marital bond in the face of adversity. The marriage should be a safe haven in which partners are able to express their differences, anger and conflict.
	Use humor and laughter to keep things in perspective and to avoid boredom and isolation.
	Nurture and comfort each other, satisfying each partner’s needs for dependency and offering continuing encouragement and support.
	Keep alive the early romantic, idealized images of falling in love, while facing the sober realities of the changes wrought by time.

These “Nine Psychological Tasks for a Good Marriage” represent a summary of research offered by Judith S. Wallerstein, PhD, co-author of the book The Good Marriage: How and Why Love Lasts, & are posted on the website of the American Psychological Association. (www.apa.com).

Making Stepfamilies Work

The following comments are based on the research of James Bray, PhD, a researcher and clinician at the department of family medicine at Baylor College of Medicine.

The so called "blended family" is no longer an aberration in Western society. It's a norm.
Planning for remarriage

A marriage that brings with it children from a previous marriage presents many challenges. Such families should consider three key issues as they plan for remarriage.

1. Financial and living arrangements
Adults should agree on where they will live and how they will share their money. Most often partners embarking on a second marriage report that moving into a new home, rather than one of the partner's prior residences, is advantageous because the new environment becomes "their home." Couples also should decide whether they want to keep their money separate or share it. Couples who have used the "one-pot" method generally reported higher family satisfaction than those who kept their money separate.

2. Resolving feelings and concerns about the previous marriage
Remarriage may resurrect old, unresolved anger and hurts from the previous marriage, for adults and children. For example, hearing that her parent is getting remarried, a child is forced to give up hope that the custodial parents will reconcile. Or a woman may exacerbate a stormy relationship with her ex-husband, after learning of his plans to remarry, because she feels hurt or angry.

3. Anticipating parenting changes and decisions
Couples should discuss the role the stepparent will play in raising their new spouse's children, as well as changes in household rules that may have to be made. Even if the couple lived together before marriage, the children are likely to respond to the stepparent differently after remarriage because the stepparent has now assumed an official parental role.

Marriage quality

While newlywed couples without children usually use the first months of marriage to build on their relationship, couples with children are often more consumed with the demands of their kids.

Young children, for example, may feel a sense of abandonment or competition as their parent devotes more time and energy to the new spouse. Adolescents are at a developmental stage where they are more sensitive to expressions of affection and sexuality, and may be disturbed by an active romance in their family.

Couples should make priority time for each other, by either making regular dates or taking trips without the children.

Parenting in stepfamilies

The most difficult aspect of stepfamily life is parenting. Forming a stepfamily with young children may be easier than forming one with adolescent children due to the differing developmental stages.

Adolescents, however, would rather separate from the family as they form their own identities.
Recent research suggests that younger adolescents (age 10-14) may have the most difficult time adjusting to a stepfamily. Older adolescents (age 15 and older) need less parenting and may have less investment in stepfamily life, while younger children (under age 10) are usually more accepting of a new adult in the family, particularly when the adult is a positive influence. Young adolescents, who are forming their own identities tend to be a bit more difficult to deal with.
Stepparents should at first establish a relationship with the children that is more akin to a friend or "camp counselor," rather than a disciplinarian. Couples can also agree that the custodial parent remain primarily responsible for control and discipline of the children until the stepparent and children develop a solid bond.

Until stepparents can take on more parenting responsibilities, they can simply monitor the children's behavior and activities and keep their spouses informed.

Families might want to develop a list of household rules. These may include, for example, "We agree to respect each family member" or "Every family member agrees to clean up after him or herself."

Stepparent-child relations

While new stepparents may want to jump right in and to establish a close relationship with stepchildren, they should consider the child's emotional status and gender first.

Both boys and girls in stepfamilies have reported that they prefer verbal affection, such as praises or compliments, rather than physical closeness, such as hugs and kisses. Girls especially say they're uncomfortable with physical shows of affection from their stepfather. Overall, boys appear to accept a stepfather more quickly than girls.

Nonresidential parent issues

After a divorce, children usually adjust better to their new lives when the parent who has moved out, visits consistently and has maintained a good relationship with them.

But once parents remarry, they often decrease or maintain low levels of contact with their children. Fathers appear to be the worst perpetrators: On average, dads drop their visits to their children by half within the first year of remarriage.

The less a parent visits, the more a child is likely to feel abandoned. Parents should reconnect by developing special activities that involve only the children and parent.

Parents shouldn't speak against their ex-spouses in front of the child because it undermines the child's self-esteem and may even put the child in a position of defending a parent.

Under the best conditions, it may take two to four years for a new stepfamily to adjust to living together. Seeing a psychologist can help the process go more smoothly.
These ideas on “Making Step Families Work” represent a summary of research offered by James Bray, PhD, a researcher and clinician at the department of family medicine at Baylor College of Medicine and are posted on the website of the American Psychological Association, (www.apa.com).

19. SLEEP DISORDERS

Not being able to drop off to sleep when tired is annoying if it happens even once. For those who have this experience of “tired and wired” most nights it can be devastating to health, relationships, happiness, productivity, in fact every facet of life is affected until there really is no quality of life.
We have been treating sleep onset insomnia for many years and we have been able to observe certain patterns.

Often the sufferer finds it hard wake in the morning, having a hangover effect which can last some hours. It seems this type of person will often wind up towards the end of the day, becoming more energetic late in the evening. Others will have no energy but still feel “wired”.

When bedtime comes they can lay wake with an overactive mind that won’t shut off.
Research suggests that a small percentage of the population have disrupted sleep-wake rhythms that are severe enough to cause chronic insomnia.

Drugs and all manner of self medication such as alcohol, marijuana etc offer limited symptom relief at a high price

We undertake a comprehensive assessment which includes sleep routines and sleep wake patterns, other related behavioral patterns, medical and dietary history, history of psychological stress. We look at EEG patterns which can reveal how the brain has adapted and is currently behaving, and we follow a treatment program which all of the data suggests.

This treatment program usually includes

	Behavioral changes which are known to begin a shift in the sleep wake cycle towards normal
	Dietary changes to support the production of good sleep waves naturally
	CBT and Mindfulness training to overcome an overactive mind and reduce the production of anxious thinking
	Biofeedback based an research, clinical experience and the persons own brain patterns.

I our experience, all of the above approaches work together like a “combination lock” to shift an entrenched and recurrent dysfunctional pattern that can wreck the quality of ones life. The real and dramatic difference we think is the biofeedback, especially Neurofeedback which appears to operate at the very level the problem is being generated. (See the references below )



20. Stopping Smoking

Since our beginning in 1988, the approach at PBP CONSULTANCY has been guided by a “solution oriented” or “strategic” orientation to our work with clients. This resourceful way of assisting our clients to generate effective methods of achieving their goals has formed the basis of our powerful one session (two hours) approach to stop smoking.

We have found that people express a wide variety of reasons behind their commitment to stop smoking. Reasons, for example, which may involve: concerns about present and future health; the ongoing and increasing financial cost of the habit; the experience of increasing restrictions of smoking in public places; the “social leper” effect of rapidly changing community attitudes; and a sense of frustration and “powerlessness” that can come with continuing to do something that they don’t want to be doing.

Apart from the sense of achievement and pride that comes from addressing or resolving an unpleasant habit, many of our clients are relieved and sometimes pleasantly surprised to discover feelings of freedom, satisfaction and confidence associated with the “automatic” and natural healing of their bodies.

The absence of the “mental battle” and ongoing rewards that can come from being regularly reminded that they no longer have to do something that they once thought they must, serve for many clients as powerful ongoing “reinforces”.

An increasing sense of confidence, joy and harmony is another frequently reported “side-effect”.

About Hypnosis for Stopping Smoking

As a society, we still harbor many traditional, inaccurate and unhelpful ideas about hypnosis.

It needs to be clear that clinical hypnosis is a tool of medicine and psychology. It is a “natural” relaxing method of treatment designed to suit the needs of each individual client.

Hypnotherapy involves a process which helps people clear their minds of distracting and confusing ideas, beliefs and internal conversations which have previously gotten in the way.

It allows for clarity of perspective by sharpening and focusing awareness on the matter at hand. Things that have seemed impossible can begin to appear more possible, and energy and confidence can be revived.

Despite ideas to the contrary and the sleight of hand of some stage magicians, hypnosis cannot make a person do something he or she does not want to do; and likewise, hypnosis cannot make a person want to do something.

What you can expect from an hypnotic session with a properly trained professional hypnotherapist is the comfort and freedom to do something you wish to do that you may have previously found difficult.

Hypnotherapy provides you with more options than you once had. Choosing not to smoke and discovering that your comfort level settles quickly, or that you feel a sense of relief upon being reminded of what you used to do, are common side-effects of treatment.

Everybody responds differently to hypnosis - some people feel the response is so dramatic, it can seem to them like a miracle. For others, the solution may be more subtle, gradual or incremental.

Hypnotherapy is a combination of both hypnosis and therapy.

To get useful and lasting results, you need to continue to be committed to your goal and be willing to modify your daily habits to support the new, healthier and more productive direction that your decision offers.



21. Stress: in its various forms

Stress management can be complicated and confusing because there are different types of stress--acute stress, episodic acute stress, and chronic stress -- each with its own characteristics, symptoms, duration, and treatment approaches. Let's look at each one.

Acute Stress

Acute stress is the most common form of stress. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. Acute stress is thrilling and exciting in small doses, but too much is exhausting. A fast run down a challenging ski slope, for example, is exhilarating early in the day. That number of levels, generally requiring professional help, which may take many months.

Often, lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives. They blame their woes on other people and external events. Frequently, they see their lifestyle, their patterns of interacting with others, and their ways of perceiving the world as part and parcel of who and what they are.
Sufferers can be fiercely resistant to change. Often, only the promise of relief from pain and discomfort of their symptoms can keep them in treatment and on track in their recovery program.

Chronic Stress

While acute stress can be thrilling and exciting, chronic stress is not. This is the grinding stress that wears people away day after day, year after year. Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-term attrition. It's the stress of poverty, of dysfunctional families, of being trapped in an unhappy marriage or in a despised job or career. It is the stress that the never-ending "troubles" have brought to the people of Northern Ireland, the tensions of the Middle East have brought to the Arab and Jew, and the endless ethnic rivalries that have been brought to the people of Eastern Europe and the former Soviet Union.

Chronic stress comes when a person never sees a way out of a miserable situation. It's the stress of unrelenting demands and pressures for seemingly interminable periods of time. With no hope, the individual gives up searching for solutions.

Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain forever painful and present. Some experiences profoundly affect personality. A view of the world, or a belief system, is created that causes unending stress for the individual (e.g., the world is a threatening place, people will find out you are a pretender, you must be perfect at all times). When personality or deep-seated convictions and beliefs must be reformulated, recovery requires active self-examination, often with professional help.

The worst aspect of chronic stress is that people get used to it. They forget it's there. People are immediately aware of acute stress because it is new; they ignore chronic stress because it is old, familiar, and sometimes, almost comfortable. We can get to see the experience of it as simply “who we are”.

Chronic stress kills through suicide, violence, heart attack, stroke, and perhaps, even cancer. People wear down to a final, fatal breakdown. Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management.

Six Myths About Stress

Six myths surround stress. Dispelling them enables us to understand our problems and then take action against them. Let's look at these myths.

Myth 1: Stress is the same for everybody.
Completely wrong. Stress is different for each of us. What is stressful for one person may or may not be stressful for another; each of us responds to stress in an entirely different way.

Myth 2: Stress is always bad for you.
According to this view, zero stress makes us happy and healthy. Wrong. Stress is to the human condition what tension is to the violin string: too little and the music is dull and raspy; too much and the music is shrill or the string snaps. Stress can be the kiss of death or the spice of life. The issue, really, is how to manage it. Managed stress makes us productive and happy; mismanaged stress hurts and even kills us.

Myth 3: Stress is everywhere, so you can't do anything about it.
Not so. You can plan your life so that stress does not overwhelm you. Effective planning involves setting priorities and working on simple problems first, solving them, and then going on to more complex difficulties. When stress is mismanaged, it's difficult to prioritize. All your problems seem to be equal and stress seems to be everywhere.

Myth 4: The most popular techniques for reducing stress are the best ones.
Again, not so. No universally effective stress reduction techniques exist. We are all different, our lives are different, our situations are different, and our reactions are different. Only a comprehensive program tailored to the individual works.

Myth 5: No symptoms, no stress.
Absence of symptoms does not mean the absence of stress. In fact, camouflaging symptoms with medication may deprive you of the signals you need for reducing the strain on your physiological and psychological systems.

Myth 6: Only major symptoms of stress require attention.
This myth assumes that the "minor" symptoms, such as headaches or stomach acid, may be safely ignored. Minor symptoms of stress are the early warnings that your life is getting out of hand and that you need to do a better job of managing stress.

Exercise and Stress

Exercise may improve mental health by helping the brain cope better with stress, according to research into the effect of exercise on Neuro chemicals involved in the body's stress response.
Preliminary evidence suggests that physically active people have lower rates of anxiety and depression than sedentary people. But little work has focused on why that should be. So to determine how exercise might bring about its mental health benefits, some researchers are looking at possible links between exercise and brain chemicals associated with stress, anxiety, and depression.

So far there's little evidence for the popular theory that exercise causes a rush of endorphins. Rather, one line of research points to the less familiar neuromodulator norepinephrine, which may help the brain deal with stress more efficiently.

Work in animals since the late 1980s has found that exercise increases brain concentrations of norepinephrine in brain regions involved in the body's stress response.

Norepinephrine is particularly interesting to researchers because 50 percent of the brain's supply is produced in the locus coeruleus, a brain area that connects most of the brain regions involved in emotional and stress responses. The chemical is thought to play a major role in modulating the action of other, more prevalent neurotransmitters that play a direct role in the stress response. And although researchers are unsure of exactly how most antidepressants work, they know that some increase brain concentrations of norepinephrine.

But some psychologists don't think it's a simple matter of more norepinephrine equals less stress and anxiety and therefore less depression. Instead, they think exercise thwarts depression and anxiety by enhancing the body's ability to respond to stress.

Biologically, exercise seems to give the body a chance to practice dealing with stress. It forces the body's physiological systems, all of which are involved in the stress response to communicate much more closely than usual: The cardiovascular system communicates with the renal system, which communicates with the muscular system. And all of these are controlled by the central and sympathetic nervous systems, which also must communicate with each other. This workout of the body's communication system may be the true value of exercise; the more sedentary we get, the less efficient our bodies in responding to stress.

Stress: When and How to Get Help

In the workplace and at home, stress and other difficult situations are at an all-time high for many of us. Being constantly worried about being laid off, or doing the job of two people, can cause serious problems for workers. On the home front, going through a divorce, caring for elderly parents, managing children in a rapidly changing world, or dealing with a life-threatening illness are some of the difficult situations that can test a family's coping abilities.

When is it time to ask for help? Here are a few indicators:

- You feel trapped, like there's nowhere to turn
- You worry excessively and can't concentrate
- The way you feel affects your sleep, your eating habits, your job, your relationships, your everyday life

Registered Psychologists can help people address the causes of their distress and teach them effective ways to deal with those causes. Early detection and treatment can head off serious consequences. See our section on Choosing a Psychologist.

Major Treatments we offer include: All of the above, including: Counselling; CBT; Hypnosis; EMDR; TFT; BSFF; Neuro-feedback; Bio-feedback; Relaxation; Meditation; Breath Training; Voice Dialogue; Mindfulness and ACT as well as a lot of encouragement to exercise regularly.



22. Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder, or PTSD as it is now commonly known, refers to a combination of symptoms that may arise following the experience (either by witnessing or participation) of events involving death, serious injury or threat to oneself and/or others.

Typically, such an experience will be unexpected and involve responses that incorporate intense fear, helplessness and horror. Common experiences that will frequently bring clients into treatment tend to include: sexual and physical abuse; road and industrial accidents; and the witnessing of / involvement in criminal scenarios such as bank robberies, murders and assaults.

The major symptoms that present for treatment tend to include: recurring and distressing memories of the event a “reliving” of the experience when awake or intoxicated; and high levels of distress when reminded of some aspect of the experience.

In addition, many people might find themselves actively avoiding thinking or talking about their experience, and may wish to avoid places, activities and people that remind them of the event. Under such circumstances, it is not uncommon for people to experience: sleep and concentration difficulties; emotional outbursts; some loss of interest in usual routines and significant activities; difficulties in experiencing love for and from others; and a heightened sense of general anxiety.

It seems important to note here that many of these symptoms can be experienced by individuals who may not have actually been involved in a life threatening or traumatic event. Whilst an alternative diagnosis may offered under these circumstances, a similar array of treatments will usually be offered.

Treatment may involve: Counselling, Defusing, and Debriefing - to assist someone in gaining a greater understanding of their experience and to help them design ways of beginning to get their life “back on track”; Neurofeedback; Biofeedback; and Hypnosis



Hypnotherapy is a combination of both hypnosis and therapy.

To get useful and lasting results, you need to continue to be committed to your goal and be willing to modify your daily habits to support the new, healthier and more productive direction that your decision offers.