Modalities of Treatment

 

Attention Deficit Disorder (ADHD)

In this newsletter, we will explore Attention Deficit Hyperactivity Disorder and its effects on children, adolescents, and adults.

Misconceptions/Myths

  • ADHD is a flavor-of-the-month fad diagnosis. It’s just an excuse for bad   behavior
  • ADHD is only a disorder of hyperactive boys.
  • ADHD is over diagnosed. Every child that acts up a bit gets placed on Ritalin.
  • ADHD is only a minor problem. People make too much of a fuss over it.
  • ADD is an American invention, made up by a society seeking simple solutions to complex social problems.
  • Bad parents or bad teachers cause ADHD.
  • If only our society had old-fashioned values, there wouldn’t be these problems.
  • People with ADHD should just try harder. Everybody gives them excuses and coddles them.
  • Everyone outgrows ADHD by the age of 12 or 13.
  • Stimulant medication is dangerous and highly addictive. It’s just like speed.
  • Medication alone is the best treatment for ADHD.

 A COMMON PROBLEM

ADHD is the single most common learning and behavioral problem in children. It is also one of the most common problems in adults, leading to job failures, relationship breakups, loneliness, drug abuse, and a tremendous sense of underachievement.

HISTORY

ADHD has been described in the medical literature for about one hundred years. In 1902, pediatrician George Still described a group of children who were hyperactive, impulsive, and inattentive. Unfortunately, he didn’t understand that ADD is a medical disorder and labeled those children as “morally defective.”

FACTS

  • ADHD affects approximately 6 percent of the population, while less than 2 percent receive treatment. The Journal of the American Medical Association (July, 1999) concluded that there was no evidence that ADHD is over diagnosed in our society. Child psychiatrist, Peter Jensen, National Institutes of Health, found that less than one in eight children who met the diagnostic criteria for ADD were taking medication.
  • Many people with ADD are never hyperactive. The nonhyperactive ADD group is often ignored because they do not bring enough negative attention to themselves; they are not a big enough problem! Many of these children, teenagers, or adults earn the unjust labels: “willful,” “lazy,” “unmotivated,” or “not that smart.” Moreover, “females have ADHD in almost the same number as males, yet are diagnosed 4-5 times less often.” (Amen, 2001) Estimates are at 9.2% for males and 2.9% for females. (American Academy of Pediatrics, 2000)
  • Many people never outgrow ADHD and have symptoms that interfere with their entire lives. Half of those children diagnosed with ADD will have disabling symptoms into adulthood. (American Academy of Pediatrics, 1996)
  • “Parents of ADHD children divorce three times more often than the general population.”
  • The harder people with ADHD try, the worse things get for them. Brain-imagining studies show that when people with ADD try to concentrate, the part of their brain involved with concentration, focus, and follow-through, actually shuts down – just when they need it to turn on.

ADHD is a serious societal problem:

  •   35% never finish high school 
  •  25% repeat at least one grade
  •   52% of untreated teens and adults abuse drugs/alcohol
  •  19% smoke cigarettes (compared to 10% of the general population)
  •  43% of untreated hyperactive boys will be arrested for a felony by age 16
  •  50% of inmates in a number of studies have been found to have ADD
  •  75% have interpersonal problems; untreated ADHD suffers have a higher  percentage of motor vehicle
  •  accidents, speeding tickets, citations for driving without a license, and suspended or revoked licenses.
  • Stimulant medication, such as Adderall, Ritalin, Concerta, and Dexedrine are among the safest and most effective medications with little if any potential for abuse. In fact, Joseph Biederman at Harvard Medical School, demonstrated that children treated for ADD have a much lower risk for drug abuse than untreated children. According to Dr. Biederman, “untreated ADHD has many more side effects than medications."

Women With ADHD

What are the signs of ADD in women? ADD in females can often be masked. Women with ADD are most often diagnosed as depressed. And many women with ADD do struggle with depression, however that is only part of the picture. As Sari Solden, author of Women with Attention Deficit Disorder, describes it, ADD in women is the disorder of dis-order. In other words, for most women with ADD their lives are filled with disorder which can feel overwhelming – piles and clutter out of control. There are some women with ADD who have successfully compensated for their ADD, but the price they pay is to expend most of their waking energy combating their natural tendency to be disorganized. Many women with ADD feel a powerful sense of shame and inadequacy. They feel constantly behind, overwhelmed and frazzled. Some women with ADD feel that their lives are so out of control that they rarely invite others into their home – too ashamed to allow anyone to see the disorder, too overwhelmed to combat the disorder that pervades their lives. 

ADD has become a more challenging problem for women as the demands in our new century lifestyles become greater and greater. Now we are expected to juggle homemaking, child care and full time employment, along with a full complement of extra-curricular activities for our children. What is highly stressful for a woman without ADD, becomes a continuing crisis for a woman with ADHD. These women frequently suffer from anxiety, depression and low self=esteem because they find they can’t live up to the superwoman image that so many women attempt today. 

What is the difference between ADHD and stress? Stress is temporary or cyclical. A woman who feels disorganized and overwhelmed due to stress will heave a huge sigh of relief when the holidays are over or when the crunch at work has passed, and will set about returning her life to order. For a woman with ADHD, the stressful times are bad, but even in the best of times there is a feeling that the wave of “to do’s” is about to crash over her head.

According to Kathleen G. Nadeau, Ph.D., editor of ADDvance Magazine, if you are an undiagnosed woman with ADHD, help could be just around the corner. Women who have blamed themselves for years as lazy or incompetent have received help, through ADD-oriented psychotherapy, medication and ADHD coaching and are now feeling and functioning much better.


TREATMENT OPTIONS

Effective and comprehensive treatment approaches are essential and include:

Education

  •  Emotional and social support
  •  Medication
  •  “Optimal treatment outcomes are achieved with a combination of psychotherapy and medical interventions.”
  • School and work strategies
  • Thinking skills
  • Social skills strategies
  • Coaching
  • Self regulation exercises


FAMILY THERAPY

Family Therapy is the treatment system of choice (Everett & Everett, 1999).

Therapy goals include:

  • Clinical assessment: interview, assessment of behaviors, feedback from parents
  • Improve parental child management skills and reduce stress
  • Improve child’s self-esteem and self-control. Normalize role of child with ADHD and reduce scapegoating
  • Repair and normalize sibling relationships
  • Repair family roles, interaction, and bonding
  • Repair damage to the bonding and intimacy of the marriage

 
WHEN IS IT TIME TO SEE A PROFESSIONAL?

Seek professional help for yourself or child if behaviors, feelings, or thoughts interfere with your abilities to reach potential. Also, if you see persistent relationship struggles (parent-child, sibling, friends, romantic), it’s time to get help.

Eye Movement Desensitization and Reprocessing (EMDR)   

Description of EMDR

EMDR is an acronym for Eye Movement Desensitization and Reprocessing. It is an innovative clinical treatment that has successfully helped over a million individuals who have survived trauma, including sexual abuse, domestic violence, combat, crime, and those suffering from a number of other complaints including depression, addiction, phobias, panic disorders, chronic pain and a variety of self-esteem issues.

What is EMDR?

Eye Movement Desensitization and Reprocessing, or EMDR, is a psychotherapy approach that demonstrates we can heal efficiently from emotional wounds, blocks and limitations. For decades the assumption has been that mental healing is slow. EMDR research has shown that to be false. In the past fifteen years, hundreds of therapists across the USA have used EMDR with successful results in patients with Post-Traumatic Stress Disorder (PTSD), depression, panic attacks and other conditions. EMDR has been approved as an effective treatment for PTSD by the respected American Psychological Association, American Psychiatric Association, the Department of Defense and the Veteran’s Administration. Learn more.

Before and after EMDR brain scans. Top photo shows woman with Post Traumatic Stress Disorder. Bottom photo shows same patient after four ninety minute EMDR sessions. The red areas indicate overactivity in the brain. Photo by Dr. Daniel Amen.

  •  Key Benefit

The major significance of EMDR is that it allows the brain to heal its psychological problems at the same rate as the rest of the body is healing its physical ailments. Because EMDR allows the minds and body to heal at the same rate, it is effectively making time irrelevant in therapy. Given its wide application, EMDR promises to be the therapy of the future

  • Key Benefit

EMDR assists survivors in the immediate aftermath of violent trauma by breaking through the walls of denial, shock, grief, and anger.

  • Key Benefit

EMDR can be used with experiences that are traumatic in the commonly accepted sense – abuse, disasters, violence – but, some (including children), may perceive and respond to more ordinary events as very threatening.

Capability

What EMDR is NOT?

  • Hypnosis
  • A miracle cure
  • A quick fix
  • A “technique” “Mind Control” A “simple treatment” that anyone can learn

EMDR is...

EMDR is a powerful tool in the hands of a skillful, compassionate, trained therapist. It is extremely useful in the treatment of the painful aftermath of rape, assault, drug addiction, and death of a loved one. It is ideal for those who have been unable to forget past traumatic life events, as it allows for a rapid reprocessing of even deeply rooted memories, giving individuals back control of their lives and their emotions.

EMDR Offers New Hope! 

Clients who have suffered for years from anxiety or distressing memories, nightmares, insomnia, abuse or other traumatic events, including losses (see Unresolved Losses), can now gain relief from a revolutionary new therapy called EMDR (Eye Movement Desensitization and Reprocessing).

Research shows that EMDR is rapid, safe, and effective. EMDR does not involve the use of drugs or hypnosis. It is a simple, non-invasive patient-therapist collaboration in which healing can happen effectively.

This powerful short-term therapy is highly effective for a wide range of disorders including chronic pain, phobias, depression, panic attacks, eating disorders and poor self-image, stress, worry, stage fright, performance anxiety, in addition to recovery from sexual abuse and traumatic incidents.

EMDR is considered a breakthrough therapy because of its simplicity and the fact that it can bring quick and lasting relief for most types of emotional distress.

The EMDR technique is most effective when used in conjunction with other traditional methods of therapy in treating emotional disorders. EMDR therapy can help clients replace their anxiety and fear with positive images, emotions and thoughts.

Many clients who have made slow progress in the past, or who have not benefited from more traditional therapies say that with EMDR they have finally found something that works for them!

Thanks to the on-going success of EMDR therapy for hundreds of thousands of people, it is not difficulty to have high expectations for the therapy program that includes EMDR technique.

The short-term benefit of EMDR is simple and straightforward – the immediate relief of emotional distress and the elimination of the debilitating effect of unresolved past trauma or loss.

The longer-term benefits of EMDR therapy include the restoration of each client’s natural state of emotional functioning. This return to normalcy brings with it a greater sense or personal power, more rewarding relationships, and a more peaceful life.

These are some of my objectives as I work with clients using EMDR therapy.


Bio Feedback
 

 

Heart Rate Variability: The Interactive Learning System Let’s breathe. Turn your attention to your breathing. Put your hands on your belly. You can do this while you sit, but it might feel more comfortable while you are lying on the floor with your knees bent. Take in a deep breath through your nose expanding your belly. Let the air push your hands up. Count to five, and then blow the air through your lips as you exhale slowly. Feel your hand lower as the air is expelled. Gently push on your belly to release all the air. How do you feel? This is called diaphramatic breathing or belly breathing. Now, focus on your heart, and try it again. Imagine that you are breathing through your heart. Let your breath massage your heart. Repeat this process a couple of more times.

The belly is one of the areas of the body that gets tight and tense when we are stressed. Belly breathing helps to slow down your rate of breathing. This enables you to take in more oxygen and release more carbon dioxide, which helps to massage all of your internal organs, including the heart. This “internal massage” has been found to be beneficial to all of your internal functions, including digestion, elimination, blood flow, and immune system (Lewis, 2000). Not to mention, it lowers your anxiety level.

The Interactive Learning System (ILS) is a technique using feedback about your heart’s rhythms to achieve heart coherence, in other words, synchronizing your heart rhythm with your slowed breathing. Heart coherence then signals to the emotional brain a sense of stability or that everything is in order. The emotional brain then sends a signal back to the heart that reinforces heart coherence. With this breathing-heart-brain synchronization, a sense of well-being and calm ensues (Living with heart coherence).

What is stress?

Stress is the wear and tear the body experiences in reaction to everyday challenges, tensions, and pressures that are real or perceived. The American Institute of Stress (2006) claims that up to 90% of all health problems are related to stress.

How has stress been found to be related to health?

Intense or prolonged stress can impair the immune system, increasing the risk of a wide range of health related problems. A compromised immune system has been found to be related to the onset of everyday illnesses such as the common cold, flu, and headaches (both tension and migraine) (Nash & Thebarge, 2006). Prolonged stress and diminished immune activity has also been found to be related to chronic and potentially fatal diseases such as hypertension, diabetes, depression, anxiety and sleep disorders, heart disease, cancer, and strokes (American Institute of Stress, 2006; Friedman & Lawrence, 2002).

Stress can’t be eliminated from your life. In fact, it is a part of life, and in moderate amounts, can even increase motivation and productivity (American Institute of Stress, 2006). Although moderate levels, in small doses, can be helpful, preventing and reducing the potentially damaging health problems related to stress are essential. Today’s stress comes from many competing sources, is persistent, and pervasive; learning to cope using emotional management skills can be beneficial to your health.

How is emotional self-regulation beneficial to health?

Emotional self-regulation (sometimes called emotional intelligence) involves the ability to accurately perceive, understand, assimilate, and manage emotions (Mayer, Salovey, & Carusso, 2000). Engaging in techniques to promote more positive emotions and cognitions allows one to more effectively regulate his or her emotions. Positive emotions have been suggested to be one of the keys to optimal functioning, which may enhance nearly all spheres of human experience. More specifically, effective emotional self-regulation has been found to be related to numerous beneficial health outcomes (Tugade, Fredrickson, & Feldman Barrett, 2004).

Stress has been shown to be related to negative emotional response states; such as sadness fear, anger, guilt and shame (Slaski & Cartwright, 2003). Whereas, positive emotions have been found to be related to cognitive flexibility and creativity, innovative problem solving, and broad–minded, action focused coping (Tugade et al., 2004). Thus, positive emotions and ways of thinking such as happiness, contentment, hope, optimism, and a high sense of control seem to be related to more effective strategies for coping with stress. In fact, they have been found to be related to enhanced immune functioning, faster recovery from major health problems, increased longevity, and psychological well-being. Stress is a very subjective experience. It may not be the stress, in and of itself, that can be potentially harmful to health, but the way one interprets the stress. Positive emotional and cognitive responses to stress have been found to be a moderating factor in the relationship between stress and health (Ciarrochi, Deane, & Anderson, 2003). Learning ways to more effectively regulate your emotions is essential to maintaining improved mental and physical health.

The Interactive Learning System: A form of biofeedback

The Interactive Learning System is a form of biofeedback and is a therapeutic technique based on the combination of the behavioral and biological perspectives. With biofeedback, you can learn to control certain physiological responses, such as blood pressure, heart rate and pulse, brain wave activity, muscle tension, and even blood circulation using various relaxation techniques. The process begins with receiving information or feedback about the level of functioning of a particular physiological system. Let’s use heart rate as our example. Then, relaxation techniques, such as belly breathing and positive imagery, are taught. These relaxation techniques are used to regulate the heart rate. The heart rate moving closer to the desired level serves as reinforcement for the use of the breathing and positive imagery. After a while, even without the feedback, you will have learned to recognize the bodily feelings that occur when the heart rate needs to be better regulated. You will then, without much conscious thought, begin to engage in the relaxation techniques that will regulate the heart rate. At this point, the lowered level of tension and feelings of calm will reinforce the behavior. Eventually, this process will become automatic.

What is heart rate variability?

Normally, heart rate varies on a beat-to-beat basis. Heart rate variability is a measure of cardiac innervation or stimulation stemming from messages sent from the brain to either increase or decrease heart rate. As was mentioned earlier in this paper, common emotional responses to stress involve negative emotions, such as fear and anger. The stimulation of these emotions in the emotional brain signals the activation of the sympathetic branch of the autonomic nervous system (fight or flight response). In the body, this results in an increase in heart rate, breathing, and blood pressure that prepares the body to fight or flee in response to the stressor. Therefore, chronic stress can promote a great deal of heart rate reactivity resulting in constant heart rate fluctuation and erratic heart rhythm patterns, otherwise known as heart incoherence.

How has heart incoherence been shown to impact health?

Stress related mood disturbances, such as depression and anxiety disorders, have been found to be related to chronic heart rate fluctuation resulting in erratic heart rhythm patterns. Together, emotional disorders and irregular heart rate and rhythm have been linked to many adverse cardiac outcomes (Gorman & Sloan, 2000). These cardiac health problems have included hypertension, cardiovascular disease, fatal arrhythmias, coronary heart disease, and strokes.

Using the Interactive Learning System to create coherence in heart rhythms

The body prefers a state of balance or coherence. Imbalance or incoherence in the system creates a chaotic internal atmosphere. Learning to regulate your heart rate and rhythm promotes coherence and a sense of calm and well-being in the body and mind.

By placing a small cuff on your finger or around your ear, your pulse, heart rate, and heart rhythm will be monitored. This information will appear on the computer screen and serve as feedback. After this has been established, slow, deep breathing is the first step in achieving heart coherence. Emptying your mind and focusing on your breathing stimulates the parasympathetic nervous system, which instantly lowers your heart rate and blood pressure.

Gradually, turn your attention away from your breathing and focus on your heart. Imagine you are breathing through your heart and the breath is massaging your body. Feel the warm, gentle sensations in your heart. As you feel these sensations, you can also think about or imagine a soothing, positive experience, which will enhance the feelings of warmth in your heart. Let the sensations envelope you.

This process will begin to regulate your heart rate and rhythm and reinforce your breathing and positive imagery. As the heart rhythm becomes less erratic and more coherent, a message will be sent to your emotional brain that things are calm and in order. The returning message to the heart will reinforce coherence and balance, creating an information loop reflecting peace and tranquility. Eventually, your breath, heart rhythm, and emotional brain will be in a state of synchronization.

Practice is the key to mastery. After much practice using the feedback from the monitor, this process will become automatic and the monitor will no longer be necessary. You will be able to maintain heart coherence.

How is heart coherence beneficial to your health?

Much past and continuing research has found a complex relationship between stress, cognitive appraisal, emotional responding, spiritual coping, physiological balance, and health (Gall, Charbonneau, Clarke, Grant, Joseph, & Shouldice, 2005). All of these factors are present in the Interactive Learning System. Slowly and deeply breathing while creating positive thoughts and emotions are related to heart-brain synchronization, heart coherence, and positive health outcomes (Living with Heart Coherence). Some of the emotional, behavioral, and physical health benefits that have been associated with achieving and maintaining heart coherence using the ILS include:

Emotional/Behavioral health benefits Physical health benefits

  • - Anxiety disorders
  • - Immune System dysfunction
  • - Depression
  • - Chronic pain
  • - Emotional deregulation
  • - Headaches (tension & migraine)
  • - Anger management
  • - Acute procedural pain
  • - Sleep disorders (Insomnia)
  • - Burns
  • - Somatoform disorders
  • - Recurrent abdominal pain
  • - Tourettes Syndrome
  • - Fibromyalgia
  • - Asperger’s Syndrome
  • - Atopic Dermatitis
  • - ADHD - Asthma
  • - Performance Anxiety
  • - Hypertension
  • - Peak Performance training
  • - Diabetes Type I & II
  • - Irritable Bowel Syndrome
  • - Inflammatory Bowel Disease
  • - Muscle Spasticity
  • - Reflex Sympathetic Dystrophy
  • - Sickle Cell Anemia
  • - Cardiovascular rehabilitation
  • - Cancer


Cheerfulness is the best promoter of health, and is as friendly to the mind as to the body.
– Joseph Addison (English essayist, poet, and dramatist; 1672-1719)

 

References

American Institute of Stress (n.d.). Retrieved October 20,2006, from http://stress.org

Ciarrochi, J., Deane, F.P., & Anderson, S. (2002). Emotional intelligence moderates the relationship between stress and mental health. Personality and Individual Differences, 32, 197-209.

Friedman, E.M., & Lawrence, D.A. (2002). Environmental stress mediates changes in neuroimmunological interactions. Toxicological Sciences, 67, 4-10.

Gall, T.L., Charbonneau, C., Clarke, N.H., Grant, K., Joseph, A., & Shouldice, L. (2005). Understanding the nature and role of spirituality in relation to coping and health: A conceptual framework. Canadian Psychology, 46:2, 88-104.

Gorman, J.M., & Sloan, R.P. (2000). Heart rate variability in depressive and anxiety disorders. American Heart Journal, 140:4, 77-83.

Lewis, D. (n.d.). The importance of belly breathing. In Authentic Breathing Resources LLC: For Health, Well-Being, Longevity, and Self-Realization. Retrieved October 20, 2006,
from http://www.authenticbreathing.com/importanceofbellybreathing.htm

Living with Heart Coherence

Mayer, J.D., Salovey, P., & Caruso, D. (2000). Models of emotional intelligence. In R.J. Steinberg (Ed.), Handbook of Intelligence. Cambridge, UK: Cambridge University Press.

Nash, J.M., & Thebarge, R.W. (2006). Understanding psychological stress, it’s biological processes, and impact on primary headaches. Headache: The Journal of Head and Face Pain, 46:9, 1377-1386.

Slaski, M., & Cartwright, S. (2003). Emotional intelligence training and its implications for stress, health and performance. Stress and Health, 19, 233-239.

Tugade, M. M., Fredrickson, B. L., & Feldman Barrett, L. (2004). Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of Personality, 72:6, 1161-1190.

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Sensorimotor Psychotherapy
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Traditional psychotherapy addresses the narrative and the emotional legacy of trauma, but lacks techniques that work directly with the psyciological elements, despite research findings that trauma profoundly affects the body and that many symptoms of traumatized individuals are somatically driven.

The Sensorimotor Psychotherapy for the treatment of trauma presents simple body-oriented interventions for tracking, naming and safely exploring trauma-related somatic activiation, creating new competencies and restoring a somatic sense of self.  In this phase oriented treatment approach, focus is initially on stabilization and then on symptom reduction.

Sensorimotor Psychotherapy identifies two general kinds of interrelated psychological issues: developmental and traumatic. Developmental issues result from disturbed early attachment relationships that lead to limiting beliefs about oneself and the world, while post-traumatic stress disorder results from overwhelming experience that remains unintegrated.