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Have you noticed that when you are actively using your hands for something like gardening, crafting, organizing, etc., that you feel calm and have a sense of well-being while engaged in the activity?  The effort driven reward cycle is related to moving your body, especially your hands, in producing results such as knitting a sweater or making a loaf of bread.  So why does your mood positively elevate when working with your hands?  When our hands are in action, it gives our mind an opportunity to rest and reset.  It can also be a chance to work on problems floating around in your head. Mindlessly working on something with your hands can allow you the space to problem solve and even have a-ha moments which may result in new ideas. 

In this day and age of technology and all the devices we use daily, getting regular activity may be a challenge or not a priority.  Finding ways to use our hands is a means to combat the sedentary lifestyle we are living as we sit behind computers, play video games, and succumb to the infinite scroll of social media.  Using our hands may contribute to maintaining a healthy mood and help to build resilience. Likewise, the absence of this type of activity could contribute to feelings of irritability, indifference, lethargy, and depression.

Now that you are aware that working with your hands can boost your mood, you may be asking yourself, but what is there to do? And what about the time it takes?  What if I need supplies?  How do I get started?  Or worrying, I can’t do anything….  Unfortunately, it can be easy to feel defeated before you even begin. Try this strategy: rather than saying “I CAN’T,” try asking yourself, “What CAN I do?”  You might not be able to organize the whole kitchen or closet, but you CAN organize a kitchen drawer or straighten up your shoes or make your bed. Instead of saying, “I CAN’T plant a whole garden,” say, “I CAN plant flowers in a few flowerpots.” In doing these types of activities, you will see the positive effects of your efforts. Interested in being creative? Purchase a variety of craft items from the Dollar Store and see what masterpiece you can make. Look at Pinterest for ideas. Find an easy bread recipe online. Jot down a list of what activities you would like to try!

In the end, it does not matter what you do to use your hands or move your body. Finding something that is meaningful to you is key. Take the time to step away from screens and devices to increase your resilience, boost your mood, and maybe even solve a problem along the way!

References

https://susanbiali.com/working-with-your-hands-can-do-wonders-for-your-brain

https://www.dr-hatfield.com/educ538/docs/Lambert,+2008.pdf

https://www.scientificamerican.com/article/depressingly-easy

Cognitive Behavioral Therapy, also known as CBT, is an evidence based treatment modality based on the idea that your thoughts influence the way you feel and behave. For example, when a negative or positive event occurs, your thoughts about it affect how you feel, which in turn impacts your behavior. Sometimes thoughts can be irrational and/or distorted. Treatment involves cognitive restructuring, which is identifying unreasonable thoughts and learning to replace them with positive, healthy ones. Homework is an integral part of CBT, which involves providing clients strategies to implement in the real world outside of therapy.

CBT is a short-term course of treatment, usually involving six to twenty weekly sessions. After gathering general background information, the therapist identifies specifically how and when your symptoms manifest, and in turn affect your life. For example, some people become anxious in social situations. They may worry others are judging them (distorted thinking), which will affect how they feel and impact their behavior. It may be difficult for them to remain in the present and respond to others because they are caught up in their own thoughts about what they believe the other person is thinking about them.

Another example of distorted thinking is a student walking across campus who sees a friend with an angry expression on their face. The student may irrationally worry they said or did something previously to their friend that made them angry, when it may simply be the friend is having a difficult day that has absolutely nothing to do with them. But because of the irrational thoughts, the student may feel bad or guilty and respond to the friend by saying something based on their feelings rather than just walking away and forgetting about it. Distorted thinking can also affect couples. For instance, if a spouse comes home from work and notices their partner looks unhappy, they may assume it is because of something they did and respond defensively rather than seek the facts of the situation.

In therapy, once irrational thought patterns are identified, then specific strategies are taught to stop and/or replace them. Strategies include challenging and replacing irrational thoughts with factual information, using Socratic questions (a series of questions named after Socrates) to reevaluate previous assumptions or perspectives, and de-catastrophizing cognitive distortions (not exaggerating or expecting the worst possible outcome). This is a sampling of CBT strategies that can be tailored to and tweaked for specific people and situations. Clients will also be taught relaxation and/or mindfulness techniques to calm their physiological responses to the anxiety (or depression, stress, etc.) they experience.

CBT is the gold standard for use with anxiety-based disorders. It is effective with generalized anxiety disorder (GAD), social anxiety, phobias, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). CBT is also used to treat depressive disorders such as major depressive disorder (MDD), persistent depressive disorder (PDD), and disruptive mood dysregulation disorder (DMDD). Other mental health issues CBT is used to treat include sleep, eating and substance abuse disorders.

It is important to note CBT is most effective when the client commits to implementing the strategies learned in real world situations. It is an active, not a passive, type of talk therapy. Practice will enable an individual to change their automatic ways of thinking and responding and replace them with healthier alternatives.

How to Plan a Successful Transition to College for Students with
Learning Disability or Attention-Deficit/Hyperactivity Disorder

Here are some practical tips for high school students who have been identified with a Specific Learning Disability (SLD) and/or Attention-Deficit/Hyperactivity Disorder (ADHD) who are transitioning to a postsecondary institution.

Contact the Disability Services Office of the university to determine the necessary requirements for academic accommodation application available under Section 504 of the Federal Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act (ADAAA) of 2008. Each institution may have a slightly different name for that office. For example, the University of North Carolina (UNC) is listed as Accessibility Resources & Services, Duke University is the Student Disability Access Office and Wake Technical Community College (Wake Tech) is Disability Support Services.

Collect and review your existing educational reports from your high school and other documentation, which may include previous standardized testing such as the Scholastic Aptitude Test (SAT) and/or the American College Test (ACT), high school transcripts, report cards, Individualized Education Plans (IEP) or End of Grade/Course test scores.

Obtain a current psycho-educational evaluation, and check with your college to find out what they consider recent enough. Often you will need to do new updated testing, which would be at the student’s own expense. This assessment must be conducted by a qualified psychologist and include background information (IEPs are helpful, but are not sufficient documentation by themselves), a clear interpretation of the test data, a specific diagnosis, an explanation of how the diagnosed disability substantially limits a student’s major life activity (learning), and recommendations for academic accommodations.

After gathering all relevant data, schedule a meeting with the appropriate disability services personnel, who have the authority to determine eligibility for accommodations. Submit the documentation prior to the meeting so personnel have a chance to review it and be prepared to discuss options. Basic accommodations include time and one-half on exams and rest breaks. Other accommodations may include double time, reader, scribe or keyboard entry aid, separate testing room, calculator, American Sign Language substitute for Foreign Language, access to class notes, taped textbooks, use of a text reader, use of a computer, priority registration, note-taker, reduced course load, course substitution.

The student may be expected to meet with a disability counselor at the beginning of each semester to discuss the disability and its relationship to accommodations for the upcoming courses or the disability services office may send a letter to the instructor. Be prepared to explain in a simple and concise manner why specific academic accommodations are being requested. LD and ADHD are lifelong conditions, but severity and manifestations may change over time, so be able to discuss your current experience and related needs.

Seek any additional support offered through the disability services office such as tutorial services, study skills and learning strategies training, writing tutorials, and stress management. Many of these offerings may be at no cost.

It is important to note there are differences in the laws that govern accommodations in K-12 education and those that apply to postsecondary education. Due to these differences, the same accommodations that were available in past educational settings may not be available in postsecondary settings. Common standards for accommodations in many postsecondary institutions are based on criteria established by the Association on Higher Education and Disability (AHEAD) or the Educational Testing Service (ETS).

Be proactive — the student needs to advocate for himself/herself! The intent of accommodations in a postsecondary setting is to provide equal access to educational opportunities to individuals diagnosed with disabilities. It is the student’s responsibility to establish and manage his/her own academic support system. To be most effective, this assistance needs to be in place BEFORE academic difficulties are experienced.

The previous article in this series provides guidelines for developing a business partnership with your parenting partner. That is, a relationship that is based mostly on logic rather than emotion. In this article, we’ll explore perhaps the biggest obstacle to this: anger.

There are many levels of anger: annoyance, irritability, anger, fury, rage, etc. It’s important to notice when you are getting increasingly angry and you are headed towards a rage explosion (whatever that looks like for you) because there is collateral damage that happens along the way – most importantly, to our children. So, the earlier we notice we are on this trajectory the sooner we can stop ourselves and not only keep from doing something unhealthy that will hurt our children, but choose to do something healthy which will help them.

Red flags are signs and symptoms that let us know we are creeping up that anger scale. A red flag is one that is typically there when we’re escalating and doesn’t tend to be there at other times when we’re feeling other things. There are four types of red flags:

1. Behavioral: things you do that others can see you are getting angry
   Examples: clenched fists, pacing, rolling eyes, yelling, slamming doors, etc.
2. Physiological: symptoms that your body creates
   Examples: face turning red, racing heart, muscular tension, etc.
3. Cognitive: your thoughts
   Examples: “This is so unfair!” “Why do they always do this?!”
4. Emotional: other feelings that precede angry ones
   Examples: frustration, anxiety, embarrassment, guilt, shame, hurt, etc.

Click image to enlarge

That curved line after the big blow up (“punch wall”) is when you suddenly figure out you’re angry and need to de-escalate. It’s good to realize that at any time, but imagine if you thought of it sooner? All the stuff that came before wouldn’t have happened and done damage. What if you began to de-escalate as soon as you noticed yourself thinking “unfair!”? You could take a time-out and cool down before you waste more time in anger and lose it in front of your parenting partner and kids. Win-win-win.

Just as important as knowing when you’re getting angry is knowing what triggers your anger. Then you can anticipate when either to avoid certain situations or be prepared with skills.

When you notice yourself getting angry, take a time-out and cool down (if it’s good enough for our kids, it’s good enough for us, right?). If you are talking with the other parent, say, “I need a break from this discussion. I’ll contact you later today/tomorrow so we can finish talking about this.” And then contact them when you promised. While you are taking your break, distract yourself first to get some distance from the event, thoughts, and emotions, and then consider where they might be coming from. When you’ve been able to empathize or at least get better control of yourself, return to the discussion as promised and ask if they would like to start or would like for you to start. That can help decrease the anxiety and anger on their part.

Now, about anxiety and anger… have you ever noticed they often go hand-in-hand? That’s because anger is often a secondary emotion to more vulnerable emotions, like anxiety, guilt, shame, fear, embarrassment, sadness, or hurt. People, especially men, are taught in this culture that anger is more acceptable than a vulnerable emotion because it is perceived as strong. So, we learn to show anger rather than a “softer” and more authentic emotion. But imagine how a conversation might go differently if both parents were willing to show their genuine, vulnerable emotions with each other rather than just show the anger? It not only decreases the reaction of fear and defensiveness but it allows us to express and understand the actual problem (“I’m worried she won’t get a good education in that school system”) rather than just issue an attack (“She’ll go to that school over my dead body!”).

The point here is to be authentic, not to be passive. Passive communication is where you don’t stand up for your rights and so you don’t tend to get your needs met (e.g., letting the other parent choose the babysitter against your better judgment). Assertive communication is where you stand up for your rights while respecting the rights of others (“Because of (x reason) I’m concerned this babysitter isn’t very responsible and I want to find a new one”). Aggressive communication is where you stand up for your rights while disrespecting others (“You are a big idiot if you think I’m going to let that imbecile take care of my child!”). Passive-aggressive communication is where you are indirectly aggressive (“The babysitter you chose is indeed very attractive but I believe other qualities are more important when it comes to taking good care of our child so I’ll pick the next one”). Assertiveness is the only direct form of communication; the rest are indirect and leave a lot to the interpretation of the other person. When passive communication is relied upon, a blow-up of some sort will happen later; either aggressive, passive-aggressive, or a “blow-in” of depression.

The next article will deal with how to express anger, how to use it to your advantage, and the relationship between beliefs, thoughts, and anger.

Anyone who has spent time in nature knows how peaceful and calming it is. Even if you don’t consider yourself an outdoorsy person and prefer living or vacationing in a city, you surely have come across a park and have enjoyed sitting on a bench admiring the landscaped flowers and trees. What is it about natural environments that make it so good for our mental health? Why are spiritual and health retreats typically held in the mountains, by an ocean, or deep in a forest? Psychologists call it Attention Restoration Theory (ART). The theory says that we have two attentional systems. The first type of attention allows us to have intense prolonged focus where we can ignore distractions long enough to solve a problem at work or to study for an exam. This type of attention is prone to mental fatigue – anyone who has studied for a big exam or needed to meet a deadline for a work project knows this mental fatigue! The second attentional system does not require such intense focus, but rather involves effortless reflection and observation. ART says that it is this second attentional system that gets activated when in nature, and which allows for recovery from mental fatigue. Mountains, oceans, lakes, streams, and forests demand very little from us, yet they still engage us in a way that does not drain our energy. Unlike cities and social media which are constantly vying for our attention to “look here! look there!” and “pay attention to this before it becomes irrelevant!” – nature allows us to pay attention in our own time. When in nature, we can think as much or as little as we’d like.

Our ancestors used to spend the majority of their lives outside and it’s only relatively recent in our evolution that we spend so much time indoors. The average American now spends 93 percent of their life inside (this includes time spent in a vehicle). It’s no wonder our alienation from nature has coincided with higher rates of illness, attention difficulties, and has diminished use of our senses (living on autopilot).

The Japanese culture has something called Shinrin-yoku, which translates to “forest bathing.” How cleansing does that sound! Forest bathing is the act of spending a few hours in a forest only engaging your five senses. Studies from Korea had patients with depression engage in psychotherapy outdoors and they found those patients had reduced cortisol (stress) levels, improved heart rate variability, and reduced overall depressive symptoms. The benefits are so great the Japanese government have officially designated certain lands for “forest therapy.” People can go to different areas based on the types of trees they particularly enjoy for their visual appeal and scents. Another lesser known benefit of being in nature? There is a harmless bacteria in soil that can decrease inflammation in your immune system, alleviating a variety of health issues. The bacteria also acts as a natural antidepressant by increasing the release and metabolism of serotonin in parts of the brain that control cognitive functions and mood. This could be why gardening has been considered a great stress reliever.

We need to start prioritizing the importance of nature on our health. Remember, one size does not fit all. Find what you like! Not down with rolling around in the dirt? Take a stroll through a public garden. Find a nature retreat for your next vacation, even ‘glamping’ is better than nothing! Play outside with your children. Whatever it is, find a place to engage your secondary attentional system on a regular basis.

Exploring the Benefits of Re-Evaluation and Review

You have previous psychological testing on your client, yet your instincts tell you something isn’t quite right. Instincts, or “gut feelings” as they are called, exist in humans for a reason. They are a combination of experience and intellect as well as our own emotional memory giving us a signal. So while instincts can clearly be incorrect, they also should not necessarily be ignored. Here are some varied cases in which re-testing and/or reviews of previous testing revealed and provided information very important to the outcome of the cases. (All identifying information has been changed to protect client confidentiality.)

1. Bias in evaluations can occur. Evaluators are human, and can be unconsciously swayed by a client’s presentation. This can result in them viewing test results more negatively or positively, and unfortunately can even affect what they include in their report and their conclusions and recommendations. Thankfully most forensic evaluators are well trained in and skilled at avoiding bias, and we do not believe it happens often. But it does happen. A few years ago we were asked to review a custody evaluation for a family with three teenage boys, where one party felt vastly misrepresented in the report. The attorney explained in hiring us that since it was common for a party in a custody case who did not like the recommendations to take issue with the report, he did not necessarily really expect us to find anything. His client, however, was insistent about a professional review of the data. We found the father’s data had been fairly accurately noted in the report, and his test results, interviews, and collateral contacts mostly matched what was written. His test results that elevated into the clinical range, showing anxiety several standard deviations above the mean, however, were minimized as ‘mild,’ and some possible anger issues were ignored. In contrast, the mother’s test data was exaggerated as problematic even when none of her scores elevated into the clinical range, and a large amount of highly relevant positive information provided by collateral contacts was omitted from the report; these two things taken together resulted in a much more negative picture of the mother than test and collateral data would suggest was accurate. (Bias can generally be avoided all-together when psychologists work as a team versus as a sole evaluator.)
2. We were asked to provide a third opinion/evaluation for a fitness for duty case, as the first evaluation had resulted in a ‘not fit’ recommendation and the second in a ‘fit’ recommendation. The client, a firefighter, had experienced post-traumatic anxiety after he had witnessed a very difficult scene. The first evaluator interviewed the client and utilized two psychological tests. In reading the report, we were uncertain if the results of one test were included; tests have certain lingo associated with their interpretation, which is how we noticed. We requested test data be sent, and received the scores for that test but no interpretive report. That is unusual but it is possible the evaluator used a manual versus the computerized method. We had the client’s answer sheet so we ran an interpretive report. What we found was the results of that test contradicted the results of the other test. Thus rather than report that and perhaps have to say the evaluation results were inconclusive, the data that contradicted the ‘not fit’ conclusion was left out of the final report. Or, it is also possible it was a mistake and the test was never interpreted, thus not included. In addition, a one-interview format was used, which is common in evaluations, however, a person describing a traumatic event will often present as much more agitated when recounting that event than they appear typically. Lastly, time is an important factor in return to work evaluations. It may very well be he was still too highly anxious to function safely on the job so soon after the event, when the first evaluation was done. Time can help dissipate anxiety, particularly when the anxiety is situational and not chronic. Thus sometimes simply due to time it can be beneficial to have your client re-tested, even if the previous testing was top-notch.
3. Sometimes even if an evaluation is recent, if done for clinical purposes it does not serve a forensic need well. When a client presents for a clinical psychological evaluation, he/she is seeking to determine an accurate diagnosis for effective treatment planning, and when psychologists perform these evaluations, we generally believe what we are told by the client and by others. In forensic evaluations, however, our role is also to question what we hear, and gather collateral information so that information is supported in many ways.A client self-referred for a psychological evaluation to use in court. She had received two diagnoses from two other mental health professionals based on testing and interviews with her and her husband. She believed her husband would use these diagnoses against her in their custody negotiations. Though she described having been ‘evaluated’ because she took tests, review of her records revealed no prior comprehensive psychological evaluation other than a few assessment tools used at various times to help determine medication and/or treatment. One test was used by their marriage therapist, as well as collateral information from the husband (who had been the therapist’s individual client previous to marriage therapy). She elevated a scale on which people with bi-polar typically elevate, and that can also be elevated when a client is highly stressed, such as when in a high conflict marriage. This therapist diagnosed bi-polar and referred to a MD for medication. The psychiatrist then also diagnosed her with bipolar based again on potentially biased collateral information from the husband who had a highly conflictual relationship with her at the time. In addition, the psychiatrist gave two tests, a mood disorder test and an AD/HD test. The doctor did not adhere to the actual scoring guidelines on the mood disorder assessment, and she administered an AD/HD rating scale meant for individuals under the age of 18 when the patient was clearly well above that age. Thus in this case, re-evaluation allowed the party to contest the original diagnoses she believed were inaccurate and based on faulty data.
4. In clinically complex cases, time can be an evaluator’s friend, allowing a wealth of data to accumulate and providing the new evaluator a better opportunity for clinical clarity. This was the case in a disability re-testing we provided. In addition, there are cases in which the evaluation needs to be extremely in-depth and specialized for accurate results. The client had been evaluated numerous times over the past 25 years, beginning with a psychotic episode at age 22. She was diagnosed with bi-polar disorder and medicated. The medication was considered effective in that psychotic symptoms did not reoccur, nor did she experience deep depressions or mania. She had extreme difficulty holding a job, had been through many over the years, and was still financially supported by her parents at age 46. Her parents explained it seemed likely she could not hold a job due to her inability to interact comfortably with others, and noted she was quite socially odd. She wanted to work and was upset by the many job losses.Social difficulty is not necessarily a problem associated with bi-polar, nor is inability to hold a job when depression and mania are controlled. Rather than too easily attach these as related to the bi-polar, we considered whether alternate diagnoses were possible, and included cognitive testing, in case neurological problems were impacting her ability to work. (Too often, cognitive issues are not assessed when a person has a mental illness and thus their difficulties are ascribed to that.) A comprehensive assessment was conducted that included: clinical interview; observations; cognitive and intellectual testing; emotional and personality testing; collateral interviews; and document review of the past 25 years. Our diagnosis was schizoaffective disorder, bi-polar type, which much better described her. In addition, cognitive testing found deficits in executive functioning, and in particular in areas of cognitive functioning that would directly impact the type of career she had endeavored on. Thus in addition to her bi-polar medication, she had always also needed social skills therapy for her schizoaffective symptoms, and needed to determine if any skill building could allow her to remain in her current field or whether she should seek career counseling to find a field that better matched her strengths.

In summary, as evaluators we would like to point out that most evaluations performed by well trained clinical and forensic psychologists are very good pieces of work. We are certainly fans of the team approach such as we utilize here at the group practice, in which peer review is built into our evaluation process to protect against human error or unconscious bias. (Generally forensic reports here are reviewed by a minimum of three psychologists before finalized.) However, as you can see, it is not only mistakes or bias that can taint a report, but things like the passage of time, the intent of the original report, and the complexity of the case all play a part as well.

You (and Your Therapist) Can Change Your Personality!
(Synopsis of the New York Times Article)

There is much controversy about how our personality is formed. Some psychologists believe it is formed in early childhood and remains stable through adulthood. Others would argue it is prone to change over time. Recently, personality psychologists have taken a more middle-of-the-road view…if personality traits change, it is slowly and somewhat limited. However, an article published in the Psychological Bulletin disputes those old ideas!

A team of six researchers analyzed 207 studies on personality-trait changes and discovered that, with a therapist’s help, personality can and does change, a lot and usually within the first month of therapy! The trait identified through this research to be the most effected by therapy is neuroticism. Individuals with this trait are more likely to be moody and to experience such feelings as anxiety, anger, envy, guild, depressed mood and loneliness. Interestingly, a person’s gender or age or type of therapy did not seem to affect the outcome.

Researchers continue to question as to whether real changes actually occur in the personality trait, i.e. neuroticism, or if therapists are able to help clients return to their “normal” before conditions such as depression or anxiety became an issue. But regardless of the underlying mechanism or process, the good news is there seems to be research to support the idea that, with the help of a therapist, personality change is possible!