Clearing The Air: Mental Illness In Relation to Smoking

The other day I was at a sports bar people watching, something I commonly do, when an attractive waitress caught my attention. I watched as she went outside on her break and then did the most disgusting and disfiguring thing, she put a cigarette between her lips and lit it.

I was shocked as I watched her inhale and then exhale a white puff of smoke. She had to be aware of the astounding amount of health issues related to smoking from cancer to cardiovascular disease, and she was smoking by herself so there weren’t any apparent social benefits, so how could someone so young and beautiful be putting that carcinogenic smoke into her body?

I immediately started thinking that she had to be self-medicating for one reason or another and that got me to thinking, is that why so many people are still smoking, can they all be self-medicating with nicotine and if so, from what?

The first obvious answer to me was stress. A lot of people smoke because they are stressed out and use nicotine to help calm their nerves. A study I read said that approximately 30% of people who smoke do so because they are depressed. For these people, nicotine actually helps them feel better, if only temporarily. These people instead of learning how to deal with their depression through counseling and appropriate anti-depressants if needed, have learned to depend on nicotine. Evidence of this came from U.S. clinical trials for Wellbutrin, an anti-depressant. During the trial to see how effective Wellbutrin was on depression, a fair number of participants who smoked suddenly stopped smoking. With drug companies being as clever as they are, Wellbuturin was soon not only sold as an anti-depressant, but was repackaged and renamed as Zyban and sold as a treatment to help people quit smoking.

Also, in an article called “Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study” published in European Psychiatry, it was shown that anxiety and depression were the two most common complaints in people who smoke, with anxiety being the highest complaint, followed by anxiety and depression combined and then depression by itself.

People with mental health issues, even if they are underlying, are twice as likely to smoke as the rest of the population. So it is possible that the people around you who smoke, your spouse, your friend, your family member, (or even you if you smoke) may actually be self-medicating for an untreated and undiagnosed issue that needs to be attended to. With proper treatment, they may lose the desire to smoke altogether. Encourage them to talk to their doctor, health care provider or other mental health provider about how their mood factors in with their urges to smoke.

Political Bullying: What Are We Modeling to Our Children?

As the political season heats up, I can’t help but to notice that the ads seem to get nastier and more personal, so much so that it takes me back to some of the countless meditations I’ve done with high school students and initially I couldn’t understand why, but then it hit me, these campaign ads are reminding me of bullying.

Just like a lot of the bullying that goes on around school campuses across the nation (and now across the internet via sites like Facebook and Twitter), these politicians are often attacking each others characters, credibility and other qualities.

Unlike the bullying I see on school campuses, this type of bullying is different, and yet similar. It’s different in that it is much more of a sophisticated type of bullying, but it’s similar in it’s purpose and even worse, it is bullying that is played out across the nation, on television screens several times a day for millions to see, often during the times our young and impressionable children are watching.

These kids may not care about either candidate, and they may not even realize what they are witnessing, yet they are being exposed, often several times a day,  to a form of bullying that they may subconsciously model, especially in situations where they want to make themselves look better than someone else, rather in their social circle, sports or even in running for high school level campaigns.

Two adults bullying each other may sound ridiculous, but that is exactly what politicians do all the time. John Mica, who won the Republican primary House District 7 acknowledged that during a brutal campaign, he was severely affected by the mean spirited ads and statements made not only about him, but his family and integrity.

Although many political analyst believe that negative campaigns are necessary as they tend to get more voters attention than positive campaigns (what does that say about our Nation), at the end of the day I am concerned about how much of that negativity and mean spirited attention truly affects us.

As the campaign season continues to play out and ads are likely to get even more cruel, don’t just turn a blind eye to your child sitting there as it interrupts their television show. You may want to change the channel, or better yet, use it as a teaching and bonding opportunity to discuss with your child anything from bullying, the state of the Nation, the economy, to your political views. After all, they are likely getting all that anyway from watching the campaign ads, just that the information they are getting is likely tainted and smeared in figure pointing and character bashing.

A Quick Glimpse at ADHD in Teenage Girls

As I wrote in a previous post, attention deficit/hyperactivity disorder is 2 to 4 times more common in boys than in girls and thus often doesn’t get discussed much when it comes to teenage and adolescent girls.

In her article Calm Down, Boys, Adolescent Girls Have ADHD Too, Mary Bates discusses how ADHD goes unrecognized in girls because they often don’t present with the stereotypical hyperactivity and attention deficit that boys usually present with and because diagnosing ADHD in itself can prove difficult because teenagers can be impulsive, inattentive and disorganized, but not noticeably hyperactive.

Kathleen Nadeau, a clinical psychologist in Silver Spring, Maryland, and coauthor of Understanding Girls with AD/HD states that girls are less likely to be hyperactive and impulsive, but instead may appear “spacey,” unfocused, inattentive, have trouble staying organized and/or remembering directives or homework.

It wasn’t too long ago that ADHD was two separate disorders, ADHD and ADD (attention deficit disorder), but now they are almost always diagnosed as ADHD with a sub-type of either predominately attention-deficit, predominately inattentive or combined.

Since girls often present with different symptoms, they are often diagnosed five years later than boys or go un-diagnosed altogether, thus missing out on proper treatment for their disorder. “A 16-year-old girl who runs stop signs and can never find her homework might not be a rebel- she could have ADHD” Bates says.

Treatment for ADHD includes stimulant medications, school and family counseling. Families can try ignoring minor annoyances while creating a point or contract system (“Wash the dishes now and I will leave you alone while you play your video games”). ADHD is not a curse, many successful and brilliant people today and in history have ADHD, just look at Michael Phelps.

help4yourfamily

Written by, Kate Oliver, MSW, LCSW-C

Based on a question I had from my parent affirmation about breathing last week, and because I teach people the mechanics of breathing several times a week, I decided to take a moment to really break this breathing thing down for everyone. Breathing is the first step in getting connected to our bodies and what our body is telling us.  Before you think that you already know how to breathe, take a moment to ask yourself whether there were any times in the last week where you noticed you had been hungry and meaning to eat for several hours but did not get around to it. Or, alternately, did you find yourself mindlessly eating away at your child’s leftovers as you were doing the dishes? Maybe you realized you needed to go to the bathroom and just did not give yourself the time to…

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Cognitive Behavioral Therapy, A Brief Primer Part 1: Automatic Thoughts, Assumptions and Personal Schemas

Cognitive Behavioral Therapy (CBT) is one of the most popular forms of therapy used in the Western world. The premise behind CBT is that stressful states such as depression, anxiety and anger are often maintain or exacerbated by exaggerated or biased ways of thinking. The role of the therapist is to help the patient recognize his or her idiosyncratic style of thinking and modify it through the application of evidence and logic.

One of the key components of CBT is getting the person to start recognizing their automatic thoughts which usually serve to maintain their undesired state.

Automatic thoughts come spontaneously, so much so that we often give no thought to them, and they appear to be true even when distorted, which often lead to problematic behaviors and disturbing emotions.

Some forms of automatic thoughts include fortune tellingdichotomous (all or nothing thinking), catastrophizing, personalizing, mind-reading and labeling.

Automatic thoughts could be true or false. For example, someone may have the mind-reading thought that “My boss doesn’t like me” and that could be true. However, the problem is that without sufficient evidence, we usually believe our automatic thoughts to be totally accurate, even when they aren’t. Combine this with the other underlying assumptions and rules that we all have, which tend to be rigid, over-inclusive, almost impossible to attain and ascribe vulnerability into the future, and we have a recipe for repeated disappointment, anger, depression, anxiety and a host of other unhealthy feelings and thoughts (Leah, 2003).

For example, if the person who has the automatic thought “My boss doesn’t like me”, also has the underlying rule that “Everyone must like me or I am a bad person”, will be deeply upset over the thought that his/her boss doesn’t like them. The same is true with rejection which partially explains why some people do not take rejection as well as others. One person can ask someone out on a date and if that person politely says “no”, that person goes on with their day, giving little thought to the rejection. But if another person has the rule and automatic thought “If she rejects me, that means I am undesirable to all women and will spend the rest of my life alone”, they will handle the rejection totally differently.

Underlying assumptions are deeply linked to personal schemas. Personal schemas are basically the core beliefs of what we belief about ourselves. We all have personal schemas, some positive and some negative, which influence the way we interpret information filtered through our automatic thoughts.

Back to our example. If someone has the personal schemas, “I am undesirable”, “I am worthless”, “I am unattractive”, they will have selective attention and memory as they look to validate their core beliefs about themselves and thus their automatic thoughts will also work to validate their core beliefs. So if the person already has the personal schema “I am undesirable”, and the automatic thought “this person will probably reject me” (mind reading), if they get rejected it will validate their personal schema and thus send them into a tail spin of self-pity, depression and anxiety, building on the strength of their erroneous thinking, assumptions, and schema.

(The ego always wants to be in balance with you and wants to make you happy. “The ego’s mission is to take the beliefs of the self and turn them into the experiences of the self.” – Falco, 2010)

This person, like many people with depression or anxiety, will filter out any information that contradicts their negative personal schemas and assumptions. For example, they may not notice the cute guy that flirts with them, but will fall to pieces at the person who makes a disapproving comment about her hair or her dress.

The goal of a CBT therapist would be to get the person to start recognizing all of these erroneous patterns of thinking, unravel them and replace them with more accurate forms of thinking.

We will discuss in a later post how thoughts create feelings.

help4yourfamily

Kate Oliver, MSW, LCSW-C

I usually get an eye-roll when I mention the idea of breathing or paying attention to one’s breathing in my office.  It is so simple.  We all breathe all day, everyday.  As my dad would say, “It’s better than the alternative.”  This week, I want to give you a simple task to go along with your affirmation.  Pay attention to your breath.  Notice how you are breathing at different times of the day.  If each breath is felt most in your shoulders, try taking in a breath that fills your belly like a balloon, then lets the air out of the balloon.  It only takes a moment.

Take a deep breath- through your nose if possible- and let it out slowly.  You can even try the trick my meditation teacher taught me called the “mindsweep.”  When someone has entered your space and left a bad feeling…

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