Chapter 65 of the book Self-Help Stuff That Works

by Adam Khan:

What is more fun: Things that require the expenditure of resources like material and electricity and gas? Or self-powered activities?
Burn Your Own BTUs

Competition doesn't have to be an ugly affair. In fact, from at least one perspective, it is the finest force for good in the world.
The Spirit of the Games

Achieving goals is sometimes difficult. When you feel discouraged, check this chapter out. There are three things you can do to make the achievement of your goals more likely.
Do You Want to Give Up?

Some tasks are just plain boring and yet they have to be done. Washing the dishes, for example. Learn how to make the tasks more fun.
A Terrible Thing to Waste

Scientists have found out some interesting facts about happiness. And much of your happiness is under your influence.
Science of Happiness

The subtitle of Red Hot LoveNotes for Lovers says it all. The book "shares the importance of great sexual communication and other essentials for extraordinary hot sex."

"Relationships, simply put," says author Larry James, "are about relating. If you can't have effective communication with your partner, if you're withholding things that need to be said, then you're cheating your love partner out of something valuable. My book elaborates on how vital this type of communication is in the bedroom."

He and his wife Sandy agree to always talk about issues, no matter how difficult they are to discuss. "One agreement is that she'll tell me what she wants, and that she'll let me know what makes her feel good. I also want to know what turns her off, and when something isn't right. Instead of holding in our feelings, we share them."

Often, James points out, a person communicates more to the woman working in the diner or to the man at the window seat on the plane than to his or her lover. So, his book contains over 250 pages of relationship-building tips, most of them one to two pages long. He dedicates the book to "love partners who are deeply committed to the idea of passionate monogamy, fidelity and having lots of fun in the bedroom! Sex is fun and pleasure is good for you!"

He points out that almost every sexual problem has an underlying problem in the area of communication. "Resentment, anger and issues left hanging can keep the wedge driven deeply," he writes. "You cannot be irresistibly approachable with unresolved issues and all the emotions that go with them. Talking about them -- in loving ways -- brings them out into the open. The tension begins to ease. What you can't talk about owns you!"

Tips range from taking personal hygiene seriously (or, as he puts it -- "in some long-term marriages, couples will often go to bed without showering or bathing, with face or legs covered with stubble, with unbrushed teeth to offensive body odor. No wonder you're not getting any!") to exercising to build up sexual energy and self esteem, from covering your partner's body with warm chocolate to watching a sexy movie together.

---

continue story below

---

Other advice includes letting go of past sexual experiences that were unfulfilling. "That was then," he writes, "this is now! Let go of being the victim. It doesn't look good on you. Acknowledge the experience. Accept it. Take responsibility for your share of the problems, forgive yourself and begin to reinvent a sexual relationship that frees your sexual soul and gives you power over the past."

Yet another tips suggests that if you're too embarrassed to tell your lover what you really want, to write down a list. "Put on your most favorite music, light some candles, get in the mood. It is important to understand that the intention of this process is not to express complaints about what the other person is NOT doing right, but to suggest 'something else' you could do together to make you both feel good."

Other tips are more explicit when describing particular acts of lovemaking. As Michael Najarian, President of Personal Growth Productions, puts it: "Larry James speaks frankly to questions about sex we have all encountered at one time or another. Playfully written, Red Hot LoveNotes for Lovers inspiring words can guide you to the joys of passionate monogamy. It will leave you with a 'knowing' smile."

At the back of his book, he includes two pages of "Recommended Reading, Listening and Viewing," along with information about his Relationship Enrichment LoveShop. He also present Mars & Venus Seminars based upon the work of Dr. John Gray, the author of Men Are From Mars, Women Are From Venus. James is on staff with Dr. Gray, and was personally trained by him.

James conducts relationship workshops in corporate settings and he hosts the Mars & Venus Chatroom on America Online. "I love what I do and I love to share what I do," he says. "I've answered thousands of questions about relationships, and between thirty and forty percent of them are specifically about sex."

He often discusses these sexual concerns on radio call-in shows. "This gives me an up-to-date focus of what interests people," he says, "and it helps me when I write my relationship books."

He shares his own experiences during his workshops and interviews, and he doesn't try to paint a perfect picture. "Whenever Sandy or I get either upset or angry, we allow a cooling off period," he says, "and we talk about the issue again when feeling level headed. We don't want to say anything stupid, because you can't unring a bell. You can't take back words in anger, and you can only say I'm sorry a couple of times for the same thing. Then, those words aren't even a Band-Aid; the apology just plain doesn't work."

Whenever James thought of a good entry for Red Hot Lovenotes for Lovers, he jotted it down. Then, he considered if the idea really encapsulated what he intended, and whether or not this advice would apply to a larger audience. He then ran his advice past psychologists and psychiatrists, and a sex therapist who used to work as an English professor proofread his manuscript.

James frequently participates in book signings to promote his books. "My book signing sales tripled after I incorporated one new technique," he says. "Instead of just sitting down at a table, I carry copies of my book around the bookstore, and I introduce myself to people. I suggest that they peruse the book, they can return it to me when they're done. If, of course, they decide to buy it, I'm happy to autograph it."

According to James, book signing events are not primarily to sell books. "They are for public relations," he says, "with the people working in the store, and with customers in the store. I give away, by the hundreds, four- color bookmarks listing my books."

Anyone interested in receiving a free copy of more book signing tips should email Larry James at HostMars@aol.com, or mail a number 10 SASE to CelebrateLove.com, P.O. Box 12695, Scottsdale, Arizona 85267-2695.

This interview was done by writer, Kelly Boyer Sagert.

next: The First Book of LifeSkills

For many children diagnosed with ADHD, the ADHD symptoms continue into adolescence and adulthood. And the risk for academic problems and other mental disorders increases.

Do ADHD children become ADHD adults?

Researchers Dr. Rachel Klein and Dr. Salvatore Mannuzza have conducted one of the most extensive prospective longitudinal studies of children diagnosed with ADHD (attention deficit hyperactivity disorder). They followed 226 children over sixteen years to determine how long ADHD symptoms persisted, and if the children were at further risk for other problems as they were growing up. At the first follow-up evaluation, the children were average age 8, at the second follow-up they were average age 25. All of the subjects were boys, and none received treatment after the age of 13.

The following are some key findings from their work. Some of the statistics may be troubling, especially those having to do with substance abuse or criminal behavior. To parents questioning whether taking their ADHD child off medication will increase the adverse risks associated with ADHD, Dr. Klein says, "First, the question should only be posed in relation to adolescents who are still symptomatic. There is no reason to keep treating those who no longer have ADHD symptoms. Among the symptomatic adolescents, no one knows the answer. But we do know that treatment is effective in adolescence; therefore it makes sense to continue treatment if it's indicated. However, it would be premature to promise a positive outcome as a result."

Do children outgrow ADHD?

Other, smaller follow-up studies have shown consistently that hyperactivity or ADHD is a highly persistent disorder from childhood into adolescence.[1] Short term studies have shown fairly consistently that children diagnosed with ADHD continue to experience significant academic, cognitive, and behavioral difficulties into their early to mid-teens (13 - 15).[2] Between 30 and 50 percent may continue to have the full disorder into late adolescence (16 to 19).[3]

Klein and Mannuzza found that 37% of the ADHD subjects[4] continued to have ADHD into adolescence, compared to only 3% of the controls. It seemed to drop off in adulthood to 7%.

However, the extent to which ADHD is likely to persist into adulthood is not easily determined from the long-term studies, largely because the methods of measuring symptoms usually change as subjects grow up. Children and teenagers are more likely to be evaluated based in part on interviews with teachers and parents, while adult diagnoses of ADHD are often based on self-reports, which tend to result in much lower rates of diagnosis.

Does ADHD lead to other problems?

• Academic difficulties

Many studies have shown that ADHD subjects often experience academic difficulties into adolescence. In one ten year follow-up study, researchers found that at age 19, ADHD subjects "completed less formal schooling, achieved lower grades, failed more courses and were more often expelled" than control subjects.[5] Klein and Mannuzza found that ADHD children were less likely than control subjects to have graduated college or attained a graduate degree. (14% vs. 52%).

• Other mental disorders

ADHD children may be at greater risk for developing other mental disorders later in life. Klein and Mannuzza found that ADHD children were more likely to have any psychiatric disorder in adolescence than control subjects. (50% of hyperactive children v. 19% of controls).

Thirty percent of the ADHD subjects in their study later developed Conduct Disorder, compared to 8 percent of the controls. Those subjects whose ADHD continued into adolescence were more likely than either the controls or those whose ADHD remitted by adolescence to develop CD.

ADHD subjects were no more likely than the control subjects to develop mood or anxiety disorders, however.

• Substance Abuse

Klein and Mannuzza found that in adolescence, the ADHD subjects were more likely than the controls to develop Substance Use Disorder. (SUD) (17% v. 2%). Interestingly, however, it was only those who subsequently developed Conduct Disorder who showed this increased risk, so it was not the ADHD itself that predicted the SUD.

It is also interesting to note that the discrepancy between the ADHD subjects and the controls only existed for substances other than alcohol; they were no more likely than the control subjects to have a problem with drinking.

• Criminal behavior

ADHD children may be at higher risk for criminal behavior. Klein and Mannuzza found that 39% of their ADHD subjects had been arrested in adolescence or early adulthood, compared to 20% of the controls. Conviction rates for the former ADHD children were also higher, 28% v. 11%. However, as with substance abuse, the arrest and conviction rates among the ADHD subjects were higher only for those who also had developed Conduct Disorder or Anti-Social Personality Disorder later in life.

Four percent of the ADHD subjects were incarcerated in adulthood, while none of the controls were.

next:

Sources

"Longitudinal Course of Childhood ADHD," Rachel Klein, Ph.D.
Presentation at New York University Medical School, March 30, 2001.

"Longterm Prognosis in Attention-Deficit/Hyperactivity Disorder," Mannuzza, Salvatore and Klein, Rachel; Child and Adolescent Psychiatric Clinics of North America, Volume 9, Number 3, July 2000

"Attention Deficit Hyperactivity Disorder: Long-Term Course, Adult Outcome, and Comorbid Disorders," Russell A. Barkley, Ph.D.

"Adolescent and Adult Outcomes in Attention Deficit/Hyperactivity Disorder," Mannuzza, Salvatore and Klein, Rachel in H.C. Quay and AE Hogan (Eds) Handbook of Disruptive Behavior Disorders. New York: Klumer Academic/Plenum Publishers. 1999 pp. 279-294

[1] http://add.about.com/health/add/library/weekly/aa1119f.htm

[2] "Adolescent and Adult Outcomes in Attention Deficit/Hyperactivity Disorder," Mannuzza, Salvatore and Klein, Rachel in H.C. Quay and AE Hogan (Eds) Handbook of Disruptive Behavior Disorders. New York: Klumer Academic/Plenum Publishers. 1999 pp. 279-294

[3] http://add.about.com/health/add/library/weekly/aa1119f.htm

[4] The subjects of the study were all boys diagnosed with "hyperkinetic reaction of childhood" under the DSM-II criteria. They had been referred by their school for behavior problems, but not for primarily aggressive or anti-social behaviors. They were followed up 6 and 9 years after the initial study.

[5] "Adolescent and Adult Outcomes in Attention Deficit/Hyperactivity Disorder," Mannuzza, Salvatore and Klein, Rachel in H.C. Quay and AE Hogan (Eds) Handbook of Disruptive Behavior Disorders. New York: Klumer Academic/Plenum Publishers. 1999 pp. 279-294

---

---

next: Difference between ADHD and ADD
~ adhd library articles
~ all add/adhd articles

The Bookshelf

Personal Relationship Coaching Fees

Interview with Larry James

The FirstBook of LifeSkills

LifeWords....For Success

Love Notes For Lovers

A Relationship Enrichment LoveShop

How to Really Love the One You're With

Red Hot LoveNotes for Lovers

Personal Relationship Coaching

KeyNotes and Seminars

---

continue story below

---

next: The Book Shelf

Detailed information on mind-body medicine. What it is? How mind-body medicine works.

• Introduction
• Definition of Scope of Field
• Background
• Mind-Body Interventions and Disease Outcomes
• Mind-Body Influences on Immunity
• Meditation and Imaging
• Physiology of Expectancy (Placebo Response)
• Stress and Wound Healing
• Surgical Preparation
• Conclusion
• For More Information
• References

Introduction

Mind-body medicine focuses on the interactions among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health. It regards as fundamental an approach that respects and enhances each person's capacity for self-knowledge and self-care, and it emphasizes techniques that are grounded in this approach.

Definition of Scope of Field

Mind-body medicine typically focuses on intervention strategies that are thought to promote health, such as relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qi gong, cognitive-behavioral therapies, group support, autogenic training, and spirituality.^a The field views illness as an opportunity for personal growth and transformation, and health care providers as catalysts and guides in this process.

---

 

---

^aCertain mind-body intervention strategies listed here, such as group support for cancer survivors, are well integrated into conventional care and, while still considered mind-body interventions, are not considered to be complementary and alternative medicine.

Mind-body interventions constitute a major portion of the overall use of CAM by the public. In 2002, five relaxation techniques and imagery, biofeedback, and hypnosis, taken together, were used by more than 30 percent of the adult U.S. population. Prayer was used by more than 50 percent of the population.¹

Background

The concept that the mind is important in the treatment of illness is integral to the healing approaches of traditional Chinese and Ayurvedic medicine, dating back more than 2,000 years. It was also noted by Hippocrates, who recognized the moral and spiritual aspects of healing, and believed that treatment could occur only with consideration of attitude, environmental influences, and natural remedies (ca. 400 B.C.). While this integrated approach was maintained in traditional healing systems in the East, developments in the Western world by the 16th and 17th centuries led to a separation of human spiritual or emotional dimensions from the physical body. This separation began with the redirection of science, during the Renaissance and Enlightenment eras, to the purpose of enhancing humankind's control over nature. Technological advances (e.g., microscopy, the stethoscope, the blood pressure cuff, and refined surgical techniques) demonstrated a cellular world that seemed far apart from the world of belief and emotion. The discovery of bacteria and, later, antibiotics further dispelled the notion of belief influencing health. Fixing or curing an illness became a matter of science (i.e., technology) and took precedence over, not a place beside, healing of the soul. As medicine separated the mind and the body, scientists of the mind (neurologists) formulated concepts, such as the unconscious, emotional impulses, and cognitive delusions, that solidified the perception that diseases of the mind were not "real," that is, not based in physiology and biochemistry.

In the 1920s, Walter Cannon's work revealed the direct relationship between stress and neuroendocrine responses in animals.² Coining the phrase "fight or flight," Cannon described the primitive reflexes of sympathetic and adrenal activation in response to perceived danger and other environmental pressures (e.g., cold, heat). Hans Selye further defined the deleterious effects of stress and distress on health.³ At the same time, technological advances in medicine that could identify specific pathological changes, and new discoveries in pharmaceuticals, were occurring at a very rapid pace. The disease-based model, the search for a specific pathology, and the identification of external cures were paramount, even in psychiatry.

During World War II, the importance of belief reentered the web of health care. On the beaches of Anzio, morphine for the wounded soldiers was in short supply, and Henry Beecher, M.D., discovered that much of the pain could be controlled by saline injections. He coined the term "placebo effect," and his subsequent research showed that up to 35 percent of a therapeutic response to any medical treatment could be the result of belief.⁴ Investigation into the placebo effect and debate about it are ongoing.

Since the 1960s, mind-body interactions have become an extensively researched field. The evidence for benefits for certain indications from biofeedback, cognitive-behavioral interventions, and hypnosis is quite good, while there is emerging evidence regarding their physiological effects. Less research supports the use of CAM approaches like meditation and yoga. The following is a summary of relevant studies.

References

---

 

Mind-Body Interventions and Disease Outcomes

Over the past 20 years, mind-body medicine has provided considerable evidence that psychological factors can play a substantive role in the development and progression of coronary artery disease. There is evidence that mind-body interventions can be effective in the treatment of coronary artery disease, enhancing the effect of standard cardiac rehabilitation in reducing all-cause mortality and cardiac event recurrences for up to 2 years.⁵

Mind-body interventions have also been applied to various types of pain. Clinical trials indicate that these interventions may be a particularly effective adjunct in the management of arthritis, with reductions in pain maintained for up to 4 years and reductions in the number of physician visits.⁶ When applied to more general acute and chronic pain management, headache, and low-back pain, mind-body interventions show some evidence of effects, although results vary based on the patient population and type of intervention studied.⁷

Evidence from multiple studies with various types of cancer patients suggests that mind-body interventions can improve mood, quality of life, and coping, as well as ameliorate disease- and treatment-related symptoms, such as chemotherapy-induced nausea, vomiting, and pain.⁸ Some studies have suggested that mind-body interventions can alter various immune parameters, but it is unclear whether these alterations are of sufficient magnitude to have an impact on disease progression or prognosis.^9,10

---

 

---

Mind-Body Influences on Immunity

There is considerable evidence that emotional traits, both negative and positive, influence people's susceptibility to infection. Following systematic exposure to a respiratory virus in the laboratory, individuals who report higher levels of stress or negative moods have been shown to develop more severe illness than those who report less stress or more positive moods.¹¹ Recent studies suggest that the tendency to report positive, as opposed to negative, emotions may be associated with greater resistance to objectively verified colds. These laboratory studies are supported by longitudinal studies pointing to associations between psychological or emotional traits and the incidence of respiratory infections.¹²

Meditation and Imaging

Meditation, one of the most common mind-body interventions, is a conscious mental process that induces a set of integrated physiological changes termed the relaxation response. Functional magnetic resonance imaging (fMRI) has been used to identify and characterize the brain regions that are active during meditation. This research suggests that various parts of the brain known to be involved in attention and in the control of the autonomic nervous system are activated, providing a neurochemical and anatomical basis for the effects of meditation on various physiological activities.¹³ Recent studies involving imaging are advancing the understanding of mind-body mechanisms. For example, meditation has been shown in one study to produce significant increases in left-sided anterior brain activity, which is associated with positive emotional states. Moreover, in this same study, meditation was associated with increases in antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive emotional states, localized brain responses, and improved immune function.¹⁴

Physiology of Expectancy (Placebo Response)

Placebo effects are believed to be mediated by both cognitive and conditioning mechanisms. Until recently, little was known about the role of these mechanisms in different circumstances. Now, research has shown that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is carried out.

Positron emission tomography (PET) scanning of the brain is providing evidence of the release of the endogenous neurotransmitter dopamine in the brain of Parkinson's disease patients in response to placebo.15 Evidence indicates that the placebo effect in these patients is powerful and is mediated through activation of the nigrostriatal dopamine system, the system that is damaged in Parkinson's disease. This result suggests that the placebo response involves the secretion of dopamine, which is known to be important in a number of other reinforcing and rewarding conditions, and that there may be mind-body strategies that could be used in patients with Parkinson's disease in lieu of or in addition to treatment with dopamine-releasing drugs.

References

---

Stress and Wound Healing

Individual differences in wound healing have long been recognized. Clinical observation has suggested that negative mood or stress is associated with slow wound healing. Basic mind-body research is now confirming this observation. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by cytokines, play a role in wound healing.16 Using a blister chamber wound model on human forearm skin exposed to ultraviolet light, researchers have demonstrated that stress or a change in mood is sufficient to modulate MMP and TIMP expression and, presumably, wound healing.¹⁷ Activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal medullary (SAM) systems can modulate levels of MMPs, providing a physiological link among mood, stress, hormones, and wound healing. This line of basic research suggests that activation of the HPA and SAM axes, even in individuals within the normal range of depressive symptoms, could alter MMP levels and change the course of wound healing in blister wounds.

Surgical Preparation

Mind-body interventions are being tested to determine whether they can help prepare patients for the stress associated with surgery. Initial randomized controlled trials--in which some patients received audiotapes with mind-body techniques (guided imagery, music, and instructions for improved outcomes) and some patients received control tapes--found that subjects receiving the mind-body intervention recovered more quickly and spent fewer days in the hospital.¹⁸

Behavioral interventions have been shown to be an efficient means of reducing discomfort and adverse effects during percutaneous vascular and renal procedures. Pain increased linearly with procedure time in a control group and in a group practicing structured attention, but remained flat in a group practicing a self-hypnosis technique. The self-administration of analgesic drugs was significantly higher in the control group than in the attention and hypnosis groups. Hypnosis also improved hemodynamic stability.¹⁹

---

 

---

Conclusion

Evidence from randomized controlled trials and, in many cases, systematic reviews of the literature, suggest that:

• Mechanisms may exist by which the brain and central nervous system influence immune, endocrine, and autonomic functioning, which is known to have an impact on health.
• Multicomponent mind-body interventions that include some combination of stress management, coping skills training, cognitive-behavioral interventions, and relaxation therapy may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis.
• Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be effective adjuncts in the management of a variety of chronic conditions.
• An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed presurgically, may improve recovery time and reduce pain following surgical procedures.
• Neurochemical and anatomical bases may exist for some of the effects of mind-body approaches.

Mind-body approaches have potential benefits and advantages. In particular, the physical and emotional risks of using these interventions are minimal. Moreover, once tested and standardized, most mind-body interventions can be taught easily. Finally, future research focusing on basic mind-body mechanisms and individual differences in responses is likely to yield new insights that may enhance the effectiveness and individual tailoring of mind-body interventions. In the meantime, there is considerable evidence that mind-body interventions, even as they are being studied today, have positive effects on psychological functioning and quality of life, and may be particularly helpful for patients coping with chronic illness and in need of palliative care.

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and on NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

NCCAM Clearinghouse

Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov
Web site: www.nccam.nih.gov

About This Series

"Biologically Based Practices: An Overview" is one of five background reports on the major areas of complementary and alternative medicine (CAM).

• Biologically Based Practices: An Overview

• Energy Medicine: An Overview

• Manipulative and Body-Based Practices: An Overview

• Mind-Body Medicine: An Overview

• Whole Medical Systems: An Overview

The series was prepared as part of the National Center for Complementary and Alternative Medicine's (NCCAM's) strategic planning efforts for the years 2005 to 2009. These brief reports should not be viewed as comprehensive or definitive reviews. Rather, they are intended to provide a sense of the overarching research challenges and opportunities in particular CAM approaches. For further information on any of the therapies in this report, contact the NCCAM Clearinghouse.

"I would rather know the person who has the disease than know the disease the person has."
Hippocrates

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.

next:Whole Medical Systems: An Overview

---

References

1. Wolsko PM, Eisenberg DM, Davis RB, et al. Use of mind-body medical therapies. Journal of General Internal Medicine. 2004;19(1):43-50.
2. Cannon WB. The Wisdom of the Body. New York, NY: Norton; 1932.
3. Selye H. The Stress of Life. New York, NY: McGraw-Hill; 1956.
4. Beecher H. Measurement of Subjective Responses. New York, NY: Oxford University Press; 1959.
5. Rutledge JC, Hyson DA, Garduno D, et al. Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. Journal of Cardiopulmonary Rehabilitation. 1999;19(4):226-234.
6. Luskin FM, Newell KA, Griffith M, et al. A review of mind/body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Alternative Therapies in Health and Medicine. 2000;6(2):46-56 7.
7. Astin JA, Shapiro SL, Eisenberg DM, et al. Mind-body medicine: state of the science, implications for practice. Journal of the American Board of Family Practice. 2003;16(2):131-147.
8. Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioral interventions for cancer treatment-related side effects. Seminars in Clinical Neuropsychiatry. 2003;8(4):253-275.
9. Irwin MR, Pike JL, Cole JC, et al. Effects of a behavioral intervention, Tai Chi Chih, on varicella-zoster virus specific immunity and health functioning in older adults. Psychosomatic Medicine. 2003;65(5):824-830.
10. Kiecolt-Glaser JK, Marucha PT, Atkinson C, et al. Hypnosis as a modulator of cellular immune dysregulation during acute stress. Journal of Consulting and Clinical Psychology. 2001;69(4):674-682.
11. Cohen S, Doyle WJ, Turner RB, et al. Emotional style and susceptibility to the common cold. Psychosomatic Medicine. 2003;65(4):652-657.
12. Smith A, Nicholson K. Psychosocial factors, respiratory viruses and exacerbation of asthma. Psychoneuroendocrinology. 2001;26(4):411-420.
13. Lazar SW, Bush G, Gollub RL, et al. Functional brain mapping of the relaxation response and meditation. Neuroreport. 2000;11(7):1581-1585.
14. Davidson RJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine. 2003;65(4):564-570.
15. Fuente-Fernandez R, Phillips AG, Zamburlini M, et al. Dopamine release in human ventral striatum and expectation of reward. Behavioural Brain Research. 2002;136(2):359-363.
16. Stamenkovic I. Extracellular matrix remodelling: the role of matrix metalloproteinases. Journal of Pathology. 2003;200(4):448-464.
17. Yang EV, Bane CM, MacCallum RC, et al. Stress-related modulation of matrix metalloproteinase expression. Journal of Neuroimmunology. 2002;133(1-2):144-150.
18. Tusek DL, Church JM, Strong SA, et al. Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Diseases of the Colon and Rectum. 1997;40(2):172-178.
19. Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet. 2000;355(9214):1486-1490.

 

---

 

---

next: Whole Medical Systems: An Overview

Self-Therapy For People Who ENJOY Learning About Themselves

Are You Considering Therapy?

Probably not!

Since you are competent enough to read and understand this, the question isn't whether you "need" therapy but whether you WANT it, and whether you want it enough.

HOW CAN I TELL IF I WANT THERAPY ENOUGH?

You can decide if you want therapy enough by mentally "weighing" the expected costs against the expected rewards.

THE COSTS OF THERAPY

You can evaluate the costs by thinking about money, time, and energy. About Money Your out of pocket costs can range from nothing (for those with great insurance) to much more than $150 per hour (for those who need a psychiatrist and must pay on their own). You need a psychiatrist if you have medical complications related to therapy.

Most people see a "clinical social worker," and some see a "clinical psychologist." If you need medication you can see a psychiatrist just once or occasionally (sometimes for less than an hour) and see a social worker or a psychologist for your regular meetings.

Fees vary greatly. On average (in Milwaukee in 1998), a psychologist charges about $110 per hour.

A social worker is likely to charge in the $90 range. [I charge $85 per appointment OR $220 per Month for 4 or 5 Weekly Meetings.] Competence is NOT directly related to fees! Fees are mostly related to the therapist's circumstances: overhead, agency policies, lifestyle, etc.

My monthly rate is low because of low expenses. Ask for info if you live in Milwaukee or want telephone counseling...]

Finances Should Not Keep You Out Of Therapy.

---

continue story below

---

If you can't afford the fees and have no insurance, call a Family Service agency or call the local Mental Health Association. They should be able to find help for you that is based on your ability to pay.

(If you have enough income but prefer to spend it on other things, you don't want therapy enough...)

About Time and Energy

One of the best ways to evaluate whether you want therapy enough is simply to ask yourself: "Would it be worth an hour of my time and energy each week talk to a therapist about all the things I'd like to change about myself and my life."

If the answer to this question is "Yes," then you probably want therapy enough. If the answer is "No," you probably don't want it enough

(... unless deciding about time and energy is one of the problems you want to work on!).

THE EXPECTED REWARDS

It is reasonable to assume that you will at least learn to understand yourself and your situation very well through therapy.

Since nothing is perfect, it is not reasonable to assume that you will solve all of the problems in your life.

When I end therapy with someone, I ask them to remember everything they wanted to change and then rate the degree to which we were successful or unsuccessful at each of them.

Most people report SOME improvement in ALL areas, and ENOUGH improvement to be quite happy about it in about 90% of the problems we discussed.

FINDING A GOOD THERAPIST

The Best Ways To Find A Good Therapist

• Go back to any therapist you had in the past if you were happy with their work.

• Ask a few friends what they like about their therapists. Then notice if these same factors are important to you.

One Very Poor Way To Find A Therapist Don't rely on your insurance company! Their primary interest is in keeping costs down. They usually refer only to therapists who agree to follow the insurance company's very restrictive guidelines. Remember: You Are HIRING The Therapist! YOU decide if they are right for you, and you have every right to "shop around" if you want. A therapist should feel like a good match for you, regardless of their credentials. One of the most important factors in finding a good therapist is whether the therapist believes he or she can help you. Notice their level of personal confidence.

Something Is Very Wrong...

• If your therapist believes they know you better than you know yourself.

• If the therapist acts as if they are "superior" to you.

Therapists Are The Experts On Therapy But YOU Are Always The Best Expert On YOU!

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Getting Practical #1: The Basics

Ginkgo Biloba is an herbal remedy for treating alzheimer's disease and dementia, memory problems and depression. Learn about the usage, dosage, side-effects of Ginkgo Biloba.

Botanical Name:Ginkgo biloba
Common Names:Maidenhair tree 

• Overview
• Plant Description
• What's It Made Of?
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Ginkgo (Ginkgo biloba) is one of the oldest living tree species and its leaves are among the most extensively studied botanicals in use today. Unlike many other medicinal herbs, ginkgo leaves are not frequently used in their crude state, but rather, in the form of a concentrated, standardized ginkgo biloba extract (GBE). In Europe, GBE is among the best-selling herbal medications and it ranks within the top five of all prescriptions written in France and Germany.

Ginkgo has been used in traditional medicine to treat circulatory disorders and enhance memory. Scientific studies throughout the years lend support to these traditional uses. Emerging evidence suggests that GBE may be particularly effective in treating ailments associated with decreased blood flow to the brain, particularly in elderly individuals. Laboratory studies have shown that GBE improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets.

---

 

---

Ginkgo leaves also contain two types of chemicals (flavonoids and terpenoids) believed to have potent antioxidant properties. Antioxidants are substances that scavenge free radicals -- damaging compounds in the body that alter cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body, but environmental toxins (including ultraviolet light, radiation, cigarette smoking, and air pollution) can also increase the number of these damaging particles. Free radicals are believed to contribute to a number of health problems including heart disease and cancer as well as Alzheimer's disease and other forms of dementia. Antioxidants such as those found in ginkgo can neutralize free radicals and may reduce or even help prevent some of the damage they cause.

Based on studies conducted in laboratories, animals, and humans, professional herbalists may recommend ginkgo for the following health problems:

Ginkgo for Alzheimer's Disease and Dementia

Ginkgo is widely used in Europe for treating dementia. The reason that ginkgo is thought to be helpful for preventing or treating these brain disorders is because it improves blood flow in the brain and because of its antioxidant properties. Although many of the clinical trials have been scientifically flawed, the evidence that ginkgo may improve thinking, learning, and memory in people with Alzheimer's disease (AD) has been highly promising.

Clinical studies suggest that ginkgo provides the following benefits for people with AD:

• Improvement in thinking, learning, and memory
• Improvement in activities of daily living
• Improvement in social behavior
• Fewer feelings of depression

One recent study also found that ginkgo may be as effective as leading AD medications in delaying the symptoms of dementia in people with this debilitating condition. In addition, ginkgo is sometimes used preventively because it may delay the onset of AD in someone who is at risk for this type of dementia (for example, family history).

Eye problems

The flavonoids found in ginkgo may help halt or lessen some retinal problems (that is, problems to the back part of the eye). Retinal damage has a number of potential causes, including diabetes and macular degeneration. Macular degeneration (often called age-related macular degeneration or ARMD) is a progressive, degenerative eye disease that tends to affect older adults and is the number one cause of blindness in the United States. Studies suggest that ginkgo may help preserve vision in those with ARMD.

Intermittent Claudication

Because ginkgo is reputed to improve blood flow, this herb has been studied in people with intermittent claudication (pain caused by inadequate blood flow [atherosclerosis] to the legs). People with intermittent claudication have difficulty walking without suffering extreme pain. An analysis of eight published studies revealed that people taking ginkgo tend to walk roughly 34 meters farther than those taking placebo. In fact, ginkgo has been shown to be as effective as a leading medication in improving pain-free walking distance. However, regular walking exercises are more beneficial than ginkgo in improving walking distance.

---

Memory Impairment

Ginkgo is widely touted as a "brain herb" and is commonly added to nutrition bars and fruit smoothies to boost memory and enhance cognitive performance. Researchers recently reviewed all of the high-quality published studies on ginkgo and mild memory impairment (in other words, people without Alzheimer's or other form of dementia), and concluded that ginkgo was significantly more effective than placebo in enhancing memory and cognitive function. Despite the encouraging findings, some researchers speculate that more high-quality research, involving larger numbers of people, is needed before ginkgo can be recommended as a memory enhancer to otherwise healthy adults.

Tinnitus

Given that nerve damage and certain blood vessel disorders can lead to tinnitus (the perception of ringing, hissing, or other sound in the ears or head when no external sound is present), some researchers have investigated whether ginkgo relieves symptoms of this hearing disorder. Although the quality of most studies was poor, the reviewers concluded that ginkgo moderately relieves the loudness of the tinnitus sound. However, a recent well-designed study including 1,121 people with tinnitus found that ginkgo (given 3 times daily for 3 months) was no more effective than placebo in relieving symptoms of tinnitus. Given these conflicting findings, the therapeutic value of ginkgo for tinnitus remains uncertain. In general, tinnitus is a very difficult problem to treat. Talk to your doctor about whether a trial of ginkgo to alleviate this frustrating symptom may be safe and worthwhile for you.

Other Uses including Ginkgo for Depression

In addition to these health problems, professional herbalists may also recommend ginkgo for a variety of other ailments including altitude sickness, asthma, depression, disorientation, headaches, high blood pressure, erectile dysfunction, and vertigo.

---

 

---

Plant Description

Ginkgo biloba is the oldest living tree species. A single tree can live as long as 1,000 years and grow to a height of 120 feet. It has short branches with fan-shaped leaves and inedible fruits that produce a strong odor. The fruit contains an edible inner seed.

Although Chinese herbal medicine has used both the ginkgo leaf and seed for centuries, modern research has focused on the standardized Ginkgo biloba extract (GBE), which is prepared from the dried green leaves. This extract is highly concentrated and much more effective in treating health problems (particularly circulatory ailments) than the leaf alone.

What's It Made Of?

More than 40 components of ginkgo have been identified but only two are believed to be responsible for the herb's beneficial effects -- flavonoids and terpenoids. As described earlier, flavonoids (such as quercetin) have potent antioxidant effects. Laboratory and animal studies have shown that flavonoids protect the nerves, heart muscle, and retina from damage. Terpenoids (such as ginkgolides) improve blood flow by dilating blood vessels and reducing the stickiness of platelets.

Available Forms

• Ginkgo biloba extract (GBE) standardized to contain 24% flavonoids and 6% terpenoids
• Capsules
• Tablets
• Tictures

How to Take It

Pediatric

There are no known scientific reports on the pediatric use of ginkgo. Therefore, it is not currently recommended for children.

Adult

• Initial results often take 4 to 6 weeks, but should continue to accumulate beyond that period. You may not see any dramatic changes for six months.
• GBE: 120 mg daily in two or three divided doses of 50:1 extract standardized to 24% flavone glycosides (flavonoids). If more serious dementia or Alzheimer's disease is present, up to 240 mg daily in two or three divided doses may be necessary.
• Tincture (1:5): 2 to 4 mL three times a day

---

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine.

GBE is considered to be safe and side effects are rare. In a few cases, gastrointestinal upset, headaches, skin reactions, and dizziness were reported.

Because gingko decreases platelet aggregation (stickiness), there is some concern that it may increase risk of intracranial (brain) hemorrhage. In fact, there have been several reports of bleeding complications associated with ginkgo use. However, it is not clear whether ginkgo or another factor (such as the combination of ginkgo and blood-thinning medications including aspirin) caused the bleeding complications.

Pregnant and breastfeeding women should avoid using ginkgo preparations. In addition, ginkgo use should be discontinued at least 36 hours prior to surgery due to the risk of bleeding complications.

Do not ingest Ginkgo biloba fruit.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use ginkgo without first talking to your healthcare provider:

Ginkgo and Anticonvulsant medications

High doses of Ginkgo biloba could decrease the effectiveness of anticonvulsant therapy in patients taking carbamazepine or valproic acid to control seizures.

Ginkgo and Blood-thinning medications

Ginkgo has blood-thinning properties and therefore should not be used if you are taking anticoagulant (blood-thinning) medications, such as aspirin, clopidogrel, dipyridamole, heparin, ticlopidine, or warfarin.

---

 

---

Ginkgo and Cylosporine

Ginkgo biloba may be beneficial during treatment with cyclosporine because of its ability to protect cell membranes from damage.

Ginkgo and MAOIs (Monoamine oxidase inhibitors)

Ginkgo may enhance the effects (both good and bad) of antidepressant medications known as MAOIs, such as phenelzine and tranylcypromine.

Ginkgo and Papaverine

The combination of papaverine and ginkgo may be effective for the treatment of erectile dysfunction in patients who do not respond to papaverine alone.

Ginkgo and Thiazide diuretics

Although there has been one literature report of increased blood pressure associated with the use of ginkgo during treatment with thiazide diuretics, this interaction has not been verified by clinical trials. Nevertheless, you should consult with your healthcare provider before using ginkgo if you are taking thiazide diuretics.

Ginkgo and Trazodone

Additionally, there has been a report of an adverse interaction between ginkgo and trazodone, an antidepressant medication, that resulted in an elderly patient going into a coma.

---

Supporting Research

Ang-Lee MK, Moss J, Yuan C. Herbal medicines and perioperative care. [Review]. JAMA. 2001;286(2):208-216.

Adams LL, Gatchel RJ, Gentry C. Complementary and alternative medicine: applications and implications for cognitive functioning in elderly populations. Altern Ther Health Med. 2001;7(2):52-61.

Barrett B, Kiefer D, Rabago D. Assessing the risks and benefits of herbal medicine: an overview of scientific evidence. Altern Ther Health Med. 1999;5(4):40-49.

Barth SA, Inselmann G, Engemann R, Heidemann HT. Influences of Ginkgo biloba on cyclosporin A induced lipid peroxidation in human liver microsomes in comparison to vitamin E, glutathione and N-Acetylcysteine. Biochem Pharmacol. 1991;41(10):1521-1526.

Benjamin J, Muir T, Briggs K, Pentland B. A case of cerebral haemorrhage-can Ginkgo biloba be implicated? Postgrad Med J. 2001;77(904):112-113.

Blumenthal M, Busse WR, Goldberg A, et al., ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998.

Briggs CJ, Briggs GL. Herbal products in depression therapy. CPJ/RPC. November 1998;40-44.

Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, Ore: Eclectic Medical; 1998:76-77.

Christen Y. Oxidative stress and Alzheimer's disease. Am J Clin Nutr. 2000;71(suppl):621S-629S.

---

 

---

Clostre F. Ginkgo biloba extract (EGb 761). State of knowledge in the dawn of the year 2000. Ann Pharm Fr. 1999;57(Suppl 1):1S8-88.

Cupp MJ. Herbal remedies: adverse effects and drug interactions. Am Fam Physician. 1999;59(5):1239à ¢Ã¢â€š ¬Ã¢â‚¬Å“1244.

DeSmet PAGM, Keller K, HÃÂ ¤nsel R, Chandler RF, eds. Adverse Effects of Herbal Drugs. Berlin, Germany: Springer-Verlag; 1997.

Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical

indications. Arch Phys Med Rehabil. 2000;81:669-678.

Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. BMJ. 2001;322(7278):73.

Ernst E. The risk-benefit profile of commonly used herbal therapies: ginkgo, St. John's wort, ginseng, echinacea, saw palmetto, and kava. Ann Intern Med. 2002;136:42-53.

Ernst E, Pittler MH. Ginkgo biloba for dementia: a systematic review of double-blind, placebo-controlled trials. Clin Drug Invest. 1999;17:301-308.

Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol. 1999;24(3):164-167.

Foster S, Tyler VE. Tyler's Honest Herbal. 4th ed. New York: The Haworth Herbal Press; 1999:183-185.

Galluzzi S, Zanetti O, Binetti G, Trabucchi M, Frisoni GB. Coma in a patient with Alzheimer's disease taking low dose trazodone and Ginkgo biloba. J Neurol Neurosurg Psychiatry. 2000;68:679-683.

Head KA. Natural therapies for ocular disorders, part one: diseases of the retina. Alt Med Rev. 1999;4(5):342-359.

Karch SB. The Consumer's Guide to Herbal Medicine. Hauppauge, New York: Advanced Research Press; 1999:96-98.

Kidd PM. A review of nutrients and botanicals in the integrative management of cognitive dysfunction. Alt Med Rev. 1999;4(3):144-161.

Kim YS, Pyo MK, Park KM, et al. Antiplatelet and antithrombotic effects of a combination of ticlopidine and Ginkgo biloba ext (EGb 761). Thromb Res. 1998;91:33-38.

Kleijnen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. [Review]. Br J Clin Pharmacol. 1992;34(4):352-358.

Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA. 1997;278:1327 - 1332.

Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo-controlled trial of the Ginkgo biloba extract EGb761 in dementia. Dement Geriatr Cogn Disord. 2000;11:230-237.

Manocha A, Pillai KK, Husain SZ. Influence of Ginkgo biloba on the effect of anticonvulsants. Indian J Pharmacol. 1996;28:84-87.

Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy and tolerability. CNS Drugs. 2000;13:201-213.

Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease. Arch Intern Med. 1998;158(9):2225 - 2234.

Matthews MK. Association of Ginkgo biloba with intracerebral hemorrhage [letter]. Neurol. 1998;50(6):1933-1934.

Miller LC. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(9):2200à ¢Ã¢â€š ¬Ã¢â‚¬Å“2211.

Mix JA, Crews WD. An examination of the efficacy of Ginkgo biloba extract Egb 761 on the neuropsychiatric functioning of cognitively intact older adults. J Alt Comp Med. 000;6(3):219-229.

Moher D, Pham B, Ausejo M, Saenz A, Hood S, Barber GG. Pharmacological management of intermittent claudication: a meta-analysis of randomised trials. Drugs. 2000;59(5):1057-1070.

Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive funciton in Alzheimer disease. Arch Neurol. 1998;55:1409-1415.

Ott BR, Owens NJ. Complementary and alternative medicines for Alzheimer's disease. J Geriatr Psychiatry Neurol. 1998;11:163-173.

Peters H, Kieser M, Holscher U. Demonstration of the efficacy of Ginkgo biloba special extract Egb 761 on intermittent claudication a placebo-controlled, double-blind trial. Vasa. 1998;27:105 - 110.

Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 2000;108(4):276-281.

Rai GS, Shovlin C, Wesnes KA. A double-blind, placebo controlled study of Ginkgo biloba extract ('tanakan') in elderly outpatients with mild to moderate memory impairment. Curr Med Res Opin 1991;12(6):350-355.

Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med. 1997;336:1108.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:207-214.

Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas associated with chronic ginkgo. Neurol. 1996;46:1775‚1776.

Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements. A 5 year toxicological study (1991-1995). Drug Safety. 1997;17(5):342-356.

Sikora R, Sohn M, Deutz F-J, et al. Ginkgo biloba extract in the therapy of erectile dysfunction. J Urol. 1989;141:188A.

Wettstein A. Cholinesterase inibitors and ginkgo extracts - are they comparable in the treatment of dementia? Phytomedicine 2000;6:393-401.

Wong AHC, Smith M, Boon HS. Herbal remedies in psychiatric practice. Arch Gen Psychiatry. 1998;55:1033-1044.

Chapter 8

The Innate Activation Programs of the brain - the emotional ones and the non-emotional ones - are very primitive. They lack the flexibility, intricacy and the complexity needed for adult life. They are not even fit the somewhat simpler life of an infant. They are really not intended for these tasks. It is most important that the new baby responds with disgust and vomiting to stale food.

But it is not so good if children and adults respond with a reflex like vomiting to each feeling of disgust. Especially if the disgusting element is a medicine or the reaction is to the disgusting behavior of others.

The main purpose of the innate activation programs is to equip the young baby for his first days of life. Then, the two main functions are:

1. to be the basic strata and building blocks for activation programs built during the years of growth and maturing;
2. to function as a defense system in emergency situations when the swift, automatic and reflex-like responses, based on genetic memory is the preferred mode. When one is in an unexpected emergency, it is possible to observe the effects of archaic versions of activation programs - especially the emotional ones.

For instance, when an adult finds that his overdraft in the bank has almost reached the limit, the operation program of the basic emotion of fear v. serenity triggered is not the innate one. Instead, this situation activates the mature and updated version of the operation program (Supra-Program(8) in the following, Supra-Plan in the theory of Bowlby). The duty of this version is twofold:

Firstly, to initiate a more thrifty pattern of behavior or other appropriate measures to take care of the overdraft; secondly, to prevent the activation of the innate program of the emotion which would cause him to run away every time he learned about a dangerous condition caused by his overdraft at the bank.

---

continue story below

---

One of the results of the plasticity of activation programs of the emotional supra-program type is demonstrated in the vast number of ways individuals respond to similar circumstances. Part of these different ways are of relatively good quality, and their activation brings about the needed results. Part of the different ways are relatively harmless - though inefficient and costly.

They can be an exaggeration of one sort or another of right steps, or be embedded with various mistakes which are not fatal. Other variations - private or common to whole groups of people - are not reliable ways to achieve the basic targets. If one is lucky, they may be merely a costly or funny means of achieving the right end; if one is not lucky enough - as are most people - one cannot expect to lead a happy life.

Other ways in which people behave are results of programs involving too little effort, or activities with a wrong or clearly damaging direction. Thus, these ways cannot bring about the desired results. Sometimes they are even clearly damaging. They are always self-defeating.

In adulthood, and especially in modern industrial countries, very few of our activities can rely on the innate emotional programs. For instance, the emotional subsystem of people who find during their visit to the bank that their overdraft is too big, relay specific "emotional announcements" to the awareness. However, in these instances people cannot rely on the activation of innate operating programs to solve the problem for them.

Some of them examine their accounts - income and expenditure and change their plans. Others may react with anxiety first, and only later make some constructive amendments. Still others with a less adaptive repertoire may only get in a bad mood, but refrain from doing anything to meet the demands of the problem.

People of another group get away from the bank very fast, and divert their attention from the sad news, using the consumption of alcohol drugs or other substances, or do many other things, irrelevant to the problem, just in order to improve their feelings.

next: Ad Hoc activation Programs

Whether you're an adult woman with an eating disorder or a parent trying to help your overweight child, these articles contain concrete ideas you can use today.

• Help for Adult Women with Eating Disorders
• Helping Your Child With Obesity

---

 

---

 

next: Help for Adult Women with Eating Disorders

Bipolar disorder creates relationship problems for family members and friends. Here's how to cope with these family tensions.

Bipolar disorder, also known as manic depression, is a serious but relatively common illness that causes sufferers to experience extreme shifts in their mood, energy, and ability to function.

What is Bipolar disorder?

The mood swings experienced by people with bipolar disorder are far more severe than the usual ups and downs of everyday life. Sufferers alternate between mania, when they feel high, full of energy, and restless, and depression, when they feel lethargic, sad, and hopeless. The severity and duration of these episodes varies and often there will be periods of normal mood in between.

The manic phase of bipolar disorder is characterized by poor judgment, resulting in high-risk, impulsive, or destructive behaviors. While manic, sufferers may engage in reckless or dangerous activities such as fast driving, wild spending sprees, provocative or aggressive behavior, and substance abuse. Family members must not only cope with their loved one acting in uncharacteristic ways, but also deal with the lasting consequences of these behaviors.

Relationship problems caused by bipolar disorder

Like any serious illness, bipolar disorder creates problems for family members and friends. Living with someone who experiences extreme, uncontrollable mood swings can be highly stressful and a source of misunderstandings and confrontations.

Alcohol and drug abuse is common in people with bipolar disorder and can make symptoms more severe. Substance abuse may reflect a lack of judgment brought on by the illness or be a deliberate act of "self-medication" by the patient. Experts stress the important of recognizing such problems in bipolar patients and ensuring they are treated by specialists.

Effective management of substance misuse has dual benefits: It minimizes the negative impact of drug and alcohol on the sufferer and their family, and also increases the likelihood that treatment for bipolar disorder will be successful.

The price a bipolar sufferer pays for the euphoric high is a crashing low, which can be just as hard for family and friends to cope with. In the manic phase the sufferer can be the life and soul of the party, whereas during a depressive episode they are likely to withdraw into themselves. They may be irritable or restless, show disturbed sleep and eating patterns, and be unable to enjoy their usual activities. This can be extremely upsetting for family members, particularly children, who may feel that they have done something wrong.

Understand that bipolar sufferers cannot control their feelings

It is important to remember that these feelings of hopelessness and depression are neither rational nor under the sufferers' control: they cannot simply "snap out of it." Try to be patient and understanding and remember that your support is crucial, even if it does not appear to be appreciated at the time.

During manic and depressive episodes, patients with bipolar disorder may become suicidal. Research suggests that at least one-quarter of sufferers will attempt suicide, and 10-15% will be successful. Fortunately, drug treatment for bipolar disorder has been proven to substantially reduce the risk of suicide, so family members should remain vigilant and ensure compliance with any prescribed medication. Suicidal thoughts, remarks, or behaviours should always be taken seriously and reported to a qualified professional.

Sometimes, severe bipolar episodes include symptoms of psychosis, such as hallucinations, delusions, and paranoia. Seeing a loved one exhibiting such symptoms can be frightening and confusing but again it is important to bear in mind that these behaviours are caused by the illness and require urgent medical attention. Drugs can be effective in reducing acute psychotic symptoms, while long-term compliance with medication will help prevent them recurring in the future.

Symptom awareness

A particularly frustrating aspect of bipolar disorder is that when someone is in the midst of an episode they are unlikely to realize there is anything wrong. In fact, most sufferers report feeling extremely well at the beginning of a manic episode and don't want it to stop. When someone with bipolar disorder is engaging in activities that are a threat to themselves or others, hospitalization may be necessary. Often this is against the person's will - in other words they are "committed". This is a legal process and only happens when a qualified professional believes that hospitalization is necessary to ensure the person is safe and has access to treatment.

Although forced hospitalization can cause considerable distress at the time, the sufferer will usually acknowledge that it was necessary once treatment has been started and their symptoms are under control.

Social problems

With all these potential sources of conflict between the sufferer and their family, it is no surprise that bipolar disorder is associated with severe psychosocial problems. Even between episodes it is estimated that 60% of sufferers experience enduring difficulties in their home and working lives. Divorce rates are around two to three times higher for bipolar individuals than in the general population; furthermore, their occupational status is twice as likely to deteriorate than those without the illness.

---

What steps can you take if someone in your family suffers from bipolar disorder?

Family and friends tend to be at the front-line of managing the illness, and there is increasing evidence to suggest that family involvement is directly beneficial to the sufferer. Indeed, studies show that family "psychoeducation" is effective in reducing the risk of relapse, improving compliance with treatment, facilitating general social skills, and promoting family harmony. Some practical ways that family and friends can help are outlined below:

• Learn everything you can about bipolar disorder (psychoeducation). Encourage the sufferer to seek treatment if they have not already done so.
• Offer to accompany them to doctor's appointments.
• Let your loved one know you care; remind them that their feelings are caused by an illness that can be treated.
• Provide ongoing emotional support and encouragement once treatment has started.
• Learn to recognize the warning signs of an imminent relapse, e.g., irritability, fast speech, restlessness, and unusual sleeping patterns.
• Identify triggers, e.g. seasons, anniversaries, stressful life events.
• While the sufferer is stable, formulate a preferred course of action in the event of a future manic or depressive relapse.
• Monitor medication compliance and remind the sufferer that treatment must be continued even when they are feeling well.
• Never ignore remarks about suicide - don't leave the sufferer alone and contact a professional urgently. Make sure your relative is able to look after themselves; alert their physician if they are not eating or drinking.

Detailed information about Bipolar Disorder can be found here: HealthyPlace.com Bipolar Center

next: Family-Focused Therapy Program for Bipolar Disorder
~ bipolar disorder library
~ all bipolar disorder articles

References:

American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revised). APA: April 2002.

Depression and Bipolar Support Alliance. Dealing effectively with bipolar disorder. DBSA: September 2002.

Depression and Bipolar Support Alliance. Helping a friend or family member with a mood disorder. DBSA: October 2002.

Dore G, Romans SE. Impact of bipolar affective disorder on family and partners. J Affect Disord 2001;67: 147-158.

Engstrom C, Brandstrom S, Sigvardsson S, et al. Bipolar disorder. III: Harm avoidance a risk factor for suicide attempts. Bipolar Disord 2004;6: 130-138.

Fristad MA, Gavazzi SM, Mackinaw-Koons B. Family psychoeducation: an adjunctive intervention for children with bipolar disorder. Biol Psychiatry 2003;53: 1000-1008.

Goodwin FK, Fireman B, Simon GE, et al. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA 2003;290: 1467-1473.

Goodwin GM, for the Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for treating bipolar disorder:

National Depressive and Manic-Depressive Association. Is it just a mood or something else? NDMA: February 2002.

National Institute of Mental Health. Bipolar disorder. NIH Publication No 02-3679: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2003;17: 149-173. Septembre 2002.

Zaretsky A. Targeted psychosocial interventions for bipolar disorder. Bipolar Disord 2003;5: 80-87.

next: Family-Focused Therapy Program for Bipolar Disorder
~ bipolar disorder library
~ all bipolar disorder articles