For a diagnosis of a hypomanic episode associated with bipolar disorder, these are the signs and symptoms doctors are looking for:

A. A distinct period of persistently elevated, expansive; or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

Source:

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

next: Diagnostic Criteria For Mixed Episode Bipolar Disorder
~ bipolar disorder library
~ all bipolar disorder articles

Professional Guidelines Recommend The Use of Proven Psychological Methods Along With or Without Medication In The Treatment of Attention Deficit Disorder:

The prescribing information provided by CIBA ( the manufacturers of Ritalin) states "Ritalin is indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate-to severe distractibility, short attention span, hyperactivity, emotional ability, and impulsivity."

The same literature also states, "Drug treatment is not indicated for all children with this syndrome..... Appropriate educational placement is essential and psychosocial intervention is generally necessary. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment...."(1)-Physicians' Desk Reference 1998

Dr. William Barbaresi notes that "Comprehensive treatment, including both medication and non-medical intervention, should be coordinated by the primary-care provider."(2)-Mayo Clinical Proceedings 1996

Similarly Dr. Michael Taylor concludes, "The most successful management of children with attention deficit disorder involves a coordinated team approach, with parents, school officials, mental health specialists and the physician using a combination of behavior management techniques at home and at school, educational placement and medication therapy."(3)-American Family Physician 1997

Research and Clinical Practice Has Shown Well Constructed Behavior Modification Programs To Be Very Useful In The Management of ADD/ADHD:

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Behavior modification programs emphasizing positive reinforcement of appropriate behavior have been useful in reducing maladaptive behavior at home and at school. Research has shown that behavior modification can improve impulse control and adaptive behavior in children of various ages (4)-Perceptual Motor Skills 1995, and (5)-Abnormal Child Psychology 1992.

The use of positive reinforcement related to daily reports from school has been found to be useful in improving task completion and reducing disruptive behavior in the classroom (6)-Behavior Modification 1995.

Some parents have been found to prefer behavioral to medical treatment (7)-Strategic Interventions for Hyperactive Children 1985.

Families are often able to succeed with their behavior modification efforts through the use of written materials only (8)-Journal of Pediatric Health Care 1993.

Teaching children with attention deficit disorder how to relax can be effective in reducing hyperactivity and disruptive behavior while increasing attention span and task completion:

Relaxation training conducted by parents in the home has been found not only to be effective in improving behavior and other symptoms but also improves over all relaxation when measured by biofeedback equipment (9, 10)-Journal of Behavior Therapy & Experimental Psychiatry 1985 & 1989.

A review of a number of studies related to relaxation training with children concluded, "Findings suggest that relaxation training is at least as effective as other treatment approaches for a variety of learning, behavioral, and physiological disorders . . ."
(11)-Journal of Abnormal Child Psychology 1985.

Cognitive Behavioral Therapy Can Help ADD Children Improve Problem Solving and Coping Skills:

Cognitive Behavioral Therapy (CBT) consists of teaching children to change their thought patterns from ones that lead to maladaptive behavior to ones that produce adaptive behavior and positive feelings. This technique can be used to help children to improve their self-esteem. It can also be used to help them improve coping skills, problem solving skills and social skills.

In one study CBT was found to be helpful in helping hyperactive boys develop anger control. The findings indicated that "Methylphenidate (Ritalin) reduced the intensity of the hyperactive boys' behavior but did not significantly increase either global or specific measures of self-control. Cognitive-behavioral treatment, when compared to control training, was more successful in enhancing both general self-control and the use of specific coping strategies." (12) Journal of Abnormal Child Psychology 1984. (It should be noted that CBT has not proven to be successful in all studies. The problem may be related to the fact that each study uses different strategies and measures of success).

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Cognitive Rehabilitation Exercises (Brain Training) Can Improve Attention & Concentration Well As Other Intellectual and Self-Control Functions:

Victims of strokes or head injury may have significant impairments in attention and concentration. Cognitive Rehabilitation exercises are often used to help these people to improve their ability to concentrate and pay attention. This approach has been applied to children with attention deficit disorder with some success. The repeated use of simple (attentional training) exercises can help children to train their brains to concentrate and pay attention for longer periods of time. (13)-Behavior Modification 1996

Focus is a multi-media psycho-educational program that combines all of the above methods in a package that can be easily and effectively implemented at home by parents:

The training manual provides a behavior modification program using the daily report card to improve performance at school.

A token economy program is provided to improve behavior at home and foster a positive parent/child relationship.

The manual also provides a series of Cognitive Rehabilitation exercises that are fun and easy to implement to improve attention and concentration while also helping to reduce hyperactivity and improve impulse control.

The manual along with audio tapes help not only teach how to improve their ability to relax but also how to apply this skill to home, school, social and sport activities.

A temperature biofeedback card is supplied as an additional aide for relaxation training.

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Audio tapes provide Cognitive Behavioral Therapy to help improve motivation, self-control and self-esteem.

The program is organized in a way to provide materials appropriate for two different age levels (6-11 and 10-14).

The program also provides additional parent education material related to attention deficit disorder as well as a set of forms for recording progress.

Please click here for more information and purchase of the Total Focus Program.

References

(1) Physicians' Desk Reference. 52nd ed. Montavle (NJ): Medical Economics Data Production Company, 1998

(2) Barbaresi, W Primary-care Approach to the Diagnosis and Management of Attention-Deficit Hyperactivity Disorder. Mayo Clin Proc 1996: 71; 463-471

(3) Taylor, M Evaluation and Management of Attention-Deficit Hyperactivity Disorder. American Family Physician 1997: 55 (3); 887-894

(4) Cociarella A, Wood R, Low KG Brief Behavioral Treatment for Attention-Deficit Hyperactivity Disorder. Percept Mot Skills 1995: 81 (1); 225-226

(5) Carlson CL, Pelham WE Jr, Milich R, Dixon J Single and Combined Effects of Methylphenidate and Behavior Therapy on the Classroom Performance of Children with Attention-Deficit Hyperactivity Disorder. J Abnorm Child Psychol 1992: 20 (2); 213-232

(6) Kelly ML, McCain AP Promoting Academic Performance in Inattentive Children: The Relative Efficacy of School-Home Notes With and Without Response Cost. Behavior Modif 1995: 19; 76-85

(7) Thurston, LP Comparison of the Effects of Parent Training and of Ritalin in Treating Hyperactive Children In: Strategic Interventions for Hyperactive Children , Gittlemen M, ed New York: ME Sharpe, 1985 pp 178-185

(8) Long N, Rickert VI, Aschraft EW Bibliotherapy as an Adjunct to Stimulant Medication in the Treatment of Attention-Deficit Hyperactivity Disorder. J Pediatric Health Care 1993: 7; 82-88

(9) Donney VK, Poppen R Teaching Parents to Conduct Behavioral Relaxation Training With Their Hyperactive Children J Behav Ther Exp Psychiatry 1989: 20 (4); 319-325

(10) Raymer R, Poppen R Behavioral Relaxation Training With Hyperactive Children J Behav Ther Exp Psychiatry 1985: 16 (4); 309-316

(11) Richter NC The Efficacy of Relaxation Training With Children J Abnorm Child Psychol 1984: 12 (2); 319-344

(12) Hinswaw SP, Henker B, Whalen CK Self-control in Hyperactive Boys in Anger-Inducing Situations: Effects of Cognitive-Behavioral Training and Methylphenidate. J Abnorm Child Psychol 1984: (12); 55-77

(13) Rapport MD Methylphenidate and Attentional Training. Comparative Effects on Behavior and Neurocognitive Effects on Behavior and Neuorcognitive Performance in Twin Girls With Attention-Deficit/Hyperactivity Disorder Behav Modif 1996: 20 (4) 428-430

(14) Myers, R Focus: A Comprehensive Psychoeducational Program For Children 6 to 14 Years of Age To Improve Attention, Concentration, Academic Achievement, Self- Control and Self-Esteem Villa Park (CA): Child Development Institute 1998

next: The Importance of The Creative Arts

Learn about the effectiveness of hypnotherapy, hypnosis for treatment of addictions, to stop smoking, eating disorders, erectile dysfunction, pain and insomnia.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background
• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

Hypnotherapy-like practices were used in ancient Egypt, Babylon, Greece, Persia, Britain, Scandinavia, America, Africa, India and China. The Bible, Talmud, and Hindu Vedas mention hypnotherapy, and some Native American and African ceremonies include trance states similar to hypnotherapy. Hypnotherapy (also called hypnosis) comes from the Greek word hypnos, meaning sleep.

Modern Western hypnotherapy can be traced to the Austrian physician Franz Anton Mesmer (1734-1815); the word "mesmerize" is based on his name. Mesmer suggested that illness is caused by an imbalance of magnetic fluids in the body and can be corrected by "animal magnetism." He believed that a hypnotherapist's personal magnetism can be transferred to a patient. His beliefs were initially questioned but were revived by 19th century English physicians. In the mid-20th century, the British and American Medical Associations and the American Psychological Association endorsed hypnotherapy as a medical procedure. In 1995, the U.S. National Institutes of Health issued a consensus statement noting the scientific evidence in favor of the use of hypnotherapy for chronic pain, particularly pain associated with cancer.

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There are three main phases of hypnotherapy: presuggestion, suggestion, and postsuggestion.

• The presuggestion phase involves focusing one's attention using distraction, imagery, relaxation or a combination of techniques. The aim is to reach an altered state of consciousness in which the mind is relaxed and susceptible to suggestion.

• The suggestion phase introduces specific goals, questions or memories to be explored.

• The postsuggestion phase occurs after the return to a normal state of consciousness, when new behaviors introduced in the suggestion phase may be practiced.

Hypnotherapy sessions may vary from a brief visit to longer, regularly scheduled appointments.

Some people seem to be more susceptible to hypnotherapy than others are, and there are several tests designed to determine a person's degree of hypnotizability or suggestibility.

The goals of hypnotherapy vary. They can include behavior change or treatment of a psychological condition. It is important that the person being hypnotized is under his or her own control at all times and is not controlled by the hypnotherapist or anyone else. Self-hypnosis is sometimes used in addition to sessions with a hypnotherapist, although study of self-hypnosis is limited.

In the United States, there is no universally accepted standard or licensing for hypnotherapists. There is wide variation in training and credentials. Certification is granted by multiple organizations, with different requirements. Many hypnotherapists are not licensed medical professionals. However, some doctors, dentists and psychologists use hypnotherapy in their practices.

Books, audiotapes and videotapes are available for training in self-hypnosis, although they have not been scientifically evaluated. Group sessions may also be offered. Hypnotherapy may be used with other techniques such as cognitive behavioral therapy.

Theory

The way that hypnotherapy works is not well studied or understood. Some research reports that changes in skin temperature, heart rate, intestinal secretions, brain waves and the immune system occur. However, similar changes are reported with other forms of relaxation. Neurologic and endocrine effects have been proposed, including alterations to the hypothalamic-pituitary-adrenal axis or the limbic system (the emotional center of the brain).

There has been scientific debate about whether hypnotherapy represents a specific altered state of consciousness. There are reports that suggestion alone, without hypnotherapy, may achieve many of the same results. However, this research is not conclusive.

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Evidence

Scientists have studied hypnotherapy for the following uses:

Pain
Studies of hypnotherapy suggest a benefit for various types of pain, including low back pain, surgery-related pain, cancer pain, dental procedure-related pain, burn pain, repetitive strain injury, temporomandibular joint disorders, facial pain (masticatory, myofascial pain disorders), sickle cell disease-related pain, irritable bowel syndrome, oral mucositis, tension headache, osteoarthritis pain and chronic pain. A 1995 consensus statement by the U.S. National Institutes of Health notes that, "Evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong... with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis, temporomandibular disorders, and tension headaches." As early small phase I clinical trial of girls aged 6 to 18 years examined the effects of a hypnosis/acupuncture treatment for chronic pain. Results from child and parent showed a decrease in pain and anxiety. However, most studies are small without clear design or results. It is not clear if a specific hypnotherapy technique or treatment duration is best, or what types of pain are most affected. Therefore, although the early evidence is promising, better research is necessary to make a strong recommendation.

Procedure-related pain
Early evidence has shown that hypnosis may alleviate procedure-related pain. In a prospective, controlled study of pediatric cancer patients, the effects of hypnosis and pain were studied. The patients reported less pain and anxiety during medical cancer treatment with hypnosis. However, studies are limited, and more information is needed to make any recommendations.

Anxiety
Several studies in children and adults report that hypnotherapy reduces anxiety, especially before dental, medical procedures or radiation. A small phase I clinical trial of girls aged 6 to 18 years examined the effects of a hypnosis/acupuncture treatment for chronic pain. Results from child and parent showed a decrease in pain and anxiety. Research also suggests children with anxiety prior to undergoing a medical procedure may benefit from hypnosis. However, most studies are small without clear design or results. There are no reliable comparisons of hypnotherapy with anti-anxiety drugs. It is not known if hypnotherapy produces different results than does meditation or biofeedback. Some research suggests that hypnotherapy may be less effective than group therapy or systematic desensitization. Better research is necessary to make a strong recommendation.

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Conversion disorder (an anxiety disorder)
Early evidence shows that hypnosis may help in the treatment of conversion disorder (motor type). However, studies are limited, and more information is needed to make any firm conclusions.

Tension headache
Reports suggest that several weekly hypnotherapy sessions can improve the severity and frequency of headaches. Preliminary research suggests that hypnotherapy is equivalent to other relaxation techniques, biofeedback or autogenic training. However, most studies are small without clear design or results. Better research is necessary to make a strong recommendation.

Adjunct to cognitive behavioral therapy
Hypnotherapy is sometimes combined with other techniques, such as cognitive behavioral therapy, to treat anxiety, insomnia, pain, bedwetting, post-traumatic stress disorder and obesity. Initial research reports benefits, although most studies are not well designed.

Labor
Preliminary research does not provide clear answers about the effectiveness of hypnotherapy on labor. Better studies are necessary to make a conclusion.

Nausea, vomiting
Research on the use of hypnotherapy for nausea and vomiting related to chemotherapy, pregnancy (hyperemesis gravidarum) and surgical recovery has mixed results. Better research is needed to make a firm conclusion.

Chemotherapy side effects
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Insomnia
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Irritable bowel syndrome
Preliminary research suggests hypnotherapy may reduce the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome. Better studies are necessary to make a conclusion.

Impotence, erectile dysfunction
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Rheumatoid arthritis
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Tinnitus (ringing in the ears)
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Allergy, hay fever
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Asthma
Preliminary research on the use of hypnosis for the management of asthma symptoms does not provide clear answers. Anxiety associated with asthma may be relieved with hypnosis. Better studies are necessary to form a firm conclusion.

Skin conditions (eczema, psoriasis, atopic dermatitis)
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Fibromyalgia
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Weight loss
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Postsurgical recovery
Research suggests that hypnotherapy may be helpful for pain, wound healing and anxiety after surgery. Several studies report that hypnotherapy may shorten hospital stays and may improve psychological well being after surgery. However, most studies are not well designed. It is not clear that hypnotherapy has any effect on physical healing.

Bedwetting
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Test taking, academic performance
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Eating disorders
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Stomach ulcers
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Fractures
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Hemophilia
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Heartburn
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Drug addiction
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Alcohol dependence
Preliminary research does not provide clear answers. Better studies are necessary to make a conclusion.

Smoking cessation
Hypnotherapy is often used by people trying to quit smoking, and it is sometimes included in smoking cessation programs. Studies in this area report mixed results; most research reports no significant sustained benefits. Better-designed research is necessary to make a strong recommendation.

Dyspepsia (difficulty with digestion)
Early evidence shows that hypnotherapy may aid in digestion. A randomized, controlled clinical trial examined the effects of hypnosis on dyspepsia. Further research is needed to confirm these findings.

Menopausal disorders
Early evidence shows that hypnotherapy may be beneficial in the treatment of hot flashes and may improve quality of life in women who are experiencing menopausal symptoms. Further research is needed to make a recommendation.

Jaw clenching
Preliminary research suggests jaw clenching may be related to hypnotic susceptibility. Better designed research is necessary to make a strong recommendation

 

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Unproven Uses

Hypnotherapy has been suggested for many uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using hypnotherapy for any use.

Agoraphobia (fear of crowds) Alertness Alzheimer's disease Amenorrhea Anticoagulation (blood thinning) Arrhythmias (abnormal heart rhythms) Attention-deficit hyperactivity disorder Bleeding Blindness Blisters Breast enhancement Bruises Cancer Cerebral palsy Chronic diarrhea Chronic dyspnea (shortness of breath) Chronic fatigue syndrome Confidence Congenital ichthyosiform erythroderma (a skin disorder) Constipation Cystic fibrosis Depression Diabetes mellitus Dissociative identity disorder Driving performance Dyspareunia (pain with intercourse) Endurance Enhanced concentration Enhanced immune system Enhanced memory Enhanced self-esteem Enhanced study skills Enhanced vision Fear of flying Functional conditions Gag reflex Gastritis Gastric ulcer Genital herpes Gastroesophageal reflux disease Gout Graves' disease Grief Hay fever Headache Heart disease Heat detection/pain threshold Hemolytic anemia High blood pressure HIV/AIDS Huntington's disease Hyperreflexic bladder

Increased strength Infections Infertility Lactation stimulation Law enforcement (recalling repressed memories) Life transition support Maternal anxiety Memory Ménière's disease Menstrual cramps Migraine Motivation Multiple personality disorder Multiple sclerosis Muscle spasm Musculoskeletal disorders Myasthenia gravis Nail biting Narcolepsy Neurodermatitis Oral hygiene Panic disorder Parkinson's disease Paruresis (psychogenic urinary retention) Pemphigus vulgaris (a skin disorder) Personality development Phobias Postpartum care Premenstrual syndrome Pruritus (itchiness) Psychosomatic conditions Quality of life Raynaud's disease Repressed memory recall Restless leg syndrome Restlessness Saliva production control Schizophrenia Scoliosis Sleep terror disorder Speech disorders Stroke Systemic lupus erythematosus Thumb sucking Tics Tongue biting Torticollis (neck spasms) Trauma Trichotillomania (compulsive hair pulling) Tuberculosis Vaginismus (involuntary spasm of vaginal muscles) Warts

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Potential Dangers

The safety of hypnotherapy is not well studied. Hypnotherapy may worsen symptoms in people with psychiatric illnesses such as schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Because limited data are available, hypnotherapy is sometimes discouraged in people at risk of seizures. Upsetting memories may surface in people with post-traumatic stress disorder. It has been suggested that some types of hypnotherapy lead to false memories (confabulation), although scientific research on this topic is limited.

Hypnotherapy should not delay the time it takes to see a health care provider for diagnosis or treatment with more proven techniques or therapies. And hypnotherapy should not be used as the sole approach to illness. Consult with your primary health care provider before starting hypnotherapy.

Summary

Hypnotherapy is used for a wide variety of health conditions. Preliminary evidence suggests that hypnotherapy may be beneficial in the management of chronic pain of various causes, anxiety (especially before dental or medical procedures) and tension headache. Initial research suggests that hypnotherapy is not effective for smoking cessation. Research in these areas must be better designed to confirm this. Other areas have not been well studied enough to draw firm conclusions. Hypnotherapy may be unsafe in patients with psychiatric disorders or at risk of seizures. Consult with your primary health care provider before starting hypnotherapy.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

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Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Hypnotherapy, Hypnosis

Natural Standard reviewed more than 1,450 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Abbot NC, Stead LF, White AR, et al. Hypnotherapy for smoking cessation. Cochrane Database Syst Rev 2000;(2):CD001008.
2. Anbar RD. Self-hypnosis for anxiety associated with severe asthma: a case report. BMC Pediatr 2003;3(1):7.
3. Anbar RD, Hall HR. Childhood habit cough treated with self-hypnosis. J Pediatr 2004;144(2):213-217.
4. Baglini R, Sesana M, Capuano C. Effect of hypnotic sedation during percutaneous transluminal coronary angioplasty on myocardial ischemia and cardiac sympathetic drive. Am J Cardiol 2004;93(8)1035-1038.
5. Brodie EA. A hypnotherapeutic approach to obesity. Am J Clin Hypnosis 2002;164(3):211-215.
6. Bryant RA, Moulds ML, Guthrie RM. The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. J Consult Clin Psychol 2005;73(2):334-340.
7. Bryant RA, Somerville E. Hypnotic induction of an epileptic seizure: a brief communication. Int J Clin Exp Hypn 1995;43(3):274-283.
8. Butler LD, Symons BK, Henderson SL, et al. Hypnosis reduces distress and duration of an invasive medical procedure for children. Pediatrics 2005;115(1):77-85.

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1. Calvert EL, Houghton LA, Cooper P, et al. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterol 2002;123(6):1778-1785.
2. Cyna AM. Hypno-analgesia for a labouring parturient with contra-indications to central neuraxial block. Anaesthesia 2003;58(1):101-102.
3. Cyna AM, McAuliffe GL, Andrew MI. Hypnosis for pain relief in labour and childbirth: a systematic review. Br J Anaesth 2004;93(4):505-511.
4. Davoli M, Minozzi S. Summary of systematic revisions of the efficacy of smoking cessation therapy [Article in Italian]. Epidemiol Prev 2002;Nov-Dec, 26(6):287-292.
5. Gay MC, Philippot P, Luminet O. Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson [correction of Erickson] hypnosis and Jacobson relaxation. Eur J Pain 2002;6(1):1-16.
6. Ginandes C, Brooks P, Sando W, et al. Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial. Am J Clin Hypn 2003;Apr, 45(4):333-351.
7. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002;97(4):954-961.
8. Green JP, Lynn SJ. Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence. Int J Clin Exp Hypn 2000;48(2):195-224.
9. Houghton LA, Calvert EL, Jackson NA, et al. Visceral sensation and emotion: a study using hypnosis. Gut 2002;Nov, 51(5):701-704.
10. Kircher T, Teutsch E, Wormstall H, et al. Effects of autogenic training in elderly patients. [Article in German]. Z Gerontol Geriatr 2002;Apr, 35(2):157-165.
11. Kirsch I, Montgomery G, Sapirstein G. Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis. J Consult Clin Psychol 1995;63(2):214-220.
12. Lang EV, Laser E, Anderson B, et al. Shaping the experience of behavior: construct of an electronic teaching module in nonpharmacologic analgesia and anxiolysis. Acad Radiol 2002;Oct, 9(10):1185-1193.
13. Langenfeld MC, Cipani E, Borckardt JJ. Hypnosis for the control of HIV/AIDS-related pain. Int J Clin Exp Hypn 2002;50(2):170-188.
14. Langlade A, Jussiau C, Lamonerie L, et al. Hypnosis increases heat detection and heat pain thresholds in healthy volunteers. Reg Anesth Pain Med 2002;Jan-Feb, 27(1):43-46.
15. Liossi C, Hatira P. Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients. Int J Clin Exp Hypn 2003;Jan, 51(1):4-28.
16. Mehl-Madrona LE. Hypnosis to facilitate uncomplicated birth. Am J Clin Hypn 2004;46(4):299-312.
17. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R. A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn 2003;Jan, 51(1):29-50.
18. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R. A randomized controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type. Psychother Psychosom 2002;Mar-Apr, 71(2):66-76.
19. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R. A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn 2003;51(1):29-50.
20. Montgomery GH, David D, Winkel G, et al. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg 2002;94(6):1639-1645.
21. Montgomery GH, DuHamel KN, Redd WH. A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? Int J Clin Exp Hypn 2000;48(2):138-151.
22. Montgomery GH, Weltz CR, Seltz M, Bovbjerg DH. Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. Int J Clin Exp Hypn 2002;Jan, 50(1):17-32.
23. Moore R, Brodsgaard I, Abrahamsen R. A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatment. Eur J Oral Sci 2002;110(4):287-295.
24. National Institutes of Health Consensus Development Program. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technol Statement Online 1995;Oct 16-18:1-34.
25. Page RA, Handley GW, Carey JC. Can devices facilitate a hypnotic induction? Am J Clin Hypn 2002;Oct, 45(2):137-141.
26. Palsson OS, Turner MJ, Johnson DA, et al. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002;Nov, 47(11):2605-2614.
27. Simren M, Ringstrom G, Bjornsson ES, et al. Treatment with hypnotherapy reduces the sensory and motor component of the gastrocolonic response in irritable bowel syndrome. Psychosom Med 2004;66(2):233-238.
28. Staplers LJ, da Costa HC, Merbis MA, et al. Hypnotherapy in radiotherapy patients: a randomized trial. Int J Radiat Oncol Biol Phys 2005;61(2):499-506.
29. Tal M, Sharav Y. Jaw clenching modulates sensory perception in high- but not in low-hypnotizable subjects. J Orofac Pain 2005;19(1):76-81. Y
30. ounus J, Simpson I, Collins A, Wang X. Mind control of menopause. Womens Health Issues 2003;Mar-Apr, 13(2):74-78.
31. Zeltzer LK, Tsao JC, Stelling C, et al. A phase I study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. J Pain Symptom Manage 2002;Oct, 24(4):437-446.
32. Zsombok T, Juhasz G, Budavari A, et al. Effect of autogenic training on drug consumption in patients with primary headache: an 8-month follow-up study. Headache 2003;Mar, 43(3):251-257.

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• Watch the video on Is a Narcissist Accountable for His Actions?

Question:

Should the narcissist be held accountable for his actions?

Answer:

Narcissists of all shades can usually control their behaviour and actions. They simply don't care to, they regard it as a waste of their precious time, or a humiliating chore. The narcissist feels both superior and entitled - regardless of his real gifts or achievements. Other people are inferior, his slaves, there to cater to his needs and make his existence seamless, flowing and smooth.

The narcissist holds himself to be cosmically significant and thus entitled to the conditions needed to realise his talents and to successfully complete his mission (which changes fluidly and about which he has no clue except that it has to do with brilliance and fame).

What the narcissist cannot control is his void, his emotional black hole, the fact that he doesn't know what it is like to be human (lacks empathy). As a result, narcissists are awkward, tactless, painful, taciturn, abrasive and insensitive.

The narcissist should be held accountable to most of his actions, even taking into account his sometimes uncontrollable rage and the backdrop of his grandiose fantasies.

Admittedly, at times, the narcissist finds it hard control his rage.

 

But at all times, even during the worst explosive episode:

1. He can tell right from wrong;
2. He simply doesn't care about the other person sufficiently to refrain from action.

Similarly, the narcissist cannot "control" his grandiose fantasies. He firmly believes that they constitute an accurate representation of reality. But:

1. He knows that lying is wrong and not done;
2. He simply doesn't care enough about society and others to refrain from confabulating.

To summarize, narcissists should be held accountable for most of their actions because they can tell wrong from right and they can refrain from acting. They simply don't care enough about others to put to good use these twin abilities. Others are not sufficiently important to dent the narcissist's indifference or to alter his abusive conduct.

 

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next: Myths about Narcissism

• Watch the video on Narcissist and Mood Changes

Question:

Can narcissism be the result of chemical or biochemical imbalances?

Answer:

The narcissist's moods do change suddenly as a result of narcissistic injury. One can easily manipulate the moods of a narcissist by making a disparaging remark, by disagreeing with him, by criticising him, by doubting his grandiosity or fantastic claims, etc.

Such REACTIVE mood shifts have nothing to do with blood sugar levels, which are cyclical. It is possible to reduce the narcissist to a state of rage and depression AT ANY MOMENT, simply by employing the above "technique". He can be elated, even manic - and in a split second, following a narcissistic injury, depressed, sulking or raging.

The opposite is also true. The narcissist can be catapulted from the bleakest despair to utter mania (or at least to an increased and marked feeling of well-being) by being provided with the flimsiest Narcissistic Supply (attention, adulation, etc.).

These swings are totally correlated to external events (narcissistic injury or Narcissistic Supply) and not to cycles of blood sugar or biochemicals.

What is possible, though, is that a THIRD problem causes chemical imbalances, diabetes, narcissism and other syndromes. There may be a common cause, a hidden common denominator (perhaps a gene).

Other disorders, like bipolar (mania-depression) are characterised by mood swings NOT brought about by external events (endogenic, not exogenic). The narcissist's mood swings are only the results of external events (as he perceives and interprets them, of course).

 

Narcissists are absolutely insulated from their emotions. They are emotionally flat or numb.

The narcissist does not have mood swings, pendulum wise, on a regular, almost predictable basis, from depression to elation as in biochemically induced mental disorders.

Additionally, the narcissist goes through mega-cycles which last months or even years. These cannot, of course, be attributed to blood sugar levels or to Dopamine and Serotonin secretions in the brain.

NPD per se is NOT treated with medication. It is usually subjected to talk therapy. The underlying disorder is treated by long-term psychodynamic therapy. Other PDs (NPD rarely comes alone. It usually appears with other PDs) are treated separately and according to their own characteristics.

But phenomena, which are often associated with NPD, such as depression or OCD (obsessive-compulsive disorder), ARE treated with medication. Rumour has it that SSRI's (such as Fluoxetine, known as Prozac) might have adverse effects if the primary disorder is NPD. They sometimes lead to the Serotonin syndrome, which includes agitation and exacerbates the rage attacks typical of a narcissist. SSRIs do lead at times to delirium and a manic phase and even to psychotic microepisodes.

This is not the case with the heterocyclics, MAO and mood stabilisers, such as lithium. Blockers and inhibitors are regularly applied without discernible adverse side effects (as far as NPD is concerned).

Additional cognitive-behavioural therapies are often applied to treat OCD and sometimes depression.

To summarise:

Not enough is known about the biochemistry of NPD. There seems to be some vague link to Serotonin but no one knows for sure. There isn't a reliable NON-INTRUSIVE method to measure brain and central nervous system Serotonin levels anyhow, so it is mostly guesswork at this stage.

Thus, as of now, the typical treatment is talk therapy (psychodynamic).

Cognitive-behavioural therapy for OCD and depression.

Antidepressants (with SSRI being currently under critical scrutiny).

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next:   The Accountable Narcissist

Chapter 72 of the book  Self-Help Stuff That Works

by Adam Khan

AS ONE CLASS GRADUATED from a largeuniversity, a group of researchers gave them an English vocabulary test and then tracked those people for twenty years. Strange as it may seem, those who knew the definitions of the most words were in the highest income group twenty years later. The researchers discovered that the people who, in the beginning, had the worst vocabulary scores were in the lowest income group twenty years later. There wasn't a single exception. Does that or doesn't that strike you as utterly astounding?

Could this really be true? And can we extrapolate the conclusion that if you started now and increased your vocabulary, your efforts could eventually put you in a higher income group than you would have been in otherwise? Let's look further.

In another study, the executive and supervisory personnel of thirty-nine manufacturing plants were given extensive testing. All of them, from the lowest level of supervisor to the top of the executive elite rated higher than average on leadership qualities. Between all the leaders, there was a close similarity in leadership ability. But there were striking differences on the vocabulary test. Basically, the higher the person's score on the vocabulary test, the higher their position in that company. The presidents and vice presidents of the companies had an average score of 236 (a perfect score was 272). The average score for superintendents was 140. Foremen averaged 114.

Why? What's going on here? continue story below

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Let's look at it this way: When you were young, you didn't know the definitions of very many words, so you didn't understand much of what people around you were saying. As you learned more words, your understanding grew. Knowing the definition of even one more word makes a difference because if there is only one word you don't know, you'll often miss more of what's being said than that one word. The word is part of a sentence that you won't completely understand. The sentence is part of a paragraph. One unknown word can create a small gap in your understanding of the entire subject.

The most obvious way to prevent that gap is to always look up a word you don't know. The bad news is that you can't really do that while listening to a lecture and most people don't like interrupting themselves when they're reading to stop and look up a word. I know I don't. So the word doesn't get looked up, and some of the ideas are only partially understood because of it. The larger your vocabulary, the less that happens and the more you understand what you read and hear.

The good news is that after you know a word, you are more likely to understand any sentence with that word in it for the rest of your life. Any effort you make to increase the number of definitions you know will have a far-reaching and long-lasting effect. Here are three ways you can improve your vocabulary:
1. When you read a word you aren't sure of, look it up. Then create two or three sentences with that word in it. Using the word in your own self-created sentence is the quickest way to cement that word in your memory.

2. Get vocabulary tapes for your car and listen to them while driving, speaking the words out loud (it makes it easier to remember how to pronounce them).

3. Buy or make vocabulary flash cards and keep some in your pocket to test yourself in spare moments — while waiting in line, for example. You can pick one every morning and carry the card with you to work, trying to use that word in several sentences that day.

TAKE THESE THREE steps and, in an adscititious manner, you may just see your income go from a flat line to an upwardly pointing falciform in the vespertine years of your life. Sticks and stones may break your bones, but words may get you a promotion.

To increase your vocabulary:
Look up words, listen to vocabulary tapes, and use vocabulary flash cards.

adscititious: added, supplemental, additional
falciform: in the shape of a sickle, curved
vespertine: pertaining to the evening
— Webster's New Universal Unabridged Dictionary

 

This is a simple technique to allow you to get more done without relying on time-management or willpower.
Forbidden Fruits

Here is a way to turn your daily life into a fulfilling, peace-inducing meditation.
Life is a Meditation

A good principle of human relations is don't brag, but if you internalize this too thoroughly, it can make you feel that your efforts are futile.
Taking Credit

Aggressiveness is the cause of a lot of trouble in the world, but it is also the source of much good.
Make It Happen

We all fall victim to our circumstances and our biology and our upbringing now and then. But it doesn't have to be that way as often.
You Create Yourself

next: Play the Game

"Consider a scenario where mother is crying in her bedroom and her three year old toddles into the room. To the child, it looks as if mom is dying. The child is terrified and says, "I love you mommy!" Mom looks at her child. Her eyes fill with love and her face breaks into a smile. She says, 'Oh honey, I love you so much. You are my wonderful little boy/girl. Come here and give mommy a hug. You make mommy feel so good.'

A touching scene? No. Emotional abuse! The child has just received the message that he/she has the power to save mommy's life. That the child has power over, and therefore responsibility for, mommy's feelings. This is emotional abuse, and sets up an emotionally incestuous relationship in which the child feels responsible for the parent's emotional needs.

A healthy parent would explain to the child that it is all right for mommy to cry, that it is healthy and good for people to cry when they feel sad or hurt. An emotionally healthy parent would "role model" for the child that it is okay to have the full range of emotions, all the feelings - sadness and hurt, anger and fear, Joy and happiness, etc."

One of the most pervasive, traumatic, and damaging dynamics that occurs in families in this dysfunctional, emotionally dishonest society is emotional incest. It is rampant in our society but there is still very little written or discussed about it.

Emotional incest occurs when a child feels responsible for a parents emotional well-being. This happens because the parents do not know how to have healthy boundaries. It can occur with one or both parents, same sex or opposite sex. It occurs because the parents are emotionally dishonest with themselves and cannot get their emotional needs met by their spouse or other adults. John Bradshaw refers to this dynamic as a parent making the child their "surrogate spouse."

This type of abuse can happen in a variety of ways. On one end of the spectrum the parent emotionally "dumps" on the child. This occurs when a parent talks about adult issues and feelings to a child as if they were a peer. Sometimes both parents will dump on a child in a way that puts the child in the middle of disagreements between the parents - with each complaining about the other.

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continue story below

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On the other end of the spectrum is the family where no one talks about their feelings. In this case, though no one is talking about feelings, there are still emotional undercurrents present in the family which the child senses and feels some responsibility for - even if they haven't got a clue as to what the tension, anger, fear, or hurt are all about.

Emotional incest from either parent is devastating to the child's ability to be able to set boundaries and take care of getting their own needs met when they become an adult. This type of abuse, when inflicted by the opposite sex parent, can have a devastating effect on the adult/child's relationship with his/her own sexuality and gender, and their ability to have successful intimate relationships as an adult.

What often happens is that 'Daddy's little princess' or 'Mommy's big boy' becomes an adult who has good friends of the opposite sex that they can be emotionally intimate with but would never think of being sexually involved with (and feel dreadfully betrayed by, when those friends express sexual interest) and are sexually excited by members of the opposite sex whom they don't like and can't trust (they may feel they are desperately 'in love' with such a person but in reality don't really like their personality). This is an unconscious way of not betraying mommy or daddy by having sex with someone that they are emotionally intimate with and truly care about as a person.

Over the last ten years, I have seen many different examples of how emotionally dishonest family dynamics impact children. Ranging from the twelve-year old girl who was much too big to be crawling into mom's lap but would do so every time mom started to cry because that interrupted her mother's emotional process and stopped her crying, to the nine-year old boy who looked me in the eye and said "How am I supposed to start talking about feelings when I haven't my whole life."

Then there is the little boy who by four-years old had been going to twelve-step meetings with his mother for two years. At a CoDA meeting one day, he was sitting on a man's lap only six feet away from where his mother was sharing and crying. He didn't even bother to look up when his mother started crying. The man, who was more concerned than the little boy, said to him, "Your mommy's crying because she feels sad." The little boy looked up, glanced over at his mother and said, "Yea, she's getting better," and went back to playing. He knew that it was okay for mom to cry and that it was not his job to fix her. That little boy, at four years old, already had healthier boundaries than most adults - because his mother was in recovery working on getting healthier herself. The best thing that we can do for any of our loved ones is to focus on our own healing.

And one of the cornerstones of healing is to forgive ourselves for the wounds we suffered and for the wounds we inflicted. We were powerless to behave any differently because of our programming and training, because of our wounds. Just as our parents were powerless, and their parents before them, etc. etc.

One of the traps of Codependence Recovery is that as we gain awareness of our behavioral patterns and emotional dishonesty we judge and shame ourselves for what we are learning. That is the disease talking. That "critical parent" voice in our head is the disease talking to us. We need to stop buying into that negative, shaming energy and start Loving ourselves so that we can change our patterns and become emotionally honest.

There is hope. We are breaking the cycles of generations of emotional dishonesty and abuse. We now have the tools and knowledge we need to heal our wounds and change the human condition. We are Spiritual Beings having a human experience. We are perfect in our Spiritual essence. We are perfectly where we are supposed to be on our Spiritual path, and we will never be able to do human perfectly. We are Unconditionally Loved and we are going to get to go Home.

next: The Concept of Empowerment

It's difficult dealing with the concept of your child self-injuring. How do you deal with that and how can you help?

Aim for long-term stability, not a quick solution

As a parent, you must come to terms with the importance of understanding why your troubled teen engages in self-injury. Knowing the reason why your teen self-injures can be the first step towards guiding your adolescent away from this detrimental coping method and help you lead him/her towards healthier means of coping with feelings.

It is difficult to be the parent of a teenager engaging in self-harm. You know that your child's physical well-being is at stake and because of this, you want him/her to give up such harmful behavior as soon as possible. But trying to force wellness and rushing treatment of such a disorder can prove to be counter-productive, says Wendy Lader, Ph.D., founder of S.A.F.E. Alternatives, a residential program for self-injurers. "From here, a battle of forces can ensue between the child and parent/therapist which may bring even more struggle to your teen's table. Now, he/she must not only deal with the inward struggle of the self but struggle with an outward force as well. This can feel like chaos for one suffering from self-harm."

Instead, it is vital to aim for long-term stability and not just the quickest path to what may be short-term wellness. Initially, the conceptualization of a treatment plan to combat a self-injurer's impulses can be the foundation for future stability and offer significant help.

If you have a friend or relative who engages in self-harm, it can be very distressing and confusing for you. You may feel guilty, angry, scared, powerless, or any number of things.

Some general guidelines are:

- Take the self-harm seriously by expressing concern and encouraging the individual to seek professional help.

- Don't get into a power struggle with the individual. Ultimately, they need to make the choice to stop the behavior. You cannot force them to stop.

- Don't blame yourself. The individual who is self-harming initiated this behavior and needs to take responsibility for stopping it.

- If the individual who is self-harming is a child or adolescent, make sure the parent or a trusted adult has been informed and is seeking professional help for them.

If the individual who is engaging in self-harm does not want professional help because he or she doesn't think the behavior is a problem, inform them that a professional is the best person to make this determination. Suggest that a professional is a neutral third party who will not be emotionally invested in the situation and so will be able to make the soundest recommendations.

--From the Self Injury and Other Issues (SIARI) website

Address the deep-seated issues of the self-injurer

The key idea behind the treatment of self-harm is showing the afflicted person other ways that he/she may deal with stress in a healthy way. Whatever deep issues lie beneath his/her everyday problems, they should be addressed in psychotherapy or guided talks with a parent. Because of these points, it may be more beneficial for a troubled teen if he is out facing reality, and not just hospitalized every time he/she acts up. Vernick suggests that parents should look to hospitalization as one of the last options, used only when he/she is dealing with suicide attempts or acute self-injury.

The key to the resolution of any issue is to get to the heart of the issue. And the best way to get to the heart of the issue is through a relationship....one that says to them, "I'll walk with you through anything, and I'll stand in front of you if you're moving to a place that you don't want to be". That's the easy part. The hard part is taking apart the puzzle and seeing the logic, progression, thinking, and habits have moved this cutter to where he/she is.

It's important to find out issues beneath the surface of self-injury. Usually, a combination of medication, counseling, therapy, group meetings, and parental support are required to help get a child through this difficult period.

Medical issues related to self-injury

Another important matter to consider is the physical wounds themselves, which are inflicted by the self-injurer. A number of self-injurers do not get the proper medical care for their wounds because of their fear of being judged by physicians or other medical staff. A female teen self-injurer recalls the look an attending physician gave her as he tended to her wounds—"The way he took a look at my wrists and then stared me back in the eye, just left me feeling like I wanted to curl up inside and hide."

Talk to your teen's therapist about letting medical practitioners in the local scene know more about self-injury to avoid situations like these that may aggravate your teenager's sensitive feelings further.

Thoughts on Depression and Suicide

It wasn't until I lost my son to suicide that I began to learn lots and lots about depression and suicide. There are a few things that, by now, you probably know but I want to tell you (again?). Maybe this will help to put things in perspective.

First, we have to learn to accept our past and know that we can't change it. We have to come to terms with it and get past any guilt or shame. It can be done. Just because something bad has happened, or because we have done something wrong, does not make us bad. Frequently, we have disproportionately built those things up in our own minds. When we can put the past behind us, we can go on with our lives. That's accepting the things that we cannot change.

To live our lives in the present, we must stop doing things that cause us guilt or shame. Guilt and shame are like vampires. When they are exposed to the sunlight of truth and openness, they burn away to nothing. This means we must be honest with ourselves and in our dealings with others; but we still must use caution when dealing with some people.

A life that is satisfactory also includes all of the good character traits that we can think of. The Boy Scout oath comes to mind, but this really depends on our own personal definitions and which traits you can take pride in. You and I can do, or be, anything that we (not someone else) can comfortably live with. We have that choice, that ability, and that much power over our lives.

Secondly, we have to take charge, and face our lives with boldness and be responsible and active (as opposed to passive) in our lives. We must stand up for what we think and believe, make our position clear, and not let people walk on us figuratively or literally. That empowers us to be leaders (someone has to be in charge), to make our own way in the world, and gives us self-pride where there would otherwise be shame, self-blame, and surrender.

Mahatma Ghandi said A no uttered from deepest conviction is greater than a yes mearly uttered to please, or what is worse, to avoid trouble. I must caution you though to start with small decisions and progress slowly because that will give you a successful history to draw on. This is changing the things we can change.

Thirdly, I was a member of a social/civic organization that opened each and every meeting with a creed, part of which was:

We believe that faith in God gives meaning and purpose to human life ...

I believe it does, and that faith can carry us when things are tough. Now this statement is not to make people go right out and join up, but we humans need faith in something, if only because it is our nature to do so. If you had faith in God, and depression has caused you to feel so bad as to lose it, remember that God has not moved, He is just where you left Him.

The Alcoholics Anonymous (A.A.) organization uses a prayer for it's members. I think they only use the first verse, but here is the whole prayer:

***

GOD, grant me the Serenity
to accept the things I cannot change
Courage to change the things I can
and the Wisdom to know the difference.

Living ONE DAY AT A TIME;
Enjoying one moment at a time;
Accepting hardship as the
pathway to peace.

Taking, as He did, this
sinful world as it is,
not as I would have it.

Trusting that He will make
all things right if I surrender to His Will;

That I may be reasonably happy
in this life, and supremely
happy with Him forever in
the next.

Amen

By Reinhold Neibuhr

***

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Fourth, there are better ways of handling all of our feelings than turning them inward. If we turn the feelings inward (bottle them up), they will consume us from within. We must feel them and deal with them to get rid of them.

We can learn to express those feelings in a variety of ways. For instance, anger can be expressed by telling someone about it, by taking a tennis racket and beating (violently) on the seat of a stuffed chair, and by writing and expressing the anger. Also, we could express our feelings in painting, music, acting, dance, or other arts. And, of course, if we're going to point that anger at someone, we should point it towards the people that caused and deserve it. We should never direct it at innocent people.

Fifth, exercise is vital to healthy living. I can't tell you how important this is to our well-being. If you think that you can do nothing (and I know how depression can paralyze people) and be happy, you are wrong. Exercise is the most effective way to feel better right now. If you will do some exercise daily, you will feel better and sleep better. If you make it a regimen, you can do it from habit even if you have a bad day or several bad days.

This is a very concentrated version of things that have made me able to live a better life in the last few years than I have ever had before. I have suffered depression all of my life, and I know the desolate feelings that were in Edgar Allen Poe's poems, in Van Gogh's paintings, and the feelings that make us think the world will be better off without us, that we are burdens to other people; and the self-hate that makes us want to die. Those are false and distorted thoughts that uselessly cost thousands of people their lives every year from suicide. The loss of those lives to the world is incalculable.

I hope this helps to put things in better order for you, and I pray that you will never be one of those people. This is a total package and should be interpreted as an overall view of what is going on with your depression. It is as good of a summary as I could muster.

It has taken me years to understand these things, and be able to put them in a form that I could communicate to other people. With these tools, you can start to see the way things really are, and start to rebuild your life if it is out of control. Being out of our control make us feel worthless. This should also change your approach to fighting depression and suicidal thinking to fighting the source of the disease (To change, so that we are in charge of our lives, and we decide and we control how we live) instead of unsuccessfully trying to fight the symptoms.

It may not cure you, but it will help you to live a more successful and a happier life, even with depression. Remember that you are the person to decide your wants and needs and you determine how you will live. Learn by starting small, to decide and take responsibility for your life, then progress slowly.

next: Listening Skills: A Powerful Key To Successful Negotiating
~ back to Apocalypse Suicide homepage
~ depression library articles
~ all articles on depression

Chapter 29 of the book Self-Help Stuff That Works

by Adam Khan:

SOMETIMES WHEN YOU WANT TO behave differently, you don't feel like it when the time comes. And sometimes when you want to feel differently, you don't really know how to get there from where you are. Maybe you want to feel confident talking with strangers or feel cheerful at work, but you don't know how to feel confident or cheerful. Well, there is a way.

The principle is simple: Assume the posture you would have if you felt the way you want to feel, breathe the way you would breathe, talk the way you would talk, think the things you would think, act the way you would act - do the things you would do if you felt the way you want to feel.

Are you depressed and want to feel happy? Move your body like you move it when you're happy. If you can't remember what it's like to be happy, move your body the same way you've seen others move when they looked happy. Put the same expression on your face. Imagine or remember the way you talk to yourself and the kind of perspective you might have about your situation when you're happy, and then say those things to yourself and take that perspective.

In other words, act as though you were happy.

If you are angry and want to be calm, act as though you were calm. Do you feel weak and want to be strong? Act as though you were strong.

What you're doing is changing everything that can be changed, and this changes your feelings, which can't be changed directly.

Remember Pavlov's dogs? Pavlov rang a bell every time he fed the dogs, and the dogs associated the sound of the bell with the taste of food. So when the bell rang, the dogs salivated, even when there was no food.

For your whole life you've been relating certain body postures, facial expressions, breathing patterns, etc., to certain feelings like happiness or calmness or strength. The postures and facial expressions and feelings belong together. So when you act as though you're relaxed, you begin to feel relaxed. When you act as though you feel good, you begin to feel good. And after awhile, you aren't acting. It's like siphoning gas - you suck on the hose at first, and then it comes out by itself.

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"Acting as though" also changes reality, which tends to reinforce the feelings. For example, people who feel depressed typically aren't very friendly. If they acted like a person who felt good, they would act friendlier, which would cause people to act friendly in return, which would make the person feel less depressed. It creates an upward spiral. Change how you act and what you do and your feelings will change. You will get a better response from the world, which will reinforce your good feelings.

Act as though you already feel the way you want to feel.

Here's another, completely different and less difficult way to change the way you feel right away:
Brighter Future? Sounds Good!

Is there someone in your family, maybe an in-law or relative, that consistently makes you feel upset or angry or depressed? There's something you can do about it. Check out:
Attitudes and Kin

Here's a completely unconventional anger management technique, and really whole new way of life that prevents much of the anger and conflict from ever starting:
Unnatural Acts

Here's a way to deal with conflict without getting angry, and coming to good solutions:
The Conflict of Honesty

Would you like a little encouragement and practical techniques for living your life with honor? Would you like to know some secrets of personal integrity? Check this out:
Forging Mettle

How about a little inspiration on your path to greater wisdom, goodness, and honor? Here it is:
Honest Abe

next: We've Been Duped