Could Schema Therapy Help Treat Narcissistic Personality?

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Narcissistic personality disorder (NPD), or narcissism, as it’s often called, is one of the cluster B personality disorders, or emotional/impulsive personality disorders.

Narcissism is one of the least studied personality disorders. Different subtypes of narcissism present with varying features, making diagnosis challenging. People with narcissism may also see no need for counseling and consider it pointless or beneath them. If they do begin therapy, they may react angrily when faced with challenges, try to manipulate their therapist, or find it hard to consider things from other perspectives. They often leave therapy early, especially if they don’t see any benefit in it.

Recent research aims to identify new therapy approaches that can help people living with personality disorders achieve lasting change. Schema therapy, one such treatment, is considered helpful for people who don’t respond well to other types of therapy. It’s proven effective in treating borderline personality, another condition long considered difficult to treat.

Research looking at schema therapy for narcissism is still in the early stages, but existing clinical data suggests it has promise.

People living with narcissism have a deep need for admiration and recognition and draw self-esteem from the praise and positive regard of others.

The Roots of Narcissism

Personality disorders are characterized by rigid, long-lasting patterns of behavior that affect life and relationships, causing distress and making it difficult to function. People living with personality disorders may not always recognize that some of their behaviors cause problems or affect others negatively.

Like other personality disorders, narcissism is a serious mental health issue. Many consider it more serious and harmful than most other personality disorders, since people with narcissism generally lack empathy and may not care about the effects of their actions.

The causes of narcissism aren’t fully understood. Some potential factors in development may include:

  • Having a parent who is extremely adoring or overly critical, or a parent who switches between these modes
  • Having a parent with narcissism
  • Inheriting certain traits that increase risk for personality disorders
  • Experiencing trauma, abuse, neglect, or indifferent parenting

People living with narcissism have a deep need for admiration and recognition and draw self-esteem from the praise and positive regard of others. Since connecting with people on an intimate level requires a level of vulnerability, people with narcissism may avoid meaningful relationships in order to protect their illusion of grandiosity and keep an unstable self-identity from being revealed.

Researchers have identified four main subtypes of NPD. It’s possible to have features of multiple subtypes or shift between subtypes at different points in life.

  • Overt narcissism most often involves entitled, attention-seeking behavior. A primary feature is an exaggerated sense of self-importance. People with this subtype tend to be charming and arrogant and often exploit others. They may do fairly well in the workplace but struggle to get along with others or do tasks they consider demeaning or otherwise beneath them.
  • Covert narcissism may include anxiety, significant emotional distress, and extreme sensitivity to criticism or perceived insults. This subtype is often characterized by shyness, even social isolation. People with covert narcissism tend to have an internal sense of superiority and fantasize about their talents being recognized while speaking modestly about themselves, even putting themselves down.
  • High-functioning narcissism involves similar traits to overt narcissism, but people with this subtype can generally function well in society and may not appear to have a personality disorder. They are often able to adapt narcissistic traits such as charm and competitiveness in order to achieve success and may have relationships that are shallow but lasting. Criticism, perceived failure, or age-related challenges such as poor health or perceived loss of attractiveness may cause distress or crisis.
  • Malignant narcissism, considered the most severe subtype, involves overt narcissism traits along with traits of antisocial personality and paranoia. People with this subtype may lie and manipulate others easily, behave in aggressive ways, enjoy intimidating others, and avoid any work or task unless it benefits them in some way. They often have no desire to change, so treatment may be very difficult.

Narcissism often involves symptoms that are less known than grandiosity and lack of empathy, including:

Most people with narcissism struggle to maintain employment and personal relationships, changing partners readily when they don’t receive the admiration they need. It’s also common for people to fantasize about being recognized for their superiority and humiliating people who have “wronged” them.

When therapy can help address these concerns, particularly vulnerability and self-esteem, narcissistic behaviors may improve.

Schema Therapy: An Effective Treatment for Narcissistic Personality?

Even when people with narcissism do seek therapy, whether for distress related to narcissism or other mental health symptoms, treatment can be complicated. Believing a therapist has insulted them, failed to recognize their specialness, or isn’t skilled or reputable enough to treat them leads many people with narcissism to quit therapy early in treatment. Research suggests therapy progresses more slowly for people with narcissism, leading to slower improvement of symptoms.

Schema therapy, however, may have increased potential to treat NPD. Schema therapists offer support and validation while helping people work to understand and address the emotional mindsets causing problems in their life. For narcissism, this is often the persistent, private sense of inferiority and fear of failure.

Schema therapy combines elements of cognitive behavioral therapy, emotion-focused therapy, Gestalt therapy, and psychodynamic therapy, among others. The idea behind this approach is that schemas, or patterns of thought and behavior, develop as a result of unmet emotional needs and other early childhood experiences. These schemas are reinforced throughout life by challenges, abuse, trauma, and other negative or harmful experiences. Unless they’re addressed in positive ways, they contribute to the development of harmful or unhealthy methods of coping. These coping styles can affect behavior throughout life, often in ways that cause distress.

Schema therapists offer support and validation while helping people work to understand and address the emotional mindsets causing problems in their life.

The goal of the approach is to help people identify needs that weren’t met in childhood and learn how to get them met in healthy ways that don’t cause harm, either to themselves or to others. To help clients achieve this goal, schema therapists group schemas and coping responses into modes and use a range of strategies to address them, including roleplay, interpersonal techniques, and cognitive behavioral approaches. Therapists may set limits, as a parent would, within the bounds of the therapeutic relationship to help clients confront schemas.

The schema modes commonly associated with narcissism are:

  • Detached Protector/Self-Soother: This avoidant mode involves behaviors that are soothing, stimulating, or distracting—anything that helps turn off emotions. These behaviors might include substance abuse, risky sex, gambling, fantasizing, or overwork. It’s also common to shut out or reject people as well as emotions. Typical function isn’t always affected, but it may seem almost mechanical and lack any personal investment.
  • Self-Aggrandizer: A mode in the overcompensation category, this involves many behaviors typically associated with narcissism—superiority, entitlement, and manipulative tactics. People in this mode tend to show little interest in anyone but themselves, boast of real or inflated achievements, and openly seek admiration to avoid revealing hidden vulnerabilities and insecurities.

By confronting these modes and working through them with the help of the schema therapist, people in therapy can begin to access the Healthy Adult mode, which helps heal the vulnerabilities of early childhood and fosters healthier modes of coping. After reaching this mode, people may be able to begin functioning at a more typical level and be more able to take responsibility for their actions and see how they affect others.

Schema therapy has been successful in the treatment of other personality disorders, including borderline personality. Clinical trials on its use with narcissism are still forthcoming, but research and clinical observations suggest schema therapy could help people with narcissism have more success in treatment.

Why Do Narcissists Seek Therapy?

People living with NPD often believe themselves superior and struggle to consider the feelings and needs of others. This can make their actions particularly hurtful. Narcissism also often involves intentional manipulation or emotional abuse—behaviors that cause significant pain to partners of people with narcissism. In fact, many therapists specialize in helping the partners of people with narcissism heal.

The typical traits linked to narcissism, along with the tendency of many with NPD to see nothing wrong with their behavior, have contributed to the belief that therapy can’t treat narcissism. But therapy can help people with narcissism improve—if they want to change.

Andrea Schneider, LCSW, a therapist in San Dimas, California, explains what might prompt a person with NPD to seek counseling. “Typically,” she says, “Someone … with narcissistic personality may have some flexibility with some behavioral change when they are confronted with significant stressors (like a relationship ending or other crisis).”

People with NPD may not ever seek therapy for symptoms associated with narcissism. Instead, they might decide to get help for other symptoms or issues. These could be co-occurring conditions or long-term mental health effects associated with narcissism. In many cases, it’s these challenges that contribute to the desire for change.

People with narcissism may seek help for:

Narcissistic personality and associated conditions can significantly impact quality of life and emotional well-being. Addiction and stress can cause health concerns, for example, while the inability to sustain a relationship could lead to complete isolation.

To date, few studies have looked at treatment for narcissism because people with NPD don’t seek therapy often. If they do, they may only do so because someone else has urged them into it. Therapy can still have benefit, but the person with narcissism must recognize the problems with their behavior and make efforts toward change.

Finding a Schema Therapist

People who don’t see a need to address their behavior are unlikely to be able to make lasting change. But research on schema therapy suggests the approach could benefit people living with narcissism when other types of therapy don’t help. Experts do agree that narcissism often poses treatment challenges for therapists and can make progress in therapy difficult.

Schema therapy involves validation and empathy for a person’s difficulties and distress. When people with narcissism approach therapy with a willingness to change, or at least to make an effort to address harmful behaviors, the mode work involved in schema therapy may help them learn to confront the vulnerabilities they fear in a healthier way.

It can be difficult to find a schema therapist, especially if you live in a smaller city. But many therapists may be trained to incorporate elements of schema therapy into treatment. If you or a loved one has symptoms of narcissistic personality disorder, consider reaching out to a therapist who offers schema therapy or practices mode work. Don’t be discouraged by the myths about narcissism—change is possible for anyone. Begin your search for a trained, compassionate counselor today.

Author’s Note: If you’re involved in a relationship where there is intimate partner abuse of any kind—physical, emotional, or sexual—relationship therapy is usually not recommended. We encourage you to review our crisis page and reach out for support.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  2. Behary, W. T., & Dieckmann, E. (2011, July 20). Schema therapy for narcissism: The art of empathic confrontation, limit-setting, and leverage. In W. K. Campbell and J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Hoboken, NJ: John Wiley & Sons.
  3. Behary, W. T., & Dieckmann, E. (2013). Schema therapy for pathological narcissism: The art of adaptive reparenting. In J. S. Ogrodniczuk (Ed.), Understanding and treating pathological narcissism (pp. 285-300). Washington, DC, US: American Psychological Association.
  4. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015, April 30). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5). Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14060723?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
  5. Dieckmann, E., & Behary, W. (2015). Schema therapy: An approach for treating narcissistic personality disorder. Fortschritte der Neurologie-Psychiatrie, 83(8), 463-477. doi: 10.1055/s-0035-1553484
  6. Ekselius, L. (2018). Personality disorder: A disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204. doi: 10.1080/03009734.2018.1526235
  7. Mayo Clinic Staff. (2017, November 18). Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662
  8. Ritzl, A., Csukly, G., Balázs, K., & Égerházi, A. (2018, September 13). Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Research, 270, 154-159. doi: 10.1016/j.psychres.2018.09.017
  9. Young, J., & First, M. (2003). Schema mode listing. Retrieved from http://www.schematherapy.com/id72.htm
  10. Young, J., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York City, NY: Guildford Press. Retrieved from https://www.guilford.com/excerpts/young.pdf?t

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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4 Things Single Women Wish You’d Talk About in Therapy

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In my practice, I have worked with my fair share of single women in their 30s, 40s, and 50s. Most of these women express a desire to be in a long-term relationship and eventually married. Not every woman desires relationships or marriage, and many are content to remain single. I want to be clear that single women are not damsels in distress waiting to be rescued. However, I want to speak specifically to those who desire to date, be in a committed relationship, or be married, and for whom it’s currently not happening.

Singleness can be particularly difficult for women over age 25 as they watch their friends marry and have children. They often ask the question, “What’s wrong with me?” while simultaneously listening to media that proclaim they should be “independent” and that they “don’t need anyone.” They may feel torn between these two messages of finding a lifelong partner and feeling the pressure to “fly solo.”

It can be tempting to minimize this desire with platitudes such as: “You’ll find someone,” “But you’re so young!” and “Don’t worry so much about it.” These do not often give voice to the single woman’s experience. For clinicians working with this population, it’s important to remember the following.

Reflect the pain and loneliness you notice and make space for the sadness, as it may have often been minimized by others.

Acknowledge the Pain and Sadness

The pain and sadness of being single is real. It may be difficult for these women to discuss this with friends who are already married because they feel their experience won’t be understood. It may be difficult for them to discuss this with their single friends, as they are in the same situation.

They may feel silly for wanting a life partner or feel as if they should be more independent. As their therapist, you can offer compassion for their painful experience. Reflect the pain and loneliness you notice and make space for the sadness, as it may have often been minimized by others. You can also offer validation for their current experience, as dating and not finding anyone can be its own set of discouragements.

Discuss the Practicalities

Being in a relationship has some tangible advantages. From finances, to chores, to emotional support, you have someone you can lean on. Talk through the practical side of things with your single female clients. They may not feel they have someone they can rely on if they have to go to the hospital in an emergency. They may be wondering if they lose their housing whether someone will take them in. This is only compounded for single women who do not have family they can call upon for help.

Help them build upon their support network. Ask them questions like “Who can you call on in times of trouble?” “Where can you find like-minded people to form a ‘family’ with?” Consider the adage, You cannot choose who you’re related to, but you can choose your friends.

Encouraging single women to live their lives as fully as possible will allow them to build the support network they need. This might include things like joining a club, church, or religious organization, playing sports, or traveling. Talk with your clients about what they enjoy and how they can connect with others in an effort to build upon their supports.

Process the Pressure

Single women feel a lot of pressure to be in a relationship. It’s possible their families are constantly asking them, “When are you going to find someone?” or “You’re such a catch—how come you’re not married yet?”

These statements only serve the purpose of making women feel worse. They look inside and ask the question “How come I haven’t found anyone yet?” which only induces more shame and guilt. They watch on social media as their friends pair off one by one, and the same is true for television and movies. Shows like The Bachelor have become incredible main stays because they highlight this very notion, that life should end in some kind of lavish engagement. This creates an incredible amount of pressure for single women who want to be married.

Explore with your clients what this is like. What kind of messages are they receiving about being single? What do they do with these messages? Are there people in their life that pressure them in a way that is unhealthy? Can they set boundaries with those who are constantly asking about their marital state? Help them develop an inner voice that is able to connect with what it really wants.

Sometimes it can be easy to get caught up in the messages that media and friends are setting, and the single women forgets to listen to her own voice.

Explore the Significance of Being Single

Singleness is not just about not having someone in your life; there is meaning behind not being in a relationship, and this is necessary to look at. For many single women at a certain age, it means not being able to have children. This is a reality for women who are not able to freeze their eggs, do surrogacy, and do not plan to adopt or foster children. There is grief that goes along with this reality.

As a therapist, it is important to validate the sadness that goes along with this loss. Likely, these women may feel uncomfortable broaching the subject with their parenting friends, and it can be helpful when a professional wants to know more about their experience.

Explore the loss with your clients and allow them to talk about the other losses connected with it, such as not “providing” grandchildren or not having someone to carry on their family name. Providing a safe space to process loss that may seem confusing to others can be incredibly important.

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Podcast: There’s More to Trauma than PTSD

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Most of us are familiar with post-traumatic stress disorder. PTSD (deservedly) gets a lot of attention, largely focused on soldiers returning from service. But trauma comes in many forms, and most people have experienced it in one form or another. In this episode, learn about the differences between PTSD and other forms of trauma, how to identify it, and what can be done about it.

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About Our Guest

Robert T. Muller, Ph.D., is the author of the psychotherapy book, “Trauma & the Struggle to Open Up: From Avoidance to Recovery & Growth,” which focuses on healing from trauma.

Dr. Muller trained at Harvard, was on faculty at the University of Massachusetts, and is currently at York University in Toronto. He has over 25 years in the field.

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TRAUMA SHOW TRANSCRIPT

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Show Podcast. My name is Gabe Howard and I’m here with my fellow host Vincent M. Wales and our guest today is Dr. Robert T. Muller and he is the author of the psychotherapy book Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth, which focuses on healing from trauma. Robert welcome to the show.

Dr. Robert T. Muller: Very, very glad to be here.

Vincent M. Wales: We are glad to have you. So the word trauma is thrown around a lot these days. What do we really mean by that?

Dr. Robert T. Muller: Well, so there are different kinds of traumatic experiences but they all are based in the fact that something clear has happened to the person in the external world. Something that overwhelms their normal coping abilities and this can be a natural disaster, of course, but it can also be an event that occurs in the home. It could be something like physical or sexual abuse from a caregiver or various kinds of assault. And these are experiences that are overwhelming and most people who go through these overwhelming experiences don’t end up with post-traumatic stress disorder or various kinds of consequences. But a number of them do. and when they do and they’re left with these feelings of great distress and that’s what we refer to as trauma. The feelings that are left in the person that affect them, that affect their choices, that affect their relationships, that affect the way they engage in friendships following an overwhelming experience. And it’s hard, it’s very, very tough for people to deal with.

Gabe Howard: You know, outside of people who work in this field, the only really thing that they understand about trauma is post-traumatic stress disorder. That’s like the closest that the general public gets when you’re talking about trauma. Where does PTSD fit in? Can you kind of help people understand that?

Dr. Robert T. Muller: So the term PTSD we see in the psychiatric literature, and by PTSD we mean that the person has a disorder after a traumatic event post-traumatic stress disorder. So that means that they are continuing to suffer and by disorder we mean that their mental health is suffering and that they’re experiencing symptoms of re-experiencing the event, flashbacks. They may remember and have memory intrusions, memories of the event. And that’s very severe. They also have startle responses where they’re stressed very, very easily and by stress that can be very overwhelming stress. They also have problems with mood because they often feel depressed because of these traumatic experiences. And then finally they try to stay away from the things that remind them about whatever happened. So we see post-traumatic stress disorder in Vietnam vets, Gulf Wars vets, vets who’ve come back from Afghanistan, for sure. So we can also see these symptoms in victims of domestic violence and people who have been to experiences even who haven’t gone to war. So PTSD refers to the psychiatric language that’s used to describe the symptoms that many people have after a traumatic event. So that’s what it’s really meant by PTSD.

Gabe Howard: Thank you so much for that. And just to clarify, you can be traumatized and not develop PTSD. Is that correct?

Well you can be. Yeah. So here we get into a little bit of different words can sometimes mean similar things but when we talk about someone who is traumatized, they have all kinds of symptoms. They may not have exactly that cluster of things that I mentioned that we call PTSD but they’re going to have very similar experiences. There’s something called Complex PTSD and that’s a little bit different. Complex PTSD refers to people very often who have had traumatic events happen in childhood and in relationships. They feel betrayed by people who have who they thought were going to care for them the most. And when people have complex PTSD, very often what they have are huge problems in relationships. So, they’ve been hurt by somebody, they may feel tremendously abandoned by someone who they trusted. And then in life and in relationships, they now struggle to trust and they often really question other people. They question whether they can really trust them and they have a hard time with developing relationships because they feel scared. There are many feelings of fear that come over them. Shame, feelings of shame are common in complex PTSD. So, complex PTSD can take longer to heal than PTSD. If treatment for PTSD tends to be something more like six months to a year, treatment of complex PTSD can be two, three years, maybe even four years something like that. Pretty common. So those are some distinctions.

Vincent M. Wales: Thank you. Gabe and I are both very familiar with abandonment disorder and that sort of thing, attachment disorders. And there seems to be a very clear relation there with complex PTSD?

Dr. Robert T. Muller: For sure there is. There often is that for sure. There are feelings of abandonment very often and people with complex PTSD, and there are attachment problems. So, by attachment, that means that in times of distress they have difficulty turning to others who if you had a secure, what’s called a secure attachment, you might have an easier time turning to the people who feel, you know, should care about you. You know you might do that more easily; you might turn to them and ask for help and feel comfortable with that. But when people have what’s called an insecure attachment, and this is very common in complex PTSD, they have a great deal of difficulty turning to those people, who really you would think that they could turn to, their husbands, wives, their friends. They have a hard time turning to them because they feel very very frightened very often that people are going to just going to let them down. It’s a very very challenging disorder to treat. But it’s important for a therapist who works with people like this be what’s called trauma informed. Where they know about the effects of trauma so they can help people like this manage and find their way through their trauma.

Gabe Howard: Trauma informed care is something again, coming up more and more in mental health circles. Can you explain what trauma informed care means?

Dr. Robert T. Muller: So, there are many conditions that are related to trauma. It’s not just trauma therapists who come across people who have trauma histories. Family doctors very often will come across people who come in complaining of migraines, fibromyalgia, chronic fatigue, irritable bowel syndrome, immune system kind of disorders, stress related disorders. All of those are greatly exacerbated in people who have trauma histories. So it’s very important for family doctors. It’s very important for teachers, actually, to be trauma informed because you may see a kid in your class who appears like they have ADHD. They can’t sit still, they’re irritable, and that may also be a reaction to trauma. And I’m not saying that every person with all these disorders has a trauma history. I’m not saying that. Most of time people have migraines not because of trauma. But, if you do have a trauma history, all of those conditions can be greatly exacerbated. And so it’s very important for professionals who work interpersonally with people, family doctors, chiropractors, dentists, temporomandibular joint dysfunctions can be a symptom of trauma. Teachers, nurses, it’s very important for them to be trauma informed. For them to understand about the different manifestations of trauma. And there are many very often the immune system because of the stress of trauma the immune system has been affected. And that makes you more susceptible to a variety of different disorders. That’s why you need to be trauma informed.

Vincent M. Wales: Now for someone who has a pre-existing mental illness, whether it’s bipolar, or depression, or what have you, how are they affected by trauma? Is it any differently than someone without those issues?

Dr. Robert T. Muller: Yeah. Yeah. So trauma exacerbates other kinds of conditions. People have, let’s say, a family history of depression or family history of bipolar illness and then very traumatic thing happens to them. That can exacerbate other problems that they have. So it’s very difficult to disentangle this symptom is caused by this and this is a symptom caused by that. It’s impossible really to disentangle what’s caused by what. But what you do want to do is you want to work with people if you’re doing therapy with an individual who’s been through this. You want to work with them in a way where if somebody has bipolar illness where you get them seeing a good psychiatrist who can prescribe the right medication. But then if they have a trauma history that doesn’t mean that that’s it. That medication is all of the treatment. No. Somebody has a trauma history, they’ve got to find a way to talk about what’s happened to them. And that’s very difficult when you’ve been through trauma. It’s hard to talk about. And so good trauma informed therapies will work with a person in a measured, paced way to help them slowly feel comfortable. We’re starting to talk about what happened. And that can be very, very challenging.

Gabe Howard: It’s interesting. As someone who lives with bipolar disorder, I know the importance of being able to tell my medical team, whether it’s a psychiatrist, or a social worker, or a psychologist, you know, what’s going on inside my head, what my challenges are, what I need help with. It sounds like you’re saying somebody who just has a trauma background really needs to respond the same way. They have to be able to explain that to their medical team in order to get the right care.

Dr. Robert T. Muller: Well the thing with trauma is that people, a lot of professionals are not trauma informed. And so what ends up happening is that you get people going in for symptoms. So somebody with a trauma history, a typical kind of presentation. I’ll just give a name, Susan. Susan was raped let’s say in university. She experiences all kinds of difficulty in classes. She then goes and sees her doctor, gets put on an antidepressant. Is O K for a year or two on this antidepressant. And then, she starts to date again and then whoa. All these symptoms start to come back. She starts to experience confusion. She experiences other symptoms like headaches. She goes back and gets sent to a specialist. Then she says she has difficulty with her eating. Then the question of what? Does she have an eating disorder? And so what you end up with is this smorgasbord of different professionals. You know, this person specializes in depression, that person specializes in eating disorders, this sort of person specializes in migraines and whatever, trying to treat this person. And you don’t have a coherent treatment plan. And it’s because none of these professionals actually sat down and said, “Tell me a little bit about what happened in your life for the last five years. Walk me through it. What’s happened? Anything important? Tell me about it.” And if you do that with people, you can look for this. Sort of sitting down where you can say OK. Yes. Look at this. This person’s had these depression symptoms and this eating disorder seem to have really gotten a lot worse when dot dot dot. And then you could start to put the pieces of the puzzle together. And so you’re not just treating for this disorder or that disorder or the other disorder, but you develop a coherent plan to help the person find a way to start to deal with the underlying trauma that led to a variety of different responses. So that’s where it’s really important to be trauma informed.

Gabe Howard: We’ll be right back after these words from our sponsor.

Narrator 2: This episode is sponsored by BetterHelp.com, secure, convenient and affordable online counselling. All counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face-to-face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counselling is right for you. BetterHelp.com/PsychCentral.

Vincent M. Wales: Welcome back. We’re here with Dr. Robert T. Muller discussing trauma. There’s a therapy relationship. What’s so important about that?

Dr. Robert T. Muller: Well it’s really, really important, the therapy relationship. And in trauma work, that’s absolutely true. It’s even true in other kinds of psychiatric or psychological problems. Research on outcomes of mental health problems and treatment strategies, what we find is, that regardless of the school of thought that the clinician uses, let’s say people go to see a cognitive behavioral therapist, or the person goes to see a psychoanalyst, or the person goes to see a Gestalt therapist, you name it. Regardless of the school of thought, the one thing that seems to run throughout therapy is the benefits of having a good, strong psychotherapy relationship. And so this means that if you’re a cognitive behavioral therapist, it might be that the person got better in part because you help them look at their underlying thoughts and how their thoughts affect their feelings and how to help them change their behaviors and they’ll improve their feelings. Maybe. Maybe that’s a piece of it. But it also is the case for research what we know is that if you do that in the context where the two of you are really working together and feel like you’re on the same page then therapy will be much more effective. So this is true for all schools of thought of therapy and psychoanalysis and everything else. And so this therapy relationship research shows is really important. So what does that mean? That therapist and client are working together, on the same page working toward similar goals. The same goals really. You have to have similarity of thought around the goals and there’s a sense of warmth. There’s a sense that the client feels that their therapist gives a darn. That they really do actually care. And that the therapist gets it. That the client has to feel that the therapist gets it and is listening and paying attention. These are really important skills. And you know, Carl Rogers in the 1950s really honed in on this. And since then we’ve come up with all kinds of therapies. And I’m not saying these other therapies are not helpful. I’m just saying that going back to basics is really important. That the skills that Rogers taught around empathy turned out to be, in fact research shows, they’re very important. This is really the case with trauma therapy. When you’ve been traumatized and you’ve been traumatized most often when people feel in relationships that they’ve been hurt, then they might work with a therapist and think my therapist doesn’t like me, or my therapist is going to abandon me. My therapist is judging me. And it’s understandable that you’d feel this way as a client. If you’ve been hurt, when your trust has been violated, you’re going to be very cautious for good reason in relationships, and you’re even going to be cautious around your relationship with your therapist. You don’t know whether your therapist is just trying to manipulate you. In all fairness, you don’t know. And so it’s very important for the therapist to be attentive to these kinds of relational issues and trauma. Are my client and I are on the same page? And that sort of thing.

Gabe Howard: Who should go to trauma therapy? I mean who is, I know that the answer might be anybody who is traumatized, but you know more specifically, like who is trauma therapy for exactly?

Dr. Robert T. Muller: So very often if you’re holding something that feels like it’s a huge burden that’s something to notice. So pay attention. Pay attention to this question. Ask yourself, am I carrying around a deep burden from years ago? Am I holding on to a secret? A secret that if other people knew, I would feel judged? I would feel that they would hate me? I would feel ashamed of those sorts of things? Am I being loyal to people who harm me? Those are all questions that you can ask yourself. I talk a little bit about this in Trauma and the Struggle to Open Up, the idea of how people, how many trauma symptoms develop, and these themes are really, really big. The themes of secrecy, feelings of betrayal, themes of loyalty to those who maybe you shouldn’t necessarily be so loyal to. But those are the kinds of questions to ask yourself. That is does the thought or some memory about something, does it make you feel sick? Does it make you feel like this feeling of I’m a bad person? You know, when I think about x y z that happened to me, I feel terrible guilt. How could I? How could I have done that? If you’re asking some questions like why me? Or if you’re asking questions of yourself like why not me? Why did X Y Z happen to my brother and not me? Those sorts of questions are very important questions that can be addressed in trauma therapy. And very often people have those questions in association with symptoms. When you know when you think about x y z that I just mentioned, maybe you feel depressed? Or maybe you feel self-loathing or disappointed in yourself? Why did I do that? Why didn’t I help my sister when such and such? When dad was, I don’t know, especially when Dad was drinking the way he was or mom was? Why didn’t I? So if you ask yourself those kinds of questions and you’re pained by it, that might be a sign that getting help, that talking to a therapist around your history is important. Because you’ve been trying to deal with this on your own for so long, and that can feel very lonely, it can feel very burdensome. And you don’t have to be alone in dealing with these things. That’s where I would think of therapy.

Vincent M. Wales: Right. We also have what we call post-traumatic growth. Is that just a fancy word for recovery or?

Dr. Robert T. Muller: Well no. No, it’s related to recovery. I mean people you hope that through trauma therapy people will get back to the way they were before you know they started really deteriorating. But it doesn’t exactly work that way. Recovery is a bit unpredictable. And what happens is as people start to talk about their problems, and start to talk about their history, they start to deal with things in a way that they never dealt with before. And so they start asking themselves questions like I mentioned. Why me? Why not me? Maybe those kinds of questions. Like what’s my place in the world after what happened to me? I thought my identity would be such and such but now I just don’t know. So when you start addressing questions like that, those kinds of questions lead to a re-evaluation of yourself. And so along with recovery, along with feeling better, along with removing, or removing and recovering from these psychiatric symptoms, that you really want to recover from, along with that comes a new understanding as you start to delve into issues from the past. And so that’s where there’s an opportunity for what’s called post-traumatic growth. That through the process of talking about and questioning and dealing with, there’s a reckoning. And that reckoning can help you grow in ways you may not have imagined. You may realize things about yourself that you hadn’t really thought of before. You know, like you may realize things like previously when I thought about such and such, I just felt guilt about what I did. But now, as I think about it now, actually, I was pretty strong the way I stood up to so and the way I did such and such. And I feel, I actually feel proud of myself for that. That may not sound like a big deal, but it can really feel like a big deal if you’ve felt ashamed of yourself for so long.

Gabe Howard: Do you do you think there’s a lot of people who are suffering from trauma who just don’t realize it? And how do we reach those people? Because you can’t exactly go ask for help if you don’t know that you are in need of help, right?

Dr. Robert T. Muller: Well this is why trauma education is so important. There’s getting to be more and more education about this. I have an online therapy and mental health magazine called The Trauma & Mental Health Report where you know my students and I, we publish articles and they’re very, very straightforward articles written for general consumption. They’re not academic heavy kinds of articles. And we’re trying to teach people about what happens in trauma. We have a lot of stories. You know for example, one of my favorite stories is A Corporal Speaks: 10 Questions for a Soldier Who Served in Afghanistan. And he tells his story. This corporal who came back and happened to be a Canadian, and who served alongside Americans. And many of the stories relate actually to the American soldiers who he served with. And it’s just a really interesting story. And these stories and so we’re trying to teach about how people struggle with these things in a way that the general public can start to learn. Not just people in mental health or whatever academics who know about this stuff, but that people in the general population can start to learn about this. And I think there’s greater interest. There’s more interest lately I’ve noticed in the topic of disassociation, people who have been through trauma, many of them dissociate. So they check out. They sort of go absent at times, you know. Why do they do this? Because sometimes. emotional trauma can be so overwhelming that they lose focus and lose attention to that and start thinking about some totally different things. And that allows them to feel okay. But you know that can be very very challenging when you dissociate a lot in your everyday life. So there’s a little bit more knowledge about that in the general public. I mean I’m noticing increasingly. So I think it’s, I think it’s really about education. And I think what you guys are doing here with this podcast and other people, other mental health podcasts, are becoming much more commonplace and people are asking these questions. There’s more stuff out there. I think that I think is the way to get people to learn about this stuff.

Gabe Howard: We agree with everything you just said except other mental health podcasts. We’re completely unaware of any other podcast other than this one. Don’t search for them. No, just kidding. I just have a couple of more questions because we’re about out of time. But one is please talk about your book for a moment and where folks can find it. I’m assuming you’re going to say Amazon. And what got you interested in researching and writing about trauma in the first place? I imagine they go kind of hand-in-hand.

Dr. Robert T. Muller: Yeah, that’s for sure. So I’ll do the thing about the book. It’s called Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth. It is available on Amazon and mental health bookstores as well. So there’s a hardcopy and a Kindle as well. So. what got me interested in trauma is not a short answer, but also what originally got me interested is a little bit different than when I realized, you know years later when I worked in the field for a long time. Originally, I just thought it was you know an interesting research topic and my supervisor was interested in it in graduate school. But what I realized in my 40s, was that there was a much deeper unconscious reason, I think, that I really got drawn into it. And I also realized that much more so as I did my own psychotherapy. And that is that my parents were children during the Holocaust. And both of them actually were separated from their families, and I believe to some extent traumatized by the Holocaust to some extent. I would say that their childhoods were shaped in ways that you can never imagine. My father’s father was actually killed. My mother’s parents were not killed they were okay, but they were there. My mom was separated from them. She was only 6 years old. She was separated from her parents for months. And so it was terrifying for a 6-year-old. She had no idea where her parents were and they left her in the care of a non-Jewish woman. Again, this saved my mom’s life, but this was a terrifying experience for her. And so I grew up with stories about the Holocaust and with stories about what it was like to be a child during the Holocaust. What it means to lose your innocence as a child. What it means to lose your childhood as a child. And so those kinds of experiences I think to a very large extent shaped me. I believe that’s ultimately why I went into this. Why I went into this field and why I can connect with trauma survivors I think it’s that experience. That’s a fair answer.

Gabe Howard: Yes. Thank you so much.

Vincent M. Wales: Wow. Well thank you for sharing that story with us.

Dr. Robert T. Muller: No problem.

Vincent M. Wales: That’s really heavy. And thank you so much for being here and for informing us on trauma so that we can recognize it and deal with it when we have it.

Dr. Robert T. Muller: OK. Ok. My pleasure.

Vincent M. Wales: And remember, you can get one week of free, convenient, affordable, private online counseling anytime anywhere by visiting BetterHelp.com/PsychCentral. Thanks. We’ll see you next week.

Narrator 1: Thank you for listening to the Psych Central Show. Please rate, review, and subscribe on iTunes or wherever you found this podcast. We encourage you to share our show on social media and with friends and family. Previous episodes can be found at PsychCentral.com/show. PsychCentral.com is the internet’s oldest and largest independent mental health website. Psych Central is overseen by Dr. John Grohol, a mental health expert and one of the pioneering leaders in online mental health. Our host, Gabe Howard, is an award-winning writer and speaker who travels nationally. You can find more information on Gabe at GabeHoward.com. Our co-host, Vincent M. Wales, is a trained suicide prevention crisis counselor and author of several award-winning speculative fiction novels. You can learn more about Vincent at VincentMWales.com. If you have feedback about the show, please email [email protected].

About The Psych Central Show Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.

Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.

Podcast: There’s More to Trauma than PTSD

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Break Free of Your Anxiety and Phobias in 4 Simple Steps

This is an interesting article I found on: www.psychcentral.com

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Anxiety that causes serious discomfort shouldn’t have to go on forever. Yet long-term talk therapy and treatment with medications don’t always free a person who’s suffering. Millions of Americans are dealing with some form of anxiety disorder: according to the Anxiety and Depression Association of America (ADAA), each year, 40 million American adults grapple with an anxiety disorder in some form.

One approach that can help you break free of anxiety and phobias is a simple series of steps. Unlike open-ended talk therapy, it’s not expensive or time-consuming, and unlike pharmacological approaches, it has no side effects.

It’s called LPA — Learning, Philosophizing, and Action.

This direct approach enables you to identify the problem, and think about the problem and its affects on your life, relationships, work, and home. After you learn more about your anxiety or phobia, and consider how it’s limited you, you can start taking clear steps to defuse its power over you.

Once you learn LPA, the only tools you need are a good chair, a pen and a notebook. Try to practice what you’ve learned three or more times a week. It doesn’t have to take long — five minutes is plenty. If you begin to feel uncomfortable, or overwhelmed by fear, stop the exercise, get up, and resolve to try again the next day.

Here’s how each step works:

1. Relax

To follow the LPA steps you need to first quiet the mind. There are many simple and effective relaxation techniques for this.

For instance: Find a quiet spot and a comfortable, supportive chair. Next, take a few easy, deep breaths. Feel yourself begin to float on each breath. When you reach a peaceful state of relaxation, you’re ready to start the next step.

2. Learn

In the learning phase, you focus on the nature and details of the problem by asking yourself questions. Write down all the details of what you remember and realize, including how you feel physically, mentally, and emotionally.

If you’re facing an anxiety, ask yourself:

  • What am I feeling?
  • What is making me anxious?
  • How do I feel when I am anxious — for instance, a stomachache, a headache, sweating?

If you are addressing a phobia, ask yourself:

  • What am I afraid of?
  • What does this fear prevent me from doing — for instance, leaving the house, taking the subway, or driving across a bridge?
  • How do I feel in the grip of this phobia?

Now ask yourself about the first time you began to this way:

  • What is my first memory of feeling this way?
  • What else was going on at the time?
  • What did I learn?

3. Philosophize

Once you have learned about the nature of your anxiety or phobia, you have enough information to look at the bigger picture. During this phase, you step back and challenge the thinking to led to this problem in the first place. Your look for the origins of your anxiety or phobia, and think about how it has affected your life, your relationships, your work and even your financial situation over time.

Ask yourself:

  • Did someone else convince me to feel this way?
  • Is it possible I picked up this anxiety or phobia from a parent?
  • What’s the big picture?
  • How did I take this belief and expand on it myself?

Without meaning to, parents may pass on their anxieties and phobias to their children. But this faulty learning can be fixed. You can use a simple math problem to illustrate: A child walks into kindergarten, having been convinced at home that 2 + 2 = 3. It’s only going to take one quick lesson to show that is wrong. This may be a simplified version, but it shows what happens with learned or even inherited anxieties and phobias. The learning passed on to you was flawed, but you believed it.

Dogs, cars, deep water, dentists — Think about how you picked up on other people’s anxieties. Were you encouraged to feel anxiety or fear in certain situations? You may have grown up thinking that feeling anxious was perfectly normal. But now you can change that thinking. Consider the impact this anxiety or phobia has had on your life. If you could undo its power, wouldn’t you?

4. Act

Taking action means unlearning those behaviors. One effective tool for this step is the Probable or Possible exercise. It helps defuse the power of the anxiety or phobia by looking at whether or not something is likely to actually happen. For instance, if you’re phobic about dogs, you may be afraid of being bitten in circumstances when it would be very hard for that to happen. For example: you are on one side of the street, and a dog and its owner are walking on the other side of the street. Yet you’re afraid the dog will bolt, escape its leash, and come and bite you. That’s often the way fear works: it takes a possibility and intensifies it until it seems like a near-certainty. Irrational or not, you believe it. Asking if it’s possible or problem is a way to take that fear and reduce it down to size.

So ask: It many be possible that the dog runs across the street to bite me. But is it probable?

Think about it: what is the likelihood of that really happening?

Investigate all the factors that would have to be in place for the fear to come true. You could even research the statistics, or learn all about dog behavior. Information is often a missing piece of the anxiety and phobia puzzle.

Once you know the different between the possible risk and the probable risk, remind yourself: This is possible, but it is not really probable. Keep reminding yourself that, and see how you feel the next time you encounter a dog.

The LPA brings new perspectives to old faulty beliefs and problems, helping you see your way out of old patterns. It also works in small steps, each just one part of the process. Do these as much as you want. Remember that you are the one in control. But the more you practice, the more effective it will be. That’s because when you do something successfully a number of times, the success-producing behaviors replace your old thought and behavior patterns with positive, productive ones.

Brick by brick, you can take the actions to face your fears, free yourself from them, change your life. And once you learn LPA and incorporate it into your routine, you can use it to tackle other obstacles. LPA has been proven to be highly effective in dealing with many forms of PTSD and conquering insomnia as well.

Reference:

Anxiety and Depression Association of America: Understand the Facts Depression. Retrieved from https://adaa.org/understanding-anxiety/depression

Break Free of Your Anxiety and Phobias in 4 Simple Steps

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5 Myths and Facts About Drug Rehab

This is an interesting article I found on: www.goodtherapy.org

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Drug abuse is a serious health concern. Overdose-related deaths in the United States have reached epidemic level. In fact, the Centers for Disease Control and Prevention (CDC) estimate an average of 130 people die from opioid overdose each day. This number doesn’t take into account deaths related to other drugs, which may increase this number.

Any drug use can become dangerous. Marijuana, now legal for medicinal and recreational use in many states, may help relieve pain, chemotherapy side effects, and symptoms of mental health concerns such as anxiety and posttraumatic stress. Research has also suggested marijuana may help treat addiction in some people. But despite these potential benefits, it can become addictive and could have health effects such as short-term memory impairment, impaired brain function, and respiratory health issues, among others.

Recreational use of illegal substances, even short-term use, can have serious health effects, including anxiety, paranoia, depression, suicidal thoughts, hallucinations, nausea, increased heart rate and blood pressure, and more. There’s also a risk of death due to overdose or complications. Long-term use of certain drugs could increase risk of violent behavior and may lead to legal trouble. Abusing drugs can also lead to drug dependency, or addiction.

Rehab can help people who’ve reached their absolute low work to overcome addiction, but it can also help people begin to break free of addiction before it significantly impacts their lives.

If you’re experiencing addiction, you’re not alone. According to statistics from the Substance Abuse and Mental Health Services Administration, more than 20 million Americans experienced a substance abuse disorder in 2014. Addiction can be difficult to overcome, no matter how hard a person tries. Professional support, in the form of inpatient or outpatient drug rehab, can benefit many people living with drug addiction.

Myths about drug rehab are plentiful. If you’re considering rehab for yourself or a loved one, making sure you have all the facts will help you make a more informed decision. Here, we present five common myths about drug rehab and the facts to counter them.

Drug Rehab Myths and Facts

Myth: Only wealthy people go to rehab.
Fact: Anyone can go to rehab.

It’s true that drug rehab can become expensive. Some people may not even consider inpatient rehab an option, believing it to be out of their budget. But the cost of drug rehab can depend on a number of factors, and there are rehab options for a range of budgets. See our article here for a more detailed explanation of rehab costs.

Some drug rehab centers offer low-cost or sliding-scale fees, based on your income. According to the 2012 National Survey of Substance Abuse, 62% of rehab facilities charge based on a sliding scale. Facilities may also offer payment programs or other types of financial assistance to people in need. Many drug rehab centers accept insurance, though not all insurance providers cover rehab.

When considering rehab, talk to your insurance provider and the rehab facility you’re interested in to get a better idea of the cost involved. Some centers may be able to work with you or refer you to another quality center that is more affordable. If the cost of inpatient rehab is a barrier, you might also consider outpatient drug rehab programs.

Myth: Rehab is for when you hit “rock bottom.”
Fact: You can begin recovering from addiction at any time.

Many people go to rehab when no other treatment option has worked. Often, they’ve lived with addiction for many years. Rehab can help people who’ve reached their absolute low work to overcome addiction, but it can also help people begin to break free of addiction before it significantly impacts their lives. Research suggests early intervention helps improve treatment outcomes.

Addiction not only contributes to emotional and physical health concerns, it can also lead to homelessness, unemployment, debt, and breakup or divorce. Choosing to enter rehab when you first find yourself becoming dependent on substances can help you begin the recovery process before addiction can have more of an effect on your life.

Myth: Rehab is only for people who can’t quit on their own.
Fact: Anyone experiencing addiction can get help in rehab.

The idea that addiction only happens to weak or flawed people is widespread. It might seem logical: Many people experiment with drugs, but not everyone becomes addicted. But drug abuse alters brain chemistry and affects cognitive function, leading to cravings for the substance and eventually addiction. Certain factors, including genetics, can increase a person’s risk for addiction.

Although a person might choose to try drugs, they don’t choose to become addicted. Once addicted, many people can’t stop using drugs without professional help. Needing rehab isn’t a sign of weakness. Changes in the brain resulting from addiction can make it extremely challenging, if not impossible, to stop using drugs without the support of health care providers trained in addiction support.

Whether you’ve tried to stop using drugs and relapsed or are just beginning to realize you may have a problem with substance abuse, rehab can help you begin recovery.

Myth: Rehab will prevent a person from relapsing.
Fact: Relapse is common, but treatment can help reduce its impact.

Between 40 and 60% of people dealing with addiction will relapse, according to the National Institute on Drug Abuse. While rehab may help reduce your risk of relapse, completing a drug rehab program doesn’t guarantee you’ll never relapse.

But rehab still has benefit. Research shows rehab can help by helping you develop skills to resist cravings, making relapse less likely. If you do relapse, the length of the relapse may be shorter. People who participate in treatment programs such as rehab also tend to relapse fewer times than people who don’t. Rehab can also lead to improvements in your relationships with friends, family, and loved ones. Developing stronger bonds with people you care for can also decrease the likelihood of relapse.

Myth: Rehab doesn’t work if you force someone to go.
Fact: Rehab can work even if you don’t want treatment.

Some people choose to enter rehab on their own, but some people experiencing addiction may not see its effects on their life, or they may not believe they have a problem with substance abuse. They may only decide to enter rehab grudgingly, after a court order or intervention from loved ones.

Being issued an ultimatum or feeling otherwise “forced” into rehab could make some people resistant to treatment, at first. According to the National Institute on Drug Abuse, however, people who feel pressured to overcome addiction in order to maintain an important relationship or avoid criminal charges, for example, often do better in treatment, even though they didn’t choose to enter rehab on their own.

Substance abuse and addiction can have serious, lifelong consequences. But there is help. Drug rehab may seem like an extreme measure, but this is partially due to the many myths surrounding rehab treatment.

Numerous studies support the benefits of rehab for addiction recovery. Inpatient centers provide a safe place to begin the detox and recovery process at any stage of addiction. Some facilities are expensive, but it’s possible to find affordable centers that will work with you to find a treatment program that’s right for your needs and your budget.

Don’t let myths about drug rehab keep you from getting addiction recovery support. Compassionate care is available! Begin your search today at GoodTherapy. Recovery may be a lifelong journey, but you are not alone.

References:

  1. American Addiction Centers. (2019, February 14). How much does rehab cost? Retrieved from https://americanaddictioncenters.org/alcohol-rehab/cost
  2. American Addiction Centers. (2018, October 15). Rehab success rates and statistics. Retrieved from https://americanaddictioncenters.org/rehab-guide/success-rates-and-statistics
  3. Blending perspectives and building common ground. Myths and facts about addiction treatment. (1999, April 1). U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/report/blending-perspectives-and-building-common-ground/myths-and-facts-about-addiction-and-treatment
  4. Centers for Disease Control and Prevention. (2018, December 19). Understanding the epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
  5. Leshner, A. I. (n.d.). Exploring myths about drug abuse. National Institute on Drug Abuse. Retrieved from https://archives.drugabuse.gov/exploring-myths-about-drug-abuse
  6. Mayo Clinic. (2017, July 20). Intervention: Help a loved one overcome addiction. Retrieved from https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/intervention/art-20047451
  7. Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder). Retrieved from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
  8. National Academies of Science, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Retrieved from http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx
  9. National Institute on Drug Abuse. (2018). Drugs, brains, and behavior: The science of addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
  10. National Institute on Drug Abuse. (2018). Is marijuana addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive
  11. Substance Abuse and Mental Health Services Administration. (2015). Behavioral health trends in the United States: Results from the 2014 national survey on drug use and health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
  12. Substance Abuse and Mental Health Services Administration. (2016). Early intervention, treatment, and management of substance use disorders. In Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK424859
  13. Substance Abuse and Mental Health Services Administration. (2019, January 30). Mental health and substance use disorders. Retrieved from https://www.samhsa.gov/find-help/disorders
  14. Walsh, Z., Gonzalez, R., Crosby, K., Thiessena, M. S., Carrolla, C., & Bonn-Miller, M. O. (2017). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review, 51, 15-29. Retrieved from https://www.sciencedirect.com/science/article/pii/S0272735816300939?via%3Dihub
  15. Weber, L. (2015, July 11). How much does inpatient rehab cost? Retrieved from https://addictionblog.org/rehab/inpatient-rehab/how-much-does-inpatient-rehab-cost

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6 Mistakes to Avoid in Your Recovery from Depression and Anxiety

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Recovering from depression and anxiety call for the same kind of shrewdness and amount of perspiration as does running a 4,000-person company. I say that having never done the latter. But hear out my logic: great leaders must master impeccable governing skills, develop the discipline of a triathlete, and build enough stamina to manage multiple personalities. And so does anyone wanting to get outside of her head and live a little.

So I think it’s fitting to translate the insight of a book about business success, The Wisdom of Failure: How to Learn the Tough Leadership Lessons Without Paying the Price by Laurence Weinzimmer and Jim McConoughey, to victory over a mood disorder, or even mild but annoying anxiety and depression.

Weinzimmer and McConoughey describe their “taxonomy of leadership mistakes,” or nine common ways an executive falls flat on his face and is made fun of by his peers. The business world is replete with calculated risks. It’s a chess game, and a few too many wrong moves will have you packing up your stuff from the corner office.

As I read through them, I kept thinking about my main job — managing my depression as best I can — and the pitfalls that I so often run into. Many are the same listed in this book. Here are six mistakes business leaders make that are appropriate for our purposes:

Mistake one: Trying to be all things to all people.

The “just say no” problem that I have all the time. If you think of requests from friends, families, bosses, co-workers, and golden retrievers as customers asking you for all kinds of products that you can’t simultaneously produce, then you see the logic in your having to draw the line at some point. You must hang on to your resources to stay well.

Mistake two: Roaming outside the box.

Clarification: thinking outside the box is good. Hanging out there, strolling around in pursuit of some meaning that you keep finding in everything that passes by — that’s dangerous. When it comes to recovery, this is very important to remember. I like to try new things: yoga, new fish oil supplements, a new light lamp, different support groups.

What gets me in trouble is when I start to think that I don’t have bipolar disorder and can go off all meds, healing myself through meditation alone. I tried that once and landed in the hospital twice. Now I double check to make sure the box is still in my peripheral vision.

Mistake three: Efficiencies before effectiveness.

This has to do with seeing the forest behind the trees, and subscribing to a policy of making decisions based on the view of the forest, not the trees that are blocking everything from your sight. The authors cite the example of Circuit City’s CEO who cut 3,400 sales people to decrease costs despite the fact that their research said that customers want knowledgeable sales people to help them make decisions when buying electronics. His approach was efficient, but not all that effective.

When you are desperate to feel better, it’s so easy to reach for the Band-Aid — booze, cigarettes, toxic relationships — that might do an efficient job of killing the pain. Effective in the longterm? Not so much.

Mistake four: Dysfunctional harmony.

Like me! Like me! Please like me! Dysfunctional harmony involves abandoning your needs to please others, which jeopardizes your recovery efforts.

“Being an effective leader [or person in charge of one’s health] means that sometimes you will not make the most popular decisions,” the authors explain. “By doing what is necessary, you will sometimes make some people angry. That’s okay. It’s part of the job. If you are in a leadership role and you try to be liked by everyone all of the time, you will inevitably create drama and undercut your own authority and effectiveness.”

So think of yourself as the CEO of you and start making some authoritative decisions that are in the best interest of You, Inc.

Mistake five: Hoarding

I’m not talking about your sister’s stash of peanuts and Q-Tips. This is about hoarding responsibility. For those of us trying like hell to live a good and happy life, this means giving over the reins now and then to other people, persons, and things that can help us: doctors, husbands, sisters, even pets. It means relying on the people in your life who say they love you and letting them do the small things so that you can try your best to be the best boss of yourself again.

Mistake six: Disengagement

Burnout. It happens in all recovery. I have yet to meet someone who can continue a regiment of daily meditation, boot camp, and spinach and cucumber smoothies for more than three months without calling uncle and reaching for the pepperoni pizza. That’s why it is so critical to pace yourself in your recovery. What’s a realistic number of times to exercise during the week? Are you really going to do that at 4:30 am? Why not allow yourself one day of hotdogs and ice-cream in order to not throw out the whole healthy living initiative at once?

Imagine yourself a great leader of your mind, body, and spirit — managing a staff of personalities inside yourself that need direction. Take it from these two corporate leaders, and don’t make the same mistakes.

6 Mistakes to Avoid in Your Recovery from Depression and Anxiety

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How to Own Your Power: Using Influence Consciously

This is an interesting article I found on: www.goodtherapy.org

See credits below.


I want to say a sentence, a prompt, to you. It will be a positive sentence. Your task is just to notice and reflect on what your internal response is.

“It’s okay to own your power.”

There are a variety of ways that people can react to this idea, but they tend to follow a few trends. Were your thoughts similar to any of these?

  • “At first the idea seemed fine, but then, on deeper reflection, I noticed that I don’t like owning my power, so I sometimes avoid it.”
  • “It doesn’t feel okay because I’m afraid I will use it to cause harm.”
  • “I became aware that I don’t think I have power at all.”
  • “I notice I’m afraid of being held accountable for everything I do or say.”
  • “I think, in alarm, about the sentence ‘power corrupts.’”

It is entirely natural to feel wary of power. The news every day gives us a dose of information about misuses and abuses of power, and we all have our own experiences of power being misused towards us. Not often do we hear stories of uses of power that support well-being and promote the good of all.

Power has become such a loaded term that you may be surprised to hear a definition of power that does not idolize or vilify it: Power is the ability to have an effect or to have influence. Power is a neutral concept. We all need power to take action, to bring forth our dreams, and to influence others. People are often looking to us to step into our power in healthy ways.

From the Right Use of Power point of view, there are four kinds of power to understand, own, and pay attention to.

  1. The first and most basic is personal power, which everyone has. It is your ability to influence your own life and to decide how to be with others.
  2. The next is role power. This is the extra layer of power and responsibility that is added on to personal power whenever you are in a position of authority, such as teacher, therapist, lawyer, employer, elected official, etc.
  3. The next is status power, which is mostly unearned and culturally conferred. It involves traits such as race, sex, religion, heritage, able bodied-ness, age, etc. (You might also call this privilege).
  4. And the fourth kind is collective power—the additional power that groups of people have when they are acting together.

Using our power wisely and well requires us, rather than avoiding or disowning, to OWN all of these kinds of power. Understanding the impacts and relational dynamics that accompany each type of power is the key to their beneficial use. There may be ways that you already use and interact with these types of power, but how conscious are you in how you do so and the impact it has?

In this article, we are focusing on PERSONAL POWER. Personal power is your birthright. We all have power. Even babies can choose to roll a ball or impact others’ behavior when they cry or smile. One of the tasks of a lifetime is to develop skillful use of your personal power so that you have the impact on others that you want to have. This self-awareness can be used to guide you to progressively healthier relationships.

There are many ways we use our personal power to influence our personal relationships. These uses of power can be seen as variables, where opposing qualities can be put on a continuum. A good way to explore the range of your own qualities is to write or print the continuums below, then put a mark on the spot on each continuum where you tend to land. Of course, in healthy relationships, there is room for a range of responses based on circumstances, but most of us have natural tendencies.

As you do this activity, please note that all of these qualities on all of the continuums are positive. One is not better than another. It is not intrinsically better to be directive or responsive, and having a healthy range of responses to different situations is a good thing.

However, misuses and abuses of power tend to happen more at the extremes of each continuum. For example, someone who is at the extreme of the strength side of the continuum may be experienced as forceful, inflexible, or mean. Meanwhile, someone at the extreme end of the heart side of the continuum may be experienced as a pushover, conflict-avoidant, or unable to give direct instructions. At both extremes, people become disconnected and relationships become painful, confusing, and difficult.

Directive ————————————————————————–Responsive

Firmly boundaried ———————————————————–Flexibly boundaried

Task-focused ——————————————————————— Relationship-focused

Persistent ————————————————————————–Letting go

Truth-focused ———————————————————————-Harmony-focused

Strength-centered —————————————————————-Heart-centered

Extroverted ————————————————————————-Introverted

Now you have a picture of your personal power profile. How do you feel about your profile? Are there any tendencies that you would like to shift in one direction or the other to have more of the influence you want to have? Are there any tendencies that feel particularly ‘stuck’ in one place? What is it like to OWN your power so that you can have conscious choice in how you use it for good?

If you want to explore this further and initiate an interesting conversation, try comparing your profile with people you are closely related to. You will be increasingly able to have the kind of relationships you want and are capable of as you grow to understand and own your power.

If you would like help addressing power-related issues in your life, you can find a therapist here.

© Copyright 2019 GoodTherapy.org. All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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Surviving a Relationship Injury: Forgive But Don’t Forget

This is an interesting article I found on: www.goodtherapy.org

See credits below.


In attachment-based counseling, we talk a lot about relationship and attachment injuries. Those of us who practice emotionally-focused therapies have our own lingo that the layperson may not clearly understand. For us, it’s second nature to discuss attachment issues, trauma, interactions, and perceptions, but what does that mean in terms of a client and their partner? How can the couple sitting in my office in tears relate that to how they’re feeling in the midst of their crisis?

It has occurred to me that I could perhaps help my clients understand and identify with these terms if I explain what a relationship injury is. I want to help couples understand what is behind the relationship injury and how to forgive each other (and themselves). This knowledge can help couples move forward in a stronger relationship.

What Is a Relationship Injury?

When we’re in a romantic relationship, we make a lot of assumptions about the person we’re with. We set out to prove these assumptions every day. You want to see your partner as someone kind, who has your best interest at heart: someone who will protect you, listen to you, be there for you in your time of need. Someone who thinks you are the most important person in their world, who loves you more than anyone. In return, you try to do all the same things for them. You see each other through the lens of love, friendship, and positivity.

When you commit to be in a relationship with your partner, you are completely invested in believing this narrative. When they fall short, the shock can feel overwhelming. The bottom drops out of all your shiny, happy perceptions, and it changes everything about the way you view your partner.

There is an entire spectrum of relationship injuries, and there’s no telling what the amount of pain caused will be. If you’re in a relationship with someone who is seen as dependable and upright, then you catch them in a lie, you can be left feeling like you don’t even know your own partner. That you’ve been living a lie.

When a partner betrays your trust at a time of great need, it can be devastating. The relationship injury could occur during a medical trauma, a death in the family, or any instance where the partner is needed for support and is not there for you. For example, a spouse may fail to arrive at your parent’s funeral when you are counting on them to be there.

When a partner lets you down so dramatically, it’s a violation of the attachment. It can be a game changer.

The Lasting Effects of a Relationship Injury

As completely invested in each other as you are, the devastation of a relationship injury can leave the injured partner feeling completely betrayed and alone. Everything gets looked at through the lens of that emotional pain. All of those positive feelings of security, of importance, of attractiveness, of well-being—they are gone in that moment.

In order for us to be happy, well-balanced individuals, we need to feel loved and important. Your partner is the person who helps you to feel that way. When all of that is suddenly taken away due to a relationship injury, it can bring up old injuries from our past, our family of origin, or prior relationships. The triggers for these injuries will further reinforce the downward spiral of emotions around feeling unimportant or unloved.

You may want to forgive your partner, but it’s not so easy to forget. Forgetting can feel like we are putting ourselves at risk; we want to avoid repeating the behavior that brought us to the crisis in the first place.

Rebuilding Connection After a Relationship Injury

How do you cope when you feel you cannot even count on the person who claims to love you the most? When you feel alone and are missing your best friend and partner? The work that has to be done requires several steps. The time frame will be different for each couple. Both have to commit to doing this work and to building up a stronger bond than the one that was broken through the relationship injury.

First, your partner needs to make a sincere apology. They have to own what happened, understand how deeply you are hurting, and come to a realization that their actions are responsible for this hurt. There’s really no making up for it. Your partner has to let you know that they truly regret the pain they caused, they will change their behavior going forward, and that they themselves are hurting simply knowing that they caused you to feel this anguish. Only then can a couple move forward with a new perspective.

The injured partner has to be able to see the sincerity in the apology with emotional presence. You need to believe your partner is committed to moving forward with a new and better relationship.

It can get tricky at this point. How do you forgive when it feels like you’ll never stop hurting? When you feel like the person that you counted on has let you down completely and you can’t see anything but the negatives in everything they say or do?

First, your partner needs to make a sincere apology. They have to own what happened, understand how deeply you are hurting, and come to a realization that their actions are responsible for this hurt.In order to truly forgive, the injured partner has to see enough positive interactions, enough good behavior to tip the scales in a positive direction. Not just lip service, but real proof over time that your partner sees you as important and is putting the relationship as a first priority. Forgiveness can happen with reservations, but there is often a trial period of “show me” that has to happen. It’s difficult not to be cynical or suspicious after feeling so hurt and betrayed.

Should you and your partner forget the relationship injury? I say no. I don’t mean that you should hold a grudge, keep score, or constantly bring up the past to your partner. What I mean is that your partner needs to keep the crisis in mind when they’re making decisions going forward. If they truly regret causing you pain, they are never going to want to do it again. Meanwhile, you need to keep the injury in mind so that you are always communicating, clarifying what may be misconstrued, and doing away with negative assumptions.

It is easy for couples to fall back into old negative patterns, especially if that has been your go-to for a long time. The work, the tough stuff, is to move forward: forgiving but not forgetting how painful it was to be estranged from each other. A couple needs to work daily to keep each other close and interact in loving ways. These habits will reinforce your positive perceptions of one another so you can build a lasting relationship.

If you need help working with your partner to rebuild trust, you can find a couples counselor here.

© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by Stuart Fensterheim, LCSW, therapist in Scottsdale, Arizona

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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Podcast: Hypersexuality with a Bipolar and Schizophrenic

This is an interesting article I found on: www.psychcentral.com

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Hypersexuality is a very common symptom of bipolar mania and a potential symptom of schizophrenia, as well. Both Gabe and Michelle have experienced being hypersexual, but because of their ages and genders, it manifested itself in different ways.

However, their personal differences aside, there is one thing that both our hosts completely agree on. . . Listen now to find out.

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“Hypersexuality is not a good thing. It was a need that I had to fill.”
– Gabe Howard

Highlights From ‘Hypersexuality’’ Episode

[1:40] What is the correct definition of hypersexuality?

[4:30] The history of sex as we understand it.

[6:45] Why hypersexuality is not a good thing.

[10:00] Being hypersexual in the digital age.

[12:30] Gabe & Michelle explain Sex Bingo.

[16:30] Is hypersexuality a compulsion, like addiction?

[22:00] It’s important to have sex safe, no matter what.

Computer Generated Transcript for ‘Hypersexuality with a Bipolar and Schizophrenic’ Show

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: [00:00:07] For reasons that utterly escape everyone involved, you’re listening to A Bipolar, A Schizophrenic, and A Podcast. Here are your hosts, Gabe Howard and Michelle Hammer.

Gabe: [00:00:18] You’re listening to A Bipolar, A Schizophrenic, and A Podcast. My name is Gabe Howard. I have bipolar.

Michelle: [00:00:23] Hi, I’m Michelle, I’m schizophrenic.

Gabe: [00:00:26] And today we’re going to talk about sex.

Michelle: [00:00:28] Sex? I don’t know if it is gay. What is that? Is this sex ed?

Gabe: [00:00:32] I think that it’s funny that you’re already uncomfortable. The great Michelle Hammer is not uncomfortable about anything, anything until two things happen. A microphone flips on and you think that your mom might be listening.

Michelle: [00:00:46] When I learned sex ed in fifth grade, that video showed me where I was going to grow hair.

Gabe: [00:00:51] Oh, my God. That I… You have left me speechless. You know,… this… it’s…We’re going to talk a lot about specifically hypersexuality, because it’s one of those things that a lot of people with bipolar disorder and schizophrenia, it happens. It’s a part of mania. It’s a part of delusional thinking. It’s something that feels good and then gets twisted, which is mental illness’ is specialty.

Michelle: [00:01:14] I hope you don’t start twisting when you have sex. I hope nothing gets twisted when you start having sex. I don’t want anything twisting on you.

Gabe: [00:01:21] Listen, the way that I have sex is my personal business.

Michelle: [00:01:24] Fine, twist it up. You know, when it when it hangs low tie it in a knot and tie it in a bow. Hang it over your shoulder.

Gabe: [00:01:29] I wish people could see how uncomfortable Michelle is. She is she is as red as my hair right now. Before we talk about hypersexuality too much, we should define it using real words.

Michelle: [00:01:44] OK.

Gabe: [00:01:44] Hypersexuality is defined as a dysfunctional preoccupation with sexual fantasy, often in combination with the obsessive pursuit of casual or non intimate sex, pornography, compulsive masturbation, romantic intensity and objectified partner sex for a period of at least six months. Even its definition doesn’t sound sexy. Yet, people think that it does sound sexy because people think that hypersexuality simply means lots of sex. And it just doesn’t.

Michelle: [00:02:12] It doesn’t.

Gabe: [00:02:13] It doesn’t. But we should also cover what hypersexuality is not. It’s not looking at porn. That doesn’t make you hypersexual. It’s not engaging in fetishes or being aroused by things that maybe you consider to be atypical. It’s not homosexuality. It’s not being bisexual. That’s not hypersexuality, that’s not sexual addiction. That’s none of the things that we’re talking about. Hypersexuality is when you use sex to really regulate your emotions and your feelings. If you have a bad day, you have to have sex. And that’s not normal. Most people don’t consistently utilize sexual arousal as a means of feeling better when having a bad day. Healthy people reach out to friends and their family members for support when they’re upset. If you get upset and the first thing you want is sex, if you have a bad day and the first thing that you want is sex, if you have a good day and the first thing that you want is sex. If all of your high or low emotions, your extreme emotions, are driving you to have sex. That’s what hypersexuality is. We’re going to go off on the biggest tangent the show has ever had. We’re just gonna forget that we’re mentally ill.

Michelle: [00:03:17] Oh, God. Okay.

Gabe: [00:03:17] What is it about sex that makes our society just, I mean, we literally use scantily clad women to sell gum. But talking about sex makes almost everybody uncomfortable. Like, what’s up with that?

Michelle: [00:03:30] I don’t really know what’s up with that. It’s something you’re not supposed to talk about sex. But, we all know what was it? What was that? Salt-N-Pepa? Let’s talk about sex, baby. Let’s talk about you and me. I mean, it obviously has been a problem for a long time if a son had to talk about it.

Gabe: [00:03:45] That’s fair. And that song is like really like you’ve dated me. Like I was in high school when that song came out

Michelle: [00:03:50] I was like in elementary school, or younger, or a fetus. I don’t even know.

Gabe: [00:03:54] I’m picturing like a nine year old Michelle Hammer sing Salt-N_Pepa.

Michelle: [00:03:58] I don’t think I was probably allowed to listen to that song when it came out.

Gabe: [00:04:01] When have you ever only done what you’re allowed to do?

Michelle: [00:04:05] I know. Sneaking watching 90210. Yeah. R.I.P. Luke Perry, R.I.P.

Gabe: [00:04:09] Aww, R.I.P. Luke Perry

Michelle: [00:04:09] R.I.P.

Gabe: [00:04:09] Sadness

Michelle: [00:04:13] Dylan McKay, miss you forever.

Gabe: [00:04:13] You know, 90210 was another show about teenagers who had a lot of sex. You weren’t allowed to watch it because of all of the sex that was in it. And that show was geared toward high schoolers.

Michelle: [00:04:25] But I was much younger than that.

Gabe: [00:04:26] Well, yes, but my point is, is that sex is everywhere. But yet when it comes to talking about sex from a medical perspective, and that’s really where the show is going to end up eventually, I promise. Why do we have such a problem with it?

Michelle: [00:04:41] It’s been a problem throughout society. I know that the beginning of the women’s sexual anything. Back in the day, women would go to the doctor and they would pull out like the vibrator and vibrate on the women’s clit. And then they would have an orgasm. And that’s like a medical thing they used to do because they didn’t know that women actually were supposed to feel pleasure from sex.

Gabe: [00:05:00] It is interesting that you bring that up because that’s absolutely true. A lot of people don’t realize that the modern day vibrator used to be a medical device. It was created in asylums to calm down hysterical women. Hysterical. Hysterectomy. These are words because doctors believed women’s reproductive organs were tied to their mental health. The sex study was started by Kinsey and he started a whole foundation where they polled a whole bunch of people anonymously about their sexual proclivities. The things that they liked, the things that they didn’t like. Kinsey learned so much about sexuality that people just did not understand in the 50s.

Michelle: [00:05:39] Like what?

Gabe: [00:05:40] Like that people like to have sex. Or that women could orgasm or, and this was big, that women masturbated. There was this misunderstanding that women did not like, enjoy, or want sex, that it was a chore for them. It was a marital obligation. It was literally their marital duty.

Michelle: [00:05:57] The lie back and think of England?

Gabe: [00:06:00] Yeah, we believed as a society that this was true. And then we found out through a lot of, thank God for science, that it turns out that women like sex. But a lot of women…

Michelle: [00:06:10] Yeah, good thing for you, Gabe. Thank God. Hey, what would you do if women didn’t like sex?

Gabe: [00:06:14] Well, but see, that’s the thing, though. Our society was so messed up that even though women didn’t like sex, they were still expected to have it.

Michelle: [00:06:23] I see what you’re saying.

Gabe: [00:06:23] We believed as a society that women did not enjoy sex. Yet they were required to do it. And we had phrases like “wifely duties.” This all segues into hypersexuality because there is probably not a more misunderstood symptom. Because the number one thing that people think about hypersexuality is that it’s awesome. They think it’s fun. People think hypersexuality is somehow good. It’s not. We’re gonna talk about a lot of stuff, and some of it we’re not gonna have horrible memories of because, hey, this is our lives. We don’t want to regret everything. But the underlying message in this entire show is that hypersexuality takes from you. It doesn’t give. It just doesn’t. There is a world of difference between having a lot of sex, which is good, and hypersexuality, which is not good. And nobody seems to understand that. Everybody thinks that one hypersexuality is fun and two hypersexuality is not a symptom of a serious problem.

Michelle: [00:07:27] What do you think about that?

[00:07:29] I think that I thought the same thing. I think that I thought that hyper exuality was having a lot of sex. It kind of sounds like it, doesn’t it? Hypersexuality, lots of sex, having sex furiously.

Michelle: [00:07:41] You say you’re hypersexual, yes?

Gabe: [00:07:41] Before medication, before treatment, before everything? Yeah. Yeah.

Michelle: [00:07:47] So you did not enjoy it?

Gabe: [00:07:49] Did I enjoy having a lot of sex? Yes. Because here’s the thing that I want to explain, it was a compulsion. It was a need that I had to fill. So by filling it, I got relief from.

Michelle: [00:08:01] Was the need like you’re so horny or is the need that you want to be with somebody?

Gabe: [00:08:07] Oh, it had nothing to do with the other person. Hyper sexuality has nothing to do with your partner.

Michelle: [00:08:10] So you were just like horny, horny, horny, horny, horny, horny, horny.

Gabe: [00:08:14] I don’t know that I would say horny, horny, horny, horny. Well, I’d say that it’s almost like an alcoholic that has to drink. They’re not thirsty. They’re compelled to do it. Or, you ever take a pack of cigarettes away from a smoker?

Michelle: [00:08:25] Yeah.

Gabe: [00:08:26] They’re just so desperate for that cigarette that they’re not even enjoying it anymore. And they’re yelling at people and they’re screaming and they’re bumming cigarettes off people and they’re angry. And then when they finally get that cigarette, they feel better. But really? That does not look like a person who’s enjoying it. Or are they just compelled? It’s a compulsion. Michelle, you have also been hypersexual. Was it something that you enjoyed or was it something that was required?

Michelle: [00:08:51] It was almost like a fun game.

Gabe: [00:08:53] A fun game?

Michelle: [00:08:54] A fun game. Yeah.

Gabe: [00:08:55] Really? So in your mind, hypersexuality and monopoly are like equivalents.

Michelle: [00:09:01] Yeah.

Gabe: [00:09:02] Were you the hat?

Michelle: [00:09:03] I sure. I don’t know. I don’t know all the characters in Monopoly. I’ve only ever played Monopoly Junior.

Gabe: [00:09:08] I love how you said the “characters” in Monopoly rather than the tokens.

Michelle: [00:09:12] I don’t even know they’re called tokens, but whatever. I am not that familiar with Monopoly. I’m not attracted to the monopoly, man.

Gabe: [00:09:18] But you’re familiar with it?

Michelle: [00:09:19] Nobody ever paid me two hundred dollars for passing “Go.”

Gabe: [00:09:20] Oh, you knew a reference?

Michelle: [00:09:23] Yes. If I got paid two hundred dollars every time when I made a man pass go, I’d have a lot of money.

Gabe: [00:09:30] How much money, Michelle?

Michelle: [00:09:32] More than two hundred dollars.

Gabe: [00:09:34] More than 400 dollars?

Michelle: [00:09:35] Perhaps. Hold up. Here’s our sponsor.

Announcer: [00:09:39] This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counselling. All counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist, whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counselling is right for you. BetterHelp.com/PsychCentral.

Gabe: [00:10:10] We’re back talking hypersexuality. We experienced hypersexuality n very different ways because male and female. But we also experienced hypersexuality differently because generationally, we’re over a decade apart. During my biggest hypersexual times, you know, there wasn’t Tinder. There wasn’t the Internet. There wasn’t online dating services. I had to go out to bars and find people. How was it different for you? Because you just hopped on Tinder and people came to your house?

Michelle: [00:10:37] It’s actually also living in New York City. Tinder can be very easy. You go on Tinder and you put it on one mile radius.

Gabe: [00:10:46] Really?

Michelle: [00:10:46] Yup, one mile radius. So you know who is in the neighborhood and you start getting messages that people you met you meet up with like, oh, you’re in Astoria? I’m in Astoria. Oh, you’re so close. We’re in Astoria over there. Oh, wow. We’re neighbors. Oh, we’re neighbors. That’s so cool. You’re so convenient. Well, I’m like, yeah, this guy doesn’t realize that I put it on one mile radius.

Gabe: [00:11:06] Did you regret it? Like when it was over, did you think, oh, I’m a bad person or did you not care?

Michelle: [00:11:11] Oh, I didn’t care.

Gabe: [00:11:12] That’s interesting. Do you think that is the typical experience of the average female? On one hand, you’re like, oh, I didn’t care. I was fine with it. But yet you are embarrassed by it.

Michelle: [00:11:20] It’s not that I’m embarrassed by it. It’s just there’s judgment about it. I mean, a lot of girls wouldn’t do stuff like that, but I don’t think anyone should judge anybody by what they choose to do as long as you’re being safe. I think what’s more judgmental is that you let a stranger into your home because you never know, you know? Like murders.

Gabe: [00:11:41] Did you learn hundreds upon hundreds of strangers in to your home?

Michelle: [00:11:43] Not hundreds upon hundreds. Are you nuts? I didn’t let hundreds. Come on.

Gabe: [00:11:45] So like dozens?

Michelle: [00:11:47] Possibly. I don’t know.

Gabe: [00:11:49] So you lost count?

Michelle: [00:11:51] Oh, I have no idea. The count. Do you know your count?

Gabe: [00:11:54] Yes.

Michelle: [00:11:55] You know your count?

Gabe: [00:11:55] I don’t know what exactly, but I know that it’s in the hundreds.

Michelle: [00:12:00] I’m not in the hundreds, Gabe, I’m nowhere near the hundreds.

Gabe: [00:12:02] Thanks. That was very judgy.

Michelle: [00:12:03] I wasn’t judging you.

Gabe: [00:12:05] Yes, you were.

Michelle: [00:12:06] Shut up. But I played a game, so I was with a therapist, but not my therapist. Don’t worry. I’ve been with a psychologist, not my psychologist. But I always wanted the trifecta and get a psychiatrist. I haven’t done that, and I don’t know if that’s going to happen. But wouldn’t that be awesome?

Gabe: [00:12:20] This is where you scare me sometimes. Because I had sex with a psychologist. I also had sex with a therapist.

Michelle: [00:12:28] Oh, no.

Gabe: [00:12:29] And I absolutely, unequivocally want to have sex with a psychiatrist.

Michelle: [00:12:33] Oh, my God, no, I’m Gabe.

Gabe: [00:12:35] You know, I call this game sex bingo.

Michelle: [00:12:39] Yes, it is such sex bingo.

Gabe: [00:12:41] Is it healthy, though?

Michelle: [00:12:42] Wait, can we make a game called sex bingo?

Gabe: [00:12:45] I already did. This is my game. I’ve been playing it since I was 19 years old.

Michelle: [00:12:51] And do you have races, different races and religions on your sex bingo?

Gabe: [00:12:55] I really go by like personality traits and or jobs.

Michelle: [00:12:58] Gingers? Brown hair?

Gabe: [00:12:58] I don’t really care about hair color.

Michelle: [00:13:00] Doctor, lawyer?

Gabe: [00:13:02] Lawyer.

Michelle: [00:13:03] I have lawyer.

Gabe: [00:13:05] You have lawyer?

Michelle: [00:13:05] I have lawyer.

Gabe: [00:13:06] I don’t have lawyer. What’s the free spot? Oh, yeah, masturbation. That was a freebie right there.

Michelle: [00:13:14] Your hand.

Gabe: [00:13:14] Your hand?

Michelle: [00:13:16] Or your vibrator.

Gabe: [00:13:18] What do you think of the fleshlight?

Michelle: [00:13:20] I have never used a fleshlight because I’m a woman.

Gabe: [00:13:22] Yeah, that was a stupid question.

Michelle: [00:13:24] Me and my friends were in a bar with a bunch of firefighters one time. And the firefighters, they were saying that one over there, he’s got a fleshlight. So we all started talking to him about his fleshlight. And he’s like, well, you know, with a fleshlight, you don’t have to talk to them before and after.

Gabe: [00:13:39] Wow.

Michelle: [00:13:39] Yeah, that’s what he said.

Gabe: [00:13:40] Did that make him more or less attractive to you?

Michelle: [00:13:43] Much less attractive.

Gabe: [00:13:43] Really?

Michelle: [00:13:45] He doesn’t want to talk to a girl before and after? He’d rather just bone his fleshlight?

Gabe: [00:13:50] This is the core difference, I think, between men and women. Not like across the board. But if a woman said that to me, I don’t want to talk before and after, I’d be like, excellent. This could work. Not any more, though. We have both grown tremendously as people because we do know people who listen to this show and they’re like, oh my God. For example, my wife listens. And if somebody is a first timer listening to the show, they’re like, wait, that guy’s married? Oh, my God. But this was.

Michelle: [00:14:17] Tell her to become a psychiatrist.

Gabe: [00:14:20] This is an excellent idea. You know, you should tell your significant other to become a psychiatrist.

Michelle: [00:14:25] Oh, that’s a good idea.

Gabe: [00:14:25] Oh, my God. Why didn’t we think of this? Oh, my God, what if, now that we are monogamous, our sex bingo should really be about getting our significant other as many jobs as possible.

Michelle: [00:14:37] [Laughter]

Gabe: [00:14:37] We’re gonna have the most successful spouses in the world.

Michelle: [00:14:42] Yes.

Gabe: [00:14:42] Hi. What do you do for a living? I’m a doctor, a lawyer, a psychiatrist, a brain surgeon.

Michelle: [00:14:46] A pilot?

Gabe: [00:14:47] I’m a pilot. I’m an engineer. What is your max number in a day?

Michelle: [00:14:53] Three.

Gabe: [00:14:54] Oh, only three?

Michelle: [00:14:55] Only three.

Gabe: [00:14:57] You only had sex with three people in one day.

Michelle: [00:14:59] I believe.

Gabe: [00:14:59] That’s …

Michelle: [00:15:01] Is that a lot?

Gabe: [00:15:01] No.

Michelle: [00:15:02] I really hope my mom listens to this.

Gabe: [00:15:04] I mean.

Michelle: [00:15:05] Well, let her know.

Gabe: [00:15:06] I’m worried, though, because one of the reasons that I enjoy doing this show with you is because at the end of the day, you’re just as fucked up as me.

Michelle: [00:15:12] Yeah.

Gabe: [00:15:12] But my max number in a day is significantly higher.

Michelle: [00:15:15] Well, I’m not surprised by that one.

Gabe: [00:15:18] Thanks. That’s terrible. You’ve never hired sex workers, though?

Michelle: [00:15:24] No, I have not.

Gabe: [00:15:25] Is that because women just don’t have to? Is it because you didn’t want to? Or is it just because you exist in the age of Tinder?

Michelle: [00:15:32] I exist in the age of Tinder, where it’s free for girls. I wouldn’t even know where to go to get a male sex worker, at all. No, I wouldn’t even know where to go. And why would I do that when Tinder is free?

Gabe: [00:15:44] When you reflect back on hypersexuality, you don’t have the same gut wrenching horror feeling that I do. Why do you think that is? Do you think that you’ve just rejected a lot of societal stereotypes, or the pressure that society gives young women? Do you think this is because you’re such a strong feminist?

Michelle: [00:16:02] I just…

Gabe: [00:16:03] Because I feel awful.

Michelle: [00:16:04] I think it’s just feminism. I need to just see you live your life. You do what you want to do. You don’t feel embarrassed by it. You shouldn’t feel ashamed. Other people, my friends, they’re like, what did you do? And I’m like, I did what I wanted to do. You can judge me. I really don’t care. I don’t care.

Gabe: [00:16:21] For me, one of the things that I dislike so much about hypersexuality is it wasn’t about having fun for me. It was about having sex and while having sex, I would be thinking about when I was gonna be able to have sex again. So I wasn’t even enjoying it in the moment. I had to. I think that’s the thing that maybe a lot of people don’t understand about hypersexuality. I had to. I didn’t want to. I didn’t enjoy it. I had to. I didn’t get any enjoyment from having sex. It was a chore that I had to do.

Michelle: [00:16:51] Mine was definitely not a chore. It was more of a like, kind of, almost a manic kind of a game, really.

Gabe: [00:16:57] So hypersexuality exists on a spectrum much like everything else.

Michelle: [00:17:00] Yeah.

Gabe: [00:17:02] You would say then that maybe you had like hypersexuality lite? And, I’m not judging it in any way. I just, there’s got to be a big difference between somebody who in a 24 hour period is like, hey, I’ll go have sex with three people and now I’m cool. And somebody that says I’ve had sex with 21 people and say, I need more. I need more.

Michelle: [00:17:18] Yeah. That’s a lot different. I wasn’t like craving and craving and craving and craving. It was more just like the thrill of the whole thing.

Gabe: [00:17:26] You know, in addition to the sex act, did you feel that the other person was validating you?

Michelle: [00:17:32] I don’t know. I think it’s kind of hot when somebody, like, wants you. You kind of feel hot when, you know, like I feel hot. I don’t know. You just feel wanted. You feel like, yea, they’re totally into me, you know?

Gabe: [00:17:43] I do. I do. And I think in addition to hypersexuality, I had like co-morbid disorders going on. Because not only did I have to have sex, not only was there this compulsion to have sex, but when somebody was willing to have sex with me, they were telling me I was worthwhile for something. They were saying, hey, you’re not terrible. I needed that reassurance that at least I wasn’t garbage.

Michelle: [00:18:07] And Gabe, can we bring up how you lost your virginity 18 times?

Gabe: [00:18:11] I did. I lost my virginity 18 times.

Michelle: [00:18:13] Tell that story, please. Why did you say it 18 times? And why did they believe you 18 times? Because that is so funny.

Gabe: [00:18:20] I was so desperate to have sex that I would just literally say whatever it took to have sex. And, you know, I was a 500 pound guy. And remember, I don’t have Tinder and none of this stuff existed. I didn’t have the Internet. I didn’t have smartphones. I had to go out to bars and find people to have sex with.

Michelle: [00:18:36] That sounds terrible.

Gabe: [00:18:37] And I still had my personality. I was still charismatic. I was still funny. I was still people were flocked to me. But that wasn’t sealing the deal because I weighed 500 pounds. I weighed, you know, anywhere from 450 to five hundred fifty pounds. And people were just like, yeah, I don’t know. He’s kind of fat. So I came up with, well, frankly, a ruse. I told people that I was a virgin. Then they thought, oh, my God, this guy is so nice. He’s so kind. He’s so funny. Oh, I’ll take his virginity for him. I mean, I’ve got to give him a shot in the world. And once I realized this worked, I did it 18 times.

Michelle: [00:19:10] That’s so funny that you did that.

Gabe: [00:19:13] Is it funny or is it sad or a combination of both?

Michelle: [00:19:16] It’s both.

Gabe: [00:19:17] Yeah, both.

Michelle: [00:19:17] I think it’s so funny that these women would feel like almost bad for you that they would have sex with you.

Gabe: [00:19:23] And that’s an interesting thing to think about as well. You know, women, we don’t think of them as in control of their own sexuality, but they were. And they thought to themselves, hey, you know, I don’t want to date this guy. I’m not even attracted to him. But, you know, he’s a good guy. And I want to give him a favor. We don’t think about it that way with men. You know, men, they have sex with people that they don’t want to date, that they’re not attracted to, etc. all the time because of convenience or desire or whatever. And people are like, oh, that’s perfectly normal. You know, we have these phrases like “men will stick it in anything.” But women? Women are discerning. They’re picky. And the reality is this has not been my experience. I can tell you with having sex with hundreds of people. Women are not picky. They are no pickier.

Michelle: [00:20:06] Some women are picky.

Gabe: [00:20:06] Of course, and some men are, too. I’m telling you, men and women think about sex much more alike. Again, in my experience, then people think.

Michelle: [00:20:18] Have you ever had sex in public?

Gabe: [00:20:20] Like with an audience watching?

Michelle: [00:20:21] No, not with an audience, but like maybe like in the woods, or by a lake, or just outdoors?

Gabe: [00:20:27] I don’t think that I’ve ever had sex outdoors like outside. But I’ve had sex in pretty much every bar bathroom in Ohio.

Michelle: [00:20:33] Eww, a bathroom? That’s disgusting.

Gabe: [00:20:36] But what are you going to do? You meet somebody. Where are you gonna go?

Michelle: [00:20:39] I’ve never had sex in a bathroom.

Gabe: [00:20:41] That is surprising.

Michelle: [00:20:42] Never.

Gabe: [00:20:43] Really?

Michelle: [00:20:44] Really.

Gabe: [00:20:45] I feel bad that I’m thinking you’re lying.

Michelle: [00:20:48] No, I’m really not lying. I’ve never had sex in a bathroom.

Gabe: [00:20:50] See, but again, you were meeting people like online so you could meet in like apartments or anything.

Michelle: [00:20:54] I didn’t. Yeah. Yeah, I see that. I see what you’re saying.

Gabe: [00:20:56] You know, you got to play this scenario.

Michelle: [00:20:58] Yeah?

Gabe: [00:20:58] So you’re horny. You’re out on the prowl. The local band is playing.

Michelle: [00:21:03] Bom bom bom bom.

Gabe: [00:21:05] It’s 1 a.m. and you’re into the person and you’re horny right now. That’s why you’re there. And they’re horny right now. That’s why they’re there. And they’re like, hey,.

Michelle: [00:21:14] I mean, I’ve done some on the dance floor make out. That’s what me and my friends in the city, we used to call it D, and no. D.F.M.O. Yeah, that’s it. DFMO. Dance floor make out.

Gabe: [00:21:21] So I did that except change dance floor make out to bathroom fuck session.

Michelle: [00:21:27] [Laughter]

Gabe: [00:21:29] Listen, on one hand, I’m not completely horrified by my past, but I want to make it clear these memories are largely showing how out of control I was and how desperate I was. And I am very lucky. I did practice safe sex. I always had condoms. I never had sex without protection. I was very, extraordinarily careful. But I know a lot of people that were very extraordinarily careful that still acquired a sexually transmitted disease or even worse, a baby.

Michelle: [00:21:59] Are you calling babies bad?

Gabe: [00:22:00] I’m not calling babies bad, but I’m saying that somebody that is so desperate and so out of control that they would have sex with a stranger in a bar at 1 a.m. and then those two have a baby?

Michelle: [00:22:11] Yeah, they shouldn’t be having a baby.

Gabe: [00:22:12] Yeah. What are the odds of good parenting there?

Michelle: [00:22:14] Yeah I see what you’re saying there.

Gabe: [00:22:15] And again, I was an untreated bipolar, hypersexual, desperate, and having sex with strangers in a bar. Does that sound like father material to you? Like when we think of our dads, is that what we’re thinking about?

Michelle: [00:22:27] Yeah.

Gabe: [00:22:27] We’re thinking about like stable, has a job, loving, caring.

Michelle: [00:22:31] You know, what’s funny about the whole thing? Is that my mom and my dad have been together since they were 14. My mom says she’s only ever been with my dad. And then I’d look at myself and I’m like, we are not the same person, at all. When I was first diagnosed at 18 with bipolar, I guess my mom looked up the symptoms and hypersexuality is a symptom of bipolar. I remember being on the phone with my mom and she was like, okay, Michelle, don’t be too promiscuous. Don’t be too high, too over sexual because I know that’s a symptom of bipolar. Okay. You know, don’t be too promiscuous. And I was like, don’t worry, mom, I’m not. That’s like what she said. She says, oh, you’re bipolar. Don’t be too promiscuous, Michelle. That was like her number one thing. Nothing else about the symptoms. Nothing else. But don’t be too promiscuous.

Gabe: [00:23:15] It shows you our misunderstanding of sex, sexuality and how we relate to it in the world. There are so many people that still believe that sex is only for marriage, and there are many people who believe that sex should not be enjoyable. That is just so sad because that’s the number one thing that I hate about hypersexuality. It made sex not enjoyable. I don’t know what the wrap up for this is because we’ve talked about it, about making sex a game. We’ve talked about, you know, having sex with strangers in bars. We have good memories of it. We have bad memories of it. We have different feelings of it based on our ages and our gender.

Michelle: [00:23:51] I have one question for you. That therapist and psychologist, did they know you are bipolar?

Gabe: [00:23:56] Yes.

Michelle: [00:23:56] Because the therapist and psychologist I boned did not know I was schizophrenic.

Gabe: [00:24:01] Well, they knew.

Michelle: [00:24:03] No, they didn’t.

Gabe: [00:24:03] Were you wearing your schizophrenic.NYC shirt?

Michelle: [00:24:07] No, I was not. No, I was not. No. One was before schizophrenic.NYC existed and one was after. And then after that, they found me on Facebook or Instagram. Me was like, okay. He’s like. And then he finds that I had some. He said that he thought he might have known, but he wasn’t really sure because he was like at one point he did seem he I was talking to myself and he goes. I don’t know who you’re talking to, but I’m over here. And I was like, oh, I’m sorry about that one.

Gabe: [00:24:34] And let’s be very, very clear. I feel the need to put up like a giant disclaimer. Gabe Howard and Michelle Hammer never, ever had sex with their own medical providers. They’ve always been perfectly appropriate. That said, it does happen. So don’t. It would be wholly irresponsible of any practitioner to have sex with a patient.

Michelle: [00:24:57] Yeah.

Gabe: [00:24:57] And if you’re the patient, report it immediately.

Michelle: [00:24:59] Yeah. That should not happen. Don’t do that. Don’t do that.

Gabe: [00:25:03] That’s the kind of thing that will set you back.

Michelle: [00:25:04] Yeah, that’s a bad idea. Don’t do that. Don’t.

Gabe: [00:25:07] Yeah, don’t do that.

Michelle: [00:25:08] Don’t do that.

Gabe: [00:25:08] And we are talking about people who held that job, but they certainly were not ours. We were not their patient.

Michelle: [00:25:14] Yes, I was not. Not their patients. Not their patients. But if I could find a psychiatrist.

Gabe: [00:25:21] Thank you, everybody, for tuning into this episode of A Bipolar, a Schizophrenic, and a Podcast. We hope that you learned some small thing about hypersexuality. And if there’s anything that you can relate to, if there’s any message that we want to send, it’s that you are not alone. Michelle and I went through it. We got help. We’re thankful that we don’t have to go through it again. And we are now monogamous and enjoying sex. Not with each other. We will see everybody next week.

Michelle: [00:25:44] Let’s talk about sex, baby, Let’s talk about you and me. Let’s talk about all the good things and the bad things that may be. Let’s talk about sex. Let’s talk about sex.

Announcer: [00:25:54] Announcer: You’ve been listening to A Bipolar, a Schizophrenic, and a Podcast. If you love this episode, don’t keep it to yourself head over to iTunes or your preferred podcast app to subscribe, rate, and review. To work with Gabe go to GabeHoward.com. To work with Michelle, go to schizophrenic.NYC. For free mental health resources and online support groups, head over to PsychCentral.com. This show’s official web site is PsychCentral.com/BSP. You can e-mail us at [email protected]. Thank you for listening, and share widely.

Meet Your Bipolar and Schizophrenic Hosts

GABE HOWARD was formally diagnosed with bipolar and anxiety disorders after being committed to a psychiatric hospital in 2003. Now in recovery, Gabe is a prominent mental health activist and host of the award-winning Psych Central Show podcast. He is also an award-winning writer and speaker, traveling nationally to share the humorous, yet educational, story of his bipolar life. To work with Gabe, visit gabehoward.com.MICHELLE HAMMER was officially diagnosed with schizophrenia at age 22, but incorrectly diagnosed with bipolar disorder at 18. Michelle is an award-winning mental health advocate who has been featured in press all over the world. In May 2015, Michelle founded the company Schizophrenic.NYC, a mental health clothing line, with the mission of reducing stigma by starting conversations about mental health. She is a firm believer that confidence can get you anywhere. To work with Michelle, visit Schizophrenic.NYC.Podcast: Hypersexuality with a Bipolar and Schizophrenic

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How Trauma and Dissociation Disrupt Your Ability to Form Memories

This is an interesting article I found on: www.goodtherapy.org

See credits below.


“Memories warm you up from the inside. But they also tear you apart.” Haruki Murakami

We all know from popular drama (TV shows, movies, etc.) that traumatic events are often forgotten by the sufferer. People who experience a devastating event such as a car accident, natural disaster, or terror attack often cannot remember the incident. It’s also common not to remember what took place right before or right after the incident. In a similar way, many adults who suffered child abuse have difficulty recalling large chunks of time from childhood. In these cases, problems with memory can continue into adulthood as well, particularly when faced with emotional distress.

Our brain and nervous system have evolved to do spectacular things: we can read, write, make music, and contemplate the meaning of life. But the brain’s first and foremost duty is to keep us alive. When it comes to traumatic events, the part of our brain that protects our physical and emotional well-being takes control. In this process, the parts of the brain that are responsible for higher thought processes, such as forming and retrieving memories, are suppressed.

How the Brain Forms Memories

On a regular stress-free day, memories for facts are made and stored in three steps: acquisition, consolidation, and retrieval.

  • Acquisition occurs through the combination of sensory experience and emotion. The amygdala processes and interprets the experience so it can become a memory.
  • The hippocampus consolidates the experience and sends the information off to the appropriate place for storage (memories are stored all over the brain).
  • It is thought that retrieval of factual memories occurs as a function of the prefrontal cortex. When we want to think of a fact, such as the definition of a word, the prefrontal cortex retrieves it and we remember.

When we are confronted with life-threatening danger, the brain behaves differently. The amygdala sends an emergency signal to the hypothalamus, which in turn activates the fight or flight response. Corticosteroids are then released into the bloodstream in order to prepare the body for action. Blood pressure, heart rate, and respiratory function all increase to provide the body and brain with extra energy and oxygen. Our alertness increases, and our body is ready to move.

When this is happening, the amygdala inhibits the activity of the prefrontal cortex. When faced with danger, this is useful, as the prefrontal cortex operates substantially slower. While it is trying to work out what is happening, our body may be harmed. The quicker, action-oriented part of the brain enables us to respond rapidly and try to avoid danger. We act fast. Later, once we are safe, we have time to think. In respect to memory, the parts of the brain involved in memory formation are shut down when faced with a traumatic experience.

The activation of the fight or flight response prevents the parts of the brain responsible for creating and retrieving memory from functioning effectively. This is why we can forget what occurred around a traumatic event. In the case of ongoing trauma, such as with childhood abuse, ongoing problems with memory and the related process can occur, leading to what is understood as dissociation.

Dissociation and Memories

At the heart of dissociation is memory disruption.At the heart of dissociation is memory disruption. During dissociation, the normally integrated functions of perception, experience, identity, and consciousness are disrupted and do not thread together to form a cohesive sense of self. People with dissociation often experience a sense that things are not real; they can feel disconnected from themselves and the world around them. Their sense of identity can shift, their memories can turn off, and the connection between past and present events can be disrupted.

In understanding the human response to trauma, it is understood that dissociation is a central defense mechanism because it provides a kind of mental escape when physical escape is not possible. This type of defense is often the only kind available for children living in abusive situations. Posttraumatic stress (PTSD) and complex posttraumatic stress (C-PTSD) often go hand in hand with dissociation. In studies investigating the impact of PTSD and memory, researchers have found that people with dissociative symptoms have a greater impairment with both working memory and long-term memory.

Long-Term Impact of Memory Impairment

To understand the long-term impact of memory impairment due to dissociation, we need to look at the context from which it arises. Dissociation occurs as a result of ongoing trauma which is associated with chronic stress. A chronically stressed brain and nervous system have difficulty learning. The hippocampus, critical for memory formation and consolidation, can become damaged from ongoing exposure to stress hormones. Researchers have found that the hippocampus actually shrinks in people who suffer from major depression. In addition to the emotional impact of chronic stress and abuse, difficulties with learning and memory can occur as well.

Implications range from difficulties with academics to reduced on-the-job learning and performance. In terms of survival, the implications are serious, as we all need the ability to prepare for, find, and keep employment. Unfortunately, once a person frees him or herself from an abusive childhood, the effects can follow into adulthood in unexpected ways. A damaged hippocampus and overactive nervous system can make life more difficult than it has to be. Over time, self-esteem and confidence can be negatively impacted as well.

Fortunately, the prognosis of dissociation can be optimistic. Researchers have found treatment with antidepressants can increase hippocampal volume. Talk therapy and other therapeutic approaches that are designed to reduce stress and increase emotional resilience may also help.

If you are experiencing trauma or dissociation, you can find a mental health professional here.

References

  1. Bedard-Gilligan, M., & Zoellner, L. A. (2012). Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis. Memory, 20(3), 277-299. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22348400
  2. Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6(1), 27905. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439425
  3. Nuwer, R. (2013, August 1) Why can’t accident victims remember what happened to them? Smithsonian. Retrieved from https://www.smithsonianmag.com/smart-news/why-cant-accident-victims-remember-what-happened-to-them-21942918
  4. Özdemir, O., Özdemir, P. G., Boysan, M., & Yilmaz, E. (2015). The relationships between dissociation, attention, and memory dysfunction. Nöro Psikiyatri Arşivi, 52(1), 36-41. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352997
  5. Phelps, E. A. (2004). Human emotion and memory: Interactions of the amygdala and hippocampal complex. Current Opinion in Neurobiology, 14(2), 198-202. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15082325
  6. Rosack, J. (2003, September 5) Antidepressants may prevent hippocampus from shrinking. Psychiatric News. Retrieved from https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.38.17.0024
  7. Sapolsky, R. M. (2001). Depression, antidepressants, and the shrinking hippocampus. Proceedings of the National Academy of Sciences, 98(22), 12320-12322. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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