Should I Seek Help?

Author Article

“Doing it yourself is a fad in the United States.”  These were the first words in my first book in psychology, which I coauthored more than 40 years ago.  Turns out we were wrong.  Doing it yourself is not a fad, but a way of life in the U.S.  These days we have so many more resources available to help us help ourselves, including self-help blogs like this one.  And, of course, YouTube, which is a wonderful resource for training videos.  I’ve turned to YouTube to learn the basics of such tasks as caulking a bathroom tub and repairing a hinge on kitchen cabinets. There’s pride in doing things yourself, even if the quality of the work may not match that of a professional.  But I would draw the line at developing a winning tennis serve by following a self-instructional tutorial.  Sometimes a good coach is needed.  There is also a line to be drawn between using the Internet for self-help—even blogs like this—and seeking professional help.

My first book in the field focused on applying principles of behavior therapy to problems in living, from losing excess weight to smoking cessation to overcoming fears and sexual problems.  For many of the problems people encounter in their daily lives, behavior therapy offered practical solutions. This blog continues in that tradition, offering tips for changing your thoughts and attitudes to change your life.  We have explored how to rethink your responses to life’s twists and turns, and along the way offered tips on a range of troubling emotions, from overcoming worry and guilt to coping with fear and managing anger.  We applied the wisdom of ancient Greece to “know thyself” by turning inwardly to examine and evaluate our thoughts and beliefs, especially the negative thoughts that underlie emotional problems like anxietydepression, and anger. We confronted the two worthless emotions, worry and guilt—worthless because we don’t need to be wracked with guilt to recognize our mistakes and correct them or to be consumed with worry to take steps to protect ourselves from impending threats.

Self-Care Is Self-Help

With all this emphasis on self-help, we can lose sight of the importance of a basic principle of self-care—seeking help from others when help is needed.  But how do you know when going it alone is just not cutting it?  The benchmark clinicians typically use is whether problems are persistent and cause significant emotional stress or impair daily functioning.  If you regularly struggle to get out of bed and get going in the morning because you’re feeling down in the dumps, your state of mind is affecting your ability to function effectively.  If you can’t shake off intrusive worrisome or guilt thoughts, or if angry outbursts damage your relationships with others, or if you are continually on edge and can’t sleep at night or relax during the day, then it’s clear your daily functioning is impaired.

Where to Turn for Help

In the forty or so years I’ve been in practice, I’ve witnessed many changes in the field, including the emergence of cognitive behavioral therapy (CBT) as the leading modality of psychotherapy in use today. When I began my practice, psychodynamic therapists schooled in the Freudian and neo-Freudian traditions dominated the field. Today, there are many different forms of therapy and many different types of therapists, from psychologists and psychiatrists to mental health counselors and clinical social workers.  Some forms of therapy, like CBT, offer briefer and more problem-focused treatment approaches than traditional therapies, such as psychoanalysis.  CBT has become the treatment of choice for a range of psychological problems from phobias to social anxiety to insomnia, and evidence from controlled trials shows that CBT more than holds its own when stacked up against other therapies for treating depression and other emotional disorders and when compared to psychiatric medication.

Over the years, the field of psychiatry has become increasingly medicalized, as psychiatrists (medical doctors with specialized training in psychiatry) largely turned from practicing psychotherapy toward medication management. Though psychiatric drugs have important roles to play in the treatment of mental health disorders, especially so with more severe disorders such as bipolar disorder and schizophrenia, popping a pill does not help people solve problems in their daily lives or learn skills they need to change how they think or improve their relationships with others. Moreover, relapse rates are high when patients stop taking psychiatric meds, and for good reason, as these drugs help manage symptoms but do not address underlying emotional or interpersonal problems. On the other hand, patients can carry the techniques they learn in psychotherapy well beyond the course of treatment and continue to apply them in their daily lives.

Am I Ready to Reach Out?  A 10-Item Checklist

If you’re thinking about whether it makes sense to seek help from a professional, you may find the following checklist to be a useful guide. There is no set number of items that determine whether you could benefit from seeking help.  But as a general guideline, answering at least a few of these questions in the affirmative suggests it might be helpful to talk to a psychologist or other mental health professional.

Yes or No? (You be the Judge)

1.       Are my efforts to change my thinking or attitudes working?

2.       Do I continue to struggle with anxiety, depression, or other negative feelings that impact my daily functioning?

3.       Am I able to step back and examine my own thoughts, or would it help to have another person’s perspective?

4.       Do I give up too easily rather than persevere in changing my thoughts and behaviors?

5.       Are other people telling me I would benefit from “talking to somebody”?

6.       Are worries making it difficult to sleep or function effectively during the day?

7.       Am I avoiding situations out of fear or anxiety?

8.       Is my behavior affecting my relationships in negative ways?

9.       Do I find it difficult to make changes on my own or to stick with them?

10.     Might I work better with a professional than going it alone?

Finding a Therapist

If you do decide to seek help, select a therapist who best fits your needs.  Do you want to work with a therapist who uses psychological methods of treatment, such as a psychologist or counselor, or would benefit more from psychiatric medication prescribed by a psychiatrist?

Find a practitioner with the appropriate licensure and credentials—for example, a licensed psychologist, or a licensed psychologist holding advanced credentials (e.g., a Diplomate in Clinical Psychology awarded by the American Board of Professional Psychology, or ABPP), or a board-certified psychiatrist.  Find out whether your medical insurance covers mental health services (check it out with your health care provider) and whether are you covered for out-of-network providers.  As with other specialists, you may need to pay the therapist’s fee upfront and be reimbursed afterwards if the services are covered by your insurance plan, less any deductibles, co-pays, and so on.

Word of mouth is a good source for finding a therapist but be aware that what works well for one person might not work for another.  You might also “google” the practitioner to see if anything untoward turns up or ask your state licensing board if there are any complaints filed against the individual. Be prepared to ask a potential therapist a lot of questions, like whether the therapist is experienced in treating people with similar problems as your own, what specific form of treatment will be used and what evidence supports its effectiveness,  how long treatment is expected to last, what adverse experiences might be expected, such as drug side-effects, whether you are responsible for cancellation fees, and so on.  Licensed professionals will openly discuss these and other questions with potential clients.  If they balk, take that as a sign to look for someone else.

Whether you try going it alone or reaching out for help, the good news is that there is a range of effective therapeutic techniques that can help people live happier and more fulfilling lives.

© 2019 Jeffrey S. Nevid

5 Tips For Dealing With Adult ADHD

Author Article
For many of us, thinking about attention-deficit hyperactivity disorder (ADHD) still brings to mind that one distracted kid who couldn’t sit still in elementary school. But as we’ve learned more about the disorder, we’ve come to understand that there are a bunch of different ways that it may actually show up in our behavior (in other words, it can go way beyond simple hyperactivity). And, because the way ADHD manifests in women may not fit our stereotypes, women often don’t get diagnosed until adulthood.

Plus, treatment is complicated: It generally consists of therapy designed to help build organizational strategies and treat any other mental health issues, and may or may not include medication, so there may be some trial and error in getting it right. That means that many adult patients — about 38% of whom are women — are still looking for a way to deal with the disorder that makes sense for them.

“Our approach is different because we highlighted that ADHD is not just about inattention — it’s about inattention and over-focusing,” says Greg Crosby, MA, LPC, one of the authors of the just-released book Transforming ADHD: Simple, Effective Attention & Action Skills to Help You Focus & Succeed.

Translation: People with ADHD don’t just find it challenging to concentrate on activities they’re not interested in but are important for them to get done (e.g. finishing homework), it’s also especially hard for them to stop focusing on activities they are interested in (e.g. playing a video game). So, a major part of the book’s strategy is helping readers find ways to pair activities they’re particularly fascinated by with activities that aren’t all that exciting.

“There’s no need for the boring, mundane, and effortful to be a horse pill you just have to swallow,” explains Tonya K. Lippert, PhD, the book’s other author. “For instance, if you like being around others, do the task with somebody else. If a change of environment — a cafe where you can sit outside — will increase the pleasantness of the task, change your environment.”

But on your path to actually getting shit done, we all know there are a million potential distractions in the way. Below are five tips — based on Crosby and Dr. Lippert’s work and book — to help you stay on track.
1. Get a planner — for start dates, not deadlines.
“That could be a calendar, an app on your phone, or on your computer,” says Crosby. But, he cautions, one often overlooked hurdle to getting a planner is actually setting a date to begin getting it done. So, don’t just “get a planner,” make a plan to buy one at 9:30am tomorrow. And Dr. Lippert explains that a planner can serve as both your “second brain” so you don’t forget things, but also as an environmental cue to check on what you need to get done (and when).

2. Carve out time to wind down before bed.
One of the major elements of the book is finding ways to get enough sleep, including exercising during the day, explains Crosby, because sleep deprivation makes it harder to pay attention and regulate your impulses. To improve your chances of getting good sleep, he says, “you need wind-down time — at least 45 minutes of transition so that when your head hits the pillow you don’t start worrying.” That nighttime ritual can be anything that works for you. Maybe it’s taking a warm bath or listening to relaxing music. Ideally, this doesn’t involve your phone or laptop.

3. Be mindful about your worrying.
That whole worrying thing may be especially common among women: “Overall, the research shows that what accompanies ADHD and its expression differ between women and men,” says Dr. Lippert. “Women are likely to present as less hyperactive but more anxious than men with ADHD.”

If you find yourself becoming anxious, Dr. Lippert advises a mindfulness-based approach: “Recognize and call it by its name — anxiety or fear — and try to allow room for it non-judgmentally, even being curious about it and where you feel it,” she says.

4. Try to “surf” your urges.
For some people with ADHD, it may be difficult to control impulses, such as interrupting a conversation to interject with a point you’re really excited about adding. But these urges come and go in waves. So you can learn to “surf” those urges rather than obeying them immediately, explains Crosby. Again, this requires you to flex your mindfulness muscles: Simply notice when the urge arises and how it affects you physically and mentally — making sure not to judge it as good or bad — without acting on it. Or, if you must act on it, try delaying it until there’s a natural break in the conversation. You’ll still be building up your surfing talents, and your friends will feel less annoyed.

5. Plan with others efficiently.
“Couples have a lot of inattention problems without having ADHD,” says Crosby, “and if you add kids and ADHD to the mix, it can be a total nightmare of who’s doing what when.” So whether you’re figuring out weekend plans with your partner or team assignments in a work meeting, writing down the details — who’s going to do what and when — and putting them up somewhere you’ll see ’em can be a lifesaver. And, if possible, have “visual meetings” at the office in which you use things like Post-It notes, whiteboards, or index cards to visually organize the group’s discussion. Your colleagues will thank you whether or not they have ADHD — after all, we could all use a little extra organization.

The Perverse Link Between ADHD and Addiction

Author Article

Credit: Marine Corps.

While the exact number of adults with ADHD is unknown, it is estimated that 4% of the U.S. adult population is affected by ADHD. While most people can function very well and become successful despite their condition, ADHD is also associated with life-long impairments in several facets of life, including educational and professional achievements, self-image and interpersonal relationships. But one of the darkest sides of ADHD is its propensity for addiction.

Why ADHD can lead to substance abuse

Addiction is a global problem that affects people from all walks of life, irrespective of gender, financial status, skin color, sexual orientation, religion, or spiritual practice. According to the American Society of Addiction Medicine (ASAM), addiction is “a primary, chronic disease of brain reward, motivation, memory, and related circuitry,” which leads to dysfunctional behavior in order to provoke relief in spite of the negative consequences a person may attract.

“Addiction is an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death,” according to a characterization on the ASAM website.

It’s these changes in the brain that make addiction so dangerous, causing a person to lose control over his or her use of substances. This also leads to subsequent problems at work, in relationships, and with one’s sense of self-worth and esteem.

Some people are more vulnerable to addiction than others. One primary factor which specialists have identified are adverse childhood experiences, which create their own brain changes. Research has also identified neurological conditions that make people prone to addiction, ADHD being one of them.

Attention-deficit hyperactivity disorder (ADHD) is a syndrome characterized by persistent patterns of inattention and/or impulsivity and hyperactivity that is inappropriate for a given age or developmental stage. The exact causes of ADHD are still unknown but the evidence so far suggests that dopamine neurotransmission dysfunction is at least partially responsible for the disorder’s symptoms. This dopamine link may also explain why ADHD often co-occurs with substance use disorders.

Symptoms of ADHD across lifespan. Credit: ADHD Institute.

The risk of drug and substance abuse is significantly increased in adults with persisting ADHD symptoms who have not been receiving medication.According to one study, ADHD is associated with a twofold increase in the risk of psychoactive substance use disorder. In addition, it is estimated that more than 25% of substance-abusing adolescents meet diagnostic criteria for ADHD. A 2004 survey found that 60% of the adults with ADHD have been addicted to tobacco while 52% have used drugs recreationally.

“One of the strongest predictors of substance use disorders in adulthood is the early use of substances, and children and teens with ADHD have an increased likelihood of using substances at an early age,” Dr. Jeff Temple, a licensed psychologist and director of behavioral health and research in the department of obstetrics and gynaecology at the University of Texas Medical Branch, told Health Line.

Bearing all of this in mind, clinicians working with patients that suffer from both ADHD and substance abuse may need to use a different approach than they would normally. While the treatment literature for ADHD in patients with substance use disorder is not well developed, the emerging trend is that medications effective for adult ADHD may be effective for adults with ADHD and co-occurring substance use disorder. Exercising regularly and having behavioral health checkups during treatment are also important.

The key seems to be starting ADHD treatment as early as possible, before a person has the chance to develop a substance use disorder during his or her teens. Although there is no “cure” for ADHD, there are accepted treatments that specifically target its symptoms. However, it is essential that ADHD treatment begins when the patient is sober, so some drug or alcohol detox may be required before treatment.

“A conservative approach for treating co-occurring ADHD and SUD would be to begin treatment with a non-stimulant pharmacotherapy, but if an adequate response is not obtained, consider stimulant pharmacotherapy. The decision regarding the use of stimulant medications for a patient with ADHD and a co-occurring substance use disorder should be made on the basis of a broad clinical assessment and an individual risk-benefit analysis. For many patients, psychostimulants can be used safely and effectively; however, careful monitoring during treatment is essential to ensure prescribed stimulants are being used in a therapeutic manner, and in the case of worsening substance use or when faced with evidence of the diversion of prescribed medication, treatment should be discontinued,” according to researchers at the New York State Psychiatric Institute.

CBD Oil for Depression, Schizophrenia, ADHD, PTSD, Anxiety, Bipolar & More

Psych Central Article Here
By John M. Grohol, Psy.D.

You can extract more than 70 different components from a marijuana plant, technically known as cannabis sativa. Two of the most common constituents are delta-9-tetrahydrocannabinol (known colloquially as THC) and cannabidiol (CBD).

Because CBD is not as regulated as THC (though it may be technically illegal under federal laws), nor does it provide any accompanying “high” as THC does, it has become increasingly marketed as a cure-all for virtually any ailment. You can now find CBD oil products online to treat everything from back pain and sleep problems, to anxiety and mental health concerns.

How effective is CBD oil in the treatment of mental disorder symptoms?

Unlike it’s sister THC, CBD doesn’t have any of the associated negative side effects of tolerance or withdrawal (Loflin et al., 2017). CBD is derived from the cannabis plant, and shouldn’t be confused with synthetic cannabinoid receptor agonists like K2 or spice.

Because of its relatively benign nature and more lax legal status, CBD has been more widely studied by researchers in both animals and humans. As researchers Campos et al. (2016) noted, “The investigation of the possible positive impact of CBD in neuropsychiatric disorders began in the 1970s. After a slow progress, this subject has been showing an exponential growth in the last decade.”

Research has shown that CBD oil may be effective as a treatment for a variety of conditions and health concerns. Scientific studies demonstrate the effectiveness of CBD to help relieve some of the symptoms associated with: glaucoma, epilepsy, pain, inflammation, multiple sclerosis (MS), Parkinson’s disease, Huntington’s disease, and Alzheimer’s. It appears to help some people with gut diseases, such as gastric ulcers, Crohn’s disease, and irritable bowel syndrome as well (Maurya & Velmurugan, 2018).

You can find low-end and high-end CBD oil products. The most popular CBD oil product on Amazon.com retails for around $25 and contains only 250 mg of CBD extract.

ADHD

In a pilot randomized placebo-controlled study of adults with attention deficit hyperactivity disorder (ADHD), a positive effect was only found on the measurements of hyperactivity and impulsivity, but not on the measurement of attention and cognitive performance (Poleg et al., 2019). The treatment used was a 1:1 ratio of THC:CBD, one of the common CBD treatments being studied along with CBD oil on its own. This finding suggests more research is needed before using CBD oil for help with ADHD symptoms.

Anxiety

There are a number of studies that have found that CBD reduces self-reported anxiety and sympathetic arousal in non-clinical populations (those without a mental disorder). Research also suggests it may reduce anxiety that was artificially induced in an experiment with patients with social phobia, according to Loflin et al. (2017).

Depression

A review of the literature published in 2017 (Loflin et al.) could find no study that examined CBD as a treatment for depression specifically. A mouse study the researchers examined found that mice treated with CBD acted in a way similar to the way they acted after receiving an antidepressant medication. Therefore, there is virtually little to no research support for the use of CBD oil as a treatment for depression.

Sleep

Loflin et al. (2017) only found a single CBD study conducted on sleep quality:

Specifically, 40, 80, and 160 mg CBD capsules were administered to 15 individuals with insomnia. Results suggested that 160 mg CBD was associated with an overall improvement in self-reported sleep quality.

PTSD

There are two human trials currently underway that are examining the impact of both THC and CBD on post-traumatic stress disorder (PTSD) symptoms. One is entitled Study of Four Different Potencies of Smoked Marijuana in 76 Veterans With PTSD and the second is entitled Evaluating Safety and Efficacy of Cannabis in Participants With Chronic Posttraumatic Stress Disorder. The first study is expected to be completed this month, while the second should be completed by year’s end. It can take up to a year (or more) after a study has been completed before its results are published in a journal.

Bipolar Disorder & Mania

The depressive episode of bipolar disorder has already been covered in the depression section (above). What about CBD oil’s impact on bipolar disorder’s manic or hypomanic episodes?

Sadly, this has not yet been studied. What has been studied is cannabis use on the effect of bipolar disorder symptoms. More than 70 percent of people with bipolar disorder have reported trying cannabis, and around 30 percent use it regularly. However, such regular use is associated with earlier onset of bipolar disorder, poorer outcomes, and fluctuations in a person’s cycling patterns and severity of manic or hypomanic episodes (Bally et al., 2014).

More research is needed to see whether supplementing CBD oil might help alleviate some of the negative impact of cannabis use. And additional research is needed to examine whether CBD oil on its own might provide some benefits to people with bipolar disorder.

Schizophrenia

Compared to the general population, individuals with schizophrenia are twice as likely to use cannabis. This tends to result in a worsening in psychotic symptoms in most people. It can also increase relapse and result in poorer treatment outcomes (Osborne et al., 2017). CBD has been shown to help alleviate the worse symptoms produced by THC in some research.

In a review of CBD research to date on its impact on schizophrenia, Osborne and associates (2017) found:

In conclusion, the studies presented in the current review demonstrate that CBD has the potential to limit delta-9-THC-induced cognitive impairment and improve cognitive function in various pathological conditions.

Human studies suggest that CBD may have a protective role in delta-9-THC-induced cognitive impairments; however, there is limited human evidence for CBD treatment effects in pathological states (e.g. schizophrenia).

In short, they found that CBD may help alleviate the negative impact of a person with schizophrenia from taking cannabis, both in the psychotic and cognitive symptoms associated with schizophrenia. They did not find, however, any positive use of CBD alone in the treatment of schizophrenia symptoms.

Improved Thinking and Memory

There is little to no scientific evidence that CBD oil has any beneficial impact on cognitive function or memory in healthy people:

“Importantly, studies generally show no impact of CBD on cognitive function in a ‘healthy’ model, that is, outside drug-induced or pathological states (Osborne et al., 2017).”

If you’re taking CBD oil to help you study or for some other cognitive reason, chances are you’re experiencing a placebo effect.

CBD Summary

As you can see, CBD research is still in its early stages for many mental health concerns. There is limited support for the use of CBD oil for some mental disorders. Some disorders, including autism and anorexia, have had little research done to see whether CBD might help with the associated symptoms.

One of the interesting findings from research to date is that the dosing found to have some possible beneficial effects in research tends to be much higher than what is found in products typically sold to consumers today. For instance, most over-the-counter CBD oils and supplements are in bottles that contain a total of 250 to 1000 mg.

But the science suggests that an effective daily treatment dose might be anywhere from 30 to 160 mg, depending on the symptoms a person is seeking to alleviate.

This suggests that the way most people are using CBD oil today is not likely to be clinically effective. Instead, at doses of just 2 to 10 mg per day, people are likely mostly benefiting from a placebo effect of these oils and supplements.

Before starting or trying any type of supplement — including CBD oil or other CBD products — please first consult your prescribing physician or psychiatrist. CBD may interact with psychiatric medications in a way that is unintended and could cause negative side effects or health problems.

We also do not really understand the long-term effects and impact of CBD oil use on a daily basis over the course of years, as such longitudinal research simply hasn’t yet been done. There have been some reported negative side effects experienced in the use of cannabis, but it’s hard to generalize such research findings to CBD alone.

In short, CBD shows promise in helping to alleviate some symptoms of some mental disorders. Much of the human-based research is still in its infancy, however, but early signs are promising.

 

For further information

Reason Magazine: Is CBD a Miracle Cure or a Marketing Scam? (Both.)

Thanks to Elsevier’s ScienceDirect service in providing access to the primary research necessary to write this article.

 

References

Bally, N., Zullino, D, Aubry, JM. (2014). Cannabis use and first manic episode. Journal of Affective Disorders, 165, 103-108.

Campos, AC., Fogaça, M.V., Sonego, A.B., & Guimarães, F.S. (2016). Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacological Research, 112, 119-127.

Loflin, MJE, Babson, K.A., & Bonn-Miller, M.O. (2017). Cannabinoids as therapeutic for PTSD
Current Opinion in Psychology, 14, 78-83.

Maurya, N. & Velmurugan, B.K. (2018). Therapeutic applications of cannabinoids. Chemico-Biological Interactions, 293, 77-88.

Osborne, A.L., Solowij, N., & Weston-Green, K. (2017). A systematic review of the effect of cannabidiol on cognitive function: Relevance to schizophrenia. Neuroscience & Biobehavioral Reviews, 72, 310-324.

Poleg, S., Golubchik, P., Offen, D., & Weizman, A. (2019). Cannabidiol as a suggested candidate for treatment of autism spectrum disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 90-96.

21 Startling Facts That Everyone Should Know About Adderall

The More You Know…

Adderalllllll facts 👀