Post-Traumatic Stress Disorder: What Is It?

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Post-Traumatic Stress Disorder (PTSD) is an acute stress reaction after experiencing a traumatic event. Events could be a violent attack, a car accident, witnessing wars, famines, and other tragedies.

PTSD is especially common in war veterans, and, as such, there’s a great deal of support for those returning military professionals. PTSD is characterised by anxiety, depression, nightmares, trembling, hypervigilance, triggers that set off flashbacks, and flashbacks that feel like the trauma is happening again in real time. Those with PTSD are taught grounding techniques, and they will go on to get trauma-focused counselling from a highly trained practitioner.

People with PTSD present with a number of symptoms. The most commonly known are hypervigilance and flashbacks. People with PTSD often relive the traumatic event through distressing memories, flashbacks, nightmares, or intrusive thoughts. These experiences can be vivid and intense, causing extreme emotional distress.

Flashbacks will feel like a person is reliving the traumatic event in reality. It can be very unsettling for a person and they may become overwhelmed with emotion. Flashbacks appear so real that a person sees, feels, hears and smells the things they did at the initial trauma.

 Individuals with PTSD may try to avoid reminders of the trauma. They may avoid certain places, people, or activities, and may also experience emotional numbness, which can manifest as feeling detached from others or unable to experience positive emotions.

Because a person has went through such a traumatic time, they may avoid situations that remind themselves of the event. They may stop going out, hiding away at home, fearing that they will be attacked if they leave the safety of their home. Avoidance can be very limiting for a person with PTSD and can actually reinforce the symptoms in the long run.

Those with PTSD can be constantly on edge. They may be easily startled, have trouble sleeping, experience irritability, and have difficulty concentrating. This heightened state of arousal can be exhausting and makes it challenging to function normally. Hyperarousal is also known as hypervigilance and can leave a person on edge, always on their guard for the next unsettling event.

Individuals with PTSD may have persistent negative thoughts and feelings about themselves or the world. They may blame themselves for the traumatic event and lose interest in previously enjoyed activities. Those with PTSD will present with low mood and anxiety. They may also experience insomnia as a result of the mood changes.

To be diagnosed with PTSD, these symptoms must persist for at least one month and cause significant impairment in daily life, including work, relationships, and overall well-being.

Treatment for PTSD typically involves psychotherapy (talk therapy), medication, or a combination of both. Effective therapies for PTSD include Cognitive-Behavioural Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and exposure therapy. Medications, such as antidepressants and anti-anxiety drugs, can help manage some symptoms. We will be discussing more on this later.

A bit About Growth

In the US army, where many of the 1.1 million employees may suffer trauma, it is also relatively common for some to experience post-traumatic growth. They become better people after the traumatic event than what they were before the event. On one end of the spectrum are people that experience PTSD symptoms, anxiety, depression, and even suicide, then in the middle there are those that experience PTSD and then recover returning to normal after a month or so, then there are those people that experience all the symptoms of trauma, but then eventually recover better than what they were before the traumatic event. So, while PTSD can be a consequence of such trauma, doing better than ever is also something that may happen.

Consequences of Childhood Abuse and Neglect in Adulthood

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Things that happen in childhood can have devastating consequences, long term effects lasting well into adulthood. As occupational medicine deals with the working lives of people, practitioners need to be aware that people have pasts.

There are certainly a number of consequences of childhood abuse. These include emotional difficulties, mood disorders, personality disorders, unhealthy coping skills, relationship and intimacy problems and a sense of seeing the world as a place to be feared.

The long-term consequences of child abuse and neglect can be both chronic and debilitating. This is especially so when there has been chronic maltreatment, which is a recurrence of maltreatment over a prolonged period. Studies have shown that this can lead to worse outcomes than single episodes of maltreatment and abuse. However, for many survivors of abuse, they have often been exposed to more than one type of abuse. They may also be exposed to poly-victimisation, such as bullying by their peers. Those that have experienced poly-victimisation and abuse tend to have worse outcomes than those that have had a single episode of abuse. That said, any type of abuse, whether it is chronic or single, can leave lasting trauma for its survivor.

One of the worst consequences of abuse is complex trauma. This refers to traumatic symptoms that encompass multiple disorders and adverse experiences. A person may have Post-Traumatic Stress Disorder (PTSD) and depression and anxiety. They may also develop agoraphobia, which is a fear of leaving their safe space (usually their home). There are complex trauma services to help survivors of abuse or maltreatment and they offer highly specialised trauma-focused therapy.

Other factors that impact on survivors of abuse include:

· The age of the individual when they experienced the abuse

· The developmental stage they were at at the time of maltreatment

· The severity of the abuse

· Type or types of abuse

· Survivors perception of the abuse: do they self-blame, feel shame, were blamed by others?

· The relationship the survivor had with their abuser

· How the abuse was discovered

· Protective factors for the child. Do they have family or peer support?

· Whether they have therapy to help

While most survivors of abuse do not go on to abuse others (i.e. their own children), those that were abused as children are at increased risk of abusing others, and of being abused again themselves. The former is known as intergenerational abuse and the latter is known as re-victimisation.

Studies have suggested that those who were abused as children are more likely to be abused as adults. Women, in particular, are at risk of re-victimisation. Studies also suggested that those who were abused as children had a higher risk of experiencing sexual assault and abuse, stalking or kidnapping and having a friend murdered or commit suicide. Those that were abused or witnessed domestic violence as children were more likely to experience low self-esteem, which is a risk factor in being the victim of violence. They may also think that violence is a normal response to conflict.

Adults that have experienced childhood maltreatment are also at increased risk of physical health problems such as diabetes, headaches, gynaecological problems, hepatitis, heart disease, arthritis, gastrointestinal problems, and stroke. There may also be neurological and musculoskeletal problems too. The reasoning for these poor health outcomes is unknown, but some researchers have speculated that it is a result of stress compromising the immune system or that adult survivors engage in risky behaviours and may make poor health choices.

It goes without saying that poor mental health is a consequence of child abuse and maltreatment. A wide range of mental health disorders have been associated with childhood abuse, and these include PTSD, ADHD, personality disorders, anxiety and depression, dissociative disorders and psychosis. Depression is seen to be the most likely outcome, but many survivors also experience PTSD.

There is a lot of evidence highlighting the link between suicidal behaviour (attempts and ideation) and childhood abuse. Both eating disorders and obesity are also common amongst those that have been abused. Alcohol and substance abuse are also problematic and may be linked to self-medicating and unhealthy coping skills.

Aggression, violence and criminal behaviour are other consequences of childhood abuse, with anti-social personality disorder being a possible psychiatric issue. One issue is that those that witnessed family violence may also use violence to handle conflict, thinking this is normal behaviour. High-risk sexual behaviour is another issue, with many of those that experienced childhood abuse at greater risk of promiscuity. Issues around passiveness, feeling unworthy and needing affection and acceptance may be linked to high-risk sexual behaviours. Those that were abused as children are also more likely to be homeless. They may have difficulties securing employment and have poor academic achievement, as well as worse mental health outcomes that leave it difficult to lead a stable, functioning life.

Neurological changes to the brain at key developmental stages can be linked to worse health outcomes later in life. A child is highly vulnerable, not least because they are young and scared, but because this is a time of great brain development. Neural pathways are being developed and the child is learning key things about the world that will form the lens they see the future with.

Some scientists have looked into the neurological changes in the brain of those that have experienced abuse. Several brain regions have two periods of key sensitivity; one in early childhood and one during puberty. It is said that ‘the brain wires itself up for adulthood based on experience in childhood.’ The amygdala, the emotional capital of the brain, has shown heightened vigilance to stress in EEGs. There are also structural differences in the brain between those who have been abused and those that have not, including a smaller sized hippocampus; the memory processing part of the brain. Various other changes can be seen, for instance, in the reduction of grey matter associated with those that have experienced verbal abuse.

As you have read, there can be lasting changes for those that are survivors of abuse. Those working with individuals with mental health disorders that have a history of past abuse should take account of this when helping them find work or vocations. Measures need to be put in place to help those that are experiencing trauma manage their symptoms.

Acceptance and Commitment Therapy: An Overview

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Acceptance and Commitment Therapy is also known as ACT and is an approach to counselling that was originally developed in the early 1980s by Steven C. Hayes. It rose to prominence in the early 2000s when Hayes collaborated with Kelly G. Wilson and Kirk Strosahl.

ACT seeks to help clients transform their relationship with difficult thoughts and emotions through the acceptance of these and emotions. ACT sees these thoughts and emotions as being a normal part of life for much of the time, and, rather than avoiding them, clients should show compassion and allow the thoughts to pass freely. It is avoidance of these thoughts and feelings that is the problem, not the thoughts and feelings themself. Clients present to counselling with issues because they are avoiding the difficult thoughts and emotions, and by suppressing difficult thoughts and emotions, they only make them worse.

Have you ever tried not to think of a pink elephant? What do you see? A pink elephant!
ACT is based on this premise. The more we try to NOT think of something, the more powerful it can become in our minds. ACT practitioners do not seek to eliminate or change a client’s thoughts or emotions, but instead seek to help the client view these thoughts and emotions for what they are – pieces of language and transient psychological events, not external “truths”.

“Unlike more traditional cognitive-behavioural therapy (CBT) approaches, ACT does not seek to change the form or frequency of people’s unwanted thoughts and emotions. Rather, the principal goal of ACT is to cultivate psychological flexibility, which refers to the ability to contact the present moment, and based on what the situation affords, to change or persist with behaviour in accordance with one’s personal values. To put it another way, ACT focuses on helping people to live more rewarding lives even in the presence of undesirable thoughts, emotions, and sensations.”-(Flaxman, Blackledge & Bond, 2011, p. vii).

 ACT practitioners encourage clients to approach problematic thoughts and beliefs and to be psychologically flexible, mindful and open. They use a range of mindfulness and acceptance-based strategies that also borrow from both cognitive and behavioural therapy approaches, and focus on a two-pronged approach: 1) helping clients develop acceptance of any unwanted thoughts and emotions and 2) committing to taking action towards living a valued life.

The basic principles of ACT

There are a number of causes of psychological distress, as suggested by the ACT model. Cognitive fusion is a term used in ACT that refers to when an individual allows their thought processes to have an excessive influence over their behaviour. The individual becomes so caught up that they become disconnected from the present moment.

During a state of cognitive fusion, a thought can seem like it is a fact and that you must obey it. Some people feel that they need to get rid of these thoughts or emotions straight away and that they command their immediate attention. Cognitive fusion is problematic because it prevents the individual living in the here and now and experiencing the present moment.

The term, experiential avoidance is used to refer to the process of engaging in strategies of avoidance and, while these strategies are effective in the short-term, they restrict an individual’s choices and usually lead to reinforcement of these problematic thoughts in the long-term. The more a person focuses on avoiding their thoughts and feelings, the more restricted their life becomes. Similarly, when a person focuses on avoiding these negative thoughts, they remove their focus from enjoying the present moment. The more energy being used on getting rid of these negative thoughts, the less energy they have for focusing on personal inner experiences and the world around them. The more energy spent on being fused, the less they have for being psychologically present. When individuals are psychologically fused, they focus too much on the past (ruminating) or the future (worrying). The goal of ACT is therefore to help clients improve their psychological flexibility so that they can be psychologically present and enjoy the moment.

The Six Core Therapeutic Processes According to ACT

The six core psychological processes that help people increase their flexibility are known as the ACT Helaflex and include the following:
  • Cognitive Defusion.
  • Acceptance
  • Contact with the present moment
  • Values
  • Committed Action
  • Self as Concept

Cognitive Defusion

Cognitive Defusion is also simply known as defusion and is the process of learning to detach ourselves from our thought processes. We simply observe them for what they are- transient private events that stream through our consciousness and are ever-changing. When an individual is defused from their thought processes, they are no longer controlled by them and do not get caught up in trying to change or control them.

Acceptance

This is the process of opening oneself up and also allowing room for unpleasant feelings, sensations and urges. This means the individual does not struggle with these unpleasant private events, but, instead, begins to accept them as a normal part of life. By releasing oneself from battling these unhelpful thoughts, the individual goes on to free themselves to enjoy the present moment.

Contact with the present moment

In this process, the individual becomes “psychologically present” and brings their full attention to the here and now. Because we have the ability to think about the past and the future, this can sometimes make it difficult to stay present in the current moment. Staying present in the moment is imperative to enjoying life.

Values

Therapists help clients identify their values, for instance, what is important to them. This is a central component of ACT and it assists the client to highlights things that are important and meaningful to them. It focuses on helping a client live out a truly authentic life.

 Committed action

Once the client has identified what is important to them (i.e. through identifying their values), they can then make steps towards living out these values, even in the face of unpleasant thoughts and emotions. Behavioural interventions such as goal setting, exposure, behavioural activation and skills training are used to help the clients take positive steps.

Self-as-context 

This is also known as pure awareness or the observing self, and creates a distinction between the observing self and the thinking self. The thinking self refers to the self that generates thoughts, beliefs, memories and judgements, whereas the observing self is the self that is aware of what we think, feel, sense and do. When we are aware of the observing self, we are able to step back and be mindful, thus separating ourselves from the thoughts, beliefs and memories that we have.

Each of these processes contribute to psychological flexibility.

The aim of ACT is to increase our psychological flexibility by using the above processes. The greater our ability to be full conscious and mindful, the better we are at tackling life’s problems and challenges. By embracing life, we become filled with vitality, which is a sense of being fully alive and embracing the present moment.

The six core components of the Helaflex are split into three types of functions. Both acceptance and defusion focus on separating thoughts and feelings, seeing them for what they are- just thoughts and feelings, and allowing them to come and go on their own accord. Values and committed action involve facilitating growth and directing the individual towards living out their authentic goals. While, self-as-context, and contacting the present moment are focused on making contact with the verbal and non-verbal aspects of the here and now. The psychological flexibility can be summed up as “be present, open up, and do what matters” and the ACT acronym is very useful for helping clients do this.

  •  A- Accept your thoughts and feelings
  • C- Choose a valued direction
  • T- Take action
Essentially, we must encourage clients to accept what is out of our personal control and take action to make positive changes that align with the client’s values.  “ACT is not about trying to reduce, avoid, eliminate, or control these thoughts and feelings. It’s about reducing their impact and influence over behaviour in order to facilitate valued living” (Harris, 2009, p. 61).
 
ACT in a Nutshell
The ACT in a nutshell exercise is a metaphor used to demonstrate the psychological processes underlying a client’s suffering and how ACT works. The therapist’s role here is to understand the psychological fusion that affects the client’s ability to be present and in the moment. When using any of the hexaflexercise techniques or metaphors, it is important to take the time to master them and also practise reading them allowed. Sharing these techniques often requires a slow, soothing voice. Recording and listening back can be very helpful here.

Mindfulness for Depression and Anxiety

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Jon Kabat Zinn is said to be the forefather of modern mindfulness. He is the man responsible for bringing this Eastern practice to the West. He defines mindfulness as:

“paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally. It’s about knowing what is on your mind.”

One of the first studies that Kabat-Zinn performed was in 1979 where he recruited chronically ill patients who were not responding to mainstream treatments for mental ill health. Kabat-Zinn’s study allowed for participants to participate in his eight-week stress reduction program, which he called the Mindfulness-Based Stress Reduction (MBSR). This proved successful and has since seen a substantial body of research providing more evidence of its efficacy. The research shows that mindfulness can improve mental and physical health comparably to other psychological interventions. Furthermore, mindfulness offers clients the ability to self-teach and use the tools anytime anywhere.

Everyone will experience restless nights and lack of sleep on occasion. However, if sleep is disrupted for weeks or months, insomnia can become a nightmare. Sleep disorders such as sleep apnea require medical attention as they can really reduce the quality of life of the individual suffering, but for those suffering from insomnia, anxiety can be the root cause.

There are different types of insomnia. Chronic insomnia is where there is disturbed sleep for at least 3 days a week for more than 3 months and it affects around 7-13% of the population. Genetics, environmental issues, and long-term stress can be the cause of chronic insomnia. Primarily older people, “worriers”, and females, tend to be more at risk. Also, those with health complications such as obesity can be at further risk. The above factors, plus a stressful situation may be enough to cause a good sleeper to develop insomnia. Similarly, adrenaline pumping events can also influence sleep.

Once a sleep problem has begun, a person may worry about being unable to fall asleep which can cause the cycle to continue. The more a person is worrying about not sleeping, the worse their problem gets. Rather than counting sheep, mindfulness can help with insomnia by breeding an awareness of what comes into mind from paying attention to the present moment and being nonjudgemental of thoughts.

Mindfulness can help us let go of the past and stop worrying about the future. It is essentially embracing the thought, showing compassion to it, and letting it go. Jon Kabat-Zinn noticed a marked improvement in sleep quality for those that participated in mindfulness-based interventions. Mindfulness can improve sleep by breaking the cycle of rumination- unhelpful worrying-and worrying about not sleeping or having enough sleep. By letting go, clients can embrace the fact that sleep will come at its own time.

Practising relaxation in bed through mindfulness-based interventions can also be very beneficial, promoting both sleep, and energy for the following day. Mindfulness also reduces stress and anxiety and can break the vicious cycle whereby clients read electronic devices or watch TV before bed. This blue light interferes with the sleep-awake cycle by affecting the hormone, melatonin, and keeps people awake longer than they should be. Mindfulness and Chronic Pain and Depression Kabat-Zinn’s work also focused on how mindfulness can help those with chronic pain and depression.

Alongside his colleagues, Segal and others, Kabat-Zinn wrote the book The Mindful Way Through Depression, and states that by not focusing on the pain, worrying about it, or trying to eliminate it, chronic pain sufferers open up space to enjoy other happier and joyous life moments. Those with chronic pain will often agonise and worry about their health and suffering, often to the point that the stress and worry exacerbates symptoms. By opening up room where the patient does not focus solely on their pain and suffering, clients can then begin to enjoy small moments within the day and gradually more as they work their way through practising mindfulness.

In those that suffer from depression, Kabat-Zinn argues to start small and focus on breathing. They can eventually work their way up to tackling their negative emotions. What the focus is on is for clients to anchor themselves and so when a negative emotion comes to the surface it doesn’t automatically trigger a whole heap of associations for the person. These can render a person helpless and ruminate in their trauma. When the person is anchored and negative thoughts can leave easily, the person can mindfully choose a response to deal with the thoughts. They move from reactive to responsive and are in a much more controlled state.

Segal, a colleague of Kabat-Zinn, argues that when a person has received mindfulness training, their responses to sadness change. When someone without mindfulness training experiences sadness, a part of the brain that seeks to diagnose is activated. This causes the person to become overwhelmed because they feel far more than just allowing themselves to feel the feeling. In those that have received mindfulness training, the two parts of the brain are able to balance each other out and the person can respond in a more responsive, controlled manner. Research into the effectiveness of MBCT for those with chronic or potentially recurring depression have shown that MBCT is 43% effective in reducing relapse in sufferers of depression and is seen to be as effective as antidepressants. Furthermore, those that have done mindfulness training begin to see if as a way of life as opposed to a treatment.

How Gratitude Improves Our Health

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Gratitude can help us physically, psychologically, and socially.

Physically, gratitude can help boost our immune systems, lower pain and blood pressure, and have better sleep. Gratitude can also build positive emotions, we feel more alert, experience more joy and pleasure, and feel more optimistic. It boosts our social lives through being more helpful, generous, compassionate, forgiving, feeling less lonely and isolated too. We become more outgoing and friendly when we experience gratitude.

The Two Stages of Gratitude

According to Dr. Robert Emmons, the feeling of gratitude involves two stages. The first one is that we acknowledge the goodness in our life. At this stage, we realise that life is good. The second stage is that we acknowledge the source of goodness lies outside of us. We are then grateful for other people, animals, blessings that have come our way.

We are grateful for the goodness in our life and where that source of goodness comes from.

Purpose of Gratitude

The purpose of displaying gratitude is that it boosts wellbeing and it also helps harness pro-social behaviour. Simply being grateful for being alive motivates us to seize opportunities. The idea that tomorrow is not guaranteed is motivating for many.

Being grateful and displaying gratitude is a selfless act. Gratitude is displayed without expecting anything in return. Displaying gratitude can be cathartic.

Reciprocity can also emerge as a result of displaying gratitude. While one does not expect an exchange from the act of gratitude, often it can spur the recipient of gratitude to reciprocate with a kind gesture. This leads to a social exchange known as ‘paying it forward.’

Trait or State?

Gratitude is regarded as a trait (dispositional) or state (how we feel). According to McCullough, Emmons, and Tsang (2002), gratitude is considered a character strength that can be used as part of everyday living, and it can be harnessed and developed (Peterson and Seligman, 2004). When emotion is displayed in response to another person’s expression of gratitude, this is called a state (Watkins, Van Gelder, and Frias, 2009).

Neuroscience and Gratitude

Functional Magnetic Resonance Imaging (fMRI) has been used in studies to assess the brain’s response to gratitude and has found that increased gratitude was associated with brain activity in the regions of the brain that deal with morality, reward, and value judgement. Gratitude is a social emotion that is linked to stress reduction, as an attitude of gratitude lowers levels of stress.

The Gratitude Letter:

Seligman, Steen, and Peterson (2005) asked participants to write a letter expressing gratitude to someone that had been kind to them, but who had never been properly thanked. The three steps to take in this gratitude letter are:

1. Identify the person that has done something important and wonderful for you, but you haven’t thanked properly.

2. Secondly, reflect on the benefits you received from this person and write them a letter expressing your gratitude for all they have done.

3. Finally, arrange to deliver the letter in person when you will both have time to talk about what you wrote.

Results have shown that those that wrote letters of thanksgiving had increased happiness for one month after writing the letter in comparison to a control group in the experiment.

Children can do this exercise to breed a heart of thankfulness.

Social bonds and relationships

Gratitude has also been linked to broader pro-social behaviour and benefits relationships. Barbara Fredrickson’s research into the Broaden and Build Theory (2004) highlights that anything that boosts positive emotions actually has an off-set response where further positive emotions are displayed. Happier, positive emotions, contribute to pro-social behaviour which means that we live out happier healthier lives, helping others, and building community. In a romantic relationship, gratitude serves to build a stronger bond, with less conflict. Being thankful for the things that your partner does only increases the amount they will continue to do. Feelings of gratitude have a reciprocal effect.

Gratitude not only boosts social wellbeing, but it increases career prospects too. It helps you manage better and cultivate better working relationships.

Understanding Neurodevelopmental Disorders: Autism, Aspergers, and ADHD Explained

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Autism and ADHD has been in the news quite a lot lately. With celebrities speaking out about their recent diagnoses, and long waiting lists for tests, social media has been rife with posts on this hot topic.

Autism and Asperger’s are disorders that impact on social functioning. They affect both children and adults alike, but less research is done on the adult population. Those that have autism or Asperger’s may have heightened intellectual capabilities, especially as they can focus on tasks very well, and often zone in on one particular topic, however, they may have problems with social functioning. But, what exactly are Autism and Aspergers?

The following are some of the characteristics and signs and symptoms of someone with Autism:

Characteristics of Autism Spectrum Disorders

• Social Difficulties

• Expressive and Receptive Communication Difficulties

• Restricted Repertoire

• Sensory Processing Difficulties

• Theory of the Mind

• Executive Functioning Issues

• Obsessions/ Rituals

• Compulsive mannerisms

• Self-stimulatory behaviour

• Withdrawal

• Self-injury

• Aggression

There are a number of areas that are associated with difficulty when it comes to Autism Spectrum Disorder and these areas include social life, being obsessive, black and white thinking, rigidity when it comes to schedule, not liking change, and difficulty regulating emotions.

Because individuals with autism may have sensory overloaded meltdowns, it is important that we are aware of some common stressors. These include unstructured time such as bus journeys, sensory overload such as chaos, noise, crowds and space, issues with organising and writing, and social events and changes. For this reason, it is best to make sure that the environment is as predictable as possible. Providing consistency and ensuring that the changes are voiced in advance can also be useful. You can reduce stressors by providing more enjoyable activities and decrease disliked and difficult tasks.

What is ADHD?

ADHD is a common behavioural disorder. It stands for Attention Deficit Hyperactivity Disorder. Those with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what is expected of them, but have trouble following through because they cannot sit still, pay attention, or focus on details.

Some of the signs and symptoms of ADHD include:

• Lack of attention

• Hyperactivity

• Inability to focus

• Poor concentration

• Interrupting people

• Disorganisation

• Risk taking behaviours

ADHD can be a comorbid disorder, and sometimes it presents with disorders such as Asperger’s or Autism. Comorbidity is characterised by two presenting disorders. When a person has more than two diagnosed disorders, we call that multimorbidity.

People with ADHD may be seen to “misbehave” because they have a different perception of a situation. They may also not know how to ask to get what they need. They may feel misunderstood, hungry, or feel the environment is too chaotic.

As you may have seen on social media, some people with ADHD and Autism diagnoses have been sharing how it is their superpower. While neurodiversity can come with some challenges in a non-neurodiverse world, those that have ADHD or Autism, when accepted and accommodated, do thrive and exceed expectations. In fact, many many people with these diagnoses do great things.

Recovering From Mental Illness: A Non-Linear Process

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Recovery is an individual process. It is unique to each individual. Treatments will vary from person to person, even if individuals have the same disorder. This is because physiological responses differ. While there are standard medication and treatment options, these will be tailored to cater to each individual’s needs. Recovery is not a linear process. Some people recover quickly, while others take time.

Recovery may mean different things to different people too. For some, it is about managing symptoms, while for others it is about eradicating all symptoms and returning to full health.

What Does Recovery Look Like for Minorities?

Recovery is not always straight-forward. While there are milestones, it is not always a linear process. One of the biggest issues in recovery is whether a person belongs to a community that stigmatises mental illness. If this is the case, help-seeking behaviours will be compromised.

We live in a multi-cultural society. While decades ago, standard treatments may have been used to help all people, nowadays this is not the case. Vietnamese communities, for instance, may not seek out help and hold the belief that the community will support the wellbeing of the individual. Other cultures may also stigmatise and shame those that have mental illness, thus people actively avoid speaking out. In Australia, for instance, the aboriginal community still faces stigma around mental illness.

There is still stigma that looks at indigenous populations as prone to joblessness and alcoholism. These wider views make it difficult for indigenous populations to seek help, and it has also affected them because they are less likely to be employed. Cultural associations and prejudice can cause great harm to minority groups. It impacts on their help-seeking behaviours, because they may feel misunderstood. There is also the fact that indigenous populations have their own communication styles, beliefs and values. If practitioners are not trained in cultural safety, then they may inadvertently offend indigenous people.

Research into Ethnic Groups Accessing Services

There have been some studies into ethnic and indigenous populations accessing care. These have brought about great reform and changes. Services acknowledge the need for cultural understanding and awareness and to train their staff in cultural safety. The movie, Rabbit Proof Fence, highlighted the generational stigmatising of aboriginals that led to the stolen generation. This has caused great distress to the indigenous population of Australia and practitioners need to be aware of that. A Eurocentric or western style of healthcare is not always fitting to indigenous or ethnic people, so the workforce also needs to reflect the community more. There is a greater need for CALD professionals because of this.

It is important for practitioners to avoid a one-size fits all model for conceptualising mental illness. Training in mental health has often focused on a western perspective, but many cultures conceptualise illness differently. For some, mental illness is spiritual and dealt with by community spiritual leaders. Practitioners need to acknowledge the unique and diverse ways minority groups conceptualise their health. The person-centred approach is best for acknowledging the values and beliefs of each individual.

Beyond a Medical Model: Working with Diversity in Mind

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In their work, Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research, Kleinman, Eisenberg and Good (1978) used the term ‘explanatory model’ that defines how patients conceptualise and construct their illness.

Conceptualising illness is an important facet of understanding the patient’s point of view, i.e., what their illness means to them. It offers up opportunities to reject a wholly biomedical model and opt for a holistic and person-centred approach that considers broader cultural perspectives. People from different cultures often conceptualise their illnesses and mental health in differing ways and these explanations may be counter to common western thought, thus isolating them from a wholly western model of care.

It would be advisable to not only gain an understanding of cultural conceptualisations of distress, but to understand that ethnic communities may conceptualise their illness in many ways. In fact, ethnic communities should not be treated as a homogenous group with a one-size fits all approach. But rather, a person-centred approach that understands the broader cultural dynamics at play, however, treats the patient as an individual with their own perspective.

Studies on conceptualisations of schizophrenia among four ethnic groups have found a range of formulations, for instance. They found that Bangladeshi and African-Caribbean groups attributed schizophrenia to social causes and the supernatural and this in turn impacted on the treatment they wanted. This also meant that these communities were seen to less likely to have insight into their mental health because their conceptualisation did not fit within the biomedical framework. This in turn meant these communities were more likely to be dissatisfied with treatment.

Help Seeking Behaviours in Ethnic Minority Groups

There have been a number of studies on help seeking behaviours in ethnic minority groups (Cochrane and Stopes-Roe, 1981; Bécares and Das-Munshi, 2013; Sue et al, 1991; Sheikh and Furnham, 2000, to name a few). Because of the number of different ways ethnic minority groups conceptualise their distress, studies have shown a number of help-seeking behaviours. Help-seeking has been linked to levels of satisfaction with services and number of previous hospital admissions, as well as how communities conceptualise their mental health. However, a study in the late 1980s found that African-Caribbean people were in receipt of an inferior level of care in the UK and were less satisfied with mental health services. Further to that, Asian communities were less likely to seek help because they were more likely to seek help within their community. Families of Chinese patients with Schizophrenia either attributed the disorder to internal or external events depending on social class.

Muslims were more likely to attribute their mental illness to the supernatural and found prayer was a way of overcoming distress. Some communities such as Indian migrants were less likely to suffer distress and seek help and other studies found a correlation between an increase in mental health disorders between White Irish people with each ten percent reduction in that community’s density. Problems arise when people from BME communities live in relative isolation and it would be beneficial to have an alternative way of accessing care.

Interventions for the Hard to Reach

Studies show that barriers to accessing care are linked to stigma attached to mental health problems and that some communities do not identify with what services are offering them. Further barriers to accessing care have been previous experiences of care, whether there is a mutual understanding between professional and patient, and language and communication barriers.

Given that there are a number of reasons why people from minority groups do not access care, a more pluralistic approach would be advisable. Firstly, interventions need to be more community-centred, with a wide range of cultural knowledge used to gain a better understanding of the needs of the individual from that community. Acknowledging the diversity within these communities has also been recommended. Further, reaching isolated individuals within communities is suggested because of the paradoxical nature of being a part of a community. The community can be both a site of knowledge of services, yet the place that hinders care through narratives of stigma.

It is important to hear the voices of individuals belonging to these communities. This will ensure that the best possible interventions reach hard to reach communities, who in turn will help improve mental health services and medical care at large.

*References available upon request

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How To Prevent Tech Neck by An Occupational Physician

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Organisations are taking an active role in educating their staff on how to develop and maintain good posture. They are often doing this by showing employees how to use technology correctly. That being said, many of us, in our rush to complete tasks, often bypass the advice and slump at our desks. This, naturally, compromises our wellbeing.

Posture is important to both physical and mental wellbeing.

Bad posture can impact on our mood, causing us to feel worse. Pain can also lead to negative emotional outcomes. Just as there is a psychological feedback loop with facial expressions, there is one with posture. Bad posture leads to low mood and a low mood can result in bad posture. Standing up straight and working on posture can thus result in a better mood.

Bad posture can lead to headaches, stress and tension, and, over time, crippling back pain that needs further medical care. Working on bettering your posture can lead to better health outcomes.

Tech Neck and Using Gadgets

Tech (or text) neck is the name given when we tilt our neck while using gadgets like mobile phones, tablets, and so forth, in an unnatural position. Over time, this tilting of the head can lead to bad posture and cause headaches, back, neck, and shoulder aches. The tilting can also cause a change in the position of our necks because we are looking down at technology all the time.

More and more people are working longer ours and not switching off. They may sit all day at their desks and then sit on the couch catching up on work emails when they get home. Not switching off and taking time to exercise and stretch can further heighten the risk of developing tech neck.

Stretches You Can Do At Home

Taking time out of your working day to do some stretches and exercises is key to helping maintain good posture. You should also check on posture, ensuring you’re not slumping at your desk. Doing stretches, such as the exaggerated nod, can help prevent tech neck from developing.

Pilates techniques are also great at helping maintain good posture. The downward dog pose can be very useful and there are plenty of free video guides on YouTube. A simple walk outside and mindfulness can help you become aware of any slumping of the back and shoulders. Holding your phone up higher instead of looking down will also help prevent the tilting of your neck. Lifting it up to eye level will be incredibly useful in preventing slumping.

Just remember, prevention is better than cure. Doing simple stretches and making small changes will go a long way in helping you maintain good posture.

 

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We acknowledge the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples.