Living Together and Quarantine. Tips for Couples
Life as a couple is another aspect that has been affected by the coronavirus crisis. Spending 24 hours a day with your partner at home without other distractions such as work, daily routines and leisure activities outside the home can generate a tedious or even conflictive climate. This could highlight differences and create tensions in the environment different from those we are used to in our relationship.
Therefore, it is important to better understand this situation and seek to create a harmonious space at home, helping each other as a team to deal with the reality of social isolation and to cope with this crisis with mutual support.
There are some difficult aspects to endure when living as a couple, and they become even more challenging when going through a situation full of uncertainty, worries and temporary loss of our freedom among other losses that we are all experiencing at the present time.
After listening to some testimonies from the couples we attend, we are able to distinguish different dynamics during the quarantine. Some couples had “hidden” conflicts that have become apparent since they are spending 24 hours a day together. Other couples are enhancing the positive aspects of their relationship as their work-related stress and workload has diminished and therefore, they have more time and motivation to strengthen their relationship. There are some others that have come to the conclusion that the problem was not their relationship but the emotional burden they would take home when working outside.
There are some steps to follow in order to enhance the enrichment of the relationship during quarantine and are described below:
1. Assertiveness, Empathy and Communication
It is beneficial to be assertive when communicating with our loved ones and therefore it becomes essential during quarantine. We use assertiveness in order to communicate in a concise and safe way so we can reduce conflicts while we respect both our point of view and the other person’s. To do so, assertiveness requires “I” messages (For example: “I feel” instead of “You make me feel”), empathy (there is always a reason why they behaved as they did, even when we find it difficult to identify that reason), and detailing the situation or describing facts instead of making interpretations (for example: “you have left the dishes unwashed” instead of “you are trying to annoy me”). The last step would be to put forward suggestions so we can prevent the same conflict to happen in the future.
There is always a reason behind someone´s behaviour. By communicating and questioning the motives of those behaviours, we will increase our wellbeing and decrease the possible negative interpretations.
We have the right to be a little bit more anxious these days, but our partner might interpret our behaviour in a negative way if we don’t communicate. It will never hurt to say “Today I woke up a little upset, I am sorry if I am acting differently”. We have the right to feel negative emotions provided that we don´t behave in a hurtful way.
2. Happy diary and enhancing intimacy
We and our partners both usually try and do things for the other person. Communicating our partner that we really liked that little gesture he or she had with us today can be very beneficial. Our partner can do the same back. The only way to eliminate negativity is by introducing positive incentives and stimuli. We can also pay attention to all those positive things that had happened today thanks to our partner and communicate it to them.
Another way of introducing positive stimuli is by enhancing intimacy, for example by hugging each other more often, sitting closer to each other, holding hands while watching a film, …
3. Avoid perfectionism
It is not the right time to be perfect. It is completely normal to behave differently when we are feeling negative emotions or when we have completely transformed our routine. We are not perfect; we are human beings under difficult circumstances and therefore by being more flexible and understanding both with the other person and ourselves we can feel a lot calmer during this period of time.
To do so, we can use self-talk statements. Would we ask someone to be 100% perfect when they had just lost their freedom? We can say to ourselves something like: “This is a difficult time; we are both losing an overwhelming number of important things and I am trying my best considering my circumstances and abilities”. As human beings, we are constantly trying to improve and to become the best version of ourselves. If we are not doing that right now, we might consider our circumstances are stopping us to achieve our goals and that we are not to blame.
4. Time to ourselves
Sometimes we tend to think that the best relationship comes as a result of sharing all our spare time together. There are lots of activities and hobbies that we can share with each other, but some of them might only be enjoyable by one member of the relationship. We cannot expect our partner to like the same activities and to have the same attitude towards a specific hobby. At the end of the day we are different human beings with diverse preferences and desires and demanding our partner to meet all our expectations can be a source of unnecessary conflicts and become strenuous.
Having time to ourselves give us space to reflect and to manage our emotions in a healthier way, as well as time to process what is happening now and the opportunity to enjoy all those activities that are only enjoyable on our own.
For example, since your partner never used to go with you to the gym in the past, do not try for him/her to join your daily exercise at home these days. If, for example, your partner used to enjoy playing videogames but you´d rather read a good book, allow your partner to have that me-time. The reality is that we all need activities that make us feel happy so we are emotionally balanced and stable, and we do not need our partner to share all their time and activities with ourselves. We can also look for all those solo activities that make us feel good, on top of sharing other activities with our partner. It is crucial to be able to find happiness within ourselves too.
5. Emotional understanding
We can keep a record of what are we feeling (name of the emotion), how intense it is (from 0 to 10) and what are the strategies that will help us to alleviate those symptoms each day. When an emotion is understood and given solutions to, it eventually fades away. This can also help us for communicating our partners how we feel so we avoid possible interpretations of our behaviours.
For example, when we feel anxious, we can try to find out what we are worried about and make a list of possible alternatives or solutions to this worry. If the worry continues or it´s too intense after doing so, we can try to distract ourselves. Psychologists recommend to worry for just a little amount of time during the day.
If we are sad, we can make a list of activities that usually make us feel happier, for example watch documentaries, sewing, talk to our loved ones…
It is also important to understand and validate our partner´s emotions. Understanding the reason why our partner feels anxious or sad may not always be possible. We are different human beings and therefore we have diverse past experiences and different coping strategies. Our partner might have learnt other abilities and may be experiencing the situation from another perspective.
If you find yourself struggling after trying all these strategies, do not hesitate to get in touch with us. We offer psychological and psychiatric therapy in multiple languages.
Marta Gray
General Health Psychologist at Sinews MTI
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Quarantine in Children, what can we all do to mitigate the impact in the little ones?
In these difficult times, when the situation forces us to be isolated and stay at home; Children may feel like the most vulnerable in the family since many fail to assimilate the current state of day to day life in which their entire environment, routine and habits are affected. Their activities, sleep schedule, their games, hobbies, friends, neighbors, or schoolmates, every regular aspect of their life changed dramatically.
For parents it can be a difficult situation to cope with and it is very important to have the tools and techniques that help to cope with these circumstances, hence, the importance of being aware of the various methods to best deal with these family challenges.
According to the biopsychosocial model, humans’ beings are integrated by three main aspects biological (genetics), psychological (thoughts and emotions) and social (social context). Optimal development of the human being must contemplate their biological potential, adding the psychological aspects that define it, and integrating it in a social context where they can explore their potential until it is fully developed.
The social context is crucial to foresee the individual as an independent entity. From the first interactions with primary care-givers, human beings explored his social context and integrated it as a fundamental part of his being. These social interactions then expand first to their nearby family, and then to their interaction with peers until they form a proper social network.
School settings allowed the interaction with peers, in a routine, regular, and safely context, which let them explore their world based on such interaction.
Given the current situation,
What happens when children are forced to be socially isolated?
Due to the mitigating circumstances that accompany us at the moment because of the presence of the coronavirus (COVID-19), individuals have been forced to renounce the social part of their being, generating an imposed social isolation. They have not only been forced to isolate themselves socially but to stay locked up at home without being able to go out except to go shopping or take the dog for a walk. Likewise, their freedom has been restricted to the length of their houses, which have become offices, playgrounds, schools, gyms, spas, among many other things ...
Although we continue with our usual work from home, there is an imminent loss of the usual routine, fresh air, and daily movement. The necessity to go from one place to another; take the children to and from school, or to go to their jobs; has been eliminated, limiting their current field of action. Besides, everyone has to comply with their work schedule and other house activities, in the same physical space, adapting themselves day by day to new forming circumstances.
Another fundamental consequence is the forced distancing of our loved ones. People has lost the physical contact as the principal source of vital affection, essential for human beings.
How can parents support children in this vital moment? How can we mitigate these effects?
Managing this situation in the best possible way implies knowing the psychological impact that affects parents, in order to empathize with the emotions and the impact that these has on the little ones.
Parents should set an example for their children, adapting the information they share with them to their age; taking each day at a time talking honestly about the changes produced by their current situation.
Emotions like "exhaustion, detachment and anxiety" are natural and expected in the present context. As a consequence, feelings of irritability, apathy and nervousness in young children could arise, triggering behaviours such as insomnia, poor concentration, lack of academic performance, rejection to tasks that require cognitive effort, among other.
Parents should accept those emotions and let their children express their thoughts and feelings to help them cope with this situation. Parents must recognize these emotions in children, help them put it into words and calm their fears or concerns with accurate and precise information adapted to their age. Through the recognition of their own emotions, parents can share those feeling with their children, making them feel understood and supported.
Some positive recommendations to follow with children would be:
- Take advantage of one of their most potent tools their imagination, which stands out above us. Their imagination allows them to create, invent new games, have fun initiatives, applying their own "magical solution". With this, they found a hopeful perspective for the outcome of the current circumstances.
- Another enhancing ingredient is to use humour and laughter. Sharing good moments with them helps to activate feelings of well-being and pleasure, very much necessary at the present moment.
- Introduce and involve them in the chores at home, especially those that involve movement, stimulating their "self-concept". Let them find the ability to feel useful with their effort and work, as well as a fundamental part of their family. If teamwork is stimulated, the benefits could be tremendous.
- Encourage interaction through creative activities, physical exercise, playing instruments or painting. Use actions that maintain a balance between their mental and physical health. For this matter, new technologies could help them share their activities and keep in touch with classmates and extended family. Not losing contact with all their love ones, even though they have to do it through the screen.
- Resilience has led us to find initiatives to alleviate, not only social isolation but also the lack of clean air. Sharing balconies with neighbours has been one of the main initiatives to help people cope with social isolation. Through songs, applause and drawings, everyone has been able to participate in social interactions hoping for a speedy recovery, and an early return to their routines. Also, challenges have been created to share on social media, trying to generate positive social interactions with our loved ones and friends.
This particular circumstance has changed lives in multiple ways, learning to appreciate aspects and details taken for granted in the past, which has brought out the best in every person. Such circumstances would allow people to emerge stronger, not only at an individual level but as a society in general, setting a former precedent for future generations.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Covid-19 and Anxiety
Question
Ines, initially I didn’t feel too anxious about the coronavirus and the quarantine, but I’m finding that as time goes on, and with no end in sight, my anxiety level are rising. Do you have any suggestions on how to deal with the fear surrounding the current situation?
Answer
Over the last few days, as a result of the current situation regarding Covid-19, we have all been exposed to alarming information from a variety of sources. Feeling a bit afraid is, therefore, to be expected. However, we should ask ourselves: When does fear become excessive and unhelpful?
Fear and worry are natural human reactions in situations of danger or risk. They are necessary in order to successfully manage the physical and mental challenges presented by a dangerous environment. Fear allows us to better handle obstacles and problems; it prepares our bodies to deal with possible threats, and our minds to consider different future scenarios and potential solutions and strategies. From an evolutionary standpoint the role of fear is to improve our odds of survival.
However, there are instances in which fear and worry do more harm than good. In some instances these feelings can spiral out of control, and we can find ourselves in a situation where our natural reactions, meant to keep us safe, do us more harm than good. We know fear becomes unhealthy when it is no longer productive and creates excessive suffering.
In the present situation with the coronavirus, once we have taken all the necessary precautions to prevent infection, living in a constant state of anxiety has little benefit. We are dealing with an unfamiliar, but temporary, situation and the concern provoked by this uncertainty is what needs to be managed.
A continued feeling of fear and worry can have a lasting negative emotional impact. Worrying can initially provide us with a sense of control and relief, but it can have a detrimental effect in the long term. Some of the potential negative effects are: inability to stay focused, problems falling or staying asleep, muscular tension, restlessness, anxiety, irritability or fatigue.
If we are still worrying constantly about the Covid-19 despite having already taken the necessary steps and measures to deal with the situation, we should turn our attention to reducing the negative emotions we are experiencing; they are no longer of use to us.
Some strategies for reducing excessive fear and worry:
1. Avoid constant information seeking
Information helps us prepare for and navigate crisis situations. However, an excess of information can be counterproductive, as we may become overwhelmed with information which only creates anxiety. For this reason, it is important to limit the occasions in we seek out information regarding the virus to one or two times per day, rather than letting it become a constant behaviour.
2. Practice relaxation
There are a wide number of relaxation, breathing, and meditation techniques that help reduce physical, mental and emotional tension. They reduce the fight-or-flight response, create a sense of wellbeing and deactivate our constant mental loop. It is highly recommended that we practice these techniques in moments in which our anxiety levels might be higher.
3. Focusing on the present
In times of uncertainty, it is natural to worry about the different possible outcomes. When this process does not result in preventing or solving a problem, it is best to avoid letting our mind wander and contemplate the “what-ifs”. In order to do that, we can focus on the here and now. We can try, for example, to focus completely on a task or activity.
4. Remember the positive
When we are going through a difficult time and we feel vulnerable, it is important to remind ourselves of the things that are going well and that make us feel safe. In the case of the coronavirus, we must remind ourselves that this is a temporary crisis, that we are not facing it alone, but in a united and coordinated manner, using the necessary tools and procedures to combat it successfully.
5. Practice pleasurable activities
During difficult times, it becomes even more important to treat ourselves with enjoyable experiences. Everyone has a go-to treat: a nice meal, a warm bath, an episode of our favourite TV series, a call to a loved one, a nice book etc. The list is long and diverse depending on the person!
6. Good sleeping, exercising and eating habits
Having a balanced diet and sleep routine allows our body to maintain a state of stability and to be well rested mentally and physically. In addition, physical exercise releases tension and helps us focus on the present moment and our bodily sensations rather than being constantly in our heads. During the following days, we may have to avoid the gym, but we can still do simple workouts at home.
7. Maintain your usual routine
Although we might have to remain at home as much as possible in the coming days, it is important that we engage in our regular activities. Our routine is something we can control and that will help lend a sense of normality to our days.
8. Doing things we did not have time to do before
We may find ourselves with more time on our hands than usual and we can put that time to good use by reducing that long list of things we haven’t had time to do up to now (ironing, organising the closet, finally finishing that book or Netflix show etc.)
In conclusion, there are countless strategies that we can use to take the reins of our emotional state, which will positively impact how we handle the situation in the days to come!
Proofreading and editing by Gráinne Keeshan
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults and adolescents
Languages: English and Spanish
Why Do Therapy Online?
We are living in digital times. We send a Whatsapp message when we want to let someone know how our day has gone, after a long day we flop and the sofa and play Candy Crush on an iPad, we stay in touch using video chat to talk to far away friends and family, we write our to-do list on our phone and we google “how to (fill in the blank)”.
Despite technology being a part of our everyday, when we think of online therapy it can seem a little strange or unusual. Having been a Clinical Psychologist for a number of years now and being accustomed to seeing patients in-person, I also had my own doubts initially: Is online therapy useful? Does it work? Is it as effective as in-person therapy? Science has this to say:
A study published in 2018 in the Journal of Anxiety Disorders stated that online Cognitive Behavioural Therapy (iCBT) is “effective, acceptable and practical”.
The study found that online Cognitive Behavioural Therapy is as effective as in-person therapy for disorders related to depression and anxiety (panic disorder, social anxiety, general anxiety etc)
In 2104, another study published in Behaviour Research and Therapy found that online Cognitive Behavioural Therapy (iCBT) is effective and less costly for anxiety disorders. The effects were shown to be long-lasting, with benefits evident a year after therapy had been concluded. Link
Also in 2014, a study published in the Journal of Affective Disorders compared the efficacy of online and in-person therapy and found that online therapy is just as beneficial as in-person therapy. Link
Armed with this information, I decided to begin seeing patients online and have since had the opportunity to treat a large number of clients who, for one reason or another, were unable to, or preferred not to, undertake in-person therapy. These patients included students, travellers, expats, migrants and their children, people who were unable to leave their houses due to physical or psychological limitations, or those who, after a long day would like to have some “me-time” in the comfort of their own home.
Online therapy allowed these people to access the psychological support that would have been otherwise unavailable to them. Their experiences allowed me to identify and witness firsthand the benefits of online therapy:
- Location independent: It allows for freedom of movement. Sometimes, due to work, travel or other commitments, it can be difficult to attend in-person therapy.
- No travel required: It eliminates the time and cost of travelling to and from therapy.
- Continuity: As we can participate in a therapy session from anywhere, there is no need to stop or postpone my mental health care when I travel or move house.
- Flexibility: It allows me to choose from a wider timeframe when making appointments, making it easier to find a time that suits me and my therapist.
- Comfort: It allows me to participate in therapy from the comfort of my own home, or the place where I feel most relaxed and safe.
- Secure: Online therapy is facilitated by secure, encrypted platforms that guarantee that the information shared remains private and confidential.
- Immediacy: I can access the documentation shared with me by my therapist immediately.
Online therapy has understandably been growing in popularity over the last few years. With ever-increasing frequency we use the tools provided by technology and science to serve the most human of needs; connection.
Online therapy provides us with the opportunity to attend to our mental health, with the warmth and humanity of our therapist, from the comfort of our own home.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Interview with a Specialist in Family Therapy
How long have you been seeing families at Sinews?
I have been seeing families in therapy at Sinews since I joined the team in 2017. This is an element of my practice that I really enjoy as, unlike working one-on-one, working with the whole family paints a fuller picture of the some of the problems or history that has been faced. It allows the psychologist to “zoom out”, see the wider picture and access an abundance of information which is harder to get at through individual therapy.
What sort of problems are addressed in family therapy?
Family therapy can help address any number of issues, but it’s main focus is on difficulties in the dynamics between the family members. Family therapy can be most helpful when poor or little communication between family members results in conflict within the family, something which can cause much distress. Family therapy can be a great tool in helping to manage situations involving mental health diagnoses, substance abuse or addictions, behavioural problems or academic difficulties in children, a death or illness in the family, caring for a family member with special needs or an impending divorce or separation, especially when there are children involved.
Who needs to attend a family therapy session?
This depends on what is to be worked on in that session. In some cases, the whole family is invited to attend, but in others it might be preferable to see a specific subsystem within the family, like the parents, or just the mother and daughter. Before attending your first family therapy session, it might be a good idea to give the therapist, or centre you’ll be attending, a general idea of what difficulties your family is facing, and they can help inform your decision. Once in treatment, your therapist may have sessions will all or some of the family members as needed.
What if a family member doesn’t want to attend?
While family therapy can certainly benefit any family that wants to improve their dynamics or get support while going through a difficult time, this is only true if all family members who attend are able and willing. If one of the family members doesn’t want to come, it’s best not to pressure them. The family members who do come can learn skills that will benefit them, which in turn could have a positive impact on the family member who is not attending.
What does family therapy look like? How does it work?
Family therapy is a space that encourages and promotes healthy communication, which aims to create empathy, trust, and ultimately, a stronger bond within the family. It is meant to be a safe space for conflict resolution, forgiveness and stress-reduction. Sometimes this might be through dialogue, through play, or by learning new skills and applying them, inside and outside of therapy. The idea is for every member of the family to be able to express themselves openly, all the while reconstructing their story as a family unit.
Is there anything families should know beforehand?
Family therapy, just like any other type of therapy, is a process that takes time. There is no magic solution, especially considering that a family is made up of so many fluid and relational interactions. Each member should take the time to think about how and what they are willing to change and to take responsibility for and commit to it.
If you think your family, or a family you know, could benefit from family therapy, feel free to get in touch with the Sinews team for a consultation.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
What Exactly does the School Counsellor do? Can my Child Receive Therapy at School?
What Exactly does the School Counsellor do? Can my Child Receive Therapy at School? In the school context, there can be a wide variety of difficulties and challenges. Schools are, by nature, a very dynamic and complex environment. Students at the same school can have a wide variety of very differing needs, and it is of the upmost importance to provide them with the specific support they require.
There are many terms to describe the process of helping an individual overcome challenges and maximise growth, such as counselling, coaching or psychotherapy. The professional who is best placed to provide these services, such as counsellor, coach or psychotherapist, varies depending on the goals to be achieved, the approach or model used or the context in which they work.
Counsellor and Psychologist are the terms that are most often used broadly and interchangeably, and although both provide support and encourage healthy development and mental health, they take different approaches to achieving these goals. It's important to make this distinction to provide clarity and recognise the differences in the roles.
The main objective of the School Counsellor is to identify and address the social, emotional and behavioural needs of the school community (students, families, teachers etc) and provide the necessary emotional support, allowing everyone to have an optimal experience at school. The School Counsellor employs a consultation approach.
In the case of a School Psychologist, they work with an intervention approach, with a focus on understanding and intervening in the emotional and behavioural context, as well as with academic issues. This is done in a more exhaustive and specific way, analysing the problem through testing and assessing.
En otras palabras, los psicólogos escolares son los profesionales de la salud mental que están capacitados para evaluar y hacer un diagnóstico oficialmente, mientras que los school counsellors pueden sugerir que existe esa problemática y derivar a un psicólogo escolar para pruebas adicionales.
As we can see, the difference between these two roles is that generally school counsellors work at the level of the entire school community (students, families, teachers etc), while school psychologists tend to focus on working with individual students with more specific issues. In other words, school psychologists are the mental health professionals that are trained to test for and officially make a diagnose, whereas counsellors can only suggest those conditions exist, and make referrals to a school psychologist for additional testing. These two school-based professionals typically provide counselling rather than psychotherapy (Hess, Magnuson and Beeler, 2012). There are similarities between counselling and psychotherapy, such as the provision of a confidential space in which to explore personal difficulties or the effectiveness of the intervention depending, to a large extent, on the quality of the relationship. However, there are also important differences.
In general, we can say that counselling is a short-term service delivered to individuals or groups to increase their adaptive functioning. In the case of school counselling, the adaptive functioning is relative to the school setting. An illustration of a counselling intervention is when a student who is struggling in her peer relationships finds, with the help of the school counsellor, solutions to reduce the conflict.
Conversely, psychotherapy provided by a psychologist tends to be a longer-term practice, representing a deeper, more fundamental level of work, over a longer period. Also, the issues or concerns that an individual presents can be more serious and may reflect a pathology (e.g., depression, suicidal ideation, eating disorder (Hughes and Theodore, 2009).
However, this distinction does not mean that School Counsellors never work with students who have a diagnosable disorder. It just means that their focus is one of support rather than treatment. For example, a student may have a serious disorder (e.g. generalised anxiety disorder) but still be seen by a school-based professional who works with the student on strategies to manage the anxiety while he or she is at school in order to achieve academic goals. Ideally, the student is also working with an external therapist to manage the anxiety disorder.
Here, School Counsellors can play an important role by providing the family with a referral to a local therapist, by staying in close contact with this therapist, by reinforcing the student’s use of newly learned coping strategies, and by consulting with the student’s teachers as appropriate.
It is important to emphasise once again that the complexity of the issue to be treated in the individual student, and the goals to be achieved will require the intervention of one professional or another. As we have seen, school is not the right context in which to carry out a therapeutic intervention and similarly, the school counsellor is not the professional best placed to carry out such work. The School Counsellor does carry out interventions throughout the school community, which can complement therapeutic interventions. Many times the work carried out by the School Counsellor is preventive, increasing exponentially the welfare and health of the entire school community.
Bibliography:
Feltham, C. (1995). What is counselling?: The Promise and Problem of the Talking Therapies. Sage Publications Ltd
Henry, A (2012). How Do I Select a Therapist or Counsellor? Recuperado de https://lifehacker.com/how-do-i-select-a-therapist-or-counselor-5874359
Hess, R.S., Magnuson, S. and Beeler, L. (2012). Counselling children and adolescents in the school. Thousand Oaks, CA: Sage.
Wake Forest University (s.f.). What’s the Difference: School Counselor vs. School Psychologist? Recuperado de https://counseling.online.wfu.edu/blog/whats-difference-school-counselor-vs-school-psychologist/
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Depression After a Cardiac Event
Interviewer: How can we improve the quality of life in these patients?
The most important thing would be to treat depression, as it has been established that depression more accurately predicts quality of life than other factors, such as lifestyle or other comorbidities.
However, treatments that reduce depressive symptoms do not necessarily result in improved quality of life. Psychotherapy might be more effective as it directly targets general well-being.
A recent meta-analysis by Hofmann et al concluded that both psycho-pharmacological treatment and cognitive behavioural treatment improved quality of life in depressed patients. Specific interventions should include enhancing socialisation (as isolation is a risk factor), treatment adherence and self-care.
Interviewer: You mentioned before that there are specific measures to combat depression in patients who have suffered a cardiac event?
Fortunately, most hospitals now have cardiac rehabilitation programs, which are a crucial element in the recovery of these patients. They form an essential component of the comprehensive management of cardiac patients, largely to reduce the detrimental emotional, psycho-social, and physical consequences of cardiac events.
Interviewer: How should these patients be treated then?
These patients should be attended by a multidisciplinary team of coordinated professionals that include: a cardiologist, a rehabilitation specialist, nursing staff, a psychologist and a psychiatrist.
Interviewer: How is treatment organised?
Treatment can be divided into different areas, such as cardiac monitoring, physical exercise and mental-health treatment. Even though I will focus on the latter, let me just give some pointers about physical rehab. Exercise training is useful for these patients, not only because of the effects on the heart but also because it has an impact on mood.
It is known that supervised physical exercise reduces the rates of depression in patients recovering from a cardiac event and could even reduce the dose of antidepressant medication.
Psychological treatment is necessary for most of these patients for several reasons, the principal one being that it can be difficult to come to terms with a life-threatening experience and patients benefit from the guidance of a trained professional.
Interviewer: How are patients treated psychologically then?
Patients usually receive cognitive behaviour therapy (CBT) which, according to Beck and Dozois, aims to counteract psychological disorders or problems that arise from dysfunctional thoughts, feelings, and behaviours that develop early in life and can become activated in response to stress. Patients are trained to modify negative and distorted thoughts, change maladaptive behaviours, and develop new coping mechanisms and skills. CBT has been proven to be useful for depression after a cardiac event.
Interviewer: What about antidepressant medication? Is it safe?
Antidepressant medication is only used for those cases identified and diagnosed with major depressive disorder; they have proven to be an effective treatment for depression. When considering antidepressants, one has to bear in mind several aspects that include safety, tolerability and efficacy. There is evidence that while some medications have better efficacy, others have shown more tolerability.
Antidepressants are generally considered safe in cardiac populations, but different classes have been associated with different risks.
Almost all selective serotonin receptor reuptake inhibitors (SSRI) are safe as they have little effect on the electrical activity of the heart, except for escitalopram. In the benefit/risk assessment, it is clear that the benefits of treating depression with antidepressants in a patient recovering from a cardiac event is much higher than the risk of any side effects that could undermine their well-being. Overall, SSRIs have good efficacy in treating depression and, for reasons of safety, are the antidepressants of choice. All this said the importance of potential interactions between antidepressants and cardiovascular medications should be considered when treating depression in cardiac patients.
Interviewer: How would you sum up everything we have spoken about?
The key points would be:
• Depression frequently appears after a cardiac event and it has been linked with increased morbidity and mortality.
• Depression is an independent risk factor for cardiovascular-related death and all-cause mortality.
• Depression is often under-diagnosed and under-treated in patients with cardiovascular disease.
• To date, there is no specific test to assess depression in patients with cardiovascular disease.
• Compared with men, women have higher rates of depression and higher mortality rates after myocardial infarction.
• Antidepressants are generally safe, effective and well-tolerated.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Quality Time with Kids at Christmas
With the arrival of the Christmas Holidays, our family routine changes, both in content and in rhythm. We have a short break from set routines, never-ending school hours, homework, extracurricular activities and everything that we associate with school-time fades into the background. Giving way to a period of rest (both physical and mental), to relaxation and enjoyment and to the opportunity to spend some quality time together. Our job as parents does not come to a halt during the holidays but with this change in activities and in pace, new opportunities arise to educate our children. The holidays provide us with the opportunity to partake in fun activities with our children that during the rest of the year we are otherwise unable to enjoy.
These moments are necessary and something we should give more weight to as they strengthen the bond we have with our children and can help them in their personal development. In short, they can serve to satisfy some of the most basic needs that children have; to feel loved, protected and valued. These fun activities also provide an opportunity to continue educating our children in values, beliefs and codes of conduct that, once internalised, they will continue to use throughout their lives.
One example of these kinds of activities, which as well as being fun can also be educational, is to watch a movie together. There is a wide variety of movies to choose from and the one we ultimately choose depends on the message/s that we wish to transmit. One movie that I recommend is Wonder, based on the book by R.J Palacio that tells the story of Auggie Pullman, a 10 year old boy that was born with congenital facial deformities. The first 10 years of his life were spent between hospitals and staying within the confines of his house. The 27 operations that he undergoes allow him to see, talk and hear like everyone, but his face looks unlike that of any other 10 year old child. He has never been able to go to school, with his mother always home-schooling him.
Auggie has his parents and his older sister who love and protect him, but he is fully aware of his appearance and suffers when other people reject him. When his mother believes that the time has come for him to face the world and attend school for the first time, he is petrified, but at the same time holds out hope that he will be accepted and be able to live the life a normal child. The movie focuses on Auggie’s first year at school and narrates his experiences as well as the experiences of those around him. The environment and the situations that are described in the movie are real and relatable, allowing the audience to easily empathise with the different characters.
The movie touches on some very important issues such as bullying, friendship, the need to feel accepted, tolerance, respect, kindness, empathy, humour, strength in the face of adversity, the need to confront difficulties in order to overcome them and many other life lessons. The way in which the film is narrated by different characters permits us to appreciate the different interpretations of the same event and the impact that these events have on each person. In fact, although the central focus is on Auggie, the secondary characters also face difficulties and learn different life lessons over the course of the movie.
Wonder is a moving and touching film portrayed with sensitivity that will appeal to both children and adults. The story is so relatable that it encourages us to think about our own lives, it invites us to be more conscious of what is happening around us and, I believe, it even pushes us to try to be better people. In the movie, there is a quote by Wayne Dyer, a well-known American psychologist, made by one of Auggie’s teachers that sums up part of the message of this movie:
“When given the choice between being right and being kind, choose kind."
This movie can be used to discuss and to highlight some very important values. After watching it, we can start a conversation and ask questions which will help our children reflect on what they would do in these situations. For example: What would you do if someone new or different came to your class? How would you react? Would you think how difficult it must be for someone to experience something like that? Would you try to help them? How?
In fact, the movie can also help parents to be more attentive to the needs of all our children and not only to those that are in obvious need of attention and support.
While the Christmas holidays can provide many opportunities for fun and overindulgence, we can also ask ourselves where the opportunities for connecting and teaching lie. Watching a movie like Wonder together with our children is a magnificent opportunity to spend some quality time with them while at the same time transmitting fundamental values that will ultimately help them to become better people.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Happy Holidays! Is it all about the Presents?
Holidays, snow, decorated trees, family gatherings… and presents of course! It’s one of the loveliest times of the year, a picture many of us are familiar with.
We devote weeks to preparing, carefully planning the perfect, age-appropriate, intellectually stimulating, exciting, surprising, you-name-it gifts for our children. Unfortunately, the novelty soon wears off the best of presents, and all too quickly, with so many others to play with, many are forgotten.
So, how many toys should we really be giving our children?
Experts hesitate to put a number on the amount of toys children should have, however it is generally agreed that fewer toys are better than too many.
Through play children learn to interpret the world around them, enriching the development of their cognitive, emotional, social, and physical skills, and ultimately their well-being. An article published in 2017 in the journal, Infant Behaviour and Development states that “When given only four toys to play with, the children played with each for twice as long, thinking up more uses for each toy and lengthening and expanding their games, allowing for better focus to explore and play more creatively—qualities that benefit children in the long term”.
Children that have fewer toys to play with are obligated to use their imagination more. As a result, they are presented with the opportunity to look for and develop new skills and talents. Furthermore, when kids have too many toys, they give up too quickly on a toy that challenges them, replacing it instead with an easier option. In the process, they miss out on the opportunity to learn patience and determination. Those with fewer toys learn to take better care of their things, they also tend to spend more time reading, writing and creating.
Having fewer toys sets the tone for healthier habits, as children who enjoy an abundance of possessions give less value to the things they have and also tend to be less inclined to share.
The Holidays present an opportunity to spend quality time with family
Kathy Sylva, a professor of educational psychology at Oxford University studied 3,000 children from the ages of three to five and found that “those children with fewer toys, whose parents spend more time interacting with them, surpass kids with greater means for personal computers, video games etc., in several areas of emotional and social development.” The reality is that the positive effects a parent’s direct engagement seems to beat any toy or screen.
Happiness is derived from experiences, not things - let’s spend more time playing with our children!
Researchers from Cornell University found that, “People are more grateful, and even more generous, when they enjoy experiences rather than material gifts”.
Experiences can be far more enriching for kids than toys can. So, let’s use the money we might have spent on extra toys for a trip to a theme park, a local market, the cinema to see their favourite movie, the zoo, the aquarium, or picnic in the park.
Memories of the experiences children enjoy last much longer than the excitement of the toys they receive during the holidays.
Happiness is derived from experiences, not things - let’s spend more time playing with our children!
Sinews MTI
Psychology, Psychiatry and Speech Therapy
How to encourage autonomy in my child
A fundamental part of growing for children is to achieve full autonomy. This encourages their sense of responsibility, self-confidence, willpower and self-discipline.
Autonomy is the ability to adhere to norms without external influence. When children can decide which rules will guide their behaviour, they are able to do what they think should be done. Moreover, children must develop their moral conscience and reasoning to promote, not only their autonomy, but also their freedom, willpower and self-esteem.
What happens when children are forced to be socially isolated?
Building up children’s responsibility is a fundamental part of the acquisition of autonomy. For that, children need to understand the impact their actions, assuming the consequences of those actions. The consequences of their actions are learned through experience, so it is important for children to be allowed to make decisions, mistakes and discover situations on their own.
They need to realise that they are the captains of their existence and become their own motivational moto.
Therefore, children who develop the ability to be responsible are those who are able to assess a given situation according to their own experience and what parents expect of them, in order to make an appropriate decision.
For children to achieve autonomy it is important to take into account the following:
- Parents must know the abilities of their children understanding what they are able to do according to their developmental stage.
- Parents must give their children freedom. Understanding that there is a continuous learning process.
- Children learn to automate processes by practicing, so it is necessary to give them enough time to learn those processes.
- Instructions should be simple, clear, concise and precise; leaving little space for them to misunderstand what is asked of them.
- The consequences of the decision the child makes should be established at the same time as the instruction.
- Small efforts should be valued, even if the final goal has not been achieved. It is important to consider the effort that they have put in to achieving that goal. Behaviour should be shaped until they reach their goal.
- Setting an example is the best way for children to learn what is expected of them. Sometimes they do not know what they have to do, if their parents show them what to do, they can imitate that behaviour and perform as expected.
It is important, from a very young age, for children to be responsible for the things they do. For example, if they spill water or milk on the table, parents should give them a cloth so they can clean it up; when they are one year old they will do it with difficulty, but when they are three they could probably do it without leaving a drop on the table; they will also be more careful when drinking from a glass.
Another example is when they refuse to go out without their coat. Usually parents get pulled into an argument that ends with the child crying and the father or mother being angry. It is difficult for parents to let them make this decision and learn from their mistake. Which is why they should let them go out without their coat, at least one time, in order for them to feel the cold and understand the consequence of their decision. After that one time, as hard as it is for parents to do, the experience would be enough for the child to learn the relevant lesson.
According to their age there are some things that parents can let the child learn, to build up that autonomy, such as:
- Between three and six years of age children can begin to take responsibility for certain activities, such as dressing by themselves, picking up their toys, putting on shoes, brushing their teeth, going to the bathroom by themselves, helping to set the table, helping around the kitchen and eating by themselves. While the task is being automatised, it will surely take more time to carry it out for them than for their parents. However, it is important to be able to properly learn the task and this can only be achieved through practice. The parent’s role would is to supervise and shape the performance of the child, making the necessary corrections. Likewise, parents can support the child’s autonomy by letting the child make small decisions, such as choosing between two changes of clothes to go to the park, or choosing their afternoon snack, or what activity they want to do with dad or mom on the weekends. These small choices can become a way to negotiate with children to carry out tasks that are tedious or boring for them, such as tidying up after playtime.
- Between the ages of six and nine , parents should allow children to take responsibility for tasks such as preparing their backpack, taking a bath, keeping their room tidy, helping to prepare food, folding and tidying away their clothes, filling the dishwasher, writing down notes, taking care of their school supplies, taking care of their pet, setting and clearing the table alone, doing their homework, taking out the garbage. Therefore, parents should be willing to support their children to create appropriate habits. During these years it is fundamental to keep in mind that limits and rules should be very well established. The routines that have previously been created could be narrowed a bit more with the inclusion of academic duties. This is a time for children to understand that there are rules that can be negotiated and others that can’t. Parents must show firmness in their decisions without becoming authoritarian, explaining why a particular rule must be adhered to, what is the final goal pursued and the benefits that can be obtained by complying with that rule. It is also the time in which children need more motivation to carry out certain tasks. Which is why parents have to do as much as they can to make these activities as attractive and motivating as possible. Scheduling and dividing home chores for each member of the family could help to create a sense of responsibility, improving the relationship among family members.
- Between the ages of nine and twelve , once certain habits have been established, parents should increase the expectations on their children. Activities such as cleaning their room, making their bed, taking out the trash, writing down phone messages, making small purchases, organising and planning homework, preparing simple dishes, tidying the bathroom, helping to clean and keep the house in order, walking the dog, having a set of house keys, going out on their own, sleeping at a friend's house. During this stage children begin to demand more and more independence, parents go from being supervisors to being more of an observer. This does not mean that the rules have to change, they should always remain firm without falling into authoritarianism. An activity that can contribute to the autonomy of children is to assign a weekly allowance so they can learn how to manage finances. This allowance should not be very high, enough to buy some snack or sports cards or to save it to buy something more significant. So that parents can teach their children how to manage their money, the consequences of spending it all on a whim and the importance of saving.
- Between the ages twelve to sixteen , being an observer parent can be difficult to maintain, especially when their children become teenagers. The challenge of this stage is maintaining rules and limits, teenagers need to differentiate themselves from others, specially from their parents. At the same time, they have the necessity to recognise themselves in their own family history without dissolving their new found independence. Which is why parents must encourage at the same time as limiting their move towards independence, adapting the rules and limits to their age and individual characteristics. In order to do this, parents should listen to their children, take their opinions into consideration, explain why particular limits should be maintained and show confidence in their abilities and judgement. During this age parents should educate their children on freedom as a fundamental part of forming their self-respect which is the ability for adolescents to choose the best way to live their life. It is necessary to let them create their own criteria so they can choose and decide for themselves. By nurturing this, they develop the ability to consider the positive and negative consequences before making any decision.
To sum up, autonomy is a fundamental part of a child’s development, and parents must help build it as much as they can. It is fundamental that while parents promote their children independence, they also encourage their study, hygiene, sleep and food habits, by stimulating their commitment, generosity and self-confidence. Therefore, they should encourage the development of confidence and security in their children while allowing them to explore the world by learning a sense of duty and responsibility.
Sinews MTI
Psychology, Psychiatry and Speech Therapy