Psychological trauma and its consequences
What ‘s trauma?
According to the World Health Organization, trauma occurs when: The person has been exposed to a stressful event or situation (both brief and prolonged) of an exceptionally threatening or catastrophic nature, which could cause profound discomfort in almost everyone (W.H.O.: ICD-10).
Trauma is a psychological reaction, following a negative and highly stressful event that appears unexpectedly and uncontrollably. By compromising the physical or psychological integrity of the person who suffers it, and being unable to cope with it, it creates a very intense discomfort in him/her.
The high psychological impact of traumatic events occurs due to the intensity of the event along with the absence of adequate psychological responses to cope with something unknown and unexpected.
To consider an event as traumatic it has to be of a negative character, unexpected and sudden.
A large part of the individuals who face a traumatic situation suffer psychological consequences afterwards, which can be acute or chronic. In the first post-traumatic moments there are symptoms that can be considered normal and very often, these symptoms remit spontaneously, but sometimes the consequences last in time or increase affecting mental health.
Symptoms associated with trauma
Once the initial shock is overcome, responses to a traumatic event may vary. The most common responses are:
- Flashbacks and nightmares.
- Anxiety and constant nervousness.
- Anger.
- Denial of the event.
- Changes in thought patterns.
- Increased difficulty concentrating.
- Avoidance behaviors towards memories of the event.
- Intense fear of a recurrence of the traumatic event, especially on anniversaries of the event or when returning to the site of the original event.
- Withdrawal and isolation in daily activities.
- Decline in general health or worsening of an existing illness.
- Changes in mood.
- Dissociation.
- Irritability and sudden mood changes.
- Physical symptomatology of stress, such as sweating, headache and nausea.
- Sleep disturbance or inability to sleep (insomnia).
For the most part, those affected will not develop post-traumatic stress disorder (PTSD), anxiety or depressive disorders or dissociative identity disorder, but normal manifestations of post-traumatic syndrome, even in situations of high psychological impact.
Traumatic disorders
After exposure to a traumatic or stressful event, severe psychological reactions may develop, leading to one of the disorders related to trauma and stress.
The diagnoses included in this category of disorders are:
PTSD (Post Traumatic Stress Disorder)
Probably the most common and studied, with a prevalence of 1-4% of the population. It is especially common in people with professions that involve a risk of exposure to traumatic events (police, health, military…). Symptoms such as persistent and recurrent nightmares and insomnia, flashbacks, isolation and high reactivity (aggressiveness, hypervigilance…), irrational fears, derealization (feeling that the world is not real) and depersonalization (feeling like an external observer of oneself) and dazedness are common.
ASD (acute stress disorder)
It is characterized by PTSD-like symptoms that occur after the traumatic event. Such symptoms may last from two days to 4 weeks after the traumatic event. What differentiates it most from PTSD is that the symptoms must appear almost immediately after the event.
Adjustment disorder
Symptomatology appears after a clear and definite traumatic event, within three months of onset, but cannot be classified as PTSD. There is intense distress disproportionate to the severity or intensity of the stressor and significant impairment in normal functioning. Distress manifests with decreased work or school performance, changes in social relationships, complications in an existing illness, problems in a partner or family, and financial difficulties.
Reactive attachment disorder (RAD) (diagnosed only in children)
It is characterized by a distortion and lack of development in the ability to relate socially. Common symptoms include sadness or fearful reactions for no apparent reason, emotionally poor reactions to others, episodes of high irritability, and limited expression of positive affect.
Disinhibited social engagement disorder (DSED) (diagnosed only in children)
Appears a lack of selectivity to attachment figures of choice, being overly familiar with unfamiliar people and seeking affectionate contact outside the close social circle
Other specified disorder related to trauma and stress
Symptomatology characteristic of trauma- and stress-related disorders appears, causing significant distress and impairment in all areas, but criteria for any of the above diagnoses are not met. In this case, it is specified which other disorder might be influencing the symptomatology
Trauma and stress-related disorder not specified
The same as the previous disorder, but without specifying any other disorder.
There are several factors that can make traumatic experiences more negative. On the one hand, factors associated with the person him/herself such as the way he/she perceives and experiences the situation, resilience or mental health history. On the other hand, there are the factors associated with the situation itself: human and material losses, extension in time or chronicity, age at which it begins (in case of abuse). Finally, factors associated with the place where the event occurs; the presence of social support, the existence of preventive measures, the community culture itself, or the existing mental health care in that society.
Trauma in childhood
Considering that during childhood a child is dependent on his or her caregivers, any abusive or neglectful behavior can have a traumatic effect, being experienced as a threat to his or her own integrity.
In addition, in childhood it is common for mistreatment to be continuous, being a chronic situation for them. It is important to highlight that abandonment is another form of maltreatment, being as psychologically harmful as physical or sexual abuse.
Consequences of childhood trauma: When to seek professional help?
The reactions shown by children and adolescents who have been exposed to traumatic events can be summarized as:
- Development of new fears.
- Separation anxiety (especially in young children).
- Sleep disturbances.
- Nightmares.
- Sadness.
- Loss of interest in normal activities.
- Decreased concentration.
- Deterioration of school work.
- Anger.
- Somatic complaints.
- Irritability.
The functioning in the family, group of friends or school can be affected by these symptoms, putting at risk the mental stability of the youngest.
Dissociative disorders: response to chronic trauma
What is dissociation?
The term dissociation refers to a disconnection between mind and body; a disruption in the way the mind handles information. You may feel disconnected from your feelings, thoughts, memories and the environment around you and it can affect your sense of identity and perception of time.
Dissociation is a human defense mechanism against trauma, which allows us to blur and even eliminate experiences that are too painful to assimilate, especially when we are children and we are developing. Thus, in the face of abuse or maltreatment (especially in childhood and adolescence), dissociative symptoms are a lifesaver for many victims; the problem is that this reaction, in principle adaptive, becomes dysfunctional very quickly, affecting the mental health of the victims.
Dissociative symptoms
Dissociative symptoms are divided into three blocks: amnesia, derealization/depersonalization and confusion/alteration of identity (Steinberg, 1995).
Amnesia serves the function of allowing the patient to go on with life by selectively forgetting the distressing situation and intolerable emotion; in Dissociative Identity Disorder for example, the parts dealing with everyday life situations usually present amnesia for previous traumas.
Depersonalization disconnects the body from consciousness so that the individual can detach the traumatic experience from his or her own emotions; often when there is severe trauma we do not perceive the emotional part of the experience to defend ourselves against the degree of emotional arousal it provokes.
The alteration of identity alternates one mental state with another without creating a meta-consciousness that encompasses both.
Dissociative disorders
Dissociative disorders include several syndromes with the common core of an alteration in consciousness that affects both identity and memory:
- Dissociative amnesia, in which patients lose autobiographical memory of certain events, usually events of a traumatic or stressful nature.
- Dissociative Fugue, in which amnesia covers all (or at least a very large part) of the patient’s life and is accompanied by loss of personal identity and in many cases a physical relocation (hence the name). Dissociative amnesia can be diagnosed with or without dissociative fugue.
- Dissociative identity disorder or DID (formerly multiple personality disorder), in which the patient appears to possess and manifest two or more identities (a «host» personality and one or more «alter egos» ) that alternate control over conscious experience, thought and action and are usually separated by some degree of amnesia.
- Depersonalization disorder, in which patients feel that they have changed in some way or are somehow no longer real.
- Dissociative disorders not otherwise specified, in which the patient manifests some dissociative symptoms to some degree but falls short of qualifying for a diagnosis of the above.
Although the effects of trauma can impact areas of functioning that seem remote from the trauma, considering trauma as the primary causal influence of symptoms can help empower individuals to heal themselves with support, and validation in a safe environment.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
The Four Horsemen Romantic Relationships and How to Manage Them
When does love end and become friendship?
Is there a time limit or happily ever after?
Why do some couples seem unaffected by the passage of time?
Why do other people repeat the same patterns in different relationships?
These topics are probably nothing new; most of us have discussed the secrets and obstacles of dating relationships on multiple occasions.
It is not surprising that it is one of the topics with the highest demand within psychology sessions or that it is something that worries us and in which we want to work and learn more.
We are social beings and dependent on the group (even for our survival) and probably due to the way we have articulated our relationships throughout the history of humanity, the romantic relationship is the chosen group in which we spend the most hours and in which that more projects we share.
These topics are probably nothing new; most of us have discussed the secrets and obstacles of dating relationships on multiple occasions.
It is not surprising that it is one of the topics with the highest demand within psychology sessions or that it is something that worries us and in which we want to work and learn more.
We are social beings and dependent on the group (even for our survival) and probably due to the way we have articulated our relationships throughout the history of humanity, the romantic relationship is the chosen group in which we spend the most hours and in which that more projects we share.
Studies that try to discover which are the variables related to greater happiness, well-being, and even longevity have shown that, above aspects such as economic, labor, or social class, what most influences our subjective well-being are the relationships we have with other people and more specifically with close family.
How can we not worry about our romantic relationships then? How not to try to learn more about building and maintaining a healthy, exciting, and long-lasting relationship? But above all, how can one not be aware of difficulties and learn to navigate them?
Thanks to advances in fields such as neuroscience, today we know that our brain behaves similarly when it "falls in love" as it does in addictions, we also know that we tend to positively value everything familiar to us and that after a rupture we experience physiological processes similar to those we feel in a grieving process.
For this and many other reasons, it is clear that romantic relationships and, above all, their well-being within them, is more complicated than we thought, from the beginning of the relationship to its maintenance over time.
As a therapist, I consider it fair and fundamental that we recognize and stop trivializing these difficulties since each relationship experiences them, and normalizing them is the first step to get rid of that feeling of "what is the problem with me?" and continue to evolve. This is the main objective of this article, to raise awareness and show common obstacles in couples from current scientific knowledge.
In the classes that I teach in Personality and Individual Differences, we usually talk about the relationship between personality traits, the duration of the relationship, and emotional and sexual well-being. Different studies and meta-analyses have shown aspects such as extraversion (due to the ability to communicate love and needs), openness to experience (which leads us to try new things and learn), awareness, and perseverance (for orientation to long-term goals) positively correlate with maintaining a stable and lasting relationship and with perceived happiness within it.
But we must not forget that all these behavior patterns can be trained and also that they are only correlations, that is, we do not know what was before if the chicken or the egg. Do we show ourselves in the most communicative questionnaires, open to experience, and focused on having a healthy and positive relationship, or are these variables the ones that make us have a satisfactory relationship?
Going deeper into what we know in the field of science as possible keys to a happy couple, we know that at first, we worked on the idea of “Quid Pro Quo”, that is, those people who had a sense of justice in their relationships were better able to last over time than those who did not feel that way.
But thanks to the advances in research and studies such as those of John and Julie Gottman (couples therapists, professors, and researchers at the University of Texas), we know that this need for "equality and justice" only appears in couples when they are already They find themselves going through bad times when they are in a state of alert due to not being comfortable in the relationship.
The Gottman method has shown high efficacy in couples therapy, probably because it approaches the relationship holistically, it focuses on the joint-life history, but also takes into account the learning and personality patterns of each of the members of the couple. Likewise, this method works on behavior, but without neglecting emotional regulation and patterns of thought and interpretation.
What we call the four horsemen of the apocalypse in a romantic relationship have thus been identified, these being the following:
- Criticism:An attitude of criticism and centered on blaming the other member of the couple for every little detail or problem, accusing their behavior, personality traits, or aspects of their family and/or life history.
- Defensiveness:The tendency not to assume responsibility and to be defensive in the face of possible criticism (which is usually perceived as an attack on my person and not as a behavior to modify). This attitude is closely linked to criticism since in addition to blaming the circumstances, the easiest way for the couple to defend themselves is usually to put the responsibility on the other.
- Contempt:A pattern of behavior both behavioral and verbal that delegitimizes or devalues aspects of the other member of the relationship.
- “Stone-walling” : The tendency not to establish communicationnot to deal with problems, and / or turn away from them, which in many relationships is perceived by the other member of the couple like turning your back on that person or the relationship.
Obviously, these 4 riders do not appear simultaneously in all couple problems, but one of them is usually found playing a leading role in the conflict.
It is right here where we find one of the main keys to understand and start working in a positive relationship. We know that the difference between a happy and satisfied couple and another that is not satisfied is not the number of conflicts that appear but their handling since we are capable of making a small conflict a big problem if we let any of these four horsemen between in Game.
But, now that we know a little more about scientific studies, about the evidence, and about these four attitudes as protagonists in romantic problems, what can we do with all this? How do I put it into practice?
- Real consciousness:As obvious as it may seem, it is as obvious as it is useful. We must cultivate awareness and try to identify these four horsemen, not only now when reading this article but in our day-to-day relationship. It is important to pause the conflict or before it begins and see if one of these riders is taking the helm and navigating the problem.
- Time out:Especially due to the difficulty of the previous point, since when anger, anger, or sadness are very active, it is more difficult for us to become aware and think more coldly.
Something that we can try to practice is to take time out (it can be to take a walk, go to another room ...) trying to perceive that the problem does not have to be solved NOW and above all that it will not do it if we do not handle it rationally. In many couples, this time out is a source of conflict since there are those who “need” to resolve or conclude immediately. It is therefore important that this technique is consensual and is not interpreted as an estrangement but as an individual space to reflect and then work together again in the relationship. - Emotional regulation:In the same way that we work on managing emotions in the couple, we must do it individually, first being aware of our emotional handicaps (which we all have) and then applying different psychological techniques such as cognitive restructuring, relaxation, acceptance, and subsequent distancing from emotion through mindfulness, self-compassion...
- Focus on common goals:Focus attention and behavior on common goals, nothing transcendental in principle, go from less to more, from sharing time together focused on a common interest (a walk, visit, series, talk about a book ) to the joint design of more medium and long-term projects.
As I said at the beginning of this article, our well-being is closely linked to the type of relationships we build, so how not to work on them, and give them the importance they deserve. It is true that our relationships are complicated by the fact of trying to fit two pieces of a puzzle that come with different forms created by the previous life, family models ... but it is also true that the handling of daily conflicts or the fact not handling them ends up being a much greater risk factor for the breakdown or discomfort in the relationship.
How many times have we ruined a pleasant moment or day by expressing ourselves from criticism, contempt, or taking a defensive attitude? How many times have we regretted not having communicated with our partner, having faced a problem, or expressed our needs?
The main problem with handling conflicts in this way is not only the amount of negative affect that we express but since time is limited and the day continues to have 24 hours and the week seven days, we are left with much less space to share positive affect and to enjoy the relationship.
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
Cuidar de Los Que Nos Cuidan
El deterioro cognitivo y otras enfermedades neurodegenerativas son cada vez más prevalentes en nuestra población actual, una población más longeva pero también con mayores niveles de estrés y desconexión del momento presente.
Cada vez más personas somos conscientes de estas problemáticas pero hoy vamos a hablar de otro colectivo, un colectivo a veces silencioso (o silenciado), un colectivo que disfruta, pero también sufre y que es tan demandado como necesario.
Hablamos del rol del cuidador o cuidadora, esa persona que acompaña en el día a día a quien sufre alguna dificultad como el Alzheimer y en la que diferentes estudios han mostrado la alta frecuencia con que padecen “burn-out”, es decir, el síndrome de agotamiento y estrés laboral, problemas de ansiedad y de estado de ánimo o depresión.
Obviamente el bienestar psicológico de esta profesión está altamente relacionado con otras personas: a la que cuida, la familia de esta y su familia o relaciones personales fuera del trabajo.
Desde Sinews queremos prestar especial atención a esta dinámica interpersonal ya que será una profesión cada vez más necesaria, importante y probablemente a la que muchos o nos dedicaremos de una u otra manera o de la que seremos clientes en un futuro. Vamos a ello, por tanto.
Como si de una pieza de piano se tratase, para que la melodía de la relación entre cuidador/a y cuidado/a suene tranquila, agradable y llena de bienestar hay al menos tres acordes que debemos de tocar:
1. El vínculo personal
Cuando trabajamos con personas debemos priorizar la importancia del vínculo terapéutico, por ello es importante que más allá de las labores diarias como cuidador/a se reserve un tiempo para conocerse, tanto con el resto de la familia como con la persona a la que se acompaña.
Conocer la historia de vida, los intereses personales, gustos y también las dificultades por las que pasamos nos ayuda a ser más empáticos, a entender mejor los comportamientos inesperados y las emociones.
Además poder compartir actividades e historias es una de las mejores formas de trabajar la estimulación cognitiva.
Conseguimos un 2×1 en este caso, reforzar el triángulo familia-persona acompañada-cuidador/a mejorando el bienestar y la comprensión en esta relación interpersonal y por otro lado se podrán estar trabajando áreas como la estimulación verbal, procedimental y de la memoria.
¿Cómo hacerlo?
Estableciendo un tiempo tanto al comienzo de la relación para conocerse como durante la misma, pequeños encuentros semanales dentro de la rutina o pequeñas actividades diarias en las que se comparta conversación o actividades placenteras para ambas partes.
2. La desconexión y el descanso
Precisamente por la alta carga física y emocional de esta profesión es necesario respetar los horarios de descanso del profesional, asegurando dos tipos de tiempos, uno para el descanso y la recuperación y otro para que ya recuperados puedan disfrutar de su vida personal, familia y otras actividades placenteras y significativas para ellos.
Aunque esto parezca obvio debido a la actividad frenética del día a día y a las facilidades que nos proveen las herramientas de comunicación instantánea no es siempre tan sencillo de llevar a la práctica.
La desconexión (lo cual implica como decíamos tanto descanso como tiempo para disfrutar de la vida personal) es una de las variables que más peso tienen en la satisfacción laboral y especialmente por el trabajo que realiza el cuidador/a debemos de prestarle especial atención.
¿Cómo hacerlo?
Durante el año laboral: Acordar entre las partes periodos de vacaciones.
Durante la semana: Contar al menos con dos días consecutivos de descanso y desconexión de las tareas de cuidador/a.
En el día a día: Respetar los horarios de finalización de tareas asegurando unas horas de desconexión laboral.
Pero ¡OJO! no olvidemos en qué consiste respetar esta desconexión:
- En caso de que la persona que cuida sea un miembro de la familia, el resto de ella deberá organizarse para asegurar los puntos anteriores, en caso de ser una persona contratada se deberá asegurar una sustitución.
- Cuidar no es solo la tarea en sí sino también la logística, por tanto esto debe quedar realizado dentro de las horas de cuidado, evitando así enviar mensajes o llamadas habituales para sobre citas, procedimientos, qué hacer…Evitemos por tanto la comunicación fuera de las horas de cuidado y respetemos el tiempo de desconexión y descanso.
- En cuanto a la persona que cuida, te animamos a que te concedas esa desconexión y que compartas con tu familia o círculo social lo importante que es ese tiempo para ti, tanto para descansar como para disfrutar de tu vida personal y otras actividades placenteras o de ocio.
3. El propósito de la tarea
Otra de las variables que han mostrado mayor peso en la satisfacción tanto laboral como en la satisfacción con vida en números estudios es el sentido por el que hacemos las cosas, es decir el propósito de nuestro día a día y de nuestras tareas.
El rol de cuidador/a puede llegar a ser muy rutinario pero podemos tratar de establecer objetivos como la estimulación física y cognitiva y el bienestar general de la persona cuidada. Para ello será especialmente relevante el punto uno, conocer con qué disfruta o disfrutaba esa persona antes de la aparición del Alzheimer. Las capacidades que se conservan durante más tiempo a pesar de la enfermedad neurodegenerativa son las procedimentales (como la cocina, tocar un instrumento, dibujar, la artesanía…).
¿Cómo hacerlo?
Podemos por tanto establecer actividades diarias enfocadas en ese bienestar emocional y estimulación cognitiva, con el objetivo de reforzar ciertas capacidades, como decíamos anteriormente esto además mejorará el vínculo interpersonal.
Estos momentos diarios o semanales en los que se comparte un café o comida y se intercambian historias de vida o que se realiza algo placentero y procedimental marcarán la diferencia en cuanto al propósito del trabajo y permitirán un tiempo más creativo y emocional dentro de la jornada de cuidado.
No nos olvidemos tampoco del papel de la GRATITUD al respecto, como bien sabemos toda conducta reforzada tiende a consolidarse. Reconocer el trabajo y los objetivos del cuidador/a no solo de manera económica sino con tiempo de descanso o simplemente a nivel verbal mejorará la relación y por tanto el bienestar de todas las partes.
Un breve resumen gráfico para recordar esto y que nos ayudará a ponerlo en práctica
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
Diary of a Global Therapist Part 4
It has been three months since the last post in which I shared my experiences working with expats from different parts of the world.
Three months of uncertainty, of continuing to hear very different stories, and of working hand in hand in managing difficulties.
They have also been three months marked by many changes, some due to the COVID-19 pandemic and others to social movements. But of course, a time in which we have not stopped working and learning.
From Sinews (and I imagine that from anywhere) we have been aware of two important and relevant changes in the day-to-day life of international companies and institutions, on the one hand teleworking and on the other the importance of respecting and empowering diversity.
Teleworking seems to have come to stay and that as a country we are approaching the European percentage of working hours from home. Although we are beginning to envision a new law to regulate it, there is much work to be done to get the most out of this new alternative.
A few weeks ago I was talking with an employee of a multinational in one of our follow-up and emotional support sessions about this new situation and it seemed very representative of what many of us live today, perhaps even because I felt deeply identified.
The employee we will call Mrs. P is working outside her home country. In her case, she has the company of her partner and children, which on the one hand appreciates and enjoys the time she can spend with them thanks to saving it on work-home transfers, but on the other hand, it has made her face difficulties, such and as she verbalized “We have been used to having a routine for so many years in which I travel, work and he takes care of the paperwork, the house, the transfers, that this situation has been almost like starting to know other parts of our relationship ”.
Mrs. P has not faced major problems with her partner, but she has experienced situations in which she has had to manage both her time and stress levels. As we mentioned in our session, despite the benefits of working from home, there are weeks in which “a waterfall of difficulties” arise in different areas.
This is how we address the importance of maintaining routines and setting limits to work. I think we have all heard a lot about this topic and about the difficulty of disconnecting when we work from home, but if we want to tackle it we should go further: what is it that makes me not disconnect, not respecting certain limits that I create myself?
For some people it may be the uncertainty and fear of the future job, for others, they need for recognition, certain personal beliefs, judgments ... or as in the case of Mrs. P the need to have everything under control, to "micro-evaluate" every detail, every possible little achievement or failure.
In our biweekly session, we talked about it and how to handle it, as well as about trying to train a kinder and more assertive communication with your family when time is required "as if by being at home you are not working" in her own words.
The session is interesting because of how representative it is of what many of us feel while teleworking, but also because it can normalize these difficulties and emotions.
I decided to write this post because the same day that I had the session with Mrs. P, in the afternoon I connected again to our online platform for the first interview with another employee of a multinational, whom we will call Mr. Q and after the two sessions I thought how much our current work and social panorama showed.
With Mr. Q I had the opportunity to address the discomfort and difficulties that he anticipated in his next project due to working with a very diverse team.
It seemed extremely sincere to me, we all know the virtues of diversity, as the famous Italian phrase "Il mondo è bello perchè è vario" quotes (the world is beautiful thanks to its variety), but this diversity is not free from difficulties and bad times.
If we want to enjoy and respect these differences, the first thing we must do is be aware of the biases we have, such as familiarity, we all tend to better evaluate what is known to us, or self-serving or group biases. , for which we will always make judgments that benefit our group and our own identity.
There begins the true work of respect and appreciation, acknowledging our evaluations, prejudices, and behaviors.
Mr. Q had a bad experience in the past with a language-related issue and acknowledges that it affects him emotionally. On the one hand, it makes him angry at the fact that he is judged for "a simple set quote" and on the other hand, it makes him feel tense in case this happens again.
During our session, we work on that discomfort and how to regulate it.
It is normal that we feel angry or in need of reaffirming our position since as Mr. Q says “I feel judged and I have to defend myself”, but I can differentiate between reacting or responding.
That is, before letting my anger and defensiveness grow I can try to give myself some extra time and to turn down the volume of my emotion in order to respond in a more rational way. Emotional regulation exercises through psycho-education, Mindfulness, and relaxation are very useful for professionals and people who work in diverse environments.
We also work not only on how to reduce discomfort and manage those difficult emotions but also on learning from the positive, that is, from the amplification of our personal strengths. Mr. Q considers himself an empathic person, in fact, he assures that his friends and family would describe him as someone who "knows how to listen".
So why not take advantage of that strength you already have? When the idea of another person or their position collides with ours and makes us feel uncomfortable, we can always turn our attention to curiosity and empathy. This is one of the practical exercises that I propose to Mr. Q:
-
Identify the discomfort, accept it and try to "turn down its volume"
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Putting ourselves in the shoes of a researcher, asking the other person, gathering information, and finally trying to understand why they feel this way.
As we discussed in our session, these exercises help us not only to improve our emotional regulation in interpersonal situations but also to cultivate an open and empathetic mind.
We conclude the interview with a series of practical guidelines for the real management of diversity and with the possibility of having another session if necessary.
As I said at the beginning of this post, these two sessions are very representative of the problems that we currently encounter and of which we are increasingly aware of our services to international companies, educational institutions, and individuals.
For this reason, at Sinews we work to develop programs aimed at continuing to grow in this digital and inclusive “new normality”.
I finished that working day, before going on a well-deserved vacation that would last three weeks, writing the report for Mr. Q, in which in addition to detailing some practical recommendations, I recommended the wonderful book "Talking to Strangers" by Malcolm Gladwell.
Back at work and remembering those two sessions I realize that this September is different but also a new beginning in terms of opportunities and challenges in the area of mental and organizational health.
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
Winter Blues
Winter blues is not a diagnosis but a general term and it means feeling sad and down, melancholic and unhappy and it´s related to the shortening of daylight hours and Autumn or Winter approaching. They are often linked to something specific, such as stressful holidays or reminders of absent loved ones.
On the other hand, Seasonal affective disorder (SAD) is a type of affective disorder related to changes in seasons. The symptoms usually start in Autumn and continue into the winter months, and go away during the sunnier days of spring and summer. The symptoms may include:
- Feeling depressed
- Losing interest in activities you once enjoyed
- Low energy
- Problems with sleeping
- Changes in your appetite
- Difficulty concentrating
- Feeling hopeless, worthless or guilty
- Having thoughts of death
Winter blues are usually temporary and the symptoms disappear, while Seasonal Affective Disorder can last for several months.
Causes
The specific causes remain unknown, but some factors that may come into play include the changes in the circadian rhythm (your body´s internal clock), and a drop in the serotonin and melatonin levels.
Usually the happiest days are those in which we make plans; weekends.
Some people also change their activity when Autumn starts. Since it´s colder and darker outside, they find it more difficult to keep up with the activities they used to do and enjoy during Spring and Summer and so when they stop or reduce these activities, there is a drop in the dopamine levels too.
There is a direct link between the number of pleasurable activities that we do and the quality of our mood. Usually the happiest days of the week are the days where people do more pleasurable activities: the weekends. In the weekends we usually spend more time with friends, we read our favourite book, play sports, and do other activities that boost our mood. This also happens when we are on holidays. When we do pleasurable activities, we increase our dopamine levels.
Strategies to deal with the symptoms
Our mood is a result of imaginary scales, where we weigh the quantity and quality of negative and positive events. The days getting shorter, the reduction of sunlight hours and the worsening of the weather conditions may lead to the reduction of outdoor activities and therefore, the reduction of positive events. If we want to improve our mood, we will then need to increase the positive events and activities and reduce the negative events when possible.
The first step would then be to increase the number of activities that we used to do and go back to the activities that we stopped doing before we started to feel low. We may use our memories and our reason and leave our actual mood aside in order to complete the following table:
| Difficulty | Level of Satisfaction | |
| Past Pleasurable Activities (Activities that we used to do but stopped doing) | ||
| Present Pleasurable Activities (Activities that we still do) | ||
| Future Pleasurable Activities (Activities that we never tried before but that we think we would enjoy) |
The first step will be for us to choose the present and past activities, and the activities that we know will take a very low effort but will provide a high level of satisfaction. For example, we cannot start by going to the gym three times a week when we have never been to the gym before. It would be easier to play guitar first if we used to play guitar in the past (low effort, high satisfaction).
Second, we will need to focus on completing the time we set for the specific activity: E.g. Playing guitar for ten minutes, instead of focusing on the results (playing a full song perfectly).
The goal is overcoming the inertia, not to obtain outstanding results in our chosen activity. So even when we don’t achieve a perfect performance, we have met our goal (to stop the circle of loss).
Here are some other tips for you to beat the Winter Blues:
- Waking up an hour early to benefit from the sunlight (So we increase our melatonin levels)
- Our brain is usually very grateful when stimulated. As winter approaches, everything gets darker and colourless. Seeking a colourful life and exposing ourselves to those colours can stimulate our brains. For example, you can go outside to a place where there is grass and colourful buildings; you can watch videos full of colour.
- Doing exercise: it is proven that exercise can increase our energy levels and reactivate our mind and body (we may need to start with low effort and high pleasurable activities and set very small goals to ourselves at first).
- Trying not to anticipate the darkness. Being conscious of the present moment and enjoying the daylight hours as much as we can.
- Being creative: Using these months to work on a goal that we set to ourselves can be a great motivation. It is important to start by taking very small steps towards that goal.
- Another suggestion is to purchase SAD lights. They do not “cure” Winter Blues but have proven to improve our Melatonin and Vitamin D levels and therefore ease the symptoms.
- Improving our diet. There are some foods that make us feel better. Eating foods with high amounts of tryptophan will naturally increase melatonin production. Tryptophan is an amino acid that our body does not produce naturally, but it is needed in the production of melatonin. Tryptophan can be found in most foods that contain protein, including almonds, oats, turkey, chicken, and cottage cheese. Also having a balanced diet and drinking lots of water can make us feel more energetic.
- Last but not least, it is very important not to be hard on ourselves. There is an explanation for our symptoms, and putting lots of pressure or judging ourselves is not going to make the symptoms better. Positive reinforcement (giving ourselves nice treats) has been proven to be more effective than punishment (self-criticism).
Remember: The more we do, the better or symptoms get, the more activities we include in our routines, the more dopamine we obtain, so the more activities we do, the less and less difficult gets to get going.
If after following these tips you still feel low and moody, CBT (Cognitive Behavioural Therapy) has been proven to be the most effective treatment for these symptoms. A qualified therapist can guide us to get through the Winter Blues symptoms.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
On Children and Gratitude
How many of us can think back to our childhood days and remember our parents, grandparents and even early-years teachers urging us to say thank you when we were presented with a gift, a nice gesture or a helping hand?
I certainly remember that showing appreciation and being thankful was tremendously important for the grown-ups around me. With time, I understood that people felt good when I said thank you to them, but before empathy entered the picture, thankfulness felt like one of those things I had to do, one more rule to go by: Saying thank you was equivalent to being polite.
Politeness was and continues to be a highly valued quality among humans. One to make sure our children possess and carry with them. After all, if we stop to really be honest for a moment, we can agree that politeness speaks well of the child that practices it, while also singing hidden praises to the caregivers responsible for that child. We could agree that it is a social skill that opens doors. A win-win all around. But in this case, politesse is merely one small part of a much bigger stance: Gratitude.
And if we were conscious about the psychological weight of gratitude as general value, we would be less concerned with mere politeness. Harvesting gratitude would then become a must (something just as important as promoting mathematical dexterity, if not more).
In general terms, gratitude is associated with the capability of being thankful, but because gratitude has been the subject of psychological interest for many years, we now know that it is a little bit more complex than that.
Robert Emmons, a Professor of Psychology at the University of California, considered one of the leading scientific experts on gratitude, approaches it as a two-stage process:
According to Emmons, the first stage consists of the “acknowledgment of goodness in one's life”.
Gratefulness -therefore- begins, when someone stops to be aware of the fact that they have received something (whether it be recently or long ago).
The Second part of the process consists of the recognition that the “source (s) of this goodness lie, at least partially, outside the self”. It is then safe to say that Gratitude is directly related to humility: We are conscious of the fact that something or someone, provided us with something and that something contributed to our well-being.
To me, it all sounds like a big gift. A magical process in which we can appreciate goodness in our own existence and contact with positive emotions along the way. But that isn´t all there is to it. Experiments in the gratitude realm have directly linked it to a more optimistic look on life, increased sense of connectedness to others, longer and better quality of sleep time and fewer reported physical symptoms such as pain. (From an interview to Mr. Robert Emmons published in the SharpBrains blog on 2007).
So how can we teach our children the attitude of gratitude, which holds and includes politeness but transcends it?
- Model it. Behavioralist psychologist understood -throughout their investigations many years ago- that visually demonstrating a behavior so that it could be reproduced by the observer, was a key part of the learning experience. Is therefore safe to conclude that If you wish to cultivate gratefulness, you need to show a child what being grateful looks like. Imagine for example that you go for a walk at a park or in the woods, in the middle of autumn: It is a great opportunity to practice being grateful. You can model excitement about the fact that you get to see all the different shades of yellow, orange and red. You can open your eyes wide, and using an excited tone of voice go into the details of what you can see and are “amazed by”, ending it with a “it´s so cool or its so nice that we get to see this and be here together”.
- Create a family gratitude ritual. Depending on how the family schedule runs, you can take a moment daily to say what each family member is thankful for (at the dinner table or perhaps after reading the bedtime story…) Depending on the child’s age you will need to use simpler words such as : “I’m happy that today…x”, for example. If schedules are complex and mom can be present at bedtime, for example, but dad can´t, creating a gratitude jar is an option. Assign each family member a color of paper. Throughout the week, when someone is grateful or happy about something, they can write it down and place their piece of paper inside the jar. During the weekend, the family can make it a habit to sit down with some refreshments and read the content of the jar.
- Promote the overt expression of gratitude using thank you notes/post cards or letters. If you take into considerations Robert Emmons definition of gratitude, you will comprehend that gratitude is active and that it requires thought and intention. By encouraging our children to write thank you notes, we will be helping them to stop and think of the actions and/or gestures that someone directed at them and that were therefore, helpful, allowing them to experience positive emotions. They will also get a chance to see in return, how their words contribute to someone else’s´ emotions and day.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Children, adolescents and adults
Languages: English and Spanish
Learning the practice of mindfulness, by Vicente Simón
To anyone who wishes to live the present moment more fully, escape the “automatic pilot mode” and experience emotional fulfillment, we are introduced to the practice of mindfulness by psychiatrist Vicente Simón.
The closest definition of “mindfulness" would be "full attention or awareness". Which means: paying close attention to the present moment with full intent and passing no judgement over what is being experienced. Or in other words: being aware of our experiences while they are being experienced. According to the author, mindfulness can also be described as “the universal and basic human ability of being aware of our mind’s content moment to moment”.
To sum it all up, practicing mindfulness consists in setting our constant worrying about the past and future aside in order to calmly experience the present moment. Instead of ruminating over dreaded future scenarios that fill us with anxiety, we attentively focus on what is happening right this second.
Over the course of this accesible and light guide, Dr. Simón brings us closer to different observations of prominent thinkers and philosophers on the subject of full awareness and experiencing the present; all the while teaching us the most important aspects of a mindfulness practice: observation, not identifying ourselves with out emotional states, acceptance and lack of judgement, curiosity, coping strategies to manage strong negative emotions, self-acceptance and practicing love and compassion for oneself.
In addition to providing us with the necessary tools to understand and practice mindfulness, Simón offers us a varied array of guided meditations which will be crucial in the endeavor of exercising this newly gained state of mind in our daily lives.
As the author concludes, the constant and overwhelming flow of thoughts that have little to do with the present moment, impedes life itself. Therefore, the practice of mindfulness becomes a basic tool in order to gain peace of mind and happiness.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults and adolescents
Languages: English and Spanish
Hooked to New Technologies
When we talk about addiction to new technologies, it is frequent that, automatically, we bring to our mind the image of a boy or girl with any electronic device.
It is not uncommon nowadays to take a look around a restaurant and see parents slow down their children's activity through a device, be it tablet, mobile or other. The effectiveness of this technique is unquestionable.
As a sedative for children and parents, keeping children absorbed in digital activity reduces their activity, as we have been saying, but also our involvement in managing their behaviors. However, the victims - yes, victims - of this strategy are not only children, but also adults, the subject on which this article will focus.
In summary, we could describe addiction to new technologies as the excessive use of electronic devices, added to the need to use them when we have been a long time (or not so long, in some cases) away from them, and with a powerful calming function and / or pleasant sensation that is, sometimes, difficult to recognize.
In the era of hyperconnectivity, it is expected that many of our activities will be done through new technologies like meeting our friends, getting informed about something quickly or buying a product in a matter of seconds. The utility is more than evident.
However, the dark side of this utility lies in the immediacy of the reward, reinforcement or satisfaction. We feel calmer when we get a response from our partner in the moment instead of waiting to see each other. We feel especially recognized when the “likes” grow like foam and we can observe this very satisfactory phenomenon in real time. We feel more in control being able to go immediately to information that solves a question of the moment. Ultimately, the promptness of the response takes on a strong tint of reward. This of course is far from being harmless..
It is necessary to make a brief explanation of our brain mechanisms to understand how the matter in question works, and, for this, we will refer to the reward mechanism of our brain. This system is part of our "primitive brain".This implies that it bears a strong relationship with animal survival, as it “informs” about pleasant sensations.
Briefly, the reward circuit locates pleasant stimuli (eg, a good plate of food, a hug, or a drug). The consequence of "accessing" this stimulus is the release of neurotransmitters, like dopamine and serotonin, which produce in us an intense feeling of well-being. Other clear examples are when I get a hug from someone I love, when I buy something through my mobile that I have been craving for a long time, when I get an answer playing a board game -and I persist in the game after that hit-, or when I see a notification from the person I like.
Well, taking into account what has been mentioned above, it is expected that adults obtain that well-being through their mobile devices, in the same way as young people and children.
It also seems interesting to refer to the calm that parents have when they have located their son or daughter thanks to their phone. Immediacy once again plays a fundamental role.
This means that the reinforcement, namely the feeling of calm that we get from knowing where our son or daughter is, makes us go to our phone more frequently to appease unpleasant feelings. It is what we would call a negative reinforcement, whose nuance consists of the reduction of discomfort.Positive reinforcers are distinguished from the previous ones since they provide well-being. An example can be when I order something to eat through my mobile, when I listen to music that I like or I am in contact with the person I crave.
Definitely, no one easily escapes the electronic device trap. In addition, as we said previously, in the era of hyperconnectivity it is paradoxical that we find ourselves increasingly distant and isolated. We are present physically but not mentally. We meet up with our friends but we dedicate a good part of those moments to being aware of things that are not related to the specific moment. I may be having a beer with my best friend but I withdraw from the situation by talking to someone who can be found in Honolulu.
Adults also experience these situations, and it seems pertinent to make special mention of parents: the use of devices and their applications give parents an illusory sense of connection with their children. When they perceive their distancing, parents try to find other ways of communicating with them, and this is where new technologies play an essential role. It is not uncommon to see parents trying to get closer to their children by showing them what they have downloaded to their mobile or the latest joke they have been sent.
The seeking for a more genuine, more intimate and less electronically mediated contact pushes parents to find other ways of access to their sons and daughters, and they may also be caught in the excessive use of these technologies.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Why does my therapist ask me about my childhood and the relationship with my parents? The importance in psychotherapy of exploring early childhood relationships
Usually, when we decide to start therapy it is because we have a problem in the present that generates discomfort or pain, and we do not have enough resources to handle the situation adequately. Sometimes the problem may have been in our life for some time (months, years); other times, something sudden happens which makes us seek help immediately. Regardless of the time we have been living with the problem, when we decide to start therapy is when the problem starts to interfere significantly with different areas of our lives (personal, family, work, academic, couple, etc.).
During therapy, our therapist will ask questions to understand how the problem manifests (symptoms), how long we have been living with the problem and how it impacts different areas of our life. Our therapist will also ask questions about our childhood, adolescence and adulthood, but especially, he/she will want to deepen in early childhood experiences with our parents or people whom we grew up with.
Understandably, it is important for our therapist to get to know us, not only in the present, but also know our life trajectory. But, why so much interest in exploring early childhood relationships?
Let’s see the importance of exploring in depth these childhood experiences in order to understand the problems or difficulties we have in the present.
During childhood, through the interaction with people around us and the outside world, we begin to develop specific thought and behavior patterns, coping strategies, emotion regulation skills, as well as mental schemas about how relationships with loved ones or people in the immediate environment work.
Since we are dependent on nearby adults for our survival, when we are kids we will do everything we have to do to keep our parents/caregivers as close as possible to meet our needs (physical, emotional, cognitive, social). So, through the interaction with our parents, we will learn how to behave in order to receive attention, love, and care. This early experiences with our parents/caregivers will establish basic notions about how affective relationships work in terms of care, safety, intimacy and dependency.
Through the interaction with parents/caregivers we will also begin to forge our self-concept based on the things we are valued, rewarded, or loved for; and based on the things we are punished, despised, or abused for. This way, we will begin to develop our self-concept, our opinion of ourselves, in terms of whether we are valid, good enough, or worthy of love/care/attention from the important figures in our lives. Likewise, we will begin to shape our values and belief system, our idea of what is valuable in the world, both with respect to ourselves and with respect to others.
Therefore, our childhood experiences with our parents/caregivers will have a great impact on who we are and how we think, feel and behave in both adolescence and adulthood. Thus, these schemas and patterns acquired in childhood will accompany us throughout our lives.
Obviously, this does not mean that later experiences in other stages of life will not have an impact on our mental schemas and behavioral patterns; for sure, they will do. However, these early experiences with our parents/caregivers will lay the foundation for how we see and deal with the world and interpersonal relationships. This idea is essential in understanding the origin of the problems we may have in the present.
Let's see an example:
If a child has suffered abandonment or neglect during childhood, if he has grown up in an environment where his parents have not been available to meet his needs in a consistent and predictable manner, the child will not feel safe with them. He will grow up feeling that he cannot depend on those close to him and may be afraid of being abandoned, because his experience is that he cannot trust those close to him to be available when needed. Thus, his mental schemas on how affective relationships work will be formed through the interaction with his parents. These schemas will be the foundation for later relationships in life.
As explained before, children will develop certain behaviors to keep their parents as close as possible to increase the chances of having their needs met. In this case, it is likely that this kid will cry inconsolably when separated from his parent in order to avoid separation. It is also likely that he will be upset if his parents pay attention to other people, as this would minimize his chances of having his needs met. Generally, the uncertainty about having our needs met translates into great discomfort, bewilderment, sense of lack of control, and fear of abandonment.
With regard to his self-concept, it is likely that this kid will feel that he is not lovable, that he is not enough, that there is something wrong with him that makes those close to him not to love him or care for him (at a more unconscious level). These self-concept schemas are formed in childhood when children are unable to understand the complex world of adults and the reasons why parents/caregivers do not care for them properly; so, kids usually take responsibility for the lack of attention or care from their parents. Thus, this kid will develop a negative self-concept which, in turn, will have an effect on later relationships and other contexts of life (couple, work, school, etc.).
Accordingly, it is very likely that when this child gets to adulthood, in future relationships, especially in love/intimate relationships, he will keep the same thought and behavior patterns and negative self-concept. In adult relationships this may manifest in jealousy, difficulties in trusting his partner, constant fear of being abandoned, constant anger at his partner for spending time with other people or doing their hobbies, etc. We see that these behaviors are very similar to the behaviors that this person used in childhood to attract attention from his parents/caregivers.
These thought and behavior patterns are usually maintained independently of the partner’s behavior, because the mental schemas on how relationship work that were developed in childhood will still have an impact on the present. Even if his partner never gives any sign of abandonment, this person would still be afraid of it because he grew up with the expectation that those close to him will not be reliable and will leave at some point. With regard to the self-concept, this person will continue to feel that he is not enough and will not understand why his partner wants to be with him; hence, his fear of abandonment.
Thus, we see how these relationship schemas acquired in childhood, mainly in the family context, will accompany this person throughout his life and will be transferred to other contexts and other people.
In this particular case, his thought and behavior patterns will probably lead to high levels of anxiety and depressive symptoms, in addition to a great deal of conflict and discomfort within the couple. These problems will be the main motives for this person to seek therapy. Hence, we see how the problems this person is currently having have their roots in his early relationships with his parents.
For this reason, in therapy we will always explore childhood relationships. In therapy will connect the present and the past, and we will see how current difficulties relate to past experiences and to ways of functioning in the world that we learned in childhood.
At the beginning of the treatment we will address the symptoms and difficulties we experience in the present, providing an understanding about the origin and maintenance of the problems and providing tools to manage these difficulties. Later, we will address deeper issues that will lead us to question our thought/behavioral patterns, relationship schemas, beliefs and values; which were established in childhood and constitutes the roots of our problems in the present. As a result of this questioning process, we will replace these schemas with other ones, more adaptive and more adjusted to reality. This will have a positive impact on our current way of thinking, feeling and behaving, and will improve our mood and quality of life.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults
Languages: English and Spanish
Back to School and Separation Anxiety
September has been a tough time for everyone, especially for teenagers and children.
After a very long time away from school, they had to go back with a lot of restrictions and measures for their safety and their teachers.
Most of them have shown an incredible amount of strength, giving us a valuable lesson adapting to our new normal. They have learned the proper distance they need to maintain from their peers, they wear their masks at all times, wash their hands as many times as we remind them, and learn new ways to greet their peers and adults. And they have made this whiteout complaint.
They know that there is a virus out there that could endanger their family and friends. They don't want to be held responsible for hurting one of their loved ones, and this has been their main motivation to follow up all the rules and restrictions we have submitted them too.
Nevertheless, with all the changes and uncertainty they had gone through, over the last six month, and with the constant reminder of the possibility of getting ill with the virus, separation anxiety has been a common feeling for some children and teenagers over the past month.
This disorder appears when children believe there is a higher probability of something terrible happening to, mainly their parents or to their most closer caregiver.
If we also take into account that for the past six months, most of them have shared their home with their parents regularly seeing them, and having them close, they have grown more attached and used to be always with them. Now they have to go back to school, which means they will be away from their parents for at least five hours, where they are not going to see them and make sure that they are safe.
They are afraid of something terrible, like having the virus, happening to their parents or loved ones. Likewise, they are scared of making any careless mistake at school that would put their families in danger.
What could we do to help our children and teenagers to help them cope with this anxiety?
The first thing we need to do is recognise the fear they have, and put feelings into words. Ask questions like are you afraid of something? Does going back to school scare you? Why? Then empathise with them with phrases like:
- "If I were in your shoes I would feel the same"
- "It's okay to feel like this/or feeling these emotions"
- "Going back to school must be tough nowadays, I think you are courageous/sting".
By empathizing we encourage them to talk to us about their feelings so we can help them overcome them.
Once we have gathered their feelings and named them, we need to set strategies to battle those fears.
- Comfort your child, don't lie to them telling them that everything is going to be okay because you don't know if that affirmation is right.
- Accept your feelings and share your fears with your children. Tell them that it’s okay to feel scared, but you are going to approach the school with baby steps. Each day that he spends at school is a battle you and your child have won against the anxiety.
- Practice relaxation techniques before going to bed and before entering school. With little children, you can use a balloon, ask them to fill it slowly and then as you let the air out of the balloon expel the air that has filled your lungs very slowly. Use the square of breathing, breath in, retain the air for five seconds and then exhale it very slowly. Repeat it four or five times.
- Write down or do a draw about their fears, what happens with them, which are their thoughts, their feelings, what they are most afraid of. This would help them to elaborate on their feelings and put them behind. Writing and drawing could be very therapeutic.
On the other hand, as parents, you should be aware of your feelings. Most of the time children and adolescents reflect their parent's emotions and behaviour.
Suppose you are worried about our current situation and are nervous regarding the uncertainty that represents the future. In that case, it is important for you to be aware of all these thoughts and feelings.
Once you recognise your feelings and thoughts the next step would be to accept them; realise where those feelings and thoughts are coming from; if they are based or not on reality; If they are accurate with the situation; After that, the following step would be doing something to cope with those feelings and thoughts, to lessen the overwhelming effect they could have over yourself. Any activity that would help you reduce your anxiety would be beneficial.
It is very important being in tune with your emotions, knowing where they are coming from will help you to recognise them in your children and find ways to cope with them.
Sinews MTI
Psychology, Psychiatry and Speech Therapy