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Can direct neurofeedback help individuals with a diagnosis of schizophrenia?

The effects of the unprecedented coronavirus will be felt by all for a currently unknown period of time.  The fear-driven behavioral responses that this pandemic has been producing is a reflection of how deep and strong our survival response goes.  And, yet, at some point, relief will come in the form of a vaccine.  However, there is another health challenge that stirs fear in the hearts of many, the life-long diagnosis of the severe mental disorder of schizophrenia.

One of my very first clients that I saw as a Marriage and Family Therapist Trainee carried a diagnosis of schizophrenia.  My client challenged me to learn more about this disorder in order to provide the best quality of service I could at that point in my training.  I learned that schizophrenia, although not as common as other mental disorders, affects feelings, thinking, and behaviors and the symptoms can be very disabling.  Symptoms of schizophrenia are categorized using the medical terms of either positive, negative, or cognitive.  Positive symptoms add and negative symptoms take away.

For example, positive symptoms might include hallucinations, delusions, or repetitive movements that are hard to control.  Negative symptoms include reduced feelings of pleasure, reduced speech, apathy, reduced social drive and social interest, and loss of motivation.  The underlying cause or causes of this severe mental disorder are still unknown and available treatments focus on eliminating the symptoms of the disease.  The first line of attack as far as treatment is concerned is antipsychotic medications.  Once a medication is found to work, then psychosocial treatments, such as therapy, is offered to help individuals learn and use coping skills.  Research has shown that participating in such psychosocial treatments reduces relapses and/or hospitalizations; however, the most challenging aspect of treatment is nonadherence to medication.  Therefore, a focus on increasing treatment adherence could have a positive effect on all impacted by this severe mental disorder.

Individuals with schizophrenia struggle to live life independently and improving this situation is a significant mental health priority.  It seems as though the negative symptoms of this disorder are associated with poorer functional status and quality of life than are the positive symptoms and this may be because primary negative symptoms generally do not respond well to the antipsychotic medications currently available.  Research has suggested that up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment.  With this information it then becomes more easily understandable why these individuals may not be compliant with their medications – because those medications don’t work for them.  The question now is what is being done to support these individuals and address this unmet medical need?

Well, there is hope on the horizon.  An article recently published in the Journal of the American Medical Association Psychiatry looked into the use of transcranial direct current stimulation (AKA direct neurofeedback) as an add-on therapy for negative symptoms of schizophrenia.  In this double-blind randomized clinical trial of 100 individuals diagnosed with schizophrenia with predominant negative symptoms, results showed that this non-medication treatment was effective and safe in ameliorating negative symptoms.

If you would like to read more, click on the button below:

Compassion for Survivors of Trauma – a New View of Substance Use Disorder/Addiction!

I remember being assigned to read the book by Dr. Gabor Maté, In the Realm of Hungry Ghosts, while in graduate school and simply feeling gratitude, compassion and validation afterwards.  I never believed in the medical model of addiction that describes the symptom of addiction as a chronic disease of the brain, even suggesting a genetic component to the disease, implying that if my parent(s) had addictions, most likely I would too.  Now, don’t get me wrong, the brains of people who struggle with addiction are different, yet those changes are created as a response to the adverse childhood experiences (AKA TRAUMA) these people survived.  And if your parents suffered from addictions when you were growing up, that experience is traumatic to a child!

I’ve written before about the impact of adverse childhood experiences, especially on physical health later in life as well as addiction; however, I felt compelled to revisit it again when I learned of research that found over 96% of the study participants suffering from substance use disorders, including prescription opioids, nicotine, and cocaine, had trauma histories.  When comparing the groups based upon their drug of choice, the prescription opiate group reported more traumatic childhood experiences than the other groups and a younger age of their first adverse childhood event.  So, when you learn about the underlying dynamics associated with substance use, the thought of “Just Say No” to drugs seems crazy!

Trauma comes in many packages and I’m grateful that the new California Surgeon General (Dr. Nadine Burke Harris) is focusing on early childhood, health equity and Adverse Childhood Experiences and toxic stress as her key priorities. (For more information on the ACEs Aware initiative, visit www.ACEsAware.org.)  It is time to stop blaming the victims and participate in bringing this information forward in order to educate.  What we don’t know, we don’t know.  However, once we know better, we can do better.  With this knowledge, we can bring more empathy and compassion in our interactions with people that struggle with substances.  We can take extra steps to explain this new research to them, validating their experiences and bringing them hope that they can heal from these past traumatic experiences and release their attachment to something that is harmful to them.  We can empower them to explore various healing modalities, such as psychotherapy, neurofeedback, meditation, hypnosis, guided imagery, and expressive arts, such as yoga, writing and drawing, all of which have been shown to support post-traumatic growth.

To read more about this research, click on the box below:

Might direct neurofeedback reduce impulsive behaviors?

The symptom of impulsivity can be found listed under several mental/behavioral health diagnoses, including but not limited to intermittent explosive disorder, substance abuse, OCD, PTSD and binge eating disorder.  When the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5™) was published in 2013 and included binge eating disorder, I finally felt validated and, at the same time, gratitude for discovering yoga, which helped to reduce my anxiety and my out-of-control eating, especially in light of the fact that I didn’t want to start taking any prescription medications.

My relationship with food has been a long and winding road.  I have memories when I was 4 or 5 of sitting at my kitchen table by myself, long after everyone else finished eating and was allowed to move on, because I was not allowed to leave the table until I finished everything on my plate, including those horrible green vegetables.  I tried every trick in the book, including slipping some to the dog under the table and putting some in my mouth, wiping my mouth with a napkin and spitting what was in my mouth into the napkin.  I also hear my parents in my mind saying “Eat your food!  There are people starving in Africa” and thinking to myself “Great, send them my food!”.

From there, after my parents got divorced, food became scarce for most of my adolescence.  My parents’ divorce and subsequent relationship was very contentious, pushing me into the land of anxiety.  I began to worry about where my next meal would be coming from and if it would be enough.  The pattern that grew from there involved eating large amounts of food (even if I wasn’t hungry) when food was available and eating very quickly (to ensure I got enough before it disappeared).  I also have memories as a young adult where I would eat my meal very quickly and then eat what was left by others on their plates.

As time passed, my relationship with food changed when my weight began to increase.  At this point, I would not allow myself to eat anything until the end of the day, after I had taken care of everyone else’s needs on my list.  Only then, almost like a reward for completing my “To Do” list for others and my sense of self-restraint or control, would I allow myself the indulgence of fulfilling one of the most basic human needs.  What didn’t change at this point though, was the speed in which I ate and the amount of food I would eat!

I then ventured into the many ‘diets’ being promoted.  My weight began to yo-yo.  My life felt so out-of-control as did I!  It wasn’t until I discovered yoga that I found myself in a space to really confront this unhealthy relationship I had with food, facing the fears lying beneath my journey in the land of anxiety.  And even with the support of my yoga practice (and a boost from some hypnotherapy), it took me many more years to see food as simply a source of energy for my body, like gas or electric for a car.

So how excited was I when I read the recent promising research on using direct neurofeedback (i.e., transcranial direct current stimulation or tDCS) to reduce impulsive behaviors!  Although it is not exactly clear how it does so, a positive effect was found in 74 out of 92 research studies.  It warms my heart to learn that there is an alternative to prescription medications, something that specifically supports the brain’s innate ability to reorganize itself towards health, and does so relatively quickly.

If you would like to read a little more on this research, click on the box below:

5 Intention-setting Ideas to Bring More Joy Into Your Life

This time of year can be stressful for most of us to say the least!  For some, including myself, it might also bring up memories of loss, family discord, and unfulfilled dreams.  So I did a little research on tools that have been shown to shift us into a space of joy and, when integrated into a regular practice, can make that joy more sustainable and available to us any time of year (also see my Reflections below on Positive Psychology).

To take a deeper dive, perhaps consider saving this website (https://itsallgoodhere.com/) in your Favorites and set a new year intention to explore these tools more.

In the meantime, consider the following intention-setting ideas to try this month:

  1. Positive Moments.  Consider setting an intention to identify at least one positive moment each day in the month of December.  You may consider it small, even insignificant, such as the first sip of your morning coffee or tea on a cold morning or climbing under the warm blankets at the end of your day.  It doesn’t matter.  What matters is that you take time to reflect on that moment and hold the experience in your awareness, perhaps for 10 to 20 seconds.  Then, consider sharing that positive moment with someone.  If you do this at night and would prefer, you can share it on Social Media.  The act of sharing allows the positive moment’s effects to linger for longer, inviting a deeper level of positivity into the body and mind.
  2. Personal Strengths.  Another option to consider for setting an intention for the month of December is to identify one of your personal strengths and then think about how you used it today or within the last couple of weeks.  You can stay with one of your personal strengths all month and challenge yourself to identify multiple times/ways you used it or challenge yourself to identify a new strength each day, along with an example of how you applied it in your life.  Or it can be a combination of both, it is all good!
  3. Set a Goal!  Perhaps start by simply reflecting on how you felt the last time you accomplished something you set out to do.  Can you remember the feelings that come with accomplishment, such as satisfaction, peace, motivation, joy?  From there, consider setting one small, attainable goal each day this month with a further intention to track your progress.  It can again be something simple like making your bed, finishing that book that you started awhile ago or reaching out to a friend that you haven’t connected with recently.  The key is to track your progress, specifically to reflect on how many times you met your goal that day.
  4. Reframe Negative as Positive.  This intention-setting idea might be a little more tricky – looking for the ‘silver lining’ in what our culture might label as negative.  When we are able to discover some benefit from an experience that brought us some level of aggravation or upset in the moment, we are doing what is called a ‘positive reappraisal’.  How do we do this?  Well, it starts with identifying something, whether an event or a routine activity that we find distasteful, for whatever reason.  Perhaps it is doing the dishes or getting stuck in traffic.  From there, we search for how these things might provide us with some positive outcome that we simply have been ignoring or have refused to consider in the past.  So, for the dishes, we might reframe it as now I have dishes ready for the next meal or the kitchen looks more welcoming.  For getting stuck in traffic, consider that you have more time to listen to your favorite podcast or music.  The more you practice this skill, the easier it gets and you tend to discover multiple positive aspects to every situation!
  5. Random Acts of Kindness.  Honda does not have to have the corner on this market!!  And it doesn’t have to cost you a thing!  During this season of connection, consider doing something kind for someone else each day this month.  It can simply be offering a genuine smile as you pass them walking by, opening a door for someone, or helping someone carry their bags in or out of their car.  Remember to take a moment to reflect on what you feel afterwards, sensing how the joy you feel inside is spreading out and touching others!

Is positive psychology really effective?

When we experience loss, it is normal and natural to feel sad.  It is also normal and natural when we are under stress to use safety seeking strategies such as pulling back from support structures, such as friends and family.  At the same time, it can sometimes be difficult to move through such normal experiences and rediscover the joys in life.  We can get stuck under the weight of loss and stress, feeling alone and on edge, especially when the stress is chronic.

Reminders of loss often arise at this time of year, whether it is the loss of the innocence of our childhood or the loss of someone that we loved.  Mix in the stress of the holiday season, when our “To Do” list grows long, and it is a recipe for pulling us down into the gloom and making us more susceptible to falling ill.  It can be especially challenging when experiencing this sense of spiraling downward when we don’t have any tools to support us in turning it around.

When we feel alone and don’t want to bother anyone with our troubles, where can we turn to support our navigation through such powerful emotions that tend to knock us off balance?  Is it truly possible to use positive psychology to get us unstuck and back in balance?  Can the technology wave of online help deliver such life balancing tools, allowing us to take this journey from the privacy of our homes?

Well, a new randomized controlled trial took a look at a facilitated online positive emotion regulation intervention with caregivers responsible for people with a diagnosis of dementia.  It was a 6-week intervention that focused on testing the effects on positive emotion, depression, anxiety, and physical health.  This study demonstrated that there are tools that can teach us to experience a more positive attitude and when we have a more positive attitude, it reduces the powerful emotions of anxiety and depression!  This study supports the use of online, remotely delivered programs to support the navigation towards psychological well-being through the use of positive psychology tools.

If you would like to read more about this research, click on the link below:

Connect with Your Inner Source of Peace

2020 Monthly Film Viewing and Reviewing Parties

Come join the party on the last Sunday of each month starting in February, 2020!

Doors will open at 6:30 pm so that you can get some popcorn and hot tea before the movie starts.  Doors will close when the movie starts at 7 pm.

After each movie, a discussion will be facilitated so consider bringing a journal to take note of what you took away from the film or what you learned from other film critics.

Vision Board Playshop to Support Your New Year Intentions!

Registration for this event is required as space is limited.  If interested, Please make sure to reserve your spot by either calling (657) 204-6262 or emailing me at linda@sanctuary4compassion.com soon!

Might integrating trauma-informed yoga into group psychotherapy be helpful in healing and health?

As a trauma-informed yoga teacher and holistic psychotherapist, I’m always on the outlook for new ways to integrate these two (East meets West) healing modalities, better supporting the alignment of the body, mind and soul (think spirituality).  Research continues to emerge in support of integrating both with positive effects.  As we continue to expand our understanding, we are learning that treating the mind (psychotherapy) separately from the body (yoga) limits the healing benefits.  Just as we are learning that treating the body (medical health) without considering the mind (mental, emotional health) limits healing.  Yet, as I have written about in a previous Blog, there are many yoga style options.

What makes trauma-informed yoga different?  A central tenet of such an approach is choice.  As such, the language used to guide students is specific to creating a choice-based environment and reminds them that they are always in control of their practice.  Certain words are used to empower participants to make choices that feel comfortable and invite a more gentle compassionate approach.  The teacher’s role is to be a supportive and non-judgmental presence.  They are aware of how their own movements and interactions are perceived, demonstrating predictability and consistency to create and maintain safety.  In maintaining such healthy boundaries, they model those boundaries, which includes no physical assisting as such assisting may be triggering to someone recovering from trauma.  Trauma-informed teachers ‘invite’ participants to draw their awareness to the sensations in their bodies to guide them in their choices of shapes and timing of their movements, not ‘tell’ them what to do and when.  Even the guidance around how to breathe in such a class is a suggestion to find a supportive breath that invites comfort.  So no focus on holding the breath is offered.  If you are interested in reading more about trauma-informed yoga, I would suggest checking out Zabie Yamasaki’s website here.

Trauma-informed yoga is new.  In fact, in 2017 the Trauma Center’s trauma sensitive yoga (TCTSY) became the first dedicated yoga program in the world to be listed as an evidence-based program/practice of psychological trauma.  So how excited was I to read the emerging research on integrating trauma-sensitive yoga into group psychotherapy for at-risk groups, such as survivors of intimate partner violence.

What this research suggests is that it may not only have positive effects for clients in Group Therapy, but also for the care providers!  If you would like to read more about this research, click the box below:

Is direct neurofeedback safe and effective for depression when pregnant?

I believe most of us want to do what is best for our health, such as eating well, exercising, getting enough sleep and staying connected with friends and family and I imagine maintaining our health and wellbeing takes another step up on our list of priorities when we think about getting (or are) pregnant.  If we smoke, we might consider stopping.  If we drink alcohol, we again might consider stopping.  However, if we experience a mood imbalance (think anxious and/or depressive symptoms), do we consider stopping any medications we are taking that are currently supporting our experience of more balance in our moods?  And what happens if we begin to experience some of these symptoms for the first time during our pregnancy, do we consider taking medications while pregnant or try to tough it out?

It is not uncommon for physicians to encourage women to stop such mood management medications as the side effects can be premature birth and low birth weight, similar to the impacts of smoking and drinking during pregnancy.  Where does this leave moms-to-be that are either taking such medications or might experience antenatal anxiety and/or depression?  There is research that shows babies have higher levels of the stress hormone cortisol when moms experience untreated depression, which increases the risk of that baby developing anxiety, depression, and other mental and behavioral challenges later in life.  So it is well known that depression in pregnancy negatively affects both mom’s and her baby’s health, so is there any other option?

A recent pilot randomized controlled research trial shows hope for a non-invasive, non-medication brain stimulation treatment option, specifically transcranial direct current stimulation (tDCS), also referred to as direct neurofeedback.  The results of this trial reflect the feasibility and acceptability of such an option along with encouraging preliminary effectiveness and no serious adverse (i.e., side) effects in this under-treated population.  The effects even lasted a month after delivery!  The results of this pilot study supported the next step to a definitive random controlled trial to evaluate tDCS for antenatal depression.

If you might be interested in reading more about this treatment option, either for yourself or someone you know that is struggling with such a decision, please click on the link below to learn more: