The Importance of Sleep for Good Mental Health

Ministry of Health Vanuatu

MOH logo

May 2019 Mental Health Newsletter

The Importance of Sleep for Good Mental Health

Sleep difficulties are a feature of nearly every mental health difficulty, including depression, anxiety, trauma, substance use issues, bipolar disorder and psychosis or schizophrenia. Take Depression for example. Up to 90% of individuals with Depression have sleep difficulties, and two out of every three have significant enough sleep problems to also have a diagnosis of Insomnia.

alarm clock analogue bed bedroom

Worse still, Insomnia does not tend to go away on its own without appropriate treatment. This is because once people start to sleep poorly, they tend to develop ways of thinking and behaving around sleep that make their problems worse over the long run.

Fortunately, there is a treatment out there that can improve your sleep. It’s called Cognitive Behavioural Therapy for Insomnia (CBT-I), which directly targets these unhelpful thoughts and behaviours around sleep.

CBT-I is an effective treatment for insomnia, with many studies showing it to be similar to sleeping pills at improving sleep in the short-term, and much more effective than sleeping pills at improving sleep in the long-term.

Research shows that CBT-I consistently reduces the time taken to get to sleep, decreases the amount of time spent awake during the night, and improves sleep quality and efficiency, with improvements persisting after treatment finishes. This is unlike sleeping pills, which typically lead to sleep difficulties coming back once people with insomnia stop taking them.

Sleeping pills are also not recommended for use beyond 2-4 weeks at a time, because they stop working after a while and people need to take bigger doses over time to get the same effects. Sometimes doctors prescribe them more because they think they will work faster for patients, but even one session of CBT-I has been shown to make a significant difference to one’s sleep at night!

beach during sunset

CBT for Insomnia consists of four main components:

  1. Psychoeducation: This provides people with helpful information around sleep, including homeostatic pressure, circadian rhythms, hyper-arousal and sleep hygiene recommendations. Sleep hygiene means having a comfortable bedroom environment, minimising light exposure before bed, exercising during the day, minimising caffeine and alcohol and doing things to wind down or manage worries before bed.
  1. Sleep scheduling: This provides people with helpful information on when they should be going to bed at night, the time they should be arising from bed in the morning, and the ideal amount of time that they should be in bed for each night. Stimulus control and sleep restriction are the two main interventions included in sleep scheduling, and both are scientifically supported for improving sleep quality and sleep efficiency if done properly.
  1. Relaxation techniques: Because hyper-arousal plays a huge role in Insomnia, it is important to help people develop strategies to quieten the mind and calm the body, during the day, before bed and in bed. Relaxation techniques can include imagery training, meditation, biofeedback training, deep and slow breathing and progressive muscle relaxation.
  1. Cognitive Therapy: This provides people with the skills to challenge their unhelpful or unrealistic beliefs about sleep. A lot of individuals with Insomnia attribute all of their tiredness, mood difficulties or poor performance at work to their sleep difficulties, and this puts too much pressure on them to get a good night’s sleep. It is therefore important to get them to see the other factors that may contribute to how they feel during the day, present them with data that challenges their fears, and help them to develop realistic expectations about their sleep.

In Vanuatu, there is currently only one psychologist located at the Mind Care Unit in Port Vila who is trained in CBT-I. Please come down to receive this effective treatment if you or a family member is struggling with poor sleep. Until then, there are other sleep strategies that you can try:

orange cat sleeping on white bed

BEST SLEEP INTERVENTIONS OVERALL

In 2017, Dr Damon Ashworth, Clinical Psychologist and Sleep Researcher, ran 26 two-week experiments on his sleep to determine which interventions were most helpful for him.

He gave each intervention a score out of 100, based on how effective he found the strategy (25 points), how easy it was to apply and use the strategy (25 points), and how much scientific evidence there was that showed that this strategy could improve sleep (50 points).

Here are all of the sleep interventions he tested, ranked from best to worst based on their overall score out of 100:

palm trees at night

High Distinction

  1. Stimulus control = 85/100
  2. Winding down before sleep = 85/100
  3. Sleep restriction = 81/100
  4. Relaxation strategies pre-sleep = 81/100

photo of a man sitting under the tree

Distinction

  1. Meditation = 77/100
  2. No alcohol = 75/100
  3. Wearing blue-light blocking glasses before sleep = 75/100
  4. Listening to music in the evening = 73/100
  5. Yoga/Pilates = 72/100
  6. Constructive worry or writing down plans = 71/100

white teddy bear with opened book photo

Credit

  1. Avoiding TV before bed = 69/100
  2. Melatonin = 68/100
  3. Aromatherapy = 68/100
  4. Sauna or hot bath in the evening = 68/100
  5. Morning sunlight = 65/100
  6. Reading or listening to audiobooks pre-sleep = 63/100
  7. Exercise during the day = 61/100

black ceramic tea cup on brown surface

Pass

  1. No caffeine = 58/100
  2. Food that helps sleep = 57/100
  3. Controlling temperature = 57/100
  4. Massage in the afternoon = 57/100
  5. Comfort of sleep surface = 56/100
  6. Sleeping alone = 53/100
  7. Creativity in the evening = 52/100

Sleep Recommendations

(Stepanski & Wyatt, 2003)
  1. Decrease time in bed – Sleep efficiency is a better predictor of satisfaction with sleep and daytime mood than total sleep time. So if you only get 7 hours of sleep per night, spend 7.5 hours of time in bed. This will allow for better sleep over time.
  2. Regular bedtime and arising time – Reducing variability in your sleep can make a huge difference in how long it takes you to get to sleep, how restful a sleep you have, and how refreshed you feel in the morning. Have a set bedtime, and whenever you feel sleepy around this time, go to bed. Then set an alarm so that you can wake up at the same time each day. If you want to sleep in on weekends, allow yourself no more than one hour later than you usually wake up. Following this regardless of how much sleep you get helps to strengthen your circadian rhythms and build up your homeostatic pressure to ensure better sleep over time.
  3. Exercise – Vigorous exercise prior to bedtime is actually unhelpful for sleep, but expending more energy during the day is likely to lead to better quality sleep at night. The earlier in the day it is done, the greater the effect it will have.
  4. Less caffeine and alcohol – Minimise these substances where possible, especially within 4 hours of bedtime as they both have significant effects on sleep quality. Alcohol can reduce worries and result in getting to sleep quicker, but results in poorer sleep quality in the second half of the night. Alcohol can also can lead to more snoring due to the loosening of the throat muscles. Caffeine boosts cortisol levels, a.k.a. stress, and results in less deep sleep and more awakenings.
  5. Do not try to sleep – It is something that has to come on naturally. The harder you try to get to sleep, the less likely you will be able to, as trying activates the autonomic nervous system, which also increase how stressed you feel. The more you allow yourself to relax, the more likely sleep is.
  6. Do not keep looking at your phone or alarm clock during the night – If your alarm is set, then there is no need to know the time in bed. This will only increase performance anxiety if you look and see that you have not slept for very long. Put it in a draw, cover it with a shirt, or face it the other way.
  7. Keep naps short – Napping during the day reduces your pressure for sleep by the time you get into bed at night. If you have to nap, keep it less than 30 minutes so that you don’t go into a deep sleep, and do it before 4pm so that sleep pressure can build up again by the time you go to bed that night.
  8. Engage in relaxing activities before bed – Just like waking up, going to sleep is a transitional process. Don’t expect that your mind will shut off immediately as soon as you get into bed. Whatever it is, do something relaxing as a pre-bed routine. Watch some T.V., read a book, listen to some music, have a hot bath, practice yoga, mindfulness or relaxation techniques. Then maintain that relaxed state in bed and allow sleep to come.
  9. Use the bedroom only for sleep and sex – This means no reading, eating, internet surfing, game playing, phones, T.V., planning, worrying etc. in bed. Want bed = sleep.
  10. Make worry list before bed – To prevent your mind from racing in bed, reflect on the day about 2 hours before you want to sleep, write down any worries, concerns or problems you may have, create a to-do-list, or plan for the day ahead. Then if thoughts come up in bed, remind yourself that you have already sorted them out or that they can wait until tomorrow.
  11. Leave the bed if awake – Sometimes no matter what we try, you may find yourself awake in bed. If you do not fall to sleep within what feels like 20 minutes, get up, go to another room, and do something relaxing until you are sleepy before returning to bed. Over time, this will recondition the bed with sleepiness rather than frustration and allow you to fall asleep quickly. If you are worried that you may never sleep if this was the case, give it a try for a week. It may be the most difficult recommendation to follow initially, but it produces long-lasting results quickly.

For more details on these interventions and strategies, go to www.sleepdetective.com.au.

If you are in Vanuatu and would like more information or advice, please contact:

Mind Care Clinic

Psychiatry Department

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1972

 

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

 

Mental Health Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

 

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

 

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

 

Dr Damon Ashworth

Clinical Psychologist

10 Bits of Advice I’d Give My 10-Year-Old Self

When I was ten, I was in grade four at primary school. I was one of the tallest kids in the class, and fairly skinny and uncoordinated.

I loved sport and computer games. I enjoyed living where I did in the north-east suburbs of Melbourne and had some good friends that I spent a lot of time with.

I hated school, talking on the phone, doing chores around the house, and my little sister. I also tried to take sick days from school fairly regularly with a sore tummy that I only realised years later was actually anxiety. I’d had a horrible teacher the year before who really didn’t seem to like me, and had no idea how to cope.

Here are the first ten thoughts that come to mind that I would say to myself if I could go back in time and have a chat with my ten-year-old self:

calm daylight evening grass

1. Before you do anything else, breathe

I know you worry a lot and stress yourself out by overthinking, but you don’t have to have all the answers yet, or maybe ever. Before you do something you may regret, stop, take ten slow, deep breaths into and out of your belly, and try to breathe out all the air with each breath. Then see how you feel and what you can do.

man wearing black and white stripe shirt looking at white printer papers on the wall

2. Focus on one thing at a time

I know that you feel that you have too many things to do and not enough time. But multi-tasking is a myth and will just stress you out more. Determine whatever it is that is most important to you in any given moment, and then try to put all of your intention and effort into that until it is complete, or you need to take a break or have a rest or something more important comes along.

analysis blackboard board bubble

3. Don’t always believe what your thoughts tell you

I know that you personalise things a lot and catastrophise or imagine the worst. Some things are your fault, but many things are not. You are not “bad” or “evil”, but you can do some pretty mean things if you want to. You’re also probably not going to die about the homework assignment that you forgot to save on your computer. Start meditating 10 minutes a day before you go to bed, and you will be successfully understanding your thoughts and managing your emotions in no time.

notebook

4. Write things down

I know you feel that your mum and dad don’t always understand you, but you can learn to understand yourself through reflection. Write down 3 things that you are grateful for every day. Make a plan to address any concerns or worries that you have before they all build up and becoming overwhelming for you. If you spend 5-10 minutes every day writing in a journal, you won’t regret it.  Also, learn how to use a calendar or diary as soon as you can. Good organisational habits now will make life much easier for you later on.

action activity balls day

5. Don’t forget to have fun

I know that you are super competitive and hate to lose, but basketball, swimming, tennis, baseball or any other sport that you do is meant to be fun. Practice isn’t always fun as that’s focused on helping you to get better, but if you don’t enjoy competing or playing the games, find another sport that you think you will enjoy, and put more time into that. You are not going to be a professional athlete who gets paid, and that is okay. Sport is a very healthy hobby to have, and if you can enjoy it, it’s even better.

pexels-photo-1148998.jpeg

6. It’s okay to make mistakes, get rejected or fail

I know that you struggle not being very good at something. Even though it doesn’t feel that good to be a novice or a beginner, the only way to become good at something is to first be okay at sucking at it. If you can persist through the sucking part, you will become a lot better over time, and not suck so much eventually, and probably even enjoy it. Keep playing and practicing guitar and trombone, keep drawing and being creative, and pay attention in Italian class. It’s pretty cool to be able to make art and speak multiple languages, and easier to learn when you are still young. Also, take French at high school, not Indonesian.

adult blur books close up

7. Keep reading and learning outside of school

I know you don’t like school much at the moment, but don’t just let your teachers dictate to you what you should learn. If something interests you, explore it further. If you have questions that you want to answer, see if you can find the answers in books. There are a lot of wise people that have clarified their thoughts and written it down for you. Their words will help you a lot as you get older, and fostering curiousity and love of learning at your age is awesome. If mum wants to teach you how to cook, bake, clean, iron, sew, listen to her, watch what she does, try it and get feedback until you know what you are doing. Same goes with dad trying to teach you about sport, cars, gardening and making things with tools. You won’t regret having these skills once you move out on your own.

men s white button up dress shirt

8. Make time for friends and family

I know that playing video games is fun, but technology shouldn’t replace face-to-face contact with other people. Be interested in people more than you are in things. You will learn a lot from them, and it will make you happier if you are yourself and they appreciate you for it. Your family won’t always be around as much as they are now, so try to enjoy the time you have with them even though they can all be annoying at times. And be nice to your sister. It’s not her fault that she is cuter and more extraverted than you. She’ll actually turn out to be a pretty cool person and a good friend to you one day.

finance sketch near laptop computer

9. Invest in index funds

I know that it is fun to spend money if you have it, but saving and investing doesn’t have to take much time and effort and is worth it. No matter how much money you earn or are given, put 10% aside and stick it into an index fund. The power of compounding interest means that you will be setting yourself up for your financial future, which will give you more freedom to do the things you want to do when you are older without having to worry about money. You probably won’t feel like you are sacrificing much, but the long-term benefit will be great.

biker holding mountain bike on top of mountain with green grass

10. Try to be the best you that you can be; everyone else is taken

I know that you often compare yourself to others and don’t feel like you are as good or as lovable as them. The truth is you will never be as good as your brother at being your brother, so don’t even try. Rather than comparing yourself to who others are today, try to compare yourself to who you were yesterday. As long as you are striving to be a better person each day, that is all you can do, so be proud of yourself for who you are and for the effort that you put in. Although it doesn’t feel like it sometimes, know that mum and dad are proud of you and love you too, even if they don’t always show it in the way that you want them to. Your life is going to be pretty cool in the future, and it doesn’t just get harder and harder, so try not to worry about the future too much. Focus on what is in your control each day, and the future will take care of itself!

 

Dr Damon Ashworth

Clinical Psychologist

 

What is Depression and How Can We Manage It?

Ministry of Health Vanuatu April 2019 Mental Health Newsletter

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What is Depression?

Approximately 1-in-5 people will experience Depression at some stage of their lives.

It is normal for people to experience short periods of sadness. Although some people may say that they are depressed if they feel sad at times, Depression, formally known as Major Depressive Disorder (MDD), is a psychological disorder of consistently lowered mood. Depression also comes with several physiological, cognitive and behavioural changes.

These changes include:

  • lack of interest or pleasure in most activities
  • fatigue
  • loss of energy
  • difficulties sleeping or sleeping too much
  • feeling restless or slowed down physically
  • increased or decreased appetite
  • substantial weight gain or loss without intending to do so
  • feelings of worthlessness
  • excessive or inappropriate guilt
  • indecisiveness
  • concentration difficulties, and
  • recurrent thoughts, plans or intentions towards death or suicide.

To meet criteria for Depression, an individual must have at least five of these symptoms most of the day, nearly every day for two consecutive weeks, and it must result in significant distress or functional impairment (American Psychiatric Association, 2013).

grayscale photography of couple walking on ground

Potential Treatments for Depression

1. Antidepressant Medications: 

Various antidepressant medications have been developed and prescribed over the years, including monoamine oxidase inhibitors (MAOIs), tricyclics antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and more recently norepinephrine (SNRIs) and dopamine reuptake inhibitors and melatonin-based antidepressants. The most commonly prescribed antidepressants worldwide are SSRIs, however, only TCAs are currently available in Vanuatu. This medication is not recommended for children, and is only recommended for adults with moderate to severe depression.

2. Psychological Treatments:

Cognitive Behavioural Therapy (CBT) for Depression is a non-drug treatment that focuses on improving what people think and believe (including their expectations) and behavioural factors associated with depression. CBT has many studies supporting it as an effective treatment for Depression, with research showing comparable or greater effectiveness than treatment by medication, especially with milder forms of Depression (Butler et al., 2006).

Furthermore, CBT and antidepressants together can have additional benefits over either CBT or medication alone for severe Depression (Thase et al., 1997). Thus, effective treatment for severe cases of Depression may benefit from both medication and psychological interventions like CBT.

3. Self-Help Strategies:

Currently, the number of Medical and Allied Health staff trained in Mental Health treatments in Vanuatu is limited, especially outside of Port Vila. There are also various instances where individuals are unable to access or do not want to use any of the traditional treatments for Depression. This is where self-help strategies for Depression can potentially assist.

In 2009, Morgan and Jorm asked several Depression experts which strategies (out of 282 possible options) they thought would be most likely to be useful for individuals with sub-threshold Depression.

They came up with a final list of 25 self-help strategies that can be frequently used by people with Depression.

brown tunnel near body of water

The 14 self-help strategies rated as most likely to be effective for Depression included:

  1. Make sure that you get out of the house for at least a short-time each day
  2. Eat a healthy, balanced diet
  3. Do something you enjoy
  4. Try to remain involved in purposeful activities for at least a small part of each day
  5. Engage in exercise or physical activity
  6. Make sure you get enough sleep at night and have a bedtime and rise time that varies little from day to day
  7. Engage in an activity that gives you a feeling of achievement
  8. Talk about problems or feelings with someone who is supportive and caring
  9. Let family and friends know how you are feeling, so they are aware of what you are going through
  10. Try methods to improve your sleep, such as not napping during the day, avoid caffeine and alcohol before bedtime, and make your bedroom as restful as possible
  11. Enlist a trusted friend or relative to help you get out and about or do activities
  12. Reward yourself for achieving a small goal
  13. Learn relaxation methods
  14. Make a list of strategies that have worked in the past for depression and use them

Seven strategies were rated by Depression experts to be less helpful but not likely to be harmful. These were:

  1. Take a nap
  2. Have a warm bath
  3. Take omega 3 fatty acids (fish oils)
  4. Get a massage
  5. Do yoga
  6. Take St John’s Wort
  7. Take antidepressants

Depression experts rated four self-help strategies as being potentially harmful for Depression. These were:

  1. Spend more time alone
  2. Drink alcohol
  3. Do something risky and exciting, such as driving a car too fast or under the influence of a substance
  4. Use illicit drugs, such as marijuana

A follow up study in 2012 by the same authors then compared what the Depression experts recommended to what individuals with Depression actually did.

By looking at their behaviour, individuals with Depression tend to isolate themselves way more than experts recommend, drink more alcohol than is valuable, and struggle to exercise, achieve things, talk to others, ask for help, and relax as much as they would like to.

What this means is that if you or a loved one has Depression, try out the first 14 self-help strategies listed above.

If they do not work or you are unable to do them, it may be important for you to seek extra help and support from someone that you trust or a qualified Mental Health professional such as a Mental Health Nurse or Psychologist. This is especially important if the Depression becomes severe and is affecting you or your loved one’s life at work, school or home

bench chair friends friendship

You do not have to suffer alone. For more information or advice, please contact:

Mind Care Clinic

Psychiatry Department

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1972

 

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

 

Mind Care Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

 

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

 

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

Dr Damon Ashworth

Clinical Psychologist

March 2019 Newsletter: Positive Psychology and the Pursuit of Happiness

Ministri blong helt Vanuatu

MOH logo

Niusleta blong Mental Helt Maj 2019

Positif Psychology mo Persut blong Hapines

11-13 Maj 2019 MoH I bin trenem araon 15 jej, women, mo komuniti lidas lo saet blo idaentifaem mo imployim Saeko sosol fes eid sapos oli kam akros sam we oli fesem mentol helt jalens lo respektif komuniti blo olketa.

Blong fulap yia, folem olgeta step blong Medsin, saekoloji hemi bin preokupaed wetem aleviesen, be i no persuiet blong hapines.

Tritmen i fokas long hao blong ridusum  dipresen, warines, o olgeta narafala difikol negatif  filing, be hao nao oli save impruvum olgeta positif filing. Be harem nogud hemi no minim sem samting long olsem harem gud? Ating hemi no rili sem samting.

Long ples ia nao we Positif Saekoloji i kam insaet…

woman in white tank top holding hardtail bike

Long ‘Flourish’, Seligman i proposem se i gat faef elemen nomo long laef we i impoten blong bes saekolojikol gudfala-stet.

Oli kolem model blong gudfala-stet hemi PERMA:

P = positif emosen: Evriwan i nidim lav, joi, hop, kompasen, apresiesen, admiresen mo eksaetmen long laef blong yumi. Wanem aktiviti nao i givimaot olgeta emosen blong yu? Hemi save watjem san i kirap o san i traon, go long solwota, spendem taem wetem klos famli, mekem volontea o helpem olgeta strenja. Wanem bae i hapen yu save inkej long olgeta aktiviti long moa regula besis?

E = Enkejmen: Samtaem oli kolem “floh” enkejmen hemi stet we taem yumi nomo save andelem long hed blong yumi o hed blong yumi i fulap long olgeta warines, be yumi enkej tumas long wanem yumi mekem long taem ia. Olgeta inkejmen eksperiens oli no save krietem isi be olgeta, kondisen blong laef oli save krietem. Long stret rul, enkejmen i kamap moa long olgeta aktiviti we i rikwaem sam skil we i no jalenj tumas be i no afektem tu.

Enkejmen hemi wanem olgeta spotman oli rifer lem taem oli stap “inaset long zon” o wanem we M. Scott Peck i rifer lem taem hemi tokbaot buk blong hem we oli salem gud we i luk olsem se buk ia i tokbaot hem wan nomo. Maenfulnes trening, ekskludum olgeta narafala benefit long stres, safring mo privensen blong dipresen we i rilaps mo i lid i go long wan hae janis blong ful inkejmen wetem wan situesen.

R = rilesensip we oli positif: Se yumi kam sosioli konfiden o selfis, humen oli stil osem olgeta sosol animol. Yumi evriwan i lukaotem blong man i save andastanem yumi mo akseptem pesonaliti blong yumi o gat wan filing se yu semak nomo long olgeta. Yumi wantem sherem eksperiens, olsem we yu save notisim wetem evri pikinini we oli wet long olgeta perens blong olgeta blong luk mo faenem wanem oli mekem bifo inkej long wan aksen. Long 2007 wan muvi “Into the Wild”, men karakta we i konkludum, “Hapines hemi kam ril taem yu sherem”.

Negatif rilesensip i save mekem man i harem nogud tu. Sikret hemi blong faenemaot mo favoretem raet koneksen (e.g. fren, patna), olsem hao blong impruvum wanem we yumi gat vinis o wanem we yumi no save jusum (e.g. famli, bos). Sipos yu gat problem long eria blong laef blong yu ia, i gat wan buk “Da Relesenjip Kua” blong John Gottman hemi wan ekselen ples blong stat, olsem storian wetem wan saekolojis o wan Nes blong Mentol Helt.

M = mining: Friedrich Nietzsche i bin fes man we i talem: “Wan man we i kat wan risin blo laef bae e faenem wei blo laef eni aoh.” Viktor Frankl i bilif se hemia tu long buk blong hem ‘Man i stap lukaotem mining”, hemi bin faenem eim we oli rikwaem blong stanap strong long deili atrositi we i fesem evri dei olsem wan Jewish presina long wan German konsentresen Kamp long World War II. Frankl, wan Saekiatris, i bilif strong long impotens blong mining we i dediketem laef blong hem i go blong helpem narawan long mining blong laef long en blong woh.

I gat o no gat univesol mining blong laef, i dipen long olgeta relijes o spirituol bilif, be hemi impoten blong faenemaot wanem hemi impoten long laef. Taem yu faenem wanem i gat bigfala mining long yu, mo hemi impoten blong traem laef long laef blong yu long wei ia sipos i posibol, Taem yu no brokem olgtea low blong sosaeti blong yu o kosem impoten problem long narawan. Toktok wetem wan pasta, lida blong wan komuniti o wan profesenol blong mental helt blong helpem yu sipos long laef yu nidim mining naoia.

A = ajivmen: Pipol oli wantem blong ajivim, saksid, winim, witaot wan narafala risen samtaem i mekem yu filim gud mo mekem yumi hapi. I mekem se i gat fulap kod blong video gem (mo from wanem nao oli bildim long gem long fes ples). From wanem i gat fulap korporet korapsen long wol mo abiyus blong draks long spots kompetisen. Fulap pipol bambae oli mekem evri samting we oli gat blong save ovakam mo win.

Ajivmen hemi wan samting we i win, be mo tu blong tekem fulap save, bildimap olgeta skil o komplitem wan wok. Taem yu rijim tri gol mo yu ajivim wan dei, bambae yu mekem evri samting blong impruvum well-being mo jenereli hapines.

Saekoloji hemi abaot moa bitim aleviesen blong safring. Hemi abaot helpem pipol blong andastanem, gro, divelopem perfeksen mo self-efisiensi, mo liv long bes laef we oli save afodem.

Blong gat moa infomesen o advaes, plis kontaktem:

Maen Kea Klinik 

Psychiatry Dipatmen

VILA SENTRAL HOSPITOL

SHEFA

VOIP: 1972

Namalinuan Klinik

LENAKEL HOSPITOL

TAFEA

Mental Health Clinic

NOTEN PROVINSOL HOSPITOL

SANMA

Mental Helt  Klinik

NORSUP HOSPITOL

MALAMPA

Mental Helt Klinik

LOLOWAI HOSPITOL
PENAMA

Dr Damon Ashworth

Clinical Psychologist

 

 

Why 18 is the New 15: The Negative Consequences of Always Wanting Our Children to Feel Special and Safe

Back in 1970, children were thought to be ready to enter Grade One at Primary or Elementary School when they could travel independently around their neighbourhood for 4-8 blocks from their house.

This included 6-year-olds being able to go to the shops and buy things by themselves, or walk or ride to school if it was close enough, and knowing how to explain to a police officer where they lived if they were asked.

These days, the police officer would probably arrest the parents for neglect if a 6-year-old child was found 4 blocks from home by themselves.

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Times have changed, but is this always a good thing for our children?

I remember having a lot of freedom growing up. My mother would let me and my siblings play down at the park by ourselves that was two blocks away from our house. I think my brother was 7 or 8, I was 5, and my sister was 2 or 3. We weren’t entirely alone. We had a pet Rottweiler watch over us too, and “she never would have let anyone hurt you kids!” according to my mother.

We rode or walked ourselves to and from school when my brother was in grade 5, I was in grade 3, and my sister was in grade 1. It wasn’t just a bike path either. We had to ride on roads, cross over a river and railway tracks, and not even at a designated crossing. Both my parents had to work though, so it was just what was done.

After school, we’d come home, open the door by ourselves, make a snack, and play some games or watch TV until our parents came back from work. We were “latch key kids”, and I don’t think we minded too much at all.

Growing up, we played outside unsupervised by adults all the time. Running around with the other kids on the street, playing a sport or making up games, having waterbomb fights during the day or playing spotlight at night. We’d ride to the milkbar whenever we felt like icecream or snack, and even did a paper round in the neighbourhood with my brother a few times well before we were old enough to legally work.

Granted, there were a few scraped knees, and maybe some storm drains that we shouldn’t have gone down. But I knew how to make my way all over town to all my friend’s places on a bike by my 10th birthday. To me, exploring places either by foot or on my bike with my friends and without any parents around were some of the best memories of my childhood.

boy riding of bicycle

Fast forward to 2019, and most children will have to wait until they leave their family home to get the same amount of unsupervised time outside that I had before I was a teenager. They spend less time hanging out with their friends in person, and any time that they do spend is likely to be supervised by their parents or done alongside them, even when they go to the local shopping mall.

In her excellent book, ‘iGen: Why Today’s Super-Connected Kids are Growing up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood’, the author Jean Twenge says that as a result of the reduced freedom for our youth, the typical 18-year-old in 2019 is similar in maturity levels to what a 15-year-old was back in 1970.

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Children and Adolescents these days are less capable of living, socialising or working independently than the previous generations, and are suffering more psychologically as a result.

Depression, anxiety, narcissism and deliberate self-harm have all been increasing, and dramatically so since 2012. This also happens to coincide with the widespread proliferation of smartphones into our society.

If parents should be concerned about anything when it comes to the safety of their children, it is about what they are getting up to online. Adolescent girls appear to be particularly impacted by the introduction of the smartphone and the increased usage of social media that comes with this. Suicide rates among teenage girls have risen to the point where they are now similar to suicide rates in boys of the same age.

What would you prefer to instil in a child?

A. A conviction that they are amazing, just the way they are?

or

B. A belief that they can face and overcome most of the challenges that they face in life if they learn from setbacks and feedback and apply themselves?

Yoy may answer both, but if you had to choose one, what would it be?

Self-esteem (A), which is defined by the Merriam-Webster dictionary as:

“a confidence and satisfaction in oneself”

or

Self-efficacy (B), which Psychologist Albert Bandura defined as:

“the belief in one’s capabilities to organize and execute the sources of action required to manage prospective situations.”

After decades of research, we now know that primarily focusing on building a child’s sense of self-worth and self-esteem (A) at the expense of improving their capacity and self-efficacy (B) in learning and doing things by themselves can have some adverse side effects.

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Research on Self-Esteem:

LOW SELF-ESTEEM IS NOT GREAT

  • Low self-esteem is linked with increased violence, teenage pregnancy, suicide, low academic achievement and increased rates of school dropout (Misetich & Delis-Abrams, 2003)
  • Living alone, being unemployed, having low socioeconomic status or having a disability is linked to lower self-esteem (von Soest, Wagner, Hansen & Gerstorf, 2018)
  • 70% of girls believe that they are not good enough or don’t measure up in some way (Dove Self-Esteem Fund, 2008)
  • Teenagers with low self-esteem have less resilience and a greater sense of hopelessness (Karatas, 2011)

HEALTHY LEVELS OF SELF-ESTEEM IS BENEFICIAL

  • People with healthy self-esteem are more resilient and able to respond helpfully and adaptively to disappointment, failure and obstacles (Allegiance Health, 2015)
  • In China, self-esteem significantly predicted life satisfaction (Chen, Cheung, Bond & Leung, 2006)
  • School programs that build self-esteem in primary school children also reduce problem behaviours and strengthen connections between the students (Park & Park, 2014)

HIGH SELF-ESTEEM ISN’T ALWAYS A POSITIVE

  • Abraham Maslow put self-esteem as a need in his hierarchy of needs pyramid. However, later in his career, he noted that individuals with high self-esteem are more apt to come late to appointments, be less respectful, more casual, more forward, more condescending, more likely to accept an offered cigarette, and much more willing to make themselves comfortable without bidding or invitation
  • Carl Rogers, another Humanistic Psychologist, got so sick of new staff coming into his Western Behavioural Sciences Institute with no desire or ability to work, that he once sent out a letter that said “less self-esteem please; more self-discipline!”
  • People with fragile or shallow high self-esteem are no better off than individuals with low self-esteem. They engage in exaggerated tendencies to protect, defend and enhance their feelings of self-worth (Kernis, 2008)
  • Academic performance is weakly related to self-esteem, with some students doing worse academically after their self-esteem increased (Baumeister, Campbell, Krueger & Vohs, 2005)

Baumeister has looked extensively into the issues with some types of high self-esteem. He found that:

  • Students with high self-esteem tend to overestimate their abilities. They also like to boast to others about what they can do
  • High self-esteem doesn’t make people more attractive to others, it just makes the individual think they are more attractive
  • Bullies at school and work tend to have higher reported levels of self-esteem
  • People with high self-esteem are more likely to take risks and engage in unprotected sex. They have a tendency to be impulsive, and not think through the consequences of a decision before acting
  • People with high self-esteem are more likely to be prejudiced against others. They tend to be smug and superior when interacting with others
  • People with high self-esteem are less likely to work through and overcome relationship conflicts. They can be abusive in relationships, and assume their needs come first no matter what situation they are in
  • People with high self-esteem seem blind to their own faults and are less likely to learn from experience, change or improve themselves

Research on Self-Efficacy:

SELF-EFFICACY HELPS PEOPLE AT WORK

  • A meta-analysis of over 100 studies found a moderately strong correlation (.38) between self-efficacy and job performance (Stakjovic & Luthans, 1998)
  • Another meta-analysis found that high self-efficacy is related to better emotional stability and greater job satisfaction (Judge & Bono, 2001)
  • Greater self-efficacy leads to less burnout for teachers (Skaalvik & Skaalvik, 2007)
  • Increased self-efficacy in nurses can improve their work performance, reduce turnover rates and protect them from exhaustion (Fida, Laschinger & Leiter, 2018)

SELF-EFFICACY HELPS STUDENTS AT SCHOOL

  • High optimism and self-efficacy in students lead to better academic performance, greater coping with stress, better health, and more satisfaction with school (Chemers, Ju & Garcia, 2001)
  • Increased self-efficacy leads to more enthusiasm and commitment to learning in students who had previously been struggling to read (Margolis & McCabe, 2006)

SELF-EFFICACY CAN IMPROVE HEALTH OUTCOMES

  • Patients with cancer with high self-efficacy adjust to their diagnosis better and are more likely to adhere to their recommended treatment (Lev, 1997)
  • Patients with high self-efficacy who have joint replacement surgery exercise more frequently and improve their performance more after the surgery (Moon & Backer, 2000)
  • Improving self-efficacy can increase how much previously sedentary adults exercise, which then enhances their overall health (McAuley, 1992)
  • Parental self-efficacy can reduce the risk of postpartum depression in new mothers (Cutrona & Troutman, 1986)
  • Low self-efficacy is related to anxiety (including social anxiety and panic attacks) and depressive symptoms (Muris, 2002)

The Coddling of the American Mind

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This fascinating 2018 book by Greg Lukianoff and Jonathan Haidt explains that we have fallen prey to three cognitive distortions that have made the children of the iGeneration less prepared for the real world, more narcissistic, and more likely to suffer from emotional and mental disorders.

The three cognitive biases are:

  1. What doesn’t kill us makes us weaker” – therefore we need to protect our children from everything and make sure that they are safe and free from emotional pain at all times,
  2. Always trust your feelings” – so if you feel something, it must be right, and if something offends or upsets you, it must be the other person’s fault, and
  3. The world is made up of good people and bad people” – therefore you must try to call out and take down anyone who has a different point of view because you are precisely right and they are clearly wrong.

We now try to protect children from all danger, monitor and structure all play so that children never get hurt or bullied, and avoid any type of criticism or activities that may dent their ego.

We tell them that whatever they think and feel must be right, and to believe in themselves. We say this even though Psychologists and Behavioural Economists know that there are nearly 100 different biases that the majority of humans fall into, including emotional reasoning, loss aversion, catastrophising and all-or-nothing thinking.

At schools, all children are made to feel like winners regardless of how they do, and they all receive participation awards or student of the week prizes at some point during the year so that no one feels left out or inferior. 40% more students now receive As for their subjects than they did in the 1970s, even though SAT scores have declined in this same timespan.

What Can We Do?

I’d rather have my children go to a school where teachers are more like Supreme Court Chief Justice John Roberts. Here’s an excerpt from his excellent commencement address to his son’s year 9 graduating class in 2017:

From time to time in the years to come, I hope you will be treated unfairly, so that you will come to know the value of justice. I hope that you will suffer betrayal because that will teach you the importance of loyalty. Sorry to say, but I hope you will be lonely from time to time so that you don’t take friends for granted. I wish you bad luck, again, from time to time so that you will be conscious of the role of chance in life and understand that your success is not completely deserved and that the failure of others is not completely deserved either. And when you lose, as you will from time to time, I hope every now and then, your opponent will gloat over your failure. It is a way for you to understand the importance of sportsmanship. I hope you’ll be ignored so you know the importance of listening to others, and I hope you will have just enough pain to learn compassion. Whether I wish these things or not, they’re going to happen. And whether you benefit from them or not will depend upon your ability to see the message in your misfortunes.

I want our kids to learn life lessons that help them to gain the skills and knowledge required to function as an independent adult in the world.

I want children to be both physically and mentally healthy and suffer less from emotional and psychological disorders.

I want them to develop high self-efficacy and a belief that they can do something by trial-and-error and effort rather than assuming that they are great no matter what they are able to do.

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How Do We Build Self-Efficacy?

According to Bandura and Akhtar (2008), there are four main ways to build self-efficacy in our children’s lives. We can do this through:

  1. Mastery experiences: Ensure that your child has regular opportunities to take on and tackle new and challenging tasks that are just outside their current level of comfort and competence. By pushing themselves with these tasks, they will grow and gain in self-efficacy more than if they just keep repeating something that they already know how to do.
  2. Vicarious experiences: Ensure that your children have positive role models or mentors that they can observe doing the things you want to them to know how to do. This could be you, another family member, a friend of yours or a coach. Because you are likely to spend more time with them than other people, it is essential to model the behaviours, mindset and skills you want them to learn. If you do this, they can learn from you, emulate what you do, and then get feedback from you on how they are going and how they can keep improving these skills.
  3. Verbal persuasion: The type of words that are used in self-talk and with others can play a significant role in how much self-efficacy one feels that they have. Like Dr Carol Dweck says in promoting a growth mindset rather than a fixed mindset, we need to praise effort and what children do (their actions and intentions) rather than who they are as a person or what the outcome was. This builds up a greater desire to want to take on more challenging tasks in the future instead of the fear of being wrong, not succeeding, or not being “smart enough”.
  4. Emotional and physiological states: We need to focus on the overall mental and physical health and well-being of children too. If they are sick, tired, sleepy, hungry, stressed, depressed or anxious, it will be more challenging for them to maintain a high level of self-efficacy, and belief in their ability to successfully tackle a challenge will decrease. By helping children to look after the other areas of their health, they are more likely to have the energy and confidence to take on whatever is in front of them, overcome setbacks, and persist until they have achieved their goals.

For more information and ideas on how to help kids to build resilience and self-efficacy, please visit the Let Grow website or learn more about the Free Range Kids’ Movement.

Crime rates are now at their lowest point since 1963. Thanks to a multitude of societal changes, your children are definitely safer than you were growing up, and yet they have way less freedom. Would you be willing to supervise your children a bit less and let them do more by themselves or with their friends if it helped them to grow into independent, resilient and capable adults?

Dr Damon Ashworth

Clinical Psychologist

Why Bother Overcoming Fears?

Last weekend I managed to successfully complete my PADI Open Water SCUBA Diver Course:

PADI Temporary Card

Open Water Diver
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Name: Damon K. Ashworth

Diver No.: 1902AA8575
Cert Date: 16-Feb-2019
Instructor Number: 305944
Store/Resort Name:Big Blue
Store Number:36279
This person has satisfactorily met the standards for this certification level as set forth by PADI.
It was a pretty big challenge for me since I don’t really like being on boats and find it scary just swimming out in the middle of the ocean. I did it though because a close friend asked me if I would be her dive buddy for the course, and I thought that there would be no better opportunity than when I am already living in Vanuatu, home to some of the best dive sites in the world.
To get your Open Water Card, you need to pass a bunch of theory about diving, and you need to complete 24 skills in a pool and then replicate these skills out in the open water across four dives. During the open water dives, we saw a shipwreck, some amazing coral and sea life, and even a few small reef sharks.
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The scariest part to me was when I was up to 18 metres underwater, and knowing that I’d need to stop for 3 minutes at 5 metres on the way up and also ascend slowly to avoid decompression sickness. It meant that if for whatever reason I felt a bit anxious or panicky, I couldn’t just get out to the surface straight away and start gasping for air. I had to try to remain calm, breathe slowly and steadily using my regulator, put some confidence in my dive master who was guiding us through the training and focus on whatever was in my control instead of worrying about things that were out of it.
It’s done now, and I completed the dives and all the skills successfully. Some times were pretty cool, especially seeing the wreck and all the sea life on the coral reef. In general, though, I didn’t love it and was utterly exhausted and a little bit relieved once it was done.
So how do I know if it was worth it? Should I have bothered challenging myself to do something where I actually worried that I could have died if something went badly wrong?
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When Is It Worth Facing Your Fears?

The answer is it depends. It depends on:

  1. What you are afraid of?
  2. How afraid you are (on a scale from 0 = no anxiety at all to 10 = completely overwhelmed and having a panic attack)?
  3. How safe or dangerous the thing you are afraid of actually (or realistically) is? and
  4. How much of an impact it will have on your quality of life if you do not face up to your fear or try to overcome it?

If what you fear has a low risk of actually occurring AND the activity is quite safe even though it feels scary AND not doing it has a significant negative impact on your life, IT IS WORTH TRYING TO CHALLENGE YOURSELF AND FACE YOUR FEARS.

For me:

  1. I think the fear of SCUBA diving was dying.
  2. The thought of actually going SCUBA diving increased my anxiety to a 7/10, which is quite high but not quite at the panic stage.
  3. In terms of actual safety, the 2010 Diver’s Alert Network Workshop Report found that only one-in-211,864 dives end in a fatality. This makes diving more risky than flying in an aeroplane or riding a bike, but much less dangerous than driving a car, skydiving, or running a marathon. We’re even more likely to die from walking or falling down stairs than we are from SCUBA diving.

risk of death

4. If I never went SCUBA diving, I doubt that it would have reduced my quality of life in any way. I did it mostly because I wanted to spend time with my friend and I wanted to challenge myself to face my fears, as not being able to withstand my concerns would have a substantial negative impact on my quality of life.
Based on the above information, I am glad that I went and got my PADI Open Water Certificate. I’m not too sure if I will ever go again though. I could enjoy it more and become less anxious about diving over time, and that did happen even across my four open water dives. If I went again, my anxiety might be a 5 or a 6. In reality, though, I think I can enjoy snorkelling just as much without it lowering my quality of life in any way, and I’ll probably do that more than SCUBA diving in the future.

What Are the Most Common Fears?

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The top ten most common specific phobias are:

  1. Arachnophobia – fear of spiders
  2. Ophidiophobia – fear of snakes
  3. Acrophobia – fear of heights
  4. Agoraphobia – fear of crowds or open spaces
  5. Cynophobia – fear of dogs
  6. Astraphobia – fear of thunder and lightning
  7. Claustrophobia – fear of small spaces
  8. Mysophobia – fear of germs
  9. Aerophobia – fear of flying
  10. Trypanophobia – fear of injections

By looking at the above common phobias, they do all have some basis for why we may become afraid of them. Some spiders and snakes can kill, as can dogs (especially if they have rabies). Planes can crash, and falling from high up can be fatal. People can become trapped and suffocate in a small space or in crowds, and lightning strikes have killed people. Germs and bacteria spread disease too, and medical mishaps are the third most significant cause of death in the US according to the latest figures from the US Center for Disease Control and Prevention. The issue is that our brain is not very good at distinguishing things that are really dangerous versus things that feel dangerous but are actually pretty safe.

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How Do We Overcome Fears?

We overcome any fear through the dual process of gradual exposure and cognitive reappraisal after the exposure:

1. We determine what fear it is we would like to master. Preferably, this is something that you are currently avoiding that is negatively impacting your life, such as not going to the doctor or dentist because you are afraid of needles.

2. We develop an exposure hierarchy on this fear. This should have at least five different tasks that are ranked from least scary to most scary (scale from 0-10) tasks that you would like to challenge yourself with. For Arachnophobia this may be a 2/10 for looking at pictures of spiders, to 4/10 for watching videos of spiders, to 6/10 for looking at spiders in a an enclosure, to 8/10 for a spider being out in the open in front of you, to 10/10 for letting a spider crawl over your hand or up your arm.

3. We start with the least scary task first and stay in the situation for at least 10 minutes if possible. This should be long enough for the anxiety to peak and then reduce substantially during the exposure exercise. Specific behavioural and thinking skills can be taught by a psychologist to help lower stress levels during the exposure if it is not reducing at all.

4. We reflect on the exposure experience afterwards and try to change our previously held beliefs about what we fear. This is called cognitive reappraisal, and is done by asking ourselves “how did it go?“, “was it as bad as I thought it would be?“, and “how would I approach a similar situation in the future?

5. Once we are comfortable with that level of the exposure hierarchy, we repeat steps 3 and 4 with the next task on the exposure hierarchy. Once we become comfortable with the next step, we repeat this process again with the next task until we are successful with all tasks on the hierarchy. This would mean the fear has been overcome or mastered.

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What if What I Fear Really is Dangerous?

If you have Ophidiophobia and live in Australia, you’re probably not going to want to befriend a snake that you run into out in the bush. Australia is home to 21 out of the 25 most deadly snakes in the world. If you wanted to overcome this fear, you might want to instead learn how to distinguish between poisonous and non-poisonous snakes and get more comfortable only with deadly ones from behind solid glass panels at your local zoo. Or you could visit someone who owned a harmless pet snake so that you could get used to being around it and touching it and realising that you are safe.

If you’re afraid of heights, I wouldn’t suggest being like Alex Honnold and trying to free climb El Capitan in Yosemite, but trying out the edge experience at the Eureka tower in Melbourne or even riding on the amusement park ride The Giant Drop on the Gold Coast might be a pretty safe way to challenge your fears.

Facts can really help some people to challenge their beliefs about their fears, but nothing beats putting ourselves in a feared situation first, and then trying to challenge our beliefs afterwards.

For me, knowing that only 12 out of the 35,000 different varieties of spiders are harmful to humans makes me not worry every time I see a little one unless it is a whitetail or a redback spider.

It helps to know that flying is one of the safest forms of travel, with a one-in-12 million chance of crashing. Although I don’t try to stand in an open field with a metal pole during a storm, it does help to know that being killed by lightning is nearly as rare, with a one-in-10.5 million chance.

Even though I don’t like to watch it pierce my skin, needles don’t hurt nearly as much as I used to imagine, and the pain goes away almost immediately after the injection. Bacteria is absolutely everywhere so I couldn’t avoid germs entirely even if I tried, and getting exposed to a bit of dirt when we are young might also be good for the development of our immune system.

If I ever feel a bit trapped or panicky the next time I dive, it will help to remind myself that I have done it before. I have my open water certificate and the skills from this, and what I’m doing is actually pretty safe as long as I don’t panic and follow what I have been taught in my training.

Just because we are afraid of something, it doesn’t mean we have to avoid it for the rest of our lives. But we don’t have to face our fears every time either, especially if it is not harming our quality of life. If you determine it would be good to challenge yourself and try to overcome a fear, I hope the steps outlined above help, and I’d love to hear about any success stories in the comments below.

 

Dr Damon Ashworth

Clinical Psychologist

To Trust or Not to Trust?

Recently, some things have come to light that I have found personally disappointing. A few people have behaved in a self-centred way and it puts me in an awkward situation.

If given a choice, I always try to be kind, open, honest, respectful and co-operative with others. However, sometimes some people don’t play by these same rules, and the more open and honest you are, the more this information can be used against you.

These experiences have led to me doubting myself. I wonder if I am too trusting like some of my friends say. Other friends tell me that the only way to respond is by playing the game also, putting my own needs first too.

What should we do if someone is being unkind, and only considering their needs irrespective of the consequences that these actions have on us?

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Game Theory

Game theory looks at what is the best rational approach to take in a strategic interaction between two people or groups of people. There are many different games, including co-operative games, where the rules and consequences can be enforced, and zero-sum games, where one person’s gain is another person’s loss.

One of the most famous examples of a game is the ‘Prisoner’s Dilemma’:

Imagine that you are a member of a criminal gang and that you have been arrested alongside one of your gang associates. You are in separate rooms at the police station, and you have no way of communicating with your associate. The Police tell you that they have insufficient evidence to get either of you on a big charge, but enough to get both of you on a smaller offence. The Police give you and the other prisoner one of two options:

  1. You can betray your associate by testifying that they were the one who committed the crime, or
  2. You can co-operate with your associate by remaining silent and refusing to testify.

The possible outcomes are:

A. If you both remain silent and co-operate with each other against the Police, you both only get one year in prison.

B. If you both try to betray each other by agreeing to testify, you both get two years in prison.

C. If they betray you, but you’ve tried to co-operate, they get to walk free, and you get three years in prison.

D. If they try to co-operate by remaining silent but you betray them and agree to testify, you get to walk free while they have to go to prison for three years.

The rational approach is not to co-operate with your associate, because at worst, you will get two years in prison (B), and at best you will serve no prison time (D). This is in comparison to the worst outcome of three years in prison (C) if you remain silent, and the best result is one year in jail (A). Not betraying your associate and co-operating will only lead to a worse outcome, even if you know that your associate will co-operate with 100% certainty.

It is therefore not always rational to try to co-operate with someone who could potentially take advantage of you, and positively not sound if you know that they are deliberately trying to take advantage of you.

person with tattoo playing paper scissor and stone

What About Long-term Strategies?

If two people play multiple games of Prisoner’s Dilemma and they can remember what the other player did previously, does it make it more desirable to co-operate rather than betray the other person? This is more reflective of how most relationships are in real life, whether with family, friends, co-workers, bosses or in intimate relationships. We may win more in one situation, but at what cost? This iterated version of the Prisoner’s Dilemma is sometimes known as the ‘Peace-War game’.

In 1984, Robert Axelrod organised a tournament where participants chose their strategies in an extended version of the Peace-War game, let’s say with 2000 trials. He found that greedy approaches to the game actually didn’t fare too well, and resulted in more years spent in prison by the end of the game.

One of the most straightforward strategies was also the most effective, and this was ‘tit-for-tat’. In the tit-for-tat strategy, the aim is to always co-operate in the first trial, and then do exactly what your opponent did on the previous trial for your next move. This way, you punish a betrayal with a quick betrayal back and reward co-operation with ongoing co-operation. Sometimes (in 1-5% of the trials), it is good to co-operate once even after your opponent betrays you, but generally, the most effective method is still tit-for-tat, which is interesting to know.

After the tournament ended, Axelrod studied the data and identified four main conditions for a successful strategy when negotiating with other people:

  1. We must be nice. What this means is that we should never defect or cheat before the other person does, even if we only want the best for ourselves.
  2. We must retaliate quickly and at least 95% of the time if people try to defect against or cheat us. It’s not good to be a blind optimist or always co-operate no matter what the other person does. This only leads to us being taken advantage of by greedy people.
  3. We must be forgiving, and get back to trying to co-operate once we can see that the other person is trying to co-operate reasonably again.
  4. We must not be envious and just try to beat our opponent or score more than them. Creating a win-win scenario is ideal if possible, even if it means giving up some points by co-operating when you could defect.

black and white sport fight boxer

What Relevance Does This Have For Real Life?

It may be easy to fall into the trap of thinking that screwing others over is the best way to get ahead in life. Or to not put ourselves out there so that we don’t get taken advantage of. In reality, this would only be the best approach in a world where every single other person tries to take advantage of everyone else every chance they can. This is not the case in any society on our planet as far as I know, so never trusting people and always assuming the worst from others is not the way to go.

Trust Don’t Trust
Untrustworthy Get hurt Don’t get hurt
Trustworthy More connection Less connection

By looking at the table above, the best outcome is to try and trust individuals who are reliable (and co-operate with them) and not trust or co-operate with individuals who are not. The worst results are being hurt by putting our trust in those we shouldn’t or not letting in or co-operating with others that we really could have.

Maybe I am a little too trusting. I do assume that other people are kind and good people who have good intentions unless I am proven otherwise. This is the position that I will continue to take, even if it means that sometimes I get hurt once I realise that someone is a bit more self-centred or dishonest than I had hoped.

Looking at the four elements of a successful negotiating strategy, I know that I am nice, forgiving and non-envious. The lesson that I do need to learn is that of swift and appropriate retaliation, or enforcing a certain consequence shortly after someone is nasty towards me. This would help to deter the other person from trying any more selfish tactics going forward and could put them back on the path towards co-operating and trying to achieve a win-win situation for the both of us.

I have thought previously that if I always co-operate, then at least I can be happy with the person that I am. However, sometimes being firm and assertive and standing up for ourselves in the face of unkind and selfish behaviour is the far better, and more self-respecting approach to take.

I hope this article has encouraged you to not give up on trying to trust or co-operate with others. I also hope it will encourage you to stand up for yourself if someone is trying to take advantage of you.

 

Dr Damon Ashworth

Clinical Psychologist

How to Cope in Times of Disaster

Vanuatu Mental Health Newsletter

February 2019

Latest Data on Mental Health in Vanuatu

In 2018, Vanuatu’s Lifestyle Disease Unit conducted 13 screening sessions for non-communicable diseases (NCDs) across the island of Efate. As part of this screening, all participants were given a Kessler Distress Scale (K10) to assess their level of psychological distress. Of the 748 participants who successfully completed a K10:

  • 135 (18%) rated their psychological distress as low
  • 213 (28%) rated their psychological distress as moderate
  • 300 (40%) rated their psychological distress as high
  • 100 (13%) rated their psychological distress as very high

More than half of the population that were screened on Efate have either high or very high psychological distress. However, when looking at the amount of people accessing services from the MindCare Clinic on Efate, only 800 out of 65,800 people saw or were seen by the clinic staff in 2018 (1.22%). This means that there are many people out there with elevated psychological distress who may benefit from assessment and treatment with the Mind Care Clinic.

If you or anyone you know has been very stressed lately and it is starting to impact how you function at work, at home, or with friends and family, please do get in contact with us, and we will try to help out where we can. We can be contacted via the Mental Health Vanuatu Facebook page, or via the contact details at the bottom of the article.

How to Cope with Trauma in Times of Disaster

The World Health Organization’s (WHO) Department of Mental Health and Substance Abuse report that exposure to extreme stressors, such as natural disasters and internal displacement, is a significant risk factor for mental health and social problems.

Both Cyclone Pam in 2015 and the evacuations and relocation from Ambae in 2017 and 2018 are two recent events that had a potentially traumatic impact on a large number of people.

Disasters trigger much mental health and long-term psychosocial challenges, as the instability of the event has shattered people’s normal routines, and can trigger stress, anxiety, fear, loss, grief, depression, ongoing adjustment difficulties and trauma. These distressing events affect entire communities, as people can lose their land, homes and belongings, become separated from family members and other close social connections, and have limited access to basic needs and services, including mental health and psychosocial support.

Furthermore, the host communities that take in evacuees are also impacted by the sudden influx of new people, which can lead to changes in regular routines, increased distress and demands, a feeling of being overcrowded or overwhelmed, and reduced access to the already limited resources that are available.

Mental Health and Psychosocial Support (MHPSS) services are critical for the recovery of affected communities, as they can mitigate the effects of such potentially traumatising circumstances. Vanuatu is amongst the top five most disaster-prone countries in the World, which further highlights the crucial need for a national mechanism and sustainable support infrastructure to address mental health needs during times of emergency.

MHPSS programs following natural disasters aim at the psychological recovery of individual community members as well as the social recovery of communities. Psychological first aid (PFA) training and implementation enable friendly, supportive responses to any individuals who are suffering or are in need of support. Such programs address the various psychological issues of affected individuals and strengthen the capacity of communities for future development. Although everyone is affected in some way by events such as natural disasters or internal displacement, some people are particularly vulnerable in crisis and may need extra help.

What is Trauma?

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The Diagnostic and Statistical Manual for Mental Disorders (DSM-V) describes a traumatic experience as exposure to an event that involves death, serious injury (actual or threatened), or sexual violence (actual or threatened). It usually creates intense feelings of helplessness, horror, or fear in the individual.

It is mostly direct exposure to an event that causes trauma, but can also be caused by witnessing an incident that happened to someone else. Other forms of trauma include indirect exposure by hearing about a close friend or family member being exposed to trauma, or through extreme or repeated exposure to aversive details of an event, typically through professional duties, such as first responders to a fatal crash site, or repeated exposure to information of child abuse.

Trauma can create long-standing changes in the brain. Imaging studies have shown heightened brain-stem activity, which controls the fight-or-flight (or freeze) system. This is the brain’s inbuilt survival mechanism. Imaging studies also show increased amygdala activation, which floods the body with feelings of fear. Both of these changes can be quite effective in keeping people safe in times of imminent danger because they allow individuals to scan the environment and react quickly to anything that is perceived to be dangerous.

The problem is that once these areas of the brain become overreactive, they will respond to anything that is potentially similar to a traumatic experience from the past, without first trying to accurately assess the actual level of threat. This makes it more difficult to respond in a calm, rational manner in an individual’s everyday life.

The hippocampus, an area of the brain that is responsible for memory, can also be severely affected by traumatic events. The more extreme, unexpected and inconsistent an event is with previously held beliefs about themselves, the world or other people, the harder it is for the brain to fully process and integrate this experience. Some of it remains unprocessed or “stuck”, which then reduces the capacity to move on from the traumatic event and process and integrate subsequent information that is taken in by the senses.

Re-experiencing symptoms, such as flashbacks and nightmares, are thought to be the brain’s attempt to correctly process and integrate the traumatic experience. As scary as this can be, it generally does help in healing and resolving trauma symptoms over time. Unfortunately, with Post-traumatic stress disorder (PTSD), the brain continues to be unable to fully process and integrate what has taken place. This can lead to devastating consequences for the individual that is suffering from the condition, especially if they don’t understand their symptoms or what to do with them when they occur.

How to Best Respond to Each Cluster of Trauma Symptoms:

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There are four clusters of symptoms that indicate that a person is suffering from an acute stress reaction in the first month after exposure to a traumatic event or a post-traumatic stress reaction after a month. Even if you do not have all of these symptoms, it can still be helpful to know what is occurring at the time when you do experience these symptoms after trauma and what you can do about it.

A: Intrusion symptoms – This includes intrusive memories, traumatic nightmares, dissociative reactions, such as flashbacks, and marked physiological reactivity and intense or prolonged distress after exposure to trauma-related stimuli or reminders.

When these intrusive symptoms occur, our brain rushes back to the past and starts to think and feel the same way that it did when the traumatic event was taking place. The mind feels that it is in imminent danger, and the initial feelings of intense helplessness, horror or fear come rushing back in.

What I have found to be most effective when this occurs is a process called grounding, as it helps people to reconnect with their senses in the moment, and brings their brain back from the past (where they were in danger) to the present (where they are safe).

Next time an intrusive symptom occurs, ask yourself the following:

  1. What are five things that I can see right now?
  2. What are four things that I can touch/feel right now?
  3. What are three things that I can hear right now?
  4. What are two things that I can smell right now?
  5. What is one thing that I can taste right now?

Once you are reconnected with the present, ask yourself “Am I safe right now?” If you are in danger, remove yourself from the situation. If not, then you are not at risk of harm and instead need to focus on reducing your distress through relaxation or self-soothing activities.

The more that these activities can engage you and your senses at the moment, the better, as it will help you to continue to feel present and safe. Grounding must occur first though, or the brain will want to stay in a hypervigilant state to protect you from the perceived threat, even if the danger is only a memory in your head.

B: Avoidance – Persistent avoidance of distressing external (people, places, conversations, activities, objects or situations) and/or internal (thoughts or feelings) reminders of the trauma

Avoidance of any reminders of the trauma in the first month after the incident is actually a good thing, as it can lower your arousal levels and reactivity, assisting your recovery.

Ongoing avoidance of these reminders, particularly after month, is not recommended, however, and may prevent a full recovery. Chronic avoidance prevents processing and integration of the traumatic event and sometimes means that people begin to avoid more and more things that may seem dangerous when they are logically quite safe.

Gradual exposure to the things that you fear (as long as they are relatively safe) is essential in the treatment of any anxiety disorder, including PTSD. I have gone through the steps of how to do this in my first article titled “Feel the Fear and Do It Anyway”. I personally followed these steps to challenge myself to get outside at night more and stop hiding when cars came past. It did get more comfortable with each time as I realised that my fear of being attacked was much higher than the actual probability of it occurring (it’s never happened again).

Also, remember that we cannot entirely run away from our thoughts and feelings. Acceptance and Commitment Therapy teaches Defusion and Expansion skills to help us better manage our thoughts and emotions. Research shows that these are more effective long-term strategies than continually avoiding internal reminders of trauma through drugs and alcohol, emotional eating, meaningless distractions or by keeping busy all the time (which only tires you out further and makes you more likely to feel out of control and react emotionally).

C: Negative alterations in cognitions and mood –  including inability to recall key components of the trauma, persistent and distorted negative beliefs and expectations about oneself, others or the world, or blame of self or others for causing the traumatic event or its consequences, persistent negative emotions, including anger, fear, horror, impending doom, guilt and shame, diminished ability to experience positive emotions, as well as loss of interest and engagement in previously important activities, and feeling isolated, alienated, detached or estranged from others. 

Exposure-based treatments, particularly cognitive processing therapy is essential for addressing the extreme shifts in cognition and beliefs that can take place after trauma, particularly if they are preventing you from doing the things that you used to enjoy.

Writing about how your beliefs and feelings have changed or explaining these changes to a friend that you can trust can help you feel more connected and better in time, but should be done in collaboration with a therapist if you are concerned about how you may react.

If you ever feel disconnected after a traumatic event, any type of movement tends to be the best strategy to reconnect you to what you are feeling in your body. This could be playing sport, doing yoga or Pilates, weight lifting, walking or running outside, or even dancing. Anything that helps you get out of your head and into your body or the world around you (as long as it is safe).

D: Alterations in arousal and reactivity – trouble falling asleep or staying asleep, difficulty concentrating, feeling jumpy or easily startled, and being super alert or watchful. 

Learning emotional regulation and distress tolerance skills are both critical to managing arousal levels, which then diminishes reactivity.

Emotional regulation skills include adequate rest, recovery, leisure and socialising, or ensuring that things are in the right balance. Too much work and stress without sufficient breaks will slowly increase our arousal levels over time. Ensuring that we minimise caffeine and alcohol intake, eat a healthy well-balanced diet and get a consistent 7 hours of sleep each night also help us to lower our arousal levels and better regulate our emotions.

Distress tolerance skills include relaxation and mindfulness skills, as well as a distraction at times. By practising these on a regular basis when you are feeling calmer, it then becomes easier to implement them when you are most distressed so that things do not become too overwhelming for too long and you are able to not panic and calm yourself down.

IF THESE STRATEGIES DON’T HELP?

Sometimes a referral to a Psychologist, Psychiatrist or Mental Health Nurse will be important to give you the best chance of making a full recovery.

Only 8-12 sessions of 60-90 minutes of therapy can make a big difference.

OTHER TIPS FOR COPING DURING TIMES OF DISASTER:

  1. Plan ahead, that is, don’t leave things to the last moment. Think about what it is that you have to do.
  • Do you have to travel?
  • Will you have people visiting?
  • Will you have to spend more money?
  • Do you have to buy special things like more food or water or other necessities?
  1. Be realistic.
  • You cannot do everything and meet everyone’s expectation.
  • your health, personal situation and family structure, may have changed. Make sure that your expectations on yourself and others are consistent with this.
  • Your home or business may have been affected by a natural disaster or accident.

You may need to reconsider what you plan to do based on this information.

  1. Learn how to say “NO” and this could be a difficult thing to do both personally and culturally.
  • Saying NO does not mean that you do not care or that you are not respectful.
  • Sometimes we do not have the time, health or resources to say YES and then follow through.
  • Saying YES to please someone and then becoming very stressed is not good for your health.
  • Take some time to think things through before you make important decisions.
  1. Reach out for help. When you are stressed and do not have the resources or health or time, talk to someone that you trust and talk things through.
  2. Tune into your feelings. You may be going through a difficult time, so try to admit to yourself if you are sad or angry. Give yourself the time and opportunity to improve.
  3. Try to resolve issues if possible. Focus on what is in your control and what is a priority. As much as you will want to fix everything at once, this is not possible.
  4. Stay healthy. Don’t eat foods that you know cause you to feel unwell or will be bad for your health like too much sugar or fatty foods.
  5. Don’t drink too much alcohol or kava or other beverages that may make you feel better temporarily but worse in the long-run.
  6. Go for a walk with your friends or family. Talk to your friends and family about their lives and yours to keep you connected.
  7. Every day take a few moments to be alone and free from distractions. Breath slowly and deeply and try to clear your mind.
  8. If you are lonely or sad or grieving, make sure you try to mix with others or if that is too difficult try to engage in community events. A church service or watching a sporting event could be helpful.
  9. If despite your best efforts you cannot manage and feel depressed or feel that life is out of control you may need to seek help from a friend, a church pastor, another person you trust. If this is not available, please seek professional help.

 

For more information or advice please contact:

Mind Care Clinic

Psychiatry Department

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1972

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

Mental Health Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

D.A. MoH Port Vila December 2018

 

The Four Ultimate Concerns in Life

I’ve been afraid to say this for a while because of how it will be perceived, but my favourite book of all time is actually a textbook. Now before you think that makes me someone that you would never want to speak to, I’ll ask if you have ever read anything by Irvin Yalom, American Psychiatrist and Author?

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His book ‘Existential Psychotherapy’ is a true masterpiece that he worked on for 10 years, and is written as eloquently as any of his other titles, including ‘When Nietzsche Wept’, for which he won the best fiction novel award for in 1992.

What is Existential Psychotherapy?

Existentialism is the philosophical exploration of existential issues, or questions about our existence that we don’t have an easy answer for. We all suffer from anxiety, despair, grief and loneliness at times in our lives. Existential Psychotherapy tries to understand what it is about life and humanity that results in these painful experiences and feelings.

In the book, Yalom explores what he considers to be our four most significant existential issues in life:

  1. Death
  2. Freedom
  3. Isolation
  4. Meaninglessness

These existential issues or ultimate concerns are “givens of existence” or “an inescapable part” of being an alive human in our world. He shows how these concerns develop over time, and how we can run into problems with each of these issues and what they might look like in patients coming to therapy. He also talks about how we can try to live with these concerns so that they have less of a negative impact on our lives, even if we don’t have clear-cut solutions to them.

Let’s go through each of these ultimate concerns…

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1. Death

Homo sapiens, or humans, as far as I know, are the only species in the animal kingdom that are aware that one day they are going to die.

The first time I heard this, it fascinated me and made me wonder if life would be more comfortable not being aware of the fact that one day we cease to exist.

Imagine it. Life is going well. Then suddenly it is no more. No worry about what the future holds. We are born. We experience life. Then suddenly we are no longer there. No fear. Just nothingness.

Being aware that we are going to die shapes and influences our lives much more than we would like to admit. A lot of our anxieties and phobias at their core are fear of some type of loss or death.

Irvin Yalom says that while the actuality of death is the end of us, the idea of death can actually energise us.

If we don’t know when we will die, being in touch with the fact that one day everything will vanish is enough to overwhelm some people and make them panic.

For others, it is enough to make them follow the maxim of carpe diem and helps them to seize the day by appreciating everything that they have so that they can make the most of the precious time that they have left on this planet. The time that is really just a bright spark of lightness between two identical and infinite periods of darkness – one before we are born, and one after.

Death is the ultimate equaliser, for no matter how much we have achieved or done with our time on this planet, the truth is that we will all one day die.

It is also true that we will not know exactly when death will happen. It might be with a car accident tomorrow, from cancer in ten years, motor neurone disease in twenty years, a heart attack in thirty years, a stroke in forty years, or during our sleep in fifty years.

Because our knowledge of our inevitable death is so inescapable and hard to confront and deal with directly, we instead focus on smaller and more manageable worries or concerns in our lives that we can do something about if we want to. If we successfully address all these minor concerns, however, we then come in contact with our fear of death again, and the cycle repeats itself.

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Most people tend to have one of two basic defence mechanisms against their fear of death:

A. They can think that they are “special” and that death will befall others but not them, and try to be an individual and experience anxiety about life.

Or

B. They can think they are an “ultimate rescuer“, and try to fuse with others and experience anxiety about death (their own mortality and that of their loved ones).

A breakdown of either of these defences can give rise to psychological disorders:

  • narcissism or schizoid characteristics for the “special” defence, and
  • passive, dependent or masochistic characteristics for the “ultimate rescuer” defence.

In general, trying to be an individual is a more empowering and effective defence than trying to fuse with others, but the breakdown of either can lead to pathological anxiety and/or depression.

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The way to feel better about death anxiety is through an exercise called “disidentification“:

  1. To begin with, ask yourself the question “Who am I?” and write down every answer that you can think of.
  2. Then, take one answer at a time, and meditate on giving up this part of yourself, asking and reflecting on what it would be like to give up this part of yourself and your identity.
  3. Repeat this with all the other answers until you have gone through all of them.
  4. You have now disidentified yourself from all parts of your identity. See how you feel, and if there isn’t still a part of you that feels separate from all the labels you give yourself. This provides comfort and reduces anxiety about death and life for a lot of people.

What I try to do to manage death anxiety is to only focus on whatever it is that is most important to me that I can do something about in any given moment. I try to appreciate and be grateful for the time that I have had with each important person in my life. I try to be as fully present in the moment and with others as I can be. I try to use every moment and meeting as an opportunity to positively rather than negatively impact someone’s life. That way, I’ll hopefully not have too many regrets and be glad for the time that I have had on this planet, no matter how long it ends up being.

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2. Freedom

The second ultimate concern is about freedom, responsibility and the will.

Every country in the world talks about fighting for the freedom of its citizens but also talks about taking away some people’s freedom to ensure the safety and security of all. The existential dilemma is, therefore, how much freedom do we give up to others to feel safe and secure, or how much safety and security do we give up to feel genuinely free? Are these concepts in direct opposition, or is it sometimes possible to have enough of both?

Responsibility means taking full ownership of:

one’s own self, destiny, life predicament, feelings, and if such be the case, one’s own suffering” – Irvin Yalom

In the past, one’s life was set out for them by their parents or society, and many people struggled to fight for the right to live a life that was authentic and genuine to them.

These days, most people struggle instead with the amount of choice that they have in their lives. They come to therapy because they don’t know what they want to do or how to choose given all of the options that are available to them. They also know that if no one else is telling them what to do, then it is ultimately their responsibility if things do not work out the way that they want them to. People wish to choose for themselves but fear not having someone to blame when things don’t work out.

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There are various defenses that we engage in to avoid responsibility and shield ourselves from freedom, including:

  • compulsivity
  • displacement of responsibility to another
  • denial of responsibility (“innocent victim” or “losing control”)
  • avoidance of autonomous behaviour, and
  • decisional pathology

We can do something over and over again to relieve anxiety or stop thinking about things. This can present as OCD or hoarding or any type of addiction ranging from technology to drugs and alcohol and even dependency on others.

We can try to coerce others to make decisions for us, or seek out and find controlling partners, bosses or friends. We can also just play it safe, and try to do what we think everyone else does; focus on keeping up with the Joneses, engaging in passive activities that don’t require much effort, and feeling stuck in an unfulfilling relationship or career.

The problem with giving up the responsibility for how our lives turn out is that it creates an external rather than an internal locus of control. Depression and other forms of psychological disorders are more highly correlated with an external locus of control. It  can also lead to learned helplessness, where people no longer feel like they can do anything to change their life in a positive direction.

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The way to manage the responsibility and freedom paradox is to develop an internal locus of control. This is generally more beneficial for most people’s well-being, unless we really are trying to blame ourselves or change things that are out of our control. This includes what has happened in the past, what other people do or say, and acts of nature.

The serenity prayer nicely spells out how we should approach responsibility:

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.” – Reinhold Niebuhr

 

Paradoxical intention is a good antidote too. This means that we try to do the opposite of what we typically do for a period of time and keep an open mind and observe how things go. We can then see if the outcome is better than what we usually do or if it has taught us something about what will be best for us going forward.

Anything that creates a double bind is potentially helpful for encouraging people to take more responsibility in their lives. One way is to remind someone who struggles to make their own decisions that by not deciding, they are still making a choice to not choose. This means that no matter what they do, it is impossible to not make a decision that impacts the direction of their lives. Even if we choose to follow what someone else wants us to do, we are still making a choice to do this. Therefore, why not take responsibility for our own lives and forge our own paths?

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3. Isolation

There are three types of isolation:

A. Interpersonal isolation: isolation from other individuals, experienced as loneliness

B. Intrapersonal isolation: parts of oneself are partitioned off from the self, and

C. Existential isolation:an unbridgeable gap between oneself and any other being.”

A common way that people try to escape from existential isolation is to fully fuse with another. This is is a strategy for dealing with death anxiety too, with people trying to be the “ultimate rescuer” of someone else. It can lead to an individual feeling temporarily less alone. However, the less isolated we are from others, sometimes the more isolated we are from ourselves.

Other people try to overcompensate for their feelings of isolation by never relying on anyone and trying to be fully independent. Both extremes can have negative consequences.

The main thing we can do to manage our feelings of isolation is to realise and accept that we are social creatures and we have always relied on others to survive. This drive creates a desire to feel closer to, more understood by and more connected to people than we can ever really achieve and sustain.

Growing up, many people feel loved and comforted in a relationship that is unbalanced towards their needs being met over their parents.  They then try to reenact this within their adult relationships and usually end up feeling resentful, angry and disappointed as a result.

Yalom believes that a good relationship involves “needs-free love”, which is about loving someone else for their sake. This is opposed to “deficiency love”, which is a selfish love where we only think about how useful the other person may be to us. Trying to create a relationship where you want the best for the other person is a healthier way to manage interpersonal isolation than demanding for them to meet every need for you.

Some of the best solutions to intrapersonal isolation are to have time to get to know ourselves through practices such as journaling, therapy and meditation. Introverts may need to have more of this time than extroverts, so it’s important to tune into to how you agitated or lonely you feel to know if you have found the right balance or not.

Unfortunately, existential isolation cannot be fully breached, and therefore needs to be accepted, as it is out of our control. To feel the pain that comes with this isolation as well as our desire to not have it is challenging, but it can help to reduce the intensity of the feeling. Being grateful for the meaningful connections we have in our lives and trying to strengthen them without losing our sense of self is another way to lessen the intensity of the feeling.

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4. Meaninglessness

According to Yalom and many non-religious philosophers, humans are meaning-seeking creatures in a world without a universal sense of meaning. As a result of this, the majority of the world turn to a religious or spiritual belief system of one type or another that clearly lays out the meaning of the world and our purpose in it. For people who truly believe these systems, they often provide a lot of clarity, reassurance and guidance. The tricky part is that these belief systems can vary widely, and it is hard to know which one is more correct or right than another, or if some of them are even harmful.

What we do know is that most belief systems tend to agree that

it is good to immerse oneself in the stream of life“.

People can try to find meaning through:

A. Hedonism: Seeking out pleasure and positive experiences and trying to avoid pain,

B. Altruism: Dedication towards a cause that helps other people, and

C. Creativity: Transcending oneself through art.

Many philosophers believe that both the search for pleasure and the search for meaning are paradoxical. By this, they mean that happiness and meaning or purpose in life are tough to achieve when they are aimed at directly, but possible if they are aimed at indirectly.

So if you or someone that you know is complaining about a lack of meaning in life, try to see if there are other issues too. If there are, address these other issues first if possible, and see if your worry about meaninglessness has lessened or gone away.

The best indirect way to increase a sense of purpose and meaning in life is to build up kindness, curiosity and concern for others. This is often best done by helping out with a charity, joining a club, fighting for a cause, or attending a group activity or group therapy.

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Yalom strongly believes that a desire to engage in life and satisfying relationships, work, spiritual and creative pursuits always exists within a person. The key to managing meaninglessness is therefore to remove the obstacles that prevent the individual from wholeheartedly engaging in the regular activities of life.

We may never be able to find the absolute meaning of life. However, what we can do is work at creating a life that is personally meaningful to us.

 

Dr Damon Ashworth

Clinical Psychologist

 

Why Do Some People Cheat in Relationships and Others Remain Faithful?

With the development of the internet, dating websites, social media, smartphones and dating apps, it is now easier than ever for someone to cheat on their partner or spouse.

This same technology can also make it easier to get caught too, due to the potential digital trail that is created with each of these unscrupulous liaisons.

The Ashley Maddison hack and subsequent scandal was one such example of technology helping people to have extramarital affairs, but also leading to them getting caught. The hackers tried to blackmail the company and many of the users, and then released all of their details in a massive data leak when their demands were not met. Families were broken up; reputations and even lives were ruined in the aftermath.

The consequences of infidelity continue to have a devastating impact on individuals, partners, children and society. Yet it remains an issue that is prevalent in every country and culture. Maybe even more so today with the advent of technology.

Given the massive changes that we have gone through in the past 30 years, I am interested to find out what the prevalence rates of cheating are, if our attitudes towards infidelity have changed, and if there is anything that we can do about it.

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What is Cheating?

The definition of cheating is actually quite hard to specify and depends on who you are talking to and what their expectations are for the relationship that they are in. The stereotype is that males tend to perceive cheating to be exclusive to physical encounters or actions, whereas females also see emotional infidelity as cheating, which is sharing something with someone that you wouldn’t typically feel comfortable saying to your partner. Many people also believe that relationships that exist purely over the internet or phone can also be considered cheating, especially if there are explicit words, photos or sexual acts exchanged using these devices.

Infidelity has been defined by Weeks, Gambescia and Jenkins (2003) to be a violation of emotional or sexual exclusivity. The boundaries of what is meant to be exclusive are different in each couple, and sometimes these boundaries are explicitly stated, but most of the time they are merely assumed. This means that each partner can have different assumed limits, making it difficult for both partner’s exclusivity expectations to be met (Barta & Kiene, 2005).

Leeker and Carlozzi (2012) believe that when someone has a subjective feeling that their partner has violated the rules around infidelity, feelings of sexual jealousy and rivalry naturally arise. If an act of adultery has occurred, the consequence is often psychological damage, including feelings of betrayal and anger, impaired self-image for the person cheated on, and a loss of personal and sexual confidence (Leeker & Carlozzi, 2012).

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Prevalence of Infidelity

Like my previous article How Have Intimate Relationships Changed Over the Years, and Where Does It Leave Us Now?, the majority of the research presented in this post comes from the surprising and entertaining book ‘Modern Romance’ by Aziz Anzari (the actor and comedian) and Eric Klinenberg (a Sociologist).

Unfortunately, people who are suspicious when it comes to infidelity sometimes have a reason to be. More than half of all men (60%) and women (53%) confess to having tried to mate-poach before. This means that they attempted to seduce a person out of a committed relationship so that they could be with them instead. I can’t believe that these figures are so high.

I also can’t believe that in “committed relationships”, where the partners are not married to each other, the incidence rate of cheating has been found to be as high as 70%.

It gets a little bit better for married couples, with only 2-4% of married individuals admitting to having an extramarital affair over the past year in the USA. However, this increases to 30% of heterosexual men and 25% of heterosexual women who will have at least one extramarital affair at some point during their marriage. It’s scary to think that somewhere between a quarter to a third of all married individuals have affairs, but good to know that two-thirds of all married people stay faithful to their partner all their lives too.

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Attitudes Towards Extramarital Affairs

In ‘Modern Romance’, they share results from an international study that looks at people’s views on extramarital affairs across 40 countries.

In the USA, 84% of people strongly agreed that cheating was “morally unacceptable”. In Australia, 79% view extramarital affairs as morally unacceptable. Canada, the U.K., South America and African countries all have similar rates of cheating disapproval as Australia. Areas that have the highest disapproval rates are typically Islamic countries, with 93% of those surveyed in Turkey stating that marital infidelity is morally unacceptable, second only to Palestinian territories with 94%.

France is the most tolerant country for extramarital affairs, with only 47% saying that cheating is unacceptable. They also happen to be the country with the most extramarital affairs, with the latest data indicating that 55% of men and 32% of French married women admit to having committed infidelity on their spouse at least once. The second most tolerant nation is Germany with 60% finding extramarital affairs to be morally unacceptable. Italy and Spain are equal third, with 64% each.

Expectations vs Reality

When you compare the level of disapproval towards infidelity with the data on the actual prevalence of extramarital affairs, the numbers don’t quite add up. In the USA especially, it seems that a large number of people who cheat themselves still condemn the practice at large and would not be okay with being cheated on themselves.

A Gallup poll on cheating even found that infidelity is disapproved of at a higher rate than animal cloning, suicide and even polygamy. Although it is against the law, being married to two people is seen as less offensive than being married to one and breaching the honesty, trust and connection that you share with your partner.

People also differ between their beliefs and their practices when it comes to whether or not to confess an affair or infidelity once it has occurred.

A Match.com nation-wide survey in the US found that 80% of men and 76% of women would prefer their partner to “confess their mistake… and suffer the consequences,” rather than “take their secret to the grave”. However, the excuse given by most people who have cheated and haven’t told their partner is that they didn’t want to hurt their partner. It’s interesting that they only worry about the impact that their actions may have on their partner after the unfaithful act has already occurred and not beforehand.

Unfortunately, most people try to keep their own affairs to themselves and make excuses for their behaviour while demanding at the same time that their partners own up to their indiscretions if they stray.  If their partner does own up, they are likely to treat them harshly for it, because after all, cheating is considered morally unacceptable by most.

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Why Do People Cheat?

Dr Selterman from the University of Maryland looked into why 562 adults cheated while they were in a “committed” romantic relationship. He found eight main reasons given for why the infidelity occurred:

  1. Anger: seeking revenge following a perceived betrayal
  2. Lack of love: falling “out of love” with a partner, or not enough passion or interest in the partner anymore
  3. Neglect: not receiving enough attention, respect or love (#1 reason for women)
  4. Esteem: seeking to boost one’s sense of self-worth by being desired by or having sex with multiple partners
  5. Sexual desire: not wanting sex with their partner or wanting to have sex more with others (a common reason for men)
  6. Low commitment: Not clearly defining the relationship as exclusive or not wanting a future with their partner or anything too serious
  7. Variety: Want to have as more sexual partners or experiences in their lifetime (a common reason for men)
  8. Situation: Being in an unusual scenario, such as under high stress, under the influence of alcohol or a substance, or on vacation or a working holiday (a common reason for men)

Interestingly, not all of these factors suggest that infidelity is a direct reflection of how healthy a relationship is. Often it says much more about the person who commits the infidelity and their personality or impulse control than anything else.

Ways to Reduce the Likelihood of Infidelity

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In ‘Modern Romance’, the authors explain that passionate love inevitably fades within every relationship. A loss of passionate love could lead to infidelity if people don’t realise that this may just be an indication of how long they have been together, not an issue with their relationship.

Companionate love, or that sense of building a life and a legacy with a partner, is different to passionate love. It can continue to grow across a relationship and a lifetime rather than decline with time. Couples in their 60s and 70s often rate their relationship satisfaction as much better than when they were younger and trying to raise children together and work full-time too.

One way to reduce the likelihood of committing infidelity then is to focus on building companionate love and a shared life and legacy together, rather than just equating real love with passion.

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In his classic book ‘On Love’, philosopher Alain de Botton said that:

“Perhaps the easiest people to fall in love with are those about whom we know nothing…we fall in love because we long to escape from ourselves with someone as beautiful, intelligent and witty as we are ugly, stupid and dull.”

It’s much easier to idealise or become infatuated with someone that you don’t know that well. To imagine that they are perfect or have none of the flaws that your current partner (or you) possess.

The quickest cure for infatuation is to actually get to know the person a bit more (without breaching the infidelity norms of your relationship) and realise that they are just as flawed as the rest of us. Once you understand this, leaving one flawed relationship for another but having to start all over again carries much less appeal.

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In another of his excellent books, ‘The Course of Love’, de Botton states:

“When we run up against the reasonable limits of our lovers’ capacity for understanding, we musn’t blame them for dereliction. They were not tragically inept. They couldn’t fully fathom who we were – and we could do no better. No one properly gets, or can fully sympathize with anyone else… there cannot be better options out there. Everyone is always impossible.”

This isn’t to say that we shouldn’t leave abusive and neglectful partners. It just means that we need to avoid imagining that there is “a lover (out there) who will anticipate (all) our needs, read our hearts, act selflessly and (always) make everything better. (This) is a blueprint for disaster.” No one is perfect, and being grateful for what we do have with our current relationship and trying to make it as good as possible is much healthier than imagining that “the one” is probably just around the corner, if only we could find them.

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Unfortunately, we still have the issue of love and sexual desire typically being separated in our society. Esther Perel, couples therapist and author, points this out better than anyone in her groundbreaking book ‘Mating in Captivity: Reconciling the Erotic and the Domestic’:

“Today, we turn to one person to provide what an entire village once did: a sense of grounding, meaning, and continuity. At the same time, we expect our committed relationships to be romantic as well as emotionally and sexually fulfilling… our need for togetherness exists alongside our need for separateness… (but) it’s hard to feel attracted to someone who has abandoned (their) sense of autonomy… Is it any wonder that so many relationships crumble under the weight of it all?”

Another way to keep the spark of desire alive then is to make sure that even though you do a lot of things together with your partner, you must also do some things individually.

Fortunately, Perel also agrees that both love and desire can be maintained or grown over time with effort and a specific way of looking at things:

“For [erotically intelligent couples], love is a vessel that contains both security and adventure, and commitment offers one of the great luxuries of life: time. Marriage is not the end of romance, it is the beginning. They know that they have years in which to deepen their connection, to experiment, to regress, and even to fail. They see their relationship as something alive and ongoing, not a fait accompli. It’s a story that they are writing together, one with many chapters, and neither partner knows how it will end. There’s always a place they haven’t gone yet, always something about the other still to be discovered.”

What About If Infidelity Has Already Occurred?

If cheating has already taken place, many people say that too much pain has occurred, trust has been breached and broken, and leaving is the best thing to do to maintain a sense of self-worth and self-respect. In other cases, going may not be the easiest, most practical, or best solution. For individuals in these cases, I would recommend reading Perel’s more recent book ‘The State of Affairs: Rethinking Infidelity’.

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In this book, Perel says that:

“Once divorce carried all the stigma. Now, choosing to stay when you can leave is the new shame.”

Perel warns against merely passing judgment about the act of infidelity, as this shuts down all further conversation about what happened and why and where to go from there. Perel believes that it is much better to see an affair as a symptom of a troubled relationship or a troubled person.

If it is the person who is troubled, and they are remorseful for what they have done and willing to try to make amends and not cheat again, it is essential that they get help to address whatever issue led to the infidelity in the first place. If they are not willing to get help and work on themselves but merely say it won’t happen again, be wary.

If it is the relationship that was in trouble, relationship counselling may be able to help too. Perel says that:

“Infidelity hurts. But when we grant it a special status in the hierarchy of marital misdemeanors, we risk allowing it to overshadow the egregious behaviors that may have preceded it or even led to it.”

If both people in a relationship can take ownership for the behaviours that they engaged in that caused pain and hurt to the other and are willing to start again to build a stronger relationship, it is possible to have a healthy relationship going forward. It’s just never going to be the same as things were before the infidelity took place.

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My Personal Opinion

Monogamy is sometimes hard, as is continuing to work at having a healthy relationship, but it is a choice. We may not always have full control over what we initially think or feel, but we do have the capacity to think things through properly before acting.

My favourite relationship researcher, John Gottman, found that couples who turn towards each other when there is an issue in their life are much more likely to stay together than couples who turn away from or against each other. In one study, he found that newlyweds who remained married 6 years later turned towards each other 86% of the time when issues arose. Newlyweds who were divorced six years later only turned towards each other 33% of the time. Turning towards your partner when a problem occurs is the key to a close and connected relationship, and is much less likely to result in infidelity.

For me, it comes down to personal values. I want to have a relationship that is close and connected, with openness, honesty and trust. I don’t want to feel like I have to hide anything, and I don’t want to do anything that I am not personally okay with or that I know that the people who mean the most to me would not be proud of.

Anything that we hide from our partners tends to lead to greater distance and a feeling of disconnection. This is especially the case with stuff that we may know is dishonest, not respectful or something that we feel ashamed of. Our body language, microexpressions and tone of voice also tend to leak out how we genuinely feel over time if we are hiding something, even if we wouldn’t like to admit it.

Existential philosophers believe that our biggest challenge in life is to come face-to-face with the true nature of who we are. I think that over time, it is our actions and not our intentions that become our character, or who we indeed are. I aim to be the best partner, and person that I can be, and to learn from any mistakes that I make along the way so that I hopefully never repeat them again. What about you?

 

Dr Damon Ashworth

Clinical Psychologist