Tuesday, November 20, 2012

Gratitude is Good for our Health

I've been thinking a lot about gratitude. It's not just a Thanksgiving thing for me. It's something I  try to think about every day.  Especially now, with so many people in New York and New Jersey still being displaced from their homes, and with family, friends and colleagues in Israel living with the daily threat of rocket attacks, I am extremely grateful for things I usually take for granted--having a roof over my head and no imminent threats to my safety.

Gratitude is a part of most spiritual traditions, it is a big part of twelve step programs, and it has been incorporated into a number of psychotherapy approaches, such as Dialectical Behavior Therapy (DBT), Positive Psychotherapy (PPT), and Accelerated Experiential Dynamic Psychotherapy (AEDP).  However, until the last decade, nobody really studied its impact. 

At the Emmons Lab at UC Davis, Dr. Robert Emmons and his colleagues are studying the nature of gratitude, its causes, and its potential impact for human health and well-being.  They are currently  developing methods to cultivate gratitude in daily life and assess gratitude’s effect on well-being, and developing a measure to reliably assess individual differences in dispositional gratefulness.

Their studies  indicate that  people who adopt a daily gratitude practice have greater amounts of high energy positive moods, a greater sense of feeling connected to others, more optimistic ratings of one’s life, better sleep duration and sleep quality, and higher reported levels of the positive states of alertness, enthusiasm, determination, attentiveness and energy compared to control groups that focused on hassles or a downward social comparison (ways in which participants thought they were better off than others).

Those who kept weekly gratitude journals  exercised more regularly, reported fewer physical symptoms, felt better about their lives as a whole, and were more optimistic about the upcoming week compared to those who recorded hassles or neutral life events (Emmons & McCullough, 2003). The researchers also noticed that participants who kept gratitude lists were more likely to have made progress toward important goals over a two-month period compared to subjects in the other experimental conditions.

Twelve step programs talk about developing an attitude of gratitude.  In DBT, one of the distraction techniques is to make comparisons between one's current situation and a situation that's worse. In PPT, the "gratitude visit," in which a person makes an appointment to read a gratitude letter to the recipient, has been found to cause happiness levels to go up for a full month.

In AEDP, the healing affects refer to gratitude toward another and feeling moved.  The healing affects have contrast embedded in them. They arise in response to experiences that disconfirm expectations, i.e., experiences of contact where isolation was before, of kindness when indifference or malice were expected, of being taken seriously rather than being dismissed. AEDP’s healing affects are transformative precisely because such a positive attachment experience was inconsistent or absent in the past. Explicitly processing these newly restored reparative intersubjective moments accesses resources and resilience, and releases a cascade of transformations that leads to what is known as core state, when one is filled with "empathy and self-empathy, wisdom, clarity about one’s subjective truth, and generosity" and feels "open and having a sense of being grounded, solid, in flow, and at ease."*

I was moved to tears when I saw all the devastation in beach towns in New York and New Jersey and heard about tragic deaths from Hurricane Sandy and again when I read about the heroism of first responders and the generosity of countless others after the storm.  I worry about the escalating conflict in the Middle East and pray for the safety of my loved ones and everyone else who lives there. My heart goes out to all those who have been affected by both of these tragedies.  May you all regain your sense of safety and security.  I am not taking mine for granted.


 Additional Sources:




Tuesday, October 9, 2012

Grief Over the Death of a Client

One of my clients died and I feel incredibly sad about it.

She was a very special woman.  She was sadistically abused from the age of three and had tremendous strength, courage and  an unshakeable faith, despite all the trauma she endured. 

I worked with her for eleven years helping her to heal from all the neglect and abuse she had suffered as a child.  It was a shared journey.  I felt her pain when she suffered and felt her joy when the suffering was transformed.  I shared my reactions so she would know the impact she had on me.  She needed to know she touched my heart and soul, that it wasn't just a job to me. That is what made it possible for her to feel safe enough to reveal her pain to me.

I learned so much from her.  She was one of the most traumatized clients I have ever worked with and I kept having to expand my toolkit to be able to help her.  I was grateful for her willingness to try new things with me.

At one point in our work together I was feeling stuck about how to help her overcome a particular obstacle and was searching for new approaches to try.  She was desperate for relief from her suffering but was trapped in her self-blame and shame.  That is what motivated me to go for EMDR training seven years ago.  I will always be grateful to her for her role in that. 

This amazing survivor had just recently stopped having flashbacks and was looking forward to the next chapter in her life.  Then she was diagnosed with brain cancer.  It seemed so incredibly unfair.  Yet she faced this new obstacle with such grace, accepting whatever God had planned for her.

First she fought to survive, then when her chance of survival was so low and her ability to function was deteriorating, she chose to go into hospice and die with dignity. I learned another important lesson as I struggled to catch up with her and accept her decision so that I could be there for her and say goodbye.

She wanted others to learn from her experience overcoming childhood trauma and had wanted to write about it, but the brain cancer made that impossible.  So she asked me to tell her story. This is one way of honoring her request.

Wednesday, August 29, 2012

New Court Ruling about the Statute of Limitations in Child Sexual Abuse Cases

Momentum continues to build in the courts towards greater justice for sexual abuse survivors.
The latest court ruling about a child sexual abuse case involves Poly Prep Country Day School, an elite private school in Brooklyn, New York. According to articles on NYTimes.com http://goo.gl/1DWGq and NYDailyNews.com http://goo.gl/TSnj9, Judge Frederic Block of the Federal District Court in Brooklyn ruled that the New York State statute of limitations on filing sexual abuse charges cannot be imposed automatically, because of the possibility that the school covered up abuse by a former football coach.

Poly Prep Country Day School in Bay Ridge, Brooklyn.
Todd Maisel/New York Daily News

Now there has to be a hearing to determine if the actions of the school prevented the 12 plaintiffs from filing charges within the statute of limitations, which is by age 23 for survivors of child sexual abuse in New York.

Twelve alumni of Poly Prep and its summer camp claim that they were raped and molested by Philip Foglietta, the former football coach. The coach worked at the school from 1966 until his retirement in 1991, then died in 1998. The court decision stated that the first time an allegation was made against the coach was in 1966, when a student told the headmaster that Philip Foglietta had abused him multiple times. The ruling went on to state that the school told the family that the student’s allegations were not credible and that the student would face “severe consequences” if he continued to make such accusations.

The plaintiffs claim that the school revered the coach and his legacy and depended on his reputation for fundraising, despite knowing that he had sexually abused boys entrusted to his care.

The New York Times article stated that:

The case is being closely watched, as allegations of sexual abuse and the way powerful institutions manage knowledge of those allegations has exploded within the Roman Catholic Church, in the Hasidic community in Brooklyn and in high-profile schools like Horace Mann in the Bronx and Penn State University.
The world is watching... and the courts are finally starting to get it right. The statute of limitations has shielded perpetrators of child sexual abuse and the institutions and communities that covered up for them from being held accountable for their crimes. It is about time that we get our priorities straight and put the protection of children ahead of the protection of reputations.

Should the statute of limitations on child sexual abuse prosecutions be eliminated entirely? Or should it only be waived in certain situations?  What do you think?

Wednesday, June 27, 2012

Watershed Moments in the Fight for Justice for Survivors of Child Sexual Abuse

Last week brought three watershed moments in the fight to bring accused pedophiles and their protectors to justice. Penn State assistant football coach Jerry Sandusky was convicted on 45 out of 48 charges of child sex abuse. Monsignor Lynn was convicted on 1 out of 3 charges of covering up abuse by pedophile priests in the Archdiocese of Philadelphia, Pennsylvania.  Brooklyn District Attorney Charles Hynes charged four Hasidic Jewish men with attempting to intimidate a witness in a child sexual abuse case after the D.A. was besieged by accusations of long-term deferential treatment of Rabbinic leaders who protect those accused of child sexual abuse in their Brooklyn Orthodox Jewish community.

The Washington Post June 22, 2012:
Former Penn State assistant football coach Jerry Sandusky leaves court in handcuffs after being convicted in his child sex abuse trial at the Centre County Courthouse in Bellefonte, Pa.
The New York Times June 23, 2012:
Monsignor William J. Lynn, walking into court before the verdict reading. Monsignor Lynn was the first senior official of the Roman Catholic Church in the United States to be convicted for covering up child sexual abuses by priests.
Photo by Matt Rourke/AssociatedPress
The New York Times June 22, 2012
The Brooklyn district attorney, Charles J. Hynes, who has been facing public criticism about his handling of sexual abuse allegations in the Williamsburg Orthodox Jewish community, on Thursday charged four men with attempting to silence an accuser by offering her and her boyfriend a $500,000 bribe, and threatening to take away the kosher certification of her boyfriend’s business.
Photo by Robert Stolarik for The New York Times

How appropriate that this all comes during PTSD Awareness Month, since post-traumatic stress disorder is such a common disorder for child sexual abuse survivors. Today has been designated as National PTSD Awareness Day by the United States Senate. Let's take a moment today to celebrate these watershed moments that can help child sexual abuse survivors feel more hopeful that our society is beginning to take their plight more seriously and hold abusers and their protectors accountable for all the suffering they have caused. 

Loss of hope is a common consequence for sexual abuse survivors that were not protected by the people that they trusted, whether it be coaches, clergy, law enforcement, teachers or family. Hopelessness makes it harder for survivors with PTSD to follow through with seeking help.  Renewed hope that there is justice in the world may be just what PTSD sufferers need in order to feel more hopeful that they can trust someone to help them to heal.

What do you think? What are your reactions to the above court cases? Do you have a different perspective that you would like to share?  I would love to hear from you.

You might also be interested in reading my November, 2011 post: "Reflections on the Penn State Sexual Abuse Scandal and a Call to Action". http://andreabgoldberg.blogspot.com/2011_11_01_archive.html

Wednesday, May 16, 2012

The Invisible Wounds of Trauma

May is Mental Health Awareness Month.  The American Psychological Association is sponsoring a blog party today, Wednesday, May 16, 2012 to help promote discussion.*

Mental Health America announced two themes for this year's Mental Health Awareness Month. Do More for 1 in 4 is a call to action to promote awareness, reduce stigma, and get help for the 25% of the American population believed to have a diagnosable, treatable mental health condition. 

Healing Trauma's Invisible Wounds is the second theme, which focuses on the impact of traumatic events on the mental health of individuals and communities.  
A Program of Mental Health America
According to the National Child Traumatic Stress Network (NCTSN), over 25% of American youth have experienced at least one serious traumatic event by the age of 16 and over 25% of teens who have suffered traumatic events develop post-traumatic stress disorder (PTSD). The Substance Abuse & Mental Health Services Administration (SAMHSA), reports that more than 60% of youth age 17 and younger have been exposed to crime, violence and abuse either directly or indirectly.** NCTSN noted that when left untreated, traumatic stress can impede child development and cause prolonged problems with behavior, emotional regulation, relationships, school performance and the ability to enjoy life. In addition:

As the number of traumatic events experienced during childhood increases, the risk for the following health problems in adulthood increases: depression; alcoholism; drug abuse; suicide attempts; heart and liver diseases; pregnancy problems; high stress; uncontrollable anger; and family, financial, and job problems. (NCTSN, Understanding Child Traumatic Stress, 2005).  Treatment from a mental health professional who has training and experience working with traumatized children can reduce child traumatic stress and minimize physical, emotional, and social problems (NCTSN Treatments That Work, 2012).***

 The above statistics demonstrate the degree to which trauma is pervasive in our society and the huge potential impact on mental health.  However, if you look through the Diagnostic and Statistical Manual of Mental Disorders (DSMIV), you wouldn't know how prevalent traumatic stress is. It is only mentioned as a significant factor in a few disorders in the entire manual even though many of the diagnoses listed could occur as a result of trauma.

Bessel van der Kolk, MD, who is an internationally recognized leader in the field of psychological trauma, proposed a new diagnostic category, Developmental Trauma Disorder,**** which would begin to address this discrepancy. The proposed criteria include: 

A. Exposure
1. Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death).
2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).

B. Triggered pattern of repeated dysregulation in response to trauma cues
Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness.
•Somatic (physiological, motoric, medical)
•Behavioral (e.g. re-enactment, cutting)
•Cognitive (thinking that it is happening again, confusion, dissociation,
•Relational (clinging, oppositional, distrustful, compliant).
• Self-attribution (self-hate and blame).

C. Persistently Altered Attributions and Expectancies
•Negative self-attribution
•Distrust protective caretaker
•Loss of expectancy of protection by others
•Loss of trust in social agencies to protect
•Lack of recourse to social justice/retribution
•Inevitability of future victimization

D. Functional Impairment
At the 2010 annual conference of the International Society for the Study of Trauma and Dissociation,  Bessel van der Kolk spoke about his attempts to get Developmental Trauma Disorder (DTD) included in DSMV. At one point, he received a rejection letter from the committee evaluating his proposal, which stated that the proposed diagnosis would effectively encompass most other childhood disorders.  As Dr. van der Kolk said in his plenary address, "No Shit!!" 

According to the website of the Trauma Center at Justice Resource Institute in Brookline, Massachussetts, founded by Bessel van der Kolk, who serves as its medical director, we can help make a difference by supporting the research studying the validity of the DTD diagnosis (http://www.traumacenter.org/research/DTD_Field_Trial.php):

It is exceedingly rare that we have the opportunity to effect far-reaching change to society. This is your opportunity to take direct action. You can personally help transform medical knowledge and quality of care for all those impacted by maltreatment and neglect by contributing a tax-deductible donation to the "DTD Field Trial, JRI TraumaCenter" as soon as you possibly can. Your continued support beyond the target fund is appreciated because there will no doubt be additional work to do beyond this phase.
  What do you think of the proposed Developmental Trauma Disorder diagnosis?

 * http://www.yourmindyourbody.org/mental-health-month-blog-day/
** http://www.samhsa.gov/children/trauma_resilience.asp