School Refusal

It is not unusual for a child to wake up on a Monday morning and complain about having to go to school. Most school age children when given the choice of fun (weekend) or learning (school), will choose fun. However, when this argument becomes intense, persistent, and frequent, we have a behavior that is described as school refusal. School refusal is when a child refuses to go to school, is frequently unable to stay in school for the whole day, or goes to school and leaves or needs to be taken home. These complaints could be direct, through verbalizing not wanting to go to school, or indirect such as physical complaints. The most frequent age we see this occur is between eight and thirteen years of age. However, any school age child could experience it.

When a child refuses or resists going to school, one of the first tasks we need to examine is the reason why he/she may be resistant. We need to rule out confirmable physical illness and mental health issues (i.e. depression). If those do not appear to be a reason, we can look at other areas. This would include peer group (encouraging to ditch school), drug/alcohol involvement, grades, choosing to do more fun things during the day, or worries/fears. A child may be resisting or refusing to go to school because they are afraid. The fear could derive from several areas: fear of a person (bullying for instance) , fear of leaving someone (separation anxiety), fear of situations (being around other people), or fear of an event (speaking in front of class).

Age, peer group, and history of the child are necessary information in determining motivation. Family history or events could also play a factor. If there is turmoil/conflict at home, this could impact on a child’s emotional stability. If there is a family history of anxiety, this may make the child more likely to have anxiety themselves.

Regardless of the reason, it is important to remember that the longer you wait to address these concerns, the more difficult it will be to get your child out of these thinking and behavior patterns. Whether their fears are real or imagined, there is a strong likelihood a pattern of feeling (somatic and emotional) and behaviors will solidify themselves. This pattern, the longer it goes on, the more challenging it becomes to undo. It is usually extremely important to involve school personnel in addressing school refusal concerns. They will be your biggest allies in overcoming this issue. If the school refusal persists, it is important to seek out professional help. A plan of action and working with support systems available are important steps to take.

Common Responses to Trauma

People reacting to losses or trauma tend to go through a set of ‘stages of grief’ which would include denial, outrage/anger, working through, and resolution. These stages don’t always occur in this order, and may happen at different time intervals. We briefly describe these stages:

Denial: You can’t believe that this is happening, it seems unreal, like a dream. The impact of the event has not been fully absorbed.

Outrage/Anger: You are furious outraged at the event. You are hurt and may find yourself crying. You are sad and angry. You feel vulnerable and are looking at someone or something at which to direct your anger.

Working Through: This happens over time. It is the process of sorting feelings out so we can return to ‘normal’. Many different feelings may still be surfacing but there is more of a stabilization of emotions.

Resolution: This is a relative term. This does not imply that people will get over or forget about these events. What it means is that they will have worked their way into more of a regular routine.

Some Symptoms of Trauma Difficulties

The intensity and reaction to these events may vary from person to person. Individuals may be more affected by this event than others. Below, we move listed some symptoms individuals may experience. To some degree, most of us will experience these symptoms. However should a person become ‘stuck’ in these reactions or they interfere with daily life activities. In some extreme cases, these symptoms last several months after the incident.

Physical Reactions: sleep difficulties, fatigue, headaches, muscle pains, change of appetite, dizziness, rapid heart beat, and forgetfulness.

Emotional Reactions: Anxiety, feeling vulnerable, anger, easily startled, flashbacks or reliving the event, low motivation, fearful, feeling jumpy, and feeling on edge.

Other responses: nervousness, isolating, preoccupation with event, problems at work, irritability, increased conflicts with others, and moodiness.

Coping Strategies

• Encourage but do not force talking. With the intense focus on this issue, we may need our periodic breaks from this. By forcing the issue, it may increase the likelihood of feeling overwhelmed about this incident. We should all set our own comfortable pace in discussing this issue.

• Combat the feeling of helplessness by volunteering to help victims. Call 1-800- GIVE-LIFE (1-800-448-3543). Talk to others who are willing to talk about it.

• Keep regular routines as much as possible.

• Maintain nutrition and good eating habits.

• Exercise regularly.

• Sustain good sleep habits.

If you are having continued difficulties with this event, it would be a good idea to talk with your therapist about it. He\she may be ale to give you additional support or ideas to cope with this. As the healing process continues, it is important that we support each other through this traumatic event. 

Decision Making

Unavoidably we are faced with major obstacles in life. These obstacles could take form in relationships, employment, or other areas. Decisions need to be made regarding what course of action needs to be taken. We invest a great deal of time and energy in trying to make these situations fit the conclusion we want them to. The end result that we desire may not be realistic or achievable. The investment in time and energy in cases such as this, could be better used in working towards a different focus. Below are three choices we have in addressing these obstacles. It is important that you understand these three options are choices you have. Which one you choose is ultimately your decision. Realizing that there is more than one option is helpful for most people who feel “stuck”.

Change: The situation in which you currently find yourself is uncomfortable and you desire to change it. There is some ability to alter the situation. The party(s) involved are willing to negotiate or compromise a solution to the problem. This does not mean that other party has to do all of the changing. It just means that there is a possibility of change. Situations that would fall under this would include: a spouse that would be willing to cut back or eliminate his\her drinking, a supervisor who may be willing to adjust his\her attitude towards you, or a family member who would be willing to stop being critical. Your time and energy is invested towards changing the situation so it can be more tolerable. Compromise is included in this area.

Adjust: The situation in which you currently find yourself in could not be modified. The individual or situation involved is not open or willing to change. You accept the limitations of the obstacle and choose to direct your time and energy into adjusting to an uncomfortable and unchangeable situation. The adjustment comes in knowing you can’t change the situation and accept your limitations. This also means that for whatever reasons, you are choosing not to leave. These reasons could be based on financial, emotional, or other reasons. This does not mean you condone what is going on but just accept you can’t change it nor are you ready to leave. Situations that would fall under this include: a spouse who most likely will not stop drinking, an inflexible supervisor or work situation, or a family member who refused to stop being critical. By choosing to focus in on this area , you have decided that you can endure this situation and you are not compromising your values.

Leave: The situation in which you currently find yourself in is unacceptable. You realize that by staying in this situation, it is going to be too uncomfortable for you. The situation will most likely not change and it would be too difficult for you to stay . Your energy is best utilized towards a transition and leaving rather than adjusting or trying to change it. Examples include: a boyfriend\girlfriend that is physically abusive or a job that has no future.

It is helpful to understand that if you commit to one of these directions, to realize the behavior that would accompany this decision. The behavior to prepare for comes from both you and the other party need to be consistent with the direction you choose. If you are putting your energy into adjusting to an alcoholic spouse(not wanting to leave the relationship and identifying change may not in the near future), yelling at him\ her, would be inconsistent with the decision you choose. Same could be said of deciding to complain to a boss about a performance evaluation you were rated poorly on, after deciding to take another job. Expecting certain behavior that is inconsistent with where you emotionally committed, could lead to confusion and additional stress.

Legal But Not Safe: K2

Some individuals have gone to great lengths to experience altered states or “highs.” When we think of getting high, the images that comes to most peoples mind is illegal drugs or alcohol. That is not always the case. There are legal or easily accessible items that could be used to induce a high. The methods used may include inhaling household products, inhaling gasoline, abusing prescription and over the counter medication, and various products advertised at Head Shops (local retail shops that specialize in drug paraphernalia related to consumption of cannabis and other recreational drugs).

If a product is legal, it may not mean it is safe. A new trend is synthetic marijuana, K2, Spice, or fake weed. It looks similar to marijuana and individuals who use it would not come up positive on hair analysis or urinalysis. This product can be legally obtained over the Internet, Head Shops, or even gas stations. It was first introduced around 1990 but in the last few years has become more popular. The ingredients include a chemical made to mimic THC (the main chemical in marijuana that produces the high). The producers of this imply in their advertisements the drug is organic but that is not the case. The component that produces the high is made in a laboratory.

Due to it’s relative newness, there is not a lot of data out on the long term effects it produces. We do know that some studies indicate the high is similar to that of marijuana but may not have the long term effects of a marijuana high. Some of the side effects may include feelings of paranoia, anxiety, and depression. Just like other potential drugs of abuse, there is the concern that individuals will rely too much on it for relaxation or to reach the desired effects. This prevents individuals from developing their own methods or coping skills to address personal issues.  There are not any legal regulations on making this product , at this time, and some of the chemicals may be mixed in home laboratories resulting in imprecise mixtures that could make the effects of its use unpredictable and even dangerous.

There are some states that have banned it or have introduced legislation to ban it. Parents could help address this issue by talking about it with their children. Rather than focusing on whether or not the product is legal, we may miss the point that the drug is harmful to children. 

Building Happy and Healthy Marital Relationships

There are many special rewards to being in

a rewarding relationship. Studies indicate

the individuals live longer and are more

happy in fulfilling relationships. Having the

friendship, support, and understanding of a

significant other is very important for most

people. Building a good life together is a

continuous and sometimes challenging

process. Couple dissolution could impact on

physical health, mental health, on children,

work, and school. This post covers areas that research has identified as problem signs in a

relationship and steps couples can take to

repair relationships.

Signs of a relationship in trouble

Most relationships face some challenges at different times. When negative interactions are more prevalent than positive ones (research indicates a 5 to 1 positive to negative ratio is important to have), this usually indicates a problem relationship. One problem area relationships experience is criticism. This is where one person attacks the character of the other, usually

with blame. Couples make “you” statements. For example, instead of a specific statement, they make global statement (ie. you always....) Or instead of a statement specific to the situation, they make personal attacks (ie: you did this...).

Defensiveness or making excuses is another problem area. Examples would include, assuming the worst, disagreeing with negative mind reading, cross complaining, and denying responsibility.

Contempt or name calling. Making crude, subtle or hostile jokes, or mockery. Body language also plays a factor as does tone of voice. The goal tends to be elevating oneself at the expense of one’s partner.

Withdrawing or Stonewalling is when one listener withdraws from interaction(ie: one spouse leaves, looking away from talker). Men usually stonewall more then woman. 

Children and Relationships

Having children is often a wonderful and rewarding experience. However, romantic ideals are more difficult to hold onto when children are introduced. Finding a consistent parenting approach and time demands are challenges couples face.Communication skills are also put to the test in these situations.

Differences Between How Men and Women Interact

Men and women usually have different approaches to communications. Men have a tendency to withdraw more when in conflictual situations or when they feel rejected or hurt. Women tend to pursue discussions more in these situations. In the face of perceived danger men are

more likely to have trouble going back to a relaxed state then women.

Fair Fighting

Even the most compatible couples tend to have disagreements. It is not if you disagree or fight but how you do it. Name calling, bringing up past hurts and unresolved issues, physical and verbal intimidation, poor listening, discounting significant other, sarcasm, and trying to

mind read (assuming you know what your partner is saying without clarifying it) are all indications of a couple who does not fight fairly.

Effective Communication\Fighting

All the above problem indicators may happen in some degree in all relationships. We must realize that not all problems have solutions. It is not if we fight but how we fight. 

1. If we disagree, it is important to still feel respected and listened to.

2. Enjoying verbal intimacy... feeling listened to.

3. Using I statements instead of you.

4. Listening without giving advice. These are all important components of good communication. When we are withdrawn we become poor receivers of nonverbal cues that may help us come to

agreements. At this point any type of communication is ineffective.

Quality Time Together

Spending quality time together is helpful. Quality time together must be a priority for the relationship to be satisfying. Developing routines and rituals together and focusing attention on each other are important to marriages.

Compromise

Couples should realize not all problems have solutions. Even the most compatible couples can not agree on all things at all times. When we disagree it is not what you say but how you say it. Your partner should feel listened to and respected.

Relationship Building

Relationships could be compared to bank accounts. If we keep making withdrawals, the account will run out. Don’t dwell on conflicts and pick your spots for disagreements. Deposits, such as humor, appreciation, consideration, fun, and affection, are what keeps relationships going.

* Keeping things in perspective. How important is the issue you are disagreeing over.

* Listen to what your partner is trying to say. One task you can try in an argument is switch sides. * Argue from your partner’s point of view. This will test your listening skills.

* Negativity encourages negativity, being positive is contagious. Nurture fondness and  admiration, let your partner influence you, create shared meaning and show your appreciation for your spouse. In happy marriages negativity is generally seen as fleeting and situational. In

unhappy marriages it is viewed as stable. By focusing on repairing problems or conflicts, being supportive of each other, and expressing appreciation to each other you find the keys to happy relationships.

Anxiety and Panic Attacks

Included are some suggestions in addressing symptoms for Anxiety and panic attacks. One approach in and of itself may not be the answer, but a combination of some of these approaches might be able to significantly

reduce the discomfort that you are experiencing.

Prevalence Data for Anxiety Disorders

Simple Phobic

A. Most common form of psycho

pathology - an estimated 19-23%

lifetime prevalence rate.  

Social Phobia

A. 2% of population have social phobia.

B. 40% of population consider

themselves to be shy and 90% of the

population admit to at least one period of

difficulty of shyness.

Panic Disorder

A. Panic disorder with agoraphobia

occurs in 2.5-5.7% of the population.

B. Panic disorder without agoraphobia

occurs in .6-1.0% of the population.

C. Woman are two times more likely to

be agoraphobic than men.

D. Men with panic disorder are more

likely to abuse alcohol than are woman.

E. 34% of the general population have a

panic attack within a 1 year period: 85%

have 5 or more panic attacks within a

year period.

1. AWARENESS OF SYMPTOMS

By keeping track of your symptoms and their severity over time, this can help gauge your progress in treatment. Keeping a journal will help you record what your thoughts and feelings are in given situations. In time, you may be able to identify patterns to your episodes. Often, these written records can provide

a broader perspective of your progress during those times you may be experiencing difficult periods in your

recovery. It is then easier to understand the connection between thoughts and actions\feelings. These records, will also be excellent resources for you at later dates in your life if these symptoms resurface.

2. ASSERTIVENESS

Improving assertiveness skills takes both education and practice. In practicing assertiveness skills, It is important to know that positive change doesn’t always come easy or without some discomfort. The benefits towards change include greater confidence in yourself and your abilities, increased trust in relationships, and a healthier sense of boundaries.

3. NUTRITION

Significant progress has been made in investigating how nutrition can influence mood and behavior. Caffeine

is a nervous system stimulant which may increase anxiety symptoms. In addition to reducing or eliminating caffeine, anxiety may be reduced by eating less processed and sugary foods which tend to deplete the

body’s energy reserves in the long run. Eating food high in complex carbohydrates can help to calm the

mind and the body by increasing levels of serotonin. Consider the use of vitamins and mineral supplements.

Your doctor or other trained professionals can assist you in making healthy nutritional choices.

4. EDUCATION

Individuals can learn about the treatment of anxiety, stress, and panic attacks from doctors, therapists, books,

the Internet, and peers. Knowledge can be empowering and reduce anxiety because individuals better understand their symptoms.

5. REGULAR RELAXATION

During anxiety and panic attacks, the sympathetic branch of the nervous system is active. The regular practice of relation can help you to over-learn the relaxation response so that it will become more dominant than the anxiety and panic response. During relaxation, heart rate and blood pressure tend to decrease as well as other changes which help to decrease the sympathetic activity and increase parasympathetic activity of the autonomic nervous system.

6. EXERCISE

Exercise can help to disrupt the cycle of anxiety, depression, and fatigue. The body becomes better able to handle the effects of physical and emotional stress. Many find that going for walk, especially in the morning, can help to reduce the symptoms of generalized anxiety.

7. SUPPORTIVE RELATIONSHIPS

There is an increasing correlation between supportive relationships and health. Relationships provide a well

needed stress buffer and help fulfill a very important human need. Often being with others helps balance the focus between oneself and others.

8. MEDICATION

Medication can help stabilization of function and create opportunities for other aspects of treatment to beneficial. Medication is often utilized when there is significant impairment in day to day functioning. Because each person differs biologically and psychologically, it is imperative to discuss the use of medication with your doctor.

9. RATIONAL THOUGHTS

Thoughts play a key role in influencing feelings and behavior. Cognitive restructuring can assist you in learning

how to change often predictable and self defeating thoughts. Through increased awareness and practice, unrealistic thought patterns can be replaced with more rational ones. These self enhancing thoughts often play a role in transforming behavior responses with reduced anxiety.

Anger Management

Walking away or changing topics are effective delay tactics. Also, when we recognize the physical buildup of anger, techniques such as relaxation, visualization, and deep breathing could be very effective. We cannot escape from anger. This is a natural human emotion. However we are able to control anger. If you have continual problems in managing your anger, discuss this with your therapist.

Anger is one of our most common and misunderstood emotions. We experience situations where we become on a regular basis. Getting angry is not necessarily unhealthy or bad. In some situations it could be healthy and productive. Anger has both a physical and psychological response and process. It is seen in babies as well as adults. Anger exists in all cultures, (although it may be displayed differently in each one). Anger is an emotion that could present itself in many different ways. It is our expression of anger that could become a problem. 

The following are indicators that someone is having trouble managing their anger.

· Frequent use of sarcasm or criticism

· Explosive outbursts

· Impaired relationships due to anger

· Withdrawing when angry

· Feeling guilty over anger

· Have hurt people emotionally and

physically) when angry

· Feeling out of control when angry

· Have a difficult time calming yourself

down when angry

· Significant others complain about

your anger

· Physical problems such as: ulcers,

hypertension, heart disease, gastritis,

and colitis.

· Complaints at work about anger

episodes

Consequences of Anger

When anger is mismanaged, the problems it can create could vary. Often physical problems such as ulcers, high blood pressure, and gastro problems could occur. Other problems such as social and relationship problems, occupational problems, and law problems could also present themselves.

Functions of Anger

When trying to figure out destructive anger, it is important to realize that anger could serve many functions for us. Examples include: getting our way through anger episodes, feeling superior to others, feeling powerful, expressing thoughts (especially hurt), discharging excessive energy, remaining a victim (not taking action but focusing on what is making you angry), and increasing production and motivation. In order to change the way

you deal with your anger, you need to be willing or motivated to change. This would involve giving up the advantages you experience when angry.

How Anger Works

Anger may be the result of a sudden situation we encounter, such as a traffic incident, or a chronic buildup of events.Often times when we find ourselves getting angry, we are reacting to a stressful situation as threat, real or perceived. This is often referred to as the Fight or Flight response. This response lies in the primitive part of

the brain. Our bodies react as if in a state of emergency. Increased hormonal production, adrenaline, blood

and oxygen flow to the major muscle groups, and increased heart rate, are among the many physiological

responses we have when angry and stressed.Our interpretations of events are important factors in determining anger outcomes. 

One individual may perceive a situation as a threat while another may not. This perception could be based on several factors including: previous life experiences, behavior patterns learned while growing up, coping abilities, and current life situation. These past experiences shape our reactions to events today.

Environmental factors could impact upon our anger management. Peer groups and cultural factors are

influences we need to consider. If people around us mismanage their anger, we may find it harder to control

ours. Other life challenges such as depression or stress are considerations we need to take into account as well.

Managing Anger

One of the first tasks involved in managing anger is developing awareness of anger patterns. By keeping an anger record, we develop more insight into our anger patterns. The more awareness we develop regarding

our anger, the more opportunity we have to intervene in the anger process. This awareness would include recognizing physical warnings of anger build ups, thought processes that contribute to anger, and a

lifestyle that contribute to anger problems.

Anger Thought

Thought processes contribute to anger. We need to begin to develop alternative ways to look at situations. It is helpful to identify beliefs that contribute to our anger states. This allows us to use other thoughts to interpret the event differently and provide a different, more rational thought process to take over. It is also important to incorporate humor into your life. If you take events less seriously, you may find yourself viewing a lot of situations with a lighter frame of mind.

Lifestyle Changes

By maintaining a healthy lifestyle, we are promoting a positive environment for ourselves enabling us to focus more on our anger problems. This would include: good sleep habits, supportive relationships, good nutrition, and regular exercise. Communication skills are important tools to use with anger problems. Learning to communicate our thoughts in less destructive ways not only derails anger blowups, but also improves the quality of our relationships. When we become more aware of our anger buildup, we could utilize delay tactics.