We All Get Scared Sometime; Even James Bond

August 21, 2008 Uncategorized, mental health No Comments

Courage is not not being afraid. Courage is being afraid and doing it anyway. Ask James Bond. Here is a great interview that can be a lesson in reality. Click on read more and share it if you like it.

EMS: EMTs and Paramedics

August 16, 2008 Crises, Uncategorized, random thoughts No Comments

I just finished presenting four talks for the Pensylvania State Emergency Medical Services (EMS) conference in Harrisburg.

I spoke about

Dealing with Emotions During Emergencies
Dealing with the Angry Person and Preventing Escalation
Dealing with the Confused Person
Managing the Hysterical Patient.

Watch my site for postings on some of these topics.

I want to share some of this great experience. First of all the people. All those who attended my workshops seemed truly interested in learning how to help their patients deal with the emotional stress of emergencies. They were open to new ideas and had lots of experience and ideas themselves about what worked to calm people down.

We all agreed that although the major focus of a medical emergency is to save lives and prevent worsening of trauma or illness this may not be possible unless the patient’s emotions are dealt with. Fear and other emotions must at least acknowledged. Communicating an understanding of a person’s feelings can go a long way to calming them.

I spoke alot about empathy and we worked hard to practice this concept and be able to figure out how to use it in common situations. If you haven’t read my blog on empathy please do. It remains one of the most powerful communication techniques for dealing with distressed, frightened, and angry people.

The EMS providers I met seem to have a great sense of humor. I have come to appreciate how important this is to surviving in such a high intensity emotional line of work. The frustrations of the job are many, misuse of services, lack of support, low pay, lack of repect and recognition for the life saving work they do. The rewards can be great.

Remember these are the first people there to help you when you need it most. We need to educate ourselves about the profession and the great job these folks do under pretty tough circumstances. My appreciation and respect to all of you.

Is There a Crisis in Overuse of Medication for Troups ?

August 10, 2008 Crises, Uncategorized No Comments

I was pretty concerned when I read this Time article about soldiers being medicated for burnout or compassion fatigue or stress and many other psychological concerns.

How can any thinking human being be in a battle zone, risking their life and seeing others killed not be distressed? We are fooling outself if we think this is possible. To think that an antidepressant will help this kind of sadness and distress is just naive. I am sure the prescribers know better.

My bigger concern in this article is the mention of Clonazepam (Klonopin) for anxiety and Ambien for sleep.

Prescribing these drugs is asking for trouble. Persons who take Benzodiazepines like Clonazepam are often in a “fog”. It’s the “new age Valium”.

Clonazepam can cause memory loss, decreased self control, slowed thinking, poor decision making and detachment. Rest assured these are not RARE side effects but happen routinely with these medications. Clonazepam is a particular worry because it can stay in the body and have effects for more then three days.

The warnings on Clonazepam tells you not to drive (due to slowed reflexes, decisions and lethergy). They do not say however not to carry a gun or fight in a war !

Ambien is a sleeping pill that is a sedative. It is less troublesome then Clonazepam because the drug usually lasts about 10 hours, but it is not uncommon to have daytime drowsiness

Some rarer side effects that are very troubling can include changes in thinking and/or behavior such as:

more aggressive behavior than normal
confusion
agitation
hallucinations
worsening of depression

Any use of drugs or alcohol can enhance all the effects of both these medications. The other worry is that long term use can cause dependence and may result in depressive feelings.

It is my opinion that the use of these drugs makes a dangerous situation even worse. Our boys at least need to be educated about what these drugs can do to them.

What are your thoughts?

Are You Experincing Burn Out? Find Out Here.

July 20, 2008 Crises, Uncategorized, stress No Comments

Buried at Work?

What is Burnout?

Burnout is physical and emotion depletion caused by an intense involvement in a situation in which the person has little control and recognition. Burnout is most likely to occur in situations where an individual perceives little effect from his or her efforts. Burnout can be caused by unrealistic expectations and demands from an outside source, or from idealistic goals, perfectionism and unreasonable expectations of oneself.

Common Symptoms of Burnout

Those working in a high stress environment may experience many of the warning signs of burnout. Some of the most common symptoms are:

Ø Increased absenteeism

Ø Avoiding or rushing through work

Ø Rigid rules and “by the book” approaches

Ø Dehumanizing clients

Ø Anger and emotional outbursts

Ø Increasingly cynical attitudes

Ø Boredom

Ø Stress from work interfering in social and family relationship

Ø Physical symptoms of stress such as headaches sleep disturbance and tiredness.

Some important reminders to prevent burnout:

Ø Take care of you, it will relieve some of your stress and allow you to better deal with others

Ø Learn and use self-empathy and self-nurturing techniques

Ø Try understanding and treating yourself with care

Ø Allow yourself to say no, offer alternatives, or even avoid situations if you feel unable to say no

Ø Increase your self-awareness

Ø Plan for a routine to help ease the transition from work to home. (Do not use alcohol to unwind)

Ø Do not expect all your feelings of self-esteem to come from your profession.

Ø Develop outside interests that have nothing to do with your work.

Ø Try to avoid over-identification with clients

Ø Recognize and allow your own feelings

Ø Develop relationships outside of work where you can talk about your feelings

Ø Practice stress reduction techniques (exercise, relaxation, meditation, distraction)

Ø Plan for regular breaks, conferences, and vacations

Ø Talk with colleagues to not only complain, but also to also make plans for burnout prevention, take charge where you can

Ø Know when to say “enough”, consider transfer if necessary

Burnout can and must be prevented. Recognition of your own level of stress and taking care of yourself are the keys to stress reduction and burnout prevention.

Burnout can also have an unexpected positive influence in your life; it can act as a catalyst to make a much-needed change. It can be the impetus to move on to different more rewarding careers. Many entrepreneurs started off as burned out employees.

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What Not To Say To Someone Who is Upset

June 27, 2008 Uncategorized, communication No Comments

I am often asked what to say or do to comfort someone who is upset. My answer is always : make an empathic comment. In thinking about it however I decided to give some examples of what not to say.

1.”I know just how you feel, when this happened to me blah, blah, blah.”

2. “Everything will work out for the best.”

3. “It’s time to put it behind you”

4.”You will get through this.”

5. “Thinking about it will just make you more upset.”

6. Attempts to change the subject

7. “Let me get you something” (coffee, sandwich etc).

8. “Do you want me to call your therapist, priest” etc.

As you can see, offering clichés like the examples given above will not help the situation or the distressed person. In fact they often make things worse. The person crying will sense your discomfort, may think their feelings are ignored, downplayed, or devalued. They may even become angry at you, or totally shut down.

Most of the comments listed signify the discomfort of the person trying to help. Becoming comfortable with someone who is crying, allowing the expression of feelings, and using the powerful tool of empathy are your best bets; silence also works.

At all costs, avoid clichés. Remember the power of empathy!

How Much Money Does Your Stress Cost You?

June 8, 2008 Uncategorized, stress 2 Comments

I would like to thank my financial advisor Jay Cappon of Rochester NY who is the author of this article. It is one of the many good and practical things he does to help people manage their money. Check out his web site at www.capvestfinancial.com

We all know that a stress-filled existence is responsible for nail biting and dark circles under the eyes. But we may not realize the heavy toll it can extract from our bank account. Chronic stress, the kind you experience when the demands of life exceed your ability to cope, increases your risk of developing ailments ranging from the common cold and gum disease to obesity and heart diseases. This, in turn, will cause you to pay more for medical treatments, insurance and dental work. If you need more incentive to do something about your stressful lifestyle, consider these potential costs:

Pills�
The list of symptoms linked to stress is long: headache, back pain, insomnia and heartburn are major ones. The lineup of nonprescription drugs used to treat these ailments can easily run several hundred dollars annually.
Bills

While health-care costs for an average adult run about $2,800. Annually, one who suffers from sever stress can easily rack up twice this amount, according to a recent survey by benefits provider Hewitt Associates. Part of the reason is that stress weakens the immune system, which can worsen chronic conditions such as arthritis, asthma and lupus. Stressed workers are also more prone to job-related injuries.
Higher Premiums�
High levels of stress hormones are commonly linked to weight gain, which in turn raises your risk of heart disease, stroke and Type 2 diabetes. Loose some excess pounds and you could get lower life insurance premium, upwards to 50% or more.
Costlier Dental Problems�
Stress also increases the risk of gum disease. Teeth grinding and eating sugary foods lead to cavities and gradual tooth enamel erosion.
Missed Career Opportunities

In the same survey by Hewitt Associates, half of all workers who call in sick do so because of a stress-related illness. Workers suffering from severe stress are away from their desks an average of 23 working days, according to the Bureau of Labor Statistics. All of these missed meetings and blown deadlines can wreak havoc on your career, resulting in tens of thousands of dollars off what you might earn over your employment lifetime.

What to do?

There is some good news: reducing stress can be as simple and inexpensive as stretching out on the sofa and breathing deeply for 10 minutes. Daily exercise is another powerful weapon. While breaking a sweat with weights is ideal, just taking a walk around the block will help. Nutrition-wise, cut back on coffee and other caffeine-containing beverages, as this aggravates the symptoms of chronic stress. Refrain from alcohol and smoking. Doing this will not only have immediate financial savings in the short-run, but even greater benefits on your quality of life over the long-run.

Check out my blog for more stress reduction techniques.

Give Our Returing Troups Time to Heal, Not a Label

May 27, 2008 PTSD, Uncategorized 1 Comment

PTSD Diagnosis up 50 % in Iraq Troups in 2007 according to an associated press article.

Is anyone really suprised that acute stress reactions are very high in troups in Iraq? I would think not. But the issue of a PTSD diagnoses is another matter altogether. In my opinion PTSD is a diagnosis in vogue these days that is overused (similar to Bi-Polar disorder) . I do not believe you do justice to a person returning from combat by labeling (and burdening) them with a diagnosis too quickly.

Persons returning from War need time to heal. They need a few months of reduced stress and expectations, a place to talk if they want, information on how to deal with common problems, help with reestablishing relationships (with very stressed family) and contact with others who have some idea of what they are going through. Lets give them the support and the time they need. This is what VA and communities should provide, not just another label. Ongoing support will provide prevention for PTSD, allow healing and time to identify those who are not doing so well.

When looking at the criteria to make a PTSD diagnosis having experienced a major stressor is only one criteria needed for the diagnosis to be made.

Any life-threatening event

Combat
Natural disasters
Accidents
Assault

Most survivors of trauma return to normal given a little time. Some will have stress reactions that linger or even get worse over time. These individuals may develop PTSD.

Signs and Symptoms that last over a month ( this seems unrealistically brief to me.)

Reliving the trauma (thinking about it with full emotional reactions)
Becoming angry or upset with a thought or reminder of the trauma
Avoiding places or people that bring memories of the trauma,
Spending lots of time alone avoiding others.
Lack of feelings or complaints of feeling numb.
Feelings of being on guard (hypervigalent), irritable, and being easily startled.

What is a Healthy Coping Style?

April 7, 2008 Coping, Uncategorized 1 Comment

Remember the four major coping styles I identified in my last post?

•1. Aggressive

•2. Regressive

•3. Withdrawal

•4. Repressive

I also posed some questions to stimulate thought about coping and to encourage you to identify your particular style. I believe self-awareness is the road to mental health.

Let me try to answer these questions in the manner of a professional therapist.

Is one style more effective then another?
Hmm, it depends, what do you think?
Is one more “mature” then another?
Hmm, it depends, what do you think?
Is one style more prevalent in certain people, populations, why?
Hmm, it depends, what do you think?
Is one style the most mentally healthy?
Hmm, it depends, what do you think?

Ok, joking aside, the answers really do depend on the situation. Many people think that an aggressive coping style (the jump in and take charge, fix it person) is the healthiest and most mature. Well it may not be! Imagine trying to cope with a stress that you have no control over. That is, trying to fix something that is impossible to fix. You have probably seen people do this many times but perhaps did not recognize it for what it is. Using aggressive coping will increase your level of frustration and stress when there is no hope of success. Think of the patient who is dying of cancer and spends his last bit of money, time, and energy looking for a miracle cure. Consider the woman, who reads every book, attends talks and conferences, seeks counseling, and tries everything she can think of to try to save a relationship that is clearly over. Clearly aggressive coping style is not what is called for in either of these situations.

Withdrawal is often not looked on as a mature healthy coping mechanism. In some cases however, it may actually be your best bet. Physically leaving an escalating argument for instance, may be wise indeed.

Can you think of a time when regression would be a good choice of a coping style? Many people can’t. Well what about the man who has had major surgery or a heart attack? Becoming more dependent and asking for help is clearly necessary in order to heal. Allowing someone to bath you and help you toilet is much healthier then insisting on doing it yourself and risking your health and maybe your life. It happens all the time!

Finally repressive mechanisms may work very well in a certain situation. If stressors cannot be managed for some reason pushing them out of your mind may be very appropriate. (Remember Scarlett O Hara, who needed to take care of business first before thinking about her lost love!) If you are worried about loosing your job, but your wife or husband has a crisis, it may be best if you can put the job problem on the back burner to help your spouse.

So the answer to the question about which coping style is the most mentally healthy is, none of them. It is the ability to use a wide variety of different styles as the situation calls for. FLEXABILITY is the key! The person who uses the same coping style over and over regardless of the situation is bound to fail. Such a person may be so stuck in a rut that they use this style even when not under stress. You know, this might be the person who avoids any confrontation at any cost (repressive style). Persons with one style approach to coping may actually have a personality disorder.

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