Wednesday, November 20, 2024
Question
I know I should reinforce good behavior, but does it matter HOW I praise my child?
Answer
Clinical Expert:
Melanie A. Fernandez, PhD, ABPP
There are certainly ways to make praise more effective in teaching, as well as encouraging good behaviors and improving self-esteem in children.
The more descriptive your praise is, the better. So instead of saying, “Good job!” caregivers should specify what was a good job. For instance, “Good job sharing your toys with your brother!” When you’re specific about what a child did well, you’re more likely to bring attention to the child’s effort-as opposed to the outcome of the effort.
It’s important to recognize that praising effort is not the same as praising success; praising your child for being smart doesn’t teach what behavior was so smart. More benefit comes from labeling the smart behavior: “It was so smart how you built a base on your tower before starting to add the other pieces.”
When a child is learning a new behavior, it’s important to offer praise whenever the behavior happens; once the child has learned the behavior, continuing to offer praise, but less frequently, helps the child maintain the behavior learned. Caregivers should be looking for opportunities to praise kids’ positive behaviors — even the behaviors they think kids should already know and be doing regularly.
Finally, praise should be genuine.
#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
www.celebratingyourgiftoflife.com
Link for 40 Habits Signupbit.ly/40HabitsofMentalHealth
If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub https://standingabovethecrowd.com/james-donaldson-on-mental-health-does-it-matter-how-i-praise-my-child/
James Donaldson on Mental Health - Does it matter HOW I praise my child?
Question
I know I should reinforce good behavior, but does it matter HOW I praise my child?
Answer
Clinical Expert:
Melanie A. Fernandez, PhD, ABPP
There are certainly ways to make praise more effective in teaching, as well as encouraging good behaviors and improving self-esteem in children.
The more descriptive your praise is, the better. So instead of saying, “Good job!” caregivers should specify what was a good job. For instance, “Good job sharing your toys with your brother!” When you’re specific about what a child did well, you’re more likely to bring attention to the child’s effort-as opposed to the outcome of the effort.
It’s important to recognize that praising effort is not the same as praising success; praising your child for being smart doesn’t teach what behavior was so smart. More benefit comes from labeling the smart behavior: “It was so smart how you built a base on your tower before starting to add the other pieces.”
When a child is learning a new behavior, it’s important to offer praise whenever the behavior happens; once the child has learned the behavior, continuing to offer praise, but less frequently, helps the child maintain the behavior learned. Caregivers should be looking for opportunities to praise kids’ positive behaviors — even the behaviors they think kids should already know and be doing regularly.
Finally, praise should be genuine.
#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
www.celebratingyourgiftoflife.com
Link for 40 Habits Signup
bit.ly/40HabitsofMentalHealth
If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub
https://standingabovethecrowd.com/james-donaldson-on-mental-health-does-it-matter-how-i-praise-my-child/
Tuesday, November 19, 2024
By Kristen Rogers and Matt Villano, CNN
Emergency department visits for self-harm have spiked since the pandemic. Experts explain the psychology behind the behavior and how to overcome it.
Editor’s Note: This story contains details of self-harm that some readers may find upsetting or triggering. Help is available if you or someone you know is struggling with suicidal thoughts or mental health matters.In the US: Call or text 988, the Suicide & Crisis Lifeline.
Megan walked the halls of her suburban Houston junior high in shame. It was the first time she had to attend school with bruises on her face from the abuse by her father, who was an alcoholic.
“I was really frustrated about that and just how unfair it was, and how embarrassed I was,” Megan — who is now 35 and asked that her last name not be used due to the sensitivity of the subject — said of that moment that occurred over 20 years ago. “And I couldn’t escape having to continue to go to (my dad’s) house.”
When Megan got home from school and found herself alone, she grabbed a kitchen knife, locked herself in the bathroom and cut her forearm open. She had just recently learned about self-harm after asking a friend about her many bandages and long sleeves.
“It was always after the visits to (my dad’s) house,” Megan said. “I would come back (to my mom’s house) and just have all of this frustration and not know what to do with it. … At my dad’s house, there was no control. I had no control. So (harming myself) was more of a way that I was in control.”
Over the next few years, Megan’s father continued to abuse her and she self-harmed to cope, as it helped her focus on the physical pain instead of the emotional pain. After getting kicked off the cheerleading squad at age 15, she ran upstairs to her bathroom with a knife in tow, Megan said. But her mother had caught on and tried to break the door down, “scared sh*tless that I was trying to kill myself.”
A couple days later, Megan began therapy to hash out her trauma and learn different ways to process her pain. Though her mother feared Megan was suicidal, Megan insisted the behavior had nothing to do with wanting to die — instead, she said, self-harming was a desperate attempt to keep her unbearable feelings of anger, sadness, guilt and shame from running wild.
What is self-harm?
Self-harm commonly takes the form of cutting or scratching until the body bleeds, but it can also include burning, bruising or even intentionally breaking bones, said Dr. Janis Whitlock, founder and director of the Cornell Research Program on Self-Injury and Recovery at Cornell University in New York state. Some experts refer to the behavior as non-suicidal self-injury, or NSSI.
In 2019 there were 363,000 emergency department visits for self-harm, according to the US Centers for Disease Control and Prevention. The following year saw a 48.5% drop, likely due to the tendency to avoid medical care to not overburden medical providers or risk getting sick during the Covid-19 pandemic, Whitlock said.
But in 2021, there were 660,000 visits — a nearly 253% increase from 2020 and roughly an 82% spike from 2019.
These increases align with reports of rates of mental health challenges climbing before the pandemic, which only made things worse for many people, Whitlock said. Also, the proximity to loved ones during lockdowns may have made parents more aware of self-harm, potentially contributing to more emergency department visits.
Inside the minds of those who self-harm
Most experts agree that self-injury is a cry for help and arises from a person trying and failing to process stress, said Dr. Jeremy Jamieson, professor and chair of psychology at the University of Rochester in New York state.
If someone is feeling disconnected from the world, Megan said, they might self-injure to try to reconnect. If someone is feeling less than human — known as depersonalization — they may self-harm to feel human again. Self-harm can also be a form of self-punishment among those feeling guilt or shame and thus like they deserve physical pain.
There’s also a neurophysiological explanation for why people hurt themselves, said Dr. Vibh Forsythe Cox, director of the Marsha M. Linehan Dialectical Behavior Therapy Clinic at the University of Washington in Seattle. It involves the body’s endogenous opioid system, a neurochemical system with key roles in pain modulation, reward, stress responses and more.
When the body realizes it’s experiencing damage, the opioid system sends out endorphins that act as painkillers so the body can escape whatever the danger is. Self-harm triggers this same response, Cox said.
“The data suggests a neurological link between the perception of physical pain and the perception of emotional pain — where there is a spike and drop in one, there may be a spike and drop in the other,” Whitlock said.
The dangers of self-harm
When people self-harm, they run the risk of accidentally causing a much more serious problem — such as irreparable damage or infection that could lead to death, Whitlock said.
Secondly, while self-injury isn’t necessarily a suicide attempt, data suggests the former can sometimes be a precursor to suicidality.
The suicide rate among adults who self-harmed was 37 times greater than the suicide rate in the general population, according to a 2017 study. And in Whitlock’s own research, she has found that 65% of teens who self-injure likely will also be suicidal at some point.
“The very act of engaging in self-injury reduces inhibition to suicidal behavior if someone becomes suicidal,” said Whitlock, senior adviser for the JED Foundation, a suicide prevention and mental health organization in Boston. “Having ‘practiced’ injuring the body repeatedly makes it easier to injure the body with suicidal intent.”
Effective therapies for self-injury
Self-injury, like many mental health issues, takes time to treat, experts said, and people who self-harm usually don’t stop until they’re ready. Typically, this happens when they learn other coping skills and find motivating reasons for living.
One effective treatment is dialectical behavior therapy, or DBT, experts said. Sometimes conducted in group settings, the approach is designed to help people overcome black-and-white thinking and develop emotional regulation skills, which are key for healthily managing emotional pain instead of turning to self-destructive habits.
This rewiring of the brain to react and respond differently takes time, usually a year or more, Cox said.
But the results can be impressive. A 2018 study investigated the effects of DBT — versus individual and group supportive therapy — on rates of suicide attempts and self-harm among 173 adolescents who had attempted suicide at least once before and had three or more criteria for borderline personality disorder (the disorder for which DBT was created).
After six months, nearly 57% of the DBT participants were able to stop self-harming, compared with 40% of those who had done individual and group supportive therapy. More than 90% of the DBT participants had no suicide attempts after treatment, compared with nearly 79% of the other group.
For around 93% of adults in a 2021 study based in Norway, DBT helped them stop self-harming within the first year. Another study, published in 2015, assessed the effects of various DBT interventions on 99 women who had borderline personality disorder and experienced suicidality — all participants experienced reductions in frequency of self-harm and found reasons for living after a year of treatment.
Advice for overcoming self-harm
If you’re struggling with self-harm, reach out to a mental health professional you can find through your doctor, insurance or crisis helplines, Whitlock said.
Also try identifying your triggers and warning signs then writing them down, she added. “Keeping a mood journal can help (you) recognize patterns and allow you to intervene early with healthy coping skills before urges become overwhelming.”
Some helpful coping techniques include practicing mindfulness, such as by focusing on your five senses to stay present and ride out intense emotions, or deep breathing, Whitlock said. A “coping skills box” filled with items such as stress balls, coloring books or photos of loved ones can also comfort you.
And “when feeling the impulse to self-injure, commit to waiting 15 minutes first,” Whitlock said. “Use this time to try alternative coping strategies. Over time the intensity of the urge will decrease.”
Lastly, don’t be too hard on yourself. “Rather than aiming for ‘never again,’” Whitlock said, “focus on extending the time between incidents. Celebrate progress while being gentle with setbacks.”
How to support someone else
If you’re trying to help a child or adult who’s self-harming, Whitlock doesn’t recommend going through the house and removing every sharp object, she said.
You should of course use common sense and not let someone have their self-harm toolkit in their bedroom, for example, Whitlock added. But full restriction could create a power struggle between you and the person self-harming — and that could rob you of the critical opportunity to meet that person’s need for connection and support that addresses the root of self-injurious behavior long term. People who are desperate to self-harm may also do so by any means necessary.
Those deeper realities get obscured and potentially squashed when power struggles ensue and a person feels like they’re being punished, Whitlock said.
#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
www.celebratingyourgiftoflife.com
Link for 40 Habits Signupbit.ly/40HabitsofMentalHealth
If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub
“We also really highly recommend taking a collaborative approach whenever possible,” added Whitlock, author of “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones.”
It’s important to validate, rather than criticize, your loved one’s strong emotions while also emphasizing that there are safer ways to manage that emotional pain, said Dr. Michele Berk, associate professor of psychiatry and behavior sciences at Stanford University in California, via email.
Don’t ask “Why did you do that?” said Australian psychiatrist Dr. Benjamin Veness. That question could amplify a person’s shame and make them feel worse, whereas judgment-free questions about their state of mind in general and when they self-harmed are a much better approach.
Ensuring loved ones, especially children, see you as supportive and accepting can help them tell you if they’re at risk for self-harm, Berk added.
Be honest about your confusion, fear or worry, and get your own professional support so you can work through those feelings instead of channeling them into anger toward your loved one, Whitlock said.
Life after self-harm
Though the tunnel that is the journey to stop self-harming may be long and challenging, there is light at the end of it.
Some families have said that while they wouldn’t wish the experience on anyone else, it did help them learn and grow as a family “because they had to work through some of the challenges around communication and authentic connection (or) whatever stuff hadn’t been dealt with that may be part of why self-harm showed up in the first place,” Whitlock said.
That’s true in Megan’s case. The time her mother caught her self-harming was the last time she ever did it, she said. Journaling using a red ink pen, per her therapist’s recommendation, was also critical for her, Megan said — the emotional release from seeing blood on her arms was replaced by the symbolic release of her pain onto the pages.
Megan now runs a successful company in Las Vegas, and doubles as a fashion influencer on social media. She doesn’t have urges to self-injure anymore, she said, since she has learned other mechanisms for dealing with pain.
“I often interpret people who self-injure as people who have a high degree of perception and sensitivity in ways that are actually gifts,” Whitlock said. “So, I always try to let people know … the urge to feel better and to come back into a sense of stability and centeredness is good.”
“They just need additional support to understand what’s happening,” she added, “and then to use the perceptual abilities they have.”
Self Harm https://standingabovethecrowd.com/james-donaldson-on-mental-health-why-some-people-intentionally-cut-burn-or-bruise-themselves/
James Donaldson on Mental Health - Why some people intentionally cut, burn or bruise themselves
By Kristen Rogers and Matt Villano, CNN
Emergency department visits for self-harm have spiked since the pandemic. Experts explain the psychology behind the behavior and how to overcome it.
Editor’s Note: This story contains details of self-harm that some readers may find upsetting or triggering. Help is available if you or someone you know is struggling with suicidal thoughts or mental health matters.
In the US: Call or text 988, the Suicide & Crisis Lifeline.
Megan walked the halls of her suburban Houston junior high in shame. It was the first time she had to attend school with bruises on her face from the abuse by her father, who was an alcoholic.
“I was really frustrated about that and just how unfair it was, and how embarrassed I was,” Megan — who is now 35 and asked that her last name not be used due to the sensitivity of the subject — said of that moment that occurred over 20 years ago. “And I couldn’t escape having to continue to go to (my dad’s) house.”
When Megan got home from school and found herself alone, she grabbed a kitchen knife, locked herself in the bathroom and cut her forearm open. She had just recently learned about self-harm after asking a friend about her many bandages and long sleeves.
“It was always after the visits to (my dad’s) house,” Megan said. “I would come back (to my mom’s house) and just have all of this frustration and not know what to do with it. … At my dad’s house, there was no control. I had no control. So (harming myself) was more of a way that I was in control.”
Over the next few years, Megan’s father continued to abuse her and she self-harmed to cope, as it helped her focus on the physical pain instead of the emotional pain. After getting kicked off the cheerleading squad at age 15, she ran upstairs to her bathroom with a knife in tow, Megan said. But her mother had caught on and tried to break the door down, “scared sh*tless that I was trying to kill myself.”
A couple days later, Megan began therapy to hash out her trauma and learn different ways to process her pain. Though her mother feared Megan was suicidal, Megan insisted the behavior had nothing to do with wanting to die — instead, she said, self-harming was a desperate attempt to keep her unbearable feelings of anger, sadness, guilt and shame from running wild.
What is self-harm?
Self-harm commonly takes the form of cutting or scratching until the body bleeds, but it can also include burning, bruising or even intentionally breaking bones, said Dr. Janis Whitlock, founder and director of the Cornell Research Program on Self-Injury and Recovery at Cornell University in New York state. Some experts refer to the behavior as non-suicidal self-injury, or NSSI.
In 2019 there were 363,000 emergency department visits for self-harm, according to the US Centers for Disease Control and Prevention. The following year saw a 48.5% drop, likely due to the tendency to avoid medical care to not overburden medical providers or risk getting sick during the Covid-19 pandemic, Whitlock said.
But in 2021, there were 660,000 visits — a nearly 253% increase from 2020 and roughly an 82% spike from 2019.
These increases align with reports of rates of mental health challenges climbing before the pandemic, which only made things worse for many people, Whitlock said. Also, the proximity to loved ones during lockdowns may have made parents more aware of self-harm, potentially contributing to more emergency department visits.
Inside the minds of those who self-harm
Most experts agree that self-injury is a cry for help and arises from a person trying and failing to process stress, said Dr. Jeremy Jamieson, professor and chair of psychology at the University of Rochester in New York state.
If someone is feeling disconnected from the world, Megan said, they might self-injure to try to reconnect. If someone is feeling less than human — known as depersonalization — they may self-harm to feel human again. Self-harm can also be a form of self-punishment among those feeling guilt or shame and thus like they deserve physical pain.
There’s also a neurophysiological explanation for why people hurt themselves, said Dr. Vibh Forsythe Cox, director of the Marsha M. Linehan Dialectical Behavior Therapy Clinic at the University of Washington in Seattle. It involves the body’s endogenous opioid system, a neurochemical system with key roles in pain modulation, reward, stress responses and more.
When the body realizes it’s experiencing damage, the opioid system sends out endorphins that act as painkillers so the body can escape whatever the danger is. Self-harm triggers this same response, Cox said.
“The data suggests a neurological link between the perception of physical pain and the perception of emotional pain — where there is a spike and drop in one, there may be a spike and drop in the other,” Whitlock said.
The dangers of self-harm
When people self-harm, they run the risk of accidentally causing a much more serious problem — such as irreparable damage or infection that could lead to death, Whitlock said.
Secondly, while self-injury isn’t necessarily a suicide attempt, data suggests the former can sometimes be a precursor to suicidality.
The suicide rate among adults who self-harmed was 37 times greater than the suicide rate in the general population, according to a 2017 study. And in Whitlock’s own research, she has found that 65% of teens who self-injure likely will also be suicidal at some point.
“The very act of engaging in self-injury reduces inhibition to suicidal behavior if someone becomes suicidal,” said Whitlock, senior adviser for the JED Foundation, a suicide prevention and mental health organization in Boston. “Having ‘practiced’ injuring the body repeatedly makes it easier to injure the body with suicidal intent.”
Effective therapies for self-injury
Self-injury, like many mental health issues, takes time to treat, experts said, and people who self-harm usually don’t stop until they’re ready. Typically, this happens when they learn other coping skills and find motivating reasons for living.
One effective treatment is dialectical behavior therapy, or DBT, experts said. Sometimes conducted in group settings, the approach is designed to help people overcome black-and-white thinking and develop emotional regulation skills, which are key for healthily managing emotional pain instead of turning to self-destructive habits.
This rewiring of the brain to react and respond differently takes time, usually a year or more, Cox said.
But the results can be impressive. A 2018 study investigated the effects of DBT — versus individual and group supportive therapy — on rates of suicide attempts and self-harm among 173 adolescents who had attempted suicide at least once before and had three or more criteria for borderline personality disorder (the disorder for which DBT was created).
After six months, nearly 57% of the DBT participants were able to stop self-harming, compared with 40% of those who had done individual and group supportive therapy. More than 90% of the DBT participants had no suicide attempts after treatment, compared with nearly 79% of the other group.
For around 93% of adults in a 2021 study based in Norway, DBT helped them stop self-harming within the first year. Another study, published in 2015, assessed the effects of various DBT interventions on 99 women who had borderline personality disorder and experienced suicidality — all participants experienced reductions in frequency of self-harm and found reasons for living after a year of treatment.
Advice for overcoming self-harm
If you’re struggling with self-harm, reach out to a mental health professional you can find through your doctor, insurance or crisis helplines, Whitlock said.
Also try identifying your triggers and warning signs then writing them down, she added. “Keeping a mood journal can help (you) recognize patterns and allow you to intervene early with healthy coping skills before urges become overwhelming.”
Some helpful coping techniques include practicing mindfulness, such as by focusing on your five senses to stay present and ride out intense emotions, or deep breathing, Whitlock said. A “coping skills box” filled with items such as stress balls, coloring books or photos of loved ones can also comfort you.
And “when feeling the impulse to self-injure, commit to waiting 15 minutes first,” Whitlock said. “Use this time to try alternative coping strategies. Over time the intensity of the urge will decrease.”
Lastly, don’t be too hard on yourself. “Rather than aiming for ‘never again,’” Whitlock said, “focus on extending the time between incidents. Celebrate progress while being gentle with setbacks.”
How to support someone else
If you’re trying to help a child or adult who’s self-harming, Whitlock doesn’t recommend going through the house and removing every sharp object, she said.
You should of course use common sense and not let someone have their self-harm toolkit in their bedroom, for example, Whitlock added. But full restriction could create a power struggle between you and the person self-harming — and that could rob you of the critical opportunity to meet that person’s need for connection and support that addresses the root of self-injurious behavior long term. People who are desperate to self-harm may also do so by any means necessary.
Those deeper realities get obscured and potentially squashed when power struggles ensue and a person feels like they’re being punished, Whitlock said.
#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
www.celebratingyourgiftoflife.com
Link for 40 Habits Signup
bit.ly/40HabitsofMentalHealth
If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub
“We also really highly recommend taking a collaborative approach whenever possible,” added Whitlock, author of “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones.”
It’s important to validate, rather than criticize, your loved one’s strong emotions while also emphasizing that there are safer ways to manage that emotional pain, said Dr. Michele Berk, associate professor of psychiatry and behavior sciences at Stanford University in California, via email.
Don’t ask “Why did you do that?” said Australian psychiatrist Dr. Benjamin Veness. That question could amplify a person’s shame and make them feel worse, whereas judgment-free questions about their state of mind in general and when they self-harmed are a much better approach.
Ensuring loved ones, especially children, see you as supportive and accepting can help them tell you if they’re at risk for self-harm, Berk added.
Be honest about your confusion, fear or worry, and get your own professional support so you can work through those feelings instead of channeling them into anger toward your loved one, Whitlock said.
Life after self-harm
Though the tunnel that is the journey to stop self-harming may be long and challenging, there is light at the end of it.
Some families have said that while they wouldn’t wish the experience on anyone else, it did help them learn and grow as a family “because they had to work through some of the challenges around communication and authentic connection (or) whatever stuff hadn’t been dealt with that may be part of why self-harm showed up in the first place,” Whitlock said.
That’s true in Megan’s case. The time her mother caught her self-harming was the last time she ever did it, she said. Journaling using a red ink pen, per her therapist’s recommendation, was also critical for her, Megan said — the emotional release from seeing blood on her arms was replaced by the symbolic release of her pain onto the pages.
Megan now runs a successful company in Las Vegas, and doubles as a fashion influencer on social media. She doesn’t have urges to self-injure anymore, she said, since she has learned other mechanisms for dealing with pain.
“I often interpret people who self-injure as people who have a high degree of perception and sensitivity in ways that are actually gifts,” Whitlock said. “So, I always try to let people know … the urge to feel better and to come back into a sense of stability and centeredness is good.”
“They just need additional support to understand what’s happening,” she added, “and then to use the perceptual abilities they have.”
Self Harm https://standingabovethecrowd.com/james-donaldson-on-mental-health-why-some-people-intentionally-cut-burn-or-bruise-themselves/
James Donaldson on Mental Health - Why some people intentionally cut, burn or bruise themselves
By Kristen Rogers and Matt Villano, CNN
Emergency department visits for self-harm have spiked since the pandemic. Experts explain the psychology behind the behavior and how to overcome it.
Editor’s Note: This story contains details of self-harm that some readers may find upsetting or triggering. Help is available if you or someone you know is struggling with suicidal thoughts or mental health matters.
In the US: Call or text 988, the Suicide & Crisis Lifeline.
Megan walked the halls of her suburban Houston junior high in shame. It was the first time she had to attend school with bruises on her face from the abuse by her father, who was an alcoholic.
“I was really frustrated about that and just how unfair it was, and how embarrassed I was,” Megan — who is now 35 and asked that her last name not be used due to the sensitivity of the subject — said of that moment that occurred over 20 years ago. “And I couldn’t escape having to continue to go to (my dad’s) house.”
When Megan got home from school and found herself alone, she grabbed a kitchen knife, locked herself in the bathroom and cut her forearm open. She had just recently learned about self-harm after asking a friend about her many bandages and long sleeves.
“It was always after the visits to (my dad’s) house,” Megan said. “I would come back (to my mom’s house) and just have all of this frustration and not know what to do with it. … At my dad’s house, there was no control. I had no control. So (harming myself) was more of a way that I was in control.”
Over the next few years, Megan’s father continued to abuse her and she self-harmed to cope, as it helped her focus on the physical pain instead of the emotional pain. After getting kicked off the cheerleading squad at age 15, she ran upstairs to her bathroom with a knife in tow, Megan said. But her mother had caught on and tried to break the door down, “scared sh*tless that I was trying to kill myself.”
A couple days later, Megan began therapy to hash out her trauma and learn different ways to process her pain. Though her mother feared Megan was suicidal, Megan insisted the behavior had nothing to do with wanting to die — instead, she said, self-harming was a desperate attempt to keep her unbearable feelings of anger, sadness, guilt and shame from running wild.
What is self-harm?
Self-harm commonly takes the form of cutting or scratching until the body bleeds, but it can also include burning, bruising or even intentionally breaking bones, said Dr. Janis Whitlock, founder and director of the Cornell Research Program on Self-Injury and Recovery at Cornell University in New York state. Some experts refer to the behavior as non-suicidal self-injury, or NSSI.
In 2019 there were 363,000 emergency department visits for self-harm, according to the US Centers for Disease Control and Prevention. The following year saw a 48.5% drop, likely due to the tendency to avoid medical care to not overburden medical providers or risk getting sick during the Covid-19 pandemic, Whitlock said.
But in 2021, there were 660,000 visits — a nearly 253% increase from 2020 and roughly an 82% spike from 2019.
These increases align with reports of rates of mental health challenges climbing before the pandemic, which only made things worse for many people, Whitlock said. Also, the proximity to loved ones during lockdowns may have made parents more aware of self-harm, potentially contributing to more emergency department visits.
Inside the minds of those who self-harm
Most experts agree that self-injury is a cry for help and arises from a person trying and failing to process stress, said Dr. Jeremy Jamieson, professor and chair of psychology at the University of Rochester in New York state.
If someone is feeling disconnected from the world, Megan said, they might self-injure to try to reconnect. If someone is feeling less than human — known as depersonalization — they may self-harm to feel human again. Self-harm can also be a form of self-punishment among those feeling guilt or shame and thus like they deserve physical pain.
There’s also a neurophysiological explanation for why people hurt themselves, said Dr. Vibh Forsythe Cox, director of the Marsha M. Linehan Dialectical Behavior Therapy Clinic at the University of Washington in Seattle. It involves the body’s endogenous opioid system, a neurochemical system with key roles in pain modulation, reward, stress responses and more.
When the body realizes it’s experiencing damage, the opioid system sends out endorphins that act as painkillers so the body can escape whatever the danger is. Self-harm triggers this same response, Cox said.
“The data suggests a neurological link between the perception of physical pain and the perception of emotional pain — where there is a spike and drop in one, there may be a spike and drop in the other,” Whitlock said.
The dangers of self-harm
When people self-harm, they run the risk of accidentally causing a much more serious problem — such as irreparable damage or infection that could lead to death, Whitlock said.
Secondly, while self-injury isn’t necessarily a suicide attempt, data suggests the former can sometimes be a precursor to suicidality.
The suicide rate among adults who self-harmed was 37 times greater than the suicide rate in the general population, according to a 2017 study. And in Whitlock’s own research, she has found that 65% of teens who self-injure likely will also be suicidal at some point.
“The very act of engaging in self-injury reduces inhibition to suicidal behavior if someone becomes suicidal,” said Whitlock, senior adviser for the JED Foundation, a suicide prevention and mental health organization in Boston. “Having ‘practiced’ injuring the body repeatedly makes it easier to injure the body with suicidal intent.”
Effective therapies for self-injury
Self-injury, like many mental health issues, takes time to treat, experts said, and people who self-harm usually don’t stop until they’re ready. Typically, this happens when they learn other coping skills and find motivating reasons for living.
One effective treatment is dialectical behavior therapy, or DBT, experts said. Sometimes conducted in group settings, the approach is designed to help people overcome black-and-white thinking and develop emotional regulation skills, which are key for healthily managing emotional pain instead of turning to self-destructive habits.
This rewiring of the brain to react and respond differently takes time, usually a year or more, Cox said.
But the results can be impressive. A 2018 study investigated the effects of DBT — versus individual and group supportive therapy — on rates of suicide attempts and self-harm among 173 adolescents who had attempted suicide at least once before and had three or more criteria for borderline personality disorder (the disorder for which DBT was created).
After six months, nearly 57% of the DBT participants were able to stop self-harming, compared with 40% of those who had done individual and group supportive therapy. More than 90% of the DBT participants had no suicide attempts after treatment, compared with nearly 79% of the other group.
For around 93% of adults in a 2021 study based in Norway, DBT helped them stop self-harming within the first year. Another study, published in 2015, assessed the effects of various DBT interventions on 99 women who had borderline personality disorder and experienced suicidality — all participants experienced reductions in frequency of self-harm and found reasons for living after a year of treatment.
Advice for overcoming self-harm
If you’re struggling with self-harm, reach out to a mental health professional you can find through your doctor, insurance or crisis helplines, Whitlock said.
Also try identifying your triggers and warning signs then writing them down, she added. “Keeping a mood journal can help (you) recognize patterns and allow you to intervene early with healthy coping skills before urges become overwhelming.”
Some helpful coping techniques include practicing mindfulness, such as by focusing on your five senses to stay present and ride out intense emotions, or deep breathing, Whitlock said. A “coping skills box” filled with items such as stress balls, coloring books or photos of loved ones can also comfort you.
And “when feeling the impulse to self-injure, commit to waiting 15 minutes first,” Whitlock said. “Use this time to try alternative coping strategies. Over time the intensity of the urge will decrease.”
Lastly, don’t be too hard on yourself. “Rather than aiming for ‘never again,’” Whitlock said, “focus on extending the time between incidents. Celebrate progress while being gentle with setbacks.”
How to support someone else
If you’re trying to help a child or adult who’s self-harming, Whitlock doesn’t recommend going through the house and removing every sharp object, she said.
You should of course use common sense and not let someone have their self-harm toolkit in their bedroom, for example, Whitlock added. But full restriction could create a power struggle between you and the person self-harming — and that could rob you of the critical opportunity to meet that person’s need for connection and support that addresses the root of self-injurious behavior long term. People who are desperate to self-harm may also do so by any means necessary.
Those deeper realities get obscured and potentially squashed when power struggles ensue and a person feels like they’re being punished, Whitlock said.
#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
www.celebratingyourgiftoflife.com
Link for 40 Habits Signup
bit.ly/40HabitsofMentalHealth
If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub
“We also really highly recommend taking a collaborative approach whenever possible,” added Whitlock, author of “Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones.”
It’s important to validate, rather than criticize, your loved one’s strong emotions while also emphasizing that there are safer ways to manage that emotional pain, said Dr. Michele Berk, associate professor of psychiatry and behavior sciences at Stanford University in California, via email.
Don’t ask “Why did you do that?” said Australian psychiatrist Dr. Benjamin Veness. That question could amplify a person’s shame and make them feel worse, whereas judgment-free questions about their state of mind in general and when they self-harmed are a much better approach.
Ensuring loved ones, especially children, see you as supportive and accepting can help them tell you if they’re at risk for self-harm, Berk added.
Be honest about your confusion, fear or worry, and get your own professional support so you can work through those feelings instead of channeling them into anger toward your loved one, Whitlock said.
Life after self-harm
Though the tunnel that is the journey to stop self-harming may be long and challenging, there is light at the end of it.
Some families have said that while they wouldn’t wish the experience on anyone else, it did help them learn and grow as a family “because they had to work through some of the challenges around communication and authentic connection (or) whatever stuff hadn’t been dealt with that may be part of why self-harm showed up in the first place,” Whitlock said.
That’s true in Megan’s case. The time her mother caught her self-harming was the last time she ever did it, she said. Journaling using a red ink pen, per her therapist’s recommendation, was also critical for her, Megan said — the emotional release from seeing blood on her arms was replaced by the symbolic release of her pain onto the pages.
Megan now runs a successful company in Las Vegas, and doubles as a fashion influencer on social media. She doesn’t have urges to self-injure anymore, she said, since she has learned other mechanisms for dealing with pain.
“I often interpret people who self-injure as people who have a high degree of perception and sensitivity in ways that are actually gifts,” Whitlock said. “So, I always try to let people know … the urge to feel better and to come back into a sense of stability and centeredness is good.”
“They just need additional support to understand what’s happening,” she added, “and then to use the perceptual abilities they have.”
Self Harm https://standingabovethecrowd.com/james-donaldson-on-mental-health-why-some-people-intentionally-cut-burn-or-bruise-themselves/
Monday, November 18, 2024
James Donaldson on Mental Health - Decades of national suicide prevention policies haven’t slowed the deaths
By: Cheryl Platzman Weinstock
Pooja Mehta, a mental health advocate, with her younger brother, Raj, who died by suicide in March 2020. Raj’s death came in the midst of decades of unsuccessful attempts to lower suicide rates nationwide. “We’ve done a really good job at developing solutions for a part of the problem,” Mehta says. “But we really don’t know enough.”(Photo courtesy of Portia Eastman)
When Pooja Mehta’s younger brother, Raj, died by suicide at 19 in March 2020, she felt “blindsided.”
Raj’s last text message was to his college lab partner about how to divide homework questions.
“You don’t say you’re going to take questions 1 through 15 if you’re planning to be dead one hour later,” said Mehta, 29, a mental health and suicide prevention advocate in Arlington, Virginia. She had been trained in Mental Health First Aid — a nationwide program that teaches how to identify, understand, and respond to signs of mental illness — yet she said her brother showed no signs of trouble.
Need help?
If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”
Mehta said some people blamed her for Raj’s death because the two were living together during the COVID-19 pandemic while Raj was attending classes online. Others said her training should have helped her recognize he was struggling.
But, Mehta said, “We act like we know everything there is to know about suicide prevention. We’ve done a really good job at developing solutions for a part of the problem, but we really don’t know enough.”
Raj’s death came in the midst of decades of unsuccessful attempts to tamp down suicide rates nationwide.
During the past two decades federal officials have launched three national suicide prevention strategies, including one announced in April.
The first strategy, announced in 2001, focused on addressing risk factors for suicide and leaned on a few common interventions.
The next strategy called for developing and implementing standardized protocols to identify and treat people at risk for suicide with follow-up care and the support needed to continue treatment.
The latest strategy builds on previous ones and includes a federal action plan calling for implementation of 200 measures during the next three years, including prioritizing populations disproportionately affected by suicide, such as Black youth and Native Americans and Alaska Natives.
Despite those evolving strategies, from 2001 through 2021 suicide rates increased most years, according to the Centers for Disease Control and Prevention. Provisional data for 2022, the most recent numbers available, shows deaths by suicide grew an additional 3% over the previous year. CDC officials project the final number of suicides in 2022 will be higher.
In the past two decades, suicide rates in rural states such as Alaska, Montana, North Dakota, and Wyoming have been about double those in urban areas, according to the CDC.
Despite those persistently disappointing numbers, mental health experts contend the national strategies aren’t the problem. Instead, they argue, the policies — for many reasons —simply aren’t being funded, adopted, and used. That slow uptake was compounded by the COVID-19 pandemic, which had a broad, negative impact on mental health.
A chorus of national experts and government officials agree the strategies simply haven’t been embraced widely, but said even basic tracking of deaths by suicide isn’t universal.
Surveillance data is commonly used to drive health care quality improvement and has been helpful in addressing cancer and heart disease. Yet, it hasn’t been used in the study of behavioral health issues such as suicide, said Michael Schoenbaum, a senior adviser for mental health services, epidemiology, and economics at the National Institute of Mental Health.
“We think about treating behavioral health problems just differently than we think about physical health problems,” Schoenbaum said.
Without accurate statistics, researchers can’t figure out who dies most often by suicide, what prevention strategies are working, and where prevention money is needed most.
Many states and territories don’t allow medical records to be linked to death certificates, Schoenbaum said, but NIMH is collaborating with a handful of other organizations to document this data for the first time in a public report and database due out by the end of the year.
Further hobbling the strategies is the fact that federal and local funding ebbs and flows and some suicide prevention efforts don’t work in some states and localities because of the challenging geography, said Jane Pearson, special adviser on suicide research to the NIMH director.
Wyoming, where a few hundred thousand residents are spread across sprawling, rugged landscape, consistently ranks among the states with the highest suicide rates.
State officials have worked for many years to address the state’s suicide problem, said Kim Deti, a spokesperson for the Wyoming Department of Health.
But deploying services, like mobile crisis units, a core element of the latest national strategy, is difficult in a big, sparsely populated state.
“The work is not stopping but some strategies that make sense in some geographic areas of the country may not make sense for a state with our characteristics,” she said.
Lack of implementation isn’t only a state and local government problem. Despite evidence that screening patients for suicidal thoughts during medical visits helps head off catastrophe, health professionals are not mandated to do so.
Many doctors find suicide screening daunting because they have limited time and insufficient training and because they aren’t comfortable discussing suicide, said Janet Lee, an adolescent medicine specialist and associate professor of pediatrics at the Lewis Katz School of Medicine at Temple University.
“I think it is really scary and kind of astounding to think if something is a matter of life and death how somebody can’t ask about it,” she said.
The use of other measures has also been inconsistent. Crisis intervention services are core to the national strategies, yet many states haven’t built standardized systems.
Besides being fragmented, crisis systems, such as mobile crisis units, can vary from state to state and county to county. Some mobile crisis units use telehealth, some operate 24 hours a day and others 9 to 5, and some use local law enforcement for responses instead of mental health workers.
#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
www.celebratingyourgiftoflife.com
Link for 40 Habits Signup
bit.ly/40HabitsofMentalHealth
If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub
Similarly, the fledgling 988 Suicide & Crisis Lifeline faces similar, serious problems.
Only 23% of Americans are familiar with 988 and there’s a significant knowledge gap about the situations people should call 988 for, according to a recent poll conducted by the National Alliance on Mental Illness and Ipsos.
Most states, territories and tribes have also not yet permanently funded 988, which was launched nationwide in July 2022 and has received about $1.5 billion in federal funding, according to the Substance Abuse and Mental Health Services Administration.
Anita Everett, director of the Center for Mental Health Services within SAMHSA, said her agency is running an awareness campaign to promote the system.
Some states, including Colorado, are taking other steps. There, state officials installed financial incentives for implementing suicide prevention efforts, among other patient safety measures, through the state’s Hospital Quality Incentive Payment Program. The program hands out about $150 million a year to hospitals for good performance. In the last year, 66 hospitals improved their care for patients experiencing suicidality, according to Lena Heilmann, director of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment.
Experts hope other states will follow Colorado’s lead.
And despite the slow movement, Mehta sees bright spots in the latest strategy and action plan.
Although it is too late to save Raj, “addressing the social drivers of mental health and suicide and investing in spaces for people to go to get help well before a crisis gives me hope,” Mehta said.
https://standingabovethecrowd.com/james-donaldson-on-mental-health-decades-of-national-suicide-prevention-policies-havent-slowed-the-deaths/
By James H. Legge III, MSN, APRN-CNP, PMHNPCertified Nurse Practitioner, Psychiatric Center of Northwest Ohio
The holiday months (mid-November to post-January) can be extremely difficult for loved ones suffering from mental illness. It’s postulated that family members and friends can reach intolerable levels of anxiety and depression during this time due to accentuated family dynamics, financial strain, and other stressors.
Veterans Day occurs at the beginning of this period and is a stark reminder of veteran suicide, in addition to the other mental health challenges that are experienced by this select group. While I was working on this topic with a local veterans’ services office, a book was brought to my attention called “Tribe,” authored by Sebastian Junger. This book stresses the importance of a strong interpersonal support network. One example discussed how Native American veterans, when reabsorbed back into their support network, experience significantly lower reported rates of mental illness-related problems. Instances such as this highlight the importance of support networks, demonstrating how we can help those suffering from the isolation of post-traumatic stress. This thought process also helps better understand a true support network.
A support network refers to people who are integrated into a person’s life and available to help not only on a personal level but on a professional level as well. In each instance, the benefits of goal setting and attainment are significant. Striving toward the completion of a satisfying goal is one of the most powerful ways to reduce suicidal thoughts and behavior. While it is concerning to consider how many of our friends and neighbors are dealing with the hopelessness of mental illness, it is comforting to know that a strong support network can truly make a difference.
Related to the support network is the concept of the “safety plan.” A safety plan is a proactive tool of empowerment. Like a seatbelt or a fire drill, a safety plan involves recognizing, planning for, and responding to warning signs. Some of the parts of a safety plan include identifying and responding to behavioral changes; building internal coping strategies (such as avoiding mental roadblocks); integrating into and utilizing the help of a support network (and mutually understanding the roles of family and friends); becoming environmentally aware and prepared (such as removing lethal items from the home); and understanding the availability of local resources designed to help (such as crisis line numbers, therapeutic contacts, and emergency room locations).
While identifying a support network and creating a safety plan can seem like difficult tasks, there are experienced care teams trained to help. As vital features of the mental healthcare landscape, support networks and safety plans have the power to save a life.
#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy
www.celebratingyourgiftoflife.com
Link for 40 Habits Signupbit.ly/40HabitsofMentalHealth
If you'd like to follow and receive my daily blog in to your inbox, just click on it with Follow It. Here's the link https://follow.it/james-donaldson-s-standing-above-the-crowd-s-blog-a-view-from-above-on-things-that-make-the-world-go-round?action=followPub https://standingabovethecrowd.com/james-donaldson-on-mental-health-holidays-and-depression/