@psychology

Counselling Apps

Technology is a part of our lives and a useful tool in helping us through everyday activities. Self-care, relaxation and mindfulness are no exception to this. A growing part of my practice is the inclusion of mindfulness and relaxation activities.  In the 2017 Royal Australian College of General Practitioners (RACGP) Health of the nation report, Mental health was cited as a top-three issue by 65% of female GPs and 53% of male GPs.  These concerns were predominantly depression, mood disorders and anxiety. Self-care and relaxation exercises are pivotal to assisting people in lowering their overall stress responses and assist in the therapeutic process.

Easy to use applications that are freely available such as smiling mind (https://www.smilingmind.com.au/) , headspace (https://www.headspace.com/), What’s Up (https://au.reachout.com/tools-and-apps/whats-up)  or Mindshift (https://www.anxietybc.com/resources/mindshift-app) are great companions to therapy and assist anybody in maintaining a mindful or relaxation routine.

My current app of choice, however, is a paid app called Calm (https://www.calm.com/). This app has many great features, easy to use and assists with relaxation, mindfulness, sleep, anxiety, depression and stress. Calm also offers master classes in areas of anxiety, depression and other ever-changing topics. For therapist or patient alike this is a useful app that I would recommend to anybody.

Referral

RACGP., (2017). General Practice: Health of the Nation, https://www.racgp.org.au/yourracgp/news/media-releases/mental-health-issues-the-main-reason-australians-see-their-gp-(1)/

Psychologist Misconduct

Psychologist Misconduct

According to a recent study by Kremer, Symmons & Furlonger (2018) between the period of 2008-2013, 42 Psychologists were found guilty of misconduct and malpractice in civil and administrative courts across Australia. Of the offenders 25 were male and 17 female. Transgressions included;

  • Boundary Violation
  • Profesisonal – Incompetence
  • Professional – Poor Communication
  • Poor Business practices
  • False use of Dr/Professor or specialist title
  • Professional – Poor reports
  • Misleading registration claim
  • Impairment (mental illness, addiction)

Kremer, Symmons & Furlonger (2018) found the most common category of transgression resulting in a court‐based guilty verdict for psychologists relates to inappropriate sexual liaisons, followed by professional incompetency, and then poor communication in the provision of services. Reasons for transgressions coalesced into three themes: the externalisation of responsibility for personal actions and behaviours, a lack of objectivity concerning why such behaviours occurred, and an inability to understand how personal circumstance affected the provision of ethical services to clients.

Glass in 2003 developed the guidelines around gray areas of boundary crossings and violations. Glass demonstrated his concept in a Venn diagram below;

Boundary Cross.jpg

 

Undertaking psychotherapy is a personal journey and trust is of the utmost importance to form a therapeutic bond. In this process boundaries can sometimes be crossed, however, it is important to understand that these crossings whilst seemingly harmless can be the start of a slippery slope and regular supervision, client check-ins and objective reasoning is important safeguards against the possibilities of transgressions.  

Reference

Glass, L. L. (2003). The gray areas of boundary crossings and violations. American Journal of Psychotherapy, 57(4), 429-44. Retrieved from https://search.proquest.com/docview/213131708?accountid=166958

Kremer, Paul & Symmons, Mark & Furlonger, Brett. (2018). Exploring the Why of Psychologist Misconduct and Malpractice: A Thematic Analysis of Court Decision Documents: Exploring the why of misconduct. Australian Psychologist. 10.1111/ap.12343.

Hotdesking

Activity Based Work or Hotdesking is a shared office approach in which individuals do not have assigned work stations. Rather the office is designed to accommodate all employees on an as needs basis including IT access, meetings, networking etc. Immediately it is clear that the greatest benefit of such a design is that it maximises office space in that you can fit more employees into an a single area. This works by having an employee who is at their desk for 40% of the day and out of the office for 60% of the day. If we have 2 employees that meet this criteria then instead of 2 desks hypothetically they could work from 1. Less space per employee means less overheads and greater savings for the organisation. Another benefit for organisations that have multiple departments is that due to the office spaces being indifferent, departments can be moved and changed as needed throughout office spaces providing greater flexibility. 

So great benefits for the organisation but what about the individual? On average not so great. 

In a study by Morrison & Macky (2017) found that shared desk environments increased distrust, distractions, uncooperative behaviour and negative relationships. Shared desk environments were also found to have a decreased perception of supervisor support. In a study by Hirst (2011) in which observations were made of a team transitioning to a hotdesking system, it was found that social patterns still persisted in that some individuals would arrive early and settle in certain spaces whilst those who were unable to were termed “wanderers” resulting in bigger environmental changes and lower perceived identity at work. Both studies also cited the issue of having to pack up and set up desks on a daily basis which was perceived as a waste of time by employees and an inconvenience. 

On the face of it a shared desk environment makes sense, much like trickle down economics. However, it only makes sense from a financial standpoint and it is at the cost of employee wellbeing. That is not to say that some employees do not enjoy a flexible work environment where they can choose to take a space that is isolated, social, standing, sitting or anything in between but it is a preference and depends on their work style and demands. Workspaces need to accommodate the needs of the worker and should be a reflection of the various work roles of a team. 


References

Hirst, A. (2011). Settlers, vagrants and mutual indifference: Unintended consequences of hot-desking. Journal of Organizational Change Management, 24(6), 767-788. doi:http://dx.doi.org/10.1108/09534811111175742

Morrison, R. L., & Macky, K. A. (2017). The demands and resources arising from shared office spaces. Applied Ergonomics, 60, 103-115. doi:http://dx.doi.org/10.1016/j.apergo.2016.11.007

Theory of Planned Behaviour

Purposeful behaviour has been a buzz phrase for me in the past few months and often working with clients we are inventing small seemingly unrelated purposeful behaviours to achieve. My reasoning for such small purposeful behaviours is not so much the behaviour change but the shift in perceived behavioural control. Behaviours are preceded by a range of variables and some the biggest predictors within that group are perceived behaviour control and attitude. This is demonstrated in the Theory of Planned Behaviour (TPB) which was proposed by Icek Ajzen (1991).

Theory_of_planned_behavior.png

 

In a recent article by Arnautovska et al. (2018) which investigates Physical Activity (PA) in older adults, they provided a summary of TPB;

The TPB (Ajzen, 1991) proposes intention as the proximal predictor of behaviour. It is further hypothesised that intention is predicted by the three beliefbased constructs: attitude (advantages/disadvantages), subjective norm (perceived social approval/disapproval), and perceived behavioural control (facilitators/barriers). In addition, it is proposed that perceived behavioural control directly predicts behaviour. The strength of intention is predicted by a person's evaluation of the target behaviour, perceptions about approval of important others for performing the behaviour, and perceptions of control and ability in relation to behavioural performance. Findings from metaanalyses support the predictive ability of attitudes and perceived behavioural control on intention, with a weaker subjective norm–intention relationship often found (Downs & Hausenblas, 2005; Hagger, Chatzisarantis, & Biddle, 2002). In line with these findings, a review of TPBbased PA studies by Hagger et al. (2002), including persons of all ages, indicated that attitudes and perceived behavioural control were the best predictors of intention (ß = 0.40 and 0.33, respectively), and together with subjective norm predicted 45% of variance in intention. In addition, perceived behavioural control was found to be associated with PA, and together with intention explained 27% of the variance in behaviour.

Our behaviours are the end of the production line of cognitive assembly and therefore provide a function. Subjective norms, attitude and perceived behavioural control are key factors in the process and can be modified to result in modified intentions and therefore modified behaviours.

Reference

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes50, 179–211. https://doi.org/10.1016/0749-5978(91)90020-T

Arnautovska, U., Fleig, L., O’Callaghan, F., & Hamilton, K. (2018). Older Adult’s Physical Activity: The Integration of Autonomous Motivation and Theory of Planned Behaviour Constructs. Journal of Australian Psychologisthttps://doi.org/10.1111/ap.12346

Downs, D. S., & Hausenblas, H. A. (2005). The theories of reasoned action and planned behavior applied to exercise: A meta‐analytic update. Journal of Physical Activity and Health2(1), 76–97. https://doi.org/10.1123/jpah.2.1.76

Hagger, M. S., Chatzisarantis, N. L. D., & Biddle, S. J. H. (2002). A meta‐analytic review of the theories of reasoned action and planned behavior in physical activity: Predictive validity and the contribution of additional variables. Journal of Sport and Exercise Psychology24(1), 3–32. https://doi.org/10.1123/jsep.24.1.3

Reducing loneliness in later life

Reducing loneliness in later life

A recent study by Dawn et al. (2018) highlighted the major health concern of loneliness for the elderly and especially for those who are widowed. Loneliness is associated with a decrease in physical and psychological health (Coyle & Dugan, 2012). According to Holt-Lunstad, Smith & Layton (2010), mortality risk associated with lack of strong social relationships is similar to smoking, approximately double that of obesity and quadruple that of exposure to air pollution.

Dawn et al. (2018) found that widows experienced significantly higher levels of loneliness than those who continued to be married. However, the study revealed that widows who volunteered 2< hours per week had similar levels of loneliness to individuals continuing to marry and also volunteering at a similar intensity.  

Volunteering appears to influence health through psychosocial pathways like a positive emotional exchange, associated lifestyle factors (increased physical, cognitive, and social activity), self-esteem and purpose in life, as well as through stress-buffering effects that moderate the influence of stressors on health (Matz-Costa, Carr, McNamara & James, 2016).

Interestingly Dawn et al. (2018) also pointed out that not all volunteering is the same. Working and religious organisations were shown to have benefits for younger volunteers, however, not so for the elderly. It is believed that due to the individual's ages they are not assigned as meaningful or important tasks reducing the mutually beneficial outcome.

This study does a great job of highlighting the risk of loneliness as well as a direction to reduce this risk. Volunteering is great for all ages but perhaps it could even be lifesaving for those who have lost a close loved one in later life.  

Reference

Coyle, C. E., & Dugan, E. (2012). Social isolation, loneliness and health among older adults. Journal of Aging and Health, 24(8), 1346–1363. doi:10.1177/0898264312460275

Dawn C Carr, Ben Lennox Kail, Christina Matz-Costa, Yochai Z Shavit; Does Becoming A Volunteer Attenuate Loneliness Among Recently Widowed Older Adults?, The Journals of Gerontology: Series B, Volume 73, Issue 3, 2 March 2018, Pages 501–510, https://doi.org/10.1093/geronb/gbx092

Holt-Lunstad , J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7, e1000316. doi:10.1371/journal.pmed.1000316

Matz-Costa, C., Carr, D. C., McNamara, T. K., & James, J. B. (2016). Physical, cognitive, social, and emotional mediators of activity involvement and health in later life. Research on Aging , 38, 791–815. doi:10.1177/0164027515606182

Canine Assisted Therapy

Canine Assisted Therapy or ironically CAT for short is growing in popularity and acceptance. This is a branch of Animal Assisted Therapy (AAT) that aims to include highly trained animals within the therapeutic context. CAT is currently still be researched and a paper recently released by Draysnik, Signal & Canoy (2018) indicates that it would be readily accepted by parents as part of a therapeutic intervention in working with children. Children who have experienced trauma have an increased risk of developing PTSD later in life. The current gold standard of assisting children who are experiencing difficulties following trauma is Trauma Focused – Cognitive Behaviour Therapy (TF-CBT). Draysnik, Signal & Canoy (2018) were exploring the acceptance of CAT within the PTSD child population due to a meta-analysis conducted by Hoagwood, Acri, Morrissey, and Peth‐Pierce (2017) which found promising results for CAT and childhood PTSD.

More research needs to be conducted within all forms of AAT to gain further understanding as to it’s mechanics and function. A literature review by Draysnik, Signal & Canoy (2018) stated that;

Extant research on the positive effects of canine‐human interactions (including the production of oxytocin, often referred to as the relational hormone, Beetz, Uvnas‐Moberg, Julius, & Kotrschal, 2012) strongly support the potential for CAT to facilitate the goals of TF‐CBT. Younger children in particular seem to have an innate attraction to canines, which may result from the predictability and simplicity that is characteristic of the behaviour of both (Zilcha‐Mano, Mikulincer, & Shaver, 2011). Just like dogs that derive affection from touch through petting, very young children experience similar affection from their caregivers by way of gentle touch and physical comfort (Levinson, 1984). Therefore, it is suggested that the inherent value of CAT is its potential to help younger children form a commitment to therapy through forming a comforting attachment to the therapy animal (Levinson, 1984).

Although more research is needed in to how best use animals within the therapeutic setting, it is already clear that there is benefits. I look forward to this area of research and hope to incorporate dogs, horses and even dolphins into future interventions.

 

Reference

Beetz, A., Uvnas‐Moberg, K., Julius, H., & Kotrschal, K. (2012). Psychosocial and psychophysiological effects of human‐animal interactions: The possible role of oxytocin. Frontiers in Psychology, 3, 1–15. https://doi.org/10.3389/fpsyg.2012.00234

Dravsnik, J., Signal, T., Canoy, D. (2018) Canine co‐therapy: The potential of dogs to improve the acceptability of trauma‐focused therapies for children, Australian Journal of Psychology, https://doi.org/10.1111/ajpy.12199

Hoagwood, K. E., Acri, M., Morrissey, M., & Peth‐Pierce, R. (2017). Animal‐assisted therapies for youth with or at risk for mental health problems: A systematic review. Applied Developmental Science21(1), 1–13. https://doi.org/10.1080/10888691.2015.1134267

Levinson, B. M. (1984). Human/companion animal therapy. Journal of Contemporary Psychotherapy14(2), 131–144. https://doi.org/10.1007/BF00946311

Zilcha‐Mano, S., Mikulincer, M., & Shaver, P. R. (2011). Pet in the therapy room: An attachment perspective on animal‐assisted therapy. Attachment and Human Development13(6), 541–561. https://doi.org/10.1080/14616734.2011.608987

 

 

 

 

Fawn

When in a perceived stressful situation our autonomic nervous system ramps up to allow the body to meet the demands of the stress. In certain cases, it activates to the point of the fight or flight response. Automatic reactions to the perceived stress that take out conscious control of the brain and just give it simple options. This is an invaluable evolutionary mechanism as it allows an animal to act under pressure and make a snap decision of two valid survival responses.

Another part of this system is the freeze response where due to the perceived danger we can dissociate from ourselves as a last resort survival tool. Common in lizards who are playing dead as a predator is within the area or victims of sexual abuse.

Recently I have come across the fourth ‘F’ in the survival system repertoire which is Fawn. Fawn is described as co-dependant behaviour in which any kind of autonomy or relationship boundaries are forfeited. A fawn relationship could look like a dominant bully and a peer that gives constant praise or an abusive relationship. Fawn I find to be a helpful concept in the understanding of people’s behaviour which often gets typical responses of “Why don’t you think for yourself?”, “Why don’t you just leave?” Fear is what drives Fawn responses and through that fear it becomes easier to understand the behaviour as a response and not a flaw of the person.

For more information on the 4-F’s please see http://pete-walker.com/fourFs_TraumaTypologyComplexPTSD.htm.     

Vitamin D

A recent study found the importance of Vitamin D3 in regulation of dopamine circuits that impact on dopamine dependant behaviours such as managing food consumption and drug use. The study by Trinko et al (2016) used mice to measure the impact of D3 on the dopamine pathways. Mice that were treated with a D3 supplement and fed a high fat diet displayed reduced food intake and weight.

Vitamin D has also been shown to be responsible for increasing intestinal absorption of calcium, magnesium and phosphate (Holick, 2006). This is vital for healthy bone development, immune functioning and maintaining mental wellbeing.

Vitamin D (separated into D2 & D3) is best received through sunlight on the skin. Vitamin D3 is a naturally made by the body during exposure to sunlight and more specifically Ultraviolet B.

Sunlight often gets a bad name and especially here in Australia due to the high skin cancer rates that occur when over exposed to the sun. However, sunlight is so important to human biological functioning and it is something to be embraces whilst also being smart. Be smart, be sun safe but ensure you take those opportunities during the morning (6am-8.30am best times for sunlight absorption for endocrine functioning), during a lunch break at work, sitting by a window or taking that afternoon walk.

Reference

Trinko, J. R., Land, B. B., Solecki, W. B., Wickham, R. J., Tellez, L. A., Maldonado-Aviles, J., … DiLeone, R. J. (2016). Vitamin D3: A Role in Dopamine Circuit Regulation, Diet-Induced Obesity, and Drug Consumption. eNeuro3(3), ENEURO.0122–15.2016. http://doi.org/10.1523/ENEURO.0122-15.2016

Holick MF (March 2006). "High prevalence of vitamin D inadequacy and implications for health". Mayo Clinic Proceedings81 (3): 353–73. doi:10.4065/81.3.353PMID 16529140.

World Happiness Report

The annual World Happiness Report has been released by the United Nations and this year it has a focus on migration. Finland tops the list with Australia coming in at 10th. Happiness rankings are based on survey data that asks residents to rate their quality of life from 0 (Miserable) - 10 (best life ever!). The authors of the report then weight the country result on 6 variables of well-being in the country including GDP per capita, Social Support, Healthy Life Expectancy, Freedom to make life choices, Generosity and Perceptions of Corruption. Country scores are also weighted against a hypothetical country (Dystopia) which has a score of 1.92 and is used as a benchmark to ensure all real countries have non-negative variable contributions to their overall happiness score. 

With the emphasis on migration for this year's report, some interesting areas were assessed. First was the increase of internal migration in countries from rural areas to cities. The report highlights China's rural migration to the city's in the past 25 years has increased by roughly 232 million people. This is over double the growth of global international migration in the same time frame (90 million people). Out of the 90 million global migrants, about 10% of that are refugees. 

So are people happier when they leave a place to move to another? According to the report on average, yes. MIgration is often the result of moving from one area to another in pursuit of higher incomes, better provisions of services or overall for a better life. The authors highlight that the most important factor in any form of migration is the frame of reference for the migrant. If you move from the countryside that has limited opportunity to the city with lots of opportunities, then your reference point of the countryside increase your views of life quality in your current location. The report finds that people moving from a country that rates lower on the happiness scales to a country higher on the happiness scales have on average an increase in their quality of life. This is reversed for those moving from a country higher on the list to a country lower on the list. Emigrants happiness levels within their new country were also influenced by a countries acceptance of emigrants within their culture and perceptions of migration. Countries that were more accepting of their views of immigration resulted in higher levels of happiness amongst emigrants. With large gaps in the happiness levels between the top 10 countries and the bottom 10 countries (average 4 points on a 10 point scale), it is easy to understand that people would look to move from one place to another in the pursuit of improved daily living and well-being. Of course, there is an upper limit to this as it is not feasible for people to live entirely in cities or just one country. The authors suggest that an obvious response is to increase happiness in the areas that compare lower on the happiness scale. This includes improving key predictors in regional and rural areas as well as countries that rate lower. It's a simple response but something that we all do on a micro level to promote happiness amongst ourselves. We practice gratitude, help others, promote connectedness and provide safety to ourselves and those around us. 

Reference 

World Happiness Report 2018, https://s3.amazonaws.com/happiness-report/2018/WHR_web.pdf

 

Goal Regression

It has been over a week since my last post, since I have been to yoga or since I have meaningfully contributed to my business. I have regressed on my goals. So I am writing today about this regression in the hope the dominos of motivation will begin to tumble. 

Goal regression in my opinion is an envitability which is mirrored in the transactional model of change through the relapse component. Size and duration of regression is varitable and dependant on many factors, some out of my control, some in my control. 

The best way to beat procrastination is often said to “just start”. You don’t have to finish what you start or even do it for long but just by starting something then you will eventually complete it. This is true,  however, to start something you have to have some motivation (internal or external) for movement without cause is without purpose. 

Through accepting my regression free of blame, excuses and reasons I am able to start to work back towards them.  Through naming the regression my meta awareness allows me to move back to maintaining my goals instead of maintaining the regression. Control what you can and accept what you cannot.