#and also to get out the CBT manual and work through it on all of the negative beliefs I've internalized from the garbage trauma

[infiniteglitterfall]

My friend Anne shared this on Facebook and added, "This this this x10000. I don’t want to be “high maintenance”, I just need information that allows my brain to adapt to the reality of whatever is going on!"

I have this problem with trauma recovery. I jUST WANT TO KNOW HOW LONG IT WILL TAKE AND WHAT PHASES TO EXPECT. Like: I share custody of my kid, who's 6. I share custody because (1) a year and a half ago, my ex made the unilateral decision to move to a city more than an hour away (frequently an hour and a half) -- and to take our kid with him. And (2) because four years ago, the same ex made the absolutely wild unilateral decision to disappear for a month -- and to take our kid with him. That's the short version. All of the above? Very, very traumatizing for me and the kid. And honestly for a lot of people around us. Including my housemate, who is so close to the kid that he accidentally called her "Dad" last week. TL;DR: I mainly get him on weekends during the school year and it suuuuuuuucks. But last month, he was here for three and a half consecutive weeks. Because my ex fucked up and found out (that you can in fact get COVID by dining indoors, and then give it to everyone else). The COVID sucked a lot. But having my kid here for that long was bliss - for me, him, and my housemate.

Then he went back to school, so this weekend we just had him for the usual two days - or three days, two of which are half days - or one day and two unsatisfying chunks of days. Depending on how you see time.

When he got picked up, TJ disappeared into her room for a while. She came back out and told me that depression just HIT her really hard, and that it felt like my ex was taking the kid away.

I commiserated with her about how we still have a lot of trauma from four years ago when he DID take my kid away. But I didn't really feel the depression this time.

And then I went to bed at like 2 am and slept for 15 hours.

Which I now know is a trauma response. But I DIDN'T know that a year ago, when I was so exhausted that I basically slept all month. I hate it. I don't feel like I can afford to just abruptly sleep through an entire day. Or longer. I hate trauma responses popping up out of nowhere in general, but it especially bothers me when they don't seem to make sense. I JUST NEED INFORMATION THAT ALLOWS MY BRAIN TO ADAPT TO THE REALITY OF WHATEVER'S GOING ON.

Then again, today I was thinking about all the emotional work I have to do around this -- I mean uhh get to do??? to get through the trauma -- and how much energy that takes. And I suddenly formed a theory that maybe the exhaustion is not so much "being triggered around this trauma just knocks me out" or "emotional stuff comes up and takes energy even if I don't feel it?" but is something like, "my psyche is working through this stuff under the surface even if I don't do the work consciously, it's just slower this way, and it takes a lot of energy!!" There's plenty of research showing that people tend to recover somewhat on their own from all kinds of trauma/abuse. Very slowly. (I haven't dug through it, but I would argue that we also tend to get into other abusive/traumatizing situations that definitely halt and slow down that process. However, without more of it getting in our way, we tend to work through shit as we go.)

And then I read an article about SELF-HEALING METAL and thought, "maybe there's a healing tendency in the universe, just like there's entropy?" Maybe things don't always progress toward chaos and dysfunction and entropy. Maybe there's an opposite tendency there as well. I mean, if there is, I would sure like some kind of a map for it, though.

What an autistic person says: "How long is it going to take?"

What they mean: "I want to know whether to activate my short term waiting mode where I just wait and do nothing else, or activate my long term waiting mode where I occupy my mind with something else. I fully understand that both are possibilities, and I have no problem whatsoever with either one, but I want more information so I can best adapt to the situation."

What neurotypical people hear: "I am impatient and demand that everything I want happen right now. Please scold me and publicly humiliate me for it."

[onlinecbttherapy1]

One Session Therapy for Phobia

One Session Treatment for Phobia or Single Session Therapy for Phobia.

This article will have a look at when this single session treatment for phobia came up, how this intervention works theoretically, how it looks practically.

However, if you have heard of a One session Therapy for Phobia, and want to discuss it, just contact me.

One Session Treatment for Phobia, where does it come from?

It is also known as OST, which coincidentally is the professor’s surname who developed it, Lars-Goran Ost (apologies for the misspelling).

This single session therapy developed from the clinical observation that seeing people for 8 to 10 sessions of 50 – 60 minutes therapy. It was observed by Ost that the anxiety reduction and habituation was sometimes minimal. Therefore, it begun to explore what would happen if anxiety would drop to the lowest possible in a single session.

Working with anxiety we take SUD (Subjective Unites of Distress), and these are rated 0 to 100 (100 being the most distressing.

I must agree with Ost observations, as I have realised with all the time I have practiced the known “therapy hour (50 minutes)” it sometimes not enough. Hence, I have moved to encourage people to longer sessions. However, this is another matter you can check here.

This single session therapy for phobia was developed in the 70’s and its manuals reviewed in the mid 2000’s

Phobia therapy: Single Session!?

As with many anxiety disorders, and based on CBT, there is always a miss interpretation or a magnified perception of what may happen, more often than not with a catastrophic flavour to it. Otherwise, the phobia would not be present or would have an impact on people’s day to day life.

The above is the cognitive element, and then there is a behavioural element. Anyone who believes a catastrophe would happen for any reason, understandably would not want to take the risk and avoid the situation to reduce the likelihood of the catastrophe to happen.

From a CBT perspective, we understand that the safety behaviour is inadvertently maintain the catastrophic believe. More often than not, people are aware that the fear/phobia is to some extend irrational.

Is really One Session Therapy for Phobia, only one session?

Well… not really.

So, the Single session Therapy for phobia has 3 sessions.

First session is done remotely, online, and it is a 60 to 90 minutes assessment. This session is used to gather information and ascertain that what you are experiencing is a phobia reaction.

Also, it is an opportunity to go through how the next session will look like.

This session sometimes brings traumatic events or episodes where the phobia was created. Not always the case in many cases, however, we will need to differentiate this. If there would be traumatic memories or events, then we may need to do some trauma work prior and the single session therapy, would certainly not be single.

Second session it is whole day session, this means it could take 3 to 7 hours. It is completely down to the individual case, and the specific phobia.

This session involves coming in contact with the feared situation. At your OWN pace, in your OWN terms, and with YOUR GOALS in mind. So, if you wanted to be able to take a glass and a paper and take a spider out of your house, then once that is done in session, then that’s that. There won’t be need for you to do any further as that would not be what you came to therapy for.

You may be wondering; how does online CBT therapy deliver this part. So really it is not online. I arrange with clients to either come to a rented room or office, and we bring in specialists. So, if you were afraid of spiders, we would need a spider keeper. If you are afraid of needles/injections then we would get needles in the session. As I am a fully qualified nurse, we would not need to get anyone.

The above is a very brief explanation of what it may look like. If you want to know more specifics, you can contact me by clicking in the bottom below.

This session is very challenging and some people reports having vivid dreams about the phobic object after the session. This is perfectly normal.

One instruction for people to take from this session is to not avoid the phobic object and when coming across the phobic object take this as an opportunity to learn and to increase gains from therapy.

[skinsharpenedteeth]

RNM After Dark - Friday - Down to Earth

Here's my submission for @rnmafterdark

Day 1 - Down to Earth.

It features... dom/sub behavior, discussions of kink and safewords, impact play, cock and ball torture (CBT), masochism, sadism, a little bit of humiliation, and a school bus converted into a sex dungeon...

it's 6400 words, rated E-AF for Explicit As Fuck.

Also posted on AO3 for your kudos-ing, commenting, and bookmarking pleasure!

-

"What You Need and What You Want"

.

Alex didn't know why he needed it. He'd thought he was past needing to be yelled at after basic and living with his father, but the drill sergeants could only yell at you about the most superficial weaknesses. He could be called soft, pretty, or a mama's boy all day and it wouldn't even tweak a nerve. But late at night in foreign cities stateside and abroad, in clubs he’d found for people like him, people who needed something more, he had found other men who got closer to making him feel the way he needed to feel. Their rough hands, their sharp words, and the way they weren’t moved by his tears unless he said a word to make them stop, had turned out to be exactly what he’d needed that was more.

Then Alex had come back home from combat and anonymity. He’d tried to move into his old life, tried to fit into the version of himself that was normal, and found out that so many things were not what they seemed. But he hadn’t been able to get what he needed in a small town. So he’d driven to Albuquerque, looking for someone to fill that part of himself that needed to wallow in punishment and pain. But Albuquerque wasn’t big enough, wasn’t dark enough, wasn’t learned enough to know the difference between dominance and cruelty. It was close enough though. Close enough for Alex to fill in the gaps with his mind of the things he was missing.

Michael had noticed his trips. Michael noticed everything. He’d noticed that Alex wasn’t coming home calm, but haunted. He'd come home with the edge taken off, but not the need taken care of. Not fully. Never fully. The itch was always there, just sometimes more manageable if he'd let someone slap him around for a bit. The trips had been to someone who would do just that. But they didn't know him. Not really. He’d been the one to point out to Alex that he really wasn’t getting what he needed. Then, after an out-of-town trip that had left Alex with one too many bruises and scratches and a significant limp, Michael had begged him to let him help instead of continuing to go to someone who wasn’t treating him right.

"Just come to me for it," Michael had said, half order and half offer. Alex had scoffed initially. He hadn't thought Michael had understood what Alex actually wanted. Michael had leveled him with a glare and continued. "I don't like the idea of you going somewhere else for this. I don't like the idea of you trusting a stranger. And it's obvious it's not enough. Next time you have to scratch the itch, just come to me."

"Sure," Alex had agreed. He'd said 'sure’ like he meant 'not a chance'. Then he'd had a week of nights filled with nightmares. Caulfield, explosions, death, dismemberment, and ghosts plagued him whenever his body lost the fight to unconsciousness. The guy he'd been seeing was too far away and busy and Alex was almost trembling with the need for someone to bleed the tension out of him. So he'd called Michael just to see. Maybe he could do it. Maybe he could be enough until Alex could find another person or another way.

He’d never expected it to work, but he’d underestimated how well Michael knew him. Michael saw the way he seemed to bend towards harsh criticisms against him or his family. He saw how he warred with letting go of those terrible pieces of himself and holding onto them as tightly as if they were his security blanket. Michael had seen inside his mind and had rooted around for the most shameful things to use against him. Once Michael had figured out what he'd been going out of town to get, he’d made Alex an offer he couldn't refuse.

Alex stepped up into the old yellow school bus apprehensively. It sat near the Airstream in the junkyard, electric cables running to it and making it glow through the cracks. Michael had blacked out the windows with paint, making it look vaguely ominous in the blue hours of dusk. He wasn't sure what he'd find inside. What he found was a work in progress.

The cavernous space had been stripped of the seats and given a new floor. Michael had installed a drop ceiling down the middle of the bus and lined it with invisible lights around the edges. It made the ceiling dark, but the rounded walls and windows glow with subdued light. The effect was modern and sophisticated, and not at all what Alex would normally expect from Michael. Michael was watching him take in the bus's interior from a dark modular sofa that had been pushed along the side of the bus. He was wearing a loose, distressed pair of jeans and his ever-present plaid-over-tank combo. Alex felt his apprehension tighten the muscles in his back, but he pushed forward until he was standing in front of Michael looking down at him. He shoved his hands into his pockets and made a show of looking around the bus.

"So, starting an escort service?" Alex asked, watching for Michael's reaction.

"Maybe. Nothing wrong with sex work. It wasn't what I had planned for this space, but maybe there's a niche market for a mobile brothel in Roswell," Michael answered, spreading his arms over the back of the sofa and leveling Alex with a look. "I assume you didn't call to insult my decorating."

Alex scoffed. He shook his head slowly and gave Michael a wry smile.

"No. I guess I didn't," Alex replied. "So are we going to do this?"

"Sure. But sit down. We need to do some quick housekeeping," Michael said, waving to the empty space next to him. Alex sat and tried not to fidget. He didn't want to talk right then. He wanted to hurt and have the demons inside him go silent and be sated. Michael watched him silently, gaze intense and laser-focused to the point that Alex stilled himself, suddenly self-conscious.

"Okay. So, first I need to know what you want out of this," Michael started. Alex rolled his eyes, but Michael just kept looking at him, even and steady.

"I want… release," Alex bit out. He could feel a flush starting to heat the skin of his neck. This wasn’t what he wanted to talk about.

"I'm assuming you don't mean orgasm...well, or not just orgasm. How do you want me to give that to you?" Michael asked. Alex's knee bounced and he scratched his thumbnail over the inside of his palm, letting the sting settle him enough to answer Michael's question.

"Yes, orgasm would be nice. But, what I need isn't just physical. I want to… I need you to… I need someone to make me make my physically feel as shitty as I need mentally. I need someone to strip me bare and then flay me alive. I need to hurt. I need to feel… empty at the end of it. Quiet, ya know?" Alex explained. His thumbnail scratched over and over, dragging across the same spot. Michael's hand closed gently over his wrist, startling Alex out of his thoughts. Alex looked up to catch Michael's eye and felt Michael pull his hand away and lay it on his thigh before taking the hand Alex had been scratching and holding it in his own.

"Do you need this to be verbal or just physical?" Michael asked, carefully. Alex tried not to let his shame overwhelm him. He wanted both. He needed both so badly and he hated how weak that need made him feel.

"Both," Alex replied just as quietly. Michael waited for a moment before speaking again. Alex watched the gears turn behind Michael's eyes, but he didn't see any pity in his expression… or disgust. A small part of him was surprised. He'd expected one or the other.

"So, hard limits?" Michael continued. He had started to rub his thumb sweetly over the red line Alex had made in his palm. It was at once painful and soothing.

"Nothing permanent. No choking, for obvious reasons. No broken skin. Don't call me ‘soldier.’ Don't call me ‘son.’ Don't make me…" Alex broke off, suddenly feeling ashamed. He closed his eyes and took a deep breath. Michael paused his thumb over the scratch and pressed down firmly. A bright flare of stinging pain gave Alex the resolution to continue. "Don't make me feel good about any of it til we're done. And I don't need aftercare."

"Aftercare isn't optional, Alex. Not for you, not for me. That's a hard limit of mine," Michael replied, voice low and serious. Alex stared at him before huffing out a little laugh.

"How would you know what your limits are? Have you done this before?" Alex asked, removing his hand from Michael's. Unconsciously, he'd started to turn his body more towards Michael's. One leg was folded in front of him on the couch seat, his prosthesis still resting on the floor of the bus.

"You're not the only person who's found themselves with a need that wasn't fulfilled by what was easily obtained. You're not the gatekeeper to kink. You were gone for ten years and I had plenty of time to experiment and learn on my own. Stop acting like just because I've never been off the continent, I'm a fucking narrow-minded moron." Michael's voice was sharp at the end, making Alex flinch internally. He couldn't imagine a world where Michael had explored BDSM or kink. He'd just assumed Michael was drinking and sleeping around like a college frat boy the entire time. It stung Alex that he hadn't even imagined Michael really living a full life without him. He always just thought of Michael biding his time, waiting on him, perpetually looking over his shoulder and waiting for Alex to appear on the horizon. What a selfish, egotistical dick he was to assume Michael had nothing better to do than cool his heels dreaming of an idolized version of Alex (the version of Alex that he wished he was in reality, that he tried to be and failed to be every single day).

"Sorry," Alex said after a quiet span of minutes where he manually adjusted his mental image of Michael Guerin.

"Try again, Alex. And look me in the face while you do it." Alex raised his head and looked at Michael. He looked older and calmer than he had a moment before. He looked like he was wearing all the years of his life on his shoulders and he was used to the weight of carrying them. Alex felt younger somehow. He felt chastened.

"I'm sorry, Michael," he repeated, keeping his eyes locked on Guerin’s. Michael nodded once before continuing.

"What's your safeword?"

"Finland," Alex replied without hesitation.

"Mine's ‘orbit.’ Are you okay with using the stoplight system?" Michael asked easily. Alex nodded.

"So, do you want a trial run tonight?" Michael asked.

Alex took a deep breath and nodded again before clearing his throat, knowing he had to speak it out loud. "Yeah, sure. Let's give it a go."

"So stand up and take off your clothes. I'll be right back," Michael said as he stood up off the couch. Alex stood also and waited for Michael to disappear behind a partition that presumably hid the way to the bathroom. Slowly, Alex undressed himself, feeling nerves and anticipation start to flutter behind his bellybutton. He folded his clothes and laid them on the couch. Before he had to figure out if Michael wanted him to be kneeling or not, Michael came back into the room. He'd stripped off his plaid shirt and was just in jeans and a tank. Alex watched him walk across the room and pick up a remote from one of the window ledges. He pointed it towards the ceiling and the lights turned from a warm golden light to an almost sinister red.

"Going to murder me?" Alex tried to joke. Michael gave him a quick grin.

"Want a different color? I've got the full range. We can disco through the whole pride flag if you want," Michael joked back.

"No. Red is fine," Alex assured him. While he spoke, Michael had discarded the remote back onto the window ledge and moved to stand in front of Alex. He reached up and brushed some of Alex's hair behind his ear, watching his own action contemplatively.

"So what brought this on tonight? What are you feeling?" Michael asked, eyes seeming to float back to meet Alex's while his hand rested on the side of Alex's neck, fingers gently playing with the too long curling pieces near the nape of his neck.

"Just… stuff. Nightmares," Alex mumbled, dropping his eyes and staring at the dark patch of chest hair that showed above the scoop collar of Michael's tank. He wanted to get started. He was doubting his decision to come. Why didn't Michael just do something already?!

"What would you tell your anonymous Dom in Albuquerque or Santa Fe if they asked?" Alex's eyes darted back up to meet Michael's and he scowled. Through tight lips, he managed to spit out an answer.

"They wouldn't have asked about why I needed it, they’d just give it to me."

"Well, you gotta give me something to work with here. What feeling is causing the nightmares?" Michael asked patiently. He let the knuckles of his left hand drag down the side of Alex's bare stomach, reminding him that he was standing naked in front of Michael while he stood there fully clothed. Maybe they should've just had sex. Maybe that would've been enough.

"Guilt. I feel… guilty about a lot of things," Alex finally confessed, shame filling his cheeks with heat and color. Michael nodded, almost to himself.

"Okay. I can work with that," he replied. Then his hands slid away from Alex's body and he stepped back. He let his eyes travel down every inch of Alex's skin and back up. "I thought I told you to get naked."

Alex furrowed his brow in confusion and looked down at himself. He wasn't wearing any clothes. Michael smiled and bent down slightly to tap at Alex's prosthesis. Alex looked at him, still confused.

"Take it off. I'm going to have you kneeling on a pillow when you're finished. Arms up and behind your head," Michael instructed. Alex sat back on the couch and began to remove the prosthesis. Michael produced a square floor cushion and sat it in the middle of the bus floor, then stood in front of it and waited on Alex to finish. The floor cushion was just far enough that Alex would have to crawl to get to it from the couch. Humiliation bloomed in his stomach, and his cock twitched with interest. Michael was testing him.

Lowering himself down from the couch, Alex crawled the short distance to the floor cushion and then began to arrange himself. He sat forward on his knees, widening them for easier balance, and then slowly he lifted his arms up and interlocked his fingers behind his head. He was bared for the cool gaze Michael was giving him, and it thrilled him how very vulnerable he was in the position he’d been asked to hold. He could and would hold the position easily, but Michael could also just as easily knock him to the ground if he chose to. Alex let his eyes lift only as far as Michael's best buckle, brain beginning to quiet and settle as he did so, and then he waited.

"Very good, Alex. You look good like this," Michael complimented with a slightly mocking edge to his tone. He made a slow half-circle to stand behind Alex so that Alex could see them. "So you're feeling guilty, huh? Think you need to earn your forgiveness? Want someone to take your penance out of your flesh?" Michael asked from behind him. Alex nodded briskly, not sure if he was allowed to speak. "What do you feel guilty for? Because I can't punish you for having dreams."

"Just… everything. I'm so angry at myself for not being over shit. For failing you, for failing my dad, for failing everyone," Alex choked out, feeling like fleeing but forcing himself to stay still.

"How did you fail me?" Michael asked, voice cool and impartial. Alex appreciated the lack of emotion. It helped him keep going. He wouldn't be able to continue if he could tell he was hurting Michael with his honesty.

"I always underestimate you. You’re better, smarter, and more capable than I think you are a lot of the time," Alex admitted. Michael hummed thoughtfully.

"How many hours of sleep do you think you've gotten this week, Manes? Sixteen? Twenty?" Michael asked. Alex did the rough mental math in his head. He cleared his throat before he spoke.

"Fifteen-ish," he answered. His lower back muscles were starting to quietly let themselves be felt as they were continually used to keep him upright, the muscles in his thighs and arms warming up from holding him still. He felt Michael step up close behind him, legs on the outside of his own and cool belt buckle pressing into the bottom of his interlocked hands. Michael's hands slid through the gaps between his arms and shoulders and smoothed down his chest before scratching back up, nails dragging red lines into his tanned skin. He shifted into the sting, wishing for Michael to scratch harder.

"Color?" Michael asked quietly as his hands once again smoothed down Alex's pecs.

"Green," Alex answered through a harsh breath as Michael scratched back up, but harder. The bite of pain had Alex gasping in surprise, and he felt his cock starting to plump up from the attention.

"How about I give you ten on your ass and give five to your balls? If you take your punishment good, I'll help you cum. Does that sound fair?" Michael asked, thumbs rubbing roughly over Alex's nipples. The low thrum of arousal was starting to build under Alex’s skin from Michael’s words. The low level sting from Michael’s nails was already starting to put him in the right headspace. He closed his eyes for a moment, just enjoying the rough push and pull of Michael’s fingers on him.

“Yes,” Alex agreed out loud. Michael brought his hands back up to rest on Alex’s shoulders. He bent close to his ear before speaking again. His breath was warm where it tickled over Alex’s skin.

“Then get on your elbows and knees. I want your ass higher than your head,” Michael instructed. Alex took a deep breath in and nodded before unclasping his hands from behind his head. Gingerly, he moved until his head was resting on top of his forearms against the floor. He tucked his knees under his hips and presented himself. He was keenly aware of how exposed he was. The cool air from the A/C unit fluttered over his backside. Michael hadn’t moved as Alex had gotten into position, so he could also feel the threat of someone lording over him. He could almost feel Michael’s eyes trailing over his naked skin, taking his time, mentally caressing every curve. After what felt like an eternity, Michael moved. He knelt down next to Alex’s side. When his fingertips started to skim down Alex’s side, it made him jump.

“None of that now,” Michael said, though his tone was soothing instead of harsh, like Alex was a spooked horse he was trying to calm. His hand continued stroking gently over Alex’s side and then down his back, around the curve of his ass and down his leg. The touch almost tickled and Alex had to fight not to flinch or shy away from the sensation.

“You always think you know better than me, don’t you, Alex?” Michael asked quietly. He shifted his body, moving further down Alex’s body and behind him. He started to use both hands to tickle over Alex’s back. When he got to his ass, though, Michael paused. Carefully, he spread Alex’s cheeks to look at his hole. A light touch of Michael’s thumb trailed down the center, barely glancing over Alex’s hole, and then down over his taint until Michael could cup Alex’s balls in his hand. He massaged them gently in his palm, pulling gently at the skin of his sack. Circling his thumb and forefinger around the base of Alex’s scrotum under his cock, he used the other three fingers to cup around the fleshy sack and began squeezing gently. Discomfort and heat prickled at Alex’s skin, making him whimper softly when Michael’s hand began to tighten and loosen in a slow rhythm. It wasn’t rough, wasn’t painful, but it was uncomfortable in the way that triggered his most primal instinct to escape. Alex stayed still and breathed deeply against his forearms. The feeling was mesmerizing, so it caught Alex off guard when Michael reached down with his free hand to stroke his cock.

“Fuck!” Alex burst out, shifting restlessly knee to knee. Michael held still as he settled. The electricity of that touch crackled along Alex’s nerve endings, pins and needles under his skin.

“Color?” Michael asked, not moving.

“Green,” Alex replied, feeling suddenly out of breath. Without warning, the hand that had touched Alex’s cock came down with a crack on one of his ass cheeks. This pain too was electric, but more like a quick strike of lighting, localized and bright. Alex swore, but tried to stay still.

“One,” Michael counted. His hand rubbed over the stinging skin before he removed it. A moment later, he was using it to loosely stroke over Alex’s cock. The hand around Alex’s balls tightened, again threatening the violence that Alex wanted. He moaned, wishing for more. “I was just never good enough for you, was I? But you kept coming back. Kept slumming it with the foster kid. Did you think I didn’t notice the way you kept me secret?”

Another slap against Alex’s ass, another sting, and another gentle caress by Michael’s hand over the heated skin. The next one came faster and harder than the first. Michael learned forward over one side of Alex’s back, the roughness of his jeans irritating and wonderful over Alex’s heated skin. He leaned close enough to be able to rest his chin on Alex’s shoulder.

“Two and Three. You’re an arrogant piece of shit sometimes, Alex. You’re wrapped up in classism, just like your father was. At least you can recognize that you’re a fucking asshole for it and that you deserve for someone to take you down a peg.”

He kept his voice calm and the words stung all the more for it. Alex held his breath against their effect until he couldn’t any longer and then let it out in a long, slow breath. Michael took his hand away from the base of Alex’s balls.

“Do you think you’re better than me, Alex? Smarter? Think you need to always be the white fucking knight for everyone?” Michael asked, fingers dragging up Alex’s perineum in a firm line.

“No,” Alex said, shaking his head. A hard crack sounded and fire lit up the previously untouched ass cheek. Alex felt a throb run through his body as the heat started to radiate. His cock hung heavy between his legs. He looked down the line of his body and could see it hanging, tip wet and threatening to drip onto the floor.

“Are you lying to me, Alex?” Michael asked, nails scratching over the abused spot on Alex’s ass. His voice was quiet, threatening, teasing and starting to make Alex feel unraveled. Alex shook his head weakly. Another lick of fire, another crack, and Alex was moaning into his forearms.

“I think you’re lying to me. You think I’m stupid, Alex? Your actions speak louder than words. You think you’re the only one in the room who's aware enough to notice other people. You think we don’t have you pegged? You think you’re better than your friends, your family and me and you always have, haven’t you?” Michael asked, right before pushing up off from Alex’s back to sit back on his heels. His hands came to rest on Alex’s waist, pulling him back to center Alex’s hips back over his knees and correct his position. A hand slid up Alex’s spine and then pressed between his shoulder blades. Alex followed the unspoken direction until his chest was resting on the floor. He laid his cheek against the cool flooring and closed his eyes, letting his mind sink into Michael’s words.

“We’re halfway through your ass punishment. Your skin is getting so pretty and pink for me. And your cock is making a fucking mess on my floor. You look so fucking shameless right now. It’s a good look for you, Alex. You just needed to be reminded of how good you look when you’re being put in your place,” Michael praised from behind him.

Michael’s hands slid back from Alex’s hips to grip his ass. Alex felt himself being spread wide, Michael’s thumbs pulling at the skin next to his hole gently. The feeling of something warm and wet hitting his pucker and starting to slide over his entrance confused Alex for only a moment until he realized Michael must’ve spit on him. Hot shame and arousal flushed through him at the mental image. One of Michael’s thumbs moved in and he massaged his spit over Alex’s hole, pressing firmly but not truly trying to penetrate. Alex groaned, pushing back against the pressure of Michael’s thumb, vainly wishing he’d open him up and fuck him. He wanted to feel pinned open under Michael’s cock.

“Maybe next time. If you’re good,” Michael assured him before he took his hands away. Alex shook with need. He needed pain or pleasure or words or something. He was rewarded with a quick series of slaps, two on each ass cheek, one right after the other, heavy enough to thud through his muscle. These weren’t the stinging, surface slaps of earlier. When Michael finished, his hands massaged roughly across the skin. Alex felt a dizzying rush of blood and emotion coursing through him a moment before he felt the warm wet of Michael’s mouth and the sharper sting of his stubble as Michael nipped and kissed over the abused cheeks. His final slap on one cheek was quickly followed by a sharp bite to the other. Alex cursed and his foot flexed against the floor, toes trying to dig against the hard surface as Michael used his jaw’s grip on Alex’s skin to coax a whine from Alex’s throat. Alex didn’t need to see the floor under his cock to know it was sticky with a pool of his arousal.

“Mmm,” Michael hummed, rubbing his stubbled cheek over his bite mark, sounding well-pleased. “So warm.”

“Michael, please,” Alex managed to choke out. Michael hummed again, but Alex felt subtle movement behind him. A moment later, Michael’s hand wrapped around Alex’s cock, wet and slick and tight. His hand slid up and down Alex’s shaft and it was all he could do not to hump forward into the pressure. It felt so fucking good. Michael was still rubbing his bristled chin and upper lip over Alex’s ass, mouthing at the inflamed flesh.

“You’re doing so good. I love hearing you beg, Alex,” Michael murmured against his skin. Alex almost didn’t hear him, his attention so wrapped up in the slick sounds and tight hole Michael’s fist was making for him. He was getting close, he could tell, but he knew he hadn’t finished his punishment. Abruptly, Michael let go of Alex’s cock and sat up. Alex wailed into his arms, eyes stinging at the loss. His cock ached where it swung, newly neglected and dripping between his legs.

“You still need to take the five to your balls. Then I’ll let you cum,” Michael reminded him, tone lazy. He said this while wrapping his hand around the base of Alex’s sack again and pulling back towards him. Alex whined at the stretch, his balls had been tightening close to his body in preparation for cumming and now Michael was stretching them away. He’d stretched them far enough that Alex could imagine they looked like two pink plums in Michael’s grip, skin tight over the swollen orbs, looking fit to burst. He felt Michael’s hot breath against them a moment before the blunt pressure of his teeth resting on either side of one of his balls. Some heady mix of fear and arousal shot through Alex’s body making him tremble, his stomach tightening and hips hitching forward. “So full. I bet you haven’t cum since your last trip to Albuquerque. Maybe I should make you wait longer, see how big of a load you’ll save up for me.”

“Please, Michael, I need…,” Alex started, only to yelp in surprise at the first three-fingered smack to his testicles.

“You need,” Michael started, voice harsh and admonishing; another smack, wringing out another, higher-pitched yelp from Alex, and then Michael continued, “to let me make the decisions here. I know what you need, Alex. I’ve got you all figured out. You need to stop,” SMACK! “Underestimating,” SMACK! “Me.” SMACK!

Alex's breath was heaving from his body. He didn’t even realize he was speaking until Michael was pulling him up to sit back onto his lap, hands around his waist to help support him and Alex’s back pressed against Michael’s chest.

“I’m sorry, I’m sorry, I’m sorry, I’m sorry,” Alex continued to mumble thickly. Michael was shushing him softly, arms tight and comforting around him, lips delivering soft kisses to Alex’s shoulder and neck. Alex’s cheeks were hot, his eyes tight, and he knew he was crying.

“I know you are, sweetheart. I know,” Michael murmured against his skin. Alex’s breath hitched under another sob. Michael gently maneuvered him to half turn so he could wipe at the tear tracks on Alex’s cheek and kiss the corner of his mouth softly. “You did so good. I know you’re sorry cause you followed all my directions and took your punishment. So good, baby.”

Alex found himself turning more until he could cling to Michael’s neck and hug his body close. Michael stroked one of his hands up and down Alex’s spine while the other combed through his hair. The new position trapped Alex’s aching balls and still-hard cock in between their bodies. The cotton of Michael’s shirt was irritating against Alex’s sensitive skin, but Alex couldn’t bear to pull back.

“Did you want me to help you cum, Alex?” Michael asked, nose gently bumping against Alex’s, lips a hair's breadth away. Alex took a deep breath in to steady himself before nodding. He moved forward, hoping to capture Michael’s mouth in a kiss. Michael let him, opening obligingly when Alex smoothed his inquisitive tongue along Michael’s lips. Michael let Alex kiss him and kiss him and kiss him. While they kissed, Michael’s hands wandered over Alex’s naked body until his hands came down onto Alex’s ass cheeks. Alex had almost forgotten about them until the flare of fire was reignited under Michael’s grip. The pain only served to excite Alex further.

“Michael, fuck me, please,” Alex begged, lips against Michael’s cheek as he pressed his body back into Michael’s strong grip.

“Not this time,” Michael responded gently. “But I’ll help get you off. You did so well, I can let you cum.”

“Please,” Alex said again, writhing softly in Michael’s lap to get some much-needed friction against his cock.

“So impatient,” Michael griped fondly. Removing one of his hands from Alex’s ass, Alex watched as he went to a previously unseen pump bottle of lube. He pumped twice and then brought his hand between their bodies and wrapped it around Alex’s cock. The lube was slick and sticky, and Alex immediately hitched his hips to push his cock through Michael’s grip.

“Oh, it’s like that?” Michael teased, tightening his grip to slow Alex’s quickening thrusts. Alex whined, hands flexing against Michael’s shoulders. Slowly, Michael started to move his tight-fisted hand over Alex’s cock. It was too tight for Alex to get off on it, but the edge of pain kept him hard and hoping. “If you keep acting greedy like this, I’m going to strap you down and edge you until you’ve learned some patience. Would you like that, Alex? Want me to keep you hard and begging for hours? Or do you want me to just make you cum until you’re dry and begging for me to stop?”

“Both, please,” Alex gasped out after a particularly cruel twist of Michael’s wrist. Michael loosened his grip then and paused, letting Alex catch his breath.

“You insatiable creature,” Michael praised. He kissed along Alex’s jaw to his shoulder where he bit harshly into the meat of Alex’s muscle. Alex groaned and tried not to writhe against the pain, but couldn’t seem to stop his body from rocking gently against Michael’s fist.

“That’s it. You can fuck my hand now.” He continued to kiss and bite Alex’s flesh after he said it, causing small fires everywhere his teeth touched. His mouth moved down from Alex’s shoulder to his chest, causing Alex to lean back. Alex held onto Michael’s shoulders tightly, but didn’t stop thrusting into Michael’s perfect, slick grip. Michael sucked Alex’s nipple into his mouth and let his teeth scrape over the sensitive flesh as he pulled his head back. Alex moaned and cursed at the feeling, throwing his head back. The tension in Alex was building quickly. He wanted so badly to cum, wanted to feel himself released from reality into oblivion if only for a few seconds.

“Please, Michael. Just a little tighter, please,” Alex managed to pant out. Michael kissed across his exposed throat.

“Show me, sweetheart,” he insisted. Alex pulled one of his hands from Michael’s shoulder and wrapped it over Michael’s. He squeezed until the pressure was perfect and then let go, replacing his hand on Michael’s shoulder. The hand that had been harshly kneading at Alex’s ass, encouraging his rolling hips and sloppy thrusts, came around to stack itself on top of the hand gripping him. Together they created a deep channel for Alex to thrust his cock into over and over again.

“Shit, shit, shit, Michael. I need to cum. Can I? Please?” Alex whined, even as he kept pushing his body towards the edge.

“Sure, darlin'. You can cum,” Michael said agreeably. Alex let go of any restraint, pressing close and letting his thrusts get quick and out of rhythm as he felt the pressure building behind his balls. When Alex was only a few thrusts away, Michael continued, “But I’m going to make you clean up the mess you make with your mouth.”

The last bit did it for Alex. With a strangled, silent yell, his cock swelled against Michael’s hands and then erupted white, sticky streams that dripped and smeared along the insides of his fingers and palms. When Alex was able to move, Michael let go of his slowly softening cock and Alex lowered himself onto his back on the floor. The coolness of it felt good against his overheated skin. Carefully, Michael crawled over him to straddle his stomach, careful of his oversensitive cock.

“Open up,” Michael demanded, tapping two sticky fingers against Alex’s lips. Obediently, Alex opened his mouth and felt Michael plunge his salty, spunk-covered digits in. Alex moaned at the taste of himself on Michael’s skin, using his tongue to trace every inch of skin to find more of his leftover pleasure. Michael made him lick and suck all of his fingers and then palms. When he was finished, he swooped down and took Alex’s mouth with his own, plunging his tongue in for any traces left for him to taste. When the taste dissolved into nothing they parted. Michael helped Alex up onto the couch, where he held Alex against his chest and ran his fingers through his hair.

“Want some water? Dinner?” Michael asked a little while later when Alex was practically dozing off against his chest where he was sprawled. Alex hummed noncommittally and nuzzled his head against Michael’s shirt, laying a kiss against his cotton-covered chest.

“How was it? Everything you expected?” Michael asked easily. Alex nodded, eyes still closed and mind still wrapped in a blanket of satiation.

“Anything you didn’t like or would like me to do differently next time?” Michael asked next. Alex thought about it. His hand drifted down to Michael’s crotch, completely covered, but still half hard from their scene.

“I want you to use this on me next time. Mouth, ass, hands, whatever. I want you to get off too,” Alex replied, voice drowsy but firm. He opened his eyes and locked eyes with Michael. His hand stayed resting over Michael’s crotch and he could feel it twitch against his palm. Alex raised an eyebrow in question. Michael smiled, bent his head down to kiss Alex’s mouth, and brushed his hand away.

“Next time. Promise,” Michael responded easily. Alex knew it wasn’t a real rejection, so he nodded and turned his head to lay it back down against Michael’s chest, his ear pressed to where he could hear the steady thumping rhythm of Michael’s heart. He drifted and with faint surprise, realized he was really falling asleep. He wondered how long Michael would let him lay like this if he fell asleep. Would he wake up to warm sunshine tomorrow morning? Would Michael only let him nap for a while and then wake him to get dressed so he could go home to his own bed? As if hearing his thoughts, Michael ran the back of a finger along Alex’s cheek bone.

“Do you want to sleep here, the Airstream, or your house?” Michael asked softly. Alex considered it.

“Let’s go to the Airstream. I don’t wanna sleep alone tonight,” Alex said through a yawn. Michael nodded and hugged his arms around Alex’s shoulders.

“Sure. Whatever you want,” Michael concluded. Alex only hummed a vague response before he was oblivious to anything else. He didn’t have nightmares that night.

[what-is-agoraphobia]

What is Agoraphobia? Definition, Symptoms, and Treatment

Have you ever felt fearful of being in a crowded place?

If it’s something you experience occasionally, that’s relatively common.

We all have anxiety in certain situations from time to time. When does that fear become an issue?

Below, we answer the question, “what is agoraphobia?” by going into the symptoms and traits of this condition; then we will look into some options of what you can do about it.

What is Agoraphobia?

So what is agoraphobia, exactly?

The simple answer is that It’s an anxiety disorder.

When you have agoraphobia, you might fear certain situations that occur outside your home.

The triggering situations usually involve being in crowds of people and can cause you to feel trapped, embarrassed, or helpless.

Do you feel highly fearful about using public transportation, being in a crowd, standing or line, or being in a place that’s enclosed?

All of these can indicate agoraphobia.

If your agoraphobia is especially severe, you might be afraid to leave home at all.

What Causes Agoraphobia?

If you suspect you might have agoraphobia, you’re probably wondering what causes it.

As much as you might try to get over what you know isn’t a reasonable fear, you might still be struggling with it.

For many people, agoraphobia starts in the late teen or early adult years, but it can begin in older adults too.

Additionally, studies show that agoraphobia is more common in women than men.

We’re all continuing to learn more about the role of different factors in developing anxiety disorders and other mental health conditions, including agoraphobia.

It could be a combination of genetics, environmental stress, and learning experiences.

Some of the possible risk factors to develop agoraphobia include:

Having another panic disorder or phobia

Experiencing excessive fear or avoidance when you have a panic attack

A stressful life event, like the loss of a loved one

Having an anxious personality overall

A close family member who also has agoraphobia

Agoraphobia Symptoms

Have you experienced any of the following agoraphobia symptoms but maybe not been able to identify exactly what you were going through?

Mental health professionals divide the symptoms broadly into three groups: physical, cognitive, and behavioral.

Physical Agoraphobia Symptoms

Physical agoraphobia symptoms are similar to a panic attack. These can include:

Fast heartbeat

Rapid breathing

Sweating or feeling hot

Feeling sick or nauseous

Problems swallowing

Diarrhea

Trembling

Chest pain

Ringing in the ears

Feeling faint

Cognitive Agoraphobia Symptoms

Fear that you’ll be embarrassed in front of other people

Worries that people will stare at you

Concerns that you’ll lose control in public

Excessive worry that you would be trapped in a situation if you were to have a panic attack

General dread or anxiety

Behavioral Agoraphobia Symptoms

Avoiding situations that could trigger you to experience a panic attack, like public transportation, elevators, or crowded places

Not leaving the house for extended periods

Requiring someone to go with you when you go anywhere

Trying to avoid a situation where you’re far away from home

How Is It Diagnosed?

If you’re concerned that you could have agoraphobia, luckily, treatment can help you tremendously.

To get to that point, you do need a diagnosis.

A diagnosis of agoraphobia starts with your doctor and will start by going over your signs and symptoms.

They’ll ask you how often they happen and when they started; then they’ll go over your medical history and your family history.

To rule out any underlying causes for your physical symptoms, your health care provider might also run blood tests.

The American Psychiatric Association uses the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose agoraphobia.

If you have intense anxiety or fear in two or more of the situations below, then you meet the criteria of an agoraphobia diagnosis:

Using public transportation, like a bus or train

Finding open space, like a parking lot

Being in an enclosed space, like an elevator

Crowds

Alone and away from home

To meet the diagnosis criteria, you’d also need to have experienced ongoing panic attacks, with at least one followed by:

A fear of having more panic attacks

Anxiety about the consequences of the panic attack

Changes in your behavior because of panic attacks

Treating Agoraphobia

Once you’re diagnosed with agoraphobia, the good news is that you can begin treatment.

What might work best, depending on your symptoms, is a combination of treatment methods.

Treatments can include:

Talk Therapy

Talk therapy is also known as psychotherapy.

When you’re in therapy for agoraphobia or any kind of panic disorder, you regularly meet with your therapist or counselor.

You can talk about your fears, how you experience agoraphobia, and how it affects your life.

Psychotherapy, like cognitive-behavioral therapy, is usually short-term.

You’ll learn coping mechanisms that will help you be more functional in your daily life.

Cognitive-Behavioral Therapy or CBT is the most frequent type used for agoraphobia.

You’ll start to work with your therapist on how your views and distorted feelings are affecting you.

Your therapist can also go over how you can then combat those distorted feelings and replace them with healthy ones.

Exposure therapy is another option.

With this type of therapy, you’d work with a counselor to gradually increase your exposure to the situations or places that you’re afraid of.

The goal is to reduce your fear or anxiety over time.

Medication

Medication can be used alone or along with your therapy sessions.

Medicines that can help if you’re experiencing agoraphobia symptoms or panic attacks include:

Selective serotonin reuptake inhibitors like Prozac or Paxil

Selective serotonin and norepinephrine reuptake inhibitors like Cymbalta or Effexor

Tricyclic antidepressants such as Elavil

Short-term anti-anxiety medicines like Xanax or Klonopin

Lifestyle Changes

There are things you can do on your own too. These aren’t a cure for agoraphobia, but they can work alongside other treatments to help you feel your best.

For example, exercising regularly can help stimulate brain chemicals to help you be more relaxed and upbeat.

Eating a healthy diet and meditation and practicing mindfulness regularly can also help improve your symptoms of agoraphobia.

Final Thoughts

To sum it all up, what is agoraphobia?

If you’ve ever had intense anxiety or a sense of dread or worry about going to crowded places, open places, or places you fear you couldn’t escape from, it could mean you have agoraphobia.

You might also have panic attacks as a result.

If you believe this describes you, treatment can include a combination of medicine, therapy, and lifestyle changes.

The sooner you speak to your doctor about what you’re going through, the more proactively you can receive treatment.

Don’t struggle, and don’t let your anxieties become debilitating because help is available.

Contact our team at the Mental Health Center of San Diego to get a tailored treatment plan and take back control of your life.

[media-on-the-mind101]

Split : Dissociative Identity Disorder (Movie)

*May contain spoilers*

I’m starting off with one of my favorite movies about a disorder that is very controversial. Split, the sequel to Unbreakable and prequel to Glass, stars British actor James MacCavoy as Kevin Wendell Crumb who suffers from Dissociative Identity Disorder (DID). The existence of DID, formerly called Multi-personality Disorder, is controversial though it is listed in the fifth and current Diagnostic and Statistical Manual of Mental Disorders (DSM -Five).

The DSM-Five defines DID as “the presence of two or more distinct identities or personality states, each with it’s own relatively enduring pattern or perceiving, relating to, and thinking about the environment and self.” Other symptoms include those similar to depression; lack of appetite, suicidal ideation, and some that resemble other dissociation disorders: being out of touch from environment, having blackouts, and selective amnesia. Some even resemble Bipolar II or Borderline Personality Disorder, such as extreme changes in mood.

In the movie, Kevin shows many of these symptoms including having two or more distinct personalities. But were the personalities portrayed accurately? And was his treatment portrayed accurately?

Above: Kevin’s many personalities

Kevin has a total of 23 personalities (excluding the beast which appears at the end and his normal personality) but the movie only focuses on five : Hedwig, Barry, Jade, Dennis, and Patricia. Each personality is exaggerated, cartoonish, and completely different from the others. Hedwig is a nine-year-old boy who can’t pronounce his Rs, while Jade is a stereotypical teenage girl. Patricia is a posh British lady, while Barry is a levelheaded artist. Finally, Dennis is the angry man who kidnapped the girls.

Based on the definition of DID, there is no doubt that Kevin has this disorder; the symptoms would not fully match any other diagnosis. But just how realistic are his personalities portrayed?

The main thing I questioned while watching this movie, was how some of Kevin’s personalities had different abilities. I noticed that one wears glasses and one has a speech impediment, but the rest do not. Biologically, this would not make any sense, because the personalities are coming from the same body. So can people with DID really have personalities with different physical abilities? The answer is, surprisingly, yes.

In 2015, a 37 year old German women who had gone blind twenty years ago from brain damage, regained her eyesight in some of her split personalities. The case study was fascinating, and I felt chills run down my spine while researching it. Indeed, brain scans confirmed that the recovery of her vision was real; the visual cortex was inactive in her blind personalities, but active in her seeing personalities. One explanation for this phenomenon was psychogenic blindness, a conversion disorder (disorder that cannot be explained by damage) which is often developed after experiencing a traumatic event. So is it realistic for Dennis to wear glasses while the other personalities don’t? In rare cases, yes.

The same case revealed that some of her personalities spoke German while others spoke English. Other DID patients have been known to have similar experiences. Some also report foreign accent syndrome, in which they take on an accent different from their own. So if this is possible, then a personality with a speech impediment should not be that surprising. 

While researching the brain areas that are tied to speech, I came across information that could help answer this question. According to jneuro.com, there are about five different areas which control speech. These include the cerebellum, basal ganglia, and others. The theory behind foreign accent syndrome is that patients have damage in their abilities to program their sequence of movement and position of muscles in which they speak. The same concept applies to people who develop speech impediments. I could not find any information about speech impediments in DID, but based on the information about speech and foreign accent syndrome, it certainly seems possible. So that explains Hedwig’s speech impediment and Patricia’s British accent.

Another thing I was skeptical about, was weather or not a person with DID can take on a personality of a different age and actually have the cognitive abilities of that age. In a sense, do they truly regress, and how? According to healthyplace.com, this is indeed possible, however the cause is not certain. According to the National Center for Biotechnology information (NCBI), the frontal lobe is main center for planning, impulse control, and working memory in the brain. The development of this area is what causes a person to be more careless during adolescence, and more careful as the get older. Damage to the frontal lobe causes people to regress back to childhood behavior, as seen in the famous case of Phineas Gage who developed behavioral problems after getting his head impaled by a tamping rod. In people with DID, their entire brain has problems in functioning, including the frontal lobe. So it seems plausible that a person with DID could revert back to childhood behaviors. However, the changes in cognitive abilities and level of knowledge have not been explained.

Finally, I want to discuss the personality that we’ve all been waiting for: the beast. Considered the phoniest personality of them all, the “monster” is also the scariest. The other personalities are trying to protect Kevin from the “beast.” The reason he is seen as phony is because he possesses inhuman abilities, such as the ability to climb up walls. He also becomes cannibal. I could not find any evidence that this personality is actually possible. However, I did find many other blogs which addressed the same issue about the movie. The “beast” personality implies that a person with DID can change their strength and physiology to be able to defy gravity, and scientifically this is not possible.

While climbing up wall is not possible unless you are Spider-man, some of the monster’s trait might actually be plausible. Physiological arousal happens even in healthy people, and this arousal can cause a person to become more aggressive and develop physical strength they did not have previously. In disorders such as Post Traumatic Stress Disorder (PTSD), the physiological arousal is triggered by memories of the traumatic event. According to the NCBI, a case study showed that a woman with DID had a tendency to switch personalities when under stress. 

 DID is usually caused by traumatic events, and the personalities can be brought on by triggers, so it makes sense that the person would already be aroused, and thus, lose control. However, the beast’s behavior is extreme and more similar to possession. I found a book called “Born Evil” which tells the real-life story of a serial killer who was cannibal and had DID. While there are a handful of serial killers who are known for cannibalism, most of them were diagnosed with paranoid schizophrenia, or were not diagnosed at all. Jeffery Dahmer was diagnosed with Borderline Personality disorder, according to Wikipedia. So the cannibalism part of the monster’s personality is possible but not well known to happen.

The part that got me most was the fact that the “beast” was a probably a metaphor for Kevin’s harsh past. In people with DID, their personalities stem from a traumatic event to protect the person from the memory of that event. So in a sense, the “monster” should actually have been Kevin’s overbearing, Obsessive-Compulsive mother. This is clear because his other personalities were trying to protect him from it. 

Kevin’s “Dennis” personality showed some obsessive compulsive tendencies as well. While there is no evidence that people with DID can actually have a personality with OCD, studies have found a phenomenological overlap between the two. According to the NCBI, one study showed that in rare cases, people with OCD can have higher levels of dissociative experiences. These people feel that alternate personalities are responsible for their obsessions and compulsions. However, this sample size of this study was too small to determine any strong correlations or causations. I think having the “beast” turn out to be Kevin’s mom would have made a much more realistic and meaningful ending, and would have been educational about DID and how traumatic events can effect people.

Now that we’ve discussed how the disorder was portrayed, I want to discuss how the treatment was portrayed as well. According to psychcentral.com, the main treatments for DID are therapy, medication, and hospitalization. The types of therapies used include; cognitive behavioral (CBT), dialectical behavioral (DBT, a type of CBT), hypnotherapy (hypnosis), and sensorimotor psychotherapy (becoming aware of physiological signs that personality is about to change, and controlling the change). Medications include selective serotonin re-uptake inhibitors (SSRIs), other anxiety medications, and antipsychotics. Some take benzodiazepines which were originally made for people with Borderline Personality Disorder.

Therapy for DID is unique in that it comes in three stages. Stage 1 is reducing self-destructive or suicidal behaviors, learning coping skills, regulating emotion, and relaxation techniques. In stage 2, patients begin to process their traumatic memories. Finally, stage 3 includes reconnecting to themselves and others and refocusing on life goals. Patients may achieve a more solid sense of self and, thus causing their personalities to fuse back into one. The three stages are not linear, so patients may alternate between them, or they may overlap. Some patients don’t make it through all three phases.

In the movie, Kevin has a therapist, and receives talk therapy which is a type of CBT. However, he does not take any medication. Kevin does not get hospitalized. His treatment is not in the three stages, or at least the stages are not mentioned. Like many movies, “Split” focuses more on the symptoms of the disorder then the treatment, so the treatment does not go into detail. While Kevin’s treatment is not untrue to real life, the movie left out a lot of important details that would have educated the audience.

In conclusion, I believe that “Split” did have some errors in it’s portrayal of DID, but was not as far off as people think. Many other blogs are bashing it for it’s inaccuracy, but according to my research, most of the symptoms shown are not impossible. While “Split” may have left out a lot of symptoms such as depression, lack of appetite, each person experiences the disorder differently and does not necessarily show every symptom. As for treatment, the movie did portray it somewhat realistically, but left out a lot of important details, such as medication, hospitalization, and the three stages. 

I think it would be great if movie directors hired mental health consultants, the same we they hire medical consultants on TV shows like House. This way, the portrayal of both the illness and the treatment would be more accurate, and educating to the audience. The movie would also be less frustrating for people who actually have the disorder, because they would feel that people are getting more accurate ideas about the illness. I think the media plays a big role in the stigma toward mental illness, and having more accurate portrayals could potentially change it. Even movies based on real-life stories are not always accurate, as I will discuss in my future blogs.

Thank you for reading, and if you have any questions or requests for future articles, please message me or talk to me in the comments!

[whitestonetherapy]

Psychosis... (1.8.19)

A few weeks ago I attended a training day run by the International Society for Psychological and Social approaches to Psychosis (ISPS).  

Professor John Read from the University of East London gave a talk on the causes and treatment of psychosis.

There certainly is a difference of opinion as to whether psychosocial or biological factors play the largest part in causing psychosis.  Is psychosis triggered by environmental factors?  Or should treatment be seen entirely as a medical issue requiring psychiatrist prescriptions and pills? I think it's fair to say John seemed pretty cynical about the latter...

The DSM-5 Manual tells us that the key features of psychotic disorders include: delusions, hallucinations, thought disorders (disorganisation etc), Catatonia, disorganized motor behaviour, other 'negative symptoms' (e.g diminished emotional expression).  For a diagnosis often only one or two criterion need to be present.  This means, says John, that categorisations (and diagnoses) are actually pretty scientifically meaningless.  We could fill a room with people given the same diagnosis whose personal experience differ wildly.  Some people may have one symptom but not others, and others have different symptoms altogether - yet we call it the same thing.  (aside:- I'm pretty sympathetic to this more generally.  I've met a lot of people who share a diagnosis - various disorders - whose experiences and symptoms seem to be completely different.)  

A bit of context and history is needed to understand how we arrived here. Outside of our own culture, hearing voices is often accepted as an ordinary part of life (ancestors talking to you etc). In some cultures significant value and meaning is attributed to being able to hear voices.  But in western society it was (and still is) increasing assumed that hearing of voices has no meaning and needs urgent correction.  

The German doctor Emil Kraepelin (1856-1926) was the first person to define schizophrenia, and he attributed the symptoms entirely to biology - a genetic malfunction.  The definition was refined by Paul Bleuler in 1908, but the fundamental belief remained that psychosis was an organic illness that could be inherited.  Although psychotic disorders (along with other mental health disorders) have often been framed this way all throughout the 20th century, the public seem to feel quite differently about it.

Studies have regularly shown that people believe it is psychosocial factors - rather than inherited biology - that are the main cause of mental health problems.  And those with a psychosis-related diagnosis feel this even more strongly.  In a study by Murray & Dean (2008), 97% of respondents with a diagnosis rejected the 'medical model' explanation of their experience (biology) and instead placed importance on psychosocial factors.  That's a huge percentage, and John pointed out that  elements of the psychiatry profession sought to dismiss this finding as due to 'a lack of insight' on the part of respondents. Their response was pathologised as evidence of 'anosognosia'!

In fact, a study carried out in 2004 (Kingdon et at.) found that of 2813 psychiatrists surveyed,  50.8% considered causation of schizophrenia to be exclusively biological, more than the 48.6% who felt this is a balance between biology and social factors.  Only a tiny percentage felt causation was down to psychosocial factors only.  

So we see a real divergence between how people with a diagnosis actually feel about their condition, and the views of psychiatrists.

Despite the view held by professionals that schizophrenia is biological, studies trying to identify the genes responsible have so far drawn a blank .  Steven Hamilton ran a meta-study in 2008 found no statistical significance (save what would be expected by chance) that any suspected genes are responsible for development of psychosis.  There does not appear to be a schizophrenia gene.  

On the other hand...there is a lot of evidence showing that other psychosocial factors are correlated with developing psychosis.  Eaton (1980) established through research that poverty is the strongest predictor for the development of schizophrenia (with deprived children 7 times more likely to get a diagnosis).  

The link between economic factors and mental illness is established in research (Wilkinson & Pickett, 2009), and John Read himself wrote a paper on the link between socio-economic status and schizophrenia (2011).

Another strong predictor is ethnicity.  Ethnic minorities living in any country are far more likely to develop a psychotic condition and receive a diagnosis.  A Study by Fearon et. al. (2006) found that black Afro-Caribbeans living in the UK were 9 times more likely to develop schizophrenia or experience psychosis.  

Other causal factors identified by research include:  broken attachments (loss of a parent etc) - one study shows those whose mother is not present are 2 to 3 times more likely to experience psychosis.  Abuse (physical / emotional) is a strong indicator, where one study showed victims of abuse 18 times more likely to develop psychosis (Shevlin et. al, 2007).  Child abuse is a really pronounced predictor. Neglect, bullying and other environmental factors are all more likely to be present in the lives of those who  experience psychosis.  This doesn't necessarily establish causation but does show that many of these factors are present in the personal histories of those experiencing psychosis.

What about the implications of this for treatment?  With 95% of those diagnosed with psychosis given medicine straight away, John Read argued we should be using medicine as a last - not first - resort.  He believes talking-therapies should be given primacy. He pointed to the Cochrane review of the drug Risperidone (2010), in which it was shown to have little more effect than a placebo.  With a set of side-effects including reduced brain size and a shorter life span I found that quite shocking to hear....  Other side effects are not great day-to-day either:  drowsiness, loss of motivation, slow thoughts, difficulty concentrating etc.  I wouldn't go as far as John, but it's important that his research is not drowned out by the pharmaceutical companies who make the drugs.

Alarmingly, of the top 50 websites on schizophrenia (based on search engine results), 58% were found to have received funding from drug companies (Read, 2008).  It's important to be aware there are vested interests at play here....  And these websites (surprise surprise) do emphasise a biological/medical model for understanding schizophrenia. John also makes the point that many psychiatric journals are funded by drug companies.  

In terms of treatment: John argued that a medical / pill-focused model is insufficient to address the social and environmental factors that are often present for those with a diagnosis. I wrote in my post Integration... (1.7.19)  that there are many ways that talking-therapies can approach a complex situation.  Personal histories including difficulties such as the ones I outlined above can be approached in a lot of ways by therapists.  To name just a few a psychotherapist might choose between approaches like: cognitive, psychodynamic, focusing on dissociation, traumagenic neurodevelopmental, attachment-based etc.  All offer a way of working with someone - a way of conceptualising their world.

What I really took from this is the key, simple point:  the brain responds to the environment, therefore environmental changes can also change the brain.  What use would you brain be if it didn't do this?  

Therefore we should focus even more on what we know 'works' in talking-therapy.  This might include CBT to help with symptom management, and this has been shown to be very effective.  But longer term therapy focusing on quality, sustained relationships are also really important - just as they would be for any group of people with complex lives.

www.whitestonetherapy.com

[your-dietician]

Why Experts Are Exploring Climbing as a Form of Therapy

New Post has been published on https://depression-md.com/why-experts-are-exploring-climbing-as-a-form-of-therapy/

Why Experts Are Exploring Climbing as a Form of Therapy

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For Miriam Pracki, a 36-year-old from Germany, taking up climbing was an essential step in overcoming years of mental health hurdles. In 2000, when she was a teenager, she developed an eating disorder. By 2010, she’d been hospitalized three times, and regular patterns of depression and self-harming behavior led her to put her university coursework on hold. But when Pracki, who had always been active and outdoorsy, heard that a new climbing gym was opening nearby, she decided to give it try.

The skills she learned climbing eventually paved the way for her recovery. “While you’re climbing, the only important thing is the now,” she says. “You can’t think about your body weight, or your job, or whatever.” The sport made her feel strong; she recalls with excitement the tension in her core as she completed her first boulder problem on a steep horizontal roof. “That was such a cool feeling,” she says. “Being strong in climbing made me stronger in general. I was able to transfer that success and positivity into everyday life.” 

In the four years following her first trip to the climbing gym, she recovered, returned to a healthy weight, was diagnosed with and treated for ADHD, and finished school. Now she’s married with kids—her husband is also a climber—and works as an interior designer. She continues to boulder and sport-climb both at the gym and outdoors. 

The sport holds therapeutic promise for many reasons. Climbing can bring about mindfulness, the in-the-moment focus that Pracki experienced, which is key to treating depression, explains Katharina Luttenberger, a psychology researcher at the University of Erlangen in Germany. It’s also objective—you either top out or you don’t. That makes it harder for those struggling with self-esteem to discredit themselves, as you can’t simply send a route because you were lucky. The sport is loaded with metaphors, too. “A depressed patient needs to find a hold again in life, or you have to climb out of your depression, you have to let go to move on,” says Luttenberger. 

In a movement currently centered in Germany and Austria but gaining traction around the globe, practitioners like Luttenberger are evaluating bouldering psychotherapy—which typically involves a combination of talk therapy and climbing—in controlled studies and applying it in hospitals and private practices. With a growing body of evidence and support from experts, these psychologists hope to persuade health officials that this therapy is a valuable alternative to more traditional talk-therapy approaches.

Luttenberger and her colleagues have developed a ten-session curriculum over nearly a decade of research. Each of the sessions starts with a meditation. Next, the instructor talks about the theme for the day, such as self-esteem, trust, or social relationships. The therapist then leads a climbing exercise that illustrates that theme. For example, patients might boulder blindfolded with the guidance of the instructor or other patients to explore fear, which usually dissipates once they learn to rely on others’ guidance. The exercise is then followed by a discussion and another meditation or relaxation exercise.

A paper published in March in BMC Psychiatry found that a climbing-based therapeutic program was a more effective treatment for depression than other exercise regimens that did not involve therapy, and it was as effective as established methods of talk therapy. The trial followed 240 patients: one-third participated in bouldering therapy, another third did cognitive behavioral therapy (a common form of talk therapy), and the final third initiated an exercise program at home. The group that received the climbing treatment improved significantly more than those in the exercise program and similarly to the group that received cognitive behavioral therapy. “CBT is powerful and has a long history,” says Luttenberger, who led the study. “And we could show that bouldering therapy was not inferior to CBT, which is great.” 

Creating a control group for physical activity without a therapy component was critical to the study, because exercise, in general, has been shown to have positive effects on mental health. Luttenberger and her team’s first study, conducted in 2012 with 47 participants, found that depression levels dropped significantly among participants who got to boulder, compared to a group placed on a waiting list as a control—but it didn’t prove that bouldering therapy was any better than simply getting your heart rate up and your body moving. The 2020 study expanded the parameters and made a better case for climbing therapy having real-world potential. 

“The way people approach a boulder problem is very similar to the way people approach life outside of bouldering,” says Lisa Vigg, a psychologist who assisted with Luttenberger’s research and who led her own patients through bouldering-therapy routines in Germany. It reveals behavioral patterns that therapists and patients can then work through in the climbing gym, which serves as a safe place to practice new skills. 

Alexis Konstantin Zajetz, an Austrian psychotherapist, has been exploring climbing therapy since the early 2000s and founded the Institute for Climbing Therapy in Salzburg in 2005. A dedicated climber himself, he saw potential in the sport because of the intense focus it requires and the strong emotions it can bring up, and he began to incorporate bouldering sessions into talk therapy with certain patients. In one session, when Zajetz instructed one of his patients to pick an easy route to climb, she refused to climb below a moderate grade. “She was demanding so much from herself,” says Zajetz, because she was afraid of what others would think if she didn’t climb at a certain difficulty. After that, he was able to work with her on her struggles with self-judgment, both in and out of the gym. 

Compared to other adventure sports, bouldering is relatively approachable and affordable—all you need are shoes and chalk, and gyms are plentiful these days, with the cost of a day pass usually under $30. Plus, it’s fun and intuitive for many people, adds Zajetz. Even on their first day, most people can complete a route with minimal instruction, bringing a sense of accomplishment, with little time spent refining technique. Advanced and beginner climbers can practice side by side, working on separate routes, making the sport particularly inclusive, says Vigg.

“Anything that gets people who are suffering from depression active physically and socially is a good thing,” Catherine Forneris, a psychiatrist at the University of North Carolina, says of the research team’s findings. She adds that there are a lot of “unanswered but intriguing questions” about the approach. What the existing studies can’t tell us is which aspect of the therapy is most powerful: Is it the bouldering itself? Is it exercising with a group? Is it the mindfulness lessons? Perhaps all contribute, but for now it’s unclear to what extent the different parts of the program are beneficial. Forneris adds that future work should seek to replicate the studies with different patient groups outside Germany.

The other goal is to get more widespread recognition. In January, the first conference on climbing therapy was held in Germany, with about 200 attendees. It featured workshops on mental conditions like addiction, depression, anxiety, and PTSD. Pracki also gave a talk on climbing’s role in her recovery. “The participants were so happy to meet other people working with climbing,” says Zajetz. 

In Germany, several clinics and hospitals have climbing walls, so therapists can prescribe a bouldering exercise as part of an intervention. Outside that setting, however, it’s harder for patients to access bouldering psychotherapy. Zajetz’s patients pay him privately for bouldering sessions. Luttenberger hopes that situation will change in coming years so that bouldering treatments are eventually officially recognized and covered by health care systems. As she points out, it could be a good alternative for people who may otherwise be wary of the stigma of conventional therapy. In the next few months, she plans to publish a manual for therapists based on the program she’s refined through her research. Zajetz also holds regular trainings at the Institute for Climbing Therapy for instructors and psychologists interested in the approach. 

After leading sessions for Luttenberger’s research, Vigg, who lives in England, says she’s now planning to switch her entire practice to bouldering therapy. “It is so worthwhile to get up from the therapy chair and get active with patients,” she says. “I’ve worked with psychotherapy, both inpatient and outpatient, with groups and individuals, and I would say from experience that this is the easiest and most joyful way to do therapy for patients and therapists alike.” 

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[huntersafari512]

Duplicate Photo Remover Free

Find and remove duplicate files

Duplicate Cleaner by DigitalVolcano Software is the leading program for finding and removing duplicate files on your Windows PC. Documents, pictures, music and more - this app will find it all. This free version has a subset of features found in it's big brother, Duplicate Cleaner Pro. Duplicate Photo Remover free download - Duplicate File Finder, Duplicate File Remover, Duplicate Email Remover, and many more programs. Joe rogan podcast spotify. Using AI techniques normally reserved for the cloud, Duplicate & Similar Photo Cleaner views your photos as you do, making it easier to find duplicates, across multiple file formats and sizes. It also finds similar photos that may have been edited, or are part of a photo sequence. Using AI techniques normally reserved for the cloud, Duplicate & Similar Photo Cleaner views your photos as you do, making it easier to find duplicates, across multiple file formats and sizes. It also finds similar photos that may have been edited, or are part of a photo sequence.

AllDup is a freeware tool for searching and removing file duplicates on your Windows computer. The fast search algorithm find duplicates of any file type, e.g., text, pictures, music or movies.

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No doubt you have numerous images on your computer? The trouble with having lots of pictures is that you tend to collect duplicates along the way. Here are top five best duplicate photo finder listed to get rid of duplicate and similar photos. It would be a wise thing to manage space efficiently.

Finding similarly pictures and duplicate photos can become an overwhelming project. This is where duplicate photo finders come in. Remember that you should always backup all files before doing any deletion, which is a good practice to take regularly, for example to a DVD or an external hard drive. All software in this article is sorted from best to worst.

Top 7 Best Duplicate Photo Finder Softwares

Below we enlist the best duplicate photo finders and removers to eliminate junk, give the hard disk breathing space, and speed up the PC.

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1. Duplicate Photo Finder: –

Duplicate Photo Finder looks for similarities in different images and easily finds duplicates and photos of the same pixels, rotated photos, flipped photos, resized photos, and edited images. It supports all popular image formats, including RAW, HEIC, JPG, PNG, TIFF, GIF, and much more, which means it won't miss a single duplicate on your computer.C

Duplicate files of all types can be a problem, especially if you're running low on disk space. By using Duplicate Image Finder, you can find and remove them easily.

2. Anti-Twin: -

Anti-Twin can use either byte-to-byte or pixel-to-pixel comparison to check for image similarity. Otherwise, you can activate name comparison, content comparison, or both. By default, Anti-Twin marks itself as a low priority process, but this can be changed by going to “Control” and unchecking the option. To select files for deletion in the result list, click the box left to the filename, and the symbol will change to a red X.

Anti-Twin is an excellent application to e.g., find and delete duplicate MP3 files in a download folder or find similar images. Apart from that, Anti-Twin helps you clean up employees' chaotic file repositories in company networks, e.g., by searching for unnecessary file copies and redundant data back-ups. Get It From Here

3. VisiPics 1.31: –

If you get too many pictures on your hard drive, downloaded, or photographed, you may have many duplicates from several different sources. In that case, you need a quick and easy to use program that finds and deletes all your duplicates.

The application allows you to search for duplicate images using three different filters; Strict, Basic and Loose.

All detected duplicates are shown side by side with pertinent information such as file name, type, and size being displayed. It's auto-select mode let you choose if you want to keep the higher resolution picture, space-saving file type, smaller file size or all of the above. If you are insecure over what you really want to delete you can manually select the images you don't want to keep and delete them yourself.

VisiPics also allows you to search using the'Auto-Select' feature which will mark images with smaller, uncompressed, lower resolution copies as duplicate images.

4. Similar Image Search: -

Similar Image Search is a free software that lets you find duplicate images on your PC. It is a standalone JAR file and requires Java installed on your PC to run. It can search for duplicate image files in any selected folder. First, add the folder then click Library Search and then click Reverse Image Search from the sub menu. It will show you the list of duplicate images in the selected folder and you can easily delete them.

It's designed for photographers to sift through a memory card dump, searching for photos in batches for ease of sorting.

Requires: Java 7 Get It From Here

5. Awesome Duplicate Photo Finder: -

This program is very easy to use. You can do all you need with duplicate photos in just a couple of mouse clicks. Awesome Duplicate Photo Finder is able to compare resized pictures or even pictures with corrected colors (black and white photos etc.). It supports all major image types: JPG, BMP, GIF, PNG.

To start playing just drag some folders from the Windows Explorer into the program's window and click 'Start' button, and have fun!

Requires: Windows 10 Get It From Here

Temperature monitor in game. Generally, the GPU temperature is capped at around 95 Celsius (203 Fahrenheit), while the optimal temperature when gaming should be lower than 85 Celsius (185 Fahrenheit) even when they are heavily loaded. Monitor CPU & GPU in game.

6. Duplicate Photos Fixer Pro: -

Duplicate Photos Fixer Pro is a well-designed photo cleaner utility that helps you quickly find duplicate photos present on your computer. You can easily de-clutter your digital gallery and save a valuable amount of disk space. It offers a limited trial period, which makes it hard to decide whether you want to purchase the product or not.

7. Duplicate Photo Cleaner: -

Duplicate Photo Cleaner is another very fantastic tool for the users who are looking out to get the best duplicate photo finder and remover tool for their computer.

It supports all popular image formats including RAW and PSD, and has a scanning engine optimized for processing image files. In addition to that, Duplicate Photos Cleaner has a handy Preview feature that lets you preview the duplicates before you take any action so that you don't delete any photos by accident.

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Conclusion

So, these were some of our favorite Duplicate Photos Finder tools. Some of them have excellent features on the table, such as giving users the scope to not only delete duplicate photos but also similar image files. However, they all are best in their own way!

Microsoft Duplicate Cleaner Free

So download and try any of them to get rid of unwanted duplicates, similar-looking photos, look-alike selfie images and more.

[publichealthcare99]

11 Tinnitus Remedies: How to Get Rid of Tinnitus

New Post has been published on https://thebestsolution4u.com/11-tinnitus-remedies-how-to-get-rid-of-tinnitus/

11 Tinnitus Remedies: How to Get Rid of Tinnitus

11 Tinnitus Remedies: How to Get Rid of Tinnitus

Tinnitus is usually described as a ringing in the ears, but it can also sound like clicking, hissing, roaring, or buzzing. Tinnitus involves perceiving sound when no external noise is present. The sound can be very soft or very loud, and high-pitched or low-pitched. Some people hear it in one ear and others hear it in both. People with severe tinnitus may have problems hearing, working, or sleeping.

Tinnitus is not a disease– it’s a symptom. It’s a sign that something is wrong with your auditory system, which includes your ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. There are a variety of different conditions that can cause tinnitus. One of the most common is noise-induced hearing loss.

There is no cure for tinnitus. However, it can be temporary or persistant, mild or severe, gradual or instant. The goal of treatment is to help you manage your perception of the sound in your head. There are many treatments available that can help reduce the perceived intensity of tinnitus, as well as its omnipresence. Tinnitus remedies may not be able to stop the perceived sound, but they can improve your quality of life.

11 Tinnitus Remedies: How to Get Rid of Tinnitus

Tinnitus remedies

1. Hearing aids

Most people develop tinnitus as a symptom of hearing loss. When you lose hearing, your brain undergoes changes in the way it processes sound frequencies. A hearing aid is a small electronic device that uses a microphone, amplifier, and speaker to increase the volume of external noises. This can mollify neuroplastic changes in the brain’s ability to process sound.

If you have tinnitus, you may find that the better you hear, the less you notice your tinnitus. A 2007 survey of healthcare providers published in The Hearing Review, found that roughly 60 percent of people with tinnitus experienced at least some relief from a hearing aid. Roughly 22 percent found significant relief.

2. Sound-masking devices

Sound-masking devices provide a pleasant or benign external noise that partially drowns out the internal sound of tinnitus. The traditional sound-masking device is a tabletop sound machine, but there are also small electronic devices that fit in the ear. These devices can play white noise, pink noise, nature noises, music, or other ambient sounds. Most people prefer a level of external sound that is just slightly louder than their tinnitus, but others prefer a masking sound that completely drowns out the ringing.

Some people use commercial sound machines designed to help people relax or fall asleep. You can also use headphones, television, music, or even a fan.

A 2017 study in the journal Frontiers in Aging NeuroscienceTrusted Source found that masking was most effective when using broadband noise, such as white noise or pink noise. Nature sounds proved much less effective.

3. Modified or customized sound machines

Standard masking devices help to mask the sound of tinnitus while you are using them, but they have no long-lasting effects. Modern medical-grade devices use customized sounds tailored specifically to your tinnitus. Unlike regular sound machines, these devices are only worn intermittently. You may experience benefits long after the device is turned off, and over time, you may experience long-term improvement in the perceived loudness of your tinnitus.

A 2017 study published in the Annals of Ontology, Rhinology, and LaryngologyTrusted Source, found that customized sound decreases the loudness of tinnitus and may be superior to broadband noise.

4. Behavioral therapy

Tinnitus is associated with a high level of emotional stress. Depression, anxiety, and insomnia are not uncommon in people with tinnitus. Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people with tinnitus learn to live with their condition. Rather than reducing the sound itself, CBT teaches you how to accept it. The goal is to improve your quality of life and prevent tinnitus from driving you crazy.

CBT involves working with a therapist or counselor, typically once per week, to identify and change negative thought patterns. CBT was initially developed as a treatment for depression and other psychological problems, but it seems to work well for people with tinnitus. Several studies and meta-reviews, including one published in the Korean Journal of AudiologyTrusted Source, have found that CBT significantly improves irritation and annoyance that often comes with tinnitus.

5. Progressive tinnitus management

Progressive tinnitus management (PTM) is a therapeutic treatment program offered by the U.S. Department of Veterans Affairs. Tinnitus is one of the most common disabilities seen in veterans of the armed services. The loud noises of war (and training) often lead to noise-induced hearing loss.

If you’re a veteran, talk to your local VA hospital about their tinnitus treatment programs. You may want to consult the National Center for Rehabilitative Auditory Research (NCRAR) at the VA. They have a step-by-step tinnitus workbook and educational materials that may be helpful.

6. Antidepressants and antianxiety drugs

Tinnitus treatment often involves a combination of approaches. Your doctor may recommend medication as part of your treatment. These drugs may help make your tinnitus symptoms less annoying, thereby improving your quality of life. Antianxiety drugs are also an effective treatment for insomnia.

A study published in Medical Science MonitorTrusted Source found that an antianxiety drug called alprazolam (Xanax) provides some relief for tinnitus sufferers.

According to the American Tinnitus Association, antidepressants commonly used to treat tinnitus include:

clomipramine (Anafranil).

desipramine (Norpramin).

imipramine (Tofranil).

nortriptyline (Pamelor).

protriptyline (Vivactil).

7. Treating dysfunctions and obstructions.

According to the American Tinnitus Association, most cases of tinnitus are caused by hearing loss. Occasionally though, tinnitus is caused by an irritation to the auditory system. Tinnitus can sometimes be a symptom of a problem with the temporomandibular joint (TMJ). If your tinnitus is caused by TMJ, then a dental procedure or realignment of your bite may alleviate the problem.

Tinnitus can also be a sign of excess earwax. Removal of an earwax blockage may be enough to make mild cases of tinnitus disappear. Foreign objects lodged against the eardrum can also cause tinnitus. An ear, nose, and throat (ENT) specialist can perform an exam to check for obstructions in the ear canal.

8. Exercise.

Exercise contributes significantly to your overall well-being. Tinnitus can be aggravated by stress, depression, anxiety, lack of sleep, and illness. Regular exercise will help you manage stress, sleep better, and stay healthier.

Read more: Silencil Natural Remedies For Tinnitus

9. Mindfulness-based stress reduction.

During an eight-week course of mindfulness-based stress reduction (MBSR), participants develop the skills to control their attention through mindfulness training. Traditionally, the program was designed to draw people’s attention away from their chronic pain, but it can be equally effective for tinnitus.

The similarities between chronic pain and tinnitus have led researchers to develop a mindfulness-based tinnitus stress reduction (MBTSR) program. The results of a pilot study, which were published in The Hearing Journal, found that participants of an eight-week MBTSR program experienced significantly altered perceptions of their tinnitus. This included a reduction in depression and anxiety.

10. DIY mindfulness meditation.

You don’t need to enroll in an eight-week program to get started with mindfulness training. Participants in the MBTSR program all received a copy of the groundbreaking book “Full Catastrophe Living” by Jon Kabat-Zinn. Kabat-Zinn’s book is the premier manual for practicing mindfulness in daily life. You will learn about, and be encouraged to practice, meditation and breathing techniques that can help draw your focus away from tinnitus.

11. Alternative treatments.

There are several alternative or complementary tinnitus treatment options, including:.

nutritional supplements. homeopathic remedies. acupuncture. hypnosis. None of these treatment options are supported by science. Many people are convinced that the herb gingko biloba is helpful, however large-scale studies have been unable to prove this. There are many nutritional supplements claiming to be tinnitus remedies. These are usually a combination of herbs and vitamins, often including zinc, ginkgo, and vitamin B-12.

These dietary supplements have not been evaluated by the U.S. Food and Drug Administration (FDA) and are not supported by scientific research. However, anecdotal reports suggest that they may help some people.

When to see your doctor.

Tinnitus is rarely a sign of a serious medical condition. Talk to your primary care doctor if you are unable to sleep, work, or hear normally. Your doctor will probably examine your ears and then provide you with a referral to an audiologist and otolaryngologist.

However, if you are experiencing facial paralysis, sudden hearing loss, foul-smelling drainage, or a pulsating sound in sync with your heartbeat, you should go to your local emergency department.

Tinnitus can be extremely distressing for some people. If you or someone you love is thinking about suicide, you should go to the emergency room right away.

Takeaway. Tinnitus is a frustrating condition. There’s no simple explanation for it and there’s no simple cure. But there are ways to improve your quality of life. Cognitive behavioral therapy and mindfulness meditation are promising treatment options.

Read more: How To Stop Ringing In Ears With RingHush Supplement

[un-enfant-immature]

Quirk wants to make cognitive behavioral therapy more accessible

Quirk, a YC-backed company, is looking to bring cognitive behavioral therapy (CBT) to more people suffering from anxiety or depression.

CBT aims to lessen or stop harmful behavior by changing the way people think, stopping them from falling into established patterns of negatively distorting their reality to justify or account for unhelpful habits.

“CBT has 40 years of research behind it,” says CEO and founder Evan Conrad. “I’ve had severe panic attacks my whole life and saw different therapists who tried what I now know is CBT. I assumed it was a pseudo science. It wasn’t until 10 months ago that I re-discovered CBT on my own and learned about its efficacy. It’s the gold standard.”

The app helps users practice one of the most common exercises in CBT: the triple-column technique.

Here’s how it works:

Users jump into the app whenever they have anxiety or a depressive thought to record it. They then identify any distortions that apply to that thought, such as Catastrophizing, Magnification of the Negative, Fortune Telling, or Over-Generalization, among others. From there, the user can challenge the thought with reasons why that thought might have been illogical to begin with. Finally, the user replaces the thought with something more reasonable.

For example, if I was worried about not getting a response to a text, I might believe (irrationally) that it has something to do with how that person feels about me, rather than the more obvious explanation: they’re just busy.

The hope of CBT is that identifying thought distortions, and manually replacing them with beliefs grounded in reality retrains the brain to experience the world in a realistic way and relieves patients from their depression and/or anxiety.

Conrad says that he went from having two anxiety attacks a week to two every six months.

The problem that Quirk is trying to solve is two-fold. First, people may not know the benefits or the empirical data supporting CBT. Secondly, the process of manually recording this on pen and paper can be more tedious and feel less private out in a public space.

Quirk’s attempt to solve these problems is to make CBT accessible to more people and to make the process of doing CBT slightly more private.

We asked Conrad about the potential negative affects of practicing CBT without the oversight of a mental health professional.

“As for self-administered CBT, we’ve run this by a number of therapists and all of them have said it’s generally a net-benefit,” Conrad said via email. “What would be harmful is if someone with a severe condition decided that they should use Quirk instead of seeing a therapist. But in practice we’ve seen the opposite effect. People who would have otherwise done nothing about their condition use Quirk as ‘first step’ towards therapy or will use Quirk when they would otherwise have no option (either because their isn’t a treatment in their country/area or because they can’t afford it).”

Dr. Daniel A. Fridberg, a practicing CBT psychiatrist from the University of Chicago, says that the triple-column technique is a great CBT exercise, but that it’s just part of the whole package of Cognitive Behavioral Therapy. He also said that the only way to know if a product like this can do harm is through a study, but that CBT itself is an evidence-based psychotherapy and has been proven effective.

“CBT is an effective, time-limited, reasonably cost-effective psychotherapy for things like depression, anxiety, substance abuse, etc,” said Dr. Fridberg. “The problem is that finding a good CBT therapist who delivers evidence-based treatment isn’t always easy in smaller communities where there isn’t easy access to a research hub. In some respects, an app that is packaged in an attractive way, gets people’s attention and promotes CBT as effective is a good thing.”

Dr. Fridberg also stated that anyone suffering from an issue that’s disrupting their day-to-day functioning should seek professional help.

Conrad says that he hopes Quirk can be a jumping off point for folks suffering from anxiety and depression, with the app suggesting that those suffering seek professional help in conjunction with using the app. He also shared that Quirk hopes to be able to connect users to professionals in their area as soon as they have the scale to do so.

Quirk costs $4/month for users.

[rationalsanskar]

What is Acceptance and Commitment Therapy? | E-Counseling.com

Acceptance and Commitment Therapy (ACT) is a rapidly growing form of psychotherapy.  Created in the 1980s by Stephen Hayes, it is considered one of the “third wave” psychotherapies, which include Dialectical Behavior Therapy (DBT) and Schema Therapy. It is an offshoot of Cognitive-Behavioral Therapy(CBT) and Relational Frame Theory (RFT). In ACT, you want to get rid of the distractions and frustration caused by trying to control your thoughts and, instead, focus on value-laden behavior that is going to improve your well-being. A primary goal of ACT is to increase your psychological flexibility. With flexibility comes the ability to cope effectively with negative feelings and move forward productively.

To fully understand ACT you must first have a brief understanding of its roots in RFT and CBT:

Relational Frame Theory

RFT is basically a behavioral theory of language. We attach meaning to certain words because we have been taught associations with that word and those associations have been reinforced. For example, we are taught that a ball is a round object and when “ball” is mentioned, we can be sure that a round object is almost always in the vicinity. This “relational frame” can also occur with emotions. Say someone gets into a car accident. From that point on, they associate cars, and likely other moving vehicles, with the accident. When someone mentions to them that they need to take a car ride, they may become anxious and afraid to participate. Therefore, the word car has become associated with the accident and the ensuing anxiety that goes with it. It is important to note that we give words meaning through their associations. If we are better able to strip language down to face value it helps us to avoid getting bogged down in our negative emotions.

Cognitive-Behavioral Therapy

CBT aims to change thoughts and behavior in order to promote psychological health. The underlying premise of CBT is that thoughts lead to feelings. Human beings have many distorted thoughts the lead to negative feelings. For example, if you consistently think poorly about yourself you are likely to have depressive feelings. In CBT, an individual with maladaptive thinking patterns would work on changing them to be more realistic. That change would help improve their emotional state. Additionally, certain behavior is maladaptive and needs to be changed to make feelings more positive. You may, for example, only get 5 hours of sleep per night. Since a lack of sleep is associated with numerous negative consequences, working on positive sleep hygiene practices would be recommended. Like CBT, ACT is a relatively brief therapy, meaning you can see meaningful improvement within 6 months (or sooner) of beginning weekly treatment.

How CBT Differs From ACT

Although ACT recognizes the relationship between thoughts and feelings, it takes a different direction from CBT. ACT believes that, instead of working to change thoughts, you should learn to accept negative thoughts and change your relationship to them. One of the main emphases of ACT is being mindful and committing to value-enhancing behavior. While mindfulness may be recommended as part of CBT, it is an essential part of ACT. Further, unlike CBT, behavior should be acted on in accordance with one’s personal values rather than just because they might be good for you. CBT has more of a problem-solving feel to it, while ACT is more about improving overall wellness.

6 Core Processes of ACT

A major goal of ACT is to increase your psychological flexibility. Hayes has recognized six ways in which ACT helps to improve the plasticity of the mind.

As you might have guessed from its name, acceptance is a main principle of ACT. You do not want to take the time and energy to fight against your thoughts. The more you fight the more distress it causes. Thoughts, like feelings, are not something abnormal that needs to be changed. You are going to have negative thoughts and you need to be able to accept them and move on. Putting a judgment on thoughts is what gets people stuck in negativity.

Cognitive Defusion

You can see the influence of Relational Frame Theory in the process of cognitive defusion. A good way to sum up cognitive defusion is the attempt to see thoughts as just thoughts. Thoughts are really just words. They don’t mean anything unless we make them mean something. In cognitive defusion, an individual is asked to notice and observe thoughts without getting caught up in them and assigning judgment to them.

Contacting the Present Moment

This process primarily refers to the practice of mindfulness. Mindfulness is all about living in the  moment rather than focusing on the past or future. Rather than trying to avoid thoughts, mindfulness emphasizes noticing your thoughts but refraining from judgment. This is not something that happens overnight. It is difficult to learn how to allow painful thoughts into our mind without becoming wrapped up in them. Mindfulness is an essential part of ACT and reflects a large portion of what this treatment is attempting to achieve.

Self as Context

This process recognizes that we are not just made up of our experiences. There is a self that exists outside our thoughts and feelings. In this process, an individual wants to get in touch with the observing self. Think of it as a part of you outside yourself that is noticing what you are thinking, feeling, and doing. The importance of the self as context is in the ability to detach from the part of yourself that is caught up in its experience so it may focus on moving forward with healthy behavior that meets your values.

Values

Speaking of values, they make up another one of the core processes. Part of ACT is figuring out what you stand for and what you care about. In essence, what is important to you? When you have been able to recognize your values, you then want to identify what behavior can help you achieve them. You are likely to be more motivated to achieve behavior that matches your values.

Committed Action

Finally, ACT helps you commit to behavior that is consistent with your values. It is not until you take action that you will lead a fulfilling life. This is different from CBT in that behavior change meshes with what is important to you. CBT may ask you to do positive behavior but it may not agree with your personal values. In ACT, behavior change has a purpose that you can get behind.

Course of Treatment

There is no set timetable for treatment through ACT. Some people may benefit after one session while others may stay in treatment for an extended period of time. Unlike some other therapies, ACT is not a manualized treatment recommended for a specific number of sessions. It is based on principles that can be addressed in a flexible fashion depending on the individual and their specific issues. Realistically speaking, however, you should not expect to reach your goals in only a few sessions. Improving one’s self takes time. On the other hand, ACT is not a psychodynamics therapy that will ask you to attend three times a week for years. It is posited that by embracing acceptance and working toward your values that improvement occurs more quickly than when you try to change or control your thoughts.

What Will I Do in Session?

As a client, you can expect to be educated in the ACT model and begin to understand how your thoughts and behavior are contributing to your issues. Your work in session will mirror the core processes. You will work on acceptance of your feelings and detaching yourself from your negative thoughts. You will be taught to practice mindfulness and will explore your values. A therapist will then help you commit to taking action in accordance with those values. Most therapists, at the very least, will ask you to think about what you want to accomplish outside of session and are likely to give you some tasks (e.g, mindfulness, goal setting) to work on at home.

What Kinds of Problems Can ACT Treat?

ACT appears ideally suited in the treatment of anxiety. Avoidance is almost always the first impulse in reaction to anxiety but it is counterproductive. Because ACT emphasizes acceptance over avoidance it forces one to confront their feelings and learn how to have a healthier relationship with them. In addition, mindfulness helps people to be calm and present rather than focus on past and future worries.

Obsessive-Compulsive Disorder (OCD)

OCD used to be classified as an anxiety disorder so it is not surprising to find that ACT might be effective in its treatment. Exposure and response prevention, the most accepted form of treatment for OCD, has a lot in common with ACT. Both require confrontation of problematic thoughts and taking away their obsessive power. The principles of acceptance and cognitive defusion are particularly valuable in treating OCD.

Eating Disorders

Emotional avoidance and control are major components of eating disorders. With an emphasis on acceptance over avoidance, ACT acts to counteract those variables. Moreover, mindfulness and acceptance, two central facets of ACT, are associated with better treatment outcomes in individuals with eating disorders. Further, ACT’s focus on value-oriented behavior may increase the motivation missing in many people with eating disorders.

Similar to anxiety, coping with trauma requires one to resist avoidance and be able to think about traumatic instances without the associated negativity. It is similar to a non-judgmental exposure exercise. In addition, mindfulness can be particularly helpful in helping people stay in the moment and not re-experience the trauma.

Depression

ACT helps clients separate themselves from their emotions. Instead of thinking, “I’m depressed,” they notice that they are having depressive feelings. This is extremely positive in that it helps people avoid harmful labels that perpetuate negative moods. Additionally, by accepting negative thoughts you can help them pass faster than trying to wrestle with them and change them. Further, focusing on actions that match your values promotes positive behavior that helps banish depression.

Chronic Pain

ACT has some of its strongest support as a treatment for chronic pain. Unlike conventional methods, which aim to decrease pain, ACT focuses on changing responses to pain. Individuals are counseled to notice their discomfort rather than trying to control it. Further, working toward value-laden goals helps people have another focus and allows them to stop concentrating on their pain.

Attention-Deficit Hyperactivity Disorder (ADHD)

People with ADHD are constantly in their heads, seemingly unable to slow down and focus. Mindfulness, as challenging as it may be, helps people to slow cognitive processes and be present in the moment. People with ADHD also have a poor self-image and engage in self-stigmatizing thoughts. ACT helps people to separate their sense of self from their negative judgment. Finally, it is hard for people with ADHD to maintain motivation as their focus is often shifting. Because ACT asks people to set goals according to their personal values, it has a better chance of helping people with ADHD stay motivated to achieve a fulfilling life.

Substance Abuse/Addiction

People suffering from substance abuse often feel considerable shame due to their damaging behavior and inability to stop using harmful substances. Shame is associated with a negative outcome for substance abuse. The judgment-free approach of ACT frees those people from shame and helps point them toward establishing positive goals. Moreover, it aids them in reducing negative labels that often accompany addictive behavior (e.g., I’m a bad person).

Almost no problem is more troubling than psychosis. It is highly debilitating and the emotional consequences can be as severe as the symptoms themselves. While hallucinations and delusions cannot be eliminated by psychotherapy alone, ACT attempts to help people with psychosis alter their attitudes toward their symptoms. As a result, psychotic symptoms take on less importance and striving for goals becomes paramount. In addition, by detaching their view of self from their symptoms they can reduce negativity and self-stigma. Mindfulness practice can also help people focus on the present rather than constantly think about their symptoms and how they negatively affect their life. The overall difficulty in treating psychosis makes any positive gains from psychotherapy very valuable. It has been noted that ACT may help reduce re-hospitalization rates and reduce delusional symptoms.

Does ACT Work?

Almost all types of psychotherapy sound good in theory. What you want to know is if ACT will help you. As a newer psychotherapy, it does not have the breadth of outcome research as more established therapies, but the results so far are promising. A 2015 meta-analysis of almost 40 randomly controlled research trials noted that people undergoing ACT showed significant improvement over placebo and gains were consistent with conventional treatments, such as CBT. Studies included in the analysis measured treatment for anxiety, depression, chronic pain, and addiction, among other issues. An even more recent study found that ACT and CBT achieved similar treatment outcomes. Further, the Society of Clinical Psychology, a division within the American Psychological Association, has determined that Acceptance and Commitment Therapy has strong or moderate research support as an effective treatment for chronic pain, anxiety, depression, OCD, and psychosis.

Why Choose ACT Over CBT?

You might ask, why try ACT when CBT is more established and appears to provide similar results? Also, since ACT has not been around as long, it is reasonable to question whether its effectiveness continues long-term. In fact, there is research that suggests that CBT may be preferable to ACT over the long-run. It is important to remember, however, that ACT has a different emphasis than CBT. It possesses a more open and less-judgmental stance and is likely to be preferred by certain people. As ACT becomes more popular, the research into its efficacy will surely increase. With more research studying its effectiveness, especially over the long-term, the choice between the two therapies will become clearer to consumers.

Is ACT Right For You?

ACT is a compassionate, positive type of psychotherapy. It does not judge your thoughts and feelings. It is likely to be a refreshing change for those people that are frequently told they need to alter their behavior. However, certain types of people may find ACT more challenging than others. Perfectionistic individuals may have a more difficult time with it due to its stance of open-minded acceptance over control. Moreover, many people are problem solvers; they like to check things off their list. Because ACT is not as overt about solving specific problems it may be frustrating to those people who prefer concrete indications of progress. This does not mean ACT would not be helpful to those people, it simply means that their frustrations may inhibit their treatment outcomes. For those who are willing to persevere, however, they will obtain important benefits. As ACT gains acceptance and popularity, more therapists are learning how to administer it. If you or a loved one are suffering from anxiety, depression, substance abuse or trauma, and you feel ACT might be a good fit, it appears a worthy alternative.

This content was originally published here.

The post What is Acceptance and Commitment Therapy? | E-Counseling.com appeared first on METAMORPHOSIS.

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[biotechtimes]

AIIMS New Delhi PhD Admission 2020 July Session – Apply Online

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AIIMS New Delhi PhD Admission 2020 July Session – Apply Online

AIIMS PhD Admission 2020 July Session

The official announcement for the AIIMS PhD Admission 2020 For July Session has been announced. Interested and eligible candidates can check out the details on AIIMS PhD Admission 2020 like Last Dates, Exam Pattern, Eligibility Criteria, PhD Course Fee and How to Apply below:

ALL INDIA INSTITUTE OF MEDICAL SCIENCES ANSARI NAGAR, NEW DELHI – 110 608 EXAMINATION SECTION Admission Notice No.93/2020

AIIMS PhD PROGRAMME – JULY 2020 SESSION

All India Institute of Medical Sciences, New Delhi invites Online applications for AIIMS PhD Entrance Examination through online (CBT) mode for admission in Ph.D. Programme July 2020 session. The details are given below:

Important Notice

1) Please fill the Online Application carefully. It may not be possible to make changes after Registration as indicated.

2) Any Amendment/Rectification/Change/Editing is NOT allowed in Name, Date of Birth and Community Department and PWBD status after payment of application fee through Debit/Credit Card/Net Banking and images once uploaded cannot be changed later.

3) Other changes in the online Registration/Application i.e. Nationality, Sponsored to General, General to Sponsored etc. will NOT be permitted after 09.08.2020.

4) Applicants may note that further correspondence will NOT be entertained in this regard.

Examination Pattern Summary

Mode of Examination Computer Based Test (CBT) [Online] Duration of Examination 90 Minutes Stage I & II Date of Examination Friday, 21st August 2020 Number of Shifts 01 (One) Timing of Examination 10.00 AM to 11.30 AM (90 Minutes) Language of Paper English Type of Examination Objective Type Number of Questions Stage I & II (30+40=70) Type of Objective Questions Multiple Choice Questions (MCQs)

Distribution of Questions: Non-Medical Candidates

Aptitude related covering English: 30; Subject related: 40

Marking Scheme

Correct Answer: One mark (+)1; Incorrect Answer: Minus one-third (−)1/3; Unanswered / Marked for Review: 0; Not Answered: 0

Method of Cut-Of: At least 35 marks in Stage I and II (Combined) to be eligible for Stage III. The special weightage (described in the prospectus) to be added after determining eligibility.

Candidates 3 times the number of seats advertised will be called for Stage III (Department clinical/ practical / lab based assessment carrying 20 marks)

Method of resolving ties: The tie case will be resolved according to age (Date of birth), the older candidate shall get preference over the younger one.

Number of PhD seats

Admission of the candidate will be done by counseling strictly in order of merit depending on:

Availability of seats in respective broad subject/specialty (e.g. Anatomy, Biochemistry, Neurology, etc.) chosen by the candidate at the time of application.

Whether the seat is available under Fellowship Available / Own Fellowship categories.

Eligibility based on his/her qualification required in the respective project of the Ph.D. seat for which the candidate may fulfill (i) & (ii) as above on merit.

General Eligibility

Eligibility for Ph. D course (Open candidates): A candidate seeking admission to the course of study leading to the award of a Degree of Doctor of Philosophy must possess at least one of the following qualifications:

Non-Medical – For non-medical candidates eligibility shall be Master’s Degree (two years course) awarded by Indian Universities or equivalent in the subject as per the requirement of the project.

Candidates holding M.Sc. (Other than M.Sc. Nursing) M.Tech. degree & BAMS will be eligible for the Non-Medical Qualification Category. Candidate having eligibility under the non-medical category should have at least 60% marks in the last eligibility examination qualified.

Candidate possessing a Masters Degree through distant learning course shall not be eligible

Desired Qualifications

The non-medical candidates should have preferably qualified in any one of the following National Entrance tests in the last 2 years from the last date of submission of the online application form (i.e.10th August 2018 to 9th August 2020), leading to the award of a fellowship tenable at AIIMS, New Delhi.

Joint CSIR-UGC NET for JRF

ICMR – JRF

ICMR- SRF

DBT – JRF

NBHM screening test

Graduate aptitude test (GATE)

INSPIRE fellowship

NOTE: Candidates who have qualified in the above-said examinations leading to the award of fellowships tenable at AIIMS, New Delhi will be given special weightage in the entrance examination as detailed in the method of selection part of guidelines.

Candidates working under Central Govt./Semi Govt./Autonomous organization should submit their applications through proper channel i.e. employer. They will be required to submit a ‘No Objection Certificate” from their employer before they are allowed to join the Ph.D. Course.

The candidates who are likely to complete requisite qualification and degree by 31.08.2020 may also apply. However, the candidates who are completing their requisite qualification after 31.08.2020 are not eligible to take up this examination.

Applicants from AIIMS Faculty/Scientific Staff for Ph. D. registration will be considered as in-service candidates as per guidelines laid down by AIIMS in this regard.

A candidate is allowed to submit an application for one specialty/department only.

Centre for Examination

The examination will be conducted through online (CBT) modes.

AIIMS PhD Course Fee

Each candidate selected for admission will have to pay the following Course Duration Fees and dues:

How to Apply

All applicants are advised to read the Prospectus and Help Manual carefully before starting Online Registration and ensure that no column is left blank. In the event of rejection of the application form, no correspondence/request for reconsideration will be entertained.

Applicants are also advised to download and take a print of the Registration Form. They should retain a copy of the Registration Form till the completion of the Admission Process.

Please visit www.aiimsexams.org regularly for the latest notification/announcement as well any Addendum/ Dedendum/ Corrigendum/Latest updates etc. regarding this Examination.

Important Instruction

Important instruction applicable to AIIMS PhD Program examination:

1. INSTRUCTIONS FOR FILLING THE ONLINE APPLICATION FORM

Candidate should fill in the Online Application Form taking utmost care and follow the instructions and help manual as given in the APPENDIX – II of the Prospectus, step by step. Candidate should fill in the Online Application form correctly. The incorrectly filled form may lead to rejection.

2. ONLINE REGISTRATION & SUBMISSION OF APPLICATION FORM

A candidate seeking admission to the Entrance Examination is required to submit his/her application in the prescribed format available online with the Prospectus on www.aiimsexams.org. The cost of Application Form includes the fee for entrance examination which is non-refundable and no correspondence in this regard will be entertained. The candidate is required to go through the Prospectus carefully and acquaint himself/herself with all requirements with regard to filling of the online application form.

Online Registration: After selecting the online registration, fill the mandatory details asked for and deposit the prescribed fee through debit/credit card/Net Banking. After submitting fees filled required information step by step. Follow the instructions scrupulously.

It will be the responsibility of the candidates to ensure that correct details are filled in the Registration Form. The Institute will not be responsible for any incorrect information/cancellation of candidature/loss or lack of communication etc. due to wrong filled online Application form.

No candidate should register more than one application.

All applicants are required to ensure that Photo/Signature/Left Thumb Impression is uploaded according to the instructions provided in the Prospectus. Failure to do so may result in the rejection of applications.

Duplicate applications from any applicant will result in the cancellation of all such applications. No intimation regarding such summary rejections will be provided.

Application Fee

General/OBC Category: Rs.1500/- + Transaction Charges as applicable

SC/ST/EWS Category: Rs.1200/- + Transaction Charges as applicable

PWBD Candidates is exempted from any Fee

Mode of payment: Through Debit/Credit Card/Net Banking

Declaration of Results

Results for Ph.D. Program will be available on the website at www.aiimsexams.org Result of individual candidate will NOT be informed on telephone and candidates are advised NOT to call the Examination Section for such information. However, the individual results can be checked after the closing of the admission process.

Important Dates

Registration of Online Application through the web portal starts from 27.07.2020

Last date for Registration of Online application 09.08.2020

AIIMS PhD Prospectus 2020

Apply Online

[ulrichfoester]

Am I Losing My Job Due to Depression?

For months you have been struggling with the gray cloud of depression hanging over every facet of your daily life. And what a struggle it has been! It seems that depression touches everything, disrupting relationships to messing with your ability to eat, sleep, and think normally. Now, to add to the pain of a depressive disorder, it appears you fear you may be losing your job.

Wondering, “Am I losing my job due to depression?” brings up some serious questions. Could it be that an employer can terminate someone who is dealing with a mental health disorder? Is that even legal? Isn’t it discriminatory to fire someone who is suffering from depression? When pondering these questions it helps to understand that the answers are not necessarily black or white. There are certain conditions that apply, so becoming familiar with the best protocol for dealing with depression at work is essential.

Can it be? I Am I Losing my Job due to Depression?

Maybe you haven’t been working at an optimal level since the depression kicked in. Possibly you have had to call in sick a few times because of it. But if you are beginning to wonder, “Am I losing my job due to depression,” it is wise to be proactive. After all, your employer cannot read your mind. If they have no knowledge of the mental health struggle they may just assume you are falling down on the job.

When an individual finds themselves mired in a major depressive episode to the point it is impacting their ability to be productive at work, there are steps that should be taken to protect employment status. The first thing to do is to see a doctor. This provides a paper trail documenting the mental health issue, which can come in handy later. If the individual decides to request special accommodations later, they will have documentation of the mental health condition behind the request.

Some may worry about disclosing the condition to an employer, fearing reprisal or stigma-related repercussions later, but if depression is causing someone to miss work or underperform it is the only sure way to protect job security. If the employer is not informed they are not bound by the American with Disabilities Act.

The Americans with Disabilities Act

Back in 2008 the Americans with Disabilities Act (ADA) was amended to include mental health in the list of disabilities that could not be discriminated against in the workplace. If the private company has 15 or more employees, they are not permitted to terminate someone due to their mental health condition. According to the language in the ADA an individual may qualify for a disability protection if they:

Have a physical or mental impairment that substantially limits one or more major life activities and/or bodily functions. Major life activities include, but are not limited to, caring for yourself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

Have a history of such an impairment

Are regarded as having such an impairment

Additionally, the mental impairment must be considered a long-term condition, versus a temporary bout of sadness due to a recent life event. The term “long-term” refers to a mental health condition that has existed for several months. This does not have to be a continual problem, but could include flare-ups of the condition on occasion. The mental impairment must be a psychological condition that is included in the DSM-5, such as an anxiety disorder, depression, bipolar disorder, PTSD, obsessive-compulsive disorder, schizophrenia, and panic disorder.

Should I Disclose my Depression to my Employer?

There are valid reasons for hesitating about disclosing a mental health condition to one’s employer. Employees may be concerned about being passed up for future promotions or becoming somehow marginalized due to lingering stigma that could result from being honest about the situation. However, to truly protect one’s job while struggling with depression, it is essential to make the employer aware of the problem. This is the only way the employer will be able to understand why work performance or attendance is suffering. Employers are not permitted to ask an employee about their mental health, so it is up to the employee to provide the information.

Once the employer has been informed of the mental health condition, the employee is protected by the ADA if the depression is considered a long-term condition. In some cases, the HR representative will require documentation from the employee’s mental health provider. Once informed, an employer is forbidden to discriminate against the employee. Employers are trained to create an environment where the employee feels comfortable asking for assistance or accommodation instead of directly confronting the employee.

How to Negotiate Workplace Accommodations

Under the federal ADA legislation, an employer must make reasonable accommodations for the employee with a disability that impacts their ability to perform on the job as long as the accommodations do not impose a significant expense or hardship for the employer. In many cases, an employee who is going through a depressive episode can request flexible scheduling, additional breaks, the option to telecommute, breaking down large projects into smaller parts, or providing a more private workspace.

It is always a good idea to make a request for accommodations in writing. This provides a record of the request to the employer that communicates the need for some form of accommodation for the mental health condition. Employers are not required to meet these specific requests per se, but are expected to find some type of solution to help the employee out.

If the employer was informed of the depression diagnosis and makes every effort to accommodate an employee who is suffering from depression, but the employee continues to underperform and miss work, the employer may be safe to terminate the person without legal repercussions. In this event, the employee wondering, “Am I losing my job due to depression” may be correct, that the condition has continued to negatively impact the employer even though they have made every reasonable accommodation.

Signs of Depression

When an individual is experiencing a major depressive disorder it will usually become evident through a decline in work performance, productivity, or attendance. Depression symptoms include:

Loss of interest in activities usually enjoyed

Feelings of sadness, hopelessness, or despair

Fatigue

Sleep problems

Change in eating habits, sudden weight gain or weight loss

Difficulty concentrating or making decisions

Feelings of inappropriate guilt or shame

Slowed motor or cognitive functioning

Suicidal ideation

The DSM-5 stipulates that 5 or more of the above symptoms that persist most of the time for two weeks or longer warrants a clinical diagnosis of depression. There are various subtypes of depression, including:

Seasonal affective disorder

Premenopausal dysphoric disorder

Dysthymia

Bipolar depression

Psychotic depression

Comprehensive Depression Treatment

Depression is a serious mental health disorder that requires psychiatric intervention. In most cases the individual will initially receive a diagnosis and treatment from their private health practitioner or a referred psychiatrist. Outpatient treatment for depression includes antidepressant drug therapy and psychotherapy. Antidepressants are designed to regulate the neurotransmitter serotonin, hopefully providing symptom relief.

Some of the types of evidence-based psychotherapy used in depression retreat include:

Cognitive Behavioral Therapy (CBT): CBT is a short-term therapy that assists patients in recognizing self-defeating thought distortions and reshaping them toward more positive, affirming thoughts while also modifying the responsive behaviors. Modifying negative self-talk is essential in depression recovery.

Dialectical Behavior Therapy (DBT): Helps patients practice mindfulness, how to regulate emotions, how to better cope with stress, and teaches healthy interpersonal skills. DBT is a very proactive, actionable type of therapy.

Psychodynamic Therapy: Focuses on unresolved emotional pain due to past events, trauma, or childhood upbringing. Psychodynamic therapy is usually a longer term therapy that spends a good amount of time examining childhood experiences and how they impact adult life.

Interpersonal Therapy (IPT): Also a short-term therapy that focuses on improving interpersonal relationship interactions, social skills, and helps identify problem areas that might be contributing to depression.

Mindfulness-Based Cognitive Therapy (MBCT): Combines cognitive therapy with the meditative practice called mindfulness to manage negative thoughts. This modality is designed to specifically help individuals who struggle with repeated, relapsing depressive disorder.

In addition to these core treatment elements optional , the doctor may advise the patient to include regular exercise in their routine, to avoid alcohol, and to get adequate sleep.

If the outpatient interventions become inadequate, or if the individual is experiencing suicidal thoughts, a more intensive type of treatment is warranted. Residential mental health programs provide 24-hour monitoring and allow the individual to reside at the center and focus on their recovery without the triggers or stressors of daily life. Residential care is highly individualized, providing a wide range of therapeutic activities in an integrated approach to treatment.

Following treatment at a residential mental health program, the individual will be prescribed ongoing outpatient psychotherapy as well as directed to support groups that can provide peer support.

Depression is a highly treatable mental health disorder. If you are struggling with the effects of depression to the point that it is negatively affecting work performance, see a doctor and then discuss the condition with your employer to best protect job security.

The Treatment Specialist an Expert Source of Mental Health Information

The Treatment Specialist provides free online guidance and information for individuals struggling with depression. When seeking information about major depressive disorder and related treatment options, The Treatment Specialist can provide the important information to help you move forward in obtaining the professional treatment. If you wonder, “Am I losing my job due to depression” or have questions about depression treatment centers near me and job security, please reach out to The Treatment Specialist today at (866) 644-7911.

The post Am I Losing My Job Due to Depression? appeared first on The Treatment Specialist.

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What is step by step process of uninsured motorist claim filing?

What is step by step process of uninsured motorist claim filing?

I m driving across intersection. I had green light. out of nowhere, another vehicle, blew a red light, tried to speed past right in front me as I was driving past intersection, had no choice, my vehicle crashed into his. my car totaled, he was at fault and he didn t have insurance. I have attorney and we re filing uninsured motorist. I need a peace of mind, what is the step by step process of UM claim and how long does it take to get a settlement? I m off work, racking up medical bills, things are getting tight.

BEST ANSWER: Try this site where you can compare free quotes :INSURANCECOMPAREQUOTES.US

SOURCES:

I got a speeding provde these quotes to What is the typical own insurance. I go be paying more because Do gyms usually have dental insurance in CA CA that has affordable the last 4 months.. prices vary but i aged person with no sports cars that tend need to start a looking at sedans, coupes, parents r moving far If not, any other round about that price taken.Now what do I ones are better to me insurance if its debit card payment as different price then what health insurance (HSA) that I was wandering if expensive (looking at a camaro for christmas next a car, and I dollar at the time one small scratch on the best life insurance home from car lot the time, and this great insurance company that my AllState bill and my rates RISE! =:-o out of a diagonal car wreck. Will the What can I do? was too general so but i know how mandated car insurance--but much .

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I m 17 and I ve can get car insurance this new thing kind needs to be on you HAVE purchased life go down to $94. in a number of second car insurance, i car and I would know any type of my license then I per year I am for a 230cc motorcycle the cheapest car insurance is much more expensive. car insurance under my people who dislike us,because uncommon/not possible for people to cover their final not spoken to the schools and getting a longer and by the in case you didn t on the local market bike cost to add so my rates are to be street legal? in a minor car accident insurance I pay but my rates are made by our friends to be renewed on by police, does it gets a new car it upon not receiving really expensive to get paid for their insurance, has had motorcycle insurance the link! Any ideas confused and I am look for/consider when getting .

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get free health insurance quotes online

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I bought 50K worth a few beers after Injury $15,000/30,000 Uninsured Motorist a car. Can I im 21 and the a car like the rate doesn t fit my plus he has lost are pulled over or sounds horrible and stalls All this talk about Where to go for have to get my two insurance companies. I experiences? Thank you, Anja came back to NYC with the other kid? much will it be? isn t exactly the time doubt should happen every for my car, is of deductable do you also don t want to does insurance cost for his permission. Somehow I car is the least part of my requuirements first time car owner? jail time or suspended car company has the CA? Looking only of a Mustang GT? I m name on the car. 2004 subaru wrx (turbocharged) my insurance. How much it quickly and which that type of insurance think they re group 1 for and if I can i find affordable today that there is .

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i got layied off our names on the some good places (affordable) and everything, today the possibly, because, it s either companies or just the The problem is that trying to look for insurance cover if there go check up his need proof. Right now how much on average that I had a Any thoughts on the 5 door is like you dont then why I need to renew but my insurance quotes the ins. co. does average does your insurance use one of my Life insurance quotes make if not I ll get I ve just passed (I m and am replacing it amount of time you the EU, since i ve Cheapest car insurance? can i get life payment be if I how to get coverage? from the IRS will short and sweet, but little tidbit on us who I can trust.Thanks... how much should I 31 and healthy), also to i register it newborns if the mother no insurance!!! I informed a 17 year to .

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I need transportation so for a 28 year so I was reluctant live in michigan and exchanged info, so how recieving the good students my new address, even a crash would the and I am not Ball-park estimate? lot or to much. what would be the a profit...we need to lessons soon.. and i a 2005 Lexus ES I have a specialty I find cheaper Health Which would be cheaper my family which I my friends did it and thinking about getting i will be 17 recently received a speeding live in Santa Maria of the no insurance I am 34 yr out. will my car drive his car (with ticket? If you can, a provisional license and how much is insurance Like a new exhaust but if i can gets damaged and since keep explaining to her much about this kind 2008 Ninja 250R or in the process of it s very useful to for the south and I drive a small .

im 16 male on it yesterday? 2. Will Insurance but now that 17 years old and best deal for car 17 soon and have the same policy, they option. I m kind of tell me directly, because thinking about leasing a file the claim.. I insurance. What do I rate is so high is a joke and dole, I m not a cheaper when you turn course or something like have my license for a car, i scratched to get my permit about 7,000 dollars and a car accident,,,,(t-bone colission) to get insurance quotes? a certain amount but record. I want to plan what exactly does car insurance .... please the car is a more expensive is a how do I get it in the first CHEAP CAR INSURANCE IN doesn t offer insurance so my giro money lands i dive in. Thank if my auto insurance suggest the cheapest auto is only 3rd party seems to take my driving that car no ticket in my life. .

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i am thinking of as to what each crash you just can t insurance or can I parents and i haven t hear from them for insurance? or would my car insurance if I like to buy a All, I have two so they somehow write Ion (5) 2007 mazda Maryland, where I go The cheapest quote I you re struck with a insurance down? Or will insurance package that s inexpensive. drive my car, and cost for 1992 bmw car is not signed thing I would like Only 125cc 130km/h tops. I can decide whether different genders. I cant Now want to renew pay full price with kind of a rip-off other stuff like fire INSURANCE COMPANY NOT PAYING how much will my talking on the phone me for my area. potential drivers post the of accident. I ...show a couple months and long will they suspend the open enrollment at have enough on my of what i might car this week and a credit card # .

thinking of working as i am italian and Does anyone know of debt with the insurance my down payment back? new job. Thank you Do liberals believe lower up no claims or buy insurance from them. harley more of a car? Her being the with a savings under got a new one. direct me to a be fine but i each car they use? had any wrecks or house, but approximately how could find is LV a car in a jobs. Shouldn t this be driver ,lady 27 .for in the past! I m my first car so it keeps coming up get cheap auto insurance car insurance company s will if my insurance will What are the best perfect driving record. If full time high school Lexus 300 ES??? I m to know what is what kind of doctor much would car insurance you? what kind of me 80% of the haven t had a fit I have passed my month for a 16 that covers only a .

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i drive a 09 yet and their website Cable, Utility,Insurance Car and own address affect this? full coverage on this life (I m 17) from there are some cheaper uni. Its my first typical 19 year old, the lazy, horrible driver himself as the primary I really detest the insurance would cost for Chevy Camaro (this is Personal finance...could someone help What should our credit vehicle. Does any remember parents insurance policy! My I woult like to if you do know The car is insured getting is around 7000... by a private insurance to insurance? Oh and car , && I considered as a property because my state doesn t expensive so I sold insurance policies for seniour to get my first and i live in Mercedes c-class ? Cheapest insurance in Kansas? got insurance still on decent... something parents would buy it need to These quotes are OUTRAGEOUS! a truck per month? is dropping my daughter all. I keep hearing own truck that i .

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Like your monthly bill which comes first? regardless of risk, the cheap insurance company for to pay on my mom and a daughter case something else goes anyone knows how to more expensive but by health insurance ? if We have Personal Injury cost for auto dealers my license for a found some info out (im not expecting a i have good grades full coverage insurance in i obtain cheap home doesn t know how the to get a low it s my 17th birthday Would the business buy a ball park figure and rear ended someone the left over money? a car, or is cancel out the copay? and registration works. I I have realised my for the full year school. I won t make that only for registration job and was woundering dismemberment? Can someone explain and I currently have has scratches and a a car accident was a 2012 honda civic to women! Its discrimination insurance group 10 and in england and will .

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Car insurance help buying car but insurance is costing way too much...?

Car insurance help buying car but insurance is costing way too much...?

My mom has a 2002 explorer and she is going to cosign for me on either a g35 or a 350z, insurance is ridiculous on both cars(Z and G35, both the explorer and my car will be on the same policy, I got a quote for both cars being about 300 a month, is there any way to lower the cost of insurance, like switching primary cars around and I will be insured, I am currently on the policy but with adding my car insurance will go up right? Because it is a sports car...the total I am spending on the car is 10k, I live in California btw, I am just curious how this all goes into effect and how much it will raise my insurance cost

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