Attachment

 

What is Attachment?

> The capacity to form and maintain healthy emotional relationships which generally begin to develop in early childhood.

> Enduring bond with ‘special’ person

> Security & safety within context of this relationship

> Includes soothing, comfort, and pleasure

> Loss or threat of loss of special person results in distress

What is the Attachment Theory?

> John Bowlby (1907-1990) British Child Psychiatrist/Psychoanalyst

> He was the first attachment theorist, describing attachment as a “lasting psychological connectedness between human beings.”

> Bowlby believed that the earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout life.

> According to Bowlby, attachment also serves to keep the infant close to the mother, thus improving the child’s chances of survival.

> Disturbance/ Disruption of initial attachment bond between child and caregiver renders person insecure as an adult.

> The central theme of attachment theory is that caregivers who are available and responsive to their infant’s needs establish a sense of security in their children.

> The infant knows that the caregiver is dependable, which creates a secure base for the child to then explore the world.

Adult Attachment

> From our childhood experiences we develop schemas that are connected with dependability of others and the worth or ‘lovable-ness’ of self.

> These schemes are easily maintained across time into adulthood as they are reinforced over and over again.

> In the literature these schemas are referred to as attachment styles.


Types of Attachment Styles

(Hazen & Shaver 1994)

> Can I count on this person to be there for me if I need them?

> Are others trustworthy and responsive?

> Am I lovable and able to elicit caring?

ANSWER: NO

Avoidant

fearful- tend to recognize their need for others, but avoid others and frame them as untrustworthy.

Dismissing- Tend to deny their need for attachment and frame others as untrustworthy.

ANSWER: MAYBE

Anxious/Preoccupied

Tend to cling to attachment figures or aggressively demand reassurance, often fearing that they are somehow deficient or unlovable.

ANSWER: YES

Secure

Tend to believe that others are reliable and see themselves as lovable and worthy of care.

***A sense of security provides better

1.better Affect regulation

> less reactivity

> less hyper arousal

> less under arousal

> more acknowledgement of support seeking

A Sense of Security Provides

2.Better information processing

> more flexibility, curiosity, openness

> tolerance of ambiguity and uncertainty

3.Better communication

> more ability to collaborate, to disclose, more assertive and empathetic

A Sense of Security Provides

4.Sense of Self (love)/ is more positive.

How This Applies to Adults

> Seeking and maintaining contact is viewed as the primary motivating principle from childhood into adult relationships

> A secure connection offers a safe haven and a secure base.(needs for connection, comfort and caring are key)

> Accessibility and Responsiveness builds bonds

> Separation Distress – a predictable process.

> Protect

> Cling and Seek

> Depression and Despair

> Dettachment

 

Attachment Styles are working models of self and others

> The way we see ourselves

> The way we see others

> The way we see relationships

> Predict the way we will respond

Role of Emotion

> Emotions will automatically arise when an attachment figure is perceived as inaccessible or unresponsive.

> Attachment Injuries

> An Attachment injury occurs when one partner violates the expectation that the other will offer comfort and caring in times of danger and distress.

> It is characterized by an abandonment or betrayal of trust during a critical moment of need.

> When a partner cries out for help and there is no response, the sense of basic trust that is the foundation upon which the welfare of their bond depends is shattered.

 

Secure Attachment

Believes and trusts that his/her/their needs will be met.

Parent: Quick, Sensitive, Constant

Child: Secure, Exploring, Happy.

 

Avoidant Attachment

Subconsciously believes that his needs probably won’t be met.

Parent: Distant, Disengaged

Child: Not very explorative, Emotional

 

Ambivalent/anxious Attachment

Cannot Rely on his needs to be met.

Parent:Inconsistent, Sometime sensitive, Sometimes neglectful

Child:Anxious, Insecure, Angry

 

Disorganized Attachment

Severely confused with no strategy to have his needs met

ParentExtreme, Frightened, Frightening, Passive

Child: Depressed, Passive, Angry, Non-responsive.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REf: OTMH, 4th Floor., attachfromscratch.com

 

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Assertive Rights and Responsibilities

ASSERTIVE RIGHTS:
1. I have the right to put myself first. In fact, my 1st responsibility is to myself. Only when I am meeting my own needs adequately, can I give to others freely, without expectations.
2. I have the right to be treated with respect.
3. I have the right to decide what to do with my own property, body, and time.
4. I have the right to evaluate my own behaviour, thoughts, and emotions, and to take responsibility for their initiation and consequences upon myself.
5. I have the right to make mistakes and be responsible for them.
6. I have the right to make self-evaluations without worrying about what other people think.
7. I have the right to not offer reasons or excuses for justifying my behaviour.
8. I have the right to make my own decisions, to make illogical decisions AND to change my mind. I have the right to change my mind after I’ve said YES.
9. I have the right to say, “I don’t know, ” “I don’t understand,” “I don’t care.” and “I don’t want to be involved.” Without feeling inferior.
10. I have the right to say “no” without feeling guilty or selfish.
11. I have the right to ask for what I want (realizing that the other person has the right to say no).
12. I have the right to have, and express my feelings.
13. I have the right to consider my own needs and to express my needs. I have the right to ask for help.
14. I have the right to judge whether I am responsible for finding solutions to other people’s problems.
15. I have the right to self fulfillment.
16. I have the right to be independent.
17. I have the right to dignity and self-respect.
18. I have the right to privacy.
19. I have the right to accept, or to refuse, challenges.
20. I have the right to change.
21. I have the right to choose not to assert myself.
ASSERTIVE RESPONSIBILITIES:
1. To assess my true feelings without exaggeration or under-estimating; to express my feeling(s) appropriately without demeaning someone else in the process.
2. To act in a responsible manner as much of the time as possible.
3. To think through my opinions and realize others can disagree with them.
4. To learn from mistakes, rather than punishing myself or others because of mistakes.
5. To reply as soon as possible or as soon as I am able, and without taking unreasonable amount of time.
6. To accept others’ answers respectfully.
7. To respect commitments to others as well as to myself; to allow sufficient time to fulfill commitments.
8. To think through my responses before answering.
9. To not impose my own values on others.
10. To express my needs and, if appropriate, work out a compromise.
11. To avoid “boxing in” myself or others by labelling or making judgement.
12. To acknowledge other’s choices and accomplishments.
13. To feel appropriate anger and sadness and to assert these feelings with the people involved.
14. To recognize anger, sadness, and joy, and see that these feelings do not interfere with others’ rights and responsibilities.

READ THESE ALLOWED TO YOURSELF:
My needs are equal to the needs of others
My needs are different from yours and need to be respected.
My recovery is the most important thing.
I can be assertive without being aggressive.
I’m moving forward in my life despite setbacks
I have the right to my own time.
I am not alone.
I am learning to cope with problems I cannot change/fix.
I am learning who I am and I give myself permission to do that.
I’m okay with nurturing myself.
I am learning to walk away from people and situations that no longer serve me.
I will be kind to myself.

ASSERTIVE STATEMENTS:
I can see you are angry/upset right now/and/or/ I am upset right now.  I need to take a moment away from this conversation.
That is a harmful comment.  That is a hurtful comment.
Will you lower your voice?  If you cannot lower your voice, I will
have to end the conversation.
Please take a  few deep breaths – you may not realize but you’re talking “at” me.
That makes me uncomfortable.
That’s unkind.
That’s not very nice.
I don’t appreciate…
That’s personal.
Wow, that doesn’t make me feel good at all.
That’s too far.

**step down approach – what your body language, and lower your voice, space the words out.**

Remember: It’s not selfless or selfish its self care.

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Smart Goal Setting

What are smart goals?

Smart goals are:

Specific
What is your goal?
How will you do it?
What actions are required to achieve my goal?

Measurable
How will I track my goal progress?

Attainable
Pick behaviours you can, or are willing to change first.

Realistic
Can I achieve this goal right now?
Can I fully commit to this goal?
How will I overcome set-backs in my goal?

Time-Bound
Set a time-frame for your goal
Include a specific start, goal and end date.
Set several small goals with shorter timelines within a long-term goal, to increase motivation and confidence.

Example Smart Goal

Specific: Increase my vegetable intake by 2 servings per day, by packing 1 snack baggie with 1/2 cup veggie sticks at lunch, and adding 1/2 cup veggies to my dinner plate.

Measurable: I will check off each day on my calendar that I achieve my goal.

Is this goal Attainable? Yes. I want to improve my meal planning skills, to benefit my nutrition and health.

Is this goal realistic?. Yes. This is a goal I can start immediately.

I will overcome set-backs by focusing on getting back-on-track the next day. I will use my calendar tracking to motivate me.

What is my Time Line?

Start date: March  11, 2017

End Date: None. I plan to make this a daily routine, and will track my progress each month.

Tips to help you reach your goal:

Set 1-3 goals at a time. Setting too many goals at once can make it hard for you to achieve them.

Record and track your progress, to help you stay focused and motivated!

Have a family member or friend work on your goal with you! Or, share your goal progress with others.

Plan a head. Consider, and be prepared for obstacles; and think about how you can overcome any set-backs.

Remember why your goal is important to you. This wil help you stau motivated when obstacles arise!

Celebrate your successes no matter how small. Find ways to reward yourself!

What should I do if I have trouble reaching my goal ?

Stay positive! Take time to reflect on what has worked so far, and think about what you can change going forward. Set-backs are normal, and should be expected. Think about:

Was my goal too big?

Was I working on too much at one time?

Do I need to focus on a different target behaviour?

What got in the way of my success?

What are some solutions?

Was my time frame realistic?

Modify your goal if needed, or start over if you need to.

 

 

smrtgoal.png

 

 

 

 

Reference: Brochure I found. Loblaws.

The Stress Vulnerability Model of Psychiatric Disorders

Psychiatric illness tend to fluctuate over time, with their severity increasing and decreasing at different points in time. An episode of an illness (or a relapse) occurs when symptoms are severe and functioning is impaired. Understanding what factors contribute to relapses can help people learn how to manage their illness more effectively, and to prevent relapses or decrease their severity.

Psychiatric illnesses fluctuate over time in their severity

The stress- vulnerability model of psychiatric disorders provides a useful way of understanding how different factors influence the course of mental illness. According to this model, the course of a psychiatrist illness is influenced by several factors: biological vulnerability, stress, medication, drugs and alcohol, coping skills, and social support. Each of these factors is described below, and illustrated in the accompanying diagram.

 

Biological Vulnerability

Each Person has biological vulnerability to different diseases. This vulnerability is determined by a combination of generic and other biological factors. For example, some people have a biological vulnerability to cardiac disease: some people have a vulnerability to specific types of cancer, and some people have a vulnerability to specific psychiatric disorders. Common psychiatric disorders to which people are biologically vulnerable include schizophrenia, schizoaffective disorder, bipolar disorder, major depression, and anxiety disorders.

Once a person has a biological vulnerability to a mental illness, that mental illness may either develop spontaneously or be triggered by stress. Even among people who have a psychiatric illness, vulnerability may differ from one person to another. On average, people who have a greater biological vulnerability to an illness experience more severe symptoms and difficulties.

Stress

Stress refers to something in the environment that forces the person to adjust in some way. Stress can take the form of specific life events, such as the death of a loved one, a major move, or being a victim of crime. Stress can also be caused by living in difficult conditions, such as living with people who are hostile and critical, living in unpredictable and dangerous environments, or living in poverty.

People who are biologically vulnerable to a psychiatric disorder and who are exposed to stress are more likely to develop that disorder. Once people have a psychiatric disorder, stress can cause relapses and worsen the course of the illness.

Stress can affect biological vulnerability, leading to symptom relapses.

Factors that affect biological vulnerability and Stress.

Although biological vulnerability and stress influence the course of the psychiatric disorder, they can be affected by several factors. Those factors include medication, drugs and alcohol, coping skills, and social support.

Medications

Medications for psychiatric disorders can decrease biological vulnerabiltiy. Medications are effective at both decreasing the severity of symptoms and preventing symptom relapses. People who take medications regularly and do experience relapses tend to have less relapses.

Alcohol and Drugs

Alcohol and Drugs use can increase biological vulnerability. Some substance can directly increase biological vulnerability, while other substances can decrease the beneficial effects of medications on vulnerability. People with psychiatric disorders who use alcohol and drugs regularly are prone to more frequent relapses of their symptoms.

 

Medications decrease biological vulnerability.

Alcohol and drugs increase biological vulnerability.

 

Factors That Affect Stress

Stress can be deceased by coping skills, social support, and engaging in meaningful activity.

Coping Skills

Coping Skills are strategies that people use to minimize the effects of stress. Examples of coping skills include relaxation, positive self-talk, problem solving, talking out one’s feelings with a friend or support person, exercising, journal writing, and artistic expression. People who have several different coping skills are less susceptible to the negative effects of stress.

 

Coping skills decrease the negative effects of stress.

Social Support

Social Support refers to the help and caring that people feel they can count on from other people. Supportive persons can include family members, friends, members of the treatment team, a clergy member, or anyone else with whom a person has a close relationship. Good social support can decrease the effects of stress. Supportive people can sometimes solve problems with a person and decrease stress. For example, if a man feels criticized by his supervisor at work, a supportive person can help him identify strategies for learning more specifically about his supervisor’s concerns. Supportive people can also help a person deal with the negative effects of stress. For example, if a woman has been a victim of crime, she can talk it over with a supportive person, and benefit from that person’s concern and empathy.

Social support and coping skills can interact with one another. People with good coping skills can obtain more social support by reaching out and engaging with other people. Supportive people can also improve others’ coping skills by helping them develop more effective strategies for dealing with stress. People who have more social support tend to experience fewer and less severe relapses.

 

Social Support decreases the negative effects of stress.

 

Meaningful Activities

Meaningful Activities are tasks that provide a strong sense of purpose and gratification to a person. Being invovled in meaningful activities helps people to structure their time and gives them somethign to look forward to every day. Examples of meaningful activities include work, going to school, parenting a child, doing volunteer work, caring for someone else, and being a regular participant at a peer support program. Having meaningful activities to engage in reduces suseptibility to stress, because people are actively pursuing their goals and are less focused on stress.

 

Engaging in meaningful activities decreases the negative effects of stress. V

 

Treatment Implications of The Stress Vulnerability Model

The stress- vulnerability model points to five ways with psychiatric illness (and their families) can improve the course of their illness and reduce relapses and rehospitalisation:

1. Take psychiatric medications as prescribed.

2. Avoid alcohol and drug use.

3. Increase coping skills.

4. Increase social support.

5. Engage in meaningful activities, such as work, school, and parenting.

Taking these steps can help reduce relapses or lessen the severity of relapses, and therefore can help people make progress toward their personal goals.

 

vulmodel

 

Reference: Unknown. Brochure

 

 

Getting Better Sleep

Are you a Lark or an Owl? or maybe you’re both and live on little sleep and caffeine.

Larks: Someone who wakes up early

Owls: Someone who stays up late (Starts projects at 10pm)

To get good sleep, try these:

Get plenty of physical exercise during the day. This helps to lower your stress level and make you sleep better.

Try to make your day meaningful and pleasant by giving yourself a sense of accomplishment, either through doing a task or sharing some time with another person.

Refrain from drinking coffee, colas, or chocolate, all of which contain caffeine which can disturb sleep if ingested within 2 to 6 hours of bedtime, depending on the individual response.

Large snacks or drinking excessively before bed cam cause indigestion and other problems.

Avoid taking naps during the day. This can upset the patterns of associating your bed with nighttime sleep.

Try to relax within two hours of bedtime. Reading a light novel or watching a relaxing television program will provide the body and mind with a “cool down” period before you sleep. Try not to solve your problems or plan your next day’s activities just before bedtime.

The traditional glass of warm milk and cinnamon has been shown to be a sleep inducer.

Smoking before bed can disrupt sleep because nicotine has a stimulating effect.

“Counting Sheep” can sometimes be helpful to lull you into sleep.

Fresh air in your room is important. Shut windows when there is a draft or the weather may be too cold.

If in a new environment, accustom yourself to the new room before it is time to sleep to help you feel more comfortable.

Make sure there are no lights shinning in your eyes.

Add or delete/remove linen for required warmth. Being too hot or too cold can keep you from sleeping.

Indigestion or pain such as a headache can keep you from sleeping.

If taking medication and you are still not sleeping well, inform your doctor.

A positive attitude about sleep is important. If you think you can’t sleep, you will likely have more difficulty in settling. Associate you’re going to bed with the thought that you will sleep well.

Use a comfortable mattress and pillow.

Form a habit of going to the bathroom before bed if you find that you are awakened by the need to empty your bladder.

If you do wake up in the middle of the night, don’t become upset. Often, it may only require a change of position or use of rhe bathroom and then you will settle again to sleep.

Establish a regular but flexible sleep schedule. With habit, sleep becomes more regulated.

If you still can’t sleep after trying to remedy the problem, inform your doctor.

A natural sleep makes you feel refreshed when you wake in the morning.

Below is a list of Sleep Disruptions:

Stress/racing thoughts

Mental psychosis/mania

Nightmares

Anxiety

Animals

Outside noise

Environment (new place, or too hot/cold)

Illness of self or partner (coughing, sneezing, clogged nose, pain, etc )

Caffeine

Sleep apnea

Self-consciousness thoughts with partner (will I snore, be an ugly sleeper, move too much, etc)

Hormones

Sleep attire

Fluid and food intake

Disruptions of routine

Medications

Varying sleep times

Napping during the day

Technology (Light from screen wakes the brain up)

 

Ideas for Better Sleep ZzZzZz

If you nap, try to slowly decrease your nap times. If you normally nap for 1.5 hours, set your alarm and try to sleep for 1 hour, etc.

Research study shows that making your bed helps people sleep better and makes you more productive overall.

Keep the room dark, get light- blocking curtains.

In the morning, open up the curtains to allow the light in

Natural supplement: Melatonin pills (talk to doc first)

Keeping a routine

Calming tea (chamomile)

Aromatherapy (lavender)

Calm music

Fresh air (crack windows a bit)

Turning your clock so you can’t see the time.

Meditation: Triangle/Diamond hands -place hands on your belly in a diamond shape and breathe

Meditation: Beam of Light- trace finger or imagine a beam of light travelling along your face in circles, relaxing each part of your face as you go along. From the nose up and over your eyebrow and around and under your eye, up to your forehead and down to your other eye and around and up to your eyebrow then down and circle around that same cheek then travel down to your chin and up over the other side and circle your other cheek, then over your lip and down around your chin again.

Meditation: Counting Down/Heavy Eye lids- Close your eyes. Say the number 10 to yourself, breath in nice and slow and deep, breath out slowly and open your eyes slowly and softly, then close your eyes and say number 9 to yourself, breath in and take a big breath then while breathing out open your eyes gently, then close your eyes and imagine the number 8, etc.

Count sheep 🙂  1 sheep, 2sheep, 3 sheep, 4. 5 Sheep.6 Sheep. 7 Sheep. Snore! Zz

 

 

 

Reference for this post is from OMTH, Oakville. 4th Floor.

 

Grounding Techniques

Grounding Techniques are designed to help you deal with painful, overwhelming feelings. Grounding can be done anytime anyplace, anywhere. You can practice the skills privately and no one has to know or you can ask for support. Do not focus on past or the future stay in the present. Do not judge things as bad or good, stay neutral. Do not journal or think negative thoughts.

Ways to Ground yourself

Find a special place in your home where you have placed safe, soothing objects.

Play a category game with yourself, ie think of types of dogs, bands from the 80s, 90s, types of cars, etc.

Describe an everyday activity in detail to yourself or to someone else.

Say an affirmation.

Read something positive saying each word to yourself.

Think of something funny.

Count to 10 or say the alphabet S l o w l y

Run cool or warm water or your hands.

Hold ice cubes in your hands.

Carry a safety object with you.

Connect your body with the environment, ie I feel my feet making contact with the floor.

Eat, Walk mindfully– noticing the subtleties of the activity.

Focus on your breathing and accompany a positive, pleasant word with each inhalation and exhalation.

Say kind statements to your self.

Think of all your favourites, ie colour, food, animals, season, TV show.

Say a positive coping statement ie, this will pass, I can handle this.

Think of positive things that you are looking forward to in the future, ie social outing with a friend.

Make an index card or upload your most effective grounding techniques.

Think about people and animals you care about. Look at photographs of them.

List 5 things you see

List 4 things that you can touch

List 2 things that you can smell

Take one breath.

 

 

Reference: OTMH, Oakville

Relationship Needs

Emotional needs

Things to think about.

How do you and your partner/friend/parent/child etc, show respect for each other? How do you not?

In what ways do you and this person show appreciation for one another? How do you not?

How do you and this person meet each other’s emotional needs?

How could you and this person meet each other’s emotional needs?

In what ways do you and this person show trust for one another?

In what ways do you and this person not trust each other?

Sense-of-security Needs

How do you and this person support each other?

How can you and this person support each other better?

How do you and this person help each other feel secure in the relationship?

What else can either one of you do to help the other feel more secure?

How do you and this person show loyalty and commitment to each other?

What else can either one of you do to show loyalty and commitment to each other?

Financial Needs (if applicable)

What kind of financial goals do you and this person share?

What money issues do you disagree about most?

How do you manage the daily money issues? (paying bills, etc?) with this person?

How does that work for both of you?

How are your spending habits the same? Different?

How are your saving habits the same? Different?

 

Sharing Needs

Describe how you and this person share household and or other types of responsibilities?

In an ideal world, how could you and this person be more responsible?

How do you meet this person’s sharing needs?

How could you better meet this person’s sharing needs?

How does this person meet your needs?

How could this person meet your sharing needs?

 

Social Needs

What types of social situations do you and this person share?

What types of social occasions do you and this person enjoy and have fun?

What social happenings do you like that this person does not?

What social happenings does this person like that you do not?

How do you and this peson meet your social needs?

How could you and this person better meet your social needs?

 

Spiritual Needs

How are your spiritual needs and those of this person’s the same ? Different ?

What types of spiritual activities do you like to do together? (church, meditate, nature walks)

In what ways do spirituality and spiritual issues interfere with your relationship?

What spiritual values do you share?

What values do you each have that the other does not?

 

Dealing Effectively with Needs Problems

A simple process that can help you and this person more effectively with differences in your needs-sets include the following steps which can help you to understand each other’s needs and learn to accept and embrace your differences.

1) Understand your own Needs.

Partners who fight often fight over the same issues repeatedly. It is important to first understand what your needs are. Now that you have completed the assessment/reflections, what would you say are your greatest needs in your relationship?

2) Permit Yourself to Express Your Needs to the Person.

My needs:

Ex: I need him to WANT to know my feelings.

How can I express this need to my partner?

Ex: Since he doesn’t always listen to me, I’ll write him a note explaining how I prefer sharing my feelings with him more than anyone else.

3) Understand The Other Person’s Needs.

It is also important to understand what the other person’s needs are. Look back at the assessment you completed. What would you say are the person’s greatest needs in your relationship?

4) Listen To What The Other Person Needs.

Think about things that this person says that should give you insights into your partner’s needs.

My partner’s needs:

Ex: To spend an occasional evening with friends.

How My Partner Tries to Express This Need:

Ex: Makes excuses about why his friend’s need him to come over.