A third of all people will be a caregiver at some point in their lives. Caregiving for people with schizophrenia presents challenges that many people are ill-prepared for.

Host Rachel Star breaks down the principles of caregiving and creative ways to navigate schizophrenia.

Dr. Sarah Kopelovich joins to share schizophrenia caregiver specific training.

About our Guest

Sarah Kopelovich, PhD is a forensically-trained licensed clinical psychologist in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. Dr. Kopelovich is an Assistant Professor in the department and holds the Professorship in Cognitive Behavioral Therapy for psychosis. Her current research is specifically oriented toward implementation and dissemination strategies for psychotherapeutic and psychosocial interventions for Schizophrenia Spectrum Disorders. She regularly conducts workshops, seminars, and professional consultation across the country for an array of mental health professionals and trainees in CBT for psychosis; Recovery-Oriented Cognitive Therapy; Individual Resiliency Training for First Episode Psychosis; Assertive Community Treatment; and diagnostic, suicide, and violence risk assessment.


Back to Life, Back to Normality: Volume 2 -outlines many of the cognitive-behavioral techniques used in the Psychosis REACH training.


Computer Generated Transcript of “Caregiving for Schizophrenia” Episode

Editor’s NotePlease be mindful that this transcript has been computer-generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.

Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.

Rachel Star Withers: Welcome to Inside Schizophrenia. I’m your host, Rachel Star, here with my wonderful co-host, Gabe Howard. Gabe, now it sounds at first like we have a very squishy, lovey-dovey topic. Caregiving, right. I could feel like just the title of it. It sounds like a nice Hallmark movie kind of thing going on. But we’re going to get into some kind of, I don’t want to say deep, but intense stuff with it. We’ve talked before, Gabe, we feel strongly about that word being used towards people with mental health problems.

Gabe Howard: Caregiving is universally thought of only in the positive, but as folks are going to learn, even very positive things can have a flip side.

Rachel Star Withers: And right off the bat, I don’t like the term caregiver because it automatically puts that person kind of over the other one. So if my mom is my caregiver, then obviously she has to take care of me for whatever reason. I’m not able to. I’m sick. I’m inferior. You know, there’s a problem somewhere, which is true in it, but it does, it just kind of that mentally puts it out there. And, you know, Gabe, I gush all the time about my parents. They’re absolutely wonderful. And I cannot live on my own. It’s hard for me to have to accept that on some level that they are my caregivers, because that means I’m a burden to them. And I know they would never describe it that way. But it makes me feel bad as a 35 year old grown woman that I do have to depend on somebody else.

Gabe Howard: So here’s sort of the issue with caregiver, right? It becomes all encompassing. Let’s say that tomorrow you get in, we’re going to use car accident and for the purposes of this analogy, you’re going to recover. But in the car accident, you break both arms and both legs. Now, that’s like pretty high level caregiving. Nobody would argue that you need care and that the person doing it is your caregiver. But in that analogy, remember I said you’re going to make a full recovery. Eventually you start getting use of your body parts back. First your hands work and then your arms work and your family or your caregiver starts doing less and less and less and less and less. And in physical health, people acknowledge that. People acknowledge that you’re needing less assistance and less help. Over on mental health, it doesn’t matter if you are the worst of the worst, the sickest of the sick, or if you are Rachel Star and all you’re really doing is just living in your parents’ basement, hanging out. It’s talked about in exactly the same way, and I think therein lies the problem. Right? Because now when people say, oh, Rachel, your parents are your caregiver, they immediately assume that you are the worst of the worst and have no partnership, no control, no faculties. And you are not assisting in your own care.

Rachel Star Withers: And I also think whoever they’re talking to, like this third party, they automatically feel sympathy, like you poor thing, you have to deal with this, you poor thing. And I don’t want to say, like as the person who has the issue, like, I get jealous, but it’s also like, OK, well, they’re not the ones who are hallucinating.

Gabe Howard: We have more sympathy for the people next to the person with schizophrenia than we do for the actual person suffering from schizophrenia. And could you imagine if somebody said, oh, you know, Rachel has cancer, but the real people suffering are her family, like everybody would just be up in arms

Rachel Star Withers: Oh, yeah.

Gabe Howard: And not tolerate that. But if you say, well, you know, Rachel has schizophrenia, but the real people suffering are her family people immediately they’re like, well, but I mean, they’ve gone through a lot. It can’t be worse for them than it is for you, Rachel,

Rachel Star Withers: Yeah, to make it clear for everybody, when we were saying caregiver today, we’re not talking about the doctors, nurses, that kind of thing, we’re talking about the kind of normal day to day stuff. So a caregiver, they could be paid but most caregivers are unpaid members that are related or in the social circle of the person who is needing care. Usually our caregivers don’t have any professional training. We have a wonderful guest today who’s actually going to talk to us more about caregiver training. The majority of caregivers are women. I think with a lot of women, you already have that kind of motherly role and they’ll usually be the first to step up to be the caregivers. Typical duties, this is all little things, OK? Daily activity stuff is what caregivers do. They manage medications, making sure that you’re taking your medications, you’re taking them correctly. They may talk to the doctor or nurse or whoever on your behalf.

Rachel Star Withers: With schizophrenia, what we need might change. So caregivers, when it comes to schizophrenia, may or may not have to help with like cleanliness, that kind of thing, making meals, making sure that the person is eating healthy, not just eating Pop tarts nonstop. So right now, there’s around 50 million family caregivers nationwide in America. Fifty million people. That’s so many. And if you were to pay them, in theory, it would be around three hundred and six billion dollars. So these family care like you are worth a lot of money. To my people that are out there listening, it is a thankless, usually moneyless job. And a third of us, a third of all people will have to be a caregiver at some point in their lives. But you also have to take into account the person and you need to make sure that they are still feeling respect and dignity. No one wants someone telling them what they can eat, what they can’t eat. OK, this is what you’re going to do today. Like nobody wants their whole life controlled by somebody else.

Gabe Howard: And nobody wants to be seen as less than. Oftentimes, people experiencing schizophrenia don’t have that level of respect to balance out the burden. We just have the burden. That’s a lot to overcome, to be seen by society as hurting our families in addition to managing schizophrenia. That’s, that’s big. That’s, that’s mighty big. We don’t want to hurt our family. We love our families. And we are incredibly thankful for everything that they’re doing for us. We just want to make sure that we’re not lost in that discussion.

Rachel Star Withers: If you are a caregiver for someone who, like you said earlier, has a broken bone, if you’re a caregiver for someone who is elderly, you kind of know what to expect. But with schizophrenia, it’s not that predictable. The caregiver of someone who has schizophrenia, you have to be on the lookout for other things. One of the biggest is going to be medications and side effects. If the person that you are helping also has depression, you really need to kind of watch out for suicidal tendencies, kind of signs that this person might not need to be alone. This person might need to have their medication changed up. And the side effects I know, Gabe, and you’ve seen me do my little dance here, but I have tardive dyskinesia where I shake and there’s just a lot of side effects that can affect people with schizophrenia differently, it’s not predictable. With those medications, and we had a previous episode about this, it opens you up to being vulnerable for more diseases. So, for instance, diabetes is a huge risk if you have schizophrenia. If you’ve ever been on any antipsychotics, you do tend to put on weight very frustratingly quickly. So caregivers need to kind of watch that. And I’ll be honest, Gabe, I don’t like the idea of someone telling me what I can and can’t eat.

Gabe Howard: Well, right, because you’re an adult and you need to make your own decisions and let’s take this at a base level like a human dignity level, if you are not choosing your own meals, your own food, if somebody else is making that basic decision for you, how much wellness do you actually have if you don’t even have the autonomy to choose what you put in your own mouth, what you eat for sustenance and meals?

Rachel Star Withers: Another thing that changes with schizophrenia versus other types of disorders, diseases, et cetera, is the cognitive ability, disorganized thoughts. Sometimes, and it’s so hard to explain when people ask me about this, but sometimes, like, I’ll forget something very simple, like, how to zip up my jacket? It’s just like the piece is gone and you can have a full conversation with me, I’m fine. But then I’ll go to do something. And I’m like, oh, no, how do I do this random thing? And I’ll get confused. That’s what caregivers have to watch out for with schizophrenia. Like, I don’t need anyone to help me dress. I don’t need anyone to come over and pick my clothes out for me. But then some days I get confused and I can’t remember how to do something. And just throwing this out there, my way around that is that I lay out my clothing ahead of time and I always have a backup set with no fun things like zippers and things. Schizophrenia isn’t predictable. Gabe, a few weeks ago, I had a really bad psychotic episode and I haven’t had one this bad in way over a year, 99% of the time, I don’t need help.

Rachel Star Withers: I hallucinate and I have little delusions and things, but I’m able to manage it myself. I usually don’t even tell anyone. But this was different. And when it happened, I became very scared. I knew I did not have a grasp on reality. I couldn’t get my phone to work. I was trying to text my mom who was upstairs, and I couldn’t seem to text. I couldn’t remember how to text. I was like fighting my phone. I don’t know if I was texting the right person couldn’t put words together and somehow I got in the kitchen. Eventually, my mom, she did get some of the text messages. She came out, got me and stayed with me the rest of the night. That was very scary. And I’m very lucky that she was there to step in. Again, this is once a year that she had to do that. But we don’t know when that once is. She may have had to, like, be up early for work or something the next morning. So taking care with schizophrenia, it’s very unpredictable. And it’s kind of like you’re on call, like you’re ready to help if the person needs help in this way. But most of the time they might be OK.

Gabe Howard: And obviously, that can be frustrating for all involved, I mean, who wants to be on call? You’re going about your day, you’re doing what you’re supposed to do and then boom, right in the middle of it, this thing happens that you have to be 100% for your loved one and that you want to be 100% for your loved one. And hopefully your loved one realizes what you’re doing and they need help. And that’s why I think that it is extraordinarily important to make a plan when you’re well. You know, one of the things that that Rachel does well and that we’ve talked about in this whole podcast series is she doesn’t just talk about schizophrenia with her family when she’s in crisis or when she’s hallucinating, when she’s having a problem. This is a continuous conversation that they have even when she’s completely well. The analogy that I like to use is it’s like having a fire drill when the house is on fire. But the best time to install smoke detectors and the best time to have a fire drill is when your house is not on fire. It’s very much the same in schizophrenia. And I think a lot of caregivers miss this. And in fairness, a lot of people living with schizophrenia, they miss it, too. We want to believe when everything is fine that it’s going to stay fine. And we just want to focus on the here and now and not make a plan for what happens in the event that things go a different way.

Rachel Star Withers: So many of these caregiver relationships, like my own, is parent, adult child and mothers out there, a lot of you just kind of don’t step in to caregiving. You just step into mothering, just taking over like you did when they were five. And that’s where a lot of the tension comes from. ‘Cause I’ve talked to so many mothers who are just overwhelmed with trying to help their adult child and don’t know what to do. And part of it is you’re trying to do too much. You need to acknowledge what the person with schizophrenia can and can’t do. Like, I would much rather just bring someone food and be like, eat it, then say, OK, well, let’s work out the plan. You’re going to cook this, not, you know, I get it. That’s like more work. It’s totally easier to just dominate over someone and make all the decisions. But you can’t. Gabe, so I have a friend around in his 30s, but he has schizophrenia and he lives with his parents and he’s on disability and they’re constantly fighting because his parents take all of his disability money and he doesn’t like that. He’s like, that’s my money. And I was like, well, if you were out on your own, you would still have to pay for rent, groceries, utilities, etc. So I do believe that they are entitled to some of that because you’re using those things. I don’t think they should take all of it. But when they do give him money, he immediately spends it on alcohol, gets drunk. I don’t know, Gabe. What are your suggestions? Because I know so many people that get caught in like, what do we do? We’re stuck in this circle and don’t know how to get out of it.

Gabe Howard: In this scenario that you’re given, both sides are right, the family needs the money for the expenses that the person living with schizophrenia is generating. We can’t ignore that. But we also can’t ignore that the disability check is this person’s. It’s in their name and they feel like they’re not being given a choice. They feel like their money is being stolen. But then again, let’s go back to the other side. They feel like, well, when I give that person the money, they make dangerous choices. You know, buy alcohol, and especially in the case of, you know, the family dynamic, if this person uses alcohol, it interferes with the meds. They have a crisis. This crisis affects the whole family. So when taking a look at everything, these are very difficult things to resolve because the reality is, is both sides are right and both sides are wrong. This is where it’s really important to understand that. I call it negotiating in good faith. If you have this idea in your head that the other side is wrong and you’re right, you’re not negotiating in good faith. And I’m speaking both to the caregiver side and the side of people living with schizophrenia.

Gabe Howard: And that also points to a larger problem, which those two sides are often at odds. They’re often looking at each other as heroes versus villains when in actuality you’re neither of those things. That’s very important. These things get resolved in any number of ways, whether it be by compromise, whether it be by walking a mile in the other person’s shoes, whether it’s understanding. So often, caregivers don’t think that they’re the ones that need to seek mental health help. They don’t think that family therapy is needed because after all, they’re this big, strong caregiver. It’s only the person living with schizophrenia that needs help. It’s vital that you understand that if something is contributing to the mental health decline of the household, it means that the entire household needs mental health help. And so often people think, oh, well, I’m not as sick as my loved one with schizophrenia, therefore I don’t need any help. Don’t think of it that way at all.

Rachel Star Withers: And you have to know what you can and can’t do. Most people have to work full time. OK, so we get this. This is almost like a second job or maybe a third job for many on top of your life. And it becomes intense. Family members are awesome because they’re usually the main support system. Whenever you’re making that decision of should the person with schizophrenia live with you, there’s actually I like this. It’s a little chart, Gabe, I have here, but it says

Gabe Howard: I love charts as well.

Rachel Star Withers: I know, but it says, living with your family and you have schizophrenia works best if you are high functioning and you can still maintain friendships and activities outside of the home, meaning I’m still able to go to a part time job, volunteer work. I still have friends I talk to. It’s not just me and my parents and that’s it. Another is that the relationship around the family is relaxed. You know, if you always have a lot of tension with a certain family member, it’s going to be a lot worse when you add in schizophrenia and then living together. You want to make sure that there are other support systems. Again, you can’t do it all yourself. We’ve talked about NAMI and different things, support groups, at the doctor asking them. Make sure as the caregiver that you’re not all the person with schizophrenia has and make sure this last one here that the living situation is not negatively impacted, if there’s young children in the home, by the person with schizophrenia, children come first. Always make sure they’re protected and everything. I’d say for the most part, my family has, they fit all of those.

Gabe Howard: Ok, Rachel, but along that same vein, what things are immediate disqualifiers? Like living with the family is not advised if what happens?

Rachel Star Withers: Well, one, if the caregiver is single, ill or elderly, that’s going to be really hard. You know, someone in their 80s is going to have a very hard time helping out with someone with schizophrenia. That’s just the truth of it. If the schizophrenic is very low functioning, if they pretty much they need more help than you can give them. So when I say high functioning, low functioning, what I mean is I’m usually considered a high functioning schizophrenic, meaning that for the most part I’m good for, let’s say, two weeks I could live alone. But after that I get weird and I have, like, little spurts of times when I’m going to need a lot more help. But I’m high functioning. Low functioning would mean I need a lot more help, more supervision. I need someone kind of stepping in my life, helping me make important decisions, helping me with my money, etc.

Gabe Howard: Makes sense. Understood.

Rachel Star Withers: You shouldn’t be a caregiver for the person in your family if it’s causing stress on your marriage, if your life is in shambles, you can’t help anybody else. I can’t stress that enough. And you’re going to hate that person you’re trying to help because you’re like, oh, well, I’ve lost my marriage. I’ve lost my job because of this person. It’s going to impact you both negatively. You just have to accept that you cannot do everything.

Gabe Howard: And I think that’s really the key. What we want to point out is that doing something about it doesn’t necessarily mean that you personally do it. It could be a matter of getting the person to the right care. For example, we’ll go back to the car crash scenario that I gave. I am not an EMT. I am not a trauma surgeon. I don’t know how to set a bone. So if that happens to my friend Rachel, the best thing that I can do for her, of course, is call 911 and get her the help. In mental health, we have this tendency to do just the opposite, to say, oh, I’m going to pick you up, Rachel, and we move her from the car accident, we start doing all kinds of damage because we’re unaware. Sincerely, ask other family members to pitch in, call friends, call the local charity, schedule an appointment with a therapist, find out what you can do. And honestly, by listening to this podcast, you’re already starting that process. You’re looking for hints and tips of how you can be better. Again, I really feel the need to be clear. Me calling 911 one for Rachel in the car accident analogy is me doing a hundred percent of what I can do and ensuring that Rachel has the best possible outcome. We need to start thinking that way in mental health rather than thinking, OK, well, I have to fix 100% of this because after all, I love my child, friend, family member, etc.

Rachel Star Withers: So, Gabe, we’ve really been a downer up until this point,

Gabe Howard: And we don’t mean to be

Rachel Star Withers: We don’t mean to, but we have all these problems we discussed. How do we fix them? One of the best things you can do is set out rules or make it very clear as the caregiver what is expected of you and as the person receiving care, what is expected of them so that, you know, if you’re overstepping your bounds. Make sure that the person receiving care has to give something too. All right? It’s not just like take, take, take. Now, it could be little things. It could be. You know what, hey, if you’re able to vacuum, if you’re able to handle the groceries, but make it clear that this is a partnership, it’s not just one person completely depending on the other. You know, what you can and can’t do might change over time. For the most part in my family, I buy a lot of like the groceries and things like that. I like that I’m able to provide food, make food and things because it makes me feel that, hey, I am contributing to the household. It’s not just me living in the basement, creepily skulking around the house, taking everything and not giving back.

Gabe Howard: I really like what you said about little things really matter, you know, I have a, I have a pseudo kid in my life. I have a granddaughter and they’re a young family. They’re in their early 20s. They have a two year old. They don’t have a lot of money. They’re just starting out in life. They just bought a house. Long story short, whenever we go anywhere, I pay 100% of the time. I buy dinner, I buy the putt-putt tickets, I put gas in the car because I can afford to do so. The other day, my daughter in law bought me a Diet Coke. She showed up at the house. She was running errands. She had to drop something off. And when she pulled in, she handed me a Diet Coke from my favorite place. Straw and all, exactly how I like it with the light ice. It cost her a dollar. That meant a lot to me, an incredible amount, and it meant a lot to her because she got to give back in some small way. And, you know, there was hugging. You have to understand that those things are very, very powerful, breaking that analogy into the caregiver relationship with somebody living with schizophrenia.

Gabe Howard: Find out what that is. Because it empowers the person and it gives you that hope and positivity to move forward as the caregiver. So often we’d rather just sit and think, well, I pay for everything. Well, I do everything? Well, they don’t help at all. Find those, I’m going to call them little Diet Coke moments. If you have this idea that you’re always going to be the caregiver and that they’re always going to need help and that they’re never going to contribute, you create a self-fulfilling prophecy.

Rachel Star Withers: And so many times when someone does have to move back home or need care, they’re recovering. They’re recovering from a very bad psychotic episode, or maybe they’ve just fully been diagnosed as having schizophrenia and they’re going through that. So make sure that you have goals of where do I want to be in a year? If your goal is to live on your own, and right now you can’t. If the caregiver is too overprotective and just taking over my life, I will never get to that point because I won’t know how to stand up on my own. You did it all for me. So make sure as you find objectives to help with that, as a caregiver, you know when to step back. As the caregiver, you need to watch out for some things in your own life. There’s actually something called caregiver syndrome, and that is when you’ve just kind of you’re burnt out. And you can get burned out on a job, lots of things in life, but you’re burnt out of caring for a person. And that manifests in exhaustion, anger, rage, depression, anxiety and even physical things. High blood pressure, diabetes. This is all stuff we talked about earlier. Gabe, this is like, you’re trying to help someone else with these exact same problems and now you have the problems.

Gabe Howard: Yeah, you can’t pour from an empty cup. I know that it’s a cliche, but if you are not well, what support are you providing? Sincerely, Rachel, would you want help from a person who was sleepless, scattershot, angry, frustrated, confused, annoyed? Is that the person that you want to show up to provide you what, in some cases, could be life-saving care?

Rachel Star Withers: I do not, Gabe. The stress there. Can you imagine now if I’m living with that person and it just never ends? You’re going to have to learn as a caregiver to step back, take a vacation, even if it’s just like little mini vacations during the day. Really cool. I actually was talking with this family and they had a young teenage son. He was diagnosed with childhood schizophrenia. And so he had been on antipsychotics for quite a while. And they’d definitely affected his weight. And the parents were just pretty much, they were at their wits end. You know, they’re doing so much trying to help their child. And now on top of that, they’re worrying about his weight gain.

Rachel Star Withers: So what happened? The uncle stepped in. The uncle decided that he was going to start working out with the young man. And it was kind of cool. You know, you got the cool uncle. The pressure wasn’t there. They would go out, he’d pick them up, they’d go and they would do some physical activity every single week. For one, that gave the parents a chance to take a little break from having to worry about the son, but also gave the son a social outing. And it made him feel like this isn’t something I have to do. I’m getting to spend time with my fun, cool uncle. And I love that. And that’s something like if you’re able to incorporate that, look around. If there’s other family members, be like, listen, I’m already doing this, this and this. Is there any way that you could help with one of these things? If one of your family members likes to cook? Yo, like, maybe you could make a little more. Maybe you could come over and show, like, find ways to give yourself a break as a caregiver. You can also look into assisted living situations like that. You know, don’t think that you have to do everything. Get help when you need it.

Gabe Howard: I think a lot of people are experiencing stress in the time of corona, so it’s very important to understand that no matter how hard your family dynamic tries, external factors out of your control can change things. And the whole point of this is this is why it has to be an ongoing conversation and an ongoing partnership between all the parties. Otherwise, you’re not going to be nimble enough to survive when things happen. Now, obviously, I don’t think anybody saw a worldwide pandemic coming, but nevertheless, people with schizophrenia are also managing a worldwide pandemic, as are the people who love them.

Rachel Star Withers: And we’ll be right back after a message from our sponsor.

Sponsor: It can sometimes feel like another schizophrenia episode is just around the corner. In fact, a study found that patients had an average of nine episodes in less than six years. However, there is a treatment plan option that can help delay another episode: a once monthly injection for adults with schizophrenia. If delaying another episode sounds like it could make a difference for you or your loved one, learn more about treating schizophrenia with once monthly injections at OnceMonthlyDifference.com. That’s OnceMonthlyDifference.com.

Rachel Star Withers: And we’re back discussing schizophrenia and caregiving.

Gabe Howard: Rachel, you got to spend time with Dr. Sarah Kopelovich, who is an assistant professor, and has done a lot of research on caregivers. She taught us things like compassion fatigue, and it was very, very cool. I loved hearing your interview. So let’s go ahead and play that now.

Rachel Star Withers: We’re here speaking today with Dr. Sarah Kopelovich, who is a licensed clinical psychologist, and she’s also an assistant professor who has been doing a lot of very interesting research into schizophrenia spectrum disorders. And today we have been talking about caretakers and the role that they play in helping different people with schizophrenia. Doctor, tell us about your research and how it deals with caregiver training.

Sarah Kopelovich, Ph.D.: Sure. So my primary area of expertise is in psychotherapeutic interventions for people with schizophrenia spectrum disorders and other forms of serious mental illness. I do a lot of work trying to increase access to these evidence based psychotherapies. And the kind of frontline intervention in that realm is cognitive behavioral therapy. In trying to increase access to cognitive behavioral therapy for psychosis, how do we leverage other members of the treatment team and the natural support team so that we can really take an all hands on deck approach to helping people get access to good quality skills that can help them cope better with the symptoms of psychosis? There is a model called Psychosis REACH, which was developed by Dr. Douglas Turkington, who also happens to be one of the co developers of Cognitive Behavioral Therapy for Psychosis that teaches family members cognitive behavioral therapy concepts and skills so that they can have more therapeutic interactions with their loved ones. We have now piloted an eight hour training in May of 2019 and it was a huge success. So we found that just through a one day training, we were able to improve the well-being, so in other words, depression and anxiety, scores of the family members who attended that one day training and there was no other intervention involved. It was just that one day in person training, correcting myths and misconceptions about psychosis, providing background, and how can cognitive behavioral therapy help improve your life and well-being and depression and anxiety? And then how can you use these skills and concepts to improve relationships with your loved ones? So we’re really excited about these preliminary findings and we’re continuing to provide this training to family members in the coming years. Now, virtually, of course.

Rachel Star Withers: That’s really amazing. So it’s just a one day training as of right now?

Sarah Kopelovich, Ph.D.: This is a one day training and it is outside of any mental health clinic. We know that our national schizophrenia treatment guidelines recommend that the care team is providing family intervention for psychosis, but unfortunately, that’s just not playing out in practice. Only about two percent of families in the United States who have a loved one with serious mental illness are receiving any kind of family intervention for psychosis. So our goal was to take this out of the clinic. And I was able to do that because I was very, very fortunate to receive philanthropic support. So we offered this training to anyone. We provided financial support for travel and lodging. We brought them all together in a beautiful space, catered and just really communicated to families you’re valued. We care about you and we want you to learn. We know you’re doing as well as you can. We want to help you do even better.

Rachel Star Withers: So why is caregiver training important?

Sarah Kopelovich, Ph.D.: Well, we know that for a long time now, families have been in the shadow of the mental health system in our country. I talked about how 98% of the time families are not brought into their loved one’s mental health treatment, and this is contrary to the overwhelming evidence. Research shows that if we can support families appropriately, we can save money, we can save relationships and we can save lives. We spend three hundred billion dollars annually on costs associated with serious mental illness. And much of that comes from hospitalization costs. Which it just so happens that family interventions like caregiver training, one of the strongest outcomes that we see for this intervention is reduced hospitalization rates and reduced number of days in the hospital. In terms of saving relationships, there’s this really interesting study about 10 years ago out of Delaware. They just asked people living in the community with a schizophrenia spectrum disorder, do you feel alone? And 90% of the people that returned a survey said yes. And yet it’s also true that 90% of individuals with psychosis are in close contact with at least one family member. Psychosis can be a terribly isolating experience. So you can be surrounded by people, and by very well intentioned people, and feel so utterly alone. And we can change that. We can help get the relationship back on track. We can improve quality of life. And then, of course, that brings me to that last point, which is that family interventions like caregiver training can save lives. So one third of people with schizophrenia will attempt suicide and one in 10 will die from suicide. When you ask about why caregiver training is important, it’s about saving families and saving lives. It’s about giving family members a very different message than they’re likely receiving, which is that they should expect recovery. That’s what the data supports, is that most people who experience a psychotic episode will experience wellness, will experience recovery, and families need to hear that.

Rachel Star Withers: Very nice, I agree on that. When I know most people hear caregiver, we tend to think of someone taking care of like an older family member. When my grandfather and my grandmother both had Alzheimer’s, I remember we kind of had to do a little caregiver training, but it really had nothing to do with the mental. How is your type of caregiver training different than, let’s say, dealing with someone who’s in their 90s like we were?

Sarah Kopelovich, Ph.D.: Yeah, well, so first I want to clarify that I’m using the term caregiver quite broadly to refer to anyone who identifies as a support person. So that could be a biological family member, a significant other, a friend. And in terms of how it differs from other kinds of caregiver training, I think the domains in terms of what it’s trying to accomplish are actually more similar than they are different. If you are the loved one or the support person of somebody who’s experiencing an episodic or potentially episodic condition, then there are some basics that we need to help you to do. One is to have accurate information about the diagnosis and to be realistic and also hopeful. And with schizophrenia and other forms of psychosis, there’s a lot to be hopeful about. Despite all the doom and gloom you might confront on the Internet or in even peer reviewed journal articles, there’s a lot of progress that is being made in the realm of psychosis, recovery and treatment. Family members need to hear that. Otherwise, they’re going to go do a Google search or they’re going to talk to a family member that has their own anecdotal experience, and it might not be positive. Right? But there’s a lot to be positive or hopeful about. Family members want and need connection with their professional care team, but also that connection with other caregivers.

Sarah Kopelovich, Ph.D.: And that’s across conditions. And then finally, I think they want resources and skills training. How do I, how do I help? What helps? And what makes things worse? They want to know what can I manage at home and what will the professionals be doing to help my loved ones recover? And then on the flipside, what in the home environment might be counterproductive to my loved one’s recovery? And what kinds of treatments might be unhelpful? There are more similarities than there are differences. But when we get a little bit more granular, a little bit more detailed, that’s where we start to see differences within the Psychosis REACH training and other kinds of family interventions. We’re going to be giving psycho education, obviously, about psychosis. We’re going to be really defining some boundaries for a training so that when we teach you these skills, our goal is not for you to do psychotherapy with your loved one. Right? That is not indicated, nor is that within your skill set. It’s really about helping you to apply some of these skills to yourself in your own life so that you could be more effective with your loved one.

Rachel Star Withers: When you’re doing these different trainings or you’re speaking with loved ones, support givers and whatnot, what are some of the common problems that they bring up to you?

Sarah Kopelovich, Ph.D.: My colleague, Maria Monroe-DeVita, conducted focus groups before we started the Psychosis REACH training and these focus groups were across the state of Washington with families who had had a loved one hospitalized for a psychotic episode. And what these families disclosed can really be boiled down to two things. They wanted skills to manage their loved one’s illness. And they said that they wished that they had had someone, and they were referring to another family member, appear to tell them, this was my experience. This is what you can expect. Here’s what worked for us. There’s something incredibly powerful about connecting with other people who have walked that path before. And then they also wanted to know things like how do I respond when my loved one is experiencing a delusion? How do I help them when the voices get really intense or really degrading? They’re referring to things like coping skills, problem solving skills, communication skills. So that’s exactly what Psychosis REACH teaches them. How do you help? What do you do in those situations? And then also how do you know when to back up? Because we also need to make sure that we are meeting people where they’re at and kind of know when to tactfully withdraw from the situation.

Rachel Star Withers: How can your loved ones know when they need to tactfully withdraw or maybe kind of step back from a situation?

Sarah Kopelovich, Ph.D.: So it’s really important to know that we cannot progress from a place of conflict. Sometimes things can escalate quite quickly or unpredictably, and you find yourself in a situation where now people are yelling. And so that’s not a therapeutic interaction, right? That’s a situation where we need to actually withdraw. You know, this is a bad time. Let’s come back to this another time. Or shift topics, right? Hey, I’m wondering if you caught the game last night. I missed it. Can you fill me in? Falling back on the relationship, going to neutral topics, getting back on the same page with your loved one. Hey, I know it’s really important to both of us that you stay out of the hospital and I can see you’re feeling really unsafe right now. What can we do to help you feel safe in this moment?

Rachel Star Withers: So many times, including my own situation, you have a support person or caregiver that’s a parent, and the person that they’re supporting is their own child, an adult child with a serious mental disorder. Not only do you have the stress of the parent child, but with that added schizophrenia and psychosis. Can you speak on that?

Sarah Kopelovich, Ph.D.: Sure, it can be a really tricky balance, right? You have a parent who wants their child to be well and can feel quite helpless and might be concerned for their well-being, for their safety, for what’s happening with their school. Are they going to get so off track that they’re going to have implications for their future? And then you have a young adult who is appropriately going through this process of separating from the parent and individuating, really becoming their own person, independent of their parent’s aspirations, their parent’s thoughts and ideas. It can feel quite stifling for the young adult to now have a parent who is taking care of them, who’s asking them about their medications. Who’s asking them about whether they’ve gone to their therapy appointment. That’s part of what we try to do with the Psychosis REACH training is to create a different dynamic. How do we change that dynamic that has started to unfold with the diagnosis or with the onset of the disclosure of the symptoms so that we don’t have so much stress and tension in the home? And this is really coming from a key finding in the psychotherapy literature where we see that that therapeutic relationship is the key to positive outcomes in therapy. So we work with the family members to identify shared goals. What’s important to you and what’s important to your child? And the way to get to those goals might be different. And usually it is, right? Usually they can both be on the same page about the fact that they want to be healthy and to kind of get back to the things that matter to them.

Sarah Kopelovich, Ph.D.: But the parent thinks that the way to do that is to take this set of medications and to throw themselves back into life as usual. And the child thinks, well, when I smoke marijuana, that’s what helps me, right? It’s not these other medications. But the goal is the same. How do we take that goal and work from there? How do we help them activate positive emotions by thinking about positive memories, by having other things that they connect about outside of just the illness. And so when we can redevelop that healthy relationship, then we can progress to other kinds of skills, like inquiring curiously. So asking and not assuming, asking good quality, curious, open ended questions about your child’s experience, about their perspective, about what they want. We can teach parents to not fear their child’s experience. A lot of that concern and that tension that’s happening is coming from a place of fear. If we can tell parents actually voice hearing is a really common experience. And there are a lot of voice hearers all over the world. And here’s what we know about what leads to distress in some and not in others. Then they feel a little bit calmer. They feel a little bit less anxious about what their child is going through. And then we can help them work on the higher level skills as well, like trying out different skills together and getting feedback.

Rachel Star Withers: Very interesting. A large part of our audience is caregivers and the support people, family that are all around different people with schizophrenia. What do you have to say to all of those people?

Sarah Kopelovich, Ph.D.: What I want to say is it’s not your fault. That if you feel like you’re not doing enough or you feel like your child or your loved one isn’t getting enough, that it’s not your fault. And psychosis is nobody’s fault. That needs to be the first message right out of the gate. Psychosis is nobody’s fault. We have a lot of wishes for behavioral health system transformation, and we know that the system isn’t doing as well as it could be to help meet their needs. So I have training in dialectical behavior therapy as well. And one of the principles of dialectical behavior therapy is this assumption that we’re doing the best we can and at the same time we can do better. That’s the message I tell myself every day. That’s the message that as a policy advocate, as a mental health professional, I communicate to mental health providers and administrators. And that’s what I share with family members as well. You’re doing the best you can. And when we know better, we can do better.

Rachel Star Withers: It’s very interesting that you said that one of the main important things is that it’s not your fault. That was just kind of really struck me because in my own situation with my parents being my main support system, I do think it comes up a lot. And I would say that for other people with schizophrenia and their support system, that our family. Yeah, that’s a big thing is did I cause this? Did I give this to my child? Did something happen under my watch to my child to cause this? And I hear that a lot. As far as like, did something traumatic happen? This is very interesting. That’s one of your main points, you’ve got to accept right away that it’s not your fault. That just when you said that, it really struck me that was very powerful.

Sarah Kopelovich, Ph.D.: Absolutely, the more we know about psychosis, the more complicated that picture becomes, because it’s really not this simplistic model of how you’ve got this set of genes, then you’re going to develop schizophrenia. There are a lot of contributors to psychosis. We used to see psychosis as this really uncommon, abnormal state. Psychosis is far more common than we used to know. And across cultures. There are the schizophrenia spectrum disorders are one kind of set of causes for psychotic experiences. But there are a lot of people who have psychotic or psychotic like experiences who don’t have a mental health diagnosis. There is not a clear formula for this, but what we do know is that it’s not any one thing.

Rachel Star Withers: It’s a very powerful point that. Definitely helps a lot of different support people out there who are listening to hear that. So how can caregivers find training?

Sarah Kopelovich, Ph.D.: In my mind, the place to start is the National Alliance on Mental Illness, NAMI is the largest mental health organization for families, been around since 1979, and it’s really become a leading voice on mental health. What NAMI provides is both a way to connect with other families and also they provide their own set of education and resources to family and caregivers. And because they are such a large organization, there’s a good chance that you’re going to have a local NAMI chapter in your region. I find their trainings are a really nice base for families who are just beginning their journey supporting a loved one with psychosis. A lot of their educational programs will teach you about some of the common terminology. They’ll talk about different treatment options for different disorders. And then a lot of families will find that they’ll benefit from more specialized training. For loved ones who struggle with a family member who doesn’t agree with their diagnosis, which sometimes gets referred to as poor diagnostic insight or something called anosognosia, for those families they might find a specialized training program is helpful. And the LEAP Foundation, which is directed by Dr. Xavier Amador, can be really informative and helpful. They have a number of offerings, a number of different trainings that they’re now offering virtually.

Sarah Kopelovich, Ph.D.: It’s kind of the silver lining to the dark COVID cloud is that so many of these trainings are now being offered via distance learning. The LEAP program uses principles and techniques from motivational enhancement therapy or motivational interviewing to really target communication patterns and to improve relationships for family members who are looking to learn concrete coping and problem solving skills and to dive deeper into their understanding of psychosis. They can sign up for the Psychosis REACH training. We had our first training back in May 2019. We got a little off track because of COVID, but we are offering now our second training. It’ll be our first virtual Psychosis REACH training. We’re really excited because of the philanthropic support that we’ve received for this training, I’ve been able to get the leading expert on CBT for psychosis, a psychiatrist named Dr. Douglas Turkington, who co developed CBT for Psychosis and Psychosis REACH, and he’ll be leading the training. And then in May 2021, we have another training that will also be virtual that folks can pre register for. They can go to www.PsychosisREACH.org to learn more and to preregister.

Rachel Star Withers: Sarah, and I understand you have some different books that you can recommend.

Sarah Kopelovich, Ph.D.: Sure, Dr. Turkington and Dr. Spencer have written a book called Back to Life, Back to Normality: Volume 2, and this outlines many of the cognitive behavioral techniques that we’re teaching to families in the Psychosis REACH training. So I highly recommend that one. That’s been a big asset to the families who’ve gone through our Psychosis REACH training in Washington. And then I have a book chapter coming out next year in 2021. It’ll be in a book published by the American Psychiatric Association called Decoding Delusions Advanced Psychotherapy Practices for the Clinician. And I’ll have a chapter in there called Supporting Families Caring for Someone with a Delusion. I will also go through the Psychosis REACH training key points.

Rachel Star Withers: Well, thank you so much for sharing all of that with us today. I know that you have definitely helped a lot of our listeners who are support family and caregivers. I know my mom, I’m definitely going to have her listen to this and check out the books and the REACH program that you spoke about. Thank you so much for joining us today on our show, Sarah.

Sarah Kopelovich, Ph.D.: Thank you so much for having me. It was so nice to be here.

Gabe Howard: Rachel, a great interview, as always. What was your main takeaway?

Rachel Star Withers: It really kind of threw me during our interview when she said it’s not your fault. I don’t know, like why that struck a chord with me, but it just kind of maybe like, I guess, peacefulness almost. You know, caregivers, a lot of times it’s a family situation. You need to know that stuff going on, a lot of it’s out of your control. You didn’t cause it. And the same thing for people like me who have schizophrenia, you didn’t pick this. This is just something you got that you have to learn to deal with. But you didn’t do anything bad. You didn’t do anything wrong. And that’s not something that we tell ourselves very much, Gabe. I think it’s easier to blame yourself for everything, whether you’re on the caregiver or the receiver end of that.  It’s easy to be like, well, you know, this is all happening because I can’t work anymore. This is all happening because this person’s lazy. But you know what? A lot of this stuff, it’s no one’s fault. We just got to figure out how to deal with it. That gave me peace.

Gabe Howard: I can certainly understand why. When you start blaming people, you expect those people to fix it. If I say this is Rachel’s fault, well, then I can just sit back and do nothing except be angry that Rachel is not fixing it. And the reality is, is if it’s nobody’s fault, then that gives Gabe and Rachel an opportunity to work together to assess the situation, find the problem and fix it. And the fixing it is what we want. I’m angry because I’ve blamed Rachel and she’s not fixing it. That manifests itself as me being angry at Rachel, but in reality, I’m mad at the problem that’s not being fixed. And I’m placing the blame not on the problem, but on an individual. That spoke to me a lot.

Rachel Star Withers: Absolutely right, Gabe, and a lot of this keeps coming back to one thing, communication. Make sure that whatever the situation is between the caregiver, the care receiver, talk, make a plan, define the roles, what is expected of each person and reexamine them depending on if I’m doing better, if I’m doing worse. If I don’t need you to help me get dressed, don’t do that. All right. However, I could be sick one day and I haven’t showered in a few days, and you might have to help me. So be up front, reexamine the roles, know what’s required of each person. That way you don’t have to, like, step on toes. And to my fellow schizophrenics, check in, let people know how you’re doing. I’m really bad at this, OK? I won’t tell people I’m having a hard time until it’s really, really bad. And I don’t need to do that. I need to speak up. But it’s awkward sometimes. Just to be like, oh, hey, just so you know, I’ve been hallucinating a lot. I don’t know, I’m bad about that. But we need to step up, you know, let the other people know when you need help or especially if there’s signs that you notice that you’re going into a psychotic episode. Give them a heads up. Hey, by the way, this has been happening a lot. If you could just kind of watch me a little bit closer. We all need caregiving in some way during our lives, you know, we need to take care of each other, whether you are a family member or a close friend or even a neighbor or let’s say you signed up for a program and this is a stranger and you’re stepping up. That’s awesome. But know that you’re appreciated and make sure to treat each other with dignity and respect. I’m Rachel Star. Thank you so much for listening to today’s episode. Like, share, subscribe, pass it around to all of your friends and we will see you next time here on Inside Schizophrenia.

Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail talkback@PsychCentral.com. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.

The post Caregiving for Schizophrenia first appeared on World of Psychology.

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Date: 28th October 2020 at 14:41
Author: Psychcentral – psychology – Rachel Star Withers


Do your feelings about a romantic relationship or your partner change significantly when it’s over? In today’s show, Gabe talks with researcher Aidan Smyth who conducted a study probing people’s feelings about their relationships — both during the relationship and after it was over.

What’s your experience? Do you recall your ex with fondness, indifference or negativity? And which of these emotions are best for moving on? Join us to hear the science behind feelings in romantic relationships.



Guest information for ‘Aidan Smyth- Relationships’ Podcast Episode

Aidan Smyth is a graduate student in the Psychology department at Carleton University who studies romantic relationships, mindfulness, and goal pursuit.





About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Aidan Smyth- Relationships’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host Gabe Howard and calling into the show today, we have Aidan Smyth. Aidan is currently a graduate student in the psychology department at Carleton University. His area of study focuses on romantic relationships, mindfulness and goal pursuit. Aidan, welcome to the show.

Aidan Smyth: Thank you very much, Gabe.

Gabe Howard: Aidan, you’re here today because you conducted a study that had some surprising results and garnered you some national attention. In a nutshell, you discovered that people’s feelings about their romantic relationships, both past and present, aren’t based on fact at all, but more how they feel in the moment. Can you tell us about your study and what specifically you were looking to discover?

Aidan Smyth: Sure. So this work was inspired by a fairly large body of research that suggests that for better or worse, we aren’t always as accurate as we might like to believe when it comes to the way that we think about our partners and relationships. For example, our perceptions of our relationships can be quite subjective and are often biased by our hopes and our goals. So assuming you want your relationship to work out, you might tend to see it through rose colored glasses, so to speak. For this particular study, my colleagues and I, Dr. Johanna Peetz and Adrienne Capaldi, we were interested in what happens to people’s perceptions of the relationships after a breakup when they may no longer be motivated to see it in the best possible light and in fact may even be motivated to see it in a negative light. Specifically, we were interested in whether or not people who had recently experienced a breakup would show a bias in the way they remember their former relationships. And we wanted to see if they would recall them as worse than they actually said that they were while they were still dating.

Gabe Howard: How did you find people who were in a relationship that they described as good, got them to break up and then asked them if they saw the, because that’s like right where my mind went, right. Like, it seems like in order to do this research, you had to find a happy couple and then follow them around until they broke up and then said, hey, what did you think of that relationship? Just to see. But I’m not a researcher, so I imagine that’s not how you did it.

Aidan Smyth: You know, that’s not a bad summary, actually. The study design was quite simple. We basically did recruit people who were in romantic relationships and we asked them how satisfied they were in those relationships. And then we waited a few months with evil grins on our faces, I suppose you could say, at which point we contacted them again. And a quarter of the sample had experienced a breakup at that point. And so at this point, we asked those individuals how satisfied they had been a few months earlier while they were still dating their now ex-partner.

Gabe Howard: And you found out that the information that they gave when you contacted them the second time was wildly different than the information they gave you the first time.

Aidan Smyth: Yes, after a recent breakup, people thought that they hadn’t been as happy as they actually had been, and they also recalled their former partners as less compatible than they actually had originally said that they were. So essentially, they recalled their past relationships as worse than they actually were, or at least worse than they said that they were while they were dating. Interestingly, it didn’t seem to matter how long they had been in those past relationships for

Gabe Howard: And just to clarify, when you first met these couples, they said we’re happy with each other. She’s great, he’s great, we’re happy, we’re dating. Everything is hunky-dory. They’re the one. And then after they broke up, it was, oh, I always knew that this wasn’t going to work out. I was miserable every day and I saw it coming. Is that sort of the answers that you were getting the second time around?

Aidan Smyth: There’s certainly a little bit of that going on, and I guess one thing to highlight would be that the people who ended up breaking up did in fact report less satisfaction in their relationships than the people who ended up staying together over the course of the study. So there was a difference even at baseline there at the start of the study in terms of how satisfied people were. But, yes, then after the fact, we did see some inaccuracies in terms of the way that they recalled their past relationship.

Gabe Howard: On one hand, it doesn’t surprise me that when you’re in a relationship, you would describe it as positive and I know putting a research modality on it or anonymity. I’m assuming that you didn’t interview them together. You interviewed each participant separately.

Aidan Smyth: Yes, so and it actually wasn’t even couples that were included in the study, it was individuals who were in romantic relationships. So,

Gabe Howard: Gotcha, gotcha.

Aidan Smyth: Yes.

Gabe Howard: So it doesn’t surprise me, again, not a researcher, that when you’re in a relationship, you would describe it positively. There’s a little bit of self-protection there, right? I mean, if somebody sat me down and said, Gabe, are you happy with your relationship? And I was like, no, I’m miserable and I hate it. That doesn’t make sense. There’s like a protective quality that’s like, no, of course not. I love her. We’re working hard. I can see using positive language like that, even if I had reservations. Did you notice sort of a read between the line language, even in the positivity, or was it just straight up happy?

Aidan Smyth: The way that we actually measured sort of their levels of satisfaction in the relationship was actually just with questionnaires. So we weren’t doing interviews with these individuals, which would be interesting to do as well, though. And I think you’d pick up on a lot more of the descriptors that you’re talking about there. But we looked at questionnaires and looked at the way their scores changed when they rated their relationship satisfaction and partner compatibility.

Gabe Howard: And what did you find out? What was the bottom line of all of this at the conclusion of the study?

Aidan Smyth: Basically, the bottom line was that people they were inaccurate in the way that they recalled their former relationships and essentially thought that they had been significantly less satisfied than they actually said they were while they were still in those relationships.

Gabe Howard: And if I understand correctly, you also found out that a lot of people realized that they didn’t hate their exes as much as they thought they did, and hate’s a strong word, maybe, maybe dislike? Weren’t as miserable did. Was that a flip side as well?

Aidan Smyth: So this is what we found, I’m not sure if the participants would acknowledge this or that they were aware of this,

Gabe Howard: Fair enough.

Aidan Smyth: We didn’t directly look into this in the study. But one possibility is that this finding could have to do with the fact that our memories of the past are often colored by the way that we feel in the present. Given that a breakup is often accompanied by a lot of emotional distress, these difficult feelings may sort of get in the way of people’s ability to recall their former relationships accurately and instead may lead them to remember them as worse than they actually were. Another possibility is that this type of bias might actually help people cope with the breakup and start to move on from that former partner. We know from past research that the way people think about their ex-partners is quite important when it comes to getting over a breakup. For example, thinking fondly of an ex has been associated with continued attachment to that partner, preoccupation with the former relationship and, ultimately, worse recovery from the breakup. And I guess it’s worth noting that this can also be problematic for the person’s subsequent relationships as well. Other research shows that recognizing the shortcomings of an ex-partner can help with adjustment and recovery after a breakup. And in fact, some researchers argue that people are unable to get over a breakup until they fundamentally change the way that they view their former partners and relationships. So to bring it back to this particular bias, if someone is no longer available to you as a romantic interest, then a bias towards viewing them in a slightly more critical light might actually provide some reassurance and comfort and reduce those feelings of regret.

Gabe Howard: Just to clarify, it sounds like your study has shown that people just are completely inaccurate in the way that they recall past relationships.

Aidan Smyth: It’s important to note they weren’t completely inaccurate when it came to the way that they recalled their past relationships. For example, it wasn’t as though they said they were absolutely head over heels in love with their former partner. And then after the breakup, they recalled that relationship as absolutely awful, although I suppose that is possible and could be the reality for some individuals. But yeah, they generally weren’t completely derogating their former relationships. It was more so that on average, they recalled them as slightly worse than they actually said they were while they were dating. And in that sense, it’s possible that after a breakup, people simply remove the rose-colored glasses and are no longer seeing that relationship in an idealized manner.

Gabe Howard: But isn’t that healthy, isn’t it good to really see somebody for who they are?

Aidan Smyth: Yes, I mean, these types of biases, it can be sort of a little unsettling almost to learn about them for the first time. And the idea that perhaps we’re not as accurate as we like to think in terms of the way we think about our partners and feel about them. But some researchers do speculate that these and similar types of biases are actually an important feature of a healthy and satisfying relationship. And often we see in past research that these types of biases are associated with greater relationship satisfaction.

Gabe Howard: Thank you so much for explaining that. I guess I need to understand, when are people in the best position to evaluate the quality of a relationship? Is it when they’re in the middle of it or only after they’ve broken up? Because obviously, if the best position to evaluate is after they’ve broken up, nobody in a healthy, happy relationship can ever get a true read on what’s going on.

Aidan Smyth: This is a really interesting question and one I’ll admit from the get go that I certainly don’t have the answer to, but it’s interesting to think about because there’s sort of this implicit assumption that we’re probably going to be more accurate in the way that we think about our relationships while we’re actually in them, as opposed to once they’re over and some time has passed. To give a poor analogy here, if you are eating a sandwich and I asked you how enjoyable that sandwich was, I would probably trust your answer now a lot more than I would if I were to ask you again a few months from now when this sandwich was over.

Gabe Howard: I like it.

Aidan Smyth: So, relationships are admittedly more complicated than sandwiches, but we know from a large body of research that when we’re in a relationship, we are prone to a number of biases that may lead us to view our relationships in that idealized manner rather than a more objective manner. Essentially, we’re motivated to see them as good, that we’ve got a great partner, we’ve got a great relationship, and therefore we’ll probably play up some of the positive aspects and downplay some of the more negative aspects. On the other hand, after a breakup, it’s possible that we’re motivated to do just the opposite. And we might want to believe that our former relationships were never really that great all along, because it probably isn’t exactly comforting to think that your past relationship, which ended for whatever reason, was absolutely fantastic and you’ll never find another one quite like it. So essentially, it seems as though we may be prone to biases on both sides of the breakup. And I think it remains an open question as to when we’re in the best position to evaluate them objectively.

Gabe Howard: What did you find in regards to people who stayed together? I mean, obviously you said 25% broke up,

Aidan Smyth: Mm-hmm.

Gabe Howard: Which means 75% were still going strong.

Aidan Smyth: Mm-hmm, an interesting finding, so our research showed that people who stayed in the same relationships over the course of the study also showed some biases or inaccuracies in the way that they thought about their relationships. These people thought that at the end of this study, their relationships had significantly improved over the past few months, even though no improvement had actually taken place. They said that they were significantly happier in their relationships at the end of the study than they recalled being at the beginning, even though they had been just as happy at the start.

Gabe Howard: Why do you think that was? Why do you think people thought that the relationships improved when in actuality they just stayed stagnant? I don’t mean, I don’t mean stagnant in any bad way.

Aidan Smyth: Mm-hmm.

Gabe Howard: Just as somebody who’s been married for almost a decade now, I’m fond of saying boring is healthy. There’s no drama. We know each other. It’s all fine. But I understand why young people are are like, man, I don’t, I don’t want to be that guy. I get it. But at the same time, that is what a healthy relationship looks like. There’s no gossip. It’s just there.

Aidan Smyth: Mm-hmm.

Gabe Howard: Why do you think they’re seeing this when in actuality they’re, I guess, boring? Is that, is that the word to use?

Aidan Smyth: Well, I think this type of a bias could also sort of reflect that idea of seeing the relationship through rose colored glasses and that it may be helpful to think of the relationship as continuing to improve or get better over time. And by downplaying or derogating the past, we’re able to do this. This bias might sort of reflect a mechanism that allows people to maintain a positive view of their relationships as time goes on. And it also probably sort of helps to fend off some of those ideas that you just mentioned about stagnation or the possibility that your relationship is getting worse over time. This type of a bias would sort of help protect against that and probably be a little more appealing. I guess I’ll also note that other research has found that we do this on a personal level as well. So, for example, there’s a study that showed that college students recalled their past selves more negatively on a number of characteristics like self-confidence or their social skills compared to how they had actually rated themselves a few months earlier. So essentially downplaying the past basically seems to be one strategy that we use to make ourselves feel better about ourselves and our relationships in the present.

Gabe Howard: We’ll be right back after these messages.

Sponsor Message: Gabe here and I wanted to tell you about Psych Central’s other podcast that I host, Not Crazy. It’s straight talk about the world of mental illness and it is hosted by me and my ex-wife. You should check it out at PsychCentral.com/NotCrazy or your favorite podcast player.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back with Aidan Smyth discussing his study about relationships and our feelings. What are some other biases that you found existed in romantic relationships?

Aidan Smyth: Sure, so there’s a large body of research, and I think even some of your former guests have probably spoken about these types of things as well. One of the biases that I’ve alluded to a couple of times here is the idea of seeing our partners through rose colored glasses or in an idealized manner. What I mean by that is there was a study that essentially found that people tended to describe their partners in a manner that more closely resembled their ideal partner rather than their partners’ actual attributes. So there’s some nice empirical evidence for the phrase love is blind, I suppose.

Gabe Howard: I understand from a research standpoint why facts matter. I get it. But romance is, it’s I know why we research and it’s fascinating. But what you just said there kind of appeals to me, this idea that I accentuate my wife’s positives and I push down and ignore her negatives and that just lets me love her so much more. I’m, of course, fond of believing that in order to sustain a healthy marriage with me, you have to do that. Like that’s yeah, you got to. But sincerely, I think anybody listening to this would think to themselves, why is science messing with this? You think the best of your romantic partner and you, you know, kind of give them a pass on the worst. It sounds like a bias is almost helpful, but I imagine it can go too far.

Aidan Smyth: So there’s a lot there and a lot of great things to think about, I think.

Gabe Howard: Isn’t it good to accentuate the positive and diminish the negative, the very first thing that I thought when you said that is, I was like, yeah, that’s like any 20-year-old that said, hey, I’m getting married. What advice do you have? And I’d be like celebrate her positives, ignore her negatives. Like, that’s, you know, if she snores? Yeah. Downplay that. She, you know, is always a half an hour late getting ready? Yeah. Downplay that. But if she’s cheating on you, you need to have like real facts. So where, when is it good to have the rose-colored glasses on and when is it important to take them off?

Aidan Smyth: So that’s a good question, and I think there is some truth to that idea, and I think that’s even reflected in some of this other research that shows that these biases can be helpful and are often associated with greater satisfaction in our relationships. Now, with that being said, I do sort of wonder about a similar question that you seem to be alluding to here, which is, is knowing about these biases helpful? For example, is it helpful to know that your relationship may not have actually improved over time, even though you thought that it did? Or is it helpful to know that your relationship may not necessarily be better than your friends’ relationships or less likely to result in a breakup? On the one hand, I’m sort of reminded of the phrase that ignorance is bliss. And on the other hand, I’m reminded of a Nietzsche quote that I think goes something like, you can measure the strength of a person’s spirit by how much truth they can tolerate. I like to believe that knowing about these biases can be helpful in the sense that perhaps it’ll allow people to recognize that their relationships aren’t perfect. And that’s OK. It’s OK that their relationships aren’t perfect. And another possible benefit is for people that are in the early stages of a relationship. This sort of research might prompt them to potentially pay attention to red flags that come up rather than sweeping them under the rug. Perhaps this could save them a lot of stress and heartache in the long run.

Gabe Howard: Humans are biased. We have biases everywhere we look and the more research that’s being done and the more we learn about our culture and society, we realize that we have biases that we’re completely unaware of. I don’t want that to go unsaid. But this show is specifically about romantic relationships. And one of the things that I think about is the bias we have when relationships are new. I call it new relationship energy. Whenever I am in a new relationship, whether it’s a friendship, a business relationship or a romantic relationship, everything is amazing and exciting and new. And I have this bias to essentially chase this dragon of awesome because it’s so exciting and it’s not boring. It’s unique. And I don’t know that I coined the term new relationship energy, but I think it’s a well understood concept that all romantic relationships are great for a week. Aren’t we ruining that? Because that week is awesome. When should you make sure that the bias is understood? I guess the thing, Aidan, that I keep thinking about and maybe I’m a hopeless romantic, maybe I’m middle aged, maybe I’ve watched one too many rom-coms, but I think about the excitement of new relationships and frankly, how ridiculous they are. I would hate to think that relationships are going to come down to scientific questionnaires. And why can’t it just be fun for a while? But I’m also aware that people get involved in relationships that are destructive and codependent and dangerous and they carry those out for long terms. Where’s the balance?

Aidan Smyth: A great question, I think that’s going to sort of boil down to the personal level, and I think it really would depend on the individual and how much of these sorts of uncomfortable truths they feel that they can tolerate, I guess, and.

Gabe Howard: Maybe don’t let people move in on day one, but also don’t run their credit?

Aidan Smyth: Yeah, I think those are two great pieces of advice.

Gabe Howard: There’s sort of a quote that’s bumping around in my mind that says Trust in God, but lock your car. And if we apply that over to romance, I think it’s OK to love love. It’s OK to get carried away. It’s OK to be excited. But maybe don’t give the person the key to your house on day one. Don’t do the Dharma and Greg and get married and, you know, fact check. Remember that there is a bias and sort of apply that as you move forward. Enjoy the moment, but don’t make any long-term decisions, is maybe the advice that comes to mind. What was it like for you personally doing this study? Because whenever love comes up, people have generally very strongly held beliefs that have little to do with science and a lot to do with their grandmothers and then their parents’ marriage and their grandparents’ marriage. As your study proved, the history of our romantic relationships plays a large role into how we feel about romantic relationships moving forward. What were the conversations in your group launching this study?

Aidan Smyth: So I guess one thing I would say is that I certainly was very surprised when I first learned about all these types of biases, because it can be sort of quite uncomfortable or almost threatening to think that you didn’t see a former partner or a current partner as accurately as you might have. Over time, though, I think learning that this isn’t necessarily a bad thing and that people need to get up in arms about that provided me with a little bit of reassurance, I guess. But it certainly prompted me to reflect on past relationships and the way that I think about them now. And I try to sort of take the perspective of how I might have felt at the time, although these are difficult things to do.

Gabe Howard: Aidan, what’s the takeaway? What do you hope that society learns from your research?

Aidan Smyth: One thing I’ll point out right off the bat is I don’t think this is a green light for people to run out and get back together with their exes. That’s not what we’re trying to say with this research here. But I think it sort of gives us the chance to reflect on our past relationships and potentially see them in a new light as valuable experiences. And maybe over time, people can get to a place where they do actually recognize that they did enjoy their time with these people and that they probably did serve them in their lives moving forward.

Gabe Howard: Just for our listeners, please keep in mind that there was a final sample size of 184 participants. Roughly half of these participants were undergraduate students, the average age of the entire sample was about 27 years old, and 60% of the sample were female, 65% Caucasian. We just want to make sure that you have all the facts because research is limited and what conclusions can be applied to humanity as a whole. 

Aidan Smyth: Absolutely.

Gabe Howard: All right, thank you so much, Aidan, for being here. We really, really appreciate it.

Aidan Smyth: Thanks for having me, Gabe.

Gabe Howard: You’re very, very welcome. Hey, everybody, my name is Gabe Howard and I am the author of Mental Illness Is an Asshole and Other Observations. It’s available on Amazon. Or you can get signed copies for less money at my website, gabehoward.com. I’ll even throw in show stickers. We have a super secret Facebook page, PsychCentral.com/FBShow. Check it out. You can hang out with me. And if you really like the podcast, where ever you downloaded it, please subscribe, please rate, please rank and please review. Remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere simply by visiting BetterHelp.com/PsychCentral. We’ll see everyone next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at show@psychcentral.com. Previous episodes can be found at PsychCentral.com/Show or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com.  To learn more about our host, Gabe Howard, please visit his website at gabehoward.com. Thank you for listening and please share with your friends, family, and followers.





The post Podcast: Relationships and Rose-Colored Glasses first appeared on World of Psychology.

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Date: 28th October 2020 at 14:40
Author: Psychcentral – psychology – The Psych Central Podcast


For too long, Western psychology has explored psychopathology without much inclusion of the positive aspects of being human, which may leave us with a bleak or stern view of psychology. Fortunately, being interested in wellness, personal growth, and positive psychology is a growing trend.

In an attempt to explain things simply, there is often a distinction made between positive and negative emotions. Positive emotions are considered to be pleasant feelings such as joy, pleasure, love, gratitude, or contentment. Negative emotions may include anxiety, anger, sadness, loneliness, fear, or other uncomfortable or undesirable feelings. 

While there is no consensus about how to define well-being, is often explained as the presence of positive emotions and the absence of negative ones. This is a simple way to differentiate between what uplifts us and what unsettles us. But there’s something about this simplistic view that unsettles me.

If we divide emotions into positive and negative ones, it creates a dualistic view of our human emotions. If we believe that some emotions are negative, it’s almost impossible for our human psyche to not want to eliminate these “negative” emotions and hold on to the “positive” ones. As a result, we’re likely to set up a tension in our psyche. We try to cling to what’s pleasant and develop an aversion what’s unpleasant. According to Buddhist Psychology, it is this very clinging that creates suffering in our lives. This is not a formula for finding joy and well-being.

There are no emotions that are bad or negative, but rather ones that are sometimes uncomfortable, unpleasant, or difficult to face and feel. If we want to enjoy more uplifting emotions, we don’t get there by pushing away, denying, or avoiding the unpleasant ones. We only get there by creating a friendly space for the full range of our human experience. The path toward inner peace and wholeness requires that we find peace with the full range of our emotions rather than trying to get rid of the ones we consider unsavory.

Befriending All of Our Feelings 

Since we are wired with the fight, flight, freeze response, it’s not surprising that our tendency would be to push away feelings that we experience as threatening to our well-being. Fortunately, there is also something in us that can relate to our experience in a more calm and measured way. We have the capacity to bring mindfulness to whatever we happen to be experiencing, whether pleasant or uncomfortable. 

One key to well-being is to honor and accept ourselves as we are. This means making room for our human experience just as it is without judging ourselves. In Eugene Gendlin’s Focusing approach, what helps us to create a shift in our inner landscape is move toward holding unpleasant experiences in a gentle, caring way. Gendlin called this approach the “Focusing attitude.” It is an attitude or orientation of kindness and friendliness toward whatever we’re experience inside.

The next time you notice feelings such as sadness, anxiety, shame, or hurt, notice how you relate to these feelings. Do you tend to push them away? Do they feel overwhelming? Before reacting or shutting down your feelings, try taking a moment to get grounded. Perhaps feel your feet on the ground or look at something pleasant in your environment. Take a few slow, deep breaths. 

When you feel grounded, see if you can bring some gentleness to what you’re noticing in your body. If it’s a feeling you don’t want to get close to, see if you can keep that feeling at some distance from yourself; maybe it’s ok to feel some part of the difficult feeling. If not, then just notice how scary or uncomfortable this feeling is. You don’t have to go into it. Perhaps you can come back to it later if you want, or work with a therapist who can help you explore it.

By viewing feelings as pleasant or uncomfortable rather than positive or negative, you might be more inclined to welcome them and explore them rather than cling to them or try to get rid of them. Unpleasant feelings tend to pass as we make room for them rather than seeing them as an enemy. Loving yourself means allowing your feelings to be just as they are. And we could all use a little more self-love.

The post The Fallacy of Positive and Negative Emotions  first appeared on World of Psychology.

Go to Source
Date: 28th October 2020 at 14:40
Author: Psychcentral – psychology – John Amodeo, PhD


We all have a friend or family member who just can’t seem to get out from under their accumulation of stuff. Their garage, guest bedroom and basement are packed, and you can’t see the top of the kitchen table. But when does “cluttered” become “hoarded?” We have all seen the sensationalized TV depictions of filthy homes that need to be condemned. But is that what hoarding really looks like?  And why can’t those folks just throw it all out?

Today’s guest explains myths surrounding hoarding, treatment strategies and why we all might be at risk.


Guest information for ‘Clutter and Hoarding’ Podcast Episode

Elaine Birchall, MSW is the director of Birchall Consulting and the founder of the Canadian National Hoarding Coalition. A hoarding behavior specialist and clutter coach, Elaine provides training, consultations, and counseling to people and organizations across the US and Canada.




About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Clutter and HoardingEpisode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in everyday plain language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of The Psych Central Podcast. Calling into the show today, we have Elaine Birchall, who is a social worker and hoarding specialist and also the co-author of Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding from Johns Hopkins University Press. Elaine, welcome to the show.

Elaine Birchall: Thank you for inviting me, Gabe.

Gabe Howard: Oh, it is quite our pleasure. Hoarding, it seems like it is everywhere, I think, in 2019 because of all the media coverage, all of the television shows. There’s just a lot more understood about hoarding today than there was 20 years ago. But I imagine that a lot of this information is incorrect. So starting right off. Can you tell us what the general population doesn’t understand about hoarding that they think they do?

Elaine Birchall: Well, the general population, I think believes that hoarding is necessarily a dirty, chaotic mess, and that’s not true. Hoarding has three criteria, Gabe. And unless each of those three criteria are met, whatever you’re looking at, at that point in time anyway, isn’t necessarily a hoarding situation.

Gabe Howard: What are the criteria?

Elaine Birchall: The first is there is an excessive accumulation. What most people would call an excess of accumulation. And I’d say a failure to resolve that proportionately. Now, that does not mean one thing in and one thing out. What it means is that fundamentally inside yourself, you either don’t have or you have a broken check and balance system that tells you when things are starting to get out of hand so that you can do it when it’s a smaller job, which is easier, obviously. The second is that some or all of the living spaces — now that can be your home, your office, your car, your back yard, your garage, it can be anywhere where you live — those spaces can’t be used for their intended purpose. You can still do the functions in your home, but you are not doing them in the spaces where they were intended to be done. That’s important because you probably don’t have the tools to do those jobs and you’re probably adding to the clutter by leaving things lying around rather than put it away when you’ve got that kind of disruption. The third criteria is somebody is upset, distress, or impairment in functioning. You’re still living there, but now you’re adapting. You’re stepping over things. You’re moving things off of a chair so that somebody has a place to sit. You stop inviting people home because you’re embarrassed about the condition. So half of your social, most of your social life, happens outside your home. Now, there’s one key thing about that stress or impairment in functioning, doesn’t mean, Gabe, that those people have to be distressed right now. You have to tick that box if people who need to know, if they knew the truth about the condition of the property, would have cause to be concerned. That’s your neighbor, who is at increased risk, that’s your family members, your pets, the fire department, children’s services, animal control, by-laws, property standards, if you’re in a multi-unit dwelling. So you can see how hoarding is not an individual problem that happens in isolation.

Gabe Howard: I really appreciate you sharing that because, of course, one of the things that I’ve learned is while my family members may hang on to things longer than I do, they don’t meet any of that criteria. They can still use their kitchen as a kitchen. They can still use their living room as a living room. And they invite people over all the time. So it shows, at least from my perspective, that I see hoarding as hanging on to stuff that I don’t like when in actuality it’s causing this… I don’t want to use the word trauma, but maybe it’s causing distress in their lives? Is that accurate?

Elaine Birchall: Yes, it does cause distress, sometimes because the individual themselves realizes this is not a good situation for me or for if you have a family, your family sometimes is in distress. So, Gabe, it’s also or more about I just wish people would get off my back. I don’t think there’s anything wrong with this. I think I have the right to live the way I want to live. Well, that’s true. But up to a point, everything has limits. When you create a hazard for yourself, no matter how big or how small that hazard is, you are probably also creating a hazard, certainly in hoarding situations. It will go on to create a public health and safety hazard as well, because to hoarding is a compulsion. It’s a compulsive disorder.

Gabe Howard: Is there a relationship among hoarding versus cluttering versus collecting vs. hanging on to things? Maybe longer than the average. Is it all part and parcel of the same thing? Or is it just completely separate and I’m barking up the wrong tree?

Elaine Birchall: Not necessarily. So hoarding is, though, to some even a minimal degree, those three criteria got ticked. That’s hoarding. All right. What we don’t know, however, is every single person who hoards has told me that they started out with clutter, but every person who has clutter is not necessarily going to go on to develop hoarding disorder. The difficulty is that at the inception, at the early, early stages of hoarding, it’s hard to tell whether that’s just clutter or whether you are really headed down a path you probably don’t want to go down. I want people to think more about that compulsion, that driving need to have things or acquire things or get the deal or all of those triggers that the people at the other end of the spectrum of hoarding look back and go, “Boy, that was a telling sign. I wish I wish I’d known back then that was a dangerous sign.”

Gabe Howard: Is it possible for somebody to be a hoarder and be super organized, clutter-free? I mean, it seems like it would be right because of your three criteria, but it doesn’t sound right like how can you be clean and organized and also a hoarder? They seem mutually exclusive, but I suspect they’re not.

Elaine Birchall: No. No, they’re not exclusive. Some of the people that I work with are extremely high functioning. Not all my clients, but I have had a number of lawyers. I have had a number of physicians. I’ve even had some practicing psychiatrists who get caught up in that sense of being overwhelmed at work. They are high functioning. They are organized. In this other area of their life, not so much. But I’ve also had people who are just average people, and they are meticulously clean and tidy. They are also very well organized. It’s about the excess of accumulation, though, Gabe. It doesn’t matter how tidy or how neat or how organized you are, if you have an excess of accumulation, then you have a problem. All right. Because we have relationships with our things, each of the things that we make important enough to keep. We form a relationship with those things. So it’s not just a matter of, oh, you have this, that and the other and you don’t really need it. If you start to engage in that logic internally where you can’t decide, no, you don’t need six toasters, but you cannot decide which of the four or five you should let go of and what to do about them. That becomes a problem.

Gabe Howard: As you’re talking about letting things go, I’m reminded of the television shows, the sensational houses that are just filled to the brim where they just do this massive clean out. Just get rid of so much stuff. And one of the things that they talk about on those shows is what’s going to prevent the person from just filling the house back up? Of just reacquiring everything?

Elaine Birchall: Absolutely, I’m happy you asked that question. Unless there is an immediate threat to safety and life, if at all possible, avoid the extreme cleanup. Now, there are occasions when a situation has gone on too long. It is too intensely deteriorated and a cleanup does need to be done. But they always cause additional damage and trauma. Sometimes, however, for the safety of the individual and the community, it has to happen. That is a real pity. That’s why I’m so happy to be on your podcast, helping people understand the sooner you identify it, the smaller the problems, the less distress. If you have the opportunity, if you have the choice, it’s the regular steady progression with the person. Not to get them to get rid of things. That’s not the point. Come at it the other way to help that person. But don’t tell them what the answer is. Only they know the answer of what’s important. Help them find the things that mean the most to them. Because we do have relationships with our things. I’m going to liken it to I guess a metaphor would be your best friend. If you find your best friends among that clutter, it’s going to be much easier for you to identify the other things that are just hangers on. They got caught up in the clutter and in the chaos and the piles. When unimportant is mixed with really important in a pile, the whole pile, whether specific items are of absolutely no importance to you or not, that whole pile feels as important as the most important thing that you believe is in that pile. That’s why slow and steady wins the race. And you are 100 percent correct, Gabe. You do an intensive clean up like that, and the moment that door shuts, it starts again. Because if nothing changes, nothing changes.

Gabe Howard: Can you describe some of the barriers to letting go of things? Why are people so fascinated with hanging on to multiple toasters, multiple televisions, just multiple numbers of the exact same thing?

Elaine Birchall: So quite often, Gabe, it’s about having, not using and people who are in this mental situation of hoarding disorder, they acquire things because things soothe them. We all need ways to soothe ourselves. And these individuals have lost track of the ability to self-soothe. They also believe that increasing number of things are important or valuable. Sometimes it’s just the process of decision making. It’s extremely difficult, particularly when you’re as overwhelmed as these folks are to make decisions that you can live with. And if you just get rid of things and some people do that, they try to remedy the situation just by pell-mell, getting rid of things. What happens is you create a void in yourself and then you fill that void and generally you fill it with things.

Gabe Howard: We’ll be right back after this message from our sponsor.

Announcer: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: And we’re back speaking with Elaine Birchall, co-author of Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding. One of the common tropes on the television shows is that hoarding is related to grief and loss. Is that true? And if so, why?

Elaine Birchall: It can be, but hoarding is a lot more than trauma or grief and loss. Anything in the human experience that makes you vulnerable and creates a state of mentally being overwhelmed. There are three paths basically to hoarding. One is genetics. All right? We do know that, depends on the study, anywhere from 50 to 84 percent of individuals who hoard have a first degree family relative who hoard, that’s mother, father, sister, brother who hoards. We know that there are 4 chromosomes with markers in common. Now, we don’t know enough about that for it to be predictive, but that we know about after the fact with studies. The second path is that if you have a high risk co-morbid factor, that’s another condition. It could be a mental health condition or it could be a physical condition. And there’s a whole list of them. And they’re well known. That if you have that co-morbid… bipolar is one, ADHD, another is social anxiety, OCD. There’s quite a long list. It puts you at a higher risk for also developing hoarding disorder. The important thing about that, Gabe, is that if you get the OCD straightened up and you’re managing it better, or bipolar or ADHD, it’s not going to make much of an impact on the hoarding disorder. It might make you, however, more available to do the unique work you need to do to resolve the hoarding. And the third path is particularly scary because I believe most of us aren’t immune from this, and that is that if you are not the most organized individual, you’re kind of chronically disorganized. You know, every so often take the phone off the hook and lock the door and you spend the weekend getting things back to the way you want them to be. But that happens repetitively. Then they become vulnerable. You have a loss, you have a trauma, you have a health crisis. You lose a job, someone dies, your pet dies, there’s some disruption. You become vulnerable. You are at a higher risk of also at that point, starting to developing hoarding disorder. And that third one I think most of us are vulnerable to hoarding.

Gabe Howard: During the research for this show, I looked over your web site and read the book, etc. and one of the things that I was surprised that came up was online shopping addiction. I wouldn’t think that hoarding and online shopping would go hand in hand, but they do. Can you talk about that for a moment? Because you identify three factors that make people vulnerable to online shopping addiction that I was just fascinated by.

Elaine Birchall: Absolutely. There’s a thing about online shopping is there’s no shame, there’s no, I’m going with a basket and I’m filling the basket and paying for the basket. I’m taking all those things home. And then I have to physically bring them back the next day because I couldn’t afford them. Online shopping, I just hit items one at a time. Generally, when I’m alone or I’m feeling vulnerable or I’m feeling something that’s not positive. And it’s so easy. It’s so accessible. And all I have to do is return it anonymously. But it’s a little like playing at the slots. You know how that turnover of serotonin and dopamine when you find the right thing. You know, you’re on certain sites where you win the auction or it’s the last item. And get a deal.

Gabe Howard: It’s exciting.

Elaine Birchall: That’s like crack cocaine to some people.

Gabe Howard: Wow.

Elaine Birchall: I’ve had people literally, this is not an exaggeration by the slightest bit, I’ve had people who, when they give me a tour of their home, have a double garage full of unopened shopping channel boxes. So clearly it wasn’t for these folks, and probably for many others, it wasn’t about what’s in the box. It was about the excitement of the arrival, the achievement of acquisition

Gabe Howard: Wow.

Elaine Birchall: And it also causes you go bankrupt.

Gabe Howard: This has just been absolutely fascinating, and I really appreciate you helping me and our listeners understand what hoarding is, because, again, the media has done a really good job of convincing us that it’s just one very specific thing. And that sort of leads me to my final question. Is hoarding disorder curable? Is there hope?

Elaine Birchall: Yes, there is hope. That’s why I do this, yes there is hope. It depends on how early the onset occurred, how long you’ve been doing it and how many other, I’m going to call them balls in the air, you’re trying to keep going. I met a woman yesterday, for instance. And even though it’s not the worst situation as far as accumulation, her life is legitimately so complicated, you know, disabled children, health issues, untreated trauma and abuse, social anxiety. There’s a list that it’s going to take quite a while.

Gabe Howard: When we talk about getting better and recovering from hoarding, what are realistic goals for people?

Elaine Birchall: Every single person, if they are willing to do the mental work, right? Because if the head and the thinking doesn’t change, if you don’t change your relationship to your things, your hands can’t help you. So every single person is capable of learning to manage at a minimum with the right resources. Right? And many people, many people the later the onset. So it didn’t start in childhood. It hasn’t gone on 50 years untreated. Later the onset, the more you reach out, when you identify the clutter isn’t working for you anymore. You realize how overwhelmed you are. We showed at that point, you can turn this around. But if you have the vulnerability towards it. Like being on a diet, Gabe, you have to understand where your triggers are and you have to learn how to either avoid them or manage them, or when you trip and fall, reach out again sooner and get back, recover what you’ve lost.

Gabe Howard: And just to boil this down to a timeframe. Is it reasonable to think that you’re going to have this under control in a couple of weeks, a couple of months, or is this a long term kind of commitment?

Elaine Birchall: Depends on the person and it depends on how long they’ve been doing the behaviors that have created the hoarding environment. I’ve had people who needed six sessions and they got the concepts. They had quite an issue with clutter and it was hoarding disorder, but they got it and they worked together. It was a couple. They worked together and they’ve made significant improvements. I’ve had other people that required a year and a half. A very, very few people, generally, those people who began hoarding at a very young age, you know, ten, eleven, twelve, thirteen in that pre-teen and got no help for it. And now they’re 50 or 60. And in addition, they have another co-morbid factor. Maybe OCD, maybe a touch of Asperger’s, other issues. Depression, bipolar, those cyclical disorders that you really have to manage. They didn’t get any help with any of that. They didn’t even know that that was part of their reality. Those people are probably going to need very long term. But the interval between changes. You’re not with them every week. Now, maybe you’re with them every month now maybe you’re with them every three months. I had a woman one time. Really interesting. It was the first time this ever happened. And I’d worked with her for about maybe eight or nine months. And she was doing really well. And I said, you know what? Let’s revisit whether you need to continue seeing me now. What do you think? And she said, well, I think I can manage on my own now, but I want to see you once a year. And I thought to myself, once a year? What good is that going to do? But I learned something. And she said, I want to see you once a year mainly because every day when I make decisions, I will know that in a year I’m going to be seeing you, and I want to use you as my own personal accountability. The people do use the skills you teach them and they do really unique things with them to help themselves. Those people make it.

Gabe Howard: Elaine, thank you so much. This has been very illuminating. And I think it will help people understand exactly what hoarding is, what it isn’t, and really add just an incredible amount of knowledge to a misunderstood disorder. So thank you for being on the show. Where can folks find you, your web site, and where can they buy Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding?

Elaine Birchall: So go to my Web site http://hoarding.ca/. I’ve got all kinds of free resources on there under the resource tab. There’s a quiz there. Are you a hoarder in the making? Now, I’ve developed that quiz specifically around the risk factors and the criteria. Go and take my quiz and identify, am I at the point that really I need help now? Because if you have a few of them, you have a compounded risk that might be expressing a vulnerability to go on and go way over the line. Once you’re over the line, Gabe, you’re overwhelmed,all right? Like you can’t move in a straight line. It’s extremely and becomes more extremely difficult to make the decisions you’re going to have to to resolve this. You can get Conquer the Clutter on Amazon.com, in Barnes & Noble bookstores; if you’re in Canada, you can get it in Indigo’s Chapters. You can go on my website. You can order it from Johns Hopkins University Press directly. Thank you, Gabe, for the opportunity. It’s really great to get a positive message out there that puts things more in a true perspective.

Gabe Howard: You’re very welcome and thank you for being on the show. And to our listeners, do you want to interact with the show on Facebook? It’s really easy. All you have to do is join our Facebook group and you can do that by going to PsychCentral.com/FBshow. And remember, we live or die by reviews. Wherever you downloaded this podcast, give us as many stars as you feel appropriate and use your words. Tell people why they should listen. And while you’re at it, share us on social media. Email a friend and tell your colleagues. We don’t have a million dollar advertising budget, so our listeners are our best chance to gain following. And remember, if you’d like to get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply visit BetterHelp.com/PsychCentral. We will see everybody next week.

Announcer: You’ve been listening to the Psych Central Podcast. Previous episodes can be found at PsychCentral.com/show or on your favorite podcast player. To learn more about our host, Gabe Howard, please visit his website at GabeHoward.com. PsychCentral.com is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, PsychCentral.com offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com. If you have feedback about the show, please email show@PsychCentral.com. Thank you for listening and please share widely.

Go to Source
Date: 23rd October 2019 at 20:39
Author: Psychcentral – psychology – The Psych Central Podcast


According to a recently-published interview with John Torous, MD, MBI, Director of the Digital Psychiatry Division at the Department of Psychiatry at Beth Israel Deaconess Medical Center, there are seven great evidenced-based mental health apps you should consider. Evidence-based means they’ve met the minimum requirements by the U.S. Food and Drug Administration (FDA) or have at least one randomized clinical research study that supports their use and effectiveness.

The recommendation for these evidence-based mental health apps comes in an interview with Dr. Torous found in the Oct. 2019 issue of The Carlat Psychiatry Report (subscribe here), a professional publication targeted toward physicians and psychiatrists. In that interview, Dr. Torous warns:

“Patients are starting to use health apps and they may not be telling you, which can be a problem because most of the apps that are available are poorly designed and lack research support. So you want to consider privacy, evidence, and ease of use. Some of the better-studied apps are coming out as prescription only products that are approved by the FDA as digital therapeutics.”

I couldn’t agree more. Just because an app appears in the App Store or on Google Play doesn’t mean it’s been vetted in any manner whatsoever as being safe and effective for the condition or concern it targets. Most mental health apps are surprisingly not designed in conjunction with a mental health expert — it may be written by some guy who took a single psychology course in college. Because of that lack of expertise, some apps give just plain bad advice, such as suggesting using alcohol to relieve stress or negative feelings.

This is also a good time to remind you of the amazing PsyberGuide, an objective non-profit project that reviews the strength of the scientific research support for mental health apps, and describes the therapeutic interventions that an app provides.



Although only available for Android devices (sorry iPhone users), this suite of 13 individual apps from Northwestern University. New users should begin with the IntelliCare Hub app, which helps manage the various apps available, depending upon each person’s unique mental health needs.

The apps are supposed by NIH-funded research, and are based upon the foundation of cognitive behavioral therapy (CBT). Apps range from Worry Knot (for anxiety), Boost Me (for stress and depression), and My Mantra (find your inspiring words), to Aspire (what is your aspiration?), Daily Feats (recognize your daily achievements) and Thought Challenger (challenge negative thoughts).

Free download.

Download now: https://intellicare.cbits.northwestern.edu/ or on Google Play

Review this app on the PsyberGuide guide.



Breathe2Relax comes from the National Center for Telehealth & Technology and is an app focused on teaching a person how to successfully do deep breathing exercises. These exercises have been proven in research to help reduce stress. The app describes itself as a “stress management tool which provides detailed information on the effects of stress on the body and instructions and practice exercises to help users learn the stress management skill called diaphragmatic breathing.Breathing exercises have been documented to decrease the body’s ‘fight-or-flight’ (stress) response, and help with mood stabilization, anger control, and anxiety management. Breathe2Relax can be used as a stand-alone stress reduction tool, or can be used in tandem with clinical care directed by a healthcare worker.”

Free download.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.

cbti coach

CBT-i Coach

Grapple with insomnia or sleep problems? CBT-i Coach is for anyone with insomnia or would like to improve their sleep regimen and habits. “The app will guide you through the process of learning about sleep, developing positive sleep routines, and improving your sleep environment. It provides a structured program that teaches strategies proven to improve sleep and help alleviate symptoms of insomnia.”

CBT-i Coach was a collaborative effort between VA’s National Center for PTSD, Stanford School of Medicine, and the U.S. Department of Defense’s National Center for Telehealth and Technology. It’s a free app.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.


Stop, Breathe & Think

You’ve heard of mindfulness. But you want some help and guidance to learn how to do it and incorporate it into your daily routine. There are a multitude of mindfulness apps in the app stores, but this is one of the best ones available. Free for basic use, but you can subscribe ($9.95/month) for additional features.

According to the app developers and supporting research, the app allows you to reduce your anxiety and stress, learn to breathe more mindfully, improve your sleep habits, daily check-ins, and track your moods over time. Check out iMindfulness and Mindfulness Daily for other apps in this space.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.

Wellness Tracker

DBSA Wellness Tracker

The Depression and Bipolar Support Alliance (DBSA) publishes this app allows you to track “your emotional, mental, and physical health. The tracker reports give you an at-a-glance summary of your health trends. This can help you better recognize potential health problems and mood triggers in your daily life, as well as help you better partner with your clinician on treatment plans.”

Sorry Android users, only for iOS devices. Free to download.

Download now: iOS App Store

Review this app on the PsyberGuide guide.

Virtual Hope Box

Virtual Hope Box

The Virtual Hope Box app, according to PsyberGuide, “is a multi-media coping skill app designed for individuals struggling with depression (particularly military service members). The four main features of Virtual Hope Box include sections for distraction, inspiration, relaxation, and coping skill options. The distraction techniques include games that require focus, like Sudoku and word puzzles.

“The relaxation techniques offer a variety of guided and self-controlled meditation exercises. The coping techniques offer suggestions for activities that reduce stress. The inspiration section offers brief quotes to improve mood and motivation.

“The app can be used in collaboration with a mental health provider through the ‘coping cards’ feature, which can be programmed to address specific problem areas. The relaxation tools can also be used with a clinical professional or other meditation partner, if desired.”

Free to download, the app was created by the National Center for Telehealth & Technology.

Download now: iOS App Store or Google Play

Review this app on the PsyberGuide guide.



Need a medication reminder app? Medisafe is one of the better and easier ones to use.

This app, created by Medisafe Inc., offers a clean and simple interface for managing your drug reminders, and allows you to share reports with others, such as your prescription provider or a family member. Also offers integration with GoodRx, a discount drug provider, and has a plethora of reminder options (including when it’s time for refills).

Free to download and use with basic features; advanced features available for $4.99/month subscription.

Download now: iOS App Store or Google Play


Go to Source
Date: 23rd October 2019 at 20:39
Author: Psychcentral – psychology – John M. Grohol, Psy.D.