TEENS/Sick Babies/Depression/Arkansas/Insight Not Enough - 10/04

[Smart Marriages ®]

subject: TEENS/Sick Babies/Depression/Arkansas/Insight Not Enough - 10/04



- STARTING EARLY - HEALTHY RELATIONSHIPS AND TEENS
- MARRIAGE EDUCATION AND PUBLIC HEALTH
- FATHER FLIGHT
- DEPRESSION'S TOLL ON MARRIAGES
- ARKANSAS: GOVERNOR'S MARRIAGE INITIATIVE
- WHY INSIGHT ISN'T ENOUGH

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- STARTING EARLY - HEALTHY RELATIONSHIPS AND TEENS

Here is a link to a webcast from the National Governor's Association that
features Barbara Whitehead and Marline Pearson - "Starting Early -- Talking
About Healthy Relationships With Teenagers" Go to http://www.nga.org and
click on the left Webcast Series Video Files September 2004.

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- MARRIAGE EDUCATION AND PUBLIC HEALTH

The two following posts illustrate connections between health and marital
success. It's obvious that marriage education could help couples struggling
w/ the birth of a sickly baby or with the mental or physical illness of a
spouse. We need to help policy people and health insurers see these
connections! - diane
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- FATHER FLIGHT
The Washington Post: Unconventional Wisdom
Oct 10, 2004

A sickly baby significantly increases the chance that the father will soon
leave the family, said researcher Nancy Reichman of the pediatrics
department of the Robert Wood Johnson Medical School in New Jersey.

"Having a child with poor health decreases the probability that the parents
will live together by 9 to 10 percentage points" after a year to 18 months
of the child's life, Reichman and her colleagues reported in the August
issue of Demography.

They analyzed data collected from the parents of more than 3,000 newborns.

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- DEPRESSION'S TOLL ON MARRIAGES
Oct. 11, 2004

(WebMD) When one spouse suffers from depression, both will have an unhappy
marriage, new research shows.

There is a growing body of research indicating that mental health and
unhappy marriages are closely entwined, writes lead researcher Mark A.
Whisman, PhD, with the University of Colorado at Boulder. His paper appears
in the October issue of the Journal of Consulting and Clinical Psychology.

Being in a relationship with someone with mental health problems may lower
the satisfaction for the partner, he writes. The burden of living with
someone who has mental health problems takes a toll.

However, few researchers have investigated the effects of both partners'
mental health on the relationship, Whisman writes.

Depression, Unhappy Marriage Linked

For their study, Whisman and his colleagues recruited 774 married couples
from seven states. Each partner was tested for depression, anxiety, and
whether they had a happy or unhappy marriage.

Researchers found that each spouse's level of anxiety and depression
predicted an unhappy marriage for the depressed spouse and the other spouse
as well.

The more anxious and/or depressed either spouse was, the more dissatisfied
he or she was with the marriage. Depression x more than anxiety x affected
whether a person considered themselves to be in a happy or unhappy marriage.
The researchers found that there were no differences between the sexes in
the magnitude of the effects.

A spouse's level of depression also predicted martial satisfaction, and
other studies have shown a similar pattern, he writes.

There's a possible flaw in this study: If a spouse was depressed when
completing questionnaires about his or her unhappy marriage, it might have
affected how he or she responded.

When treating spouses with an unhappy marriage, therapists should closely
evaluate each partners' mental health, he writes.

SOURCE: Whisman, M. Journal of Consulting and Clinical Psychology, October
2004; vol 72: pp 830-838.

Again want to recommend the tape by Dennis and Emily Lowe on Marriage
Education and Depression.

Order tape #752-511 at 800-241-7785.
#752-511
Marriage Education and Depression
Dennis Lowe & Emily Scott-Lowe, PhDs
Marriages in which one spouse is depressed are 9 times more likely to
divorce. Teach couples to identify depression and the skills and resources
that will help them cope more effectively.

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- ARKANSAS: GOVERNOR'S MARRIAGE INITIATIVE

Diane, I thought you might be interested in hearing about the Covenant
Marriage initiative we are about to launch in Arkansas.

As you know, we passed covenant marriage in 2001. Since that time, only
about 670 couples have either entered a covenant marriage or converted to a
covenant marriage. We knew, going in, that this would only succeed to the
degree that the clergy grasped it and used it. So, we are planning an
ambitious event for February 14, 2005 (Valentine's Day).

On Valentine's Day, the governor and his wife, Janet, along with at least
1,000 other couples - and hopefully closer to 5,000 - will convert their
marriage to a covenant marriage at a public ceremony at Alltel Arena. Our
office is partnering with Dennis Rainey and FamilyLife, which is
headquartered in Little Rock, to pull this off. In November, Governor
Huckabee will do a statewide fly-around to hold press conferences
throughout Arkansas publicizing this event. We will ask pastors to meet us
at each stop along the way. We have developed a DVD highlighting the
stories of couples whose troubled marriages were saved and we produced a
CDROM containing a PowerPoint explaining the covenant marriage law.

Following our fly-around, my assistant and I will be holding regional,
technical assistance workshops for pastors and counselors to equip them to
walk their people through the process.

This is an ambitious initiative. It will be a wonderful opportunity for us
to affirm marriage, not to protest anything. We are going to show that
Arkansas' pastors are serious about addressing divorce and protecting
marriages. Stay tuned!

Chris Pyle
Health & Human Services Policy Advisor
Office of the Governor
Little Rock, AR
501-682-8568
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- WHY INSIGHT ISN'T ENOUGH
Diane, (I'm sorry this is so long, but it is very, very good) I got
this from the Psychotherapy Networker's current website. Perhaps, the
therapist author is a bellwether, and can lead his colleagues to understand
that EDUCATIONAL ASPECTS OF RELATIONSHIP TRAINING is the key to lowering the
divorce rate, not seeking and waiting for insight (during the most stressful
times of a person's life). I looked for any words or phrases pertaining to
the value to children and society and marriage preservation--sadly, they're
hard to find it in the field of psychotherapy.
Roger in Wichita

Roger is right, you can't read this without thinking it was written to
explain how/why marriage education programs work. I especially thought of
Stosny's Compassion workshop and his HEALS protocol for self-regulation. But
it applies to ALL the programs and their approach that reconditions
couples/family behaviors - teaching self-soothing, time outs, communication
guidelines and protocols, experiential practice, repetition, imagery - as
they change couples behavior habits and patterns, change moods and regroove
the brain. - diane

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Why insight by itself isn't enough for lasting change
by Brent Atkinson

In the 15 years that I've been following developments in neuroscience,
the most compelling clinical lesson I've learned is likely to rub you the
wrong way. An overwhelming body of research now suggests that we clinicians
rely too much on insight and understanding-and too little on repetitive
practice-in promoting lasting change.

This wasn't welcome news to me. I'm a couples therapist, and I got
into this business because I loved transformative moments when intimate
partners' defenses crumbled and their deep emotions emerged. That was what
juiced me-not, getting couples to do the same things over and over again.

Yet, year after year, I watched couples let go of judgment and blame
for an instant, only to show up for the next session as miserable, critical,
or withdrawn as ever. They didn't even remember the profound insights they'd
had that I felt sure were going to rock their worlds.

Then I encountered a series of studies published by neuroscientist
Jaak Panksepp, from Bowling Green State University, and came to understand
that when they were upset, my clients were in the grip of one of seven major
body-brain mood states, which he calls "executive operating systems."

Our Brains' Executive Systems

Panksepp uses the terms rage, fear, seeking, lust, care, panic, and
play to describe the signature emotion of each system. But they're more than
passing moods. They're complex neurochemical cascades, in which hormones
race through the body and brain and electrical impulses fly over familiar
neural synapses, shaping what we feel, do, and think. When one of these
systems becomes active, emotions, motivation, and thoughts take over in the
service of the goals it's programmed to achieve. It's as though we've gotten
on a plane to Paris, and no amount of fiddling with the seatbelt is going to
change the plane's direction before the wheels touch down at Orly.

Four of the systems are wired for love: they draw us together. One of
these is old-fashioned lust. Another promotes spontaneity and play. A third,
the instinct to nurture others, which Panksepp calls care, is activated by
the release of the hormone oxytocin into the bloodstream and brain. Another
mood system Panksepp calls "panic" is experienced as yearning or even
abandonment, when an intimate partner leaves on an unexpected business trip
or storms out of the house during a fight.

Most of these mood states can help promote emotional bonding during
couples therapy. But the states that therapists find the most frustrating in
the consulting room-and often the most common-are two other body-brain mood
states that used to be called fight or flight. Activated by the amygdala,
they produce self-protective thinking and action. Fight, which Panksepp
calls rage, quickens the breathing, sends blood to the muscles in
preparation for striking out, and releases adrenaline and noradrenaline into
the bloodstream and brain. It sharpens some mental functions and leads a
person to think in decisive, impulsive, blaming, oversimplified ways. It's
accompanied by the attitude "You're wrong, and I'm right."

This hormonal cascade can be lifesaving in the appropriate
situation-in the face of a dangerous driver, say, or a possible mugger or
rapist. But in intimate relationships, it's often toxic. In its grip, men
(and some women) can become physically abusive; others yell, nag, blame, and
complain. And as almost everyone knows, it's much easier to get on this
particular tiger than to get off.

The second self-protective cascade, which Panksepp calls fear,
produces feelings ranging from anxiety to intense fright, along with worried
thoughts and the impulse to freeze, flee, withdraw, or hide. It, too, is
accompanied by critical thoughts about the intimate partner. A man in the
grip of this neurochemical cascade may exhibit sullen, disgusted, or spacey
withdrawal in the face of a barrage of angry complaints from his wife.

Hence my frustration. I couldn't understand why couples continued in
these patterns when they'd learned-in those magical moments of insight-that
blaming or withdrawing didn't help them get what they wanted. It seemed so
irrational. But when people are in the grip of these emotional takeovers,
certain parts of the prefrontal cortex (the folded outer layer of the brain
behind the forehead) are less active than when they're calm. The prefrontal
cortex is the seat of free will and self-awareness. It allows us to plan,
strategize, imagine the results of our actions, and choose to do one thing
rather than another. When portions of it are inactive, as they appear to be
when we're in the grip of one of our executive operating systems, our inner
switchmaster is asleep: we simply can't shift from one state or course of
action to another. So the wife keeps blaming, like a hamster on its
treadmill, and the husband, in an equally mechanical state, keeps staring
out the window.

Learning to Shift Mood States

When I first encountered this information in the early '90s, I worked
at getting clients to shift out of these powerful mood states. When I got
frustrated, I reminded myself that they were caught in neurochemical
reactions beyond their control. I'd usually have one partner wait in the
waiting room for a few minutes while I worked with the other, finding that a
few minutes of concentrated empathy, validation, and acceptance would often
calm someone down. Under these conditions, they could hear me say-in a
soothing tone-that blaming would only stimulate the other's defensiveness
and not get them what they wanted. We could then brainstorm more pragmatic,
emotionally open, skillful ways of communicating. I was training them to
reactivate the neocortex-the inner switchmaster-in the face of strong
emotion.

I assumed the lessons would stick, but I was disappointed. I'd
underestimated the hardwired nature of my clients' automatically activated,
neural- response programs, ingrained through years of relating to each
other. They needed far more practice than a weekly therapy session could
provide.

It wasn't enough for my clients to rehearse new thoughts in calm
moments. They needed to practice new ways of thinking under "game
conditions"-when they were actually upset and least able to think clearly.
And they'd have to do this over and over: most neuroscience researchers
agree that the brain acquires new habits through repetition. One of the most
enduring concepts in neuroscience is Hebb's Law, named after the pioneering
McGill University neuroscientist Donald Hebb, who stated that brain
processes that occur together over and over again become grafted together,
and are more likely to occur in conjunction in the future. According to
Hebb's Law, if my clients engaged in new thinking processes while they were
upset, and did this enough times, the new thinking processes would begin
happening spontaneously each time they became upset.

Audio-Facilitated Change

Then one of my clients, a registered nurse named Judy, who kept
struggling to tame her tendency to get enraged with her husband, said to me,
"If only I could take you home with me!" When she was furious, she was in
the grip of the delusion that her anger was her empowering friend, only to
find that her outbursts actually disempowered her. She asked me to make an
audiotape for her to listen to precisely at the moments when she became
upset with her husband. In this audiotape, I offered encouraging words and
reminded her repeatedly that she was far more influential and powerful when
she stood up for herself in ways that didn't put her husband down.

She loved the tape and listened to it not only when she was upset, but
also when she was driving in her car and on a Walkman, while she was doing
the laundry and cleaning house. Within three weeks, she experienced a
dramatic shift in a lifelong destructive pattern.

I made more elaborate tapes for Maria and Tony, who trudged into my
office one crisp October evening for their fourth session. Maria was so
upset that she refused to speak to Tony. She'd had elective surgery the
previous week, and had gone into rage mode when Tony left her alone in the
hospital one night to go home and get some sleep. I asked Tony to stay in
the waiting room while Maria told me how incredibly selfish he was for
thinking of himself when she was in so much distress. In the grip of her
amygdala-driven cascade, she couldn't see that her attack was sending Tony
into disgusted withdrawal as usual. I sympathized with her feelings, and
then simply suggested that although her attitude was perfectly
understandable, she'd need to drop the idea that he'd done something wrong,
and simply tell him how she felt. She struggled inside for a moment and then
relaxed. Her eyes moistened and she said softly, "Okay, I think I can do
it." When Tony joined us, Maria spoke from a different place inside, and
Tony responded instantly with an apology.

I then made an audiotape that essentially repeated the words that had
helped Maria shift during this session, and asked her to listen to it each
time she became upset with Tony during the following week. The next day, she
got off work early, pulled into the driveway, and saw her children playing
at the neighbor's house, even though Tony had agreed that he wouldn't let
the kids go out to play after school until they'd finished their homework.
She felt a surge of anger, but as she reached for the car door, she
remembered the audiotape in her purse. She paused for a split second, torn
between the urge to vent and the desire to avoid going down the same old
path.

Reluctantly, she plugged in the tape and listened in the car. After 10
minutes, she realized that she was in no frame of mind to talk to Tony, and
decided to take a walk around the block. After 20 minutes, she felt calmer,
and by the time she saw Tony, she was able to keep an open mind and simply
ask him why the kids were playing, rather than accuse him of breaking their
agreement.

What happened during Maria's walk around the block? Frankly, I don't
know. In Maria's audiotape, I didn't tell her what to do or how to shift her
attitude, I simply reminded her of a few reasons why she might want to try.
The decision was hers. Clients often have difficulty describing how they get
shifts to happen. Most report a willingness to let go of control and a
momentary surrender to the fact that you can't make life go exactly
according to your plans. The shift is usually accompanied by physical
relaxation and a release from obsessive thinking. The client returns to the
present moment, and is able to respond to what's actually happening, rather
than what they fear is going to happen. The most important ingredient in
getting an attitude shift to happen is desire. When clients decide they
truly want to shift, they do.

Ancient Wisdom

What clients report helps them shift brain states has something in
common with many repetitive religious practices-from praying "Thy will be
done" to practicing mindfulness, kissing a St. Christopher medal before
going up to bat, or making a list each night of things one is grateful for.
All of these approaches help people create enough of a pause to free them
from the grip of intense rage or fear and to generate states of generosity,
acceptance, and trust. Like them, my audiotapes allow the body and brain to
calm down, and they serve as timely reminders that it's in the client's best
interest to try to shift.

Maria, for instance, used her tape as regularly as some people light
candles at mass. She told me that she often could feel an attitude change
beginning as soon as she heard my calm, confident tone. It reminded me of
what attachment researchers speak of when securely attached children evoke
images of their caregivers to soothe themselves. In her third week of using
the tapes, Maria told me that she began to spontaneously hear my voice
inside her head every time she got upset.

Some clients need little more than a verbal reminder. Others require
vivid images or metaphors. Tony, for instance, once told me that when he
reflexively defended himself, he felt like he was swatting Maria's
complaints back at her with a baseball bat. In a minisession without Maria,
I helped him imagine turning the bat into a pillow. The image worked, and
when Maria returned, he was better able to absorb and digest what she had to
say.

I put the pillow image on a tape for Tony. Then we got Maria to record
a tape full of her complaints-a litany about how Tony didn't keep his word,
didn't fix things around the house, and hadn't kept the kids quiet on
Saturday morning after promising he'd let her sleep in. In a solo session, I
had Tony listen. As soon as he began feeling defensive, we'd stop the tape
and he'd focus on how his body felt; he'd tremble and go into a sort of
disgusted shutdown. Then he'd practice trying to shift, seeing the pillows,
relaxing physically, reminding himself that there might be some validity to
her point of view. Then we'd start the tape up again and repeat the process.
Tony used the tape regularly in his truck and became so adept at generating
a state of acceptance and compassion that one of his employees remarked that
he'd undergone what seemed like a spiritual shift.

I still love the drama of transformative experiences, and my favorite
moments are still the tearful ones, when partners drop their defenses and
exchange heartfelt expressions of love. But nowadays, I see these moments as
just the beginning. They give clients the motivation for the real work of
change, which is much less dramatic. I rarely get to see it because it
doesn't happen in my office. It happens a little bit at a time, day in, day
out, as clients practice letting go of the critical judgments that arise
with the brain's self-protective mood states.

My happiest clients make shifting a daily practice, not unlike prayer.
The tape recorder, and all my modern knowledge about neuroscience, have
ended up supporting the practice of routine and ritual, largely ignored by
modern psychotherapists, but intuitively known and practiced by sages since
the beginning of time.

Brent Atkinson is the director of the family therapy program at
Northern Illinois University, and is in private practice in Geneva,
Illinois. Address: School of FCNS, Northern Illinois University, DeKalb,
IL 60115. E-mails to the author may be sent to: Brent at thecouplesclinic.com.
Letters to the Editor about this article may be sent to:
letters at psychnetworker.org.

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