Over the past few months the media has featured a number of stories of high profile people with alcohol and other drug problems, from our own Zac Guilford to the early deaths of singers Whitney Houston and Amy Winehouse. It doesn’t take a lot of thought to recall the names of many other sportspeople, actors, singers and other celebrities whose alcohol or other drug use has become public in recent years, and many more besides going further back such as singers Hank Williams, Billy Holiday, and Johnny Cash, or footballer George Best.

Are celebrities more likely to develop problems with alcohol and other drugs? Yes and no. Having a lot of money is a risk factor, as one of the things that limits our consumption of any product is price. For alcohol there is what is called a “bimodal distribution” of heavy drinking depending on income: The heaviest drinking group is in fact the poorer segment of society, but risk doesn’t simply steadily reduce the more financially comfortable you are, instead there is another bump up in the graph for the wealthier segment of society. So it seems that when it comes to disposable income either an excess or, somewhat paradoxically, tight financial circumstances increase the temptation to indulge in heavy drinking.

Another risk factor for some of our celebrities is that certain occupations and industries involve greater exposure to alcohol and other drug use. The entertainment industry is certainly one of these. Professional sport in contrast is one where you might expect recreational alcohol and other drug use to be low as these substances are detrimental to a sportsperson’s performance (we won’t get in to performance enhancing drugs in this column). We know however that in New Zealand, as in many other countries, alcohol sponsorship is widespread and deeply enmeshed with many sporting codes. This sponsorship often includes free or discounted alcohol being provided to players. In such situations players have been found to drink more alcohol and experience higher rates of hazardous drinking. Our sporting heroes are disproportionately the very demographic – young males – where we find heavy drinking to be prevalent, to the point of almost being the norm, so we shouldn’t be surprised that this group finds the temptation of heavy drinking difficult to resist from time to time.

We shouldn’t lose sight of the fact that there are an enormous numbers of celebrities, entertainers, sportspeople and public figures who don’t have these problems however. Reporting on that isn’t news and doesn’t sell papers and magazines. The media can inform us about what is happening in the world but sometimes its inherently selective nature can act to misinform us, as is the case here.

So what can we learn from these examples of alcohol and drug excesses? They do provide an example of the hazards of substance use, but at the same time there is a risk of glamorising use.The flip side to how the public could react to and learn from this is the experience of the public figure. There is arguably less respect for privacy shown to individuals with drug or alcohol than would be the case were they to suffer a different mental illness or physical illness. Is this fair? Part of this may be that we as a society tend to see heavy drinking/drug use is a personal choice for which a person must bear responsibility. While this is entirely valid in many cases, for some it is not so simple, with those experiencing addiction struggling to exert control over their substance using behaviour. Public shaming is a very blunt tool to try to bring about change for such individuals, and can easily end up being simply another cost of their drug problem.

Ultimately as a society we may be better off if we respect the privacy of others, even public figures. When use occurs to the extent of pushing itself into the public eye we should exercise caution in our tendency to rush to judgement.

One of the biggest problems with setting goals is that we often set ourselves (and others) up to fail. By making a goal too big at the start, we lose hope as we begin to realise how long it’s going to take to reach it. And when hope declines, motivation declines.
So what’s the answer? It’s my “One degree of change” rule. This means that I only set goals in terms of one degree of change at a time. The analogy I like is of a huge ship that has so much momentum that it’s really difficult to change direction. But, once you have one degree of change in direction, the momentum guarantees that the change continues for some time, and the ship can change course quite dramatically. Our habits are also really hard to change, but once you make one degree of change, the success builds motivation, making it easier to continue the change.

A current example is trying to get children to sleep through the night in their own beds. Lots of children have disrupted sleep patterns since the earthquakes began – not wanting to go to bed at night; not staying in bed and calling out; and waking in the night and coming through to parents. Inevitably, parents attend to their children in terms of reassuring them or comforting them or trying to get them back to their own beds and this attention has taken on a life of its own: Children struggle to go to sleep alone, disrupting everyone’s sleep, and people end up tired and grumpy. Parents come and see me for help with getting their children back into regular sleeping routines. We use a range of strategies like gradual withdrawal and reward systems, with the ultimate goals of having the child go to sleep alone and staying asleep until morning – or, at least, being able to go back to sleep alone if they do wake in the night.
Understandably, exhausted parents hope for a relatively quick resolution to the sleep disturbance, and set the goal too high. They may set up a goal of the child staying in his or her own bed all night and promise that, if the child can do this for a week, there will be a reward. Inevitably, the child cannot satisfy this requirement, everyone is disappointed, frustration sets in, and motivation drops. In desperation, parents may have to depend on sleeping medication for their children to ensure that everyone gets some sleep.
So, a big part of my job is to help parents make the initial goal small enough that everyone is set up to succeed. For example, the first goal may be that the child goes to sleep alone in the first instance with no calling out or getting out of bed (irrespective of what happens during the rest of the night), and an immediate reward is provided for each night that this is achieved. If this is too difficult, then the goal is made smaller – the child stays in bed but has the parent check in every 10 minutes until they go to sleep. If this is too hard, then the parent may sit on the child’s bed until they go to sleep. As long as the child stays in bed with no calling out, the reward is earned. Alongside the behavior change programme, I encourage parents to replace the attention the child is getting through sleep disturbance with some one-on-one attention at more appropriate times. Once success is achieved with a small sleeping goal, the goal can be made incrementally bigger. Critically, the child (and the parent) experiences success, and the belief that change is possible will grow, so that once some confidence develops, change is easier to achieve.

It’s one degree of change that gets the change process started.

Earthquake Stress and Dangerous Escapes

Dr Simon Adamson

In the year following the February earthquake many of us have had to deal with a wide range of earthquake related issues – in addition to coming to terms with the experience of the major seismic events themselves there is the loss of jobs, loss of homes, disruption to school and work routines, and sense of loss when we are continually confronted with ever increasing change to our cityscape.

Under such circumstances we shouldn’t be surprised that people may seek to escape their physical and mental reality. Escape can take many forms but some of these can be unhealthy. In particular psychoactive drugs, including alcohol, and also absorbing compulsive behaviours such as gambling and pornography use
Figures on alcohol and drug use post earthquake are hard to come by, but in terms of gambling recently released figures show a 10% increase in spending on Canterbury’s “pokie” machines in the past 12 months, which is remarkable when you consider the number of pokie machines reduced significantly, with over a quarter of venues affected, including the largest, the Christchurch Casino, which was closed for many months. There has been an increase in spending across the country in the past 12 months, but Christchurch and surrounding districts accounted for about half of the total increase – as much as the rest of the country combined in other words
Gambling venues were not the only ones affected by building damage/closure. These same venues, and others besides, were also licensed drinking premises. The result has been more people socialising at home, or in the homes of friends, and a move to the suburbs, with places such as Merivale and Papanui becoming hot spots for socialising and the negative consequences of public intoxication.

For many, an increase in drinking or other unhealthy choices isn’t a matter of consciously “self-medicating”, rather it is the fact that the earthquake and their aftermath have put lives under pressure in so many ways. And when under pressure small cracks can become large cracks and it is the cumulative weight of all of these worries that make the desire for escape become stronger.

We can respond to this challenge though by recognising two things: firstly, wanting to forget about your worries is natural and reasonable – having a break is important, but choose healthy options, look after yourself. Secondly, forgetting/escaping is fine for a break but in order to move forward and get life back on track you can’t spend all of your time not thinking about the big issues. The big issues have to be tackled.

The Earthquakes and Family Stress

Prue Fanselow-Brown

We know that children enjoy the most favourable outcomes in all spheres of their lives when their parents manage to balance authoritative (firm and kind) parenting practices with a great deal of warmth.

Research suggests that children most equipped to cope with major stress are children who enjoy positive relationships with their parents. Positive relationships with parents are also fundamental to success in parenting and children’s respect for parental authority. However, these positive relationships can be disrupted by stress. Major stress arising from anxiety, loss and disruption to homes and finances (as in Christchurch over the past year or more) impacts negatively on parenting practices and families. We have heard the statistics on the increase in domestic violence and spousal conflict. All these effects may be devastating to individuals, the family and also to the child’s ‘world’ and well-being.

Take some quiet time to review and reflect on how you’re doing. How much of your own stress and anxiety may your children witness? Stand in their shoes and see and hear yourself through their eyes. Recall their facial expressions. How do you think they are feeling about their relationship with you? Are you sounding calm, firm and warm to your own ears, and managing to contain their anxiety or is there tension or irritability? Are you happy with the childhood experiences you are providing and will you look back on these years with happiness and the safe knowledge that you did your best? Will you be able to stand proud when you look your future adult children in the eye, having earned their respect and their desire to follow your modelling?

How do you stack up to yourself? With courage we can honestly and kindly reflect on our own behaviour and well-being and not attempt to be heroes; afraid to acknowledge we may need some help, some practical support, or a break now and then. The effects of ongoing stress may just sneak up on us and become part of our lives…hard to remember how we were before this all started. What are all the sources of stress in your life? What are you proud of? What are you enjoying? Do you laugh enough? How are your thoughts and energy? Is the work/pleasure balance healthy? What are you putting up with that could be changed? What fills your ‘cup’? Write down your ideas and discuss these with someone you trust. Go through the process of problem solving; clarify the problem, brainstorm creative solutions, select one or a combination and take action. Review your progress. Remember that life is short and should be enjoyed. Both you and those you love will benefit.

Domestic violence following earthquakes

Craig Prince

Domestic violence is a topic that often elicits little sympathy with the public because of people’s unrealistic perception that victims should “just leave”. Following natural disasters, this issue often receives less attention than other emotive topics, such as the effect of the disaster on people’s pets. Some interesting findings pertaining to this very real social problem in the aftermath of the Canterbury earthquakes have been highlighted.

While crime has decreased significantly in Christchurch and surrounding areas, the overall rates of domestic violence reported to the police have remained largely unchanged. However, women’s refuges have identified significant increases in women reporting abuse, especially in the periods directly following the September, February, and June quakes. International research supports the trend of increased domestic violence immediately and for lengthy time periods following major disasters.
The violence is largely attributed to increased levels of stress. People are in a frequent state of arousal and anxiety making them less tolerant and more likely to “snap”.

Stressors include frequency and severity of aftershocks, loss of possessions, disruption or loss of amenities, being forced to live with others, diminished access to supports, loss of routines at home and work, tiredness due to loss of sleep, emotional fatigue, and uncertainty regarding the future. Individual thresholds for coping lessen and relationships become strained. In an effort to cope, many people resort to alcohol and drug use, thereby fuelling already tenuous relationships.

It therefore comes as no surprise that those who had previously resorted to domestic violence displayed an increased frequency and severity of violence following the quakes.

Paradoxically, some victims are more inclined to leave abusive relationships following natural disasters because of the increased visibility and accessibility of social support services and the availability of financial grants. Further, if they have lost many of their possessions, there may be less investment in remaining in the relationship. Some victims come to realise that if they can survive a significant disaster, then they can survive on their own.

Unfortunately, alternative pressures may be created for those that leave abusive relationships. The lack of alternative accommodation may result in lengthier stays in safe houses; child custody arrangements may not be addressed in a timely fashion; there may be less access to child care arrangements; less jobs available; and transport issues.

Victims of domestic violence may attribute their abuse to factors associated with the quakes and thus anticipate that it will resolve in the short term. However, as stressors are likely to remain in the medium to long term and due to some violence already having become entrenched, victims are encouraged to end the cycle of violence by seeking help.

Christchurch, Earthquakes, Anxiety and Depression

Alan Prosser

December 23 was a cruel blow to the residents of Christchurch and Canterbury. Prior to the powerful shakes on that Friday – just two days before Christmas Day – there was the sense that things were gradually settling. Prior to that afternoon, Canterbury residents had over the preceding fifteen months been contending with a huge amount of uncertainty and unpredictability – firstly, with respect to the potential for further earthquakes (and of unknown magnitude) and what risk might there be to life, limb, or property; and secondly, confusion and distress for many residents around matters regarding zonings, issues with local bodies, the insurance industry, and EQC.

Our emotional, psychological, and neurochemical wellbeing is reliant on there being a reasonable degree of consistency and predictability to our lives. When events such as those of September, February, June, and December occur, they disturb our equilibrium significantly. We are suddenly made aware of just how, in a flash, our life circumstances can be profoundly altered – and that is not an experience we find at all pleasant. Whilst each of us has our own unique reactions to such an event, it would be fair to say that most of us will experience some sort of reaction to such a sudden, uncontrollable, unpredictable, and maybe life-threatening event – and that is normal. Traumatic events, whether natural or manmade, are likely to cause us to question some very basic assumptions about how the world works and our level of personal safety within it: our take on the future, where we fit in the world, and our belief that human beings are fundamentally benign, may be called into question following a traumatic event. Unconstructive or insensitive responses from the various agencies to those affected by a catastrophe may potentially aggravate an already distressing situation.

Sleep difficulties, flashbacks, irritability, feeling on edge, and being on an emotional rollercoaster, are just a few of a number of reactions that may be experienced following a catastrophe. The curse of our situation in Canterbury is that the catastrophe has been ongoing, and whilst the geological scientists are providing us with the best data they can with regard to likely future patterns with aftershocks, it is very difficult for us to inform our fight/flight centre inside our brain to just “settle down”; and this is because the quakes have been ongoing – and some of very disturbing proportions – so that part of our brain can remain primed. Over time, this state of alertness can tire our neurochemical system. This unpredictable and uncontrollable stress can affect us physically and emotionally, and in due course a depressed mood may eventuate. Again, this is not at all unexpected; it is not a sign of lack of willpower or resiliency, as, unfortunately, some people are inclined to label themselves. In fact, there is likely to be a significant number of Cantabrians who have very appropriately spoken to their general practitioners or a mental health professional over these months, and sought assistance, whether it be medication, psychological intervention, or both.

The impacts of the earthquakes for people living with disability

Dr Debbie Snell

For people and their families living with disability the consequences of the Christchurch earthquakes have been far reaching and have created unique challenges. First there have been significant environmental changes. These changes to our physical community have meant the central business district is no longer accessible, bus routes have been altered, roads and footpaths damaged and many facilities have moved or are no longer operating. This has affected people’s routines, activity levels, well-being and quality of life. Negotiating footpaths can be a risky affair now and for a person who uses mobility aids such as walking sticks or a wheelchair, this can mean reliance on others to get out and about, thus impacting on self esteem and independence. Damage to homes has created obstacles for people with mobility problems, for example those in wheelchairs have reported interesting experiences negotiating chemical toilets and portaloos. Second, there are social and psychological changes that have impacted on our community, friends, families and supports. The uncertainty and associated chronic stress and anxiety created by the earthquakes and ongoing aftershocks are overlaid on a life already complicated by disability. For example, the importance of daily routine and a predictable living situation for a person with a significant brain injury is critical to maintaining both physical and psychological health. The earthquakes and ongoing aftershocks have been anything but routine and predictable. However, the experiences for people living with disability are not all negative. While for some, the earthquakes and related changes to our physical and social environment have indeed been markedly isolating and distressing, for others these events have created some surprises. One woman living with a brain injury described how she had not realised people in her neighbourhood knew about her, much less cared. But they came to find her on February 22nd and made sure she was safe and supported in the days following. She now describes a greater sense of connectedness to her neighbours and local community. This connectedness has given her more confidence to contribute to and participate in local activities. Finally, as part of the rebuild of Christchurch the City Council is consulting with disability groups about building a better and more accessible city and this is a very real opportunity for Christchurch to develop a fabulous and inclusive space for all members of our community. You can find more information about this consultation process at www.odi.govt.nz

Trauma and Growth

Dr Fran Vertue

While it’s undoubtedly true that the chronic stress of the past 18 months has taken a massive toll on individuals and the community in Christchurch, there is also some good news. Over the past decade, researchers have moved away from an exclusive focus on the negative aftermath following traumatic events. There is now a large and growing literature showing that people with cancer, parents of children with severe health problems, people who have suffered a heart attack, people who have served in war, and those who have survived natural disasters identify positive ways in which their lives have changed as a result of the traumatic events. The name that is generally assigned to these positive changes is “posttraumatic growth”. The originators of the concept, Tedeschi and Calhoun said “Posttraumatic growth is the experience of positive change that occurs as the result of the struggle with highly challenging life crises”. The research from other countries (and now New Zealand) suggests that post-traumatic growth tends to occur in five general areas. First, people who must face major life crises can develop a sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before. We have seen so much of this in Christchurch where innovation is the name of the game and people have adapted to the changing landscape with exciting new projects. A second area is a change in relationships with others. Some people experience much closer relationships with specific people, and they can also experience an increased sense of connection to others who have suffered in the community. Again, we have seen this as neighbours get to know each other and the community band together for mutual support. Unfortunately, there is also the risk that relationships that were troubled before the trauma, may founder completely in the face of the ongoing stress. A third area of possible change is an increased sense of one’s own strength – “if I lived through that, I can face anything”. My personal crusade with children and families is to have them celebrate their survival and strength after any shock rather than live in constant fear of the next one. A fourth aspect of posttraumatic growth experienced by some people is a greater appreciation for life in general. We have also seen evidence of this, as people place more value on the non-material – experiences becoming more important than “stuff”. There is lots of talk around about being mindful in our daily lives and loving the little things that we notice as we become more keenly aware of our lives. People make changes to their lifestyles as they stop to reconsider their priorities in the areas of work, leisure, relationships, and so on. The fifth area involves the spiritual or religious domain. Some individuals experience a deepening of their spiritual lives. However, this deepening can also involve a significant change in one’s belief system, and there are those who abandon their religious beliefs in their grief.

What is particularly exciting is that these possibilities are available for everyone. Remember that tiny changes can lead to large benefits, so even opening up a little window to see the world a little differently can bring wonderful rewards.

Simon Adamson, Prue Fanselow-Brown, Craig Prince, Alan Prosser, Debbie Snell, and Fran Vertue are clinical psychologists practicing in Christchurch. You can read more about these clinicians and their work at www.christchurchpsychology.co.nz.

The popular image of problem drinkers is, more often than not, a young person in town at 2am, or perhaps a middle aged person whose drinking may be in response to, and impacting on, family and work pressures. Younger and middle aged problem drinkers do get older of course and so can become older problem drinkers. It is also possible for problem drinking to emerge later in life for the first time. Drinking can become an issue for a variety of reasons later in life including becoming more social isolated through bereavement and retirement, chronic pain and insomnia, and increased family conflict.

Increased age brings with it a range of specific risk factors. Although most people continue to exhibit healthy cognitive functioning as they age our intellectual reserves, the spare capacity that comes in to play when under stress, become more limited and so heavy drinking can more easily push adequate functioning into the territory of poor functioning, with impaired memory, confusion, and poor decision making. As we become more physically frail intoxication presents greater risk of injury through falls, burns and cuts. Alcohol can act as a depressant and older adults are increasingly being identified as a high risk group for the development of clinical depression. Another critical factor to consider is the potential for alcohol to interact with medication, with older adults commonly prescribed a range of medications where this could be an issue.

As well as the risks associated with alcohol consumption there are potential benefits. In addition to the pleasure people gain from drinking alcohol, there is information to suggest that there are benefits to cardiovascular health with moderate alcohol consumption. These benefits are modest at best and don’t apply to everybody. Potential health benefits can easily be overemphasised and used to justify unhealthy drinking. The risk of over-doing it greatly exceeds the risk of under-doing it when it comes to alcohol consumption.

What is a safe level of alcohol consumption for older drinkers? National drinking guidelines are largely targeted at a younger population and may not be appropriate for older drinkers. The profile of drinking habits for older drinkers in New Zealand is typically frequent, often daily, drinking, but seldom in large quantities, more usually in the one to four drinks range. This contrasts with a youth pattern of less frequent but heavy drinking – i.e. a binge drinking pattern. This “steady state drinking” exhibited by older drinkers can appear harmless in contrast and flies beneath the radar. Given the health complications indicated above for older adults though it is cause for concern. For those in the 65+ age bracket it is advisable to drink no more than two “standard drinks” (1 standard drink = a can of beer or a 100ml glass of wine) and to have regular alcohol free days. If you are on medication discuss this with your doctor as even these amounts may be unhelpful.

Drinking problems can be difficult to identify in older adults as symptoms may be difficult to separate from possible dementia or depression. Deterioration in functioning can be difficult to pin down to the correct cause. This may lead family members, and even health professionals, to overlook the role of drinking. In addition, people who develop a drinking problem may become somewhat secretive about it and older adults are particularly prone to feeling shame under these circumstances and to also not want to bother relatives or burden the health system with their issues.

Talking with an older relative about their drinking may be an uncomfortable thing to do, but if you have any concerns, even if you are not sure, it is important to take the initiative and be honest about your concerns. If you are concerned about your own or someone else’s drinking call the Alcohol Drug Helpline on 0800 787797.

Dr Simon Adamson is a clinical psychologist specializing in alcohol, other drugs and behavioral addictions. You can learn more about him and his work at www.christchurchpsychology.co.nz.

A community’s resilience may be defined as its capacity to withstand major trauma and loss, overcome adversity, and to prevail, usually with increased resources, competence and connectedness. After trauma the community and its members face challenges arising from major disruptions to life, stress, loss and grief, and ruptures in connectedness. This comes as no surprise to us Cantabrians.

Resilience is a process taking place at all levels from micro (individual) to macro (communal). It has been defined as the capacity of individuals to navigate their way to resources that sustain well-being: the capacity of an individual’s physical and social worlds to provide these resources and the capacity of individuals, families and communities to negotiate culturally meaningful ways for resources to be shared.

Resilience, coping and healing may be enhanced in the presence of ritual and celebration which also occurs at all these levels from micro to macro. An example of a simple individual ritual may be that, prior to, or on arrival home from work, one takes a short break to arrive and ‘ground’ oneself before carrying out tasks or engaging with children and others. Couples, friends or partnerships may have rituals that provide pattern, comfort and connectedness. An example could be a date (day or night) or a shared meal on a regular basis with friends. Family rituals are many and varied and often deeply ingrained in family history and culture. These often occur around transitions, birthdays, weddings, funerals, religious dates and occasions, or may be simple weekly practices like a family movie and treats night. Simple bedtime rituals for children provide connection and routine which hold comfort. Simple sleep routines are possible even in times of major upheaval.

There is evidence to suggest that all these rituals enhance family health and functioning. They also assist family members to cope with ongoing stress and to heal from trauma and grief.

An upcoming example of family, group, community or mass celebration is Guy Fawkes. The fact that it commemorates the failed plot in the 1600’s of the attempt to blow up the House of Lords has become somewhat lost in the joy that children (especially) experience in the excitement of the late night, the fun, bonfires and fireworks.

This year, over a year on from the first of the Christchurch earthquakes, the function of this ritual may hold benefits for many. However, some traumatised children may require special attention. Traumatic memories may be triggered by sights, sounds, smells. Memories of what has been lost may also be triggered by the ritual itself and how it used to occur or who or what has been lost. While there may be comfort in retaining the familiar, for some it may be helpful to change the way the celebration occurs to minimise triggering of loss experiences and sadness.

While we all need to attend to our individual and family needs, the community and its activities are a vital part of our recovery and growth also. The celebration of Guy Fawkes is just one opportunity for joining the larger mass for the purpose of celebration. If choosing a smaller celebration, take time to plan what your family may enjoy, involve the children in planning and preparation, allowing them to experience achievement or success, make an example of yourself by practising optimism and attending to your own needs, keeping your own worries and stress away from children’s awareness. Finding optimism and holding the expectation of positive outcomes will help children and actually increase the likelihood that these positive outcomes will occur.

Children need adults to look after themselves. Pay attention to your own and others’ emotional and physical safety, plan and prepare and allow the healing powers of celebrations to take effect.

An acquired brain injury (ABI) refers to any brain injury that occurs after birth and can result from an accident or something non-traumatic such as stroke or brain tumor. The Brain Injury Association of New Zealand reports that approximately 90 New Zealanders sustain a brain injury every day and it has been suggested that 6000 New Zealanders have a stroke each year.

People sustain a range of impairments after an ABI, including changes in physical and cognitive abilities, and in personality and emotions. However one of the biggest changes impacting on life after an ABI is loss of identity. Loss of sense of self or identity is common and distressing after an ABI. This can range from a vague feeling of “differentness” right through to feeling completely disconnected from one’s previous life. This change is usually sudden and one that is invisible and potentially very destructive.

Everybody has a sense of self or identity. Who we are includes the roles we fill such as in our job (e.g. a teacher, a plumber), our social relationships (e.g. a husband, a daughter), through to things we do in our spare time (e.g. a runner, a musician), as well as things about our personality (e.g. a hard worker, reliable, funny, shy) and physical attributes. Our sense of who we are is formed very early in life. Children as young as four form views about themselves (e.g. I am the tallest at preschool, I am good at helping Mum). After an ABI some of these views of self are challenged and many survivors are faced with the question “so who am I now?”

Sometimes this loss of identity is a consequence of the brain injury. Damage to the frontal lobes or deep in the white matter of the right hemisphere can cause problems with self awareness such as knowing how one is coming across socially or noticing when others are upset or bored by your conversation or behaviour. This is not the same thing as denial although this can also occur after an ABI such as when the person resists accepting they might be different.

Loss of identity has a huge impact on social relationships. The person with ABI may no longer react the same way in social situations or at home. This can place great strains on relationships. Things that they used to enjoy may no longer be easy to engage in or even fun. When they are asked what they do in social situations they can say “well I used to be a …” and this can sometimes be embarrassing and difficult to explain. Working out what has changed and what is still the same after an ABI takes time, often through many trials and errors, frequently coming at a huge cost.

If you would like advice about how to seek help after ABI, you can discuss the problems you or your loved one are having with your GP, a psychologist (www.christchurchpsychology.co.nz) or contact the Brain Injury Association (www.brain-injury.org.nz or ph 365 3262). With support and time it is possible to increase your understanding about the impact of your brain injury and to learn how to manage these changes so that you can once again trust in and feel optimistic about, who you are.

Dr Debbie Snell is a clinical psychologist specializing in neuropsychology, concussion and rehabilitation. You can learn more about her and her work at www.christchurchpsychology.co.nz.

Christchurch and Canterbury have taken a beating over this past year, and the sentiment, “I’m just over it”, is frequently expressed by many. Because this natural disaster was not a one-off event, but multiple – and extended over a prolonged period of time – this can be very wearying to our neurochemical and psychological systems. Just a few of the common reactions to such a disaster would include grief over the loss of a loved one, a home, or possessions; flashbacks of the event; difficulties with sleep/nightmares; anxiety regarding future quakes; feeling intolerant and easily irritated; feeling emotionally numbed; and experiencing varying degrees of fraughtness within intimate relationship settings. Traumatic events, whether natural or man-made can call into question some basic assumptions about how the world ticks and our level of safety within it. The way we view our future, how we view ourselves, and what is the meaning of life, are sometimes brought into question following a catastrophe. Expectations of potential harm, betrayal, or danger may follow a traumatic experience. Thus, allowing ourselves to be emotionally close or intimate with another may evoke anxiety within that relationship.

These reactions can all impact to varying degrees upon the way we may relate to our loved ones, friends, and work colleagues. Within an adult relationship where emotional communication and intimacy is of prime importance, if one or both partners are experiencing the various effects of trauma and loss – and the more prolonged the trauma, the more likely we may be affected – then the relationship could over time begin to experience difficulties. Following trauma, the ability to manage our emotional reactions can be compromised, as can the way we process information. Hence, we may sometimes respond with rage, or simply shut down – like an “all or nothing” reaction. Often there is the complaint, “I just can’t think”, or “My brain’s gone to mush”; not only might this be frustrating for our partner, but can also further undermine the partner who is struggling to problem-solve or make a decision about a matter which in normal circumstances would be straightforward.

As a result of trauma, we may “regress” emotionally; this means emotions may be expressed in some physical way (eg stomach pain or headache), or we may become more avoidant and “locked-down”. Whereas emotions would ordinarily act as a signal that steers a couple towards communicating with each other, now one partner may complain that the other is emotionally distant, and express increasing frustration about the loss of emotional connection that they can no longer depend upon the other to make important decisions. On the other hand, the traumatised partner’s intention may be to protect their loved one from their painful emotions and experiences.

Despite these tensions, the relationship is also likely to hold the key to recovery. When an understanding is established of how trauma can impact upon us and why we may behave and react differently to our usual selves, this can provide a very important platform upon which a couple can begin to realise that their relationship has a resiliency that can foster change and recovery. Being able to reduce feelings of shame, guilt, and blame leaves room for the couple to realise that their relationship has a capacity to recoup the intimacy they once had. And sometimes, not uncommonly, the traumatic event and its emotional and psychological consequences may act as a catalyst for a relationship to develop a closer emotional connection than was there prior to the event.

Every couple will have their own unique ways of responding to the impact of a trauma upon their relationship. It is important to keep in mind that it is hard to live with someone who is frequently irritable, angry, depressed, anxious, or disconnected. In time a partner may run out of patience and energy, and feel despair. And the afflicted partner may experience guilt and shame, their sense of personal integrity diminished.

A key step to ease tensions and protect loved ones is to let them know what has happened to you. Your partner needs to know what you have been through, and where you are right now. And although you may not have sorted all that out, it is helpful for a partner to receive some kind of progress reports along the way.

The following suggestions may be a helpful guide to keeping your partner “in touch”:

• Describe what you basically experienced, but keep it simple. Bear in mind that too much detail may overwhelm your partner.
• Whilst making this effort to keep your partner informed, try to maintain realistic expectations. It is very easy to assume that, because you have been together in a relationship for a period of time, that somehow, magically, your partner will “know” or understand what is going on for you.
• When describing the experience, try and focus more upon what the event meant to you – that is, describe your reactions and feelings, as opposed to an overload of factual details about the event.
• Keep updating loved ones about your continuing reactions. Again, keep it simple – eg “I saw it again last night”, when describing a nightmare or flashback; and, once more, try and describe the emotional effects of that nightmare, eg “And when it happens like that, I just freeze up”. And, hopefully, your partner is able to listen, and be genuinely sympathetic, not be judgemental or cynical.
• Informing your partner that when you emotionally “disappear”, or become angry or sad, that this is your way of trying to control yourself; that it is not a reflection of how you feel about your partner.

Telling your partner how your feelings or reactions interfere with your relationship with them conveys powerfully the message that, despite the on-going challenges, you are invested in wanting to preserve your relationship. Don’t be hesitant in asking how your behaviour affects them, and what you may be able to do to help alleviate their levels of stress:

• Tell them what you are doing to get better, and if there is anything that your partner could do to help.
• Whilst you may ask your partner to be patient during the recovery, you also need to be able to accommodate and be patient regarding your partner’s own struggles during this time.

There are many other ways you might reassure and “keep on board” your loved ones whilst making your recovery. One important strategy might be to follow an appropriate stress-management programme. (This is a topic in itself and there is insufficient space to address this in the current article).

These suggestions may go some way towards assisting in emotionally reconciling a relationship which has been affected by a very disturbing life event. Once a couple can create a sense of safety within their relationship, partners can begin to relax somewhat, and the potential for emotional reconnection gradually increases. Fundamentally, it is about partners being able to afford each other some “room to move”, thus diminishing the risk of recurring emotional impasses and hurts.

Alan Prosser is a clinical psychologist who works with adults and adolescents on a wide range of issues including trauma-related issues and couples therapy. You can learn more about him and his work at www.christchurchpsychology.co.nz.

“When the going gets tough, the tough get going.” Is optimism helpful?

Optimists are people who expect good things to happen to them even when the going gets tough. Pessimists on the other hand expect bad things to happen to them. Folk psychology suggests that optimists cope better when things go wrong and demonstrate higher resilience to stressful life events. Optimists also tend to feel better; with research suggesting an optimistic outlook produces a more positive mix of feelings. There is research that even suggests optimists cope better and have better outcomes after health problems such as heart disease and cancer. This work shows that people who are more optimistic tend to be less distressed by what is happening to them and have better life satisfaction for example after surgery. In addition people who are more optimistic have been shown to be more resilient and to cope better with natural disasters such as earthquakes, tsunamis and even other types of disaster such as terrorist attacks.

So why is an optimistic outlook helpful? One suggestion is that people who are more confident about eventual success are more likely to keep trying even if things are hard. In contrast, people who are uncertain and less confident may avoid facing the problem in front of them, or may simply give up more easily. In addition it is suggested there are links between optimism and helpful ways of coping. For example, people who are optimistic are more likely to take practical steps to solve the problem they face and to seek support from others. Thus the optimist may be better at using available supports and resources and more likely to face a problem head on. The optimist may also be better equipped to hang in there when the going gets tough and the stressful situation has to be endured.

Are there any drawbacks? Some suggest optimists may be vulnerable to “optimism bias” by seeing things through rose-colored glasses. Perhaps optimists only see what they want to see, set oversized goals and have unrealistic expectations. That is, maybe optimists just don’t know when to give up. However these aspects have not generally found support in the research literature.

Can pessimists become optimists? There is some suggestion that optimism is relatively stable over time and part of a person’s personality make up. However this does not mean that it is impossible to change your perspective to think more positively and to become more optimistic. Certain kinds of negative thoughts can lead to negative feelings and emotions, and lead people to stop trying to reach their goals. Cognitive behavior therapy is an approach focusing on assisting people to notice and change such unhelpful patterns of thinking. Working with a psychologist to modify negative thinking patterns can help you develop more realistic perspectives about yourself and the community around you, perhaps even to adopt a more optimistic viewpoint.

At the end of the day, when the times are hard optimists may manage better not because they are in denial; rather they might just be better at hanging in there!

Dr Debbie Snell is a clinical psychologist specializing in neuropsychology, concussion and rehabilitation. You can learn more about her and her work at www.christchurchpsychology.co.nz.

Imagine the following scenario: Your character in the game Grand Theft Auto visits a prostitute and is ironically rewarded with “health points”, however, you lose “money” due to paying for the service. Thus, to recuperate your “money”, you kill the prostitute and take your money back. Does enacting this type of behaviour through a game carry any real life significance?

It has been suggested that video games heighten aggression, decrease levels of empathy, discourage prosocial behaviour, and glorify violence. Rather than just watching characters on a screen, players interact with the game physically, psychologically, and emotionally. Many thousands of opponents (and other characters) are killed in various graphic ways and the player is rewarded (assuming that they “win”). Thus, behaviour is rehearsed, becomes desensitised, and accepted.

However, years of research on the link between violent video games and individual violence has resulted in heated debate and mixed findings. One of the difficulties with long-term research in this area, is that individuals are exposed to a great number of potential factors that alone, or in combination, can contribute to individuals engaging in violence. Naturally, when significant violent acts occur, especially when firearms are involved – like school shootings in the USA – everyone assumes a link to violent video games. However, research has shown that a very small proportion of school shooters were attracted to these games and rather had other pre-existing difficulties. So what is the long-term risk involved to users?

It is worth noting that while most children under the age of 17 play video games, the largest market is that of adults. Supporters of video games have argued that while the number of people playing games has increased significantly, the rate of violent crime in many western countries is actually decreasing. Further, the vast majority of these youth and adult players have not demonstrated violence. In fact, many positive effects have been reported, such as better hand-eye coordination, resistance to distraction, peripheral vision sensitivity, development of social capabilities, and games even being an outlet for stress and anger. To add to this, video games can be a legitimate source of fun. Some argue that on-line gaming is akin to play-fighting and part of normal development in which competition is healthy. Therefore, we have to look at violent video game effects on a case-by-case basis.

Someone that is predisposed to aggression may be more strongly influenced by what they experience. Playing violent games may bring out violence in individuals already prone to violence (due to factors such as genetics, poverty, culture, family violence, etc). Concerns relate to those who are (i) prone to anger, highly emotional, easily upset, and depressed; (ii) cold and indifferent to others; and (iii) those that frequently break rules and don’t appear to think before they act.

Parents can take a number of steps in an attempt to limit the possible negative effects of video games, namely: Check the rating labels about game content. Consider the possibility that children have accessed games for more mature audiences through older peers. Play or watch some of the games with children to be in touch with what actually happens and how the child reacts. Ensure that games are played in view of adults, rather than in bedrooms. Set limits on game time. Encourage physical activities like sport and physically playing with peers.

Video games will remain. They are neither inherently good nor bad. The focus needs to be on lessening the potential harm to a vulnerable group of individuals.

Craig Prince is a clinical psychologist who specialises in the assessment of people facing criminal or civil proceedings. You can learn more about him and his work at www.christchurchpsychology.co.nz.