About 53,000 children pass away each year in the United States and nearly 19% of the adult population has experienced such painful loss¹. The death of a child is a severely traumatic event for parents and represents a major risk for future emotional, psychological and physical problems.^{2, 3, 4} The loss of a child challenges parents’ expectations for the natural order of life events and shatters hopes and beliefs for the future.⁵ Some psychologists suggest that parental grief is more severe that other types of grief and lasts longer, presenting with more serious psychological, physical, behavioral and social issues. ^{1, 6} This may be explained by the special role that a child plays in a person’s life – the child represents a unique amalgam of feelings for parents, as it is both part of themselves and representation of their feelings for each other.⁷ In essence, bereaved parents mourn the loss of self, their hopes and dreams.²

The fact that parents think of their child as a “part of, and the same as themselves” ^{7, p. 234} suggests that the loss of a child is very much the loss of a part of one’s self and represents a unique challenge.

The Shock of Sudden and Unexpected Death

The death of a child has become rare in the Western world, due to improved prenatal and perinatal care, it is considered exceptionally painful and traumatic, with parents not being prepared to face such loss.^{8, 9} Nowadays, pregnancies continuing after the 20th week are usually wanted and anticipated with joy and commitment. In the case where such joyous event ends up being a tragedy, parents face a major challenge. For many young parents, this may be their first experience with death and loss.⁸ When the death occurs unexpectedly and suddenly, as opposed to following a long disease or terminal condition, the shock, guilt and bewilderment experienced by the parents are much more severe and long lasting.^{1, 3} Although a long and debilitating disease is another source of trauma for parents, it provides an opportunity to psychologically prepare for the death and understand the cause of death.^{3, 10} In fact, sudden and unexpected loss is correlated with higher levels of distress and parents are at much higher risk of experiencing complicated grief.⁹

In one study¹ researchers interviewed and assessed bereaved parents about 20 months after the child’s death. Their results showed that mothers who experienced the sudden death of a child had more prolonged grief than those who anticipated the grief. Results from the same study did not support expectations that mothers experience more severe grief than fathers. A Swedish population-based study⁵ by demonstrated that fathers’ opportunity to know about the impending death of a child in advance is correlated with better prognoses of grief processing. These results indicate that medical practitioners need to be honest with parents, when the death of a child is concerned, to allow time for accepting and preparing for the imminent death. However, research finds that physicians are aware of a child’s terminal prognosis 3 months before parents are (Wolfe cited in ⁵).

Findings about the profound negative effects of sudden loss explain why parents who experience Sudden Infant Death Syndrome (SIDS) face especially troublesome complications and adjustment problems. These parents suddenly have to deal with the unexplained and, possibly unpreventable, death, the sudden severing of the the attachment and bonding and the involvement of other agencies in the investigation process.¹¹ Currently, SIDS is identified as “the sudden death of an infant younger than one year that remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history.” ^{12, p. 870} It is the leading cause of death among healthy infants and accounts for about 2,200 deaths each year.¹²

(For additional information about Sudden Infant Death Syndrome, including statistics and risk factors, see here)

References:

Pharmacological Treatment

A number of studies have pointed out that Postpartum Depression (PPD) is essentially the same as Major Depression (MDD) and, therefore, benefits from pharmacological treatment with antidepressant medication, but very few studies have conducted randomized controlled trails comparing different medication and placebos.¹ In general, pharmacological treatment of MDD has proven to be just as effective as psychological interventions.² However, the adverse effects on breastfeeding and infant well-being remain largely unknowns and medication has to be prescribed with caution.^{1, 2} An extensive review by Fitelson and associated¹ outlines several open studies that have established fluoxamine, sertraline, bupropion, nefazodone and venlafaxine as effective pharmacological treatment for PPD. Yet, the validity and generalizability of these studies is limited by small sample sizes (4 to 15 participants) and tainted by pharmacological companies’ sponsorship. In  cases where patients have responded well to a particular antidepressant in the past, experts advise practitioners to choose the same medication for the treatment of PPD.^1,3

Pharmacological Treatment as a Preventative Measure

There is some evidence that pharmacological treatment can have preventative properties as well. A randomized placebo-controlled pilot study by Wisner and colleagues (2004)⁴ has shown that sertraline treatment started shortly after delivery prevented women with history of PPD from experiencing another episode. Yet, these results remain inconclusive and more research is needed to establish the role of antidepressants in PPD prevention.

Pharmacological Treatment’s Effect on the Child

The major concerns surrounding pharmacological treatment of PPD revolve around its effect of lactation, breastfeeding and infant well-being.¹ Infants are particularly vulnerable to the effects of medication, due to their immature blood-brain barrier, hepatic and renal systems and still developing neurological systems and brain structures.⁵ Still, research on the effects of antidepressants on the baby through maternal breastfeeding is very limited and largely contains of small studies with questionable external validity, and isolated case studies.¹ Some researchers have deducted that sertraline and paroxetine, among the Selective Serotonin Reuptake Inhibitors, are least likely to be detected in the infant’s system and adverse effects have rarely been observed.⁵ In comparison, citalopram and fluoxetine, appear to be more readily transmitted through breast milk. Their effects range from sleep changes in the infant to more serious respiratory, gastrointestinal problems and even seizures.⁵ In addition, antidepressants in infants have been correlated with increased plasma levels.¹ Although the observed effects among infants have been of mild to moderate severity and have remitted after the mother discontinued medication use, there are no guarantees there will be no effects in the long run. In addition, research has not determined whether lack of clinically significant amounts of antidepressants in the baby’s system actually means the child is not affected in any way.¹ These concerns suggest the need for further research, including more longitudinal studies.

Why Medication May Not be The Best Option

The benefits of breastfeeding have been extensively studied and firmly established by prominent organizations, such as the World Health Organization, the American Academy of Family Practitioners and the American Academy of Pediatrics, all of which recommend breastfeeding for at least six months after birth.^6,7,8 Considering this, most clinicians recommend non-pharmacological treatment for cases of mild or moderate depression, especially since these can be just as effective, but without the risk of side effects.¹ Yet, if pharmacological treatment is initiated, experts suggest that the baby’s pediatrician is immediately informed and begins to routinely examine for possible exposure and monitor any changes of sleeping and feeding patterns, sedation, irritability and other signs of drug toxicity1.^1,9

Research has demonstrated the effectiveness of psychological and psychosocial treatments of PPT, which also bypass the risk of side effects and infant drug toxicity.^{1, 10}

Interpersonal Therapy

Interpersonal therapy (IPT) has been suggested as effective psychological treatment for PPD and women who received IPT had a significant decrease in PPD symptomatology.¹¹ The typical course of IPT lasts for 12 to 20 weeks and focuses on four main interpersonal problem areas: role transition, role dispute, interpersonal deficits and grief. Clients are encouraged to transform their problematic interpersonal approaches into more healthy and adaptive ones, which is expected to improve the mother-infant and  mother-partner relationships and help the new mother for the upcoming transition back to work.¹¹ It has been further established that a group format of IPT may have benefits compared to individual therapy, as it increases social support, helps new mothers improve their interpersonal skills, allows for realization of the normality of the symptoms and issues and reduces the stigma associated with PPD.¹

Cognitive behavioral Therapy

Cognitive Behavioral Therapy (CBT) is another therapeutic modality that has proven no be beneficial in the treatment of depression, including PPD.^1,12,13 The main focus in CBT is to help clients modify their distorted cognitive patterns and negative thinking and initiate behavioral changes that will enhance their coping and reduce distress.^13,14 Fitelson and associates¹ have reviewed a study where only six sessions of CBT correlated with significant decrease of depressive symptoms in postpartum women. A pilot study by Cho and colleagues (2008)¹³ has examined antenatal CBT as a way of primary prevention. The intervention incorporated classic CBT components for treatment of depression and components aiming at enhancing marital relationship and communication. Their CBT intervention proved effective in reducing automatic negative thoughts, marital dissatisfaction and communication dissatisfaction. This individual CBT intervention not only improved well-being during pregnancy, but also during the postpartum period. The authors’ conclusion is that individually-tailored CBT intervention is more effective than a group format. However, if group sessions are the only option, helping professionals should avoid issues around personal fatigue, the condition of the unborn baby and dissatisfaction from partner.¹³ One key hypothesis in these studies is that interventions  that improve the quality of the marital relationship have great preventative power for PDD, as they increase both actual and perceived support.

Person-Centered Therapy

Person-centered counseling, also referred to as non-directive counseling, has also shown to decrease depressive symptoms in postpartum women in a number of randomized controlled studies.¹

Social Support

Lack of adequate social support is among the first risk factors for PPD, therefore peer and partner support groups have received a lot of attention among researchers.¹ Dennis (2003)¹⁵ has studied the effects of mother-to-mother support over telephone communication and has observed the beneficial effects of this approach. In fact, the severity of depressive symptoms was significantly reduced in eight weeks. Additionally, women who have been identified as high risk for developing PPD were involved in telephone-based peer support over 12 weeks and were later recorded to have lower incidence of PPD when compared to a control group. This gives hope that these noninvasive and cost-effective therapeutic approaches can also serve as preventative measures.

Alternative Therapies

Interesting research by Field and colleagues (1996)¹⁶ has shown that teaching new mothers to massage their infant reduces irritability and sleep problems in the baby, while leading to reduced depression in the mother. This massage therapy is a relatively simplistic techniques with potential to greatly benefit both the mother, child and their interaction. Findings like these increase our hopes that researchers will establish new methods of prevention and treatment which can transform the prevalence rates of PPD among new mothers.

References:

A previous article already introduced some of the symptoms and risks of Postpartum Depression (PPD), but I would still like to emphasize the profound effects of this disorder. In this particular stage of life, depression does not only hurt the new mother, but poses threat for the well-being of the baby as well. In other words, It could be an ailment for two. This makes the need for timely and adequate help even more compelling.

Beyond the emotional and psychological suffering experienced by women with PPD, there are multiple negative effects for the infant. Women who experience more severe or prolonged PPD symptoms are more likely to develop insecure attachment to their infants and perceive their baby in a negative way, unable to enjoy the bonding and joy reported by healthy mothers.¹  A body of research shows that children of depressed mothers tend to receive lower scores on measures of intellectual and motor development when compared to children born to non-depressed mothers. These babies also tend to be fussier  and of more difficult temperament.¹  Another unfortunate consequence is that children of depressed mothers typically react poorly to stress, show poorer academic performance, delayed development of self-regulation, low self-esteem, lack of social competence and multiple behavioral problems.²

At least one study³ has shown that infants born to depressed mothers experience significant sleep disturbance in the developmental period between two weeks and the first six months of life. The difference is compelling when compared to infants of non-depressed mothers. This is especially troubling since it is known that this initial phase of life is a critical developmental period for sleep-wake cycles, melatonin and temperature rhythms.³

Depressed mothers tend to be more irritable and hostile towards their child, interacting with either intrusive, controlling and over-stimulating style or with withdrawn, passive and under-stimulating style.⁴ Neither of those extremes is beneficial for infant development. In comparison with healthy mothers, mothers with PPD touch their babies less frequently and more often do it in a negative, harmful way. Depressed mothers also have different vocal behavior, more negative affect and engage in less baby talk. Overall, they spend less time playing with the child or reading, talking, and touching. This contributes to creating an inadequate environment for the developing infant, which is deprived of mother-child bonding, synchrony and enrichment activities. Additionally, depressed mothers are less likely to begin breastfeeding and even when they do, they are more likely to discontinue in around 4 to 16 weeks.⁴

Women with PPD are more likely to start smoking or abuse alcohol and illicit substances which can further exacerbate the severity of their symptoms and the negative effect on the child. Further, these mother are at greater risk for experiencing physical, emotional or sexual abuse.⁵

References:

1. Cho, H. J., Kwon, J. H., & Lee, J. J. (2008). Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study. Yonsei Medical Journal, 49(4), 553-562.   2. Goodman, S. H. & Gotlib, I. H. (1999). Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychological Review, 106(3), 458-490.   3. Armitage, R., Flynn, H., Hoffmann, R., Vazquez, D., Lopez, J., & Marcus, S. (2009). Early developmental changes in sleep in infants: the impact of maternal depression. Sleep, 32(5), 693-696.   4. Field, T. (2010). Postpartum depression effects on early interactions, parenting and safety practices: a review. Infant Behavioral development, 33(1), 1. doi:10.1016/j.infbeh.2009.10.005.   5. Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression:clinical, psychological and pharmacological options. International Journal of Women’s Health, 3, 1-14.

Postpartum Depression (PPD): A Psychological Disorder

Postpartum Depression (PPD) is a fairly common complication of childbirth and often accompanies the postpartum period, leading to psychological suffering for the mother, negative effects on the infant and strained family relationships.¹

Pregnancy, childbirth and the postpartum period involve intense emotional experiences for most women and are characterized by a major developmental transition, physical and psychological demands, body image changes, as well as psychosocial changes, all within a short period of time.² Sadly, psychiatric disorders are the leading cause of maternal deaths, very often through suicide.¹

Women with PPD suffer from depressive mood and profound sadness, frequent crying, insomnia, lack of appetite, fatigue, lack of motivation, low self-esteem, perceived inability to cope, suicidal ideation as well as multiple physical complaints.^3,4

Some researchers attempt to conceptualize PPD as a complicated maternal identity formation, where the new mother is unable to achieve a sense of maternal competence and incorporate her new psychosocial role.³ In other words, there is a dominating American middle-class perspective on mothering, which expects an intense child-centered parenting that is both economically and emotionally demanding. Yet, we often fail to appreciate the largely diverse population of the United States in the context of child rearing. Thus, mothers who may not fit the middle-class American script may feel like a failure and begin to experience growing maternal incompetence, diminished self-efficacy, self-esteem and increased distress. All of these may be contributing to the onset of PPD.³

Why is this Disorder Often Undiagnosed?

Women diagnosed with PPD often describe themselves as “bad mothers” and report intense feelings of guilt and shame.^{3, p.374}  This gives us an idea about the social stigma associated with PPD and would partly explain why most women do not seek professional help and remain undiagnosed and untreated. That is why helping professionals need to put every effort into promoting psycho-education and establishing PPD as a diagnosable, treatable disorder, so that no mother and her child remain in suffering. In fact, researchers point out that some women may experience the diagnosis of PPD as a relief, helping them accept their symptoms and reduce their personal feelings of guilt, self-blame and shame.³

How Common Is The Disorder?

The estimated prevalence rate of PPD is about 13%, with higher incidence among teenage mothers.⁵ A study of women in Sweden has shown depressive symptoms in around 17% of pregnant women during the late stages of pregnancy and in 13% of new mothers.⁶ Other studies have found prevalence rates of 14% in both early pregnancy and during the first year after delivery.^{Rubertsson cited in 6}

Such prevalence rates pinpoint PPD as a serious public health issue that affects not only mothers, but also their children and other family members.

Risk Factors

Many life events and psychological factors have been identified as risk factors for PPD. Among these, anxiety and depression during pregnancy have shown to be strong predictors for the onset of PPD.⁷ Many studies have also established low socioeconomic status as a strong risk factor.^3,6 Obese pregnant women are also at higher risk of developing PPD.⁷

Postpartum depression might be more common than you have imagined. It is not as common as “baby blues” also referred to as “postpartum blues” that affect about 75% of new mothers within the first ten days after delivery.^8,9 PPD’s symptoms are more serious and longer lasting than those of postpartum blues. Still, if your wife, partner, or friend is experiencing such profound sadness, you should not underestimate the possible seriousness of the issue. Pay close attention to the symptoms and provide support and understanding. (An article on prevention and treatment will be posted soon).

References:

1. Bick, D. & Howard, L. (2010). When should women be screened for postnatal depression? Expert Reviews of Neurotherapeutics, 10(2), 151-154.    2. Clark, A., Skouteris, H., Wertheim, E. H., Paxton, S. J., & Milgrom J. (2009). The relationship between depression and body dissatisfaction across pregnancy and the postpartum. Journal of Health Psychology, 14(1), 27-35.   3. Abrams, L. S. & Curran, L. (2011). Maternal identity negotiations among low-income women with symptoms of postpartum depression. Qualitative Health Research, 21(3), 373-385.   4. Cho, H. J., Kwon, J. H., & Lee, J. J. (2008). Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study. Yonsei Medical Journal, 49(4), 553-562.   5. O’Hara, M. W. & Swain, A. M. (1996). Rates and risks of postpartum depression: a meta-analysis. International Review of Psychiatry, 8, 37-54.   6. Claesson, I., Josefsson, A., & Sydsjo, G. (2010). Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.  BioMed Central Public Health, 10, 766-776.   8. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Being able to recognize and perceive the positive aspect of each situation is perhaps the single most valuable ability we can possess. It creates a buffer zone against the stress we are all exposed to. It can give us comfort in difficult moments and motivate us when facing problems.

Many philosophers, writers, psychologists (especially Existential psychologists) and stress management experts talk about humans’ ultimate ability to choose. We always have a choice! If we cannot always change events, we are free to choose how to perceive these events, what to think of them and what to focus on.¹

Even when faced with the worst possible situation, we have the power to focus on the positive (How can this make me stronger? What can I learn from this? There are people out there suffering greater hardships than me. Is there any way I can help them?) while de-emphasizing the terrible side of things. Of course, this is easier said than done, but you can begin moving in this direction in little steps. Try developing selective awareness for the positive and make it a lifestyle.

Here are some little things you can do that will help you come to better know and cherish the positive things in your life.

1. Learn to accept compliments and congratulations.

I have often wondered why so many people are having a hard time accepting an honest compliment. I would say, “What a lovely dress!” and hear back, “What? This old thing!” At a dinner invitation I may congratulate the host on preparing such an abundant and delicious treat. At this point, I often receive, “Oh, it’s nothing really. I just put a few things together in a hurry.” . . . Puzzling, isn’t it?

Have I ever given such responses? It is quite possible, but I surely try to shift in a different direction. So, what are we really saying when we give such a response to an honest compliment? There are a few options: “I am not worthy of a compliment” or “I am not used to being complimented, so I can’t react adequately” , “I’m not used to people giving me credit for my looks/taste/abilities” and so on.¹ We have gotten so used to receiving criticism, we don’t even know how to accept a proper compliment. Sometimes, the feeling behind a compliment is sheer embarrassment. We feel embarrassed because someone has noticed something good about us! How ironic is that? Isn’t recognition what we generally want?  Someone has noticed a good thing in us/about us and is offering a friendly tap on the back – this is wonderful – accept it! There is nothing wrong with saying, “Thank you! I haven’t worn this dress in a long time, but I’m glad it still looks good” or “Thank you! I am truly glad you like the meal. I was trying to prepare a nice dinner for my guests to enjoy.”

Learning to accept compliments and congratulations will naturally take you to the next step . . .

2. Congratulate yourself.

I have to put a disclaimer here: I am not suggesting that we all should become obnoxious and self-absorbed, but there is nothing wrong about giving yourself credit for sincere effort, hard work or successful outcome. Our self-efficacy, the perception that we can face challenges and deal with problems effectively, is based on successful previous experience. If we never notice the progress we are doing, we can never build a sense of self-efficacy that can make us stronger and more determined in overcoming bigger challenges. This can be applied to virtually anything, from quitting smoking to being more productive at work. Give yourself credit for the effort and for the work. Notice the positive, the progress, every step of the way, and this will surely make the journey more pleasant and the goal closer to reach.

3. Take time to recognize the positive.

We are usually so consumed with daily routine and hassles that we don’t physically give ourselves the time to sit down and reflect. We move from one task to the next, often with a sense of urgency, we deal with distress and forget about contentment. Take some time of your day to spend with a good friend, only that friend is YOU. Reflect on the things that happened, offer support, an honest compliment and congratulations. If your best friend was in distress, wouldn’t you try to comfort him/her? Wouldn’t you try to pull them out of the dark hole they are in and show them the beauty outside? How are YOU any different? Why can’t you be your own best friend?!

Taking time to reflect on the positive can only take as little as a few minutes at the end of the day, while driving home from work, brushing your teeth, or before going to bed. Jot it down, if you wish to make it more tangible and keep a list for future reference. I’d say, you owe it to yourself.

References: 1.  Greenberg, J. S. (2011). Comprehensive Stress Management, 12th ed. McGraw Hill.

About 1/3 of patients with acute illnesses fail to follow their doctor’s recommendations for short-term treatment (such as completing an antibiotic course). The rate is even higher among those who suffer from a chronic illness.¹ In fact, about 50% of patients fail to adhere to long-term treatment plans.² This is a little ironic, don’t you think? On one hand, feeling ill leads to actively seeking out medical help and advice; on the other hand, the advice and prescription for medical regimens quickly go out the window after leaving the doctor’s office.

Since there has been a significant increase in the prevalence of chronic diseases, poor patient adherence to treatment has become a major health care problem. More than 90 million Americans live with some sort of a chronic illness³ and these people account for 70% of the annual mortality in the United States.⁴ Poor adherence to treatment is linked to more than 125,000 deaths each year, not to mention, innumerable and completely unnecessary clinic appointments, emergency room visits, hospitalizations, nursing home admissions and additional diagnostic tests. The estimated annual cost of such unnecessary procedures and treatment complications is anywhere between 13 and 15 billion US dollars, which is a tremendous financial strain.^{1, 2, 5} To sum up, poor adherence to treatment is costly, complicated, painful and can even cost one’s life. So, why do we do it?

The term adherence suggests that the patient plays an active role in treatment and the healing process.⁶ No doctor can wave a magic wand and make problems disappears. Usually, healing requires efforts and persistence on the side of the patient, especially when dealing with chronic illnesses. Often times, a major lifestyle change is required, such as changing your diet, exercising or quitting a bad habit. If you’ve tried any of those (or, as in my case, all of them) you know it is a daunting task, which requires will power and patience. What makes matters worse is that it takes a long time before you begin to feel better or experience any other benefits from your efforts. That explains why more than 75% of patients neglect recommended lifestyle changes or are unable to follow through.⁷

However, noncompliance does not always suggest willful disregard of professional advice. We also see cases of doctor-patient miscommunication, patient’s failure to accurately remember the advice or mere knowledge and skill deficits among patients.⁶

Failure to Remember

One study⁸ investigated how many of doctors’ recommendations were actually understood and remembered by patients (and their parents) in a a childhood diabetic clinic. On average, the health-care provided gave about seven recommendations per patient, with both the child and parents present. However, when asked about those, patients and parents recalled only about two recommendations. Shockingly enough, in 40% of the cases, the remembered “recommendations” were never made by the doctor (but were probably some outside information or false memories).

Another study⁹ observed that patients recalled only about 50% of the physician’s instructions.

When elderly patients suffering heart failure were interviewed, 45% of them could not remember the name of the medication prescribed, 50% could not remember the prescribed dose and 64% could not remember when they were supposed to take it.¹⁰

These are just a few examples that show the difficulty of treatment adherence, even when both the patient and health care provider are well-meaning.

Keep this in mind next time you visit your physician. The advice and recommendations they provide may be perfectly clear at the moment, but may soon fade away. There is nothing shameful about taking notes, for example. After all, the faintest ink is better than the strongest memory.

Patient-Doctor Miscommunication

What about the cases when professional advice is so vague that is practically useless? Then patient will be in trouble, even if they remember exactly what the doctor said.

Sometimes, physicians forget that technical knowledge which is a given for them is alien to most of us. Therefore, they may quickly go over diagnosis and treatment, leaving you nodding along, not understanding any of it. In this case, you should not feel intimidated and should not hesitate to ask questions until you clearly understand your situation and recommended treatment. After all, your physician is there to help you.

Other times, health-care providers only give advice in general terms (“Get more exercise” or “Avoid high-fat foods” or “Cut off the alcohol”)⁶. This is not specific enough for most patient to comprehend and break down in small and measurable steps, so they can measure progress and get more motivated. On the contrary, such a general suggestion can be overwhelming, causing you to give up easily. Other times, people make some change, but it’s hard to know if that is what the doctor had recommended. For example, what does “more exercise” suggest? Taking the stairs instead of the elevator? Walking for 30 minutes each week? Running for half an hour three times a day? Which is it? Make sure you can answer questions like these before you leave your doctor’s office.

Knowledge and Technical Skills Deficits

Quite often, treatment involves behaviors and procedures performed by patients, that require some level of skillful administration (insulin injections, glucose testing, using an inhaler, etc). Many researchers have studies these disease management behaviors in patients and have found out that even when people were certain they did everything right, there were mistakes than tempered effective treatment.⁶ A study of asthmatic children¹¹ observed that 93% of them used a deficient meter-dose inhaler (MDI) technique and their parent were also unaware of it. Among adult asthma patients, more than 75% made at least one technical error in the MDI process (even after having received previous training)¹². Glucose testing errors and deficient insulin injections have been documented multiple times among children and adults with diabetes.¹³ After closely studying parents who were giving factor replacement therapy to their hemophiliac children, numerous administration errors were recorded even after years of experience.¹⁴ This is not tho say that parrots and patients don’t care, but simply shows how easy it is to make mistakes and be inadvertently non-compliant with treatment. Just keep that in mind and take any steps necessary to get trained and repeatedly supervised by professionals.

You can never be too careful with matters of health. It is the single most important thing we possess, so cherish it and take good care.

If you would like to learn more about adherence to treatment and disease prevention visit the Center for Disease Control and Prevention.

References:

1. DiMatteo, M. R. (1994). Enhancing patient adherence to medical recommendations. Journal of the American Medical Association, 271, 79-80.   2. Rapoff, M. A. (1999). Adherence to Pediatric medical regimens. New York: Kluwer Academic/Plenum Press.   3. Centers for Disease control and Prevention. (2004). Chronic disease prevention.   4. Centers for Disease control and Prevention. (1999). Chronic Diseases and their risk factors: The nation’s leading cause of death.   5. Mistry, S. K., & Sorrentino, A. P.  (1999). Patient nonadherence: The $100 billion problem. American Druggist, 216, 56-62.   6. Johnson, S. b. & Carlson, D. N. (2004). Medical Regimen Adherence: Concepts, Assessment, and Interventions. Handbook of Clinical and Health Psychology, Vol. 2. American Psychological Association, Washington, DC.   7. Epstein, L.  & Cluss, P. (1982). A behavioral medicine perspective on adherence to long-term medical regimens. Journal of Consulting and Clinical Psychology, 50, 950-971.   8. Page, P., Verstraete, D. G.,  Robb, J. R., and Etzwiler, D. D. (1981). Patient recall of self-care recommendations in diabetes. Diabetes Care, 4. 96-98.   9. Falvo, D. & Tippy, P. (1988). Communicating information to patients: Patient satisfaction and adherence as associated with resident skill. Journal of Family Practice, 26, 643-647.   10. Cline, C. M., Bjorck-Linne, A. K., Israelsson, B. Y., Willenheimer, R. B., & Erhardt, L. R. (1999). Non-compliance and knowledge of prescribed medication in elderly patients with heart failure. European Journal of Heart Failure, 2, 145-149.   11. Winkelstein, M. L., Huss, K., Butz, A., Eggleston, P., Vargas, P., and Rand, C. (2000). Factors associated with medication self-administration in children with asthma. Clinical Pediatrics, 39, 337-345.   12. Larson, J. S., Hahn, M., and Ekholm, B. (1994). Evaluation of conventional press and breath MDI technique in 501 patients. Journal of Asthma, 31, 193-199.   13. Perwien, A., Johnson, S. B., Dymtrow, D., and Silverstein, J. (2000). Blood glucose monitoring skills in children with type 1 diabetes. Clinical Pediatrics, 39, 351-357.   14.  Sergis-Deavenport, E. & Varni, J. W. (1983). Behavioral assessment and management of adherence to factor replacement therapy in hemophilia. Journal of Pediatric Psychology, 8, 367-377.

A sleep-deprived nation

Sleep – everyone does it. It’s so simple. No one taught us how to do it. We just surrender in its sweet embrace… or do we?

In 2008 the National Sleep Foundation asked Americans about their sleep habits. The results confirmed what psychologists and medical doctors already knew: people don’t get enough sleep and even when they do, it is often poor quality sleep. People explained their sleep deprivation with increased work hours and not having enough time.

• One third of people in the survey complained they get a good night’s sleep only a few nights each month.
• 20% shared they have often lost interest in sex, because of feeling too tired and sleepy.
• 29% said they regularly felt extremely sleepy during the day or fell asleep at work.
• 36% of drivers admitted to have nodded off in the past year. Rates are even higher among daily commuter drivers.

Why do we sacrifice sleep?

That same year USA Today survey revealed that 57% of the interviewed sacrificed sleep in order to get more work done. This is partly explained by our society’s attitude towards sleep. We just don’t think it’s all that important or even consider it a waste of time. We say “I’ll sleep when I’m dead” or “Life is too short to sleep.” We’ve fallen for the illusion that we don’t need sleep. That’s why we run on coffee and energy drinks, trying to get 5 more hours of energy, ignoring our bodily signals: fatigue, distractability, aches, altered mood and  irritability.

Ironically, we sacrifice sleep in order to get more done, but we end up messing up the work we’re doing. It either takes us longer, because we’re simply not able to focus and carry through tasks as productively as when we are well rested, or we make mistakes and bad decisions because sleep deprivation reduces mental capacity and flexibility. In the end, no one wins when we deprive ourselves of this natural biological need, that’s no different from the need for food and water.

How much sleep do we need?

Not everyone needs to get 7 or 8 hours of sleep every night. While this is considered the optimal amount for adults, there’s nothing magical about it. Some people need as few as 5 or 6 hours to wake up rested and refreshed, while others can’t function without their 8 or even 9 hours. We have found that those who need less sleep simply sleep more effectively. Scientists know this from studying people in Sleep Clinics. The number of such clinics in the United States has skyrocketed in recent years.

Don’t kid yourself, we all need sleep. Sleepless nights might actually sound like fun when you’re 20, but the truth is lack of sleep is altering our natural sleep-and-wake cycle, which can predispose to insomnia and other sleep-related disorders. Not to mention, we are purposefully depriving our bodies and brains of the vital rejuvenating power of sleep (that has shown to improve memory, concentration, physical and mental performance).

There are more than enough drivers nodding off as it is. There are more than enough people who cause accidents at work because they don’t get enough sleep. You really don’t want to be one of them, do you?

My advice?

If you are sleep deprived, just go to bed! You will get things done in the morning. Your body will thank you later.

Creativity and creative problem-solving can be that extra something that distinguishes sheer talent and hard work from booming success.

There are a lot of talented young artists, but there is only one Lady Gaga. It’s not because she is more talented or more beautiful. It’s not because she sings or dances better and it’s not because she’s interesting, in her weird Gaga way. It’s because she has that extra touch of creativity in building her business empire.

In fact, Lady Gaga was crowned at first place in the Top 100 Most Creative People in Business in 2010 by Fast Company. Some other creative minds that impress with their idiosyncratic approach to business and entrepreneurship are Ryan Murphy (the creator and producer of Glee), Eddy Cue (VP of Internet Services at Apple), Jay Z (artist and founder of Roc Nation), Haiping Zhao (Senior software engineer at Facebook) and James Cameron (filmmaker).

So what are some things that these folks have in common?

1. Higher than average intelligence

Research with creative people reaches a definite conclusion: smarter individuals tend to be more creative. This doesn’t mean you have to be a genius. The average college graduate has an IQ of 120 (the average for the general population is 100), which seems to be ‘just enough’ to nurture creativity in any field of work. Interestingly, people with extremely high IQ are not any more creative¹.

2. Substantial general knowledge and diverse interests

Creative souls usually have a broad knowledge base. To be an expert in only one field  is great for an academic or a researcher, but it’s not optimal for creativity. For example, knowing something about marketing, psychology, and finance in addition to your field of expertise is much more beneficial for any venture.

Creative people also appear to have various interests. They combine ideas from different fields fluently. Their though is flexible in finding connections between fields, problems and solutions. They often use metaphors and mental images to express their ideas².

3. Openness to experience

Creative minds are hardly rigid and conventional. On the contrary, they accept new ideas, even ‘weird’ ones. They tend to be uninhibited about their fantasies and feelings³ and make them come to life. They love to challenge assumptions, break established rules and find order in the chaos.

Creative people often have more unusual experiences (vivid dreams, daydreaming, mystical experiences)⁴.

4. Enjoy symbolism

Creative individuals appreciate symbolism and often use it to express their ideas, explore possibilities and talk about concepts (just look at some Jay Z, Madonna or Lady Gaga lyrics). Creative minds are interested in the truth and always look for it. They appreciate beauty and are not as concerned about recognition and success (although it often follows them wherever they go). Their creative work is an end in itself¹.

5. Value independence and complexity

Rigid work routine and inflexible boundaries are torture for the creative mind. These people value independence and prefer complexity, that’s why they may often feel constricted and oppressed in their work and might therefore challenge the rules. Although they usually are nonconformists in their work, they are not usually bizarre personalities.

What would you do, if you were given an extra day?online surveys

In 2008 a USA Today survey of more than 2,000 Americans asked about their work, personal life and the 24/7 war on time.

The results confirmed what most of us already know intuitively:

• 70% complained they were very busy.
• 50% said they were busier now than the previous year.

• More than 60% said they were angry with slow services, traffic and people being late for appointments, meetings, deadlines.
• More than 30% were consistently angered by slow PC start-up and slow downloads.

People consistently complained about the sacrifices they have to make in order to get work done.

• 45% said they sacrifice time spent with friends.
• 30% regularly sacrifice family time.
• Overwhelming 57% sacrifice sleep (shocker!)

• A confident 90% wished they had more time to spend with their family and friends.

Here comes the paradox! All participants were asked what they would do if they were given an extra day.

• Only 9% said they’d spend the time with friends.
• 31% said they’d spend the day with family.
• 25% wanted to have fun.
• Most (35%) wanted to get more work done.

So, most people wished they could have more time with family and friends, and yet, if given an extra day, they would use it to get some more work done?! Is it just me, or this really makes no sense?

The truth is that with the internet, globalization and being able to work remotely, there will never be enough hours in a day, or enough days in a year to get it all done. This really is the age of information. The competition has never been more fierce. Snooze for an hour and you lose. What you read in the news this morning, is already old news. It just seems we can never know it all and trying to keep up in the hamster wheel soon gets us real exhausted and desperate … Desperate to have more time, when what we really need is not more time. What we need is to set our priorities straight, so that if we want more family time, we make more family time. If we want more work done, we get more work done. Just make sure you are consistent with what you want to do with your time and what you actually do with your time.

So, what would you do if you had an extra day?

Image: Miguel77

Believe it or not, self-confidence is necessary for being and staying motivated. Self-confidence is our basic belief that we can successfully carry out activities and attain our goals. This makes it the first step to being motivated and energized if your life.

If you want to improve your everyday motivation, you first need to work on your self-confidence by doing the following:

• Set specific goals.

Don’t just talk about things in general. “I want to look great in a bikini next summer” or “I want to start reading more” are way too vague to be your goals. Besides, what are you saying exactly? What do “great” and “more” mean? Those are too subjective and so you can never be sure if you have reached your goal. You need to be more specific. For example, your goals can be: “I want to lose 15lbs by July 2011″ or “I want to read 6 books by New Year.”

• Make sure your goals are challenging, but attainable.

If you set up unrealistic goals for yourself, you are doomed to fail. Each failure only hurts your self-confidence and makes it more difficult to be motivated in the future, because you’ll be remembering all the times that you failed miserably. In order to set realistic goals you have to be real with yourself. No one knows you better than you! Forget about all the excuses you give to others. Forget about defenses and lies and see what’s left. Instead of “I’m too busy and stressed out to read in the evenings”, you should just give yourself the real version, “I’m too lazy in the evening and would rather vegetate in front of the TV than do anything else.”  Once you acknowledge the truth, you can begin to set your realistic goals.

• Visualize the steps you need to make to reach your goal.

A lot of research and studies of successful people show they are able to visualize the success ahead of time. Really think about where you want to get. How does that bikini look like? How do you look in it? Which books would you like to read? How would you feel after you’ve read them all? Hold that image in your mind’s eye and it becomes to be a powerful source of motivation.

• Advance in small steps.

If you try to tackle the big goal right away you may become overwhelmed, stressed out and hopeless. Instead, break it down into real small and manageable parts that you conquer victoriously one by one. “I will have salad with no dressing for dinner” or “I will read 30 pages tonight” is one thing you might do. Completing those will make you feel good about yourself and it is this ‘feeling good’ that makes the process of pushing yourself easier. In time, you’ll notice that you’re getting very good at it and will be able to kick it up a notch.

• Focus on the process of learning and acquiring a new skill, instead of comparing yourself to others.

If you compare yourself to the Victoria’s secret models or to people who destroy a book in a day, you might get discouraged and give up. You want to stay away from comparing yourself to those folks. Your goal is your own. It is accompanied by the unique strengths and weaknesses that you have. Some people are naturally slender, others are naturally fast readers. What does that have to do with you?! Focus on the process, cherish the progress that you make and take pride in the accomplishments, each step of the way.

• Get expert instructions.

Once you get on the right path of learning skills and forming the right habits, it is time to seek some expert instructions. If you can’t meet with a trainer or instructor, you are sure to find great information online, for free. Experts who really know their stuff well have blogs, participate in forums or write articles for bigger websites. Find expert instructions to make sure you are using the best and most efficient approach to achieving your goal. Educate yourself in the area you want to blossom in and that is a guaranteed self-confidence boost that will pay off big time.

• Get support and encouragement.

Yes, I did say that your goal is your own. It is often futile to set up goals for someone else. “I want to look great in a bikini because I want guys to like me” is the wrong approach. You should do thing for yourself, because you will like it, because it would be beneficial for you. This doesn’t mean that you don’t need encouragement from others. Let’s be real, it feels nice when we get a tap on the back for our efforts, so surround yourself with people who appreciate your hard work and support you.

• Regard failure as a sign that you need to try harder and not as a sign that you’re not good enough.

Sometimes you will fail. The sooner you accept this, the less frustration and disappointment you’ll face. Anyone who is trying a new thing is destined to fail now and then. Athletes, scientists, artists, actors – they have all been rejected, criticized or booed at some point of their careers. What distinguishes the truly successful people is that they do not internalize failure, but turn it into a driving force to work harder and get better.

• Last but not least, learn to cherish honest feedback (not to be confused with ‘great job’ comments).

Honest feedback is quite often plain old criticism and when given by the right person, is the most helpful tool for improvement you will ever get. Objective critique is not the enemy, it is your friend. I know it can hurt, but success and excellence come at a price, so be smart, man up and make criticism work for you.