Caroline > Books: psychology‎ (63)

Vincent Felitti and Robert Anda conducted an Adverse Childhood Experiences study. They sent 17,000 patients questionnaires about adverse childhood experiences.
70% responded. 75% of them were white and 75% of them had been to college. Their average age was 57.

They were surprised at the prevalence of childhood trauma in this generally well-off population. Many of them mentioned physical abuse or neglect, sexual abuse, emotional neglect, divorced or separated parents, or a family member in prison, mentally ill or with an addiction.
Over 25% were brought up in a household with an alcoholic or drug using parent. Over 25% were beaten as children.

The correlation between negative childhood experiences and negative adult outcomes stunned the researchers. Obesity, depression, early sexual activity, history of smoking and so forth. People with negative scores were 2X more likely to smoke, and 7x more likely to be alcoholics. They also had more health problems. Whilst many of the physical illnesses could be put down to bad lifestyles, this wasn't always the case. When they looked at patients with high negative scores who didn't drink too much or smoke and who weren't overweight - they found that their risk of ischaemic heart disease was still 360% higher than those with positive childhoods.

Those with particularly high scores for negative childhoods were 30x more likely to have attempted suicide than those with positive scores. Men with very high cores for negative childhoods were 46x more likely to have injected drugs than men with no negative history.

The main culprit for all the above is stress, or at least the body's reaction to stress.
Robert Sapolsky, a neuroscientist, says that like all mammals we evolved to react to brief and acute stress. Instead most stress today comes from mental processes, ie from worrying about things. this can be highly destructive, especially in infancy and childhood.

Suniya Luther also did research with middle class children with problems like alcohol misuse, smoking, cannabis, harder illegal drugs, elevated levels of depression and anxiety and chronic academic difficulties.

She concluded that with regard to the ones showing maladjustment it was caused by:
*Low levels of maternal attachment.
* High levels of parental criticism.
*Minimum after school adult supervision.
*Isolation from parents.
* Excessive achievement pressure.
*However alongside this emotional disconnection, parents were often unusually indulgent of their children's bad behaviour.
*The children also lacked challenges in their lives, because their parents protected them from the sort of experience that can lead to character growth, instead they were over-indulged.

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Michael Meaney from McGill University did research with rats.

When mother rats lick their pups to calm and reassure them after something stressful has happened (like being handled by a human), tests showed that their stress hormones quickly subsided.
Meaney tested the rats when they were about 100 days days old. Rats who received adequate attention from their mothers as pups were a lot more adventurous than those who didn't receive adequate attention. In fact they excelled in every test they were given. Rats who received less attention from their mothers were much more anxious and nervous when faced with new situations.

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Clancy Blair, a researcher in psychology, found that environmental risks like family turmoil or chaos, or overcrowding, only affect children when their mothers were inattentive or unresponsive. When the mothers were responsive these drawbacks didn't seem to matter.

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Similarly John Bowlby and then Mary Ainsworth in the 1960s and 70s found that babies whose parents responded readily and fully to their cries in the first few months of their life, were, at one year, more independent and intrepid than the children of parents who had ignored their cries. In pre-school the pattern continued.

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Alan Sroufe and Byron Egeland tested this further. They conducted a long term study on low-income mothers and their children. They recruited 267 mothers when they were pregnant. All had incomes below the poverty line. 80% were white, 63% were unmarried and 50% were teenagers. They followed them for 30 years.

Sometimes attachment relationship changed over the course of childhood, but for most of the children their well-being at one year of age was highly predictive of a wide range of outcomes in later life.

Secure attachment:
More socially competent throughout their lives.
Able to be attentive and engaged in class and rarely acted out.
No behaviour problems.
More curious and self-reliant.
Calmer.
Better able to deal with challenges.

Anxious attachment:
Did badly at pre-school
Were labelled as dependent by their teachers.
More often also labelled as mean, anti-social or immature.

However if a mother with poor attachment issues gets the right type of intervention she can become a mother who forms a secure attachment with her child.

Antabuse/Disulfiram and Willpower 97

This is an effective deterrent for those who wake up in the morning determined not to drink, but by the evening have lost their resolve. It turns out that willpower is not an infinite human resource. It's more like exercising a muscle, and it can get tired the more we use it.

Depression and Addiction 78

Schuckit, a professor of experimental psychology, did a study of depressed men. They went into hospital for 4 weeks, during which time they received no treatment for depression, other than stopping alcohol. After one month of not drinking, 80% no longer met criteria for clinical depression.
This finding implies that for the majority, clinical depression was the result of heavy drinking and not a co-occuring depressive disorder. Of course there are explanations for these results....but the robust findings are remarkable given that standard treatments for depression, whether medications or psychotherapy, have a 50% reponse rate.

Depression and Anxiety 45

Anxiety is significantly more prevalent and impairing in high-income countries than in low or middle income countries.
The number of new cases of depression worldwide increased 50 % between 1990 and 2017. The highest increases in new cases were seen in regions with the highest income, especially in North America.

Dopamine 49

Dopamine is a neurotransmitter. It may play a bigger role in the motivation to get a reward than the pleasure of the reward. Genetically engineered mice unable to make dopamine will not seek out food, and will starve to death even when food is placed just inches away from their mouth. Yet if the food is put directly into their mouth, they will chew and eat the food, and seem to enjoy it.
With repeated exposure to the same or similar pleasure stimulus, in initial deviation to the side of pleasure (on the pleasure/pain see-saw) gets weaker and shorter and the after-response to the side of pain gets stronger and longer. A process scientists call neuro-adaptation. With repetition, we need more of our drug of choice to get the same high we initially got.
Needing more of a substance to feel pleasure, or experiencing less pleasure at a given dose is called tolerance.
People on high doses of opioid therapy (OxyContin, morphine, fentanyl etc) for chronic pain, find that their pain gets worse and worse over time. Why? Because exposure to opioids had caused their brain to resent its pleasure-pain balance to the side of pain. Now they find that their original pain was worse, and they had new pain in parts of their body that used to be pain free.
This phenomenon, widely observed and verified by animal studies, has come to be called opioid-induced hyperalgesia. Algesia means sensitivity to pain. What's more, when these patients tapered off opioids, many of them experienced improvements in pain.
55
Neuroscientist Nora Volkow and colleagues have shown that heavy, prolonged consumption of high-dopamine substances eventually leads to a dopamine deficit state. She compared the brains of healthy controls v the brains of people who had given up taking heavy drugs 2 weeks ago. In the healthy controls the reward and motivation part of the brain was able to light up (indicating high levels of dopamine neurotransmitter activity. In the people who recently gave up drugs that part of the brain was showing little or no activity.
57
In the two years in which I compulsively consumed romance novels, I eventually reached a place where I could not find a book I enjoyed. it was as if I had burned out my novel-reading pleasure centre, and no book could revive it.

The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia, which is the inability to enjoy pleasure of any kind.
My patients with addiction describe how they get to a point where their drug stops working for them. They get no high at all any more. Yet if they don't take their drug, they feel miserable. The universal symptoms of withdrawal from any addictive substance are anxiety, irritability, insomnia and dysphoria.
A pleasure-pain balance tilted to the side of pain is what drives people to relapse even after sustained periods of abstinence. When our balance is tilted to the pain side we crave our drug just to feel normal (ie get a level balance.)
Here's the good news. If we wait long enough, our brain (usually) re-adapts to the absence of the drug and we re-establish our baseline homeostasis: a level balance. Once our balance is level, we are again able to take pleasure in everyday simple rewards. 60

Once we get the anticipated reward, brain dopamine firing increases well abou tonic baseline. But if the reward we anticipated doesn't materialize, dopamine levels fall well below baseline. Which is to say, if we get the expected reward, we get an even bigger spike. If we don't get the expected reward, we experience an even bigger plunge.

How does cue-induced craving translate to our pleasure-pain balance? The balance tips to the side of pleasure (a dopamine mini spike) in anticipation of future reward, immediately followed by a tip to the side of pain (a dopamine mini deficit) in the aftermath of the cue. The dopamine deficit is craving and drives drug-seeking behaviour.

Dopamine Fast 79

(For instance stopping drinking, social media activity or gambling for a month.)
I never suggest a dopamine fast to individuals who might be at risk to suffer life-threating withdrawal if they were to quite all of a sudden (eg severe alcohol, benzodiazepine or opioid dependence.) For those patients, medically monitored tapering is necessary.
Sometimes, patients ask if they can swap one drug for another: cannabis for nicotine, video games for pornography. This is seldom an effective long-term strategy.
Any reward that is potent enough to tip the see-saw balance towards pleasure can itself be addictive, thereby resulting in trading one addiction for another (cross addiction) Any reward that is not potent enough won't feel like a reward, which is why when we're consuming high-dopamine rewards, we lost the ability to take joy in ordinary pleasures.
A minority of patients (about 20%) don't feel better after the dopamine fast. That tells me that the drug wasn't the main driver of the psychiatric symptom and that the patient likely has a co-occuring psychiatric disorder that will require its own treatment.

Gastric Bypass Surgery 98

One in four gastric bypass surgery recipients develops a new problem with alcohol addiction.
Most people who are obese have an underlying food addiction, which is not adequately addressed with surgery alone. These people don't get the behavioural and psychological interventions they need to help them change their eating habits. Hence many of them resume eating in unhealthy was, expand their now smaller stomachs, and end up with medical complications and the need for repeat surgeries. When food is no longer an option, many switch from food to another drug, like alcohol.

Genetic Inheritance & addiction 20

The risk of addiction increases if we have a biological parent or grandparent with addiction, even when we're raised outside the addicted home.

Honesty 205

I am convinced as a parent that I can and should emphasize honesty as a core value in raising my children.
For me honesty is a daily struggle There's always a part of me that wants to embellish the story just the slightest bit, to make myself look better, or to make an excuse for bad behaviour. Now I try hard to fight that urge.
Although difficult in practice, this handy little tool - telling the truth - is amazingly within our reach. Anyone can wake up on any given day and decide, "Today I won't lie about anything." And in doing so, change their lives for the better
224 If we are open and honest with our children about our struggles, we create a space for them to be open and honest about their own. We must also be ready to admit when we are wrong in our interactions with them and with others. We must embrace our own shame and be willing to make amends.
234 Honesty promotes awareness, enhances intimacy, and fosters a mindset of plenty.

Medication problems in the long term.

Patients with anxiety and insomnia who take benzodiazepines and other sedative-hypnotics daily for more than a month may experience worsened anxiety and insomnia.
Patients with pain who take opioids daily for more than a month are at increased risk not only for opioid addiction but also for worsened pain. (opioid-induced hyperalgesia.
Medications like Adderall and Ritalin prescribed for attention deficit disorder promote short-term memory and attention, but there is little or no evidence for enhanced long term improvement. Public health psychologist Gretchen LeFever Watson has written "Compelling new evidence indicates that ADHD drug treatment is associated with deterioration in academic and social-emotional functioning.
Recent data show that even antidepressants may lead to tolerance and dependence, and possibly even make depression worse over the long haul, a phenomenon called tardive dysphoria.

Mental Illness & addiction 20

Mental illness is also a risk factor for addiction, although the relationship between the two is unclear: Does the mental illness lead to drug use, does drug use cause or unmask mental illness, or is it somewhere in between.

80 Co-occuring psychiatric disorders should be treated concurrently with any form of addiction (or withdrawal from an addictive substance), Managing addiction without also addressing other psychiatric disorders typically leads to bad outcomes for both.

Mental illness in wealthy countries 37

Over the past 3 decades, I have seen growing numbers of patients who appear to have every advantage in life - supportive families, quality education, financial stability, good health - yet develop debilitating anxiety, depression and physical pain.

Moderation 86

Emerging evidence suggests that some people who have met criteria for addiction in the past, especially those with less severe forms of addiction, can return to using their drug of choice in a controlled way In my clinical experience, this has been true.

Older women and alcohol. 20

Between 2002 and 2013 diagnosable alcohol addiction rose by 50% in older adults (over the age of sixty-five) and 84 percent in women, two demographic groups who had previously been relatively immune to this problem.

Pain 148
Hormesis is a branch of science that studies the beneficial effects of administering small to moderate doses of noxious and/or painful stimuli such as cold, heat, gravitational changes, radiation, food restriction and exercise.
Intermittent fasting has become somewhat popular as a way to lose weight and improve well-being. Not long ago fasting behaviours would have warranted the label "eating disorder, but in many circles it is considered normal and even healthy.
Exercise increases many of the neurotransmitters involved in positive mood regulation. Just walking for 30 minutes a day can effect mood, anxiety, cognition, energy and sleep, & has a more profound effect than any medication.
ECT is still practised today to good effect, although much more humanely than it used to be, with muscle relaxants paralytics to prevent painful contractions. Anaesthetics allow patients to remain asleep and mostly unconscious throughout the procedure. So, although not painful as such, ECT provides a hormetic shock to the brain, which in turn spurs a broad compensatory response to reassert homeostasis.

Prohibition verses Availability 20

Increased access to addictive substances may be the most important risk factor facing modern people. We all fall prey to the vortex of compulsive overuse. For instance the cigarette-rolling machine invented in 1880, made it possible to go from 4 cigarettes rolled per minute to a staggering 20,000
Prohibition - the ban on selling alcoholic beverages in the US from 1920 - 1933, led to a sharp decrease in the number of Americans consuming and becoming addicted to alcohol. Rates of public drunkenness and alcohol-related liver disease decreased by half during this period.
There were unintended consequences of course, such as the creation of a large black market run by criminal gangs. But the positive impact of Prohibition on alcohol consumption and related morbidity is widely under-recognised.
The reduced drinking effect of Prohibition persisted through the 1950s. Over the subsequent thirty years, as alcohol became more available again, consumption steadily increased.
By the 1990s, the percentage of Americans who drank alcohol increased by almost 50 percent, while high-risk drinking increased by 15 percent.

Trauma: Social Upheaval: Poverty

These also contribute to addiction risk. Drugs become a means of coping and lead to epigenetic changes - heritable changes to the strands of DNA outside of inherited base pairs - affecting gene expression in both an individual and their offspring.

Victimhood versus taking responsibility. 186

Patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes, are often unwell and remain unwell. They are too busy blaming others to get down to the business of their own recovery. By contrast, when my patients start telling stories that accurately portray their responsibility, I know they're getting better. Even when people have been victimized, if the narrative never moves beyond victimhood, it's difficult for healing to occur.
One of the jobs of a good psychotherapy is to help people tell healing stories. Even if we can take responsibility for the event itself, we can take responsibility about how we react to it in the here and now. We are then empowered to move forward with your lives.

White Working Class & death via addiction. 30

Middle-aged white Americans without a college degree are dying younger than their parents, grandparents and great-grandparents. The top three leading causes of death in this group are drug overdoses, alcohol-related liver disease and suicide.

"....in the fall of 1892, one patient in particular caught Freud’s attention in his efforts to refine this method.   Her name was Ilona Weiss, but she would forever be known in the annals of Sigmund Freud under the code name of Fraulein Elisabeth von R. Freud was forward in both his treatment and analysis of Fraulein. As was typical of Freud with most of his female patients, he was quick to declare that much of her problems came from sexual repression. This was apparently deduced during a physical exam in which after the uninhibited Freud pinched the girl’s bare thigh he received what he believed to be a“pleasurable” response. As Freud stated in his notations on the event, “Her face assumed a peculiar expression, one of pleasure rather than of pain; she cried out—somewhat, I could not help thinking, as with a voluptuous tickling—her face flushed, she threw back her head, closed her eyes, her trunk bent backward.” Freud believed that his simple little pinch was allowing this distressed girl to finally satisfy the sexual desires that she had suppressed so long. Most experts in the field of psychology today would quickly dismiss such reaching interpretations, but for Freud, such perceptions often seemed to equate solid evidence. He believed he was making a breakthrough in his pioneering field of psychoanalysis. With these first observations of Elisabeth made, Freud then set about curing her inhibition and repression by talking it out of her system. He engaged in free association."Using this technique Freud felt he was learning how to "push back against psychological barriers and resistance".   He would keep pushing/asking questions until his patients provided feedback."

JANUARY

Happiness:

Happiness is a virtuous circle. Happiness = more energy, and that makes it easier to be active (more exercising, more socializing.)

Exercise:

Just 20 minutes exercise a day, 3 days a week for 6 weeks, will boost your energy. Even walking. As Nietzche says...."All truly great thoughts are conceived while walking."

Weight training/strength training is also nice, because you don't sweat.

Decluttering:

Do it. It makes you feel better and it gives you energy.

Throw things away, but also create more filing and storage. You want stuff stored away, not stashed on surfaces.


Tackle a nagging task:

Studies show that one of the best ways to lift your mood is to engineer an easy success, such as tackling a long-delayed chore. It can give you a dramatic boost.

Act the way you want to feel:

William James "By regulating the action, which is under the more direct control of the will, we can indirectly regulate the feeling, which is not."

Or another way of putting it - "Fake it until you make it."

FEBRUARY

Seeing the good in people

With regard to other people - it's easy to focus on bad habits, and take good habits for granted. Practise enjoying their good habits.

Try and keep cheerful.

GK Chesterton "It is easy to be heavy: hard to be light."

Unconscious over-claiming:

This is a phenomenon whereby we unconsciously overestimate our contributions or skills, relative to other people. This again involves celebrating the good stuff about people around us.

Good arguing:

1. Tackle one subject at a time.
2. Ease into arguments, don't just blow up immediately.
3. Don't say "You always", or "You never".
4. Be aware of how to bring an argument to an end, instead of keeping it going for hours.

Showing matters:

We need to SHOW love and caring.

Pierre Reverdy "There is no love; there are only proofs of love".

The experience of 'growth' versus achievement:

Many researchers agree that it isn't achievement that brings us happiness, but rather GROWTH, eg training for a marathon, or learning a new language.

There is also the "hedonistic treadmill" whereby we quickly get used to new pleasures, so the good feeling wears off. An atmosphere of growth offsets that, that is why gardening is better than admiring your new dining room table.

MARCH

Novelty:

Novelty gives us pleasure.

Mastery:

We enjoy mastering new things.
New things also enable us to expand how we see ourselves.

Goals:

The arrival of a goal often brings more work and responsibility eg having a baby or buying a house. Arriving at one goal usually reveals another, yet more challenging goal. The challenge therefore is to take pleasure in the 'atmosphere of growth'. Enjoying the now, without worrying too much about the future.

APRIL

This was the section on parenthood. I didn't take any notes from this section (I have no children), but it was my favourite chapter in the book. Rubin isn't the perfect parent, but sometimes she is darn good. She warmed my heart in this chapter.

MAY

Emotional contagion.

Studies show that we subconsciously catch emotions from other people, whether good moods or bad ones. Taking the time to be silly means we are infecting one another with good cheer, and people who enjoy silliness are a third more likely to be happy.

Benefit of the doubt.

We need to cut people slack when they appear rude or impatient. We don't know the things that may be going on in their lives.

Familiarity.

Familiarity breeds affection in most instances. The more see someone the more we like them - although obviously this doesn't apply in all cases.

Spontaneous trait transference.

Studies show that people unintentionally transfer to you the traits you ascribe to other people, so if you gossip about someone being arrogant, that trait will also be ascribed to you. Luckily it applies to positive things too.

And if you complain a lot.....

Samuel Johnson "To hear complaints is wearisome alike to the wretched and the happy."


OCTOBER

No notes....


NOVEMBER

Kindness:

"Nothing can make our life, or the lives of other people, more beautiful, than perpetual kindness." Tolstoy.

Good conversation:

Listen. Get involved in someone else's conversation, rather than just waiting for when you can speak up about your experiences.

Bad conversation:

Being a know-it-all (telling lots of anecdotes that show off your knowledge.) (Hum...except I enjoy other people's knowledge.)

Being a topper: "You think YOU had a crazy morning. Let me tell you about mine!"

Being a "deflator": " You liked the movie? I thought it was kind of boring."

Being beligerant: Looking for ways to contradict what someone says.

Goody goody two shoes:

Exercise: Try having a Pollyanna week. You may well not do it perfectly, but it's a great exercise.
In many way Pollyanna-ish behaviour is good, and cheers everyone up.

DECEMBER

No notes....

Placebo effect:

Research has shown that .50 to .75 of patients improve due to the placebo effect. Invasive procedures have the greatest effect, eg injections rather than pills, even placebo surgery (where people are cut open and sewn up with little or nothing done.***) We are still not fully sure why it works, but it is powerful.

*** See comment 11, (below), by Carol.

Anti-social personality disorder:

This is a term that embraces both the psychopath and the sociopath. (I found the descriptions describing the differences between these terms contradictory/unconvincing.)

Basically they involve people who have no conscience, and are incapable of empathy, guilt or loyalty. They also cannot 'bide time'. They like the here and now, and having an exciting time. They eschew stability and routine, and often seem devoid of physical or social anxiety. They are often in trouble with the law and authority figures, primarily because they are impulsive. Their crimes include things like petty theft, fraud, forgery and failure to pay debts. They lie to everyone with apparent candour and sincerity. They often seek thrills associated with alcohol, gambling, drugs and sex.

Clever psychopaths have massive but superficial charm. They often have to keep 'on the move' because after a while communities get to know and mistrust them. This geographical and vocational mobility is a good index of their pathology.

When asked about justice and morality in the abstract, they tend to give the 'correct' conventional answer. They just don't apply this knowledge of right or wrong to themselves.

Psychopaths at work often appear relatively normal or successful. They build up relationships with powerful or influential people. They exploit them, then they cast them aside.

Stress:

People prone to stress:

1) Anxious worriers.

2) People with 'negative affinity' - a mix of anxiety, irritability, neuroticism and self-deprecation.

3) People who have an external locus of control, and feel their lives to be a function of luck, chance, fate or God, or general powers beyond their control.

4) Very competitive, driven people.

5) People in stressful jobs who don't get enough support.

6) People who are pessimistic (optimists tend to concentrate more on problem-focused coping, which is helpful with stress.)

Cognitive dissonance:

All of us dislike experiencing cognitive dissonance. This happens when we have chosen an attitude that we feel is wrong, and we did this totally of our own free will. We weren't ordered to chose this attitude, nor did we have no alternatives to choose from. It was a choice of free will. It also has to be an attitude that cannot be changed by issuing an apology, or making good our bad behaviour.

Ways we ameliorate the experience of cognitive dissonance: we say things like...

"Oh it wasn't THAT bad"
"Everyone was doing it"
"He deserved it."

Alternatively we can compensate the person or people we have hurt, & that will make us feel better.

Commitment:

If we make a commitment to something, we are likely to follow through. Salesmen know that very well eg "Would you buy if the price was right?" The idea is to get you committed to a position, quickly and unthinkingly, which you feel you should honour. Now all they have to do is offer you a cheaper price.

Commitment is powerful - avoiding inconsistency is a strong motivation for us.

The Gambler's fallacy:

This is a misunderstanding of probability and statistics.

Judgement and Problem solving

Common mistakes people make:

1) People believe that results taken from small samples are as valid as those taken from large samples.

2) Easy-to-recall or vivid instances have more weight in our mind than other less obvious instances. We over-emphasise their importance.

3) We rely too much on one trait or piece of information, when making decisions.

4) We look for information that confirms our biases.

5) We think we are better judges of people and situations than other people are.

6) We think we have more control over events than we do.

7) We are over-confident about our predictions.


Decisions:

It is better to reach decision by thinking things through by yourself rather than brainstorming in a group. In the latter instance we self-censor ourselves, plus it can be muddling. It can also lead people to make extreme decisions.

We tend to have habitual ways of making decisions, eg we do plus and minus lists, or consult with other people, or we get very emotional about it.

Loss aversion:

We attach more to the possibility of loss than the possibility of gain. We are more sensitive to loss - sometimes taking great risks to try and avoid the experience of loss.

The sunk-cost fallacy:

Once we have paid for something we feel very strongly that we have to use it - even if it turns out to be unsatisfactory. We hate wasting time or money that we have invested, so we 'throw good money after bad'. Sometimes this can have very bad results, even resulting bankruptcy.

Once we have committed a lot of time, money or energy to a cause, it's extremely difficult to convince us that it was not a good idea, or worthy of support.

Choices:

The more choices we have the more likely we are to do nothing. The more attractive the different options, the worse the delay or paralysis we experience.


Memory:

Most people have strongest memories of when they were about 12-25 years old, and also they have a good memory of the last 6 years. Our ability to recall the past is enhanced by keeping diaries, or having access to old home videos.

Memories are distorted, constructed and reconstructed.

Repression and Expression:

Psychologists have differentiated between people who repress their fears and those who express them. Say you are going to have a serious operation in two weeks. Some people will try to put this to the back of their minds, filling their time with distracting activities (repressors), whilst others would talk about it constantly (sensitizers) Both are dealing with their anxiety in different ways.

Repressors are highly defensive people who try and convince themselves that they're not prone to negative emotions. They always claim to be healthy and adjusted and try and give the impression of being resilient and calm. But if you measure their physiological and behavioural responses to things - particularly negative emotions - they react very strongly.

A good example of repression is childbirth. Women who describe childbirth immediately after the experience, say it is incredibly painful. If you ask them again, months later, they usually describe it as being less painful.

TOT - tip of the tongue memory:

We have all had this experience. You can almost remember the name of something 'it's on the tip of my tongue', but you can't quite remember it. This is because words are just abstract names for things, the actual thing, the meaning of the thing, is easily remembered. We can describe the thing, we just can't name it.

This gets worse as we get older.

* Worriers appear to be very good at defining problems, but extremely bad at solving them. Recent research shows this tends to be because worriers tend to be slower than non-worriers when attempting to make a decision. This delay seems to stem from a reluctance to make decisions unless they are absolutely sure that they are doing the right thing. They become uncertain, doubtful and stressed, and they catastrophise.

*If you are catastrophising, ask yourself how many people in the world have survived the experience of your problem. (Answer - millions.) Also coping with real 'bad outcomes' is sometimes easier than coping with an imagined one. Often the real experience is far less bad than we imagined.

*We need to regard worry as a useful mental event that we can use to diagnose issues in our lives.

*Worry tends to creep up on us. It is good to recognise it as early as possible, otherwise it will get worse.

*We need to try and turn our worry into constructive problem-solving.

*Everyone responds to worry differently. It may make you feel depressed rather than tense.

.*Often in the middle of a stressful situation you are not at your best. Put off your problem-solving until you feel calmer. In the meantime, try and distract yourself from your worries.

*Defining a problem is surprisingly difficult. Everyday problems can be extremely complex. Talking things over with a friend can help you see what is actually bothering you. Research shows the more you do this the better you feel.

*It might be an idea to start with your easiest problems first. Only attempt to solve problems that you have a sporting chance of solving.

*Try brainstorming solutions to your problems. Just get ideas out on paper. It will also help you get out of the trap of "Yes but...." Afterwards note the pros and cons of each suggestion, plus you can allocate a number (1-100 gives you a lot of leeway), so you can rate the importance of your pros and cons. If after doing this your gut tells you that the outcome is wrong for you - you may have to dig further - perhaps by talking with a friend.

*We also have to make sure we aren't doing something just because someone else wants us to.

*Practice decision-making, by taking small and unimportant decisions quickly.

*Practice problem-solving whenever you can. Treat even your trivial worries as opportunities to engage in problem-solving.

*All decisions are risky (this is why people follow astrologers etc.) It is always possible to think of things that may go wrong. Feeling a little uncomfortable after making a quick decision is a small price to pay for worry reduction. The quicker you deal with your problem the less time you will spend worrying. There is never enough evidence to ensure a decision is absolutely right.

*Once you have made a decision focus on the pros. It is all too easy to focus on the cons, and regret your decision.

* Questions you can ask yourself

1. What am I worried about?

2. What do I want to happen?

3. What can I do to make it happen? (Brainstorming.)

4. What is my decision?

5. Did it work?

*Issues with decisions

1. You are bound to make a few mistakes.

2. You might define a problem incorrectly

3. You might choose the wrong coping strategy.

4. You might be trying to solve a problem that simply cannot be solved.

*The personalities of worriers.

1) They tend to take a negative view of things.

2) They are especially negative about their own personalities and ability to cope.

3) They tend to have low levels of self-confidence.

* You are bound to make some mistakes when attempting to problem-solve. If you consider these early attempts as 'failures' then you are more likely to give up. Make a clear distinction in your mind between'setbacks' and 'failures'. It is far more useful to see early difficulties as 'a temporary setback'. After a setback, you may find that the next coping strategy you choose will work really well.

*Reward yourself for your successes when you have managed to solve a problem. It is easy to overlook our successes, and thus fail to gain confidence in our abilities.