Self-acceptance is defined as “an individual’s acceptance of all of his/her attributes, positive or negative.” It includes body acceptance, self-protection from negative criticism, and believing in one’s capacities………CLICK & SEE
English: Robert Plutchik’s Wheel of Emotions (Photo credit: Wikipedia)
Many people have low self-acceptance. There can be many reasons for this, but one widely accepted theory is that because we develop our self-esteem, in part, from others appreciating us, people with low self-acceptance may have had parents who lacked empathy during their childhood. Consequently, in their adult lives, they may need much stronger affirmation from others than most people do. In other words, ordinary levels of approval do not “move the needle” on their self-esteem.
Some people with low self-acceptance try to bolster it by accomplishing great things. But this only helps your self-esteem for a while. That’s because achievement is a poor substitute for intimacy. In addition, these people are often under the impression that “taking it” when suffering is the main reflection of their value. It’s hard for them to believe in genuine caring, and when it does come their way, they are suspicious of it.
Of course, self-acceptance (or lack thereof) does not exist in a vacuum — it actually has profound effects on your physical and psychological health. For that reason, it is worth understanding what these effects are, and what you can do about it. The emotional and physical consequences of low self-acceptance:-
Without self-acceptance, your psychological well-being can suffer, and often, beneficial interventions are less helpful for you than for others with higher self-acceptance.
For example, practicing mindfulness can help many people reduce the impact of stress. But when you cannot accept yourself, it becomes less effective. Also, if you have a physical illness such as rheumatoid arthritis, not accepting yourself can make you more anxious about your body. In this context, your automatic negative thoughts increase.
In addition, if you feel negatively about yourself, the brain regions that help you control emotions and stress have less gray matter than someone with a greater degree of self-acceptance — that is, these regions actually have less tissue to “work with.” This lack of gray matter may also appear in regions of the brainstem that process stress and anxiety. Stress signals from these latter regions, in turn, disrupt the emotional control regions. So, poor self-acceptance may disrupt emotional control in two ways: directly, by disrupting the brain regions that control it, and also indirectly, by increasing stress signals in your brain that subsequently disrupt these regions. How to bolster your self-acceptance:-
Self-regulation involves suppressing negative emotions such as self-hatred, refocusing on the positive aspects of yourself, and reframing negative situations so that you see the opportunities in them. For example, looking for ways in which negative criticism can help you grow constitutes reframing.
However, self-control may be less powerful than we think. The lack of self-acceptance can be deeply unconscious — that is, it can exist at a level beyond our conscious control. Also, when you do not accept or forgive yourself, “you” are still split from “yourself” — you do not feel “together.” Both of these parts — the one that needs to forgive, and the one that needs to be forgiven — are at odds with each other. In this situation, self-transcendence can be helpful.
When you are “self-transcendent,” you rely less on things outside of yourself to define you. Instead, you turn to an unforced sense of connectedness with the world. You can achieve this by contributing to work, family, or the community at large. The goal is to seek unity with some system in a way that is heartfelt and authentic. Any of the methods I’ve described in this post may also contribute to self-transcendence.
Fortunately, just like self-acceptance, self-transcendence also engenders physical changes in the brain. It has been associated with increased serotonin transporter availability in the brainstem. As mentioned earlier, this same region impacts self-acceptance. Transcendental meditation is another potential tool to consider for self-transcendence. It decreases cortisol and reduces your stress response.
Meditation as a path to self-acceptance:-
Self-acceptance can also be achieved by two other kinds of meditation: mindfulness meditation and loving-kindness meditation.
Mindful attention to emotions involves not “judging,” but observing, your emotions when they arise. This can lower your brain’s emotional response to anxiety and distress. It effectively “calms down” your amygdala.
Having more compassion toward yourself appears to be helpful in increasing self-acceptance. Loving-kindness meditation can help you achieve this state by changing the activity in regions of the brain that perceive and process emotions. For example, people previously numb to praise may be able to become more accepting of it. It is also associated with greater connectivity within the brain. This makes sense, as lack of self-acceptance has been associated with excessive right-hemisphere activity in the brain. Loving-kindness meditation provides a potential way to correct this imbalance.
Find the ways to self-acceptance that work:-
Not all of these methods work for everyone. And while double-blind placebo-controlled trials remain the scientific gold standard to assess whether each intervention “works,” they are limited too. They tell us little about what will work for an individual — an individual is, by definition, uniquely different from everyone, including study participants. So, it is most important to do what works for you. Self-acceptance is key to a healthy emotional and psychological life. Start exploring what works for you today.
Definition: Anger is an emotional response related to one’s psychological interpretation of having been threatened. Often it indicates when one’s basic boundaries are violated. Some have a learned tendency to react to anger through retaliation. Anger may be utilized effectively when utilized to set boundaries or escape from dangerous situations. Sheila Videbeck describes anger as a normal emotion that involves a strong uncomfortable and emotional response to a perceived provocation. Raymond Novaco of UC Irvine, who since 1975 has published a plethora of literature on the subject, stratified anger into three modalities: cognitive (appraisals), somatic-affective (tension and agitations), and behavioral (withdrawal and antagonism). William DeFoore, an anger-management writer, described anger as a pressure cooker: we can only apply pressure against our anger for a certain amount of time until it explodes. CLICK & SEE THE PICTURES Modern psychologists view anger as a primary, natural, and mature emotion experienced by virtually all humans at times, and as something that has functional value for survival. Anger can mobilize psychological resources for corrective action. Uncontrolled anger can, however, negatively affect personal or social well-being. While many philosophers and writers have warned against the spontaneous and uncontrolled fits of anger, there has been disagreement over the intrinsic value of anger. The issue of dealing with anger has been written about since the times of the earliest philosophers, but modern psychologists, in contrast to earlier writers, have also pointed out the possible harmful effects of suppressing anger. Displays of anger can be used as a manipulation strategy for social influence.
Effects of anger:
Anger occurs in an area of the brain called the amygdala. In a quarter of a second it releases the chemicals arginine-vasopressin, dopamine, noradrenalin, and corticotropin-releasing hormone and lowers serotonin levels. These chemicals make our bodies ready for a “fight or flight” reaction. The heart rate and blood pressure go up, pupils dilate and sweating occurs. Almost immediately, the blood supply to the frontal lobe of the brain increases. It reacts, releasing other chemicals like serotonin. As its levels rise, reason sets in and higher functions take over. Angry reactions are suppressed.
There are two types of anger : Passive anger and Aggressive anger. These two types of anger have some characteristic symptoms:
Passive anger: Passive anger can be expressed in the following ways:
*Dispassion, such as giving someone the cold shoulder or a fake smile, looking unconcerned or “sitting on the fence” while others sort things out, dampening feelings with substance abuse, overreacting, oversleeping, not responding to another’s anger, frigidity, indulging in sexual practices that depress spontaneity and make objects of participants, giving inordinate amounts of time to machines, objects or intellectual pursuits, talking of frustrations but showing no feeling.
*Evasiveness, such as turning one’s back in a crisis, avoiding conflict, not arguing back, becoming phobic.
*Defeatism, such as setting yourself and others up for failure, choosing unreliable people to depend on, being accident prone, underachieving, sexual impotence, expressing frustration at insignificant things but ignoring serious ones.
*Obsessive behavior, such as needing to be inordinately clean and tidy, making a habit of constantly checking things, over-dieting or overeating, demanding that all jobs be done perfectly.
*Psychological manipulation, such as provoking people to aggression and then patronizing them, provoking aggression but staying on the sidelines, emotional blackmail, false tearfulness, feigning illness, sabotaging relationships, using sexual provocation, using a third party to convey negative feelings, withholding money or resources.
*Secretive behavior, such as stockpiling resentments that are expressed behind people’s backs, giving the silent treatment or under the breath mutterings, avoiding eye contact, putting people down, gossiping, anonymous complaints, poison pen letters, stealing, and conning.
*Self-blame, such as apologizing too often, being overly critical, inviting criticism.
*Bullying, such as threatening people directly, persecuting, pushing or shoving, using power to oppress, shouting, driving someone off the road, playing on people’s weaknesses.
*Destructiveness, such as destroying objects as in vandalism, harming animals, destroying a relationship, reckless driving, substance abuse.
*Grandiosity, such as showing off, expressing mistrust, not delegating, being a sore loser, wanting center stage all the time, not listening, talking over people’s heads, expecting kiss and make-up sessions to solve problems.
*Hurtfulness, such as physical violence, including sexual abuse and rape, verbal abuse, biased or vulgar jokes, breaking confidence, using foul language, ignoring people’s feelings, willfully discriminating, blaming, punishing people for unwarranted deeds, labeling others.
*Manic behavior, such as speaking too fast, walking too fast, working too much and expecting others to fit in, driving too fast, reckless spending.
*Selfishness, such as ignoring others’ needs, not responding to requests for help, queue jumping.
*Threats, such as frightening people by saying how one could harm them, their property or their prospects, finger pointing, fist shaking, wearing clothes or symbols associated with violent behaviour, tailgating, excessively blowing a car horn, slamming doors.
*Unjust blaming, such as accusing other people for one’s own mistakes, blaming people for your own feelings, making general accusations.
Unpredictability, such as explosive rages over minor frustrations, attacking indiscriminately, dispensing unjust punishment, inflicting harm on others for the sake of it, using alcohol and drugs, illogical arguments.
*Vengeance, such as being over-punitive, refusing to forgive and forget, bringing up hurtful memories from the past.
People can “feel the heat” as anger builds up in the body. Three responses are possible at this point. The emotion can be vented out, suppressed or attempts can be made to calm down. Expressing anger to a superior or an authority figure may not be the wisest path.
Suppression of anger, especially if the aggravation is continuous and long term, can have negative effects. The blood pressure can go up, it can precipitate a stroke or heart attack and it can result in overeating and obesity with its attendant problems or depression.
People feel angry when they sense that they or someone they care about has been offended, when they are certain about the nature and cause of the angering event, when they are certain someone else is responsible, and when they feel they can still influence the situation or cope with it. For instance, if a person’s car is damaged, they will feel angry if someone else did it (e.g. another driver rear-ended it), but will feel sadness instead if it was caused by situational forces (e.g. a hailstorm) or guilt and shame if they were personally responsible (e.g. he crashed into a wall out of momentary carelessness).
Usually, those who experience anger explain its arousal as a result of “what has happened to them” and in most cases the described provocations occur immediately before the anger experience. Such explanations confirm the illusion that anger has a discrete external cause. The angry person usually finds the cause of their anger in an intentional, personal, and controllable aspect of another person’s behavior. This explanation, however, is based on the intuitions of the angry person who experiences a loss in self-monitoring capacity and objective observability as a result of their emotion. Anger can be of multicausal origin, some of which may be remote events, but people rarely find more than one cause for their anger. According to Novaco, “Anger experiences are embedded or nested within an environmental-temporal context. Disturbances that may not have involved anger at the outset leave residues that are not readily recognized but that operate as a lingering backdrop for focal provocations (of anger).” According to Encyclopædia Britannica, an internal infection can cause pain which in turn can activate anger.
Anger makes people think more optimistically. Dangers seem smaller, actions seem less risky, ventures seem more likely to succeed, and unfortunate events seem less likely. Angry people are more likely to make risky decisions, and make more optimistic risk assessments. In one study, test subjects primed to feel angry felt less likely to suffer heart disease, and more likely to receive a pay raise, compared to fearful people. This tendency can manifest in retrospective thinking as well: in a 2005 study, angry subjects said they thought the risks of terrorism in the year following 9/11 in retrospect were low, compared to what the fearful and neutral subjects thought.
In inter-group relationships, anger makes people think in more negative and prejudiced terms about outsiders. Anger makes people less trusting, and slower to attribute good qualities to outsiders.
When a group is in conflict with a rival group, it will feel more anger if it is the politically stronger group and less anger when it is the weaker.
Unlike other negative emotions like sadness and fear, angry people are more likely to demonstrate correspondence bias – the tendency to blame a person’s behavior more on his nature than on his circumstances. They tend to rely more on stereotypes, and pay less attention to details and more attention to the superficial. In this regard, anger is unlike other “negative” emotions such as sadness and fear, which promote analytical thinking.
An angry person tends to anticipate other events that might cause him anger. She/he will tend to rate anger-causing events (e.g. being sold a faulty car) as more likely than sad events (e.g. a good friend moving away).
A person who is angry tends to place more blame on another person for his misery. This can create a feedback, as this extra blame can make the angry man angrier still, so he in turn places yet more blame on the other person.
When people are in a certain emotional state, they tend to pay more attention to, or remember, things that are charged with the same emotion; so it is with anger. For instance, if you are trying to persuade someone that a tax increase is necessary, if the person is currently feeling angry you would do better to use an argument that elicits anger (“more criminals will escape justice”) than, say, an argument that elicits sadness (“there will be fewer welfare benefits for disabled children”). Also, unlike other negative emotions, which focus attention on all negative events, anger only focuses attention on anger-causing events.
Anger can make a person more desiring of an object to which his anger is tied. In a 2010 Dutch study, test subjects were primed to feel anger or fear by being shown an image of an angry or fearful face, and then were shown an image of a random object. When subjects were made to feel angry, they expressed more desire to possess that object than subjects who had been primed to feel fear.
To control anger:
Seneca addresses the question of mastering anger in three parts: 1. how to avoid becoming angry in the first place 2. how to cease being angry and 3. how to deal with anger in others.
Calming techniques have to be learnt, as they do not come naturally. As soon as you feel your heart pounding in anger, count mentally to 10 before retorting verbally or physically. This gives time for the frontal lobe to counter the amygdala. At the same time take a few deep breaths. Sometimes a word like peace or shanti repeated mentally several times can help with control. Yoga and meditation are time-tested ancient techniques.
When intense anger takes over, you can either leave the scene (probably an appropriate and safe response), or respond with physical or verbal aggression. If serotonin levels are low, unreasonable anger and aggression take over.
Standing before a mirror and looking at yourselves, may reduce the anger and sometimes taking a shower also reduces anger.
Logic defeats anger. Considering and analysing occurrences can often defuse anger. Listening to the other person, thinking things through, walking in the other man’s shoes, are all practical ways to tackle the problem of anger.
Regular aerobic exercise such as walking, jogging, running, cycling or swimming for 40 minutes or more a day has profound effects on physical and psychological make up. Chemicals are released from the muscles and these elevate serotonin levels. Anger does occur in people who exercise regularly, but the chemicals released by the body tend to put a “brake” on violent, irrational anger.
Cognitive behavioral affective therapy for anger:
A new integrative approach to anger treatment has been formulated by Ephrem Fernandez (2010) Termed CBAT, for cognitive behavioral affective therapy, this treatment goes beyond conventional relaxation and reappraisal by adding cognitive and behavioral techniques and supplementing them with affective techniques to deal with the feeling of anger. The techniques are sequenced contingently in three phases of treatment: prevention, intervention, and postvention. In this way, people can be trained to deal with the onset of anger, its progression, and the residual features of anger.
We encounter a wide variety of people our lives through. Many of them touch us in some positive way. Occasionally, however, we encounter those individuals who, for whatever reason, can be difficult to deal with. Perhaps this person is a colleague or your boss or close friend that you feel is deliberately being obtuse, inviting in trouble, or doing foolish things that you find annoying. Sometimes, it may be possible to appease or avoid those people short term. Dealing with them in the long term, however, can be exhausting. The behavior of difficult people can even make you feel like losing your temper, but keep your cool. Staying calm is the first step, especially when you are ready to confront them.
Avoiding a difficult person can improve impossible and not in your best interest, especially if you live or work together. Likewise, attempts to steer clear of them can become a source of stress and anxiety when they are a part of your social circle. When this is the case, it is best to kindly address the problem. Try not to let their actions or mood affect you. You also may want to try expressing your feelings directly. Tell to the person how their actions make you feel and encourage them toward a more positive course of action. Speak assertively, but respectfully, and don’t portray yourself as a victim. Another approach for dealing with a difficult individual is to gain a deeper understanding of who that person is. Ask them why they do or say certain things. If you disagree with their motives, question them further so you can try and discover the root of their behaviors. In doing so, you may be able to gently shift their perceptions, or at least help them understand your ! point of view.
You may want to think about what you want to say to a difficult person before you actually talk to them. If you can, avoid being judgmental or defensive, and try to approach the conversation objectively. If the person is open to the idea, try coming to an agreement. If approaching them fails, let it go and move on. There is no reason to let difficult person or situation have power over your state of being. Remember that a lot can be accomplished when you take the time to listen and offer up alternative perspectives.
Definition:– Feeding problem of infancy or early childhood is characterized by the failure of an infant or child under six years of age to eat enough food to gain weight and grow normally over a period of one month or more. The disorder can also be characterized by the loss of a significant amount of weight over one month. Feeding disorder is similar to failure to thrive, except that no medical or physiological condition can explain the low food intake or lack of growth. CLICK & SEE THE PICTURES
Infants and children with a feeding disorder fail to grow adequately, or even lose weight with no underlying medical explanation. They do not eat enough energy or nutrients to support growth and may be irritable or apathetic. Factors that contribute to development of a feeding disorder include lack of nurturing, failure to read the child’s hunger and satiety cues accurately, poverty, or parental mental illness. Successful treatment involves dietary, behavioral, social, and psychological intervention by a multidisciplinary
Feeding problems are common throughout childhood and affect both boys and girls.
The kind of feeding problem may depend on the age of the child.
Some new mothers take a while to get the hang of breastfeeding and may worry they’re not producing sufficient milk or their baby isn’t satisfied. But as long as the baby is gaining weight at the normal rate, there’s no need for concern.
Occasionally, early feeding problems are due to anatomical difficulties (for example, a severe cleft palate or oesophageal atresia) or more general illness, but these are usually quickly identified.
Minor infections, such as a cold, can interrupt established feeding patterns, but rarely for long.
More serious conditions can interfere with the absorption of food and weight gain, including coeliac disease, cystic fibrosis, inflammatory bowel disease and food intolerance.
In toddlers and older children, emotional and social factors can cause feeding problems. Older children, especially girls, are more likely to develop eating disorders such as anorexia nervosa and bulimia.
The symptoms of feeding disorders can vary, but common symptoms include:
•Lack of appetite
•Crying before or after food
•Failing to gain weight normally
•Regurgitating or vomiting
Between 25% and 35% of normal children experience minor feeding problems. In infants born prematurely, 40% to 70% experience some type of feeding problem. For a child to be diagnosed with feeding disorder of infancy or early childhood, the disorder must be severe enough to affect growth for a significant period of time. Generally, growth failure is considered to be below the fifth percentile of weight and height.
Feeding disorder of infancy or early childhood is diagnosed if all four of the following criteria are present:
•Failure to eat adequately over one month or more, with resultant weight loss or failure to gain weight.
•Inadequate eating and lack of growth not explained by any general medical or physiological condition, such as gastrointestinal problems, nervous system abnormalities, or anatomical deformations.
•The feeding disorder cannot be better explained by lack of food or by another mental disorder, such as rumination disorder.
•The inadequate eating and weight loss or failure to gain weight occurs before the age of six years. If feeding behavior or weight gain improves when another person feeds and cares for the child, the existence of a true feeding disorder, rather than some underlying medical condition, is more likely.
Successful treatment of feeding disorders requires a multidisciplinary team approach to assess the child’s needs and to provide recommendations and education to improve feeding skills, behavior, and nutrient intake. The multidisciplinary team for treatment of feeding disorders in childhood usually includes physicians specializing in problems of the gastrointestinal tract or of the ear, nose, and throat; a dietitian, a psychologist , a speech pathologist, and an occupational therapist. Support from social workers and physicians in related areas of medicine is also helpful.
An initial evaluation should focus on feeding history, including detailed information on type and timing of food intake, feeding position, meal duration, energy and nutrient intake, and behavioral and parental factors that influence the feeding experience. Actual observation of a feeding session can give valuable insight into the cause of the feeding disorder and appropriate treatments. A medical examination should also be conducted to rule out any potential medical problems or physical causes of the feeding disorder.
After a thorough history is taken and assessment completed, dietary and behavioral therapy is started. The goal of diet therapy is to gradually increase energy and nutrient intake as tolerated by the child to allow for catch up growth. Depending on the diet history, energy and nutrient content of the diet may be kept lower initially to avoid vomiting and diarrhea. As the infant or child is able to tolerate more food, energy and nutrient intake is gradually increased over a period of one to two weeks, or more. Eventually, the diet should provide about 50% more than normal nutritional needs of infants or children of similar age and size.
Behavioral therapy can help the parent and child overcome conditioned feeding problems and food aversions. Parents must be educated to recognize their child’s hunger and satiety cues accurately and to promote a pleasant, positive feeding environment. Changing the texture of foods, the pace and timing of feedings, the position of the body, and even feeding utensils can help the child overcome aversions to eating. If poverty, abuse, or parental mental illness contribute to the feeding disorder, these issues must also be addressed.
If left untreated, infants and children with feeding disorders can have permanent physical, mental, and behavioral damage. However, most children with feeding disorders show significant improvements after treatment, particularly if the child and parent receive intensive nutritional, psychological, and social intervention.
Providing balanced, age-appropriate foods at regular intervals—for example, three meals and two or three snacks daily for toddlers—can help to establish healthy eating patterns. If a child is allowed to fill up on soft drinks, juice, chips, or other snacks prior to meals, appetite for other, more nutritious foods will decrease.
Positive infant and childhood feeding experiences require the child to communicate hunger and satiety effectively and the parent or caregiver to interpret these signals accurately. This set of events requires a nurturing environment and an attentive, caring adult. Efforts should be made to establish feeding as a positive, pleasant experience. Further, forcing a child to eat or punishing a child for not eating should be avoided.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Definition: Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.
Electroconvulsive therapy (ECT), formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown. Today, ECT is most often recommended for use as a treatment for severe depression which has not responded to other treatment, and is also used in the treatment of mania and catatonia. It was first introduced in the 1938 and gained widespread use as a form of treatment in the 1940s and 1950s.
Informed consent is a standard of modern electroconvulsive therapy. According to the Surgeon General, involuntary treatment is uncommon in the United States and is typically only used in cases of great extremity, and only when all other treatment options have been exhausted and the use of ECT is believed to be a potentially life saving treatment. However, caution must be exercised in interpreting this assertion as, in an American context, there does not appear to have been any attempt to survey at national level the usage of ECT as either an elective or involuntary procedure in almost twenty years. In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent
Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and positive outcomes. After treatment, drug therapy is usually continued, and some patients receive continuation/maintenance ECT. In the United Kingdom and Ireland, drug therapy is continued during ECT.
The treatment involves placing electrodes on the temples, on one or both sides of the patient’s head, and delivering a small electrical current across the brain, with the patient sedated or under anaesthetic. The aim is to produce a seizure lasting up to a minute, after which the brain activity should return to normal. Patients may have one or more treatment a week, and perhaps more than a dozen treatments in total.
Although ECT has been used since the 1930s, there is still no generally accepted theory to explain how it works. One of the most popular ideas is that it causes an alteration in how the brain responds to chemical signals or neurotransmitters.
Why & when it is done?
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of a number of mental health conditions. It may be an effective treatment in someone who is suicidal, for instance, or end an episode of severe mania.
ECT is used to treat:
*Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
*Schizophrenia, particularly when accompanied by psychosis, a desire to commit suicide or hurt someone else, or refusal to eat.
*Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision making, impulsive or risky behavior, substance abuse and psychosis.
*Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and some other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
Electroconvulsive therapy is sometimes used as a last-resort treatment for:
#Treatment-resistant obsessive compulsive disorder, severe obsessive compulsive disorder that doesn’t improve with medications or other treatments
#Parkinson’s disease, epilepsy, and certain other conditions that cause movement problems or seizures
*Tourette syndrome that doesn’t improve with medications or other treatments
ECT may be a good treatment option when medications aren’t tolerated or other forms of therapy haven’t worked. In some cases ECT is used:
#During pregnancy, when medications can’t be taken because they might harm the developing fetus
#In older adults who can’t tolerate drug side effects
#In people who prefer ECT treatments over taking medications
#When ECT has been successful in the past
Patients are given short-acting anaesthetics, muscle relaxants and breathe pure oxygen during the short procedure in order to minimise the risks. However, although ECT is much safer than it was, there are still side effects to the treatment. The most common are headache, stiffness, confusion and temporary memory loss on awaking from the treatment – some of these can be reduced by placing electrodes only on one side of the head. Memory loss can be permanent in a few cases, and the spasms associated with the seizure can cause fractured vertebrae and tooth damage. However, the recommended use of muscle relaxant nowadays makes the latter a very rare occurrence. Patients can also experience numbness in the fingers and toes.
The death rate from ECT used to be quoted as one for every 1,000 patients, but with smaller amounts of electric current used in modern treatments, accompanied by more safety techniques, this has been reduced to as little as four or five in 100,000 patients.
A common argument against ECT is that it destroys brain cells, with experiments conducted on animals in the 1940s often cited as evidence. However, modern studies have yet to reproduce these findings in the human brain.
Some activists, however, still campaign against the widespread use of ECT in psychiatry, quoting those cases which have resulted in long-term damage or even death, whether because of the built-in chance of problems, or through errors by doctors.
Experts say that given the correct staff training, and when used for the right clinical conditions, ECT can ‘dramatically’ benefit the patient. An audit of ECT in Scotland between February 1996 and August 1999 said concerns about unacceptable side effects, effectiveness of the treatment and disproportionate use on elderly people were ‘largely without foundation’.
It said that in nearly three quarters of cases people with depressive illness showed ‘a definite improvement’ after ECT. Women were more likely to receive the treatment than men, but the auditors said this was because they were twice as likely to suffer from depression. Only 12 per cent of patients who got ECT were aged over 75. However, the Royal College of Psychiatrists has admitted that in the past the treatment has been administered by untrained, unsupervised junior doctors. However, modern guidelines have changed this and ECTAS (ECT Accreditation Services) exist to check that such treatment is being given safely and efficiently.
Guidelines on ECT from NICE (2003) recommend that it’s used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment. options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with:
•Severe depressive illness
•Prolonged or severe manic episode
NICE also says that ‘valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. The decision to use ECT should be made jointly by the individual and the clinician(s) responsible for treatment, on the basis of an informed discussion. This discussion should be enabled by the provision of full and appropriate information about the general risks associated with ECT and about the risks and potential benefits specific to that individual. Consent should be obtained without pressure or coercion, which may occur as a result of the circumstances and clinical setting, and the individual should be reminded of their right to withdraw consent at any point. There should be strict adherence to recognised guidelines about consent and the involvement of patient advocates and/or carers to facilitate informed discussion is strongly encouraged.’