I have listened to a public radio program for many years called The Moth Radio Hour.  It is an amazing radio program and now podcasts that can be downloaded where people tell these amazing real life stories that they have lived and experienced. One day, I was listening when I heard Mike Birbiglia's amazing story, which eventually lead to the production of the movie "Sleep Walk with Me", where Mr. Birbiglia talks about his amazing sleep related struggles. Here is the link to his story:

Mike Birbiglia "361 Fear of Sleep" -- Moth Radio hour segment

http://www.thisamericanlife.org/radio-archives/episode/361/fear-of-sleep?act=1

After listening to this incredibly fantastic story, I decided to ask my friend Richard Smith, who works at WisconsinSleep, which is a sleep clinic in Madison, as a High Density Sleep Technician as well as for UW-Madison Dept of Psychiatry in the Center for Sleep andConsciousness as a Research Specialist, some questions to get a better understanding of sleep, sleep disorders and it's impact on mental and physical health. Here are the questions and his responses:

What were your reactions to Mr. Birbiglia’s humorous but definitely intense story about his struggles with his sleep disorder?

Mike Birbiglia

Probably like most listeners, I think humor was my initial reaction. But, as with most humor, right below the surface was a sense of incredulity mixed with awe and identification. Even though I have never acted out a dream before, I can certainly identify with realizing that my behavior was not under my primary control. His story also taps into my fascination with the brain and behavior, and reminds me of how little we know about consciousness and how it arises. When I was young, my parents would occasionally catch me sleep walking and tell me about it the next day. I was always surprised because I had no recollection whatsoever of the event. Sleep walking (somnambulism) and sleep talking (somniloquy) occur in the deepest state of sleep (stage 3)where dreams are generally absent. During this stage our muscles are able to be activated by the brain; therefore walking and talking can occur even though one is in a deep sleep.  It is quite common among young children and most children stop by adolescence. As you will see, this is distinct from what occurs during RBD, which is what Mr. Birbiglia suffers from.

What is a REM sleep disorder?

Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia that occurs in the state of sleep called REM. REM is most commonly known as the state of sleep where one is dreaming and gets its name from the eyes rapidly moving horizontally back and forth while dreaming. This state has also been called paradoxical sleep because the brain is just as active as it is during wake (however, the story is a bit more complicated because research has shown that dreams can also occur during non-REM sleep, but they usually occur during REM sleep). Most people spend about 25% of their night in REM sleep. During this state of sleep, your brain sends signals from your lower brainstem to inhibit motor signals so that you do not physically act out your dreams. This inhibition is clinically called muscle atonia. For those with RBD, this inhibition does not occur, and therefore, the body is able to act out its dreams.  Loss of muscle atonia during REM sleep is the primary indicator of this disorder and is easily diagnosed during an all-night sleep polysomnogram.  

The people that find themselves in the clinic for this disorder tend to do so because of acting out violent behavior while dreaming. People have reported being chased or attacked then only to awaken while assaulting their bed partner. There is no evidence why acting out aggressive dreams is more common in this disorder, but it could just be that one is more likely to seek help when they are putting themselves or their bed partners at risk. This disorder tends to be more prevalent in older males (60yr+), and it's estimated that about 0.5% of the population has RBD. RBD can be classified as either primary or secondary disorder, with the estimates from 38-64% of patients with primary RBD going on to develop a neurodegenerative disorder within 15 years, such as Parkinson’s Disease (PD). However, only a minority of patients with PD begin with RBD. It has been speculated that those with RBD, who later develop PD, could be a distinct subgroup. Secondary RBD has been associated with Narcolepsy. Pharmacological agents, such as tricylic antidepressants, SSRIs (fluoxetine, paroxetine, citalopram, sertraline, and venlafacine), alcohol, and beta blockers have also all been associated with secondary RBD. Clonazepam is an effective treatment of RBD for 90% of sufferers.

How does the research that you are involved with begin to recognize some of the connections between sleep and mental health?

Disruption in sleep and circadian rhythms is one of the most prevalent symptoms of psychiatric disorders. We now have decades of studies comparing healthy controls with those suffering from a psychiatric disorder. I will just touch on a few historical findings, as well as some more recent studies that show a connection between sleep and mental health. 

It has been known for some time now that people suffering from major depressive disorder (MDD) show a decrease in slow wave sleep (this is the deepest stage of sleep and is known as stage 3). They also experience their first REM period earlier and this period lasts longer than healthy controls. This correlation, of an earlier and longer first REM sleep period, has been shown to persist after remission and can even precede a depressive episode. Some researchers have suggested that this can serve as a biological marker for MDD. One of the ways to increase the duration and depth slow wave sleep (SWS) in this first sleep cycle, which precedes REM, is through sleep deprivation. Sleep deprivation has been found to act as an antidepressant in that subjective reports of depressive symptoms seem to disappear when the patient is sleep deprived. However, they quickly return once the patient goes to sleep; and, for those with bipolar disorder, sleep deprivation can trigger a manic episode. Many, but not all, antidepressants inhibit REM sleep. This is another interesting finding that indicates there is an intimate relationship between mental health and sleep. Although, despite decades of research, much of this relationship is still a mystery, as is most of the functioning of the brain. 

A fairly recent finding in our lab, looks at differences in sleep spindles, is a burst of oscillatory brain activity visible on an EEG, between people with schizophrenia and healthy controls. Sleep spindles occur during stage 2 of sleep. What we found is a reduction in spindle number and duration in people with schizophrenia. The area of the brain that generates sleep spindles has also been indicated in working memory, language, and sensorimotor integration. It is also the area of the brain where sensory input can be reduced or enhanced on the way to the brain. Deficits in both attention and sensory motor gating are common in people with schizophrenia. 

One of the most interesting findings coming from our lab recently was that rats can have areas of their brain that are actively sleeping while the animal is awake for all practical purposes. Many species of birds and marine mammals can have one half of their brain sleeping while the other half is awake (unihemispheric slow wave sleep). In rats it was assumed that they were either asleep or awake. Although they don't sleep with half their brain, areas of the brain can be going off-line and into sleep while the animal still appears actively awake. This has also been found in humans and, in fact, parts of your brain involved in memory can begin to "sleep" up to 20min before you experience subjective sleep. Perhaps this is one of the reasons while someone who is awake for 24hrs is just as impaired as someone who is legally drunk. Another reason not to sleep and drive.

As we further explore the reciprocal relationship between waking and sleeping brain states, perhaps we will one day be able to more accurately diagnose, treat, and perhaps even prevent the number of people that suffer from mental health disorders.

I know that meditation is a passion of yours and that some of the research that you are involved with is looking at meditation. What can you share about the power of meditation and your experiences with meditation?

I started meditating about 8yrs ago and have been meditating daily for about 5yrs now.  Hands down, it has been the most effective way of reducing daily stress and increasing my general quality of life that I have come across. It has also been the most challenging practice I have ever engaged in. Knowing the science behind it helps me understand why all of these apply.

 In the broadest sense, meditation is the act of directing your attention back, again and again, to an object or state of being that one chooses and holding it there. This is opposed to the hundreds of times a day that our mind free associates and gets lost in its own self reflective thoughts of I, me, and mine. This free association is our default state and is what the brain has been found to be doing at rest. When the brain is imaged using fMRI during rest, the part of the brain that is most active has been coined the Default Mode Network (DMN). There is nothing wrong with the mind's active meanderings, but with so many things clamoring for our attention these days, and probably nothing yells louder than our own self-reflective thoughts, it's nice to put the mind at rest once and a while and, paradoxically, I have found that paying attention is both relaxing and rejuvenating. It has also helped me to realize that my thoughts are not who I am and to be able to treat them with a degree of curiosity and amusement that they deserve.

 One of the reasons meditation can be so challenging in the beginning is because one is literally rewiring their brain to behave in a different way. Through years of not paying attention to how we use our minds, the path of least resistance is to mind wander. Some people struggle with this more than others, but I wasn't even aware to the extent that this was the case, until I actively decided to "watch" what my mind did when I was trying to do something as simple as count my breath for 35min. At first I was generally surprised at how difficult it was, but, over time, it became easier and easier. It is quite amazing at how much basic richness in experiencing the present moment is available when I let my thoughts settle, so that I can be more present to my experience vs. my thoughts about my experience. 

Meditation research has been going on since the 1960's; however, based upon the number of publications, it has continued to increase greatly over the last 15yrs or so. Our lab, in collaboration with Center of Investigating Healthy Minds (CIHM), has been investigating the neurophysiological correlates of meditation for a number of years now. Previous studies of long term meditators (LTMs) vs. healthy controls have found the following: greater tolerance for pain, increased volume in the hippocampus (area involved in memory), less motor deficits after sleep restriction,  more robust immune response, various positive psychological effects (increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation), reduction in morning stress hormones, and enhanced brain connectivity just to name some. Some of these effects have been found in even short meditation training sessions over a period of 8weeks. The current meditation study we are working on is systematically comparing LTMS, with those learning Mindfulness Based Stress Reduction (MBSR), a control group similar to MBSR (but without the meditation) and a wait list control in areas such as: brain activity during sleep, brain imaging during emotional tasks in an MRI machine, markers for stress, prosocial emotional states as well as measuring psychological and physical reactions to a stressor. Through these studies, we hope to show that even 8weeks of training can show significant changes in these markers and help to better understand how meditation training affects numerous psychological and physiological states of being.

Anything else that you would like to say?

One area of sleep I just want to briefly mention since it is becoming more and more prevalent as the number of obese people in the U.S. rise, is obstructive sleep apnea (OSA). I have seen many people in the lab who stop breathing anywhere from 10 times per hr to 100+ per hr. Each time this occurs, oxygen supply is cut off to the body and brain and in some ways can resemble a mini-stroke. Many people with OSA complain of feeling unrested after awakening, memory problems, and daytime sleepiness. A recent study at UW-Madison found that people with severe sleep disordered breathing have a 5 fold increase of dying of cancer, and even those with mild OSA double their chances. There have also been numerous studies showing increase risk for cardiovascular disease in those untreated. It is estimated that 1 in 5 Americans suffer from some form of sleep disordered breathing.  If you are interested in more info on sleep and basic steps for good sleep hygiene, here is the link to Wisconsin Sleeps website:  http://wisconsinsleep.org/index.html

There is even a short quiz to determine your risk of OSA.

Thanks Rick for your insights on sleep, sleep disorders, and it's impacts on health and wellness.

 

Jeff Ryan, LPCIT, CSAC

Therapist

Get Connected Counseling

 

Further damage to already fragile children

In a Sept 8th NYTimes article, A Terrifying Way to Discipline Children, we are reminded that children that are often times diagnosed with trauma, attachment and other developmental disorders can be vulnerable to further abuse by various systems. These fragile youth, whom at times can have some very challenging behaviors, can be the victims of policies and procedures that at times are created to "provide reduced stimulation" or "protect them from themselves" but very quickly become just another form of abuse. 

Bill Lichenstein in his article lays out instances when restraints and isolation are being used in modern day schools leading to horrible results with further traumatization to students. Additionally, school systems are being sued for their use of these methods.  Growing up in Colorado, our school systems used corporal punishment on it students for behavior that was deemed problematic. When I was reading this article it brought back memories of students that were "swatted" by principals and/or teachers using a large wooden paddle to spank children for their behavior.  These children often remarked about how it left long term marks emotionally, but equally damaged their relationships with their authority figures resulting in longer term problems for students not being able to trust those in power.

What we know about trauma and attachment, it is often too common that systems and individuals reenact abuse with people that have preexisting trauma and attachment disruptions. Trauma is characterized by cyclical patterns that reoccur over and over in a person's life because trauma is a evolutionary looping and stuck pattern in our brains. Additionally, we all form our bonds with others based upon our patterns of "attachment" which grows out of the foundation of connection and relationship with parents.  Many children that struggle with various emotional and psychological problems, we know are directly related to their insecure attachments that they have with others. Insecure attachments are often based upon the premise that others around us are not nurturing enough or safe enough so as a result of these underlying definitions it is reenacted in relationships, around them, such as teachers and school staff. 

At Get Connected Counseling, we hope to help people and systems understand trauma and attachment so we can be better informed thus not having these destructive events continue to occur.  We believe that when we are better trauma and attachment informed then we can avoid making these mistakes that further damage already struggling individuals.

Jeff Ryan, LPCIT, CSAC
Therapist
Get Connected Counseling, LLC
Appleton, WI
920-750-6120

Image from Dr. Jill Bolte Taylor 's TED Talk - "Stroke of 

Insight"

 
Saw this amazing TED talk by Jill Bolte Taylor. She is an accomplished Neurologist that ends up having a stroke.  Through her experience of the stroke she is able to experience her brain in a unique and powerful manner.  Her experiences got me thinking about how it overlaps with Brainspotting.  Brainspotting is a  very neurologically based approached which use brain specific process and indications as markers in the healing process. In her talk, Dr. Taylor talks about the right hemisphere of her brain feeling like the global or spiritual link to the world around her while her left hemisphere is where she experiences the self or her personal dimensions.  Sometimes when we are processing material using Brainspotting, we will use goggles that cover up either the left eye or the right which allows for a reduction in the overall distress while processing however it also can be flipped around where one eye may be a source of distress the other eye's perceptions can be experience as a resource because it is is less activating.  This got me thinking that our trauma can be simply seen as a personal or spiritual trauma thus something that takes me away from connection with myself or that which is greater than me.  So when we are healing traumas, we are essentially healing relationships either with ourselves or with the spiritual relationships for which arise.

Check out Dr. Taylor's talk below and I hope you enjoy it. Leave a comment to your thoughts on this topic.

Stroke of Insight Link

Jeff Ryan, LPCIT, CSAC
Therapist
Get Connected Counseling, LLC
Appleton, WI
920-750-6120

Using developmentally and culturally appropriate interventions

Researchers and theorists involved in creating criteria for substance abuse in the revision to Diagnostic and Statistical Manual of Mental Disorders IV for version V are suggesting using language that implies substance abuse as a “developmental disorder.”  They believe that substance abuse is a disorder that onsets when we are youth evolving in chronicity the older we get.  Along with developmental foundations of the disorder, most see substance abuse evolving out of many cultural contexts which either promote permissiveness or increase healthier perceptions of substance use.  This is especially obvious for all of us that live and grew up in Wisconsin where rates of alcohol abuse are astronomical.

Thus to treat substance abuse, the leading research and best practices are promoting using both developmentally and culturally informed methods to treat substance abuse.  This has been so obvious to many that have attempted in the past to treat adolescent substance abuse using an adult model or people of color using a primarily Caucasian normed methodology – it just doesn’t work.  In fact, it does more than just not working it often times increases substance abuse and repel individuals and families from seeking help.  Ask anyone that grew up in the 70s, 80s and 90s and had to go through or be a professional in a substance abuse treatment program and they will tell you that it was an awful experience with generally horrible results.  A common response of professionals during this period was to blame the Teens for being untreatable or too reactive when in fact it was the model of treatment that was flawed and not the youth.  An adult model of treatment has substantially lower effectiveness rates with youth because it is developmentally inappropriate.  A very simple example of this that many treatment programs that are developmentally informed harness the natural forces of adolescent individualism to be used as part of the therapeutic process rather than miss labelling this resistance and trying "break" a teen of their defiance like many of the historic models attempt to do.

In the same vein, using Caucasian informed, normed, and researched methods while working with African Americans or Native Americans often results in the same perceptions by those seeking services or treatment professionals.  For example, a Caucasian defined treatment approach is usually very individualistic and can use disempowerment (i.e. confronting powerlessness) as a framework.  Both these concepts can be more culturally appropriate to white folks, but when working with many African Americans these concepts can create frustration, fear and discomfort especially for individuals that are strongly identify themselves within the black community.  Similarly with Native Americans, using a perspective that is not informed by culture and spiritual perceptions along with not addressing historic and present experiences of prejudice can lead to a non-empathetic experience which highly correlates with reduced effectiveness in treatment.

So to be effective in treating clients with substance abuse problems, it is extremely important to evaluate the concentric circles around an individual that inform and define them which include culture, developmental stage, gender, substance sub-culture (i.e. cannabis, heroin, alcohol) and sexuality to name a few.  With these lenses present in the therapeutic relationship, effectiveness of treatment increases and individuals seeking treatment feel empathically affirmed leading to less struggles, greater attendance rates, and higher rates of motivation.


Jeff Ryan, LPCIT, CSAC
Therapist
Get Connected Counseling, LLC
Appleton, WI
920-7506120

Helping those suffering from substance abuse to truly change

Hello all,

Jeff Ryan, LPCIT, CSAC

My name is Jeff Ryan.  I am a new therapist at Get Connected Counseling in Appleton, WI.  Get Connected Counseling is a new mental health private practice offering counseling services to teens, adults, couples and families in the Fox Valley and beyond.  We strive to offer a different experience for people seeking services which focuses on transformation healing of mind, body and spirit.  We do this by using such profound and effective interventions as Brainspotting, Eye Movement Desensitization Reprocessing (EMDR), Ego State therapy and Motivational Interviewing while treating Substance Abuse.

As some that has been around the field of substance abuse counseling for quite some time, I have been on a journey to understand how do we truly help individuals suffering from substance abuse to heal and change.  In my early years as a substance abuse counselor, I witnessed so many individuals young and old not being offered effective pathways to actually change while in a system that often punished them for doing exactly what they came seeking help to solve.  Additionally, individuals were often told such things as 'stay clean or sober for 6 months to 2 years then we will help you find a way to heal the deep -- grief, trauma, and abandonment' that was deeply embedded in their substance abuse which kept them from succeeding.

From my experience and the experience of the many individuals that I have learned from over the years there are a few core principles to effective substance abuse treatment: be relational and empathetic, use developmentally and culturally appropriate interventions, understand that motivation and change are dynamic forces and know that substance abuse is a complex disorder that is embedded in multifaceted issues such as trauma, grief and attachment disruptions.  When substance abuse treatment is informed by these key concepts then it can be more successful and meet each individual where they are at when they make the decision to seek services.

Carl Rogers, preeminent psychologists of the 20th-century, is quoted as saying, "It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried." (On Becoming a Person, 1961)  This simple but profound truth, that Rogers evolved while working at UW-Madison, summarizes very nicely the key principles that we at Get Connected Counseling strive to follow.  When treating substance abuse, specifically, we will allow the inherent truth that you hold along with your body and brain to be our guide while finding the unique path fits you where you are at.

Please call to talk about how Get Connected Counseling to discuss how we can be of service to you.

Jeff Ryan, LPCIT, CSAC
Therapist
 920-750-6120

Welcome to the Get Connected Counseling blog! We are a new mental health practice based in Appleton, Wisconsin, that specializes in using cutting-edge innovations to heal mind, body and spirit. Our services include proven methods and techniques to help you heal from past experiences and live a fuller, richer life today. We offer such innovative methodologies as Brainspotting, Eye Movement Desensitization & Reprocessing (EMDR), Ego State Therapy, Substance Abuse Services, Cognitive Adaptive Training (CAT), Cranial Sacral Bodywork and more. Stay tuned for new updates to come!