Attachment: The Balancing Act

The COVID-19 pandemic has prompted swift lifestyle changes for folks across the globe. Drastic social and quarantine measures have triggered fears and concerns about the foreseeable future. For caregivers, this has translated to increased time at home facing new challenges with their children. Mental health has become a secondary priority which can disrupt attachment patterns between parents and children of all age and developmental spectrums.

Caregiver characteristics that promote or hinder a safe and trusting relationship with their infants are the basis of attachment theory and have been correlated with later psychological functioning. Attachment can bear significant weight on self-perception and personal beliefs, and primary caregiver dynamics often mirror relationships with friends and romantic partners across the lifespan. Stemming from the womb, infants ingest, process, and interpret surrounding sensory inputs, including caregiver emotional states. Thus, greater exposure to parents experiencing anxious or traumatic distress during the quarantine period can trigger maladaptive mental health symptoms and family functioning.

Below are some pointers to foster a healthy home environment promoting secure attachment with your child while prioritizing self-care and emotional well-being.

  • Space

As the saying goes, everything in moderation, and this includes attending to your child. Engage in favorable outlets just for you to promote relaxation and mental healing. This will model and encourage your child to accomplish individual tasks and respect personal space. Benefits include enhanced autonomy, self-confidence, and agency to problem-solve. Take the breather!

  • Stability

It’s impossible to entirely mimic your child’s school structure, but it doesn’t mean that you can’t borrow some tactics and strategies. Healthy attachment is promoted by stable and safe parenting, and predictability throughout your child’s day can help reinforce that. Try to identify and jot down times for eating, sleeping, and playing. If developmentally appropriate, include your child in creating the daily plan to value their choices while establishing a consistent routine.

  • Praise

It’s important to remember that the pandemic has disrupted life as we knew it- provide patience and grace while your child projects their worries and fears. They too are navigating this new territory. Praise them for rolling with the punches, instill gratitude, and lend a shoulder for them to cry on when they miss their friends. This is the time to build them up while creating space for vulnerability. Critical parenting can contribute towards poorer psychological functioning. Highlight your child’s strengths while attempting to minimize negative language when they misbehave.

These deliberate practices will reap many rewards including enhanced ability to practice self-forgiveness, healthy emotional expressiveness, and self-soothing strategies with an intrinsic awareness that you are a reliable source of support. It’s okay for your child to not be okay, so long as they know that you will always be the lighthouse leading their way to safe terrain.

Dr. Bahar Rahnama obtained her Doctor of Clinical Psychology degree at the APA-accredited California School of Professional Psychology at Alliant International University, Los Angeles (CSPP-LA). Dr. Rahnama completed coursework and field-based training in congruence with her graduate specializations across family, child, and couple dynamics. Through both research and clinical practice, Dr. Rahnama’s interest encompasses the correlation between enactment of cultural norms and parent-child attachment styles. Her examination and focus on these factors have led to a multitude of clinical opportunities and advancements including her UC-Davis certification in Parent Child-Interaction Therapy (PCIT), an evidence-based model that meticulously targets disruptive behaviors in children between the ages of two and seven while enhancing a positive and healing bond between caregiver and child.

Pandemic Parenting Tips

Pandemic, coronavirus, COVID-19. Regardless of what you choose to call it, this globally-impacting disease translates to one universal fact—these are challenging and unprecedented times for all. In the midst of a new normal, mental health is sacrificed while many scramble to establish structure in their daily lives. In other words, life doesn’t simply stop, even when it may feel like we’re in a perpetual state of limbo. With survival mode as our shield of armor, we learn to shift and adapt.

Now picture this: school is closed for the remainder of the academic year, and parents suddenly have to tackle new roles including teacher, tutor, therapist, mediator, and friend—just more skills to add to your repertoire as a parent. Children are ripped from their routine, and in turn, may be manifesting these sudden changes in the form of anxiety, depression, and developmental regression. You may find that your fiercely independent six-year-old is now begging you to let her sleep in your bed. Your sweet and shy four-year-old is kicking and screaming with every ounce of his being. Your Tic-Toking teen has officially locked herself in her room and is refusing to engage with the rest of her family. Here’s where the good news kicks in—you are not alone, and this is not your fault—nor your children’s.

Below are some tips and tricks to tackle common behavioral and emotional concerns that parents are facing today, and more importantly to start welcoming mental health back to the forefront of your mind.

1.     Gut over guilt: Parental guilt is inherent, and especially now can be at an all-time high. It’s understandable to feel upset that your child was robbed of the joys and benefits of school, yet your desire to fill the void and promote happiness may be hindering them. By needing to fulfill their every demand, wish, and desire, you are strengthening your child’s capacity to eventually push back against structure and defy your requests. Follow your parental gut, the one suppressed underneath the guilt, and follow accordingly when something isn’t sitting right. It’s okay to delete that extra toy out of your Amazon cart, or to have difficult conversations with your child, even if it may upset them.

2.     Establish structure: This is both to your benefit and theirs. Create a makeshift school or daycare, one where rules are written and verbalized. Sit down with your child and identify at least three rules or tasks to be followed daily. Including your children in this activity places the accountability in their court. Children thrive off structure, even when they crave chaos and spontaneity. Find a happy medium and attempt to create a weekly schedule to check off homework, meals, and playtime.

3.     Negative attention = attention: Highlight positive behaviors you are desiring more of, and practice selective ignoring when the negative behaviors are not posing a safety threat. This applies to children across all ages. Ignoring your child does not make you neglectful, so long as you are boosting their confidence and recognizing them for their polite manners, problem-solving skills, and following the rules. Replace words that are trigger points for children including “don’t” or “stop” with positive statements that promote the behaviors you are wanting to see in them (e.g. please use your inside voice; please keep your hands to yourself).

4.     Set consequences: This one is tough. Every family has a different tactic and strategy when it comes to discipline. However, removing desirable objects and activities from your child of any age when they are breaking important rules or acting defiantly is an effective measure to establish greater harmony at home. Sit down with your child and identify three consequences that can be enforced in a single day if a house rule is broken. These may include losing electronic privileges such as the television or cellphone for four hours after refusing to complete homework, or losing coloring time for 20 minutes after screaming at a sibling. Setting concrete consequences removes the power struggle and heated arguments by simply identifying and sticking to the structure. Selective ignoring will be a key player if your child attempts to refute.

5.     Spend quality time with your family:  You’re probably wondering why that would be a suggestion when you are with your loved ones more than ever, but there is a difference between physical presence and emotional connection. Go for walks as a unit, play board games, spend a few minutes each day letting your child pick the activity to build their confidence and assurance that their opinions matter, and remind every family member that you love and appreciate them. These are trying times, but your family will get through this as a team, one day at a time. Remember to prioritize your mental health—your silent, but efficient, captain chartering new territory in the right direction.

Dr. Bahar Rahnama obtained her Doctor of Clinical Psychology degree at the APA-accredited California School of Professional Psychology at Alliant International University, Los Angeles (CSPP-LA). Dr. Rahnama completed coursework and field-based training in congruence with her graduate specializations across family, child, and couple dynamics. Through both research and clinical practice, Dr. Rahnama’s interest encompasses the correlation between enactment of cultural norms and parent-child attachment styles. Her examination and focus on these factors have led to a multitude of clinical opportunities and advancements including her UC-Davis certification in Parent Child-Interaction Therapy (PCIT), an evidence-based model that meticulously targets disruptive behaviors in children between the ages of two and seven while enhancing a positive and healing bond between caregiver and child.

Turkey or Trump: Navigating the Holidays in Post-Election America

Following the highly controversial presidential election of 2016, our nation is clearly divided. A dangerous “Us vs. Them” ideology has emerged and is threatening the nation’s sense of unity and oneness. People are feeling uneasy and (more) fearful of strangers, neighbors, friends, and even family members, wondering who is on their side versus against them. Sometimes they discover that their deeply held beliefs differ from those of their friends and family. This emotionally charged political race has engaged (and in many cases, enraged) Americans in a unique and historic way. When we are in a heightened state of arousal–feeling panicked, afraid, threatened, and vulnerable, we are susceptible to making irrational, poor decisions. We may preemptively lash out or become defensive in relation to those we perceive as being in opposition. Acting without thinking about the consequences (i.e., who we may hurt in our path of righteousness) can have hurtful, even devastating, results on interpersonal relationships.

With the holidays upon us, many people are understandably feeling anxious about, even dreading, get-togethers with their families. Spending time with family at the holidays can be stressful during a typical year, but perhaps especially so in the midst of what may be considered a national crisis. This is because families are comprised of people of different generations, levels of education, ethnicity, and religiosity. They live in geographically diverse places and often have vastly disparate experiences, values, and perspectives on hot-button, divisive topics, such as LGBTQ and women’s rights, immigration laws, minority protections and legislation, taxes, gun control, international affairs, etcetera. As people do not usually choose their family members (aside from their spouses), it is almost inevitable that there will be significant differences of opinion with at least some relatives.

It has been said that it is safest to never bring up politics or religion at the dinner table. Is that possible in the aftermath of this historical and controversial election? The following are some difficult questions you may be asking yourself. Is it best to spend time with family and attempt to avoid discussion of politics or forego seeing family this holiday season in anticipation that it may become too contentious and heated? Is it healthier to avoid potential confrontation and the inevitable politicking at the dinner table and/or give everybody time and space to calm down and heal? Would it feel disingenuous to not address important current events? Is it possible to have genuine connections with family members when you know they are on the “other side” (whatever side that may be)? If you do wish to engage with family on the issues that you feel a strong personal investment in, you may consider allowing a cooling off period post-election and addressing these issues one-on-one at a later date, rather than at a big family gathering.

People naturally make efforts to preserve the important social bonds and relationships they have with family and friends. This begs the question: Is it possible to reconcile our differences when we vehemently disagree with the other side’s position, and if so, how? Can we preserve the relationship and maintain our love and respect for the other person even if it seems like their beliefs/perspectives are antithetical to what we value? Individuals may perceive that those family members who voted for/supported the “other” candidate have personally betrayed them, disrespected, or even invalidated their identities and beliefs. It may be worth remembering that a particular political affiliation does not necessarily mean that a person condones all of their candidate’s attitudes/behaviors or embrace wholeheartedly everything they represent or have promised. For instance, a Trump-supporter is not necessarily “ignorant, misogynistic, or racist,” nor is a Clinton-supporter necessarily a “brainwashed, morally depraved liberal.” Taking another person’s perspective into account and developing empathy may help decrease anger toward your loved ones. Would your parent, partner, child, or dear friend say that they were trying to intentionally hurt you by voting for a particular candidate, or more likely, that they were voting based on particular values (i.e., economic growth, equality, etc.)? You may think that this election has brought to light irreconcilable differences between you and a family member, and while this could be true, you may want to allow time to pass before making any rash decisions that you may one day regret.

There is ultimately no right or wrong decision about whether or not to attend the holidays this year and how to participate in them. If you decide to see friends and family, you may wish to reevaluate your expectations about the interactions you may have. Consider putting a ban on political discussions. You may even designate one or more non-partisan individuals to respectfully enforce the “No politics” rule and redirect the conversation to more polite, neutral, and friendly topics. Find common interests and shared beliefs. It is important to know your audience as well. You may decide whether or not it is worthwhile (and safe) to share your thoughts and feelings on a particular matter depending on who is present. Another suggestion is to pick your battles wisely, and consider your end game. Is it more important to try to convince your grandparent, sibling, cousin, uncle, [fill in blank] who has equally fixed beliefs as you to change their minds or to maintain your relationship(s) and still have that family member in your life in a week, a month, or a year from now?

If you do decide to tackle these topics around the Thanksgiving dinner table, there are ways to communicate more respectfully. Dr. Susan Heitler, a clinical psychologist, suggests strategies to both maintain friendships and family bonds while discussing politics (2012). She offers recommendations about effective communication skills that include listening with an open mind and curiosity, asking open-ended questions, not trying to prove you are “right,” and using a neutral, gentle tone of voice. Successful communication with those who express divergent opinions also involves remembering what you have in common and maintaining respect for one another (http://www.wikihow.com/Deal-With-Friends-With-Different-Political-Views). Avoid defensiveness, bullying, name-calling, degradation, and intimidation. Personal attacks do not help get your point across, and if anything, only make you and your perspective seem less credible.

For most, the holidays are about connecting and spending time with loved ones. If emotions are still too raw post-election, consider getting together with supportive friends for a Friendsgiving this year. Take care of yourself (and maybe preserve your familial relationships in the long-term). It is key to know your own limits and thresholds. Whether you are with family or friends, decide if/when you have had too much talk of politics and excuse yourself from the conversation. In that time, do something personally productive, such as going for a walk, journaling, playing with the family pet, calling a friend, and so on.

This sociopolitical climate feels unpredictable and uncertain, as we do not yet know what the future holds for our purportedly united nation, which many folks have only recently come to realize, is comprised of people with quite disparate experiences, beliefs, and points-of-view. As the election outcome has been highly contentious, many people are left in a state of surreality, wondering, “Is this really happening?” Uncertainty often contributes to a sense of anxiety. We want to know things, to feel certain, but this is of course not always possible. Sometimes, all we can do is tolerate the unknown and cope as best we can.

There are several things you can do to better cope and tolerate the distress you may be feeling:

  1. Watch or listen to your favorite comedy. We can all use some levity now and again, especially when everything feels intense, chaotic, and impossible to reconcile. Positive emotions (i.e., joy, hope) are incompatible with and may even “undo” dysphoric feelings, such as anger and depression (Fredrickson, 2001).

  2. Know your personal limits. Know when to turn off the news and pause the barrage of social media commentary, articles, videos, in-person debates, etcetera. (It will inevitably all still be there if/when you decide to tune back in.)

  3. Connect with others. Seek the good in people and that which makes us alike (i.e., desire for happiness, health, connection, safety, justice, freedom). Do something kind for someone else.

  4. Take action. Try to channel your energies into a cause you truly believe in, rather than worrying about all the “what ifs.”

  5. Do what is within your control: Sleep. Exercise. Focus on your health.

  6. Remember the temporary nature of life. Change is inevitable. What feels catastrophic in one moment may feel less so in time.

  7. Be kind and compassionate to yourself. Validate your emotions and treat yourself with the gentleness that you would extend a friend or loved one.

  8. Challenge unrealistic/irrational beliefs (i.e., “The world is over” and “We are doomed”). Is there evidence against this? Are there alternate ways of looking at the same situation?

  9. Try not to panic. Anxiety is normal; honor that, but do not dwell. Panicking contributes to bad decision-making. Try to make rational decisions by achieving a state of calm via deep breathing, meditating, exercising, etcetera.

  10. Look at pictures/videos of animals online (especially baby animals). These images can certainly lift most spirits (even if temporarily)! Or, spend time cuddling and playing with your own pet.

  11. Think about your personal values. If you do not believe that name-calling and degrading others is helpful, don’t do it (even if provoked). At the end of the day, you are responsible for your actions and choosing behaviors that are in line with your values.

Dr. Jacquie Talesnick is a licensed clinical psychologist at the Rowan Center for Behavioral Medicine who has trained in both cognitive-behavioral and psychodynamic therapeutic approaches. She considers herself to be an integrative therapist, pulling from different methodologies and theories to tailor treatment to each individual with whom she works. She offers psychotherapy services to the adult population in individual and couples modalities. She specializes in working with individuals in the LGBTQ community. Her other specialties include treatment of relationship difficulties, trauma, depression, and anxiety.

REFERENCES

Deal With Friends With Different Political Views. Retrieved November 17, 2016, from http://www.wikihow.com/Deal-With-Friends-With-Different-Political-Views.

Fredrickson, B. L. (2001, March). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56 (3), 218-226.

Heitler, S. (2012). 8 Ways to Lose Friends By Talking Politics. Retrieved November 13, 2016, from https://www.psychologytoday.com/blog/resolution-not-conflict/201209/8-ways-lose-friends- talking-politics.

Life-threatening Pediatric Medical Diagnoses and Treatment: Overcoming the Adversity

Pediatric patients diagnosed with a life-threatening medical condition and their families are catapulted into crisis mode as they embark upon a challenging journey with numerous potentially traumatizing situations.  These children and adolescents may experience frightening diagnoses, emergency room visits and multiple hospitalizations with unknown duration, painful or distressing procedures, adverse side effects, and repeated losses related to one’s underlying illness or disability. Even with such experiences, both research and clinical experience have shown that many of these youngsters and families and are resilient, meaning that they are able to cope and adjust effectively to the challenging circumstances; however a subset of patients and families continue to experience emotional and adjustment difficulties that can lead to significant disruption to their lives. 

Life-threatening pediatric medical conditions and treatment can hinder the achievement of normal developmental tasks of pediatric patients, especially for adolescents. A medical illness may impede their ability to establish an identity, make decisions about education and career paths, and form relationships (Dahl, 2004).  Particularly challenging can be the clash between their need for independence (and sense of invincibility) and the dependent status as a patient.  In addition, their usual concerns with body image and emerging sexuality may be worsened by the changes in physical appearance related to the medical condition and treatment, such as weight gain, hair loss, and scares from procedures/surgeries.  Mintzner and colleagues found that 16.3% of adolescents who underwent solid organ transplant met all criteria for post-traumatic stress disorder (PTSD), and an additional 14.4% endorsed post-traumatic stress symptoms (PTSS).  In study of 63 cancer patients (ages 7-20 years), 25.4% met the DSM-IV criteria for Major Depressive Disorder (MDD), 14.3% for anxiety disorder, and 12.7% for comorbid MDD and anxiety disorder (Gothelf et al., 2005).  These symptoms are alarming as it can not only impact one’s quality of life, but also lead to avoidant behaviors that negatively impact treatment and recovery (e.g. missing clinic appointments and being non-adherent to their treatment regimen). 

Of note, pediatric illnesses have a significant impact on parents and siblings, representing a psychological health risk for the whole family.  Caregivers must often absorb complicated medical information and make critical decisions about treatment, witness the child in pain and undergoing intensive treatment, as well as face uncertainty about their child’s future.  Thus, it is not surprising that PTSS have been well documented in caregivers.  In particular, Kazak et al. (2001) found that 11% of mothers (who had a child diagnosed with cancer) met criteria for PTSD diagnosis, while 95% of them met criteria for the re-experiencing symptom cluster and 53% for the hyperarousal cluster; for families who had two participating parents, 80% had at least one parent with moderate-to-severe PTSS (Kazak, Boeving, Alderfer, Hwang, & Reilly, 2005). Similarly, Farley and colleagues (2007) reported 19% PTSD prevalence among parents of children who underwent heart transplantation.  Similarly, healthy siblings may be suddenly separated from family members for long periods of time, witness the physical and emotional pain of the ill brother/sister and parent distress, and deal with the uncertainty of the future.  Research has shown that siblings experience mood disturbances, conduct problems, poor academic achievement, and difficulties in social relationships (Alderfer, Labay, Kazak, 2005; Barbarin et al., 1995).  

Overcoming the Adversity:

While mild symptoms of most children and family members will be resolved without formal psychological or psychiatric intervention, evidenced-based treatment is indicated for those who continue to have elevated and/or escalated psychological distress. While there is no one specific template or road map for maneuvering the pediatric illness journey, trauma-focused cognitive-behavioral strategies have demonstrated efficacy for traumatized children and their families, and should be considered the first line treatment.  Psychopharmacological treatment, involving Selective Serotonin Reuptake Inhibitor (SSRI), is recommended for the treatment of PTSD in combination with psychotherapy; it is considered as a first line medication for children who are not responding effectively to psychotherapy or when symptomatology is severe (Forgey & Bursch, 2013).

It is important to note that the effects of traumatic experiences may not be universally negative.  In fact, childhood cancer survivors have shown to report increased maturity, greater compassion and empathy, new values and priorities, new strengths, and recognition of one’s vulnerability and appreciation for life (Parry and Chesler 2005).  In addition to being resilient, research and clinical experience have also revealed the phenomenon, posttraumatic growth (PTG), which is the positive psychological change that results from a struggle through a life-altering experience (Seligman & Csikszentmihalyi 2000; Levine et al., 2008).  Picararo and colleagues (2014) conducted a literature review and posited that PTG may involve numerous components, including greater appreciation of life, improved interpersonal relationships, greater personal strength, recognition of new possibilities in one’s life course, spiritual or religious growth, and reconstruction of a positive body image.  They authors revealed that parents and children may experience PTG following medical trauma through a combination of cognitive and affective processing of their subjective experience.  These findings are encouraging as psychotherapy provides a safe place for such cognitive and affective processing to take place, guided by a skilled and empathic clinician.   

A family-based approach to assessment and treatment is central to the overall adjustment and well-being of the pediatric patient.  Given that a secure attachment to a caregiver, healthy parental psychological functioning, effective parenting skills, and cohesive family functioning have demonstrated to be protective factors in the face of adversity (Laor et al., 1996; Lavingne & Faier-Routman, 1992), families can benefit from treatment that aim to foster these relationships and skills.  When receiving support that is grounded in trauma-informed care, many can experience posttraumatic growth and develop resilient characteristics that allow them to overcome ongoing or future adverse experiences. 

Dr. Kanchi Wijesekera, is a licensed clinical psychologist currently completing a postdoctoral fellowship at University of California, Los Angeles (UCLA).  Here, she provides trauma-focused assessment, consultation, and treatment to children, adolescents, and families who have been exposed to a wide range of challenging life circumstances and traumatic experiences.  In addition to providing services in the general family trauma clinic at UCLA, she’s also part of two multidisciplinary teams that serves the needs of patients and families in the pediatric heart transplant and hematology-oncology outpatient clinics.  She co-facilitates support groups for caregivers of solid-organ transplant pediatric patients who are admitted to Mattel Children’s Hospital as well.  Dr. Kanchi has many years of experience working with youth and families; using evidence-based treatment, she builds upon the current strengths of her patients and offers tailored treatment to bolster coping skills and optimize their emotional health. She also provides outpatient treatment to children, adolescents, and families in her private practice office in Westwood, CA, located within just 1-mile of UCLA. She can be reached for questions or consultation at (310) 800-7112.

REFERENCES

Alderfer, M., Labay, L., Kazak, A. (2003).  Brief report: Does posttraumatic stress apply to siblings of childhood cancer survivors? Journal of Pediatric Psychology, 28(4), 281-286. doi: 10.1093/jpepsy/jsg016

Barbarin, O., Sargent, J., Sahler, O., Carpenter, P., Copeland, D., Dolgin, M., et al. (1995). Sibling adaptation to childhood cancer collaborative study: Parental views of pre- and postdiagnosis adjustment of siblings of children with cancer. Journal of Psychosocial Oncology, 13, 1–20.

Dahl, R.E. (2004).  Adolescent brain development: a period of vulnerabilities and opportunities. Keynote address.  Annals of the new York Academy of Sciences, 1021, 1-22.

Farley, L., DeMaso, D., D’Angelo, E., Kinnamon, C., Bastardi, H., Hill, C., Blume, E., Logan, D. (2007). 

Parenting stress and parental post-traumatic stress disorder in families after pediatric heart transplantation. Journal of Heart Lung Transplant; 26(2):120–126.  

Forgey, M. & Bursch, B. (2013).  Assessment and management of pediatric iatrogenic medical trauma. Current Psychiatry Reports, 15(2):340.

Gothelf, D., Rubinstein, M., Shemesh, E., Miller, O, Farbstein, I, Klein, A., …, Yaniv, I. (2005).  Pilot study: fluvoxamine treatment for depression and anxiety disorders in children and adolescents with cancer.  Journal of American Academy of Child and Adolescent Psychiatry, 44(12), 1258-1262.  

Kazak, A., Barakat, L., Alderfer, M., Rourke., M.,Meeske, K., Gallagher, P., et al. (2001). Posttraumatic stress in survivors of childhood cancer and mothers: Development and validation of the Impact of Traumatic Stressors Interview Schedule (ITSIS). Journal of Clinical Psychology in Medical Settings, 8, 307–323

Kazak, A., Boeving, C., Alderfer, M., Hwang, W., Reilly, A. (2005) Posttraumatic stress symptoms during treatment in parents of children with cancer.  Journal of Clinical Oncology, 23, 7405–7410.

Laor N, Wolmer L, Mayes LC, et al. (1996). Israeli preschoolers under scud missile attacks: a developmental perspective on risk-modifying factors. Archives of General Psychiatry, 53(5), 416– 23.

Lavigne, J. V., & Faier-Routman, J. (1992). Psychological adjustment to pediatric physical disorders: A meta-analytic review. Journal of Pediatric Psychology, 17, 133-157.

Levine, S. Z., Laufer, A., Stein, E., Hamama-Raz, Y., & Solomon, Z. (2008). Posttraumatic growth in adolescence: Examining its components and relationship with PTSD. Journal of Traumatic Stress, 21(5), 492-496.   

Mintzer, L., Stuber, M., Seacord, D., et al. (2005). Traumatic stress symptoms in adolescent organ transplant recipients. Pediatrics, 115, 1640-4.

Parry, C. & Chesler, M. (2005).  Thematic evidence of psychosocial thriving in childhood cancer survivors.  Qualitative Health Research, 15, 1055-1073.

Picoraro, J., Womer, J., Kaza, A., and Feudtner, C. (2014).  Posttraumatic growth in parents and pediatric patients.  Journal of Palliative Medicine, 17(2): 209–218.

Seligman MEP., Csikszentmihalyi, M. (2000). Positive psychology: An introduction. The American Psychologist, 55, 5–14.

Part 1: Hugs Not Drugs

What happens to you physiologically when you give someone a hug?

I am guessing everyone who is reading this blog has either given or received a hug at least one time in their life. If you haven’t that is okay too. Hopefully after reading this blog, you will be convinced to get out there and find someone to hug.

I am assuming that a majority of you have never questioned what actually happens to your body physiologically when you engage in the act of hugging. This is not something we ever think about but the truth is that there is an entire cascade of reactions that happens in our body that has scientifically been shown to induce positive health outcomes.

Simply hugging someone can boost a range of hormones in your body. The focus of today’s blog will be looking at the physiological benefits of hugging. I will focus on the main hormone that is released when you simply touch another person (appropriately that is!). Simply touching another being releases oxytocin causing healthy changes to happen in our body.

            Oxytocin, the bonding hormone, has been found to:

1)     Play a strong role in protecting the cardiovascular system (Grewen et al. 2003 & 2005). First, oxytocin alone reduces free radical production and other inflammatory markers lowering the risk for heart attacks.  Oxytocin also causes an increase in nitric oxide production. Nitric oxide then causes the dilation of blood vessels leading to a decrease in blood pressure while also lowering inflammation and plaque build-up.
2)     Inversely correlated with depression (oxytocin goes up, depression goes down; Scantamburlo, 2007; Arletti and Bertolini, 1987; Andeberg and Uvnas-Moberg, 2000)
3)     Inversely correlated with anxiety (oxytocin goes up, anxiety goes down; Scantamburlo, 2007; Andeberg and Uvnas-Moberg, 2000)
4)     Act as the body’s own anti-stress hormone (Legros, 2001)
5)     Reduce levels of cortisol (Ditzen et al. 2009; Taylor, 2006; Heinrichs et al. 2003; Carter, 1998; Insel, 1997)
6)     Create a sense of belonging and social connection (Heinrichs et al. 2003; Taylor, 2006)
7)     Increase positive communication (Ditzen et al. 2009)
8)     Improve the length of relationships (couples who hug more stay together longer)
9)     Improve quality of sleep (by lowering our stress-hormone cortisol)
10)  Boost your immune system (Gimpl & Fahrenholz, 2001; Carter, 2014)
11)  Increases your pain tolerance (Dunbar et al. 2012; Mazzuca et al. 2011)
12)  Be involved in the development of the human brain (Carter, 2014)
13)  Increase empathy (Hurlemann et al. 2010; Singer, T. et al. 2008; Bartz, J.A. et al. 2010)

In sum, a simple hug can assist in lowering an individual’s level of stress, pain sensitivity, and heart rate. Hugs also improve sleep, positive communication, a sense of belonging, and social connectedness, as well as empathy. Sounds easy, doesn’t it? Well get out there today and give someone a hug. Even if you don’t think you need it, the other person might.  

***Tip: the hug must be for at least 20 seconds

***Note 1. Please remember, always ask permission if you approach a stranger and give them a hug. Proceed at your own risk. 

***Note 2. A hug is not intended to substitute for conventional medicine. If you have been prescribed medication by a physician please follow your physicians recommendation. You can always use a hug as a complimentary method but not as an alternative treatment method to reduce the above mentioned effects.

***Part 2: Advanced Hug Physiology

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES 

1.     Andeberg, A.M., Uvnas-Moberg, K., 2000. Plasma oxytocin levels in female fibromyalgia syndrome patients. Z. Rheumatol. 59, 373–379.

2.     Arletti, R., Bertolini, A., 1987. Oxytocin acts as an anti-depressant in two animal models of depression. Life Sci. 41, 1725–1730.

3.     Bartz, J.A. et al. (2010) Oxytocin selectively improves empathic accuracy. Psychol. Sci. 21, 1426–1428 

4.     Carter, C.S., Oxytocin pathways and the evolution of human behavior. Annu Rev Psychol, 2014.

5.     Carter, C.S. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology, 23, 779–818. 

6.     Ditzen, B. et al. (2009) Intranasal oxytocin increases positive communication and reduces cortisol levels during couple conflict. Biol. Psychiatry 65, 728–731

7.     Dunbar RIM, Baron R, Frangou A, Pearce E, van Leeuwen JC, et al. 2012. Social laughter is correlated with an elevated pain threshold. Proc. R. Soc. B 279:1161–67

8.     Gimpl G, Fahrenholz F. 2001. The oxytocin receptor system: structure, function and regulation. Physiol. Rev. 81:629–83

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