Can Having a Fuzzy Friend Improve Your Mental Health?
Many people with different kinds of physical and mental challenges have been using service and emotional support animals for a while now. Support animals are being used to help adults with dementia in geriatric care settings, help sick children in children’s hospitals, help people lower anxiety, help people with cancer recovery, help children with autism or other developmental disabilities, and to help veterans with PTSD. Animal therapy has also been shown to be helpful for people in psychiatric care institutions.
Indeed, being around a pet can have many positive effects on our mental healthiness and well being. A study published last year even showed that having a pet can even help with the most serious of mental illness. Participants in this study, all with a diagnosis of either schizophrenia or bipolar disorder were interviewed regarding the often difficult day-to-day experience of living with a serious mental illness.
The findings from this study found that pets contributed significantly to the participant’s feelings of emotional and social support. The pets in the study also helped the people gain a greater sense of control and effectiveness in their lives; which was grounded in their being able to care for a pet. Most interestingly, pets also gave the study participants a sense of security and routine which helped them feel that they could turn to and rely on their pets in times of emotional need.
Some participants from this study said about their pets:
“When I’m feeling really low they are wonderful because they won’t leave my side for two days,” “They just stay with me until I am ready to come out of it.”
“If I didn’t have my pets I think I would be on my own. You know what I mean, so it’s — it’s nice to come home and, you know, listen to the birds singing”. (Brooks, 2016)
But having pets can also help people who don’t have a significant mental illness. Companion animals can help people cope with all of life’s challenges and for many, many people, having a pet can relax us, relieve loneliness, calm us, and often just make us feel all around better and more positive about our life.
Studies have shown that having a pet can improve our mental health by increasing positivity and reducing depression, increasing social connections, increasing our levels of trust for others, increasing our empathy, reducing our feelings of aggression, and reducing anxiety and stress levels. (Beetz, et al, 2012).
In 2010, researcher Allen R. McConnell, and his colleagues at Miami University and Saint Louis University, in a study entitled, Friends With Benefits: On the Positive Consequences of Pet Ownership, examined the benefits of pet ownership for “everyday people”. The researchers found evidence that pet owners managed better in terms of mental well-being than people who didn’t own pets. More specifically, pet owners
often experience greater well-being (e.g., greater self-esteem), exhibit healthier personality characteristics (e.g., more conscientiousness), and show attachment styles that are less negative toward the self (i.e., less fearful, less preoccupied).
The study also found that pets can really help fulfil their owner’s needs for social support and connection. Pets
provide greater social needs fulfillment, were related to better owner well-being (e.g., less depression, less loneliness, greater self-esteem, greater happiness).
So how can caring for and loving our pets help us with supporting our positive mental wellness? There are a really a number of ways, including the following:
Stress and Anxiety Reduction
Your dog or cat loves it when you cuddle, stroke and pet them, but it’s actually quite beneficial to you as well! Petting your fluff-butt has actually been shown to release happy brain chemicals like oxytocin, the hormone related to love and friendship and also related to stress and anxiety relief. Stress causes our blood pressure to rise and also creates an increase of the stress chemical cortisol in our bodies which can actually damage our bodies over the long term.
Petting your dog or cat releases oxytocin, causing your blood pressure and cortisol levels to decrease. From this lowering, you feel a reduction in anxiety/stress and a greater sense of wellness. A study of people with high blood pressure, who then get a pet, showed a significant lowering of systolic and diastolic blood pressure in response to environmental stressors than those who did not get a pet (Friedman, 2007).
In a 2015 study for US Centres for Disease Control and Prevention (CDC) researcher Anne Gadomski and her colleagues tracked 643 children aged between 4 and 10 over the course of 18 months. The researchers actually found that having a pet in the home was associated with a significantly decreased probability of childhood anxiety, particularly social and separation anxiety.
Mindfulness and Pets
It’s hard for most people to be mindful and live “completely in the moment”. We’re either thinking about the past, worrying about our to-do list or fretting about the future. But when we engage in play and interact with our pets, it helps us take our minds off of any negative worries/stressors and focuses us instead on the adorable fuzz-butt in front of us, forcing us to “be” in the moment.
Our animals love us unconditionally, even if we don’t love ourselves sometimes; they don’t judge or criticize us. They totally live their life non-judgementally, always present and in the moment. When we spend time with our animals it gives us the change to maybe emulate them to some degree and practice being nonjudgmentally in the moment! Pets can be the greatest teachers of mindfulness!
You Don’t Feel Alone
Sometimes we can feel isolated, disconnected and alone, even when we’re around our coworkers, friends and loved ones. Feeling alone and isolated can be one of the triggers that can lead to developing mental health problems like depression.
From the research, there is much evidence that pets may actually help alleviate loneliness. Many college students away from home suffer from feeling alone and isolated or in other words, homesickness. For most this is a minor issue, but for others, homesickness becomes more serious and really affects their mental well being and functioning.
A recent study investigated the usefulness of having AAT, animal-assisted therapy, as a treatment for homesick first-year college students. In the study participants had one 45-minute session on Friday of each week where they interacted with a dog for 45 minutes. The results actually showed that the intervention was successful in significantly decreasing homesickness and even in increasing the student’s overall satisfaction with life (Binfet & Passmore, 2016).
When we spend time with our pets, we feel like we’re really connected to something outside of ourselves, we feel connected to them. This human-pet connection can help make us feel more happy, safe and secure. Perhaps, it’s because they really love us unconditionally that allows us to connect with them in a special way that is really powerful in alleviating our feelings of being alone or isolated?
So in sum, having a pet can really improve our mental wellness and add to our lives in lots of positive and wonderful ways. When your dog gives you that smile and wants to be petted or to play, or your cat cuddles up with you and a good book, you can’t help but smile and feel a connection. When we take our dog for a walk or to the dog park we can’t help but feel an improvement in our mood and mental and physical well being.
If you don’t have a pet of your own? You can still obtain these benefits by making the effort to volunteer at a shelter or animal rescue. There are many animals out there alone who would love your companionship and the act of giving through volunteering also has some really positive benefits for our mental health.
If you or a loved one is interested in exploring mental health treatment, please contact me today. While I’m not fuzzy or fluffy and I don’t have a wagging tail, I would be happy to speak with you about how I may be able to help you.
“If you pick up a starving dog and make him prosperous, he will not bite you. This is the principal difference between a dog and a man”. (Pudd’nhead Wilson, Mark Twain)
References:
Allen R. McConnell, PhD, Miami University; Christina M. Brown, PhD, Saint Louis University; Tonya M. Shoda, MA, Laura E. Stayton, BA, and Colleen E. Martin, BA, Miami University; Friends With Benefits: On the Positive Consequences of Pet Ownership,” Journal of Personality and Social Psychology, Vol. 101, No. 6.
Barker S. B., Knisely J. S., McCain N. L., Schubert C. M., Pandurangi A. K. Exploratory study of Stress-Buffering response patterns from interaction with a therapy dog. Anthrozoos. 2010;23(1):79–91. doi: 10.2752/175303710X12627079939341.
Binfet, J.T., & Passmore, H.A. (2016) Hounds and homesickness: The effects of an animal-assisted therapeutic intervention for first-year university students, Anthrozoös, 29(3), 441-454, doi: 10.1080/08927936.2016.118136
Beetz A, Uvnäs-Moberg K, Julius H, Kotrschal K. Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin. Frontiers in Psychology. 2012;3:234. doi:10.3389/fpsyg.2012.00234
Friedmann E., Thomas S. A., Cook L. K., Tsai C.-C., Picot S. J. A friendly dog as potential moderator of cardiovascular response to speech in older hypertensives. Anthrozoos. 2007;20(1):51–63. doi: 10.2752/089279307780216605
Gadomski AM, Scribani MB, Krupa N, Jenkins P, Nagykaldi Z, Olson AL. Pet Dogs and Children’s Health: Opportunities for Chronic Disease Prevention? Prev Chronic Dis 2015;12:150204. DOI:
H. Brooks, K. Rushton, S. Walker et al., “Ontological security, and connectivity provided by pets: a study in the self-management of the everyday lives of people diagnosed with long-term mental illness,” BMC Psychiatry, vol. 16, pp. 1–8, 2016
What is a Highly Sensitive Person (HSP)? Are you one?
Some people just seem to be more sensitive to their environment than others — they are just more “high-strung” and aware or “sensitive” to what’s around them. For whatever reason, these people just tend to be more sensitive than their friends, or even than their brothers and sisters. They are really affected by the world around them and sometimes they can’t get through a movie or even a sappy TV commercial without feeling emotional or even shedding a few tears. The type of TV commercials about abused animals or poverty in a third world country can actually affect them deeply on a visceral level. They can also really be affected by violent TV shows or the news.
Judgement or criticism from others really affects them and may even cause them to feel real emotional pain even if the critique is actually fairly innocuous. They are also often very empathic and try to be kind, considerate and accommodating to those around them, sometimes even to their own detriment.
Often these people are told, “You’re way too sensitive!” or “Why do you let everything bother you so much?” The reality is that some people are simply just more sensitive than others. Sometimes they are not only sensitive to emotional situations, but also to loud noise/sound, bright or sudden light, and even other physical stimuli around them like the smell of a strong overpowering perfume someone in the elevator is wearing.
A popular term that is used in the current vernacular is that these people are, literally, called, Highly Sensitive People, or HSP for short. People who are HSP might react very strongly and negatively to a mildly difficult social situation, a loud noise or a strong smell that most people would barely pick up on their radar.
There is solid psychological research showing that being an HSP is certainly a “real thing” and is likely a certain “personality trait” known as “Sensory Processing Sensitivity” (SPS) that was really first discovered by personality researchers Aron and Aron in 1997.
Research suggests that Sensory Processing Sensitivity (SPS), is found in about 20% of humans and in over 100 other animal species! There is even fMRI brain scanning research showing that people with Sensory Processing Sensitivity even have brains that are much more likely to have recurrent activation in the regions involved in environmental attention and awareness, “emotional meaning making” and empathy (Acevedo, et. Al. 2014).
Why does it happen?
Evolutionarily speaking, HSP appears to be an adaptation to our environment that is designed and intended to help us survive as a species (Aron and Aron 1997). By being more aware of and reactive to our environment, we gain an enhanced awareness of environmental possibilities and opportunities. Being sensitive to our environment can help us in finding and accessing food sources and helps us to be more aware of threats from predators and other environmental dangers.
Being sensitive and socially aware of the nuances of human relationships can help us relate to others better and consequently have better success choosing and keeping mates, creating stronger social connections/alliances and forming stronger community bonds. Awareness of our surroundings and creating community are some of the things that have allowed humans to thrive. Unfortunately, people who are HSP may have too much of a good thing. Their over-sensitivity to the environment may actually hinder their relationships and complicate their lives.
Might You Be a Highly Sensitive Person?
Do the following signs/characteristics seem familiar to you?
- Sensitivity to criticism Almost all criticism feels personal and even painful. To many HSP’s there is no such thing as constructive criticism. You are not able to let criticism “roll off your shoulders” as others seem to do. Unfortunately, this can make you too much of a “people pleaser” and you may find it hard to set boundaries and limits with others.
- You find it difficult to be watched when you “perform” or do something You dislike doing things in public where you might be watched, critiqued or judged by others
- You feel “overly” emotional in numerous situations in your life Both positive or negative emotions are experienced intensely and you react strongly to them.
- Sometimes you feel alone Because other people may have told you that you need to “stop being so sensitive” or to “toughen up,” you see yourself as overly sensitive and judge yourself as inadequate or different and consequently you feel isolated or alone.
- You’re very compassionate and generous You have a high degree of empathy and try to offer help to those who hurt or suffer. You’re really the person the cliché “walk a mile in another’s shoes was written for”. You really go out of your way to avoid offending, insulting or hurting others feelings.
- You’re especially sensitive to all kinds of external stimuli. You seem to notice that the sounds of the nearby street are distracting, or that the overhead fluorescent lights are really “flickery”, annoying and loud. Driving in fast heavy traffic may make you feel overstimulated. Even noticing small things like the rough fabric of a shirt or being slightly cold in a room may make you feel much more uncomfortable than most people.
- You notice how your body “feels” a lot of the time You’re attuned to your body’s internal sensations and feelings. You really feel being tired, cold, hungry, sad, anxious or worried.
- Your emotions are “reactive” Your personal feelings are often very strong and seem to always be there on the surface for you to think about. You also have persistent reactions to what others around you are going through emotionally. When your feelings and emotions about yourself and others come on so very strong, it’s really hard to ignore them or “put them away”.
- You over analyze, overthink and worry too much You seem to notice every little detail and spend too much time overthinking what should be a simple decision, like which laundry detergent to buy in the supermarket. You also sometimes get stuck worrying about the future and spend a lot of time wondering: “What if this or that happens, what if, what if, what if?” (Here’s a link to a previous blog with some ways to start to change that overthinking pattern https://roberthammel.com/strategy-reducing-anxiety-worry-cbt-therapy/).
- You’re really affected by making any bad decisions When you finally do make a decision, and it turns out to be a bad one, you really take it hard. You really beat yourself up for making even the smallest mistakes. This can create a vicious cycle that slows down your decision-making process even more — you learn that even small bad decisions affect you greatly, so you have to be super cautious making all decisions, even those small ones.
- You may be quite sensitive to caffeine or other stimulants.
- You often feel fatigued or tired and often feel a sense of being overwhelmed Because you deal intensely with your own and even other people’s emotions, and you feel a high degree of stimulation from the environment — a good part of the time — you may feel overwhelmed by all of it and feel as though you need may need to unplug or recharge more often than others.
- You are especially polite. Your sensitivity and awareness of the emotions of others make you very well mannered. You pay close attention to how you affect the people around you and you are very giving and “nice”. You also get very irritated when other people are seen to be inconsiderate or ill-mannered.
- Your mood can be significantly affected when you’re cold, hot, hungry or tired.
- You find it really hard to say no Because you don’t want to offend others or hurt their feelings you find it hard to say no and you often say yes when you really don’t want to. This can leave us feeling “put out”, overwhelmed and even resentful.
- You may be considered “artistic” and highly moved by art, nature, movies, literature etc.
If you have a good number of these characteristics, you may just be an HSP and possibly have the kind of brain that might be prone to experiencing Sensory Processing Sensitivity (SPS). The only way to really tell for sure though is to meet with a qualified individual like a Psychologist who can help you explore this further.
So, What Can You Do If You Are an HSP or experience a number of these characteristics?
Being an HSP is not an easy row to hoe sometimes. It can be difficult to have such a strong emotional connection to your world — but there are some things you can start to do for yourself to make it a bit easier:
- Reframe your sensitivity as a positive — i.e. it’s a positive to be empathic and caring with others
- Realize people and even the world itself are imperfect and it’s OK to make mistakes and bad decisions once in a while
- Realize being HSP makes you unique and special and not less than others
- Develop a sense of acceptance of who you are and remind yourself there is nothing wrong with you
- Learn to set boundaries with people who may “take advantage” of your kindness. Learn to say NO… politely.
- Learn who you are and what your needs truly are.
- Try relaxation strategies like deep breathing, physical exercise and meditation to lower your arousal
- Have realistic expectations on yourself and cut yourself some slack
- Limit being in highly stimulating environments and learn your sensitivity limits
- Avoid negative ways to reduce environmental stimulation like overeating, drugs and alcohol
- Be kind to yourself and give yourself the same empathy and kindness you give to other people
- Realize it’s OK to take time alone to recharge and rest
- Realize that as you grow and learn throughout your life — you can develop coping mechanisms to help you live in better ways and have HSP affect you less and less
- Consider seeing a therapist if being HSP really affects how you want to live your life
If you find yourself feeling lots of anxiety or even feel depressed because of your emotional sensitivity — maybe it’s a good idea to talk to a therapist and find some effective coping strategies.
References:
Acevedo, B. P., Aron, E. N., Aron, A., Sangster, M.-D., Collins, N., & Brown, L. L. (2014). The highly sensitive brain: an fMRI study of sensory processing sensitivity and response to others’ emotions. Brain and Behavior, 4(4), 580–594. http://doi.org/10.1002/brb3.242
Aron, Elaine N. and Aron, Arthur Sensory-Processing Sensitivity and Its Relation to Introversion and Emotionality. Journal of Personality and Social Psychology Copyright 1997 by the American Psychological Association, Inc. 1997, Vol. 73, No. 2, 345-368
Aron, E.N. The highly sensitive person (HarperCollins Publishers Ltd, 1999)
What Now? Questions to Ask After an Affair
Discovering that your partner has been unfaithful can feel utterly overwhelming and for some, even devastating. It can feel like our comfortable secure world has seemingly ended! On top of the pain from the physical/sexual betrayal are the lies they may have told and the horrible, horrible feeling of having been being deceived by the person we trust the most. It is very common for people to feel completely overwhelmed once they discover the infidelity and not know exactly how to feel or react to the situation.
It can leave us feeling angry and hostile, sad and upset, anxious and worried or even numb and empty. When you first find about the deception, the first reaction is probably an emotional shock. We feel the gamut of emotions — from emotional paralysis to rage, disbelief, shock, anger, self-loathing, hatred and maybe even desperate and painful feelings of love for our partner.
Most importantly with all of these strong and often painful emotions, we need to make sure we are feeling safe. If you’re feeling very depressed and have thoughts of self-harm or want to harm others it’s important to contact a mental health professional, call 911, call a “helpline”, or go to our local hospital emergency room.
We especially need to be sure we are taking care of ourselves by getting enough sleep, eating healthy, getting exercise and really trying to believe there is hope at the end of the tunnel and that we’ll get through this!
Here are some ways to perform better emotional self-care: https://roberthammel.com/7-steps-to-emotional-self-care/
Once we’re taking care of ourselves better and we’re feeling calmer, a little less emotional and more balanced, we need to slow down and ask ourselves: What now?
1. What Now?
Once the affair has been discovered, it’s normal to feel completely out of control emotionally. You may find that it is hard for you to think calmly and clearly and very hard to focus on daily tasks like getting to work, running errands or cooking meals. It’s also not uncommon to have no appetite or have significant problems sleeping. For this reason, it is important that you avoid making any rushed decisions that you might regret later. Rushed judgments and bad choices can even hinder your healing process.
Even though it may be difficult, it’s important to take your time to think about and reflect on what has happened and to take note of your thoughts and emotions before making any permanent decisions. As you calm yourself and gather more information, you will be able to make an educated decision rather than a hurried one at the height of pain, emotion and stress.
We want to explore questions like these ones:
- Did the affair actually end, is it really over? Is your partner doing what it takes to make it so?
- What did the affair mean to your partner? Was it just for excitement or is your partner emotionally connected to the other person?
- Has your partner totally checked out of your marriage? Be honest and really see them as they are, not as you want them to be.
- Is your partner truly contrite and sorry and wanting to repair things?
- Do you actually want to put in the effort to continue the relationship? Was it a good relationship in the first place?
- Can you really see yourself as being able to forgive this and move on someday?
- Scary to ponder, but could your life actually be better without this relationship?
- Is this a one-off or has your partner done this before?
- Know yourself. What do you really and truly want? Is that even possible in these circumstances?
- Be reasonable and logical. We can’t go back in time or predict the future.
- Might individual counselling help you get support and sort through this?
- Might marriage counselling help?
- Writing our thoughts and emotions in a journal may be a big help to sort through our emotions and feelings. The process of writing helps us slow our emotional thinking, look at things a little more accurately and make better decisions.
2. Is This Trauma?
After discovering your partner’s affair, it is very common for some people to experience many symptoms associated with trauma. Most people believe trauma is only shown in individuals who have experienced a violent crime, had a car accident, are returning from combat or have experienced some other “big” thing. The reality is, trauma can be also experienced by individuals who are dealing with their partner having an affair. Trauma is simply and accurately defined as being a strong emotional response that someone has to an extremely negative event in their lives.
Trauma symptoms may include:
- Obsessing about or reliving the event in your mind
- Avoidance of people, places and activities previously enjoyed
- Lack of interest in the world around you
- Negative thoughts about self (I’m not good enough, I’m a loser, the affair is my fault)
- Heightened anxious emotions and reactivity
- Shock, denial, disbelief
- Depression, feeling sad and hopeless
- Feeling weepy or crying all of a sudden out of the blue
- Difficulties focusing and concentrating
- Anger and irritability
- Feeling a sense of depersonalization/feeling disconnected from the world around us/like we’re 10 feet underwater
- Hypervigilance and self-protective behaviours like checking your partner’s wallet, pockets, email, phone apps, browser history, etc.
- Isolating yourself
- Going into denial mode and ignoring the situation
- Sleeplessness, nightmares, lack of appetite
If you are experiencing any of these symptoms and they are really affecting your life, consider speaking with a therapist who can help you navigate your emotions and help you truly heal.
3. How Do I Feel About Me After the Affair?
After discovering your partner’s affair, you may begin to question yourself. You may find yourself asking things like, “What did I do to make them do this?” Or “What is wrong with me?” Or “Why am I not good enough?”
Even the most self-confident people can be humbled into being irrational and insecure self-doubters after an infidelity comes into the light. In a heartbeat, you are taken from feeling safe and secure to feeling insecure, angry, sad, anxious and even afraid for your future. Blaming yourself is a super-common response, even though it’s not very helpful to your overall well-being or getting through the situation at hand — in fact, it can even further your traumatization and delay your healing.
It’s super important to remember that when we’re feeling extremely emotionally distraught after an affair that we may not be looking at the situation or even ourselves very accurately and our emotions may be filtering how we see the world. Try to not criticize yourself and your character because of what someone else did! It’s important to look at our role in the situation, but not beat ourselves up necessarily with negative and critical self-talk about how we aren’t good enough or, how we deserved what we got because we weren’t a good husband or wife.
Yes, you probably have a role in what happened, but it’s not really your fault if our partner made bad choices and acted in deceitful ways. That’s on them and not you.
For a fresh perspective on the hows and whys and what to do’s of affairs check out this Ted Talk from Esther Perel on Rethinking Infidelity.
Are you or a loved one currently dealing with the emotional aftermath of an affair? Do you need help sorting out your emotions and making the important decisions that are right for you? If you are interested in exploring counselling/therapy, please contact me today. I would be more than happy to speak with you about how I may be able to help.
This blog is not intended as medical advice, treatment or diagnosis and should in no way replace consultation with a mental health or medical professional.
7 Ways to Help Overcome Codependency
Do you feel like you are always trying to please others and in doing so, you neglect your own needs? Do you find you that you often find yourself accepting the responsibility for a loved one’s emotions or behaviours?
Is it hard to set effective boundaries and limits with others? Do you often feel mostly negative and unhappy but still have difficulty stepping away from what’s become a dysfunctional relationship? Are you overly emotionally reactive to relationship problems and conflicts?
Codependency can be defined as an ongoing pattern of behaviour in which you find yourself becoming overly dependent on approval from those close to you — where you depend on a relationship or intimate partner to define your own sense of self-worth and even your identity. Where it seems we can only really see ourselves through the eyes of another.
A red flag that often signifies codependency is when your purpose in life seems to be focused on your relationship and partner’s needs — where you find yourself always making significant sacrifices to maintain the relationship and to meet your partner’s needs. It’s where our own individual fulfilment becomes highly dependent on your partner and relationship — where we find ourselves losing our own sense of independence or self-sufficiency.
People who experience and struggle with codependency often have childhoods that contain emotional abuse or neglect; childhoods where they do not have their emotional needs met by the people closest to them. Their parents are often abusive, neglectful or selfish —- centring on their own needs and not their child’s. This creates an ingrained pattern of behaviour in which the individual repeats their childhood pattern of trying to construct and maintain a relationship even when their partner is very difficult, checked out and emotionally unavailable.
Codependent people often display some of these signs:
- Find it hard to set boundaries and limits with others, often to their own detriment
- Are “people pleasers”, often to their own detriment
- Need a sense of control and predictivity in relationships
- Are caretakers and often put others in front of their own needs
- Find it very hard to express their own needs, feelings and thoughts
- Are dependent on others and have a great fear of rejection
- Have low self-esteem and fear of failure, being judged by others or making mistakes
- Problems being intimate, open and honest in relationships
- Are often in denial about their codependency
- Often struggle with symptoms of stress, anger, anxiety and depression
- Are very unsettled by arguments, disagreements and conflicts
- Give too much time effort and energy in a relationship
These are some of the signs of codependency. Codependent people look to social cues from other people to tell them:
What they should feel
What they should need
What they should behave like
While most would agree that sensitivity to others is a wonderful and positive trait, people who are codependent often take it to an extreme, largely because of an inability to create healthy boundaries. They lose themselves in trying to meet the needs of others and have very few of their own boundaries.
Healthy boundaries are super important. Boundaries draw a line of separation and responsibility between our own thoughts, feelings, and behaviours — and the thoughts, feelings and behaviours of others. Because these boundaries are blurred or missing, people who are codependent may experience high levels of stress, anger, resentment, anxiousness and even symptoms of depression.
While it may take time to break long-standing patterns of codependency, there are things you can do to overcome it.
1. Look to Your Past
The first step on your path to rescue is to take a look at your own past to reveal and understand experiences that may have contributed to your codependency. What is your family history? Is there emotional neglect and abuse? Were there events that led to you distancing yourself from your true inner emotions and ignoring your own needs?
This can be a difficult process and one that involves thinking about and re-experiencing childhood emotions. You may even find that you feel angry, sad, shameful or guilty as you think about this.
Note: This type of exploration can be very emotional and stressful and is often best done in a safe therapy relationship.
2. Recognize Denial
The second step to healing is to really be frank with yourself and recognize the problem. There probably a very good chance you have intellectualized and justified your codependence over time. While it can feel scary to admit to being codependent and/or involved in a dysfunctional relationship, honesty with yourself is really the first step toward healing.
3. Detach and Disentangle Yourself
In order to truly work on and improve ourselves, we have to first disconnect from the things we are troubled with. Personal growth will require giving up our preoccupation and over-involvement with trying to control, rescue, or change others and our defaulting to always trying to please someone else.
This means taking a deep breath, letting go and acknowledging we cannot fix problems that are not necessarily ours to fix. What problems do we “own” and what problems are “owned” by others in our lives? It’s about really trying to differentiate where you end and others begin.
4. Practice Self-care
Giving up your attempts to constantly please others is a good start to healing, but learning self-care is absolutely necessary as well. It’s super important that you really begin to explore and become aware of your own thoughts, feeling and needs. We also need to learn how to communicate them to others in our relationships. This may feel very hard and even foreign to us at first as if you are being especially self-centred. But that’s part of learning how to take care of our own needs.
Self-care means taking care of ourselves physically — eating healthy, getting enough sleep, exercising regularly, and going to our doctor and taking any prescribed medications. Self-care also means caring for ourselves emotionally, making social connections, finding happy positive activities to fill our time, and allowing ourselves emotional downtime and rest if we need it. It also means really getting in touch and examining our own thoughts, opinions, values, wants and needs — regardless of what other’s opinions are. Good strategies to do this can be writing and reflecting through the process of journaling, reading appropriate books on self-care, and of course, going to therapy.
To create healthy long-term relationships with others, you must first build a strong one with yourself.
5. Learn to Say No!
One of the best ways you can begin to set healthy boundaries is to learn to say no to situations that are damaging to your own well-being. This will feel uncomfortable at first, but the more you do it, the easier it will become. We have the right to say no to others and often we don’t need to give them a long explanation. We have the right to say no to things that are not the best for us. This is not about being selfish and uncaring towards others — but it’s about setting boundaries and putting our own needs first.
6. Be Kinder to Yourself!
Be kind to yourself! This is about self-compassion and treating yourself the same way you would treat the others you love!
Here is a good little exercise to try to do this:
Close your eyes and visualize your best friend.
Now imagine they come to you and says they are really hurting because something has really gone sideways in their life. They’ve lost a job or a relationship is faltering or they’ve “failed” in some way.
Would you say to them, “Well, it’s probably your fault because you didn’t do this or that” or “You should have tried harder” or say “It’s because you aren’t good enough or smart enough”
Of course, you wouldn’t say that to a friend. So why would you say that kind of stuff to yourself?
It’s more likely that you would embrace your friend and say, “That’s terrible. I’m sorry, how can I help”
You really should be kind to yourself in this way, too. Treat yourself as you would treat a friend who is suffering. Learn to challenge any negative, critical self-talk, and any negative beliefs about yourself and your self-worth.
7. Learn Independence
Finally, try separating from others for certain periods of time to create a healthy sense of independence. Reduce dependence through learning to be alone and actually learning to like it! People who are codependent often find it very hard to spend time alone without others around.
Find an individual hobby or interest just for you. Go read in a coffee shop on your own, go the movies alone, go to the gym alone. Find some ways to create independence and learn to spend time with yourself!
Codependency can be changed and healed! Does changing this part of yourself make you feel uncomfortable? Perhaps seeking the guidance of a therapist might be beneficial as you work your way through exploring how codependency affects your life. A good therapist will be able to help you explore your past, your uncomfortable feelings and experiences, and help you learn more healthy ways of relating to yourself and to others.
If you are worried that you or a loved one is codependent and are interested in exploring therapy, please contact me today. I would be more than happy to speak with you about how I may be able to help.
This blog is not intended as medical advice, treatment or diagnosis and should in no way replace consultation with a mental health or medical professional.
10 Signs of Depression in Teens
Ask any parent what their most important job is, and they will tell you it’s protecting their children and keeping them safe in the world. New parents spend hours, if not days, preparing, by worrying, reading baby books and baby-proofing their homes. They research the best car seats, the best colleges, and the safest bike helmets, and often struggle to figure out ways to keep their kids safe online.
But, no matter how hard parents work to keep their kids safe, it can be very difficult to protect children against mental health issues such as depression. According to the US National Comorbidity Survey-Adolescent Supplement (NCS-A), Major Depressive Disorder affects roughly 11% of adolescents by age 18. A significant percentage indeed. Also if we look at depression like a continuum, it doesn’t take into account the number of teenagers that suffer from depression that doesn’t quite meet the level of clinical diagnosis.
In addition to the critical challenges of treating adolescents with the more severe symptoms of depression, depression has also been associated with the development of chronic health conditions, significant social/economic costs for society and a greatly reduced quality of life for the sufferer. Teenagers with depression often have a hard time getting their lives and careers started, and depression may be a big factor in their “failure to launch”. Sadly, and understandably, it’s probably really hard to “start your life” when you depression makes you feel empty and worthless and tells you that maybe life has no point.
If you are concerned and worried as to whether your own teen may be suffering from depression, here are 10 important signs to look for:
1. More than mood swings
Thanks to naturally rampaging hormones, it is quite normal for teenagers to experience mood swings. But those suffering from depression will often show excessive and more frequent swings of anger, sadness, self-doubt and irritability.
2. Academic problems
A drop in enthusiasm for school, struggling to maintain grades and even notes home from teachers can be a big signal that something is going on. Is your teen regularly getting to school late or cutting classes? Are there frequent absences from school?
3. Changes in social behaviour
Is your child spending less time out of the house with their friends? Do they have new friendships that seem negative or that you question? Are they spending more and more time alone and isolated? Changes in social behaviour are often a primary signal kids may be in trouble.
4. A lack/loss of interest in their favourite activities
Did your teen use to love playing sports or spend hours gaming, listening to music or drawing? Have they seemed to suddenly lose interest in these activities? If your child no longer shows interest in favourite hobbies and activities, this is an indicator that something may be wrong.
5. A Lack of Motivation
Granted, teenagers are not known for being highly-motivated, but those suffering from depression will show a marked decline in motivation and drive. Again, it’s important to look for changes in this area.
6. Lack of energy and feeling tired all the time.
Does your teen complain of having no energy to do anything, that they are “tired to the bone” or they have physical complaints like stomach or back pain? Again teenagers are sometimes known for being “lazy”, being tired and sleeping too much. But lack of energy and malaise can also be a definite sign of depression.
7. A change in sleep patterns, appetite or weight that has changed considerably
Diet changes like a lack of appetite, or binging on comfort foods can point to an issue. As does changes in sleep patterns which can be sleeping too much or having insomnia. Depression can affect appetite, eating and sleep patterns.
8. Restlessness, agitation (pacing, wringing hands, feeling like they can’t sit still)
Often depression can be displayed in agitation and irritability. Some sufferers describe it as having a motor inside them that continually runs on and on, not letting our mind or body rest.
9. Complaints of feeling guilty or worthless
Feelings of negativity and guilt, feeling like “everything is my fault’, ‘I am bad’, “I’m not good at anything” can point to the negative and flawed thinking that underlies and maintains depression.
10. A Family History of Depression
If you or someone else in your close family suffers from depression or other mental illness, there is an increased chance your teen may also suffer as well.
Getting Help
If you have noticed a few, or many of these signs in your teen, it’s important to seek help from a mental health therapist like a Psychologist. While you may want to, you can’t just love your child’s depression away. It’s often imperative to get professional help and an ongoing plan for treatment and management. There is a great deal of research showing that therapy works to heal depression and is probably the best first thing to try before things like antidepressant medications that may not be the best thing for your teenagers developing mind and body.
A therapist will be able to assess your teen for depression and provide them with treatment, including coping skills and tools for dealing and lessening the impact of the symptoms.
How To Really Get the Most Out Of Couples Therapy
As a therapist, I get to see many relationship miracles happen in therapy…
Well, okay, there are no miracles really. The fact is that “fixing” a relationship takes work. Hard work. It takes two people wanting it to work, getting help, changing their behaviours and then putting in an effort.
Having said that, I have seen many couples go from being on the precipice of divorce to rekindling their love, and developing a new sense of respect and admiration for each other — from resenting to actually liking each other again!
Couples therapy can really be a powerful agent of change in peoples lives, there is no doubt about it. But why do some couples make it while others simply don’t? The couples I have seen recover successfully from a myriad of marital problems/issues usually have certain things in common.
Here are some ways you and your partner can get the most out of couples therapy and set yourselves up for success.
Commitment and drive
Many couples view therapy as a place to make a last-ditch, “Hail Mary” effort, which really makes it all the more important to go all-in and commit to the process entirely. And even if therapy is your first attempt to salvage the relationship, it’s important that both parties give it their time, effort and energy.
This also means that even if nothing else has worked, and even if sometimes it feels hopeless, you still try to leave negativity, past arguments, defensiveness, criticism, contempt, or stonewalling at the door. These negative things are what caused the problem in the first place.
Be Optimistically Open Minded
It’s common to be cynical or doubtful of the therapy process if you have no experience with it. It’s also common to feel sceptical that your particular problems or issues are just way too big to be overcome in counselling. While there are no guarantees or warranties in life, my professional experience has shown me that a great number of relationship problems are solvable. But if you believe that they aren’t, you’re setting yourself up for failure right at the outset.
Real change requires an optimistic open mind
Do Your Homework!
Most people don’t spend tuition money and time on college or university to NOT do any of your homework. The absolute same goes for homework in couples therapy!
During most sessions, your therapist will help facilitate respectful and effective communication and give you some tools to get the same results at home. But it is really up to YOU to actually USE these tools at home!
Your relationship will not be “fixed” every Wednesday from 5:00 to 6:00 pm, it will be fixed from the work you both do on your own time at home and out in the world. The point of therapy is to learn how to navigate obstacles and conflict as they arise in everyday life outside of the therapist’s office — to make the relationship work you have to be aware and present all the time. Make fixing your relationship a priority all the time, not just at therapy. Like tuition, therapy isn’t cheap! Spend wisely and make it worth your time and money! Do Your Homework!
What is your role?
You are totally responsible for 100% of your 50% in the relationship. What are you doing that isn’t working? Taking responsibility for your role in why things aren’t working is crucial to success. It really takes two to tango! Are you really present and available to your partner? Are you really in it to win it? Do you really want to be in the relationship and are you willing to really and truly look at yourself and what the things are you doing that aren’t productive or positive in the relationship?
Couples therapy is a wonderful resource that helps many couples overcome all kinds of difficulties. If you’re really willing to commit to being a part of the process and responsible for your own actions, have an optimistic and open mind, and do the homework, you and your partner have an excellent chance of creating a robust and respectful relationship.
And did I mention, Do your homework! 😀
Time to go? Leaving a long term relationship in the best way.
So, you’ve been in a relationship for a year or two, or perhaps for even ten or twenty or more… but unfortunately for a while now, you’ve been really feeling unhappy or dissatisfied and have been thinking that maybe your relationship is past its best before date. How do know if it’s time to end it? It’s the very nature of relationships that sometimes, they end. In fact, all relationships we have in our life will come to an end in one way or another. In this blog, we’ll look at ways to explore and possibly end a relationship in a way that will help us feel more confident and positive in our decision and hopefully limit the harms to ourselves and others.
Please note: if you’re in a relationship that has violence or abuse it’s a different matter and here are a few links to some help in this scenario:
How to leave a violent relationship
RCMP Intimate Partner Violence and Abuse
So how then should we go about making that big decision without having regrets, and then if we decide we need to leave a relationship, how do we do that in the best way possible?
Be sure you have really tried to make it work.
One of the best ways to make sure you don’t have regrets about leaving is to honestly look at the situation and be confident that you’ve really given it a good try. For example, if it’s been a ten-year long marriage making a decision to leave should be a well thought out and reasoned decision, not a decision made in haste due to anger or frustration at circumstances that just may be temporary! Ask yourself was the relationship good last year or even three or six months ago? If so, could it be good again, and if you both want to put in the effort, maybe it could just be?
Do the math
Really sit down and be honest with yourself. Look at the relationship accurately and with some sense of detachment if you can. It’s really important to really look at your situation without the filters of love/romance or of anger clouding our thinking — use your logical thinking brain and really look at the situation as clearly as you can. For instance, has the relationship been 40% good and 60% bad, or is good 70% of the time and only 30% bad? Is your partner willing to take responsibility for their role in the problems and are they truly willing to making things better or do they blame you for the situation? Are you honestly taking responsibility for your role?
Be sure that it’s the relationship making you unhappy
In working with hundreds and hundreds of clients over the years I’ve seen time and time again that sometimes people blame the relationship/their partner for their unhappiness when in fact their unhappiness has much much more to do with them, their thinking patterns and maybe even their negative attitude. Or maybe you’re suffering from anxiety, depression or with an addiction issue, if so maybe it’s important to really look at yourself first. Are you looking to leave for the right reasons or are there other things affecting your thinking and attitude? Maybe seeing a psychologist like myself or another type of therapist can maybe help you sort out what’s you and what’s the relationship?
How do you define love as a concept? Are your expectations realistic?
Now I’m going to say some things that are a little controversial. What is love? Often people say that I’m no longer “in love” with my partner. Or I “love” them but I’m not “in love” with them. What does that really mean though? Unfortunately, it often means that people equate being “in love” with the exciting rush of sexuality and passion that often comes with a new and sparkly relationship. In a shiny new relationship, there is a rush of exciting “in-love” hormones and neurotransmitters in our brain.
In a nutshell, evolution makes new relationships feel that way so that we hook up and procreate lots of babies! But is it reasonable to expect a long-term relationship to always feel like an exciting new relationship? Maybe we need to really look at how we define love as a concept? Perhaps deciding that love is a verb and committing to our partner through thick and thin and realizing that often the rush of love feelings will come and go and that’s natural. Maybe true love isn’t necessarily about the shiny fresh tingling feelings of passion and sexuality in a new relationship? Maybe true and abiding love is more about accepting our partner, flaws and blemishes and all? Maybe it’s about having their “having their back” and making the effort to the commitment to being with them, even though sometimes it will be hard to do that?
To me true love isn’t about the tingly rush of meeting someone new — it’s more about acceptance, effort and really giving our best self to our partner — where two people make the conscious and deep decision to be with each other for the long term.
Here is a link to a previous blog on how to build acceptance in your relationship:
Create love and acceptance in your marriage!
Really look at what your life will look like if you end the relationship
It’s important to really look forward honestly at what your life will look like if and when you end it. For example, if you have children, what will it really be like to have to afford the costs of divorce, like paying for lawyers and having to sell a house or now having two households to pay for. What about dealing with all the challenges of having to co-parent? It’s more than OK to take into account financial matters and really look at how different your life will be after the split. Of course, money isn’t everything and shouldn’t be the sole reason to stay unhappy… but sometimes digging in and working on a savable marriage may be better than spending tens of thousands of dollars on two $500 an hour divorce lawyers.
Be sure you truly want to end the relationship
Sometimes we feel like we want out of a relationship when what we really want is a “remodel” of the relationship. We still love the other person but wish that things were different day to day. Maybe our needs aren’t being fulfilled practically, emotionally or sexually. Ask yourself would the relationship be better if… there was more or different sex, if your partner did more around the house, paid more attention to you, was more involved and present? Just because a relationship is unhappy or unsatisfying doesn’t mean that it can’t be changed with some work and effort if both people are willing to try to change things up. This is where it’s important to really be honest and forthright in letting your partner know what your needs really are. I don’t mean hints… I mean really having a sit down with them and being frank and honest about your needs and feelings and why things aren’t working for you!
Don’t cheat sexually or emotionally before you go!
Leaving a long term relationship should be done in the best and most honest way you can. Unfortunately, sometimes people look outside the relationship to others when things aren’t going well. Engaging in emotional and/or sexual relationships before you’ve ended the relationship often happens because the “leaver” is looking to build their self-confidence and prove to themselves that they are still attractive before they venture out on their own again. Sexual and emotional attention from being with a new lover can, of course, make us feel excited and giddy even! Some people even leverage this rush of good feelings as a way to feel stronger and then use this strength to leave their current relationship. The problem with this is that it often can really hurt the person being left — much more than if you left in a more respectful and kind manner. Infidelity can really affect people in lots of negative and painful ways; we’re actually wired to really be affected by infidelity and adding this pain on top of the pain of a relationship ending is unnecessary and even kind of selfish?
Here is a great TED Talk that takes a new perspective on infidelity from Esther Perel — Esther Perel: Rethinking Infidelity
Additionally, jumping into a new relationship right away before we’ve even left our current one often guarantees that the new relationship will probably crash and burn. A relationship built on the shaky foundations of deceit and dishonesty is probably not a good one. After leaving a long term relationship it is probably best to maybe take some time away from relationships and dating — a time to really concentrate on building our own life, distinct and separate from other people. It’s a time to maybe do a relationship autopsy and really figure out why our long term relationship ended. To honestly look at what was our role in the relationship ending. You’re really responsible for 100% of your 50% of what happened in your last relationship. It really takes two to tango! Try to leave with kindness, respect and empathy instead of anger and spite.
Even if you’re really ANGRY!!!!
Try to leave with kindness, respect and empathy
So if you’ve done the homework and decided its time to end it? Ask yourself how would you want to be treated if you were the person being “left”? What would you feel like if someone ended the relationship with you in a negative, unkind or even cruel way? Leaving someone behind can really hurt them and affect their life in many negative ways.
Even if you’re holding lots of negative anger and resentment towards your soon to be ex-partner, it may still be best to leave with “good karma”; to try to be kind and respectful. What if the relationship is really ending on a bitter note? What if the resentments and anger are really affecting you and the thought of being kind and sweet to them is too much for you to stomach? Maybe then it’s important to shoot for being neutral and detached rather than mean or spiteful?
A good strategy I often recommend to clients is to treat it like you would a business situation or decision. Try to be detached and keep your anger in check. This strategy is especially good to try if you have children involved or if you have assets to split up. Any divorce lawyer can tell you stories where a couple splitting up will fight tooth and nail over a few minor possessions. Really ask yourself is it worth it to battle it out over who gets the cheesy wooden salad bowl, the 10-year-old television or the threadbare couch in the basement? Try to be kind and respectful and if you can’t? Maybe the best strategy is to aim for neutral and “business-like”; really try to step away from your emotions and make this as pain-free as possible for everyone involved.
It’s also probably best for you emotionally and psychologically to make a clean break without anger and the creation of even more bad feelings and memories. Learning to let go of all the anger and resentments is probably the healthiest way for you to try move forward with your life.
Ending a relationship is never easy. Make sure you’re doing it for the right reasons and that you’ve really thought it through!
If you need help sorting this out further, maybe contact a psychologist like myself who can help you sort out what’s the best way to make this hard decision in the best way possible.
This blog is not intended as medical advice, treatment or diagnosis and should in no way replace consultation with a mental health or medical professional.
Can Empathy and Compassion Help Your Addicted Loved One?
It can be super difficult navigating through any relationship that is affected by serious addiction issues. There is a strong belief out there in the world that helping our loved ones and treating them too kindly can end in creating a codependency and worsen their addiction — instead, the best thing to do is show them some tough love! That you have to be “cruel to be kind”. (Thank you Nick Lowe).
Without a doubt, it can be hard to be with a person who is addicted. They may even act in some really negative ways; they may ask for or steal money for drugs or alcohol; they may continually cross our boundaries and cause us pain or heartache, they make be continually rationalizing and making all kinds of excuses for their negative and even destructive behaviours.
Lots of research has found that family, friends and even the community can play important roles in recovery. While loved ones can’t actually change their addicted friend or family member, they can make the effort to try to act in ways that will help create a loving and caring environment where their loved one feels supported and cared about.
Much new research in addictions is showing that many of those who are addicted actually quit without professional help and that one of the primary factors that helps someone end an addiction is when the addicted person has a strong connection to their loved ones and to the greater community. It also helps significantly when their relationship with their loved ones is based in respect and acceptance (Heyman 2013).
Why are Empathy and Compassion So Powerful?
When we offer a loved one our genuine empathy and compassion, we intentionally join them in their suffering and then, and only then, can we give them the authentic support and love that are truly the synergists that may spark their healing and recovery.
Being empathic and compassionate means that we are an active witness to the suffering they are dealing with in their addiction. Making a concerted effort to have compassion allows us to really see our loved one and the suffering they are going through.
In their excellent book, When Your Partner Has an Addiction: How Compassion Can Transform Your Relationship (and Heal You Both in the Process), co-authors Christopher Kennedy Lawford and Beverly Engel explore how spouses/partners can help the recovery of the people they love. From their book:
“Compassion is the most powerful tool you can have when it comes to healing addictions of any kind. Put simply, what your partner needs most from you is compassion.”
“Human beings have a deep need to bond and form connections. If we can’t connect with each other, we will connect with whatever we can find … It is disconnection that drives addiction.”
Lawford and Engels’s book is an excellent resource on how to connect with a loved one who is struggling with addiction.
So now that we understand why empathy and compassion are so important, how do we do that?
Here are some good strategies to help you help your loved one:
Validate Them and Their Experience
To feel validated, the addicted loved one needs to feel seen, heard and understood. To feel understood our loved ones must know they have the space to express their anger, frustration, fears, suffering, sadness, or any other strong emotion they are feeling. Negative emotions are often one of the biggest causal factors at the centre of an addiction. Negative emotions are the fuel that keeps the addiction churning along. Friends and family members who disregard or minimize their loved one’s suffering may actually be helping the addiction and harming their loved one! 
Empathy helps us stop judging and validate the person. Compassion allows us to judge less and listen more.
Provide Comfort
Whether it’s physical or emotional pain, sufferers from addiction often have a great need to be comforted. Simple things like a loving touch, a warm glance, or just a few kind words can make a huge difference in how our addicted loved one feels supported and loved.
It is also incredibly important to be compassionate toward yourself during your loved one’s addiction and recovery. Self-compassion asks that we treat ourselves kindly; that we validate our experience and show ourselves the same comfort we show our loved one. Here’s a link to some good emotional self-care tips: https://roberthammel.com/7-steps-to-emotional-self-care/
No Shame!
Many people who have an addicted loved one try to use shame as a tool to help their loved one “see the light” or as a tool to motivate them “to do better”.
Unfortunately, it can actually backfire in some unexpected ways! One of the most insidious parts of an addiction is the sense of often overwhelming shame that it creates.
The addict cannot pass his own survey. He is appalled by the failures from which he suffers, and shame is the appropriate, respectful, humane, first-person response to these failures. Shame begets using and more using begets more shame, and the vicious cycle is produced and maintains itself. Overcoming shame is part of overcoming addiction. Shame is also normally a crucial factor motivating the addict’s attempt to reclaim, reconstruct, and improve himself. (Flanagan, 2012)
Shaming someone makes them feel isolated and alienated from their support system. Shaming them may actually feed their emotional cycle of addiction.
Addiction, Love and Boundaries
One last thing. I am not suggesting we should totally do away with setting boundaries with our addicted loved one. Not at all, we need to set appropriate boundaries with everyone in our lives and particularly those that are acting out in negative ways that may harm us… Perhaps, though, along with setting good boundaries for our loved one, we should also try to make a place for them in our hearts… realizing that love, empathy and compassion may be more important than tough love in helping them to recovery.
Here is a great blog from my colleague Sharon Martin on setting boundaries with a loved one dealing with addiction:
https://blogs.psychcentral.com/imperfect/2017/08/how-to-set-boundaries-with-an-alcoholic-or-addict/
If you or a loved one is suffering with addiction and you’re interested in exploring therapy for you or for them, please contact me today. I would be happy to speak with you about how I may be able to help.
References
Heyman, G. M. (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry, 4, 31. http://doi.org/10.3389/fpsyt.2013.00031
Christopher Kennedy Lawford and Beverly Engel When Your Partner Has an Addiction: How Compassion Can Transform Your Relationship (and Heal You Both in the Process) 2016 https://www.amazon.com/When-Your-Partner-Has-Addiction/dp/194163186X/ref=sr_1_1?ie=UTF8&qid=1475599896&sr=8-1&keywords=when+your+partner+has+an+addiction
Flanagan, O. (2013). The Shame of Addiction. Frontiers in Psychiatry, 4, 120. http://doi.org/10.3389/fpsyt.2013.00120
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