A psychodynamic model of anxiety in parents of intellectually and developmentally disabled - PowerPoint Presentation

A psychodynamic model of anxiety in parents of intellectually and developmentally disabled children(or, how to be a philosopher instead of a prisoner*)John Gamache, Ph.D.Jgamache.net * Reference to Plato's cave allegory

The Bears in the Park: Anxiety and the Autism Parent“I don’t want stress to win, but it’s ever present. It steals from me sleep, laughter, and peace. Joy? It’s fleeting. Found in bits and snatches — and always bestowed to me by my children. Yes, it’s there. But it’s often stolen by the thieves of anxiety and fear”.Written by Leigh Merryday , 8/8/2014 https://www.huffingtonpost.com/leigh-merryday/the-bears-in-the-parkanxi_b_5652328.html Edited with permission

Pediatrics, August 2014, Vol 134, Issue 2Reducing distress in mothers of children with Autism and other disabilities“Compared with other parents, mothers of children with ASD and other neurodevelopmental disabilities experience more stress, illness and psychiatric problems…….At baseline, 85% of this community sample had significantly elevated stress, 48% were clinically depressed, and 41% had anxiety disorders .”

Pediatrics International, Volume 60 (2017), Issue 3, pp 247-253.Alexithymia, depression and anxiety in parents of children with neurodevelopmental disorder: Comparative study of autistic disorder, pervasive developmental disorder not otherwise specified and attention deficit–hyperactivity disorder.“The possibility of alexithymia, depression and anxiety should be kept in mind when working with parents of children with neurodevelopmental disorders .”

Current Opinion in Psychiatry. 2010 Sep;23(5):407-11Chronic stress and health among parents of children with intellectual and developmental disabilities.“Although parents raising children with (versus without) I/DD have long reported greater levels of psychological stress, only recently have parental physical health problems been linked to aspects of the child with I/DD.”

Fighting Caregiver Burnouthttps://childmind.org/article/fighting-caregiver-burnout-special-needs-kids/By Juliann Garey , 2018Moms and dads of children with developmental and mental health challenges often have to deal with strain of a different magnitude. The consequences of chronic stress related to raising kids who have intense needs are real. Studies show that parents of children with developmental, psychiatric or learning disorders are far more likely than others to experience anxiety, depression, insomnia, fatigue, marital problems .”

Stimulus Bears Organism Processing Response Anxiety History of Experiences Conscious influences Unconscious (manufactured) Influences

What is Anxiety?Anxiety is a psychological, physiological, and behavioral state induced in animals and humans by a threat to well-being or survival, either actual or potential. It is characterized by increased arousal, expectancy, autonomic and neuroendocrine activation, and specific behavior patterns. The function of these changes is to facilitate coping with an adverse or unexpected situation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181681/

“State” AnxietyState anxiety describes the experience of unpleasant feelings when confronted with specific situations, demands or a particular object or event. State anxiety arises when the person makes a mental [perhaps more limbic than frontal-lobe based] assessment of some type of threat. When the object or situation that is perceived as threatening goes away, the person no longer experiences anxiety. Thus, state anxiety refers to a temporary condition in response to some perceived threat.

“Trait” AnxietyLike state anxiety, trait anxiety arises in response to a perceived threat, but it differs in its intensity, duration and the range of situations in which it occurs. People with trait anxiety experience more intense degrees of state anxiety to specific situations than most people do, and they experience anxiety toward a broader range of situations or objects than most people. Thus, trait anxiety describes an enduring rather than temporary feeling…..something that we feel in anticipation of a threat. It is understandable why parents of I/DD children are predisposed to experience trait anxiety, because not only do we live among the bears, but we are constantly vigilant to the possibility of a bear. In other words, in an effort to protect we are predisposed to perceiving the next, inevitable bear.

Theories of Emotion

What these theories suggest is that conscious, cognitive interpretation of our emotions plays an integral role in the processing of a stressor and may play an intervening role in our response to a stressor. We also know that the conscious interpretation of an emotion is in part a product of our history with that stressor. Parents of developmentally disabled children have a large history of stressors. That’s the principal behind PTSD. And our cognitive interpretations of a current stressor are based on that unusually large number. We perceive the current stressor with more potential risk than the average parent. That’s because we have a very real history of high risk …..we’ve been walking through a park with many very real bears. This influences our conscious interpretations of current stressors. And that influence is known to be largely unconscious. Previous emotional experiences are stored in the limbic system, particularly the hippocampus, “ as memories that can be recalled [or evoked] by similar circumstances ”….stressors. ( http://schoolbag.info/test/mcat/4.html ) These less-than-conscious “memory emotions” shape our perception of our stressor, in large part defining our conscious, cognitive interpretation. These emotional interpretations are similar to sensory illusions. Throughout this presentation I will be using visual illusions as a metaphor for emotional illusions. Emotional illusions play a large role in our conscious interpretations. And I will be using the notion of PROJECTION as the mechanism of emotional illusions.

Does it make sense (seem)?Internal “senses” or “powers”… the internal senses as “messengers bringing news back to the common sense” so that the external senses have meaning (Al-Ghazali).

Perception is the product of the Projection of aspects of a pre-existing mental image (memory or feeling, repressed conflict) onto current sensory data….sound frequencies, light waves, tactile pressure. Projection is meant to aid in defining the meaning of our sensory data. We perceive that meaning and use it in our conscious cognitive interpretation. There is always a more or less congruent fit between the projection of meaning and its target object, the stressor. In other words, we are perceiving that this is a bear, and it also might be one. The experience is seamless.

How we “make sense” of what we sense Cortex

Perception is more how things seem than how things are.

Perception as illusion

Pulling It All TogetherThe Bears in the Park are real. State anxiety is a normal psychological, physiological, and behavioral response to a real stressor. And it remits with time.Trait anxiety helps us stay vigilant in anticipation of a stressor. And, like too much adrenalin, it can exhaust us because of its intensity and duration. Parents of I/DD children are predisposed to suffer sub-clinical and clinical levels of trait anxiety because of the hypervigilance and anticipation. Projection, like the shadows on the wall of the cave, is the mechanism our mind uses to make sense and minimize confusion. But it can often be like a tourniquet around our neck to stop a nose-bleed….overkill. Confusion, if tolerated, usually clarifies the stressor.

SuggestionsListen closely to pronouns. Generalizations (“You” instead of “I”) are usually meant figuratively. But sometimes they’re projections…displaced responsibilities. Ask more context questions to postpone presumptions and to buy some time to think:“Can you say that some other way?” “Are you asking or telling?” “Do you mean that literally or figuratively?” Pay attention to irrational idealizing and superstitious thinking….”If you had…, then I would have…”, “You should have known…” Trust your confusion. It is always an accurate red-flag that something outside of you doesn’t yet make sense. Defensiveness is less likely when we stay vigilant to our confusion, rather than to the stressor. Hone your tolerance of frustration in the small events (aggressive drivers). They’re not cutting you off…. you’re driving too closely. Wonder why you feel the way you do and reflect on the thought that your emotions are not caused by the outside world. You will need that skill in the larger events. Acknowledge that it is OUR job to teach those who don’t understand, and it’s OUR job to find those who do.

Bears in the Parkhttps://www.huffingtonpost.com/leigh-merryday/the-bears-in-the-parkanxi_b_5652328.htmlAnxietyhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181681/ State/Trait Anxiety https://www.livestrong.com/article/98672-differences-between-state-anxiety-/ Theories of Emotion http://schoolbag.info/test/mcat/4.html Perceptual illusion https://www.iep.utm.edu/epis-per/ Internal sense http://bartholomew.stanford.edu/onsensesalgazel/intro.html cortex http://udel.edu/~ckerins/art205/project1/taste-smell.htmlLimbichttp://thinktankcentre.blogspot.com/2015/08/the-limbic-system.html#!/2015/08/the-limbic-system.htmlBrain Gameshttps://www.nationalgeographic.com/tv/brain-games/ Locus of Controlhttp://www.assignmentpoint.com/science/psychology/locus-of-control-in-personality-psychology.html Boundarieshttp://www.make-my-christian-life-work.com/boundaries.htmlTransference/Projection https://peace-inthestorm.blogspot.com/2015/02/transference-vs-projection-whats.htmlhttps://drjohngkuna.com/transference-perception-is-in-the-eye-of-the-beholder-and-we-need-to-talk-about-it/