Mental Illness and Marriage

I was interviewed on how mental illness affects marriage and how to cope. Listen to the podcast.

What kind of impact does mental illness have on a marriage?

In today’s society, it’s becoming more and more common for individuals to be living with some sort of mental health condition or illness like anxiety or depression. And while there are many issues and conditions that present themselves in different, unique ways, oftentimes the effects on a marriage are very similar.

In addition to anxiety and depression, some people suffer from more extreme conditions like post-traumatic stress disorder and substance abuse problems. When these issues creep in without the proper treatment, their impact on a marriage and the individual can be fundamentally problematic. In some situations, the partner without the condition will have to pick up the slack for the other. And in many cases, couples will begin to suffer from tension and exhaustion within their marriage.

Our guest today is Dr. Nerina Garcia, a clinical psychologist with Williamsburg Therapy and Wellness in Brooklyn, NY. Nerina is here to give us some advice about how couples and individuals can learn to cope with mental illnesses within marriages while building a network of support.

To find out more about Nerina and her practice, visit her website or call (917) 816-4449.

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Preventing Posttraumatic Stress Disorder by Facing Trauma Memories

This article discusses the benefits of facing our painful memories, challenging our beliefs about the traumatic experience, self care and breathing exercises.

Nov. 27, 2012 Sciencedaily.com— Posttraumatic stress disorder (PTSD) is a form of learning that begins at the moment of the exposure to extremely stressful situations and that grows in impact as trauma-related memories are rehearsed and strengthened repeatedly. This somewhat oversimplified view of PTSD yields a powerful prediction: if one could disrupt the rehearsal and strengthening of traumatic memories, a process called reconsolidation of memories, then one might reduce PTSD risk or PTSD severity after potentially traumatic events.

To be certain, it is tricky to attempt to alter traumatic memory reconsolidation. In fact, some early strategies for "trauma debriefing" turned out to strengthen rather than diminish posttraumatic learning.

Despite these challenges, a new study by Dr. Barbara Rothbaum and colleagues reports that a behavioral intervention delivered to patients immediately post-trauma is effective at reducing posttraumatic stress reactions.

"PTSD is a major public health concern," said Rothbaum, professor in Emory's Department of Psychiatry and Behavioral Sciences. "In so many people, what happens immediately after a traumatic event can make things worse or better. Right now, there are no accepted interventions delivered in the immediate aftermath of trauma."

To conduct the study, the researchers approached patients who presented to the local emergency room due to a traumatic event, including rape, car accident, or physical assault. Half of those who agreed to participate received the behavioral intervention, which was started immediately, while the other half did not. All patients were repeatedly assessed for symptoms of depression and stress over a twelve-week period.

The intervention is a modified form of exposure therapy in which a survivor confronts anxiety about a traumatic event by recounting it. Administered over the course of 3 1-hour sessions, the goal is to alter the person's thoughts and feelings about the traumatic event. Trained therapists asked the participants to describe the trauma they just experienced and recorded the description. The patients were instructed to listen to their recordings every day. The therapists also helped the patients look at obtrusive thoughts of guilt or responsibility, and taught them a brief breathing relaxation technique and self care.

They found that the intervention was safe, feasible, and successful at reducing posttraumatic stress reactions, compared to those who were assigned to the assessment-only condition, at 4 and 12 weeks post-injury.

"This study provides an elegant and clinically important test of the trauma reconsolidation hypothesis," commented Dr. John Krystal, editor of Biological Psychiatry.

The implications of this study are immense, Rothbaum explained. "If we know what to do, then we can train emergency workers to intervene with patients on a large scale. In addition to being implemented in the emergency room, it can help on the battlefield, in natural disasters, or after criminal assaults."

She concluded, "More research is needed, but this prevention model could have significant public health implications. A long-standing hope of mental health research is to prevent the development of psychopathology in those at risk instead of being limited to symptom treatment after disease onset."

Elsevier (2012, November 27). Preventing posttraumatic stress disorder by facing trauma memories. ScienceDaily. Retrieved December 10, 2012, from http://www.sciencedaily.com­ /releases/2012/11/121127094102.htm

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Childhood Trauma Leaves Mark On DNA of Some Victims: Gene-Environment Interaction Causes Lifelong Dysregulation of Stress Hormones

How we live and what happens to us changes our genes. Trauma in early childhood can change DNA and lead to PTSD, anxiety and depression.

Dec. 2, 2012 from Sciencedaily.com— Abused children are at high risk of anxiety and mood disorders, as traumatic experience induces lasting changes to their gene regulation. Scientists from the Max Planck Institute of Psychiatry in Munich have now documented for the first time that genetic variants of the FKBP5 gene can influence epigenetic alterations in this gene induced by early trauma.

In individuals with a genetic predisposition, trauma causes long-term changes in DNA methylation leading to a lasting dysregulation of the stress hormone system. As a result, those affected find themselves less able to cope with stressful situations throughout their lives, frequently leading to depression, post-traumatic stress disorder or anxiety disorders in adulthood. Doctors and scientists hope these discoveries will yield new treatment strategies tailored to individual patients, as well as increased public awareness of the importance of protecting children from trauma and its consequences.

Many human illnesses arise from the interaction of individual genes and environmental influences. Traumatic events, especially in childhood, constitute high risk factors for the emergence of psychiatric illnesses in later life. However, whether early stress actually leads to a psychiatric disorder depends largely on his or her genetic predisposition.

Research Group Leader Elisabeth Binder of the Max Planck Institute of Psychiatry examined the DNA of almost 2000 Afro-Americans who had been repeatedly and severely traumatised as adults or in childhood. One-third of trauma victims had become ill and was now suffering from post-traumatic stress disorder. The risk of developing post-traumatic stress disorder rose with increasing severity of abuse only in the carriers of a specific genetic variant in the FKBP5 gene. FKPB5 determines how effectively the organism can react to stress, and by this regulates the entire stress hormone system. The scientists hoped to cast light on the mechanisms of this gene-environment interaction by comparing modifications of the DNA sequence of victims who had not become ill with that of those who had.

The Munich-based Max Planck scientists were then able to demonstrate that the genetic FKBP5 variant does make a physiological difference to those affected, also in nerve cells. Extreme stress and the associated high concentrations of stress hormones bring about what is called an epigenetic change. A methyl group is broken off the DNA at this point, causing a marked increase in FKBP5 activity. This lasting epigenetic change is generated primarily through childhood traumatisation. Consequently, no disease-related demethylation of the FKBP5 gene was detected in participants who were traumatised in adulthood only.

Torsten Klengel, a scientist at the Max Planck Institute of Psychiatry, explains the findings of the study as follows: "Depending on genetic predisposition, childhood trauma can leave permanent epigenetic marks on the DNA, further de-repressing FKBP5 transcription. The consequence is a permanent dysregulation of the victim's stress hormone system, which can ultimately lead to psychiatric illness. Decisive for victims of childhood abuse, however, is that the stress-induced epigenetic changes can only occur if their DNA has a specific sequence."

This recent study improves our understanding of psychiatric illnesses which arise from the interaction of environmental and genetic factors. The results will help tailor treatment particularly for patients who were exposed to trauma in early childhood, thereby greatly increasing their risk of illness.

Story Source:

The above story is reprinted from materials provided by Max-Planck-Gesellschaft (2012, December 2). Childhood trauma leaves mark on DNA of some victims: Gene-environment interaction causes lifelong dysregulation of stress hormones. ScienceDaily. Retrieved December 10, 2012, from http://www.sciencedaily.com­ /releases/2012/12/121202164057.htm

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El Huracán Sandy: Como Lidiar con las Secuelas Emocionales

Por Nerina Garcia,-Arcement Ph.D. Traducción por Carla Saad, B.A.

Los desastres naturales, como el Huracán Sandy, nos recuerdan que tan vulnerables somos.  Entre más cercano haya sido la experiencia de uno con el huracán, la reacción que uno sentirá después podrá ser más intensa.  Al sobrevivir un desastre natural como el Huracán Sandy, uno puede sentir estrés, ansiedad, depresión y síntomas del trastorno de estrés postraumático.  Si usted ha sufrido de problemas emocionales en el pasado, el enfrentarse con un evento estresante, como el Huracán Sandy, puede exacerbar éstas condiciones pre-existentes.

Algunas de las reacciones emocionales típicas que uno puede sentir tras vivir un desastre natural incluyen sentimientos de incredulidad, sentirse confundido o indefenso, irritabilidad, tristeza, miedo, dificultad para concentrarse y para tomar decisiones, sentirse preocupado y pensar constantemente acerca de lo que paso durante/después de la tormenta, sentir preocupación por consecuencias negativas que puedan llegar a ocurrir, y sentir que uno está volviendo a vivir los eventos del desastre.  Algunas de las reacciones físicas comunes que uno puede tener incluyen: dificultad para dormir, tener pesadillas, sentirse nervioso y sobresaltarse con facilidad, latidos rápidos del corazón, problemas para respirar, dolor de cabeza y sentirse tembloroso.

Hay varias cosas que usted puede hacer para sentirse mejor si ha notado que está teniendo éstos problemas:

1. No se aísle: Busque apoyo de gente querida, amigos y vecinos que entiendan lo que usted está viviendo. Esto le ayudará a darse cuenta que no está solo, y no es el único que siente éste dolor.
2. Hable con amigos y gente querida acerca de como se siente: El expresar sus preocupaciones, miedos, ansiedades, tristeza, sentimientos de incredulidad y confusión puede ser un proceso curativo y catártico.
3. Limite ver noticieros: Ver las imágenes de destrucción únicamente recuerdan la experiencia traumática y reafirman los sentimientos de miedo y vulnerabilidad.
4. Participe en actividades de recursos de socorro: El ser voluntario y donar su tiempo en esfuerzos de ayuda humanitaria le ayudará a sentir mayor control y sentir que puede causar un impacto positivo. Ayudar a otras personas a sentir menos dolor, le puede ayudar a aliviar su propio dolor.
5. Participe en pasatiempos o en actividades positivas: El participar en actividades que uno disfruta le ayuda a distraerse y en no pensar en su aflicción, y le recordará que aún existe belleza y creatividad en el mundo, y no solamente destrucción.
6. 6.      Manténgase activo: Haga ejercicio, o salga a dar caminatas. Estas actividades le ayudarán a no pensar en sus problemas. El mantener el cuerpo activo le ayuda a liberar hormonas que reducen el estrés.

Si después de intentar éstos consejos usted todavía se siento afligido, considere hablar con un experto en problemas de salud mental o con un consejero espiritual.  El sobrevivir un desastre natural puede tener impactos negativos y duraderos en la manera en que nos sentimos y en la que vemos el mundo.  El enfrentar el dolor emocional lo antes posible reduce las probabilidades de que los síntomas de estrés, ansiedad, depresión y del trastorno de estrés postraumático sean duraderos, y persistan en los años por venir.

Trauma and Disaster: Helping Teens Manage the Impact of Hurricane Sandy

Listen to my interview on The Mary Waldon Show on the emotional impact and how to cope with Hurricane Sandy. Hurricane Sandy has had a tremendous impact on countless families up and down the east coast of the United States. Such an event can leave even the most well-informed parent with questions and concerns.What is the potential impact of natural disasters and other traumas on teenagers? What can parents do to help mitigate the impact of Hurricane Sandy? What is an expected reaction to such extreme events, and what kinds of reactions indicate a need for professional intervention? For answers to these and other related questions, please tune in to The Mary Waldon Show to hear the insight and expertise of Dr. Nerina Garcia-Arcement, an expert in the treatment of Post Traumatic Stress Disorder.

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Hurricane Sandy: Coping with the Emotional Aftermath

By Nerina Garcia-Arcement, Ph.D. Natural disasters, such as Hurricane Sandy, remind us of our vulnerability. The closer the impact of the hurricane to you the more intense your reaction can be. Surviving a natural disaster such as Hurricane Sandy can bring about stress, anxiety, depression and post traumatic stress symptoms. If you have experienced emotional distress in the past, then a major stressor such as Hurricane Sandy is likely to exacerbate a pre-existing condition.

Typical emotional reactions include disbelief, feeling confused or helpless, irritability, sadness, fear, difficulty focusing and making decisions, feeling preoccupied and ruminating about what happened during/after the storm, worrying about what future negative things could occur, and re-experiencing events from the disaster. Common physical reactions are sleep problems, nightmares, feeling jumpy and being easily startled, racing heart, trouble breathing, headaches and trembling.

If you notice you are experiencing these problems there are actions you can take to feel better:

1. Do not isolate yourself: Seek out support from loved ones, friends and neighbors that know what you are going through.  This will help you realize you are not alone in your pain.
2. Talk to friends and loved ones about how you are feeling: Expressing your worries, fears, anxieties, sadness, disbelief and confusion can be healing and cathartic.
3. Limit your news watching: Seeing the images of destruction simply reminds you of your traumatic experience and reinforces your feelings of fear and vulnerability.
4. Donate or volunteer your time through relief efforts: This will help you feel more in control and that you can make a difference. Aiding others through their pain helps reduce your own.
5. Engage in hobbies or life affirming activities: Doing things you enjoy will help distract you from your distress and remind you that there is beauty and creativity in the world, not just destruction.
6. Stay Active: Exercise or go outside for walks. These activities will get your mind off of your problems.  Getting your body moving will help release hormones that relieve stress.

If you find you are still distressed after trying these suggestions, consider talking to a mental health professional or a faith based adviser. Surviving a natural disaster can have a lasting negative impact on how you see the world and how you feel. Addressing your emotional pain now can reduce the chances of your stress, anxiety, depression or PTSD symptoms lasting for years into the future.

How Are You Coping With the Recent Mass Shootings?

I was quoted on the important topic of PTSD and typical reactions to mass shootings and trauma. In this I share tips on how to cope after a trauma.

By Rheyanne Weaver  |

The two mass shootings in the last couple of months have been on the minds of many Americans, especially because they took place in seemingly safe places -- a movie theater and a temple. Experts have suggestions for how the general public and victims can cope with such saddening and scary events.

Nerina Garcia-Arcement, a licensed clinical psychologist, said in an email that she previously worked with 9/11 survivors. “Unfortunately many people do not seek help for mental health problems following a trauma and most people wait an average of 10 years to seek mental help,” Garcia-Arcement said.

“A majority of my 9/11 clients sought help six to 10 years after 9/11. By this point many were isolated from all social support, had difficulties working as they avoided public transportation and public spaces, and suffered from chronic stress due to fear of the ‘next terrorist attack.’"

She hopes that victims of recent shootings get help from mental health professionals sooner in order to cope with trauma. There are a plethora of mental health issues that could result from being a victim of a shooting.

“The closer the person was to the event, the more emotionally impacted they are likely to be,” Garcia-Arcement said.

“For people directly affected by the recent shootings, it is common to experience Post Traumatic Stress Disorder (PTSD), anxiety (including panic attacks, generalized anxiety and phobias related to the attack, such as social phobias or fear of the dark) and depression symptoms.”

“It is a normal reaction for people to re-experience or remember the event, have nightmares, feel sad and scared, be hypervigilant, avoid reminders of their trauma and isolate from people,” she added. “This is the mind trying to process and make sense of what happened.”

“Survivors of the [Colorado] shooting will find that things like the smell of popcorn, popping sounds, the dark, being in crowded spaces or watching a movies might trigger reminders of their experience,” Garcia-Arcement said.

“These are normal reactions that can be managed with deep breathing, relaxation exercises and positive self talk (i.e., ‘this is just a reminder, it is not happening again. I am okay. I am safe.’). For many survivors, those in the theaters and injured, survivor's guilt is common.”

People who were not directly involved in the shooting can still suffer from slight mental health issues as well, such as “sadness, horror and anxiety,” and avoidance of reminders of the shootings.

Here are some tips from Garcia-Arcement to help people cope with the recent shootings:

1) “Offer each other social support, as individuals and as a community.”

2) “Remind yourselves that this was an isolated horrible event that happened to good people. It was not their fault.”

3) “My strongest recommendation is that survivors and the general public do not avoid reminders of the trauma and do not isolate. It is instinctive for people to avoid things that remind them of their trauma. Unfortunately once they begin avoiding going to movies or spending time in crowded spaces, it often escalates to avoiding more and more things. They begin to misinterpret the fact that they are safe simply because they avoided going to the movies, instead of forcing themselves to go to the movie and realizing they are safe.”

4) “A person should seek mental health support if they are feeling overwhelmed by their reactions to the shooting. If after a few months they find they are still experiencing PTSD, anxiety or depression symptoms, they ought to seek a therapist that could help them process their normal reactions.”

Robin Zagurski, a licensed clinical social worker, works with adults and teens who have gone though traumatic experiences. She said in an email that a major indicator that professional mental health is needed after a mass shooting is if people are unable to function in their daily lives.

She suggested keeping the same daily routine in order to distract from thinking about the recent shooting, and taking care of one’s overall health and well being.

She said that it’s difficult to plan for rare shooting situations, but to be aware of any “leakage” statements, where a future shooter may tell someone or post on the Internet what their plans are.

Don’t assume these statements are merely threats. Reporting this to authorities could potentially save lives.

“Think ... of maintaining your safety in all environments, especially for hazards that have a higher likelihood,” Zagurski said.

“For example, always know where the exits are in any building in case of fire. Practice evacuations so that you know how to get out safely. If someone talks to you about hurting themselves or others, report it to authorities immediately.”

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