Tuesday, August 29, 2017

Guilt in Bereavement: The Role of Self-Blame and Regret in Coping with Loss

People often wish that they could have done things differently following the death of a loved one; this can make them feel guilty. For example, bereaved persons may think that they should have done more to prevent the death or to have lived up to their own expectations in their prior relationships with the deceased (e.g.,[1] [2]). Guilt is typically listed not only among reactions to the loss of a loved one [3] it is also an integral part of depression. Guilt in the bereavement context has been defined as “a remorseful emotional reaction in bereavement, with recognition of having failed to live up to one's own inner standards and expectations in relationship to the deceased and/or the death” [4](p. 166). Although there is some evidence that it has a detrimental impact on adjustment to bereavement, empirical investigation has been limited and results have so far been inconclusive. For example, although identified as associated with grief, its precise role in the development of severe complications in bereavement remains unclear [4]. Yet, establishing the relationship between guilt and complications/symptomatology would seem critical. For example, in the bereavement field, one of the foci in psychotherapeutic intervention programs for persons enduring complications in their grieving has involved altering persisting negative attributions, including those associated with guilt, self-accusations and remorse (e.g.,[1]). This would point to an assumed causal role of such reactions in grief complications.


Understanding the role of guilt in adjustment to bereavement is complicated by the fact that guilt incorporates a variety of cognitive and emotional components [4], suggesting the need for finer-grained examination. The present study focuses on two components of guilt, namely, self-blame and regret. There are good reasons to select these two: They are the most-frequently identified forms of guilt in the bereavement literature (reviewed below), yet systematic comparisons of their impact have so far been lacking. Given the specific characteristics of self-blame and regret, one might assume that they have different associations with psychological well-being among bereaved persons: Self-blame and regret are close, yet distinct phenomena, ones which may play different roles in the adaptation process after loss.


To elaborate: Self-blame in the bereavement literature usually refers to making self-attributions about the cause of the death (e.g.[5],[6]), and a sense of culpability due to failure to live up to standards of the deceased or one's self [7],[8]. Regret has been identified in the general literature as involving painful thoughts and feelings about past actions and how one could have achieved a better outcome [9], and in the bereavement specific literature, as feelings associated with unfinished business with the deceased in general [10], or the perception that one could have done things differently [11]. Accordingly, we define regret in the context of bereavement, as a negative emotion accompanied by the belief that one could have done something differently to bring about a more desirable outcome with respect to the relationship with the deceased and/or the death-related events.


As evident from the above definitions, while self-blame stresses responsibility for the death, and implies accusation of oneself, regret in bereavement focuses more on possible better outcomes, without impaired sense of self. Negative cognition focused on oneself, as in self-blame, has been suggested to play a more detrimental role in psychological well-being [12],[13],[14] and adjustment in grief [15] than negative perception of one's behaviour or the event per se, as in regret. A major purpose of the current longitudinal investigation is, then, to compare the role of self-blame with that of regret in the process of coming to terms with the loss of a loved one. We examine their role not only as determinants but also their course over time, across the months of acute grief and grieving.


Next we examine the extent to which relationships between these two phenomena and health outcomes have been established so far in the bereavement literature.

The role of self-blame in bereavement


Some studies have reported a negative influence of self-blame on grieving people's well-being. Associations between these variables have been found in some cross-sectional studies. Hazzard et al. [16] conducted a study among bereaved parents and concluded that higher self-blame for the death was associated with more intense grief reactions, as measured using the Grief Experiences Inventory [17]. However, this study included only one item to measure participants' self-blame for the death, raising concerns about the reliability and validity of their assessments of self-blame and resulting conclusions. Using a somewhat better measure, Garnefski and Kraaij [18] adopted the self-blame subscale from an emotion regulation scale to investigate the concurrent relationship between self-blame in bereavement and depressive symptoms. These investigators also found positive correlations between these variables.


Relating self-blame to a somewhat different measure of the course of grief, in two earlier studies by Weinberg [6],[19], participants were asked to indicate their level of “recovery” from their loss: to what extent they thought they had “got over” the death. Participants who blamed themselves more for the death also reported poorer recovery. Again, these studies also relied on single item measures at a single time-point.


More recently, adopting a measure with better psychometric properties, the self-blame subscale of the Grief Cognition Questionnaire, Boelen and colleagues [15],[20] found that higher self-blame was correlated with higher psychological distress (using the depression subscale of the SCL and anxiety subscales of the SCL-90), as well as more severe grief reactions (on an established grief scale, see [21]). However, these investigations were also cross-sectional, so no statements could be made about the impact of self-blame on grief (or vice versa).


The strongest evidence comes from longitudinal investigations, given that causal connections can be more firmly established than in cross-sectional ones. The available longitudinal studies have focused on whether self-blame during the early stages of bereavement predicts later adjustment. In a classic early study by Horowitz et al [22], attributions of blame for the death were investigated. Bereaved adult children with severe grief who had sought (and were receiving) treatment were compared with a bereaved non-patient, so-called “field”, control group. Participants' self-blame and psychological distress were evaluated over time until just over a year after loss. Psychological distress was assessed using a battery of symptom measures, including clinicians' ratings and scales such as the SCL-90 and Impact of Event Scale. Those who attributed more responsibility for the death to themselves, showed a slower decline in psychological symptoms, the effect being stronger for patients than field participants [22]. This study investigated self-blame as a predictor, not its course over time. Thus, only self-blame assessed at the first point in time was used to predict the decline of psychological distress. Furthermore, only general mental health, but not grief reactions, was examined. Finally, a point which applies to studies using the total SCL, is that this symptoms list contains two (or one, in short versions) items on guilt: blaming oneself for a variety of things and feeling guilty. So, unless excluded (to our knowledge only Boelen et al. [15] did so), there is conceptual overlap between this and guilt measures, which would increase the likelihood of a positive relationship being found between these variables.


Two more recent studies by Field and colleagues, using a very different methodology, have provided further evidence regarding the predictive value of self-blame on adjustment to bereavement [8],[7]. Field et al. examined the content of bereaved spouses' monologues directed toward the deceased, 3–7 months after the death [8]. A higher degree of self-blame as coded from the spouses' narratives predicted higher grief symptoms (but not depression) at 14 months. In the Field and Bonanno follow-up investigation, it was found that self-blame 6 months after bereavement predicted grief symptoms as long as 5 years after the loss [7]. These studies were stringent in controlling for symptom levels at the first point of measurement. However, their index of self-blame was based on judges' assessments and not psychometrically-tested rating scales.


Not only are there methodological limitations in studies claiming a relationship between bereaved peoples' self-blame and general psychological distress, but some researchers have failed to find a negative influence between these two variables. Downey, Silver, and Wortman traced a group of bereaved parents at one, three and 18 months after the death of their child [23]. The concurrent correlation between self-blame and psychological distress (as measured on a shortened version of the SCL-90) was significant, while the longitudinal association was not. This included the entire depression subscale, which again contains one item on guilt (which was not deleted). Downey and colleagues concluded that there was no causal relationship between self-blame and maladjustment in bereavement. It is possible that self-blame was assessed too early in their study to have predictive validity, since it is common for people to experience high distress and negative cognitions soon after the death, which attenuate with time [24]. In fact, most of the studies assessed self-blame after at least 6 months. It is also noteworthy that the measure was not grief-specific but one “indexing generalized distress” [23](p. 929). By contrast, another more recent study compared people diagnosed with complicated grief with a group of healthy controls [25]. Here too, though, when self-blame was the focus, no significant difference between these groups was found. The study was cross-sectional. Taken together, the negative results reported in these investigations do not provide strong evidence against the hypothesis that self-blame is associated with higher general symptomatology or grief.

The role of regret in bereavement


Compared with the empirical studies on self-blame, there have been even fewer studies focusing on regret in bereavement. Again, longitudinal designs provide more conclusive evidence on the causal relationships between these variables than cross-sectional ones. One longitudinal study by Torges, Stewart, and Nolen-Hoeksema asked participants “Are there things you wish you had done differently?”, and found that reported regret was positively associated with depression [11]. Furthermore, the interaction between regret and time significantly predicted decrease in depressive symptoms. However, another recent study by Holland et al. [10] suggested that it is important to take the trajectory of regret over time into account in association with grief symptoms. These investigators measured grief reactions and frequency of regret felt by bereaved participants at four, 18 and 48 months after loss. They divided their participants into three groups, stable low regret, stable high regret, and worsening high regret. The worsening high regret group showed higher levels of grief symptoms at all three points in time and at 48 months, even higher levels than the stable high regret group. None of the regret trajectories was related to differences in depressive symptomatology.


Two cross-sectional studies [26],[27] have reported positive association between regret and psychological distress (including depression), and grief. However, both of these investigations combined items of regret and self-blame into one measure, thus giving little information on the unique role of regret. Moreover, only Japanese participants were included in these studies, which - while usefully extending investigation to another culture - raises the question about comparability of their findings with those of other studies, which have typically been conducted in western countries.


Conclusions

In summary, the results on the role of either self-blame or regret in bereavement have been quite discrepant, making it difficult to draw overall conclusions from the available literature. With respect to self-blame: Some investigations have suggested that it impacts on grief, with perhaps the strongest evidence coming from the Field studies[8],[9]. A relationship between self-blame and more general symptoms (depression in this study) was not found by these investigators, but others, such as Horowitz et al. [17], have found associations between such variables. Turning to regret: There are some indications of an association of regret with depression and with grief reactions, but firm conclusions are difficult to draw from the sparse literature specifically on regret.


In general, longitudinal investigation on the impact of either self-blame or regret on adjustment to bereavement has been scarce. The few available investigations over time have measurement shortcomings (e.g. single item measure and mixed items of self-blame and regret). Another shortcoming (linked to the general lack of longitudinal studies) is the paucity of information on the course of the self-blame and regret manifestations over time, for example, regarding whether they actually decline. Finally, some investigations have focused on grief-specific, others on more generic (e.g., depression) outcome variables with possible overlap of guilt in the latter studies. Although sadness and depression are important symptoms of grieving, they are neither the only nor necessarily the most important ones. There is some evidence that depression and grief are influenced by different aspects of the marital relationship. For example, Stroebe, Abakoumkin and Stroebe found that marital quality affected only yearning for the loved one who died, but not depression, whereas experiencing support from family and friends reduced depression but did not ameliorate yearning[28]. Therefore, there seem to be good reasons to include both types of outcome variables within one investigation.


**If you or someone you know is coping with feelings of guilt after losing a loved one please contact Therese Schmoll, M.A., LMFT, MFC50082, at 310-281-6977 today, for a consultation

***For more information about the Present Study taking place visit: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0096606

Source:


Stroebe M, Stroebe W, van de Schoot R, Schut H, Abakoumkin G, Li J (2014) Guilt in Bereavement: The Role of Self-Blame and Regret in Coping with Loss. PLoS ONE 9(5): e96606. https://doi.org/10.1371/journal.pone.0096606

Friday, April 7, 2017

Stress Management

Stress is a state of emotional strain resulting from a variety of circumstances. Family, work, friends, school, and various new life changes can contribute to stress. Signs of stress include feelings of sadness, anxiety, bodily pain, changes in sleeping patterns, illness, digestive problems, skin conditions, increased blood pressure, fluctuation in weight, reproductive issues, difficulty focusing, or trouble recalling memories.
With all these symptoms, it is important that you have an outlet to remove, or relieve, their stress level as it can have negative emotional and mental effects. Sustaining the emotional strain for too long can cause more serious symptoms, such as depression and chronic illness.
Techniques to Reduce Stress
1.      Name It: Dig deep and uncover what it is that is causing the stress. In what area of your life are you most stressed? Is it a particular person, place, or time of day? Is it caused by your own expectations about yourself or by the demands of others? Where in your body do you feel the stress (i.e. stomach feels nauseous)? Think about the times when your body tells you it is stressed; what are you doing / who are you with? Often, just by naming the stressor we begin to feel relief as it takes away its mystery and complexity thus allowing for clarity to the solution.
2.      Identify What is in Your Control: Take note of those things in which you can change to reduce stress. You may not be able to quit your job tomorrow but maybe you can organize your week so you do only do the stressful tasks a couple hours a day and more enjoyable tasks the majority of the day. Or perhaps you can hire a gardener to free up time on the weekends.
3.      Just say NO: Your time is valuable and precious. Understanding this will enable you to say no to the demands of others with confidence. There is no need to make excuses, apologize, or worry about disappointing others because it is your life priorities that come first.
4.      Treat Your Body Well: Countless studies have been conducted concluding that when people eat healthier, sleep well, and exercise (at least three times per week) they are more prepared to handle future stressful situations, reduce current levels of stress, and increase your energy level throughout the day.
5.      Schedule Play Time: Engaging in activities that you enjoy may seem like an inefficient use of your time however, research shows that when adults schedule in time to play (such as singing in the car, dancing while cooking, watching a movie, or engaging in a hobby) every day they experience reduced levels of stress, anxiety, and depression. 
6.      Mindfulness: Brotto (2013) defined mindfulness as, “present moment, non-judgmental awareness” (p.63). This state of being requires one to stay focused on the present, and to consciously shift away from any intrusive thoughts, good or bad, that may come into mind, so as to not stray from the present moment. Mindfulness and relaxation skills (such as deep breathing) have been found to reduce stress, depression, and anxiety by placing the individual in the present moment, and thereby allowing you to view stressful thoughts as fleeting events.
7.      Let it All Out: Talk therapy allows you to bring all your life stressors to the surface in a safe and confidential environment. Once this is done, you and your therapist work together towards reducing your stress level and increasing health and positivity in your life.

Therese Schmoll treats patients experiencing high stress levels in her practice. To schedule an initial consultation, please call her office at (310) 281-9677.



Resources
Brotto, L. A. (2013). Mindful sex. The Canadian Journal of Human Sexuality, 22(2), 63-68. doi:10.3138/cjhs.2013.2132
Brown, B. (2015). The gifts of imperfection. Tullamarine, Victoria: Bolinda Audio.
Relaxation techniques: Try these steps to reduce stress. (n.d.). Retrieved from http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-technique/art-20045368


Stress Management - Ways to Relieve Stress. (n.d.). Retrieved from http://www.webmd.com/balance/stress-management/stress-management-relieving-stress

Friday, March 10, 2017

Why The Narcissist Cheat

The Narcissist:
According to the Diagnostic and Statistical Manual of Mental Disorders (2013) Narcissistic Personality Disorder diagnostic criteria are as follows:
·         Persistent pattern of grandiosity
·         Requires disproportionate admiration.
·         Largely lacking in empathy or unwillingness to recognize others’ feelings.
·         Self-importance (unjustifiably high importance of ones self, their accomplishments, their abilities)
·         Requires acknowledgment of their preeminence with little corresponding accomplishments.
·         Consumed with fantasies of unparalleled beauty, success, intelligence, love and wealth. 
·         Feelings of being outside the norm and therefore can only be understood by those of prominence.
·         Self-entitled and expects special treatment.
·         Manipulative and exploitative of others for selfish needs.
·         Jealous and resentful of others and believes others are jealous of them.
 “Narcissism” originated from the Greek myth of Narcissus, who was a handsome young man who fell in love with his own reflection from the river water and remained there until he died (Editors of Encyclopedia Britannica, 2014). 

Narcissus, wall painting; from the House of Lucretius Fronto, Pompeii, Italy, ad 14-62.
Alinari/Art Resurse, New York
Freudian psychoanalysis of narcissism suggests that it is a necessary for all people to be narcissistic.  He believed that we are all driven by personal agendas and survival instincts; which he called primary narcissism.  In terms of personality and relationships Freud spoke of narcissistic love suggesting,
“A person may love: According to the narcissistic type:
·         What he himself is (himself)
·         What he himself was,
·         What he himself would like to be,
·         Someone who was once part of himself” (Jackson, 1995, p. 27)
It is because of this need for self-love and superiority at the expense of others, narcissism is often a predictor of infidelity.
Why Narcissist Cheat
Narcissistic people need to feel in control, have power over people, constantly requiring the admiration from others and their short attention span are just a few of the reasons narcissists are often not able to commit.  They often idealize their mates in the beginning of a relationship and set unreachable expectations for them.  Believing that their mate, "should meet his every sexual and emotional need 24/7/365, without fail. In his narcissistic and self-focused way, he doesn’t understand that his spouse may be juggling multiple priorities in addition to him and the relationship" (Diamond, 2010).  Once their partner does not meet their impossible expectations they feel entitled to look to someone else for someone who fills their needs. 
Another reason is that true intimacy cannot exist for them because they are not able to empathize with another person.  According to the investment model, commitment is made up of satisfaction, investments and alternatives.  “Narcissists perceive greater alternative to their relationships and this leads to lesser commitment (Campbell & Foster, 2002 in vous).  It is because narcissists are always looking for more admiration they are very aware of their alternatives and therefore seek them out. 
            From the admiration of others, a narcissistic person may gain an emotional high or rush.  Similar to a drug addiction, they are constantly looking to increase the high once they are desensitized to it.  Cheating then becomes sport like and can be described as “fun” by a narcissistic person.  They are energized from it and therefore are in a constant quest for praise and admiration.  Knowing they need admiration, like a car needs gas, a narcissistic person is always putting their best foot forward in order to attract their current or their future romantic conquests (Wood, 2008).
Rationalizing “Bad” Behavior
According Sperry (2003), when a person with Narcissistic Personality Disorder is confronted with their moral mishaps they rationalize their behaviors using eleven defense mechanisms such as, but not limited to, the following:
-Intellectualization: The client uses excessive abstract thinking, intellectual reasoning, or generalizations to control or minimize emotional discomfort.
-Repression: The client expels disturbing wishes, thoughts, or experiences from consciousness. The emotions may remain.
-Devaluation. The client attributes grossly exaggerated negative qualities to themselves or to others.
-Projection. The client falsely attributes to another person their own unacceptable feelings, impulses or thoughts. This is a protective measure to prevent the erosion of self.
-Rationalization. The client conceals their true motivations for their own thoughts, actions, or feelings through the elaboration of reassuring or self-serving but incorrect explanations” (Sperry, 2003).
From the narcissist’s perspective using these defense excuses their behavior and those around them accept it and will not prosecute them for it.  The narcissist, in turn, has gotten all he/she needs from the relationship and will continue to commit the bad behavior as long as they can rationalize it.  
            Although people with narcissistic personality traits feel little empathy for those they cheat on they are not purposely trying to hurt their partner.  It has very little to do with the partner at all because the narcissists does not naturally put themselves in the other persons shoes and therefore does not comprehend the trauma and pain they have caused their mate.

Therese Schmoll treats both narcissist and those in relationships with a narcissist in her practice. To schedule and initial consultation, please call her office at (310) 281-6977.


References
Campbell, W., & Foster, J. Narcissism and Resistance To Doubts About Romantic Partners. Journal of Research in Personality, , 550-557.

Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

Editors of Encyclop√¶dia Britannica. (2014, January 2). Narcissus (Greek mythology). Encyclopedia Britannica Online. Retrieved March 5, 2014, from http://www.britannica.com/EBchecked/topic/403458/Narcissus

Foster, C. A., & Campbell, W. K. (). Narcissism And Commitment In Romantic Relationships: An Investment Model Analysis. Personality and Social Psychology Bulletin, , 484-495.

Jackson, E. (1995). Calling the Question. Strategies of deviance studies in gay male representation. Bloomington: Indiana University Press.

Mayo Clinic Staff. (n.d.). Narcissistic personality disorder. Definition. Retrieved April 16, 2014, from http://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/basics/definition/con-20025568

Narcissistic Personality Disorder (NPD) Treatment, Symptoms, Causes - MedicineNet. (2012, May 31).MedicineNet. Retrieved April 3, 2014, from http://www.medicinenet.co m/narcissistic_personality_disorder/article.htm

Sperry, L. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders (2nd ed.). New York, NY: Brunner-Routledge.

Wood, J. V. (2008). Narcissism and Interpersonal Self-Regulation. The self and social relationships (). New York: Psychology Press.



Monday, February 13, 2017

The Sandwich Generation: How Therapy Can Help


The Sandwich Generation refers to the 6.5 million Americans who are caregivers to both elderly adult and child recipients. These caregivers are involved, at varying levels, with the physically and emotional wellbeing of their care recipients and responsible to complete daily tasks such as managing medications, completing personal errands, keeping up their hygiene, household chores, preparing meals, and managing finances. The level of one’s responsibility to a care recipient directly effects the caregivers level of stress, financial burden and his or her health.

Time Stress

In addition to the general responsibilities of a dual caregiver they have the additional pressures of, “finding time, energy, and resources to balance the competing demands of the needs of aging parents, the needs of dependent children, and responsibilities associated with work/careers” (Bowen & Riley, 2005, p. 53).

Financial Stress

With dual caregiving comes the need to financially support a multigenerational household. As an elderly care recipient ages, the level of care they require increases. Consequently, many caretakers feel forced to leave his or her career, or cut down hours worked, to accommodate for this need.  It is for this reason, in addition to financially supporting both his or her children and the dependent elderly person, that According to the National Alliance for Caregiving and the American Association of Retired Persons Public Policy Institute (2015) 18% of caregiver’s report having high stress regarding their financially strain (p. 54).

Deteriorating Health Stress

Due to the chronic high stress of a dual caregiver it is, “estimated that close to 50% of sandwich generation caregivers suffer from anxiety and depression (Chisholm, 1999, p. 179). The chronic stress of a dual caregiver is not static; it is ever changing and transmissible throughout their household.

Effects on the Caregivers Marriage and Family

            The dual caregivers aren’t the only ones effected by the pressures of caregiving, it is a shift in dynamics that the entire family experiences. One study found that the stress the caregiver is under at work correlates with the couple’s marital satisfaction (Hammer, Icekson, Neal & Pines, 2011, p. 380). However other studies have show that caregiving can bring a family closer together as they then are all working toward one common goal; the comfort of their elder family member. Findings show that young adults care recipients are home more often and form stronger bonds with their siblings though caretaking (Naud, 2008, p. 12).

Therapy Can Help

Giving caretakers an opportunity to discuss how their new role will or has impacted their relationships and careers is an important aspect of self-care. Therapist can assist caregivers with reducing anxiety via relaxation techniques and managing maladaptive thoughts (Akkerman & Ostwald, 2004, p. 122).
Multiple studies have been done on the effectiveness of talk therapy on a caregivers’ level of stress. Gaining further education about depression, dementia, stages of aging, coping skills and importance of self-care have been found to decreases stress level, depression and likelihood of elderly abuse (Pinquart & Sorensen 2006, p. 557). Caregivers who seek therapy, read self-help books, join a caregiving group or reach out to friends have been found to have lower levels of depression because they find they share similar experiences and have an outlet to express their feelings with others who can empathize (Pinquart & Sorensen, 2006, p. 581).


Resources

Akkerman, R. L., & Ostwald, S. K., (2004) Reducing anxiety in alzheimer’s desease family caregivers: The effectiveness of a nine-week cognitive-behavioral intervention. American Journal of Alzheimer’s Disease and Other Dementias, 19, 117-123. doi: 10.1177/153331750401900202
Bowen, C., & Riley, L.D., (2005). The sandwich generation: Challenges and coping strategies of multigenerational families. The Family Journal, 13, 52-58. doi: 10.1177/1066480704270099
Chisholm, J. F. (1999). The sandwich generation. Journal of Social Distress and the Homeless, 8, 177-180.
Hammer, L. B., Icekson, T., Neal, M. B., & Pines A. M. (2001). Job burnout and couple burnout in dual earner couples in the sandwiched generation. American Sociological Association, 74, 361-386.
Image. The Depression Tool Kit.(2016) Retrieved from
http://www.depressiontoolkit.org/news/depression_in_the_sandwich_generation.asp
National Alliance for Caregiving & AARP Public Policy Institute. (2015). Caregiving in the u.s 2015. Retrieved from http://www.caregiving.org/wp-content/uploads/2015 /05/2015_CaregivingintheUS_Final-Report-June-4_WEB.pdf
Naud, R., (2008). Caring for aging parents can bring families closer together: Sandwich generation. The Calgary Herald, p. 12. Retrieved from ibproxy.csun.edu/hottopics /lnacademic/?verb=sr&csi=8349&sr=HEADLINE(Caring+for+again+parents+can+bring+families+closer)%2BAND%2BDATE%2BIS%2B2008
Pinquart, M., Sorensen, S., (2006). Helping caregivers of persons with dementia: which interventions work and how large are their effects. International Psychogeriatrics, 18, p. 557-595. doi:10.1017/S1041610206003462.


Friday, September 16, 2016

Am I an Alcoholic? Self-Test

Am I Alcoholic Self-Test?
(Questions Provided by National Council on Alcoholism and Drug Dependence, Inc)

Do you try to avoid family or close friends while you are drinking?
YES or NO
Do you drink heavily when you are disappointed, under pressure or have had a quarrel with someone?
YES or NO
Can you handle more alcohol now than when you first started to drink?
YES or NO
Have you ever been unable to remember part of the previous evening, even though your friends say you didn't pass out?
YES or NO
When drinking with other people, do you try to have a few extra drinks when others won't know about it?
YES or NO
Do you sometimes feel uncomfortable if alcohol is not available?
YES or NO
Are you more in a hurry to get your first drink of the day than you used to be?
YES or NO
Do you sometimes feel a little guilty about your drinking?
YES or NO
Has a family member or close friend expressed concern or complained about your drinking?
YES or NO
Have you been having more memory blackouts recently?
YES or NO
Do you often want to continue drinking after your friends say they've had enough?
YES or NO
Do you usually have a reason for the occasions when you drink heavily?
YES or NO
When you're sober, do you sometimes regret things you did or said while drinking?
YES or NO
Have you tried switching brands or drinks, or following different plans to control your drinking?
YES or NO
Have you sometimes failed to keep promises you made to yourself about controlling or cutting down on your drinking?
YES or NO
Have you ever had a DWI driving while intoxicated or DUI driving under the influence of alcohol violation, or any other legal problem related to your drinking?
YES or NO
Are you having more financial, work, school, and/or family problems as a result of your drinking?
YES or NO
Has your physician ever advised you to cut down on your drinking?
YES or NO
Do you eat very little or irregularly during the periods when you are drinking?
YES or NO
Do you sometimes have the shakes in the morning and find that it helps to have a little drink, tranquilizer or medication of some kind?
YES or NO
Have you recently noticed that you can't drink as much as you used to?
YES or NO
Do you sometimes stay drunk for several days at a time?
YES or NO
After periods of drinking do you sometimes see or hear things that aren't there?
YES or NO
Have you ever gone to anyone for help about your drinking?
YES or NO
Do you ever feel depressed or anxious before, during or after periods of heavy drinking?
YES or NO
Have any of your blood relatives ever had a problem with alcohol?
YES or NO

Disclaimer:  The results of this self-test are not intended to constitute a diagnosis of alcoholism and should be used solely as a guide to understanding your alcohol use and the potential health issues involved with it. The information provided here cannot substitute for a full evaluation by a health professional.

To Take the actual self-assessment online and see your results go to:


Ms. Therese Schmoll treats many alcoholics in recovery in her practice.  To schedule an initial consultation, please call her office at (310) 281-6977. 

Wednesday, September 14, 2016

Worldview Survey


(This survey is to be used for entertainment purposes only.)


Rate your world view:

1. I am optimistic about my future?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

2. People who care about me tell me that I have a lot of positive view points?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

3. If something can go wrong for me, it will?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

4. I expect more good things to happen to me than bad?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

5. I hardly ever expect things to go my way?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

6. I rarely count on good things happening to me?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

7. When something misfortunate happens to me, I begin to think that more
misfortune will come my way?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

8. I am more likely to see the strengths in myself than the weakness in myself:
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

9. If something can go wrong for me in the future, it will:
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

10. When I do not succeed at a new skill, I think that I am “stupid?”:
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

11. When some misfortune happens to me, I think that it is “my fault?”
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

12. I encounter more unhappy experiences than happy experiences?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

13. Things go my way most of the time?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

14. In uncertain times, I can expect the best?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

15. If something misfortunate happens to me, I expect the same outcome in
a similar situation?
a. strongly disagree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

16. I rarely count that good things will happen to me?
a. strongly agree;
b. disagree:
c. neither agree or disagree;
d. agree;
e. strongly agree

17. I see myself with more weaknesses than strengths?
a. strongly agree;
b. disagree;
c. neither agree or disagree;
d. agree;
e. strongly agree

18. During times of transition, I expect the worse?
a. strongly agree;
b. disagree;
c. neither agree or disagree;
d. disagree;
e. strongly disagree

19. Over the last several years I have had more positive experiences than I have had negative experiences:
a. strongly agree;
b. agree;
c. neither agree or disagree;
d. disagree;
e. strongly disagree

20. Over the last several years I have had more negative experiences than I have had positive experience:
a. strongly agree;
b. agree;
c. neither agree or disagree;
d. disagree;
e. strongly disagree

Here is how to score your answers:

For numbers: 1, 2, 4, 7, 8, 13, 14, 16, 17 and 19 assign points to your answers as follows:

a. 1 point;
b. 2 points;
c. 0 points;
d. 3 points;
e. 4 points

For numbers: 3, 5, 2, 9, 10, 11, 12, 15, 18 and 20 assign points to your answers as follows:
a. 4 points;
b. 3 points;
c. 0 points;
d. 2 points;
e. 1 point

So, what is your world view?

Point Scale

80 points-60 points: Optimistic: You tend to take the most hopeful views of a matter; 59 points-39 points: Realistic: You tend to look at the actual existence of a matter; 38 points-20 points: Cynical: You tend to find fault in the matter; 19 points-0 points: Pessimistic: You tend to take negative, skewed view of a matter.

Survey Created By: Therese L. Schmoll, M.A., LMFT MFC50082.