What is Drug Rehabilitation

What is Drug Rehabilitation

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Drug rehabilitation (often drug rehab or just rehab) is the processes of medical or   psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cocaine, heroin or amphetamines.

The general intent is to enable the patient to confront substance dependence, if present, and cease substance abuse to avoid the psychological legal, financial, social, and physical consequences that can be caused, especially by extreme abuse. Treatment includes medication for depression or other disorders, counseling by experts and sharing of experience with other addicts.

 

Psychological dependency-

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged, or possibly even required, to not associate with friends who still use the addictive substance.

Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but also to examine and change habits related to their addictions. Many programs emphasize that recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized, (“One is too many, and a thousand is never enough.”)

 

Types of treatment

The brain’s chemical structure is impacted by drugs of abuse and these changes are present long after an individual stops using, this change in brain structure increases risk for relapse, making treatment an important part of the rehabilitation process.

 

Various types of programs offer help in drug rehabilitation, including:

1)            Residential treatment (in-patient/ out-patient),

2)            Local support groups,

3)            Extended care centers,

4)            Recovery or sober houses,

5)            Addiction counselling,

6)            Mental health and medical care.

For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems.

 

Rehab pathways.

 

Types of behavioral therapy include:

Cognitive-behavioral therapy, which seeks to help patients to recognize, avoid and cope with situations in which they are most likely to relapse.

Multidimensional family therapy, which is designed to support recovery of the patient by improving family functioning.

Motivational interviewing, which is designed to increase patient motivation to change behavior and enter treatment.

Motivational incentives, which uses positive reinforcement to encourage abstinence from the addictive substance.

Treatment can be a long process and the duration is dependent upon the patient’s needs and history of abuse. Research has shown that most patients need at least 3 months of treatment and longer durations are associated with better outcomes.

Medications

Medicines are maintenance therapies intended to reduce cravings for opiates, thereby reducing illegal drug use, and the risks associated with it, such as disease, arrest, incarceration, and death, in line with the philosophy of harm reduction. Both drugs may be used as maintenance medications (taken for an indefinite period), or used as detoxification aids.

 

A few antidepressants have been proven helpful in the context of smoking cessation/nicotine addiction; these medications include bupropion and nortriptyline.

Residential treatment

In-patient residential treatment for alcohol abuse is usually quite expensive without proper insurance. Most American programs follow a traditional 28–30 day program length. The length is based solely upon providers’ experience in the 1940s that clients needed about one week to get over the physical changes, another week to understand the program, and another week or two to become stable. 70 to 80 percent of American residential alcohol treatment programs provide 12-step support services.

These include, but are not limited to AA, NA, CA, Al-Anon. One recent study suggests the importance of family participation in residential treatment patient retention, finding “increased program completion rate for those with a family member or significant other involved in a seven-day family program.”

 

 

 

Recovery

The definition of recovery remains divided and subjective in drug rehabilitation, as there are no set standards for measuring recovery. The Betty Ford Institute defined recovery as achieving complete abstinence as well as personal wellbeing while other studies have considered “near abstinence” as a definition.

 

Counseling

Traditional addiction treatment is based primarily on counseling.

Counselors help individuals identifying behaviors and problems related to their addiction. It can be done on an individual basis, but it is more common to find it in a group setting and can include crisis counseling, weekly or daily counseling, and drop-in counseling supports. They are trained to develop recovery programs that help to reestablish healthy behaviors and provide coping strategies whenever a situation of risk happens. It is very common to see them work also with family members who are affected by the addictions of the individual, or in a community to prevent addiction and educate the public. Counselors should be able to recognize how addiction affects the whole person and those around him or her.

 Counseling is also related to “Intervention”; a process in which the addict’s family requests help from a professional to get this person into drug treatment. This process begins with one of this professionals’ first goals: breaking down denial of the person with the addiction. Denial implies lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, besides of continuing the destructive behavior. Once this has been achieved, professional coordinates with the addict’s family to support them on getting this family member to alcohol drug rehabilitation immediately, with concern and care for this person. Otherwise, this person will be asked to leave and expect no support of any kind until going into drug rehabilitation or alcoholism treatment. An intervention can also be conducted in the workplace environment with colleagues instead of family.

One approach with limited applicability is the Sober Coach. In this approach, the client is serviced by provider(s) in his or her home and workplace – for any efficacy, around-the-clock – who functions much like a nanny to guide or control the patient’s behavior.

Twelve-step programs (12 steps)–

The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939.

 

 

 SMART Recovery

Joe Gerstein founded SMART Recovery in 1994 by basing REBT as a foundation. It gives importance to the human agency in overcoming addiction and focuses on self-empowerment and self-reliance. [32] It does not subscribe to disease theory and powerlessness. The group meetings involve open discussions, questioning decisions and forming corrective measures through assertive exercises. It does not involve a lifetime membership concept, but people can opt to attend meetings, and choose not to after gaining recovery. Objectives of the SMART Recovery programs are:

  1. Building and Maintaining Motivation.
  2. Coping with Urges.
  3. Managing Thoughts, Feelings and Behaviors.
  4. Living a balanced Life.
  5. This is considered similar to other self-help groups who work within mutual aid concepts.
  6. Client-centered approaches

In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items in the therapeutic relationship could help an individual overcome any troublesome issue, including alcohol abuse. To this end, a 1957 study compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Though the authors expected the two-factor theory to be the most effective, it actually proved to be deleterious in outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques per se.[37] The authors note two-factor theory involves stark disapproval of the clients’ “irrational behavior” (p. 350); this notably negative outlook could explain the results.

A variation of Rogers’ approach has been developed in which clients are directly responsible for determining the goals and objectives of the treatment. Known as Client-Directed Outcome-Informed therapy (CDOI), this approach has been utilized by several drug treatment programs

Relapse prevention

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach.

 Marlatt describes four psychosocial processes relevant to the addiction and relapse processes:

  1.  self-efficacy,
  2. outcome expectancies ,
  3.  attributions of causality, and
  4.  decision-making processes.

Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs that relapse to drug use is a result of internal, or rather external, transient causes (e.g., allowing oneself to make exceptions when faced with what are judged to be unusual circumstances). Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant.

 

Cognitive therapy-

An additional cognitively based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book Cognitive Therapy of Substance Abuse. This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.

Emotion regulation and mindfulness

Acceptance and commitment therapy (ACT) is showing evidence that it is effective in treating substance abuse, including the treatment of poly-substance abuse and cigarette smoking. Mindfulness programs that encourage patients to be aware of their own experiences in the present moment and of emotions that arise from thoughts appear to prevent impulsive/compulsive responses. Research also indicates that mindfulness programs can reduce the consumption of substances such as alcohol, cocaine, amphetamines, marijuana, cigarettes and opiates.

Behavioral models

Community Reinforcement Approach and Family Training

Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models exists for both working with the substance abuser (Community Reinforcement Approach) and their family (Community Reinforcement Approach and Family Training). Both these models have had considerable research success for both efficacy and effectiveness. This model lays much emphasis on the use of problem solving techniques as a means of helping the addict to overcome his/her addiction.

if you had any question regarding Drug  Rehabilitation ,feel free  to contact us ,at given below address.

 

 

Drug Detoxification

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Detoxification is the process of safely removing addictive drugs from an individual’s body.

 

Definitions

Addiction is a chronic disease of the brain, which involves compulsive and uncontrolled pursuit of reward or relief with substance use or other compulsive behaviors.

 

Anxiety is a negative emotional state characterized by feelings of nervousness, worry, and apprehension about imagined danger.

 

Benzodiazepines are a class of drugs slow the nervous system and

are prescribed to relieve nervousness and tension, to induce sleep, and to treat other symptoms. They are highly addictive.

 

Recovery is a series of steps an individual takes to improve his or her wellness and health  while living a self-directed life and striving to reach his or her highest potential.

 

Seizure is an episode of abnormal electrical activity in the brain that results in changes in the brain and in behavior.

 

Description

 

Detoxification is the process of removing toxic substances (e.g., drugs, alcohol, mind-altering chemicals) from an individual’s body, usually, under the care of a physician. Individuals who use drugs or alcohol can develop a physical dependence over time. Abruptly stopping the use of alcohol and drugs can result in significant withdrawal symptoms. It is extremely important for an individual with an addiction who is going through the detoxification process to be observed and treated by a health-care professional, as several drugs  can result in life-threatening situations. For example, an individual who consumes alcohol or benzodiazepines on a daily basis can have a seizure if the individual abruptly stops using the substance on his or her own. Often, an individual will be prescribed a medication  while being treated for detoxification so that he or she is more comfortable and also that he or she does not experience a seizure.

 

When an individual becomes physically dependent on drugs or alcohol, the individual may experience severe withdrawal symptoms when he or she stops  using. Depending on the drug being abused, symptoms will vary. For example, an individual who is withdrawing (detoxifying) from heavy use of alcohol may experience increased heart rate, difficulty sleeping, anxiety, shaking, and seizures. An individual who is withdrawing from benzodiazepines may experience difficulty sleeping, muscle cramps, irritability, restlessness, seizures, and even death. The first step to recovery for individuals with addiction is detoxification.

 

Treatment

 

Treatment for detoxification is designed to remove toxins that are left in the body. An individual can go through the process of detoxification at several facilities(e.g., private clinics, addiction clinics, and mental health centers). An individual can also participate in an inpatient or outpatient treatment program for detoxification.

This option is very beneficial because medical staff closely observes individuals. Furthermore, individuals are more likely prevented from using alcohol or drugs in an inpatient or outpatient program. Typically, the detoxification process can take less time when participating in an inpatient or outpatient treatment program.

if you have any questions in this regard feel free to contact at given address.

 

Relaxation therapy

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Relaxation therapy is a practice by which anxiety or tension in the mind is released in order to improve physical and mental health.

 

Definitions

 

Mindfulness is the moment-by-moment awareness of one’s thoughts, feelings, sensations,and environment without evaluating or judging them.

 

Relaxation is the state of being free from tension and anxiety or the restoration of equilibrium following emotional disturbance.

 

Stress management is a set of psychological techniques for increasing the capacity to better cope with psychological stress. It usually includes relaxation methods.

 

Description

During the 20th century, a group of famous yogis brought eastern meditative approaches to the West.These approaches were an alternative and a challenge to some of the practices of Western medicine. Therefore, groups began to develop a plan to legitimize relaxation and meditative practices through scientific study.

When research on meditation was conducted by medical practitioners at many universities, it turned out that quieting the mind and body helped subjects in achieving a state of physical and mental relaxation.

 

These states of relaxation led to faster and better healing,  both physically and psychologically. With scientific research to support its effectiveness, relaxation, meditation, and mindfulness therapies are now proven therapeutic approaches and recommendations for those with mental and physical disorders. It is now practiced in many clinical settings under a variety of different names and with slightly different approaches.

 

Development

 

Dr. Edmund Jacobson was the first American physician to become widely known for using relaxation therapy as a therapeutic technique. He began using it especially to  release tension from muscle groups. His seminal work  Progressive Relaxation was published in 1938. In the 1950s, Dr. Joseph Wolpe, a behavior therapist, used similar ideas and therapeutic techniques to help treat anxiety and other behavioral disorders. Progressive relaxation became an effective method of stress management.

 

One of the most famous American physicians and advocates of relaxation therapy is Dr. Herbert Benson. He first published his popular book The Relaxation Response  in 1976. It was based on the teachings of Maharishi Mahesh Yogi and his transcendental meditation  that became very popular as a cultural phenomenon in the early 1970s. Cultural icons such as the Beatles went to India and learned from the Maharishi. In part, this helped popularize meditation and relaxation approaches among young people.

 Dr. Benson’s success was partly based on his ability to clearly explain the benefits of meditative relaxation. He could scientifically describe and show how the regular practice of relaxation therapy, with or without  spiritual roots, could help treat a wide range of stress-related disorders. Dr. Benson went on to found  Harvard University’s Mind Body Medical Institute to study the methods and effects of meditation, mindfulness, and similar therapies on healing.

Current Status

Today many hospitals and clinical settings regularly use  or recommend the use of meditation or relaxation techniques. These recommendations are made to decrease  tension as a key factor in the promotion of recovery and better health. In clinical trials, patients suffering a diverse range of problems, from cardiac and cancer patients to those suffering from depression and anxiety disorders, all showed significant improvement through the use of relaxation therapy. With these results, it is no wonder that at least 20 million Americans practice meditation, yoga, and other methods of relaxation as asystematic treatment to prevent problems experienced by the mind and body.

 

If you want to learn Relaxation method you contact our team and can book appointment on WhatsApp.

 

Alcoholics Anonymous AA

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Alcoholics Anonymous (AA) is a self-help fellowship  that was founded by Bill Wilson and Dr. Bob Smith in  1935 to help people struggling with alcoholism.

 Definitions

 Addiction is a chronic disease of the brain which involves compulsive and uncontrolled  pursuit of reward or relief with substance use or other compulsive behaviors.

 Alcoholism is a general term for the compulsive and uncontrolled consumption of alcohol  to the detriment of the drinker’s health, relationships, and social standing.

 Self-help fellowship is a community in which individuals struggling with the same problem (e.g., alcoholism) help one another. It is also known as a mutual aid fellowship.

 Temperance movement was a national crusade that encouraged total abstinence from alcohol.

 Twelve Steps refer to the 12 guiding principles on which AA is based.

 Twelve-Step Programs are self-help groups whose members attempt recovery from various addictions based on a plan called the Twelve Steps.

 Twelve Traditions are the rules that govern how Twelve-Step Program groups operate.

 Description

Alcoholics Anonymous is a mutual aid fellowship intended to help people with alcohol problems. AA is the first of many Twelve-Step Programs based on it. AA developed from an early 20th-century temperance movement called the Oxford Group.

Members believed that alcoholism was a spiritual illness rather  than the result of a weak will. They proposed a spiritual program that involved accepting a higher power and helping others. Many of these practices were carried over to AA.

AA members assist one another through sharing personal experiences, offering guidance, and  sponsorship. This generally takes place during attendance at AA meetings, which may focus on member’s stories, the Twelve Steps, or some other topic  

 

The AA fellowship is nonprofessional and does not employ doctors, counselors, or any other type of trained helper. A main principle of AA is that an alcoholic is best suited to understand and help another

alcoholic. AA is not considered to be formal  treatment but rather an additional method of support.

 

AA groups operate independently from one another, though there is a small governing body based in NewYork. The organization does not take part in political,religious, or any other kind of debate. This is toprotect its stated primary purpose of helping alcoholics achieve sobriety. AA claims that its current membership is nearly 2 million people worldwide. There are AA meetings in many different countries and those which cater to specific genders, age groups,and sexual orientations. 

The core of AA is the Twelve Steps and Twelve   Traditions. These have remained unchanged since their  original format. The Twelve Steps focus on the process  of addiction recovery. They include tasks such as admitting  powerlessness, completing a moral inventory, making amends to those who were harmed, and helping  other alcoholics. For example, 

Step 1 is “We admitted  we were powerless over alcohol—that our lives had become  unmanageable.”

 The ultimate goal of the Twelve Steps is to achieve a spiritual awakening which will help the alcoholic remain sober. The Twelve Traditions  focus on AA’s organizational principles. They include maintaining anonymity in the press, staying out of public  debates, and declining outside financial contributions. 

Both the Twelve Steps and Twelve Traditions  are found in Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism.

 This text is popularly called the “Big Book” by AA members. It is frequently read during AA meetings and contains chapters devoted to employers, unbelievers, and the family members of alcoholics.

 Bill Wilson (1895–1971) was a founding member  of AA. Born in East Dorset, Vermont, Wilson was a shy man who struggled with depression and anxiety throughout his young adult years. He served in the military during World War I and enrolled in law school on his return home. To deal with his increasing social anxiety in law school, Wilson drank excessively. The result was being dismissed from law school for drunkenness.

After that he worked as a stock speculator and traveled the country with his wife, Lois. His drinking continued to worsen, resulting in financial failure and numerous hospitalizations at Towns Hospital in New York.

It was during one of these hospitalizations that he was reacquainted with Ebby Thatcher (1896–1966), an old friend who had stopped drinking with the help of the Oxford Group.  

Wilson continued to drink until he had what he described as a “spiritual experience” during another hospitalization. He reported that he saw a bright light and felt the presence of God. Wilson never drank again after this event. He joined the Oxford Group and helped another alcoholic, Dr. Bob Smith (1879–1950), during a business trip to Akron, Ohio, in 1935. The two began helping other alcoholics and promoting a spiritual program of recovery. They eventually split from the Oxford Group and started their own fellowship with the publication of Alcoholics Anonymous. Wilson was the primary author of this book, which contained the original Twelve Steps.

Bill Wilson continued to develop the AA program throughout his lifetime and remained a central figure in the movement.

Here I had given small introduction about AA .If you want to know more let me know.

 

Addiction Counseling

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Addiction counseling is therapy provided to people   who are dependent on the use of one or more substances or activities.

 

Definitions

Addiction is a chronic disease of the brain which involves compulsive and uncontrolled   pursuit of reward or relief with substance use or other compulsive behaviors.

Addiction recovery is the state of abstinence   from addictive behaviors, usually achieved through self-reflection and spiritual,exploration.

Relapse is the recurrence of symptoms after a period of improvement or recovery.

Sober means not consuming alcohol and drugs or engaging in other addictive activities.

 

Description

 

The American Medical Association defines addiction  as a chronic disease with physical and emotional factors  that impair control over the use of substances. Some examples of substances and activities people can become addicted to are alcohol, drugs, sex, gambling, and the  Internet. For addiction counselors working with people who are substance dependent or abusive is difficult because of a high rate of relapse, defensiveness, and a lack of research as how to best treat the conditions. The   addiction counselor offers a different view and believes   the problem of addiction is how you respond or fail to respond to substances and treatment. Addiction counseling rests on the idea that alcohol and drug problems  become independent of their beginnings.  In counseling training, students have been taught to remove their own experience from the client’s recovery processes. In addiction counseling there is more of a demand for personal involvement than seen in other counseling professions. Providing hope is a crucial dimension for addiction counselors as they offer themselves as “living proof” of hope. It is important to model the potential for long-term recovery   through their own story and by guiding the client to a community of people in recovery.

 

Addiction counselors are exposed to many frustrations   and losses. First, there is a high mortality rate of substance   abusers. Many counselors use these experiences   to deepen their understanding of the nature of addiction   and to recommit themselves to finding new ways to reach their clients. Addiction counselors are aware that their   clients are often involved in a life or death struggle for recovery. The stakes involved in this work are high and   awareness brings its own burdens and rewards.

 

There are several rituals that are considered best practice for addiction counselors. These activities

include rituals such as prayer, meditation, and self-reflection.  Also included are mirroring rituals like

reaching out to others for support and inspiration. Acts of self-care for the body and mind are also important  for addiction counselors. Lastly, unpaid acts of service   such as serving as a sponsor or giving back to the recovery community are valued.

 

 

  

Development

As early as 1774, the effects of alcohol abuse were   known to be devastating. Substance-related problems

in the United States began with the attack on Native  Americans in the 18th and 19th centuries. Treatments   for these problems at the time included use of native medicines, religion, and limiting its use and availability.

 

Addiction counseling started as a grassroots recovery  community. Therapy with this population began in

1913 at a church in Boston with religious leaders called   the Oxford Group. However, most laypeople believe  that alcohol and drug treatment did not begin until the founding of Alcoholics Anonymous (AA) in 1935. Bill  Wilson and Bob Smith used the Oxford Group as a  model when they founded AA with a shift away from  religion. AA viewed alcoholics as having an allergy to  alcohol, which formed the basis of the disease or medical   model. This was a change in the view of alcoholism, which had  previously been viewed as a moral weakness

.

Soon after AA was founded, members began to be  employed at substance abuse treatment centers.

In the early days alcoholics did not go to treatment   centers through AA; they simply went through a

detoxification process. This usually occurred in their   local hospital, and from there most were referred to AA   meetings. Supporters of AA and other Twelve-Step   groups, believe it is the most effective way of treating  addiction and should be the primary treatment  program.  

Accordingly, it became the norm that clients needing help with alcoholism or substance abuse were referred to. This often was recommended instead of professional help or as an add-on to addiction counseling treatment.

In the 1940s it became clear that a definition and   formalization of the addiction counselor should occur.

The next major event in the treatment and counseling of alcoholics and other drug abusers was the opening  of the Hazelden Treatment Center in Minnesota in1949.  

Hazelden developed what later became known as the Minnesota Model. This model includes a combination of therapy, spirituality, group treatment, and the Twelve Steps. At Hazelden they integrated recovering,non  professionally trained counselors as part of the alcoholism  treatment team. In 1954 addiction counselors  were provided a professional role in Minnesota and  other states later followed. The Substance Abuse and  Mental Health Services Administration reports that  today most residential treatment centers are a variation  of the Minnesota Model. 

Current Status 

Currently, AA has over 115,000 independent groups   throughout the world, with over 2,100,000 members (Alcoholics Anonymous, 2010). In the field of substance   abuse there are three main approaches to addiction  counseling. The traditional approach is the   disease model which treats the addiction in the same medical model as other conditions. The research approach   seeks the scientifically supported methods to treatment. And last, the managed care approach wants to identify the greatest benefit for the least cost.

These three movements conflict with one another, resulting in unrest among professional addiction counselors.

The medical model believes in dependency   where the research approach finds there is not enough

evidence to support the claim. The managed care approach   is unlikely to pay for anything that is highly

disputed among professionals. Therefore, the conflicts   in the field have led to difficulty in uniting and identifying common goals in addiction counseling.

 If you need Addiction counseling,can contact us .

Are you Social Media Addict ?Yes or No

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“Internet Addiction” is mentioned on more than 26 million websites, with those at risk suffering from depression, bipolar disorder, anxiety, low self-esteem, or addiction to substances, at least previously. Online surveys find that 4 to 10 percent of users meet criteria for “Internet addiction,” defined as having at least five of the following signs and symptoms:

(1) preoccupation with the Internet,

(2) increasing amount of time spent online,

(3) failure to cut back use with concomitant restlessness,

(4) moodiness or depression,

(5) staying online longer than originally intended,

(6) running the risk of losing a job, relationship, or other opportunity because of Internet use, and

(7) lying to conceal the extent of Internet use and/or using the Internet to escape

negative feelings.

 

Social Media Addiction

 Mobile social media offer a large number of experiences from a psychological viewpoint, each with powerful features that can lead to problem behavior. For example, the extrovert might spend much time on Facebook, compulsively checking  their profile to see the number of ‘likes’ their latest post received.

For others, with a narcissistic inclination, Instagram may prove to be an addictive medium for them to display themselves to others with ‘selfies.’ Social anxiety can also fuel social media addiction. The fear of missing out (FOMO) can be the main  reason for frequent social media use regardless of time of day at the expense of other activities.

 The mobile phone can be used while walking, riding on public transportation and even while driving. These ‘micro – time slots’ in which people can engage in a multitude of online  activities were not previously available. This can lead to obsessive mobile phone usage and can interfere with face-to-face interaction and harm academic performance.

 

 

Research on problematic mobile media usage is limited but has attracted increasing attention recently. A study of Taiwanese female university students, for example, found that students, who scored high on a test of mobile phone addiction, showed more extraversion and anxiety, and somewhat lower-self-esteem (Fu-Yuan and Chiu, 2012). Women seem to be more vulnerable to mobile phone addiction than men.

A Likert scale consisting of fourteen items was used to measure social media addiction. This scale was based on  Young’s (1996) measurement of Internet addiction.

Table given below shows the items

 

1 I often find myself using social media longer than intended YES NO
2 I often find life to be boring without social media.    
3 I often neglect my schoolwork because of my usage of social media    
4 I get irritated when someone interrupts me when I am using social media    
5 Several days could pass without me feeling the need to use social media.    
6 Time passes by without me feeling it when I am using social media    
7 .I find it difficult to sleep shortly after using social media    
8  I would be upset if I had to cut down the amount of time I spend using social media.    
9 My family frequently complain of my preoccupation with social media    
10  My school grades have deteriorated because of my social media usage    
11 I often use social media while driving.    
12  I often cancel meeting my friends because of my occupation with social media.    
13 I find myself thinking about what happened in social media when I am away from them.    
14 I feel my social media usage has increased significantly since I began

using them

   

 

Hours Spent Using Social Media per Day

Respondents were asked a single question about the total  number of hours spent using social media daily on an  eight-point scale:

(1) less than two hours,

(2) from two to 4 hours,

(3) from 4 to 6 hours,

(4) from 6 to eight hours,

(5) from eight to 10 hours,

(6) from 10 to 12 hours,

(7) from 12 to 14hours,

(8) more than 14 hours.

 Social medium used  in preference by people.

1)Whatsapp

2)Instagram

3)Twitter

4)Others

 

Treatment for Internet Addicts. A subset of web pages offer a chance to evaluate  one’s Internet use as possibly pathological and offer both education and online counseling, with some urging face-to-face counseling as a way of

becoming less involved with the Internet.

Treatment is similar to other addictions, using  a)motivational interviewing, B)  cognitive behavior and other psychotherapies.

Medication occasionally is used for associated anxiety and depression.

Twelve Step groups modeled on Alcoholics Anonymous offer face-to-face

support.

 

After reading the article, if  you find that you or your friend  having this problem. You can contact us.

Rape trauma syndrome -Demand Death sentance.

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Rape Is Not about Sex, It is about Control.

 

Rape trauma syndrome (RTS) is the psychological trauma experienced by a rape victim that includes disruptions to normal physical, emotional, cognitive, and interpersonal behavior.

The theory was first described by psychiatrist ANN W Burgess and sociologist Lynda Lytle Holmstrom in 1974. 

RTS is a cluster of psychological and physical signs, symptoms and reactions common to most rape victims immediately following and for months or years after a rape. While most research into RTS has focused on female victims, sexually abused males (whether by male or female perpetrators) also exhibit RTS symptoms. 

RTS paved the way for consideration of (PTSD) post-traumatic stress disorder, which can more accurately describe the consequences of serious, protracted trauma than PTSD alone.

 The symptoms of RTS and post-traumatic stress syndrome overlap. As might be expected, a person who has been raped will generally experience high levels of distress immediately afterward. These feelings may subside over time for some people; however, individually each syndrome can have long devastating effects on rape victims and some victims will continue to experience some form of psychological distress for months or years. It has also been found that rape survivors are at high risk for developing substance use disorders, major depression, generalized anxiety disorder, obsessive-compulsive disorder, and eating disorders. 

RTS identifies three stages of trauma a rape survivor goes through: the acute stage, the outer adjustment stage, and the renormalization stage.

 

Acute stageThe acute stage occurs in the days or weeks after a rape. Durations vary as to the amount of time the victim may remain in the acute stage. The immediate symptoms may last a few days to a few weeks and may overlap with the outward adjustment stage.

 Behavior present in the acute stage can include:

·         Diminished alertness.

·         Numbness. Severe Anxiety.

·         Dulled sensory, affective and memory functions.

·         Disorganized thought content.

·         Vomiting

·         Nausea.

·         Pronounced internal tremor.

·         Obsession to wash or clean themselves.

·          Confusion and crying.

·         Bewilderment.

 The outward adjustment stage

Survivors in this stage seem to have resumed their normal lifestyle. However, they simultaneously suffer profound internal turmoil, which may manifest in a variety of ways as the survivor copes with the long-term trauma of a rape.

The outward adjustment stage may last from several months to many years after a rape.

RAINN identifies five main coping strategies during the outward adjustment phase:

·         Pretending ‘everything is fine’-Minimization.

·         Cannot stop talking about the assault-Dramatization.

·         Refuses to discuss the rape-Suppression

·         Analyzes what happened-Explanation

·         Moves to a new home or city, alters appearance-Flight.

Lifestyle-

Survivors in this stage can have their lifestyle affected in some of the following ways:

·         Their sense of personal security or safety is damaged.

·         They feel hesitant to enter new relationships.

·         Sexual relationships become disturbed.] Many survivors have reported that they were unable to re-establish normal sexual relations and often shied away from sexual contact for some time after the rape. Some report inhibited sexual response and flashbacks to the rape during intercourse.

·         Conversely, some rape survivors become hypersexual or promiscuous following sexual attacks, sometimes as a way to reassert a measure of control over their sexual relations.

 

Reorganization stage-

·         May return to emotional turmoil

·         The return of emotional pain can extremely frighten people in this stage.

·         Fears and phobias may develop. They may be related specifically to the assailant or the circumstances or the attack or they may be much more generalized.

·         Appetite disturbances such as Nausea and vomiting. Rape survivors are also prone to developing eating disorders.

·         Nightmares, night terrors feel like they plague the victim.

·         Violent fantasies of revenge may also arise.

The renormalization stage

In this stage, the survivor begins to recognize his or her adjustment phase.

During renormalization, survivors integrate the sexual assault into their lives so that the rape is no longer the central focus of their lives; negative feelings such as Guilt and shame become resolved, and survivors no longer blame themselves for the attack.

 

After reading the article, you know about pain , the rape  victim has to undergo.

Just demand Death sentence for rapist .

if you  have any question ,let me know .

 

 

Pretty Good Privacy OR Bad Privacy.

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Digital world creates the situation where there are no secrets anymore.

 

 

 

Pretty Good Privacy, commonly known as PGP, is a user-friendly computer application used to  encrypt e-mail correspondence. PGP can also be used to include an encrypted digital signature to an e-mail message without encrypting the message. PGP is the most widely used encryption software  for e-mail correspondence worldwide.

 Pretty Good Privacy was the creation of Phillip  Zimmerman who, in 1984, first conceived of the  idea of a widely available, cost-free, open source computer program that ordinary people could use  to send and receive e-mail correspondence that  could not be read by others.

According to Zimmerman, his concept for PGP relied on a programming “breakthrough” that had occurred more than a decade before, involving the most essential(and most vulnerable) element in any secret   communication scheme: turning plain text into coded text, and vice versa. Thus, if a user wished to send someone else an encrypted message, he  or she had to give the recipient the necessary key to unlock the encryption code. The challenge was to develop a protocol to send the encryption key  so that it could not be intercepted and thus make  secret communications not so secret.

Zimmerman pondered the question of how to  exchange encryption keys over a period of years,  developing PGP’s complex algorithms in the limited free time he had available between parenting  and engaging in freelance work. It was not until a clause introduced by U.S. Congress in a proposed  anti-terrorism bill that Zimmerman threw himself into the task of completing PGP and making it available to anyone who wished to use it.

Zimmerman  first uploaded the source code to PGP into a USENET newsgroup in June 1991, and invited people to use it for free. Shortly thereafter, PGP was used by human rights activists in what, at the time, was the intensely conflict-ridden region of the Yugoslav successor states, most notably in Kosovo, Sarajevo, and Croatia. It was also used in the early 1990s in volatile states including,but certainly not limited to, Guatemala.

There,in 1992, Dr. Patrick Ball collaborated with the International Center for Human Rights Research in Guatemala (CIIDH) to develop a database of more than 43,000 human rights violations that he protected from the authorities through PGP encryption.

The Impact of PGP

At the time of the release of PGP, Zimmerman argued the encryption software “dramatically changed the security landscape.” Zimmerman noted, “Before PGP, there was no way for two ordinary people to communicate over long distances without the risk of interception. Not by phone, not by FedEx, not by fax.” Users, ranging from human rights defenders to students, wrote to Zimmerman to report that he only thing standing between them and oppressive regimes was his technology.

Zimmermann was promptly “considered the Godfather of encryption software,” according to the New York Times. Such wide attention had a downside for Zimmerman; shortly after its release, PGP came to the attention of the U.S.

National Security Administration (NSA), the government body that oversees all issues pertaining to encryption. The NSA informed Zimmerman in February 1993 that he was being  investigated for violating U.S. export control laws. Because the U.S. government considered encryption software weaponry at the time, PGP was restricted for export under a munitions clause of import/export.

 Interestingly, while at the time, it was illegal to transport PGP on a (then commonly used) floppy disk or computer hard drive, it was possible to carry a printout of the million or so lines of Zimmerman’s computer code that instructed the functionality of PGP.

The NSA eventually dropped the charges in January 1996, after which Zimmerman founded the commercial startup PGP Inc., which was purchased by Network Associates in 1997.

 Zimmerman’s prediction in 2000, that “We’ll be accessing the Internet all the time, which means a dramatic increase in security requirements,” eventually led him to a partnership with former U.S. Navy Seals security expert Mike Janke and their start-up, Silent Circle, a security firm that encrypts phone calls, texts, and video calls. Silent Circle reported a 400 percent increase in new customers after the 2013 disclosures about the National Security Agency’s surveillance efforts.

 

 

Do not fear Digital world , it will not kill us  all.

 

 

 

What is EUTHANASIA.Yes or No.

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EUTHANASIA

“I Will neither give a
Deadly drug to anybody if asked
For it, now will I make a suggestion?
To this effect”.

The Hippocratic Oath.

Introduction: — During the past century, dramatic changes have occurred in the Physicians ability to prolong life. Earlier to that, little more than rudimentary supportive care could be offered to the critically ill patients. Doctors now choose from a vast array of interventions that, often greatly prolong life. Unfortunately, the quality of the additional life so skillfully sought can be miserable, painful and degrading to the patient. Paralleling this has been the soaring coast of health care, scarcity of treatment resources for the care of the hopelessly ill and strident cries about rights of individual patients.

Therefore, a vigorous medical and political debate has begun again on euthanasia; a practice prescribed 2500 years ago in the Hippocratic Oath.

Definition: the ward has its origins from a Greek word – “Eu” means ‘well’ and “Thanatos “means ‘death’. Persons suffering from incurable. Conditions/disease.

Types of Euthanasia

1. Passive: A physician may choose not to treat acute bronchopneumonia in a patient with
Alzheimer’s.
2. Semipossive: A physician may withhold medical treatment such as nutrition or fluids from a Person in coma.
3. Semi active: A physician may disconnect a Ventilator from a patient who is in a stable
Vegetable state.
4. Accidental (Double-effect): A physician may administer a narcotic to relieve bone pain in a patient with terminal metastatic cancer and the narcotic may incidentally depress respiration sufficiently to cause death directly.
5. Suicidal: A physician may provide barbiturates or opioids, which the person with metastatic lung cancer may intentionally use in an overdose to cause his own death.
6. Active: A physician may administer a large, surely fatal overdose of morphine or potassium cyanide in a patient with AIDS who has indespreed Kaposi’s sarcoma.

General ethical fundamental: Some basic Principles:

1. Preservation of life
2. The alleviation of suffering
3. First do no harm.
4. Respect for the autonomy of the individual patient.
5. Ensure that medical resources are allocated fairly.
6. Truth telling; honesty.

Most of the debate on mercy killing revolves critically around this cluster and medical practice often brings this principle into conflict. Then which amongst these would take precedence?

Methods of Ethical reasoning:

William Franken distinguishes two philosophical theories of moral obligation – Teleological and deontological ethical theories.

Teleological ethical theories: This holds that the ultimate standard, which an act is judged morally right or wrong, is the general happiness of all people concerned, or the greatest not balance of good over evil. (J.s.Mill, G.E. Moore)

The decision-making process starts with the perception of a problem and proceeds to a listing of all the conceivable alternatives, for which consequence are predicted and values of happiness assigned.

The limitation of this method are that the method fails if one is unable to predict the consequences accurately or if one is unable to estimate accurate happiness values.
In addition, there is much disparity between the individual happiness and the general social welfare. Whose happiness is being considered when a respirator is turned off?

2. Deontological ethical theories: This maintains that there are rules or principles of action that have moral validity independent of the consequences and that one must act in accordance with these rules/ principles. They assert that there are considerations other than goodness/ badness on which decisions are to be based, things such as keeping a promise, maintaining justice, adhering to a commandment of God/state, which are important regardless of the consequence of the action.

Levels or Care: It can be useful for the physician to designate the level of care for the hopelessly ill patient that is appropriate at a given stage of the disease process.
General levels of care can be described as follows.

1. Emergency resuscitation: CPR.
2. Intensive care and advanced life support.
3. General medical care- Antibiotics, surgery, cancer chemotherapy, artificial hydration & nutrition.
4. General nursing care and efforts to make the patients comfortable, including pain relief and
Hydration & nutrition as dictated by the patient’s thirst & hunger.

Guidelines for decisions about initiating and maintaining life support measures (LSM):

1. Obtain the correct facts: Physicians should review the most current literature on the outcome of different life support measures in specified conditions.
2. Avoid irreversible decisions under uncertainly: L.S.M. should be initiated and maintained until there is time to review the facts, Prognosis and other ethical considerations
3. Withdrawing treatment is ethically preferable to withholding. It may be psychologically more difficult to stop treatment of a patient but it is preferable from the patient’s perspective.
4. Resolve disagreements with the use of outside consultation: If there is conflict with in the
Family/the treating team, outside consultations with ethics committees should be obtained.
5. Inclusion of the entire family in decision making process to avoid later disagreement and
resentment.
6. Consent is a process & not events: So regular discussion should be hold the family regarding Continuation of LSM.

Hospital Ethics Committees: These are Voluntary multidisciplinary groups, which are based on a procedural notion of ethics called “Ideal observe theory”, which holds that decisions are more likely to be ethically defensible if they are based on:

1. Careful consideration of all relevant facts.
2. Decision arising from disinterested persons who have no rested interest in outcome.
3. Revivers who are dispassionate and do not get overwhelmed by emotion at times if crisis.
4. Empathy – The ability to put oneself in another’s shoes.

Physician – Patient communication: The physician should hold frank discussions with the patient and family. He should help the terminally ill patient to understand and deal with the prognosis and alternatives for treatment without destroying all hope.

One important consideration is the matter of Informed consent.
There are 3 basic requisites for this.

1. The patient must have the capacity to reason and make judgements.
2. The decisions must be made voluntarily and without coercion.
3. The patients must have a clear understanding of the risks and benefits of the proposed treatment alternatives, or non-treatment. In addition to being thoroughly informed, he must also understand clearly his right to make choices about the type of care to be received.

Do not resuscitate order: (DNR)

Three rationales for DNR:

1. No medical benefit: A commonly accepted ethical principle is that physicians have no obligation to provide medical treatment that is of no demonstrable benefit.
2. Poor Quality of life after CPR: The quality of life that would result after the cardiac arrest and the subsequent CPR is unacceptable.
3. Poor quality of life before CPR: Although the patient may survive the CPR, His current quality of life is judged unacceptable.

Quality of life (O1): It is defined by three components:
1. Functional status 2. Perception and 3. Symptoms .

1. This includes the ability to perform activities of daily living and to engage in social relationships.
2. This involves the patient’s perception of his health status, life satisfaction and general sense of well-being.
3. This involves the symptoms the patient experiences as a reflection of disease severity and the effects of treatment.

Q1 is a Central concept in the decision to initiate or withdraw life-sustaining, treatment because of:

1. Its role in clinical decision-making.
2. Its importance as a variable in prognostication.
3. Its importance as an outcome measure in evaluation of treatment.

Living Will: This term was coined by Luis kutner in 1969 to describe a document in which a competent adult sets forth directions, regarding medical treatment in the event of his future incapacities.
They suffer from 4 major shortcomings.

1. They are applicable only to those who are “terminally ill”.
2. They limit the types of treatment that can be refused.
3. They make no provisions for the person to designate another person to make decisions on his behalf.
4. There is no penalty if health care providers do not honor these documents.

Health care proxy: Also called the attorney/ agent/ surrogate.
This allows the competent adult to choose another person and assigns to him the power of attorney, such that he could make treatment decisions for him, if he becomes incompetent to make them.

A few land mark cases:

1. Geetruide Postma : 1971, Netherlands. Killing of a debilitated lady by her physician daughter.
2. Karen Ann Quinlan: 1976, New Jersey: Court authorized her removal from a ventilator.
3. Baby Doe: 1982, Indiana, with holding of medical treatment from a handicapped infant.
4. ‘Debbie’: 1988, Active Euthanasia of a terminally ill young women by a resident.
5. Nancy Cruzan: 1990, Missouri. Court disallowed the discontinuation of tube feeding.

Euthanasia in Netherlands: Only country where active Euthanasia is openly practiced.

75% of Dutch citizens new endorse mercy killing by physicians. The Dutch National movement for decriminalization of Euthanasia began in 1971 following the Gertrude Postma case. In 1985 the final report if the commission on Euthanasia recommended a new exception to the criminal code covering homicide – mercy killing. Hollano has not legalized mercy killing however, the physicians will not be prosecuted, provided they can prove that have following certain circumscribed guidelines before carrying out active Euthanasia.

1. There must be explicit and repeated request by the patient, which leave no reason for any doubt concerning his desire to die.
2. The mental / physical suffering must be very severe with no prospect of relief.
3. Informed, free and consistent decisions by the patient.
4. The last of other treatment options, those available having and having been exhausted or refused by the patient.
5. Consultation by the doctor with another medical practitioner and with nurses, pastors or others.

The usual method of performing euthanasia is to induce sleep with a barbiturate followed by a lethal injection of curare. Estimated 5,000 – 10,000 patients receive euthanasia each year in the Netherlands.

Euthanasia in India: Mr. Gopal Mandlik a well-known social worker in Poona ended his own life in 1980 after waiting fruitless sly for 2 yrs., for the Govt. of India to an end the I.P.C. to make it possible for him to do so legally. This was one of the factors that led to the establishment of the society for the right to die with dignity in 1981. This was the 28th of its kind in the world.

There has recently been a great deal of debate on this issue. Much of this is due to a bill introduced by Prof. S.S.Varde in the Maharashtra legislature provide immunity to physicians who withdraw life sustaining treatment.

Social Darwinism, Nazism and (?) Euthanasia: From the end of 19th century the idea of mercy killing without consent was combination of the biological theories of evolution and ‘selection’ were used to explain the difference in mental, physical and social qualities of human beings . The social Darwin’s like Tille (1895) Ploctz (1895) Binding and Hochos (1920) emphasized the danger for the eugenic welfare of the human race, and they were convinced that this could be avoided only by supporting the healthy through the extermination of the worthless and the defective.

Hitler and other National socialist leaders of Germany used this viewpoint of r justifying the extermination of thousands of people. The Nazis carried out the principle of “life unworthy of life” through 5 identifiable steps:

1. Coercive sterilization
2. Children action
3. T4 action
4. Killing of impaired in mates in concentration camps.
5. Mass killing of Jews in extermination camps.

However, one should be clearly aware that the Nazis never engaged in Euthanasia or mercy killing. What they did was merciless killing – either genocidal or for ruthless experimental purpose.

The Case against Euthanasia:

1. As public policy, euthanasia is unacceptable because of the likelihood of involuntary euthanasia. There are 4 ways in which this could happen: A. Crypthanasia B. Encouraged euthanasia C. Surrogate euthanasia D. Discriminatory euthanasia.
2. Euthanasia violates the norms of medicine:
a) It diverts attention from the real issues in the care of the dying patients – improved pain control, better communication between doctors and patients, respect for the patient’s rights to choose life sustaining measured, and improved management of the dying process, again * care.
b) Euthanasia subverts the social role of the physician as healer. Physicians have scrupulously avoided participating in punishment/torture. Physicians should distance themselves from euthanasia to maintain public confidence and trust in medicine.
c) Euthanasia strikes at the heart of what it means to be a physician. Since the time of Hippocrates, the prohibition against euthanasia has been fundamental to the medical profession.
3. Burdening the relatives with the decision of whether euthanasia is to be carried out may load to scruples of conscience and guides, and natural grief may became distorted.

Case for Euthanasia

1. Relief of suffering: A person who has become a vegetable mass of protoplasm and who has no hope of recovery, should has be forced to live? Should he not be allowed to die peacefully without suffering from further physical or mental agony?
2. Individual rights: The well recognized right of patients to control their medical treatment should include the right to request and receive euthanasia. While the state has given him the right to life, can’t he be endowed with a right to die?
3. Economics: Prevention of unnecessary and possible financial ruin of the family. Drain on resources for treatment of other patients who are not hopelessly ill.
4. Organ transplantation.
5. I few do find that decriminalization of Euthanasia leads us down the slippery slope’ we could always recriminalize it.

What is your Opinion  .YES OR NO .

Emotional Problems.

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Article by DR BSARORA ,Psychiatrist .

Emotional problems make direct tasks and simple errands harder. High feeling, bubbling disappointment and hurt emotions motivate the person. Certain people become very protective. Protectiveness causes us to pry on others. Others might want to disconnect completely and resolve issues in a different manner. A great many people manage their emotional issues by opposing, quelling and overlooking them. At this point, your brain feels uneasy and you end up making rash decisions. However, there are ways to deal with emotional problems. These are as follows:

  1. Be aware: Try to stay active and be aware of solid feelings and sentiments. Work on improving them as they show up and quickly misidentify with them. Advise yourself that you are not your feelings and that they are only temporary.
  2. Use labeling: Utilize naming. Research has demonstrated that naming and surveying a feeling changes the feeling into a subject of examination and consequently diminishes its power on you. So in case you are feeling furious, essentially let yourself know that this is you being angry and you will in all probability see that the force of the inclination instantly drops.
  3. Get curious: Rather than opposing the emotions and sentiments, get inquisitive about them. Focus on how they affect you. Where in the body do they show? How do the diverse muscles in your body feel? How is your breath? Hold your emotions and sentiments in present mindfulness and simply let them do their thing without judging or sticking to them. Utilise the possibility of your brain as the sky and your emotions and sentiments as clouds that are passing by.
  4. Face-to-face interaction: Up close and personal social interaction with somebody who thinks about you is the best approach to quiet your nervous system and calm anxiety. It additionally relieves stress-busting hormones, so you will feel better regardless of the possibility that you cannot change the upsetting circumstance itself. The key is to collaborate with somebody who is a decent audience or someone you can consistently talk with face to face, or who will hear you out without a prior motivation for how you need to think or feel.
  5. Exercise and meditation: The brain and the body are inherently connected. When you improve your physical well-being, you will consequently encounter more prominent mental and enthusiastic betterment. Physical movement likewise discharges endorphins, intense chemicals that lift your state of mind and make you happy. Normal exercise or action can majorly affect mental and enthusiastic medical issues, mitigate stress, enhance memory, and help you to rest better.

In case that you continue facing this frequently, you will soon find that your relationship with your mind will begin to change. You will build up an intense metacognition (the capacity to face your reasoning) which helps you to handle your emotions and feelings in a great manner.

If you facing emotional problems. Let me know and   feel free to contact me.