The new issue of *Behaviour Research and Therapy* (vol. 48, #2, pp.
152-157) includes a study: “When self-help is no help: Traditional
cognitive skills training does not prevent depressive symptoms in people
who ruminate.”

The author is Gerald J. Haeffela.

Here’s the abstract:

[begin excerpt]

A randomized trial was conducted to test the efficacy of three self-
directed prevention intervention workbooks for depression.

Cognitively at-risk college freshmen were randomly assigned to one of
three conditions: traditional cognitive, non-traditional cognitive, and
academic skills.

Consistent with hypotheses, participants who were high in rumination and
experienced stress exhibited significantly greater levels of depressive
symptoms after completing the traditional cognitive skills workbook than
after completing the other two workbooks.

This pattern of results held post-intervention and 4 months later.

These findings indicate that rumination may hinder ones ability to
identify and dispute negative thoughts (at least without the help of a
trained professional).

The results underscore the importance of identifying individual
difference variables that moderate intervention efficacy.

They also raise concerns about the potential benefits of self-help
books, an industry that generates billions of dollars each year.

[end abstract]

Here’s the contact info from the author note: Gerald J. Haeffela,
Department of Psychology, University of Notre Dame, Haggar Hall, Notre
Dame, IN 46556, < g h a e f f e l @ n d . e d u >.

Courtesy of Ken Pope

From John Gottman “7 Principles that make marriage work”

First – what does not work:  Signs of a marriage in trouble

  • A harsh start up — leading off a discussion with criticism and/or sarcasm, a form of contempt.  If your discussion begins with a harsh start up it will inevitably end on a negative note.
  • The “four horsemen of the apocalypse” – criticism, contempt, defensiveness, stonewalling strongly predict divorce.
  • A complaint focuses on a specific behavior, but criticism ups the ante by throwing in blame and general character assassination — “what’s wrong with you?”
  • Contempt includes sarcasm, cynicism, name calling, eye rolling, sneering, mockery, and hostile humor.  It is poisonous to a relationship because it conveys disgust.  It’s virtually impossible to resolve a problem when your partner is getting the message you are disgusted with him or her.  Inevitably, contempt leads to more conflict.
  • Defensiveness rarely has the desired effect.  The attacking spouse does not back down or apologize.  This is because defensiveness is really a way of blaming your partner.  You are saying in effect, “the problem is not me, it’s you”.  Defensiveness just escalates the conflict.
  • With stonewalling, eventually one partner tunes out.  Rather than confronting his wife, the husband disengages.  By turning away from her, he is avoiding a fight, but he is also avoiding his marriage.  This is far more common among men.  He tends to look away or down without uttering a sound.
  • Usually people stonewall as protection against feeling flooded.  You feel so defenseless against the sniper attack you learn to do anything to avoid a replay.
  • Recurring episodes of flooding lead to divorce for two reasons.  First they signal that at least one partner feels severe emotional distress.  Second, the sensations of feeling flooded make it almost impossible to have a productive, problem solving discussion.  Your ability to process information is reduced, meaning it’s harder to pay attention to what your partner is saying.  When either partner begins to feel flooded routinely, the relationship is in serious trouble.  Frequently feeling flooded leads almost inevitably to distancing yourself from your spouse.  This in turn leads you to feel lonely.
  • Failure of repair attempts (“let’s take a break”, “wait I need to calm down”) to put on the brakes so that flooding is prevented.  When the four Horsemen rule the couples communication, repair attempts often do not even get noticed.  In unhappy marriages, a feedback loop develops between the four Horsemen and the failure of repair attempt.  The more contemptuous and defensive the couple is with each other, the more flooding occurs and the harder it is to hear and respond to a repair attempt.
  • In a happy marriage couples tend to look back on the early days fondly.  When a marriage is not going well, history gets rewritten – for the worse.  Or the past is difficult to remember because it has become unimportant or painful.

What does work: the 7 principles Gottman discovered by observing successful couples

  • Principle one: enhance your love maps – awareness of your partner’s life and experieinces. Check in with each other often, share lots.
  • Principle two: nurture your fondness and admiration. Give messages of appreciation and affection. Focus on the good in your spouse.
  • Principle three: turn towards each other instead of away. Make a habit of helping each other cope, turn to each other in times of stress, connect lots.
  • Principle four: let your partner influence you. Yield in order to win. Accept influence. Choose “us” over “me”. Compromise.
  • Principle five: solve your solvable problems. Do this by raising problems gently and respectfully, make and receive efforts to moderate conflict, sooth self and each other,
    compromise and be tolerant of each other’s faults.
  • Principle six: overcome gridlock on unsolvable problems (70% of marital problems never really go away). move from gridlock to dialogue.  Learning to be able to talk about it without hurting each other.  You learn to live with the problem.  You first have to understand its cause.  It is a sign that you have dreams for your life that are not being addressed or respected by each other.
  • Principle seven: create shared meaning with shared goals, values, stories, symbols, rituals, and compatible roles in life.

Obviously there is much more to this than a checklist, and Gottman’s book includes many questionnaires for couples to use to study their relationship and identify problem areas along with practical exercises to increase the quality of the relationship using the 7 principles.

Summarized by Brian Grady PhD R.Psych.

Resources on reproductive loss

1) When Part of the Self Is Lost: Helping Clients Heal After Sexual and Reproductive Losses by Constance Hoenk Shapiro was published in 1993 but may be hard to get, its not currently available on Amazon.

2) CBC had a program called “mother of miscarriage” that can be ordered on tape. it is mostly to validate the loss, giving permission to grieve, and reminding the woman she is not alone.

3) Nancy Newman has an excellent website as well:

4) MISS Foundation, online support groups for all family members and resources for caregivers.

5) “Empty Cradle, Broken Heart” by Davis is a written resource.  There is also a website:

Another book is:  An Empty Cradle, a Full Heart: Reflections for Mothers and Fathers After Miscarriage, Stillbirth, or Infant Death
Author: Christine O’Keeffe Lafser.

6) Hope is like the Sun: Finding Hope and Healing after Miscarriage,
stillbirth or Infant death by Lisa Church (Book).

compiled by
Natacha Ferrada, Ph.D
Registered Psychologist,
Vancouver, BC
with input of BC colleagues

People with Borderline Personality Disorder experience violent and frightening mood swings. They can be euphoric one moment, despairing and depressed the next. Symptoms include:

* a shaky sense of identity, feelings of emptiness
* sudden violent outbursts
* oversensitivity to real or imagined rejection
* brief, turbulent love affairs
* frequent periods of intense depression
* eating disorders, drug abuse, and other self-destructive tendencies
* an irrational fear of abandonment and an inability to be alone

Some resources suggested by a variety of my colleagues in British Columbia include:

Eliana Gil’s slim volume “Outgrowing the Pain: a Book for and About Adults Abused as Children.” It’s a great “what to expect if you had a suboptimal childhood” guide, it’s very basic (it even has pictures!), and many clients who struggle with post-abuse emotional dysregulation – even those with years of therapy – find it useful.  (Dr. T. Estrin)

Sometimes I Act Crazy: Living with Borderline Personality Disorder‎
by Jerold J. Kreisman, M.D., Hal Straus – Psychology – 2006 – 256 pages
Complete with case studies that detail specific symptoms and behaviors, this book offers proven techniques to help people with BPD manage mood swings, improve their self-esteem, control destructive impulses, develop lasting relationships, and find professional help. It covers today’ s most effective medical and psychotherapeutic treatments and includes coping strategies for the family and friends of BPD sufferers.

The mindfulness & acceptance workbook for anxiety by John P. Forsyth, Georg Eifert – Self-Help – 2008 – 267 pages
This workbook comes with a CD that includes a full-length audio guided meditation and electronic copies of the worksheets that appear inside the book.

“I hate you, don’t leave me” Jerold Kreisman & Hal Straus (2001). Dr. Jerold J. Kreisman and health writer Hal Straus offer professional advice, helping victims and their families to understand and cope with borderline personality disorder.

Lost in the Mirror: An Inside Look at Borderline Personality Disorder‎ by Richard A. Moskovitz – Psychology – 2001 – 224 pages
Explores the frightening world of BPD patients and helps readers understand their pain.

The Borderline Personality Disorder Survival Guide: Everything You Need to know about living with BPD.
by Alexander L. Chapman, Kim L. Gratz, Perry D. Hoffman, Ph.D. (FRW) – Self-Help – 2007 – 238 pages
This compassionate book offers people with BPD a detailed guide to the disorder and a point-by-point plan to the treatment and condition-management process.

The Dialectical Behavior Therapy Skills Workbook by Matthew McKay, Jeffrey C. Wood, Jeffrey Brantley – Self-Help – 2007 – 232 pages
DBT can improve your ability to handle distress without losing control and acting destructively. In order to make use of these techniques, you need to build skills in four key areas-distress tolerance, mindfulness, emotion regulation, and interpersonal effectiveness. The Dialectical Behavior Therapy Skills Workbook, a collaborative effort from three esteemed authors, offers straightforward, step-by-step exercises for learning these concepts and putting them to work for lasting change. A clear and practical guide to better managing your emotions.

Judith Herman’s Trauma and recovery (2007) Trauma and Recovery brings a new level of understanding to a set of problems usually considered individually. Herman draws on her own cutting-edge research in domestic violence as well as on the vast literature of combat veterans and victims of political terror, to show the parallels between private terrors such as rape and public traumas such as terrorism.

———- for therapists ——–

Understanding and treating borderline personality disorder: a guide for professionals and families. by John G. Gunderson, Perry D. Hoffman – Psychology – 2005 – 171 pages A concise, clearly written, and eminently practical text.

Treatment of Borderline Personality Disorder – A Guide to Evidence-Based Practice”(2008) by Joel Paris.
Presents a practical approach to the management of patients with this disorder. Designed for readers who are skeptical of facile explanations, this book provides a broader view of the etiology of BPD than has been presented in previous studies.

Skills Training Manual for Treating Borderline Personality Disorder‎ by Marsha Linehan – Psychology – 1993 – 180 pages
Linehan’s comprehensive treatment program, this manual details precisely how to implement the skills training procedures and includes practical pointers.

(Book summaries courtesy of Google Books)

A recommended website is

by Kohl, Herbert R. 2007.

As the title says, an aging man, educator and overachieving social activist learns how to learn in a painting class alongside 5 and 6 year-olds. Along the way he learns something about painting in the classical Chinese style, but he also gets to have a proper childhood finally, gains access to grounding in meditative painting, learns something about reconciling life’s contradictions, begins to come to terms with aging, and discovers how to get the goal out of the way in order to master the art of being present in the world.  I liked it.

The War on Pain — by Scott Fishman Very helpful in understanding the many biological/medical sides of pain better. Fishman is Chief of Medicine somewhere and has done/seen it all. Embedded throughout are helpful suggestions for coping. Gives a picture of what is “normal” regarding chronic pain.

Based on interviews with pain patients and pain healthcare professionals:

Pain. The Science and Culture of Why We Hurt by Marni Jackson

The Truth about Chronic Pain by Arthur Rosenfeld. In both, there are plenty of sketches of what the typical chronic pain experience is like.

Managing Pain Before It Manages You by Margaret Caudill. Provides practical suggestions for managing many of the common issues confronting people living with pain.

*New England Journal of Medicine* (Volume 356, Number 25,
June 21) includes a review of the book *The Art of Aging: A Doctor’s
Prescription for Well-Being* by Sherwin B. Nuland (302 pp., Random
House, 2007. $24.95. ISBN 978-1-4000-6477-9).

The review is by A. Mark Clarfield, M.D., Ben-Gurion University of the
Negev, Beersheva, Israel.

Here’s the review:

As a geriatrician, I am familiar with most of the biological and medical
topics discussed in this book. But as Sherwin Nuland is above all an
excellent and thoughtful writer, I simply enjoyed reading it. The book
does not, it seems to me, speak primarily to physicians or their aged
patients but speaks to anyone interested in human aging. As Nuland
points out, the purpose of the book is “to tell of human aging and its
rewards — and also of its discontents . . . to tell of how best to
prepare for the changes that inevitably demand accommodation, demand a
shift in focus, and demand a realistic assessment of goals and directions.”

Nuland, a retired surgeon who had a long career in general surgery at
Yale-New Haven Hospital and is currently a clinical professor of surgery
at Yale University, has written a number of popular and well-received
books on subjects both medical (How We Die: Reflections on Life’s Final
Chapter. New York: Vintage, 1995) and nonmedical (Maimonides. New York:
Schocken, 2005). Perhaps it was inevitable that as he began to age,
Nuland would turn his formidable analytic and literary skills toward the
universal biological process of aging.

This is not a long book, and it does not try to exhaust the subject of
gerontology. It does, however, touch on many aspects, from the basics of
the biology of aging to the sociology of senescence. Nuland reports on
his interactions with superstars of aging — including Michael DeBakey,
pushing 100 and going strong — as well as with more ordinary people to
show how they have tried (more or less successfully) to deal with their
own aging. This literary device is useful, but the book does not offer
enough examples of the many unfortunate people who feel defeated by
their old age or who just hang on by the skin of their increasingly
loose teeth. Given that Nuland has written an award-winning book on
dying, I was surprised that so little of this book deals with the
subject — one of the many concerns of older people, their caregivers,
and (though perhaps not often enough) their physicians.

Nuland builds a strong case for the “use it or lose it” school of
thought, and he gently but effectively debunks the notion that the human
lifespan may be increased to hundreds, if not thousands, of years.
Nuland, along with most gerontologists, thinks that such a lifespan
would render our world unlivable. His critique, primarily ethical and
sociological, is convincing.

The Art of Aging offers a lot of good advice and thoughtful ideas for
the interested lay reader, and it wouldn’t hurt for doctors to read the
book — especially those who hope to reach a healthy old age themselves.
They could do worse than to recommend this fine work to their patients,
especially to baby boomers, who are not likely to go so gently into that
good night. Those who take Nuland’s advice will be spared a lot of grief
as they age.