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The symptoms of schizophrenia can seem peculiar to people who observe them. However, when people are experiencing symptoms, they may have little or no insight that their thoughts or behaviors are strange. The lack of insight can make schizophrenia very frustrating and frightening for loved ones.

Clinical Symptoms

The Diagnostic and Statistical Manual, 5th Edition (DSM-5), is a clinical resource that practitioners use to diagnose mental health conditions. As with other conditions, there are specific clinical criteria that need to be met in order for someone to be diagnosed with schizophrenia.

Schizophrenia is classified as a psychotic disorder.﻿﻿ People with schizophrenia have symptoms of psychosis, an abnormal state of consciousness in which the higher functions of the mind are disrupted. In psychosis, some combination of a person's perceptions, thought processes, beliefs, and emotions appear to become disconnected from reality. These symptoms may come and go.

Positive Symptoms

Symptoms of schizophrenia are referred to as positive or negative. That doesn't mean that some are good and some are bad. Positive symptoms are those that are present in someone with schizophrenia that someone without schizophrenia or another mental health condition would not experience.﻿﻿ Examples of this can include things like:

Delusions

Hallucinations

Disorganized speech

Disorganized behavior

Delusions are false beliefs that don't make sense in the context of a person's culture. Although everyone has wrong beliefs from time to time, psychotic delusions also have an abnormal obsessive quality. People with psychotic delusions can't be convinced that their beliefs aren't real.

Hallucinations

Hallucinations are false sensory experiences that have no basis in the external world. Psychotic hallucinations occur when the person is fully awake and not under the influence of alcohol or illicit drugs. Auditory hallucinations (hearing voices) and visual hallucinations (seeing things) are the most common, but a person can hallucinate a touch (for example, bugs crawling on the skin), taste, or smell.

Disorganized Speech

Also known as loose association. In psychotically disorganized speech, words are not linked together based on the normal rules of language but are strung together based on sounds, rhyme, puns, or free associations. Although everyone makes speech errors, especially when they're tired or stressed, psychotically disorganized speech is obviously abnormal and is difficult or impossible to understand.

Disorganized Behavior

Psychotically disorganized behaviors are not goal-directed and don't make sense in context. For example, taking one's clothes off to take a bath is sensible. Taking one's clothes off on a public bus is an example of disorganized behavior. Laughing at inappropriate times or for no reason is a disorganized behavior. Adopting strange postures or freezing are catatonic behaviors.

Negative Symptoms

In addition to these symptoms that become present in someone with schizophrenia, there are others that are referred to as negative symptoms. This means that the person is experiencing an absence or reduction of certain traits that are often present in healthier individuals.﻿﻿ The term negative suggests that something feels as if it is being taken away or disappearing from the person's daily experience. Examples of negative symptoms can include things like:

Flattened affect

Anhedonia

Reduced speech

Lack of initiative

Flattened Affect

People with flattened affect appear emotionless or have a very limited range of emotions. They show little response to emotional or disturbing situations or images. This limited expression of emotion can be alarming to others, as it can feel like the person with schizophrenia is disappearing from them.

Someone with the condition of schizophrenia can demonstrate a lack of joy in things that used to bring them pleasure. This change tends to be quite noticeable by others around them and is not simply a change in interests.

Reduced Speech

A negative symptom of schizophrenia can involve someone speaking noticeably less than they used to. This particular symptom could also be observed as someone speaking less fluently than before.

Lack of Initiative

The loss of will to do things in a negative symptom of schizophrenia. Remember that a negative symptom refers to a characteristic that seems to be lessening or disappearing from the person. Loss of motivation and initiative, also known as avolition, is a common negative symptom.

Positive Symptoms

Negative Symptoms

Cognitive Symptoms of Schizophrenia

Cognitive symptoms of schizophrenia have to do with the way a person thinks.﻿﻿ Although cognitive symptoms are not used to diagnose schizophrenia, some are fairly common with the condition, such as:

Difficulty maintaining attention - The inability to maintain focused attention makes people with schizophrenia seem spacey or "out of it."

Memory problems - Schizophrenia often affects working memory, which is the kind of memory you use to keep things in your head for active processing, like the digits of a phone number you're about to dial.

Difficulty planning and structuring activities - Caused by reduced executive control. Executive control is the mental process that allows us to identify the steps needed to complete a task and then execute them in a proper order. Executive control also allows us to suppress our response to distractions in order to get something done.

Lack of insight - People with schizophrenia have a specific cognitive blind spot that prevents them from understanding that they are ill. This means that loved ones and caregivers should remain as vigilant as possible to help the patient maintain the routines of treatment in order to control symptoms.

Psychiatric Assessment

Because of the variety of symptoms that can be present, schizophrenia can be difficult to diagnose. In an effort to achieve greater precision in the process of diagnosing, the clinical criteria for schizophrenia within the DSM-5 have become more complicated over time. There are reasons why it is important to diagnose schizophrenia accurately:

It is a more common condition than people might think.

People who develop schizophrenia can experience symptoms for the rest of their lives.

Symptoms can greatly impact someone's social abilities and work functioning.

Often medication must be taken for the rest of their lives.

DSM Criteria

As outlined within the Diagnostic and Statistical Manual, fifth edition (DSM-5), the clinical features that must be present for the condition of schizophrenia to be diagnosed include the following:﻿﻿

1. Presence of at least two of the following symptom types (with at least one of the symptoms being in the top three listed here):

Delusions

Hallucinations

Disorganized speech

Disorganized behavior

Negative symptoms

2. The symptoms are to be experienced for at least six months, with the psychotic features (the top three listed above) being present for at least one month.

3. The person experiences significant problems with work and social functioning as a result of their symptoms.

4. The diagnosing clinician can determine that the symptoms the person has been experiencing are not caused by another medical condition, mood disorder or substance use.

Other Symptoms

In addition to the formal diagnostic criteria, there are a variety of other symptoms that can often be found in people with schizophrenia.﻿﻿ These symptoms include things like:

Distractibility

Anger

Anxiety

Depression

Lack of insight

Sleep disturbances

Substance use (especially tobacco use)

Other Diagnostic Considerations

In addition to exploring and identifying whether or not someone meets the formal clinical criteria as listed in the DSM-5, there are additional things that a clinician will consider in the diagnostic process.﻿﻿ Things that a mental health provider will consider include:

Family history of schizophrenia. A close relative with schizophrenia can increase someone's chance of also being diagnosed with schizophrenia.

Response to medication. People may have taken medication as part of mental health treatment in the past. Depending on someone's responses to certain medications in the past, a clinician may better be able to rule out other conditions.

Age at onset. Typically symptoms become present around someone's early to mid-'20s. If someone's symptoms are presenting later in life it could suggest there is something else going on. It doesn't necessarily rule out schizophrenia, it is simply something to consider in the diagnostic process.

Situational factors. Experiences that can cause severe emotional distress can lead to brief periods of psychosis. As a clinician conducts their assessment, they will likely be considering any significant life changes or events to determine duration and severity of symptoms and whether or not there are other mental health conditions that should be considered.

Comprehensive exams are an important aspect of diagnosing schizophrenia. A clinician will not rely on limited pieces of information or only on self-report from the client.

They will be gathering information about the client's family history, substance use and medications, sleep disturbances, appetite changes and more.

In addition, it is important for a clinician to explore information related to the person's values system, their perspectives on the world, their interests and talents as well as their beliefs and relationship dynamics. Family and close friends may also be interviewed in the process to help provide helpful collateral information.

When to Consult a Doctor

Because of the complexity and variety of symptoms associated with schizophrenia, it can be difficult for people to know if what their loved one is experiencing is concern enough to see a doctor.

Schizophrenia Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Onset and Duration of Symptoms

The onset of symptoms tends to be gradual, building in severity over time.﻿﻿ This sometimes slow progression of symptoms can also make it difficult to know if what you, or someone you love, is experiencing is to be of concern.

Functioning in Social and Professional Situations

When social and work (or school) functioning is impaired it may be helpful to consult with a doctor.﻿﻿ Because the symptoms tend to develop over time you may not realize how long you have been experiencing trouble in these areas of your life. Noticing that a pattern has developed can be a signal to consult with a professional.

Challenges in Reaching Out

It can be challenging for people with schizophrenia to reach out to a doctor or other health professional about their concerns. This can be particularly tough for people who may be experiencing symptoms that leave them feeling suspicious of others.

Reassurance from people they trust can be helpful in encouraging and prompting someone to speak with a doctor or other mental health professional.

Closely-Related Conditions

Schizophrenia is a complex diagnosis with a lot of symptoms and variables to consider. What makes things more complicated is that there are also several closely-related conditions that involve psychosis. Some of the conditions that are to be ruled out can include:

Schizophreniform disorder

Schizoaffective disorder

Brief psychotic disorder

Delusional disorder

Dissociative disorder

Substance or medication-induced psychotic disorder

Mood disorder with psychosis

Cognitive disorders with psychosis

Personality disorders

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How Schizophrenia Is Diagnosed by Observing Symptoms

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The symptoms of schizophrenia can seem peculiar to people who observe them. However, when people are experiencing symptoms, they may have little or no insight that their thoughts or behaviors are strange. The lack of insight can make schizophrenia very frustrating and frightening for loved ones.

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What is Section 504

The U.S. Department of Education enforces Section 504 of the Rehabilitation Act of 1973, as amended, (Section 504) a civil rights statute which prohibits discrimination against individuals with disabilities. The Office for Civil Rights (OCR) also enforces Title II of the Americans with Disabilities Act of 1990 (Title II), which extends this prohibition against discrimination to the full range of state and local government services, programs, and activities (including public schools) regardless of whether they receive any Federal financial assistance. The Americans with Disabilities Act Amendments Act of 2008 (Amendments Act), effective January 1, 2009, amended the Americans with Disabilities Act of 1990 (ADA) and included a conforming amendment to the Rehabilitation Act of 1973 (Rehabilitation Act) that affects the meaning of disability in Section 504. The standards adopted by the ADA were designed not to restrict the rights or remedies available under Section 504. The Title II regulations applicable to free appropriate public education issues do not provide greater protection than applicable Section 504 regulations. This guidance focuses primarily on Section 504.

Section 504 prohibits discrimination on the basis of disability in programs or activities that receive Federal financial assistance from the U.S. Department of Education. For more details, please refer to the United States Department of Education Section 504 Frequently Asked Questions document.

Students protected under Section 504

Section 504 covers qualified students with disabilities who attend schools receiving Federal financial assistance. To be protected under Section 504, a student must be determined to: (1) have a physical or mental impairment that substantially limits one or more major life activities; or (2) have a record of such an impairment; or (3) be regarded as having such an impairment. Section 504 requires that school districts provide a free appropriate public education (FAPE) to qualified students in their jurisdictions who have a physical or mental impairment that substantially limits one or more major life activities. For more details, please refer to the United States Department of Education Section 504 Frequently Asked Questions document.

Evaluation

At the elementary and secondary school level, determining whether a child is a qualified disabled student under Section 504 begins with the evaluation process. Section 504 requires the use of evaluation procedures that ensure that children are not misclassified, unnecessarily labeled as having a disability, or incorrectly placed, based on inappropriate selection, administration, or interpretation of evaluation materials. For more details, please refer to the United States Department of Education Section 504 Frequently Asked Questions document.

Placement

Once a student is identified as being eligible for regular or special education and related aids or services, a decision must be made regarding the type of services the student needs. For more details, please refer to the United States Department of Education Section 504 Frequently Asked Questions document.

Procedural Safeguards

Public elementary and secondary schools must employ procedural safeguards regarding the identification, evaluation, or educational placement of persons who, because of disability, need or are believed to need special instruction or related services. For more details, please refer to the United States Department of Education Section 504 Frequently Asked Questions document.

How to file a complaint

Online: You may file a complaint with OCR using OCR's electronic complaint form at the following website: http://www.ed.gov/about/offices/list/ocr/complaintintro.html.

Mail or Facsimile: You may mail or send by facsimile information to the address or phone number available at this link. You may use OCR's Discrimination Complaint Form or write your own letter. If you write your own letter, please include:

The complainant's name, address and, if possible (although not required), a telephone number where the complainant may be reached during business hours;

Information about the person(s) or class of persons injured by the alleged discriminatory act(s) (names of the injured person(s) are not required);

The name and location (city and state) of the institution that committed the alleged discriminatory act(s); and

A description of the alleged discriminatory act(s) in sufficient detail to enable OCR to understand what occurred, when it occurred, and the basis for the alleged discrimination.

Email: You may email OCR's Discrimination Complaint Form or your own signed letter to . If you write your own letter, please include the information identified above

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The U.S. Department of Education enforces Section 504 of the Rehabilitation Act of 1973, as amended, (Section 504) a civil rights statute which prohibits discrimination against individuals with disabilities. The Office for Civil Rights (OCR) also enforces Title II of the Americans with Disabilities…

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Credit: Julius-Maximilians-Universität Würzburg, JMU

An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection.

Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body. They are trapped in a vicious circle, as the fear of new contamination returns quickly after washing. Sufferers see no way out. They are even incapable of changing their behaviour when the excessive washing has led to skin irritation or damage.

Around two percent of the general population suffer from some kind of obsessive-compulsive disorder (OCD) at least once in their life. The disorder is characterised by persistent intrusive thoughts which the sufferers try to compensate for by repetitive ritualized behaviour.

Like depression, eating disorders and other mental diseases, OCD is treated with antidepressants. However, the drugs are non-specific, that is they are not tailored to the respective disease. Therefore, scientists have been looking for new and better targeted therapies that have fewer side effects.
Missing protein triggers urge to wash
Professor Kai Schuh from the Institute of Physiology at the Julius-Maximilians-Universität (JMU) Würzburg (Germany) and his team explore the underlying causes of obsessive-compulsive disorder in collaboration with the JMU's Departments of Psychiatry and Neurology.

"We were able to show in mouse models that the absence of the protein SPRED2 alone can trigger an excessive grooming behaviour," Schuh says. He believes that this finding is crucial as no clear trigger for this type of disorder has been identified until now. Previous research pointed to multiple factors being responsible for developing OCD.

Occurring in all cells of the body, the protein SPRED2 is found in particularly high concentrations in regions of the brain, namely in the basal ganglia and the amygdala. Normally, the protein inhibits an important signal pathway of the cell, the so-called Ras/ERK-MAP kinase cascade. When it is missing, this signal pathway is more active than usual.
Hyperactive signal cascade in the brain
"It is primarily the brain-specific initiator of the signal pathway, the receptor tyrosine kinase TrkB, that is excessively active and causes the overshooting reaction of the downstream components", biologist Dr. Melanie Ullrich explains.

Administering an inhibitor to attenuate the overactive signal cascade in the animal model improves the obsessive-compulsive symptoms. Moreover, the JMU research team was able to treat the OCD with an antidepressant, similarly to standard therapy in humans. Their detailed results have been published in the journal Molecular Psychiatry.
New targets for therapies pinpointed
"Our study delivers a valuable new model that allows the disease mechanisms to be investigated and new therapy options for obsessive-compulsive disorders to be tested," Professor Schuh says.

The recently discovered link between OCDs and the Ras/ERK-MAP kinase cascade also opens up new targets for therapy. Drugs that inhibit this cascade are already available and some of them are approved for human treatment.

According to Melanie Ullrich, these are cancer drugs, as overactivation of the Ras/ERK-MAP kinase cascade is also a frequent trigger of cancer: "So we are wondering whether such drugs could also be effective in the treatment of obsessive-compulsive disorders and whether they are beneficial in terms of side effects."

More information: M Ullrich et al. OCD-like behavior is caused by dysfunction of thalamo-amygdala circuits and upregulated TrkB/ERK-MAPK signaling as a result of SPRED2 deficiency, Molecular Psychiatry (2017). DOI: 10.1038/mp.2016.232

Provided by Julius-Maximilians-Universität Würzburg

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An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection. Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body.

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New brain link to anxiety and OCD | PowerBrain RX

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Comprehensive approach on mental health: Assessments - Counseling - Cognitive & Behavioral Training - Expressive Arts. Four locations across Hong Kong for your convenience.

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The ways in which symptoms of obsessive-compulsive disorder (OCD) are experienced varies widely from person to person. The "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) provides a broad definition of obsessive-compulsive disorder that includes the presence of obsessions and/or compulsions that cause major distress or disruption to daily living. Clinicians and researchers suggest that OCD can be divided into different types based on the nature of the symptoms experienced.

5 Symptom Subtypes of OCD

Although specific symptom types appear to be relatively stable over time, it is possible to experience a change in the nature and focus of your symptoms. Additionally, although the majority of your symptoms might be consistent with a particular symptom subtype, it is possible to experience symptoms of other types at the same time.

1. Contamination Obsessions With Washing/Cleaning Compulsions: If you are affected by this symptom subtype, you will usually focus on feelings of discomfort associated with contamination and wash or clean excessively to reduce these feelings of distress. For example, you might feel that your hands are dirty or contaminated after touching a doorknob or worry that you will contaminate others with your germs. To get rid of these feelings, you might wash your hands repeatedly for hours at a time.

2. Harm Obsessions With Checking Compulsions: If you experience this symptom subtype, you will often have intense thoughts related to possible harm to yourself or others and use checking rituals to relieve your distress. For example, you might imagine your house burning down and then continually drive by your house to make sure that there is no fire. Or, you may feel that by simply thinking about a disastrous event, you are increasing the likelihood of such an event actually happening.

3. Obsessions Without Visible Compulsions: This symptom subtype often relates to unwanted obsessions surrounding sexual, religious, or aggressive themes. For example, you could experience intrusive thoughts about being a rapist or that you will attack someone. You may often use mental rituals such as reciting particular words, counting in your head or praying to relieve the anxiety you experience when you have these involuntary thoughts. Triggers related to obsessions are usually avoided at all costs.

1. Symmetry Obsessions With Ordering, Arranging, and Counting compulsions: When experiencing this subtype, you feel a strong need to arrange and rearrange objects until they are "just right." For example, you might feel the need to constantly arrange your shirts so that they are ordered precisely by color. This symptom subtype can also involve thinking or saying sentences or words over and over again until the task is accomplished perfectly. Sometimes these ordering, arranging, and counting compulsions are carried out to ward off potential danger. For example: "If I arrange my desk perfectly my husband won't die in a car accident." However, this is not always the case.

2. Hoarding: Hoarding is now recognized as a distinct diagnosis in the DSM-5. Hoarding involves the collection of items that are judged to be of limited value by others such as old magazines, clothes, receipts, junk mail, notes, or containers. Often your living space becomes so consumed with clutter that it becomes impossible to live in. Hoarding is often accompanied by obsessional fears of losing items or possessions that may be needed one day and excessive emotional attachment to objects. People affected by the hoarding symptom subtype will tend to experience higher anxiety and depression than people with other subtypes and are often are unable to maintain steady employment. Importantly, compulsive hoarding can occur independently of OCD.

Obsessive-Compulsive Related Disorders

The DSM-5 included new definitions or moved these disorders to this category.

Skin Pricking Disorder (Excoriation): This disorder was also recognized as a distinct diagnosis in the DSM-5. It is persistent pricking at your skin that results in lesions, infections, and clinically significant distress. It is prevalent in between 1 percent and 2 percent of the population.

Hair-Pulling Disorder (trichotillomania): In this OCD-related disorder, you have a strong urge to pull the hair from your head, eyebrows, eyelashes, or elsewhere on your body. It is usually treated with habit-reversal training and cognitive-behavioral therapy.

Body Dysmorphic Disorder: This disorder is a "preoccupation with one or more perceived defects or flaws in appearance that are not observable or appear slight to others." The criteria include that you have performed repetitive behaviors of grooming or checking your appearance or have mental acts such as constantly comparing your appearance to others. Muscle dysmorphia is a subtype of body dysmorphic disorder in which you think your body is too small or not muscular enough.

OCD and Related Disorders Induced By a Substance/Medication or Due to Another Medical Condition: Exposure to certain substances and medications can induce the development of OCD symptoms. There also are certain medical and neurological conditions that can be associated with the development of the disorder.

In addition, although it is not uncommon for new mothers to experience a wide array of emotions following the arrival of a new child, the postpartum period has long been known to be a time of increased risk for the appearance, worsening, or recurrence of mood and anxiety disorders. A number of studies have suggested that the postpartum period may also present a risk for the onset or worsening of OCD.

Although many people think of OCD as a disorder that affects only adults, a similar percentage of children are also affected. While there are many similarities between adult-onset and childhood-onset OCD, there are also many important differences-particularly with respect to treatment and the nature of symptoms.

Although we usually think of OCD as being caused by a combination of stress, genetic factors, and an imbalance of chemicals in the brain, there is growing evidence that a specific form of childhood OCD may actually be an autoimmune disorder. In pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), children develop OCD or tic disorders suddenly after a strep infection (such as strep throat) or scarlet fever or have a worsening of already existing OCD symptoms. Studies at the National Institute of Mental Health have shown that a strep infection can produce cross-reactive "anti-brain" antibodies that produce the symptoms of PANDAS in children between age 3 and puberty.

Treatment for OCD

What has worked in the past

Your attitudes toward medication

Your motivation to undergo exposure response prevention (ERP) or cognitive-behavioral therapy (CBT)

The severity of your symptoms

The presence of other disorders such as depression

In general, most OCD types respond to some combination of cognitive-behavior therapy, exposure-response prevention, and medication. An important exception may be hoarding, which does not seem to improve with medication but does seem to respond to psychotherapy.

Nevertheless, it may be useful for you to discuss with your psychologist or physician the ways in which ERP, CBT, and medication can be adjusted for maximum benefit based on your symptoms.

A Word From Verywell

If you have symptoms of OCD or its related disorders, see your health care provider as there is treatment available. You are not the only person with one of these disorders. You will find support and get the help you need to relieve yourself of these symptoms.

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The 5 Types of Obsessive-Compulsive Disorder

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The ways in which symptoms of obsessive-compulsive disorder (OCD) are experienced varies widely from person to person. The "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) provides a broad definition of obsessive-compulsive disorder that includes the presence of obsessions and/or compulsions that cause major distress or disruption to daily living.

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Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry. These are called obsessions. To alleviate the anxiety caused by their obsessive thoughts, they perform repetitive, ritualized actions called compulsions. A child with OCD might need to line things up, touch things in a certain order when leaving the room or wash his hands repeatedly.

Obsessions Common in Kids With OCD

Contamination: Kids with this obsession are sometimes called "germaphobes." In schools, this plays out with kids worrying about other kids sneezing and coughing, touching things that might be dirty or getting sick in many different ways. This is the most common obsession seen in children.

Magical thinking: This is a kind of superstition, like "step on a crack, break your mother's back," taken to extremes. For example, kids might worry that their thoughts can cause someone to get hurt, or get sick. A child might think, "Unless my things are lined up in a certain way, mom will get in a car accident."

Catastrophizing: Some kids easily jump to the conclusion that something terrible has happened. For example, if her parents are five minutes late picking her up, a girl who is catastrophizing might tell herself that they've decided to abandon her.

Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.

What ifs: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. "What if I hurt someone? What if I stab someone? What if I kill someone?"

The "just right feeling": When OCD first develops, from about 6 to 9 years of age, kids may not know why they are doing something, but just that they need to do it until they get what we call the "just right feeling." So: "I'll line these things up until it just kind of feels right, and then I'll stop." And then over time - in the 9- to 12-year-old range - it evolves into magical thinking and becomes more superstitious in nature.

Behaviors You Might See in Students With OCD

Frequent requests to go to the bathroom: This could be to wash hands, if someone near the child was coughing or sneezing, or if she touched something that she perceives as contaminated. She could be washing items-pens, pencils, backpacks, books. It could also be an excuse to get out the classroom and just be away from everyone, and have some respite.

Constant reassurance-seeking: This takes the form of repetitive questions. "Are you sure that's the answer? Could you tell me again? Did you hear what I said?" Checking doors, windows, lockers, desks. Over and over and over again.

Getting stuck on tasks: Sometimes kids with OCD will need to finish something to completion, or understand it to completion, before they're able to move on. So if a child is working out what he did wrong on a math test, and the teacher says, "Now let's open the textbook and start a new chapter," he's not going to be able to shift gears.

Retracing: If a child leaves the classroom and worries that she left a pencil behind, she'll go back into the classroom and go to her desk and check. If she had a bad thought as she went through the doorway, she might have to "fix it" by going back through the doorway again saying a good word. If she had a bad thought when she went down a flight of stairs on the way to class, she might need to go back up that same stairway at the end of the period, even if it means being late to her next class.

Obsessive erasing: A child could be erasing a lot because the letters have to look perfect. Or he could have used a word that disturbs him. For example, if he has a fear of vomiting and he's written the word vomit, he might not be able to stand seeing that word, so he erases it. Kids start having erasers worn down to the metal. Teachers start to see holes in the paper. Words will be drawn over on the back of the page. A lot of different areas of writing become problematic.

Behaviors Often Confused With Another Disorder

Some behaviors associated with OCD are easy to confuse with ADHD, learning problems or being oppositional.

Distraction: If a child is busy thinking that if she doesn't turn the pen cap and count to four the right way then her mom is going to get sick, she's not going to be paying attention in class. And if her teacher calls on her to answer a question, her distraction might look like ADHD, but it isn't.

Slowness on exams, papers and tasks: Sometimes when kids take a long time, they're struggling with the perfectionism of needing to do things the right way. This could look like learning problems, or inattention, but it isn't.

Avoidance: Teachers might see a child who doesn't want to sit on the floor, or pick things up that touched the floor, or get his hands dirty in art class. He may avoid a lot of playground activities - kids with germ fears will view the playground the way some adults view the subway: it's gross. Why touch anything there?

Tapping and touching symmetrically: If a child sits down at her desk and she accidentally kicks the chair of the kid next to her with her right foot, she's going to have to then kick it with her left foot. That might look like somebody who's being oppositional, or somebody who's got too much energy, but actually it's OCD.

Complaints of anxiety and fatigue: There's one interesting theory that kids with OCD are smarter than other kids. And if you consider how much thinking they're doing, they're really using their brain more frequently than a lot of other kids are. But when that's coupled with a lot of anxiety, you can have a lot of fatigue. So it's common for kids with OCD to want to come home and take a nap after school.

How to Help Students With OCD

For children struggling with OCD, functioning in school can be complicated and very difficult. Here are some things you can do to help them, and the class as a whole, focus on learning:

Seating arrangement: If the school has noisy hallways, you might not want to have a child with OCD sit by the door. You might have her sit in the front, where she's less able to hear the noise and can stay more focused on her work. On the other hand, a child who has very observable symptoms, and doesn't want other kids to see her fidgeting with her hands, rocking or getting up a lot, might be better off closer to the door, toward the back of the room.

Extended time for tests and papers: If writing is a problem for a child who needs to find the perfect way to say something, he's going to need more time to finish those essay questions or papers.

Laptops for writing: If writing and rewriting/erasing is really problematic for a child, consider letting her use a laptop for taking notes, and having all assignments be typed instead of handwritten.

Private testing rooms: Research is quite clear that kids with OCD do better, are less overwhelmed and are more in control of their thoughts and their reactions if they're in a quiet place away from the other kids.

Skip reading out loud: Kids who feel they need to read perfectly may have to go back and reread sentences or whole paragraphs over and over to make sure they've got them right. So reading becomes a very laborious task, and reading in front of the class can become a nightmare. So if we know doing this is a problem for children, we can spare them.

Books on tape: If kids get so hung up reading that it takes forever, listening to the books can be a solution.

Break homework into chunks: If looking at a whole page of math makes kids feel overwhelmed and anxious - think of the potential for mistakes! - the problems can be broken up over four pages. It helps kids stay focused on doing the problems instead of worrying.

How to Minimize Behavioral Problems

Plan an escape route: Try working out a communication system so that if the student feels symptoms coming on, she can signal to you and leave the classroom, or go to a protected place in the classroom, without interrupting the class. It can prevent an embarrassing and disruptive blowup of symptoms in the classroom, and the other kids picking on or bullying her about it.

Be aware of triggering events: It's very important for teachers to know what kind of things might trigger the symptoms. Fatigue is a huge piece of OCD, and it can be exacerbated by medication. So it's important to know that if a child is drowsy in class, and maybe he's putting his head down, it's not because he's being oppositional or disrespectful, but because he's overwhelmed with fatigue.

Advance notice: Irritability and frustration are two of the longer-lasting things that kids with OCD are feeling on a daily basis. Changes in schedule can be very disruptive for a child with OCD, so it can be helpful for teachers to give advance notice of things. Kids who know what to expect are less likely to be thrown by the change.

Children with OCD are often teased and bullied because of their symptoms. Kids feel very uncomfortable about their rituals, knowing that they're being watched. It can be helpful to educate the whole class about what's going on, especially if a child is going to be in the same school for a number of years, and it can inspire a surprising amount of support from other children.

Peer understanding program: A peer understanding program includes a presentation in the classroom that explains (with the child participating) what OCD is. The child might say, "Listen, I have OCD. It's an anxiety disorder. It makes me think that my hands are dirty and I have to wash my hands a lot, so if you see me getting up and going to the sink to wash my hands, that's why." Psychologists can role-play with the teacher and child ahead of time, to anticipate questions his classmates might ask, and how to answer them.

A buddy system: A buddy is like a peer coach who sits next to the child and prompts him to keep up with note taking and staying on task. It can be great for the buddy, to foster a sense of confidence and pride and to be able to help someone in need, and great for fostering friendship.

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry.

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What are Disruptive, Impulse Control and Conduct Disorders?

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What are Disruptive, Impulse Control and Conduct Disorders?

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Psychiatry.org - What are Disruptive, Impulse Control and Conduct Disorders?

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Learn about disruptive, impulse control and conduct disorders, including symptoms, risk factors and treatment options

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Bipolar disorder (depression & mania) - causes, symptoms, treatment & pathology

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National Institute of Mental Health (NIMH)

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Overview

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person's mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely "up," elated, irritable, or energized behavior (known as manic episodes) to very "down," sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called "rapid cycling."

Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.

Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as "other specified and unspecified bipolar and related disorders."

Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and symptoms

Risk factors

Treatments and therapies

Join a study

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

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Learn about bipolar disorder, including signs and symptoms, types, risk factors, how it is diagnosed, and potential treatments and therapies.

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What is cyclothymic disorder?

Cyclothymic disorder, also known as cyclothymia, is a mental health disorder which affects mood. People with the condition experience mood swings between highs and lows that have the potential to interfere with everyday life.

Cyclothymic disorder affects between 0.4 percent and 1 percent of the population, affecting women more often than men by a ratio of 3:2.

Cyclothymic disorder usually begins early in life and is manageable with treatment. Less than half of people with the condition will go on to develop bipolar disorder. Some people will experience cyclothymic disorder as a chronic condition which lasts a lifetime, while others will find it goes away over time.

Symptoms of cyclothymic disorder

People with cyclothymic disorders experience frequent swings between high and low mood. These swings are extreme enough to be classified as hypomania and depression, though not as extreme as those found in bipolar disorder.

People with cyclothymic disorder tend to have extreme reactions to external events or stimuli. They can be overly happy and enthusiastic in response to a positive event, such as:

Success at work

A period of good weather

Feelings created by substances, like drugs and alcohol

They can also be overly pessimistic and depressed by negative events, such as:

A relationship setback

Onset of winter

Stressful situations, such as moving house

People experiencing symptoms of cyclothymic disorder should seek professional medical help. In addition, they can use the free Ada app to carry out a symptom assessment.

Hypomania

People with cyclothymic disorder can experience hypomania, which is a feeling of exaggerated happiness or wellbeing (euphoria). It is not as extreme as mania. Someone experiencing hypomania may appear to be managing day-to-day activities well, though it can still be disruptive.

Symptoms and signs of hypomania in cyclothymic disorder can also include:

Being irritable and agitated

Impulsive and risky behaviour

Extreme optimism

Lack of inhibitions and poor judgement

Racing thoughts and talking more than usual

Increased sexual drive

Easily distracted

Overly confident and inflated sense of self-esteem

Not sleeping much

Excessive physical activity or fidgeting

Good to know: Unlike bipolar disorder, hypomania in cyclothymic disorder will not develop into mania.

Depression

Someone with cyclothymic disorder will experience depression, which is characterized by low mood. These feelings are more intense and longer-lasting than the feelings of sadness that everyone experiences from time to time.

Symptoms and signs of depression in cyclothymic disorder can include:

Low mood for most of the time

Feeling hungrier than usual

Weight changes

Feeling very fatigued and sluggish

Sleeping more or less than usual

Not enjoying life and activities, even ones normally found pleasurable

Feeling upset or tearful

Lack of concentration or motivation

Feeling guilty or worthless

Loss of interest in sexual activity and intimacy

Loss of interest in activities and hobbies

Being irritable, agitated or tense

Being restless

Suicidal thoughts and feelings

Read more about Signs of Depression "
Mixed episodes

Mixed episodes can be difficult to cope with, because the emotional experience is confusing. Someone in a mixed state also poses a greater risk of attempted suicide, as the person may feel the sadness and hopelessness of depression while in an energized state.

Causes of cyclothymic disorder

Risk factors for cyclothymic disorder

The instability of cyclothymic disorder can increase the risk of suicide. This is because of moods shifting relatively rapidly between depression and feeling energized, as well as a tendency towards extreme emotional reactions.

If you have symptoms of cyclothymic disorder you should seek professional medical help. In addition, you can use the free Ada app to carry out a symptom assessment.

Diagnosing cyclothymic disorder

Cyclothymic disorder shares some characteristics with bipolar disorder, but is less intense. This can feel as though the condition is being classified as not serious, when in fact it can have a significant impact on a person's life.

The ICD-10 defines cyclothymic disorder as having numerous periods of depression and mild elation, or hypomania, none of which are severe, or extended enough, to be classified as bipolar disorder.

DSM-5 criteria defines cyclothymic disorder as having the same mood swings as the ICD-10, but notes that:

A person should have had many periods of hypomania, and periods of depression for at least two years, or one year in children and teenagers

Stable moods should last for less than two months at a time

Symptoms do not meet the criteria for bipolar disorder or another mental health condition

Symptoms are not caused by another medical condition or by substance misuse

Symptoms significantly affect day-to-day life

Treatment of cyclothymic disorder

A person with cyclothymic disorder can require treatment even during periods of stable mood. Treatment should be guided by a mental health provider with experience in treating the condition.

If necessary, cyclothymic disorder should be treated with psychotherapy combined with appropriate medication.

Psychotherapy

Other talking therapies, such as support groups or cognitive behavior therapy (CBT), can help someone with cyclothymic disorder manage the condition and prevent it affecting day-to-day life. The duration of psychotherapy sessions will depend on clinical need.

Long-term psychotherapy can help by:

Instigating healthy daily routines

Developing strategies to cope with extreme emotional responses

Rebuilding self esteem

Medication

Whether to treat cyclothymic disorder with medication, and what kind of medication to use, depends on how difficult the person with the condition finds day-to-day life.

Mood stabilizers can work by evening out the high and low mood swings. Commonly prescribed mood stabilizers include valproic acid, lamotrigine and lithium. However, people with cyclothymic disorder may not respond as well to medication as people with bipolar disorder.
Read more about the treatment and management of bipolar disorder "
Cyclothymic disorder FAQs

Q: Is there a test for cyclothymic disorder?
A: There is no test to see if you have cyclothymic disorder. If you think you might have the condition, your doctor will talk to you about your mood history and make an assessment. You may be referred to a psychiatrist if necessary.

Q: Can cyclothymic disorder turn into bipolar disorder?
A: Some people with cyclothymic disorder will develop bipolar disorder. It's unclear exactly what determines who will develop bipolar disorder and who will not, but it's thought that between 15 percent and 50 percent of people with cyclothymic disorder will go on to develop bipolar disorder.

Q: Can cyclothymic disorder be cured?
A: Some people with cyclothymic disorder will find that symptoms go away with time and treatment. It isn't clear whose symptoms will disappear and whose will not.

Q: Is cyclothymic disorder a personality disorder?
A: Cyclothymic disorder is considered a subset of bipolar disorder. People with cyclothymic disorder are often thought of as having a particular type of personality, in that they switch rapidly between highs and lows and have extreme responses to positive and negative events. Someone with cyclothymic disorder may also have a personality disorder, such as obsessive compulsive disorder (OCD).

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Cyclothymic disorder, also known as cyclothymia, is a mental health disorder which affects mood. People with the condition experience mood swings between highs and lows that have the potential to interfere with everyday life. Cyclothymic disorder affects between 0.4 percent and 1 percent of the population, affecting women more often than men by a ratio of 3:2.

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I Have Bipolar. These Tools Help Me Manage My Mental Health.

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The shift to remote work that accompanied lockdown has had a significant, deleterious impact on the wellbeing of workers globally. This impact, however, has been acutely felt by those with mental health conditions like bipolar disorder. Nahla Davies discusses what has helped her stay focused and pro…

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Resource Guide-Bipolar and Depressive Disorders

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National Institute of Mental Health (NIMH)

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Are you afraid of being judged by others? Are you self-conscious in everyday social situations? Do you avoid meeting new people due to fear or anxiety? If you have been feeling this way for at least 6 months and these feelings make it hard for you to do everyday tasks-such as talking to people at work or school-you may have social anxiety disorder.

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. This fear can affect work, school, and other daily activities. It can even make it hard to make and keep friends. The good news is social anxiety disorder is treatable. Learn more about the symptoms of social anxiety disorder and how to find help.

What is social anxiety disorder?

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others, such as speaking in public, meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store. Doing everyday things, such as eating or drinking in front of others or using a public restroom, also may cause anxiety or fear due to concerns about being humiliated, judged, and rejected.

The fear that people with social anxiety disorder have in social situations is so intense that they feel it is beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things. Other people may be able to accomplish these activities but experience a great deal of fear or anxiety when they do. People with social anxiety disorder may worry about engaging in social situations for weeks before they happen. Sometimes, they end up avoiding places or events that cause distress or generate feelings of embarrassment.

Some people with the disorder do not have anxiety related to social interactions but have it during performances instead. They feel symptoms of anxiety in situations such as giving a speech, competing in a sports game, or playing a musical instrument on stage.

Social anxiety disorder usually starts during late childhood and may resemble extreme shyness or avoidance of situations or social interactions. It occurs more frequently in females than in males, and this gender difference is more pronounced in adolescents and young adults. Without treatment, social anxiety disorder can last for many years, or even a lifetime.

What are the signs and symptoms of social anxiety disorder?

When having to perform in front of or be around others, people with social anxiety disorder may:

Blush, sweat, or tremble.

Have a rapid heart rate.

Feel their "mind going blank," or feel sick to their stomach.

Have a rigid body posture, or speak with an overly soft voice.

Find it difficult to make eye contact, be around people they don't know, or talk to people in social situations, even when they want to.

Feel self-consciousness or fear that people will judge them negatively.

Avoid places where there are other people.

What causes social anxiety disorder?

Risk for social anxiety disorder may run in families, but no one knows for sure why some family members have it while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety and that genetics influences how these areas function. By studying how the brain and body interact in people with social anxiety disorder, researchers may be able to create more targeted treatments. In addition, researchers are looking at the ways stress and environmental factors play a role in the disorder.

How is social anxiety disorder treated?

If you're concerned you may have symptoms of social anxiety disorder, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

Social anxiety disorder is generally treated with psychotherapy (sometimes called "talk therapy"), medication, or both. Speak with a health care provider about the best treatment for you.

Psychotherapy

Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT also can help you learn and practice social skills, which is very important for treating social anxiety disorder. CBT has been well studied and is the gold standard for psychotherapy.

Exposure therapy is a CBT method that focuses on progressively confronting the fears underlying an anxiety disorder to help you engage in activities you have been avoiding. Exposure therapy is sometimes used along with relaxation exercises. CBT delivered in a group therapy format also can offer unique benefits for social anxiety disorder.

Another treatment option for social anxiety disorder is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts and uses strategies such as mindfulness and goal setting to reduce your discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness. However, different therapies work for different types of people, so it can be helpful to discuss what form of therapy may be right for you with a mental health professional.

For more information on psychotherapy, visit the National Institute of Mental Health (NIMH) psychotherapies webpage.

Medication

Health care providers may prescribe medication to treat social anxiety disorder. Different types of medication can be effective in treating this disorder, including:

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

Beta-blockers

Anti-anxiety medications, such as benzodiazepines

SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of social anxiety disorder. They may take several weeks to start working. Antidepressants may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe, especially if the dose starts off low and is increased slowly over time. Talk to your health care provider about any side effects that you may experience.

Beta-blockers can help control some of the physical symptoms of social anxiety disorder, such as rapid heart rate, sweating, and tremors. Beta-blockers are commonly the medication of choice for the "performance anxiety" type of social anxiety disorder.

Benzodiazepines, which are anti-anxiety sedative medications, are powerful and begin working right away to reduce anxious feelings. These medications can be very effective in rapidly decreasing anxiety, but some people build up a tolerance to them and need higher and higher doses to get the same effect. Some people even become dependent on them. Therefore, a health care provider may prescribe them only for brief periods of time if you need them.

Both psychotherapy and medication can take some time to work. Many people try more than one medication before finding the best one for them. A health care provider can work with you to find the best medication, dose, and duration of treatment for you. People with social anxiety disorder usually obtain the best results with a combination of medication and CBT or other psychotherapies.

For basic information about these and other mental health medications, visit NIMH's Mental Health Medications webpage. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, and information on newly approved medications.

Support Groups

Many people with social anxiety find support groups helpful. In a group of people who all have social anxiety disorder, you can receive unbiased, honest feedback about how others in the group see you. This way, you can learn that your thoughts about judgment and rejection are not true or are distorted. You also can learn how others with social anxiety disorder approach and overcome the fear of social situations.

Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Both psychotherapy and medication can take some time to work. A healthy lifestyle also can help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support. To learn more ways to take care of your mental health, visit NIMH's Caring for Your Mental Health webpage.

How can I support myself and others with social anxiety disorder?

Educate Yourself

A good way to help yourself or a loved one who may be struggling with social anxiety disorder is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing social anxiety disorder symptoms, have an honest conversation about how you're feeling with someone you trust. If you think that a friend or family member may be struggling with social anxiety disorder, set aside a time to talk with them to express your concern and reassure them of your support.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life-such as avoiding social situations at school, at work, or with friends and family-it's time to seek professional help. Talk to a health care provider about your mental health.

Are there clinical trials studying social anxiety disorder?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions-including social anxiety disorder. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH's clinical trials webpage.

Finding Help

Behavioral Health Treatment Services Locator

This online resource, provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), helps you locate mental health treatment facilities and programs. Find a facility in your state by searching SAMHSA's online Behavioral Health Treatment Services Locator . For additional resources, visit NIMH's Help for Mental Illnesses webpage.

Talking to a Health Care Provider About Your Mental Health

Communicating well with a health care provider can improve your care and help you both make good choices about your health. Find tips to help prepare for and get the most out of your visit at Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider. For additional resources, including questions to ask a provider, visit the Agency for Healthcare Research and Quality website .

If you or someone you know is in immediate distress or is thinking about hurting themselves,call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website .

Reprints

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus (National Library of Medicine) ( en español )

ClinicalTrials.gov ( en español )

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 22-MH-8083
Revised 2022

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Social Anxiety Disorder: More Than Just Shyness

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Information about social anxiety disorder, including common signs and symptoms, treatment options, and how to find help.

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Section 504 Accommodations & Modifications | Forming a Section 504 Plan | Navigate Life Texas

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If your child needs special accommodations at school with the way content is taught, supported, or tested, you might be able get assistance through a Section 504 plan.

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Child Mind Institute | Transforming Children’s Lives.

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The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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When evaluating for ADHD, clinicians will use a variety of clinical practice tools to gather information, including standardized clinical rating and self-report checklists, behavior questionnaires and/or rating scales. These tools are an essential component of a comprehensive evaluation for ADHD and provide information needed to screen, diagnose and develop a treatment plan. During treatment, they can be used to track symptoms and monitor treatment progress.

These practice tools are typically completed for

Adults - by the individual client/patient and significant others (spouse, boss, co-worker)

Children - by their parent(s) or caregiver(s), other family members and/or educators

Teens - by the teen, their parent(s) or caregiver(s), other family members and/or educators

Rating Scales and Checklists

Scales and checklists help clinicians obtain information from adults, parents, teachers, and others about symptoms and functioning in various settings. Symptoms must be present in more than one setting (such as both at home and in school or work) to meet DSM-5 criteria for an ADHD disorder. Remember, however, that these instruments are only one component of a comprehensive evaluation.

The Agency for Healthcare Research and Quality (AHRQ) has noted that ADHD-specific rating scales are more accurate in distinguishing between children with and without the diagnosis of ADHD. These are preferable to global, nonspecific questionnaires and rating scales that assess a variety of behavioral conditions.

Child and Teen Rating Scales

The following rating scales are often used to screen, evaluate or monitor children and teenagers with ADHD. Due to the variability of a child's behavior based on the setting, their relationship with the person completing the form, or the subjective nature of the responses, it is best to have several significant people in the child's life (mother, father, grandparent, teacher, daycare provider, etc.) complete the forms for comparison. The responses and scores are not sufficient for a diagnosis of ADHD but are an important component of the comprehensive evaluation process.
Child Behavior Checklist (CBCL/6-18)

Identifies problem behavior in youths ages 6-18 years, including possible disorders and internalizing or externalizing problems

Consists of a checklist of 120-questions

Scored on a 3-point scale that ranges from 0 (not true) to 2 (very true/often true)

Conners' Rating Scales

Conners' Parent Rating Scale-Revised for parents/caregivers

Conners' Teacher Rating Scale-Revised for teachers

Consist of 27/28 questions (short versions of the scale) divided into 4 subscales: 1)oppositional problems, 2) cognitive problems,3) hyperactivity and 4) an ADHD index

Scoring is based on a 4-point scale

Conners-Wells' Adolescent Self-Report Scale for teenagers
Administered to teens for their self-report.

Vanderbilt ADHD Rating Scales

Vanderbilt ADHD Parent Rating Scale (VADPRS)

Provides information on a parent's perception of social functioning and school performance

Consists of 45 questions

Teacher Rating Scale (VADTRS)

Provides information on school performance and ADHD symptoms

Consists of 43 questions

Based on 4- and 5-point scales with high scores indicating more severe symptoms, except for the performance section where higher scores indicate better performance in classroom behavior and academic achievement

ADHD Rating Scale-IV (ADHD-RS-IV)

Includes separate forms for parents/caregivers and teachers

Based on an 18-item scale divided into subscales for hyperactivity/impulsivity and inattentiveness

Scored on a 4-point frequency scale ranging from 0 = never/rarely to 3 = very often

Adult Rating Scales

The following scales have been developed to screen, evaluate and monitor adults with ADHD. Because rating scales are based on self-reported perceptions, and therefore subjective, it is recommended that significant person's in the adult's life also complete the forms. These can include the person's spouse, a close relative, employer and/or colleague.
Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2

Provides information on current adult symptoms of ADHD

Based on a semi-structured clinical interview

Consists of 18 items

Adult ADHD Self-Report Scale (ASRS) v1.1

Used as an initial symptom assessment to identify adults who may have ADHD

Consists of 18 items

Adult ADHD Self-Report Scale (ASRS) v1.1 Screener

Developed as a 6-question subset of the 18-question ADHD ASRS v1.1

Used as an initial self-assessment tool

Consists of 6 items: 4 for inattentive symptoms and 2 for hyperactive-impulsive symptoms

Scoring is based on symptom frequency

Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults

Used as a self-report or as part of a clinical interview

Consists of 40 items representing 5 symptom areas: activation, attention, effort, affect and memory

Asks about the adult's clinical history, work and/or school functioning, leisure, mood, and sensitivity to criticism

Scoring is based on a 4-point frequency scale from 0 (never) to 3 (almost daily)

ADHD Rating Scale IV (ADHD-RS-IV) With Adult Prompts

Rates the frequency and severity of ADHD symptoms

Consists of 18 items: 9 assess inattentive symptoms and 9 assess hyperactive-impulsive symptoms

Scoring is based on a 4-point frequency scale ranging from 0 (never) to 3 (very often)

References
Achenbach T. Child Behavior Checklist for Ages 6-18. Burlington, VT: ASEBA, University of Vermont. 2001.

Adler L, Cohen J. Diagnosis and evaluation of adults with attention-deficit/hyperactivity disorder. Psychiatric Clinics of North Am. 2004;27(2):187-201.

Collett BR, Ohan JL, Myers KM. Ten-year review of rating scales, V: scales assessing attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42(9):1015-1037.

Conners CK. Development of the CRS-R. In: Conners CK, ed. Conners' Rating Scales-Revised. North Tonawanda, NY: Multi-Health Systems. 2001:83-98.

Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology. 1998;26(4):257-268.

DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation. New York, NY: The Guilford Press. 1998.

Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine. 2005;35(2):245-256.

Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods Psychiatry Research. 2007;16(2):52-65.

Murphy K, Adler LA. Assessing attention-deficit/hyperactivity disorder in adults: focus on rating scales. Journal of Clinical Psychiatry. 2004;65: 12-17.

Wolraich M. Vanderbilt ADHD Diagnostic Teacher Rating Scale. 1998.

Wolraich Ml, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology. 2003;28(8):559-567.

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When evaluating for ADHD, clinicians will use a variety of clinical practice tools to gather information, including standardized clinical rating and self-report checklists, behavior questionnaires and/or rating scales. These tools are an essential component of a comprehensive evaluation for ADHD and provide information needed to screen, diagnose and develop a treatment plan.

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What Is Conduct Disorder?

Conduct disorder is an ongoing pattern of behavior marked by emotional and behavioral problems. Children with conduct disorder behave in angry, aggressive, argumentative, and disruptive ways.

Conduct disorder in children goes beyond bad behavior. It is a diagnosable mental health condition that is characterized by patterns of violating societal norms and the rights of others. It's estimated that around 3% of school-aged children have conduct disorder. It is more common in boys than in girls.﻿﻿

Conduct disorder extends beyond normal teenage rebellion. It involves serious behavior problems that are likely to raise alarm among teachers, parents, peers, and other adults. In order to qualify for a diagnosis of conduct disorder, children must exhibit at least three of these symptoms in the past year and at least one in the past six months:﻿﻿

Aggression Toward People and Animals

Bullying, threatening, or intimidating others

Initiating physical fights

Using a weapon that could cause serious harm

Physical cruelty to people

Physical cruelty to animals

Stealing while confronting a victim

Forced sexual activity

Property Destruction

Deliberate fire setting

Other destruction of property

Deceptiveness or Theft

Breaking or entering a house, car, or building

Lying for personal gain

Stealing without confronting the victim (such as shoplifting)

Serious Rule Violation

Staying out at night before the age of 13 years

Running away from home overnight at least twice

Truancy beginning before the age of 13

Conduct disorder isn't just a challenge for caregivers-it actually impairs a child's ability to function. Some areas where the condition may affect a child's life include:

Education: Children with conduct disorder misbehave so much that their education is affected. They usually receive frequent disciplinary action from teachers and may skip school. Children with conduct disorder may be at a higher risk of failure or dropping out of school.

Legal issues: Adolescents with conduct disorder are also more likely to have legal problems. Substance abuse, violent behavior, and a disregard for the law may lead to incarceration.

Relationships: Children with conduct disorder also have poor relationships. They struggle to develop and maintain friendships. Their relationships with family members usually suffer due to the severity of their behavior.

Sex: They may also engage in risky sexual behavior. Studies show that teens with conduct disorder are more likely to have multiple sexual partners and are less likely to use protection.﻿﻿

Conduct disorder in children can be diagnosed by a mental health professional or a physician. Often, a diagnosis is made after attempts to remedy behavior problems at school and at home aren't effective.

A professional may interview the child, review records, and ask that parents and teachers complete questionnaires about the child's behavior. Psychological testing and other assessment tools may also be used to evaluate the child.

Researchers aren't exactly sure why some children develop conduct disorder. A variety of biological, psychological, and social factors are likely involved. Quite often, those factors overlap. Some that may play a role include:

Brain abnormalities:Imaging studies suggest children with conduct disorder may have some abnormalities in certain areas of the brain. The pre-frontal cortex (which affects judgment) and the limbic system (which affects emotional responses) may be impaired.

Cognitive deficits:Low IQ, poor verbal skills, and impairment in executive functioning may make children more vulnerable to conduct disorder.

Genetics:Studies suggest that inherited genes may be responsible for about half of anti-social behavior.﻿﻿ Researchers aren't sure which specific genetic components contribute to conduct disorder.

Social issues: Poverty, disorganized neighborhoods, poor schools, family breakdown, parental mental illness, harsh parenting, and inadequate supervision are all strongly linked with conduct disorder.

Oppositional Defiant Disorder as a Precursor

Common Comorbid Conditions

Many children with conduct disorder have other mental health issues or cognitive impairments. These can include:

Self-harm

Substance misuse

Depression and anxiety

Posttraumatic stress disorder

Learning disability

Children with conduct disorder may be more likely to develop antisocial personality disorder later in life.

There are three subtypes types of conduct disorder. These subtypes are distinguished by the age at which symptoms first appear.

Childhood-onset indicates that the symptoms started before the age of 10.

Adolescent-onset indicates that the signs of the condition began during a child's teens.

Unspecified-onset indicates the age exact age that the symptoms first began is not clear.

The Diagnostic and Statistical Manual ( DSM-5), which is used to diagnose mental illnesses, also distinguishes between conduct disorder with or without "limited prosocial emotions."

Individuals with limited prosocial emotions are characterized by callousness and a lack of remorse and empathy. They are unconcerned about their performance at school or work and have shallow emotions. When present, their emotional expressions may be used to manipulate others.

Treatment for conduct disorder depends on several factors, such as a child's age and the severity of behavior problems. The most common treatment methods include:

Family therapy: Parents, siblings, and other family members may be invited to attend therapy with the child. Sometimes, improving the relationship between parents and a child may improve family interactions.

Medication: There isn't a medication that specifically treats conduct disorder. But sometimes doctors may prescribe medication to treat the disorder's symptoms or to address other underlying mental illness.﻿﻿

Parent training: Treatment often involves caregivers and parents. Parents may be taught behavior management strategies and techniques to increase safety in the home if a child is aggressive or violent.

Psychotherapy:Individual therapy may be helpful when a child could benefit from learning new skills, such as anger management and impulse control.

Residential placement:In cases where a child or adolescent's behavior has become out of control, treatment in a residential program may be necessary to keep everyone safe. A therapeutic environment may address substance abuse issues, sexualized behavior, or violence.

Early intervention is key to getting the most effective treatment, so it's important for parents, educators, and physicians to be aware of the signs of conduct disorder in children so that appropriate referrals and interventions can be put into place.

Research suggests that taking part in psychosocial treatments can help both children and families cope with the effects of conduct disorder. Such approaches often involve working with parents and caregivers to help them find effective ways of managing their child's behavior. This may include such things as:

Creating structure

Enforcing limits

Providing clear instructions

Rewarding positive behaviors

Using time-outs after inappropriate behaviors or outbursts

The ultimate goal of such training is to help parents and children interact more effectively. This can lead to less conflict and help children better regulate their behavior.

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Conduct Disorder in Children Can Cause Serious Behavior Problems

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Conduct disorder is an ongoing pattern of behavior marked by emotional and behavioral problems. Children with conduct disorder behave in angry, aggressive, argumentative, and disruptive ways. Conduct disorder in children goes beyond bad behavior. It is a diagnosable mental health condition that is characterized by patterns of violating societal norms and the rights of others.

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“Conduct disorder” refers to a group of behavioral and emotional problems in youngsters.

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Eating Disorder Assessment

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Eat-40 – EAT-26: Eating Attitudes Test & Eating Disorder Testing

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Instructions: This is a screening measure to help you determine whether you might have an eating disorder that needs professional attention. This screening measure is not designed to make a diagnosi…

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Family-Based Treatment
Family Therapy
Behavior Therapy
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-290
CBT
Enhanced CBT for Eating Disorders

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Eating Disorder Examination Interview (EDE and EDE-Q; Cooper and Fairburn, 1987)

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Eating Disorder Examination Interview (EDE and EDE-Q; Cooper and Fairburn, 1987)

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" I have the worst luck in the entire world. "

" I just failed that math test. I'm no good at school, and I might as well quit. "

" She's late. It's raining. She has hydroplaned and her car is upside down in a ditch. "

These are all prime examples of cognitive distortions: thought patterns that cause people to view reality in inaccurate - usually negative - ways.

In short, they're habitual errors in thinking. When you're experiencing a cognitive distortion, the way you interpret events is usually negatively biased.

Most people experience cognitive distortions from time to time. But if they're reinforced often enough, they can increase anxiety, deepen depression, cause relationship difficulties, and lead to a host of other complications.

Research suggests that people develop cognitive distortions as a way of coping with adverse life events. The more prolonged and severe those adverse events are, the more likely it is that one or more cognitive distortions will form.

One early theory even suggests that human beings might have developed cognitive distortions as a kind of evolutionary survival method.

In other words, stress could cause people to adapt their thinking in ways that are useful for their immediate survival. But these thoughts aren't rational or healthy long-term.

In the 1960s, psychiatrist Aaron Beck pioneered research on cognitive distortions in his development of a treatment method known as cognitive behavioral therapy.

Since then, researchers have identified at least 10 common distorted thinking patterns, which are listed below:

Sometimes called all-or-nothing, or black and white thinking, this distortion occurs when people habitually think in extremes.

When you're convinced that you're either destined for success or doomed to failure, that the people in your life are either angelic or evil, you're probably engaging in polarized thinking.

This kind of distortion is unrealistic and often unhelpful because most of the time reality exists somewhere between the two extremes.

When people overgeneralize, they reach a conclusion about one event and then incorrectly apply that conclusion across the board.

For example, you make a low score on one math test and conclude that you're hopeless at math in general. You have a negative experience in one relationship and develop a belief that you just aren't good at relationships at all.

Overgeneralization has been associated with post-traumatic stress disorder and other anxiety disorders.

This distorted type of thinking leads people to dread or assume the worst when faced with the unknown. When people catastrophize, ordinary worries can quickly escalate.

For instance, an expected check doesn't arrive in the mail. A person who catastrophizes may begin to fear it will never arrive, and that as a consequence it won't be possible to pay rent and the whole family will be evicted.

It's easy to dismiss catastrophizing as a hysterical over-reaction, but people who have developed this cognitive distortion may have experienced repeated adverse events - like chronic pain or childhood trauma - so often that they fear the worst in many situations.

One of the most common errors in thinking is taking things personally when they're not connected to or caused by you at all.

You may be engaging in personalization when you blame yourself for circumstances that aren't your fault, or are beyond your control.

Another example is when you incorrectly assume that you've been intentionally excluded or targeted.

Personalization has been associated with heightened anxiety and depression.

When people assume they know what others are thinking, they're resorting to mind reading.

It can be hard to distinguish between mind reading and empathy - the ability to perceive and understand what others may be feeling.

To tell the difference between the two, it might be helpful to consider all the evidence, not just the evidence that confirms your suspicions or beliefs.

At least has found that mind reading is more common among children than among adolescents or adults and is associated with anxiety.

Another distorted thought pattern is the tendency to ignore positives and focus exclusively on negatives.

Interpreting circumstances using a negative mental filter is not only inaccurate, it can worsen anxiety and depression symptoms.

Researchers have found that having a negative perspective of yourself and your future can cause feelings of hopelessness. These thoughts may become extreme enough to trigger suicidal thoughts.

Like mental filters, discounting the positive involves a negative bias in thinking.

People who tend to discount the positive don't ignore or overlook something positive. Instead, they explain it away as a fluke or sheer luck.

Instead of acknowledging that a good outcome is the result of skill, smart choices, or determination, they assume that it must be an accident or some type of anomaly.

When people believe they have no control over their circumstances, it can reduce motivation and cultivate a sense of "learned helplessness."

When people find themselves thinking in terms of what "should" and "ought" to be said or done, it's possible that a cognitive distortion is at work.

It's rarely helpful to chastise yourself with what you "should" be able to do in a given situation. "Should" and "ought" statements are often used by the thinker to take on a negative view of their life.

These types of thoughts are often rooted in internalized family or cultural expectations which might not be appropriate for an individual.

Such thoughts can diminish your self-esteem and raise anxiety levels.

Emotional reasoning is the false belief that your emotions are the truth - that the way you feel about a situation is a reliable indicator of reality.

While it's important to listen to, validate, and express emotion, it's equally important to judge reality based on rational evidence.

Researchers have that emotional reasoning is a common cognitive distortion. It's a pattern of thinking that's used by people with and without anxiety or depression.

Labeling is a cognitive distortion in which people reduce themselves or other people to a single - usually negative - characteristic or descriptor, like "drunk" or "failure."

When people label, they define themselves and others based on a single event or behavior.

Labeling can cause people to berate themselves. It can also cause the thinker to misunderstand or underestimate others.

This misperception can cause real problems between people. No one wants to be labeled.

The good news is that cognitive distortions can be corrected over time.

Here are some steps you can take if you want to change thought patterns that may not be helpful:

Identify the troublesome thought

When you realize a thought is causing anxiety or dampening your mood, a good first step is to figure out what kind of distorted thinking is taking place.

To better understand how your thoughts affect your emotions and behavior, you may want to consider reading " Feeling Good: The New Mood Therapy " by clinical psychologist Dr. David Burns. This book is considered by many to be the definitive work on this subject.

Try reframing the situation

Look for shades of gray, alternative explanations, objective evidence, and positive interpretations to expand your thinking.

You might find it helpful to write down your original thought, followed by three or four alternative interpretations.

Perform a cost-benefit analysis

People usually repeat behaviors that deliver some benefit.

You might find it helpful to analyze how your thought patterns have helped you cope in the past. Do they give you a sense of control in situations where you feel powerless? Do they allow you to avoid taking responsibility or taking necessary risks?

You can also ask yourself what engaging in cognitive distortion costs you. Weighing the pros and cons of your thought patterns could motivate you to change them.

Consider cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a widely recognized form of talk therapy in which people learn to identify, interrupt, and change unhealthy thinking patterns.

If you'd like some guidance in identifying and changing distorted thinking, you might find this type of therapy useful.

CBT usually focuses on specific goals. It generally takes place for a predetermined number of sessions and may take a few weeks to a few months to see results.

Look for a therapist who's properly certified and licensed in the state where you live. Your therapist should be trained in CBT. Try to find a therapist who has experience treating your type of thinking pattern or issue.

Cognitive distortions are habitual ways of thinking that are often inaccurate and negatively biased.

Cognitive distortions usually develop over time in response to adverse events. There are at least 10 common distorted thinking patterns that have been identified by researchers.

If you're ready to tackle a cognitive distortion, you may want to try some of the methods found in cognitive behavioral therapy. This type of therapy has been successful in helping people identify cognitive distortions and retrain themselves to look at the world in a clearer, more rational way.

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Cognitive Distortions: 10 Examples of Distorted Thinking

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If you buy something through a link on this page, we may earn a small commission. How this works. " I have the worst luck in the entire world. " " I just failed that math test. I'm no good at school, and I might as well quit. " " She's late.

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Biopsychosocial Assessment and Mental Status Exam

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Biopsychosocial Assessment and Mental Status Exam

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3.3 Lesson: The Biopsychosocial Assessment and the Mental Status Exam: Graves_AODS 255_Sandbox

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We all deal with stress on a daily basis, whether we're old or young, large or small, lofty thinkers or practical doers.

Even the most practiced meditator and the yogi who radiates peace experience this inevitable aspect of the human experience.

Reality is the leading cause of stress amongst those in touch with it.

Jane Wagner

It's inescapable, and it brings with it a host of uncomfortable and distracting symptoms. Stress isn't just a feeling or a mental state; if you don't address it, it seeps into every aspect of your life.

One way to cope with stress is through mindfulness-based stress reduction, or MBSR, an eight-week course that teaches how to use mindfulness in daily life. It's a proven way to help deal with the stressors of daily life. In this article, we'll explore what MBSR is and what resources are available for people interested in participating in and administering MBSR courses.

Before you read on, we thought you might like to download our 3 Mindfulness Exercises for free. These science-based, comprehensive exercises will not only help you cultivate a sense of inner peace throughout your daily life but will also give you the tools to enhance the mindfulness of your clients, students or employees.

Symptoms of Stress

According to WebMD, stress can produce the following symptoms:

Low energy;

Headaches;

Upset stomach, including diarrhea, constipation, and nausea;

Aches, pains, and tense muscles;

Chest pain and rapid heartbeat;

Insomnia;

Frequent colds and infections;

Loss of sexual desire and/or ability.

Beyond these physical symptoms, stress can also have a big impact on your emotions and general mood.

Stress.org describes a few of the mental or emotional symptoms of mounting stress:

Difficulty concentrating, racing thoughts;

Trouble learning new information;

Forgetfulness, disorganization, confusion;

Difficulty in making decisions;

Feeling overloaded or overwhelmed;

Frequent crying spells or suicidal thoughts;

Feelings of loneliness or worthlessness;

Little interest in appearance, punctuality;

Nervous habits, fidgeting, feet tapping;

Increased frustration, irritability, edginess;

Overreaction to petty annoyances.

Looking at these symptoms, it's clear that stress can reach its hungry tentacles into every nook and cranny of your daily life.

This all seems rather negative, but don't get too down yet.

"Stressed spelled backwards is desserts."

The quote above, while humorous and simplistic, is actually onto something. Stress is inevitable in life, this we know. But we should remind ourselves that succumbing to the negative symptoms of stress is not inevitable.

When we treat stress as an opportunity instead of a threat, we can change our mindset and meet the challenge head-on, contributing to our own growth and development instead of throwing up our hands and waiting to be swallowed whole.

So, how do we turn our "stressed" into "desserts?" What can we do to turn times of struggle into opportunities for positive change?

MBSR has answers for us.

What Is MBSR? A Definition

Mindfulness-based stress reduction is a group program that was developed by Jon Kabat-Zinn in the 1970s to treat patients struggling with life's difficulties and physical and/or mental illness (Kabat-Zinn, 2013).

Although it was initially created to aid hospital patients, it has since been used effectively by a wide range of people from all walks of life.

In fact, according to the Center for Mindfulness at the University of Massachusetts, more than 24,000 people have taken advantage of the MBSR program the center debuted in 1979 (Center for Mindfulness, 2017).

MBSR is a flexible and customizable approach to stress reduction. It's composed of two main components: mindfulness meditation and yoga. Instead of following a script or acting out meticulously described steps, mindfulness is practiced in the manner that best suits the individual (Center for Mindfulness, 2017).

While MBSR is often different for every person in practice, it is based on the same set of principles. The following descriptions are pulled straight from the Center for Mindfulness website:

1. Making the experience a challenge rather than a chore and thus turning the observing of one's life mindfully into an adventure in living rather than one more thing one "has" to do for oneself to be healthy;

2. An emphasis on the importance of individual effort and motivation and regular disciplined practice of the meditation in its various forms, whether one "feels" like practicing on a particular day or not;

3. The immediate lifestyle change that is required to undertake formal mindfulness practice, since it requires a significant time commitment (in the clinic 45 minutes a day, six days a week minimally);

The importance of making each moment count by consciously bringing it into awareness during practice, thus stepping out of clock time into the present moment;

1. An educational rather than a therapeutic orientation, which makes use of relatively large "classes" of participants in a time-limited course structure to provide a community of learning and practice, and a "critical mass" to help in cultivating ongoing motivation, support, and feelings of acceptance and belonging;

2. A medically heterogeneous environment, in which people with a broad range of medical conditions participate in classes together without segregation by diagnosis or conditions and specializations of intervention. This approach has the virtue of focusing on what people have in common rather than what is special about their particular disease (what is "right" with them rather than what is "wrong" with them), which is left to the attention of other dimensions of the health care team and to specialized support groups for specific classes of patients, where that is appropriate (Center for Mindfulness, 2017).

For more information on these principles, visit the Center for Mindfulness website.

When added to existing medical and/or psychological treatment, MBSR has shown to effectively enhance the results of treatment related to:

Anxiety and panic attacks;

Asthma;

Cancer;

Chronic illness;

Depression;

Eating disorders;

Fatigue;

Fibromyalgia;

Gastrointestinal distress;

Grief;

Headaches;

Heart disease;

High blood pressure;

Pain;

Post-traumatic stress disorder;

Skin disorders;

Sleep problems;

Work, family, and financial stress (Center for Mindfulness, 2017).

With such an impressive list of benefits, it's hard to argue against giving MBSR a shot, especially since the program does not require an unreasonable amount of time, energy, or resources.

The following section goes into more detail about how MBSR was established and what it entails.

Jon Kabat-Zinn's Work on MBSR

Jon Kabat-Zinn is considered the founding father of mindfulness-based stress reduction, as he created the practice in the 1970s.

He took a modern, scientific-based perspective to traditional Buddhist principles of mindfulness and meditation and developed a flexible approach to reducing stress.

MBSR was first put into practice at the Stress Reduction Clinic at the University of Massachusetts Medical School, where Jon Kabat-Zinn was established as a professor of medicine.

At the time, the program Kabat-Zinn founded was called the Stress Reduction and Relaxation Program, which was later changed to mindfulness-based stress reduction (Center for Mindfulness, 2017).

With the name change came a shift in perspective, from emphasizing the Buddhist foundations to making the program more secular and inviting to people from all systems of belief (Wilson, 2014). Kabat-Zinn viewed mindfulness as a practice that every human has the capacity to engage in, and MBSR promotes this perspective by allowing for individualization (Center for Mindfulness, 2017).

Kabat-Zinn's work with MBSR contributed to a movement of acceptance and awareness in an environment of seemingly unending stress, but his vision of mindfulness for all may be his enduring legacy.

There are virtually no barriers to the practice of mindfulness or yoga. If you have a mind, you can practice mindfulness, and if you have a body that is capable of movement, you can practice yoga.

This is one of the best things about MBSR: it's accessible for just about everybody.

So, without further ado, let's jump in and explore MBSR!

The 8 Most Popular MBSR Exercises and Techniques

The website www.themindfulword.org provides an excellent outline of some of the most popular Mindfulness-Based Stress Reduction Exercises.

Mindfulness Techniques

As expected, mindfulness is heavily featured in MBSR techniques. While it's easy to think of mindfulness as a certain state of mind, there are actually several different ways to practice or engage in mindfulness, with varying areas of emphasis.

1. Focus Mindfulness

Practicing mindfulness with an emphasis on focus involves looking inward to observe what is happening in your mind.

It can be described as "eyes on the road" in that there is a singular focus on one experience.

To keep your focus, it can be helpful to use a particular stimulus (like breath) to keep yourself grounded in the moment (The Mindful Word, 2012).

2. Awareness Mindfulness

Unlike focusing, practicing awareness emphasizes the external instead of the internal. Awareness focuses on the mind but from an outside perspective. When trying mindfulness from an awareness angle, try to view your mental activity as if it belonged to someone else.

In general, awareness mindfulness can be described as looking at your thoughts and feelings from outside of your usual self-centered experience and observing your mind as a stream of consciousness without attaching judgment.

For an example of a simple awareness exercise, use the following guide:

"Start by taking your mind inwards for a moment by focusing on the breath. Take a few gentle deep breaths, from the belly. In and out. Relax. Let go. Continue to breathe for as long as you wish.

Now take your mind outwards. See your thoughts, feelings, moods, and sensations as objects floating down a stream, coming into view and vanishing from sight. Simply watch without judgment or analysis. Just watch them pass.

Now pluck an object from the stream and focus on it. Let the other sensations and thoughts go by in the background. Note any new thoughts or feelings that arise from observing this object. Sit with these thoughts and feelings for a moment.

Whenever you're ready to leave this object behind, simply deposit it on a leaf and let it float downstream"

(The Mindful Word, 2012).

3. Shifting from Focus to Awareness

For switching from focus mindfulness to awareness mindfulness, try these tips:

Watch the stream of consciousness, dispassionately

Pluck something from the stream and deliberately focus on it (e.g. a dream image, a memory, a painful feeling).

Mindfulness Exercises

The Mindful Word outlines several popular mindfulness exercises, including:

1. The Breath

The exercise described above is one such exercise that facilitates mindfulness by focusing on the breath.

2. Body Scan

Lie with your back on the floor or a bed and close your eyes.

Move your awareness through your body, focusing on one area at a time.

Stop whenever you find an area that is unusually tight or sore and focus your breath on this area until it relaxes.

You can use a calm and healing visualization at this point as well (e.g., a ball of white light melting into the sore spot).

For an extended guide to practicing the body scan, click here.

3. Object Meditation

Hold an object that is special or interesting to you. Focus all of your senses on it and note the information your senses feed back to you, including its shape, size, color, texture, smell, taste, or sounds it makes when manipulated.

4. Mindful Eating

Like the previous exercise, this exercise can be completed with all your senses while you focus on eating a particular food, like dark chocolate or a raisin.

Eat slowly, utilizing all five senses: smell, taste, touch, sight, and even sound.

5. Walking Meditation

Take a leisurely walk at a gentle but familiar pace. Observe how you walk and pay attention to the sensations in your body as you walk.

Notice how your shoulders feel (Tight? Loose? Strong?), the sensations in your feet as they meet the ground, the swing of your hips with each stride. Match your breathing to your footsteps.

6. Mindful Stretching

You can practice mindful stretching with any set of stretches that you like, but if you want a guided practice you can give yoga a try (more on that in the next section).

Awareness Exercises

The Mindful Word also describes two awareness exercises. If you'd like to try an exercise in improving your awareness, try one of the following exercises.

1. Simply Watching

This exercise involves only you and your thoughts. Instead of focusing on your thoughts as they rise to the surface, let them pass by like clouds in the sky.

Refrain from attaching value judgments to your thoughts (e.g., "I'm terrible for thinking that," or "What a kind thought! I am a good person.").

If it helps, you can identify or even vocalize each thought, feeling, or sensation as they come up (i.e., "sore neck, pizza, best friend, anger, tingling, empty stomach, pizza again, grandma, I miss her") (The Mindful Word, 2012).

2. Worry or Urge "Surfing"

Approach your thoughts and feelings like you're surfing on a wave.

Turn your awareness to the warning signs of a negative feeling like worry, anxiety, or anger approaching.

Imagine the negative emotion coming at you like a wave that gets bigger and bigger as it approaches, crests as it reaches you, and falls as it moves away.

Imagine riding that wave as it passes, and let the negative emotion go with it. Make sure to celebrate your ability to let the emotion go, but acknowledge that more will come eventually and remember to "ride the wave" again when they do (The Mindful Word, 2012).

For more detailed explanations of each exercise, visit The Mindful Word website here.

Yoga and Mindfulness-Based Stress Reduction

As noted earlier, yoga can be an excellent way to reduce stress and practice mindfulness.

Several studies have shown that practicing yoga can benefit people from all walks of life.

For example, a study of mental health professionals showed that practicing yoga significantly reduced work-related stress and enhanced their ability to adapt and react to stress (Lin, Huang, Shiu, & Yeh, 2015).

Yoga can also help school employees enhance their levels of calmness, comfort, and cheerfulness, as well as decrease their cognitive and body stress (Nosaka & Okamura, 2015).

Veterans suffering from post-traumatic stress disorder (PTSD) can also benefit from yoga. Yoga has proven effective for veterans in improving PTSD-related symptoms and quality of sleep (Staples, Hamilton, & Uddo, 2013).

Female veterans, in particular, showed a reduction of PTSD-related symptoms and substance abuse behavior when they participated in a 12-session yoga treatment (Reddy, Dick, Gerber, & Mitchell, 2014).

Even children can enjoy the benefits of yoga. One study found that a 10-week yoga class decreased cortisol, a stress-related hormone, in second-graders (Butzer et al., 2015). It also contributed to a decrease in behavior problems in second- and third-graders.

Another study showed that yoga can decrease academic-related stress in children (Venkataramana, Poomalil, & Shobhasree, 2008).

According to Kabat-Zinn, there are seven foundational attitudes that are integral to the practice of mindfulness for the purpose of stress reduction:

Non-judgment: intentionally assume the mind frame of an impartial witness;

Patience: a form of wisdom that allows us to give ourselves space and time to have our experiences;

A beginner's mind: a mindset that is willing to experience everything as if it is the first time;

Trust: having trust in yourself and honoring your own knowledge and experience;

Non-striving: an attitude that eschews the usual state of trying to get somewhere or accomplish something in particular, but encourages the practitioner to simply be;

Acceptance: seeing things as they really are in each moment, rather than as you would like them to be or as the worst interpretation may present; in other words, taking things as they come;

Letting go: intentionally releasing control and allowing ourselves to fully participate in our experience.

For a guided yoga practice, see this video from Dr. Lynn Rossy.

If you liked the last video and want more, here's part two of Dr. Rossy's series.

If you're more interested in reading about how yoga contributes to MBSR, here are three book recommendations:

1. Mindful Yoga, Mindful Life: A Guide for Everyday Practice by Charlotte Bell

2. Functional Anatomy of Yoga by David Keil

3. The Science of Yoga by William J. Broad

Other Stress-Relieving Techniques

Besides mindfulness and yoga, there are many ways to reduce stress. One of my personal favorites is to cuddle with my dogs.

Pets can be excellent guards against fear, stress, and anxiety.

If you don't have pets, try visiting a friend's pets or making a shelter dog's day by taking them for a walk and having a bonding session. Be sure to check with the shelter staff about the dog's personality and friendliness before getting too close and cuddly, though.

If you're not a big fan of animals, fret not! There are many more ways to reduce stress. You can try:

1. Getting together with friends to get your mind off of your worry or anxiety. Hosting a board game or card game night is a great way to try this method;

2. Taking a long, hot bath, if you're the kind who enjoys baths! Bonus stress-reduction points if you use candles, bubbles, or take a glass of wine in with you;

3. Taking a leisurely walk through an interesting environment;

4. Watching a funny movie or T.V. show;

5. Rereading a favorite book;

6. Playing a video game (another one of my personal favorites);

7. Cleaning out a closet or spare room. Sometimes getting rid of a little bit of clutter can brighten up your day;

8. Listening to relaxing music. This one is up to interpretation-if German death metal relaxes you, feel free to indulge! Jack Johnson is my go-to for relaxing music;

9. Simply sitting in the sun-just don't forget to wear sunscreen.

This list provides several potential stress-reducing activities, but it is by no means complete. Do whatever it is that takes you out of your negative thoughts and into a calmer place.

Meditation and MBSR

Meditation is not like pressing a button that immediately relieves you of your stress.

However, it may be the closest thing to it.

When we meditate, we take responsibility for our mental states and learn to alter our reactions to the experiences we have in order to produce more positive outcomes (Wildmind, 2007). Regularly practicing meditation facilitates awareness of our thought patterns, our emotions, and how we experience stress. Once we have become aware of problematic patterns or processes, we have the ability to change them.

How to Practice Meditation to Reduce Stress

Now, we'll examine how to actually practice meditation with the aim of reducing stress.

1. Meditation Posture

Your first concern when beginning a meditation practice is figuring out how to position your body.

You want to be comfortable, but you also want to be sure your posture is contributing to the right frame of mind.

Meditation can be practiced sitting, standing, crouching, kneeling, or in just about any other position. The position does not matter as much as the fundamentals.

To make sure your posture is conducive to successful meditating, refer to this list:

Your spine should be upright, following its natural tendency to be slightly hollowed;

You should neither be slumped nor have an exaggerated hollow in your lower spine;

Your spine should be relaxed;

Your shoulders should be relaxed, and slightly rolled back and down;

Your hands should be supported, either resting on a cushion or on your lap so that your arms are relaxed;

Your head should be balanced evenly, with your chin slightly tucked in;

The back of your neck should be relaxed, long, and open;

Your face should be relaxed, with your brow smooth, your eyes relaxed, your jaw relaxed, and your tongue relaxed and just touching the back of your teeth (Wildmind, 2007).

Next, prepare your breath. This exercise does not manipulate the breath in any way, but it can help to take a few deep breaths to prepare for the meditation.

After you are prepared, move into the first stage by counting your breath. Do not attempt to change your breath, just count.

Use this counting method: one inhale, one exhale, count.

Continue counting your breath for about five minutes. If you find your mind wandering, gently bring it back to the sensation of breathing.

The next stage of breathing meditation is essentially the same as the first stage, except you count your inhales instead of your exhales. This is a slight change that can lead to a distinctly different experience.

For this stage, use this counting method: count, one inhale, one exhale.
Preparation:
As with the previous stage, count for at least a few minutes, gently bringing your mind back to your breath when it inevitably gets mischievous.

Instead of counting, simply allow your breath to come naturally, and pay attention to the sensations of breathing. Focus specifically on the transitions from inhale to exhale and back again, since these transitions are when you are most likely to get distracted. Try to see breathing as a continuous process rather than a series of inhales and exhales.

This stage calls for a narrowing of your awareness. Try to focus on how you are feeling as you breathe. Notice the tiny sensations that come with each breath, like the slight breeze on your lip from each breath, or the feel of air moving down your throat and into your lungs (Wildmind, 2007).

Meditation Exercise for Countering Anger

Metta Bhavana, or loving-kindness meditation, can be a useful tool to counter chronic anger. It involves learning to cultivate patience, kindness, acceptance, and compassion for ourselves.
Stage Three:
You can prepare for practicing loving-kindness meditation by cultivating emotional awareness.

Sit quietly and bring your awareness to your body, relaxing each muscle as you go;

Bring your awareness to your heart and see what emotions are there;

Pay attention to your thoughts if you need clues as to the emotions you are experiencing;

Try to reserve judgment of yourself;

Don't berate yourself for feeling negative emotions. Try to be kind and patient with yourself.

To begin loving-kindness meditation, assume your usual meditation posture. You will work through this meditation in five stages.

1. In the first stage, you cultivate loving-kindness toward yourself. Try to become aware of the emotions you are feeling, and, as noted above, do not judge them. Instead, show yourself compassion. Open your heart to yourself and accept what you are feeling. Extend a hand of friendship to yourself, and wish yourself well;

2. In the second stage, expand this loving kindness to a good friend. Decide on the friend beforehand, so as not to waste any time during the meditation. If it helps, imagine that your friend is going through a difficult time and needs your support. Show them compassion and accept them for who they are;

3. The third stage expands loving-kindness to a "neutral" person. Think of a person that you do not have an emotional connection with, someone who you neither like nor dislike. Extend your loving-kindness to this person. Wish them well, and offer them your acceptance, compassion, and kindness;

4. The fourth stage is perhaps the most difficult stage, as it calls for cultivating loving-kindness for someone you do not already have kind thoughts or feelings toward. Think of someone who you have a difficult relationship with or someone you actively dislike. Now, begin the hard work of extending loving-kindness to this person. Try to let go of your tendencies to think badly of them, and wish them well. You can use a wish like, "May they be well, may they be happy, may they be free from suffering," or any other wish you are comfortable with, but it must be positive (Wildmind, 2007);

5. The fifth stage is the culmination of this practice. In this stage, we extend our loving-kindness to all sentient beings. Widen the circle of your loving-kindness to touch every being in the known universe. You can start with yourself, your friend, the neutral person, and the difficult person. Think of all four of you together, and wish all of you well. Avoid "playing favorites" with your friend, and try to wish all of you happiness and joy.

From here, widen your circle to include more friends, more neutral people, and more difficult people. Widen the circle again to include all friends, all neutral people you know, and all difficult people you know.

Continue this process until your circle includes all sentient beings, and wish for happiness and joy for all of them. One wish covering all sentient beings that I have heard is: "May all beings everywhere be happy and free."

Feel free to use this wish, or invent your own to make it feel more personal.

MBSR Courses, Teacher Trainings, and Certification Programs

There are so many MBSR classes, programs, and trainings provided worldwide that it would be a monumental task to list them all here.

Instead, we'll provide an overview of the resources available to those interested in MBSR.

MBSR Courses

Besides the flagship course at the Center for Mindfulness where MBSR was developed, there are other opportunities to participate in MBSR.

To find an in-person MBSR course near you, use the Center for Mindfulness' search feature at this link. This search reveals MBSR teachers near you that are certified by the Center for Mindfulness to offer their MBSR course.

If you cannot find a certified teacher in your area or would like the convenience of taking the course online, there are two options outlined below.

1. Sounds True Course

The Sounds True website offers an online Mindfulness-Based Stress Reduction course that follows the same method as the Center for Mindfulness, with the curriculum developed by Jon Kabat-Zinn.

The course is offered over eight weeks and is facilitated by Dr. Saki F. Santorelli, the director of the Stress Reduction Clinic and executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, along with Florence Meleo-Meyer, a longtime teacher of MBSR and member of the executive leadership team at the Center for Mindfulness (Sounds True, 2015).

The course is split into the following sections:

Orientation
The first session provides an overview of the history and development of MBSR.

Week One
The first week gives participants an overview of the course and presents the theory and evidence behind the idea of mind-body medicine. Participants will be introduced to some of the basics of MBSR, including mindful eating, mindful breathing, and the body scan.

Week Two
Week two opens participants up to the examination of their perceptions, assumptions, and the perspective they use to interact with the world around them. The session will revisit the body scan exercise and explore how participants react to stress.

Week Three
The third week brings a greater focus on the body, with hatha yoga, sitting meditation, and walking meditation. This session encourages participants to learn how to be present in the moment, as well as how to maintain this presence in their daily life.

Week Four
In week four, participants will learn about how the body reacts to stress and how mindfulness can mitigate or reverse these effects. They will also be introduced to strategies for applying a mindfulness practice to stressful situations.

Week Five
This session marks the halfway point in the course and expands on the concepts and techniques participants have learned so far. Participants will be encouraged to think about the situations in which they often get bogged down in unhealthy or self-defeating patterns of thought, emotion, and/or behavior. Additionally, they will be walked through some strategies for applying mindfulness to these situations before these self-defeating reactions set in.

Week Six
The focus of week six is on resilience, or productive coping strategies that course participants can put into effect when they face challenges. The session also covers interpersonal mindfulness, which applies to person-to-person communications, situations that can be accompanied by stress, anxiety, or other difficult emotions.

At over six hours, this session is longer than the others, and it provides participants with an opportunity to put the techniques they have learned into practice in a variety of situations.

Week Seven
The second-to-last week is all about how to integrate the practice of mindfulness into everyday life. Participants will learn how to maintain their growing practice and how to commit to non-judgment, awareness, and presence in the moment.

Week Eight
The program closes with a review of the course content, a focus on how to carry on practicing mindfulness, and an overview of the resources and support available for course graduates as they continue with their lives.

The course has a regular price tag of $297, although at the time of this posting, the course is offered at a special price of $197. To read reviews of the course, see the details of their 100% satisfaction guarantee, or to learn more about this course, visit the website at this link.

2. Palouse Mindfulness Course

Another online MBSR course is offered through Palouse Mindfulness by Dave Potter, a certified MBSR instructor who trained at the University of Massachusetts Medical School.

This course is modeled on Kabat-Zinn's work, but the week-to-week content is not an exact copy of Kabat-Zinn's work. To see a description of each session, follow this link and navigate through the session outlines on the left side of the page.

The main difference between the Palouse Mindfulness course and the Sounds True course is that this course is self-directed. As such, there are no costs associated with taking this course, although many of the potential benefits are the same.

To learn more about this course, see the introduction here or read the FAQ section here.

3. Other Online Mindfulness Courses

This post provides links to other mindfulness courses that you can take online to learn more about practicing mindfulness.

Although these are not specifically MBSR programs, these courses can be a great way to add mindfulness knowledge and techniques to your repertoire.

MBSR Training and Certification Programs

The Center for Mindfulness also offers MBSR training for professionals who want to learn how to lead an MBSR course of their own.

MBSR Teacher Education & Certification

This program consists of six courses, usually offered over 36 months, and culminates in an MBSR Teacher certification from the Center for Mindfulness.

The courses include MBSR in Mind-Body Medicine, MBSR Fundamentals, MBSR Practice Teaching Intensive, MBSR Group Supervision, MBSR Individual Supervision, and MBSR Teacher Certification.

Each course carries a different price tag. Some tuition assistance is offered, which you can learn about here.

Mindfulness-Based Stress Reduction Retreats

As noted above, some MBSR training programs require attendance at an MBSR retreat.

Several such retreats are offered, some for MBSR teachers and teachers in training only, and some for anyone who is interested in practicing MBSR.

The Awareness and Relaxation Training website also provides information on upcoming MBSR retreats, which you can peruse here. These retreats are led by Steve Flowers, director of the Mindful Living Program at the Enloe Medical Center, and Dr. Bob Stahl, founder of several MBSR programs in the Bay Area and current director of the programs three California hospitals. Both of these professionals completed training with Jon Kabat-Zinn. The retreats are offered to a variety of health care professionals, including physicians, nurses, psychologists, and counselors.

The Shambhala Mountain Center offers several MBSR-based retreats, which take place near the Rocky Mountains in Colorado. The retreat aims to provide a safe and nurturing environment where retreat attendees can find support and guidance from MBSR teachers and deepen their meditation practice. For a list of upcoming retreats, check the website.

The MBSR Workbook

A Mindfulness-Based Stress Reduction Workbook by Dr. Bob Stahl and Dr. Elisha Goldstein is a great resource for engaging in MBSR. This workbook is based on Kabat-Zinn's work on MBSR and offers readers a method for addressing the stress they experience in their daily life.

If a course or retreat sounds like a little too much for you to take on right now, this workbook is a great way to practice MBSR and mindful meditation at your own pace.

The Best Free Body Scan and Guided Meditation YouTube Videos

If you are already familiar with MBSR program content or would like to jump right into the practice, these YouTube videos may be just what you are looking for.

Body Scan Videos

This guided body scan exercise is offered by meditation coach Greg de Vries and has more than 930,000 views on YouTube. It also includes an introduction to the body scan beforehand.

The video below is a popular 30-minute guided meditation that moves into the practice after a short introduction from narrator Michael Sealey. This meditation is also available as a downloadable track from Michael Sealey's website and from iTunes.

YouTube channel TheHonestGuys offers a guided meditation video on YouTube intended to provoke a deep state of relaxation. This video is an extremely popular one with more than 14 million views. The video clocks in at a little over 18 minutes and includes relaxing visuals and nature sounds as well as narration.

If you're trying to settle down for a night of restful sleep, the guided meditation for sleep from Jason Stephenson may be perfect for you. This video, described as "floating among the stars," layers Stephenson's soothing voice over a visual of twinkling stars and peaceful piano music.

At just over an hour, this video provides ample opportunity to float off to sleep, and the 6 million views suggest that it has helped many viewers drift into a peaceful rest.

If you enjoyed Michael Sealy's body scan, you may like his guided meditation video for detaching from overthinking. This video is another popular one with more than 16 million views, and it is also available to download from his website. This video is specifically intended for those struggling with anxiety, depression, Obsessive-Compulsive Disorder (OCD), or other conditions involving persistent overthinking and negative thoughts.

Other Online Resources

To learn more about other MBSR resources, visit the University of Massachusetts Center for Mindfulness website or the University of California San Diego's Center for Mindfulness website. Both institutions provide excellent resources for those interested in practicing and studying MBSR.

The Mindfulness Programs website also offers great content and information about MBSR. You can find this website here.

Finally, the web page on the MBSR workbook includes a list of several resources for those interested in MBSR. Check it out.

A Take-Home Message

We all experience stress in our daily lives, and sometimes it feels overwhelming. While there are many ways to address this abundance of stress, mindfulness is one that carries extra benefits.

Mindfulness meditation not only addresses current stress, but it can also help you defend against future stress, creating a deep and lasting sense of peace. It can even improve physical measures like blood pressure and heart rate.

As we often end our pieces that are about the benefits of mindfulness practice, I will leave you with this thought: What's the harm in giving it a try?

Happy meditating!

Have you experienced any benefits from practicing mindfulness? Have you given one of these MBSR courses a shot? Would you consider attending a mindfulness course or a silent retreat? Let us know in the comments!

We hope you enjoyed reading this article. Don't forget to download our 3 Mindfulness Exercises for free.

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Mindfulness-Based Stress Reduction: The Ultimate MBSR Guide

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We all deal with stress on a daily basis, whether we're old or young, large or small, lofty thinkers or practical doers. Even the most practiced meditator and the yogi who radiates peace experience this inevitable aspect of the human experience. Reality is the leading cause of stress amongst those in touch with it.

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Dr Susan H. Spence, PhD, is Professor Emeritus at Griffith University in Queensland, Australia. Her research in the area of clinical psychology focuses on the causes, assessment, treatment and prevention of anxiety and depression in young people. She is the developer of the Spence Children's Anxiety Scale that is widely used across the world and has been translated into over 20 languages.

You can read more about her work by clicking on the following links:-

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SCAS Home - The Spence Children's Anxiety Scale

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Dr Susan H. Spence, PhD, is Professor Emeritus at Griffith University in Queensland, Australia. Her research in the area of clinical psychology focuses on the causes, assessment, treatment and prevention of anxiety and depression in young people. She is the developer of the Spence Children's Anxiety Scale that is widely used across the world and has been translated into over 20 languages.

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Revised Children's Manifest Anxiety Scales

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Revised Children's Manifest Anxiety Scales

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Revised Children’s Manifest Anxiety Scale (RCMAS) - Subject Baseline

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This measure appears in the following time-points: Baseline.

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State-Trait Anxiety Inventory for Children

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State-Trait Anxiety Inventory for Children

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Description of Measure: The State-Trait Anxiety Inventory (STAI) is a commonly used measure of trait and state anxiety (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). It can be used in clinical settings to diagnose anxiety and to distinguish it from depressive syndromes. It also is often used in research as an indicator of caregiver distress (e.g., Greene et al., 2017, Ugalde et al., 2014).

Form Y, its most popular version, has 20 items for assessing trait anxiety and 20 for state anxiety. State anxiety items include: "I am tense; I am worried" and "I feel calm; I feel secure." Trait anxiety items include: "I worry too much over something that really doesn't matter" and "I am content; I am a steady person." All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always"). Higher scores indicate greater anxiety. The STAI is appropriate for those who have at least a sixth-grade reading level.

Internal consistency coefficients for the scale have ranged from .86 to .95; test-retest reliability coefficients have ranged from .65 to .75 over a 2-month interval (Spielberger et al., 1983). Test-retest coefficients for this measure in the present study ranged from .69 to .89. Considerable evidence attests to the construct and concurrent validity of the scale (Spielberger, 1989).

Studies also have shown that it is a sensitive predictor of caregiver distress over time, and that it can vary with changes in support systems, health, and other individual characteristics (Elliott, Shewchuk, & Richards, 2001; Shewchuk, Richards & Elliott, 1998).
References
Greene, J., Cohen, D., Siskowski, C., & Toyinbo, P. (2017). The relationship between family caregiving and the mental health of emerging young adult caregivers. The Journal of Behavioral Health Services & Research, 44(4), 551-5663. doi: 10.1007/s11414-016-9526-7

Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Palo Alto, CA: Consulting Psychologists Press.

Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

Ugalde, A., Krishnasamy, M., & Schofield, P. (2014). The relationship between self-efficacy and anxiety and general distress in caregivers of people with advanced cancer. Journal of Palliative Medicine, 17(8), 939-41. doi: 10.1089/jpm.2013.0338

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The State-Trait Anxiety Inventory (STAI)

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Description of Measure: The State-Trait Anxiety Inventory (STAI) is a commonly used measure of trait and state anxiety (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). It can be used in clinical settings to diagnose anxiety and to distinguish it from depressive syndromes.

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Resource Guide-Bipolar and Depressive Disorders