The link between brain inflammation as a result of chronic pain and depression

University has been pretty full on in my second year, and as a result the consistency of my blogs have become some what hindered. However! I have officially finished my second year now and completed all my academically testing - soul destroying - brain breaking tasks... otherwise know as "exams". I get my results in July and hope to God that the work has paid off.

Anyways that is enough on me, lets get onto looking at the main focus of this blog which is the link between chronic pain (causing brain inflammation), depression,  and anxiety.



A 5 year study conducted by Catherine Cahill and colleagues have found an association between those suffering chronic pain and depression. People may think that this is "obvious" but it is not until now that a biopysical link has been ascertained through the use of careful experimental design. Second to bipolar, chronic pain sufferers are much more likely to attempt illness related suicide - it has been found that around a quarter of Americans suffer chronic pain and as a result costs society a shocking $635 billion per year. Considering this exponential sum I highly doubt big pharma are complaining in the slightest.

So we have identified this link but what does this all mean on a cellular level? Well what was found is that brain inflammation is a byproduct of chronic pain, causing increased growth and activation in cells known as "microglia" -  microglia is a form of glia which along side neurons make up the brain and spinal cord acting as front-line defense within the central nervous system  (but lets not get into that). Now the main job of microglia is to act as a residential clean up service which helps to evict and extinguish any infectious agents and to also seek out damaged neurons. However these cells also trigger chemical signalling throughout neurons that inhibits the release of dopamine (which is otherwise known as the go to neurotransmitter for pleasure seeking) thus increasing the risk of depression (if you would like to know more on microglia then follow the link at the end of the blog)

In an attempt at countering this lack of dopamine response, the use of morphine was suggested which is renowned for its dopamine boosting properties. Unfortunately it was discovered that it made no difference in chronic pain sufferers showing that the consistent production of microglia can in-turn prove to be more influential than the likes of morphine which is used worldwide as a way of decreasing serious pain.

Due to the failure in the use of dopamine increasing drugs another approach was taken. This consisted of the use of microglia activation inhibitors, and as hoped this proved to be successful.

Afterthoughts 

Now this study is important for one of two reasons. The first is that for over 20 years a connection like this was always researched and never discovered until now - having this insight allows us to further increase our understanding of the brain, and with this understanding comes our ability to better preserve it, which is where the second reason comes in. So not only has this link been made, a beneficial strategy has also been contrived in the hopes of preventing depressive symptoms from the result of chronic pain.

With time this type of research will become more advanced hopefully coming up with ways to completely eradicate the burden that is chronic pain.

If you would like to read the original article on this then visit:   http://www.sciencedaily.com/releases/2015/06/150609213337.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28Latest+Science+News+--+ScienceDaily%29

For more information on glia visit: http://en.wikipedia.org/wiki/Microglia

My published paper on self-hypnoses

I have written a couple of papers in the hopes of potentially getting them published in my university journal (which is a great accomplishment if successful). I failed last year, however this just motivated me to try again for the next edition of the journal. So when I was in Greece a paper I read on a case study involving self-hypnoses and insomnia inspired me and as a result I worked on the following paper over the summer holidays. 

When I received the email saying how I have made it into the next edition of the journal I was very pleased. The feeling of working hard on a project and it finally paying off is amazing. Below you will find the punished paper and I hope you enjoy it. 

The beneficial effects of self-hypnosis on psychopathological disorders, and its influence on negative impulsions. 

Hypnotism…

Hypnotism is an English word derived from the brain of a Scottish Physician and surgeon in 1841, he went by the name James Braid. Braid suffered from rheumatism which peaked in severity in 1844 where three days of continuous discomfort and pain pushed him to the end of his tether. In order to relinquish this pain, Braid proposed that he would attempt to use self-hypnotism. In the presence of two friends, both of which had a capable understanding of the process, Braid attempted it; nine minutes in and to his surprise all pain had diminished - he repeated this process every time any symptoms would re-surface and had successfully remained free from rheumatism for over six years (Braid, 1960).

The word “self-hypnosis” is Greek, meaning sleeping. Self-hypnosis is similar to normal sleeping, in the sense that it’s a form of deep relaxation but differs from sleeping because you still have a sense of control. Throughout the hypnosis process the person is capable of responding to surrounding events and sounds, regardless of their eyes being open or closed (Miller, 1979). There are various forms of self-hypnosis which can be achieved in a variety of ways, these include: deep concentration, day dreaming, driving a car for a long period of time, remembering a shopping list or past event, recalling strong fears, and can even occur in classrooms (Lecron, 1971). So contrary to what many may think, self- hypnosis is in fact achieved on a regular basis.

The title of this paper should not lead people to think that self- hypnosis can only be applied to the areas in which I mention. This paper is going to look into how self- hypnosis can benefit mental disorders such as Anxiety, Insomnia, and Depression, and to also identify its influence on impulsions such as alcoholism and smoking. These specific topics are of interest to me and are among many other areas to which self-hypnosis can benefit.

Other areas where self-hypnosis has proven to be affective are: the overcoming of bad habits, increasing ones quality of life, eradication of phobias (Sulaman, 2014) and stimulating the brain helping promote memory recall which can be particularly useful for eyewitness testimonies and criminal investigations, especially in areas of sexual abuse or aggression (Bonnet, 1994). The main benefiters of self-hypnosis are those who would like to fix a problem, an example being a study conducted by Hawkins and Peter (2002) where children between the ages of 8-12 who suffer sleep problems as a result of being traumatized from loss were taught self-hypnosis. The efforts of the experimenters paid off and were successful in teaching the children strategies to help manage their sleep accordingly; this is just one example of the positive effects of self-hypnosis. Using suggestive hypnosis as a form of remedial treatment was also highly supported by Sigmund Freud, and because of this he was considered the spiritual father of the hypnosis movement (Strus, 1998).

Self -hypnosis is a learned behaviour to which the councillor and the counselee must have a sense of mutual cooperation and understanding. In order for there to be a positive impact it must be practiced for at least two days, and for the individual to become a professional in this skill it has to be practiced for one day weekly (Sulaiman, 2014).

Anxiety

Anxiety is a very voluminous disorder that is made up of multiple phobias and disorders. These can come in the form of: Panic disorders, Social phobia, PTSD, OCD, and many more. Unfortunately Anxiety disorders are the most common mental disorder and have the highest life time prevalence at 33.7 percent of the population at risk, this percentage derives from a study in the United States (Kessler et al, 2012). To help put that percentage into perspective there are 317 million people living in America as of the start of 2014, or 317,297,938 to be exact. 33.7 percent of this figure is 107 million, the overall population of the United Kingdom is only 64 million as of 2014. These figures show the Monumental influence that Anxiety has on the population. Even though America has a much larger population and many more areas of poverty, these are still shocking figures.

Self hypnoses is somewhat renowned for its therapeutic effects on the mind and its ability to decrease stress and anxiety, but when researched its interesting just how beneficial it can be. VandeVusse and Leona (2010) conducted the effects of self-hypnosis on 30 female college students. A variety of factors were measured such as their heart rate and respiratory rate. Once the data had come in, the researchers concluded that hypnosis is a low budget, high efficiency approach to stress reduction that proves beneficial for nurses when providing patients with stress reduction techniques. This evidence also showed increased activation in the Parasympathetic Nervous System which is in charge of the regulation of internal organs and glands found in the Autonomic Nervous System. This can help maintain a steady equilibrium in the body and therefore helping the mind be clearer.

Another study looked into and compared the effectiveness of two treatments towards pediatric cancer. The methods consisted of the use of local anaesthetic and pairing local anaesthetic and self-hypnosis. Evidence shows that out of the three groups tested, the group that was provided local anesthetic and self hypnoses showed a decrease in anticipatory anxiety and less procedure related pain (Liossi & Christina, 2006). Having Pediatric cancer is said to not be very painful in its self, but in pursuit of a successful recovery many medical methods have to be used, and unfortunately most include a fair bit of pain, but with the use of self-hypnosis and anaesthetic this mental anguish can diminish to an extent.

Due to the shocking susceptibility Humans have to anxiety, there have been many forms of self-help platforms that can be purchased, such as Mindfulness or self-help books. There are also many ways to receive support through a variety of establishments, whether it’s through the NHS or a University, either way self-hypnosis can be highly recommended due to its renowned effects, and once practiced could be the difference between mental distress and one’s normative well being.

Depression

Depression is a very serious mental disorder, it has the ability to ruin lives and induce such emotional dysphoria that even the idea of restored normality does not feel achievable. There has been a vast improvement of our knowledge of psychopathological disorders over the past two decades, understanding the reasons behind depression is much more attainable within modern times as opposed to speculation and conjecture.

There are a variety of neurotransmitters involved with depression, these are: Dopamine, Serotonin, and Norepinephrine. Along with these neurotransmitters, an area within the brain named the Limbic system which contains the Subgenual Cingulate Cortex is also associated with depression. But what causes depression is not always biological, there can be social and environmental factors involved (Such as death of a loved one or rejection etc).

There are a number of ways in tackling depression, some use antidepressants others use counselling. You can also partake in meditations or incorporate physical activity within your daily routine. Self-Hypnosis has also been a realistic solution, Dobbin, Maxwell, and Elton (2009) conducted an experiment on 50 patients suffering depression, they found that self-hypnosis programs had positive effects and showed promise for future use of such methods within primary care, meaning that people who suffer depression can be advised self-hypnosis programs via their doctors or counsellors.

In the early 1990s a self-hypnosis program for depression management was created by McBrien (1990). Over the course of this treatment both relief and reduced depression can be achieved with preventable relapse interventions in place. Increased confidence and an increase in positive thoughts are obtainable with proper use of the programme, but it takes care knowing that self-hypnosis is more developmental that an immediate remedial strategy.

When introducing someone to a hypnotic learning experience, there are a variety of key elements to remember, these include:

1.      Induction.

This is the process of moving from an awake state of consciousness to a relaxed state, commonly known as a trance.

2.      Formulating the suggestions.

Using carefully chosen words to effect the change of physical and mental sensations.

3.      Ego strengthening.

Direct the client towards the use of positive thoughts.

4.      Deepening.

Help the client venture into a stronger state of trance.

5.      Mental Rehearsals.

Guiding the client towards a desired ambition.

This is only a very brief explanation of the client centered hypnotism Programme (McBrian, 1990) much more depth into this specific area can be reached via the references.

It is important to know that self-hypnosis is not the miracle cure for depression, however in some cases has shown to be a mental anchor for those on the road to repair.

Insomnia

Insomnia is another serious mental disorder that interferes with a normal functioning life. It is ones inability to sleep, this can cause all sorts of problems all of which are made worse with a consistent lack of sleep. If a pharmaceutical solution is not an option then self hypnoses can be a suitable alternative. A paper by Sulaiman (2014) goes into great depth on a case study looking into the effects of self-hypnosis on insomnia, evidence showed that it helped to increase sleep and reduce the amount of times sleep was disturbed. This paper also goes into every procedure taken to obtain these results. Another study found that similar methods can help to reduce anxiety associated with time spent in bed (Mangioni, 1986).

One factor behind insomnia is how the brain does not repose, all the racing thoughts occurring can cause sleep to feel like an impossible choice, but with the deep relaxation inhibited via self-hypnosis the mind can relax and sleep, can feel more achievable.

Smoking and Alcoholism

Both smoking and alcoholism are impulsions that the human race could benefit without, but unfortunately in a world run by money; cooperation’s take advantage of the public by supplying such substances that can initiate an addictive response, which financially is an opportunistic gateway to a profitable business. Gamberino and Gold (1999) does well in grasping the concept of addiction as: “A loss of control with compulsive drug use despite adverse psychosocial and health consequences”. For a while addiction was seen as a way to avoid unpleasant withdraws from substances (a form of negative reinforcement). But as research has advanced over the years it is now seen as a drive for brain rewards (a form of positive reinforcement) (Gamberino & Gold, 1999). It has been found that long term use of a substance evokes changes on a neuronal level within the central nervous system (CNS), which in turn can manipulate the function of neural circuits leading to the brain leading to neuro-adaptive processes such as dependence, tolerance, and sensitization (Gamberino & Gold, 1999).

In the 20^th century smoking was named the number one preventable cause of death in the world with estimates of around a 100 million deaths worldwide (Hartwell, Prisciandaro, Borckardt, Li, George & Brady, 2013). Facts like these can help motivate people to stop but sometimes it is never that easy, this is where the use of self-hypnosis can be a realistic substitute for other smoking prevention techniques. A paper by Spiegel (1970) discusses a study on 615 smokers who were treated via 45 minutes of psychotherapy reinforced by hypnosis. Just this one session showed results that are better than other prevention strategies with a number of hardcore smokers stopping for a minimum of six months, and another 20% significantly reducing their smoking. Even though only 44% of the 615 participants were followed up; these results are still very much positive.

A case study from Rosewarne (2004) showed how one women who was the victim of many emotional issues stemming from her past was able to overcome them and smoking with the use of hypnosis incorporated into an array of counselling sessions. This is a prime example of how hypnosis can be used hand in hand with techniques such as counselling. Even though this is not strictly “self” hypnosis, the methodology used is similar but merely originates from a different perspective (that being the orders issued from someone in the same room and not through audio devices).

Going on from audio devices, Davidson (1985) devised an experiment which involved the distribution of audio tapes among 32 subjects. 15 of the participants stopped smoking after the 3^rd session and the remaining 17 also stopped by the 6^th session. Six months down the line 24 of the original 32 had remained abstinent. This highlights how self-hypnosis can be highly beneficial to those motivated, it can act as an anchor in situations where addiction can become consuming, and it allows the mind to follow its unique methods in sustaining or pursuing desired goals.

Alcoholism follows the same line as smoking in the sense that it is another easily purchased substance that can elicit addiction. Alcohol allows the user to access a state of mind which in some cases is more desirable than that of a sober mind, this is when drinking can be a problem. Whether you waste your life in pursuit of a constant fix or if you are a high functioning alcoholic with a steady job; the end result is all the same with an array of health problems being almost certain.

However like smoking there are methods and prevention techniques used to help anyone wanting to change for the better. Among these methods of prevention self-hypnosis can be used towards these goals, although it is more widely known to prevent smoking addiction to the lay person - it can also help with sufferers of alcoholism. Pekala et al (2004) conducted a study on 261 veterans who were admitted to Substance Abuse Residential Rehabilitation Treatment Programs. Among the groups tested, those who played the self-hypnosis audiotape more regularly (this being 3-5 times a week) showed increasingly positive results of abstinence and higher levels of self-esteem and serenity. Jacobson and Silfverakiöld (1973) on the other hand found that a comparison between two groups of 40, one of which receiving hypnotic treatment and the other not, showed there to be no statistically significant difference between the two. Even though the data points to this conclusion the authors did say that the general trend of the data was supporting the idea that hypnoses was more beneficial to the group using it than the group that was not.

When researched, the studies involving the use of hypnoses to battle alcoholism are not quite as prominent as those involving such things like mental illness or smoking. This could be a result of self-hypnosis being somewhat a victim of its own success; due to the sensationalised success stories of smokers becoming non-smokers and the depressed being more joyous or the insomniacs more inclined to welcome sleep, these end up being the faces of self-hypnoses which can lead to its uses on other areas such as alcoholism to become unappreciated.

Throughout this paper self-hypnoses has been highly regarded. Even with highly beneficial methods such as this, there are still implications when practiced. One example is ones susceptibility to the methods used, due to misconceptions people may not be fully accepting of the use of self-hypnoses which can lead to overall failure of all used techniques (Waxman & David, 1985). Another difficulty that may occur is the mutual cooperation required for success, the patient needs to fully cooperate with the councillor and vice versa otherwise things may be falsely interpreted (Strus, 1998), this is important especially when the methods of self-hypnoses is taught to a patient. External validity can also be problematic as some case studies are not able to generalise to the wider population (Sulaiman, 2014).

Like any medical practice; there are always going to be pros and cons, and our jobs as scientists and medical experts is to minimise the bad and maximise the good through the use of studies. Self-hypnoses may have its limitations but in general is a highly efficient way of dealing with a large selection of problems which when used produce many positive results. The more recognition it receives the more it can help evolve into a strategy used in a larger number of medical facilities across the world.

References

Bonnett, O. T. (1994). Confessions of a healer: The truth from an unconventional family doctor. Aspen, Colo: MacMurray & Beck

Braid, J. (1960). Braid on hypnotism: The beginnings of modern hypnosis. Julian Press.

Davidson, G. P. (1985). Smoking control: Audiotaped self-hypnosis as adjuvant treatment in      a clinical series. Australian Journal Of Clinical & Experimental Hypnosis, 13(2), 107-112.

Dobbin, A., Maxwell, M., & Elton, R. (2009). A benchmarked feasibility study of a self-hypnosis treatment for depression in primary care. International Journal Of Clinical And Experimental Hypnosis, 57(3), 293-318. doi:10.1080/00207140902881221

Gamberino, W. C., & Gold, M. S. (1999). Neurobiology of tobacco smoking and other addictive disorders. Psychiatric Clinics of North America, 22(2), 301-312.

Hartwell, K, Prisciandaro, J, Borckardt, J, Li, X, George, M, Brady, K. Real-time fMRI in the treatment of nicotine dependence: A conceptual review and pilot studies. Psychology Of Addictive Behaviors [serial online]. June 2013;27(2):501-509. Available from: PsycINFO, Ipswich, MA. Accessed January 4, 2015.

Hawkins, P., & Polemikos, N. (2002). Hypnosis treatment of sleeping problems in children experiencing loss. Contemporary Hypnosis, 19(1), 18-24. doi:10.1002/ch.236

Jacobson, N. O., & Silfverakiöld, N. P. (1973). A controlled study of a hypnotic method in the treatment of alcoholism, with evaluation by objective criteria.British Journal of Addiction to Alcohol & Other Drugs, 68(1), 25-31.

Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-18

LeCron, L. M. (1971).The complete guide to hypnosis. New York: Harper Row.

Liossi, C., White, P., & Hatira, P. (2006). Randomized clinical trial of local anaesthetic versus a combination of local anaesthetic with self-hypnosis in the management of paediatric procedure-related pain. Health Psychology, 25(3), 307-315. doi:10.1037/0278-6133.25.3.307

Mangioni, P. V. (1986). Hypnosis and behavioural self-management in the treatment of insomnia. Australian Journal Of Clinical & Experimental Hypnosis, 14(2), 157-165.

McBrien, R. J. (1990). A self-hypnosis program for depression management. Individual Psychology: Journal Of Adlerian Theory, Research & Practice, 46(4), 481-489.

Pekala, R. J., Maurer, R., Kumar, V. K., Elliott, N. C., Masten, E., Moon, E., & Salinger, M. (2004). Self-Hypnosis Relapse Prevention Training with Chronic Drug/Alcohol Users: Effects on Self-Esteem, Affect, and Relapse. American Journal Of Clinical Hypnosis, 46(4), 281-297. doi:10.1080/00029157.2004.10403613

Miller M. M. (1979).Therapeutic hypnosis. New York: Human Sciences

Rosewarne, P. (2004). Hypnosis and smoking. Australian Journal Of Clinical & Experimental Hypnosis, 32(1), 86-102

Spiegel, H. (1970). A single-treatment method to stop smoking using ancillary self-hypnosis. International Journal Of Clinical And Experimental Hypnosis, 18(4), 235-250. doi:10.1080/00207147008415923

Strus, R. A. (1998.). Creative self- hypnosis: new, wide-awake, nontrance techniques to empower your life and work. New York: Prentice Hall

Sulaiman, S. M. (2014). The Effectiveness of Self Hypnosis to Overcome Insomnia: A Case Study. International Journal of Psychological Studies, 6(1), p45.

VandeVusse, L., Hanson, L., Berner, M. A., & Winters, J. (2010). Impact of self-hypnosis in women on select physiologic and psychological parameters. Journal Of Obstetric, Gynecologic, & Neonatal Nursing: Clinical Scholarship For The Care Of Women, Childbearing Families, & Newborns, 39(2), 159-168. doi:10.1111/j.1552-6909.2010.01103.x

Waxman, D. (1985). Modern trends in hypnosis. New York: Plenum Press

How a broken heart could be considered a medical condition

The term "broken heart" has been commonly used in association with relationships where one or both parties are seriously affected through a separation. The severity of this feeling can be the deciding factor on whether or not you experience something similar to a heart attack, the symptoms of a broken heart can include: chest pain, and difficulty breathing which can be mistaken for cardiac arrest. Other technical terms for this condition are; "stress induced cardiomyopathy", "Takosubo's cardiomyopathy", and Transient apical ballooning syndrome".  Broken heart syndrome is more prevalent in women over 50, however... it can affect both men and those in a younger period of their life. The underlying cause has not yet been discovered but has been found to be reversible with no prolonged side effects; with normal functioning re-occurring after a short period of time.

Most people at least once will experience what they feel to be a broken heart at least once in their lives. It is shocking knowing that a break up can cause not only sever emotional and mental anguish but can simulate a cardiac catastrophe. Although I believe that when people split in a relationship that they do experience a great deal of pain, I don't feel that terming it "heart broken" is justified. I think a bond has to be made between two people, a bond that is sustained through a lifetime which through thick and thin came out untainted. It is only when this type of bond is torn from you that the full burden of a broken heart can feel truly consuming. However as cliche as it is, a broken heart is indeed healed over time, the brain has a remarkable ability to adjust to situations, no matter how bad they may seem. So no matter what, there is always light at the end of the tunnel :)

If you would like more information on this topic then follow the link below:
http://www.sciencedaily.com/releases/2015/02/150210130502.htm

 

Could elements of anxiety have benefits?

Anxiety is an extremely widespread disorder that most people will experience at least once in their lives; whether as a predisposition or one that manifests due to some kind of event experienced. On a day to day basis 70% percent of our thoughts are negative, this is an unfortunate statistic (it is amazing everyone does not suffer anxiety). Now if everyone had better control over their thoughts... or at least better control over the nature of their thoughts (allowing more positivity)  lives could potentially be lived without the burden of constant negativity.

A picture that I feel strongly conveys the difficult nature behind our thoughts  

Thoughts are a very hard concept to grasp, they are an innate phenomenon that practically control everything that is not done via automatic processes - such as breathing etc. However... from a biological perspective; thoughts and emotions are made up of energy, molecules, and axons which release vibrational frequencies. When the frequencies are low then they are transformed into low level emotions such as fear and guilt, but when high they are transformed into higher level emotions such as courage.Thanks to this kind of information we are now able to use strategies in order to convert the lower emotions into higher ones, such methods can include mindfulness and breathing techniques.

Now the symptomatology created through anxiety can be increasingly unpleasant, although experiencing them can in turn make you a stronger person, or help you to avoid experiencing them again. So instead of looking at anxiety as a barrier it should be perceived as premature wisdom; the only way to deal with hardships is by living through them. Mereley just paying attention to the reasons behind your anxiety can lay the foundation to overcoming it.
Please find more information at this link: http://brainblogger.com/2014/12/07/is-anxiety-really-a-gift/

I personally feel that if used right, anxiety can be beneficial. However depending on one's lifestyle, support, and tools available to them it would be naive of me to think that everyone could possess such an outlook. I am a great believer in ones ability to take control of themselves and change for the better but some circumstances can make this philosophy somewhat difficult to comprehend.

 I hope that some of my posts prove to be interesting and would like to thank those that take the time to read them, it is much appreciated :) until my next post I wish everyone well!!

Why is adolescence sometimes considered a particularly difficult time for some children?

Adolescence can be a rather difficult and confusing time for people, it is set between the comforting childhood and the responsible adult, and this transition from one to the other can prove strenuous for most. It is a time where hard work becomes a regular thing and a harsh reality begins to seep in to a life which has been free of such concepts since birth.

Adolescence is the second decade of human life in which maturity and growth reach their peak,  however can also bring on an onset of other complicated behaviours, such as risk taking (Silveri, Tzilos, Pimentel & Yurgelun, 2004) and addiction ( Hyman & Malenka, 2001). It is a stage in life where there is a particular focus on the development of one’s identity, this can include such formations of; identifying occupational interests and vocational pathways, forming interpersonal relationships, and considering sex roles (Erickson, 1968). Along with the consideration of sex roles, an advancement of intimate romantic relationships and intense friendships will arise (Zimmer-Gembeck, 2002), however these types of connections with others… especially those in an affectionate context, are difficult to achieve without substantial progress of one’s own identity, this idea is termed “fusion of identity” (Erickson, 1968).

Erickson (1959) conceptualised a theory of psychosocial development which is made up of eight distinct stages, each stage highlights specific age groups and the complications that can transpire within these timeframes. The fifth stage is titled identity vs role confusion which focuses on the adolescent period. This stage discusses how the re-examination of one’s identity is used to identify favoured roles, nonetheless this realisation can be disrupted due to the uncomfortable perception one could have on their image, and until this is overcome the “virtue of fidelity” cannot be accomplished. “Fidelity” refers to the commitment one makes to others regardless of the difference in ideologies (Erickson, 1959). Within this period, explorations are used to form an identity, but failure to establish this can result in career ambiguity which in turn can lead to role confusion, or the more easily understood uncertainty of one’s place in society.

All though Erickson laid the foundations in understanding the potential difficulties that arise at certain points in life, he failed to consider the possibility that specific events could be gender dependent, and how the difference between male and female could have a considerable impact on their perception of life obstacles (Silveri, Tzilos, Pimentel & Yurgelun, 2004). Gilligan (1982), Miler (1991), and Surrey (1991) discuss the differentiation between genders. They talk on how the importance of relationships help develop and organise the self from the female perspective, whereas contrary to the latter, boys focus more on independent identity development. Thus the difference in experiences lead both male and females to encounter the world differently, with males taking an autonomous approach and females from a relational perspective. Throughout this paper I will continue to expand on the difficulties that can occur within adolescent life and how both social and cognitive factors could facilitate the onset of these adversities.

Adolescence is a time surrounded by mass confusion, even if your journey to adulthood is relatively smooth, there are times when you find your choices are questionable, and one common choice refers to future ambitions; such as job roles. School is essential when it comes to achieving these job roles however, it is not that easy for everyone. With the huge accumulation of pupils at secondary schools, personalities inevitably will clash and this can result in bullying. Bullying is a common problem with more than 40,000 children in 2013 calling child line regarding the matter (Childline, 2013). Brunstein, Marrocco, Kleinman, Schonfeld, and Gould (2007) performed a study which found that those being bullied or do the bullying are at a much higher risk from depression as opposed to those not experiencing bullying. A greater suicide risk was also discovered in the same study which proves the severity that bullying has on the mind and the potential academic disruptions it could cause leading to future complications.

Extending the discussion on suicide, Hansen and Lang (2011) discuss how there is a significant drop in suicides during the summer seasons at school, although during winter seasons these statistics increase, especially when the start of term is around the corner. This could be down to the influence of seasonal affective disorder (a disorder associated with late autumn and winter. Bringing on the onset of depression due to lack of light), or it could be linked to factors that adolescence just do not want to re-live for another year (such as bullying, academic pressure etc.) This is indicative of the issues within modern day educational establishments and their clear failure in recognising potential destructive symptoms within pupils. Although in many cases this is the exception and not the rule.  Loades and Mastroyannopoulou (2010) produced a study questioning 113 teachers on their ability to identify potential mental health issues, they found that participants were competent in recognising when a child presents a problem, however there was difficulty in labelling certain symptomatology, and this difficulty was enhanced when it came to analysing the difference between genders. Further research in these areas could help to create and promote effective strategies which can be used to highlight mental illness symptoms. Without such interventions, an adolescences quality of life could become significantly worse as a result of no support.

Complications within adolescence are not always due to education; some problems can be traced back to the prenatal stages. There have been links found between behavioural learning difficulties in adolescence and prenatal alcohol exposure (Olson, Streissguth, Sampson, Barr, Bookstein, & Thiede, 1997).

             Olson, et al. (1997) found that even socially drinking whilst pregnant can have a significant effect on future behaviour and cognition, resulting in potential learning difficulties. With a predisposition towards difficulty in learning, frustration can begin to manifest resulting in a loss of interest for any type of academic work, this could lead towards interests in other things; such as antisocial behaviour. Savolainen et al. (2012) looked into this area and discovered a link between how the absence of academic skill correlates with antisocial risk factors. A similar study which is not on antisocial behaviour but more directed towards risk taking behaviour sheds light on depressive disorders through the analyses of sexual partners. It was found that adolescents of either gender who have had multiple sex partners with the absence of contraception are more likely to exhibit depressive disorders (Kosunen, Kaltiala‐Heino, Rimpelä, & Laippala, 2003). Studies like these show how issues in adolescence and cognitive flaws can be interrelated. When going through adolescence problems can be common; it is natural. Although dealing with them when you suffer from things like depression or learning difficulties can make a bad situation worse, increasing the chances of future implications.

When identifying the root to troublesome experiences in adolescence, it will not always lead back to cognitive influences. Social factors can be as equally responsible. A classic example of this would be peer pressure and conformity. Santor, Messervey, and Kusumakar (2000) performed a study on 148 adolescent boys and girls; finding that both peer pressure, and social conformity are strong predictors of risky behaviours such as substance abuse and sexual attitudes. Even though these outcomes are not always intentional to begin with, the need for social acceptance can cloud the mind into thinking that it is worth it as long as you have gained a level of social acceptance. On the other hand, if your peers alienate you deeming you socially unaccepted, then this can trigger an array of difficulties with the main one being aggression. This was found in a study looking into 114 mixed race boys. Biases within schools particularly in elementary showed a subsequent increase in aggression (in those considered socially unfavourable as a result of their skin colour) when adolescence is reached (Lochman & Wayland, 1994). Being considered an “outcast” can have its consequences. If the internal frustration of isolation is not expressed through impulsive aggressive behaviour then it can come in the form of depression (Witvliet, Brendgen, van Lier, Koot, & Vitaro, 2010) and social anxiety (La Greca, & Lopez, 1998).

All of the points discussed prior to this paragraph can occur even in a safe and secure family environment; which is going to lead me on to discussing the repercussions of living in an abusive home. Whitbeck, Hoyt, and Ackley (1997) distributed a questionnaire among homeless adolescents, and in doing so found that a majority of them were living on the streets because it was considered a better alternative that living in an abusive household. This is an example of how terrible an abusive household can be, especially when you feel the need to become homeless. Homelessness is a very serious matter, however abuse encountered from a young age can lead to an array of psychological issues such as; post-traumatic stress disorder, depression, and separation anxiety disorder (Pelcovitz, Kaplan, DeRosa, Mandel, & Salzinger, 2000). These repercussions could complicate the adolescence stage even further. Even if an abusive household was only experienced prior to the reaching of the adolescence stage, it can still lead to poor adjustments through adolescence and early adulthood therefor disrupting your way of life (Bank, & Burraston, 2001).

As unfortunate as some of these studies are. They do help to highlight how social factors can lead to implications such as depression (through isolation, bullying, or abuse), or how cognitive factors can worsen as a result of things such as seasonal affective disorder, isolation or lack of support. One common pattern found throughout this paper and the studies discussed show how there can be a fine distinction between both social and cognitive factors and trying to determine this can see you faced with a certain level of ambiguity. One could experience difficulties as a result of a predisposition such as depression, but this may not manifest until that same individual experiences a certain social scenario such as social exclusion or bullying. Therefore we do not know what to blame the depression on; cognitive factors or social factors? But in such cases a perspective from both could prove to be the best solution. Throughout this paper we have looked at some of the original research from Erickson and more recent research from an array of researchers who help in promoting the harshness of adolescence. This research plus future endeavours may help in the creation of support and coping strategies to those in need of it. The more teenagers who receive help, the more chances of a stable society being achieved for future generations.

Due to the nature of this paper adolescence has been made to sound like a ruthless and unpleasant experience, however a lot of these cases only makes up a small percentage of the population and should not be generalised. Even though adolescence can be difficult it is also a time where you really begin your life, and become independent as a person; Learning new experiences and making life-long friends. Most obstacles can be overcome, which helps strengthen your ability to deal with similar occurrences later in life. It is these experiences that shape you as a person and prove to be the foundation of what hopes to be a long and satisfying life.

References

Brunstein Klomek, A., Marrocco, F., Kleinman, M., Schonfeld, I. S., & Gould, M. S. (2007). Bullying, depression, and suicidality in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 40-49.

La Greca, A. M., & Lopez, N. (1998). Social anxiety among adolescents: Linkages with peer relations and friendships. Journal of abnormal child psychology, 26(2), 83-94.

Hansen, B., & Lang, M. (2011). Back to school blues: Seasonality of youth suicide and the academic calendar. Economics of Education Review, 30(5), 850-861.

Childline (2013). What’s affecting children in 2013?. NSPCC. Retrieved December 11. 2014, from www.nspcc.org.uk.

Santor, D. A., Messervey, D., & Kusumakar, V. (2000). Measuring peer pressure, popularity, and conformity in adolescent boys and girls: Predicting school performance, sexual attitudes, and substance abuse. Journal of youth and adolescence, 29(2), 163-182.

Pelcovitz, D., Kaplan, S. J., DeRosa, R. R., Mandel, F. S., & Salzinger, S. (2000). Psychiatric disorders in adolescents exposed to domestic violence and physical abuse. American Journal of Orthopsychiatry, 70(3), 360-369.

Kosunen, E., Kaltiala‐Heino, R., Rimpelä, M., & Laippala, P. (2003). Risk‐taking sexual behaviour and self‐reported depression in middle adolescence, a school‐based survey. Child: care, health and development, 29(5), 337-344

Olson, H. C., Streissguth, A. P., Sampson, P. D., Barr, H. M., Bookstein, F. L., & Thiede, K. (1997). Association of prenatal alcohol exposure with behavioural and learning problems in early adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 36(9), 1187-1194.

Lochman, J. E., & Wayland, K. K. (1994). Aggression, social acceptance, and race as predictors of negative adolescent outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 33(7), 1026-1035.

Savolainen, J., Hughes, L. A., Mason, W. A., Hurtig, T. M., Taanila, A. M., Ebeling, H., & Kivivuori, J. (2012). Antisocial propensity, adolescent school outcomes, and the risk of criminal conviction. Journal of Research on Adolescence, 22(1), 54-64. doi:10.1111/j.1532-7795.2011.00754.x

Bank, L., & Burraston, B. (2001). Abusive home environments as predictors of poor adjustment during adolescence and early adulthood. Journal of Community Psychology, 29(3), 195-217.

Whitbeck, L. B., Hoyt, D. R., & Ackley, K. A. (1997). Abusive family backgrounds and later victimization among runaway and homeless adolescents. Journal of Research on Adolescence, 7(4), 375-392.

Silveri M. M., Tzilos G. K., Pimentel P. J., Yurgelun-Todd D. A. (2004). Trajectories of adolescent’s emotional and cognitive development: effects of sex and risk for drug use. Ann NY Acad Sci, 1021:363-370.

Loades, M. E., & Mastroyannopoulou, K. (2010). Teachers recognition of children’s mental health problems. Child and Adolescent Mental Health, 15(3), 150-156.

Witvliet, M., Brendgen, M., van Lier, P. A., Koot, H. M., & Vitaro, F. (2010). Early adolescent depressive symptoms: prediction from clique isolation, loneliness, and perceived social acceptance. Journal of abnormal child psychology, 38(8), 1045-1056.

Hyman S. E., & Malenka R. C. (2001). Addiction and the brain: the neurobiology of compulsion and its persistence. Nat Rev Neurosci 2:695-703.