Test Mastery

All students have attitudes about and reflexes toward taking tests.  In the college student, these are acquired over many years' experiences with testing, leading to conditioning of thought, emotion and behavior.  If students are not aware of these factors they will influence their responses to exams and control them, sometimes unconsciously.  Fortunately, just as behavior can be conditioned so it can be unconditioned, if you will.  But it takes knowledge, practice and skill.  Anyone can learn these skills and that is the good news.


First, beware of negative attitudes such as pessimism, magnification, catastrophic thinking and fatalism.  These thought patterns will diminish performance before the test even begins.  So check yourself for "stinking thinking" well ahead of the exam, such as when you are in class and during study.

In order to manage thoughts, we must increase awareness of negative thinking and actively combat those patterns when they are detected.  Here are some examples:

• Pessimism: these are thoughts of doom and gloom about testing or performance.  Address these by countering with “I am qualified to be in this program and if I work hard enough I will do well enough.”
• Magnification: thoughts like this magnify the importance of an exam way beyond what is healthy.  Respond with “This is one exam among many and it is no more or less important than the others.”
• Catastrophic thinking: this form of thought leads one to believe life as we know it will be over if we don't do well on a test.  Counter with “One way or another everything is going to work out OK.”  (This is absolutely true, by the way).
• Fatalism: these are thoughts that we will get the same outcomes no matter what we do.  Address this with “My effort counts.  Good preparation will get good results.”

Say them aloud when you can, and to yourself when you can't.  Repeat them, over and over again, even if you question or doubt them.  Remember, you are working on reconditioning your thinking in ways that promote good performance, not dismantle your confidence.  Some find it helpful to place colored stickers in places which will remind you of positive thinking, such as a backpack, notepad, refrigerator, or mirror.  A colored bracelet can also serve the same purpose.

The second part of test mastery involves managing anxiety.  This step is highly important as anxiety interferes with higher cortical processing.  Students who "go blank" during exams often have so much anxiety that it blocks access to memory.  Negative experiences with exams sometimes condition people to have anxiety reactions before, during and after them.  But this too can be undone if you work on it.

• The single best antidote to test anxiety is good preparation.  There are no shortcuts here!  See my earlier post on study habits and skills for more information on this topic.
• Don’t defeat yourself through negative habits related to eating, sleeping, and partying.  You must get enough of each, but not too much!  We perform at our best when our bodies are appropriately nurtured.
• Avoid “anxious talk” and anxiety-provoking situations.  There is no point in asking classmates last-minute questions, or in participating in hallway comparisons before the exam.  There's always someone who will say things like "I studied for 48 hours straight!", or "I'm going to ace this one just like I did the last one."  Statements like these can make us feel bad, even if there's no truth to them at all.
• Learn to manipulate your physiological anxiety response through focused attention and controlled breathing, both before and during exams.  A psychologist can help you learn these skills.
• Follow the principles of exposure and desensitization.  This means placing yourself in situations similar to testing, repeatedly and long enough to experience a reduction in anxiety.
• Practice testing, engage in testing rehearsal, and engage in actual test-taking in the same or similar environments.  Many benefit from taking a practice test in the same room where the actual test will occur.  Obviously, one must have the instructor's approval for this.
• Understand your degree of reactivity.  If it is very high, medication may be needed, but NEVER by itself.  A little therapy will maximize the benefits of the medication, and help you address issues on your own once you stop taking it.

With some effort and practice you can condition yourself to think positively and remain calm and focused during exams.  This gives your brain a good shot at accessing memory and performing well when it counts.  So go get 'em!

The importance of family support

Fourteen years ago, after working  11 years at mental hospital wards  I started working as a community psychiatric nurse. A month later I had to take my partner to a psychiatrist because he was psychotic. An unexpected  experience.

It started on a Saturday. We decided to wait till tuesday  so we could see the GP we knew. Monday was a bank holiday.Things got worse over the  weekend  and I had no idea where it would end. Although I was familiar with psychosis it was like getting hit by an avalanche in mid summer. We only just met a year and a half earlier.

On tuesday the GP referred us to an office for mental health that same day. We were welcomed very friendly by a  CPN who knew I was a colleague from another hospital. He took us to an office. A few minutes later he introduced us to the psychiatrist who seemed  unpleasantly surprised . His words: “ It is not usual that family comes along unannounced” . Then he shook my hand reluctantly.

That is not the best way to introduce yourself  to a highly stressed person with an adrenaline level way beyond that of the average marathon runner. I can’t imagine a doctor of an emergency room would have said the same if my partner would have had a heart problem or an accident. This was an emergency  as well. A psychiatric one. 

During the visit my partner only told about 40 %  of what had happened - being distracted and paranoid. After some time I added a few things to the conversation but I was being ignored  by the psychiatrist.  And when he finally asked me: “Do you have any idea what psychosis is?“ I was so mad that I answered very calm : “ I have read some about it a while ago”   

He wrote a prescription for an anti-psychotic  and handed us the piece of paper. I asked him to add Biperiden in case of side effects.  I guess he had not expected that because he looked a bit confused. He wrote it down and wanted to say something but I felt too reared for further conversations. I felt like yelling  , throwing things around or burst into tears and I didn’t want to do either one of them. If you come for help the last thing  you need is people who make you feel  worse. A few minutes after we got home the phone rang: the  psychiatrist. He asked me if I could come long next time.  I asked him if he would  have called if I had not been a CPN. Later on we talked and things went better. He learned from the experience. 

And so did I. Although I always had a focus on family support : really knowing the despair, fear and frustration helps to keep it on top of the “to do”- list and encourage others to do so. This was just a bad experience, educational though. Many psychiatrists do an excellent job.

Family support is an important thing in mental health care. Ifcourse there are very dysfunctional families  and some people have caused problems our clients are facing now. No need to deny that and very important to take that into account. But most of them have good intentions and are willing to learn and help.And they usually know their ill family member better than we health professionals do. We shouldn't consider ourselves too important but see family members as team members. 

Psycho-educational family interventions and family support can reduce relapses, readmissions and suicide risk. An important part of our work because it benefits to the welbeing of our patients and a better future for them.

Many family members have felt left alone by mental health care in the past on more than one occasion.Imagine yourself in their shoes and do the best you can to make their next experience a better one.

If family  is visiting a hospital ward make them feel welcome and comfortable. That will make it easier for them to visit more often. For mental health workers a mental hospital ward might be an everyday thing but for visitors it’s often a very  unusual scary place to go , especially the inpredictable crisis wards. If possible give them a quiet place to talk and relax. Encourage family and friends to stay in touch. 

Loneliness is a huge problem for people with mental illness. And it is important to prevent that as much as we can.Giving good information and support to friends and family can make an important difference here.

-           

The Hidden Faces of Abused Children

Most folks with even cursory access to the news are familiar with more obvious variations of child abuse.  These include breathtaking accounts of physical abuse, horrific tales of sexual abuse and trafficking, kidnapping and torture, and unlawful restraint in confined spaces by parents and caretakers.  Even glaring cases of extreme neglect, such as declined medical care and abandonment in vehicles, often resulting in death, make it to the news and the consciousness of readers.  It is a good thing that the worst of these stories are given appropriate attention.

In recognition of April’s Child Abuse Prevention Month, let’s turn our attention to less obvious forms of abuse and neglect, as these also take an enormous and in some ways even more pernicious, toll on humanity.  In over 20 years of work as a psychologist I have known a great many who have suffered all manner of abuse and neglect.  Some succumbed to the trauma.  Some survived and later thrived.  All were heroic in one way or another.  Their voices and expressions resound in my memory; they tell me that physical wounds heal, that sexual victimization can be overcome, and that the neglected can find nurturance and love.  Of all these, the ones that stand out in their pain are those who have been rejected and abandoned by their families and caretakers.

This type of wound, more than any other in my experience, leads more consistently to lasting damage, to serious alterations in psychic architecture which can take a lifetime to modify.  To be told, in word or deed, “I don’t love you” or “I don’t want you” or “Go away” is tantamount to murder of the soul, as others have described it before me.  And this form of abuse has a thousand manifestations at every stage of development all the way through late adolescence and early adulthood.  Obvious abandonments are, well, obvious, as in the literal abandonment of a child to the streets or to the state.  But there are many, many variants which occur even while the child is still technically in the home and care of family.

Space prevents me from detailing every manifestation.  Suffice it to say that refusal or avoidance of the provision of support to the reasonable physical and emotional needs of children can be heard by them as “I don’t want you.”  This is especially true when the caretaker fails to come to the aid of a child, teen or young adult in a moment of crisis.  I have witnessed this many times over, and the psychic pain it causes is legion.  Some learn to abandon hope as a result, which of course is a literal dead end.  The more fortunate learn to find support elsewhere, because somehow they know they are worth it.

In our endeavors then, let’s work to prevent and react to abandonments, large and small, when we see them.  In so doing let us also demonstrate in word and deed the inherent value of all humans.

20 Commandments for Mental Health workers

1. Thou shalt respect your patient and not judge
2. Thou shalt increase the well-being, opportunities and happiness of your patient
3. Thou shalt be in time for appointments and phone calls. It will show your patients that they matter
4. Thou shalt have a well-chosen and well-timed sense of humour
5. Thou shalt reconsider your ‘professional distance’ if it makes your patient feel he stands alone; show that you are a person too
6. Thou shalt not let your bad mood or personal issues influence your professional attitude
7. Thou shalt have an open conversation if your patient is suicidal and give good support and protection if necessary
8. Thou shalt not hide behind a newspaper or smartphone on the ward or make any other unapproachable impression otherwise
9. Thou shalt not hide and chat in the nurses’ offices but be with your patients as much as possible to create a safe and friendly environment
10. Thou shalt consider family and good friends of your patient as team players (unless it’s impossible) and support them well in the interests of your patient
11. Thou shalt inspire and support your colleagues to make mental healthcare as good and friendly as possible and ask and give feedback on a regular basis to become a ‘winning team’
12. Thou shalt inform your patient well about side effects of medication, observe well and help to find solutions if needed
13. Thou shalt not avoid the subject ‘sexual side effects of medication’
14. Thou shalt help your patient to get good dental and physical care and support them on doctor and dentist visits if needed
15. Thou shalt help and support your patient to exercise on a regular basis to increase their health and give support to decrease smoking.
16. Thou shalt support your patient to overcome financial or housing problems and fight bureaucracy
17. Thou shalt listen well to the patients' aspirations for their life and give support to achieve them
18. Thou shalt stand up for the rights of your patient
19. Thou shalt fight the stigma of mental illness at every opportunity
20. Thou shalt help your patient to keep up hope

 © Nursewithglasses 2012-2013