L. Mezir. Barton College.
Social Anxiety Disorder - The effectiveness of ZOLOFT in the treatment of social anxiety disorder (also known as social phobia) was established in two multicenter placebo-controlled studies (Study 1 and 2) of adult outpatients who met DSM-IV criteria for social anxiety disorder generic priligy 30 mg fast delivery. Study 1 was a 12-week order priligy 90mg otc, multicenter buy discount priligy 30 mg line, flexible dose study comparing ZOLOFT (50-200 mg/day) to placebo trusted priligy 30 mg, in which ZOLOFT was initiated at 25 mg/day for the first week. Study outcome was assessed by (a) the Liebowitz Social Anxiety Scale (LSAS), a 24-item clinician administered instrument that measures fear, anxiety and avoidance of social and performance situations, and by (b) the proportion of responders as defined by the Clinical Global Impression of Improvement (CGI-I) criterion of CGI-IStudy 2 was a 20-week, multicenter, flexible dose study that compared ZOLOFT (50-200 mg/day) to placebo. Study outcome was assessed by the (a) Duke Brief Social Phobia Scale (BSPS), a multi-item clinician-rated instrument that measures fear, avoidance and physiologic response to social or performance situations, (b) the Marks Fear Questionnaire Social Phobia Subscale (FQ-SPS), a 5-item patient-rated instrument that measures change in the severity of phobic avoidance and distress, and (c) the CGI-I responder criterion ofSubgroup analyses did not suggest differences in treatment outcome on the basis of gender. There was insufficient information to determine the effect of race or age on outcome. In a longer-term study, patients meeting DSM-IV criteria for social anxiety disorder who had responded while assigned to ZOLOFT (CGI-I of 1 or 2) during a 20-week placebo-controlled trial on ZOLOFT 50-200 mg/day were randomized to continuation of ZOLOFT or to substitution of placebo for up to 24 weeks of observation for relapse. Relapse was defined as >/= 2 point increase in the Clinical Global Impression - Severity of Illness (CGI-S) score compared to baseline or study discontinuation due to lack of efficacy. Patients receiving ZOLOFT continuation treatment experienced a statistically significantly lower relapse rate over this 24-week study than patients randomized to placebo substitution. Major Depressive Disorder -ZOLOFT ^ (sertraline hydrochloride) is indicated for the treatment of major depressive disorder in adults. The efficacy of ZOLOFT in the treatment of a major depressive episode was established in six to eight week controlled trials of adult outpatients whose diagnoses corresponded most closely to the DSM-III category of major depressive disorder (see Clinical Trials under CLINICAL PHARMACOLOGY ). A major depressive episode implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning (nearly every day for at least 2 weeks); it should include at least 4 of the following 8 symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation. The antidepressant action of ZOLOFT in hospitalized depressed patients has not been adequately studied. The efficacy of ZOLOFT in maintaining an antidepressant response for up to 44 weeks following 8 weeks of open-label acute treatment (52 weeks total) was demonstrated in a placebo-controlled trial. The usefulness of the drug in patients receiving ZOLOFT for extended periods should be reevaluated periodically (see Clinical Trials under CLINICAL PHARMACOLOGY ). Obsessive-Compulsive Disorder -ZOLOFT is indicated for the treatment of obsessions and compulsions in patients with obsessive-compulsive disorder (OCD), as defined in the DSM-III-R; i. The efficacy of ZOLOFT was established in 12-week trials with obsessive-compulsive outpatients having diagnoses of obsessive-compulsive disorder as defined according to DSM-III or DSM-III-R criteria (see Clinical Trials under CLINICAL PHARMACOLOGY ). Obsessive-compulsive disorder is characterized by recurrent and persistent ideas, thoughts, impulses, or images (obsessions) that are ego-dystonic and/or repetitive, purposeful, and intentional behaviors (compulsions) that are recognized by the person as excessive or unreasonable. The efficacy of ZOLOFT in maintaining a response, in patients with OCD who responded during a 52-week treatment phase while taking ZOLOFT and were then observed for relapse during a period of up to 28 weeks, was demonstrated in a placebo-controlled trial (see Clinical Trials under CLINICAL PHARMACOLOGY ). Nevertheless, the physician who elects to use ZOLOFT for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient (see DOSAGE AND ADMINISTRATION ). Panic Disorder -ZOLOFT is indicated for the treatment of panic disorder in adults, with or without agoraphobia, as defined in DSM-IV. Panic disorder is characterized by the occurrence of unexpected panic attacks and associated concern about having additional attacks, worry about the implications or consequences of the attacks, and/or a significant change in behavior related to the attacks. The efficacy of ZOLOFT was established in three 10-12 week trials in adult panic disorder patients whose diagnoses corresponded to the DSM-III-R category of panic disorder (see Clinical Trials under CLINICAL PHARMACOLOGY ). Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i. Nevertheless, the physician who elects to use ZOLOFT for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient (see DOSAGE AND ADMINISTRATION ). Posttraumatic Stress Disorder (PTSD) -ZOLOFT (sertraline hydrochloride) is indicated for the treatment of posttraumatic stress disorder in adults. The efficacy of ZOLOFT in the treatment of PTSD was established in two 12-week placebo-controlled trials of adult outpatients whose diagnosis met criteria for the DSM-III-R category of PTSD (see Clinical Trials under CLINICAL PHARMACOLOGY ). PTSD, as defined by DSM-III-R/IV, requires exposure to a traumatic event that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others, and a response which involves intense fear, helplessness, or horror. Symptoms that occur as a result of exposure to the traumatic event include reexperiencing of the event in the form of intrusive thoughts, flashbacks or dreams, and intense psychological distress and physiological reactivity on exposure to cues to the event; avoidance of situations reminiscent of the traumatic event, inability to recall details of the event, and/or numbing of general responsiveness manifested as diminished interest in significant activities, estrangement from others, restricted range of affect, or sense of foreshortened future; and symptoms of autonomic arousal including hypervigilance, exaggerated startle response, sleep disturbance, impaired concentration, and irritability or outbursts of anger. A PTSD diagnosis requires that the symptoms are present for at least a month and that they cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The efficacy of ZOLOFT in maintaining a response in adult patients with PTSD for up to 28 weeks following 24 weeks of open-label treatment was demonstrated in a placebo-controlled trial. Nevertheless, the physician who elects to use ZOLOFT for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient (see DOSAGE AND ADMINISTRATION ). Premenstrual Dysphoric Disorder (PMDD) - ZOLOFT is indicated for the treatment of premenstrual dysphoric disorder (PMDD) in adults. The efficacy of ZOLOFT in the treatment of PMDD was established in 2 placebo-controlled trials of female adult outpatients treated for 3 menstrual cycles who met criteria for the DSM-III-R/IV category of PMDD (see Clinical Trials under CLINICAL PHARMACOLOGY ). The essential features of PMDD include markedly depressed mood, anxiety or tension, affective lability, and persistent anger or irritability. Other features include decreased interest in activities, difficulty concentrating, lack of energy, change in appetite or sleep, and feeling out of control. Physical symptoms associated with PMDD include breast tenderness, headache, joint and muscle pain, bloating and weight gain. These symptoms occur regularly during the luteal phase and remit within a few days following onset of menses; the disturbance markedly interferes with work or school or with usual social activities and relationships with others. In making the diagnosis, care should be taken to rule out other cyclical mood disorders that may be exacerbated by treatment with an antidepressant. The effectiveness of ZOLOFT in long-term use, that is, for more than 3 menstrual cycles, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use ZOLOFT for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient (see DOSAGE AND ADMINISTRATION ). Social Anxiety Disorder - ZOLOFT (sertraline hydrochloride) is indicated for the treatment of social anxiety disorder, also known as social phobia in adults. The efficacy of ZOLOFT in the treatment of social anxiety disorder was established in two placebo-controlled trials of adult outpatients with a diagnosis of social anxiety disorder as defined by DSM-IV criteria (see Clinical Trials under CLINICAL PHARMACOLOGY ). Social anxiety disorder, as defined by DSM-IV, is characterized by marked and persistent fear of social or performance situations involving exposure to unfamiliar people or possible scrutiny by others and by fears of acting in a humiliating or embarrassing way. Exposure to the feared social situation almost always provokes anxiety and feared social or performance situations are avoided or else are endured with intense anxiety or distress. In addition, patients recognize that the fear is excessive or unreasonable and the avoidance and anticipatory anxiety of the feared situation is associated with functional impairment or marked distress. The efficacy of ZOLOFT in maintaining a response in adult patients with social anxiety disorder for up to 24 weeks following 20 weeks of ZOLOFT treatment was demonstrated in a placebo-controlled trial. Physicians who prescribe ZOLOFT for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient (see Clinical Trials under CLINICAL PHARMACOLOGY ). All Dosage Forms of ZOLOFT:Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) is contraindicated (see WARNINGS ). Concomitant use in patients taking pimozide is contraindicated (see PRECAUTIONS ). ZOLOFT is contraindicated in patients with a hypersensitivity to sertraline or any of the inactive ingredients in ZOLOFT. ZOLOFT oral concentrate is contraindicated with ANTABUSE (disulfiram) due to the alcohol content of the concentrate. Clinical Worsening and Suicide RiskIncreases Compared to PlaceboDecreases Compared to PlaceboThe following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality. If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms (see PRECAUTIONS and DOSAGE AND ADMINISTRATION-Discontinuation of Treatment with ZOLOFT, for a description of the risks of discontinuation of ZOLOFT). Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for ZOLOFT should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose. Screening Patients for Bipolar Disorder: A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that ZOLOFT is not approved for use in treating bipolar depression.
Other characteristics you should look for are:High concentration of omega-3 fatty acids per capsule purchase priligy 90mg visa. Quality brands of fish oil manufacturer use nitrogen to produce the fish oil discount 60 mg priligy otc. No fish liver oils due to high levels of vitamin A and D trusted 90 mg priligy. Start with a high EPA brand order priligy 60mg free shipping, approximately 3 grams of EPA. If you are a vegetarian, use flaxseed oil (1 to 2 tablespoons is a good starting dose). Using a lignan rich flaxseed oil might have some advantages. David: Just a note here: I received a couple of messages from people who are concerned that we may be advocating dropping your bipolar medications and taking omega-3 fatty acids instead. As I said at the top of the conference, any information presented here is for your information only. If you find it useful, I suggest you talk it over with your doctor. But please, do not stop taking your medications based on what is presented here. Pjude9: How long before one would notice any effect from omega-3? Severus: You might notice beneficial effects within the first two weeks, however, you should take it for four weeks to be sure whether it is helpful for you, or not. In addition, omega-3 might be a good option, if you are not stable on your current medications. Furthermore, always talk to your Primary Care Physician or psychiatrist before changing any medications. Severus: Well, any antidepressant may worsen the course of the disease and trigger manic or mixed episodes. On the other hand, Wellbutrin is the one which is very well tolerated in general. The side effect profile of Topiramate does not include rages as a common side effect. David: One of the things we get a lot of email about is people who are prescribed antidepressants, when they really needed mood stabilizers. How does a person know which type of medication would be right for them? Mood stabilizers should be the first-line treatment. And it might be a good option to add Lamotrigine instead of an antidepressant, because Lamotrigine seems to have mood-elevating and stabilizing properties. Severus, if mood stabilizers and antidepressants are used, and a patient achieves some degree of stability, does this necessarily confirm the diagnosis of bipolar disorder, even if the patient has never had a "true" manic episode? Severus: The diagnosis should not rely on a treatment response. Bipolar 1 disorder requires a manic or mixed episode, Bipolar 2 disorder "just" hypomania. I was diagnosed after my son was born, and have been told the pregnancy might have triggered my illness to surface. I am Bipolar and have Obsessive Compulsive Disorder (OCD). My question is what chance is there that my son will suffer from a mental illness? Severus: It is hard to tell, but you should remember: Even if the genes are involved in bipolar illness, environment also plays an important role. Severus: Sure, there is a new psychotherapeutic approach called: Social rhythm therapy. Severus: Yes, social rhythm therapy focuses on restoring and maintaining personal and social daily routines to stabilize body rhythms (especially the 24 hour sleep-wake cycle). Severus: Well, we think that it translates into increased mood stability. It may also decrease the stimulation threshold, however, this is a hypothesis. Christmas holidays are usually the hardest, but not all the time. Severus: You can try it, but you should start then pretty soon. Another, and maybe better option, might be to invite friends for Christmas, if it is possible. Severus: Are you hypothyroid, or do you have elevated T3/T3 levels? Taking a thyroid supplement might be good option for a "hypothyroid" goiter if you developed it under Lithium. Pjude9: Could you explain why anti-psychotics such as Zyprexa and Seroquel are used in treating bipolar? Severus: If you are suffering from severe depression, than this combination alone is not helpful, you might consider adding the Omega-3s. By the way, I would always recommend a daily mood chart to monitor symptoms and improvement when you change medications. I think that this is extremely helpful, especially also in retrospective. This is why polypharmacy (taking several medications) has become so frequent. You can click on this link, sign up for the mail list at the top of the page, so you can keep up with events like this, please take a look around. She mentioned that when she was first diagnosed, that they gave her some test that pointed to manic depression. Was there ever such a test, and will there ever be a definitive test to prove medically that I suffer from bipolar? Severus: I doubt that this test was reliable, and I am a bit skeptical whether we will have such a test in the near future. However, we can diagnose bipolar disorder even without a "test" pretty well. PSCOUT: Can you please discuss the use of Neurontin as a mood stabilizer? Severus: Gabapentin seems to be especially helpful in the treatment of anxiety in bipolar disorder. Furthermore, I am not aware of any well-controlled data regarding long-term mood-stabilizing properties. David: Just to make sure, Gabapentin and Neurontin are one and same, correct? SaxDragon78412: I have read some reports that people with bipolar should not take Melatonin supplements, and other reports that we should. Severus: Melatonin might be helpful to improve sleep during a depressive episode, but it does not have anti-depressive properties. It might also be useful to treat jetlag, which is especially dangerous for people suffering from bipolar disorder. However, even on the medications, I still have some mood fluctuations. What besides medications and omega 3, can I do to try to keep my moods stable? Severus: Here are some suggestions for maintaining mood stability:Exercise on a regular basis. Some people also report that white sugar makes them feel worse. Start some kind of relaxation technique (Diaphragmatic breathing for example seems to be helpful for some). Try to reduce stress at work and during your leisure time! Start with approximately 3 grams of EPA per day, or 1-2 tablespoons of lignan-rich flaxseed oil.
Studies show that the more we see the best in others order priligy 90mg with visa, the better healthy relationships get buy generic priligy 60 mg on line. Healthy relationships are between winners who seek answers to problems together 90 mg priligy amex. Studies tell us that loyalty is very important in good relationships order priligy 60 mg otc, but healthy relationships are NOW, not some hoped-for future development. Studies tell us warmth is highly valued by most people in their relationships. Sometimes it looks like everyone else in the world is confident and connected. Actually, most people feel just like you feel, wondering how to fit in and have good relationships. Healthy relationships can be learned and practiced and keep getting better! Healthy relationships are made of real people, not images! What I call "the masters of marriage " are individuals who are being kind to one another. They may raise difficult issues, but they also soften them in a very considerate way. They communicate respect and love every day in numerous small ways. There are so many more positive exchanges in these relationships, than those that are heading for divorce. These individuals show more affection for each other, and they communicate greater interest in one another, and use more humor. They scan their environment, looking for opportunities to say "thank you" rather than searching for mistakes the other person has made. They look at their partner through a different filter. The other thing they are doing, is they are very mindful of people trying to reach out and connect with them (i. In contrast, couples headed for divorce are responding only 30% of the time. Robinson and Price found the same thing when they studied positive interaction in couples. Unhappily married couples were not noticing 50% of the positive things their partner was doing. The observers could see the positive behavior, but the spouses were not seeing it. What this means is, that for a lot of unhappy couples you do not have to change their behavior at all; you just have to get them to see what is actually going on. In addition, Gottman has shown that the following components are also important to successful long term relationships for couples. They spend time in and enjoy conversation with each other. They do keep score by remembering the good things their partner does for them. There is a positive sense of humor in the relationship. There are shared goals and a sense of team work in the relationship. There are good conflict resolution skills in the relationship. You may feel as if you grew up on a desert island, far from the mysterious world of lasting romantic love. You may believe that even if you do fall in love, you are destined to jinx the relationship, or be abandoned, or be terribly hurt. You may fear conflict and change and have a tough time separating from your parents, even though you left home years ago. A new book, based on a lengthy study, argues that emotional complications like these are common among adult children of divorced parents -- and that they may not be fully evident until decades after the breakup. Lewis and New York Times science correspondentSandra Blakeslee, is based on a 25-year examination of the lives of 93 Marin County adults. Wallerstein, founder of the Center for the Family in Transition in Corte Madera, began examining this group in 1971, when they were children and adolescents. Initially, researchers expected that the study findings would be different -- that the most stressful time for the children would come right after the divorce. Instead, they found that post-divorce difficulties become most severe when the children of divorced parents reach adulthood, as their search for lasting commitment moves to center stage. Some experts question how many of the problems Wallerstein identifies can be truly attributed to divorce and not to other causes such as poor parenting skills. Others question the reliability of a study based on such a narrow sample, or say the effect of divorce is not as wrenching as the study concludes. Mavis Hetherington, a sociology professor emeritus at the University of Virginia who also studies divorce, said her studies have shown that although children of divorced parents do have more problems, the majority of them function well. When kids move into a happier family situation with a competent, caring, firm parent they do better than they do in a nasty family situation,' Hetherington told the Associated Press. Indeed, they argue that children raised in highly dysfunctional marriages were no better off -- and sometimes worse off -- than children of divorced parents. Rather, what the study shows is that parents, society and the courts need to pay closer attention to the consequences of divorce on children, said Lewis, who began working with Wallerstein about 10 years into the study. That, I think, is hard for a lot of adults to swallow,' Lewis said. Although some of the divorced parents in the study did go on to lead happier lives, that did not translate into happier lives for the children, Lewis said. Wallerstein found that these otherwise well-functioning adults must fight to overcome such feelings as a fear of loss because of childhood anxiety about abandonment or fear of conflict because it leads to emotional explosions. Their adolescence lasted longer, the study found, because the children were so preoccupied with their parents. For example, Wallerstein said, many girls end up fearing success, thinking: "How can I have a happy life when my mother or father has been unhappy? The same experiences that hindered relationships helped in the workplace. The study participants were very good at getting along with difficult people, Wallerstein said. And with mothers who often said one thing and fathers who said another, the grown children also became adept at making up their own minds. The study also compared the adults from divorced families to 44 adults from intact families. I realized that children indivorced families never mentioned play. They all said that `the day my parents divorced was the day my childhood ended. A landmark study on the long-term effects of divorce by Marin County psychologist Judith Wallerstein followed 93 children of divorce over 25 years. Among adult children from intact families, 61 percent had children. This story appeared in the San Francisco Chronicle - Sept. Every serial killer on TV, it seems, has schizophrenia. And the idea schizophrenia means a +??split personality+?? is also prevalent. In fact, though, schizophrenia is not a split personality nor is schizophrenia a violent illness. Schizophrenia is a recognized, severe, persistent mental illness that affects thought patterns and beliefs. This brain disorder commonly consists of hallucinations, delusions and impaired information processing and communication skills.
Pratt has worked in the field for fifteen years order priligy 30mg on line, and has extensive experience with Dissociative Identity Disorder 60 mg priligy overnight delivery. I can imagine that having several alters within can become very disrupting purchase 60mg priligy fast delivery, making it difficult to live a "normal" life purchase priligy 90 mg online. Pratt: Sometimes a person with DID is called a liar, because people accuse them of doing things that they deny doing. Sometimes they are viewed as weird or flaky because their behavior is so variable. Their internal experience is that the world is kind of unpredictable, difficult to navigate at times. David: Tonight, we want to discuss getting your alters working together towards a common goal, whether it be healing or just everyday living. Is that even possible or reasonable to expect that to happen? When people can get their alters to agree on things, life gets much easier and less disrupted. Alters were created because there were things that were too hard for one person to accept that happened to them. So, the barriers between alters, barriers between knowing what one or another is thinking or doing, are there for a reason. David: Is this something that can only be accomplished in a therapeutic setting? David: A moment ago, you used the term "openness within the system". Pratt: By that, I mean "internal communication," or communication among alters. Internal communication is the first step toward cooperation. David: How does one accomplish internal communication amongst the alters? Pratt: For many people with multiplicity, it is a difficult task. This is because, as I said earlier, the barriers between alters are there for a good reason, self-protection. Others, who can hear each other, might start trying to have conversations about their different needs and wishes. You find ways to get the word out, and then you take care to listen carefully to each other. David: As you can imagine, we have a lot of audience questions. Like any group of people who experience conflict, this is not easy. Even those alters who have seemingly self-destructive points of view have them for a reason. If their reasons are understood and respected, it will build a bridge to working together toward mutual goals. Chandra: I have a seven year old alter that cuts me after I do anything that she perceives is not safe. Pratt: Chandra, you bring up another common problem, and one which makes working together really difficult. I guess the short answer is, negotiate (easier said than done, I know). David: I know that this is sort of controversial, but just so we know and understand where you are coming from Dr. Pratt, is "healing" to you the same as "integration" of the personalities, or is it getting the alters to work and exist together? Pratt: I think that everyone needs to define healing for themselves. I cannot dictate my idea of what healing is to another person. I personally believe that doctors have made too much of the idea of integration. Many multiples, if they are able to cooperate internally and are not losing time or missing what is going on when others are out, can live completely satisfactory lives without trying to integrate. If someone chooses to work toward integration, that is certainly their option. If they choose not to, I would support that decision too. I have been trying to contract with her, or reach her in some way, but have been unable to. Do you have any suggestions in obtaining a contract or communication with her? Pratt: Asilencedangel, you are describing one of the most difficult problems to address. I would make the same suggestion, though, with perhaps the added encouragement to persist, and keep on persisting. However, the key is definitely, "I disagree with your method, but I think we may have something we do agree about. Pratt: This is where the help of a therapist sure comes in handy. As that happens in the very beginning, sometimes the therapist is the conduit for communication between alters. Falcon2: How do you teach alters to do specific things when you are not co-conscious? Pratt: Falcon2, I guess the answer is, you try to communicate and really try to listen. But you might be able to ask them to do "x" for you if you can do "y" for them. For example, they will refrain from drinking, if you can give them some time for recreation for themselves. David: Besides the journaling, what other ways are there to establish a workable system of existence with your alters? Pratt: I think that the help of a therapist is really useful in helping people develop internal communication and cooperation. Sometimes the therapist is the one who can most easily recognize the common goals, from alters who seem to have very different goals indeed. These comments illustrate how much good information multiples can get from each other. Pratt: I would have to underscore what We B 100 said, that giving alters their own time to do their own thing is a very positive step. Everyone, multiple or not, has different needs, and in a multiple, meeting the needs of alters is one way to keep everyone settled down and willing to work together. David: One of the common questions we are getting, Dr. Pratt, is how long should it take to obtain a peaceful coexistence with your alters? I think, if the person has alters who are doing highly destructive, scary things (like intensely suicidal or self-injurious behavior, severe addictions or eating disorders, to name a few, it may take a few years to get it all settled down. Not everyone with multiplicity experiences these very difficult adaptations. The goal of internal communication and cooperation might be accomplished with almost NO rehashing of the past. But the reasons why alters do various things, and the reasons why one has alters to begin with, will probably mean some thinking about and talking about the past. We are at a loss as to what to do to try get her back. Our job, up until now, has been to teach her how to live, and we feel very alone. Pratt: Jewlsplus38, I think you are most likely doing a great job. I would guess that, if all her life she has dissociated strong feelings, the process of learning to feel them for the first time is going to be on-again/ off-again. Offer support when she reappears, and keep her life in order while she is away.