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It's some destination that we have to reach. You are "successful" when you are walking your path, always learning, always growing. Where a lot of Millennials and young adults my peers seem to get frustrated is they see everything as permanent. They say, "I'm stuck here," looking at their cubicle job as the end, there is nowhere else to go, and they feel like they will never reach the desired destination of "success.
And unless you can discover those lessons and embrace your own journey, you will never actually reach the state of feeling "successful"--in the sense that you are learning and growing and effortlessly becoming a better version of yourself. The reason why so many people struggle with this is because it means taking accountability.
It is so, so easy to sit in a cubicle or an office or even somewhere you enjoy being and say, "This place isn't giving me enough. It's not making me grow. Just like a mirror, if you point, your reflection will point back. The key is to point at yourself. If you look in the mirror and you point at your physical self, your reflection in the mirror will point at itself. When you "pull the thumb," you take accountability. You are shifting your perspective from "blame" to "ownership. This same theory goes for everything: work, personal relationships, even the way you feel about yourself. Let me tell you a story: When I was 14 years old, I fractured my spine playing hockey.
It was one of the most painful experiences of my life. To me, hockey was everything--I loved that sport more than anything else in the world, and I was determined to play in the NHL. I used to watch The Mighty Ducks with my hockey gloves on, acting out the scenes in front of the television with my hockey stick in the living room, my mom yelling from the kitchen reminding me to be careful and not break anything.
The fracture was big enough to make walking extraordinarily painful, but small enough that I couldn't have surgery. The only thing to do was take Advil and let it heal on its own.
At first, I was extremely depressed. I was an awkward teenager and didn't have many friends. The only place I felt like I fit in was on the ice with other people who loved hockey as much as I did. And I'll admit, at first I did what was easy. I blamed everyone else.
The validity of the often-used 1. Cronbach's alpha at T1 was 0. Living difficulties were measured with the Post-Migration Living Difficulties Checklist 33 , 34 adapted to the Swiss context The PMLD scale has consistently been identified as a predictor of mental health among displaced populations 12 , 31 , Written informed consent was obtained, with participants being informed they were free to withdraw from the study without influence on future treatment. In MAPSS, self-report questionnaires are presented on an electronic tablet in both written and auditory form in the respondent's mother tongue.
Assessments were supervised by a clinical psychologist or a masters-level student of clinical psychology. Participants were reimbursed CHF 40 approx. USD 40 for participation. Descriptive statistics are given in terms of means and standard deviations in continuous variables, and counts and percentages for categorical variables.
Changes over time were calculated for all variables. Variables entered into the models included gender, trauma exposure, visa status secure vs. Afghanistan, Somalia, etc. Participants reported severe lifetime trauma exposure with an average of The most commonly reported PTE included torture The least commonly reported were sexual assault by a stranger A comparison on key variables between participants, who completed both time points versus those who completed Time 1 only, indicated significant differences exclusively regarding age and length of time in Switzerland, but not regarding symptoms scores, trauma exposure, and PMLD.
With regard to anxiety, At T1, Fourteen participants P—values are not controlled for multiple comparisons. More than half of PMLD types improved significantly along the treatment trajectory. The overall model was not associated with changes in PTSD, though the individual predictor was significant. Along with mental health improvements, we found a significant reduction in more than half of the examined PMLD types as well as of the mean PMLD scores.
Remarkably, while PTSD symptom scores on average improved under treatment, 14 participants As all participants had a clinically established diagnosis of PTSD at the beginning of treatment being a requirement for treatment uptake , it seems that after initially benefitting from therapy until the baseline assessment, some patients later experienced increased posttraumatic stress again.
This finding has been described in other studies investigating refugees in the post-migration 37 , Further longitudinal research is required to investigate this hypothesis. These findings connect to earlier studies showing that, in general, trauma-related factors seem to explain more variance in rates of PTSD, while post-migration or displacement-related stressors appear to particularly influence rates of mood and anxiety disorders, over and above the effects of past trauma [for overview s.
The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. The next highest category, transportation at We are not just talking about nice species out there; this is our life-support system. When the price of a good rises, consumers tend to purchase less of it and to seek out substitutes instead. My youngest, Molly, who is 12, has been involved in the school climate strikes. By the early s, the Bureau of Labor Statistics was using alternative mathematical methods for calculating the Consumer Price Index, more complicated than just adding up the cost of a fixed basket of goods, to allow for some substitution between goods. By , there were more than 40 million cellular phone subscribers in the United States—but cell phones were not yet part of the CPI basket of goods.
In addition to the existing cross-sectional evidence, our longitudinal data suggest that, in a treatment-seeking sample of severely traumatized refugees and asylum seekers in the post-migration, improvements in PMLD predict a favorable treatment trajectory with regard to depression and anxiety, and could therefore be valuable targets of therapeutic interventions. This finding, though preliminary in nature and in need of replication, contributes to several fields of discussion and potentially has substantial implications:.
A first implication appears with regard to explanatory models and causality. There is solid evidence that refugee mental health is related to both pre-migration, traumatic as well as post-migration stressors 7 , The scientific discourse on how these aspects are causally related, however, is prototypically divided between two opposing models 8 , 39 , 40 : The war-exposure model on the one hand focuses on traumatic experiences and consecutive PTSD.
Post-migration living difficulties are at least partly considered a consequence of trauma-related psychological impairment and supposed to be manageable after symptoms have improved. Accordingly, trauma-focused interventions within a cognitive-behavioral framework are considered first-line approaches. On the other hand, representatives of multimodal or psychosocial interventions primarily target general sources of distress, particularly exile-related stressors, with the objective of secondary psychological stabilization. While the direction of causality is clear regarding traumatic experiences and trauma-related disorders, it is much less clear with PMLD and psychiatric symptoms: post-migration stressors could promote mental disorders such as depression and anxiety, and the latter could lead to functional impairment and, therefore, to PMLD.
The findings in our sample now suggest that PMLD have a permissive or even causal role regarding the development of depression and anxiety in traumatized refugees, rather than vice versa. From a clinical perspective, this makes sense as many of the most distressing PMLD, such as insecure visa status, separation from family members, or restrictive asylum policies, are unswayable for affected persons, even if psychological impairment is successfully treated.
The assumption of a unidirectional model seems therefore less conclusive than a circular model with PMLD contributing to mental health problems, and, to a minor degree, vice versa. A second implication touches the question of how refugee mental health should best be addressed in the context of service provision. While the effectiveness of trauma-focused interventions with regard to symptoms of PTSD is well documented, this applies only to a minor degree to other psychiatric disorders such as depression and anxiety disorders, and so far not to psychosocial interventions Our findings provide preliminary support that addressing PMLD via psychosocial interventions within a multimodal framework, including trauma-focused approaches, could enhance treatment response with regard to depression and anxiety and, therefore, justify the delivery of respective treatment options.
Remarkably, in our sample, not all PMLD types were equally amenable to change. Most significant improvements were found in stressors related to visa status. Unfortunately, this issue is entirely out of reach for therapeutic as well as psychosocial interventions. On the other hand, no significant improvement at all could be achieved with regard to stressors related to separation from family members in participants' home countries.
Therefore, the most promising targets of psychosocial interventions seem to be those post-migration stressors related to social integration such as language and employment. A third important implication relates to immigration policies and social integration. In many high-income countries, the barriers for asylum seekers are high in order to avoid pull-factors. Many aspects of daily life of asylum seekers such as long asylum procedures, placement in camps, restrictive access to labor market, or prohibition of family reunion are intentionally harshened by the authorities.
In contrast, after obtaining a residency permit, refugees are usually expected to rapidly engage in the host societies, particularly regarding language proficiency and financial independence. An earlier, cross-sectional study on partly the same sample found a high correlation between psychological impairment and integration difficulties In addition, our longitudinal findings suggest that host societies could facilitate successful social integration of mentally ill asylum seekers and refugees by complementing timely and appropriate treatment with psychosocial interventions targeting PMLD.
This is in line with a recent study of severely traumatized refugees which found multimodal treatment including social counseling to foster economic integration on family income level Conversely, restrictive policies aiming at establishing stressful living conditions for refugees and asylum seekers might fuel PMLD and consecutive mental health problems, with negative consequences for social integration.
This study has a number of limitations. First, the sample size was small. This may have reduced our statistical power in uncovering relationships between variables.
Second, participants were examined in different stages of therapy, rather than in proper pre-post-assessments, which may limit the comparability of trajectories. Due to the clinical character of the sample, our findings are not generalizable to subclinical refugee populations. Third, though we used transculturally validated measures whenever available, participants were from numerous cultural backgrounds, and thus, it was not possible to use measures validated with each cultural group.
Yet, the use of a tablet-based therapist-assisted assessment tool allowed participants to be assessed in their respective mother tongues independently of their level of education. Finally, self-report measures were implemented instead of clinician-administered diagnostic interviews and an objective index of PMLD.
Living the Changes explores the nature and extent of women's changing realities . The contributors include writers, artists, academics, street kids and social. Living the Change is a feature-length documentary that explores solutions to the global crises we face today – solutions any one of us can be part of – through.
It may be the case that those participants with high symptom scores were more likely to perceive objective stressors as more stressful. This study provides preliminary evidence for the causal role of PMLD with regard to mental health problems of refugees and asylum seekers. Our findings support an ecological model of refugee mental health, which suggests that both pre-migration and post-migration stressors contribute to mental health outcomes In addition to well-established trauma-focused interventions for the treatment of PTSD, our data suggest that psychosocial interventions focusing on PMLD might be able to contribute to a favorable treatment response, particularly with regard to depression and anxiety, and may therefore be a legitimate and valuable add-on in a multimodal treatment approach.
Future research should examine a what PMLD topics are causing the most distress and impairment, b what topics are amenable to therapeutic interventions, and c what interventions are the most effective ones in order to achieve the greatest relief. Policy makers should recognize the role of daily stressors in contributing to psychological distress and their negative impact on social integration. It may be in the interest of host societies to support aid agencies, caseworkers or settlement service providers in addition to psychological treatment. In addition, psychosocial interventions may be of particular interest in view of the fact that the highest share of displaced persons in need of support are not located in high-income countries, but in conflict, post-conflict or neighboring countries without access to appropriate mental health services.
Non-medical approaches such as accessing social support and problem management, provided by helpers without health-professional background, are urgently needed The required task-shifting from highly-qualified specialists to less specialized workers with fewer qualifications may be more likely to succeed with interventions addressing daily stressors than specific diagnoses MS was involved in the conception of the study, in the interpretation of the data and the drafting of the manuscript. NM was involved in the conception and design of the study, the acquisition, analysis and interpretation of the data, and the drafting of the manuscript.
PM was involved in the analysis and interpretation of the data, and the drafting and revision of the manuscript. All authors read and approved the final manuscript.