The report hypothesizes that veterans with auditory disorders would use Veterans Administration (VA) mental health facilities less due to communication difficulties. The initial results found that disabled veterans with hearing issues had used VA mental health services at least once. Later the article states that although veterans with auditory disorders were more likely to seek initial mental health care, they were less likely to follow up on subsequent visits. This remains a national problem due to the steadily increasing in this population since 2001 will undoubtedly rise rapidly with our modern wars. In fact the report indicates that in the years 2005 there were 822,413 veterans diagnosed with a service-connected disability, a 176.2% increase in auditory disorders.
There has been some evidence that veterans with posttraumatic stress disorder (PTSD) and tinnitus have a link; it was reported that 34% of veterans seeking mental health care have both disorders. The article seems to be long on words to facilitate the information; although the study was comprehensive I felt that it could be condensed into a smaller package. The level of research involved would indicate that the intended reader were other researchers to offer direction in future studies. The language is sterile and includes terminology indicative of the mental health professions and overcomes the racial and cultural differences in veterans. As in the VA means testing system, once you have a diagnosis equal care is given on a scale of service-connection to the medically retired.
The article gives a perspective that has not been fully realized with protocols and assessment procedures. “Although veterans disabled by auditory disorders seem to readily connect with VA mental health services, the reduced frequency or repetition of services use may require intervention” (Kendall, and Rosenheck, p. 1357, 2008). Since the mental health field has a greater number of social workers they have the necessary skills to implement multidisciplinary approaches to best fit the issues at hand. Psychometric measures can be established maximized through the skill sets of social workers; including better assessments that include audio disorders, mental health disorders and measures taken when assessed properly.
Kendall, C. J., and Rosenheck, R. R. (2008). Use of mental health services veterans disabled by auditory disorders. Journal of Rehabilitation Research and Development, 45(9), 1349-1360.
July 31, 2009
July 30, 2009
Review of Auditory Dysfunction in Traumatic Brain Injury
The article was informative with regards to giving a clearer picture of the growing population of veterans with hearing loss attributed to their military service. The report found that admissions for traumatic brain injury (TBI) increased 47% since the beginning of Operation Iraqi Freedom (OIF). A subgroup of blast related (BR) veterans were reported as having 62% hearing loss and 38% of this group with tinnitus. The authors indicated a gap in screening services for veterans as they had inadequate training for the management of tinnitus. The article was well organized and concise in that it gave specific representations of populations and subpopulations. The article does recognize some limitations to the service streams within the Veterans Administration (VA), but falls short in fully recognizing and advocating for the veteran.
One possibility as to the articles soft stance on identifying problems and barriers to care, it appears the target audience was for the VA. Hence, while identifying some issues with assessment and services the full exposure and extent of problems in the continuum of care and the bureaucratic entanglements might impede funding for further research monies for the authors. The article quickly lists the figures for comparisons and draws conclusions delineated from two groups. Forty months before the beginning (group I) of OIF and forty months after (group II), the two groups were compared, and found that group II had a significant amount of younger veterans with BR-TBI and hearing loss. This matter of younger veterans with TBI and hearing loss marks a significant change in the topology and identity of a growing population of veterans who have limited resources for an ever growing pool of patients.
The authors dance around the problems and charging forward with a battlement of statistics and cross analytics encompasses the VA’s endless studying the problem without addressing the quandary. More proof that was suspected and witnessed and now corroborated. Endless speculation as to the causes and no end in sight to the ramblings of those that need “proof positive” before treatment remedies can begin to trickle down to the masses of veterans needing services. A social work perspective and holistic approach would begin to recognize the problem and begin effect treatments in conjunction with research for improving modalities while building on the clients strengths. The most significant piece of information revealed in this endeavor is the low statistical and counter-intuitive expectation in the rupture of the tympanic membrane in percussion blast waves. Even more interesting, this information only covered less than half of a paragraph in the results section and missing in the discussion section.
As far as helping the social worker, this article does little to add to the discussion in helping the veterans. Except that it might add to the growing avalanche of data that the government requires before allocating funding for services and care for the veteran.
Lew, H. L., Jerger, J. F., Guillory, S. B., and Henry, J. A. (2007). Auditory dysfunction in traumatic brain injury. Journal of Rehabilitation Research and Development, 44(7), 921-928.
One possibility as to the articles soft stance on identifying problems and barriers to care, it appears the target audience was for the VA. Hence, while identifying some issues with assessment and services the full exposure and extent of problems in the continuum of care and the bureaucratic entanglements might impede funding for further research monies for the authors. The article quickly lists the figures for comparisons and draws conclusions delineated from two groups. Forty months before the beginning (group I) of OIF and forty months after (group II), the two groups were compared, and found that group II had a significant amount of younger veterans with BR-TBI and hearing loss. This matter of younger veterans with TBI and hearing loss marks a significant change in the topology and identity of a growing population of veterans who have limited resources for an ever growing pool of patients.
The authors dance around the problems and charging forward with a battlement of statistics and cross analytics encompasses the VA’s endless studying the problem without addressing the quandary. More proof that was suspected and witnessed and now corroborated. Endless speculation as to the causes and no end in sight to the ramblings of those that need “proof positive” before treatment remedies can begin to trickle down to the masses of veterans needing services. A social work perspective and holistic approach would begin to recognize the problem and begin effect treatments in conjunction with research for improving modalities while building on the clients strengths. The most significant piece of information revealed in this endeavor is the low statistical and counter-intuitive expectation in the rupture of the tympanic membrane in percussion blast waves. Even more interesting, this information only covered less than half of a paragraph in the results section and missing in the discussion section.
As far as helping the social worker, this article does little to add to the discussion in helping the veterans. Except that it might add to the growing avalanche of data that the government requires before allocating funding for services and care for the veteran.
Lew, H. L., Jerger, J. F., Guillory, S. B., and Henry, J. A. (2007). Auditory dysfunction in traumatic brain injury. Journal of Rehabilitation Research and Development, 44(7), 921-928.
July 29, 2009
Review of The Association Between Tinnitus and Posttraumatic Stress Disorder
The author of this article explains the evidence for connections between tinnitus and Posttraumatic Stress Disorder (PTSD). In the initial paragraph he lists several articles that support a co-occurring relationship and related neural mechanisms. The article jumps back and forth in presenting the information and keeps a central focus on PTSD and its impact on assessment protocols. The article is presented in the Journal of Audiology, so this could explain the emphasis on the psychological aspect of the equation. Audiologists have a unique perspective in their field of practice and would not need a substantial explanation of auditory pathology, hence the concentration on the psychological effects and the similarities in treatments for both PTSD and tinnitus.
The paper details the similarities in diagnostic criteria for symptoms of increased arousal compared to the diagnostic criteria for tinnitus, such as difficulty in falling asleep, irritability or outburst of anger, difficulty concentrating, hypervigilance and exaggerated startle response. The symptoms of sleep disorder and concentration difficulties translate directly to tinnitus screening measures along with hypervigilance and exaggerated startle response as relational to irritation and anger associated with tinnitus. The overlap of symptoms suggests that the presence of both diagnoses would exacerbate either condition bi-directionally. Of 300 patients studied, 34% had both conditions.
The author suggests that clinical evaluations and mental health screenings, when dealing with trauma related disorders and audiology assessments should include screening criteria for both tinnitus and PTSD. He suggests that audiology testing should incorporate sensitivities to patients with diagnosed and undiagnosed PTSD, as the startle responses could be increased with the sudden tones and high pitches related to auditory testing. Many patients self-report of the resounding silence within the sound booth as an anxiety stressor, and listed many offending characteristics of the hearing screening regimen.
One word used throughout the paper that struck me as possibly harmful in translation to the population was the repeated use of the word “complaint” and its many variations. The medical model uses many such words in addressing medicalized “problems” which maintain a distance between the medical profession and patients. With and understanding of comorbid etiology, social workers can better assess the individuals situation and provide a better chance of successful outcomes in treatment and referrals more conducive to the clients best interest. Recognition of treatment modalities that could benefit both conditions, the client can find relief from an efficient use of time and techniques employed by the educated social worker. Treatments indicated to work in both conditions are antidepressants and cognitive-behavioral therapy.
Fagelson, M. A. (2007). The association between tinnitus and posttraumatic stress disorder. American Journal of Audiology, 16, 107-117.
The paper details the similarities in diagnostic criteria for symptoms of increased arousal compared to the diagnostic criteria for tinnitus, such as difficulty in falling asleep, irritability or outburst of anger, difficulty concentrating, hypervigilance and exaggerated startle response. The symptoms of sleep disorder and concentration difficulties translate directly to tinnitus screening measures along with hypervigilance and exaggerated startle response as relational to irritation and anger associated with tinnitus. The overlap of symptoms suggests that the presence of both diagnoses would exacerbate either condition bi-directionally. Of 300 patients studied, 34% had both conditions.
The author suggests that clinical evaluations and mental health screenings, when dealing with trauma related disorders and audiology assessments should include screening criteria for both tinnitus and PTSD. He suggests that audiology testing should incorporate sensitivities to patients with diagnosed and undiagnosed PTSD, as the startle responses could be increased with the sudden tones and high pitches related to auditory testing. Many patients self-report of the resounding silence within the sound booth as an anxiety stressor, and listed many offending characteristics of the hearing screening regimen.
One word used throughout the paper that struck me as possibly harmful in translation to the population was the repeated use of the word “complaint” and its many variations. The medical model uses many such words in addressing medicalized “problems” which maintain a distance between the medical profession and patients. With and understanding of comorbid etiology, social workers can better assess the individuals situation and provide a better chance of successful outcomes in treatment and referrals more conducive to the clients best interest. Recognition of treatment modalities that could benefit both conditions, the client can find relief from an efficient use of time and techniques employed by the educated social worker. Treatments indicated to work in both conditions are antidepressants and cognitive-behavioral therapy.
Fagelson, M. A. (2007). The association between tinnitus and posttraumatic stress disorder. American Journal of Audiology, 16, 107-117.
July 28, 2009
Review of Knowledge and Attitude of Infantry Soldiers to Hearing Conservation
The article presented a clear and concise measure of the attitudes among combat arms soldiers. The message was that soldiers were ignorant of Hearing Conservation Programs (HCP) in the British army. With noise levels of 90 decibels (dB) were enough to cause hearing damage. The infantry units are regularly exposed to levels ranging from 145 to 200 dB, enough to cause hearing impairment to a high percentage of soldiers. The report estimates that only 22% knew about a military hearing conservation program. The majority (91%) of troops said that their reasons for not wearing hearing protection or use them improperly was due to personal experiences in firearm training and in combat. These figures point to an audience of probationers, pointing to the need for a stronger and more ambitions HCP.
The article did not touch on racial or cultural issues; it had to do with a systemic problem related to the inadequacies of the present HCP. The language of the article was general enough in words and efficient in expounding without becoming too cumbersome. This report translates especially well in the promotion and advocacy of awareness within the military community. The problem has a coupling of many issues that engender the social worker in systemic solutions that would be outside the scope of many professions.
The soldier firing their weapons in many different atmospheres evokes a situation where extreme conditions could foster greater advancement in the research and study of hearing loss, hearing loss prevention and tinnitus. This many perspectives enables a person-in-environment look at the complete problem, from the extremes of combat to the monotony of the firing range. The social worker has been trained to look at the issue from a micro to a macro investigation of presenting problems. The article points out glaring inefficiencies within the militaries HCP. A social worker would be able to encompass and envision solutions from a multi-perspective view, enabling holistic approaches from individual treatments, to improved hearing conservation education and revamping the HCP from the inside out.
The article did not touch on racial or cultural issues; it had to do with a systemic problem related to the inadequacies of the present HCP. The language of the article was general enough in words and efficient in expounding without becoming too cumbersome. This report translates especially well in the promotion and advocacy of awareness within the military community. The problem has a coupling of many issues that engender the social worker in systemic solutions that would be outside the scope of many professions.
The soldier firing their weapons in many different atmospheres evokes a situation where extreme conditions could foster greater advancement in the research and study of hearing loss, hearing loss prevention and tinnitus. This many perspectives enables a person-in-environment look at the complete problem, from the extremes of combat to the monotony of the firing range. The social worker has been trained to look at the issue from a micro to a macro investigation of presenting problems. The article points out glaring inefficiencies within the militaries HCP. A social worker would be able to encompass and envision solutions from a multi-perspective view, enabling holistic approaches from individual treatments, to improved hearing conservation education and revamping the HCP from the inside out.
July 27, 2009
Deaf and Hard of Hearing Veterans: Auditory Disorders from Combat
I took a class this summer on the Deaf and Hard of Hearing (DHH) population because I wanted to learn about people like me. Today I started posting the first of those reviews, I hope you find some meaning and insight into the veterans mind who has suffered from auditory injuries in combat.
I wear hearing aids and have only 25% of hearing in my left ear and 50% in my right ear. I sustained this injury in Desert Storm from an artillery impact, just far enough out of the kill zone, but close enough to have permanent damage to my hearing. I have been rated 10% service-connection compensation for hearing loss, 10% for tinnitus and 30% for Posttraumatic Stress Disorder (PTSD).
As you will read in a couple of other posts, hearing loss and especially tinnitus can lead to misdiagnosis of mental illnesses and greatly impede coping and functioning. While writing these reviews I was thinking back and had come to realize it took me 7 or 8 years to desenitize to the constant drone of static and auditory garbage. The constant roar, ringing, and pulses triggered my PTSD and I did not realize it until I read these articles. My oh, my how we can forget some of the biggest things to happen in our lives, that is, we who have the blessing of traumatic experinces.
Review of Blast-Related Ear Injury in Current United States Military Operations: Role of Audiologists on the Interdisciplinary Team
The article opens up with the author, Col. Chandler breaking down the statistics of blast-related inquiries and how they affect the soldier and the history of combat wounded, survivability and the latest advances in armor protective gear and medical advances. The survival rate of the wounded has risen to 88%, up from 78% from the first Gulf War. About 68% of the wounded have a blast-related injury, since the leading weapon in the enemies arsenal is the improvised explosive device (IED). With the new technology and the latest in medical advances, more soldiers survive their wounds.
The article opens well, but then starts to cite data from two research articles that seem to conflict with his presentation of the facts as it relates to blast injuries in the ear. The one articles talks about speech language pathologist receiving referrals and the breakdown of statistics related to such. Then he moves on to the other article that relates the findings of audiologist’s research concerning statistics on actual hearing loss, types and percentages. The article only gives the percentages and does not compare or contrast the meaning of the research or make any connections to the same. I would assume that the intended reader would be audiologist and related professionals, as they would able to ascertain the meaning of the data.
The author is a colonel in the Army and states his language succinct and unapologetically sterile, typical of a career military person. To his credit, in the middle of the article he touches on the difficulties and possibilities of misdiagnosing hearing loss as an affect related to a traumatic brain injury (TBI) or psychological problems. Then he goes on to explain how the military interdisciplinary team works together to prevent such misattributions and diagnoses. While he does nothing to add to the racial and cultural sensitivities, his writing stems from the perspective of an officer and expounds in a manner of expertise.
Surprisingly the article has significant relevance to profession of social work in that the articles viewpoint has a holistic approach to meeting the needs of the wounded soldiers. The article may endeavor the social worker working in hospitals in not assuming a symptom fits a certain bias and to consider other possible considerations.
One final critique, the article falls flat at the end where the military has in the last decade has cut funding to hearing conservation, even after the research had proven that the program worked. As a result we have seen a marked increase in soldiers and veterans with hearing problems that tend to plague them in later years as most hearing problems increase over the years. Col. Chandler presents the initial information in an upbeat manor and then gives a dreary outlook as the increase of blast-related ear injuries will continually add to the already overburdened Veterans Administration.
Chandler, D. (2006). Blast-related ear injury in current U. S. military operations: Role of audiology on the interdisciplinary team. The ASHA Leader, 11(9), 8-29, 3pp.
The article opens well, but then starts to cite data from two research articles that seem to conflict with his presentation of the facts as it relates to blast injuries in the ear. The one articles talks about speech language pathologist receiving referrals and the breakdown of statistics related to such. Then he moves on to the other article that relates the findings of audiologist’s research concerning statistics on actual hearing loss, types and percentages. The article only gives the percentages and does not compare or contrast the meaning of the research or make any connections to the same. I would assume that the intended reader would be audiologist and related professionals, as they would able to ascertain the meaning of the data.
The author is a colonel in the Army and states his language succinct and unapologetically sterile, typical of a career military person. To his credit, in the middle of the article he touches on the difficulties and possibilities of misdiagnosing hearing loss as an affect related to a traumatic brain injury (TBI) or psychological problems. Then he goes on to explain how the military interdisciplinary team works together to prevent such misattributions and diagnoses. While he does nothing to add to the racial and cultural sensitivities, his writing stems from the perspective of an officer and expounds in a manner of expertise.
Surprisingly the article has significant relevance to profession of social work in that the articles viewpoint has a holistic approach to meeting the needs of the wounded soldiers. The article may endeavor the social worker working in hospitals in not assuming a symptom fits a certain bias and to consider other possible considerations.
One final critique, the article falls flat at the end where the military has in the last decade has cut funding to hearing conservation, even after the research had proven that the program worked. As a result we have seen a marked increase in soldiers and veterans with hearing problems that tend to plague them in later years as most hearing problems increase over the years. Col. Chandler presents the initial information in an upbeat manor and then gives a dreary outlook as the increase of blast-related ear injuries will continually add to the already overburdened Veterans Administration.
Chandler, D. (2006). Blast-related ear injury in current U. S. military operations: Role of audiology on the interdisciplinary team. The ASHA Leader, 11(9), 8-29, 3pp.
July 23, 2009
Where Seconds Become Days and Hours Become Eternity
I received this comment today on a post about Eye Movement Desensitization and Reprocessing (EMDR) treatment from an anonymous reader. As always I welcome all questions, negative or otherwise. It seems that the commenter has some grieving to do and to identifying some resentments toward the Veterans Administration (VA).
I don't mean to insult you, but my father served in heavy combat in Vietnam for 8 months, and he suffered from severe PTSD all of his life until he died of a stroke. If I posted his experiences, everyone would puke. I read a post about something you said that you missed feeling alive in combat. This is not and never was a part of his illness or what caused it in the least. I just don't think that eye treatment would have helped him. It's not something the VA offers, as he was actively being treated by the VA just 3 years ago before his death.My comment,
I am not insulted at all. Not every combat veteran experiences the same phenomenon while serving in a battle zone. Additionally, the veterans reactions to unimaginable situations could be polar opposites.
I do not expect everyone who reads my material to have a complete understanding of my combat experiences and reactions. Further, some people do find my writings difficult to read and troublesome. I have included a warning disclaimer at the top of my blog for this reason.
When I wrote the article about missing the feeling of aliveness. I was describing a psychological and phyisological change within myself. This altered consciousness shifts the brains entire focus on the immediate arena of experience. All the rambling thoughts that we incur in normal life cease to exist and all of the minds faculties automatically focus on interpreting sensory input. All of the senses sharpen exponentially and time suspends its rush toward the future, where seconds become days and hours become eternity.
I do not expect you to understand this unless you have encountered a life threatening episode. Please, go back and reread the post and try to get past the line you described. The entire article should be absorbed to appreciate my reaction to an unimaginable situation. I did not think that the killing was beautiful; I was in awe of the massive tank battles, the Apache Helicopters rain of hellfire missiles, the Bradley Fighting Vehicles missiles and cannon, and the A10 Warthog airplanes strafing of the enemy.
One has to distance themselves from that kind of carnage to do what needs to be done to survive and win the battle. Some use anger to create an "othering effect" where they assign a monstrous value to the enemy in order to justify killing them. In my case my experience converged on omnipresence.
The VA does have EMDR therapy at many hospitals. I believe that this therapy is new to the VA, so your father may not have had access to it. I have read some on EMDR and the research has proved many successes using this treatment. I am in the PTSD program at the VA in Louisville, Kentucky and have been considering going through EMDR treatment. I want to stress that not all therapies will help everyone. Thoughtful consideration on choosing a therapist will maximize the benefits on deciding what treatment(s) will the individual profit from. It has taken me three years of extensive treatment to obtain the level of independence that I command today.
God bless you and your father, may you find peace.
July 22, 2009
Catch Me Live on KFJC 89.7
Check this out, I have been invited to do a a Radio Show at KFJC 89.7 FM in Los Altos Hills California. I believe it will a live on the air interview at 7-7:30pm California time and 10-10:30pm Kentucky time. I will be discussing the difficulties our soldiers face while reintegration back into society.
July 11, 2009
Unconscious Scripts & Self Defeating Behaviors
This posting expounds more on my last article from July 10, 2009. There might be more on this subject coming soon.
We all have unconscious scripts that we operate from originating in our childhood; from friends, family, community, culture and nation. When we fail to identify these scripts, standard operating procedures or behavior patterns, the consequences from such can become overwhelming. Baffling choices can leave us questioning our decision making skills and can have deleterious effects on our lives leaving us with a lifetime of regret and sorrow.
When we fail to look at why we make our decisions and how we made them, then we can become caught in a cycle of self defeating behaviors. Sometimes we may begin to accept our "bad luck" or "fate" and resign ourselves to a life of broken dreams. If we believe in our perceived life restrictions then we fail to live to our potential.
We all have unconscious scripts that we operate from originating in our childhood; from friends, family, community, culture and nation. When we fail to identify these scripts, standard operating procedures or behavior patterns, the consequences from such can become overwhelming. Baffling choices can leave us questioning our decision making skills and can have deleterious effects on our lives leaving us with a lifetime of regret and sorrow.
When we fail to look at why we make our decisions and how we made them, then we can become caught in a cycle of self defeating behaviors. Sometimes we may begin to accept our "bad luck" or "fate" and resign ourselves to a life of broken dreams. If we believe in our perceived life restrictions then we fail to live to our potential.
July 10, 2009
Negative Self Beliefs
A friend of mine and I were discussing why she was depressed and how she may address it. The conversation finally boiled down to some key elements in her negative self appraisals. She believes that her depression is due to her laziness. In our conversation I suggested that this was due to her response to her mothers overbearing nature.
This conjecture can apply in many ways and to many situations. As combat veterans we have developed a set of combat values that we attempt to apply to our civilian life and find they do not fit into our past lives. We can try and push this square cog in a round hole and find ourselves loosing our minds becuase we have not identified the inner changes we have made to survive a unimaginable situation. Everyone is shaped by their parents, community and culture for better or worse. Nurture and nature both have significant effects on our developing minds.
I am not suggesting that your are blaming your mother for the way you are. I am suggesting that some of your mothers negative appraisals of you have become your standard operating procedures and effect your life today. What I am suggesting is the opposite of blaming your mother. I am saying that you are the one who makes the choice to believe you are lazy based on your acceptance of your negative self appraisals. You are responsible.
One thing that may determine whether your mom is a factor in your negative self appraisal. When you put yourself down, the negative self talk, are the words you use in your head similar to your mothers when she was putting you down? In your lowest moments of depression when the obsessing over what you have not done resounds, does the voice in your head sound like your mother or repeat in similar phrases?
This is probably something you have not thought about. At first you may think no way, but the only way to tell is to listen for this voice and note what it says. Negative self beliefs run through our minds and reinforce our negative self appraisals. You have come to believe that you are lazy so that's what you tell yourself and this in turn reinforces that you are lazy.
I would suggest a way to change your negative self beliefs. When you catch your negative self appraisals degrading yourself, in that moment, say the opposite of the negative self belief. If you are saying that you are lazy, say NO, I am not lazy I am (pick one or find one that suits you) "hard-working, diligent, active, busy, steady, productive, energetic, conscientious, tireless, zealous, laborious, assiduous, or sedulous" (from freedictionary.com).
Pick a word that you like and use it to countermand your negative stereotyping of yourself. Use this new operating procedure to change all of your negative self appraisals and reinvent yourself. This will take some time, months, eventually you will become to believe in yourself the way you wish to be and you will act accordingly.
Ever heard the term "fake it till you make it"? It sounds, um well...fake. But the only fake in this whole endeavor is the belief that you are not worthy of true happiness and joy. Tricking yourself to believe that you are less than is the real faking.
This conjecture can apply in many ways and to many situations. As combat veterans we have developed a set of combat values that we attempt to apply to our civilian life and find they do not fit into our past lives. We can try and push this square cog in a round hole and find ourselves loosing our minds becuase we have not identified the inner changes we have made to survive a unimaginable situation. Everyone is shaped by their parents, community and culture for better or worse. Nurture and nature both have significant effects on our developing minds.
I am not suggesting that your are blaming your mother for the way you are. I am suggesting that some of your mothers negative appraisals of you have become your standard operating procedures and effect your life today. What I am suggesting is the opposite of blaming your mother. I am saying that you are the one who makes the choice to believe you are lazy based on your acceptance of your negative self appraisals. You are responsible.
One thing that may determine whether your mom is a factor in your negative self appraisal. When you put yourself down, the negative self talk, are the words you use in your head similar to your mothers when she was putting you down? In your lowest moments of depression when the obsessing over what you have not done resounds, does the voice in your head sound like your mother or repeat in similar phrases?
This is probably something you have not thought about. At first you may think no way, but the only way to tell is to listen for this voice and note what it says. Negative self beliefs run through our minds and reinforce our negative self appraisals. You have come to believe that you are lazy so that's what you tell yourself and this in turn reinforces that you are lazy.
I would suggest a way to change your negative self beliefs. When you catch your negative self appraisals degrading yourself, in that moment, say the opposite of the negative self belief. If you are saying that you are lazy, say NO, I am not lazy I am (pick one or find one that suits you) "hard-working, diligent, active, busy, steady, productive, energetic, conscientious, tireless, zealous, laborious, assiduous, or sedulous" (from freedictionary.com).
Pick a word that you like and use it to countermand your negative stereotyping of yourself. Use this new operating procedure to change all of your negative self appraisals and reinvent yourself. This will take some time, months, eventually you will become to believe in yourself the way you wish to be and you will act accordingly.
Ever heard the term "fake it till you make it"? It sounds, um well...fake. But the only fake in this whole endeavor is the belief that you are not worthy of true happiness and joy. Tricking yourself to believe that you are less than is the real faking.
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