Therapy: What is Music Therapy?

Therapy: What is Music Therapy?

By: Keely Fell

Music therapy is a relatively new form of therapy being used across the nation. According to the American Music Therapy Association, music therapy is described as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program”. (AMTA) To be considered a qualified music therapist, an individual must attend a school that is currently accredited by the American Music Therapy Association (AMTA). Upon completion of a degree, an individual will then take the National Examination Certification Board for Music Therapists, which will then give them the title of Music Therapist – Board Certified (MT-BC). While there are other certifications that an individual can acquire, most states will only recognize individuals with the MT-BC certification.

Music therapy can be used for a wide array of interventions, some of those being: stress management, pain relief, promoting the expression of feelings, physical rehabilitation, memory enhancement, and enhancing cognitive functioning due to early delays. The integration of music therapy into schools, rehabilitation centers, assisted living centers, hospitals, and hospice care is growing rapidly throughout the nation.

The integration of music therapy in hospitals has been growing rapidly as well. Using music to sooth patients before medical procedures, as well as using singing, instrument playing, lyric discussion, and forms of song writing to “allow the patients to reconnect with the healthy parts of themselves”. What was recorded is that with the use of music therapy, patients were able to achieve acute pain relief which then allowed them to rest.

Studies have shown that the brain reacts to music in a very different way than it reacts to anything else. When music enters the brain the first mechanisms that are triggered are the release of dopamine in the pleasure centers. Moving past just making an individual feel good, research has shown that music is associated with an increase in immunity-boosting antibodies, which means that music is also improving an individual’s immune system. Doctors have recently studied the use of vibroacoustic therapy in the treatment of Parkinson’s disease, by using “low-frequency sound” to produce “vibrations that are applied directly through the body. The rhythmic pulses allow for stabilization of the disorientation.

If you or someone you know is experiencing these symptoms, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

 

Sources:

https://www.ashford.edu/online-degrees/student-lifestyle/how-does-music-affect-your-brain

https://www.apa.org/monitor/2013/11/music

https://www.musictherapy.org/

https://www.billboard.com/articles/news/6873880/music-brain-effect-scientists-mit-study

PTSD in Refugee and Unaccompanied Children:

By: Luz Melendez

Post-traumatic stress disorder (PTSD) is a disorder that can occur to someone after being exposed to one or more traumatic events. These traumatic events can vary from a natural disaster, war/combat, serious injury, sexual violence, and/or exposure to death threats. After experiencing a trauma there can be an emotional reaction to these events which can include fear, helplessness, and even horror. There may also be distressing memories of the traumatic event which can be recurrent and involuntary. In order to be diagnosed with PTSD, symptoms have to last for more than a month and be persistent. (American Psychiatric Association, 2013).

One population that is less talked about when it comes to PTSD is children, but more specifically refugee or asylum seeking children. The current population of children with PTSD in the U.S. is about 5% and among refugee children in the U.S. it’s about 54%. These children are experiencing hunger, extreme poverty, bombings, abductions, sexual assault, and even witnessing deaths. These stressors can often co-occur making everyday life very difficult for them. The effects of these events are causing developmental regression, clinginess, repetitive play of the trauma/s, anxiety, depression, ACES, and mood changes. One effect that is very important is how the brain is being affected by these traumas. PTSD is developed in two key regions of the brain, the amygdala and the prefrontal cortex. The amygdala reacts too strongly while the prefrontal cortex impedes the ability to regulate a threat response. It’s the perfect storm that leads to hyperarousal, hyper vigilance, and sleep deprivation which are big issues when it comes to children. Children’s brains are growing and developing and these traumas are stunting the global developmental growth of these children’s brains.

Often PTSD in refugee or asylum seeking children, if left untreated/undiagnosed, can and will lead to life long-lasting effects. In the situation these children are in, it’s difficult to not only diagnose them but to properly treat them. Many if not all have witnessed one or more of the stressors mentioned above and these children are out in the world not only having their lives completely change but having their mental health deteriorate. Thankfully some host countries who take in refugees, screen them and try to help them adjust to their now new lives and overcome barriers that come with accessing physical and mental health care. This also includes overcoming the stigma that refugees have of seeking mental health care. Like mentioned before only some host countries do this, others are still fixing their processing of refugees.

 

If you or someone you know is struggling with PTSD, Arista Counseling and Psychotherapy can help. Please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

 

Reference:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Arlington, VA: American Psychiatric Association.

Depression: Have a Case of the Winter Blues? Understanding Seasonal Affective Disorder

 

By: Keely Fell

Can’t seem to shake the winter blues? Nearly five percent of adults are experiencing symptoms that align with major depressive disorder with recurring seasonal pattern, which is more commonly known as Seasonal Affective Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), an individual who is experiencing “two major depressive episodes in the last two years” that show relations to the time of year, and experience full remissions at other times they may be experiencing Seasonal Affective Disorder (SAD).

It is also important to understand what is happening in the body and why an individual is experiencing such symptoms. When an individual is experiencing these symptoms, often it can be as a result of the lack of natural light due to the shorter periods of daylight during the winter season. With the lack of light, the human brain slows down the production of serotonin, and increases the production of melatonin which leaves individuals feeling drowsy. Melatonin production increase is caused by darkness, which is why we get sleepy when the sun goes down. The regulation of these chemicals is what helps create your body’s specific circadian rhythm. When this system is affected it can cause a feeling of lethargy and or restlessness.

Here are some tips and tricks to shaking those winter blues:

  1. Take a few minutes during your day to get outside Whether that’s during your lunch break or walking to pick up the mail, going outside during daylight will increase the serotonin production in your brain.
  2. Light Therapy During the dark winter months, if these symptoms are taking over you can try light therapy. Light therapy allows for the brain to think it’s being exposed to sunlight. People who use light therapy typically invest in a light box (if interested Harvard Health has many they recommend) which delivers around 10,000 lux, compared to a standard sunny day that ranges 50,000 lux or above. They recommend that, you sit in front of the light box for no more than 30 minutes a day. This allows for the brain to regulate its circadian rhythms by allowing the retinas to be stimulated. Light therapy does not work for everyone.
  3. Talk Therapy If these symptoms persist and are affecting your day talk therapy is also affective. Reaching out to a psychologist, psychiatrist, psychiatric nurse practitioner, or psychotherapist to come up with symptom relief is another big way to combat these symptoms. Symptom relief may include the use of antidepressants, or various therapeutic methods.

 

If you or someone you know has Seasonal Affective Disorder or seems to have the symptoms of SAD, and needs help, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources:

https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml

https://www.health.harvard.edu/blog/seasonal-affective-disorder-bring-on-the-light-201212215663

https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder

 

CBT & DBT

Image result for cbt and dbt therapy

CBT & DBT

By: Vanessa Munera

When it comes to psychotherapy, there are different types. Psychotherapy is also known as “talk therapy”. According to the American Psychiatric Association, “Psychotherapy is a way to help people with a broad variety of mental illnesses and emotional difficulties”. This is when an individual speaks with a therapist or psychologist in a safe and confidential environment. During these talk sessions, you are able to explore and understand your feelings and behaviors, and develop coping skills. In fact, research studies have found that individual psychotherapy can be effective at improving symptoms in a wide array of mental illnesses, making it both popular and versatile treatment. There are different types of psychotherapy that can assist people. The most common types of psychotherapy are Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT).

Cognitive Behavioral Therapy or CBT, is a form of therapy that consists of focusing on exploring relationships among a person’s thoughts, feelings and behaviors. This type of therapy helps patients gain control over and accept unwanted thoughts and feelings so that they can better manage harmful or unwanted behaviors. CBT is usually used to treat conditions related to anxiety, depression, substance abuse, eating disorders, and social skills. As a matter of fact, Cognitive Behavioral Therapy has been shown to be an effective treatment for these conditions, as well as improving brain functioning. CBT can benefit people at any age, such as a child, adolescent, and adult.

Dialectical Behavioral Therapy, or DBT, is a type of therapy that was originally designed to help individuals with borderline personality disorder (BPD). Over time, this type of therapy has been adapted to help treat people with multiple different mental illnesses, but it is mostly used to treat patients who have BPD as a primary diagnosis. Although DBT is a form of CBT, it has one big exception: it emphasizes validation and accepting uncomfortable thoughts, feelings and behaviors instead of struggling with them. DBT allows patients to come in terms with their troubling thoughts, emotions, or behaviors that they have been struggling with. Studies of Dialectical Behavior Therapy have shown effective long-term improvements for those suffering from mental illness. DBT also helps lower the frequency and severity of dangerous behaviors, utilizes positive reinforcement to promote change, and helps individuals translate what they learned in therapy to everyday life.

 

References:

https://www.nami.org/learn-more/treatment/psychotherapy

https://manhattanpsychologygroup.com/difference-dbt-cbt-therapies/

https://www.psychiatry.org/patients-families/psychotherapy

Anxiety and Bullying

Image result for anxiety and bullying

 

Anxiety and Bullying

By: Vanessa Munera

Being bullied is not an easy thing to handle. It can be a traumatic experience for teens that are being targeted. Those who are bullied experience impacts in their lives such as feeling lonely, anxious, isolated, and vulnerable. Unfortunately, when a bully moves on to the next target, these consequences of bullying linger longer for the victim. After prolonged exposure, victims of bullying can develop adverse effects. These victims will experience depression, eating disorders, and thoughts of suicide. In addition, victims of bullying can develop some sort of anxiety disorder. The top four major anxiety disorders victims of bullying can experience are Post-Traumatic Stress Disorder (PTSD), generalized anxiety disorder (GAD), panic attacks and social anxiety disorder.

  1. Post-Traumatic Stress Disorder (PTSD): this occurs after a traumatic or life-threatening event. PTSD can develop due to events such as a car accidents or losing a close relative. This disorder can also show up after repeated abuse or even bullying. Children who are bullied may experience nightmares, flashbacks, withdraw from others, or are easily startled. Kids, who undergo long term and abusive bullying, have increased chances of developing PTSD.

2. Generalized Anxiety Disorder (GAD): Kids with GAD are often tormented with worries and fear that distract them for their daily life activities. Those with generalized anxiety have a constant feeling that something bad is going to happen. This is not uncommon with victims of bullying. With GAD, physical symptoms may appear such as insomnia, stomachaches, fatigue, and restlessness.

3. Panic Attacks: Those who suffer from panic disorders must deal with unpredictable and repeated attacks. When suffering from a panic attack, the attack is usually with no warning and can cause physically symptoms. These symptoms include sweating, chest pain, and rapid or irregular heartbeats. In fact, a part of the brain called the amygdala plays a pivotal role in panic attacks. When left untreated, the sufferer will begin to avoid going out or things they once enjoyed, in order to prevent another panic attack.

4. Social Anxiety Disorder: People who suffer from social anxiety fear being humiliated or seen negatively by others. Those with this disorder often worry that the way they look or act cause others to mock them. This can cause sufferers to avoid social gatherings to avoid being humiliated. In fact victims of bullying often develop social anxiety due to the repeated shame and public humiliation they experienced.

If you or a loved one appears to be suffering from an Anxiety Disorder, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

 

References:

https://www.verywellfamily.com/bullying-and-anxiety-connection-460631

https://www.stopbullying.gov/blog

 

 

Grieving Vs Persistent Complex Bereavement Disorder

loneliness

Grieving Vs Persistent Complex Bereavement Disorder

By: Karime Herrera

Coping with grief can be difficult. You are in complete disbelief that your loved one, family or friend is no longer a phone call away. When grief begins to drastically disrupt your life, it is best to seek professional help.However, some people might not know when it is necessary to seek help. At what point does grief turn into persistent complex bereavement disorder? Persistent complex bereavement disorder is when an individual has been experiencing severe grief symptoms for over twelve months. Some symptoms that a person with PCBD encounters are trusting people, hallucinations of the person who has passed away, suicidal thoughts, loss of interest in preforming daily tasks, and constant feelings of sadness. If you are experiencing these symptoms for an extreme period of time it is best to see a psychologist in order to help you cope with your loss. A licensed practitioner can treat PCBD with cognitive therapy, mindfulness, psychotherapy or a combination.  Mediation might be helpful in relieving the symptoms and often helps individuals suffering from PCBD continue with their daily lives.

Healthy Communication Skills

By: Toni Wright

Oftentimes when we’re communicating it’s just to respond and we’re not actually actively listening. Communication needs to not only be about active listening, but about listening to understand and comprehend. There are numerous ways to improve one’s communication skills with others, whether it is familial, platonic, or romantic.

1) Speak face to face – Texting is not beneficial when it comes to trying to communicate effectively. Pick a time where both parties are able to meet face to face. This way both parties are directly focused on one another and things are less likely to get misconstrued as they might through text.

2) Use “I” statements – When issues occur using “I” statements help the person feel less attacked. An alternative to saying, “YOU made me angry when…” is “I was feeling angry when THIS happened.”

3) Don’t interrupt or try to redirect the conversation to your worries – For instance, “If you think your day was bad, let me tell you about mine.” Actively listening and waiting to speak is not the same thing. One cannot actively listen and also think about what they’re going to say next when the other person is done speaking. The speaker will be able to tell that you are not giving them your full attention.

4) Look for compromise – Instead of focusing on who’s right or wrong or “winning” an argument try to settle in a place where both parties are happy. Whether it’s through compromise or finding an entirely new solution, it is important that both parties feel that they are getting what they want.

5) If you need help reach out for it – Sometimes communicating isn’t easy and during conflict it may be even more difficult to try and stay respectful or if the conflict doesn’t seem to be improving with solely just the two parties involved, it may be beneficial to see a therapist. Therapy can help one find new strategies to use when communicating that can be used to avoid future conflict.

If you or someone you know has trouble communicating and/or resolving conflict, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/.

Sources:

https://www.marriage.com/advice/relationship/effective-relationship-communication-skills/bb

https://www.helpguide.org/articles/relationships-communication/effective-communication.html

https://www.verywellmind.com/managing-conflict-in-relationships-communication-tips-3144967

Image Source: https://www.marriage.com/advice/communication/communication-with-partner/

 

Borderline Personality Disorder

Borderline Personality Disorder

Borderline Personality Disorder

By: Julia Keys

Personality disorders are often tricky to spot and hard to treat. This is because the symptoms of many personality disorders lie at the core of one’s identity. It is easy to dismiss someone’s behavior as their personality or “just the way they are”. It is important for these individuals to seek help when the symptoms cause them distress, dysfunction or danger.

Borderline Personality Disorder, also known as BPD, is characterized by a general instability in: moods, relationships with others, sense of self and behavior. About 2% of adults are affected by BPD and 75% of those affected are women. BPD can be dangerous because it can cause suicidal behavior and impulsive choices.

Symptoms of BPD:

  • Efforts to avoid real or imagined abandonment
  • A pattern of unstable and intense interpersonal relationships
  • Persistent and unstable sense of self
  • Impulsive behaviors such as: excessive spending, unprotected sex, reckless driving, and substance abuse
  • Self-harming behavior
  • Rapidly changing mood swings
  • Feeling like they are “losing touch with reality”
  • Difficulty regulating emotional reactions

Perhaps the most pervasive and debilitating symptom of BPD is the unstable pattern of relationships. People with BPD can quickly attach themselves to others and idealize them, but when a conflict occurs they may feel intense anger and dislike towards them. BPD tends to produce all or nothing thinking, which can explain the tendency to see people as either fantastic or terrible. Moods, relationships, people and ideas are oftentimes perceived as either all good or all bad. The highly volatile state of a person with BPD can be very confusing and distressing for the person experiencing it.

Fortunately, there has been a considerable amount of research on BPD and how to treat it in the past two decades. Dialectical behavioral therapy, or DBT, is a type of psychotherapy developed specifically for those struggling with BPD. DBT teaches mindfulness, self-soothing, emotional regulation, and relationship regulation techniques to help those with BPD. Medications such as antidepressants, mood stabilizers, and antipsychotics are also used to aid in treatment.

If you or a loved one is suffering from Borderline Personality Disorder, please contact Arista Counseling & Psychotherapy, located in New York and New Jersey to speak to licensed professional psychologists, psychiatrists, psychiatric nurse practitioners or psychotherapists. To contact the office in Paramus NJ, call (201) 368-3700. To contact the office in Manhattan, call (212) 722-1920. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources:

https://www.psychologytoday.com/us/blog/resolution-not-conflict/201210/when-your-mother-has-borderline-personality

https://www.psychologytoday.com/us/blog/hope-eating-disorder-recovery/201609/what-is-dbt

Source for Picture:

https://www.google.com/search?q=borderline+personality+disorder&rlz=1C1OPRB_enUS649US649&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjKk47I8qDiAhVpzlkKHShgDhUQ_AUIESgE&biw=1600&bih=708#imgdii=n6EV53iQ9vAFJM:&imgrc=bEKwFmmmcc_FPM:

 

Self-Harm

Self-Harm

Self-Harm

By: Julia Keys

        Self-harm is the act of intentionally injuring oneself without intending suicide. Self-harming behaviors may include, but are not limited to: cutting, scratching, burning, banging/bruising or interference with an injury so that it cannot heal. Self-harm has become a huge concern within the adolescent demographic. Research shows that girls are more likely than boys to self-harm. A recent study shows that up to 17% of teenagers self-harm. To many others who do not self-harm, the act of intentionally hurting oneself may be perplexing, however there are many reasons why people self-harm.

The root of self-harming behavior stems from a lack of healthy coping mechanisms. Oftentimes people turn to self-harm when they have overwhelming feelings of anger, anxiety, depression, or guilt that they do not know how to express. Some self-harm as an act of release, similar to crying or screaming. Once they self-harm, the body releases endorphins which are the body’s natural painkillers, giving the individual feelings of relaxation or happiness. Sometimes people self-harm because they “feel numb”, and harming themselves makes them feel alive.

Here are some signs someone you love may be self-harming:

  • Unexplained cuts, bruises or marks
  • Patterns of parallel cuts or scars
  • Sudden change in mood
  • Wearing clothing inappropriate to the weather in an attempt to cover certain parts of the body
  • Secretive behavior
  • Self-isolating behavior

While self-harm is usually not an attempt at suicide, it is a very serious sign of emotional distress. If you are struggling with self-harm or know someone struggling with self-harm, here are some resources you may find helpful.

Self-Harm Hotline: 1-800-DON’T-CUT (1-800-366-8288)

Self-Harm Text Hotline: Text CONNECT to 741741 in the United States.

If you or a loved one is struggling with self-harm, do not hesitate to seek help by contacting Arista Counseling & Psychotherapy, located in New York and New Jersey to speak to licensed professional psychologists, psychiatrists, psychiatric nurse practitioners or psychotherapists. To contact the office in Paramus NJ, call (201) 368-3700. To contact the office in Manhattan, call (212) 722-1920. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources:

https://www.psychologytoday.com/us/blog/evidence-based-living/201805/why-do-youth-self-injure

https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Self-harm

https://www.webmd.com/mental-health/features/cutting-self-harm-signs-treatment#3

Source for Picture:

https://www.bing.com/images/search?view=detailV2&id=70C2902B0BC552C00A01D3254CDAA5F74916A647&thid=OIP.kRmbbAZz8C3wXx0wFCH7bAHaHb&exph=602&expw=600&q=semi+colon+tattoo&selectedindex=25&ajaxhist=0&vt=0&eim=1,2,6

 

Gambling

Gambling

By Lauren Hernandez

              Gambling can be a fun occasional activity to do with friends or family. However, some individuals can develop a serious addiction known as Gambling Disorder. Through frequent compulsive, habitual impulses, a person who is unable to resist gambling can have extreme negative consequences throughout their life which may affect relationships, finances, and even be a stepping stone towards engaging in criminal behavior. Typically a person addicted to gambling will develop this pattern of behavior during adolescence or young adulthood.  Gambling Disorder may begin with occasional gambling and develop into habitual, problematic gambling episodes. An increase in gambling is associated with stress, depression, and substance use or abstinence. Patterns of problematic gambling may also include periods of long term remission.

According to the DSM-5 the symptoms of Gambling Disorder include:

  • Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the fol­lowing in a 12-month period:
  • Needs to gamble with increasing amounts of money to achieve the desired excitement.
  • Is restless or irritable when attempting to cut down or stop gambling.
  • Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
  • Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
  • Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
  • After losing money gambling, often returns another day to get even (“chasing” one’s losses).
  • Lies to conceal the extent of involvement with gambling.
  • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
  • Relies on others to provide money to relieve desperate financial situations caused by gambling.
  • The gambling behavior is not better explained by a manic episode.

The treatment for Gambling Disorder is an eclectic approach. It is important to seek treatment early, before the individual poses any extreme risks to themselves or friends and family. Prevention may not always be possible; however limiting exposure to casinos, scratch off tickets, or other triggers is helpful. Compulsive gambling is best treated through psychotherapy in the form of therapy or support groups. In addition to psychotherapy, medications such as antidepressants or mood stabilizers are extremely helpful. If you or someone you know is struggling with Gambling Disorder or has problematic gambling habits, it is important to reach out to a mental health practitioner such as a psychologist or psychiatric nurse practitioner.

If you or someone you know who may have Gambling Disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

 

 

 

 

 

 

 

Source: https://www.psychologytoday.com/us/conditions/gambling-disorder-compulsive-gambling-pathological-gambling

Image Source: https://www.google.com/search?q=gambling&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjb9amb7PDiAhUC0FkKHejVDsEQ_AUIESgC&biw=990&bih=595#imgrc=traFs2aEWBYMlM: