December 6, 2010

Have Yourself a More Relaxed Holiday Season

For one reason or another I check in on my blog this evening.  I see that I haven't posted in over a month.  A month!  My goal is to post every two weeks at the very minimum.

Yes, Virginia, even behavioral psychologists fall short of their goals.  More often than some of us would like to admit, surely.  

A goal I've set for myself over the past few years has to do with the busy holiday season. From the time the Halloween costume box comes down from the attic it feels as though the speed of life is cresting over the highest peak of a roller coaster ride.  Gaining rapid momentum with no chance to get out of the cart or make it stop until January 1st.  But then it's time to put away the decorations and think about one of the least favorite times of year:  tax season.

My goal?  To do less.  To shop less.  To let go to some holiday traditions so that I can better enjoy others.  Stress less.  Relax more.

People resoundingly complain about the all-consuming demands of the holiday season.  Recently a friend of mine proclaimed it has gotten to the point where she "hates" Christmas.  An honest and brave friend.  After all, it's downright un-American to make such a statement.  Un-human, even.  

Bah humbug. 

The reality is we all have choices when it comes to holiday traditions.  Whether it be adorning our homes with lights and decorations, sending seventy-five Christmas cards and photos in the mail, baking sugar cookies from scratch, entertaining guests with a punchbowl full of homemade eggnog, singing carols, setting up the train set, hosting large family gatherings around a lavish home cooked meal, hustling over to the in-laws for a second lavish home cooked meal, attending midnight church service, or driving all over town to find just the right gift for loved ones even if it means spending ourselves into debt, we all retain the right to put a stop to the annual practice of wearing ourselves to a frazzle.  

So let's try a little CBT, shall we?

A typical rationalization and automatic negative thought might sound something like this:  

"But it wouldn't be Christmas/Hannuka if I didn't ______ (fill in the blank)." 

A healthy cognitive replacement involves challenging our long held beliefs and rationalizations.  The holidays are not just about our hand made hot tamales (a Mexican-American tradition), are not just about the gifts we give, are not just about the decorations and the lights. These are mere details that add tinsel and sparkle to the true meaning of the season. 

No, the holidays are really about ... what exactly?  

This is where you get to step in and express your own individual sentiments.  What do the holidays mean to you specifically?  Which traditions can you give yourself permission to let go of so that you are free to enjoy the true meaning of the season as it applies to you?   So that you can spend quality time with your family or friends or community and not be too busy to slow down and really appreciate what you've got in life. Or where you want to be.

In cognitive behavioral therapy a replacement thought might sound something like this:  

"I choose to let go of _____, _____, and _____ so that I can be more relaxed."

"I can get more out of the holidays this year by deciding to ______ rather than ______."  

"I want to more fully embrace the meaningful elements of my holiday.  This year I plan to _____ and not _____ so that I am free to devote more time to ______ instead."

Notice I wrote "this year" as opposed to forever because it's best to take it one year at a time.  Next year, who knows?  You can always revise or alternate traditions.  

So there you go, readers.  The framework of change is there.  You get to fill in the blanks.  Give it a try.

Another goal of mine this holiday season?  To give myself permission to post less often.  Maybe not until next year!

Now go and have yourself a more relaxed, more meaningful holiday season.  

November 1, 2010

Understanding Chronic Pain

The causes of chronic pain come in many shapes and sizes.  Sometimes chronic pain stems from recurring migraine headaches.  Sometimes it's lower back pain caused by a range of problems with the spine.  Chronic pain can result from a serious injury that fails to heal completely or following surgery.  Other conditions associated with chronic pain include arthritis, TMJ (temporo-mandibular joint), fibromyalgia, endometriosis, pudendal neuralgia, and repetitive strain injuries.  

Regardless of the cause, people who suffer from chronic pain often feel misunderstood by their friends and family.  Typically during the initial phases of an illness pain sufferers receive sympathy and understanding .  After a long period of prolonged pain, however, it is common for loved ones to appear uncaring and "tired of" the patient's persistent complaints of pain, particularly in the midst of decreased functioning.  Unable to help with household chores, attend social functions, or participate in recreation activities formerly shared with others, chronic pain patients begin to feel like a burden.  It is not unusual to feel blamed for the persistence of their condition.  Losing the support of loved ones is one of the most emotionally distressing aspects of chronic pain.  

Given the importance of feeling understood, I am sharing the following letter written to help enlighten people close to the person suffering from chronic pain.  The letter was previously posted on the HOPE website (Health Organization for Pudendal Education).  


Having chronic pain means many things change, and a lot of them are invisible. Unlike having cancer or being hurt in an accident, most people do not understand even a little about chronic pain and its effects, and of those that think they know, many are actually misinformed.

In the spirit of informing those who wish to understand …

These are the things that I would like you to understand about me before you judge me…

Please understand that being sick doesn’t mean I’m not still a human being. I have to spend most of my day in considerable pain and exhaustion, and if you visit, sometimes I probably don’t seem like much fun to be with, but I’m still me– stuck inside this body. I still worry about school, my family, my friends, and most of the time – I’d still like to hear you talk about yours, too.

Please understand the difference between “happy” and “healthy”. When you’ve got the flu, you probably feel miserable with it, but I’ve been sick for years. I can’t be miserable all the time. In fact, I work hard at not being miserable. So, if you’re talking to me and I sound happy, it means I’m happy. That’s all. It doesn’t mean that I’m not in a lot of pain, or extremely tired, or that I’m getting better, or any of those things. Please don’t say, “Oh, you’re sounding better!” or “But you look so healthy!¨ I am merely coping. I am sounding happy and trying to look normal. If you want to comment on that, you’re welcome.

Please understand that being able to stand up for ten minutes doesn’t necessarily mean that I can stand up for twenty minutes, or an hour. Just because I managed to stand up for thirty minutes yesterday doesn’t mean that I can do the same today. With a lot of diseases you’re either paralyzed, or you can move. With this one, it gets more confusing everyday. It can be like a yo-yo. I never know from day to day, how I am going to feel when I wake up. In most cases, I never know from minute to minute. That is one of the hardest and most frustrating components of chronic pain.

Please repeat the above paragraph substituting, “sitting”, “walking”, “thinking”, “concentrating”, “being sociable” and so on … it applies to everything. That’s what chronic pain does to you.

Please understand that chronic pain is variable. It’s quite possible (for many, it’s common) that one day I am able to walk to the park and back, while the next day I’ll have trouble getting to the next room. Please don’t attack me when I’m ill by saying, “But you did it before!” or Oh, come on, I know you can do this!” If you want me to do something, then ask if I can. In a similar vein, I may need to cancel a previous commitment at the last minute. If this happens, please do not take it personally. If you are able, please try to always remember how very lucky you are–to be physically able to do all of the things that you can do.

Please understand that “getting out and doing things” does not make me feel better, and can often make me seriously worse. You don’t know what I go through or how I suffer in my own private time. Telling me that I need to exercise, or do some things to get my mind off of it¨ may frustrate me to tears, and is not correct if I was capable of doing some things any or all of the time, don’t you know that I would? I am working with my doctor and I am doing what I am supposed to do. Another statement that hurts is, “You just need to push yourself more, try harder…” Obviously, chronic pain can deal with the whole body, or be localized to specific areas. Sometimes participating in a single activity for a short or a long period of time can cause more damage and physical pain than you could ever imagine. Not to mention the recovery time, which can be intense. You can’t always read it on my face or in my body language. Also, chronic pain may cause secondary depression (wouldn’t you get depressed and down if you were hurting constantly for months or years?), but it is not created by depression.
Please understand that if I say I have to sit down/lie down/stay in bed/or take these pills now, that probably means that I do have to do it right now – it can’t be put off or forgotten just because I’m somewhere, or am right in the middle of doing something. Chronic pain does not forgive, nor does it wait for anyone.

If you want to suggest a cure to me, please don’t. It’s not because I don’t appreciate the thought, and it’s not because I don’t want to get well. Lord knows that isn’t true. In all likelihood, if you’ve heard of it or tried it, so have I. In some cases, I have been made sicker, not better. This can involve side effects or allergic reactions. It also includes failure, which in and of itself can make me feel even lower. If there were something that cured, or even helped people with my form of chronic pain, then we’d know about it. There is worldwide networking (both on and off the Internet) between people with chronic pain. If something worked, we would KNOW. It’s definitely not for lack of trying. If, after reading this, you still feel the need to suggest a cure, then so be it. I may take what you said and discuss it with my doctor.

If I seem touchy, it’s probably because I am. It’s not how I try to be. As a matter of fact, I try very hard to be normal. I hope you will try to understand. I have been, and am still, going through a lot. Chronic pain is hard for you to understand unless you have had it. It wreaks havoc on the body and the mind. It is exhausting and exasperating. Almost all the time, I know that I am doing my best to cope with this, and live my life to the best of my ability. I ask you to bear with me, and accept me as I am. I know that you cannot literally understand my situation unless you have been in my shoes, but as much as is possible, I am asking you to try to be understanding in general.

In many ways I depend on you – people who are not sick. I need you to visit me when I am too sick to go out…

Sometimes I need you help me with the shopping, cooking or cleaning. I may need you to take me to the doctor, or to the store. You are my link to the normalcy of life. You can help me to keep in touch with the parts of life that I miss and fully intend to undertake again, just as soon as I am able.

I know that I have asked a lot from you, and I do thank you for listening. It really does mean a lot.

Author Unknown

October 8, 2010

Getting the Sleep You Need: Tips for a Better Night's Rest

Getting a good night's sleep is an integral part of mental health. When we get too few hours of sleep or wake up feeling as though we haven't had enough rest, especially on a regular basis, our emotional and physical wellbeing can suffer dramatically.  Too many sleep deprived nights and we are at risk for depression, panic disorder, and persistent insomnia, to name a few long term problems.  Below are many changes and sleep hygiene tips often recommended to those struggling to get to sleep.


Do not nap during the day - you will throw off your body clock and make it even more difficult to sleep at night. If you are feeling especially tired, and feel as if you absolutely must nap, be sure to sleep for less than 30 minutes, early in the day.

Limit caffeine, alcohol and nicotine. Avoid drinking caffeine or alcoholic beverages for several hours before bedtime. Although alcohol may initially act as a sedative, it can interrupt normal sleep patterns. Nicotine is a stimulant and can make it difficult to fall asleep and stay asleep. Many over-the-counter and prescription drugs disrupt sleep, especially decongestants (examples: Sudafed, phenylpropanolamine).

Expose yourself to bright light/sunlight soon after awakening. This will help to regulate your body's natural biological clock. Likewise, try to keep your bedroom dark while you are sleeping so that the light will not interfere with your rest.

Exercise early in the day. Twenty to thirty minutes of exercise every day can help you sleep, but be sure to exercise in the morning or afternoon. Exercise stimulates the body and aerobic activity before bedtime may make falling asleep more difficult.

Check your iron level. Iron deficient women tend to have more problems sleeping, so if your blood is iron poor, a supplement might help your health and your ability to sleep.


Keep your bedroom peaceful and comfortable. Make sure your room is well ventilated and the temperature consistent. And try to keep it quiet. You could use a fan or a "white noise" machine to help block outside noises.

Your bed. Make sure your bed is large enough, and comfortable. If you are disturbed by a restless bedmate, switch to a queen- or king-size bed. Test different types of mattresses. Try therapeutic shaped foam pillows that cradle your neck or extra pillows that help you sleep on your side. Get comfortable cotton sheets.

Your bedroom. Make your bedroom primarily a place for sleeping. It is not a good idea to use your bed for paying bills, doing work, watching tv, etc. Help your body recognize that this is a place for rest or intimacy.

Your clock. Hide it. A big, illuminated digital clock may lead you to watch the time. You end up feeling stressed and anxious worrying about how many hours sleep you will, or will not, get. Place your clock so you can't see the time when you are in bed.


Keep a regular schedule. Try to go to bed and wake up at the same time everyday, even on the weekends. This will help your body expect sleep at the same time each day. Don’t oversleep to make up for a poor night’s sleep – doing that for even a couple of days can reset your body clock and make it hard for you to get to sleep at night.

Turn down the lighting in the evening. The closer you are to bedtime, avoid bright or blinking lights. Late night internet browsing is a big cause of insomnia. If you must use the computer at night, turn down the contrast button on your monitor. The television and video games are other sources of blinking lights that disrupt your body's ability to move toward sleep mode.

Relax for a while before going to bed. Spending quiet time can make falling asleep easier. This may include meditation, relaxation and/or breathing exercises, or taking a warm bath. Try listening to recorded relaxation or guided imagery programs.

Incorporate bedtime rituals. Establish a routine. Turn down the lights, listen to soft music, sip a cup of herbal tea (caffeine free), put on PJ's, brush teeth, wash face, etc., A routine cues your body that it's time to slow down and begin to prepare for sleep.

Don’t eat a large, heavy meal before bed. This can cause indigestion and interfere with your normal sleep cycle. Try to eat your dinner at least two hours before bedtime.

Light bedtime snacks can help. An amino acid called tryptophan, found in milk, turkey, and peanuts, helps the brain produce serotonin, a chemical that helps you relax. Try drinking warm milk or eating a slice of toast with peanut butter or a bowl of cereal before bedtime. Plus, the warmth of the food may temporarily increase your body temperature and the subsequent drop may hasten sleep. Light carbohydrates can help. Crackers in bed, anyone?

Jot down your concerns and worries. Anxiety excites the nervous system, so your brain sends messages to the adrenal glands, making you more alert. Write down your worries and possible solutions before you go to bed, so you don't need to ruminate in the middle of the night. A journal or "to do" list may be very helpful in letting you put away these concerns until the next day when you are fresh.

Go to sleep when you are sleepy. When you feel tired, go to bed.

Avoid "over-the-counter" medication sleep aids, and make sure that your prescribed medications do not cause insomnia. Over-the-counter "sleep aids" can be effective in the short term but can lead to long term, harder to treat cases of insomnia. In some cases, there are safety concerns. Antihistamine sleep aids, in particular, have a long duration of action and can cause daytime drowsiness. Always talk to your doctor or healthcare practitioner about your concerns.

Nutritional supplements. Check with your doctor, pharmacist or health care professional before trying nutritional supplements. Some people find that a relaxing, natural sleep aid does wonders.  A list of five supplements commonly recommended for insomnia can be found here.  


Try guided meditation and/or visualization. Focus all your attention on your toes or visualize walking down an endless stairwell. Imagine yourself in your favorite vacation spot. Use all your senses: imagine what you can see, feel, taste, smell, and touch. Thinking about repetitive or mindless things will help your brain to shut down and adjust to sleep. There are many guided mediations available online.  Meditation Oasis is a great resource.  Lots of meditation podcasts to choose from.  You will never regret learning to quiet your inner mind. 

Try deep breathing for relaxation. Focus on full inhales followed by emptying exhales. Repeat calming statements upon exhales, such as, “I feel peaceful” and “I am floating” and "I can let myself feel calm."  Make up your own.  Breathing exercises can be found here.  For added help, watch and practice deep muscle relaxation (aka, progressive muscle relaxation), here.  

Get out of bed if unable to sleep. Don’t lie in bed awake. Go into another room and do something relaxing until you feel sleepy. Reading something quiet, calming and a little on the boring side is best. Worrying about falling asleep actually keeps many people awake. We call that insomnia about insomnia. 

Don't do anything stimulating. Don't read anything job-related or watch a stimulating TV program (commercials and news shows tend to be alerting) or read an intense thriller. Don't expose yourself to bright light. The light gives cues to your brain that it is time to wake up.

Consider changing your bedtime. If you are experiencing sleeplessness or insomnia consistently, think about going to bed later so that the time you spend in bed is spent sleeping. If you are only getting five hours of sleep at night, figure out what time you need to get up and subtract five hours (for example, if you want to get up at 6:00 am, go to bed at 1:00 am). This may seem counterproductive and, at first, you may be depriving yourself of some sleep, but it can help train your body to sleep consistently while in bed. When you are spending all of your time in bed sleeping, you can gradually sleep more, by adding 15 minutes at a time.

September 22, 2010

Please Sir, I Want More

From Oliver, the 1968 movie version.

Psychologists often explore the role of sexual satisfaction in a patient's emotional health.  Sex plays a unique role in marriage and monogamous relationships. Sex is one of those activities that depends on partner willingness. If a partner or spouse doesn't like to read and discuss books, for example, the avid reader can join a book club. If a partner doesn't like to go bowling, it's socially acceptable to join a bowling league.
But if a person does not meet the sexual needs of his or her partner, couples generally are not free to go out and have sex with others; or, at least this is not viewed as a socially acceptable option. The promise of monogamy means sex with my partner or spouse only.

The result of the demands of monogamy are thus: When a sexual stalemate occures, couples need to keep trying, keep improving the relationship, and work at communicating.

Disclaimer: This post does not talk about relationship problems and resentments that can interfere with sexual satisfaction, and there are many. Nor does it talk about medical problems that can interfere with healthy sex. Please talk to your physician, preferably a discussion with Ob-Gyn, urologist, or other medical specialist to rule out some of the physical causes of sexual dysfunction. An annual exam, complete with blood work, is essential to rule out physical problems and for maintaining good sexual health.

When I assess an individual's or a couple's sexual intimacy, one the most common problems I see in heterosexual women is believing that their sexual preferences are neglected, ignored, or in some way not prioritized. While similar problems occur in same sex relationships, I will confine this discussion to straight couples for the ease and flow of wording.

In many cases, women report sexual passivity: A typical pattern is for the man to initiate the sexual flow, from start to finish, with the woman giving little input. Not surprisingly, she is often deprived of an orgasm.

Or if she does experience one, it is not fully satisfying. After all, some studies indicate that the average female orgasm can last up to 20 seconds. Compared to a man's 8 seconds. But many women estimate their orgasms last in the 4-5 second range. It's an orgasm, yes, but not as satisfying as can be. Researchers tell us women are capable of so much more. More frequent, longer and even multiple orgasms.

In short, many women are left humming the familiar Peggy Lee tune:

For too many women, too much untapped potential remains. Which may help explain why so many long-term couples report the bed-dead syndrome. No sex at all. For years. Or near dead. Sex that occurs along the order of once or twice a year. A sex life in need of resuscitation.

With this in mind, I frequently encourage women to let their partners know what they want. Simple enough, right?

Not at all, as it turns out. Many women report finding it difficult to approach their mates with sexual requests or to give honest feedback when their needs are not met. When, in short, they don't reach orgasm. Many women report feeling shy, awkward, and inhibited.

Sexual Assertiveness 101 - I wish it were a required course in the school of relationships.
Let's look at cases where women DO tell their husbands what they want, usually some form of wanting more direct clitoral stimulation, either orally or manually. Problem solved? Not so fast. The complaint I frequently hear is that the man doesn't follow through. He doesn't change his usual repetoire. Or the change is so short lived that she still doesn't get where she wants to go. So he may give her more, but its only about a minute or so more, when what she really needs is, say, 20 minutes more. Or longer.

In fact, research has shown us that women require, on average, 20 minutes of direct clitoral stimulation to reach orgasm during partner sex (from a partner; during masturbation, the average time required shortens considerably).

On average means that some women take only a few minutes and some women take much longer, say 30 or 40 minutes. Which is not to say women can't work to reduce this time frame. Women can. With practice and experimenting with various modes of stimulation. And with regular communication, men can learn what women like and lessen her time-to-orgasm and help her achieve more satisfying orgasms.

But back to women communicating with little success. I often hear that after a woman works up the nerve to express her preferences, her partner follows through for the next few encounters, but then the changes trail off. Back to the ordinary fare. No orgasm for the unlucky lady. She often feels neglected and assumes her pleasure is unimportant to him.

This scenario can be a disappointing, frustrating, confusing, lonely, and even an angry, time in a relationship. Must he be handed a honey-do-list before each and every sexperience? Why doesn't he get that these preferences are something needed as part of the main course and not an optional dessert? Is he that dense? Or uncaring? These are some of the questions I hear.

Some women are left wondering if he cares more about (1) pleasing himself; (2) giving the woman what he wants her to enjoy (refer to #1) rather than what she actually enjoys; (3) giving the woman what he hopes she will enjoy, without checking to see whether she actually does enjoy it -- unless we count the cursory and often dreaded question, "Was that good for you, too?" Too often, however, neither the question nor the answer is honest.

Speaking of dishonesty, many women report they fake orgasms in order to "get it over with" because they know their partner won't stop until he thinks she's had one. The thinking goes, if he's going to persist in all that misguided thrusting, often to the point of soreness, she may as well end it sooner rather than later. It's easy to see how a vicious cycle of faking can develop.

An equal opportunity factoid: Men fake orgasms too. But it's certainly more common in women.

Men, when confronted with their partner's request for change, have reportedly replied, "But what we've been doing has always worked for you before." This sets up what can become an opportunity for the woman to admit she's been faking. But should she? A dicey situation. The answer is highly individual, depending on the couple (true of virtually every sexual scenario). Women often report feeling more worried about their partner's ego than they do about their own pleasure. They often will not admit to faking. They feel stuck.

Yet another motive in the man's lack of persistence in following his partner's request: He avoids the awkwardness and uncertainty of trying unfamiliar techniques. It's psychologically uncomfortable. It feels risky. What if this doesn't work, either? Does that make me a lousy lover? He may not want to ruin his heretofore all too infrequent chance at sex. And who wants to end sex with nobody having an orgasm? With disappointment and despair? So he sticks to his comfort zone, the safety of what he knows, and hopes for the best.

So is this another one of those men-are-selfish-cads rant? No. Most men report that they want very much to please their partners. They find a woman's pleasure a big turn on. In this regard, traditional pornography may be teaching us something relevant (reluctant as I am to admit that pornography offers anything close to a healthy education). Ever notice how the camera is frequently aimed at the woman's face? Way more often than the man's? Men, apparently, are turned on by seeing a woman's facial signs of pleasure (never mind that the porn star is faking, too). Porn fantasy is all about placing oneself in the starring role, and for men, that role is being a successful, knowing sex partner, reliably giving his partner an orgasm. Giving her scads of them, in fact, and if pornography is to be believed, orgasms with just his magnificent penis!

But the plain truth of couple's sexuality is that only 20% (or thereabouts) of women regularly orgasm through penetration alone. I haven't checked out much pornography lately, but the "penis only" formula was pretty much the standard fare the last time I looked. Little or no oral sex for the woman. Little or not manual stimulation. Little or no direct clitoral stimulation. At least not for the length of time most women require.

By the way, you've probably noticed by now that 20 seems to be the magic number* when it comes to female sexuality:
- 20-second orgasms
- 20-minutes to get there
- 20% can orgasm through penetration alone.

*These numbers are approximates, of course. Different studies show varying results.

There are many avenues this post can take, but my main point is to inform women and men of something I don't think we hear often enough: You are not alone. Forget what so many magazines say. Sexual surveys are some of the most inaccurate -- this has been studied, too -- with people consistently over reporting their sexual frequency and satisfaction.

Don't go by what you read, or what you see in the movies or pornography (never) and certainly not what he hears in the locker room. Go by what you feel. Take an honest accounting of your sexual experience. If you're feeling dissastified, if you realize that your partner is not responding to your needs, don't give up on yourself.

Work on it. Read about it. Talk to your partner about it. Explain that you want to have good orgasms too, and yes, maybe even multiple orgasms. And that you want to bat closer to 1000 like he does (maybe). It's an entirely doable goal to reach orgasm close to 100% of the time.

Or, okay, maybe you don't want to shoot for the moon. Shoot for stopping the charade and letting him know you want both of you to enjoy more satisfying sex at least most of the time. If you have trouble talking about it (most couples do), write him a letter, leave him a love note on his pillow, send him an email, send him a link to this post, suggest a book, or better yet, read a book together.

Here are a few books that I like to recommend:

1. The Elusive Orgasm by Vivienne Cass, Ph.D. A comprehensive, up-to-date exploration of physiological and emotional contributions to the female orgasm.

2.. How to Give Her Absolute Pleasure by Lou Paget. This book covers the full gamut in a plain speech format. I especially like how she covers the politics between men and women in the bedroom. She is helping men understand us a little better, like, why, for instance, we are worrying about the piles of laundry while he's trying to pleasure us and what he can do about it (fold laundry), such as, help us unwind before sex instead of "diving right in."

3. Satisfaction by Kim Cattrall ("Sam" from Sex in the City fame). This book gives special attention to oral sex technique, with simple illustrations that men can see for themselves "how to do it." When my husband saw these, he said, "Finally! A picture that lets me see what to do!" Read an excerpt os Satisfaction, here.

4. She Comes First by Ian Kerner. Excerpt here. This book presents this rarely promoted but highly useful concept: couples should prioritize the woman's orgasm first. Afterward, he can have his, because, in general, his is easier, and because her prime is pumped and she can have another while he's having his. Because many women are capable of orgasm via penetration alone AFTER they've had their first (or better, multiple) orgasm. And mostly because, as we experienced women know, he falls asleep after his.

If after much time and communication attempts you feel you are getting nowhere, talk to a licensed professional about it. People routinely consult a professional to improve their golf game or change their hair color. Think of how fulfilling marriage and relationships could be if people reached out as readily for something as vital and as sex.

-Sandy Andrews, Ph.D.
CBT Cognitive Behavioral Psychologist 

Austin, Texas

August 12, 2010

Thinking About Natural Supplements for Your Symptoms?

When you go into your local health food store or grocery store, are you overwhelmed by the sheer number of herbal remedies and nutritional supplements on the shelves? If you answered yes, you are in good company. It is apparent that many people are taking supplements these days for psychological symptoms, such as depression, anxiety and insomnia to name a few. But how are they getting their information?

I will start with an important disclaimer. I am a clinical psychologist, trained in using psychological techniques and therapies to help people with a variety of mental health symptoms. I am not trained in the use of herbal or nutritional supplements. I do however, often get asked about supplements to help with anxiety, depression, sleep problems, etc. I have heard many anecdotal accounts in my office of some relief using a host of herbs and supplements. But when asked, I typically will discuss and recommend several of the following resources to get the answers my clients seek:

First stop should be your medical provider, such as your physician or psychiatrist.

Ask your doctor what herbs and nutritional supplements s/he recommends for your particular symptoms. Discuss precautions and potential harmful interactions with the medications you are currently taking. Perhaps your physician will be able to make some recommendations. Perhaps not. Then what?

You can ask your doctor to recommend another health care provider who may know more about herbs and nutritional supplements. Physicians who specialize in homeopathic and alternative medicine, for example, may be available in your community. Clinical nutritionists are another type of professional who have been trained in understanding herbal and nutritional remedies. Some pharmacists have a clinical nutritionist on staff. Getting a recommendation from a professional you trust is probably the safest and most reliable direction to take.

Many people rely on the internet for information, however. They try to figure out which supplements to take for what problem by winding through a maze of internet sites.

But many (if not most) internet sites are designed to sell products for profit rather than educate. They often do not contain safety guidelines, contraindications, or disruptive medication interactions. Again, it is wise to talk to your physician or health care provider before you take any nutritional supplement.
My local healthy grocery store has a large vitamin and supplement reference book on hand and staff ready to answer patrons' questions. While this can be helpful, I prefer to also look for research based advice when it comes to understanding which supplement is good for which symptom. After talking to my medical doctor, I want to know what supplements have been researched in controlled outcome studies and what the research says.
The University of Maryland Medical Center's Complementary and Alternative Medicine Index is a great resource that covers several of the essential bases. Here you can browse specific supplements and herbs and find out how to take them, for what purpose, at what recommended dose, and what the research says.
The UMM site offers an easy to use cross reference tool. For example, you can start with a particular condition, such as depression, and read about various physician prescribed medications as well as herbal and nutritional strategies that have been found to be therapeutic.

Hypericum perforatum, commonly known as St. John's Wort flower
The herb known as St. John's Wort, for example, has been prescribed for mild depression at clinics in Europe for many years now. According to the UMM website:
"Most studies show that St. John's wort may be an effective treatment for mild-to-moderate depression, and has fewer side effects than most other prescription antidepressants. But the herb interacts with a wide variety of medications, so it is important to take it only under the guidance of a health care provider."
You can also use the cross reference tool by clicking on a particular herb or nutritional supplement. What does the UMM site have to say about the omega-3 fatty acids (found in fish oils and flax seed oils)?

"Research shows that omega-3 fatty acids reduce inflammation and may help lower risk of chronic diseases such as heart disease, cancer, and arthritis. Omega-3 fatty acids are highly concentrated in the brain and appear to be important for cognitive (brain memory and performance) and behavioral function. In fact, infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk for developing vision and nerve problems. Symptoms of omega-3 fatty acid deficiency include fatigue, poor memory, dry skin, heart problems, mood swings or depression, and poor circulation."
UMM's alternative medicine site offers supporting research references from peer reviewed journals. It discusses potential complications and interactions with medications. It's a great place to start. But, again, check with your doctor after you do your research and before you take a new supplement.
So what are your preferred sites for researching vitamins, herbs and nutritional supplements?