December 23, 2011

Vulnerability and Worthiness

If you have a little bit of time over the busy holiday season, have a seat and listen to this powerful message.  Or, if you are like me, have a stand and listen as you bake or wrap presents or chop vegetables.  It's a timely message since holidays often represent spending extended time with extended family. It's also a great way to become familiar with some of the more personal, fascinating, and relevant types of research on interpersonal interactions.

November 26, 2011

Keeping a Sleep Diary

Depression and anxiety go hand in hand with sleep problems.  By no means a hard and fast rule, its common to find that people with an anxiety disorders have trouble falling asleep while people struggling with depression have trouble staying asleep.  The reverse trend is seen also or some blend of both.

What comes first, the chicken or the egg?  Do persistent sleep difficulties cause depression and anxiety?  Or does the disorder come first causing insomnia?  I have seen what appears to be both cases.  Sometimes a very stressful life event occurs (death of a loved one, birth of a child) and sleep disorders present as a result.  Other times a patient will present with a history of poor sleep that has persisted so long that panic disorder is now seen by day.  

No matter the origin, targeting more hours and better quality sleep is a typical treatment goal in cognitive behavioral therapy.  Changing one's sleep routine is a great example of a behavioral goal.  Eliminating caffeine is another.  Cognitive goals include meditation, visualization exercises, and thought replacement.  

Here's an example of a typical thought that teaches your brain to stay awake:  

What time is it?  I'll never get enough sleep! 

But you can help ease your mind into restful sleep by changing that thought to, 

I can calm my mind and think about a beautiful sunset.  


I am thinking of all the things I am grateful for.  I am grateful for ... and start a list while deep breathing (another behavioral technique).  

Regardless of your sleep troubles, keeping a Sleep Diary is a great way to show your doctor or therapist exactly what your patterns of sleep (and non-sleep) are.  Here is a list of various sleep aspects we professionals like to assess:  

1) Time you went to bed and woke up;
2) Total sleep hours;
3) Quality of sleep (e.g., soundly, restless, exhausted in the morning);
4) Times that you were awake during the night and what you did (e.g. stayed in bed with eyes closed or got up, had a glass of milk and meditated);
5) Amount of caffeine or alcohol you consumed and times of consumption;
6) Types of food and drink and times of consumption;
7) Feelings - happiness, sadness, stress, anxiety;
8) Drugs or medications taken, amount and times taken;
9) Stressful events and particular worry thoughts ongoing, that day or pre-bedtime. 

You can copy or download an example of a sleep diary, here or here.   

In addition to keeping a sleep diary you can review this list of tips for improving your sleep.  Look to see which of the helpful sleep habits are part of your routine and which are habits you routinely break or have never practiced.  These steps are a way to use your time while you search for a qualified psychologist, sleep expert or physician and help your doctor help you toward finding sleep solutions.  

Insomnia painting by Micheal Lemus Fletchall, here.  

October 21, 2011

Say No To Drugs - What Helps for Depression

It is more and more common for clients to tell me they want to work on their mental health symptoms without the use of medications, especially in light of recent findings questioning the efficacy of several commonly prescribed antidepressants.  I like to support the goal of avoiding psychotropic medications in some situations.  While it is true that some disorders typically require medication (bipolar disorder, schizophrenia), especially those where the symptoms have reached severe levels (persistent suicidal thoughts, planning or intent), it is often a welcome sign that a person is interested in doing all they can, on their own, to feel better. 

So when I read this review on PsychCentral, written by Therese Borchard, I wanted to share a summary here for those of you who want to know what are some of the most effective ways to manage your depression without medication.  Although, I want to add, these are excellent suggestions for people taking medications as well.

Six Steps for Beating Depression
“The Depression Cure: 6-Step Program to Beat Depression without Drugs,”
by Stephen Ilardi

1. Omega-3 Fatty Acids   Seafood, oils (flaxseed oil -unheated; canola or soybean oil for cooking), beans (kidney, pinto, mungo), nuts, seeds, spinach, winter squash, broccoli, cauliflower, dietary supplements (fish oil, flaxseed oil).

2. Engaged Activity  keeps us from ruminating, and ruminating causes depression.
Socializing, reading, hobbies, creating art, exercise of all kinds.

3. Physical Exercise    Research suggests 30 minutes  of brisk walking three times a week can be as effective as some medications AND exercisers are less likely to become depressed again later.    
Activities such as walking, biking, jogging, and weight lifting.  Exercise changes the brain. It increases the activity level of important brain chemicals such as dopamine and serotonin and a key growth hormone called BDNF. Because levels of this hormone plummet in depression, some parts of the brain start to shrink over time, and learning and memory are impaired. But exercise reverses this trend, protecting the brain in a way nothing else can.

4. Sunlight Exposure Important for keeping the body’s internal clock working properly. Without light exposure, the body clock gets out of sync, throwing off important circadian rhythms that regulate energy, sleep, appetite, and hormone levels. On average – a half hour of sunlight is enough to reset your body clock, even on gray, cloudy days.

5. Social Support   Relationships matter. The more satisfying the connections, the better. Think about ways to increase the number of people in your social network especially those you can confide in.

6. Sleep    Disrupted sleep is one of the most potent triggers of depression, and there’s evidence that most episodes of mood disorder are preceded by at least several weeks of subpar slumber.   Keep a sleep log.  Each morning write the estimated number of hours you slept the night before to include approximately how many times you woke up throughout the night and couldn’t get back to sleep for more than ~ten minutes.  

August 5, 2011

You Are Here To Risk Your Heart

Life will break you. Nobody can protect you from that, and living alone won't either, for solitude will also break you with its yearning. You have to love. You have to feel. It is the reason you are here on earth. You are here to risk your heart. You are here to be swallowed up. And when it happens that you are broken, or betrayed, or left, or hurt, or death brushes near, let yourself sit by an apple tree and listen to the apples falling all around you in heaps, wasting their sweetness. Tell yourself you tasted as many as you could.

Louise Erdrich
from The Painted Drum

July 28, 2011

On Relieving Stress

     We hear so much about stress these days:  The effects of stress on our bodies - high blood pressure, headaches - and on our mental state - increased substance abuse, anger outbursts, depression.

    Stress management is frequently taught in Cognitive Behavioral Therapy (CBT).  A series of tools that help teach us to lower the negative effects of stress, to help us cope with the stress we face in our daily lives, to help us return to physical and psychological health.

One tool I frequently recommend is deep breathing.  Daily practice in taking deeper breaths: fuller inhales and emptying exhales.  You can click on this link to read about ways to improve your breathing patterns.  

Below is a discussion on different kinds of stress, physical and psychological problems related to stress and a list of suggestions to help cope.  These were found on the website of the American Psychological Association.


Most people have felt stress at one point in their lives. Sometimes it’s brief and highly situational, like being in heavy traffic. Other times, it’s more persistent and complex — relationship problems, an ailing family member, a spouse’s death. And sometimes, stress can motivate us to accomplish certain tasks.

Dangerous Stress

Stress becomes dangerous when it interferes with your ability to live a normal life for an extended period of time. You may feel “out of control” and have no idea of what to do, even if the cause is relatively minor. This in turn, may cause you to feel continually fatigued, unable to concentrate, or irritable in otherwise relaxed situations. Prolonged stress may also compound any emotional problems stemming from sudden events such traumatic experiences in your past, and increase thoughts of suicide.

Natural reactions to stress

Stress can also affect your physical health because of the human body’s built-in response mechanisms. You may have found yourself sweating at the thought of an important date, or felt your heartbeat pick up while watching a scary movie. These reactions are caused by hormones that scientists believe helped our ancestors cope with the threats and uncertainties of their world.
If the cause of your stress is temporary, the physical effects are usually short-term as well. In one study, the pressure of taking exams led to increased severity of acne among college students, regardless of how they ate or slept. The condition diminished after exams were over. Abdominal pain and irregularity have also been linked to situational stress.

The longer your mind feels stressed, however, the longer your physical reaction systems remain activated. This can lead to more serious health issues.

Physical wear and tear of stress

The old saying that stress “ages” a person faster than normal was recently verified in a study of women who had spent many years caring for severely ill and disabled children. Because their bodies were no longer able to fully regenerate blood cells, these women were found to be physically a decade older than their chronological age.

Extended reactions to stress can alter the body’s immune system in ways that are associated with other “aging” conditions such as frailty, functional decline, cardiovascular disease, osteoporosis, inflammatory arthritis, type 2 diabetes, and certain cancers.

Research also suggests that stress impairs the brain’s ability to block certain toxins and other large, potentially harmful molecules. This condition is also common to patients suffering from Alzheimer’s Disease.

Pressure points

Although sudden emotional stress has been linked to severe heart dysfunction in otherwise healthy people, scientists are uncertain whether chronic stress alone causes cardiovascular disease. What is clear is that excessive stress can worsen existing risk factors such as hypertension and high cholesterol levels. Studies also show that people who are quick to anger or who display frequent hostility—a behavior common to those under stress—have an increased risk of heart disease and crying fits.

Feelings of despair that accompany stress can easily worsen into chronic depression, a condition that can lead you to neglect good diet and activity habits. This, in turn, can put you at a greater risk for heart disease, obesity, and kidney dysfunction.

Stress can also complicate your ability to recover from a serious illness or nap. A Swedish study found that women who have suffered heart attacks tend to have poorer chances of recovery if they are also experiencing marital stressors such as infidelity, alcohol abuse, and a spouse’s physical or psychiatric illness. On the other hand, stress management training is a proven method for helping speed recovery follow a heart attack.

What you can do to help reduce stress

Learning to deal with stress effectively is a worthwhile effort, even if you already consider yourself capable of handling anything life sends your way.

Many of the most common long-term stressors — family illness, recovery after injury, career pressures—often arise without warning and simultaneously. Stress management is particularly valuable if your family has a history of hypertension and other forms of heart disease.

Identify the cause.
You may find that your stress arises from something that’s easy to correct. A psychologist can help you define and analyze these stressors, and develop action plans for dealing with them.

Monitor your moods.
If you feel stressed during the day, write down what caused it along your thoughts and moods. Again, you may find the cause to be less serious than you first thought.

Make time for yourself at least two or three times a week. 
Even ten minutes a day of “personal time” can help refresh your mental outlook and slow down your body’s stress response systems. Turn off the phone, spend time alone in your room, exercise, or meditate to your favorite music.

Walk away when you’re angry.
Before you react, take time to mentally regroup by counting to 10. Then look at the situation again. Walking or other physical activities will also help you work off steam.

Analyze your schedule.
Assess your priorities and delegate whatever tasks you can (e.g., order out dinner after a busy day, share household responsibilities). Eliminate tasks that are “shoulds” but not “musts.”

Set reasonable standards for yourself and others. 
Don’t expect perfection.

June 13, 2011

Couples Communication: Assertiveness with Empathy

Sheep Herd Tapestry 

The conception of two people living together for twenty-five years 
without having a cross word suggests a lack of spirit 
only to be admired in sheep.  
-Alan Patrick Herbert, English writer and Member of Parliament

Most all of us understand that constant bickering, arguing, and loud shouting matches are not healthy for relationships.  But what too few people understand is that the opposite is not healthy either.  Any longtime partnership, be it love or work, will involve conflict.  And conflict necessitates talking it out.

John Gottman, PhD and his research team have found* that couples who seldom argue, conflict avoiders as he calls them, are at high risk to break up.

Couples therapy almost always involves learning and practicing assertive communication skills.  In my couples work and individual therapy I encourage assertiveness with empathy as one form of resolving conflict.

This will probably take you by surprise but I don't like going to the same restaurants all the time. I know they are your favorites but I'd like to try something new. What do you think? 

Text in red denotes statements of empathy or showing that you understand and care about the other person's viewpoint.

Using empathic statements helps make assertiveness more successful.  Helps the partner you are communicating with feel heard, more at ease, understood, rather than attacked. Helps the partner be more open to your suggestions.

I know you like for me to do the laundry but I want to change things up.  I want do my own and you do your own from now on. I've gotten busier at work and don't have as much free time as I used to.  You may not know how, but I can show you this weekend if you'd like.

Can you think of a complaint you have aimed at your partner that you can turn into an assertive, empathic request?

*Gottman, John M.; Krokoff, Lowell J., Marital interaction and satisfaction: A longitudinal view. Journal of Consulting and Clinical Psychology, Vol 57(1), Feb 1989, 47-52. doi:10.1037/0022-006X.57.1.47

June 1, 2011

Tips for Addressing ADHD in Children

Thanks to Jeff's link at PillsDon'tTeach, I downloaded a free version of the eBook 7 Crucial Tips for Parents and Teachers of  Children with ADHD by Bryan Hutchinson.

Free, as in, click this link and the eBook (a .PDF file) downloads onto your computer and pops onto your screen.  It's that easy.  

May 10, 2011

A Shrink's Take on Speed Shrinking

I recently read the novel Speed Shrinking by Susan Shapiro. The title derives from heroine Julia's quest to find a new shrink after her longtime psychologist, Dr. Ness, moves away.  Determined to find one she clicks with, Julia interviews eight shrinks in eight days.

In short, I liked the book.  Ms. Shapiro is a stylish writer.  She delves into modern woman issues with sophistication and informed wit.  Her self-deprecating and self-analytical insights are sometimes hilarious, sometimes sincere and always poignant.

From a therapy standpoint, Shapiro lets the reader into the sacred territory of the complex interactions between doctor and patient. And I don't mind admitting that as a practicing psychologist I like to see what goes on in the offices of my contemporaries, even if these revelations derive merely from the mind's eye of a fiction writer.

What I loved about Shapiro's novel (and her earlier book) was her smart play on words.  Speaking of Julia's early cat-and-mouse games with her husband, for example, she writes, "I was ambivalent about him - until he abandoned me for the West Coast where I followed, chasing him until he caught me."

What I didn't like about Speed Shrinking?  And what provoked me to write this post?  Reading a series of highly questionable if not most certain ethical violations on the part of the treating psychologists depicted in the novel.  Most of the violations fell under the heading multiple relationships (better known as dual relationships) and lack of professional boundaries.

Some examples of what I believe to be violations found in Speed Shrinking are given below (hoping I am remembering them correctly as I don't have the book in front of me) where one or more of Julia's treating  psychologists do the following:

- Provide therapy while simultaneously serving as editor and professional consultant for a manuscript the patient is writing.

- Discuss details of their own therapy, supervision and psychological issues with the patient during and give detailed answers to the patient's personal questions.

- Continue the therapeutic relationship via telephone, digi-cam (such as Skyping) and in-person meetings despite Julia's transition to and regular participation with a new psychologist, i.e., the former psychologist fails to adequately terminate treatment.

- Go to the patient's home to help her make remodeling decisions.

Multiple relationships as defined by the American Psychological Association (APA):

   A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

In addition to multiple role violations, there are a few examples of broken confidentiality.  In one example, Julia's new psychologist readily acknowledges that he is treating a friend of hers.  He then discloses details gleaned from their sessions.

As I came toward the end of the book, I predicted that Shapiro's character would grow from the realization that her beloved Dr. Ness may have been doing more harm than good.  That part of the reason Julia was obsessed with him had to do with his failure to adhere to professional boundaries.  That her persistent feelings of betrayal stemmed from his having created a false sense of specialness.  Indeed, the frequency and rapidity with which he responded to her between session contacts suggested she was his only patient.  I hoped Julie would gain these insights as a result of the new shrink applying strict, ethically appropriate boundaries within and outside of their sessions.

Do my predictions come true?  Stay tuned for my next post where I discuss this and other ethical implications.

March 10, 2011

A Week for Women

This is a big week for women.  Today is National Women and Girls HIV/AIDS Awareness Day.   Every 9-1/2 minutes an American is infected with HIV.  We don't hear as much about HIV prevention these days but the threat lives on.

You can help spread the word and Rock the Red Pump. Please check out the website, sign up, promote HIV protection on your blog, Twitter or Facebook and encourage those you care about to be safe.

Also this week, the 10th anniversary of International Women's Day.  This year's theme:  Equal access to education, training and science and technology: Pathway to decent work for women.  

Why even have a women's day, you might ask?  Aren't women equal by now?  One fact that stood out for me in this video: 

 "Women are responsible for 2/3 of the work done worldwide 
yet own only 10% of the total income and only 1% of the property."

Please watch this video, below, to see Daniel Craig in drag to learn more eye-opening statistics: 

We still have a long way to go.  This week and every week, promote equality and safety for women.

January 24, 2011

Materialism Examined

Happiness means wanting what you have not having what you want, is a paraphrase of the former Rabbi from Houston, Hyman Schnactel's inspirational message.  

Turns out, there's research backing up this idea, more or less.  There are even blogs devoted to this theme.  Now you know you can bank on an idea if someone is blogging about it (wink).   
Materialism and mass consumerism are concepts we hear a lot about in the news. We hear ranting against the trend of buying more and more stuff, especially costly stuff  -- electronic gadgets, designer clothes, and trendy, luxury vehicles (one in particular comes to mind, rhymes with bummer) to name a few. Spend too much time around materialistic people, or label droppers, and you might find yourself developing subtle feelings of discontent, irritability and a case of what I call the wants. What my parents called the gimmes.  

A couple years ago I listened to an interview with Dr. Tim Kasser talk about his research on the psychology of materialism, a body of literature I didn't know existed until I heard him speak.  His findings indicated that the higher people rate materialistic goals (also known as "extrinsic" goals) as important, the less happy they were and the lower their quality of life. Materialistic goals include making more money, owning more stuff, engaging in high status pursuits, etc. 

Kasser said that the more people buy into messages of "consumer society," the less satisfied they were with their lives, the less self-actualized they report being. Materialistic goals are also correlated with more symptoms of depression and anxiety. His findings are the same between females/males, the old/young, the rich/poor and across cultures.

Materialistic desires were associated with lower empathy, being more manipulative, more Machiavellian, and the preference for competitive rather than cooperative strategies. Their relationships are more conflictual and shorter lived.

Additional research interests of Kasser's were cited such as looking at the relationship between materialism and "ecological well being." Not surprisingly, materialistic people leave higher ecological "footprints" and are less likely to engage in eco-friendly behaviors (recycling, energy conservation).  

Kasser concludes that people who live in more simplistic ways are happier. 

Kasser then went on to talk about a concept known as time affluence, something we Americans don't have much of compared to other western nations. We work nine weeks more per year than Europeans, fourteen weeks more than Scandinavians. Over the decades, our work week has been expanding and we become less and less time affluent. We have less down time, less time with our families, hobbies, exercise, vacation. 

Time affluence, then, is also associated with greater happiness. Again, it's not how much we can buy, it's how much we engage in pleasurable pursuits.

All of this to say, when you are feeling down about out-of-style clothes, dated electronics, that used car you just bought, or home decor that will never be showcased in House Beautiful Magazine, remember that living a simpler life can leave you with a much bigger abundance in intrinsic wealth. 

Is it working yet?