blogging behavioral

Feeling Low? Make a Pleasant Events List

2012-01-06T18:41:00.002-06:00

In honor of the New Year and good intentions to make improvements in our lives, I am re-posting a revised Pleasant Events List. Those of you who read the previous post will be glad to see I've made a few changes, out with some of the old and in with some new ideas.

For those reading this list for the first time, what is it all about?

When someone is experiencing a sad, down, angry, lonely, or otherwise lowered mood, one tip that can help is to consult your own personal Pleasant Events List.

Below is a lonnnnnng list of Pleasant Events. It was compiled from a variety of sources, some of which I no longer recall. But I do remember a co-therapist telling me she gathered lists generated by clients in a former therapy group she ran. I kept most of the list intact, even when I was puzzled by the content. Different people find different activities uplifting (cleaning the bathroom, being one that I find a real stretch, but... different strokes).

The list is meant as a starting point: A list of ideas that will help you generate a list of your own. So that you can write your own personalized list of activities and thoughts you find pleasant, fun, funny, joyful, entertaining, relaxing, soothing, or in some other way, mood-lifting.

So I post this list in the hopes that readers will be inspired to read it, to do some of the things on the list, or to merely think about doing some of the things on the list, to leave a comment with some new pleasant event that can be added to the list, or to generate a new list of your own. Best of all, generate your list with as many readily do-able, easily accessable, easily affordable events as you can come up with.

As one exercise, I often suggest before reading the list that you rate your mood on a scale of 1 to 10, where:

1 = feeling very down or "low"

and

10 = feeling really happy or "up"

Then, after you have finished reading the list, rate how you feel once again. Any change?

PLEASANT EVENTS LIST

1. Soaking in the bathtub

2. Looking at the stars

3. Feeling the wind in my hair

4. Collecting things (coins, shells, etc)

5. Listening to fun, educational programming, such as TED or NPR podcasts

6. Thinking how it will be when I finish school

7. Working a crossword or sudoku puzzle

8. Trying out a new hair style

9. Sitting under a shade tree

10. Going to a movie in the middle of the week

11. Taking a walk around the block or even to the mailbox

12. Thinking about how I have done a full day's work

13. Watching or renting a favorite old movie

14. Recalling past parties

15. Surfing the internet

16. Lying in the sun

17. Planning a career change

18. Rearranging furniture in a room or a bookshelf or a cabinet

19. Thinking about or looking at pictures of my past trips and vacations

20. Listening to others tell happy stories

21. Reading magazines I've got sitting around

22. Hobbies (stamp collecting, model building, etc.)

23. Spending time with good friends

24. Planning my next day off

25. Hunting around for beautiful images on the web: flickr or photobucket, etc

26. Looking for pictures in magazines, books or on the internet of places I'd like to visit

27. Thinking of ways to meet new people

28. Looking at clouds and imagining different shapes

29. Re-potting a plant

30. Eating my favorite dessert

31. Practicing karate, judo, yoga

32. Thinking what I will do when I retire, writing a "bucket list"

33. Repairing things around the house

34. Working on my car (bicycle, motorcycle)

35. Remembering the words and deeds of loving people

36. Looking at artists' paintings and works online, such as Olga's Gallery or Artspan

37. Writing a hand-written note, letter or thank you card

38. Taking care of my plants

39. Plan a healthy meal, make a salad

40. Going swimming

41. Doodling

42. Exercising, watching an excercise video, jogging in place, or jumping rope

43. Phoning up a friend and asking them to tell you a joke

44. Going to a party

45. Learning something new on video, like how to make a the best paper airplane.

46. Playing golf, hitting practice balls

47. Playing soccer

48. Flying kites

49. Having discussions with friends

50. Planning family get-togethers

51. Riding a motorbike or scooter

52. Having sex with the person I love or with myself

53. Hugging a tree, yes literally hugging a tree

54. Going camping

55. Singing around the house

56. Arranging flowers

57. Practicing religion (go to church, praying, etc)

58. Going to an art gallery

59. Going to the beach

60. Thinking of the many ways I'm an OK person

61. Thinking how I would spend a day with nothing to do

62. Looking into class reunions

63. Going skating

64. Walking in a field and looking for different wildflowers or birds

65. Exploring local clubs or groups, by reading the paper or looking online (i.e., MeetUp )

66. Painting, drawing, watercolor

67. Doing something spontaneously

68. Go to a local nature or botanical garden. Ladybird's Wildflower Center free the month of January!

69. Sleeping, taking a nap

70. Taking a drive in the country

71. Planning the next time I'll entertain, making calls to invite people

72. Going to clubs (garden, support groups)

73. Thinking about getting married

74. Going hunting

75. Singing with groups or karaoke

76. Flirting

77. Playing musical instruments

78. Doing hobbies, arts and crafts

79. Making a gift for someone

80. Buying CDs

81. Watching boxing or wrestling

82. Window shopping on such sites as Craigslist or Ebay or Etsy (handmade items)

83. Cooking something special

84. Going hiking

85. Writing poems, personal journals, articles or essays

86. Sewing or mending something

87. Light a scented candle and watch the flame flicker

88. Going out to dinner

89. Scrapbooking

90. Discussing books, joining or looking for a book club

91. Taking a walk in tourist areas of my city

92. Gardening

93. Getting my hair done

94. Early morning coffee and newspaper

95. Taking up some new, interesting form of exercise (but going easy)

96. Kissing

97. Watching children play

98. Thinking I have a lot more going for me than most

99. Going to plays and concerts

100. Daydreaming

101. Exploring ideas for a new hobby or interest at educational center such as UT Informal Classes

102. Stretching my muscles

103. Making a collage, book making, therapeutic collage using magazine cut outs

104. Listening to a stereo

105. Refinishing furniture

107. Making a to do list. Choosing one that takes 15 minutes and deciding to do it

108. Going bike riding

109. Walking in the woods, in a park, or along a waterfront

110. Buying gifts for someone special

111. Thinking about what national or state parks I want to visit

112. Completing a 15-minute task I've been putting off

113. Collecting shells

114. Going to a spectator sport

115. Eating my favorite comfort food

116. Teaching, planning a new lesson

117. Photography

118. Going fishing

119. Exploring new hiking trails

120. Thrift shopping

121. Playing with my pets or a neighbor's pets

122. Looking up volunteer opportunities

123. Re-reading a favorite novel

124. Pursuing acting in local theatre or helping with production

125. Being alone

126. Writing diary entries or letters

127. Organizing one drawer that needs it

128. Reading a self-help book or magazine article

129. Taking children to fun places

130. Dancing

131. Going on a picnic

132. Listening to online radio, such as Pandora or KUT

133. Meditating, visualizing my special place

134. Playing basketball, shooting baskets

135. Having lunch with a friend

136. Reading blogs (like you are doing now), starting or writing a blog

137. Thinking about having a family

138. Writing a list of my Top Ten Happiest Moments

139. Splurging on a fun treat, such as a fruit smoothie or snow cone

140. Playing cards, solitaire

141. Going to garage sales

142. Having a political discussion, following political blogs

143. Signing up and playing softball

144. Seeing and/or showing photos or slides

145. Playing guitar or other musical instrument

146. Knitting or crochet or cross stitch or other hand work

147. Doing crossword puzzles

148. Shooting pool

149. Reading the newspaper

150. Reflecting on how I've improved

151. Playing online video games such as Pogo or Yahoo games

152. Talking on the phone

153. Going to museums

154. Thinking religious thoughts

155. Going to a sports bar to catch a game

156. Listening to the radio or stereo

157. Sending an email to someone I've lost touch with

158. Saying "I love you" to someone I love

159. Making bead jewelry

160. Buying or trading books

161. Taking a sauna or steam bath

162. Holding hands with someone I care about

163. Spending time at the library

164. Canoeing

165. Throwing a frisbee

166. Doing woodworking

167. Fantasizing about the future

168. Practicing ballet or tap dancing

169. Taking a drive on a pretty road or in a unique neighborhood

168. Taking my dog for a walk or offering to walk a neighbor's dog

169. Sitting in a sidewalk cafe

170. Having an aquarium

171. Painting my nails

172. Going horseback riding

173. Thinking about becoming active in the community

174. Doing something new and challenging

175. Completing jigsaw puzzles

176. Thinking I'm a person who can cope

177. Giving myself a pedicure

178. Thinking about the last time I laughed so hard my face hurt

179. Taking a hot shower

180. Lying in bed listening to the rain outside

181. Making a long distance phone call

182. Taking a bubble bath

183. Browsing a book store

184. Thinking of someone I could have a good conversation with

185. Going to the beach

186. Finding a $20 bill in your coat from last winter

187. Laughing at yourself

188. Midnight phone calls that last for hours

189. Running through sprinklers

190. Reading blogs (like you are doing now), starting or writing a blog

191. Writing a list of my strengths, what I have to offer a friend or partner

192. Relaxing in a hot tub

193. Playing tennis, hitting balls against a backboard

194. Watching the sunrise or sunset

195. Waking up and realizing you still have a few hours left to sleep

196. Thinking about a first kiss (my very first or with a new partner)

197. Playing pingpong

198. Visiting a local animal shelter or humane society. Better yet, volunteer.

199. Letting a child or grandchild play with my hair

200. Hula hooping

201. Making myself a hot chocolate or cup of herbal tea

202. Thinking about a road trip with friends, a previous one or one I'd like to take

203. Swinging on a swing

204. Drinking a glass of ice water with lemon

205. Reading song lyrics printed inside your new CD so you can sing along

206. Going to a music concert

207. Eating chocolate chip cookies, fresh out of the oven

208. Winning a really competitive game

209. Reader? Can you add a pleasant event?

210. Looking at old pictures or home movies

211. Turning off and tuning in to myself and being one with source

212. Taking a moon bath

213. Using tarot cards

214. Surfing in the ocean

215. Reader? Can you add a pleasant event? Or spot check and let me know if my list repeats?

Vulnerability and Worthiness

2011-12-23T12:03:00.000-06:00

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.

Keeping a Sleep Diary

2011-11-26T10:26:00.001-06:00

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.

or,

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.

Say No To Drugs - What Helps for Depression

2011-10-21T10:19:00.002-05:00

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 require medication (bipolar disorder, schizophrenia, as two examples), especially those where the symptoms have reached severe levels (persistent suicidal thoughts 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

From
“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.

Recovery Inc: A Cognitive Tools Support Group

2011-09-14T08:48:00.000-05:00

This a repost from two years ago. I continue to believe in the potential effectiveness of this support group for people experiencing anxiety, depression and other disorders.

There's a little known but excellent support group resource available here in Austin, Texas and in hundreds of cities nationwide. It's called Recovery, Inc. It also goes by Recovery International.

The names are misleading which may explain the relative obscurity of the support group. Recovery is now a term that most people, including myself, associate with substance abuse recovery. But Recovery, Inc. is a self-help support group designed to assist people struggling with anxiety and depression. It can also help people with a variety of different psychological and emotional difficulties. For a list of the many struggles Recovery, Inc. can offer assistance with, click here. People who have alcohol and drug abuse issues can be helped, too, so long as their substance abuse is under control.

I assume the name confusion is why Recovery, Inc. has been undergoing some name changes. Their website tells me it is now being referred to as the Abraham Low Self Help Systems after the group's original creator, Abraham Low, M.D. You can read more, here.

But the name isn't so important. What matters is the group's core focus: teaching and helping group members persistently use cognitive skills to reduce symptoms.

I've had a few patients attend these groups. I have been consistently impressed with the quality of the skills taught there. I often refer my clients to the group in the hopes they will use it as a place to practice the cognitive skills learned in my individual therapy sessions, learn new skills above and beyond what our sessions have covered, and gain social support. I also refer individuals who are not attending therapy but would like some free-of-charge group support.

Recovery, Inc. teaches tools to help people cope better with situations that provoke unpleasant feelings and emotions. They call these tools "Recovery Language."

One typical example: Many people experience significant anxiety walking into a support group for the very first time. Anxiety that, for so many, is anticipated ahead of time to such an extent that they fail to go to the group at all. Typical thoughts are, "I won't know anyone and I'll feel stupid." "I won't know what to say." "I'll be too nervous to talk and then I'll look ridiculous." "What if I walk into the room and everyone stares at me?"

The anxiety, fed by these negative, fear inducing thoughts, can mount until one feels overwhelmed and stays home, or stays in the car and drives away.
Recovery language might encourage you to "spot" and replace these negative thoughts with more realistic and empowering ones, such as:

"These thoughts are distressing, not dangerous."

"It is perfectly average for someone to feel nervous when walking into a new group."

"I can do this. I am capable."

"I will move my muscles and start heading inside."

"Bear the discomfort and comfort will come."

For more examples of personal situations, use this link to get to the in the self-help forums.

I've had a few patients attend only one meeting. Their complaint was that they didn't quite "get it." As I understand the group format, members use Recovery Language and new people feel a bit lost and confused. My advice to patients is this: Plan to attend at least three groups. See if some of the initial confusion, which again is average (a recovery term) lessens over time. See if you don't start to feel a little more comfortable. Find out how you can learn the Recovery Language for yourself. You will likely be encouraged to buy a book but it isn't essential.

So take the first step. Move your muscles to use the following link to find the support group closest to you.

I would love to hear readers first hand experience with Recovery, Inc. so feel free to share in the comment section.

You Are Here To Risk Your Heart

2011-08-05T08:56:00.001-05:00

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

On Relieving Stress

2011-07-28T20:00:00.000-05:00

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.

More Tips for Coping with Stress

By 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.

Couples Communication: Assertiveness with Empathy

2011-06-13T06:16:00.012-05:00

Sheep Herd Tapestry

by Barbara Levitux

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

Tips for Addressing ADHD in Children

2011-06-01T06:59:00.002-05:00

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.

A Shrink's Take on Speed Shrinking

2011-05-10T21:06:00.002-05:00

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.

List of Common Cognitive Distortions

2011-03-21T16:18:00.000-05:00

Whether the diagnosis be depression, bipolar, anxiety, anger issues, chronic pain or _______ (insert disorder of your choice), in other words, virtually all psychological conditions, identifying cognitive distortions is a very important step in treatment.

What is a cognitive distortion? Also known as automatic negative thoughts (ANTs), these are thinking patterns that are largely inaccurate. Using ANTs repeatedly and in a variety of situations can lead to any number of symptoms including: anger outbursts, sadness, hopelessness, mistrust, procrastination and the darling of psychotherapy, guilt. In a previous post I give a better explanation of cognitive distortions so I invite you to click here to learn more.

Today I'd like to share lists of commonly used ANTs. Occasionally I go online to look for lists of faulty thinking patterns as a refresher or to learn a few that I'm not familiar with. Like earlier this month, for example. I was writing my notes and struggling to remember the pattern used by someone I am seeing. I came across this list of 15 Common Cognitive Distortions posted by John Grohol, PsyD, at PsychCentral:

1. Filtering.

We take the negative details and magnify them while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted.

2. Polarized Thinking. In my office, this is known as "All or None Thinking."

Things are either “black-or-white.” We have to be perfect or we’re a failure–there is no middle ground. You place people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure.

Here I will add the All or Nones that I hear frequently:

Always
Never
Every (especially when followed by, "Single. Time!")
Can't
Nothing

Listen to your words the next time you are arguing with a loved one. Or theirs. I bet you will here more than a few of these words sprinkled throughout.

3. Overgeneralization.

We come to a general conclusion based on a single incident or piece of evidence. If something bad happens once, we expect it to happen over and over again. A person may see a single, unpleasant event as a never-ending pattern of defeat.

4. Jumping to Conclusions.

Without individuals saying so, we know what they are feeling and why they act the way they do. In particular, we are able to determine how people are feeling toward us. For example, a person may conclude that someone is reacting negatively toward them and don’t actually bother to find out if they are correct. Another example is a person may anticipate that things will turn out badly, and will feel convinced that their prediction is already an established fact.

5. Catastrophizing. This one is big, folks.

We expect disaster to strike, no matter what. This is also referred to as “magnifying or minimizing.” We hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”).

For example, a person might exaggerate the importance of insignificant events (such as their mistake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of significant events until they appear tiny (for example, a person’s own desirable qualities or someone else’s imperfections).

6. Personalization.

Thinking that everything people do or say is some kind of reaction to us. We also compare ourselves to others trying to determine who is smarter, better looking, etc. A person sees themselves as the cause of some unhealthy external event that the were not responsible for. For example, “We were late to the dinner party and caused the hostess to overcook the meal. If I had only pushed my husband to leave on time, this wouldn’t have happened.”

7. Control Fallacies.

If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I can’t help it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For example, “Why aren’t you happy? Is it because of something I did?”

8. Fallacy of Fairness. Another big one.

We feel resentful because we think we know what is fair, but other people won’t agree with us. As our parents tell us, “Life is always fair,” and people who go through life applying a measuring ruler against every situation judging its “fairness” will often feel badly and negative because of it.

9. Blaming.

We hold other people responsible for our pain, or take the other track and blame ourselves for every problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel any particular way — only we have control over our own emotions and emotional reactions.

10. Shoulds. One of the easiest to identify. You hear the word? Change it.

We have a list of ironclad rules about how others and we should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may often believe they are trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they can do anything.

For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are also offenders. The emotional consequence is guilt. When a person directs should statements toward others, they often feel anger, frustration and resentment.

Here's an example of changing a should: replace with a "want" or a "wish" statement.

I shouldn't eat this candy. ----------> I don't want to eat this because I want to lose weight.

11. Emotional Reasoning.

We believe that what we feel must be true automatically. If we feel stupid and boring, then we must be stupid and boring. You assume that your unhealthy emotions reflect he way things really are — “I feel it, therefore it must be true.”

"Feelings are not facts" is a common phrase heard at Recovery, Inc., support group meetings for people suffering with depression and anxiety disorders. And as I like to put it, just because I feel it, doesn't make it true. Just because I am angry doesn't mean the person I am angry at did something to deserve my yelling or cursing at them.

12. Fallacy of Change.

We expect that other people will change to suit us if we just pressure or cajole them enough. We need to change people because our hopes for happiness seem to depend entirely on them.

13. Global Labeling.

We generalize one or two qualities into a negative global judgment. These are extreme forms of generalizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in context of a specific situation, a person will attach an unhealthy label to themselves.

For example, they may say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behavior rubs a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For example, instead of saying someone drops her children off at daycare every day, a person who is mislabeling might say that “she abandons her children to strangers.”

14. Always Being Right. Anyone spot the All or None language right in the name?

We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.

15. Heaven’s Reward Fallacy.

We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.

What to do about these negative thinking patterns? Dr. Grohol was kind enough to include a link to Fixing Cognitive Distortions, another tool for helping rid oneself of these pesky, repetitious thoughts.

A Week for Women

2011-03-10T12:00:00.002-06:00

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.

Materialism Examined

2011-01-24T19:28:00.034-06:00

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?

Have Yourself a More Relaxed Holiday Season

2010-12-06T22:18:00.003-06:00

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.

Understanding Chronic Pain

2010-11-01T08:17:00.002-05:00

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).

LETTER TO PEOPLE WITHOUT CHRONIC PAIN:

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

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

2010-10-08T09:25:00.011-05:00

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.

Many people come into therapy with sleep problems as one of their main symptoms. So it is fairly common to spend therapy time looking at a patient's sleep habits. Below are many changes and sleep hygiene tips often recommended to the sleep deprived.

TIPS FOR BETTER DAYTIME HABITS

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.

TIPS FOR A BETTER PLACE 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.

TIPS FOR A BETTER PRE-SLEEP RITUAL

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" sleep aids, and make sure that your prescribed medications do not cause insomnia. There is little evidence that supplements and other over-the-counter "sleep aids" are effective. 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.

TIPS FOR GETTING BACK TO SLEEP

Try 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.

Try deep relaxation. Focus on full inhales followed by emptying exhales. Repeat calming statements upon exhales, such as, “I feel peaceful” or “I am floating.” Make up your own.

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. Worrying about falling asleep actually keeps many people awake.

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). Don't expose yourself to bright light. The light gives cues to your brain that it is time to wake up.

Get up and eat some turkey. Turkey contains tryptophan, a major building block for making serotonin, a neurotransmitter, which sends messages between nerve cells and causes feelings of sleepiness. Note that L-tryptophan doesn't act on the brain unless you eat it on an empty stomach with no protein present, so keep some turkey in the refrigerator for 3am.

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.

Please Sir, I Want More

2010-09-22T07:45:00.002-05:00

From Oliver, the 1968 movie version.

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.

PostSecret

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.

Thinking about herbal remedies for your symptoms?

2010-08-12T07:38:00.002-05:00

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 by offering a 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?

Just Do It - Use the One Minute Rule

2010-07-30T08:28:00.001-05:00

And speaking of doing it now rather than procrastinating, here's a quick and helpful pointer. It's called the one-minute rule and it's courtesy of Gretchen Rubin of The Happiness Project.

I mean, who doesn't love reading, or in this case watching a video clip, about a one-minute-solution?

In this world of looking for unrealistic, so-called quick solutions, isn't it wonderful to find a one-minute-rule that might actually do some real good? Maybe help boost our organization?

And maybe even a blog post that takes one minute to read? (Give or take.) Grammar check: does the period go inside or outside the parentheses? And yes, I do have an MLA Handbook on the shelf behind me. And no, I will not reach up to grab it and risk an allergic reaction to the dust that will surely find it's way into my nostrils.

In the words of Gretchen, outer order contributes to inner calm.

15 Steps to Better Mental Health

2010-07-16T08:17:00.001-05:00

Walking in the Rain

by L C Neill

Yet another excellent post by Dr. Deb -- A list of 15 Tips for Mental Fitness that she found on a University of Washington publication. It's such a great list, in fact, I had to post it here:

1. Learn to Relax
Allow yourself to let go of inner tensions by giving yourself a “mini vacation.” Give your mind a break by becoming engrossed in a good book, watching a movie, listening to music, taking a walk, working on a hobby, meditating or similar activity that is relaxing for you.

2. Be Kind To Yourself
People are frequently too hard on themselves when things don’t go right. Tune into your self talk, and counteract your negative thoughts about yourself with positive statements.

3. Eat Properly
Nutrition has a direct impact on feeling mentally positive. Limit your intake of sugar, fat, salt, caffeine and alcohol and help yourself stay mentally fit.

4. Find A Friend
Friendships are very important to mental fitness. Working on developing and maintaining friendships is one of the best ways to continue growing as a person. Expressing feelings and ideas to another person can help us clarify what’s truly important to ourselves.

5. Learn to Say “No”
Often people feel the need to respond immediately when a friend or family member make a request. Help yourself set limits by avoiding the quick “knee jerk” response in the affirmative. Instead, let them know you will get back to them shortly. Then do a check of your schedule; ask yourself if you really want to add to your load. Give yourself permission to say “No” when you are too busy to take on additional commitments of your time or energy.

6. Exercise
Check with your doctor about what level is best for you. Even a brisk 15-minute walk, three times a week does wonders for how you think and feel.

7. Do It Now
Procrastination can lead to negative feelings about yourself. One doesn’t have to go to extremes, but it can feel very satisfying at the end of the day to have accomplished a hard task or met a difficult situation head-on.

8. Adapt To Rather Than Resist Change
Change is inevitable and is a necessary part of life. The important thing is to be patient with yourself when you are going through change, and to give yourself time to go through the phases of transition. Realize it takes time to let go of the old and embrace the new.

9. Test Your Assumptions
Sometimes in our interactions with other people, we make the most incredible assumptions and act as if they are true. Rather than assuming, it might be worth the risk to ask directly what was meant.

10. Express Your Feelings
Emotions are a natural response to life. It is important to find ways to express your feelings. Journaling your thoughts is one way that can help you clarify what you are feeling. Once you have identified your feelings, you may find it easier to share them with others.

11. Grieve Losses
Sadness and grief are natural and appropriate responses to the losses which we all experience. Grief over the loss of a love one can be very painful and may last for some time. By being kind and allowing ourselves the time to grieve, we have the potential to be stronger than ever

12. Rest
Get a good night’s sleep. Not everyone needs the same amount of sleep, but it should be restful sleep. There are many techniques available to help promote relaxation; or, you might want to check with your doctor rather than assuming your restless sleep is simply something you have to live with.

13. Review Your “Shoulds”
If you feel stuck by some things you “should” be doing and aren’t, set a time limit by which you will either have them done or get rid of them. Staying stuck in the middle is a good way to punish yourself and cause mental anguish and stress.

14. Have A Laugh
Nurture your sense of humor, especially about yourself. Trying to see the humorous side of things makes even the most difficult situations easier to bear. Laughter is good medicine. Being too serious limits your ability to enjoy life.

15. Ask For Help
If you need emotional support or just someone to talk to, don’t be afraid to ask for it. There are times in life when everyone must look outside themselves for comfort and advice. If friends can do the job, ask them to help. If not, be assured that professional help is available through your employee assistance program.

I would like to add a suggestion of my own to the list: Look at art. Even better, create some yourself.

How about you, reader? Anything you'd like to add to the list?

Getting the Most Out of Your Therapy Sessions

2010-07-07T21:45:00.012-05:00

Has this happened to you? You're sitting on the couch talking to your therapist. You look up at the clock and see that you've got only five minutes left. How did that happen? You've got so much more to talk about! You leave feeling frustrated that you derailed from something really important.

What to do?

Check out PsychScamp's helpful suggestions for better time management during your therapy sessions by clicking here.

I would add to PsychScamp's list a therapy tool I often suggest:

Keep a therapy notebook.

This can be any kind of bound (spiral or otherwise) paper on which to write down your important thoughts, feelings, ideas to discuss at your next therapy session, attempts at change, areas where you are struggling, questions for your therapist, the list goes on. It's especially helpful if your therapy notebook has a pocket of some sort to keep handouts and worksheets.

You can shop for a fun, fanciful notebook or, for the recyclers among us, dig up an old college or school notebook that's buried in your office or bedroom closet. Make use of all that empty paper.

The type of notebook is not important. What matters is that you have a space on which to write.

Some people like to keep the notebook by their bed. Jot down thoughts right before going to sleep. Keeping note of worries and to-do lists right before bed can be a helpful tool when struggling to overcome bouts of insomnia. Two birds with one stone?

A note about the length of your entries: Keep it short.

Lengthy, paragraphs-long or pages-long entries can be tiring, prevent you from getting enough sleep, and lead to a dread or avoidance of your notebook. Concise reminders or bullet items are often adequate for therapy material.

Some people prefer to log their thoughts into their handheld devices, smartphones, or computers, etc., rather than use a paper-and-pencil format. Electronic gadgets of this nature can work, too, but not so convenient for keeping track of the paper handouts.

Whatever you do, be an active manager of your therapy time. In many cases, the more involved you are in contributing to the agenda, the more likely you'll get your therapy needs addressed.

Must Love Dogs or At Least Want to Walk One

2010-06-14T09:42:00.007-05:00

In previous posts I have talked about the challenge of finding friends and how to make small talk once you meet new people. Cultivating healthy friendships and getting social support are often such an integral part of therapy.

Not long ago I read a blog post on the topic, 13 Ways to Make Friends. You can read the full post, here.

There are a few additions in the 13 Ways that I hadn't talked about in my posts so I thought I would mention three of them here.

Volunteering: Not only will you come into contact with other caring, proactive fellow volunteers, but receptive and appreciative individuals at the receiving end of your efforts as well. Research has shown that engaging in meaningful work and activities helps alleviate depression, for example.

In short, good feelings can come from helping others.

I should know.

In my city of Austin, Texas, checking out the Get Involved section on the KUT public radio website is a great way to explore volunteer opportunities.

You might check out the websites of your local radio stations, newspapers, churches, or simply ask around. In addition to finding worthwhile volunteer work, asking someone to share their volunteer experiences is a great way to get someone to open up to you.

Get Cyber-Social: Though not as beneficial as face-to-face interactions, joining internet support groups and social networking sites have been shown to help lift a person's spirits and decrease feelings of loneliness. Sometimes that sense of "not being alone" via online discussion forums and emails can add to one's positive wellbeing. Feeling validated in one's thoughts, opinions, and experiences is described as helpful by many.

Whether you explore medical conditions, mental health issues, books, art, music, energy conservation, the list is virtually endless these days, there's a good chance you can find like-minded individuals who are willing to connect online.

Social networking sites, the ones where you can search and reconnect with old friends scattered far and wide, are seemingly the new wave of staying in touch.

But remember, spending time close up and personal, such as having lunch together, taking a walk, meeting face to face, tends to yield more benefits that limiting your interactions to the electronic screen. And second, when moving from an internet-only relationship to meeting in person, please take precautions and observe safety rules.

Get a Dog: Having completed my doctoral dissertation in the area of the health value of pet ownership, I learned there are many benefits, including lowering blood pressure. Increasing social opportunities is another. For example, I worked with someone who met his girlfriend at a dog park.

Studies have shown that people walking a dog tend to be viewed as more approachable and friendly. It's similar to the baby stroller effect. People are drawn to babies and pets, especially dogs.

I cannot say for sure that walking an iguana, say, would have the same effect, but maybe.

Man Pauses While Walking His Iguana

by Matthew Eastmond

I mean, an iguana is a curiosity and there are those that think iguanas are the cat's meow. But there are others who would run in the opposite direction if they saw a small, horny-backed creature scurrying their way. So factor in the social likeability factor when choosing a pet to parade in public.

Puppies probably rate highest but that doesn't mean you should run out and buy a new puppy when you've already got a dog. The expense and effort of too many pets could backfire.

I recently finished a cute book, Must Love Dogs, where the heroine borrows her brother's dog to meet a man from the personal ads and he, too, shows up with a borrowed dog.

The book was made into a really funny movie of the same title, starring Diane Lane and John Cusack, if you'd rather watch it on your home screen. Laughter is the best medicine, right?

Better yet, watch it with a friend. The two-footed or four-footed variety.

Making Marriage Work - A Recommended Book

2010-06-08T18:34:00.008-05:00

Speaking of marital therapy, one book I really, really like to recommend for couples, one that has helped many that I've worked with, probably more than any other (in my experience), one that both partners seem to easily buy into (very important), is The Seven Principles for Making Marriage Work by John Gottman, PhD.

This couples self-help book is fairly easy to understand, fairly straight forward. Gottman uses very common, everyday speak. It's largely research / outcome /evidence based advice, which means he bases his suggestions on findings in a lab, instead of touchy-feely, abstract, unituitive, flowery language that leaves readers feeling good and hopeful but without any explicit tools to apply to their relationship, and thus, no true or lasting impact.

Gottman's Seven Principles deals quite a bit with anger and how a high degree of anger can negatively impact a marriage, whether the anger is externalized - yelling, blaming, name-calling, stomping, hitting, having an affair; or internalized - stewing, turning away, shutting oneself off, silent treatment, self blame, martyrdom.

The portion in the book I refer to most often is the section Gottman refers to as the "Four Horsemen of the Apocalypse" -- four communication patterns to eliminate from your relationship:

1. Criticism - or as one psychologist described them, ad hominem personal attacks. Rather than make a complaint about a specific behavior, followed by a request for positive change, habitual criticisms and verbal attacks are toxic in a marriage or partnership.

2. Contempt - I like to describe this as saying one thing with your words but saying something entirely different, and critical or derogatory, with your voice tone and/or body language. Some researchers believe that 90% of communication is non-verbal. So ugly, harsh voice tone tends to be the loudest of all. Gottman's research has also suggested that men, in particular, are highly sensitive to women's voice tone. Maybe the condescending or critical female tone reminds them of being scolded by dear-old-Mom, the powerlessness associated with those unpleasant memories. I don't know. But it bears reminding that a shrill tone of voice is a huge turnoff.

3. Defensiveness - When faced with a partner's complaint, taking a super defensive posture can be a fast track to getting nowhere. So often in an arguement we see the pattern of complaint, followed by the partner's defensiveness, followed by the same partner's cross complaint.

example:

Partner 1: You don't help enough around the house.

Partner 2: Me? I do plenty around this house! What about you? You never make the bed in the morning and you're always leaving a mess on the bathroom counter!

Defensiveness followed by cross complaint followed by defensiveness followed by cross complaint. It can be an endless, vicious cycle. No one is listening. No one is taking responsibility. No one is offering to make changes.

4. Stonewalling - Shutting down communication is the cornerstone of stonewalling. Refusing to talk, basically. And it isn't only verbal. Meeting a spouse's complaints with a blank stare or a hostile glare or other forms of aggressive body language (arms crossed, jaw jutted out), walking out, otherwise known as storming out, slamming doors, staying gone, pouting, sullen expression, avoiding the spouse who dared to voice displeasure.

Gottman is widely published in professional, peer-reviewed journals. He has been doing research on marriages for more than twenty years, looking at what helps marriage last and what behavioral trends are associated with divorce. He touts that he and his researchers are able to predict what factors bring couples to divorce court 95% of the time. Excessive anger is one communication pattern and behavioral style at the top of the list.

Many troubled couples come from families where a lot of anger was freely expressed and heartily justified. Individuals with this background often come into therapy looking for validation that anger is healthy, that anger is good to express.

Gottman's work cuts right through these justifications. Instead of loud, ranting discontent, expressing wants and preferences in a calm and respectful voice tone is at the heart of healthy communication. Disagreement is healthy, yes. Expressing disagreements is healthy, yes. In fact, Gottman points out that marriage with the least amount of conflict are often the most at risk.

But aggressive attacks and screaming matches? Not good.

Communicating in a healthy, assertive way isn't always natural and seldom is it easy. Gottman's work helps show the way in simple, concrete terms. In a world full of bookstores full of relationship self-help books, this one is a keeper.

Is Therapy Effective for Highly Distressed Couples?

2010-04-20T13:11:00.006-05:00

Inquiring psychologists want to know. Our clinical instincts tell us it must be true. Although we've probably all had days where we have wondered.

Now a large study, the largest of it's kind, in fact, indicates that yes, therapy can help even severely distressed couples, so long as both partners want to save the relationship.

Nearly 135 couples were included in this study. They were provided twenty-six sessions of therapy. Then they were followed for five years after the therapy. Not followed in the creepy stalking way. But assessed at six month intervals for a period of five years to see how they were doing.

"The couples all participated in one of two kinds of therapy. The first, traditional behavioral couple therapy, focuses on making positive changes, including learning better ways of communicating, especially about problems, and better ways of working toward solutions. The second, integrative behavioral couple therapy, uses similar strategies but focuses more on the emotional reactions and not just the actions that led to the emotional reactions. In this approach, couples work at understanding their spouse's emotional sensitivities."

Encouraging results were found. At the end of the study, approximately two-thirds of the couples showed significant improvement.

At the five year follow up, half of the couples remained improved. One third even went from significantly distressed to "happy." Most of us would agree that is a sign of real progress.

Not everyone was helped, however. One quarter were separated or divorced. One quarter stayed the same.

As for the two different types of treatment, long term gains were about the same whether couples participated in the traditional Cognitive Behavioral Therapy or the Integrative Behavioral Couple Therapy.

You can read more about the study in a summary posted at Science Daily, here. Or to read the study in it's entirety by following this link.

Journal Reference:

Christensen et al. Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy.. Journal of Consulting and Clinical Psychology, 2010; 78 (2): 225 DOI: 10.1037/a0018132

One more thing, Dr. Andrew Christensen (UCLA) and Dr. Brian Doss are developing an online training program for couples. If you are interested in signing up for their online study, you can sign up at OurRelationship.com, here.

Tips for Easing Chronic Pain

2010-04-07T09:44:00.006-05:00

Contemplation, I Guess
bas relief painting

Robert Terrell, Lubbock, Texas

Relaxation exercises. Deep breathing, meditation, recalling pleasant memories, progressive muscle relaxation, letting your mind go completely blank, these are all methods for achieving relaxation. For more examples, click here.

Visualization is a powerful relaxation tool. Learn to visualize a peaceful and calming place. This exercise is sometimes called visualizing "special place" or "vacation place." It is especially therapeutic when you use deep breathing tools before you visualize and during.

Pleasurable Activities Choose activities that are pleasureable and take your mind off the pain: listen to music, paint or draw, meet up with an old friend, watch a movie that you associate with good feelings.

Keep a Diary of your pain. Also known as a pain journal. The more aware you are of when the pain intensifies the more in control of the pain you will be. (This will be of value to both you and your doctor.)

Cognitive Skills Try to minimize negative thought patterns. For example if a normal feeling is, "I don't want to do this project." Try changing that to, "I will feel much better when this project is done."

Stop and Rest. Listen to your body when it is telling you that it is tired or in pain. Try to get 7-8 hours of sleep a night and be sure not to over or under sleep.

no umbrella needed

2010-03-28T13:15:00.015-05:00

If you are like me and find the sound

of a gentle rain or a distant thunder storm comforting,

you'll love this internet site:

Rainymood.

Turn on your computer, turn up the volume, and allow yourself to be lulled by one of nature's most soothing sounds by clicking here.

RainyMood sound track is a nice accompaniment to my relaxational deep breathing instructions, posted here.

Make it a part of your relaxation or meditation experience. Or turn it on before you go to bed. Relaxing sounds or music at bedtime can often help people overcome insomnia.

And perhaps the best part? No umbrella needed.

How about you, reader?

What sounds in nature do you find soothing?

Do you have a similar site you can share?

deep breathing exercises

2010-03-04T08:25:00.004-06:00

Breathing Fire by Carmen R. Sonnes

One of the most helpful behavioral tools you can use to manage anxiety, panic, stress, anger, and fear is deep breathing exercises.

Many people with anxiety disorders and anger management issues, for example, breathe in a shallow manner, also known as "upper chest breathing." This type of shallow breathing is unintentional and largely goes unnoticed until something triggers the anxiety/fear/anger mechanism. At this point, a "tightness" in the chest might be felt. Others describe this as "pressure" or feeling as though a heavy "weight" is on their chest. These are classic signs that now is the time to engage in some deep breathing exercises.

Begin by lying flat on your back on a firm surface. A padded, carpeted floor is an excellent location.

You may also sit up straight in a chair, if that is more comfortable. If sitting, be sure your feet are flat on the floor and your knees are level or at a slight decline from your hips out to your knees.

You can also practice this exercise standing upright.

All sorts of choices for all sorts of situations you may find yourself in. For example, I like to do deep breathing exercises while standing in long checkout lines. Gives me something to do besides glare at the slow check writers in front of me.

Lower Abdominal Breathing:

Place your hand on your stomach area.

Breathe as you normally would and notice whether your hand and stomach rise and fall, or your chest rises and falls, as you breathe.

When you are breathing properly, your chest will stay still while your stomach will rise slightly as you inhale. When you breathe out, or exhale, your chest will continue to stay still while your stomach lowers slightly.

To learn to breathe correctly, begin by slowly inhaling through your nose on the count of six while gently allowing your stomach to lift or raise your hand.

Hold the breath for a count of four.

Slowly exhale through your mouth for a count of eight while gently pushing down on your stomach.

Repeat this process for a good five minutes.

It is quite normal to feel slightly dizzy or fuzzy-headed, especially as a beginner. If the deep breathing causes you to begin panicking, only do it for as long as you are able. Increase the length of time each day until you can do the exercise for at least five minutes twice per day. If you continue to practice breathing this way, you may begin doing it more naturally throughout the day.

An additional benefit will be that once you are familiar with the exercise, you may do it while experiencing anxiety or at the beginning of a panic attack, and you may feel relief. The more you practice the deep breathing throughout the day, the more effective you will be at heading off anxiety and panic symptoms.

Tips:

Slow, emptying exhales tend to be the most therapeutic. Really concentrate on exhaling fully. You might experiement with exhaling to the point of emptying your lungs. You want to feel a slight discomfort and then take a relaxing, relieving, natural inhale. Concentrate on the feeling of relief that you are now able to breathe in a comfortable, natural, unforced way. Alternate several natural breaths in between the deep breathing exercises.

Do not be angry with yourself or give up if you cannot do this exercise correctly. It takes practice. Give yourself time. Do not give up.

Do not be afraid of the exercise causing panic. Remember: you are in control and can stop at any time. Take it as slowly as needed.

Breathe by Laurinda Stanton

Small Talk, Big Skill

2010-01-30T13:49:00.014-06:00

Very often in therapy, building friendships becomes a behavioral goal. Two of my earlier posts talk about finding oneself with too few friends and some general strategies for finding friends. This post will give some suggestions on what to actually talk about once you have found people worth getting to know.

Putting yourself in a situation where you can meet people is an important step in the friend-building process. A next, big step and helpful skill is the art of initiating a conversation. A step many people find very anxiety producing. A step many believe they are no good at. A step many people are too afraid to try. A step the leaves people avoiding social situations altogether.

It may be a comfort to know that many people experience social anxiety and many people report having trouble coming up conversation starters. So it never hurts to remind yourself that you're not the only person who struggles to break the ice and make small talk.

But when two people are standing next to each other, and the idea is to socialize, somebody's got to do it, right? And it may as well be you. Especially if you're motivated because (a) you want more connections in your life and (b) someone has caught your eye.

And you never know, the person you're eyeing could be more shy than you. Could be hoping you talk first. Could welcome an end to the awkwardness. This is when you can take a deep breath and tell yourself that your attempt at small talk might just be appreciated.

There are three main types of small talk that I will cover: (1) Ice Breakers (2) Introductions, and (3) Follow Ups. Today's post will concern itself with Ice Breakers. In a later post, or two, we'll talk about Introductions and Follow Ups.

With Ice Breakers, here are some suggestions to keep in mind:

(1) You're not trying to make a deep connection the first time you meet. You don't need to dazzle or impress. You're just trying to get some conversation, any conversation, started. So keep your opener short and simple.

(2) The less you know the person, the less personal your comment or question. Keep your comments neutral and general. Focus on something around you, not about you.

(3) Likewise, the more conventional your location, the more conventional you will want to keep the conversation topics. Conventional means neutral, common, general, maybe even boring. Don't ruffle feathers. Don't try to be profound. Keep it light and upbeat.

If you are in an edgy nightclub, at a rock concert, or watching performance art, taking risks might work. But in general, it's safer to keep your comments bland. You don't know this person yet, or very well, so you don't want to startle, pry or challenge. You want to keep it comfortable. And the less you know about a person, keeping it bland is the safest bet.

(4) Look for something you have in common with the person you're trying to talk to. You may be wondering, what if I don't know this person very well? How you can I possibly know what we have in common. Well, here's the answer. At a minimum, what you have in common is your location.

So look around you. Whether you're in the same room or standing on the same sidewalk, at a minimum you've got your physical surroundings in common. And always? There's the weather.

Here are some general topics along these lines:

4The weather (again, it works).

4Traffic (everybody hates it).

4The building.

4The club, organization or group that is holding the function.

4The sports team that's on the television above the bar (but only if he is paying attention).

4The music that's playing.

4The people you both know.

4The class you're both taking.

4The store in which you're standing in line.

Here are a few examples of Ice Breakers:

At a house party: "Who do you know here?" Or, "How do you know Jon and Cara?" "Do you know this neighborhood very well?"

At a wedding: "Are you here with the bride or the groom?" "How long have you known her?" "Their vows were so unusual. Do you know if they wrote them?" "I know the bride but not much about the groom. Do you know how they met?"

At a neighborhood barbeque: "Do you live in this neighborhood?" "I can't believe how overcast it is today. I hope it doesn't rain." "I see Donna has put in some new landscaping over there. She's really keeping her yard nice." "It's been ages since I've had barbeque. I definately brought my appetite with me today. How about you? Are you much for beef brisket?"

At a restaurant or nightclub: "Have you eaten here before?" "Did you have to wait long for your glass of wine?" "What do you suggest on the menu?" "Have you tried the sushi here? Is it any good?" "Where do people park in this town? It took me forever to find a place."

If you look back at the Ice Breakers I suggested, they mostly tend to focus the topic of conversation away from the personal, away from the individuals involved. Instead they direct the questions to people and things around them.

When someone doesn't know you very well, they may not be interested in discussing anything very revealing about themselves. So wait a good while before asking questions of a personal nature.

Sometimes the person you approach will respond to your ice breaker in a talkative way. But there's also the chance of a lengthy pause, an awkward silence. So a future post will talk about the next step, conversational Follow-Uppers.

Meanwhile, picture yourself in a recent situation where you wish you had tried to start a conversation. Or you did make an attempt but didn't get very far. And now refer back to my suggestions and see if you can come up with a few Ice Breakers of your own. Practicing in your head, or covert rehearsal in CBT language, is a good way to up your chances of success the next time around.

A few links you might find helpful:

Tips for Starting Conversation with People you Don't know by Laurie Pawlik-Kienlen

The Shy Person's Guide to Conversation by Susie Cortright

Small Talk on the Job

And there are books on the topic:

The Fine Art of Small Talk by Debra Fine

Small Talk: The Art of Socializing by Kathy Schmidt, Louise Jordan, and Marisha Rogers

The Art of Mingling by Jeanne Martinet

Conversationally Speaking by Alan Garner

Painting: The Conversation by Shelley Grund

January's Here!

2010-01-06T20:51:00.014-06:00

It's official! January is here! Right now! On this very blog!

Ok, maybe it's not Mad Men's January Jones. Not a television star. Not as good as that.

It's the month of January. The month of resolutions.

Here we go again, right? How am I gonna change this year?

You know the drill. Take inventory. Have my my ready made list of personal disappointments. Doesn't take long, does it? We know each and every one of those suckers by heart, don't we? Every failure? Every mistake?

Now whip it into a to-do-list:

Lose weight.

Drink less.

Exercise more.

Yell less.

Work more.

Spend less.

But enough of that noise. How about something completely different this year?

Maybe resolutions where we take stock in our strengths. Our good points.

What do I like about myself?

That's right. A List of Likeables. What I accomplished this year. What I'm proud of. What brought me joy. Pleasure. Happiness. What I wouldn't change about myself.

Here are some examples of what might apply:

I experimented with a few new recipes. Even liked one of them.

I made my friends laugh.

I finally cleaned out the garage back in June. The fact that it's chaos again? No matter.

Went two months without arguing with my co-worker.

Made a new friend. Or two.

Took a risk.

Volunteered my time.

Showed compassion.

Passed my annual performance eval. Everybody else did, too? So what. I showed up and didn't get fired.

Passed on second helpings. ~~Most~~ Some of the time.

Helped my sour puss neighbor.

Held my tongue.

Paid my bills on time.

Paid down my credit card debt.

Listened to someone who needed to talk.

So, that's the gist of it. An agreement to recall what I like about myself. What I'm happy about.

Therapy couches are full of people who focus exclusively on their faults.

Yes, especially Super Man.

One part of my job is to help people reframe in a more healthy direction. To help clients take credit for the things they have done right instead of continually echoing things they feel shame about. Giving permission to make mistakes. Understanding that inconsistency is the human condition.

So maybe this year we can vow to take it easy on ourselves. Make this a year of uplifting changes. Appreciate my strong points. Cut down on the self-criticism. Try out a kinder, gentler me. Feel good for a change.

And now it's your turn, reader. What is something you will put on your list? What is something you did in the past year that you feel good about? Proud of? Happy about, even? What are your positive traits? What do others like about you? What do you like about you?

Holiday Plan

2009-12-23T17:16:00.008-06:00

Whether your holiday plans involve spending time alone or spending time with a large gathering of family, it's often a good idea to come up with your own Holiday Plan.

What do I mean by this?

A Holiday Plan is one way of making sure the holiday is special and pleasurable for you.

A Holiday Plan can be therapeutic for people who are alone over the holidays. People in transition (recently divorced, widowed, relocated) are especially vulnerable to feeling lonely, alienated, sad, and in some cases, ashamed of their solitary status. Ashamed when others ask them, for example, "Who did you spend your holiday with?" The fear that others will judge them in some negative way or feel pity for them can weigh heavy. Many feel worse about their solo status when confronted with an onlooker's pity, no matter how caring and well-intentioned the concern may be. A Holiday Plan can help fill the gap when asked, "What did you do over the holiday break?"

Sometimes people who are alone prefer the solitude to merry making or the energy required to put on the facade of feeling merry. Take, for example, someone who works two jobs and is looking forward to the precious down time. Or someone who is grieving and prefers the quiet recovery time. Or the recovering alcoholics who refrain from a holiday gathering because they are newly sober and don't trust themselves to be around a spiked punch bowl. There are many reasons for choosing to be alone but the choice isn't always understood, or approved of, by others.

So back to a Holiday Plan. Think about ways you can make your holiday a special time of relaxation or pleasure or holiday ritual.

Make a list. This is a great time to consult with your personalized Pleasant Events List, discussed in an earlier post.

What are some activities that would give you pleasure? Which would help you feel the most refreshed? A hot bubble bath? Reading the latest edition of your favorite mystery series? Video gaming? A phone call to a friend or loved one? Taking a long walk along a scenic trail? Slipping out to see a movie? Starting a new knitting, art or woodworking project? Putting a puzzle together? Baking cookies? Sometimes getting caught up on household chores can be fulfilling. Just so long as it brings you pleasure.

If you expect to be around a large group over the holidays and you anticipate feeling drained rather than rejuvenated, as many of us do, give yourself permission to modify your plans. Excuse yourself for a walk after the large meal. Pass on the egg nog for a healthy drink you have brought as an alternative. Leave early so you can fit in some relaxing alone time at home or in your hotel room. Bring along a fun board game or favorite magazine as an alternative to the usual football game watching. Unless, of course, watching the bowl game is on your Holiday Plan.

Whatever your plan includes, be sure to give yourself plenty of time to prepare. Research a pleasant outing or day trip. Shop for needed supplies. If your list includes cuddling under a blanket, with a cup of hot cocoa (mini-marshmallows on top) while watching several rented movies with a pleasantly scented candle nearby, you will want to make your trip to the video and grocery store in advance. Most stores close or keep earlier hours during the holidays. You don't want your Holiday Plan foiled because you are caught empty handed.

Happy holiday planning, everyone!

Out, Out, Belief System!

2009-12-06T12:01:00.001-06:00

One important therapy tool in Cognitive Behavioral Therapy is exploring thoughts and beliefs that contribute toward an emotional or mental health disorder.

Thoughts can be viewed as relatively simple ideas or statements that guide our self-talk. For people suffering from depression, for example, these thoughts tend to run toward negative, discouraging themes. They may seem quick and random, such as,

I'm never going to get this right!

Or, What is wrong with me?

Or, There's no point in trying.

Cognitive therapy involves paying attention to these automatic negative thoughts, or cognitions, and coming up with healthier alternatives. That is, ultimately changing them or replacing them with more accurate, positive, uplifting, and/or calming thoughts.

Often, in therapy, we CBT psychologists look a little deeper for underlying belief systems that influence our clients' moods and actions.

Gloom and Foreboding

These belief systems, or beliefs, for short, can be made up of a single powerful statement, such as the following examples,

I'm destined for failure.

I can't say no. I hate letting other people down.

Nobody will ever love me.

Something is wrong with me.

Or they can be made up of a series of thoughts that clump together:

Why is my life so hard? At this rate, I'll never get ahead. Why keep trying? It's no use. Every time I take one step forward, something happens that sets me back. I may was well give up.

Belief systems are typically made up of a complex pattern of thoughts that group together to feed and maintain the one, highly charged belief.

Let's take for example a common underlying belief found among people experiencing anxiety and depression symptoms:

Nobody loves me.

Or,

I am unworthy of love.

This belief is usually fueled by dozens or hundreds of smaller impact thoughts.

Look at me! I'm in terrible shape.

She won't come back, I just know it.

I need him. There is noone else out there for me.

I'm not going. What's the use? There's no point in trying to meet anyone.

I'll never find anyone else.

Why would anyone want to go out with me? I have nothing to offer.

I feel so fat and horrible.

I'm disgusting. No wonder he hasn't called me.

All of these thoughts could be related to the core, underlying belief, Nobody loves me. Or, I am unloveable.

One of the keys of CBT is uncovering dysfunctional belief systems, bring them to the light, and helping the client let go of their powerful hold, and move forward.

Sometimes dysfunctional beliefs are formed in early childhood. An abusive, neglectful parent can contribute to their formation. A group of teasing, bullying kids in the neighborhood can do the same.

Sometimes beliefs get started in adolescence or later in adult life, say, when a cherished lover or spouse is abusive, unfaithful, or abandons.

Whatever their origins, the good news is they can be outed and purged using CBT techniques.

More examples of dysfunctional belief patterns to come.

bumper sticker of the month

2009-11-25T16:01:00.004-06:00

Saw this one today on the back of a pick up truck:Happy Thanksgiving, readers.

And please, do not bring your bartender to our therapy sessions. I wouldn't want to have to prove you wrong. The power of positive thinking and all that.

freedom

2009-11-09T09:48:00.010-06:00

There are many reasons I am a big proponent of Cognitive Behavioral Therapy.

Chief among them is the freedom to overcome the unhappy elements of our past.

Freedom to decide that, at this moment, change begins.

Freedom to let go of our former selves.

Freedom to let go of patterns that bring us distress.

Freedom to move forward into wellness.

Today marks 20 years of another, equally profound, form of freedom. Freedom from political oppression.

Twenty years ago today the Berlin Wall came down.

Twenty years ago today 16 million people were united with the west.

How is Germany celebrating?

A long string of dominoes mark the former placement of the wall. Germans will line the colorful wall and watch as the dominoes fall, one by one.

An angel watches over the Berlin dominoes:

The celebration began one month ago when giant marionettes walked through Berlin:

You can see more pictures documenting the event, here.

Congratulations, Germany! Wir gratulieren!

decide not to decide

2009-10-19T20:47:00.000-05:00

Indecision by Pat Kumicich

It is quite common for people to enter therapy in the midst of a crisis. They want answers.

Is my marriage over?

Cognitive therapy is all about replacement thinking. A cognitive therapist will listen for faulty or dysfunctional thinking patterns that are contributing toward a client's lowered mood, anxiety, anger, or indecision.

And sometimes those problematic thoughts are questions. Especially questions whose answers involve major life decisions. Upheaval.

My job is horrible! Should I quit now or find a new job first?

One calming thought replacement is decide not to decide. At this moment, anyway. Perhaps for an undetermined period of time, if the situation allows. Give yourself the time to make a more informed decision.

I'm not happy here. Should I move back to the West Coast?

First we must explore whether there is an urgency to decide now. Many, if not most, of life's crises do not require immediate action. They may, at some point, require a decision. But right now? Not usually. And hasty decisions are often the source of regret or self-doubt down the road.

My neighbors are so toxic. Is it time to move?

What crises typically do require is calm and thorough deliberation. Careful consideration of the options available. Analyzing the situation so that we know what we're dealing with. Generating a range of steps to take before making a drastic change.

By the time someone has entered the therapy room, however, they are often worked up into a frenzy or feeling overwhelmed to the point of depression. They are not thinking clearly. They cannot focus. They are unable to come up with creative solutions. They're engaged in black or white, all or none, thinking.

So rather than focus on making the decision, we want the client to slow down, calm down, reduce the stress, increase the self care, and decide not to decide.

Concentrate on self-soothing. Take care of yourself until you are in a position where you can carefully assess the available information, until it can be gathered in a calm, deliberate and accurate manner. And then reflected on without haste. Seek opinions from respected experts or someone who has been in your shoes.

Slow down.

Get some good sleep.

Regroup.

Think of my options.

List pros and cons.

Consult with colleagues.

Get some support.

Take a walk.

Take deep breaths.

And full exhales.

Again.

And again.

Give myself the time to decide.

In good time.

Decide not to decide.

Until I am ready.

finding friends

2009-10-05T07:19:00.000-05:00

In my last post, I talked about being new in a city and the struggle to find friends.

Years ago, I read a research study dealing with social support. It found that the variable most predictive of a friendship developing between any two people was, simply, time spent together. Not common interests, like I guessed. Not same background or religion. Not age. Not level of education.

Greater length of time spent in each other's company was the factor most associated with friendship bonding. Either long periods of time in one space (think weekend workshop or jury duty) or repetitive intervals across time (weekly art class). Time that allows for talking and getting to know each well enough to break down the barriers and move to a point where calling each other for a get together feels acceptable. Safe. And eventually easy.

I wish it were faster. I wish we could attend a party, walk up to someone new and say, "Hi. I overheard your conversation and you seem like someone I could be friends with." But this rarely happens. It might have been this easy in kindergarten. The older we get, though, the longer it usually takes. We grown ups are a leery lot.

Place of employment is a common venue for making friends. We can see the "time spent together" factor at work here. Many of my clients in this friendless predicament report the social scenerio at their jobs is lacking They might have made slight inroads or none. "Everyone is married." Or, "They're all older than me." Or, "They all do the bar hopping scene. I don't like bars." When friends don't arise in the work place, it can lead to looking around and wondering, "Now what?"

Well, here's one idea for the now what. Remember this one goal: Put yourself into situations where you are likely to see the same people again and again.

Visiting a museum one afternoon is not going to cut it. Signing up for a book club where the same people will be meeting week after week might.

What kind of situations? Start with an interest. A hobby. A creative outlet. An athletic pursuit.

What do I like to do? What am I interested in doing that I've never done before? What have I long wanted to try but haven't made the time to do so? Gardening? Creative writing? Volley ball? Woodworking?

Thumb through the newspaper in the local/metro or life section. Check out informal classes or adult education available at nearby colleges. Read over the available class schedules as a way of getting ideas or jogging your memory: photography, landscaping, stained glass, salsa or country western dance, yoga, walking tours, home improvement, bridge, dominoes.

Look for events that meet repeatedly, once/week or every other, where it seems likely you'll see the same faces on a repeat basis. A one-time seminar on a Saturday is better than sitting home and meeting no one. But a class or support group that meets regularly is a better bet for getting in the time needed to develop a friendship.

Some venues encourage interacting, such as team sports, creative writing classes, support groups, walking clubs. Others are more of a solitary pursuit. Avoid the latter. We want to optimize our recreation and volunteer time. Go where the opportunity for getting to know others is made easy.

The beauty of my plan is this: Even if your pursuit doesn't result in friends, let's say you're not interested in anyone who shows up, you are spending time doing something entertaining, challenging, and fun. You might be learning something.

Another benefit? You become more interesting this way. So when you do meet someone who has friendship potential, you're more likely to have something to offer. To be found friendship worthy.

So starting with something you're interested in is one friendship finding avenue. I'll have more to offer in a later post or two.

feeling friendless

2009-09-24T08:30:00.005-05:00

Living in a large city, I see quite a few people coping with transition. One of the common requests for an initial appointment will go something like, "I'm new in town," or "I've lived here a year," followed by their complaint, typically something to do with depression or anxiety.

Many clients, particularly those beyond their mid-20's, are shocked, at a loss, or somewhat ashamed when they realize they are struggling in the friendship department.

Maybe they were used to making friends easily. Or they remember that reaching out to make friends never was easy but they somehow stumbled into a group of chums.

And now they find themselves feeling friendless. They start to feel the panic rise. How do I do this? Where do I start?

At some point in therapy, it becomes apparent to me that they are struggling to establish friends. It might take us awhile to reach the stage where we decide the client needs to target socializing. It's seldom a problem area people feel comfortable bringing up on it's own. People feel awkward admitting their lack of affiliation. The worry about the stigma of appearing friendless. The fear of being judged as a social dud.

In therapy we explore the client's friendship history. How did they make friends in the past? Did it feel easy or was it a struggle. What types of friendships did they enjoy? Close confidantes or more distant acquaintances? Feel a part of a close knit group or often like an outsider looking in?

We often talk about the ease of making friends in high school and college, in particular. Life surrounded by hundreds or thousands of same-age, similarly situated peers. Mostly single, working part-time jobs, flexible schedules, with a variety of clubs and avenues available to study, exercise and socialize. To make friends. Dorm life is a friendship building tool for the asking. Close to campus apartment living is another. Potential friends all around, within arms reach, even.

Sometimes friends come in a bundle. A sports team. A choir group. Or we start to date someone and they have a big group of friends. We like them, spend a lot of time with them, and gradually they become our friends, too. Though not always easily. This wriggling into and feeling accepted by a pre-existing set of friends can feel difficult for many. Especially when their friendships seem to go back to their days in the nursery. It's a situation ripe for feeling odd-person-out.

Which brings me to relationship break-ups and divorce. These are transitions where friendships are often lost. Partners exit and take their friends with them. You see this in a large group of couples. After the break up, maintaining friendships with those remaining in the couples club is a logistical nightmare. Seeing and hearing about the ex can be too painful. Too close a reminder of what is lost. Learning about their new dating interests. Ouch.

Sometimes the friends appear to take sides. Or they don't know what to do and in their uncertainty, fail to reach out. This can really hurt the person left behind. Loss on top of loss can leave someone with profound self doubt, feeling sad and lonely.

It is well documented in the research literature that socializing on a regular basis is associated with physical health and emotional wellbeing. Feeling connected and cared about, laughing and going places together, keeping busy, exercising together, having someone to confide in. These are all benefits of friendships. It is no wonder, then, that finding oneself in a suddenly-friendless situation is associated with the onset or exacerbation of depression, anxiety, or a number of psychological conditions.

So how does one go about finding friends, exactly? Stay tuned. In my next post we'll talk about the goal of meeting new people and making friends.

this is your brain on stress

2009-09-13T13:33:00.001-05:00

The New York Times reported on a Portugese study which demonstrated that persistent stress changes the structural makeup of the brain. And not in a particularly helpful way.

According to Dias-Ferreira and his colleagues at the University of Minho, brains under chronic stress show an increase in the neurological pathways associated with doing familliar, repetitive, rote kinds of responses, even in the absence of success.

Think of the end of an intense and tiring work week. You find yourself channel surfing, up and down, dozens of times, even though you know nothing is on.

Circling around the kitchen, searching various cabinets, fridge and freezer for a salty/sugary/creamy treat, coming up empty each time.

Then there's the supervisor who schedules yet another staff meeting where the same, tired ideas are passed around, the same ineffectual instructions are issued. Where everyone leaves muttering, "Why do we think it's going to work this time?"

According to the article, brains under longterm stress also show a decrease in neurological connections in "regions of the brain associated with executive decision-making and goal-directed behaviors."

A shortage of problem solving circuitry, in other words. The light bulb burns out. We stop thinking creatively. We shrink away from new and different ways to respond. Instead we retreat into old, familliar and comfortable habits.

We get ourselves into a big, fat, rut. (Pass the Oreo cookies, please?)

The good news is, relaxation helps undo these stress induced changes. Taking brisk walks. A friendly game of hoops. Talking it out with supportive listeners. Thinking positively. Deep breathing. Contemplating nature. Getting away for the weekend. Creative outlets. Good nutrition. A full night's sleep, or two, or three. Exercise. Meditation. Yoga.

So turn off the TV. Stop circling the kitchen. Do something different. Step outside and take several rounds of full inhales and full, emptying exhales. Gaze at the stars. Resolve to get to bed earlier and engage in a healthier self care routine. Talk more respectfully and assertively to loved ones and co-workers. Eventually (four weeks, in the case of the rats in the study) your brain can revive and new connections can branch out.

Recharged, you might just find that the light bulb flickers back to life.

Six Psychology Myths

2009-08-24T15:14:00.008-05:00

Cracked doesn't exactly have a reputation for scientific journalism. But they hit the nail on the head with their six mistaken facts, therein referred to as BS, about psychology that people tend to believe. And spout off at cocktail parties when they don't know they're talking to an actual psychologist.

You can read the whole piece here and I urge you to do so because the writers at Cracked have a way with words that I can't duplicate here.

But I'll summarize:

BS #1: So angry you want to smash something? Think you'll feel better afterwards?

Fact*: Don't. It won't help and will probably lead to more anger down the road. We're better off managing our anger, controlling it, letting go of it, deep breathing and changing the way we think about the situation that is leading to our anger. Less anger is better than "getting it all out" in some kind of aggressive rage. Kind of undercuts one of the selling points of Sarah's Smash Shack. Sorry, Sarah. (But I still wouldn't mind giving it a shot.)

BS #2: You can do anything you want to do as long as you believe in yourself.

Fact: Better success can be had with learning self improvement skills. Take lessons. Practice. Practice some more. And yes, work on improving your self-image while you're at it. Drop negative self-talk. Give yourself affirming messages. But increasing your "self esteem" alone? Probably not gonna cut it, unless you already have a good skill set.

BS #3: People who join cults are naive idiots.

Fact: Cult members are no less smart, on the whole, than you or me. Cults target people who are in transition, vulnerable, feeling desperate, and in need of social affiliation.

BS #4: Subliminal messages cause us to buy things we don't want or need.

Fact: Nope. There's no conclusive evidence that it works.

BS #5: Lie detectors work.

Fact: Slightly better than flipping a coin, yes. Which means, too many times it says we're lying, when we're not. There are ways to beat polygraphs. There are variables that interfere with producing reliable results. They're not admissable in court and with good reason.

BS #6: All homophobes are secretly gay.

Fact: Again, no real evidence supports this widely circulated belief. People who hate or fear homosexuality report a range of reasons. Yes, there are some who are secretly harboring homosexual impulses and they are too ashamed to deal with it. But there are others who rant and rage for the effect or because they've grown up being fed a lot of negative messages about gays and lesbians, not because they're deep down attracted to same sex individuals.

*refers to what is widely believed in the psychological community at this moment in time.

Image source: John Malkovich in Burn After Reading (see it for his performance alone).

Are you Shoulding on Yourself Again?

2009-08-04T21:32:00.000-05:00

In the cognitive part of cognitive behavioral therapy (CBT) we look for thinking patterns that get in the way of healthy feelings and behavior. Thoughts associated with unhappy feelings.

Sad, anxious, angry, shameful, hurtful feelings.

One of the easiest thoughts to identify and change are those that contain the word "should."

Should statements, as they are called.

You should go check on your neighbor. He hasn't been out much lately.

I should exercise more.

She shouldn't talk to her in that tone of voice.

Should statements are one form of automatic negative thoughts, or ANTS. Should implies that someone has done something wrong. Or bad. That someone behind you is shaking a finger, going, "tsk, tsk, tsk, bad person."

The shoulds are often immediately followed by subtle feelings of shame and guilt. Sometimes not consciously detected. But it's there. The essence of it. Building up throughout the day, if you happen to be a daily should-er. Many of us use should statements dozens of times a day, if not hundreds. Out loud or silently, to ourselves.

I should be able to figure this out.

She should be more careful.

You should buy the red sweater.

Shoulding on oneself. Shoulding on others.

The examples above aren't all that toxic, granted. But the effect is insideous. Disapproval. Judging. You're doing wrong. I'm unworthy. These feelings can add up. At the end of the day, we feel more stressed out. More hostile. More _____ (fill in the blank with an unpleasant feeling). Its cumulative. It adds up. I know this personally. I know this professionally.

Even the innocuous, commonly heard response to receiving an unexpected gift, "You shouldn't have!" It delivers an entirely different message when, instead, we say, "You are so thoughtful. Thank you."

How to remedy this common thinking error? In some cases, change should to want. Or wish. Or like.

I want to figure this out.

I wish she would be more careful.

I like the red sweater. I hope you buy that one.

The idea is to change the negative, judgemental idea to something with a positive message. Or more positive. More upbeat. More hopeful.

Below are a few examples that are a little more toxic. Try to change them yourself.

You should watch what you eat.

He should take better care of his car. We're not made of money!

I shouldn't be having these thoughts. She just died, afterall.

And how about the image at the top of this post. Vanity Fair cover of teen television star, Miley Cyrus, aka Hannah Montana, of Disney Channel. Does this image of a 15-year-old bring up a should statement or two?

I don't know about you, but I feel slightly better when I say, "I wish young stars (and their agents) didn't feel pressure to pose in such a sexually suggestive manner." Instead of, "She should not be posing like that. What were her parents thinking?"

Working Out. Must Have Music.

2009-07-24T14:59:00.000-05:00

When I work out, which is to say, when I climb on top of a stair master type contraption in order to get my aerobic exercise, I must have music. Or, better put, I greatly prefer to have music.

These days it's a small mp3 player. No, not an iPod. I can't afford one of those. Only my kids can. Go figure.

Working out with my favorite tunes, selected for their fast paced beat, I get a better workout. I don't think about how tired I feel, or how hard I'm breathing, or how my heart feels like it might explode out of my chest. The music entertains and distracts me. I work out longer and harder.

Today I got to the gym only to discover that I had left my mp3 player in my gym bag, on my kitchen table. Damn. It's always something that gets forgotten. If it isn't my towel, it's my bottle of water. Today it was my music.

I also like to read when I work out. Music plus reading material. I'm in that bad of shape, ya'll.

So I did remember my reading glasses. I grabbed an Oprah Magazine, picked a stairmaster that had one of those plexiglass book holders, found an empty eliptical machine between two gym rats, climbed on, hit QuickStart, and away I rode.

It was then I discovered another reason why I prefer earphones. The guy next to me.

My earphones block the sound of nearby exercisers. Heavy breathing, throat clearage, coughs, sputters, growls, grunts, and groans. And then there was the piped in muzack. Loud enough to be a nuisance, not loud enough to be of any incentive.

Reader, what helps you get a better workout?

night owls get a name and a test

2009-07-05T23:59:00.002-05:00

One evening while walking along a pasture, I looked across toward a giant live oak tree. In the tree sat three large owls. They were perched on two branches, all in a cluster. They made the most picturesque silouette. Still as statues, all facing east, the sun setting behind them. Three sentinels waiting for the darkness to decend, harbingers of a post I had been working on about night owls.

I have long believed I am a night owl. Or as sleep experts would now say, I suffer from Delayed Sleep Phase Syndrome (DSPS).

"Delayed sleep phase syndrome (DSPS) is a disorder in which a person’s sleep is delayed by 2 or more hours beyond the socially acceptable or conventional bedtime. This delay in falling asleep causes difficulty in waking up at the desired time...Most with DSPS describe themselves as "night owls" and say they function best or are most alert during the evening or night hours. If they were to keep a sleep log it would show short sleep periods during the school/work week (with few or no awakenings during the night) and lengthy sleep-ins (late morning to mid afternoon wake up times) on the weekend."

I can remember struggling with insomnia when I was in grade school, lying awake at night singing to my menagerie of stuffed animals. In high school, the singing was replaced by listening to late night radio, The Dr. Dimento Show being one of them. Due to my difficulty waking in the mornings, I was often late to school despite a five minute walk.

It seemed to become more pronounced over time. In college, as I chose my courses (no morning classes, thank you). In graduate school, I wrote the bulk of my dissertation between 10pm and 4am.

When I was offered a job in a psychiatric hospital I was told by the HR staff: "The only problem is that the hours are 4pm-10pm."

Problem? What problem? I loved it. I earned extra pay for late shift, even. I left my job in plenty of time to hit the college pubs, which really didn't get hopping until 11pm anyway. Close the place down and sleep in. Ahhhhhhh. Fit me to a tee.

I recall feeling energetic during this period of my life. I exercised enthusiastically. Typically a walker, I started to jog.

I knew this nirvana night schedule couldn't last forever, though. Eventually I did a one year internship at a medical setting, for example. It required the standard 8am-5pm hours. Oh dread. It about killed me.

But I was hopeful, deciding this was a good experiment: early morning wake up call, everyday, for a whole year. While it did get a bit more tolerable once I caved to the earlier bedtimes, it never, ever, EVER, felt easy. Or natural. I hated mornings as much as always.

So this confirmed night owl wasn't exactly surprised when she learned that researchers identified a particular gene, a mutation, they call it, that determines circadian rhythm. But she did feel vindicated. No, I'm not lazy. No, I wouldn't wake up easier if I'd just go to bed earlier. Okay, well maybe that one is true.

Naturally it's described as a mutation, rather than a variant of normal. But that's okay. I, and plenty of other night owls, have lived our lives feeling like we missed the normal boat.

Back to the gene. The night owl gene was first identified in a mouse, and later in more mice.

This mutation was kindly named the "after hours gene" (AFh). Very aptly named, I would argue, since it's a universally accepted, scientifically verified truth that things happening "after hours" are way more fun and exciting than things happening, say, at 7am (snore).

Everyone wants an invitation to the after hours party, right?

And now one more giant step for night owls. It's been announced there is an official test we can take, a simple mouth swab, to determine if we are, in fact, a morning lark or a night owl.

For more information about night owls, check out the DSPS blog.

Image source: owls, here.

cognitive behavioral therapy, 101

2009-06-26T22:26:00.009-05:00

I get a lot of phone calls from new clients who want to schedule with a therapist who specializes in Cognitive Behavioral Therapy (CBT). They've been told by their doctor, attorney or friend to seek out CBT but they don't know what it is, exactly.

I welcome these questions. When clients are more informed about their treatment, they tend to feel more comfortable in our sessions and do better when they get home. And I don't believe clients who ask these questions are dummies, just so you know (I can't speak for the authors of the book). I expect that most people have little idea what CBT is and I'm happy to explain.

CBT refers to two different components: Cognitive is the thinking part of therapy; Behavioral is the doing.

Very simply, CBT aims to help us change how we think and change how we behave. To recognize patterns of thinking that lead to unpleasant

feelings. To change what we do so that we feel better more of the time.

The example I give most often: You're depressed because you've gained a lot of weight. You feel hopeless about ever losing the extra pounds. Your depression leaves you feeling unmotivated to exercise more.

The cognitive piece of CBT will help identify faulty thinking patterns

that contribute toward gaining weight and feeling depressed:

"I'm never going to lose this weight. Why even try? I give up."
"All I can think about is food."
"I deserve to eat this dessert."

"I can't stand how I look."

"I feel just awful."

"I want to crawl into bed and stay there."

The behavioral component will help identify small changes in behavior that will help you reach your goals (exercise more, eat less). Tweaking the goals in such a way that you are more likely to succeed. Small, doable steps replace lofty, out-of-reach goals.

There are many common, nearly universal thinking patterns that I listen for and teach my clients to hear within themselves. And to change. We'll get to those in later posts.

1st image source here

2nd image source here, but originally found here

mars and venus and all that

2009-06-11T22:42:00.000-05:00

Questions by my "single and looking" clients that leave me most bewildered go something like this:

"He gave me his phone number. What do you think he meant by that?"

Or,

"Do you think that means she wants to go out with me.... or not?"

According to the old school rules of dating, women are supposed to play hard to get and men are supposed to ask a woman straight out, right? And that mars and venus guy? Even he tells us we're looking for different things in a relationship.

Does any of this conventional "wisdom" hold true?

Wisdom, by the way, is codeword for advice given by people who have lived a whole lot longer than you but really have no clue how the dating game is played, either.

But thanks to a couple of dating studies summed up by the good people at BPS Research Digest we don't have to rely on antiquated advice. And we may now be able to say that we are finally beginning to meet up on the same planet.

In 2006 researchers studied what types of come-on lines women see as most effective when a man is trying to show he is interested.

Women, according to this study, are positively swayed when men demonstrate their helpfulness, generosity, athleticism (really? this works?), "culture" and wealth (again with the really?). They are unimpressed by jokes, empty compliments and sexual references.

And how about the guys? What works for them? A 2009 study found that men are most convinced when women use straightforward forms of communicating compared to more subtle lines. So the direct, "Let's go out sometime," is seen as more effective than the indirect, "Is that an iPhone in your pocket or are you just happy to see me?"

And here's where the common planet comes in. Neither men nor women find sexual humor and innuendo to be all that helpful in figuring out whether to expect a follow up phone call. Or text. Or email. Or Facebook friend request. Let alone a date for Saturday night.

So according to the latest in dating research, if you are really interested in a particular someone you are chatting up, here's some potential applied advice.

Women, you might say something like this:

"Want to go out sometime?"

And men, you would say something like this:

"Thanks to my speed and strong throwing arm (athleticism), I caught a little old lady (helpfulness) who stumbled in my Buddhist meditation class (culture). She was so appreciative that I offered her a ride home in my Porsche (wealth) and donated a sizeable chunk to her charity fundraiser (generosity)."

And then you would suggest a night on the town.

Actually, I added that last piece of wisdom. Because it kind of seals the deal, doesn't it?

If you want to read these studies for yourself, in their entirety, you can either go to your nearest university library and look for the journal called Personality and Individual Differences, or, click on the links below and pay $31.50 each to purchase the studies online. You can also read a more in depth explanation here at PsyBlog.

Bale, Christopher, Morrison, R., & Caryl, P. G. (2006). Chat-up lines as male sexual displays. Personality and Individual Differences, 40(4), 655-664.

Wade, Joel T., Butrie, L., & Hoffman, K. (2009). Women’s direct opening lines are perceived as most effective. Personality and Individual Differences, 47 (2), 145-149.

Image source: Oil on canvas by Illingworth, 1971, found here.