December 9, 2013
WHY CBT INSTEAD OF MEDICATION?
I am in the process of researching the professional literature to write an article about anti-depressant use vs. cognitive-behavioral therapy (CBT) for the treatment of anxiety and depression. Although I was trained in behavioral medicine and supported the need for medication for these conditions, the more I research and read the literature the more concerned I have become about medication.
In a nutshell, the research does not show medication to be more effective than CBT but does show greater serious side effects. The question is: are the side effects of medication really worth the ease of use when it is no more effective than more natural methods provided by CBT?
Until I finish my more comprehensive review I thought I would share the following article I came across that is written by a psychological researcher: Things Your Doctor Should Tell You About Antidepressants
December 5, 2013
MAKING AN ASSERTIVE COMPLAINT
I'm sure that you have experienced the frustration of making a complaint to the customer service of a large company such as the phone
company or cable company. Recently I heard my husband handle a complaint about a package delivery and I thought his words were pure magic.
How we handle the daily "hassles" of life can impact our overall stress level which can influence our health. People recognize the impact of major stressors but they
may not realize how much these daily hassles can add up to impact our quality of life. Living in this modern world, our daily hassles seem
to have multiplied exponentially. So we need to have methods to manage these situations. Unfortunately, many people either release their
frustrations to the customer service representative or they hold their feelings in. Either of these methods are probably not very effective
at solving the problem.
So, what can you do? First, it is important with assertive communication to remain calm and pleasant. Explain the problem as clearly and
succinctly as you can.
And the magic words? "I'm sure this is not up to <COMPANY NAME> standards." I love this! How can they argue with you? The most likely response is
"No, that is not up to our standards" and once you have someone agreeing with you they are more likely to help you. One caveat: this may be more
effective when talking to someone at the managerial level.
December 4, 2013
The above audio is part of a series of short mindfulness practice exercises to help train your brain to be more mindful or present focus.
This mindfulness practice is particularly helpful in learning to create a trigger for being more mindful in daily activities. By practicing
mindfulness with one of your first activities of the day, it can help you remember to create mindfulness throughout the day.
December 3, 2013
PsychNote: MANAGING CHRONIC PAIN THROUGH “DECENTERING”
For many people with chronic pain, the pain becomes the center of their attention, focus, and life. They feel unable to engage in many of life's pursuits and often avoid activities and isolate. Unfortunately, this self-protective behavior may have the opposite effect of what is intended. The individual is trying to reduce pain by reducing demands and activities. Yet, instead of reducing pain, this behavior may prevent the individual from functioning and may even increase the experience of pain.
Cognitive-behavioral therapy (CBT) methods can help reduce the intensity of pain as well as improve functioning. In particular, the concept of “decentering” is to learn to observe the self and the pain from a distance or in a more detached manner. Researchers Lance McCracken and colleagues (2013) suggest this approach is related to mindful acceptance and psychological flexibility which is the ability to be present-focused and aware in a non-judgmental way of immediate experience. Although this research found a relationship between the ability to “decenter” and a higher quality of life for chronic pain patients, they did not examine teaching this method to determine if life function improved.
However, these methods are standard procedures in CBT which focuses on teaching people how to think differently to better manage problems. The “decentering” method teaches people to mindfully step back from the thoughts and feelings and examine them more objectively. As they do, thoughts such as “I'm in too much pain to go out with friends” can become “I will hurt no matter what so I might as well enjoy the company of friends.” By focusing on the event rather than the pain, the individual is able to detach from the pain experience. The pain becomes less of a focus and is more likely to decrease in intensity.
Obviously, this method takes practice and time to master so it is not as attractive as fast-acting medication. Yet it is more likely to improve the overall quality of life and does not have the side-effects of medication.
McCracken, L.M., Gutierrez-Martinez, O. and Smyth, C. (2013). “Decentering” Reflects Psychological Flexibility in People With Chronic Pain and Correlates With Their Quality of Functioning. Health Psychology, 32, 820–823.
November 29, 2013
Explains what panic is and is not, how it is maintained by the anxiety cycle, and some methods to learn how to control it.
In addition, you may want to download the free Panic Assistance Audio
that coaches you through a panic attack.
"...even panic is normal. Most of us will experience a spontaneous panic attack some time in our life...Because a panic attack feels awful many people assume that it is dangerous..."
November 25, 2013
Describes how to change irrational thinking styles by using the cognitive diary technique. In addition to the Cognitive Diary technique on the
website, you can also download the Cognitive Diary CBT Self-Help app
for Android devices (update just announced previously).
"Our thinking is very changeable. If you worked on changing your thinking everyday by reading, listening to the audio exercises, and
completing a cognitive diary you will find your thinking changing even within a few weeks."
November 23, 2013
This Excel At Life android app helps to identify irrational thinking that can contribute to anxiety, depression, conflict, and other life problems. The update makes the interface more user friendly. This app has had nearly 150,000 downloads since it was first released 2 years ago.
The Cognitive Diary is a method in which you record your thoughts and feelings about a situation. Then you examine your thoughts to determine the accuracy. If the thoughts are irrational, you develop a way of challenging the thinking and use the challenging thoughts repeatedly until they become automatic.
For more info: Understanding and Using the Cognitive Diary
November 20, 2013
Discusses the concept of happiness and the common obstacles to achieving happiness. Reviews the methods on how to reduce the obstacles to happiness.
"...happiness doesn't come with fireworks and a parade. Instead, it sneaks in quietly as the night so that you don't realize it has been there for awhile."
November 18, 2013
Discusses the concept of adapting to change and how CBT can improve psychological flexibility.
November 17, 2013
New PsychNote: REWARDING DESIRED BEHAVIOR VS. EVERYONE GETS A REWARD
Behavioral modification of childrens' behavior is based upon reinforcing desired behavior with a reward. It requires identifying a specific behavior as a goal and rewarding that behavior. However, our society seems to have confused this concept. It seems that the concept of reward is understood, but not the concept of identifying the specific behavior.
As a result, we have seen where praise is given indiscriminately rather than based on the behavior. For example, “You are so smart!” rather than “That was wonderful in how you persisted in figuring out that problem!” As you can see, the second statement encourages a specific behavior (persistence) whereas the first statement is too general and doesn't indicate anything the child can do to obtain the reward of praise.
Our society believes that if praise is good, then lots of praise must be even better. But nothing could be further from the truth. Indiscriminate praise teaches a child that he/she doesn't have to do anything to obtain reward—just the fact that he/she exists is enough. Trying to raise a child's self-esteem with meaningless praise can do more harm than good. Children are smart enough to know the difference and can come to believe that they must not be very capable or talented if the adults in their lives can't identify specific things at which they excel.
Children need to learn to strive for something. However, if we reward all behavior or if everyone gets a trophy, children learn there is no point to their effort. Giving them direction, a goal to strive for, helps them to succeed.
For example, research has shown that rewarding school children engaged in cooperative behavior improves that behavior (Embry, 2002). However, such reward involves such things as a longer recess for the winning team. Isn't that interesting? Competitively rewarding cooperative behavior improves cooperation!
Therefore, eliminating competition is not the answer. Competition is important. However, we need to pay greater attention to how it is done. Competition needs to focus on improving the self rather than defeating opponents. As parents, educators, coaches, we need to identify the specific behavioral goals and how we will reward them. Yes, this takes more work than indiscriminate reward, but when done right, it is much more effective.
Creating the right kind of nurturing environment in schools and homes that can provide appropriate specific rewards with limit-setting can improve overall well-being as well as the ability to act based upon long-term goals and values (Biglan et al., 2012). In other words, children learn through competition and limits but we need to clearly define what we want to teach and how the reward and limits achieve that goal.
Biglan, A., Flay, B.R., Embry, D.D. And Sandler, I.N. (2012).The Critical Role of Nurturing Environments for Promoting Human Well-Being, American Psychologist, 67, 257-271.
Embry, D. D. (2002). The Good Behavior Game: A best practice candidate
as a universal behavioral vaccine. Clinical Child and Family
Psychology Review, 5, 273–297.
November 12, 2013
The above audio is part of a series of short mindfulness practice exercises to help train your brain to be more mindful or present focus.
This mindfulness practice is particularly helpful in learning to create a trigger for being more mindful in daily activities. The more you do
this exercise, it will become a reminder and train your brain to trigger mindfulness for whatever you experience after touching the door knob.
Some people may be curious as to why this website is
dedicated to the "pursuit of excellence" when I am
constantly warning about the dangers of
perfectionism. To address this question we must
differentiate between the pursuit of excellence and
the need to be perfect. These concepts are not only
different but can be considered antagonistic to one
another. In fact these concepts are so opposed to
one another that excellence can best be attained by
giving up the demands of perfection.
What is Perfectionism?
is the individual's belief that he or she must be
perfect to be acceptable. Perfectionism is black and
white with no gray area. Anything other than perfect
is failure. Perfectionism is an attitude, not
necessarily a behavior. In other words, two people
can engage in the same behavior such as trying to
win an Olympic gold medal but one can be pursuing
excellence and the other is demanding perfection.
The difference lies in the thought process about the
goal or behavior, not in the goal or behavior
Listening to the weather forecast one frigid day, I
realized how much we are influenced by the
catastrophic thinking of the media. The weatherman
reported, "The weather has brought more misery
to the St. Louis area." Certainly, the weather was
causing problems that day. An ice storm caused car
doors and locks to be frozen so that people had a
great deal of trouble getting into their cars.
However, I thought, unless someone was in the middle
of nowhere with no cell phone and they were unable
to open their car door because of the ice, this was
not "misery." Instead, I would call it an
"inconvenience." Most of us walked out to our cars
to find that we couldn't open the door, went back
inside a warm house or office, and found some
solution to our problem.
For many years when my husband and I were first
together I would ask him "When are things going to
get better?" We were dealing with the usual
stressors that couples face: not enough time, not
enough money, and the inevitable random events such
as family conflict, deaths of loved ones, illnesses
and injuries. In addition, for most of our early
years together I was in school and struggling with
the balancing of demands of advanced education,
part-time work, and a family.
But I had the belief that we were working towards
this perfect life that one day would emerge shining
a rainbow of happiness forever over us. My husband,
inclined more toward the practical, just answered my
question of "When are things going to get better?,"
with "Another six months." That answer typically
pacified me for awhile because I thought I could
handle any amount of stress for six months.
However, a point would occur when I once again I
asked my husband "When are things going to get
better?" Once again, he would answer "Another six
months." This scenario occurred fairly routinely
for many years.
However, fortunately during this time I had
experiences that began to teach me about my
expectations of life. In particular, when I was
completing my internship at the Veterans
Administration Medical Center I had the opportunity
to work on the spinal cord injury unit. That
experience forever changed my thinking. In
particular, I was struck by the differences in
attitude among the patients.
Not a day goes by when I don't throw down the
morning newspaper complaining about the use of
statistics in an article. In our world the media
liberally sprinkles statistics throughout articles
and television programs to support a point of view.
The problem, however, is that statistics are
frequently misleading if not outright inaccurate.
Without a clear understanding of the nature of
statistics and the definitions of statistical terms,
the public believe the statistic-supported
statements as if they are fact. In addition,
without understanding the agenda of the journalist
or analyst using the statistics, the public accepts
these "facts" uncritically.
Frequently, I am asked how to handle irrational
jealous feelings. Usually, the individual
recognizes that her feelings are unreasonable with
no valid evidence but feels incapable of controlling
the jealousy. In addition, the person usually
recognizes the destructive nature of indulging in
the feelings and the resulting behavior. Such
behavior typically involves excessive questioning of
her spouse, suspiciousness, and accusations. Many
spouses become extremely frustrated with this
behavior because they have no way of proving their
faithfulness. This leads to an escalating cycle of
anger which is used as further evidence by the
jealous spouse that her suspicions are correct.The jealous spouse often desperately wants to stop
the behavior but finds that he can't control the
thoughts which makes him feel miserable. He
believes that if he can just prove his suspicions
one way or another, he will feel better. The
unfortunate fallacy in this thinking, is that trust
can never be proven; it can only be disproved. The
definition of trust is the belief
something is true. Therefore, without evidence to
the contrary, if we want a satisfying relationship,
we have to choose
to trust the person we
don't have any willpower."
"I can't do it."
Do these statements sound familiar? Too often, our
self-statements about weight management interfere
with our efforts and lead to failure. By changing
how we think about developing a healthy weight we
are able to change the behaviors that can lead to
Not long ago I conducted a little experiment with my
cardio-kickboxing class. After an intense class I
told them to get the heaviest weights they could
curl 8-10 times. I spent a minute telling them to
focus on feeling tired, that they had just worked
out hard and they couldn't do anymore. Then, they
were to curl the weights to exhaustion. Once they
finished, I spent another minute telling them to
focus on having energy, feeling good, feeling
refreshed, and knowing they could do more. Once
again, they lifted the weights to exhaustion. The
results were that out of nine people, only one did
fewer lifts the second time! And typically, when
someone lifts weights to exhaustion they should not
be able to lift as much the second time when it is
only a minute later. Although this was not a
controlled scientific experiment, it was a
demonstration to my class to show how powerful our
thinking can be. What this exercise showed was how
positive thinking overcame the natural exhaustion of
the body and created a self-fulfilling prophecy of
lifting more weight because the participants
believed that they could.