by Monica A. Frank, Ph.D.
Clinical and Sport Psychologist
November 16, 2015
When Doctors Don't Listen
Have you ever had a medical situation where you understood your body and what you needed better than your doctor but the doctor wouldn't listen to your needs? Unfortunately, such scenarios happen too often. A particular issue for many people with mental illness is that physical complaints or anxiety about medical treatment is viewed by health professionals as part of the mental illness and not taken seriously.
Even in situations where guidelines exist for the medical professionals, communicating the proper information can sometimes be difficult. My husband, for instance, couldn't get medical staff to understand his serious adverse reactions to certain medications so he just started listing them when asked, “Are you allergic to any medication?” even though he wasn't technically allergic to the medications. By doing so, however, the staff seemed to understand but usually didn't follow-up for more information. Best medical practices indicate that the question about allergies should include “adverse reactions” as well as determining the type of reaction (Lyons, et al., 2015).
Interviews with diabetics educated to self-manage their disease showed that many had difficulty explaining their training to doctors who wanted to handle treatment differently especially when hospitalized. Diabetics who know how to manage their blood sugars wouldn't be allowed to self-control in the hospital (Snow, et al., 2013).
In our health care climate today, doctors are overworked with more documentation demands so it seems that the aspect of patient care that suffers is truly listening to the patient. As a psychologist examining the report regarding diabetics' communication with their doctors, I concluded that more attention to assertively communicating their needs could have helped improve the interactions. Certainly, it would be best if medical professionals were better trained in collaborating with patients, but patients need to be prepared when the ideal situation doesn't occur. Read more...
November 6, 2015
Mindfulness: What's in a Name?
When we are talking about mindfulness, we are often referring to several different aspects of mindfulness. Depending upon each individual's needs, the practice of mindfulness may look very different which can lead to confusion about what mindfulness is. “Simply put, some researchers, clinicians and Buddhist scholars have suggested that mindfulness...has been altered from its traditional Buddhist construction to such an extent that it is inaccurate and/or misleading to refer to the resultant technique as ‘mindfulness’ (Van Gordon, et al., 2015).”
When working with clients I recognize they have various needs. Some just want to feel better and need some tools to help with that. Some need to learn to tolerate uncomfortable emotions. Others need a new approach to life or a change in perspective. However, when using a mindful approach to each of these goals we refer to it as “mindfulness” which can be confusing when trying to explain or define mindfulness. To reduce the confusion, we need to have clearer terms: Read more...
November 2, 2015
Efficiency: Determining the Difference Between Perfectionism and Striving for Excellence
The primary problem with perfectionism is that it reduces efficiency. This leads to the conclusion that if you are trying to be perfect in a way that makes you more efficient, then you probably aren't being perfectionistic. In other words, it isn't the striving to be perfect that is the problem, it is whether it interferes with your life. Such interference can occur in several ways:
1) Takes longer to complete tasks
. When a person is worried about making mistakes they tend to be slower in completing tasks because they may be excessively precise or need to check their work repeatedly. By doing so, they become less efficient in their work.. Read more...
October 27, 2015
Mindfulness Practice and Relapse Prevention When Using Anti-depressants
It has long been shown that discontinuing anti-depressants has a high relapse rate. However, when mindfulness training results in greater emotional tolerance, not only does the relapse rate decline but improvement continues. Learning how to decenter from mindfulness training increases curiosity and the tolerance of thoughts and feelings because they are viewed as temporary events in the mind (Bieling, et al., 2012).
Previous research that examined patients treated with anti-depressants and then randomly placed in groups to either continue with the anti-depressants, receive a placebo, or discontinue anti-depressants to receive Mindfulness-Based Cognitive Therapy (MBCT) found no difference between those who remained on the medication and those who stopped medication and were trained in mindfulness techniques (Segal, 2010).
However, additional research examining the same patients showed that when mindfulness training results in greater emotional tolerance it continues to reduce depression after medication is stopped. Read more...
October 26, 2015
The Mindful Journey
When I first started learning Tai Chi, I expected to learn everything, every move within a few months. I wanted to master Tai Chi in ten easy lessons. I saw all knowledge as something to be conquered—tell me how and I can do it.
Instead, I discovered frustration. Just learning the movements seemed impossible. Normally, I have a good memory. In fact, at the same time I started Tai Chi I was learning katas in my karate and I could easily remember those. But the Tai Chi movements eluded me. Wasn't it just another kata, I thought? I bought books to help me remember what I was being taught, but I still couldn't seem to get the movements down. I almost quit out of frustration but my instructor told me to not worry about memorizing the movements. He encouraged me to just attend and enjoy the class without even practicing outside of class. Read more...
October 21, 2015
Intuitive vs. Deliberate Thinking: Which is Better?
If it takes 5 hens 5 days to lay 5 eggs, how long would it take
100 hens to lay 100 eggs? _____ days (adapted from Cognitive Reflection Test, Frederick, 2005).
When answering this question, for our purposes, it is not whether you got the right answer, but how you went about answering the question. Intuitive thinkers will jump to an automatic response that is often incorrect whereas analytical thinkers will think through the math of the problem and more likely achieve the correct answer. Therefore, this test is not an intelligence test as some people describe but shows how you think through problems. Read more...
October 17, 2015
The Benefits of Mindfully Washing Dishes
Simple daily exercises can increase your mindful state. Researchers gave subjects a passage to read prior to washing dishes. Half the subjects read about the sensory mindful experience of dishwashing and the other half read about dishwashing techniques. Those who read the mindful approach to dishwashing showed a 27% decrease in nervousness and a 25% increase in mental inspiration whereas those who read about techniques did not show a significant change (Hanley et al., 2015). Read more...
October 15, 2015
Being Too Aware of Your Body Can Lead to General Worrying
Excessive worrying can be problematic for some people causing extreme anxiety and interfering with relationships. The official diagnosis for this problem is called Generalized Anxiety Disorder (GAD). Interesting research by Andor and colleagues (2008) shows that being too attentive to the normal physiological changes in the body can lead to excessive worrying.
Everyday, we all have changing physical sensations in our bodies which can fluctuate from hour to hour or minute to minute. Most of us dismiss these normal fluctuations before they even reach our conscious awareness. However, the researchers found that those with GAD are more aware of these sensations. Read more...
October 7, 2015
The Difference Between Mindful Focus and a Mindful Attitude
In some ways, it is unfortunate that mindfulness is becoming more mainstream because it means that the term (if not the concept) is being co-opted and used in ways that are not necessarily an accurate reflection of mindfulness. For instance, someone just pointed out to me that the military is using mindfulness training to improve the effectiveness of their soldiers. In other words, potentially to be better at killing (although a case could be made that it makes them better at problem resolution—one resolution which may be killing).
In any case, I would not call this training “mindfulness.” Instead, it is teaching the soldiers to be mindfully focused similar to an athlete being “in the zone” or “in the flow" (although perhaps some of those soldiers will move on to developing a more mindful attitude). The techniques that are used in this training may come from the mindfulness practices, but it is not true mindfulness. Mindful focus does not have the ability to bring peace to the world because it only uses one aspect of mindfulness. Which is why I refer to developing “the mindful attitude.” Read more...
October 6, 2015
Cognitive Diary Training Example: Husband's Unreasonable Expectations of ADD Wife
: Husband doesn't understand my ADD and gets angry.
: frustration, agitation, exasperation
: 6--Feeling bad
: "My husband knows that I suffer from Attention Deficit Disorder (ADD} which means sometimes I'm not really in the moment when I am doing something. The way he pushes my buttons is to put something somewhere and leave it there knowing that I am working or cleaning in that particular area of the house and he does not say "I need you not to move or touch this thing right here." Then he becomes loud and aggressive when I move it and do not realize where I moved it to.”
CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE?
There are at least 3 irrational beliefs.
HOW CAN YOU CHANGE THE THINKING?
What is another way of thinking about the situation that won't cause the feelings of frustration, agitation, and exasperation?
TAP HERE FOR ANSWER
October 4, 2015
Passive-Aggressive Example: Husband's Unreasonable Expectations of ADD Wife
Question: My husband knows that I suffer from Attention Deficit Disorder (ADD} which means sometimes I'm not really in the moment when I am doing something. The way he pushes my buttons is to put something somewhere and leave it there knowing that I am working on cleaning in that particular area of the house and he does not say "I need you not to move or touch this thing right here." Then he becomes loud and aggressive when I move it and do not realize where I moved it to.
TAP HERE FOR RESPONSE
October 3, 2015
Mindfulness Training Shows Promise for Attention-Deficit Hyperactivity Disorder
A number of studies show that mindful techniques can help reduce the problems associated with Attention-Deficit/Hyperactivity Disorder (ADHD). Research is still in the early stages and more is necessary to draw strong conclusions. However, this early research is promising in showing that mindfulness training can improve attention and behavioral control among those with ADHD.
A study that examined mindfulness training for adults with ADHD showed not only improved ADHD symptoms but also a comparison with medication indicated that mindfulness training can be just as effective as medication for controlling the symptoms. Read more...
October 2, 2015
Forgiveness and the Process of Healing
: Often people think of healing, if shown on a graph, as a straight line rising upward showing progress. Although they recognize healing has its ups and downs, they still expect movement to average out to a straight line showing improvement. Thinking of progress this way, if they return to a familiar issue they believe they have already dealt with, they think of it as backsliding and feel like they are starting over.
However, I like the concept of “recursion” which I think describes more accurately what people experience when they are healing. The word “recursion” comes from computer science and refers to a method of programming where the ultimate solution to a problem depends upon having solved previous aspects of that problem. To best explain the recursive process, think of a spiral staircase. What you see, instead of a straight line, is a line that proceeds in a circular fashion but rising from level to level. When you walk to a higher level on a spiral staircase and look at the view it is the same as what you saw at the same point on the lower level but your perspective has changed. You now see it in a different way from the higher viewpoint.
Many times my clients will say “I thought I resolved this issue. Why am I dealing with it again?” If you think of progress as a spiral, you can see that it is rising from level to level. However, as you proceed through each level you come back again and again to the same point—the same issue. But you're returning to that issue at a higher level with a different perspective.
September 24, 2015
Think Multi-tasking Makes You More Efficient? Think Again!
Do you often do more than one thing at a time to get more done?
Do you believe that multi-tasking makes you more successful?
Does your work require multi-tasking to make employees more productive?
Guess what—multi-tasking is a myth. I'm writing an article to explain this in more detail. However, I just came across an interesting research study I thought I would share about multi-tasking with everyday entertainment.
September 22, 2015
Free Educational Audio! Distrust of Others and Learning to Discriminate
Those who have been severely hurt or traumatized by others often have problems with trust. They may distrust everyone or trust someone too much. This audio discusses the concept of trust and to learn to discriminate. In other words, learning how much you can trust someone and to what degree you can trust them. In this way, you can examine others motives and behaviors more realistically and decide whether they are someone who you want in your life.
This audio, in combination with other audios and resources on this site can help you with problems of distrust. However, as with all the resources, it is best to review the transcript with a mental health professional to determine if it is appropriate for your situation.
TAP HERE FOR AUDIO
September 20, 2015
Women and the Decline of Violence (Part 3)
In his book, The Better Angels of Our Nature, Dr. Steven Pinker observes from the historical and statistical evidence that violence declines with the “feminization” of society. In other words, as women develop greater influence in a society and are not relegated to subservient or invisible roles, violence declines.
Women have often been thought to be a major civilizing force of society. Ralph Waldo Emerson in the 1800s stated “I have thought a sufficient measure of civilization is the influence of good women.” The impact of women upon the amount of violence in a culture makes sense given the greater emotional empathy that women experience. “Emotional empathy” is the ability to feel intensely others' experiences as opposed to “empathy” which is the ability to understand others' experiences. It is the difference between “I feel your pain” and joining in their tears versus “I understand you are hurting.”
September 19, 2015
165,000 Health Apps and Excel At Life's Apps are Selected in the Top!
IMS Health has chosen at least six of Excel At Life's apps to be included in its AppScripts program for healthcare professionals. IMS Health evaluated over 100,000 health apps: “Each app is assessed using our proprietary IMS Health App Score, which ranks apps based on functionality, peer and patient reviews, certifications, and their potential to improve outcomes and lower the cost of care.” AppScripts is a program that allows healthcare professionals to prescribe apps to patients, send the apps directly to their patients' device, and monitor their usage over time.
Excel At Life's Cognitive Diary CBT Self-Help
is listed in the top 5 of the Android health apps with a score of 91 (out of 100). Three of Excel At Life's apps are the top three in the depression category: Depression CBT Self-Help Guide
and Happy Habits: Choose Happiness
in addition to the Cognitive Diary app.
September 16, 2015
Are We Evolving? Thoughts on Violence (part 2)
As I read Pinker's book (The Better Angels of Our Nature: Why Violence Has Declined) it occurred to me that the evidence he provides shows how human nature is changing for the better. Particularly, it shows the development of a collective conscience. What I mean by this is that as humans we develop individually and collectively. We each have an individual conscience that is based upon our experiences and beliefs. However, society can also have a conscience which is what we impart to the people of that society either through explicit education or in implicit ways such as how we treat one another. For instance, at one time, public hangings were entertainment—families would pack a picnic lunch and go to town to watch the hanging. Now, we find that reprehensible by today's standards (although we may not be above watching people degrade one another on reality TV). Read more...
September 15, 2015
Violence is Declining
Most people find it difficult to believe we are living in the most peaceable time in human history. We tend to be nostalgic for the past believing we were safer, times were simpler, and we were happier: “In the good ole' days...”
Why do we have the impression that our world is becoming more violent? Because media has mushroomed. At one time the U.S. only had three television networks and the news was focused on providing facts. However, now with the proliferation of media, to stay in business the media has to get our attention. And how do they do that? By playing on our emotions. Sensationalizing. Fear grabs our attention. The media is like vultures, circling, circling, above the dead. Almost relishing the sordid narratives they spin, sort of like the neighborhood gossip seeking attention by delightedly describing the tales of woe of her neighbors: “Did you hear about the Smiths?! Well, let me tell you...” Read more...
September 11, 2015
20 Steps to Better Self-Esteem
Step 20. Re-write Your Life Script.
If you have been working through these steps, some time has passed since you wrote your first life script. It takes time to practice each of these steps until they occur more automatically so it could be six months or more since you wrote it. But if you have been practicing the steps consistently over a period of time, your life script should have changed. It is time to re-write your life script.
If you have not been consistently working on these steps for at least six months, stop here! True change is not simple and the mistake that most people make is wanting quick change. Someone who loses 20 pounds over six months is more likely to keep it off than someone who loses 20 pounds in six weeks. Take the slow road and you are more likely to be successful at permanent change.
Re-writing your life script can consolidate the changes you have made and continue to reinforce your self-esteem overtime. In addition, it can help you determine whether you need to address any of the steps further. Read more...
Index to 20 Steps to Better Self-Esteem
September 10, 2015
20 Steps to Better Self-Esteem
Step 19. Redefine Rejection.
Many people with low self-esteem engage in “impression management” which is the attempt to influence how others perceive them. Instead of being genuinely who they are, they act in a way to get approval from others: agreeing with others when they have a different opinion, dressing or acting in certain ways to conform with others, trying not to be noticed in a negative way. Interestingly, even people who appear to not care about approval because they are acting in ways that might give rise to disapproval, if you examine their primary group, their behavior may actually be approval-seeking. I think a good example of this is terrorists or people who belong to violent extremist groups—they are still seeking approval from within their group even though they may cause harm to others. However, such a behavioral contrast occurs in less dire ways: teenagers who seek approval from a peer group while rebelling against parents or people who persecute or mistreat those with different beliefs.
Learning to redefine rejection allows you to act according to your personal beliefs and desires rather than acting based upon the approval of others. Read more...
Index to 20 Steps to Better Self-Esteem
September 6, 2015
20 Steps to Better Self-Esteem
Step 18. Act with Confidence.
Many people view confidence from the wrong direction. They believe “When I have self-esteem, I will act with confidence.” Yet, confidence is a behavior more than a feeling. And behaviors can be produced even when you don't experience the emotion. For instance, have you ever been in an argument with someone, you're feeling intense anger, you receive a phone call, and with a smile and brightness in your voice, you answer, “Hi! It's great to hear from you!” This is a common example of how we can compartmentalize emotions and almost instantaneously switch our behaviors—in this instance, tone of voice, facial expression, word choice. In fact, I would bet that if you pay attention in such an instance, you would even notice a relaxation of the angry tension you were experiencing.
The axiom often used by recovering alcoholics in AA, “Fake it til you make it,” is based on a concept proposed by psychologist George Kelly in the 1950s (The Psychology of Personal Constructs) and incorporated into “fixed-role therapy.” Kelly believed that we act based upon the roles that we have constructed for ourselves from past experiences. However, we can construct new roles and concepts of ourselves and base our behaviors upon those new roles. For instance, he described a man acting based upon a written description of the person he would like to be. By doing so, his belief about his ability became “I CAN change” because “I HAVE changed.” By acting differently, he was able to prove that he has the ability to be different. Therefore, this therapy circumvents one of the common core beliefs that prevents change: “But that's the way I am!” Read more...
Index to 20 Steps to Better Self-Esteem
September 5, 2015
New Free Audio Download! 5 Methods to Managing Anger
This audio is for people who have trouble managing their anger and find it affecting their relationships personally, at work, and in their community. The primary focus for managing anger is about taking personal responsibility rather than blaming others for the anger. Therefore, the focus is about taking control of your anger to change yourself and your reactions rather than expecting others to change. The audio teaches ways to managing unreasonable anger but the methods provided require effort over time to truly make a difference in your life. The transcript is provided below for your convenience.
TAP HERE FOR AUDIO
September 2, 2015
New Free Audio Download! Hot Spring Relaxation
This audio relaxation exercise focuses on teaching
the three main methods of relaxation which
include slow, relaxed breathing, muscle
relaxation, and guided imagery. The imagery
describes sitting in a hot spring in the wintertime, feeling the contrast of the cold air with the hot water, and the soothing flow of water against your body. At the end of the audio it provides an opportunity for creating healthy suggestions for yourself as you relax by the fire next to the hot spring.
TAP HERE FOR AUDIO
September 1, 2015
20 Steps to Better Self-Esteem
Step 17. Mentally Rehearse.
Once you have developed specific goals through visualizing success and how to achieve it, the next step is to rehearse those goals. This is the step that many people miss. They believe that just having a goal and a plan is good enough. But often, it is not.
For example, have you ever known someone who has good intentions but no follow through? Let's say they are always late for work and although they intend to get up earlier and get to work on time they are unable to do so. For many people this is a problem of lack of mental rehearsal. In other words, they tell themselves the night before, “I'm going to get to work on time” and set the alarm earlier. But that's where it stops. Achieving the goal of getting to work on time is more likely if they practice in their mind getting up to the alarm and planning their time. People who are on time aren't just magically punctual. Instead, they have considered the tasks they need to accomplish, the time it takes, and when to start each task: “These are the things I need to do in the morning: I need to shower by X time and eat breakfast by X time and return emails by X time and leave the house by X time.” It's also about being realistic. If the person knows that it takes a half hour to awaken to the alarm, then saying "I will jump out of bed when the alarm rings" is not realistic but setting the alarm a half hour earlier might be more effective. Read more...
Index to 20 Steps to Better Self-Esteem
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
itself. Read more...
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. Read more...
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. Read more...
Index to PsychNotes
Index to Articles
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.