pi3: December 2017

Sunday 31 December 2017

Least Popular Posts of 2017

2017 was a really bad year. The U.S. is more divided than ever, the truth is meaningless, well-researched journalism is called FAKE NEWS, the President lies once every minute, white supremacist rallies have been normalized, some tech companies¹ continue to invade our privacy/extract personal data, exploit the middle and lower classes,² and displace long-time residents from urban areas. And who knows what health care and Alaska will look like in 2018.

Yes, this is classic Neurocritic pessimism.³

While everyone else rings in the New Year by commemorating the best and brightest of 2017 in formulaic Top Whatever lists, The Neurocritic has decided to wallow in shame. To mark this Celebration of Failure, I have compiled a Bottom Five list,⁴ the year's least popular posts as measured by Google Analytics. The last time I compiled a “Worst of” list was in 2012.

Methods: The number of pageviews per post was copied and pasted into an Excel file, sorted by date. Then the total pageviews for each post was prorated by the vintage of the post, to give an estimate of daily views.⁵

Results: The posts are listed in inverse order, starting with #5 and ending with #1 (least popular).

5 Most Unpopular Posts of 2017

5. Terrorism and the Implicit Association Test – I actually worked pretty hard on this one. It's about the stereotyping of Muslims, the importance of language (e.g., Theresa May: “the single, evil ideology of Islamist extremism that preaches hatred, sows division, and promotes sectarianism”), a demonstration that semantics derived automatically from language corpora contain human-like biases, the Arab-Muslim IAT (which found little to no bias against Muslims), and some general problems with the IAT.

4. Smell as a Weapon, and Odor as Entertainment – This was from my two-part olfactory series, which covered the interesting history of Olfactory Warfare (e.g, stink bombs, stealth camouflage) and the use of smell in cinematic and VR contexts. {or at least, it was interesting to me}.

3. The Big Bad Brain – This featured a fun and catchy music video (High) by Sir Sly, which was an earworm for me. But too esoteric and not much staying power.

2. What's Popular at #CNS2017? – This falls under the perennially unpopular category of “yearly conference announcements”, which is only relevant around the time of the meeting.

1. Olfactory Deterrence – This was about the prospect of nuclear war and how putrid smells might deter the use of nuclear weapons, along with eradicating cavalier attitudes about them.

Discussion: We can easily see some themes emerging: the IAT, olfaction, music videos, and the Cognitive Neuroscience Society meeting.

Conclusion: People are sick of the IAT, aren't thrilled about the sense of smell (especially in relation to nuclear war), and do not like music videos or CNS Meeting announcements. However, they do like meeting recaps, as shown by the popularity of What are the Big Ideas in Cognitive Neuroscience? and The Big Ideas in Cognitive Neuroscience, Explained.

Footnotes

¹ Uber deserves special mention.

² This one is from 2016, but it's a real eye-opener: The Not-So-Wholesome Reality Behind The Making of Your Meal Kit.

³ This has been the worst-ever year for me personally as well, so I see no reason to be optimistic.

⁴ Actually, #5 is Survival and Grief. I cannot bear to feature this one, so the closely ranked #6 is a stand-in.

⁵ The post with the absolute lowest number of views (Brief Guide to the CTE Brains in the News. Part 2: Fred McNeill) was written on 12/11/2017. For a true reading of yearly “staying power” we'd need to follow all posts for 365 days.

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When Rehabs Look at Patients as Dollar Signs

“The whole system is designed to keep people in it, I think.”

“Statistically, you’re wasting your money sending your kid to rehab,” Scott Steindorff tells me without a second of hesitation. “I have three grown kids and I’ve come to the conclusion that if one of them had a [substance abuse] problem, I wouldn’t know where to send them.”

Steindorff, the Hollywood producer whose eclectic credits include the movie Chef and the TV series Las Vegas, has turned his sights on overhauling the $35 billion-a-year rehab industry that’s now coming under fire. “There’s not one facility in the world that’s getting the job done,” he argues. “If you find a rehab center that really gets it, call me—and I’m being serious.”

At the moment, many agree with Steindorff: there’s virtually no shortage of cautionary NPR pieces, disturbing news features, and almost-weekly stories of arrests and busts. In fact, one NPR exposé reported that a convicted rehab owner had “billed insurance companies for more than $58 million in bogus treatment and tests, and recruited addicts with gift cards, drugs and visits to strip clubs.” It’s clear that the rehab industry may be at a critical crossroads, as it needs as much saving as the millions of Americans seeking help themselves.

My good friend Mike Verlie, who just celebrated four years of sobriety after a decade-long heroin addiction, credits sober housing for helping him find his footing and, well, saving his life. But he’s also keenly aware that good sober homes are few and far between.

“The problem lies in that [sober homes] are mainly privately-owned and non-regulated at all,” he notes. “Some may claim to follow non-profit guidelines, but in reality, it’s mostly just a single guy or a couple of people who own houses and call them sober houses.”

Many of these “houses,” Verlie says, cram more people than are legally allowed by fire standards into places that are poorly funded (at best). In fact, many of them are simply way stations between rehab centers, sometimes getting kickbacks for each referral. “A good sober house is a rarity,” Verlie says.

Sadly, shady ethics aren’t limited to homeowners operating businesses that are little more than treadmills leading right back to treatment centers.

Sometimes, it’s a lot bigger than just one specific person or center…

How do we create rehabilitation options that don’t view patients as dollar signs? Learn more in the original article The Unethical Side of Addiction Treatment at The Fix.

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Recently, I’ve Been Feeling Really Really Overwhelmed

I have plenty of friends, but I feel very alone. I feel like a constant disappointment to my parents, and I don’t know how to feel comfortable with them. I’ve been eating really really badly and I’ve been having a stomach ache for a couple of days this week. I’ve been procrastinating to the point where i rarely do my homework. Also, I love doing theater, yet i haven’t been able to get into the mindset of memorizing lines. Is this just the season, a phase in my growing up, or is something legitimately wrong with me?

A. You stated that you are “really overwhelmed” but didn’t describe what is making you feel that way. Your feeling overwhelmed suggests that you might have too much going on in your life. Has something recently changed? Did you take on more work than you can handle? You might be doing too much.

You mentioned feeling like an “constant disappointment to your parents” but didn’t say why. Perhaps you think they are expecting something that you cannot deliver. It’s possible that you are correct, and they are expecting too much from you. It’s also possible that your perception of what they expect of you is wrong. You might try speaking with them to clarify whether your perception is accurate. I suspect that it is not and you are placing unnecessary pressure on yourself to succeed but I cannot know that with certainty.

If I were interviewing you in person, I would want to know how long you have been feeling this way. It would have helped me to better answer your question regarding whether or not this is a phase or a more serious problem. In general, if you’re not feeling well, then something must be wrong. If you’re unsure, it’s wise to consult a mental health professional, in-person. They would be able to gather information and determine what might be wrong. Most importantly, they can provide guidance about how to fix the problem. If you are amenable, counseling could quickly resolve this issue. I would highly recommend it. Please take care.

Dr. Kristina Randle

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Recently, I’ve Been Feeling Really Really Overwhelmed

I have plenty of friends, but I feel very alone. I feel like a constant disappointment to my parents, and I don’t know how to feel comfortable with them. I’ve been eating really really badly and I’ve been having a stomach ache for a couple of days this week. I’ve been procrastinating to the point where i rarely do my homework. Also, I love doing theater, yet i haven’t been able to get into the mindset of memorizing lines. Is this just the season, a phase in my growing up, or is something legitimately wrong with me?

Dr. Kristina Randle

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One New Year’s Resolution a Couple Can Make Together

Maybe you’ve already made a resolution or two for the New Year. Have you and your partner ever made one together? Choosing one that you’re both likely to keep can do wonders for your relationship. One is the key word, because keeping it simple makes it more likely that you’ll both follow through.

Any relationship, no matter how great it already is, has room to grow. So instead of thinking, “Were fine,” think “The sky’s the limit!”

Tips for Making a Resolution Together

Whether you make a resolution together or independently, make it as specific as possible, by stating the resolution in a way that includes:

when you will start keeping the resolution;
for how long you intend to carry it out;
how often you will do it.

For example, rather than simply resolving to be nicer to each other, a couple might commit to giving each other at least one compliment every day for the next three weeks, starting today.

It takes 21 days to change a habit, or to establish a new one, so if you want the daily compliments or some other new behavior to become a lasting lifestyle, you might decide to commit to do it every day, starting now, and for at least three weeks.

You might like the idea explained below (Resolution #2) about giving each other at least one compliment a day. This might be your joint resolution, or it can be your own personal resolution if your spouse isn’t on board now for it. Even if you start out as the only one giving compliments daily, your relationship will probably get better. Your spouse will appreciate your sincere compliments, and you’ll find yourself noticing your partner’s virtues, so you’ll feel warmer toward him (or her) more often.

Maybe you both already excel at compliments. What would be a better resolution for the two of you to consider making together? You may have one in mind or you might want to select one of the other two ideas listed here:

Resolution 1: When we disagree, we will take turns listening to each other kindly and respectfully. When one of us states our viewpoint, the other will say what he or she heard, then asks if they got it right. Once the first speaker says yes, the other gets to state their own position and get listened to. It can be tempting to compose our rebuttal instead of totally listening. Listening doesn’t necessarily mean agreeing. The active listening technique is so worthwhile because it fosters emotional intimacy. When most spouses really want is not to win an argument, but to feel understood.

Resolution 2: We’ll tell each other daily what we appreciate about each other. This is a worthwhile resolution because busy spouses often forget to notice each other’s positive traits and actions. Sometimes their communication gets loaded with complaints or demands. Strive to implement Dr. John Gottman’s researched based advice to make at least five positive comments for each negative one.

Resolution 3: We’ll hold a weekly marriage meeting. This is a worthwhile resolution because couples who do this effectively, as explained in my book, Marriage Meetings for Lasting Love: 30 Minutes a Week to the Relationship You’ve Always Wanted, gain intimacy, romance, teamwork, and smoother resolution of issues.

CHOOSE JUST ONE

In case you’re feeling tempted to make more than one resolutions, remind yourself to choose just one. Changing just one long-established way of behaving is challenging enough, so keep it simple. You can always add a new resolution once you’ve firmly put your first one into practice.

Happy New Year!

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The Reason Some People Don’t Learn From Mistakes

The reason some people find it hard to weigh risk and reward.

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Book Review: How To Be Single & Happy

“Why are you still single?”

For many single women, this is a question that implies not only that they should they be coupled up, but that if they are not, there is something wrong with them.

In overanalyzing their past relationships, many women experience feelings of guilt, shame, and confusion as to how to go about finding their soul mate, while still coping with being single.

In her new book, How To Be Single and Happy: Science-Based Strategies for Keeping Your Sanity While Looking for a Soul Mate, Jennifer L. Taitz, a clinical psychologist who specializes in dialectical behavioral therapy, offers women a way out of shame and toward their life partner, while also challenging many of the most common myths about dating.

For many women, the prospect of aloneness, in itself, incites a cycle of emotional reasoning that goes something like this:

I’ve been alone forever, and now, no one will ever want to be with me.

The process of dating – in which rejection is inherent – then taxes women further.

“Meeting someone promising who then disappears without apparent cause or explanation is the epitome of invalidation,” writes Taitz.

Taitz cites the work of Baumeister and many others who show that feelings of rejection and invalidation come with emotional, social, and cognitive consequences, often compromising our ability think clearly, and manage our emotions.

Yet the advice women are often given – to think like a lady and act like a man, wear compromising clothing, or even move to another state – only invalidates them further and doesn’t really help.

“To sidestep hopelessness, we all need wisdom,” writes Taitz.

The first step, she says, is to identify unhealthy psychological habits that obfuscate fulfillment.

“The belief that your happiness hinges on an external circumstance that you can’t control (i.e. meeting a romantic partner) not only makes it harder to find love, but also sets you up for unhappiness,” writes Taitz.

Happiness comes from letting go of the idea that you are not complete until you meet the right person.

Not only is it possible to be happy right now, but it also is the best way to actually increase your chances of finding love. Pointing to the work of Sonya Lyubomirsky, one of the foremost researchers on happiness, Taitz tells us that happiness is comprised of three factors: our genetics (what is referred to as our “happiness setpoint”), our circumstances, and our activities. What is most promising about this, however, is that circumstances – like relationship status – only account for a small part of our happiness.

What matters more in the happiness equation is our activities. For this reason, Taitz often prescribes activities to her patients, like Rachel, who after going to a concert, stated, “music is amazing.”

Interestingly, this was not only the first positive emotion Rachel had experienced, but the first one not connected to her relationship status.

“David Johnson, at the Pennsylvania State University, suggests that people who marry and stay married tend to report feeling above average life satisfaction before they wed, which again supports the idea that marriage arises from happiness, not the other way around,” writes Taitz.

However, many things can interfere with happiness. Social networking, comparing our lives to others online portrayals of happiness, obsessing over our situation, regretting our decisions, and even anticipating regret can all keep us stuck in a cycle of paralysis where happiness evades us. Here Taitz offers powerful advice:

“If your concerns are based on your values and inner wisdom, allow fear of regret to be there and act courageously anyway,” she writes.

Pursuing our values, Taitz tells us, also keeps us focused on the process of our lives, as opposed to the outcome.

“Values aren’t measured by what we get but what we give,” she writes.

Knowing what we want and crafting a plan to create it can give us a feeling of control over our lives, releasing us from feeling as though our happiness is based on external circumstances that we can’t control.

Through practicing acceptance, Taitz says we can learn to see painful experiences as natural and normal parts of life, and not things that lead to irreversible suffering.

Developing a sense of compassion for ourselves will also improve our self-acceptance, mindfulness, and positive emotions – all things that, according to the work of Barbara Frederickson, help us expand our thinking, connect with others, and avoid getting stuck in our heads – especially about relationships.

Drawing on fascinating and relevant research about human relationships and happiness, and numerous relatable examples from her years of clinical practice, Taitz turns the tables on the relationship-happiness equation.

A relationship is not a recipe for happiness, rather, it is often the outcome of a happy, fulfilled life. How To Be Single and Happy shows women just how to create this life – empowering them along the way.

How To Be Single and Happy: Science-Based Strategies for Keeping Your Sanity While Looking for a Soul Mate
Jennifer L. Taitz
Tarcher Perigree
January 2018
Softcover, 217 Pages

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Is Talking to Myself Normal?

From a 13 year old boy in the U.S.: So I started talking to myself when I was about 6 or 7. I’ve always felt a little bit psychic. Which has nothing to do with this I think. But everytime, a week before a loved one of mine dies, without notice. I get a dream, which I wake up crying and the dream tells me I should start treating this person right, and outta nowhere. EXACTLY a week later the person dies. On from that, I have always talked to myself.

I just had a case of talking to my self and just started wondering if it was normal. It mainly happens when I am bored and have nothing to do. I was just riding my scooter and I got bored so I talked to myself. It consisted of me acting like 4 different personalities all with a different accent. Like, the dispatcher as a british man. The fellow police officers as scottish. Just many personas. I can hop out and be normal anytime I want but is this normal? I dont know if acting like different people is normal. But sure enough, sometimes, I act like I’m people talking to each other debating about stuff, arguing, ect.

Is this normal? Is this leading to any condition? I dont think its a habit. Because when I feel like doing it, I lose sense of my surroundings and mainly focus on the conversation. I was riding my scooter while doing it and someone was sitting around the corner and I got scared when they said “Hey there!” I didnt even know they were there. Is it normal?

A: I don’t know how to explain the psychic incidents. It may be that you have exquisite powers of observation, and that you notice things unconsciously that other people don’t notice. Or it may be a “gift”. As far as I know, no one has yet explained exactly why some people seem to intuit things that others don’t.

Highly creative, imaginative people often talk to themselves. Ask anyone who writes or who is in theatre. There’s nothing wrong with it unless doing it when riding causes an accident! I suspect you might have the talent to be a novelist or screen writer. It’s something to at least explore.

I wish you well.
Dr. Marie

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Healthy Ways to Navigate Your Grief

Even though my dad was hooked up to the most high-tech ventilator in the hospital and had five chest tubes connected to his body, I thought he’d come home with us. Sure, the recovery wouldn’t be easy, but we’d take it slow, and eventually, he’d return to his healthy, energetic self.

At his funeral, I really wanted to say something, to make everyone there understand just how kind-hearted, funny, playful, brave, and resilient my father was. This was a special person, and I yearned, a yearning that knotted my stomach, for others to feel that. Instead, I stayed silent as the rabbi read through paragraphs we’d provided, paragraphs that barely captured the beauty of my dad.

When they picked me up from the airport, my aunt and cousin tried to warn me. But nothing could prepare me for what I saw when I walked into my grandmother’s apartment. My 5-foot-8 grandma weighed around 90 pounds. Her once rosy, full cheeks were hollow. I’d never seen her move so slowly. I usually had to almost jog to keep up with her pace. The bone cancer was whittling away her body, and all I wanted to do was drop to my knees and cry for days. That night, she hugged me and told me that she really wanted my mom to have her gold necklace when she died.

At her funeral in February, New York City looked like a snow globe. The snowstorm started that morning, and we feared we’d have to cancel the service. As we stood by her grave and one by one dropped red roses onto her casket, the snowflakes started coming down faster and faster and bigger and heavier. And it felt like our tears would turn into icicles, staying on our faces forever.

These are some of the bits and pieces I remember from my biggest, deepest losses, from the darker days of my life. Of course, there are many happy, hilarious, vibrant memories. Memories that have nothing to do with hospitals and death. But some days, these are the moments I replay in my mind, a decade later, triggered by something random on TV or something someone says, or triggered by nothing at all.

They say that time heals our (grieving) wounds. But I don’t think it’s time. Instead, I think we just get used to the person not existing in our day to day. We create different routines and rhythms that replace the routines and rhythms they inhabited. Our lives change. We have kids. Our kids go to college. We move to new homes, to new jobs. We simply don’t expect to see our loved one in these places.

In the book On Grief and Grieving, Elisabeth Kübler-Ross writes, “The reality is that you will grieve forever. You will not get over the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same, nor would you want to.”

Grief is a shape shifter. It takes many different forms, said Stacey Ojeda, a licensed marriage and family therapist who specializes in working with grief and loss. It can resemble depression with sadness, irritability, hopelessness and helplessness, she said. You might isolate yourself from others and stay in bed all day. You might be easily distracted and forgetful.

Grief can resemble denial, she said. You avoid your heartache and focus on the day to day. Laundry. Work. Dinnertime. Dishes. You stay “productive” and busy, hoping to skip over the pain, or bury it so deep it stops coming up to the surface.

Grief can turn into a spiritual crisis, according to Ojeda, sparking big questions like: “What is life about?” “Why am I living?” and “How could God do this to me?”

Ojeda shared the below suggestions for navigating grief in a healthy way.

Realize that grief is not linear. There is no timeline you need to abide by. “There is no date that you need to be better by,” Ojeda said. In fact, the worst thing you can do is give yourself a timetable or time limit, as in: “”I should feel better already” “Why am I still feeling this way?” “So and so only felt sad for X amount of time when she lost her ____.”
Be patient and kind with yourself. For instance, you haven’t completed your to-do list and all you want to do is lay in bed and cry. Instead of telling yourself, “What are you doing? Get out of bed. You have so much to do. This isn’t good,” you say: “It’s OK,” Ojeda said. You accept where you are, and give yourself whatever you need. “Judging yourself and getting upset at yourself for whatever pace you’re healing at will only make that process harder.”
Talk to others. “Seek support from those who allow you to grieve in a healthy way [such as] friends, family, coworkers or a counselor,” Ojeda said.
Set time aside to grieve. If your life is hectic, carve out time to express your feelings, Ojeda said. Cry in the car before work or before going home. Scream. Replay a specific memory. Give yourself the space to process your pain.
Allow yourself joy, too. At the same time, give yourself the opportunity to savor sweet moments. Go out with your friends. Start a new painting project. Start your next short story. Take a trip. See a silly movie.
Plan ahead for bad days. For the toughest days, have a list of go-to strategies and people you can turn to for support. For instance, Ojeda said, your coping strategies might include: journaling; reading an article or book that comforts you; keeping sneakers by the front door to take a calming walk. Mark on your calendar “anniversary dates” that could trigger a wave of grief. These might be your loved one’s birthday, the day they died, a day that was special to you both.
Honor your own path. Grieving looks different for everyone. Ojeda underscored that there’s no right or wrong way to navigate grief (unless, of course, you’re doing something that puts you in danger). “Everyone has their own path and journey after loss and it needs to be honored.”

“Grief, I’ve learned, is really love,” writes Jamie Anderson in this beautiful piece. “It’s all the love you want to give but cannot give. The more you loved someone, the more you grieve. All of that unspent love gathers up in the corners of your eyes and in that part of your chest that gets empty and hollow feeling. The happiness of love turns to sadness when unspent. Grief is just love with no place to go. It’s taken me seven years to realize that my grief is my way of telling the great vastness that the love I have still resides here with me. I will always grieve for my Mom because I will always love her. It won’t stop. That’s how love goes.”

And somehow, for me, knowing that our shattering grief is simply tied to our significant love brings some comfort. Maybe it does to you, too.

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Saturday 30 December 2017

30 Ways to Take a Mini Break

Vicki was exhausted. Between raising three kids, working a full-time job, being married, and managing her household, she was worn-out. Desperately wanting a holiday, Vicki knew that even vacations weren’t really a vacation. The kids still needs constant supervision and eating out for every meal wasn’t economical. What she really needed was some time alone but that wasn’t possible either with too few people to watch the kids.

She loved her career and family but craved some time apart. Desperate to find a way, Vicki decided on taking a couple of mini breaks during the week that take between 5-30 minutes. By changing up the type of rest she enjoyed, things remained fresh. Here are some of her ideas.

Try a new sport. Invest in learning a new sport that is of interest such as yoga, running, tennis, swimming, or kickboxing.
Do some gardening. When done in smaller chunks, gardening can be very therapeutic rather than a chore.
Take pleasure in a deep clean. Pick a small area and clean it thoroughly. Don’t try to clean large areas at a time. The accomplishment of a smaller task is very satisfactory.
Take a walk. Go for a casual stroll around the neighborhood and try to notice things that might have been overlooked in the past.
Go for a bike ride. A simple ride around the neighborhood might reveal some streets or parks that might not have been discovered otherwise.
Go shopping alone. There is nothing quite as relieving as being able to walk through the grocery store in peace without the constant demands of “I want”.
Take some deep breaths. Breathe in from the belly for a count of 4, hold for a count of 4 and breathe out for a count of 4. Do this 3 more times to get a whole body cleansing.
Be present. Instead of living in the future or in the past, focus on living in the current moment. It’s amazing how this simple practice is calming.
Explore emotions. Take a few moments out of the day to ask, “What am I feeling now?” Explore whatever emotion arises instead of stuffing it.
Purge some anger. Releasing anger periodically prevents the volcanic like explosion that happens when anger has built up over a period of time.
Watch a sad movie. To purge some sadness, watch a sad movie and allow the tears to flow. This releases stress, anxiety, and grief.
Have a cup of tea. A simple cup of tea, especially in the middle of the day, can be a nice break and bring some relaxation.
Read a novel. Explore a fantasy novel from another time or place. This sparks the imagination and creativity.
Do some painting. Even painting by numbers can be fun. It doesn’t take much talent to paint this way and the results tend to be rather good.
Take up knitting. Doing the same stitch over and over can be very soothing. This is one activity that can be done while watching TV or supervising the kids.
Cook for fun. Cooking for daily feeding of a family can be dull especially when there are so many different tastes to navigate. Try a new recipe just because.
Take a cat nap. A 20 minute cat nap can do wonders to rejuvenate. Try not to sleep longer or it might be difficult to sleep that night.
Watch a funny show. Laughter is the best medicine. A favorite comedy show can be just the right prescription.
Phone a friend. Instead of turning to Facebook, call a friend. Connecting with others increases intimacy and bonding.
Have adult conversation. It is common when there are young kids around to engage in child-like conversation. Be intentional about talking about adult topics unrelated to the kids.
Take some pictures. A picture is worth a thousand words so take a picture with a different perspective.
Play some music. Music calms the soul. Listen to some non-lyrical music that is enjoyable and peaceful.
Play an instrument. Taking up a musical instrument requires dedication but it can be very pleasurable when done just for fun.
Organize a closet. This may not be everyone’s thing but organizing a closet can be relaxing when it is completed.
Write a note. This is not an email but rather a hand written note to someone that might need some encouragement.
Make a list. Start by making a bucket list of things to do. Then list out places to do, people to meet, and books to read.
Smell the flowers. Stopping to smell the flowers can be taken literally. The scent of a favorite flower can bring back good memories.
Walk around the house. Take a stroll around the outside of the house and look for small changes such as a blooming plant or a pretty view.
Hold a pet. There is a reason therapy dogs are all the rage. Holding a pet has a calming effect even in the most stressful environments.
Touch something soft. This might sound strange but every child knows how wonderful it is to touch something soft like a blanket. It brings about a sense of comfort.

Once Vicki started doing her mini breaks she got more creative with her time. This improved her relationships at home and her productivity at work.

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Five Ways to Help Teens Practice Self-Compassion

Being a teen today may be harder than ever before. Between a rapidly changing world, constant stimulation on social media and rampant cyber-bullying on top of the normal challenges of adolescence, it’s no surprise that rates of depression among teens are rising.

Whereas self-esteem used to be all the rage in treating common teen concerns like fitting in, doing well in school, body image, safe sex and dating, contemporary approaches to teen mental health are increasingly relying on self-compassion instead.

So what exactly is self-compassion?

According to Dr. Kristen Neff, self-compassion consists of three parts: self-kindness, mindfulness and common humanity. These three parts work together to make self-compassion an effective skill for teens to use in difficult times.

In her new book, “The Self-Compassion Workbook for Teens,” Karen Bluth, Ph.D offers practices and exercises to help teens learn self-compassion skills to navigate, cope with and overcome self-criticism, self-doubt and difficult emotions.

The following tips for helping teens learn self-compassion have been adapted from her work.

1.Normalize the Challenges of Adolescence

Teenagers can often feel alone in their struggles to fit in, tolerate their bodies, get along with their families and have their lives post-graduation figured out.

Self-compassion involves remembering that adolescence is a tough time for everyone and that struggling through the years before early adulthood is completely normal. Between new schools, friend groups, body changes and classes, it’s almost as if to be a teenager is to be in a constant state of change. Given that change is difficult for everyone, it’s no wonder being a teenager is so hard.

It may also help to remind teens that while they may not necessarily hear others talk about their challenges openly, that doesn’t mean they’re alone in having a hard time.

2. Debunk the Myths

Just like adults, teens may resist the idea of self-compassion out of fear that being kind to themselves will mean laying around all day, ignoring school assignments and failing all their classes. But in fact, the opposite is true.

“We know from research that folks who are kinder to themselves are actually more likely to be motivated to get stuff done. They are less likely to procrastinate and more likely to try new things. You know why? Because they give it their all without worrying about failure or giving in to doubt. They know that if they don’t achieve their goal, they’re not going to beat themselves up’ they’ll just either let it go or keep trying. And they are overall happier as a result,” writes Bluth.

3. Define Self-Compassion

According to Bluth, self-compassion is “treating ourselves, when we’re going through a hard time, the way we would treat a good friend.”

Like many things, self-compassion sounds simple in theory but isn’t always so easy in practice. It takes practice and willingness to try something new the service of what’s really important to teens, such as doing well in school, having a better social life, getting along with their families or simply feeling better.

4. Bring Mindfulness Into the Mix

Mindfulness helps us take our thoughts less seriously by seeing them as mental events that come and go, rather than hard facts. And mindfulness is in some ways a prerequisite for self-compassion because it allows us to notice harsh or self-critical thoughts as they arise and be willing to intervene and extend self-kindness instead.

Without basic mindfulness skills, it’s difficult to notice those moments when self-compassion is really needed.

“One simple way to practice mindfulness is to remember this: Physical sensations bring us to the present moment. When you’re paying attention to your physical sensations, you’re in the moment,” writes Bluth.

5. Help Teens Figure Out for Themselves why Practicing Self-Compassion is Worth it.

We can tell teens to practice self-compassion until we’re blue in the face, but if being kinder to themselves isn’t connected to a personal value that they’ve chosen for themselves, they’re a lot less likely to want to do the work.

There are a number of free resources available for helping clients identify their core values. Bluth offers the option of having teens make a promise to themselves based on one core value that they can implement in daily life.

For more about self-compassion for teens, check out “The Self-Compassion Workbook for Teens.

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The Power of Vulnerability

Welcome to my confessional!

(Yes, my confessional is an international website where thousands of people read and–perhaps–groan at my pithy columns).

As I write my latest screed, I often wonder, Am I being too vulnerable? From discussing my frayed family (insert a wry Happy Holidays) to my smoldering anxiety, I divulge my biggest, baddest secrets to, well, everyone.

Despite my well-worn hesitation, the answer is a resounding no. In fact, maybe I should be a little more vulnerable.

Sure, there is an understandable tinge of embarrassment and anxiety when sharing my personal failings. There is a nagging sense that my brazen honesty could jeopardize my future employability. Perhaps a future employer will google “Matt Loeb” and discover my treasure trove of anxiety-soaked ruminations on obsessive-compulsive disorder, depression, and familial strife.

And that would be okay — even if I do have to subsist on Ramen noodles and saltine crackers for the indefinite future.

You see — there is power in our shared vulnerability.

In my columns, I touch on human foibles and failings. Specializing in self-doubt — with a touch of self-deprecation, there is an inherent relatability for many readers. Notwithstanding the occasional caustic email (“Your column was so insensitive”), most readers respond with an appreciative message. I struggle with the same paralyzing bouts of depression. …Geez, you summed up my family’s Thanksgiving. Can we just celebrate the holiday season to-go?

More than just commiserating over brutal family soirees, there is a sensitivity — even humanity — underlining our snark. For many of us — myself included, we shroud ourselves in secrecy when discussing difficult emotions and thoughts. It has taken me years to discuss my simmering sibling feuds with my beloved aunts and uncles. It can be equally distressing to broadcast my deepest emotional ebbs to the (Psych Central) world.

But as I have aged and wisened, I recognize there is fortune in misfortune. And power in, at times, feeling powerless. Sharing vulnerability — whether an emotional, physical, or spiritual hardship — strengthens our collective humility and self-awareness.

This truism is more than just a personal Mattism; influential leaders intuitively recognize the power of vulnerability. Starbucks CEO Howard Shultz,”The hardest thing about being a leader is demonstrating or showing vulnerability…When the leader demonstrates vulnerability and sensibility and brings people together, the team wins.” Sharing vulnerability — from confiding to a friend to a therapist to a room of powerful CEOs — provides an opportunity to connect in meaningful, authentic ways. This emotional connection results in mutually beneficial outcomes; research corroborates that we are more likely to act inclusively and compassionately toward others after learning of their personal hardship.

As winter unleashes its ugly wrath. I understand the temptation to retreat into a depressive cocoon of self isolation — and self-flagellation. The holiday season can be particularly challenging — even more so if familial relationships chill. But there is power in our own narrative — even if our pockmarked story doesn’t match our peers’ sparkling narratives.

The real winter chill: concealing your own vulnerability. And not letting anyone else read your book — or, tongue in cheek, Psych Central column.

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Book Review: The Diagnostic System

While it’s true that many illnesses are foreign to the average person, many of the core symptoms of mental illness are familiar to virtually everyone.

“Not only does the public have a reasonable sense about what the symptoms of mental illness feel like, it also has some intuitive grasp about what causes them,” writes Jason Schnittker.

In his new book, The Diagnostic System: Why The Classification Of Psychiatric Disorders Is Necessary, Difficult, And Never Settled, Schnittker explores the evolution of the manual we use to understand mental illness – the Diagnostic and Statistical Manual.

Schnittker explores the often confusing and seemingly contradictory processes of defining criteria of mental illnesses, helping readers appreciate that a fluid approach is an adaptive strength of mental health professionals, and one that is necessary to boost our understanding of mental illness.

To understand how we develop a framework for understanding mental illness, we must appreciate that the way clinicians, scientists, and the public think about mental illness seek to serve different needs, yet cannot be segregated.

“The science of psychiatric disorders, for example, proceeds from how clinicians define disorders. And controversies surrounding how the public understand mental illness have corollaries in debates surrounding how scientists conceptualize mental illness,” writes Schnittker.

Yet clinicians themselves rarely agree on diagnoses. Schnittker points to one study where agreement among clinicians on thirty five separate cases amounted to only 46 percent on the category of the disorder and 20 percent on the specific diagnosis.

We also cannot look to the research on psychiatric disorders to provide much consensus.

“Results of one study could not easily be compared with another. A study could be promising but not easily reproduced in another setting,” writes Schnittker.

Psychiatric disorders are, after all, human disorders.

Robert Spitzer, who led the task force that wrote the DSM-III was tasked with writing a manual that accurately reflected psychiatric diagnosis as they may appear in varied and nuanced forms in a wide variety of people. He also had to do so without displaying any bias toward any one theoretical orientation, be both sensitive and specific, and base diagnoses on their symptoms while still allowing them to be classified into categories.

The result of the DSM-III, however, characterizes the problem that diagnosing and classifying mental disorders may always face: it solved one problem while introducing many more.

“Once the problem of reliability had been addressed, researchers were in a position to question the validity of psychiatric disorders using better evidence – and indeed, evidence that could not be provided before the development of the specific criteria,” writes Schnittker.

As the process goes, there will always also be proposals for revisions to better improve the DSM and perhaps satisfy individual interests. However, Schnittker points to Allen Francis, the architect of the DSM-IV, who conceded that there was likely no way to articulate a thoroughly satisfying definition of a mental disorder, even if there were ways to create useful diagnostic criteria.

Francis even went further to argue that in reality there might be no way to even define the concept of mental disorder.

What we can embrace, and what Schnittker suggests, is a dimensional approach.

“In a dimensional framework, psychological functioning is assessed on a spectrum. Individuals suffer, for example, from more or less depression, anxiety, and phobia. The dimensional approach assigns more significance to individual symptoms than entire syndromes,” writes Schnittker.

While the DSM may induce reification – the transforming of the abstract into the real – it might also obscure, and perhaps falsely create disorders out of what would be better left transparent.

“Clinical utility – always a goal of the DSM – is not well served by categorical thinking,” Schnittker writes.

One example is the diagnosis of schizophrenia. While the hallmark of the disorder is positive symptoms, clinicians have long noticed many other symptoms, such as cognitive deficits and poor working memory that occur as part of the disorder.

However, pharmaceutical research has been tailored to the symptoms explicitly listed in the DSM, and only those symptoms, which leads “to a discontinuity between the schizophrenia that is the subject of research and the schizophrenia that is the target of treatment,” according to Schnittker.

While scientists use the DSM to set the foundation for research on psychiatric disorders, the public seek insights to shed light on their experiences, and clinicians seek a way to effectively communicate and represent their work to other clinicians and outside parties. Schnittker points out that the DSM will continue to remain controversial because it is difficult – if not impossible – to envision a criteria that would satisfy every stakeholder.

In a well-written critique of the process of understanding and diagnosing psychiatric disorders, Schnittker exposes the many competing constituencies that complicate the development of the DSM. However, Schittker also encourages us to think beyond the polemic approach, to see that while a perfect agreement of psychiatric disorders may never be found, the strength of the mental health profession is its adaptive approach.

The Diagnostic System: Why The Classification Of Psychiatric Disorders Is Necessary, Difficult, And Never Settled
Jason Schnittker
Columbia University Press
August 2017
Hardcover, 305 Pages

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Fighting with Mom

Hi, I am having a lot of issues with my mom. We have always had a rocky relationship, if we are ever nice to each other it is fake. She makes the fighting seem like it is all my fault, and that I do not respect her. She thinks I am just a “teenager” and does not listen to a word i say. She is the most overprotective person I have ever met in my life and I just cant do it anymore. She clearly does not trust me when I have never done anything for her not to, and she knows that. i have never been caught doing anything, nor do I do anything remotely bad in any sense. She thinks I am basically the devil, and has never ever been real with me. She has these fantasies about who I am, and I honestly think she has something wrong with her. She has this obsession with taking my phone 24/7 no matter what. Every night at 8:00 she takes my phone, and never misses that time by a minute. Lately, she even tried to say I get my phone for an hour after school, and then it gets taken until the next day. I am a teenager??? I honestly think she has a mental disorder because every night, she will just go crazy. I cannot describe it but its like she becomes a different person. take this Friday for instance, she calls me while I am out with my friends to call my friends mom and make sure that she is still bringing me home. Its like when she gets bored she just tries to instagate me. Most people would say this is just her making sure I am safe, but once I gave her the moms number– she thought i was giving her the wrong number and threatened to call the grocery store where the mom worked, just to tell the mom that my friend was rude in the car? Please help! How do i make her understand I’m just a teenager? (From the USA)

A: I appreciate you writing in about this as I believe the struggle for independence is a common source of friction — particularly between mothers and daughters. Just like you have trouble understanding your mom’s behavior, she has trouble understanding yours. When things are going okay would be the time to ask her to sit down and talk. It sounds like there is a bit of a pattern where something happens — a fight, and then a lull, then another fight. I think that needs to change.

When things are okay — and no fights or conflicts are present — ask your mom to talk. Plan out what you would like to say ahead of time, and see if she is open to it. Three things seem important. The first is to find times when the relationship has been good and recall those times with your mom. Find a few memories to remind both of you that not everything is a fight. Secondly, you want to know what the two of you could do to improve the relationship. That you notice how much you fight and ask if there can be an opportunity for change. Finally, let your mom know that you would even be willing to go to a counselor (if you are) to work with her on making things better.

You want her to respect you more, and I think the way to do this is through a conversation you have when you are not fighting. If you need some help with this you may want to talk to your high school counselor as he or she might be able to give you some pointers about approaching your mom.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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The Surprising Sexuality of (Male) Gamers

The modern stereotype of people who frequently play video games needs to finally be put to rest. Gamers, as they’re known, are actually not losers residing in their parents’ basement, but rather people from all different kinds of backgrounds who enjoy the entertainment value that spending time playing video games affords.

Along with that stereotype is the belief that gamers’ sexuality must also be less than ideal. Losers in basements can’t have a healthy, positive sex life, right?

Let’s find out…

Research published earlier this year explored the sexual health of male gamers. As the researchers (Sansone et al., 2017) of the current study note, “Videogame use has been associated with improvements in cognitive functions, with improvements in specific intellectual fields according to different game types, such as working memory, processing speed, and executive functions. This ‘brain training’ seems to have positive influences on and, in some cases, preventing obesity and ensuring a correct lifestyle.”

So the researchers wanted to explore gamer’s sexual health as well. In the present study, they did this through the administration of two scientific research questionnaires, the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function (IIEF-15) online. Researchers also asked the men (ages 18 through 50) to provide additional information about their lifestyle and living habits, as well as their gaming habits.

In all, 599 men answered the call to complete the surveys, but 199 of those men had no sexual activity during the previous four weeks, so the researchers didn’t examine their data. In all, the scientists analyzed data from 396 survey respondents and classified them into two groups — gamers (who averaged at least 1 hour per day playing video games) and non-gamers (who averaged less than 1 hour per day playing video games).

Compared to non-gamers, the researchers found that gamers were less interested in sex — their sexual desire was significantly less. However, gamers were less likely to suffer from premature ejaculation when they did have sex.

Gamers Less Likely to Have Premature Ejaculation, Sexual Desire

The clearly good news based on this self-reporting survey research is that gamers say they have less premature ejaculation than their less-gaming counterparts.

What about the lesser sexual desire reported by gamers? After all, most people might say, “Hey, loss of sexual desire is a bad thing.”

But remember, we’re talking only about men here… Men typically appear to have a higher level of sexual desire than women (although that may be just due to men being more vocal about their sexual needs than women in many relationships). So maybe having a slightly lower level of sexual desire may not be such a bad thing — it really depends on the specific relationship.

How do the researchers explain the possible mechanism at work here?

…[T]he ‘reward system’ of videogames might affect the dopaminergic system; as previously described, dopamine levels increase while gaming. The dopaminergic system also is involved in facilitating orgasm and ejaculation, and dopamine acts as the most important ‘pleasure hormone,’ with an excitatory role in intercourse. D1 receptors, because of their decreased affinity, are activated only during dopamine peaks, in contrast to D2 receptors, which are activated by a slow, progressive release of dopamine. Gaming, as a source of repeated dopamine peaks, might lead to an enhanced steady-state homeostasis and to decreased activation of receptors given the same levels of dopamine; this might cause tolerance in the ejaculatory reflex and a decreased interest in intercourse, providing an explanation to our results.

I think that’s a possible, reasonable explanation, since gaming is intrinsically rewarding (otherwise people wouldn’t be doing it so often). And it would also neatly explain why there’s lesser sexual desire in gamers.

Keep in mind, this is apparently the first observational study that’s investigated this link directly. More research is needed to confirm these results.

But the results are surprising, in that gamers are not the obvious sexual losers the traditional societal stereotype makes them out to be. In fact, if you’re a person looking for a partner who doesn’t suffer from premature ejaculation and isn’t always bugging you for sex, a gamer may be just the ticket.

References

Sansone A, Sansone M, Proietti M, Ciocca G, Lenzi A, Jannini EA, Romanelli F. (2017). Relationship Between Use of Videogames and Sexual Health in Adult Males. J Sex Med., 14, 898-903. doi: 10.1016/j.jsxm.2017.05.001.

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The Saddest Thing About How Men View Their Own Depression

Try reaching out with even the simplest question like ‘How are you doing?’

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Escape from low mood or depression with my "Activate ebook"
Discover how to deal with anxiety in my "Anxiety plan ebook"
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by Dr JEREMY DEAN

***

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I Am Having Homicidal Thoughts and Urges

I am 14 years old. I am in 8th grade. For the past year I have had more and more thoughts of killing people. Every day these thoughts and urges get worse and now I have a constant pounding headache accompanied by dizziness and nausea. I want to know why I am having these thoughts and urges because I have a few good friends and I am happy about that. Now I have this gnawing paranoia that someone will find out about these thoughts and try to put me in a mental hospital. Another thing that worries me is that I almost tried to kill someone. I know I need help but I don’t like being separated from my friends and family.

A: You did the right thing by reaching out to Psych Central about these thoughts and urges. I know the thought of being separated from your friends and family is scary, but I highly encourage you to talk to your family about this. The fact that you wrote us and expressed fear about harming someone indicates that you have genuine concern about doing so. It is important that you seek psychological evaluation from a professional.

– Dr. Mimi

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Psychology Around the Net: December 30, 2017

It’s almost 2018 darlings, and I thought I’d use this week’s Psychology Around the Net to share with you information specific to certain important areas of our lives that might help you as you venture into the new year.

Celebrate safely this weekend, and here’s to an amazing new year for each and every one of you!

CAREER

10 Things to Do in the New Year to Skyrocket Your Career in 2018: Actually, these tips could help you in several areas of life. Get ready to take put yourself out there and take risks (and fail), speak publicly (it’s about way more than giving a presentation), set priorities and boundaries, and more.

FINANCIAL

Top 10 New Year’s Resolutions for Consumers for 2018: Money is a HUGE stressor, so the it makes sense that getting your financial ducks in a row (or, at least, getting a good handle on where you stand, where you want to stand, and how you plan to get there) can benefit most areas of your life. Pennsylvania Secretary of Banking and Securities Robin L. Wiessmann has 10 ways you can not only protect, but also grow, your money in 2018.

FAMILY

How to Support a Family Member with a Mental Illness: If you have a family member living with mental illness, here are five ways you can provide the support they need.

FRIENDSHIPS

Good Friends Might Be Your Best Brain Booster as You Age: Give your friendships a little extra love in 2018 — and in all the years to come. According to various research, “SuperAgers” — people who are 80 years old or older and have memories as good as or better than people 20 or 30 years their junior — tend to work hard at maintaining friendships.

RELATIONSHIPS

5 Ways to Reignite the Passion in a Tired Relationship: Sometimes, the passion you experienced in the beginning of a relationship begins to fade the longer you’re in the relationship. That doesn’t mean you love each other any less; it just means that certain thrill has gone missing. These researchers and therapists have several ideas for you and your partner to get back that thrill.

SPIRITUALITY

This Spiritual Practice Is So Simple but So Effective: When we think of the new year, we often think of resolutions — things we’re going to do, or stop doing, or change, or whatever. It’s all about taking some sort of action…which makes Rachel Jonat’s suggestion for getting back to your spiritual self (however you might define that) all the more intriguing.

HEALTH

10 New Year’s Resolutions for Your Health and Your Family’s: The American Health Association has given us a list of 10 ways we can keep (or, get and then keep) our health on track. Healthy bodies help healthy minds, y’all.

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Friday 29 December 2017

Smiling Improves Your Emotional and Spiritual Health

I’ve been fortunate to visit Thailand many times and after being here again, I’ve been asking myself: How is it that so many Thai people are quick to flash spontaneous and radiant smiles? Spend even a little time here and you’ll understand why Thailand is called “The Land of Smiles.”

A cynical interpretation is that smiling faces are a fake show of happiness designed to captivate tourists. And of course, a smile can sometimes cover up one’s true feelings, such as nervousness, anger, or sadness. But from my own observations and after speaking with many savvy travelers, I’m convinced that the smiles are often genuine.

How can it be that in a third world country where the average salary is so low, people can seem—and perhaps actually be—happy much of the time—or seemingly content with themselves and their lives? Is there something we can learn from this attitude and way of being that might help us Westerners find greater happiness?

Thailand is a Buddhist country. The attitudes and worldview reflected in Buddhism might have something to do with the sense of contentment many people seem to exude. Another factor may be the sense of community and connection that seems to stem from a strong sense of extended family and interpersonal attachments.

Excessive Expectations and Hopes

Westerners grow up on a steady diet of wanting, expecting, and hoping for more. The media and advertising fan the flames of our desires. It seems that we’ve become increasingly preoccupied with achieving some final, far-off goal rather than enjoying the journey. We keep postponing living our lives rather than relishing the present moment.

It takes a strong sense of self to not succumb to the belief that we’ll be happier with more stuff and the things. We work hard to buy a big house and then work even harder to make the mortgage payment and property taxes. If someone has more than us, we may become envious and perhaps crave the sense of belonging and connection that comes with “keeping up” with the latest trends and gadgets.

There’s nothing wrong with wanting to make our lives more comfortable. People in developing countries and even in the West would like to have a reliable washing machine or better smart phone. There’s no shame in this.

But when is enough enough? Can we find a middle path between wanting more and having gratitude for what we have? Can we find a way to hold those desires lightly and not allow them to interfere with appreciating what we have? A greater sense of freedom comes with accepting our limits. We’ll be happier as we develop the art of living in the moment rather than constantly leaning into the future.

A spontaneous smile springs from an inner sense of feeling content and connected. If we’re feeling deprived or neglected, it’s not easy to offer a generous smile to people we encounter. We’re more inclined to smile when we’re experiencing a sense of inner peace. Being at peace with ourselves is only possible when we’re living in the present moment, rather than being preoccupied by what we don’t have.

I’m not suggesting that Thailand or other developing countries are a paradise free from suffering. Far from it. It is stressful to wonder how you’ll feed your family next week…or tomorrow. Nor am I suggesting that social and political factors are not a dominant suppressive force all over the world.

Yet in cultures that value kindness and family, there seems to be a sense of community and connectedness that prevails despite challenges. There appears to be an ongoing societal co-regulation of each other’s nervous systems that I don’t see as much in the West. Healthy attachments and values of kindness and gentleness contribute to allowing an authentic smile to emerge from the depths of their being.

My spirits are always buoyed when an authentic smile drifts my way. Smiling is contagious. And it feels good to smile. Research has even shown that faking a smile can make us feel better. Smiling reduces stress and lifts our mood.

Here is an exercise from Thich Nhat Hanh that you might try to boost your smiling capacity and mood:

As you breathe in, say to yourself:
Breathing in, I calm body and mind.

Then, as you breathe out, think:
Breathing out, I smile.

I invite you to be more mindful of when you smile—or don’t smile. Perhaps you can find a little more generosity in your heart to offer a warm smile to people you encounter. You might just find that smiling offers a wonderful gift to yourself—the gift of enjoying more moments of being present and connected—and that smiling offers a wonderful gift to others, as well—it’s contagious!

If you like my article, please consider viewing my Facebook page and books below.

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Managing Drug-Seeking Patients: Q&A with Damon Raskin, MD

CATR: What’s your initial approach to patients who ask for controlled substances?

Dr. Raskin: First, it’s important to exclude the possibility that someone may have an unrecognized or undertreated medical condition. In an addiction treatment setting, this has often been done before the patient sees you, but in other settings it can be more challenging. Once I’ve ruled out an underlying condition like severe pain, I like to begin by reviewing a prescription drug monitoring program (PDMP) database report to see if they’ve gotten prescriptions from other doctors, when, and how often. [Editor’s note: See the lead article for more information on PDMPs.] After that, I sit down with the patient and say, “Let’s look and see if these prescriptions are something that you really need for a medical condition, or if this has more to do with a possible addiction issue.” And I always screen for alcohol metabolites in the urine tox screen that I perform on all patients.

CATR: What do you do after you’ve explored all these alternatives and concluded addiction is the main issue?

Dr. Raskin: I tell the patient my opinion in the most gentle, straightforward way I can. I will say, “Look, for medical purposes, I think that you do have a true problem, and it’s called addiction.” I don’t just say, “Get off these drugs,” or, “I’m not going to give you these drugs.” If patients are ready to accept they might have a substance use disorder, then I will offer to help them. I will say, “Look, I have the knowledge and the ability to help you get off these medications. If you are willing to work with me, I can help you—whether that means an inpatient program or an outpatient program or medication-assisted therapy with drugs like buprenorphine, which I’m certified to give.”

CATR: What about patients who don’t agree they have a problem with addiction?

Dr. Raskin: If a patient isn’t ready to explore that possibility and just insists on a prescription, then unfortunately I can’t have that in my practice, and I have to let them go. Usually, I don’t have to actually fire them or send them a letter of dismissal—they leave when they realize they aren’t going to get what they want. But again, I don’t just tell patients, “I’m not giving this to you.” I want to offer them real solutions for the problem they have, and they can always come back when they are ready.

CATR: That sounds like good advice. Let’s talk about some common scenarios. Do you have any strategies that could help our readers decide when a patient who is requesting opioids is endorsing more pain than they actually have?

Dr. Raskin: It’s tricky. The fact is there is no great measure or marker of pain, and even after 20 years as a practicing internist, I often rely on my gut instinct. But I’ll also look carefully at the patient’s history and exam. For example, clues like elevated blood pressure and body language can indicate when someone is in pain. Talking to family members can occasionally be helpful. One very useful clue is whether someone is willing to explore alternative therapies for pain. For example, if it’s back pain, is the patient willing to see someone for an epidural injection, consider physical therapy, or try a mindfulness group? If they are, they are much more likely to have a legitimate pain problem. On the other end of the spectrum, there are patients who reject alternatives and say, “This is what I have to have—my 8 Percocet a day.” In that case I’m going to say, “I’m not comfortable with that, although I can help you detox and I can help you in other ways.”

CATR: Interesting. What about sedative-hypnotics? For example, what do you say to patients who complain of severe anxiety and insist benzodiazepines are the only thing that help them?

Dr. Raskin: This happens a lot, and I usually start by educating patients. I explain to them that benzodiazepines are indicated for short-term use and for acute panic attacks once in a while, but that they are addictive and have serious side effects like memory impairment, fatigue, and sedation. And I say, “Look, this is a situation where we have to get to the root of the problem. Benzodiazepines are like a Band-Aid for a wound, a wound that needs actual treatment.” I explain, “If there is a true anxiety disorder, then we need to look at a treatment that will not just cover it up. We need to consider an SSRI or an SNRI, or maybe cognitive behavioral therapy if we don’t want to deal with medications.” If I get the sense that there is a benzodiazepine addiction issue—if a patient is getting them from multiple sources, asking to fill prescriptions earlier, etc—sometimes I’ll just confront the patient.

CATR: What do you say?

Dr. Raskin: Something along the lines of, “Look, I think you might be addicted to this type of medication, and I’m qualified to help you get off of it.” And if they continue to insist that benzos are the only thing that works, I’m going to say, “Well, that’s not something that I feel comfortable with.” You have to sort of set boundaries with these patients.

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15 Ways to Stand Out at Work

Jennifer thought that once she got into a field she enjoyed, her upward mobility would be guaranteed. It wasn’t. Frustrated by the competition in her office, she wondered if all the hard schooling was worth the effort. Things were not working out as she planned and her dreams of owning her own firm someday were quickly crashing.

Worse yet, her first review at work wasn’t good. Her boss said Jennifer lacked a solid work ethic which was holding her back from achieving. While she was capable of the work, she wasn’t giving it her all and the quality of her showed it. Jennifer’s first response was to be defensive and then blame her boss for unreasonable expectations. But after she had some time to consider the points, Jennifer knew she had to change.

The problem was Jennifer didn’t know what to change. So she sought out counseling to improve at work. Here is what she learned.

Show up early. An old English proverb says, “The early bird catches the worm.” By getting into the office early, any crisis that developed overnight can be handled timely. This is also a good time to manage time wasting emails so the rest of the day can be more productive.
Stay late. This doesn’t have to be an everyday event, but staying late a few days out of the week on a regular basis is helpful. This shows dedication to work and a willingness to go above and beyond.
Be consistent. One of the greatest challenges at work is to do a job consistently well. Don’t do some tasks better than others. Strive to do well in all areas of the job’s expectations.
Be present. Too often work time is used for personal time and personal time is used for work. Having clear lines between the two will keep exhaustion down to a minimum.
Do more. Take what is expected and do 10% more. This slight amount done over time will greatly increase the overall work product.
Seek mentoring. In every profession, there are people who have achieved a higher level. Seek out a mentor that is accomplished and willing to share their wisdom.
Develop relationships. It takes a bit of effort to make relationship with people who might not be within a normal circle of friends. But this is one step that is worth the effort. Having solid relationships with other people at work can be a useful connection later on.
Be kind. Regardless of the position of a person, be kind to everyone. Nothing gets around an office faster than gossip about unkind behavior.
Keep learning. There is always something new to learn. Those who succeed look for opportunities for growth and continued education. Consider studying outside of the current area of work to increase future job opportunities.
Work hard. A hard worker is someone who gives their all. No matter how they feel or what is going on in their personal life, they still give their all at work.
Work smart. In every job there are opportunities to become an expert in one or two areas. Working smart is narrowing down this focus to become invaluable at work.
Embrace criticism. Instead of running away from criticism or seeing it as a failure, embrace the critique. Take away one thing that can be improved and concentrate on it until it is mastered.
Stretch beyond comfort. In every job there are times when opportunities arise that are beyond the normal job opportunities. Stretching past a comfort level demonstrates a willingness to try new things and expand.
Use humor. Even tense moments can be lightened with a bit of humor. This is not about being the office clown but rather having a bit of levity at work.
Be patient. Patience is a virtue especially at work. Be patient with self as well as others. Remember everyone has opportunities to learn and develop and not everyone will grow at the same pace.

To get noticed at work, try these 15 suggestions. A strong work effort brings a sense of satisfaction from having performed well. This is the best reward.

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My Boyfriend Cheats When He Is on Drugs

From a young woman in Ireland: We have been together for 3 years and neither have us have ever cheated before we have always been so faithful and loved each other so much, I know that he had taken drugs before and I’m not ok with it so he has always hidden it from me ,

I seen a video of him dancing with another girl on snapchat, and he confessed to cheating on me with that girl the next day. He says it wasn’t him it was a ****ed up version of him and he regretted it instantly.

I always had total faith he would never cheat on me and I felt so safe with him , , I can’t believe he has done this I’m so shocked it hasn’t even hit me yet. What do I do ,

I don’t want to break up but I feel like we have to because I will never trust him again as he has lied to me about taking drugs and now he has cheated on me. He swears this is the first time and that he only kissed her but how can I believe him. I don’t know what to do I really don’t want to break up with him but I know that our relationship will never be th same as I firmly believe that once a cheat always a cheat.

Please help me I feel lost and so alone, I feel sick at the thought of what has happened and don’t know how to react. we are currently in a long distance relationship as he moved to liverpool about 3 months ago whilst i live in ireland, the plan was for me to move to liverpool in the summer. so therefore im oblivious to anything does unless he tells me , trust was so important and now its destroyed. the only thing i can think is if he has done it before, why did he tell me about it this time?

A: Please, don’t make any major life changes — like a move — unless and until your guy straightens out his life. He has “cheated” on you in more ways than one. Yes, he was unfaithful by cheating with the other girl. But he is also “cheating” by hiding his relationship with drugs. Yes, that is cheating, too.

This man is not the honest man you deserve. A relationship based in lies isn’t going anywhere.

I wish you well.
Dr. Marie

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Book Review: Paraverbal Communication in Psychotherapy

Communication is said to be only 7% what you say and 93% how you say it. In many ways, it’s all about what isn’t said—body language, eye contact, tone of voice—because what isn’t said shows the true emotion behind the message.

In Paraverbal Communication in Psychotherapy: Beyond the Words, authors James Donovan, Kristin Osborn, and Susan Rice put nonverbal communication in psychotherapy under the microscope.

Through case studies and both qualitative and quantitative analysis, the authors present a clear case for the value of understanding and leveraging paraverbal communication for the betterment of the patient.

Paraverbal Communication in Psychotherapy is reminiscent of a research-paper-turned-book, yet with a readability often lost in the technicalities of scholastic writing. The structure establishes credibility and offers a delineated roadmap, making it clear that despite its accessible tone, this isn’t Sunday reading for the everyday psychology nut. Rather, it is a genuine primer and experiential evaluation of using paraverbal communication as a tool in psychotherapy.

The authors relied on tapes of themselves and of other clinicians, and a quantitative rating guide – the Achievement of Therapeutic Objectives Scale (ATOS) – to determine the communicable connectivity between the paraverbal signals and the course of the treatment session.

The authors used distinct case studies followed by evaluations of the treatment session as determined by the ATOS score, clinicians’ perspectives, and a notated “script” of each participant’s nonverbal communication. In doing so, they were able to demonstrate not only the role of paraverbal communication in the session, but best practices and opportunities for clinicians to learn from in their own work.

I am a student of communication, psychology, and public speaking, but I am not a licensed therapist. That being said, my review takes into account the established credibility and academic structure of the book. Despite my lack of professional experience in the field, the brief history of psychotherapy provided in the opening pages was truly educational and set a solid foundation for the case studies.

Because the authors took the time to summarize the practice as well as the current and historical research, I had a base understanding from which to contextualize the “experimental” portions and evaluations that followed. As the book followed the structure of a well-researched paper, the case study portion was presented as mini-experiments, tested over time and analyzed for this book. This lent an air of objectivity to the research, which was well-established and communicated in a way that was both academically sound and accessible.

What did surprise this reader was that the body language portion of communication – referred to as paraverbal communication in this context – seemed to be a less-discussed topic or an ancillary study, as opposed to a core.

In my study of leadership, public speaking, and relating to others in those roles, understanding where people are coming from based on their body language is foundational information and something you are trained to be constantly aware of. It is quantified well by the research both preceding this work and shown in the case studies, and the authors further prove its validity as an important component in psychotherapy.

One additional strength of this book, and part of what kept it from being too bogged down by academic thoroughness was the tone. As mentioned previously, it is both accessible and clear, but more than that, it is personal. The authors – notably James Donovan – maintained an intimate connection to the reader that grabbed my attention and gave me the perspective of sitting in a small classroom and learning directly from the source.

While it laid the concepts clearly, built a solid research framework, and presented in an accessible yet authoritative tone, I found myself lacking the action steps for application on a case-by-case basis. This is where the downfall of the academic structure is seen, as there is not as clear a focus on “what do we do with it now,” in direct, actionable terms.

While a licensed therapist might know what to do with the information presented, the accessible tone would be topped off perfectly with a more direct application. By providing readers with methodology to apply the principles learned, this would be stronger as a primer on the topic as opposed to just a presentation of research.

In closing, what Donovan, Osborn, and Rice have done is take the principles of non-verbal communication and demonstrated their value in psychotherapy sessions. Backed by research and experience, Paraverbal Communication in Psychotherapy is an excellent primer on the topic for licensed therapists eager to better understand and respond to what their patients are really feeling and walking through in the moment.

Though I speak from outside the field as a formal participant, I can see how this work could be transformational for the practices of those who read it.

Paraverbal Communication in Psychotherapy: Beyond the Words
James M. Donovan, Kristin A. R. Osborn, Susan Rice
Rowman & Littlefield
October 2016
Paperback, 262 pages

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How to Stress Less While You Travel

For most people, traveling is always synonymous with lots of stress. Whether you’re traveling for business, taking a vacation, or going to see your relatives and friends, there are simple steps you can take today to actually reduce the severity of your stress levels on your next trip. The following tips can help turn what would have been a stressful adventure to one that is looked forward to with anticipation and ease.

Before you leave to catch a bus, a scheduled train, or an airplane, be sure to curtail your stress by doing some planning ahead of time. It’s important to stay on top of any delays you will potentially encounter that can set your stress levels off kilter. The more prepared you are, the better off you will be, however long or short your trip is.

Since many individuals have a hard time packing, especially women, it is very important to pack wisely. Make a list of only the essential things you may need to bring with you, and nothing more, checking each one of them off as you pack them to better ensure that you don’t leave behind anything important. Keep a little notebook by your bed to remember to jot down things you might have forgotten, so you will remember in the morning. Pack the night before you leave, or earlier, to avoid the stress of being rushed and possibly nervous you’ve forgotten something. Keep things you may need while in transit in your carry-on bag, so you can access them with ease.

It is truly important to dress comfortably while you travel, especially when going to destinations many hours away. Be sure you wear comfortable shoes and slacks. Dressing in layers helps too, since climates can change in a flash from one region to another.

Just because you are traveling, you should still remember not to neglect what your body and mind need most. The importance of sticking to your normal routine is critical. That may mean to take your vitamins at your usual time, get the same quality of sleep that you more or less get back home, and have some stress relievers on hand to decrease your chances of getting sick from the stress of travel.

There are some additional important tips to remember as you are traveling. You have heard this countless of times before, but do your best to arrive early, before sprinting out the door late in a panic. Allowing yourself ample time will enable you to deal with any unexpected travel difficulties with ease. Worse comes to worse, if you end up being early, you can read a book, do some gentle stretches, charge your devices, or grab a cup of coffee.

Eating well beforehand (bonus points if it’s healthy) and during your trip, while staying amply hydrated, will go a long way to preserving and stabilizing your energy and blood sugar levels. Having these levels fluctuate or dip in any way can affect your mood dramatically. Think healthy snacks like healthy protein bars, popcorn, and a handful of nuts to keep satiety at bay, and make your wallet thicker.

If you feel that you are starting to get overwhelmed with travel-related stress, breathing exercises, and other quick stress relievers can help you feel calm more quickly. Find the ones that work for you. Having a few quick stress relievers on hand, whether it’s a deck of cards, a stress ball, a good book, inner reflection, or quiet meditations, will all go a long way towards preserving your sanity as you deal with the stress that often comes with traveling.

At the end of it all, there is nothing better than a good old fashioned cognitive reset. Rather than thinking of this as a stressful mess, think of it as an adventure, or a challenge that your brain needs to overcome. Viewing your experience in this light can make traveling much less stressful — and actually enjoyable. With this handy travel stress-less checklist by your side, you can feel not only more comfortable before, during, and after your trip, but actually look forward to reaching your destination, wherever that may be, in a more peaceful state of mind.

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