Where you live matters: “The Geography of Bliss” by Eric Weiner

When I first studied to become a clinical psychologist, I looked at mental health issues as a reflection of the individual’s history. I focused very much on how interactions with important figures in our formative years shape and affect us for years to come.
Later, when I did my degree in social work, I delved more into the ways in which sociological and economical factors affect our personality and the challenges we face.
The “Geography of Bliss” brought me a new perspective on broader forces that shape us as people. I had not paid much attention to the way in which values of the culture we live in determine our level of happiness. In hindsight it is obvious that the culture we live in and grew up in will influence us.
This book describes the journey of a journalist through the world in search of the secret to happiness as a function of geography and culture. He makes an effort to rely on the most current research into happiness and to understand which countries are most happy and which are most miserable and why.
Even the definition and the experience of happiness is rooted deeply in place and culture. The author describes an emotion spanning the exuberance expressed in the United States (“I am so excited”) to the calm contentment of people in Switzerland.
Happiness comes in different forms in different countries that report a high average level of happiness. There is a basic low level of income that is a fundamental requirement for happiness, enough to insure a level of food security and health care. Beyond that cultures that engender a high level of happiness take many different forms.
Some of the countries that report the highest levels of happiness are Switzerland, Iceland and Bhutan.
In Switzerland the author traced the high level of contentment to a high level of personal trust between people and to the high level of organization in society. Although for some it can be stifling, on an aggregate level the very orderly society and the high level of predictability made people content.
In Iceland, on the other hand, the small community has a robust safety net and as a society accepts failure as part and parcel of what happens when people take risks and allows them to do so, so people are less oppressed by the constant fear of failure.
As opposed to the first two examples Bhutan is not a wealthy country. It is a country that takes happiness seriously. At a national level they have a concept of of Gross National Happiness in their constitution. What impressed me most in their view of happiness, informed by Buddhist practice, is to think about our death as a way to a happier life. This practice helps puts things in perspective, it urges us to put aside the petty and unimportant irritations and to focus on the important things in our lives.
On the other hand, Moldava stood out as a miserable nation. Because of the lack of trust and lack of community. In a place where where people don’t help each other, happiness is in short supply
On the extreme end of wealth, as embodied in Qatar, the old adage rings true :Money doesn’t bring happiness. With no challenges in their lives to motivate them, boredom sets in and material wealth cannot compensate for that.
After reading this book you will not find the secret to happiness, you may not be any happier, but it is a fun and interesting read and it sparked, for me, thoughts about the broader forces that shape us.

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A new Approach to Weight Loss: Slim by Design

Excess weight and obesity are problems that plague many of us in today’s world with easy access to plentiful food.  Excess weight has severe health implications leading to a high incidence of diabetes, heart conditions and even cancer. Obesity also has an impact on a persons self esteem and can lead to emotional problems.

We are all aware of the challenges of losing weight.  A huge industry has sprung up around weight reduction and countless books offer miracle diets that promise quick fixes. The real challenge of maintaining a healthy weight is not only to lose excess pounds but to keep the weight off over time.
Brian Warnsink offers a somewhat different approach to the issue of maintaining a healthy weight. In his approach, called slim by design, and book by the same name, Dr. Warnsink suggests simple steps to adjust our surroundings and tweak our behaviour so that we will eat less, without conciously having to exert will power to achieve that goal.
Dr Warnsink points out that trying to constantly exert will power to overcome temptaions , while seemingly laudible, is exhausting and when we are emotonally depleted by other demands we easily lose the self control required to monitor our food intake. His ideas have been experimentally validated and have been implemented in school cafeterias, restaurants, homes, and even at Google. The book is funny, easy to read, easy to implement. It is  a leisurely afternoon read.

The premise is that we are  unconsciously manipulated by our physical environment and so we should use it to our advantage.

There are some obvious changes to our environment such as making healthy food, such as fruit and vegetables, easily accesable and in sight while keeping less healthy snacking food such as cereals in a harder to reach cupboard.

There are other less obvious changes to our eating habits that make a measurable change to the amount we eat. Dr Warnsink has found that the size of the plate we eat from has a large influence on the amount we eat. He suggest eating from a smaller plate.

Dr Wansink offers strategies for reducing food consumption at home,  in restaurants and for negotiating shopping in a supermarket so as to eat a more healthy diet. While some of this may seem obvious, the value of the approach is to find ways in which we do not have to consciously work at reducing calories.

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Side Effects of Psychotherapy

I am a therapist and I believe in the power of therapy to alleviate suffering and contribute to people’s quality of life. I have seen it happen many times. In this post I would like to discuss some of the potential risks of therapy, these potential side effects are not widely discussed.

  1. Dependence: Some clients start to depend on their therapist for every decision they need to make.

A related issue is when the client effectively channels the therapist in his everyday interactions with friends and family. When the client overly identifies with the therapist it can lead to awkward social interactions and impedes the quest of the clients in finding their own voice. It is up to the therapist to point out excessive dependence, to explore its meaning and to prevent it.

  1. Reliance on the connection with the therapist as a sole resource to meet emotional needs, instead of expanding a support network. Therapy should help a person improve their social skills, expand their social network and not serve as a substitute.
  2. Not knowing when to terminate therapy: I have heard countless stories about patients wanting to stop therapy, and well-intended therapists have convinced them to stay. My policy is clear. I greatly respect the clients’ wishes to terminate therapy. There are times at which I initiate the discussion on stopping therapy. Similar to the role of a parent, there often comes a point that the client needs to be gently pushed out to stand on their own two feet.
  3. Expense. – This is probably the most recognized issue. .The money that you pay towards therapy, may prevent you from pursuing other activities that could improve your quality of life, and contribute to your growth as a person.
  4. Time – the time and energy you invest in therapy, could have been spent with loved ones, on meaningful activities that could contribute to your quality of life. No, I do not recommend avoiding psychotherapy, if you could benefit from it. I work as psychotherapist because I believe in the benefits of this approach. There is a large body of empirical evidence that supports the benefits of therapy, for specific concerns  above and beyond what medication alone can offer.

However:

It is OK to gauge whether there is a fit between you and your provider.

It is OK to check from time to time with your provider about the approach, directions, goals and the need for continuation.

It is OK to weigh the benefits of psychotherapy against the cost – what does it prevent you from doing because of the investment in both time and money.

It is OK to see your provider on less than a weekly basis, or as needed – provided it works for both of you.

My policy on terminating therapy is that if a client decides to quit therapy, I do not try to dissuade them unless there is a clear indication of danger.  I do check with the client whether they wish to stop therapy

 

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16 Mental Health Digital Resources that I Found Interesting

Here are a few digital resources that I have found helpful. This is not an exhaustive list, but I have checked these out and found them to be good.

Wherever possible I looked for free apps. In no case do I have any commercial connection with these recommended sites.

  1. mood chart

This tool was developed for suffers of bipolar disorder.   With this tool you can track your mood, find patterns, and track how your mood is influenced by medications, events in your life, exercise, and more.  This could give you an early warning that you are starting a manic or depressive episode, so you can take measures to prevent it.

  1. Todoist

For people that suffer from ADD/ADHD , but also for all of us who want our life more organized and efficient.

This website and app helps you organize and prioritize your tasks. The free version is very good. You can pay and get some additional features.

There are many other similar tools. I found this to be the most friendly and useful for the lay person..

  1. DBT skills

DBT (Dialectical Behavior Therapy)   is a collection of practical skills to help you better manage your emotions, stress and hence your life.   This is an app that lists all the DBT skills by modules.  You can create an “emergency list” tailored to your personal preferences.  This app will probably be most useful for people already familiar with this approach.

  1. the motivation hacker

A surprising resource – a small book that describes how to set goals for yourself and how to get things done.  This appears to have been written by a geek. The book is based on solid understanding and research, and is better than many others written by mental health professionals.

OK, it is a book and not an app. But it is available only as kindle book. So it is included.

  1. P E coach

PTSD coach

For people who suffer from trauma.

  1. esense skin response

Biofeedback is a promising field.  It is based on giving you immediate auditory or visual feedback on a measured response that you cannot normally sense, such as skin conductivity (GSR) or an electrical measurement corresponding to of the tension in your muscles, (EMG). These types of response are related to factors that we would like to learn to control such as stress and hypertension. Research and clinical practice show that with feedback, you can learn to control these functions. Most are related to the autonomic system – it is a way to reduce the activity of the sympathetic branch (fight or flight) and increase the parasympathetic branch, which induces relaxation.

Many apps carry the key word biofeedback, nearly all of them have nothing to do with it. Sometimes it is a general relaxation app with nice music. Sometimes it is an app designed to train you to breathe slower and deeper, which will induce relaxation. But you do not need the app for that- you can do it on your own. Breathing is partly voluntary, and certainly you know how to control your breathing if you pay attention to it.

Esense skin response is an actual biofeedback app that  uses the GSR(electrical conductivity of the skin). It does require a pretty large investment for a skin conductivity measurement attachment.

  1. Cognitive diary self help

An app for Cognitive therapy for depression, including a cognitive diary

  1. rejection therapy

A pretty wild app designed for people who suffer from social anxiety. It consists in asking you to put yourself in absurd and embarrassing situations voluntarily. After you do it a few times, and discover that you stayed alive, you will not be so anxious in regular social circumstances. I did not dare to use it, but I believe it to be useful. Comes from the geek community in San Francisco. Essentially, it is a form of exposure therapy.

  1. Succeed socially

A website full of articles, to help the “socially awkward” people function better socially. A bit repetitive, but informative. You can read it on the web for free, or pay and get it on kindle.

  1.  Operation reaching out

This app was developed by the military, as a measure to prevent suicide among soldiers and veterans. It is useful for anyone with a  severe and persistent mental health disorder, who  may be in a situation where they may harm themselves.

The app lets you list people’s phone numbers whom you can reach out to when you are in severe distress. It encourages you to reach out for help, points out the distorted thought process when there is only tunnel vision and you cannot see other options for relieving the pain you are in.

     
  1. Quantified mind

A website that contains neuropsychological tests.  It lets you take them under different conditions and find out under what conditions your brain functions best. (Morning vs evening, before or after coffee/ medication/exercise/meditation, ext.) The tests are based on solid neuropsychological understanding, and test executive functions.

     
  1. a-chess

An app for recovering alcoholics, with many resources. Has been shown in research that it is helpful.

     
  1. iSleepEasy

A serene female voice helps you detach from your day and take the time to relax and sleep, in an array of visualizations and guided meditations. You can control both voice and music tracks. Includes tips for falling asleep. There are many similar apps. I liked this one the best.

     
  1. Relax Melodies

A free relaxation and music app.  I liked the option of mix and match nature sounds with music.

     
  1. Dreamboard

An interesting site for tracking your dreams. Your dreams can give you valuable knowledge about yourself and your life when you listen to them carefully and are able to decipher their code.

  1.  TED

A website that  will keep your brain alive.

If you know about any other digital resource that you found helpful, please let me know and I’ll be more than happy to include these.

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Vaginismus – the unspoken sexual dysfunction.

Vaginnisums is the term used for a condition that affects a woman’s ability to engaged in any form of vaginal penetration. This includes not only intercourse, but also use of tampons, or getting routine gynecological examination. The vaginal muscle becomes spastic in an involuntary way, which makes any penetration either very painful or impossible. (From Wikipedia).
People tend to believe that with the sexual revolution, and the widely available knowledge about sexuality, this kind of dysfunction no longer exists.  This is not the case; I have come across the conditions several times in my practice just in the last year.

We do not hear about the condition, possibly because  of shame or maybe because there is no pharmacological  solution available, so there are no ads  from the  pharmaceutical companies.
However, the good news is that it is quite easily treatable. All the women that I have seen with this condition, and that have persisted with treatment, succeeded in overcoming their issue and were able to have an enjoyable sex life.
The treatment consists in learning to relax the pelvic floor and vaginal muscles, and using dilators in increasing size to learn how to get used to penetration.
You can buy the dilators with instructions from Vaginismus. It is highly advisable to use specific physical therapy that addresses this issue. In my vicinity, you can find qualified physical therapists at the University of Michigan health center. . If the issue has already created stress in the relationship and secondary emotional issues, it is important to consult a qualified sex therapist.

 

 

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Reading facial expressions – a help for those with Asperger and all of us

 

People with Asperger syndrome face many challenges as they cope with life and society. From my professional experience, the most painful area is that of interpersonal relationships. There is often a misconception that people on the autistic spectrum are not interested in other people, in friendships or relationships. From my experience, they actually crave relationship and friendship, as most of us do. Many  times people on the autistic spectrum lack the skills to attain the relationships that they want and need.

One of the reasons that social skills prove to be so challenging is that often people with Asperger do not read facial expressions well. While this skill comes naturally to most of us, people with Asperger tend to lack this innate ability. Luckily this skill can be acquired, if you are willing to invest the time and  effort.

Dr Paul  Ekman dedicated his life to research of  facial expressions in different parts of the world. He found that there are 6 basic emotions for which facial expressions are universal. The universal nature of these expressions indicate that they are most likely  hardwired in us.

Dr. Ekman built an online course dedicated to teaching people to better read facial expressions. There are a few modules to the course. personally, I recommend that those who have trouble reading expressions complete all the modules.

The online Course:

a course in reading facial expressions

 

The basic book that describes his research:

Emotions revealed/Paul Ekman

 

An entertaining TV show, that is based on his research. As entertainment it sensationalizes the content, but it is based on his actual work. TV serie:

Lie to me

 

Full disclaimer: I do not have any business relationships or affiliation  with these programs.

 

 

 

 

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Permission to be an Introvert

 

In my clinical practice I often see people who feel they need to apologize for being introverts, at times they see it as a character flaw to be corrected.

Being an introvert is not the same as being socially anxious, socially awkward or lonely. Introverts tend to have fewer friends, but their friendships are often long term and deep. Introverts tend to avoid small talk; but they love to talk about what really matters. Introverts prefer social interaction in small groups, but are capable of dealing with large gatherings when needed.

Introverts can derive great joy from their social connections, but they need time alone in order to recharge themselves.

Introverts enjoy solitary activities, and are not scared to be alone, nor are they bored. They do not depend on other people for entertainment. Introverts tend to have a rich inner world that provides them with stimulation and reward.

Our society tends to value and promote extroverts. Introverts should not shy away from their natural tendencies. Being an introvert is a stable trait and has a recognized genetic component. If you are an introvert embrace your nature and enjoy your strengths.

Recommended book:

Quiet: The power of Introverts in a World that can’t Stop Talking

 

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6 evidence based tactics to Build your Resillience

 

Resilience is the ability to manage the stress response. Managing our stress response is critical to us all so that in times of stress we may actually find benefit and not damage our psychical and mental health. Contrary to popular belief, stress in itself is not bad.  Stress can facilitate growth and self-esteem once we have mastered the challenge that induced the stress. Resilience   predicts success in many areas of life. We all face setbacks, but only some of us know how to respond to them creatively and productively. Many environmental factors are not under our control, but when stress arises, there are tactics that can build and strength our resilience, that are under our control.

Known strategies to build resilience:

1. Learning to accept ourselves, including our faults. This does not mean being complacent or and that we do not try and work on our faults but we should not waste energy on self-criticism. We have to work with what we have.

2. Learning to manage  stress and  regulate  emotions, particularly the negative ones such as anger, sadness and fear. This is extremely important when coping with negative events. The negative emotions, especially in high volume, can impair our ability to perceive reality, to think clearly and respond appropriately in a difficult situation.

There is a therapy approach, called DBT (Dialectical Behavior therapy) which is, really, a collection of skills for emotional management. DBT skills were initially constructed for borderline personality disorder. In my opinion and clinical experience, they can be highly effective for all of us in dealing with stress.

3.  Use of cognitive reframing. Many times reinterpretation of an event can give it a different meaning, which can help us cope with a difficult event.  We can reframe the source of stress as a challenge and not as a catastrophe or a negative event. Depending on the specific source of stress it can help to reframe in a less personal way. (“It is not about me.”)

4. Exercise, a healthy diet and good sleep habits all help us cope with stress.  Exercise has been shown to strengthen attention, decision making and memory. Of course we are always being admonished to live a healthy lifestyle, and this is easier said than done. Still it is important to recognize that these lifestyle habits we have will have an important influence on how we deal with stress.

5. Support system – Get support from friends.  According to some studies, this may be the most important tactic. Close friends help you vent, help with your reality testing, give you good advice.  Some people tend to shy away from friends in times of hardship. This is very unfortunate.

6. When things are going well tackle new challenges. If you dare to challenge yourself and get out of your comfort zone when things go well, you are more likely to be able to cope with less favorable circumstances.

Adapted from Southwicck, S. & Charney, D. : Ready for Anything. In :  Scientific American Mind, 2013 (5) 32-42.

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2 Effective Study Techniques that work (and some that do not.)

Effective study habits are critical throughout our life. We are particularly aware of the need to learn efficiently when we are in school, but it is just as important in our professions and in life in general.

Recently, researchers have done a meta-analysis, a statistical analysis of many studies, in order to use a data driven approach to figuring out the best methods for learning effectively.

Techniques found to be effective

  1. Active reading

For lack of a better name, I would call the first technique “active reading”. The writers of the article highly recommended doing practice tests, or to answer questions at the end of the chapter, immediately after reading a chapter. There is some evidence that trying to answer questions about the material even before reading is also beneficial. However, most of us do not read text books once we graduate; but we do read non-fiction, for pleasure or for professional reasons.

The researchers suggest a couple of practical techniques that utilize the principle of testing oneself at the end of a chapter. As you read the text you can write down key terms and concepts that you can ask yourself about at the end of the chapter, effectively generating a self-test.

Another approach is to persistently ask “why” in the manner of a curios toddler until you dig down to a deeper understanding of what you read, which will lead to  better retention. A variation on this, if you do not want to revert to the toddler mode,  is called “self-explanation”. In self-explanation you ask yourself what did you learn from the text, and how does  it relate to what you already know, or how you can use it.

 

  1. Slow study

The second technique that works is to spread study over time.  This, of course, requires organization, planning ahead, and getting over the tendency to procrastinate. It has been shown in many studies that knowledge acquired over long period of time – as opposed to a crash course – is retained better.

 

Techniques that do not work, even though they are very popular

 

1. Repeatedly reading the same thing. There is some modest benefit after second reading. After the second reading no further benefit has been found.

2. Highlighting profusely. This may be beneficial only if it serves as a first step for active reading – by  generating questions and key concepts you will use later.

3. Visual aids such as diagrams, colors, etc. , except in very specific contexts when the material itself is highly visual, or the diagram forces you to rethink and integrate what you learned.

 

There is another technique that was not mentioned in this article, and I believe to be highly effective. When you teach others, you are bound to learn and understand better. At least from my experience as a tutor (in my college years) this was the case. This may account for the fact that sometimes  study in a small group can be highly effective.

Some people say that this is exactly what therapists do – teach others what they need to learn.

Adapted from:

J. Dulosky, K. A. Rawson, E. J. Marsh, M. J. Nathan & D. T. Willingham: What Works, What Doesn’t. In: Scientific American Mind, 2013 (5) 47-53.

 

 

 

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