Effective Psychotherapy

Stress is often portrayed in the media as the bane of modern life, a source of many of our ills and difficulties. There is no doubt that excessive stress is not good for us and can affect both our mental and physical well-being.

Stress management is a set of skills used to reduce stress in our daily life.  A recent study by Dr. Epstein sheds new light on this concept.

Dr. Epstein looked at different skill sets associated with stress management. These skills are commonly taught in courses, coaching or psychotherapy. Dr. Epstein looked at three broad sets of skills.

1 .Preventing and managing the sources of stress. This includes proper organization of home and work space, good time management, and effective prioritization and planning of tasks.

Some of these skills are reactive, for example, I have just noticed how stressful overstuffed and disorganized my filing cabinet is. Some skills are proactive such as buying Christmas presents early thus avoiding last minute stress and long lines.

2. Relaxation skills. These skills are what many of us tend to think about as stress management tools. These include practices such as meditation Yoga and guided imagery

3. Cognitive coping skills. These include Reframing situations and control of irrational thought patterns.

To the surprise of the investigator, the most useful coping skills were those mentioned in the first category. Good organization, planning, and time management had the most benefit. The second category, of relaxation techniques, although useful, had less of an impact. Cognitive coping skills ranked last. Cognitive skills are very helpful when coping with depression but apparently less effective when dealing with stress.

Dr Epstein’s study shows that while it is nice to do yoga, meditation and other relaxation techniques, if you really want to manage your stress,  go back to basics. Organizing your physical environment, managing your time and prioritizing your tasks are all straightforward tools to reduce stress.

Managing your physical environment means that the pile of papers on your desk, the one next to the three coffee cups needs to go. You need adequate storage for you papers and other things.

Better management of time entails making realistic estimates of what you can and cannot do, so you will not stress yourself later.

Managing priorities can best be done with a good old “to do list”.  The list can be Hi-Tec or simple low-Tec pen and paper, as long as it lists all your tasks, and assigns priority to each. If you do your tasks according to their priorities, you will get ahead in your work. Plan your day in the morning. This way you will be more productive. Try and plan ahead for a week, a month, even a year.

After you have done all of these, you will probably have a time to do yoga. (And I am all for it…)

People that report better stress management skills, report feeling lower levels of stress, being happier, and being more productive and successful professionally. The good news is that these skills can be learned.

Adapted from Scientific American Mind October 2011, 31-35

* Dr Epstein actually defined four types of stress management skills. Since two of them overlap to a large degree, I grouped them under one heading.

The last page of the internet.

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Recommended book:

Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life

This book is a valuable introduction to the concept of mindfulness. The book teaches to value and savor the present. This approach can help deal with stress and the practice of mindfulness has been shown to increase ones quality of life.

Dr. Zinn brought the concept of mindfulness from Buddhist meditation, and has shown how it can be applied as a basic technique for improved well being and stress relief.

Mindfulness means the ability to live in the present moment, to be absorbed completely, fully aware of each thought, feeling or sensation that arises. This awareness implies a nonjudgmental attitude towards our flow of thoughts, even unpleasant sensations or mental events.

The mere act of watching our mind,  allows us to distance ourselves from our emotions. This enables us to gain a better perspective on our challenges.  Through mindfulness  we realize that our emotions are just that, not the ultimate truth about reality. The common thought distortion “I feel, therefore it is reality” loses its hold on us.

Living in the present means that we do not dwell on the past, or think anxiously about the future . Many people believe that if they immerse themselves in painful emotions, it will provide them an insight and ultimately lead to inner transformation. Delving into the past must be done with care, as it may  strengthen and reinforce  the neural pathways of pain and depression.  This reinforcement may lead to further deepening of the depression and pain, as opposed to the hoped for alleviation. Mindfulness offers an additional method for dealing with ones challenges.

Studies have shown that practicing mindfulness is a good tool for stress management, depression management, and  it leads to better quality of life, enhance creativity, and can  improve chronic pain and other medical conditions.

Deficiency in vitamin D is linked to depression, Parkinson disease and to cognitive decline according to a new article in Scientific American. According to the article, about three quarters of the population in the USA suffer from vitamin D deficiency. Here, in Michigan, the percentage may be even higher because of the lack of sunlight.

If you suffer from depression, it would be prudent to ask for a blood test, to determine whether your blood levels are within normal limits. Do not take extra supplements of Vitamin D without consulting your primary care physician, as it can be toxic in large doses.

The original article can be found here.

Recommended movie: Up

This poignant movie describes the grief process of an older man who has  lost his wife, the love of his life. We witness both his pain and despair and his  process of recovery.   His recovery is initiated by his determination to carry out a dream that they had together, in spite of his wifes absence. Underneath  the adventure story and amusing animation lies a deeper truth about the need, not to forget but  to continue living , forming new bonds and connections while remembering .

Depression contributes, and is maintained by common distorted thought patterns.

This checklist is taken from the Wikipedia, “Feeling Good” book  and other sources, with some changes and additions. As you go through this list try to  identify these patterns that you tend to use. It may be an  eye opener: You will realize that what sounded like “the reality”,  is indeed very subjective. This is the first step to start controlling those thought patterns, and influence your mood. You may want to keep track of these thought patterns in a journal.

1. Black and white thinking – No shades of grey. Thinking of things in absolute terms, like “always”, “every”, “never”.     If it is not perfect, it is a failure.
2. Overgeneralization – Taking isolated cases and using them to make wide generalizations. Generalization from one detail , or aspect of a situation, to the whole situation.
3. Mental filter – Focusing almost exclusively on  negative or upsetting aspects of an event while ignoring other positive aspects.
4. Disqualifying the positive – Continually deemphasizing  positive experiences.
5. Jumping to conclusions – Drawing negative conclusions  from little  evidence. Two specific subtypes:
   • Mind reading – Assuming you can read the feelings and thoughts of others. You know for sure what other people think of you, and of course is it negative.
   • Future reading –  Catastrophizing.  You expect the worst possible outcome, however unlikely. You ruminate about “What if”.
6. Magnification and minimization – Distorting aspects of a memory or situation through magnifying or minimizing them such that they no longer correspond to objective reality.  If you are depressed, often the positive characteristics of other people are exaggerated and negative characteristics are understated. The reverse  happens when you think about yourself.
7. Emotional reasoning – Accept your emotions as a valid evidence.  ”I feel therfore it is true”. If you feel stupid , than you are  stupid.
8. Should statements – You know the way things “should” be.  You have rigid rules which  always apply, no matter what the circumstances are. Using “should” statement  leaves you and others feeling preasured, guilty, and on the long run  jeopardizes any motivation for change. It does not allow you to be flexible and adapt to  changing circumstances.
9. Labeling –  Rather than describing  a  specific behavior, you assign a negative  label to yourself.  it is not the action that was a mistake, you are the mistake. Frequntly, you judge others as harshly as you judge yourself.
10. Personalization - Attribution of personal responsibility and guilt to yourself   for events over which you have no control.
11. False expectations: Assuming that other people should be able to read your mind, without any need of your part to express your emotions and needs.  Assuming that your happiness depends on somebody else.

Social anxiety can reduce you quality of life, not let you achieve your full potential, and ultimately lead to depression. What results is a vicious cycle – the more anxious you are, the more barriers you will encounter in your life, the more depressed you become, which ultimately contribute to your anxiety. I recommend this self-help book. It is part of a serie published by Oxford University Press. All the books adhere to cognitive-behavioral approach. They come in pairs – one for the client, one for the therapists. All those I have seen so far, were excellent.If you read this book, and work along its guideline, you may not even need to see me. And if you do, it will shorten the treatment and make my work easier.

A different approach to mental health. Historically, psychology and psychiatry developed though trying to understand – and correct – pathology. Prof. Zeligman, one of the prominent psychologists today, recommends using our strengths. According to him our mental health consists not in overcoming our weaknesses but recognizing and using our strengths. It give a fresh look at the ancient saying “know thyself”. The site contains articles, videos, and self tests. The self tests are particularly helpful. We are so used to think in terms of our faults, that we forget to look at our strengths and use them more.

Positive Psychology Website