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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The Rashomon effect is defined as the way in which different people may describe the same observed event in very different ways. This may happen while all observers of the event believe that they are being completely honest.

We are all familiar with this phenomenon to some degree, yet we are often uncomfortable when confronted with the extent  to which our personal perception is subjective, a lens through which we view reality.

This term originated in a movie by Kurosawa, a renowned Japanese director. In the movie four people meet in the forest; a young samurai, his beautiful wife, a bandit, and a passer-by. The young samorai is killed. The four people come to testify in the trial that follows, including the ghost of the samurai.  Strangely enough, three of them plead responsibility for the murder.  The event appears very differently in the story that is told by each of the four participants. Each of them is convinced that he or she is telling the truth, and the events are shown through the protagonists eyes.   In the movie there is no resolution.

Unfortunately, this happens all too often in relationships. When People describe  events that have led to a crises in a relationship, they often give completely different accounts of these events. Often the people involved are convinced that the other person is not telling the truth.

I often come across this phenomenon in my practice. When a couple is in a crisis and are recounting the events that led to the crises, it is critical to first accept that, as a rule,   no one in the room is lying. The next step is to  listen to each other carefully and try to understand what lens each person is using to view reality. Understanding the distortions that these lenses impose upon our perception, can provide us  clues on how to repair a relationships that is ailing.
It is often humbling to discover how subjective our perception is.

It is known that many of medications used to treat insommnia are addictive, can make you drowsy the next day, or are simply ineffective.

A new study by Dr. Nofzinger from the University of Pittsburgh School of Medicine brings a fresh and interesting approach to this problem. Dr. Nofzinger has built a device designed to cool a specific area of the brain while a person sleeps. The device consisted of a cap with circulating water that cools the prefrontal cortex, the area just behind the forehead.

The idea behind this approach is that insommnia is caused by hyper-arousal of the prefronal cortex, as has been shown in previous studies. This hyper-arousal is experienced by the  insomniac as excessive rumination, worries and  incessant thoughts.  Cooling this area  slows the metabolism  and reduces brain activity.

According to the study, 75% of the subjects reported better sleep – a higher percentage than any medication could accomplish.

I wonder if one could use simply one of those ice packs or eye masks you can buy in any drugstore…

Adapted from Scientific American Mind, November 2011 p. 11.

The longevity project is a long term study that followed the lives of 1500 children from the age of ten over a period of eight decades. The study was initiated by the psychologist prof. Terman in 1921, with other researches continuing the work of tracking these children through their adult life after he passed away. Prof.  Terman was very diligent in his approach and collected a vast trove of information about the background, upbringing and families of the children he chose. While Professor Terman started the study in a quest to understand intellectual leadership, his detailed work, and the detailed tracking of 1500 people through out their lives yields rich information about many facets of Human development. The book ” the longevity project” focuses on what the study can teach us about health and longevity. The study looks at longevity as a reliable indication of health, more so than many other studies based on subjective self reporting. The study comes to some fascinating conclusions that at time run counter to commonly accepted notions.

Among the many findings of the study that I found most compelling or surprising:

• The most important personality trait that predicts long life and health is being conscientious ;  being prudent and  persistent. This was a very statistically significant result. This runs counter to today’s accepted wisdom that optimism cheerfulness and lack of stress can lead to a longer life. You can be a dour contentiousness person and you statistically have a chance to live longer than the cheerful optimist.
•  Exercise in childhood and adolescence does not predict health and longevity later in life, but exercise  in middle age does. So even if you were a couch potato as a child, it is worth you while to start exercising at an older age.
• The happiness of husband in a marriage is a much better predictor of health and longevity of both  husband and wife, than the wife’s happiness. ( No explanation for that one, unfortunately.)
• A person’s social network is an important factor that contributes to one’s health and longevity. What counts is not how much you feel loved, but  how much you feel needed and the sheer volume of your social network.
• People that are accomplished in their career tend to live longer, even if they work very hard under stress for many years.
• A parent’s death,although traumatic and devastating  for a child, does not affect their longevity and health later. Divorce of parents does  have a detrimental effect on children’s health and longevity . That does not mean that couples “need to stay together for the children”. Living in a stressful environment is not good either.
•  A fulfilling sex life  predicts longevity, even after controlling for general happiness in the marriage.
•  Hand writing of future physicians and lawyers  was illegible relative to their peers even as children…

Food for thought.
The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study

Thanks to P., who brought this video to my attention.

Most people look at old age with dread. The common image is of failing health, failing cognitive ability, and general misery.

However, new studies point out that this is not the case. Actually, older adults tend to be happier than the middle aged. Curiously enough, this finding is true across many countries and cultures.

It appears  that happiness, measured in many different ways, is shaped like the letter “U” across life. People tend to be happy and hopeful starting their life as young adults, in their twenties. Than stress, and the disappointments of life take their toll. There is steady decline of happiness until middle age. Than something suprising happens: In spite of all the losses that age may bring, people start to feel happier. Even after controlling for income level, health and many other variables the distinctive U shape is maintained. The lower point of happiness, averaged across many people, is around the age of 46. Even more surprisingly, average happiness during old age surpasses that of early adulthood.

At first glance, a cynical observer may be excused for thinking that this is wishful thinking of a cohort of ageing baby boomer researchers. Taking a closer look, the research appears valid and is worth understanding.

There are a number of explanations that may clarify this trend. One explanation is demographic. The stress of raising children passes as they leave the house and life becomes calmer. But this explanation is not enough by itself. It seem that the growing happiness is a result of inner transformation.

As young adults we feel the need to prove ourselves and we are constantly and restlessly striving. As middle age advances, we become more accepting of the point we have reached in life. We are able to enjoy what we have with less constant frustration over what we have not attained.

Maybe this is what is called wisdom.

At a later age, in spite off losses around them, people enjoy and value their time, in spite of difficulties that age imposes, precisely because they do not take the time they have for granted. Older people are less concerned over what others may think of them. They use skills they acquired over lifetime: They are better at managing their emotions. They are much less angry and judgmental. They are better at managing conflicts, so their support system is better.

Happiness is a valid goal in itself. It also has tangible benefits. Happiness has been shown to lead to  a healthier and more productive life.

The question is,  how can we accelerate our path along the happiness curve without having to wait for the passage of time.

adapted from an article published in the Economist, December 18th, 2010.

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.

These two books  by Shel Silverstein, are in themselves two parts that make a whole.  The two books describe peoples struggles with relationships and various alternatives.
The Missing Piece (An Ursula Nordstrom Book)
The Missing Piece Meets the Big O

In the first book, the  missing piece,  a circle that has a missing piece, goes on a journey. For me the circle is a female, although in the book she has no gender.  She believes that the her partner must be another piece, who would exactly match the slice that is missing and make a perfect circle. She  is able to enjoy the  journey to some degree, but is invested in finding  that missing piece. The circle meets  many pieces on her way, but none of them is an exact fit.  She  doesn’t give up. She  rolls along happily, talking to a butterfly,  smelling a flower, and singing her song. Although she enjoys her journey, she does not appreciate that joy since she is so intent on her search to find that precise match to her missing piece.  On the way the circle finds various slices that can fit to some degree but none is a perfect fit, some leave a void and others are oversized with their point gouging into the circle.

After a long eventful journey the missing piece joyfully finds a slice that makes her perfectly whole. Now as a perfect circle she whizzes past the flower and the worm so fast that she can no longer appreciate them. The circle decides that it is better to be without that perfect missing piece so that she is better able to take in her surroundings. The simple story can be easily interpreted as our search for the romantic notion of the perfect love, the precise match for us. What the book conveys is how being intent on searching for an answer to that romantic notion we can miss out on many things. Even more powerfully it shows the  the complexity  of relationships and that all relationships have a price that we may not be willing to pay.

In the second book “The missing piece meets the big O”  We meet the missing piece again. She roles around experiencing life. As she roles around her shape slowly changes and the missing slice eventually disappears so that she becomes a whole circle without finding a complimentary piece for her missing slice. At one point the missing piece finds a big O and together they role around side by side. This second, more optimistic book, shows Shel Silverstein’s view of human relationships. In his view, when someone seeks out a relationship to fill a void it will eventually lead to either a mismatch or suffocation. Only when a person feels whole with themselves can a mature relationship develop where two people enjoy life together.

Someone on Amzon recommended these two books as a wedding gift. Not a bad idea.