by Michelle

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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by Michelle

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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by Michelle

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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by Michelle

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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by Michelle

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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by Michelle

Self compassion

Many people believe that they will function better if they “beat themselves up”. They believe that harsh self criticism is an effective way to motivate themselves.

Actually, research shows that those people that are high in self compassion, which does not imply self indulgence or self deception, are better adjusted and recover better from life crisis. They do not waste their  energy on self blame.  

For those who struggle with being compassionate to themselves,  the best path is to  focus on the compassion they have for others.  It is  beneficial to view those things that anger us about ourselves through the prism of those around us. We are often more forgiving to failings in those around us than those failings in ourselves.  We may perceive this as a strength but it is actually a weakness. Through compassion to others it is possible to learn a degree of self compassion.

You can find recorded meditation for self compassion here:

Guided Meditation

According to  Kristin Neff, The power of self compassion.

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by Michelle

How to deal with trauma – The Life of Pi

One great difficulty in dealing with trauma is that there is at its root a contradiction. Dwelling on the trauma is often debilitating but we cannot ignore or erase it. One way of dealing with trauma is to tell ourselves a story that captures the essence of the trauma but strengthens us. At its essence the life of Pi  delves into how we deal with trauma and illustrates one way that we may handle severe trauma. Do I choose to concentrate on the horror, the loss, the anger? Or do I choose to concentrate on my own resourcefulness, ability to overcome hardships, the lessons that I learned? Do I concentrate on the loss of loved ones, and the void that was left in my life, or do I concentrate on the good memories I had with them, the lessons they taught me?
I highly recommend both the book or the movie.

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by Michelle

Holidays Blues

Many people experience stress and depression around the holiday season. There are many factors that can contribute to this feeling of stress. The incessant message of cheer and happiness can seem in stark contrast to our mundane lives and can accentuate our feelings of unhappiness or dissatisfaction. For those of us who are alone during the holidays, or not in a fulfilling relationship, the holiday is a reminder of our unsatisfied state. it is challenging when  many rituals and festivities during the holidays focus around family. Family itself can often be the source of stress. Families congregate during the holidays, old tensions surface, people may say tactless hurtful things. Indeed it often seems that, among our larger family, we revert to some earlier unfinished version of ourselves. For those of us who are alone during the holidays, the period of year seems to exclude us, as if we are standing on the outside in the cold with our face pressed up against the pane looking at the warmth and cheer inside.

If you don’t have family to be with and are feeling lonely and left out make an effort to comfort and support yourself. Do things that bring you pleasure. Be on your guard for destructive behavior that you will regret such as overeating and excessive drinking, which is a pale and false stand in for happiness.

There are additional sources of stress which may be financial, with expectations of gifts and particularly children’s expectation which may be difficult to fulfill. There are many complications over sharing family among sets of parents that expect you to come to one festive occasion or another.

Make an effort to remember that the holidays are meant to be a joyous time. If the holiday is causing you stress because of some demand on your wallet, your time or a strained relationship, take a step back and remember that you are in control. You can decide not to purchase a gift or can take some time to disconnect from a stressful situation.

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by Michelle

…Some Like it Seven Days Old

In an experiment designed to research the influence of environmental cues on our behavior, two groups of participants got popcorn in a movie theater. One group got  fresh popcorn. The other group got popcorn that was seven days old.

They ate the same amount.

When presented with fresh and stale popcorn in a different environment, a conference room, the two groups did not exhibit the same mindless eating.

The moral is that when you try to change habits, pay close attention to environmental cues and plan ahead,  rather than trying to rely on will power alone.

More about effective ways to change habits later.

Adapted from Neal & all  (2011): The pull of the past: When do Habits Persist despite conflict with Motives. In: Personality and social Psychology Bulletin, 37 (11) 1428-1439

 

 

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by Michelle

A New Approach to Stress Management

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 High-Tech or simple low-Tech 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.

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