Saturday, December 5, 2009

Seasonal Affective Disorder for Dummies book review

While some may be put off by the “For Dummies” series title, I have found most to be excellent starting points. Seasonal Affective Disorder for Dummies by Laura Smith and Charles Elliot is where I would suggest you begin if you have questions or interest in Seasonal Affective Disorder (SAD). It references up to date research in a practical, readable manner. It is very well organized and written.

While there is a very good chapter on Light Therapy, what I appreciate most is that most of the book addresses other interventions. What is known to date, is that effective treatments for depression are effective treatments for SAD. Another thing I like is how the authors give examples of negative thoughts in various chapters, followed by healthier thinking. Many will see their own negative thoughts and then see how they can begin to change it to healthier thinking.

If SAD is an issue for you, I highly recommend Seasonal Affective Disorder for Dummies.

Happy Holidays,


Tuesday, November 24, 2009

Winter Blues book review

Winter Blues (Revised 2006) by Norman Rosenthal, MD is THE classic book on Seasonal Affective Disorder (SAD). Rosenthal started his psychiatric career as a research fellow at the National Institute of Mental Health (NIMH) and was one of the original researchers. In this addition, he also references his own experiences with SAD and what has been helpful to himself.

While the main thrust is on Light Therapy (LT), he also gives full and balanced discussion to other researched interventions, i.e., medications, psychotherapy (especially Cognitive Behavioral Therapy – CBT), negative ions, exercise, vitamins, etc. I appreciate that Dr. Rosenthal is not afraid to give his own opinions to questions about LT, after giving what is known through research.

Overall, it is important to know that SAD is very treatable for most people, whether with LT and/or with other interventions.

Winter Blues is well written and practical, doing an excellent job in referencing scientific studies in understandable language. Recommended for anyone with concerns about possible SAD issues.

Wednesday, November 18, 2009

Reducing further suicide attempts

Suicide is the fourth leading cause of death for those under 65! A study in Philadelphia showed that recent suicide attempters treated with cognitive therapy (CT) were 50 percent less likely to try to kill themselves again within 18 months than those who did not receive the therapy. People were recruited for this study in the emergency room, following a suicide attempt. One hundred and twenty people were either assigned to CT or usual community treatment.

Seventy-seven percent had major depression and 68% a substance use disorder. About half of the participants in both groups took psychotropic medications and about 13% to 16% received drug abuse treatment. About 27% of those in the usual care group received psychotherapy outside of the study, compared to 21% of those also receiving cognitive therapy.

Over the year-and-a-half follow-up period, only 24% (13) of those in the cognitive therapy group made repeat suicide attempts, compared to 42% (23) of the usual care group. Although the groups did not differ significantly in suicidal thoughts, those who received cognitive therapy scored better on measures of depression severity and hopelessness, which the researchers suggest "may be more highly associated with a reduced risk of repeat suicide attempts."

One of the researchers reported, "We were surprised by the amount of energy and resources it takes to reach out to individuals who attempt suicide. This population lacks a positive attitude toward the mental health system and often fails to show up for scheduled appointments. However, the combination of cognitive therapy plus case management services was effective in preventing suicide attempts." He suggests that cognitive therapy's short-term nature makes it a good fit for treatment of suicide attempters at community mental health centers.

If you know someone that has made a suicide attempt, some psychotherapy follow-up should be mandatory.

Best wishes,


Sunday, October 11, 2009

Review of the Legend of Bagger Vance

Directed by Robert Redford, this is an unusual tale of a champion golfer who comes back from WW I a broken man after all of his men were killed in one battle. Retreating into the bottle for over a decade, he is rescued by a golf exhibition, the support of Savannah (his hometown), and the life lessons from Will Smith. Smith plays Bagger Vance, who is the mystical caddy who helps Matt Damon's character get back his “authentic swing.” This is a movie of redemption and finding his place back in life. One of the lessons is that “Golf (life) is a game that can't be won. Only played.”

This is a very spiritual, yet entertaining movie that reminds us that we are all capable of being broken by circumstances, but that we Can get back our “authentic swing.” Inspiring and highly recommended. Movie Trailer.

Best wishes,


Saturday, October 10, 2009


Watch this and then try to NOT count your blessings. I don't think that can be done.

To all of you who feel like giving up. Video

Best wishes,


Tuesday, September 29, 2009

eletter - Peace of Mind

If you get something from these posts, subscribe to my eletter "Peace of Mind." Send an email to

Catch Yourself Being Good

The most powerful change strategy for children's behavior problems is the parents increasing the focus on positive behavior and reinforcing those behaviors. A powerful strategy of improving your mood and self-esteem is increasing positive self-talk. Human nature is such that most of us look for when we make mistakes and then be self-critical. Much of the time, that is automatic and under our awareness.

Begin NOW to monitor yourself for negative self-talk. Watch for negative things that others have repeatedly said to you, such as “You can't do ANYTHING right!” or “STUPID!” Throw those scripts away! Acknowledge that whoever said those things was WRONG, even if they may have had good intentions.

Awareness is the first step. The second is action.

Next, tell yourself things like “STOP calling yourself names!” and “STOP criticizing yourself!” Begin to replace the criticisms with statements like “Nobody's perfect,” “What have I learned so as to not make the same mistake again?,” etc.

Begin to monitor yourself for what you've done well, made progress, or completed. Become your own cheerleader and tell yourself things like “Good job!, “Great effort,” etc. As you work on a project that can't be completed in one setting, tell yourself that you made good progress for that episode.

If you find this to be difficult, consider starting by looking for positive things to say to others. (Even if this is easy for you, it is an excellent idea to increase compliments to others). As this gets easier with practice, as most things do, you will probably begin catching yourself doing some of the things that you are complementing others. Continue to compliment others and begin doing the same for yourself.

Making these changes will not give you a swelled head. Rather, doing so will decrease your stress, make you less susceptible to stress conditions (like headaches), and generally improve your mood.

Catch yourself being good! You'll be glad that you did.

Best wishes,


Monday, August 24, 2009

Online Cognitive Behavioral Therapy effective when delivered in real time by a therapist

Online therapy or “eTherapy” has been provided by some therapists in a number of different ways, ranging from email, to computerized therapeutic programs (one to be posted here soon), to real time video, for over 10 years. A brief history from 1972-2002 can be found at

A number of questions remain fully unanswered. Probably the most critical question is how to ensure confidentiality. Additionally, there are questions of how effective these interventions are.

A study in England looked at 297 adults who were diagnosed with depression. Half of these people (149) received online cognitive-behavioral therapy and “usual care” (presumed to mean anti-depressant medication) and half (148) received “usual care” from their general practitioner while on an 8-month waiting list for online CBT. At fourth months, 113 in the CBT group and 97 in “usual treatment” completed a four month follow-up, where 38% of the CBT group were considered recovered from depression compared to 24% of the second group. There was a small increase at eight months to 42% for the CBT group and 26% of the second group.

The authors conclude: “The number of patients for whom online CBT is feasible and attractive will grow. It could be useful in areas where access to psychological treatment is scare, and for patients whose first language is not English. It could make access to psychotherapies more equitable by providing a service to patients in areas or even countries where psychological treatment is not readily available. Real-time online CBT offers the flexibility and responsiveness of face-to-face CBT and is appropriate for people with severe symptoms. It affords an opportunity for reflexion and review as part of the therapeutic process, which could enhance its effectiveness.”

There are some limitations to this study. There was no no-treatment control group. The summary did not report how much improvement there was or was not in the majority of people who were not considered “recovered.” It is also unclear whether online CBT would be as effective as in-person treatment. Many questions for further studies.

For a summary of the study

Best wishes,


Thursday, August 20, 2009

Leaving the Land of Misery

While this is aimed at teens, it is relevant for ALL of us.

Do you tend to assume the worst in how you will be treated? Do you often have thoughts like “People are ALWAYS mean to me,” “NOBODY likes me,” “EVERYBODY is mean to me,” “Why bother? NOTHING EVER goes my way,” etc? None of these thoughts are true and any of these thoughts are guaranteed to make you MISERABLE!

Do you look for being wronged? Do you tend to assume the worst? Or do you look for the best in others? (Some do a good job of hiding the good from you.)

It probably surprises you that you CAN CHOOSE how to feel. Many say things like “But that is how I FEEL” and “That's the way I've ALWAYS been.” Take a moment and decide, “How do I WANT to feel?” If you want to feel miserable, you are already an expert. If you don't want to feel miserable, then you can work on changing your thinking and behavior.

WHY would anyone CHOOSE to be miserable? There are a number of possible reasons:

1) It is habit. An automatic response, requiring nothing to be done;
2) Feeling miserable can prevent you from trying something new;
3) It keeps you from facing that you are anxious about something;
4) It is human to hold on to our hurts when we are wronged;
5) It can be addictive.

Misery usually results from us holding on tightly to how we have been wronged. It can feel like there are no other alternatives but to feel upset. Actually, we can hold our resentments; we can feed our resentments; or we can work on letting them go. Letting go often takes time, along with effort. It usually helps to repeat statements like, “Today, I'll do my best to let go,” or “Today, I'll do my best to take back my power from those who are mean to me.” Some find it helpful to write down the offense and/or offender and then tear that paper up, burn it, or even flush down the toilet. Letting go is a gift you give yourself.

Make lists of:

1) Your friends;
2) Your favorite memories;
3) Your favorite possessions;
4) Things you enjoy doing;
5) Anything else that makes you happy.

When you feel badly, look at your lists BEFORE you are miserable. Do some of the things you enjoy instead of dwelling on the negatives. Listen to some music that makes you happy. Don't listen to down or angry music that makes you feel worse.

Misery loves company. Are your friends negative? If so, the two of you will reinforce how lousy the world is. This will keep you stuck in your misery. If some of your friends are more positive, ask them how they would look at a situation that is difficult or upsetting to you.

Does any of this mean that everyone will treat you well? Of course not! Rather, you can choose how you want to respond to being mistreated.

Best wishes,


Sunday, August 9, 2009

Tale of the Two Wolves Revisited

There is a long told Native-American tale that I will paraphrase a little.

There was a wise grandfather who was speaking with his grandchildren about life. He told them that he had two wolves battling inside of him. He went on to explain that Everybody has these two wolves.

He said that the first wolf stands for love, peace, charity, kindness, forgiveness, and letting go of past wrongs that were committed against us.

He said that the second wolf stands for anger, depression, excessive worry, resentment, panic, obsessive thoughts, hopelessness, and suicidal thoughts.

After a brief silence, one of the grandchildren asked, “Which wolf will win?”

The grandfather replied, “The one we feed.”

I have known this story for many years, but hadn't thought of it for some time. I suppose the reason it came to mind was my reflecting on how I had been feeding the second wolf. Most of us will sometimes feed the second wolf. When we do, the results are reliably misery of different flavors.

Have YOU been feeding the second wolf lately?

Best wishes,


Thursday, August 6, 2009

Medical Cost-Savings from Counseling

Medical insurance is increasingly being priced out of what many feel they can afford. It can be argued that ever increasing health insurance costs have largely decimated the US car manufacturers.

What if there was a way to save 20% of medical costs? What if I told you that is such a way? It has been reported that when numerous rigorous studies were examined on medical cost savings after psychotherapy, that the average savings was about 20%! Some studies have shown higher.

Many will be surprised to learn that psychologist Nicholas Cummings, PhD first wrote about this in 1962! One of the first studies to look at these issues was conducted in the 1960s at Kaiser. Records were followed over a 5 year span for 152 patients who had received psychotherapy. Of those, 80 were seen for only one session. A control group (No therapy) was matched for age. Over the five years, the medical utilization of the control group increased. Utilization decreased for those who had received therapy. Hospitalization rates fell from 5 days/year prior to the study to .7 days/year.

Studies range from studying groups with no common diagnoses to groups of distinct diagnoses. While some studies looked at single issues, such as depression, panic attacks, etc, many of the studies looked at people with all kinds of medical problems, such as hypertension, other cardiac difficulties, chronic pain, cancer, etc. In addition to looking at those who received individual therapy, other studies looked at marital therapy as an adjunct to alcohol treatment, brief intensive in-home family therapy for children and adolescents with severe behavioral issues, and group therapy.

Another review of studies showed that 85% of 58 studies showed a decrease in medical utilization after psychotherapy.

There is momentum where health care reform will soon be attempted. It is past time for the public to learn that psychological interventions often decrease and sometimes eliminate the need for medical interventions. There needs to be a greater education of this information.

If you are interested in learning more about these issues, an excellent read is The Impact of Medical Cost Offset on Practice and Research: Making It Work for You (2002) edited by Nicholas Cummings, et. al.

Best wishes,

Thursday, June 25, 2009

Dealing with mortality

Michael Jackson (50) and Farah Fawcett (62) both died today (6/25/09). Whether you liked them or not, both were fairly young. Deaths like this remind us that life can be short. After I turned 50, my experience is that mortality slaps me increasingly harder every year.

Presently, I have two friends (ages 66 and 36) who are fighting cancer. My parents have been dead for years. My wife has not only lost her parents, but also both her brother and her sister.

What does our mortality try to teach us?

1.That we don't know how much time we have on earth.
2.To be grateful for our health and other blessings.
3.To love and to treat others well.
4.To try to live life to the fullest.
5.To live in moderation and with a healthy lifestyle.
6.For those of us with a spiritual practice, to do just that. PRACTICE it it!

More personally, I think God is trying to remind me to stop my whining about insignificant things.

In the immortal words of Bill and Ted, “Be EXCELLENT to each other!”

Best wishes,

Wednesday, June 24, 2009

15 Tips to Deal with Anxiety During Difficult Economic Times

It has been widely reported that anxieties have greatly increased as the economy has declined. This has sent many to their family doctors for medication and others seeking psychological services. With so many foreclosures, which has yet to bottomed out, many have valid reasons for concerns. Many have lost jobs, through no fault of their own and worry about paying their bills, being employed again, etc.

In an American Psychological Association poll in September, 2008, 80 percent reported the economy's causing significant stress, up from 66 percent last April. Many worry about having lost half or more of the value of their 401K, IRAs, and other investments. The stock market has not lost as much value since the Great Depression. With the economic downturn in the last year and one half, there has been a significant increase in anxiety and depression.

Many have always labeled themselves as worry worts. For these people, the economy has turbo-charged their worries. Others may be seriously worrying for the first time.

With these realities, what can one do to cope?

1.Decide to NOT allow worries to run your life. Accept the reality that you CAN learn to control your worries.
2.The first step is to monitor yourself for worries.
3.One technique is to use Thought Stopping. This is telling yourself to STOP when you notice yourself worrying.
4.Another technique is to schedule a 10 to 20 minute time which is the only time you allow yourself to worry. When the worries come at other times, shut them down immediately and postpone them to your Worry Time.
5.Decatastrophize your thoughts.
a) Refuse to let All/None thoughts rule your thoughts.
b) Don't allow yourself to assume the worst.
c) Refuse to believe that you are powerless.
6.If you HAVE experienced a major loss, remind yourself that worry only zaps your energies that you need to problem solve.
7.Limit your use of caffeine, alcohol, and recreational drugs.
8.Exercise. This is one of the best ways to combat stress.
9.Practice deep breathing, meditation, and/or other relaxation exercises.
10.If you have a spiritual practice, USE it.
11.Limit your exposure to potentially upsetting financial (and possibly other) news.
12.Remind yourself that downturns in the economy have historically been followed by financial upturns. It is just unclear how soon.
13.Remind yourself that over time, the stock market has proven to be the best investment.

14.Whether or not you agree, government interventions appear to have aided in preventing the economy from a total free fall.
15.Read or listen to some cognitive-behavioral readings and/or recordings.

For more information, send an email for a FREE 22 page ebook Anxiety Control. Techniques to get your life back! If you email, an email will automatically be returned giving them a link where they can view and/or download the ebook.

There is also good information at, including FREE relaxation recordings, articles and other resources for worry and anxiety.

If these efforts are insufficient, strongly consider seeing a counselor. Anxiety disorders are both very common and very treatable.

Life is NOT for wimps!

Best wishes,


Sunday, May 24, 2009

Brain Stimulation for Treatment Resistant OCD

Obsessive-Compulsive Disorder (OCD) is a chronic condition, affecting about 2.2 million Americans. People have intrusive, distressing thoughts that are relieved by engaging in compulsive behaviors. Most people receive at least some benefit with behavior therapy and/or medications. Some, however, are treatment resistant. The FDA recently approved Medtronic’s Reclaim Deep Brain Stimulator device for those who have failed to benefit from other treatments.

The Reclaim device is implanted under the skin of the chest and then connected to four electrodes in the brain. The electrodes deliver steady pulses of electricity to areas of the brain that control mood and anxiety. Similar devices have been used since the 1990’s to treat movement disorders like Parkinson’s disease and tremors.

Many don't realize the impact OCD can have on people's lives. Minimally, those with OCD are miserable from the worries and the compulsions. It affects some to the extent of losing or preventing relationships. Others may be unable to work. Some are even unable to leave their homes.

“Reclaim is not a cure,” Dr. Daniel Schultz said in a statement. “Individual results will vary and patients implanted with the device are likely to continue to have some mild to moderate impairment.”

Behavior therapy for OCD is generally necessary for optimal benefit. Yet, no one is spending millions of dollars to refine this treatment and/or to teach these techniques to more therapists. Medications and medical treatments such as this will cost much more than behavioral treatments. The difference is that Big Pharma has millions to market the medical treatments.

It will be interesting to see what, if anything, happens legislatively and otherwise with coming attempts at refining our medical and insurance systems. I'm afraid that it is unlikely that 40 years of research showing even one therapy session cuts down significantly on the number of medical visits and medical costs will push for this to happen. The safer bet is to stay where the money is, which suggests this won't change much, if at all.

For more information on OCD and treatments, go to and

Best wishes,

Sunday, May 17, 2009

Dietary Considerations for ADHD and Behavioral Difficulties

There have been many claims for restricted diets to eliminate ADHD. I remember Dr. Lendon Smith on the Phil Donahue 40 years ago (yikes!) who claimed that all ADHD and learning disabilities were the result of food colorings and food allergies. When these claims were put to rigorous studies, very few kids improved significantly. For a very few, it made a huge difference.

Since then, there have been many other dietary claims. Most studies have failed to substantiate these claims. However, there is a study published in Lancet and posted online at That study also references a meta-analysis (a technique of evaluating a number of different studies) that supports that ridding food colorings and food additives improves behavior.

Nonetheless, there are some frequent recommendations. The rationale is that while following these recommendations does not eliminate ADHD, it does help the brain function optimally. These and a few other recommendations were listed in the summer issue of ADDitudes magazine ( Their 10 recommendations are:

1. Lean protein.
2. Balanced meals.
3. Multivitamin/multimineral.
4. B vitamins.
5. Zinc, iron, and magnesium.
6. Omega-3s. Omegabrite is a flavored form that kids are more likely to tolerate. (Some research, but not conclusive)
7. Picamilon. (I did not find supporting research)
8. Ginko and ginseng. (Some research, but not conclusive)
9. Pycnogenol. (Some research, but not conclusive)
10. Rhodiola rosea. (I did not find supporting research)

Many parents are reluctant to for a medication trial. It is universally accepted that a balanced and healthy diet, as opposed to a fast-food diet is a good idea.

While studies fail to show that sugar makes much difference for most, many parents feel that it can make a huge difference for their child. KNOW YOUR CHILD. If sugar (or whatever) negatively affects your child, then monitor closely and act accordingly. Parents can further investigate and decide whether they want to try more restricted diets.

As always, discuss the use of herbs or supplements with your (or your child's) physician.

For more information on ADHD and a variety of treatments, go to ( and

Sunday, May 3, 2009

Affirmations for Anxiety and Worry

An affirmation is simply any positive statement that you say to yourself. Repeating these statements can help facilitate reprogramming your brain away from automatically going to and accepting negative thoughts. Affirmations are something that you use when you aren't especially anxious. Coping statements can be very similar, but are used more when you are especially anxious. Read through the list below and see if any seem to be a good fit or even where you would like to get to. If saying “I'm safe” is something you can't believe at this time, change the statement to “I'm working toward accepting the reality that I'm safe.” Better yet, for all of these statements, change the wording that may better fit YOU! Better still, write your own!

There are a number of ways to practice affirmations. Practice is the key. The more you practice, whether writing them out, saying them to yourself or out loud, the more you will benefit. Best to practice throughout the day. For further suggestions go to

I am safe

I let go of my “What If” thoughts.

I find it easier and easier to let go of my “What Ifs.”

I accept that Life = Uncertainty.

I find it easier and easier to breath through my anxious feelings.

I let go of all the things of which I have no control.

I fear not.

I find it easier and easier to let go of the worries that come to my mind

My symptoms are nothing more than a false alarm.

I refuse to let finances (or whatever...) determine my state of mind.

I trust in God. (If you don't, ignore this one)

Best wishes,

Tuesday, April 28, 2009

Steps to Stop Worrying

Mark Twain said, “I’ve had a lot of problems in my day - most of which never happened.” It has also been said that worry is interest paid in advance on a debt you may never owe. Worry is a significant problem for many people. It is the major component of all anxiety disorders. It is also something that all of us do, to varying degrees.

Some talk about "good" and "bad" worry. I feel that a clearer conceptualization is between concern and worry. I differentiate between the two in that concern reflects realistic attention to things in our lives and leads to constructive efforts to deal with them. It is certainly in one's best interest to be concerned enough to watch a young child when they are around traffic, pay your taxes, exercise, etc. It is NOT in one's best interests to incessantly dwell on all the possible dangers in the world for a child, incessantly worry about tax issues, incessantly be hyper-focused on what is going on in one' s body, etc. Worry almost always leads to catastrophizing about dire potential outcomes and generally assuming those outcomes WILL occur, especially if one does not worry about them.

Dr. Robert Leahy points out that worriers usually have mixed feelings about their worries. On the one hand, worries are bothersome and difficult to get out of your head. But there is a way that these worries make sense. For example, many think:

Maybe I'll find a solution.
I don't want to overlook anything.
If I keep thinking a little longer, maybe I'll figure it out.
I don't want to be surprised.
I want to be responsible.

Many also feel that worrying gives them a feeling of being in control. Many have a hard time giving up on their worries because the worries are perceived to have been working.

There has been an increasing recognition that worriers generally have an intolerance of uncertainty. Ask yourself the following questions and write down your responses. See if you can come to an understanding of the disadvantages and problems of being intolerant of uncertainty.

Is it possible to be certain about everything in life?
What are the advantages of requiring certainty, versus the disadvantages? Or, how is needing certainty in life helpful and unhelpful?
Do you tend to predict bad things will happen just because they are uncertain? Is this a reasonable thing to do? What is the likelihood of positive or neutral outcomes?
Is it possible to live with the small chance that something negative may happen, given its likelihood is very low?

At the cognitive level, all worry will begin with a "What if," followed by a catastrophic thought. An example is “What if there is a traffic delay and I'm late? I just KNOW that I will get fired!” Monitoring for and recognizing the exaggerated negative possibilities is the first step. Ask yourself:

What’s the evidence that the thought is true? That it’s not true?
Is there a more positive, realistic way of looking at the situation?
What’s the probability that what I’m scared of will actually happen?
If the probability is low, what are some more likely outcomes?
Is the thought helpful? How will worrying about it help me and how will it hurt me?
What would I say to a friend who had this worry?

Frequently, worry also is strongly shaped by “Emotional Reasoning,” i.e., I FEEL so strongly that I will fail the test, therefore I KNOW I will fail the test. This may be in spite of having a strong command of the material, aced the quizes, put in the study time, etc. When this is a frequent event, it is extremely helpful to monitor for this, as well as to remind yourself that, “Feelings are NOT facts!”

Monitoring your "What ifs" can be a powerful and necessary tool in getting increasing control over your thoughts. This is one way to nip the worry in the bud. It is also easier to tell yourself, "STOP!!!", “SHUT UP!!!,” or to shift your focus," at this point. This is referred to as “thought stopping.” Someone once told me, "It's easier to stop when you are going 5 mph than when you are going 60 mph." The thoughts will often come back, but each time you use such interventions, you are becoming stronger and the worry becomes weaker.

Another powerful intervention is to schedule a “Worry time.” This may sound silly, but when worries come to mind, refuse to think about them until the time scheduled to do so. If a worry comes to mind at 3 PM and the worry time is at 6:30 PM, you tell yourself you will not think about that matter until 6:30 and continue to chase the thought out of your mind.

Exercise is often helpful. It generally shifts one focus off the worries. It can also give release to some of the tension most worriers carry. Yoga, relaxation exercises, guided imagery, and meditation can also be beneficial.

Regardless, in order to decrease worries, one must monitor themselves for worry. If one remains passive, the worries will win every time. With increased awareness and effort, YOU CAN beat worry.

Best wishes,

Wednesday, April 15, 2009

Long-term (6-year) follow-up of children and adolescents who received Cognitive-Behavioral Therapy (CBT) for anxiety disorders.

A six year (6.17 average) follow-up was reported from Queensland Australia for anxious children and teens who were treated with CBT. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed, using diagnostic interviews, clinician ratings, and self- and parent-report measures. After receiving CBT, 85.7% no longer had any anxiety disorder. These gains held at both 1 year follow-up, as well as after 6 years. Both CBT, as well as CBT plus family management were equally effective at the follow-ups.

This study strongly supports the long-term effectiveness of using CBT in treating children and adolescents with anxiety disorders. As other research shows that most anxious adults were first anxious children, this is very good news. Further, treating these conditions early on would prevent years of misery and often, medical treatment.

Two excellent books written FOR kids are What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety by Dawn Huebner and Bonnie Matthews and What to Do When You're Scared and Worried: A Guide for Kids by James J. Crist. An excellent book for parents is If your Adolescent has an Anxiety Disorder by Edna Foa and Linda Wasmer Andrews. These books are recommended whether or not the child is receiving counseling.

Many kids respond quickly to CBT counseling. When presented in a more concrete way than to most adults, kids can understand which thought makes them “feel bad” and which thought makes them “feel good,” as an eight year old boy said to me today. Helping them develop mastery over their emotions can be powerful, to all involved.

The original study was by Barrett PM, Duffy AL, Dadds MR, Rapee RM and was titled “Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up.” It was reported in the Journal of Consulting and Clinical Psychology, 2001 Feb; 69 (1): pp. 135-41.

Best wishes,

Friday, March 13, 2009

Emotional fasting

We are now in the Lenten season. This is when Jesus went into the wilderness, fasted for 40 days, and resisted temptations. Many Christians have emulated this and give up chocolate and the like during this time. Most of the other religious traditions also have times of fasting. Many find this a meaningful spiritual. Regardless of whether you are Christian or an athesist, consider a fast in this season.

Rather than giving up chocolate (or in addition to it), consider working on giving up negative and catastrophizing thoughts. If your intent is to emulate Jesus (or Mohammed, Buddha, etc.), letting go of negativity will be much more spiritually cleansing than forgoing chocolate.

How would one do this? The first step is to become more aware of your automatic thoughts. Catch yourself saying things like, “Why even try. It won't work anyway!” or “What if everyone laughs at my efforts?” These automatic thoughts will generally fall into one or more of the following categories:

1.All/None thinking “It's perfect or it is crap!”
2.Overgeneralization “Nothing EVER works out!”
3.Mental filter You focus ONLY on problems and ignore the 99% of when there are no problems.
4.Discounting the positive Someone offers you a compliment and you deny it.
5.Jumping to conclusions “I KNOW that things won't work!”
6.Magnification and minimization “I mess up EVERYTHING.”
7.Emotional reasoning “I FEEL the test will show cancer, therefore, I HAVE cancer.”
8.Should statements “They SHOULD be competent if they work here!”
9.Labeling “I'm a loser.”
10.Blame Instead of problem solving, you blame yourself or others.

Once you identify that you frequently use any of the categories, begin to monitor yourself for those type of thoughts. For example, monitor yourself for “What if” thoughts, should worry be a problem. Don't be concerned that there is often overlap between the categories. Two good books that elaborate on this approach are Feeling Good and the Feeling Good Handbook, both by David Burns.

Best wishes,

Monday, February 16, 2009

Are All Anti-depressants created equally?

Historically, it has been reported that the overall effectiveness of the newer and older anti-depressants were all about equally effective, differing in their side effects. A very recent article in The Lancet disputes this, comparing the effectiveness of 12 of the newer anti-depressants for Major Depression in adults. It looked at side effects, as well.

A summary of their findings found the following to be more effective:


They also reported the following to be less effective:

Edronax (least efficacious)

Lexapro and Zoloft were found to have significantly fewer discontinuations due to side effects.

This does NOT mean that if you are taking one of medications found to be "less effective" and it is working, that you should change. Nor does it mean if you are taking one of the "more effective" medications and are having difficult side effects, that you need to continue that medication.

Any medication is the Best medication for one person and the Worst for another. It is imperative that you consult and work closely with your prescribing physician.

An earlier post of mine Drugs vs. Therapy (9/5/08) compared the effectiveness of each. Here is a summary:

Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.

Best wishes,

For a Summary of the article:

Monday, February 9, 2009

Get on Your Feet

If you are dealing with anxiety and/or depression, exercise is something that you should begin, increase, or continue. There is 40 years of research that exercise is not only be very helpful, but some studies indicate they work better than anti-depressant medications, especially in follow-up studies! The self-help group Recovery, International (formerly Recovery Inc.) has taught for over 70 years that when depressed to "move your muscles.” Sleep quality and insomnia often improve with exercise.

It is best to consult with your physician before beginning a mild to moderate exercise program. Often, walking is a great place to begin. No special equipment is necessary and you can do this year round. In winter, many go to indoor malls to walk. Start at a comfortable pace and don't over do. Even 10 minutes has been shown to be beneficial.

The trick is to find something that you don't hate and preferably enjoy. Studies generally utilize 20 to 60 minute sessions at least three times a week, although you may not be ready to begin at that length of time. Nor do you necessarily have to join a gym. Finding someone to exercise with can be very helpful, but should not be an excuse to not exercise. Consider walking with your spouse or a friend. Bike ride with your kids. Consider exercise classes.

Having different things that you sometimes do can help keep things from getting boring. However, if you say love and want to primarily do one activity, Great! Changing where you walk, run, bike, etc. can also help keep things more fresh. Another advantage of sometimes doing different things is using different muscles.

Exercise is not guaranteed to beat your anxiety or depression alone, but it frequently is very helpful.

Best wishes,

Sunday, February 8, 2009

What is Your Recovery Plan for Anxiety and Depression?

What is your recovery plan? What is it that you will do to get past your depression, anxiety, or whatever? This may be a foreign concept to you. Many may wonder, “What is it that I CAN do to improve my anxiety, mood, or whatever? Non-medication possibilities include (but are not limited to) exercise, self-help reading, tracking and challenging negative thoughts, self-help group involvement, facing your fears, affirmations, diet, spiritual practices, relaxation exercises, yoga, and journaling.

Whether or not you are seeing a therapist, generally, the more you do the kind of things just mentioned, the more quickly you get better. If you are working with a therapist, it is best to check your activities with them. Most of the time, you will get encouragement and possibly tips. Many to most therapists will gladly make suggestions of thing they think you will find helpful.

If you have experienced a lot of trauma and/or very severe trauma, then trying to recall memories and some self-help reading may take you at a faster pace than you can manage. In these cases, it is better to go too slow than too fast. However, it does not preclude you from doing most of the other activities listed above.

Activities that are often suggested and helpful are to think about different things related to what you want to change, to notice the times when things are actually better, as well as trying to picture in your mind how you would like things to be.

Best wishes,

Friday, January 23, 2009

Setting Goals

With the New Year, many of us have decided to make changes.  Losing weight is probably the most frequent goal.  A problem that prevents many of us from achieving that goal is the failure to spell out HOW we will do that.  We may have general goals like exercise more and eat less.  These are generally too vague to be effective,  Instead, we need to be more specific.  What will we do? How many times a week will we exercise?  For how long? Specific ways of addressing food might be to follow a diet, increase eating healthy snacks, or stop buying sweets.

When a goal is stated in a negative way, ex. stop picking on one's brother, what will the siblings do INSTEAD? One goal might be to increase playing together in a cooperative way. When you want to change a negative behavior, it is best to try to increase an incompatible behavior. An example might be for one who wants to feel less tension in their body, to do 10 or more minutes a day practicing relaxation exercises, listening to guided imagery recordings, meditating, or doing Yoga. Many ex-smokers have found other things to do with their hands than hold a cigarette.

When you create specific goals, it is much easier to spell out what concrete tasks might help you achieve those goals. It has been said “If you DON'T know where you are going, you will probably end up SOMEPLACE ELSE!”
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