Sunday, July 15, 2012
Beginning to Make Changes
Perhaps the most difficult part of making changes is persistence. Human nature is to continue to do what we automatically do (habit). Change means establishing new habits. This requires intention and persistence. Gently (and sometimes NOT so gently) reminding ourselves of our goals helps maintain our motivation.
One of the tricks to successfully make changes is to approach tasks as experiments. By this, I mean to try different strategies and see what the outcome is. Many will try something one or several times, not get the results that they hope for, and then conclude that the strategy "doesn't work." Sometimes people will give up exercise, trying to learn to play an instrument, or whatever after they have done it five times and not lost twenty pounds, mastered the instrument, etc., concluding that the strategy doesn't work or that it is too hard for them.
When you make a plan, decide WHEN you will begin. There is a hilarious commercial by Blue Cross at www.youtube.com/watch?v=Vtil_kFMvoU sung to the song "Tomorrow." You'll get a chuckle and maybe motivation.
Thirty years ago I was in great shape and ran a few marathons. Let's just say I've "outgrown" that level of fitness! I began doing more running instead of walking this past June. For months, I would rulk (run, walk, run, walk...). I felt like a slug! It has only been in the past month or so that I have felt less like a slug and am even having moments that I've begun feeling almost like a "real" runner, again. My point is that we often reach plateaus in our weight, fitness, spirituality, etc. Sometimes continuing to practice a good program, strategy, etc. long enough will eventually get us to a higher level. Other times, we need to turn up the intensity or even to develop a new strategy or program.
Continue to collect information and periodically re-evaluate your strategies and/or need for new strategies to create the life that you desire.
New West Side Address
As of July 1, 2012 I now spend two days a week in Westlake, OH - 30400 Detroit Rd. #301 and am no longer in Rocky River, OH.
I now spend three days in Independence, OH - 6133 Rockside Rd. #207.
The phone number remains (216) 520-5969.
Wednesday, September 7, 2011
Paradox of Exposure and Acceptance
Psychologist Reid Wilson states that Obsessive Compulsive Disorder (OCD) and other anxiety "Wins," i.e. maintains and gets stronger, by making the rules of the "game." By making the rules, it always wins. He sees the rules as:
1. Be careful or you might cause a horrible problem OR you have already harmed
someone.
2. If a fearful thought ("content") occurs, take it seiously.
3. You MUST feel ABSOLUTELY certain.
4. Use your anxiety as a gauge. If you feel uncomfortable, then there IS danger.
5. ALWAYS act defensively. Avoid, worry, escape, and do rituals.
In order to stop the anxiety from continuing to win, he suggests the following NEW RULES:
1. Don't pay attention to the "Content," i.e., the specific obsessions and
fears.
2. Accept the obsession when it pops up - "It's fine that I just had that
thought."
3. Tell yourself "I WANT to be anxious and STAY anxious. It's NOT about the
content." It's purposefully choosing to feel the generic sense of
uncertainty and anxiety.
4. If necessary, make rules and follow them, i.e., "Here is how I am going to
wash my hands, check doors, etc." This means what procedures and limits will
be used, as opposed to doing those things until they "feel right."
On first take, this is counter-intuitive - and sounds impossible to anyone struggling with significant anxiety. The natural response to this type of anxiety is to avoid and try to escape. Avoidance and escape is how anxiety maintains itself and gets stronger.
By this logic, if you have your fingers in a Chinese finger trap, you pull your fingers apart. The result is the finger trap becoming tighter on your fingers, making escape impossible. The only escape is pushing your fingers together, just as Dr. Wilson suggests accepting and inviting the anxiety.
What happens when you accept and stay with the anxiety is that over time, it diminishes. This is called habituation. I have often seen anxiety decrease (not totally go away) in a matter of mainutes. It is important to note that this may take longer. It is routinely suggested to spend an hour for exposure practice. Habituation generally occurs most quickly when you perform exposure frequently, you accept a higher level of anxiety, and you stay with it for longer periods of time.
Here are some ways he suggests responding to various "content:"
When obsessive doubts occur, responding to them with statements like "I'm glad that I'm having these doubts." "I'm not answering that question."
"If I imagine something inappropriate, then it means I'm a bad person - AND I CAN handle that."
"If I imagine something inappropriate, then it means Ill feel uncertain and anxious - AND I CAN handle that."
"If I don't check the stove, it will be my fault that the house will burn down - AND I CAN handle that."
"If I have a "bad thought," it means that I really feel that way - AND I CAN handle that."
"If X does/not happen, something bad will happen and it will be my fault - AND I CAN handle that."
The more you "play" by the new rules, the weaker the anxiety will become. Maintaining the anxiety rules, maintains the anxiety and makes it stronger. Several videos are available for viewing on Dr. Wilson's website (www.anxieties.com) or YouTube.
1. Be careful or you might cause a horrible problem OR you have already harmed
someone.
2. If a fearful thought ("content") occurs, take it seiously.
3. You MUST feel ABSOLUTELY certain.
4. Use your anxiety as a gauge. If you feel uncomfortable, then there IS danger.
5. ALWAYS act defensively. Avoid, worry, escape, and do rituals.
In order to stop the anxiety from continuing to win, he suggests the following NEW RULES:
1. Don't pay attention to the "Content," i.e., the specific obsessions and
fears.
2. Accept the obsession when it pops up - "It's fine that I just had that
thought."
3. Tell yourself "I WANT to be anxious and STAY anxious. It's NOT about the
content." It's purposefully choosing to feel the generic sense of
uncertainty and anxiety.
4. If necessary, make rules and follow them, i.e., "Here is how I am going to
wash my hands, check doors, etc." This means what procedures and limits will
be used, as opposed to doing those things until they "feel right."
On first take, this is counter-intuitive - and sounds impossible to anyone struggling with significant anxiety. The natural response to this type of anxiety is to avoid and try to escape. Avoidance and escape is how anxiety maintains itself and gets stronger.
By this logic, if you have your fingers in a Chinese finger trap, you pull your fingers apart. The result is the finger trap becoming tighter on your fingers, making escape impossible. The only escape is pushing your fingers together, just as Dr. Wilson suggests accepting and inviting the anxiety.
What happens when you accept and stay with the anxiety is that over time, it diminishes. This is called habituation. I have often seen anxiety decrease (not totally go away) in a matter of mainutes. It is important to note that this may take longer. It is routinely suggested to spend an hour for exposure practice. Habituation generally occurs most quickly when you perform exposure frequently, you accept a higher level of anxiety, and you stay with it for longer periods of time.
Here are some ways he suggests responding to various "content:"
When obsessive doubts occur, responding to them with statements like "I'm glad that I'm having these doubts." "I'm not answering that question."
"If I imagine something inappropriate, then it means I'm a bad person - AND I CAN handle that."
"If I imagine something inappropriate, then it means Ill feel uncertain and anxious - AND I CAN handle that."
"If I don't check the stove, it will be my fault that the house will burn down - AND I CAN handle that."
"If I have a "bad thought," it means that I really feel that way - AND I CAN handle that."
"If X does/not happen, something bad will happen and it will be my fault - AND I CAN handle that."
The more you "play" by the new rules, the weaker the anxiety will become. Maintaining the anxiety rules, maintains the anxiety and makes it stronger. Several videos are available for viewing on Dr. Wilson's website (www.anxieties.com) or YouTube.
Tuesday, January 26, 2010
Comments on Haiti
If nothing else, the recent earthquake in Haiti should give us perspective with all that we have in our lives. We can focus on the stock markets correction or other negative things. But, we are alive. Our economy didn't collapse. We have clean water and food. We didn't lose our homes.
Most of us were born in the United States. Perhaps by accident? Why weren't WE born in Haiti? Or in Darfur? Or other places with vast disease and lacking adequate food, shelter, medicine, jobs, etc? What did we do to be born in the world's greatest country? Many of us come from modest means. But took advantage of opportunities available to many of us.
Some look away from this tragedy out of indifference. Others don't follow very closely, as they would otherwise be so overwhelmed by the sheer horror that many are continuing to experience.
I think that we minimally should acknowledge that we could have just as easily to have been born in Haiti or other undeveloped countries. For those of faith, we need to offer prayers for Haiti and other places of great need. We need to continue to give thanks for our many blessings. When you open your heart, how can you not do something? I for one, believe that we ARE our brothers' keepers.
Best wishes,
Mike
http://drmikemiller.com
Most of us were born in the United States. Perhaps by accident? Why weren't WE born in Haiti? Or in Darfur? Or other places with vast disease and lacking adequate food, shelter, medicine, jobs, etc? What did we do to be born in the world's greatest country? Many of us come from modest means. But took advantage of opportunities available to many of us.
Some look away from this tragedy out of indifference. Others don't follow very closely, as they would otherwise be so overwhelmed by the sheer horror that many are continuing to experience.
I think that we minimally should acknowledge that we could have just as easily to have been born in Haiti or other undeveloped countries. For those of faith, we need to offer prayers for Haiti and other places of great need. We need to continue to give thanks for our many blessings. When you open your heart, how can you not do something? I for one, believe that we ARE our brothers' keepers.
Best wishes,
Mike
http://drmikemiller.com
Thursday, January 14, 2010
Commentary About Study Questioning Anti-Depressants Effectiveness for Mild to Moderate Depression
An article just published in The American Journal of American Medicine (JAMA) questions the efficacy of the use of anti-depressant medications (ADM) with mild to moderate depressions. The article is not an easy read! Here is an abstract from JAMA.
It looked at six studies with randomized control groups. Three of the studies evaluated imipramine (an older anti-depressant) and three evaluated Paxil. The conclusion is that ADM may be no better than placebo for mild to moderate depression. Further, that there was greater change with ADM as the depression was more severe. The authors reported that it has been known for more than 50 years that more severe medical and psychiatric conditions respond to a greater degree than less severe conditions.
It was also reported that FDA studies of ADM study only those with severe depressions, which they correctly report are not the impressions that Pharma's advertising gives us.
One statement in the Abstract is questionable: “Antidepressant medications represent the best established treatment for major depressive disorder.” Studies comparing ADM with several brief psychotherapies show that the latter are equally effective to ADM. Other studies show regular exercise to also be very effective. Further, therapy and exercise have dramatically lower relapse rates.
So what does this mean if you are on ADM? My suggestion is that if it is working, continue it. Don't suddenly stop altogether. Direct your questions and concerns to your prescribing physician. However, be aware that much of what many physicians know about medications, especially newer ones, is given to them by drug representatives.
It looked at six studies with randomized control groups. Three of the studies evaluated imipramine (an older anti-depressant) and three evaluated Paxil. The conclusion is that ADM may be no better than placebo for mild to moderate depression. Further, that there was greater change with ADM as the depression was more severe. The authors reported that it has been known for more than 50 years that more severe medical and psychiatric conditions respond to a greater degree than less severe conditions.
It was also reported that FDA studies of ADM study only those with severe depressions, which they correctly report are not the impressions that Pharma's advertising gives us.
One statement in the Abstract is questionable: “Antidepressant medications represent the best established treatment for major depressive disorder.” Studies comparing ADM with several brief psychotherapies show that the latter are equally effective to ADM. Other studies show regular exercise to also be very effective. Further, therapy and exercise have dramatically lower relapse rates.
So what does this mean if you are on ADM? My suggestion is that if it is working, continue it. Don't suddenly stop altogether. Direct your questions and concerns to your prescribing physician. However, be aware that much of what many physicians know about medications, especially newer ones, is given to them by drug representatives.
Friday, January 8, 2010
email reponse to feature on depression by WCPN
This morning, there was a segment on depression treatments on our local public radio station (WCPN). It was 99% about medical (brief reference to exercise at end) treatments, i.e., anti-depressants, deep brain stimulation, etc. This unbalanced and shallow report bothered me enough to email WCPN. Below is the email I sent to them. I am interested in how YOU feel about this.
Your brief report on depression was woefully lacking. One was left with the impression that the only treatments for depression depression are medical. It is clear that Ms. Cuda had little prior knowledge about depression and that her sources were MDs, medical websites, and/or drug companies.
There have been debates in the past that depression was biological OR psychological. For 25 years, most acknowledge it is BOTH. It would be more accurate to describe it as a bio-psycho-social process.
Trauma can alter one's biology. Negative thoughts can also alter one's biology. Turning the negative thoughts around can IMPROVE one's biology. Schwartz showed this about 20 yrs ago with PET scans of those treated for OCD.
I missed ANY reference to brief psychotherapies that have proven at least equally effective as the anti-depressants. There is about 35 yrs of research that prove this. The research with exercise is another 5 to 10 yrs longer.
A good place to get a more balanced understanding of depression is http://www.nimh.nih.gov/health/topics/depression/index.shtml
While a study reported this week questions the efficacy of anti-depressants for mild to moderated depression http://blogs.consumerreports.org/health/2010/01/antidepressants-most-effective-for-severe-depression-best-buy-drugs-for-treating-depression.html do NOT make the mistake that this message is an attack on medications. Rather, it is a criticism for a lack of depth and balance. I expect MUCH better from WCPN.
Mike Miller, PhD
Psychologist
http://drmikemiller.com/depression.html
Your brief report on depression was woefully lacking. One was left with the impression that the only treatments for depression depression are medical. It is clear that Ms. Cuda had little prior knowledge about depression and that her sources were MDs, medical websites, and/or drug companies.
There have been debates in the past that depression was biological OR psychological. For 25 years, most acknowledge it is BOTH. It would be more accurate to describe it as a bio-psycho-social process.
Trauma can alter one's biology. Negative thoughts can also alter one's biology. Turning the negative thoughts around can IMPROVE one's biology. Schwartz showed this about 20 yrs ago with PET scans of those treated for OCD.
I missed ANY reference to brief psychotherapies that have proven at least equally effective as the anti-depressants. There is about 35 yrs of research that prove this. The research with exercise is another 5 to 10 yrs longer.
A good place to get a more balanced understanding of depression is http://www.nimh.nih.gov/health/topics/depression/index.shtml
While a study reported this week questions the efficacy of anti-depressants for mild to moderated depression http://blogs.consumerreports.org/health/2010/01/antidepressants-most-effective-for-severe-depression-best-buy-drugs-for-treating-depression.html do NOT make the mistake that this message is an attack on medications. Rather, it is a criticism for a lack of depth and balance. I expect MUCH better from WCPN.
Mike Miller, PhD
Psychologist
http://drmikemiller.com/depression.html
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,
Mike
http://drmikemiller.com/sad.html
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,
Mike
http://drmikemiller.com/sad.html
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.
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,
Mike
http://drmikemiller.com/suicide.html
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,
Mike
http://drmikemiller.com/suicide.html
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,
Mike
http://drmikemiller.com
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,
Mike
http://drmikemiller.com
Saturday, October 10, 2009
INSPIRING Video
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,
Mike
http://drmikemiller.com
To all of you who feel like giving up. Video
Best wishes,
Mike
http://drmikemiller.com
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 drmike@drmikemiller.com.
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,
Mike
http://drmikemiller.com
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,
Mike
http://drmikemiller.com
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 http://www.metanoia.org/imhs/history.htm
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 http://www.bristol.ac.uk/news/2009/6502.html.
Best wishes,
Mike
http://drmikemiller.com/depression.html
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 http://www.bristol.ac.uk/news/2009/6502.html.
Best wishes,
Mike
http://drmikemiller.com/depression.html
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,
Mike
http://drmikemiller.com
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,
Mike
http://drmikemiller.com
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,
Mike
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,
Mike
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,
Mike
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,
Mike
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,
Mike
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,
Mike
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 emailanxiety@drmikemiller.com , an email will automatically be returned giving them a link where they can view and/or download the ebook.
There is also good information athttp://drmikemiller.com , 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,
Mike
http://drmikemiller.com/worry.html
http://drmikemiller.com/media.html
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
There is also good information at
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,
Mike
http://drmikemiller.com/media.html
Subscribe to:
Posts (Atom)
Posts
