Thursday, December 31, 2009

Live 2010 Like You Want To

By Bill Callahan, M.D. 

It’s that time again.  Big balls dropping, toasts given, resolutions given and many broken.  We are on the eve of a New Year. I look at a resolution for change, whether on January 1 or on any anniversary, as a battle between the healthy part of me that is for change and courage, and the destructive part of me that wallows in ruts and familiar patterns.

A careful review of our behavior over the past year allows us to see the thoughts, actions, and fear that causes us to retreat into familiar patterns with known results.  We can predict, if we are honest with ourselves, how we talk ourselves out of change, and perhaps berate ourselves after we get disappointed.  This hopeless pattern does not need to continue.

I find when I set out for my three mile run in the dark at the end of the day, that there is a point just before a mile where my mind and body scream out with every reason to give it up (just for today they tell me) with all kinds of legitimate reasons to postpone, and yet when I make myself persevere there is a powerful euphoria related to the genuine side of me winning over the part that wants to quit and postpone.  We all have the chance to strengthen our healthy side and weaken the self destructive parts of us.

A few ideas that I use to keep resolutions for change, at New Year’s or any anniversary that matters to me:

1.      1. Do set goals.  The focus of our minds makes a huge difference.  Take a look at the movie What the Bleep Do We Know to get a glimpse into the untapped potential of the human mind and spirit.

2.      2.  Catalogue the ways you talk yourself out of change, postpone and procrastinate so that you know the enemy parts of yourself and their maneuvers.  Every time you stop one of them it’s another win for you.

3.     3. Pat yourself on the back for successes, but don’t reward yourself by undoing your gain (spending money if you are reigning that in, eating excessively when you wish to lose weight).  Speak honestly to yourself when you have given in to your destructive side but without berating yourself.

4.     4. Learn to talk in terms of what you want and will do.  Remove the words should, need, have to, can and can’t from your vocabulary.  This language reinforces obligation, which can cause a  knee-jerk stubbornness, and the helpless part of our character.  These parts are not our friends.

5.     5. Remember, when waging war for your independence, there will be many battles.  You simply need to win more than you lose, and you can do that.

Monday, December 28, 2009

New Routines for the New Year

by R. Scott Benson, M.D.

A reader asked what to do before you get to the doctor asking about medication for a child’s school behavior problems. I thought it appropriate to answer that question and take advantage of the tradition of setting New Year’s resolutions.

In general, the answer is increased structure, not punishment. Set routines that head off trouble before it starts. Families can improve structure with a behavior plan. You will get the best success if you focus on one problem area to address and promote a positive behavior that would prevent the problem. And it will take 2, 3, even 4 weeks to see consistent change.

Let me give an example. I asked a second grader “What time do you get up in the morning?” He gave his mother a puzzled look, hoping she would answer the question. But I pressed a little, “Tell me about getting up in the morning.” Now we get the interesting part. “Well, my mother wakes me up, but I can stay in bed. She calls me a couple of times before she sends my dad in. Then I get up.”

Many families do this kind of complicated dance every school morning. Of course, it adds to the parents’ frustration when the same sleepy-head child bounds out of bed early Saturday if cartoon time is scheduled.

One family faced with this fight every morning decided to send Dad first. And they kept score with punch tickets which could be traded for a treat (a special late movie on Friday, a lunch out with Dad on Saturday). And they practiced their lines, “Good morning, this will be a great day.” Or something similar.

Has you family found a different solution to this problem? What are the other conflicts that repeat every day in your house?

Friday, December 25, 2009

Healthy Eating

by Felicia K. Wong, M.D.

In my previous blog post, I brought up the importance of exercise as an effective treatment for depression. Today, I’d like to focus on another aspect of lifestyle that you can control to improve how you feel about yourself:

Healthy Eating.

Psychiatric medications and mental illness can pose a double threat to maintaining healthy weight. A common challenge faced by people with mental illness is weight gain. Some psychiatric medications can stimulate appetite and lead to overeating. Others cause sedation, decreasing your energy expenditure and calories burned. Mood disorders have been shown to create carbohydrate cravings because carbs increase serotonin, a chemical that makes us feel better. Eating too many carb-rich foods can lead to repetitive episodes of weight gain or failure to succeed on weight loss regimens.

For people with mental illness, proper nutrition is extremely important to overall health. Weight gain is not only detrimental to emotional health, as it can lead to poor self-esteem and worsening depression - it can also be physically dangerous, increasing the risk for many medical problems including diabetes, heart disease, osteoarthritis, hypertension and gallbladder disease.

Here are some basic tips to jumpstart a healthier diet and promote weight loss:

1. Read the food label.

2. Pay attention to portion size.

3. Eat slowly to give the stomach time to signal the brain when it's full.

4. Eat more frequent small meals and snacks to lower insulin levels, reducing the production of body fat.

5. Differentiate between stomach and psychological hunger. Try not to soothe your negative feelings with food.

6. Reduce fast food intake.

7. Minimize soft drinks with sugar and other high calorie beverages.
8. Eat more fruits, whole grain, vegetables, lean meat, fish, and poultry.

9. Prepare food by broiling or baking more often instead of frying.

10. Keep food/activity diaries.

Start the New Year out with a resolution to eat healthier and lose weight!

Tuesday, December 22, 2009

Am I Alone?

by Gariane Phillips Gunter, M.D.

Am I Alone? by Megan Hance

I get a funny feeling, it comes from deep inside.

I get all mad and angry, wanting to go and hide.

My doctor calls it depression, my dad says it's just me.

But the thoughts and feelings, no one will ever be able to see.

Some say I'm psycho, some say I'm just weird.

It's like I'm a different person, and the old me just disappeared.

I get really edgy, I want to commit suicide real bad.

Then I get a headache, followed by feeling sad.

I wish I could get help, I wish it would go away.

Maybe if I keep praying real hard, it will some day.

I came across this poem and think that the author does a beautiful job of describing the stigma often experienced by those with mental illnesses. The holiday season can be a particularly difficult time as symptoms of depression and anxiety may flare, and feelings of hopelessness creep in.

If you feel yourself slipping away, please contact your doctor or a friend and get help right away. Receive the gift of treatment that everyone deserves. I wish you all a safe and Merry Christmas.

Friday, December 18, 2009

Thanksgiving – the true spirit of this holiday season.

By Roberto Blanco, M.D.

I love Thanksgiving. It is my favorite holiday of the year. Each year my family gets together to catch up, share quality time and make plans for the future. Leading up to the holiday season this year, however, I had been feeling less than excited about the holidays. Having become accustomed to my daily routine, I found myself searching for a way to escape that monotonous, empty feeling.

So, this year, in celebration of Thanksgiving, I began a list of gratitude: 100 things for which I am thankful. This is not a list of wants or obligations that we create for ourselves - a Christmas wish list, a list of New Year’s Resolutions, or a ‘Bucket List’ (a list of things to do or see before you die). It is a celebration of that with which you have already been blessed. On my list included things like having my health, living in a country with tremendous opportunity, and being able to spend time with family.

Nobody’s family, financial, or personal situations are perfect. For evidence of this, just look at the personal lives of celebrities. And so it’s not surprising that many people can get down during the holiday season because it often reminds us of what we don’t have or didn’t accomplish. This often leads to feelings of emptiness or longing that set the stage for self-destructive situations.

Many individuals take what they have been blessed with for granted and don’t truly appreciate what they have until it’s gone. If you have ever lost something dear to you, you understand this adage all too well. This year, let’s try not to make the same mistake. This year, let’s focus on what we have rather than what we don’t.

Wednesday, December 16, 2009

Too busy to relax?

By Gina Newsome Duncan, M.D.

For most of us, stress is a part of everyday life—at home, at work, during our commute. Even going on vacation can be stressful. Stress not only has a psychological effect. It also has a physiological effect. That is, it affects us physically, leading to direct changes in our heart rate and blood pressure, and over time, our risk for certain illnesses such as heart attacks and strokes.

Stress also plays a significant role in anxiety, depression and other mental illnesses. This is detailed in the book The Relaxation Response, by Dr. Herbert Benson, a Harvard physician and expert in Mind/Body medicine.

Relaxation, the antidote to stress, can often seem like a luxury. How many of us picture a hot bubble bath complete with scented candles and soothing music, or a long walk on a sun-soaked beach as the perfect way to relax? The problem is that most of us don’t have time to do these things on a regular basis. When you’re in the midst of a crisis, or have a deadline looming at work, it’s not always possible to take an extended break.

The good news is that there are steps we can take psychologically to improve how we feel physically. With practice, you can learn how to relax anywhere and in any situation.

Some of the most common relaxation techniques are:
1. Deep breathing
2. Progressive muscle tension and relaxation
3. Guided Imagery/Visualization
4. Mindfulness

If you have a moment, try this simple exercise right now:

Sit in a comfortable position, either reclining slightly or laying down.
Take a deep breath in while slowly counting “one-thousand-one, one-thousand-two”. Then exhale, while counting “one-thousand-one, one-thousand-two, one-thousand-three, one-thousand-four”. Repeat this for several minutes.

Next, while maintaining a slow, regular pace of breathing, move on to progressive muscle tension and relaxation. This means tensing and relaxing the different muscle groups of your body one at a time. For example, start with your feet, curling your toes under… holding…and then relaxing. Then move on to your legs, stomach, etc, until you have worked your way up to your head.

How did that feel? Don’t worry if you couldn’t relax right away. It takes practice!

Most major bookstores and entertainment stores carry relaxation CDs that incorporate the breathing and muscle relaxation techniques described above. Combined with guided imagery and soothing music, these CDs can be a great way to learn the relaxation response if you don’t feel confident doing it on your own. A quick Google search can also pull up many websites with different types of relaxation exercises, suggestions, and even video.

The best thing is that this can take as little as 5 minutes and can be done anywhere—at your desk or while parked in your car—anytime you need to recharge.

Taking time to relax is not a luxury, it’s a necessity!

Tuesday, December 8, 2009

Holiday Anxiety

By Jeffrey Borenstein, M.D.

As we begin the holiday season, people have hopes and perhaps expectations of an ideal holiday. Time with family and friends, time off from work or school, plans to travel – but the preparation and anticipation is often stressful. While some people may experience feelings of sadness this time of year, often people experience anxiety.

Family gatherings – both large and small may bring up memories and emotions which have been on the back burner but which now result in a higher level of emotions. The holiday season is also a busy time, juggling usual work/school/household activities with holiday preparations. With time off from work and school, our usual routines are interrupted, which is an additional stressor. All this can result in feelings of anxiety. What should you do?

Most importantly – step back and realize what emotions you are feeling. If you are experiencing heightened anxiety, there are steps you can take. I was interviewed for a New York Times article that may be helpful: “Easing Anxiety in All It’s Forms.”

Excessive drinking during the holidays is also a problem for many people. Some use alcohol to help with their stress and anxiety, and those with alcohol problems are particularly vulnerable. Instead of helping, drinking can do the opposite and make you feel worse.

To help you cope during the holidays, make sure you get adequate sleep, make sure you exercise (and walking counts), and share your feelings with friends or family. If you begin to feel overwhelmed and have difficulty functioning, you should seek professional assistance. Most importantly – realize that you are not alone. Many people experience holiday anxiety. Accept support from family, friends, and if need be professionals.

Wednesday, December 2, 2009

What do the holidays mean to you? It’s how you frame the question.

R. Scott Benson, M.D.

Thanksgiving seems to be the one time a year we can get a national focus on family and sharing with others. And before we finish that pumpkin pie everyone seems to start working on the next holiday which comes in different names in different cultures, but typically involves gifts. In the Santa tradition the focus is on what will he bring me.

But then we realize that is not the real meaning of the holidays.

A tool from cognitive therapy might help at this point, reframing. Reframing involves recognizing distorted thinking and focusing on other thoughts that reflect the reality that we want.

Let’s try an example. Typically we ask children “what do you want?” and later we ask “what did you get?” And these are the questions that define the meaning of the holiday season for them.

I don’t think that is the meaning we intended. So we can try a different approach. And it takes a lot of practice. In working with children or in my community I try to start the conversation with “What have you been thinking about doing for your mother during the holidays?” Or “What do you think your brother would like this year?”

And after the presents have been opened I ask, “Who really liked the present you gave?” And always in this era of instance messaging and Tweeting it never hurts to ask “Have you started on your thank you notes yet?”

Well? Have you?