O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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Powering off to reboot your internal drive

When your iPad or smartphone is having issues—unresponsive, randomly crashing, or just running sluggishly—it’s time to power off and reboot the system. When do you power off so that you can reboot your drive?

Irritability, Fatigue, Lack of Enthusiasm?  Time to Power Off

When you are having issues such as irritability, fatigue, or lack of enthusiasm, it’s time to power off. In a previous post, I mentioned that relaxation is one of the eight therapeutic lifestyle changes that help people cope with depression, anxiety, and sleep problems. Taking time to relax is often the last thing on a long to-do list for most people. And being last on the list, it’s often neglected. People might think they’re powering off by surfing the web, watching TV, attending to email, or having a bowl of ice cream while talking to a friend on the phone. These things will give you a break but won’t provide the restorative stillness we need to feel replenished.

When you reset your iPad by shutting it down, the apps that have been causing problems are cleared, giving a new start—a clean slate that will clear up the system so it can function the way it’s designed to. You, too, can reboot your internal drive by practicing deep relaxation. Listen to the audio at the end of this post to taste a few minutes of relaxation.

Ten Minute Lying Down Meditation

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The Benefits of Practicing Mindfulness in Nature

The Benefits of Practicing Mindfulness in Nature

Research has consistently shown that time spent in nature helps people cope with depression and anxiety. Combined with other self-care activities, it can be as effective in treating psychological problems as anti-depressants.

But too often we run from activity to another and then finally, plop down on the worn sofa—unaware that these moments in nature are always available to us. In the park by the office, or in our own backyard, we can rest, listening to the buzz of sound all around. When we slow down enough to see the canvas of nature, we can experience contentment akin to one-ness with the natural world.

In mindfulness-based cognitive therapy and stress reduction, we ask participants to practice meditation daily, both formally and informally. Formal practice includes sitting or laying down and focusing on the breath, or on sounds– the intent is to be still and focused. Informal practice can be doing any routine activity mindfully. As the old saying has it, “Chop wood, carry water.” Some days we can eat a meal mindfully, without watching TV or reading the paper, just chewing and noticing the senses of smell, color, taste, and texture. Mindfulness can mean sitting in the garden and being attentive to the sounds of insects and the rustle of the breeze and doing nothing but sitting. (The Japanese Buddhist word for mindfulness practice, “zazen,” simply means “seated meditation.”)
Beginning a formal meditation practice can be daunting because of our innate resistance to sitting still with no distraction but paying attention to your breathing. In some meditation practices, the instruction will be to focus attention on a word, or to count to ten and start over. There are many ways to be still and it is important to try different kinds of meditation to find a practice that best suits you. When I teach Mindfulness-based stress reduction groups, participants will gravitate to one form of meditation over another. Each person is different. Some find mindfulness of sights and sound to be more effective, while others will focus on their breathing. In these classes, we practice many different ways to meditate and each participant is encouraged to find one they think they can continue to work with after the group ends.

Mindfulness Meditation: Informal Practice in Nature

But informal practice is always available and readily accessible to most of us: no special cushions, meditation rooms, or fancy teacher required. In fact, giving yourself permission to just do one thing, with presence, is a great way to slow down. If you can find some time each day to be mindful, especially in the natural world, that will go a long way in helping ease the symptoms of depression. Go outside and sit in your garden or the local park and be with nature. Even just a few minutes of watching the birds, weeding or pruning the roses will help boost your mood.

Berman, M. G., Jonides, J., & Kaplan, S. (2008). The cognitive benefits of interacting with nature. Psychological Science, 19, 1207–1212.
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta- analytic review. Journal of Consulting and Clinical Psychology, 78
Maller, C., Townsend, M., Pryor, A., Brown, P., & St Leger, L. (2006). Healthy nature, healthy people: ‘Contact with nature’ as an upstream health promotion intervention for populations. Health Promotion Inter- national, 21, 45–54.

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The fullest experience of the adventure of life: Eleanor Roosevelt, Blogging, and Mindfulness

I just returned from Rhinebeck, NY, where I took an intensive professional training course in Mindfulness-Based Cognitive Therapy (MBCT) for the Prevention of Depression Relapse. The five-day course was developed for health-care professionals who already have experience with mindfulness-based approaches.

Many years ago, I studied Mindfulness-Based Stress Reduction with its developer, Dr. Jon Kabat-Zinn. Since that time, research has continued to demonstrate the effectiveness of mindfulness training in treating many forms of emotional difficulties. Offspring treatments that involve mindfulness as a major component to their treatment protocol include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT).

Taking a course in MBCT  gave me the opportunity to study with one of the major researchers and writers in the field. It was given by Zindel Segal, PhD, and Susan Wood, MSW, LCSW. Dr. Segal is the author of Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, 2002, The Guilford Press.

While the course was valuable and added to my skills in teaching this treatment approach, the highlight of the trip was my excursion to Val-Kill, the unpretentious, comfortable home of Eleanor Roosevelt. Just down the road in Hyde Park, NY, stands the opulent estate of her husband, Franklin Delano Roosevelt. Ms. Roosevelt created her separate home in a style that reflected her sensibilities, not those of her husband. Set among trees and brooks, the house contains simple furniture and cozy, intimate rooms.

I was fascinated to learn that Eleanor Roosevelt was a kind of pioneering blogger extraordinaire. She wrote a daily letter to Americans that came to be called “My Day,” one of the most popular syndicated columns of the time. She wrote her column six days a week, often dictated in any free moment she found. She published over five hundred words per column, at least six days a week for 26 years from 1936-1962. Personal as well as socially relevant, her work communicated her thoughts, joys, and intimate concerns.

As a beginning blogger, I have wondered about my urge to write. In a previous post, I talked about how this form of writing allows me to take my many years as a psychologist and put words to this experience that can go beyond the confines of my confidential private office. Social media has provided a means for anyone to make his or her thoughts and opinions public, taking journaling to a new level—but not an unprecedented one, as I saw by Eleanor’s example.

Pleasant and Unpleasant Events Calendar

I often suggest that my clients journal. Collecting thoughts and feelings by observing them and taking the extra step to write them down allows insights to emerge. In MBCT, one of the first homework exercises is to write a daily note about a pleasant and an unpleasant experience that occurred during the day. By noting the thoughts, feelings, and sensations associated with such experiences, we bring mindful awareness to daily life. This can allow us to experience and appreciate the moment simply as it is, without adding further elaboration in the form of wishing, dreading, or judging. It is often our mental elaboration that triggers rumination, a common symptom in depression. We can begin to realize that even unpleasant events can be tolerated. Bringing awareness to each situation, whether we label it good or bad, is an important step in learning to relate differently to them. This takes practice. And curiosity.

The Fullest Experience of the Adventure of Life

As Eleanor Roosevelt writes in You Learn by Living: Eleven Keys For a More Fulfilling Life, “There is no experience from which you can’t learn something. When you stop learning you stop living in any vital and meaningful sense. And the purpose of life, after all, is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience. . . . The experience can have meaning only if you understand it. You can understand it only if you have arrived at some knowledge of yourself, a knowledge based on a deliberately and usually painfully acquired self-discipline, which teaches you to cast out fear and frees you for the fullest experience of the adventure of life.”

Being attentive to thoughts and writing them down takes discipline. When keeping a journal (or a thought record of daily events, or writing a blog) our life experience is enlarged and enriched. For people struggling with depression, being able to notice even slightly positive things during the day allows them to see that such events are already there for them. For some, it may be noticing the song of a bird, or the stars on a clear night—these simple experiences are always within reach, but for someone who struggles with depression, they go unattended. Writing is a vehicle of self-expression.

References:

Roosevelt, E. (2001). My Day: The best of Eleanor Roosevelt’s acclaimed newspaper columns, 1936-1962. D. Emblidge (Ed.) Cambridge, MA: Da Capo Press.

Roosevelt, E. (2011). You learn by living: Eleven keys for a more fulfilling life. New York: Harper Perennial.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.

 

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Chronic Pain and Narcotics

A Behavioral Approach to Treating Chronic Pain and Medical Problems

In the June 2 edition of The New York Times, the article “Pain Pills Add Cost and Delays to Job Injuries” Barry Meier points out that powerful drugs such as OxyContin actually delay recovery from injuries that occur at work. But beyond the financial cost of using opioid painkillers to treat back strain and other pain problems, the human costs are heartbreaking.

I have treated chronic pain since I first began working as a psychotherapist. Using biofeedback, cognitive therapy, and relaxation training, I worked with medical patients referred by their physicians. The people I treated were on multiple medications from many different classifications within pharmacology. Sedatives were combined with opioids, sleeping pills, antidepressants, and mood stabilizers.

In the pre-digital age, where medical records were in the form of a paper chart, these patients had the thickest charts, often in several volumes. Pain patients can be docile, following doctor’s orders to take the pills exactly as prescribed. But in chronic pain, the tolerance to these strong medications grows. Increasing the drugs’ strength and frequency may not cure or even lessen pain; in fact, the pain is often made worse. In medical jargon, the pain becomes iatrogenic—meaning that the treatment causes the problem.

Over time, the side effects of taking opioids lead to a plethora of new medical and psychological problems. These drugs cause lethargy, drowsiness, depression, and irritability. The lifestyle behaviors that would ameliorate pain, such as exercise, relationships, and engagement in pleasurable activities, are difficult to do if one is bedridden due to stupor, further delaying recovery.

The cost to the patient’s family is also a big problem. The reduced income stresses everyone and reduces the patient’s self-esteem. The healthy partner becomes a caregiver, putting a strain on sex and intimacy. Pain patients take on what I call “pain behaviors” such as wincing, grimacing, and grunting, signals that often look like helpless dependency. Caregivers’ own helplessness to do anything, creates burnout, leading them to ignore patients’ suffering. Resentment grows on all sides. Marriage counseling is often warranted to help partners adapt to their spouses’ pain and to learn new ways of coping.

When I started treating chronic pain, Behavioral Intervention was the treatment model. Self-care was the cornerstone of healing, with medications as an adjunct. My work was to help patients see that being in bed most of the day and night was robbing them of their life. By suggesting and encouraging gradual exercise and teaching meditation and relaxation, I could help them begin to engage in life again. While working at Kaiser Hospital, I conducted research for my doctoral dissertation that showed a significant reduction in medical costs for patients who had completed short-term behavioral therapy for their chronic pain. The treatment was effective for reducing medical costs for up to five years after the therapy was concluded.

In addition to medical costs, the psychological literature has focused on the “secondary gain” of chronic pain. This refers to the usually unconscious benefits one derives from pain. This could come from worker’s compensation benefits, attention from family, or legal compensation from an injury incurred at work or an accident, but also the insidious creep of opioid dependence.

Chronic pain patients often fall through the cracks of the medical and legal system. Lawyers get involved. Settlements get delayed due to the difficulty getting appointments with doctors, medical examiners, and the many ancillary people involved in the care of these folks. This added complexity prolongs recovery thereby increasing the toll of chronic pain on the patient’s life.

A unified team approach is necessary to prevent this kind of delay. Delays cost in big ways. As the Times article states, insurers spend $1.4 billion a year on narcotic painkillers. If these medications are used too early, too frequently, or for too long, the disability payouts and expenses will end up delaying return to work and in many cases will lead to permanent disability. In 2010, prescribed opioids cost $252 million in California. This cost is passed onto the taxpayers, who underwrite coverage for public employees like firefighters and police officers.

In this time of budget cuts, and controversy regarding pension plans we need to work in a systematic way to help the patient learn to cope with pain without the use of addictive medications. This will alleviate the burden on many fronts. Psychologists have had a role in treating patients with medical conditions for many years, yet referrals for mental health treatment have been affected because of to the many restrictions insurance companies put on providers, and limited coverage for this form of treatment.

One of the most effective treatment approaches is Mindfulness-Based Cognitive Therapy and Stress Reduction. This approach often utilizes a group format so that coping techniques can be taught efficiently. A growing body of research supports the use of meditation, and acceptance, in the treatment of medical problems. Psychologists can diagnose other problems a patient may be experiencing such as depression and anxiety, that may be compounding recovery. I often make recommendations for couples therapy. A comprehensive team approach is the most effective way to help a patient recover so that use of addictive medications will not impede a return to living life well, despite recurrent medical problems.

 

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Appreciating the Absence of Pain

 

You don’t appreciate not having a toothache until you have a toothache.  Sitting in the endodontist’s chair last week, I was asked if my tooth ached.  I paused for a long moment, and then replied, “ache is a very vague term”.  We both laughed.  Pain is difficult to measure.  Equally difficult to measure is joy– elusive and fleeting.

Thich Nhat Hanh used the toothache analogy when he spoke to a group of therapists many years ago. “When you have a toothache, you are enlightened—you know something very important—that not having a toothache is a wonderful thing. “

He further elaborated; “when you do not have a toothache, you don’t seem to enjoy it—peace is there in the present moment, but we find it boring and that is why we look for something more exciting”.   It feels so good when a toothache finally goes away.  If only we could appreciate the absence of that pain all the time.

Not all pain can be resolved by a dental procedure.  We are surrounded by pain in our work.  We see so many varieties of suffering, some themes repeated like a familiar chorus, others particular and unique to a single human being.   Our hearts ache with the daily news from places both remote and in our own backyards.  But when we experience extraordinary pain, we remember how fortunate we were for the time when pain was absent. Most of the time, however, we slug through our days, not noticing the absence of pain.

During the root canal, I listened to a favorite playlist on my iPod.  Steve Jobs had died a few days before.  I could not help but silently thank him for the music that distracted and entertained me, drowning out the sound of the drill.  Like many, I shed tears when I heard the news of the great man’s death. Grief is too strong a word for my feelings.  Rather, I felt a tender softness for the man I never met, for he enhanced my life at almost every turn.  From the podcasts that enrich me, to the MacAirbook that keeps track of my notes and projects, power points and photos, to the iPad that keeps me from double booking my clients (most of the time) and gives me a library full of books, and finally to that most magical of devices, my iPhone—that lets me check the weather, the news, the map, and gives me countless sources of entertainment.

Technology has enhanced our lives.   We have become experts at multitasking.  But it is in the moments of quiet, when our senses are awake, that we can feel the absence of ache.

Autumn has arrived.  October is my favorite month.  It is the month of my birth, but that is not the main reason I love it.  I love the long shadows and the harvest moon.  The light and the darkness meld into one another as the center of day holds until it succumbs and leaves the evenings long, for soup, for hearth, for stories.

And with the arrival of autumn, the holiday season approaches.  Our clients feel the tug of opposing emotions—joy, gratitude, resentment, and disappointment. We listen.   And we try to help integrate their dark and light.

But at the end of the day, we must shed our helping selves for a time, so that we can appreciate the absence of ache.  So that we can enjoy the moments that, when strung together, give us that delicious taste of all that is good in our lives.

“Be hungry, be foolish.”  Mr. Jobs spoke that advice at Stanford after hearing of his cancer diagnosis.    As we head into this holiday season where autumn fades into winter, let’s remember to be hungry for creative urges, for love, and for all that feeds us around the hearth. In our consulting rooms as we listen deeply to our clients as they work with their pain let us be present.

I remind myself to be playful and look for newness even if it seems foolish.  Mindful living is to be in touch with life—in order to enjoy the presence of your non- toothache.

Originally published:  President’s Column October 21, 2011