O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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How Lifestyle Changes Can Be Therapeutic—And What To Do When They’re Just Too Hard

The October 2011 issue of American Psychologist featured an article on how mental health professionals significantly underestimate how unhealthy or missing lifestyle factors—for instance, nutrition and diet, or service to others— contribute to many emotional health problems. It also discussed how immensely helpful improving these factors was in treating many mental and physical health problems. Researchers have termed these improvements TLCs, or therapeutic lifestyle changes.

The eight lifestyle factors include exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement, and service to others. Plentiful research supports the importance of these eight TLCs—as does plain common sense. And each lifestyle factor contributes to the others. Exercise and diet affect mood, and recreation (inscribed in the word itself: re-creation) will help instill a sense of well-being. In a virtuous cycle, when people feel physically comfortable with their bodies, when they feel vital and energetic, they will have the energy to engage in activities such as service to others and feel inspired to spend time in nature and contribute by giving to others.

Many folks today are facing challenges in obtaining the most basic and fundamental needs, such as food and shelter and financial and physical safety. These must be met before additional needs can be addressed. Yet by addressing lifestyle factors with the means at your disposal, it may be possible to shore up your resilience, your ability to withstand hard times. Certainly, it is difficult to think about exercise in times of financial stress, but it could be possible to carve out time to participate in a softball league or to make time to walk in nature, or the public park. Cutting out the cable channels can make for creative ways to spend that time. Some of the poorest people are the most active in service to others, because of what giving gives back to them.

It seems obvious that TLCs have to potential to help people lead better lives. When we’re healthy and we know something is good for us, we usually do it. But how do we implement these when depression or anxiety are present? In that case, those TLCs begin to feel like burdensome “shoulds”—and most everyone has resisted doing something just because we should, even if not depressed.

Depression & Anxiety Make Implementing Healthy Behavior Difficult

Depression and anxiety make change feel impossible to achieve. A well-meaning partner will say, “Just get up an hour earlier and go for a walk.” But to a depressed person, that’s a monumental effort. Getting up and exercising when you are feeling fatigued and lethargic is no simple thing. Sleep, as well as energy, is affected by depression; bouts of insomnia, for example, can lead to too much daytime sleeping, making sufferers look lazy to their families. ”Just get up and go,” the non-depressed person might say; “don’t lie around all day.” And while this may be absolutely the right thing to do, the depressed person has no “get up and go.”

Likewise, someone with social anxiety has trouble engaging in activities that will bring social connection. Avoiding people becomes the norm, thereby limiting potential rewards that come with socializing. For the depressed or anxious, not doing what they know they should be doing leads to self-incrimination and shame, worsening both conditions.

How Psychotherapy Can Help

Psychotherapy can help. During the first appointment, psychologists take a history that includes past and current relationships, educational and employment history, and family background. We also ask about current and past medical problems, medications, and use of substances. It is imperative to take this history to understand how the various life factors are impacting the current or “presenting” problem, as we call it.

Of course, while psychotherapy can begin the dialogue, the difficult part for many is implementing TLCs. What gets in the way of exercise, eating well, and taking time for you? If relationships are difficult, how are you contributing to that? Are you engaging in retail therapy or overindulging in drugs, alcohol, or other substances? An important component to any therapy is to look at what is working and what is not—and then taking responsibility for making changes in your life. Good therapy is not just about saying “Uh huh, you poor thing.”

Including the eight lifestyle behaviors in your life will undoubtedly help you feel better, use fewer psychiatric medications, and live life more fully, but if getting there from where you now feel like climbing Mt. Everest, then consider finding a good psychologist to help you.

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Being Playful Gives Freedom from the Restrictions we Put on Ourselves

Finding your playfulness again
Learning to Play

Gerald Heard visited Georgia O’Keeffe at Ghost Ranch in 1937. He had an interest in Eastern religions and metaphysics. One morning, O’Keeffe found Heard’s footprints around the tree where he had been dancing as well as a cryptic inscription he had etched into the earth at the base of the tree. “Gerald’s Tree was one of many dead cedars out in the bare, red hills of Ghost Ranch. From the footmarks around the tree, I guessed he must have been dancing around the tree before I started to paint it. So I always thought of it as Gerald’s Tree. “ Georgia O’Keeffe.

O’Keeffe painted two versions of the tree, indicating its importance to her. On a visit to Ghost Ranch, I heard this story and was captivated.

David took this photograph in 2008. The tree has not changed in the years since O’Keefe painted it. That this twisted tree, would be the subject of several paintings fascinates me. To see color in dirt takes a willing eye. It is easier to see beauty in vivid flowers or lush forests. The desert makes you work to see it’s unique beauty.

Over the years, I have made many trips to theSouthwestt. One of my favorite pieces of writing is from the novel, Song of the Lark by Willa Cather. This takes place after an intense period of her life as an opera star. She goes to the desert to rest and recuperate.

I sat down in the middle of the garden, where snakes could scarcely approach unseen, and leaned my back against a warm yellow pumpkin. There were some ground-cherry bushes growing along the furrows, full of fruit. I turned back the papery triangular sheaths that protected the berries and ate a few. All about me giant grasshoppers, twice as big as any I had ever seen, were doing acrobatic feats among the dried vines. The gophers scurried up and down the ploughed ground. There in the sheltered draw-bottom the wind did not blow very hard, but I could hear it singing its humming tune up on the level, and I could see the tall grasses wave. The earth was warm under me, and warm as I crumbled it through my fingers. Queer little red bugs came out and moved in slow squadrons around me. Their backs were polished vermilion, with black spots. I kept as still as I could. Nothing happened. I did not expect anything to happen. I was something that lay under the sun and felt it, like the pumpkins, and I did not want to be anything more. I was entirely happy. Perhaps we feel like that when we die and become a part of something entire, whether it is sun and air, or goodness and knowledge. At any rate, that is happiness; to be dissolved into something complete and great. When it comes to one, it comes as naturally as sleep. 1918

Sitting down in the dirt, or the grass, and letting the sounds and small movements of the tiniest creatures catch your attention is a way to play. Play comes naturally to children. They can play by dancing round the mulberry bush, or by laying down in the tall grass and watching the clouds move across the sky, creating castles and animals in their mind. Or watching a line of ants as they carry their burdens along their well-worn tiny paths, letting imagination carry them away.

Think of the ways you play

Wake up early, dance around the base of a tree and find a communion with nature. Being spontaneous, playful, and indeed silly gives freedom from the restrictions we put on ourselves. Think of the ways you play. Write down the most vivid times you played in the last five years. What do they have in common? What do you feel as you remember them? Then think back on some of your earliest memories of playing when you were small. Do these experiences have anything in common?

Being mindful and playing are ways to find the ever-elusive joy we often let slide by for more routine tasks of life. Give in to the urge to dance in the early morning, or in the starlight and watch as you come alive again.

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140 Characters or Less: The Three-Sentence Rule in Communication

 

Couples frequently come to therapy complaining of communication problems. Conflicts don’t get resolved. Intimacy has left the relationship. They lead parallel lives. The focus is on the kids, or their work or friends, but not each other.

During the first session of couples counseling, I take a history of the relationship and ask them to talk about a current problem for ten minutes. Invariably one partner will dominate the discussion. In subsequent sessions, I see the same thing.

For instance, Jody and Tom came to couples therapy because Jody feels Tom never listens to her. She is upset because he tunes her out and doesn’t open up about his thoughts and feelings. Observing Jody and Tom for a few minutes gives an important clue to why they have come to this place in their relationship: Jody talks a lot. In fact, she talks in paragraphs—even pages. She is animated, eager to express herself. Tom sinks into the sofa, shoulders hunched in resignation as Jody takes over the conversation. There is no doubt that she has important points to make and makes them well, but Tom doesn’t get a chance to speak. When I prompt Jody to let Tom speak, he gets a couple of sentences out, and then Jody interrupts, speaking for him.

Who Talks More in Your Relationship?

I have seen this scenario over and over again in my work with couples. Do women talk more than men? This is a controversial issue and many factors come into play. American neuropsychiatrist Louann Brizendine reported that the average man speaks about 7,000 words a day, while the average woman clocks in at 20,000. My observations would bear that out, although admittedly, I see a skewed sample. However, I don’t think it is a genetic or neurological issue so much as a relationship one.

The very thing that Jody wants from Tom is closeness, but she doesn’t give him a chance to talk. The pattern gets further entrenched as Tom’s unexpressed resentment grows and he retreats into his own thoughts, which often see Jody in a negative light. This perpetuates the cycle, with Jody seeing him in turn as distant and aloof. Furthering the pattern is a subtle dynamic at play: as Jody sees Tom’s discomfort and reluctance, she talks for him—letting him off the hook, so to speak.

They each have a role to play in this dynamic but are not aware of their roles.
Using a variety of interventions, I have Jody and Tom change the way they talk and listen. I frequently invoke what I call the “three-sentence rule” for the partner who dominates the conversation. When they come to see the pattern, this rule is met with chuckles and relief. Jody doesn’t really want to do all the talking, and Tom wants a chance to be listened to.

Reciprocity is Essential to Good Communication

Lately, because of the popularity of Twitter, I suggest a rule of 140 characters or less. Tech-savvy couples know this means to limit talk to the most pertinent points, usually in three sentences. Pause. Give your partner a chance to respond. Resume. Reciprocity is essential to good communication. As Tom expresses himself more, Jody can relax and feel less need to control the conversation. In this way, couples learn more about each other, bringing closeness and, in time, greater intimacy. Couples are often surprised to see their patterns of communication are changeable.

So if you catch yourself speaking in paragraphs abounding with run-on sentences, stop and let your partner have a chance to speak. You may be surprised by what you learn from each other.

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How Mindfulness Can Reduce Stress

Mindfulness-Based Stress Reduction

DSC_0231 2 In 1979, Dr. Jon Kabat-Zinn founded the Stress Reduction Clinic at the University of Massachusetts Medical School—the oldest academic medical center-based stress reduction program in the west. In response to inquiries about the clinic’s eight-week course, Dr. Kabat-Zinn wrote Full Catastrophe Living (1990), a the seminal book on mindfulness practice that has spawned numerous offspring, including mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT.) Mindfulness practices have made their way into schools, prisons, business, hospitals, and health clubs. Psychologists and researchers have explored combining cognitive therapy and mindfulness to help depression, anxiety, and medical problems. Given the ubiquitousness of the practice, it is important to understand what it is, and what it is not.

I have always considered the title of Dr. Kabat-Zinn’s book unfortunate. The title suggests that life is catastrophic, but the book is really about living well with the ordinary stresses of life. In his introduction, Dr. Kabat-Zinn tells the reader why he choose the title:

I keep coming back to one line from the movie of Nikos Kazantzakis’ novel Zorba the Greek. Zorba’s young companion turns to him and inquires, “Zorba, have you ever been married?” to which Zorba replies, “Am I not a man? Of course I’ve been married. Wife, house, kids, everything…. the full catastrophe!”

But despite Zorba’s responsibilities and multiple roles, he lived his life with gusto, very much in the moment. “’Just now I’m thinking of the chicken and the pilaff sprinkled with cinnamon,’” he tells the narrator. “’Everything in good time. In front of us now is the pilaff; let our minds become pilaff. Tomorrow the lignite will be in front of us; our minds must become lignite! No half-measures, you know.” Whether considering the pleasurable dinner or the difficult work, Zorba gave his mind to what was in front of him, never just being a spectator of his life.

We all have stress. As Michael Baime, director of the Penn Program for Mindfulness at the University of Pennsylvania Health System, put it recently:

“Stress doesn’t go away, ever. That’s why we call it stress management rather than stress elimination…in practicing mindfulness you create a world where you experience depth, meaning and connectedness. You see joy and sadness more fully and settle more deeply into an authentic way of being.”

Learning to Live With Stress

There are no avoiding daily hassles, relationship conflict, money worries, and health concerns. Yet by living side by side with our stress, we come to know ourselves more deeply. In mindfulness practice we learn to sit with uncomfortable feelings in a non-judgmental way and thereby develop the ability to tolerate the difficulties of life with more equanimity. The practice of observing our thoughts without getting wrapped up in them gives us the ability to bring insight to thoughts, feelings, and perceptions. By bringing our focus back to our breathing each time we notice our minds wandering, we learn to stop ruminating and obsessing, which will eventually help in reducing symptoms of anxiety and depression.

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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