O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

By Leave a Comment

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.

By Leave a Comment

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

By 40 Comments

Amour: Keeping Marriage Strong After a Stroke

How Marriage Can Survive Health Problems

The French film Amour is a touching, realistic window into the world of a committed marriage in which one partner has suffered a stroke.

The elderly couple are music lovers, their apartment chock-full of music books, records, and CDs, plus a concert-size grand piano. Yet the film has no musical score, just the mundane sounds of everyday life. The couple’s need to cope with change is so profound that the music of life fades, replaced by the clinking of forks against plates, sweeping away crumbs from the kitchen table, or shower noise as a caregiver washes Ann’s back. The story gently unfolds, depicting the couple’s commitment and love as the outside world shrinks, startlingly magnifying their life lived in three rooms. There is no shaking of fists at their plight, no angry outbursts from either partner.

How Stroke Affects Marriage

When giving talks on how stroke affects marriage, I say, “When one partner has a stroke, both partners have a stroke.” The stroke survivor grapples with loss of bodily function, speech, and often dignity, and the caregiving spouse must come to terms with the magnitude of the change in their lives.

A stroke can alter two people’s lives in an instant. For the person with the stroke, simple tasks suddenly become difficult or impossible. For the person’s partner, life revolves around the stroke survivor’s needs, requiring many adjustments.

And while stroke (like any chronic medical problem) affects marriage, it can also open a gate to improving communication and building and strengthening skills that were taken for granted.

Empathy on both sides is needed for the marriage to survive. Learning new ways to communicate fondness and appreciation serve as protective factors. Building new rituals of connection and remembering the positive aspects of your marriage before the stroke are necessary to keep your relationship healthy.

Coming to Terms with Suffering

While stroke can create strain, frustration, and distance in your marriage, coping with its effects is an opportunity to reset your priorities and goals. You may be able to strengthen your marriage as you and your spouse work together on common problems you will face. It is by accepting the limitations that life imposes on us that we can overcome them. As we learn to carry our burdens well—in the yielding and in the striving—we become whole.

Viktor Frankl was a psychiatrist who survived the Holocaust; his parents, brother, and pregnant wife did not. In his remarkable memoir, Man’s Search for Meaning, he discusses how people face unavoidable burdens. Why did some crumple beneath the horrors of the death camps, while some comforted others and gave away bread?

“When a man finds that it is his destiny to suffer, he will have to accept his suffering as his task; his single and unique task. He will have to acknowledge the fact that even in suffering he is unique and alone in the universe. No one can relieve him of his suffering or suffer in his place. His unique opportunity lies in the way he bears his burden. . . . The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified, and unselfish. Or in the bitter fight for self-preservation, he may forget his human dignity.”

I do not mean to minimize the great accommodations that must be made in marriage when a stroke occurs. But there is a phenomenon seen in marriage counseling that often predicts good prognosis; therapists term it “glorifying the struggle.” This describes a couple that comes to therapy with a crisis, but they can talk about how they see the struggles that they have gone through as ways to grow and that they can grow together. The likelihood of that couple being able to keep their marriage whole and strong is better than when there is bitterness and resentment toward their marriage struggles.

Of course, sometimes caregivers can’t look after a stroke survivor at home. In Amour, the husband was the caregiver until he could no longer tolerate bearing her pain for her. In the United States, if a caregiver is no longer available and/or funds have run out, the best option is a skilled nursing facility (or SNF in the medical jargon). But in many families, life must go on: living together, but with tremendous challenges for both partners.

Ways to Cope When Stroke Strikes

Here are some issues to consider in coping with the aftermath of a stroke.

1. Spousal support: This is a powerful aid to stroke recovery for several reasons, including a spouse’s ability to improve the stroke survivor’s mood and increase physical and social activity levels.

2. Role changes and division of labor: Most couples must change their usual division of labor. Tasks and duties that were previously performed by one spouse may need to be reassigned. Outside help should be considered when possible.

3. Emotional support: High levels of emotional support lead to the best possible recovery after a stroke, and support is most effective when it is seen by the stroke survivor as meeting his or her particular emotional needs. Empathy—your ability to see things from the other person’s perspective—is important for both partners. Even a stroke survivor with speech problems (aphasia) can still listen. To truly listen is a great gift, even when your replies are non-verbal.
4. Counseling and group support: Both partners can benefit. There are many great agencies that offer classes following a stroke, and ongoing groups to help maximize coping.

In the best of circumstances, marriage is challenging. When couples face chronic medical problems such as stroke, the marriage vows -in sickness and in health are tested to the limit. Compassion by both partners for each other, as so tenderly shown in the film Amour, is imperative to preserving love.