Thrive! Please, don’t just Survive.

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I have been doing a lot of reading on the web, read published academic articles, and having consultation with my psychologist colleagues about how many people see therapy as a place to fix a problem, or something is wrong with them if they come in. That is not true! First off the question should not be, “So… what is wrong with you?” THE RIGHT QUESTION is, “So… tell me what happened to you?”

Many* (not all) of us got into this line of work to help people THRIVE, live their best life, and enhance and accentuate their positivity, light, and God-given talents. If you have a good marriage but you want a great one, come see me! If your marriage or personal mental health is on the verge of crumbling come see me! But please do not think you are labeled crazy if you come to therapy or walk into my office. Fun Fact: In NY people think you are WEIRD if you DON’T go to a “Shrink.” It is true, no joke.

So it seems people may just not know that some psychologists can be like coaches helping an athlete be a better athlete. Or how to find us. Sure, I am equipped to handle psychotic break downs, suicidal crises, and strange/bizarre behaviors if needed; however, my bread and butter lies in helping people THRIVE. I had a recent patient come into therapy and asked me, “Doc, can you help me just get back to normal with a quint little job (that’s all I want)?” I replied, “Sure, but can I also help you get all the way to happy and thriving? Want for us to strive for that instead?” I do not just want to stop there, to where that person can survive and get by, I want to see him/her self-actualize their potential and FLY! God/The Universe gave each of us a purpose and talents. It is my personal belief that the meaning of life is to figure out how to best use our talents to heal or help this world, whether it be by being a GOOD president, doing the math/physics for air space launches, being an amazing parent, painting your best painting, writing your best song, or giving people their best hair cut of their life.

In my therapy, I want to figure out where do you want to go and let’s get you there together, or at least go down trying! You are not alone. And if you want support it is out there. My Best advice is never stay with a therapist that does not feel right to you. “Therapists are like shoes. If they don’t fit right the experience can hurt you, you can end up with more problems because of it, or you can decide to never look for a new pair of shoes ever again.” Be courageous and dare to ask for help if you need it. Find a good one (that uses evidence/research-based treatment) that truly gets you and that you feel cared by. It really helps to have an outside perspective and 5-6 years of graduate school training and teachings to help you with whatever life throws at you. You are NEVER alone. And nothing is EVER bad forever. Love your life and yourself (body, mind, feelings, & spirit) . You are the only one you have for certain for the rest of your life. Take good care of you.

Dreams, Sleep, & Mental Health: What’s the deal?!

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I recently have been conducting trauma therapy with many personal injury victims such as survivors of horrible car crashes, dog bites, and assaults. The first complaint or issue they bring up is, “I can’t sleep.” As a former insomniac myself, I know how frustrating that is and the effects it had on my mood, hunger, energy, memory, and ability to focus. I see my patients struggle to be on time to their engagements, lose things, have zero appetite or motivation, and ultimately feel a major hit to their self-confidence. Due to their trauma they experience flashbacks and plenty of nightmares… BUT…when they start to feel better, many of them begin to dream and tell me about them. Now, this is very interesting to me. This means that either they are sleeping better/more deeply or their memory for dreams is improving. This also suggests that there is some connection between mental health, or recovery from whiplash (for example), with sleep and dreaming. I wanted to get to the bottom of this. So I conferred with the research, once again.

[I don’t know if you’ve noticed, but when I look into something I make sure I do a thorough review. (Stay with me since I get to the good stuff relatively quickly!) So let’s start from the beginning…]

I learned that the first written record of dream interpretation came from the Egyptians  around 1275 BC and it was called the “Dream Book.” Then the Greek philosophers took a stab at it and believed that dreams revealed important information about the future and Oracles began to exist. Later, Freud believed that it was the concept of repression that caused people to be unable to remember their dreams. Research did not support this.

<<Fast Forward>>

Then in the 50’s, Aserinsky and  Kleitman (1953) discovered and introduced the concept of Rapid Eye Movement (REM), which then became associated with the dream state. This was recently found to be untrue because we still definitely dream, albeit less vividly, during NonREM sleep (NREM). Anecdotally, I have observed that in times of personal grief or heightened anxiety, I do not dream (or remember dreaming) and if I do I have nightmares. However, when my insomnia goes away I begin to dream again or remember my dreams. Similarly, patients that I work with seem to be describing an increase in dreaming recall correlated with an increase in sleep total hours when they report feeling symptom relief (mentally more healthy). This made me wonder, why are people beginning to speak about their whimsical/normal dreams (non-nightmares) once they start to seem less depressed and traumatized and when they are more happy? Do we need a certain  level of mental stability and peace of mind to dream? Or to remember dreaming?

The factors that the literature says contribute to being able to recall our dreams are: Intense negative mood before bed, (e.g. stress); having positive attitudes towards dreams; thinking about and consciously trying to remember dreams; and the most common finding- frequent broken sleep (suddenly waking up while you are in the middle of dreaming). Notice, this is different than what I am seeing with my patients. Interestingly, some gender differences have emerged in the sleep and dreaming research. For example, both Armitage (1992) and Shredl & Doll (2001) found that stress tends to increase dream recall in females but tends to reduce recall in males. This has clinical implications for clinicians doing sleep and dream work with patients with PTSD and trauma. Dreams have been shown in studies to help people solve problems and continue working on problem solving while sleeping. Furthermore, researchers have found that dream recall and positive attitudes towards dreams were correlated with mental wellness for males. AHA! So for males, when they begin to tell me that they are sleeping better, dreaming, and there are no nightmares–> I can feel confident that they are more mentally healthy or going in that direction. For women, I seem to be seeing a similar pattern so maybe it is because they too are healing from trauma and these studies did not look into sleep, dreams, and trauma.

The continuity hypothesis of dreams posits that dreams reflect waking life. This means they are somehow connected to real life experiences or things we are learning currently in real life. Sleep is also well known for its learning purpose, whereby we must sleep to consolidate and solidify new memories (ie. studying well for a test and topping it off with getting a good nights rest). Ermann (1995) found that insomniacs had dreams of self-deprecation, self-doubt, aggression, problems, and generally negative content. Insomniacs were found to have more health worries than normal controls. Anti-depressants seem to make people unable to remember their dreams and to reduce REM sleep.

Sleep’s function is still evading us. We do know that losing one night of sleep does not effect our brain but when you cannot sleep for 2+ days you are affecting your brains ability to complete neurogenesis, which means it cannot heal and properly recharge itself much like a cell phone or computer. One thing research has found is that sleep disorders are correlated with mood disorders and that mood disorders are correlated with sleep issues. Can you say “chicken or the egg phenomenon in full swing?”..One interesting read told me about the similarities in the brain between psychosis and dream states. They found that when the corollary discharge or feed forward (CDFF) mechanism is “disabled” neural activity in an individual’s brain is experienced as produced by the external environment (outside of the self). Researchers have learned that our brains look similar on fMRIs when we are day-dreaming than when we are asleep dreaming. They posit that this all plays a huge role in better understanding what happens in schizophrenia and the whole hearing voices or seeing visions. The CDFF part of their brain is disabled and they perceive that the stimuli are coming from outside their body and mind. In terms of what shuts off in our brain when we sleep- it is parts of the executive functioning part of our brain (pre-frontal cortex) which is in charge of planning, decision making, and organization. This may be why we need to sleep to turn off that part of our brain so we can recharge and have that part be ready for the next day.

The bottom line is we still do not fully understand sleep. One thing is for sure, sleep is generative of brain matter, it consolidates our memories, we recharge much needed control centers of our brain, dreams reflect waking life, and when males begin remembering their dreams this may be a sign of good mental health. Who knew??

 

 

References

Aserinsky E, Kleitman N. Regularly occurring periods of eye motility, and concomitant phenomena during sleep. Science 1953;118:273e4.

Armitage R. Gender differences and the effect of stress on dream recall: a 30-day diary report. Dreaming 1992;2:137-141.

L. Palagini, N. Rosenlicht / Sleep Medicine Reviews 15 (2011) 179e186 doi:10.1016/j.smrv.2010.07.003

 

Scientific finding: Spiritual Meditation, specifically, can help you tolerate pain during a migraine episode.

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I have recently been on a personal spiritual journey. I am trying to practice daily Zen Buddhism, do morning meditations, practice individual yoga, and have generally been doing what I would call a “Thinking Cleanse.” After a few weeks, I noticed that I had significantly changed my life for the better in profound ways. I feel great, my husband and I have been enjoying each other’s company so much more, my friends and family have been more interested in socializing, I feel better in my clothes, and I have been handling the typical emotions of anger, disappointment, and sadness of life that we all go through with a newfound gracefulness and calm. So I conferred with the research to better demystify the validity of these insights.

And behold! I found a jaw-dropping research article on these very phenomena: (https://www.researchgate.net/publication/5304282_Migraines_and_meditation_Does_spirituality_matter)

In a nutshell, researchers found that not only does spiritual meditation compare with pharmaceutical intervention and biofeedback intervention for managing migraines, but it matters what kind of meditation you practice exactly.

What they did: In their study, they had four intervention groups and one control group. There was a relaxation techniques group, which is self-explanatory. There were three types of meditation groups which were all trained the same way on how to meditate, except for the types of mantras they were taught to use. There was an Internal Secular Meditation group that was instructed to think about phrases such as: “I am content” or “I am good”. They had an External Secular Meditation group which focused on such phrases as “Sand is soft” or “Cloth is smooth.” And, lastly, they had a Spiritual Meditation group that focused on phrases such as “God is Peace,” “The Universe is good,” or “God is Love.”

Findings: Not only did “migrainers” who practiced Spiritual Meditation report a significantly greater reduction in the number of headaches they experienced over time, they reported a significantly greater ability to tolerate the pain. It is important to note that the practice of spiritual meditation in the study did not alter people’s sensitivity to pain (based on ratings of pain severity), but it did alter how well they tolerated those pain levels (Wachholtz & Pargament, 2008). In other words, this emphasizes our perception of pain and how we relate with our pain in our minds.

Furthermore, regular practice of spiritual meditation in this study created significant decreases in negative mood among its practitioners and showed a larger decrease in negative affect than those in any of the nonspiritual technique groups. It is not unusual for practitioners of meditation to report a general reduction in negative mood and trait anxiety (Wachholtz and Pargament 2005). However, the unique finding of this study is that the spiritual component enhanced this effect compared to migrainers using nonspiritual meditation techniques.

“As a whole the findings speak to a fundamental improvement in emotional health and improved feelings of control following the use of spiritual meditation that was not replicated with non-spiritual techniques (Wachholtz & Pargament, 2008).”

So what do you think? >>>Was the important factor that the participants of this study opened themselves up to the Universe or God and that is what helped them manage their pain or was it the Universe/God helping them through the pain, after all? I guess we will never know. Either way, I plan to meditate tomorrow morning, and the next, and the next…

My proposed “Developmental-Stress Model of Happy Marriage”

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Cape-rey-carlsbad-wedding-photos-d-m-683
Love is friendship on fire.

I know many people in my life have been curious about what came out of my dissertation on how to maintain a happy long-term marriage. I have decided that the best way to present it is through my blog. I am planning on discussing my proposed model with both the general public and practitioners in the mental health field. Therefore, I am using a vignette I got from the International Positive Psychology Association website and am going to apply how I would use my model and interventions in therapy to help a struggling couple. Please feel free to ask me questions if something is not clear or if you are curious about anything related to my study or findings.

Dissertation: The lived experience of long-term happily married heterosexual individuals (access: https://search.proquest.com/openview/1ee820ac9e1a139074b39b66073c1c1c/1.pdf?pq-origsite=gscholar&cbl=18750&diss=y;THE)

Vignette:

2. Ahmed and Fatima are a middle-aged couple who immigrated to America from the Middle East more than two decades ago. Highly educated and professional, both have worked hard to realize their “American Dream.” They work in the same health care facility, helping people with chronic and complex medical issues, and are known for their kindness and empathy. Both, however, have lately been arguing about their teenage daughter. Ahmed, originally from a conservative family, objects to her clothing preferences. He also disapproves of her socializing freely with her male peers. He hopes to see her become an accomplished physician. His wife, however, disagrees with him and approves, by and large, of autonomy for her daughter. The issue has driven a wedge in their otherwise relatively peaceful marriage. The daughter, who used to be very close with her father, has become estranged from him and finds him narrow-minded and overly observant to cultural norms and gender roles, which are less relevant to her American upbringing.

Intervention: Based on my research, I created and proposed a “Developmental-Stress Model of Happy Marriage.” This model posits that happy and healthy married individuals have successfully gone through a developmental process as a couple that allows them to advance to the next stage of their marriage with more positive skills and a stronger bond. Often couples could benefit from identifying at what stage they are in their marriage using the model and to learn how to handle conflict and increase their bond at their particular juncture. This is how my intervention works: When couples present for couples therapy they often conceptualize their issues as a specific point of conflict or upsetting event, but they are unaware that there are many other reasons why their marriage could be in distress. I have attached my proposed marriage model (linked below), which I hand to all my couples during our second session. I teach them about the stages of marriage, the stressors that come with childrearing, and help them reconnect through their mutual values, strengths, goals, plans, and learning to have a positive outlook on their conflict as a learning experience. For this vignette couple, in particular, I would identify that they are in the stage where there are stressors that are normal and that they have some clashing values currently. Issue: Autonomy of women vs. conservatism/traditionalism or female modesty/grace. I would help them see that they both love their daughter and they just have different views on how to express their value system in this issue. I would highlight their strengths as a couple and I would highlight the values that they do share: pursuing the “American Dream”, being kind, having empathy, being hard workers, being in the helping professional field. I would teach them about common marital pitfalls and then show them the value of increasing their bond and learning to problem solve together. In my model (see link below), you can see that those are the main goals of therapy for the middle marriage couple: “Increase the Bond” and “Coping Skills/Decrease Stress.” Underneath those headers are ways to accomplish that. We work on all of these things during sessions and for homework until the couple is doing it on their own and they rediscover why they fell in love with their partner and are working as a team again. I would also throw in some interventions on psycho-education about acculturation differences with their daughter, given that she has mainly grown up surrounded by American values. I would remind them that it sounds like they both want the best for their daughter. They both love her very much and value being the best parent they can be, though they may have different interpretations of what that looks like.

Prolonged Exposure Therapy for Veterans with PTSD

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braine imageIt is quite frustrating that many people working in the field as mental health workers are still unsure or unaware of the research-based protocols and treatments out there that have been found to be successful in helping severe PTSD. Here is an article that can explain the importance of treating PTSD and trauma with exposure treatments. Prolonged Exposure therapy has been shown to be extremely effective in working with veterans and still many practitioners do not use it or know about it. Please spread the word if you know someone who is getting therapy now for their PTSD and is a veteran. Clients should be empowered to feel free to ask their therapist if they are doing evidence-based work with them and ask if they are doing PET or not.

Prolonged exposure therapy for combat-related Post-traumatic stress disorder: An examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq http://www.sciencedirect.com/science/article/pii/S0887618510002203

Resource for Understanding ADHD

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ADHD can be a difficult diagnosis to understand for many people and some have even questioned its validity saying it does not exist. ADHD is very real. It is true that it is often overly diagnosed and that people who do not have it often seek out the use of stimulants in high school or college. However, it is clear based on fMRIs and other cognitive neuroscience tests that it can be seen affecting the brain in many ways. ADHD is a neurological childhood-onset disorder that is caused by certain neurons not firing enough, not being active enough, and neurotransmitters not being transported from neuron to neuron. Concentration, self-control, planning, concept of time, and social skills are often areas of weakness or vulnerabilities for folks with ADHD. Please follow the links below for more information and resources:

http://www.chadd.org/

http://www.addforums.com/forums/showpost.php?p=815547&postcount=11

On knowing what is important…

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Personal-Values-QuoteWhat do you want your tombstone to read? This question is often used in Acceptance and Commitment Therapy (ACT) to help people figure out what is truly important to them. So how do You want to be known and remembered? For me, its about being hard-working, caring, invigorating, resilient, creative, and competent. I aspire to make at the very least one person’s life more comfortable per year. I appreciate the chance I have to make a person breathe a little easier every day when I go to work. This makes me wake up with a smile pressed on my face. If a person is experiencing depression, especially an existential struggle to find meaning, it could be very helpful to try and understand what your values are and then trying to live in line with those values.

“Happiness is when what you think, what you say, and what you do are in harmony.” –

Mahatma Gandhi