Category Archives: Uncategorized

Smoking Cessation

Positive Thinking: Negative for Habits and Smoking Cessation

Positive thinking is typical in our New Year’s Resolutions. Resolutions aren’t the only reason to change habits, but if they motivate you, great. The Scientific American magazine article (link below) is a short four paragraph summary of a study published a few years ago that might be relevant. The Northwestern University study demonstrated that a certain kind of belief (cognition), restraint bias, may put those with bad habits or addiction at risk.

The study may also have raised the possibility that it is fairly easy to influence this belief in research participants.

Smokers were randomly assigned to two groups, both of which took a self-control test. But one half was randomly told they had low self-control and the other half was told they had high self-control. Therefore, some of these individuals would have unrealistic positive thinking, i.e., his/her self-control is really low, but he/she was told it was high.

Then they watched a movie that included smoking. They were offered a choice to be paid to resist smoking during the film by keeping an unlit cigarette in their mouths, their hands, or on a desk in another room. The cash rewards were higher for the greater level of temptation.

Those smokers told they had high self-control were much more likely to take higher levels of temptation. But they ended up being more likely to light up and smoke during the film.

It appears that overestimating one’s level of self-control could lead to putting oneself at greater risk of temptation only to end up giving in to a habit one may be trying to resist. Having accurate beliefs about our capacities can be really important in behavior change. In this case, even positive thoughts, which are inaccurate or irrational, can be harmful. So telling ourselves positive things is not always good advice.

http://www.scientificamerican.com/article/why-we-return-to-bad-habits/

#habits #positivethinking #smoking

wifi infidelity

When Infidelity is Healthy

Is More Wireless Fidelity Healthy

The psychology of advertising is fascinating to me, or perhaps more accurately put, confusing. Sometimes I spend more time imagining the brainstorming session that developed the idea of Vikings selling credit cards or geckos explaining car insurance, than contemplating whether the products themselves are worthwhile. I recently saw two ads letting me know I would have more access to the internet, uninterrupted financial news on my tablet or cell phone, and access to Wi-Fi while on an international flight.

The first ad was for a Bloomberg News App that would allow me to watch broadcasts wherever my device can be connected. The ad copy was something like this:

“Consider all future vacation time officially compromised. Sorry.”

The second was part of American Airlines’ new campaign to let me know no matter where I fly with them, I will have Wi-Fi access.

“It is enough to bring tears to your eyes,” the ad says.

“Sorry” and “tears” in ad copy not selling Kleenex or Hallmark cards- interesting…

Despite loving Bloomberg news and being a self-aware workaholic and technophile, tears might come to my eyes and I may deserve an apology, because more of a good thing, even wireless fidelity, may be unhealthy.

Abnormal Connection

It may be unhealthy, but it certainly isn’t abnormal to be connected in today’s fast paced world- at least not in the statistical sense. In fact it may be abnormal not to at least be able to “connect” to one device or another. And from the looks of things, the numbers of people who are constantly connected is growing.

Although we spend hours per week tethered to our devices, and despite concerns over cell phones being used to detonate bombs by terrorists, Wi-Fi for subway commuters has already been piloted on some lines in New York City. Goodness forbid we aren’t faithful for a few minutes of the day. But faithful to whom or what? What did we do just five years ago? Were we that unproductive, uninformed, and disconnected from friends, colleagues, and customers? Have our goals changed? What are the benefits of maintaining constant fidelity to the internet, even during a 20-minute subway ride?

What’s your Function

Well, it seems clear that it will be ubiquitous if it isn’t already. It is also clear that the internet provides many benefits. We can do all kinds of things on-line, e.g., order lunch without being placed on hold, read reviews about a general contractor before checking her availability, or post our resume to LinkedIn in hopes of landing a better job.

The consequences of those actions compared to the alternatives, e.g., placing a lunch order by phone, trying to call references provided by the contractor herself- seem to greatly favor on-line actions. There is no question, that on-line membership has its privileges. What seems less salient, are the costs associated with being plugged in, all of the time. After all if we are faithfully connected to our devices, from what did we disconnect?

The high levels of ambivalence I hear from clients, and workshop attendees when discussing their relationship with their smartphones (and the internet in general) implies there are costs, even if they are not as obvious as the benefits. The double-edged nature of these devices makes it a complicated issue.

I often ask if any of them have been out of touch with their precious phones because the phone was lost, stolen, or perhaps they were on a plane, or in a remote area of the world. Then I ask, “What was that like, being out of touch and seemingly out of control?” I get responses like, “It felt great, I felt free,” “Relief, I could breathe.” What might this tell us about the real consequences of our “connection?” If disconnection resulted in relief and freedom, what is constant connection like?

Have you ever been without your phone for a full day. What was it like? What thoughts and feelings showed up?

Is your pattern of use really serving your interests, i.e., helping you to achieve the goals you value?

From my standpoint, the critical question isn’t determining whether using these devices is good or bad, but rather “How can devices be used to best benefit you, and under what circumstances?”

To identify the healthiest use pattern, you may want to answer a few questions. What is you goal right now? What are the consequences of going on-line right now, both short-term and longer-term? Based on that information, what can you hypothesize drives these behaviors?

These questions may help you to understand the function of a particular behavior. Let’s look at two common uses for our devices, in these cases, a smartphone.

I often utilize my iPhone to help me find the best route when traveling to an unfamiliar destination. If I look at the pros and cons of this behavior, it seems the pros outweigh the cons, hands down. So in similar circumstances in the future, I will continue to use my iPhone to help me with directions.

I also have found myself pulling out my iPhone when I am out to dinner with one other person, and he or she excuses him/herself to the bathroom. Typically, I open my email and check my inbox. Depending on how long the line or what is taken care of, I may then move on to reading a news story. Have you ever felt the urge to pull out your phone when sitting/waiting for someone in a restaurant or coffee shop? For me, the news stories I might read on my phone are not ones that I would necessarily read later, if my companion hadn’t left me alone. What then are the pros and the cons of this kind of a behavior? And what is its function?

For me, checking my inbox is typically about reducing my anxiety about some imagined “what if” email that could have arrived and presented me with a task to which I need to attend.

Likewise, once that is complete, moving on to read a news story on my phone is less about needing that information at that time, and more about not coming into contact with thoughts like, “What am I supposed to do with my hands right now and where do I look, as I sit here alone at this table (and who knows what other thoughts or feelings that could arise, if I created space for them)?” Here I do benefit from using the iPhone by reducing my emotional discomfort. But, what are the costs?

From a behavioral perspective, using my iPhone in these ways is negatively reinforcing. That means an aversive thought or feeling is removed and thereby the behavior is likely to occur again in the future. It is similar to how drinking alcohol may work for someone struggling with addiction. This is not to say iPhone use and alcoholism are the same, only that the function of the behavior can be similar. If I were to walk into a party and become anxious once I see a well-dressed crowd of intellectuals conversing, I may order a cocktail, and begin to sip it. The alcohol acts on my nervous system to reduce my experience of anxiety. I then order a second cocktail and continue to drink. Drinking alcohol in this case would be negatively reinforcing. The negative refers to the removal of something, in this case, anxiety. Reinforcement refers to an increase in behavior, in this example drinking alcohol.

What are the potential implications of negatively reinforcing behaviors like these, when they are in response to aversive thoughts and feelings, i.e., internal stimuli? For most of us, it is difficult to totally control our internal experiences, and there is scientific research that indicates attempting to do so may be counterproductive. Therefore some of these patterns can quickly get out of hand.

That means, we may find ourselves on autopilot, frequently checking our phones more as a habit than a conscious informed choice (CIC). Checking a phone in that manner, may or may not significantly impact one’s happiness or ability to function. But if the behavior becomes increasingly frequent and automatic, there could be potential problems on the horizon.

First, since these devices are carried everywhere (I’ve heard sales calls from men’s room stalls. I almost hope those are automatic and not well thought out decisions), they can be used to ameliorate any, even the slightest, momentary contact with emotional discomfort, e.g., boredom waiting for a ride, frustration with a long line at the DMV, or social anxiety at a networking event.

While very effective in the short-run, using mobile devices in these ways consistently deprives of us opportunities to experience these emotional states. It may sound odd, because avoiding “bad” feelings seems to be in large part what many of us have been socialized to believe successfully living is, at least in part, all about, minimizing pain, but at what cost?

There are in fact opportunity costs in skipping over or immediately reducing all of these natural episodes of transition or adjustment, which often include mild to moderate levels of discomfort. Using a smartphone while waiting in line may prevent boredom, the same way a wetsuit prevents a surfer from feeling the cold water. There are cold temperatures that in fact could be detrimental to the surfer. There probably is not an amount of boredom likely to occur while waiting in a line that could harm any of us. If we think of the wetsuit more as a metaphor though, the surfer never habituates to the cold water, so if/when either the wetsuit tears, she outgrows it, or forgets to bring it to the beach, she will be sensitized to the cold water, never having practiced habituating to it, or using any strategy to help her surf while fully experiencing the cold temperature. Therefore constant use of a tactic to insulate us from what is uncomfortable may make us more vulnerable in the future by depriving us of the opportunity to learn how to experience these states.

Those of us growing overly dependent on our mobile devices may be reducing our internal bandwidth to what we experience well. Imagine a child who was brought up constantly entertained, never having to experience boredom. Can you imagine how well adjusted he/she might be for an entry level position in any industry?

When connecting to the internet is used constantly to override any natural downtime or transition time in our day, we may also be depriving ourselves of the few times that in the past we might have used for reflection or a time to be fully present in the moment. If we remove these opportunities we may miss seeing the forest or touching the trees, disconnecting us from both the larger picture and the smaller details and textures of what is right in front of us.

Mobile device use is a behavior like any other that needs to be evaluated in context, the situations in which it occurs, the consequences that follow, and the values of the individual all have to be considered in understanding how well the behavior is serving the individual. If you suspect your mobile device use could be in question, I would recommend a few tiny experiments. If you engage in these behavioral exercises, pay attention to what thoughts, feelings, sensations, or memories arise. Perhaps notice if any of your behaviors change or if new ones develop. Are you paying more attention to what others are saying? Are you able to more precisely identify what you are feeling? Do you begin to ask yourself questions about where your life is headed in more than a rhetorical fashion?

WI-INing: Wired/Wireless Infidelity

I recommend starting small. That may mean keeping the duration short, or it may mean selecting to do the exercise every three times you are in the situation. Weaning ourselves through wired/less infidelity can be uncomfortable at first. But if you are willing, here are some exercises to try.

1. Sit on a blanket at the park or a public bench for 15 minutes with all devices turned off or at home. Pay attention to what thoughts, feelings, and sensations arise naturally while you simply sit and watch your surroundings without reading, writing, talking, etc.

2. Identify times you “automatically” pull out your smartphone, e.g., while waiting in a long line and commit to refraining from this every other time you find yourself in that situation. Try not to engage in any other form of distraction either, and again just notice your experience.

3. Intentionally leave your smartphone at home while running an errand, e.g., going to the grocery store. It may seem dangerous, but long ago a number of members of our species successfully navigated such a hunting and gathering venture without the safety of the “smartphone spear.”

4. When you decide you are willing, set aside a block, or multiple blocks of WI-INing time, where you leave your phone in a place you will not see or hear it, or at least put it on airplane mode if you are carrying it with you, and commit to not checking it for the entire time. Examples could be one hour on Monday and Wednesday evenings, or all of Saturday. (if you plan on doing this, it defeats the purpose if you leave the phone, but use a laptop, tablet, etc.). For many of my clients, this takes a lot of negotiation and practice with the other exercises first.

What or Who’s the Tool

For a little motivation, consider what tool means. I found two definitions for the word “tool.”

Tool = a handheld device that aids in accomplishing a task (Merriam Webster)
Tool = an unskillful workman 1698 (English Stackexchange)

For me at least, without practicing putting down my iPhone and experiencing what comes, it is easy to imagine who becomes the tool.

JAMA- Hot Flashes and Alternative to HRT

The Journal of the American Medical Association (JAMA) recently published a double-blind, placebo-controlled trial that found women who took escitalopram (Lexapro) had 50% fewer hot flashes than those who didn’t.

For many women, hot flashes can be very debilitating and, as the author of the study states, there haven’t been many interventions that have been effective. Since escitalopram didn’t show any serious side effects, it may be an option that menopausal women whose hot flashes seem unbearable would want to try.

[fontawesome icon=”fa-file-text-o” circle=”no” size=”medium” iconcolor=”#000000″ ] Nicholas Bakalar’s NY Times article on the study Click the Antidepressant May Help Quench Hot Flashes

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worried man

How Worry Makes Things Worse

Some people are just natural-born “worriers.” They seem to have inherited a worry gene. You know the type. You may have family members who (or you, yourself may) belong to this esteemed group, always concerned about the welfare of others (or their own). Does that ring a bell? What benefit(s), if any, are there in worrying?

If the worrying and certain associated behaviors reach the level of obsession, they are likely to cause problems in one’s career, job, and/or relationships. It might have, at that point, entered the realm of the generalized anxiety disorder (GAD).

Most people with GAD worry and obsess about their family, friends, and colleagues. Ironically, however, the behaviors manifested as a result of their anxiety (e.g., over-protecting, enabling, nagging, micromanaging, or, on the other hand, detachment, withdrawal, alienation) tend to sabotage or even ruin their relationships with the very people about whom they are so concerned.

Researchers studying people with GAD found that they demonstrated four distinct styles of interacting with others: intrusive, cold, non-assertive, and exploitable. Although the study participants all worried to the extreme and at about the same level, they did so in different ways. Have you ever found yourself exhibiting any of these types of behaviors? Asking your spouse a thousand questions on his/her return from a business trip (intrusive)? Offering only negative criticism regarding your child’s attempt at cleaning his room or competing in her first tennis match (cold)?

Most psychotherapists who treat patients with generalized anxiety employ cognitive behavior therapy (CBT) to do so, and it has shown positive results. Psychologists’ recommendations from this study, published recently in the Journal of Abnormal Psychology, are that treatments for GAD should not focus solely on the anxiety/worry issue, for optimal effectiveness, but instead should target both interpersonal relationship and worry issues simultaneously.

 

therapist

How do I find a therapist? (Part 1)

What is Good Therapy?

As a clinician, I treat a variety of problems in any given week, ranging from gambling addiction to sexual dysfunction. I receive more anger management and weight loss referrals than most, which means I see a lot of couples and individuals facing medical complications.

So one hour I may see a 42-year-old physically abusive husband who has had a restraining order taken out against him, and although afraid of losing custody of his children, believes his wife caused the problems, and the next hour see a 29-year-old attorney who was just been told she has diabetes and rushes to Krispy Kreme before heading home to order dinner and pour her first glass of wine that night.

Effective behavior change often involves recognizing that although behaviors are frequently multiply determined, they may also be governed by common psychological and physiological processes (or behavioral principles).

Taking a swing at your boss the day before your pension vests may have been caused by more than just your rage at his off-color remark in front of your colleagues. It could also be related to the mounting sexual frustration at home, the financial anxiety around your adjustable-rate-mortgage, the guilt about not seeing your daughter’s lacrosse match, or not taking lunch that day.

But, whether it is accumulating guilt, frustration, anxiety, or a combination leading to an act of impulsive aggression or sitting down to a well planned 5,000 calorie binge, both may be about avoiding negative feelings, a lack of well-rehearsed coping strategies, and physiological imbalance.

I am often asked by friends, family, and colleagues to recommend a therapist. They start with “How do I find a therapist?” They asked me a number of additional really good questions:

  • Is a psychologist better than a social worker?
  • Doesn’t Cognitive Behavioral Therapy just treat the symptoms?
  • Will a psychoanalyst take too much time to help me?
  • Should I go with a therapist who has been in the field for a few decades?
  • Can someone who hasn’t had an addiction really understand and help me?
  • How can she advise me on parenting skills if she doesn’t have kids?
  • Should I see a man or a woman for my problem?
  • What does in-network and out-of-network coverage mean?

I will try to hit each of these questions at some point, but for today, let me at least address whether the degree or profession matters.

In my experience, the letters following a therapist’s name are not the most crucial factor. I have come across many M.D, Ph.D., and Psy.D. clinicians that I wouldn’t want a family member to see, for even a minor problem. And I’ve known Master level therapists (and unlicensed students for that matter) who have provided tremendously valuable guidance, and precise technical interventions according to sophisticated treatment plans.

The scientific literature seems to back this up. What is central to effective therapy is a motivated client and the appropriate interventions intended to target the right mechanisms of change. That means the right clinician is a necessary ingredient, because she/he needs to do the right things.

But, age, years in the field, and certainly the specific degree only matter if that impacts the client’s motivation, because with motivation and a strong therapeutic alliance, as long as the therapist has been well trained (which can be done in a 2-year Social Work program or a 6-year Clinical Psychology program), effective treatment can take place.  In my next entry, I’ll address very specific questions that can be helpful in finding the best therapist for you.