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Sunday, October 31, 2010

Learn What Works Better Than Dieting for Weight Management

Research shows dieting alone doesn’t work for long-term weight loss. In one study, less than 20% of obese participants were able to lose 5% body weight and keep it off for 5 years. One reason for this regain seems to be your body's natural tendency to maintain body weight when it detects that food is scarce. Thus, dieting can slow metabolism, requiring further calorie restriction to lose weight.  Severe calorie restriction causes negative psychological effects, including depression, anxiety, irritability, obsessive thoughts about food, binge-eating, and not feeling full even after a binge. 
As psychologists and counselors, we have much to contribute in the weight loss arena. The most effective weight loss programs are those that focus on  nutrition, exercise, and psychological intervention. According to a recent Cochrane review, which aggregates results of many research studies, increasing the length or intensity of the psychological aspects of a weight loss intervention significantly improves patient outcomes.

Cognitive Therapy 


A psychological intervention for weight that has some research support is Dr Judith Beck’s Cognitive Therapy for Weight Loss. Cognitive Therapy is based on traditional Cognitive-Behavioral principles of planning what to eat, scheduling your day to include food shopping and mealtimes, arranging your environment to support weight loss, and planning for “high-risk’ situations, such as a friend’s birthday party. The program also includes daily reading of flashcards and countering counterproductive thoughts about food, such as “I deserve this piece of cake” or “I’ll never lose the weight.” In a Swedish study, a group that received Cognitive Therapy lost more weight and kept it off over the next 18 months, while those assigned to a waiting list control group actually gained weight over the same period.  

Mindfulness-Based Eating Awareness Therapy (MB-EAT)


MB-EAT  is based on a mindfulness philosophy and focuses on developing “innate wisdom” about food and appetite. Mindfulness exercises teach participants to tune into their own bodily cues of hunger and satiety as well as what specific tastes they are hungry for (e.g., salty vs. sweet). There is also a behavioral component in which participants learn to tolerate increasingly tempting situations, including going to a buffet. The focus is on satisfying and pleasurable eating, rather than restriction. A study of obese people and binge-eaters given MB-EAT showed that this intervention was more successful than a waiting list control condition at reducing emotional eating and depression.

A multi-faceted problem


It is important to keep in mind that the factors maintaining excess weight are different for different people, which is why there can never be a “magic bullet” weight loss cure that works for everybody, despite advertisers' claims to the contrary.  A study conducted in Spain and published in the Journal of Clinical Endocrinology and Metabolism suggests that the hormonal biomarkers leptin and ghrelin were able to identify obese people more likely to regain weight after dieting. Other studies have shown that people prone to emotional eating, that is eating in response to depression or anxiety, are also more likely to regain weight. There is a research link between child abuse and obesity. Environmental factors such as poverty, lack of access to healthy food and exercise facilities, lack of time, and cultural practices also play a part in the weight loss and fitness picture. Finally "fat shaming" and stigma create extra stress for our patients that can interfere with weight loss efforts.

Final Thoughts

As psychologists working with overweight or obese patients, we need to individualize treatment to our clients’ lifestyles, biological makeup, and emotional and environmental factors. We also need to use approaches that have research support. We should work collaboratively with other professionals, such as exercise trainers, nutritionists, and doctors, to most effectively help the patient. The rewards of this work are that you can teach people new healthy lifestyles that should help to improve both the quality and quantity of their lives. Finally, it is important to assess and treat shame and low self-esteem issues in patients with disordered eating. We need to empower patients psychologically as well as changing behavior!  
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Tuesday, October 26, 2010

Emotional Storytelling after Stressful Experiences

This is an excerpt from my chapter entitled Emotional Storytelling After Stressful Experiences in the Handbook of Positive Psychology edited by Snyder and Lopez, published by Oxford University Press, 2002. This work is protected by copyright. All rights reserved.

Dr. Elie Wiesel; a Heroic Emotional Storyteller

Elie Wiesel, an American Jewish writer and Holocaust survivor of Eastern European descent is an internationally recognized writer, teacher, and scholar, who dedicated his life to raising awareness about the Holocaust and about the importance of actively speaking up against human rights violations and genocide, wherever in the world these may occur. In 1986, he was awarded the Nobel Peace Prize for his contribution to human rights, and he has been an inspiration to other leading humanitarian figures, including Oprah Winfrey, whose moving visit with Dr. Wiesel to Auschwitz was broadcast on her program in 2006. Dr Wiesel’s novel Night, which was translated into English in 1960, is an autobiographical account of his deportation in 1944 as a young boy to the concentration camp, Auschwitz-Berkenau, along with his whole family. His mother and younger sister were taken away upon arrival and he never saw them again. He remained with his father until the latter, too, died in Berkenau several years later. 

Night has become the defining chronicle of the inhumanity and evil of the Holocaust. In the following excerpt, Dr. Wiesel describes his difficulty in finding words to describe such horrors and the motivation to bear witness that finally gave him the courage to write about his Holocaust experiences:

Convinced that this period in history would be judged one day, I knew that I must bear witness...Was there a way to describe the last journey in sealed cattle cars, the last voyage toward the unknown? Or the discovery of a demented and glacial universe where to be inhuman was human, where disciplined, educated men in uniform came to kill, and innocent children and weary old men came to die? Or the countless separations on a single fiery night, the tearing apart of entire families, entire communities?...

Only those who experienced Auschwitz know what it was. Others will never know… But would they at least understand?... having lived through this experience, one could not keep silent no matter how difficult, if not impossible, it was to speak…The witness has forced himself to testify. For the youth of today, for the children who will be born tomorrow. He does not want his past to become their future (From Preface to the New Translation of Night by Elie Wiesel, 1997).

Why we need to tell our stories of trauma

        Despite the difficulty in finding words to describe these unimaginable experiences, Dr.Wiesel felt a moral obligation to testify and bear witness on behalf of his own family members and other victims and survivors. He wrote to convey the horrors of Auschwitz to those who had not experienced it, and to motivate societies to actively oppose human rights violations; so that future generations could be protected from such a fate. It is not in the traumatic events themselves that Dr Wiesel finds meaning, but in the potential power of his words to evoke outrage and empathy, thereby motivating others to act to prevent a recurrence.
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Thursday, October 21, 2010

Starved for Time? Mindfulness and Therapy Can Help

As Americans, we live in the richest country in the world. In the midst of all this abundance, there is one thing most of us are starving for. And that is more time!  More time to sleep, more time with our families and friends, more time to get our errands done, more time to think about our lives and make the best decisions for ourselves, more time for self-care, more time for exercise, more time for fun!

As a nation, we are characterized by our work and productivity ethic. To slow down means to fall behind the competition, to not meet our sales goals or not make payroll, or to fall behind in rent, mortgage or college payments.  From High School onwards, most children and adults in this country don't get enough sleep, with damaging effects on concentration, learning, mood, weight, stress-tolerance, and health. 


Lack of time hurts kids and families


Despite the wealth of our country, the quality of life for US children is lower than in many European countries, according to current worldwide statistics. In one survey, when asked what one thing they would most like to have, most US children asked for more time with their parents.  Part of the problem is that people in urban areas move around a lot, so we can't count on having family around to  help us out. For the sandwich generation, there is added pressure to look after our kids and try to figure out how to visit or care for aging parents living far away.  Marriages are strained when there is no time for physical intimacy or to communicate and negotiate conflict.


Why we need mindfulness


All of this time pressure leads us to be on automatic pilot a lot of the time, disengaged from the fabric of our lives. This creates anxiety, depression, and impaired quality of life. That is why we so desperately need the attitude of mindfulness! 

Based on ancient Buddhist philosophy and validated by neuroscience studies, mindfulness involves slowing down for long enough to observe your breathing, your thoughts, your feelings, and your body's reactions.  When you observe your own reactions with relaxed acceptance, you begin create distance from your judging, worried mind and can get closer to your own, authentic truth.  When you let go of your attachments to things having to be a certain way in order to be happy, you can tune in to what you really want and need at a deeper level. Such self-awareness helps you make more conscious and authentic choices about your values and how want to spend your time and energy.


What is most important to your happiness?



Do you really want the drive for status, and keeping up with the neighbors to have such power over your life? Research shows that beyond the point at which your basic needs are met, more money doesn't necessarily lead to more happiness. Rather, it is the quality of relationships and living an authentic life that makes us most happy!  Exercise, health, and fitness can also help us combat depression, sleep better, and feel happier. 

Learning mindfulness skills like meditation and a mindful attitude to living can help you slow things down and refocus. Seeing a psychologist to deal with an important life issue takes time and investment, but by helping you make better choices about your life priorities, it is an investment that can pay huge dividends by giving you more authenticity, time, choice, and freedom.
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Monday, October 11, 2010

Five Tips for Dealing With Work and Financial Stress in a Changing World

We live in times of rapid change in the world of work. Companies are merging, cutting costs, laying off employees, outsourcing and consolidating jobs. This results in more work, more stress, and less financial security. If you are an entrepreneur, you have to deal with raising money and staying afloat long enough to give your business a shot at success. Financial and work stress is a fact of life for many of us these days.

In my practice, I see many patients suffering from career and financial stress.  Stress can arise from a difficult boss, unreasonable demands, job loss, lack of capital, or insufficient opportunities to advance, I see older patients and recent college graduates who have endure long periods of unemployment and lower wages. Chronic stressors of this type can lead to relationship difficulties, irritability, insomnia, weight gain, and alcohol consumption. For men, in particular, not being able to provide for their families leads to feelings of personal failure, depression, and low self-esteem. Unrelenting stress can also increase your risk of heart disease, diabetes, and other serious illnesses.


Here are some tips to deal with work or economic stress without losing your health:


(1) Be patient and accept


Many of these stressors are out of your control and you can't  change them. Focus on learning to accept what is and put energy into parts of your life you can control. If you can keep showing up, hanging in there, and working hard, you are more likely to find a new opportunity. Be patient - sometimes change is slow and you have to wait.


(2) Revise your priorities

In the economic boom period before 2008, we were more likely to spend frivolously and accumulate stuff we didn't need. Now life requires us to be more careful. Instead of focusing on accumulating possessions and keeping up with the neighbors, you can learn to simplify and focus on relationships and family, enjoying nature, and participating in your community. Play with your children instead of taking them to the mall and they'll be just as happy.


(3) Exercise

Exercise will get you out of the house and into the fresh air and sunshine or into the gym with its social opportunities. Exercise can make your brain sharper, improve your mood, and make you more disease-resistant.  If you can't get off the couch, buy a dog, especially an active breed like an Aussie shepherd that will spend the day trying to herd you out the door!


(4) Give back to your community

Volunteering for your local PTA, in the classroom, or for a charity is not only meaningful, but offers new opportunities for friendships. Focusing on doing something concrete to help your community can distract you from your own problems and give you a sense of efficacy.


(5) Breathe!

Breathing engages your parasympathetic nervous system which puts the brakes on your stress response and gets your body moving back towards calm and balance. Some forms of exercise, such as yoga or Pilates involve deep breathing, combined with stretching, which can engage your relaxation response. The air is free so take in as much of it as you want!


If your stress is ongoing, interfering with your mood, sleep, appetite, concetration, or relationships, you may want to consult a psychologist for a professional evaluation.




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Thursday, October 7, 2010

Six Ways to Deal With Anxiety

We all know the uncomfortable feeling of anxiety. Your heart races, your fingers sweat, and your breathing gets shallow and labored.  You may find your thoughts racing and feel fear in your belly.  That's because your "fight or flight" response has kicked in, resulting in your sympathetic nervous system pumping adrenalin throughout your body, readying it to fight or flee. Your attention and focus narrows and becomes preoccupied with the stressful situation. You seem to be locked in that vigilant state, unable to focus on your daily chores or longer-term goals. But what can you do about it? 

I have found a variety of practical tools based on Cognitive-Behavior Therapy that I can teach my therapy patients who have anxiety disorders such as phobias, panic attacks, or chronic worry. Some tools are based on changing thoughts, others on changing behavior, and still others involve changing physiological responses. The more aspects of anxiety we can decrease, the lower the chance of relapse post-therapy. 


(1) Reevaluating how likely it is to happen 

 Anxiety makes you feel like a threat is imminent, yet most of the time what you worry about never happens. By recording your worries and how many came true, you can begin to notice how much you overestimate the likelihood of negative events actually happening.

(2) Decatastrophizing


Even if a bad event happens, you may still be able to handle it by using your coping skills and problem-solving abilities, or by enlisting others to help. Although not pleasant, you could  survive encountering a spider, having a panic attack, or losing money. It's important to realize that very few things are the end of the world.

(3)  Using deep breathing and relaxation to calm down


By deliberately relaxing your muscles, you begin to calm down so you can think clearly. If you practice this without a threat present at first, it can start to become automic and will be easier to use in the moment  when you do face an actual threat. Deep breathing engages the parasympathetic nervous system to put the breaks on "fight or flight.".

(4) Being mindful of your physical and mental reactions


The skill of mindfulness involves calmly observing your own reactions, including fear, without panicking or feeling compelled to act. It is a coping skill and attitude to living that can be taught in therapy and improves with practice.

(5) Accepting the fear and focusing on core values


Acceptance and Commitment Therapy (ACT) is an approach that helps you to accept the inevitability of negative thoughts and feelings and not try to repress or control them. By directing attention away from the fear and back onto important life tasks and valued goals, you can live a full life despite the fear. Instead of letting the anxiety rule, be proactive in living a meaningful and connected life.

(6) Confronting what you fear (Exposure)


Exposure is the most powerful technique for anxiety and it involves facing what you fear and staying in the situation long enough for the fear to go down, as it naturally does.  Fear makes you want to avoid or run away, so your mind and body never learn that much of what we fear is  not truly dangerous.


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