By incorporating mastery into your day — even solving a puzzle or nailing a recipe — you can give your self-esteem a significant lift. Read more on my new blog post here.
Author Archives: sarahlebo
Balancing Act
Dialectics, the conceptual heart of dialectical behavior therapy, reconciles seemingly incompatible ideas to uncover truth. Find out more in my latest “expert topic” blog post on Goodtherapy.org.
Finding the Magic in This Moment
Practicing meditation and mindfulness may not win you a Superbowl, but it CAN help you get more control over your brain (which in turn can effect your emotions and behavior). Mindfulness is like weight lifting for your brain and attention span – with practice, it can make your behavior more effective and allow you to feel a greater sense of personal peace. Who wouldn’t want that? Click here to read more about how this idea is catching on in popular culture in my latest “Expert Topic” blog post on GoodTherapy.org.
New Year, New You?
Christmas cards are in the mail and a new year is around the corner. The timing is prime for personal reflection or the annual “year in review.” Even social media is in on the phenomena with links to viral family Christmas videos and comprehensive lists of your most important posts.
If you value progress and growth, taking stock of where you’ve been and where you hope to go can be really helpful. I’m not talking about how you measure up against others, but how you measure up against YOURSELF — your own hopes and dreams for where you’d be at this point in your life.
Find out how psychotherapy can help you do that in my latest blog post on goodtherapy.org:
The ‘Year in Review’ and Why It Matters
Sleep, Substances, and Online Resources
Last post I talked about healthy sleep: if we’re tired after a night of sleep, or it’s taking us longer than 30 minutes to fall asleep, we might actually try going to bed LATER. The key is condensing our sleep/time in bed, while maintaining a consistent wake-up time and exposure to light. This is a behavioral treatment for insomnia called “Stepped Care.”
So we talked about behavioral adjustments to bed time, but what about what occurs during the day? How does our alcohol, marijuana, caffeine or over-the-counter medication affect our sleep? In a word, badly.
A key part of sleep is our cognitions about it. We can psyche ourselves out about it. Easily. The more we use a tool like Ambien or Benadryl to get a good nights sleep, the more we are telling our brains, “I can’t do this on my own” (which is not true). It’s also likely we might have a night where the substance is not available and the thought, “I sure hope I can get to sleep without my ___” occurs, followed by feelings of doubt and our body taking those cues and having a terrible night of sleep.
In psychology, we call this a decrease in self-efficacy, and it’s not a good thing. There are ripple effects to it – most obvious may be a dependence on a certain item to get to sleep (for example, smoking pot, or a couple of glasses of wine).
Often the substances that seem to relax us and promote sleep, actually are not giving us good, quality of sleep. Some people realize this with alcohol – while we can drink enough to knock ourselves out, we don’t typically feel well-rested the next day. That’s because we never really entered into that blissfully deep REM sleep, and we ended up waking up a few times or waking up prior to obtaining enough rest. Even Melatonin can affect our circadian phases, and regular use can increase dependence.
All these things work but do not promote long-term, healthy sleep like these components do:
exercise, daily routines, creating a comfortable sleep environment, and controlling the amount of stimulating activity we have prior to bedtime. Humans are like computers, we can program ourselves. In psychotherapy, we utilize strategies like relaxation training to do this.
There are resources available online, such as:
1. Sleepio
a. 6 sessions
b. Weekly or longer
c. $11.30 / week
d. $80 / 12 weeks
2. SlumberPro
a. 4 – 8 weeks
b. free for first week, then $39
3. Cognitive Behavioral Therapy for Insomnia
a. 5-week, 5 session course = $34.95
b. on-line or CD
4. Shut-I
a. 16 week subscription = $129
5. The Insomnia Doctor: www.get2sleepnow.com
a. $29.99 / 1 month
b. $69 / 3 months
List (and inspiration for this blog post) courtesy a training by Rocky Garrison, PhD, CBSM, a psychologist specializing in the treatment of insomnia. www.rockygarrison.com
Healthy Sleep
We all know how crappy it feels to miss a good night’s sleep. Maybe one of our kids is sick and needed tending to, maybe our dog kept asking to go out, or maybe we just woke up on our own, plagued by thoughts of work responsibilities or personal pressures.
Makes for a rough next morning, no matter what the interruptions are.
For some people, those interruptions or an overall irregular sleep pattern are all too common. If left unattended, that sleep schedule can cause a lot of chaos in a person’s life.
From a Dialectical Behavior Therapy approach, lack of sleep is seen as a vulnerability. It makes us more vulnerable to experiencing negative emotions and at times making decisions based on our emotions, rather than rational thought.
So how do we promote a healthy sleep pattern to reduce our vulnerability to our “emotional mind?”
The key components are looking at our schedule and our exposure to light.
Our bodies are like computer systems that we can train, over time, to respond as we would like them to. We can condition ourselves to think, feel and act differently (and that’s often what we promote in psychotherapy).
We need to structure our sleep, paying attention mostly to a consistent wake up time. We often try to correct a late night out with sleeping in, taking a nap mid-day, or utilizing extra caffeine. Don’t do it. This is part of what messes with our circadian rhythm and can disrupt the following night. Continue with your regular wake-up time, and allow yourself a day to feel “under the weather” or tired, until your normal bed-time that night. Your body will re-calibrate better this way.
Reduce Your Time in Bed
Another key to our scheduling is decreasing our time in bed. We can gradually test out exactly how much time we need to obtain our optimal level of sleep. This is your own scientific trial: How much time in bed do I need to get the best sleep? This is the one component within our control.
So if you find that you are not sleeping the full night through (ie. waking up at 2 a.m. worrying about work), you would actually go to bed LATER the following night, but continue with your consistent wake-up time and exposure to light. If you need to get up in the middle of the night to feed the baby or go to the bathroom – keep the lights off or dim, and you may not disrupt your circadian rhythm at all!
Some things to consider:
– Don’t go to bed unless you are sleepy and don’t stay in bed in the morning unless you are asleep.
– What was your activity level during waking hours? If you didn’t do that much physical activity, your body expended less energy and was less alert/aroused, which often leads to difficulty falling asleep. This might mean going to bed later that night for a more efficient night.
– Get out of bed in the morning when you are awake. When you hit the snooze, or lay in bed for an additional hour, even when you are somewhat awake, you are damaging your potential for a good night’s sleep the next night. (*A caveat is that if you hit the snooze for the same amount each morning, and see the light turn on at the same time, you may still be OK)
Stay tuned for the next blog post, which will explore the effects of substances on our circadian rhythm and provide resources for self-help insomnia treatments online.
Therapy relieves chronic stomach pain in kids
I’ve always known there was a connection between my physical state and my mental state. This was most obvious whenever I had a big test or presentation in school: my digestive system would tell me. I don’t want to go into too much detail, but in my family, we always knew that if someone had a nerve-wracking performance coming up, they could most likely be found in the bathroom some time before the big event. Sometimes I’ve appreciated this because I haven’t actually felt the nervousness or stress as an emotion. I’ve wondered if it somehow that nervous energy gets channeled into my stomach or how my body is processing its food. It’s hard to know exactly how that connection works, but a recent study shows some evidence behind this mind body connection ― and how talk therapy (a behavioral and cognitive activity) can help reduce what’s going on in the stomach.
The study was done by researchers at Emma Children’s Hospital Academic Medical Center in Amsterdam, Holland. They randomly assigned children, ages 7 to 18, to talk therapy sessions or to meet weekly with a pediatrician. The children who went to therapy were treated with cognitive behavior therapy (CBT) that was tailored to the needs of each child. Techniques included relaxation exercises and strategies to distract kids from stomach pain or change the way they thought about their pain. The children who met with a pediatrician were given information about diet and nutrition and prescribed medication if necessary.
After one year of treatment, both groups noted significant improvement, but it is interesting to note that more children improved via the CBT method than with medication and dietary changes. This is notable because somewhere between 8 and 25 percent of kids suffer from chronic abdominal pain ― pain that does not seem to have any direct medical cause, such as celiac disease or inflammatory bowel disease. 
Source: Randomized controlled trial published in Pediatrics Oct. 14, 2013: http://pediatrics.aappublications.org/content/early/2013/10/09/peds.2013-0242
The easy argument against ‘other’
The recent news stories regarding the police shooting and killing a 34-year-old woman after she had driven frantically through the Capitol were concerning on several fronts. As is often the case with an event appearing to be a threat to our national security, the reports following it discussed the mental health status of the woman. Family members explained that she was experiencing postpartum depression with psychosis.
As the news media seeks to provide an explanation for what occurred, I fear that the general public will focus on several key facts printed in the media:
– the mental health diagnosis
– the psychiatric medications the person was prescribed
– the person’s medical history of psychiatric hospitalizations
– and at times, the personal history of trauma in childhood or prior to the event.
It seems easy for people to classify these things as “other,” alien or foreign, and attribute them as reasons why a person would be so “unreasonable” as to drive frantically away from police officers, or take a trip from her home in Connecticut to Washington, DC to potentially confront the president regarding ideas she had about him putting surveillance on her home.
What’s disturbing is the fear, and the reaction our community has if a person acts unreasonably … it’s violent. It’s with law enforcement. It’s starting to appear that there’s no room for error or “unstable,” confused thinking. I’m not saying that we excuse delusional thinking, but we need to be ready to work with people a little bit. The person who is on psychiatric medications or who has a history of hospitalizations is not so different than the rest of us – that could be me, or that could be you. A person with a family, a person with a career, a person who is possibly very scared and uncertain about what they are experiencing, and unsure who to go to for fear that they will be chastised or pushed away. This idea that they are something unique or “other” smacks of Freudian defense mechanisms like projection or reaction formation. People who may speak out against the mentally ill may actually be aware, on some unconscious level, that they relate to that person, that they are not so far from some kind of mental health issue themselves (because, really, we aren’t). But it’s much easier to push that away and on a conscious level, state that the person was “crazy.”
While we used to have state psychiatric hospitals where people were housed, now, too often, I believe, we are pushing so hard against the mentally ill that we are prosecuting them legally, and housing them in prisons. It’s distressing to see a health problem, treated as a legal problem. We had hoped to deinstitutionalize this country years ago, but if we look at the statistics of how our jails and prisons have grown, we see that another type of institutionalization is occurring. One were many nonviolent offenders are put behind bars for convictions related to drugs or other crimes, some related to mental health issues.
As Dr. Gabor Mate states in a wonderful documentary on the criminalization of addiction (The House I Live In), we cannot view the results — the erratic behavior or, in this case, the high speed car chase that might pose a threat to our security as “the problem. It’s not the problem. It’s simply the manifestation of a problem. It’s a symptom.”
Sugar, a Substance?
The average American eats 22 teaspoons of sugars every day. I’ve read many articles over the years saying this amount is way too high. Have you ever considered sugar a “substance?” It actually stimulates the brain in the same way cocaine does, which is why we are driven to crave more and more of it.
Obviously substances are all on a spectrum and we must all make decisions around how much enjoyment versus harm they are doing to our lives. But my point is that there are many different substances out there — everything we ingest and even the activities we do send messages to our brains. These messages can affect our future thoughts, cravings and behavior.
Every human has a relationship with substances (and a a variety of harmful and helpful relationships at that). I’ve often heard friends and family ask me about working with people who struggle with diagnosable chemical dependency, posing questions like, “why do they like [the drug],” “can’t they realize what it’s doing to their bodies and lives?”, and “isn’t it depressing when they just continue to go back to it and relapse?”
My response is always the same. I return their questions with a question: “Have you ever tried to change a behavior in your life? Maybe your diet, or how much you exercise?” Typically the answer is yes. I then have an opening to discuss with the person how difficult it was, how many days you experienced progress and how many days you “relapsed” or fell back into old patterns. The bottom line is change, like recovery, is a lifelong process. That process begins with personal insight. One of my favorite quotes from the Dalai Lama states, “critical thinking followed by action’ is the most important thing we can do now.” I love that idea, since it’s why talk therapy can be helpful to so many people. In most cases, we need to have an understanding of what’s going on, to think critically about it, before we can strategize about the action to take. I think all those articles about 22 teaspoons of sugar are trying to tell us all something (and prompt people to cut back!).
Barriers Go Up, Suicide Continues
Construction to erect “suicide-prevention screens” on the historic Vista Bridge began in early August and were expected to be completed by the end of the month. Unfortunately, the installation was too late for one man, who jumped to his death on August 12, becoming the fifth suicide of the year at the Portland landmark (the highest rate in years). The event was witnessed by a crisis volunteer.
There’s been much publicity around the city’s scramble to address the high number of suicides, with actions in the past including posted signs listing crisis hotlines, enlisting volunteers to patrol the bridge during construction, and most recently erecting this mesh deterrent.
The idea behind all these measures is an attempt to provide one important thing for people in distress: time. Time to reconsider, time to connect with another human, time to remember the network of support or potential that might exist for that person. There are many different factors that might lead a person to consider ending their life, however one consistent factor in most cases is a chronic or temporary mental health issue.
The state’s 2012 report “Suicides in Oregon: Trends and Risk Factors,” indicated that roughly a third of the people suffered a crisis within the last two weeks prior to the suicide. They also found that nearly 30 percent indicated an intimate partner problem at the time of the suicide incident. Many of these short-term crises can be explored through some of the resources below, or connecting with appropriate mental health treatment providers for counseling.
• The Multnomah County Crisis Line is available 24 hours a day at (503) 988-4888.
• Lines for Life is available 24 hours a day at (503) 972-3456.
• Cascadia Behavioral Healthcare has an urgent walk-in clinic open from 7:00 a.m. to 10:30 p.m., 7 days a week. Payment is not necessary. Call (503) 963-2575.
• Finding a Licensed Professional Counselor for 6-10 sessions of cognitive-behavioral psychotherapy. Many credible counselors can be found through Psychology Today at http://therapists.psychologytoday.com